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HALIFAX, THURSDAY, MAY 1, 2008

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

4:10 P.M.

CHAIRMAN

Mr. Wayne Gaudet

MR. CHAIRMAN: Order, please. The Committee on Supply will now be called to order.

The honourable Deputy Government House Leader.

MR. CHUCK PORTER: Mr. Chairman, would you please call the estimates for the Department of Health.

Resolution E11 - Resolved, that a sum not exceeding $3,205,939,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health, pursuant to the Estimate.

MR. CHAIRMAN: I will now recognize the honourable Minister of Health to make some opening comments and maybe introduce his special guests.

HON. CHRISTOPHER D'ENTREMONT: Thank you, Mr. Chairman. I'm very pleased to be here today to discuss the budget for the Department of Health for 2008-09. I'm joined by, of course, most of you know my Deputy Minister Cheryl Doiron and my Chief Financial Officer Allan Horsburgh, beard and all. I thank them, they're very (Interruptions) I had to shave it off after awhile, I couldn't get new shoes, and I decided it was good to get rid of that beard, look a little cleaner, make myself look younger - I thank the member for Timberlea-Prospect for saying I look younger without the beard. Again, I'm very pleased to be here today to discuss the estimates for the Department of Health.

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Our vision for health care in Nova Scotia is simply generations of Nova Scotians living well. That is a goal we share with our partners in the health care system. The district health authorities and the IWK, through whom we work to deliver health care treatment and services to the people of Nova Scotia. Our budget this year, as it has been in previous years, remains focused on ensuring appropriate, effective and sustainable health care services to promote, maintain and improve the health of Nova Scotians.

Sustainability is not an easy objective to achieve as costs increase, as populations increase, as they age, the demand for services continues to increase. Not only is that increasing, but the treatments themselves and the demand for those new and innovative - and a lot of times expensive - treatments increases. Which is why the department, together with the district health authorities and the IWK, have embarked on a journey of health care system transformation.

Just three months into this mandate, we have already been making solid progress in beginning this transformation. We've launched three project teams for the model and care initiative, the citizen engagement model and the integration of continuing care. We've established the governance model for the initiative and the project management office will soon be up and running and a lead for the health system transformation will soon be in place.

[4:15 p.m.]

It's a difficult process. There's a lot of projects happening all at the same time and it was one I was unable - and I'm sure my deputy minister was unable - to manage off the corners of our desk because of the importance of system transformation in Nova Scotia.

In keeping with the principles of this work, we have asked for no new money in our budget to develop and initiate these changes. Instead, over the course of this year we do expect that the districts will realize some significant savings from some of our early work, which we will continue to reinvest to support transformation in the health care system in Nova Scotia.

Now the principles we have embraced in accepting all 103 recommendations of the Provincial Health Services Operational Review, I believe, is one of the reasons why we have been able to keep our budget increases down to a modest but effective amount this year. Health continues to be the largest percentage in program costs to government - this year at 43 per cent. At the same time, total new initiatives for the department - that is new initiatives, not the expansion and continuation of programs - is only at 1.39 per cent, or $41 million.

Now, by far, the largest new initiative that we have for this year is the new Nova Scotia Family Pharmacare Program. This year we receive $26.7 million to make the total budget for the program, since its inception, since its start back in early March, $32 million. With over 8,000 families already registered, and that number growing every day, the program

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is already providing much-needed pharmaceuticals and financial relief to those Nova Scotians who need it the most.

I do want to thank our Premier and all my Cabinet colleagues for their dedication and their interest in making sure that no Nova Scotian will be left behind when it comes to pharmaceutical coverage under this Family Pharmacare Program.

Mr. Chairman, it is also to be said that, this being a new program, we will continue to monitor the progress of this program, the uptake of this program, the coverage of this program, to make adjustments as we go along to make sure that it is appropriate and effective for as many Nova Scotians as we possibly can make it.

Not so long ago, maybe a few hours ago when we had the opportunity to be questioned as we normally do during Question Period, I believe the member for Sackville-Cobequid talked about wait times - and I am sure he will be talking about wait times when his opportunity comes up to discuss these issues. Reducing waits and improving access to appropriate health care services is an important priority for this government and would be more important for Nova Scotians, which is why I will be tackling this issue on a number of fronts. Mr. Chairman, just by saying a wait time doesn't mean that you are going to be able to address it - there are many factors that come into consideration when looking at wait times and finding ways to better manage the list that we do have.

We will be increasing spending on our colorectal cancer screening program by $2.7 million, to allow full implementation of a population-based colorectal screening program this year. Every year, 750 Nova Scotians are diagnosed with this terrible disease, and through screening we know that we can catch this disease early, resulting in better outcome for patients.

I am very pleased to increase mental health spending this year by $2.8 million. This advancement will allow us to expand mental health and addiction services across the province, with a particular focus on children and youth and on addressing areas with the highest waits, particularly here in Capital as well as at the IWK.

One that I think is going to have a huge impact on our health care system is the investment of $3.96 million in a self-care tele-care service. Patients will get to talk to a nurse who can provide much-needed information to direct them to the appropriate place for service and, in doing so, emergency room visits will be reduced. You will be able to call an RN and you will be able to say my son, my daughter, my mom, my husband, my wife, is experiencing this kind of symptom, to be able to get the best information that they possibly can have and they can make their own decisions whether the visit to the ER or a call to 911 is warranted.

Mr. Chairman, a lot of times, there are some very commonsensical issues or things that can be done to maintain the health of our loved ones that do not require a visit to an emergency room. So I do feel, again, that this is a very important piece and will be a very

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well-used program in our health care system. It also gives us, I believe, an opportunity to offer employment to, I would say it would qualify as either late career nurses or nurses who have issues with working 12-hour shifts and those kinds of things - it gives them an opportunity to use their very important skills and knowledge to help many more Nova Scotians. So I think it's a win-win for Nova Scotians, for nurses, as well as for the Government of Nova Scotia.

Now, we're well on the way of our goal to the wait time guarantee of eight weeks for patients needing radiation therapy, with the help of Canada's $33 million at this time. Two pilot projects are underway to improve access to diagnostic imaging and orthopaedic services for patients. Additionally, another component of wait times when it comes to orthopaedics, we'll be establishing a clinic where orthopaedic patients can be assessed much faster and, therefore, receive faster treatment. A similar project - Bone and Joint Canada, I believe is what it's called - in Alberta, reduced wait times in that province from a number of months. I forget the total length of wait times in that province - I do believe it was very similar to what ours was - it brought it down to weeks with this assessment clinic, every person waiting for referral for a specialist to look at either knees, or hips, or whatever it may be in the orthopaedic world, to get them the appropriate type of treatment.

In a lot of cases, the individuals who are on our orthopaedic wait lists need physiotherapy, and if they got physiotherapy now they wouldn't need a hip later; they wouldn't need a knee later - they need maybe some certain pharmaceutical interventions, et cetera. By getting to see these individuals through a clinic which will be staffed by nurses and other professionals, physiotherapists, with visiting orthopaedic specialists, we believe we can really cut down our wait lists, when it comes to orthopaedics, by this initiative. So we're confident that Nova Scotians will see significantly shorter wait times as a result of this project which fits well into realigning, as we have over the last number of months, $1 million in our current orthopaedic budget where 500 more patients will be treated through a demonstration project with Capital Health and Scotia Surgery.

Mr. Chairman, I know from sort of the exit surveys that we are doing, that Capital Health monitors patient satisfaction with the services that they are receiving from Scotia Surgery, that it is very, very good at this point and people are very happy with the service, being able to be seen for minor orthopaedic surgeries, knee scopes and the like, at a faster rate - and I do have some numbers that maybe I'll share later on of the costs that we're seeing related to those minor surgeries as we go along.

Another great piece that we've been working with through Capital Health and through the Department of Surgery there, they just completed a one-day pilot project using operating room facilities at CFB Halifax. The Stadacona Hospital has been a landmark, just down in the North End, off North Street, for many, many years and it's basically a very underutilized hospital, one that has a number of operating suites, endoscopy suites - I believe it does have a CAT scan in it - it does have a number of different diagnostic equipment that can be used to see patients. It is a hospital that is being used maybe a couple days a week. So

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why not use a facility like that in conjunction with of course, DND, the Department of National Defence. In using that facility - because it uses the facility, we know that the equipment is working and the staff working at that hospital can also be helping out and keeping up their skills. So we think it's a very good fit to the overall surgical capacity for the province, especially here in HRM.

I do want to personally thank for this project and for - I believe we'll end up having a good agreement written up and signed off by both parties in the very near future. I want to thank Rear Admiral Dean McFadden for his dedication to this one. I know Admiral McFadden will be moving on - I believe on Friday - to another posting, but I do know that he did want to see the completion of this project and the utilization of this project towards the patients here in Nova Scotia in being able to use a hospital, I believe, that is a very good asset to this community.

I also want to thank Dr. Jaap Bonjer, head of the Department of Surgery, for his foresight in this one - to work with DND in setting up this project and to see its continuation. I also want to thank Jaap for his work in keeping the promise. Of course there's a document brought out by Capital District Health and Dal's Department of Surgery to utilize the existing infrastructure here in Halifax, and what we found is there were a number of surgical suites which were not being used for a number of reasons - principally the lack of anaesthesiologists. Knowing we recruited a full complement of anesthesiologists here in the HRM through Capital Health through the hard work of Dr. Mike Murphy, we can now utilize all those suites.

I know that utilization is up and I believe it's causing us a bit of a numbers crunch as well to make sure we have the dollars available to them to see the patients that are lined up to have their surgeries done here in Halifax. So I do want to thank Jaap and his staff over at the QE II, through Capital Health, for their dedication to see more patients and get them the surgeries that they need.

Over the next two years - which is another item you'll see in our budget - is an additional $10 million over two years being invested in our electronic health records system. This $28 million project will create an electronic health record for all Nova Scotians, to support decision making and case management by health professionals. I was a bit - well I wouldn't call it upset, but I was . . .

HON. RODNEY MACDONALD (The Premier): Perplexed.

MR. D'ENTREMONT: Perplexed - thank you very much, Mr. Premier, for that - perplexed how my medical records could not be seen by a doctor in Sydney if I were to get ill in Sydney, or my medical records would not be able to be seen in Ontario or B.C. or wherever I may find myself in a bit of a problem medically. God forbid, over the last number of weeks I've found myself in a couple of situations that have kept me in hospital, so hopefully that can be rectified as well. But my information cannot travel with me, so we need

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to have an electronic medical records system so that information can travel with us so doctors or specialists who are seeing us can make the best decisions possible when it comes to our care if we make it to hospital.

The best example, or best story that goes along with this would be comparing the health system as an airline where you would get on an airplane, being the one physician or the one specialist getting on that airline and flying somewhere and you have to stop - let's say you were heading for Toronto and you had to stop in Montreal, but then you'd have to go and book your flight again. You'd have to get out, book your flight, fill all your information out again and then get on the next airplane. For some reason, the airline industry - whether rightly or wrongly - do track patients, track their passengers from one point to another and most times get their baggage along with them as well. Our health system cannot transfer information in that way, so I think it's very important for us to invest dollars when it comes to EMR to make sure our information, that when doctors look at our file, when they see us they can make the best decisions possible because of that information sitting before them.

[4:30 p.m.]

I also want to say that over the next number of months, we've also taken the lead when it comes to Canada Health Infoway. Canada Health Infoway is the federal organization that funds dollars when it comes to electronic issues in the province - I think this is a good fit to make sure we have the dollars available to put this EMR into place and have our information readily available to those practitioners when they see us for whatever ails us.

Finally, to coordinate our many activities relating to wait times, again, this is an issue of not being able to manage all these things off of the side of our desks. We've hired a chief executive, wait time improvements, in the province, and they'll be the one person who will be our "go-to" when it comes to wait time reduction in this province. This dedicated physician will monitor progress, improve capacity and responsiveness and, of course, the efficiency of the programs that we will be putting in place to make sure that patients in this province will be treated in a much more efficient manner.

Another very important priority for me and our department is to enhance and expand continuing care services through our Continuing Care Strategy. This year we will spend $142 million on home care; we will be spending $377 million on long-term care services across this province.

Now research and analysis that is now underway will inform us how to best provide adult day programs to Nova Scotia. We believe that helping people stay in their communities longer, helping them stay at home longer really is helped out by having some kind of respite option for the families who are taking care of them, as well as true recreational opportunities for the senior who might only have the opportunity to sit at home and watch a television. That is not an appropriate type of recreation if we are trying to keep our population healthy

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and especially this population that does require a little extra in keeping them as healthy as we possibly can to keep them out of hospital and, of course, out of long-term care facilities. This year we will open 400 new spaces, giving patients and their families that much- needed support. So I look forward to really expanding that adult day service so that more seniors can be seen and treated and helped out in their daily activities.

I am also pleased to report that this year we will be expanding our palliative care services. We have established the provincial palliative care coordinator position. We do have an acting person placed in there - I believe it is Mrs. Scaravelli - who is very well received by the palliative care community to make sure that this program continues to expand over the next number of years. That position will help with the development and implementation of a province-wide standard and, of course, the policies that go with it on a palliative care program in this province.

Of course, through the Continuing Care Strategy, government has committed to building 1,320 new long-term care beds; 840 of these beds will be open by March 31, 2010. Mr. Chairman, I do believe that everything is still well on track to have these beds in place when we ask them to be.

Mr. Chairman, also I had the opportunity yesterday to visit Glasgow Hall - and also the member for Dartmouth South-Portland Valley was there with me as well - on the opening of this wonderful facility. This facility will be housing 72 seniors. They are large rooms with their own bathrooms and showers. They are also equipped to hold husbands and wives, so couples can actually go and stay together if they choose to, within this facility.

I want to personally thank the Shannex Group for their help on this one. The opportunity came to us, as they were building this retirement campus over in Dartmouth, that they could - with little effort - transfer what they were building to be a residential care facility into a long-term care facility to house these 72 individuals. I have to say they did it right. The opportunity to live within your own community, of about 12 seniors on a floor, to get to dine together, to get to do recreation together, get to live together is absolutely phenomenal.

The other option that I found very interesting is that next door, through the connection of a hallway, is the residential care or assisted-living facility. That assisted-living facility next door can house couples, of course, and take away a lot of the responsibility of taking care of a home. I thought it was very impressive because you went into a dining area. I don't know if you saw the dining area where it is actually restaurant-style so the senior who is there can go sit down and order from a menu so there is not just one choice or two choices, as a lot of our residential care facilities do offer - they can actually go, sit down, have a meal of their own choice. There is a lounge downstairs so they can actually have a pool game with their friends. There is a theatre where they can sit down and watch movies with their friends - all within this large community. Heck, there was even a bowling alley. There is a bowling alley in the basement with two lanes, and what they were actually doing with it is that people

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who are in the long-term care facility, they were wheeling them down in their wheelchairs and they actually have the opportunity to bowl in this bowling alley.

I have to say also, Mr. Chairman, I was very proud of my capability. I hadn't actually really bowled in awhile, but I have been practising with my 9-year-old son on his Wii and I was able to get a spare on the bowling alley so I thought I did pretty darn good there. I do know that having that type of recreation available to those seniors is extremely important for their well-being.

The Minister of Health Promotion and Protection talked about healthy living activity and all those things - that it's very important to keep people healthy and out of the hospital, I think is being replicated by the group over in Portland Valley. Now, Mr. Chairman, again, my personal thanks to Jason Shannon and his father, Joe, and of course all the Shannex Group for all the phenomenal work that they did in setting up this - and their dedication to take care of seniors in this province. So I do want to thank them for a wonderful facility over in Dartmouth.

MR. CHAIRMAN: Could the Minister of Finance make an introduction, please?

MR. D'ENTREMONT: I will cede the floor to the Minister of Finance.

MR. CHAIRMAN: The honourable Minister of Finance on an introduction.

HON. MICHAEL BAKER: Mr. Chairman, it is my honour to introduce to the House today a number of visitors who are in our gallery. They are a group of students from the Netherlands who are visiting Nova Scotia over a period of a number of weeks. They are staying in Lunenburg and, in fact, one of the young men is staying at our house with my son, Matthew, and the rest of our family. The students are also accompanied by a number of students from Lunenburg Junior-Senior High School and the teacher from Lunenburg High School, Dawn Ernst, who is also accompanying those students.

So, Mr. Chairman, I would ask that those students and visitors and chaperons and Ms. Ernst rise and receive the warm welcome of the House on their visit to Province House today. (Applause)

MR. D'ENTREMONT: Mr. Chairman, I do, also, welcome all of these visitors to the House of Assembly.

AN HON. MEMBER: The Minister of Immigration is anxious to talk to them.

MR. D'ENTREMONT: Yes, the Minister of Immigration over here might be interested in talking to you if you do want to stay.

AN HON. MEMBER: Don't give him any money. (Laughter)

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MR. D'ENTREMONT: It's a long story. Just for that comment, I have to apologize to them. Our member opposite really knows not what he says. (Laughter)

AN HON. MEMBER: If they all want to stay in Nova Scotia, we can arrange that.

MR. CHAIRMAN: Order. Let's get back to business.

MR. D'ENTREMONT: Mr. Chairman, going back to long-term care and the importance of the Continuing Care Strategy and all the things that are going on there, of course, as we are opening up the 840 beds across the province, it also means that we are planning to ensure the right health human resources are in place to staff them. Last year, over 900 new continuing care assistants were enrolled in training and this year we expect another 1,000 more individuals to be enrolled in our programs.

Mr. Chairman, I can also say that I sign off on every one of those certificates for them and I am looking forward to signing off on another 1,000 of these certificates to allow them to practise their skills in long-term care facilities in this province. To ensure we maintain this momentum, this year we hired an HHR continuing care project manager who is working closely with the continuing care sector in the development of a new HHR strategy to increase organizational and human resource capacity for the continuing care sector. Beyond what we are doing in concert with NSCC, a number of our partners - whether it be the Shannex Group, the GEM Group, et cetera - are also doing some of their very own training to make sure that they have the professionals available to work in their facilities. So that's a tremendous amount of training that we do need to do, but I can assure everyone in this House, and all Nova Scotians, that we will be ready to open those beds and staff those beds when that time comes.

Now, retaining and recruiting the right human resource is a challenge that faces every province and every country, Mr. Chairman. The Opposition continually ask us questions around retention and improvement and, of course, their personal experience is in their own communities, especially the rural ones, in the attraction and retention of those individuals. Now, in Canada, Nova Scotia is one of the most successful provinces, not only with more family doctors per capita than any other province, but also many other professionals - we have a lot of nurses, we have a lot of physiotherapists, occupational therapists, and many of the other allied health professionals.

Mr. Chairman, I know, we know, this government knows, that many more people are needed to staff the hospitals, the long-term care facilities and health clinics in this province. That's why this year we intend to spend another $11.4 million to either maintain or expand the baccalaureate in nursing seats at St. F.X. University, Cape Breton University, and Dalhousie University, the Halifax and Yarmouth campuses - this investment will also support practical nursing seats at the Nova Scotia Community College.

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Now, continuing education is a key priority for our nurses. I know the member for - I believe it was the member for Sackville-Cobequid who brought this up during Question Period today, when it came to nursing as well, that nurses are, of course, a priority for us, the continuing education for them is important to us and they'll be able to provide patients with the highest quality of care. Under the nursing strategy, this year the province is launching an e-learning program for registered nurses and licensed practical nurses to give them easier access to continuing education opportunities regardless of where they are located.

My experience with the nursing program, of course, is with the Yarmouth campus - we've always had a nursing program in Yarmouth, whether it was the old two-year program or whether it ended up being the four-year program through Dalhousie University. I never really thought so much about having that availability, having that kind of talent pool to draw from in some of the other areas, but, Mr. Chairman, I can assure you that through our Telehealth system nurses in some of the other areas that don't have the opportunity to have a school nearby, that that training can continue to happen on a regular basis rather than them having to pack up stakes and head to Halifax, or head to Cape Breton University, to get that further education, and therefore we lose them for a certain period of time so they cannot offer the services that we so well need.

When this program is fully implemented, nurses will have access to extensive educational materials on about 50 topics, and over time the number of materials is of course expected to grow and all of these topics will be destined for a specialty that nurses would like to go into. Of course, that would be more appropriate, we feel for us, whether it be OR nurses, whether it be, I believe, in a whole bunch of other programs that nurses could be available to.

We'll soon be finalizing a new contract. I think something that we talked about a little bit today during my scrum with the media, our master agreement with Doctors Nova Scotia - I've talked about it in this House as well, but I believe that a new agreement will strengthen the health care system in Nova Scotia, will strengthen the issues that we've been having over the last year or so, whether it comes with the ICU issues in Amherst, or Bridgewater, whether it comes with the ER closures that we're seeing in the wonderful community of Digby, or the community of Tatamagouche. We need to have better ways to remunerate and incent and retain physicians in some of these areas.

[4:45 p.m.]

I believe that this new agreement, as innovative and new as it is, will have a tremendous effect on helping us in these rural areas. Our focus on the new agreement has been developed. It is a development product that will fund service improvements for our citizens and support the health system transformation process that we've already begun.

Now, Mr. Chairman, I can also say that this was a year process that I know our department had an offer and I know that Doctors Nova Scotia had an offer, but all the time,

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I think everybody sitting at that negotiating table had system improvement and system transformation on their minds. I believe the program and the agreement that we're presenting to doctors - starting tomorrow, I believe - is one they will sign on to and one they know will make a true change here in Nova Scotia.

Again, this agreement has gone to Cabinet, has been ratified by Cabinet and then it has to go for ratification from the doctors across the system, which will be happening, I believe, hopefully, we'll have a positive agreement by about the May 20^th or 21^st.

Overall, the budget spends about 75 per cent of its Health budget on human health resources and we're excited, for the first time ever, this contract is helping to shape and support the changing role of physicians as we strive to provide more and better incentives for things like chronic disease management, more access for patients and expansion of the electronic medical records system to doctors' offices as I did mention earlier in my speech.

With those short words, in closing, I would like to thank you for this opportunity to highlight some of the priorities of the 2008-09 budget for the Department of Health and I look forward to answering your questions. I will take my seat and I look forward to questions and comments from the NDP critic, the member for Sackville-Cobequid.

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

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, it's always a pleasure to stand before the committee to discuss what I think is one of the most important things here in our province, not only to government but to the people of Nova Scotia, and that's the health care system.

The minister opened his remarks, what he has said and explained some of the things that are in the upcoming budget, painted more of a rosy picture of what the positives are here in Nova Scotia around the health care system and what's in the budget. We know there are a lot of issues in health care. Myself, as the NDP Health Critic, I know my colleagues, I'm sure the minister and his deputy minister and their office and all members, receive numerous calls, concerns related to health care and health care issues here in this province.

The minister mentioned a vision for health care here in Nova Scotia. They're going to have a vision for health care which is great, I think that's a positive thing. But, what the minister doesn't say is the fact that - I know he hasn't been the Minister of Health since the mandate for this government started in 1999 - but the government has been in power in this province for close to 10 years, nine years now, Mr. Chairman, nine long years, as the member for Glace Bay stated. Nine years ago, the Opposition member, Leader of the Progressive Conservative Party at the time, was Dr. John Hamm. Dr. Hamm campaigned, at a time in the history of the province that had just seen numerous cuts to health care and I think that was one of the pivotal points in that election of 1999, around the state of health care here in Nova Scotia.

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At the time, Dr. Hamm stated that, with $46 million, if you elected the Progressive Conservatives, they would fix health care. Here we are, nine years later, we know those numbers were way off and the government hasn't fixed the health care problems that we have here in this province. What I'll do over the next hour, over the next day or so, with Health estimates is try to bring some clarification, try to get some answers from government on why they haven't gone down the path to try to improve health care delivery here in the province to ensure that Nova Scotians receive health care in a timely manner.

We know that we have long wait lists for surgeries, we know we have long wait lists for placement to long-term care facilities. We know there are long wait lists to see specialists and long wait lists when Nova Scotians find themselves in an emergency room, if they are open, Mr. Chairman, because many rural emergency rooms close on a regular basis, sometimes on a daily basis.

That's a major concern with Nova Scotians, and part of the problem, I truly believe - and that is why I mentioned the minister's statement around the vision for Nova Scotia - part of the problem is that we didn't have that vision. The government didn't have that vision back in 1999, they didn't have the plans in place. The minister stated today that it's great to see - they have put money toward Health Human Resource Strategy in this budget. That's great, but that should have been done, I think, in the first few months of anybody taking government, Mr. Chairman, especially if you run a campaign on that you were going to fix health care here in the Province of Nova Scotia.

We've seen some changes over the last year, some positive changes, some changes that really took place because of advocates in the community, because of MLAs in this House, things like Avastin, and I will talk about that later on, Mr. Chairman. But we have seen changes, I think that, I know for myself as the NDP Health Critic and our caucus have seen, are negative ones, changes that we did not want the government to implement. I am mentioning the fact that the government has turned to the use of a private clinic for surgeries here in this province.

I mention that because the minister mentioned that the exit opinions they are taking on individuals leaving that clinic are positive ones, no question they are positive. If I have been waiting 12 months, 18 months for a knee surgery, I wouldn't really care where it was done. I would have a good experience and I would be thankful that it was done. I understand that, but that is part of the problem, the fact that we have such long wait lists that the public now will revert to anything. They don't care what happens. They need to get their surgery. They need to get on with healing and getting the procedures they need.

Honestly, when I heard that the minister announced the contract for Scotia Surgery, I believe it was on the Friday before March break, unfortunately, I wasn't here, I was away with the family at that time, but I heard that the minister made that announcement and made the agreement with Scotia Surgery, what it really said to me and I think to a lot of my colleagues is that the government just gave up. They realized that the initiatives they were

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trying to implement over the years just weren't working, and they have washed their hands of it, and now we are seeing private clinics here in Nova Scotia. I know the minister would disagree, no question we disagree on that, but that's our opinion.

I think the fact that we have gone down that road is unfortunate. When I think there were obvious options that we had here in this province, if we had only seen the plans that I talked about earlier implemented by a government who was elected on the premise of fixing health care. I will explore that throughout my questioning over the next little while. Really, that was, I think, a pivotal point here in Nova Scotia when the government agreed to do that. We knew the government was looking at that. The minister stated maybe a year ago or more that everything was on the table when it came to health care. We knew that, but it was an unfortunate day, I think, for myself, to realize that that is the vision that the government is looking at.

We all know, it was quite recently that I heard on the radio that the British Columbia Government just cancelled their agreement with their private surgery clinic because that surgery clinic was going to charge the Province of British Columbia, I believe, somewhere around 20 per cent more, and the government realized, whoa, we are over our heads here, we can't absorb that kind of cost increase in one year. So that is just one example around my concern of the private clinic, when we have options, as I said.

We just witnessed, I think it was two weeks ago, Dr. Jaap Bonjer experiencing what might be able to happen at Stadacona, just down the street here, a facility which is there, it is well staffed, well equipped and I think ready to address some of the needs. Some of the questions I have around that is why didn't we use that before? Why didn't we attempt to use that before? I will give the minister a chance in a little while, when I ask that direct question, the line of questioning around that facility. That is a facility that was paid for by taxpayers and there are no shareholders who are going to profit from them doing surgery and providing health care here in the province. Basically that's my concern with private clinics, is someone's going to make some money off this and it's going to be an additional cost to the public system.

So with those few intro remarks - I know the minister would love to jump up and just talk about every one of those points but, as I said before, Mr. Chairman, there are concerns. We have concerns in long-term care, concerns around the transitional care, the closures of ERs, closures of ICUs, and recruitment and retention of rural physicians, but the most important thing we need to look at, we need to recognize, and we need to get some answers and, hopefully, ensure that the government recognizes the importance of it, is the key component to the whole health care system and that's our health care providers. We've seen, in the last year, an attempt by the government to bring in legislation that really picked a fight with health care workers, I'm talking about Bill No. 1, to take the right to strike away from health care workers.

[Page 14]

In my mind, Mr. Chairman, the last thing I want to see our government do is to increase the dissatisfaction of our health care workers when they go to work or when they perform their duties here in the province. Our key role here in Nova Scotia is to retain and recruit as many professionals as we can, we need them, and we're competing against places like Alberta that can pay them a lot more than we can. I think the government and the minister says that that's not a part of why someone would come here, you know, in questioning before, but I think it has a lot to do with if you have someone who knows someone in the health care field here in Nova Scotia asking what the atmosphere is like, well, we're still battling this thing with the government. Some of the terminology I heard is that they're using that to hold it over their heads over the next little while because we know the government hasn't brought that to a vote because they know that we would not support that and the Liberal caucus said they wouldn't support that.

So over the last year we've seen some changes, some positive as I said, but some I think have had a negative effect on the health care system and our health care providers. As I said, those individuals are the most important individuals. So with that, I don't want the minister to respond to everything I just said, that was my opening comment. I will ask questions on a lot of those topics over the next couple of hours today and then tomorrow.

We all know our workforce is getting older. The need to recruit and retain health care providers is so important. It's the key to ensuring that we have a good system and a delivery of a good system. Here in Nova Scotia we have the lowest percentage of RNs in Canada under the age of 35. That's an astonishing number. We have the lowest percentage across the country of RNs under the age of 35. We've got that figure - and I hope the minister has some documentation on that, which I see him going through - but we got that information from the Canadian Institute for Health Information report for 2007. So really what my question is to the minister is that we could talk about the actual percentage but we are the lowest in the country, why is Nova Scotia at that bottom? Why are we seeing less and less younger people working in our health care fields, either from we're trying to recruit them or retain the individuals who are being trained in our province now?

[5:00 p.m.]

MR. D'ENTREMONT: Mr. Chairman, I couldn't go without maybe answering a few of the overarching comments that the member brought forward. The biggest one that he underlined was that the minister was very rosy and very positive about the health care system in Nova Scotia and I am. To use a comment that I made yesterday, I'm very bullish about the future for health care here in Nova Scotia. I'm very positive about it because I have to be, because if we go and talk about all the negatives, and I'm not saying that there aren't negative things going on within our health care system. There are things that can be worked on and can be fixed but if we are to do a good job of recruiting, a good job of retaining our health care workers, we have to be very positive about our system and I hope that everyone within that system is as positive about it as I am.

[Page 15]

Now, Mr. Chairman, even the Leader of the NDP is very positive about it. I remember him making comments and saying that we have the best health care system in Canada - I think it was Canada, he might have even said North America - and I agree with that because we do, we do have the best workers, we have the best staffing, we have great people because they believe in the same thing that I believe in - one of the very fundamental issues when it comes to health care in this province which is the patient is first. It's about the patient. It's not about buildings. It's not about programs. It's not about MRIs. It's about people and we need to keep that person and that patient the first thing that we think about when we talk about any of these issues and that's why I'm going to continue to stay positive about health care in this province.

Mr. Chairman, also the member opposite talked about Scotia Surgery so I'm going to look forward to his questions on that one where we maybe can talk a little bit about cost comparisons with Scotia Surgery versus other options within our system and I will have some information on that one, but he did talk about recruitment and retention of nurses. I agree that we do have an aging population of nurses in this province. I did talk about one opportunity that we're making available to late-career nurses, the ones who have a lot to offer to this province but maybe just can't work on the floor anymore or, you know, feel that they should be doing something different. I believe the nurse call line will be one option for some of those nurses, so not only finding new nurses but also retaining some of that expertise that we really need to maintain and continue the system that we have in Nova Scotia.

To give you some numbers on nursing and through our nursing strategy, Mr. Chairman, our nursing strategy is still utilized as a model and one of the better ways to retain and keep and train nurses in all of Canada. I can say that in nursing retention and strategies, recruitment and strategies in Nova Scotia, we're going to be spending $9.7 million on that very issue in this province. So I'm hoping we will reap the benefits of that in the near future.

Mr. Chairman, yesterday, from a question that I received on nursing again, as I said, at the end of academic year 2008, 296 registered nurses will graduate. At the end of 2008 as well, there will be 153 LPNs graduating. From what we can understand at this point from CareerBeacon - which is, of course, the listing agent for jobs in the province and for our district health authorities - there are I think 103 postings. There could be multiple postings within that but we believe it to be probably somewhere near 100 and 150 open positions.

I do have some other numbers and I forget where I put them, they could be in my Blackberry, but it really talks to how many nurses we have employed in this province and how many are on full-time contracts, how many of them are on either part-time or casual, and we do have probably a larger number of full-time nurses than any other province in the country, full-time nursing of that percentage. So we'll continue to offer real jobs. You know, I think some of the problems we've had in the past is district health authorities, regions, hospitals, were hiring people on casual contracts and, if you're a young individual with a student loan, whatever it may be - and I could probably talk a lot about what the Department

[Page 16]

of Education is doing and what the Minister of Education is doing when it comes to debt relief and when it comes to students, but I'll stay away from that one for today.

Even through our department, we know that we retain over 80 per cent of the new trainees in the province. So it doesn't take long to do the math that out of that 200 in 1996 plus 153, that 80 per cent of those will stay here in Nova Scotia and offer services to our patients in Nova Scotia. So I think that our nursing strategy is working and, hopefully, that number will continue to drop, that percentage of older nurses versus younger nurses. So it is something we'll continue to work on and I believe, again, our nursing strategy which is made up of staff from the Department of Health, the Nurses' Union, the College of Nurses, et cetera, are all working together to find solutions to keep more nurses in training, more nurses in this province.

MR. DAVID WILSON (Sackville-Cobequid): Thank you. That's why I wanted to start off with the figure I mentioned where we have the lowest percentage of nurses under the age of 35. It truly reflects what the demographics are of our health care system, especially with nursing. As the $1 million report of Corpus Sanchez stated, we're going to have close to 1,300 - I think it's 1,290-something - nurses eligible to retire in the next two years. So, it's good to see in this budget that the government has looked at putting more funds towards increasing the number of new seats for nursing here in the province.

A quick question to the minister, I believe it's the $851,000 figure - is that the number that is targeted or is going to increase the number of seats available in the province? If that is the number or whatever the number is, how many new nursing seats will we see in the province this year or in the coming year?

MR. D'ENTREMONT: The member opposite underlines a very important thing when it comes to our health system and the things we did learn from the Corpus Sanchez Report - what is the real impetus on transformation to begin with. Transformation in the system is really being pushed by three things - one being demand, as I spoke to in my opening remarks of the aging population that we have and requiring more and more services;

the changing medical technologies and treatments that people deserve to have, as well as our HHR issues; as well as the growing cost that I believe the member from the Liberal Party did mention in her remarks earlier today.

To speak more specifically to your comment and question, the $851,000 increase does not speak to the new seats that we're adding. It speaks to the regular increase in operating the two programs at St. F. X. and UCCB and maybe if you ask another question, I'll have further details on it. (Interruption) Sorry, CBU. I wrote that down wrong. I have to apologize to the member for Glace Bay and all members from Cape Breton for calling it UCCB - that, of course, is something hard to get out of your head.

[Page 17]

The expansion of RN seats in the province - I forget how many seats that is, but, there's$1.3 million for expanded seats in the province. LPNs, of course, to NSCC there's an added $1.9 million to expand seats in the province.

The other very important piece when it comes to training nurses in this province is that the number we have - I forget the total number of training seats that we have in this province - is as many training seats today as we had prior to the 1990s when the two-year programs were brought in place. We are, finally, caught up, I think, on training seats for nurses. Of course, the work will be through our strategy in hiring and retaining these individuals.

MR. DAVID WILSON (Sackville-Cobequid): I thank the minister for giving me those figures for the RN and the LPN. If you could, at a later date, get me the number of seats you project. I would assume you would calculate what that would be and how many new seats. The reason I mention that and the reason I'm looking at numbers is because that's what we need. We need numbers. We need to get more health care providers trained, especially nurses and we need to entice them and recruit them and make sure they stay in the province.

From our records, I believe the Dalhousie campus has 135 nurses and the Yarmouth facility takes another 20, so it's about 155 nurses being trained - of course, that's on a yearly basis and the turnover is every four years. Then, of course, we have the LPNs and then the CCAs who are trained at community college.

One of the reasons I'm concentrating on the nursing seat number is I think it's an important one because that is where we seem, every time I stand up to question the minister, it's that we don't have enough seats. I asked the minister today about OR nurses, and of course we need a nurse to be trained and then later on get specialized training, which I think the telehealth that the minister mentioned would be appropriate for that. But we really need those individuals, those young people - because we have such an aging work force - to enter the health care fields and the professions.

I believe, from what we know, at Dalhousie, for example, the nursing program last year had over 700 applicants for those 135 seats - 700. I must say, I was always under the assumption in the last number of years that the health care field wasn't as appealing to new students, young students coming out of high school. I just assumed that. But then, and over the next few minutes I'm going to cover quite a few disciplines within the health care field, I've recognized that there's quite a few students who want to work in health care, that they want to be trained. Many of them - 80 per cent of them anyway right now - would stay here.

So my question is, why are we allowing those young adults to, I think, be lost in the health care field because you know what is going to happen if you apply to nursing and you are one of 700 to get 135 positions? They are going to choose to do something else, get in some other field and who knows, we've lost them forever. So with such high numbers like that, I think, why are we not putting more of an emphasis, and that's why I asked for the

[Page 18]

number of seats, on increasing the capacity for training, especially around nursing, like this one.

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I'm just trying to crunch some numbers, what my total nursing seats are in the province. But just to speak to what this year's budget does bring us, total LPNs, we'll be increasing the number by 223 LPNs. So that's six additional 30 student classes, that's 180, plus some other program expansions, so 223 new seats for LPNs.

Total RNs, and this will max out the capacity, I believe, in the current school so whether it be CBU, whether it be St. F.X., whether it be Dalhousie University, we're expanding that by 70 seats. What I'll do is I'll try to have the number of total seats across the province for nurses.

That doesn't speak to, as well, as I did in my opening remarks, the 1,000 CCAs that we'll be training this year. Also this is a great opportunity to thank NSCC for the work that they are doing in health human resources. They've done a phenomenal job in meeting our requests. I'm sure that when we started talking to them on expansion of these programs, that they looked at us like we had holes in our heads, that we needed that much training to go on in a very short period of time. But hats off to them, that they've been able to meet our demand.

The other program that I'm very, very happy about is the MLT program, the medical laboratory technologist program over at the new campus in Dartmouth. For the first year - this is the first year that we've had a medical laboratory technologist program on Nova Scotian soil in a very, very long time and I think there's 25 students, I believe, going through there per year. So over the next number of years we're going to be able to train 25 per year as they'll run through the system.

[5:15 p.m.]

Again, one of the issues that was brought forward in the Corpus Sanchez report was by 2015 - so the clock is ticking really quick - that about half of our medical laboratory technologists around the province will be ready to retire.

Anyway, we are starting to see a true expansion in maximizing the opportunity that we have in this province, starting some new programs. Next year we're starting the medical radiological assistant program, to help out in hospitals with that kind of technology. So more and more we're training right here at home and I think the opportunity to train right here at home is to train our Nova Scotia students and incent them and hope they go back to their home communities to work, live and raise a family.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, one of the things that government needs to recognize is that they need to have benchmarks set up in order to know

[Page 19]

what the recruitment and retention numbers will be, or what they're going to use to recruit new health care workers in the coming years. The province needs to know how many they're going to go after. I think you should know how many you're going to go after. The question is, is there a benchmark of how many health providers you're going after like RNs, lab technologists, X-ray technologists, even social workers over the next year, two years or maybe even seven years? I'm wondering if the minister can comment on their benchmarks for those health care providers.

MR. D'ENTREMONT: Mr. Chairman, maybe we can just use a different word, we're going to call it a "target" and whether that be a benchmark or a target, I really don't think it matters. Our target is approximately - and this is just on RN, LPN and CCA - 2,298 individuals. So there's an opportunity for Nova Scotians, our own kids in our communities, our loved ones, our families, our friends, to have an opportunity to work in Nova Scotia in the health care field. Two thousand two hundred and ninety-eight individuals is our target when it comes to those specifics.

MR. DAVID WILSON (Sackville-Cobequid): With that target, how does that compare - and I don't have the figure - with what the Corpus Sanchez Report indicated? Do you know that target they had set in that report?

MR. D'ENTREMONT: From what we know at this point - and we're continuing to have a new and invigorated HHR strategy available in June but, with the information that we now have through Corpus Sanchez and the work that we have already been doing in the communities through our health care system, we believe we are pretty much all in the same ballpark, that that 2,300 number is one that will address the system gaps that we have today.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, we'll definitely be keeping an eye on that. And that was one of my questions later on - when will that new Health Human Resource report be released? And the minister said June. Hopefully that will be publicly released so that Nova Scotians can see that. I'll hold you to that date - not July, but you said June. That goes back to one of the criticisms I had at the start. I mean here you are, you've been Health Minister for maybe over two years in government, your government being in government for nine years and we're going to see it in June 2008, nine years later. I hope that it has positive information in that.

I believe it was in the paper today, and I don't know if the minister is aware of this, it was the Truro Daily News, around the frustration of a Grade 12 student who was interviewed, an honour student who wants to be educated as a diagnostic medical ultrasound individual in the program at Dalhousie. She's frustrated, not because she doesn't have an opportunity to seek the training, but she's frustrated because she did apply for that program and was told that she was on a waiting list. We've talked about waiting lists for surgeries, waiting lists for specialists, waiting lists for long-term care, and now we're starting to hear - like I said about the 700 students who applied for the nursing program - we have a Grade 12 student who wants to work in it and she's on a wait list.

[Page 20]

But what's more frustrating for this young individual, this person - and this is a more rural community - we should be ensuring that this person can be educated here in Nova Scotia and stay in Nova Scotia. What was most frustrating for this individual is that she just recently heard Peter MacKinnon, CEO of Colchester-East Hants District Health Authority, speak around the fact that they're creating a bursary program aimed at trying to entice local high school students to fill positions that they could not fill in the hospital, like diagnostic medical ultrasound.

This individual is going in the right direction. We need this individual. She was told she was 90 on a wait list for that program which, I believe, only has five seats. What do you say to a young girl like this who wants to be trained, wants to be educated here in Nova Scotia and wants to return to her roots, her community? What are we going to do? I think we're going to lose this individual. Why is it so hard for this individual? If we need them, then what government needs to do is increase the money to support the increase in seats to train these individuals. There should not be a wait list for medical ultrasound students; there should not be a wait list for nursing students, for doctors - my Lord, we should be going after these people.

We could eliminate recruitment, and we'd only need to work on retention, keeping those individuals in our province. We do have a good success rate - 80 per cent, and I think it could be better. Why has this situation happened? Why is this young person from the Truro area, from Colchester-East Hants area, unable to get the training she wants and work in the field that is needed here in the province?

MR. D'ENTREMONT: Mr. Chairman, this is one of my frustrations on a regular basis. It doesn't matter the profession within the system, it does happen quite often, whether it be trying to be a physician or one of those other pieces, like the ultrasound technician or radiological technologist. They are very small programs, within Dalhousie University for the most part, and what we really need is a better appreciation, a better partnership with Dalhousie University in health human resource.

They have to really, I believe - and we've had discussions around this - ramp up their health profession programming, and really decide whether they are the right service provider to be training these individuals, or should they be focusing a little more on the nursing and the doctorate program?

I believe there's an opportunity through our community colleges to be training some of these individuals. NSCC has really stepped up when it comes to the laboratory technologists, they've really stepped up on CCA, on LPN and I think there are some other professions they would really like to take over from Dalhousie University. I'm probably sure that Dalhousie University might want to let those programs go into a more public opportunity, and I think the seats they might have available would be better.

[Page 21]

I've talked about it here in the House, I've talked about it in many speeches around this province, that I believe it's much easier to retain a professional that we've taken and trained from a local community, and got them to go back into that community, than we have in trying to attract somebody from Hong Kong or the Yukon, or someone who has been trained in Toronto. It's difficult to get somebody to not go into their milieu, to get into their comfort zone unless the person has been there.

Dal, actually - and I do speak negatively about Dal sometimes, but I can also speak positively about them - they're supporting the opportunity for educational laddering now, where an individual today can go and maybe start off in CCA, NSCC will allow them to continue in LPN, and Dalhousie will then allow them to go from LPN to RN, et cetera, et cetera, to be able to move and react to the needs within our system. I think there has been a lot of work done in that respect, but at the same time we do hear quite often of these individuals who want to go on to the health profession and really can't get there.

I don't know the details around how many seats are available for ultrasound technologists or how they are trained, but I could look into that information as we come along.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, from our information it's five seats for medical ultrasound, 13 seats for radiology technology, and eight seats for nuclear med. Radiology has 37 people waiting on a list to get into the course; nuclear med has 18 and, as I said, our stats say there are 40 people waiting for the ultrasound - but the young lady who was quoted in the paper said she was told she was somewhere around 90.

With all due respect to the minister, that wasn't good enough. Why are we not doing it? The number one thing people ask me is, why don't we just train more doctors? It's a good question. I understand that Dalhousie University is separate from government, but the funding is there. We need to do something - if our ERs are closing, our ICUs are closing, our labs are shutting down because we don't have people to work there, government is responsible and we need to address those health care needs - we need to invest more money in it. We need to say, listen, the priority of government right now is to ensure that we have enough health care workers to meet the needs.

I think we need to see more of a move towards addressing that, and I'm frustrated when I see and hear young people say they want to do that but they can't do that. It comes down to, as I said, recruitment and retention of health care workers - and job satisfaction, really. That, I think, plays such an important role with the retention of health care providers, because if you're going to be enticed to go somewhere else and you're not happy with the job you are in now, you're going to go. Sometimes you go for less money, but often they're being enticed with a lot more money. So that's why it's so important that we recognize job satisfaction and the working environment that our health care workers are in.

[Page 22]

Now I'd like to turn towards the overtime that we see so many of our health care workers put in over the course of a year, Mr. Chairman. It is unbelievable how much our health care workers work overtime to meet the needs of the people of this province.

Mr. Chairman, you were there, I was there, we worked a lot of hours to ensure that Nova Scotians were safe when it comes to medical care, ground ambulance. We know our colleagues, nurses, doctors, technologists, every one of them, the majority of them, if not all of them, work some form of overtime. The most discouraging part of when I first learned this was when my son was born and he was in the special care nursery. We had this wonderful nurse - and I agree with the minister about the care we get here in Nova Scotia, it is unbelievable - we had a wonderful nurse take care of our son.

She was there all week and we talked with her, my wife sat with her all day during her shift and she was so looking forward to the weekend, and so on Saturday, when I came in, I noticed the nurse was still there and I asked her what happened. You know what she told me, Mr. Chairman? She said she answered her phone. I said, well what do you mean, you answered your phone? She said, we have mandatory overtime, I answered my phone, I had to come in for the shift. So that's a prime example of an individual, a health care worker, who is in a job that is stressful. Any nursery, a special care nursery, intensive care for children is such a high level of stress area and the importance to have that individual have such good job satisfaction is important for any outcome for a sick child.

So what does the province pay in overtime for nurses? Do you have that figure, the overtime costs for nurses? I see that the guy who does the books is shaking his head "no", so maybe I should sit down, he might want to reply to that. Do you calculate, or can you calculate, can you get to me at a later date what the province pays in overtime to nurses?

[5:30 p.m.]

MR. D'ENTREMONT: We don't hold those numbers centrally, but what I can do is maybe get some numbers from the district health authorities that are responsible for the day-to-day hours of the nursing staff and get that back to you as soon as I can. So we'll survey the district health authorities.

Mr. Chairman, what I do want to talk about a little bit here is that the overtime issue is very concerning and one that if you're asking too much of a person, eventually that person will end up burning out. And that's the last thing we need in this province, to have people in our system who are burned out, which is why one of the recommendations within the Corpus Sanchez Report was to design a model of care. A model of care really means allowing different practitioners to work to their full scope of practice. We do have a number of people, whether they be nurses or clerks or what have you, not doing the things that they are trained to do, not working to the full scope of their training of being clinicians, of being what have you. We are finding that nurses are spending far too much time filling out paperwork - you know, spending the last hour or two of their shift simply filling out

[Page 23]

paperwork, which really a ward clerk could be doing. We could be getting way more service out of a nurse for the two hours that we could spend on having a ward clerk in place.

So the model of care will truly look at the roles and responsibilities of the staff within units and look at the most appropriate way to use them. I think, personally, through that we will save a lot of money in overtime. That is where it is, and I know exactly where the member opposite is coming from, because I hear it too often. I, too, have an aunt who is a nurse, who happens to work in a special nursery and she leaves the phone off. That's a hard statement and it's hard for her to say, listen, I need today off or I'm not going to be any good tomorrow - and I know there are a lot of other staff who are doing that very thing. I can't blame them at all; the work that they do is difficult. There are many of us in this room who could not do that kind of work, even though we do seem to work ourselves to the limit sometimes.

At the same time, it is very traumatic, it's very difficult mentally, very challenging, and I think that we do need to do much better work in harnessing that overtime, in letting nurses be nurses, and let cleaners be cleaners and let the ward clerks be ward clerks - and even to the point of letting RNs be RNs and letting LPNs be LPNs. There is a lot of overlap that is happening today on those wards and on those floors that is causing this overtime issue. I believe through this model of care initiative that we have initiated, it will make that difference.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, it's kind of unbelievable, a little bit shocking to know that you don't have that figure with you, in your books, something you could give me. It's an over $3 billion investment in health care and you don't have the figure for overtime. I know it might even be in the tens of millions of dollars.

The figure I have, Mr. Chairman, just from the VG and Halifax Infirmary nurses, and this is over a year, it would be 17 months, and that 17-month figure that I asked for and was told was $5.5 million for over 17 months. Now that is just one-quarter, if not even a quarter of the health care workers - I think that might just include maybe 6,000 nurses. There are some 25,000 or more throughout the province, so we are talking millions and millions and millions of dollars. Some people might say, that's great, I wish I could grab hold of that and put it in my pocket. But I can tell you, money isn't everything it adds up to when it comes to the hours put in by health care workers. They don't work regular shifts like most people do. They don't work eight-hour shifts - it's not like they are going in for eight hours, they work12-hour shifts, sometimes longer, because of the overlap, because maybe they have a critically ill patient they cannot leave without stabilizing them.

Or, it is like paramedics - they can't say no, my shift is over, I'm not responding to this car accident. They are made, it's mandatory, they are forced into it - and they love doing it, they don't mind doing it and, as I said, the money is not important to them. What I think would be more important to them - well, it might be a little bit important to them, everybody

[Page 24]

likes making a little more money - what is most important is that job satisfaction and that ability to just exhale.

The minister mentioned he knows personally the work that's entailed in health care, dealing with the death and dying individuals in this province. I've been there - I've seen children dying; I've seen adults dying. It's a stressful, stressful situation. I'm always curious on where back in history it was ever written that health care workers, who work in probably the most stressful environment there is, will work twelve-hour shifts compared to someone who works in an office, working eight-hour shifts. Not that office work isn't stressful - I know by switching professions that sitting behind a desk sometimes for eight hours can be stressful. But I still don't understand why we put that pressure on our nurses, our paramedics, our health care providers, let alone the doctors, interns and residents who work days on end.

So why I turned it towards the stress and not only just the overtime is the fact that recently we - and I think the minister knows, and deputy minister might know of problems around the OR and some of the staff in the OR and the requirements on them to perform their job many times past the end of their shift, and then being required to show up to work sometimes within six hours.

I know that recently in the OR here in Halifax, RNs, perfusionists, OR techs, LPNs, anaesthesia assistants frequently work past 1:00 a.m. because of emergencies and other things beyond their control and are required to return to work within six hours. Right there, that's a prime example of how I can see if that situation isn't addressed, it would turn into a highly stressful job, satisfaction rates for those health care workers will go down and what happens is they're going to refuse to work. That has happened because of their fear of doing something wrong - I know a couple of individuals in the ORs here in Halifax have refused to show up to work the following day because of those safety concerns. They're worried about their drive home, the safety of themselves but, most importantly, we always hear from health care workers that they're worried about the patients that they may need to work on tomorrow, the next day.

I've worked a forty-eight- hour shift as a paramedic and, I can tell you, when you get a call on the 48^th hour, the service that individual gets is not the same as in the first two to three hours of a 48-hour shift. That's an example of what happened in the past. I'd like to ask the minister, what is he doing to ensure the people in the OR are safe but, most importantly, the people they're looking after because of that short window where they're required to return to work? I know that's under policy and procedure of district health but you're the Minister of Health - you need to step in and say we can't let this happen. Can you give me any information on what's happening with that, and what you could do to fix that issue?

MR. D'ENTREMONT: Mr. Chairman, there are a lot of issues in the collective agreement that I can probably help provide to the member when it comes to the management of those shifts and things.

[Page 25]

The twelve-hour shift is also something that I have a hard time understanding. I know in the past, other governments have tried to change that twelve-hour shift to maybe eight- hour shifts and things like that and nobody wanted it. It's sort of a Catch-22 - that's the model of care that nurses and other health professionals are comfortable working in and it's a very difficult thing to change.

The member opposite also talked about the availability of the numbers, the numbers available to know how much overtime is being spent on our nursing staff in the overtime. We do have a challenge knowing what exactly is happening on a day-to-day basis on the finances of our district health authorities. I'm very happy to say that in this year's budget there is about $4.4 million in operating cost under the SAP system for health care, and this year's also is to expand this into all the districts, of course, is an investment of $10.9 million so that we here in Halifax at the department can know and react to issues that are happening on the ground. We can look at district health authorities and ask, why is there so much overtime, what are your concerns there, is it about hiring, is it about sicknesses, is it about something else, and I think we can be more reactive to that. So I'm very happy to have those kinds of dollars available there.

The other thing that I talked about - when I had the question today in Question Period - revolved around training for OR nurses. We really need to have more OR nurses in this province and I can say through our $500,000 investment in the skills lab over at the VG site, or the old nurses' residence - if anyone remembers where that is, and I'm sure a lot of people visited nurses in their time at the nurses' residence - but anyway in the basement of that is a beautiful, brand new skills lab. If any one of you is interested in dropping in to see what kind of equipment and training will be able to be had there, I invite you, just ask me any time, we'll pop down and we'll use a couple of endoscopy machines and we'll cut some ribbons and do some stuff. (Interruption) Yes, anytime that you want to drop by, but I don't think you can use it on me. I think the member opposite suggests he doesn't want to use anything endoscopically on me. Just having a couple holes and some sticks in me, it doesn't sound appealing if I don't need to have it.

Mr. Chairman, all jest aside, it's a phenomenal facility. Again, one that was the brainchild of the district health authority and of Dal Surgery - of Jaap Bonjer and his team - to have the ongoing skills available to physicians and nurses. I can say that when I got to visit it just the other day, there was a course of nine OR nurses who can go and train and get the simulation of doing endoscopy - I believe there are a whole bunch of different simulators there, but they can do anything from eye surgeries to different endoscopic surgeries, to different kinds of scopes that are available there, and get their skills to the best possible they can be, but also train those nurses who have the interest in working in the OR, and of course increasing our complement of individuals there.

Mr. Chairman, the other thing that I do want to quickly mention is that all through Capital Health's keeping the promise and Dal Surgery's keeping the promise is taking those ORs and utilizing them to their fullest. I can say that today - I forget how many ORs it is, is

[Page 26]

it 32 or 28? - anyway, somewhere close to 30 ORs are now being used on a regular basis, when I can say that less than a year ago less than half of those ORs were being used because of a lack of anesthesiology. So we have stepped up and Capital Health has stepped up to make a difference in wait times, in having the surgeries available for them. So with those quick comments, I'll take my place.

MR. CHAIRMAN: The honourable member has approximately three minutes left.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, the question I was asking the minister - I don't know if he really answered it but he went down a road, and I know he was trying to use some of the time up here. And I'm quite aware of the area that he's talking about - actually in the Bethune Building, in the basement or in where the skills clinic is was actually where I started my paramedic course and then we moved up to the floor where the nursing residence used to be.

[5:45 p.m.]

You know, we all understand changes in the health care system but that was another change that I think had a negative effect on the health care system - when we did transfer to a degree program, when we had that facility which was a hospital-based facility with a two- year diploma program for a registered nurse. That's why it's so important we recognize what we had there because, you know, those hospital-based training experiences are probably the best way to ensure that we have competent health care providers, that we have health care providers who are exposed at an early stage in their education to what the real world is going to be like. Far too often, we hear from those health care providers who are in an extended program that it wasn't until the second or maybe third year before they actually put their hands on a patient and were exposed to what would be required when they graduated. I think that was shortsightedness on behalf of everybody involved - government and those who were making the decisions at that time.

I know for myself that experience having a hospital-based setting for my education had a positive effect on my career as a medic, and I think had a positive effect on my skills and what I could bring to the patients that I treated once I graduated. It still doesn't get around the fact that once we have people educated, once we have them in the workforce, then all of a sudden we've attracted an individual and we've placed them in environments like I mentioned earlier in the OR, where they're stressed, where they're working long hours.

I think with those comments I will pick up from there in my next hour after the critic for the Liberal Party.

MR. CHAIRMAN: The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, we find ourselves at this time of the year that we all so dearly love in Budget Estimates. I'll say this to begin with - there

[Page 27]

is nobody, in all fairness to the minister, who has all the answers to health care problems in this province, me included and members of the Opposition. Former ministers haven't had the answers as a matter of fact, so we know that the problems are so complex that the answers are probably going to be just as complex. We know we can use sessions like this to try to drill down a little deeper, unfortunately it almost seems sometimes like a bottomless pit that we're drilling into in terms of health care.

I know that in all honesty - I've said this before and I'll say it again to start out my comments during Budget Estimates on the subject of health - that I know your staff that are associated, the Deputy Minister and her staff as well, have all the good intentions in the world, unfortunately they can't have all the money that goes with it or else they could solve the problem. They do have a good percentage of that money that goes with it in Nova Scotia and we know that percentage unfortunately has not gone down and we know all of the problems that are associated with it - everything from ER closures to shortages of doctors, shortages of nurses, shortages of other health care professionals, technicians and technologists, that are going to come up over the next several years.

Where we are now - I think most of us will admit we are in somewhat of a crisis regarding health care in this country and in this province and that we could be headed for somewhat of a bigger crisis. I think right now it's incumbent upon us all that if we don't tackle this problem we know that we're going to have something on our hands in the not-too-distant future that we just won't be able to handle.

In a session like this it's important, number one - and I'm not lecturing, Mr. Minister - for you to have some of the answers, and it's important for you to certainly have the willingness to provide those answers to questions that the Opposition members are going to ask, because they are important to us and they are important to you and your staff in finally determining and coming about to somewhat of a conclusion as to where we're going to go with this, and some of the solutions that may be out there. As I said, not all of us have all of the solutions - together, perhaps we can come up with some.

Let me state that unfortunately as we continue to talk about such things as ER closures and doctor shortages and nursing shortages we don't have to go too far into the past to find out that those issues are with us here today. We talk and you've been talking about solutions to the issues surrounding nursing vacancies. We're aware of the fact that Fishermen's Memorial Hospital - its ER was closed due to a lack of nurses today. So we know that's not the first time that it has happened at that hospital. We know that it has been closed due to a lack of nurses before, and sadly we know that is likely not going to be the last time that that happens as well.

During the questions to you from the member for Sackville-Cobequid, of interest to me as well and I think of interest to all of us, there was some discussion about the numbers involved in nursing and so on and the number of initiatives that there are. I would like to know, as my first question, if the minister could indicate what initiatives there are under

[Page 28]

nursing initiatives in the Supplementary Detail on Page 14.7. On Page 14.7, I would like to know if the minister could indicate what initiatives under those initiatives will address the issue of ER closures that are due to a lack of nurses.

MR. D'ENTREMONT: Mr. Chairman, from time to time we have had closures of ERs due to the lack of nursing staff. It's one thing that, of course, concerns us on a regular basis. We have said, and we will continue to say, that we will not be closing ERs in the province and we will be trying our best to find the full complement of individuals there.

Mr. Chairman, more specifically to the member's question, just on recruitment because I think it is sort of the general issue of having nurses in our system, and by having new nurses in our system the ones who are more seasoned can move on and get that extra training so they can move into places like ERs or ORs or what have you that does require more training.

So just to give you a listing basically from that item, this year in advertising and promotion - which includes TV, radio, theatres, job fairs - we will be spending $500,000; the RN recruitment initiative, we will continue to work on the strategy for that, $250,000 has been allocated; the RN third-year cooperative experience, which 40 students are experiencing, I think it is about $60,000 a pop on that, so that is $240,000; facility-based recruitment and retention initiatives fund so each hospital has access to some dollars to recruit, which is about $239,000; facility -based placement premiums, which are, of course, incentives for premiums to get into some more of our remote areas or places that have more challenges, which is I believe $84,370; as well as upgrades for food handlers and medication management modules, that sometimes they don't have when they have their new training, which is somewhere close to $80,000.

We will continue to work through the strategy, through the college, with assessors for prior learning assessments of $200,000 and a coordinator, so that this transfer of credit programs and things like that would be about $150,000. So just in recruitment today, in this year's budget, we are looking at $1.7 million or $1,744,170. These are additional dollars this year on recruitment - there are already other dollars within the overall $5 million nurses strategy - so we feel that we are doing an awful lot to incent and retain nurses in this province.

MR. DAVID WILSON (Glace Bay): I will ask the minister for a little clarification if he would there. There are a lot of numbers there to digest, but what I was looking for is directly what is going to go towards the issue of ER closures because of a lack of nurses? You and I both agree there is a problem there. We know there is a problem there and we know the problem has been around for a while and it may be around for a little while longer, but specifically how much of what you are talking about is going to go directly toward the problem of the lack of nurses within emergency rooms?

[Page 29]

MR. D'ENTREMONT: Mr. Chairman, more specifically, there are really two axes in which we're working on this one. One that I speak to when it comes to recruitment and retention of nurses is to have more nurses in the system - more nurses in the system will allow advancement of the nurses who are there today to go and work in places like emergency rooms. So I think that will help the opening of those closed ERs. At the same time, as I responded to the NDP Critic, the model of care initiative I believe will really redesign the way nurses are utilized within the system, that we can more efficiently have them in our system. So I think those two axes will stop, or at least slow, the closures of ERs in this province.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, in discussion as well with my colleague from Sackville-Cobequid, the minister mentioned that there was a figure of $851,000 that would be involved under the nursing initiatives that would go towards the number of nurse training seats - is that the number? Can the minister confirm that figure of $851,000?

MR. D'ENTREMONT: No, the $851,000 is simply the increase in cost to offer the existing seats today, so the increase in wages and salaries and benefits and those kinds of things. There were some - I forget what the dollars were attached to the new seats that we're adding to St. F.X. and Dalhousie and Cape Breton, I believe we're adding $1.3 million for RN training and we're adding $1.9 million for LPN training.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, would the minister please tell us, then, how many nursing seats is that going to create, and where they'll be created?

MR. D'ENTREMONT: I don't have it per site, but I do have the general numbers for the expansion - for LPNs it was 223 new seats, some new training seats, and 70 new RN training seats. What I can do is I will endeavour to have those numbers, hopefully, tomorrow, on how many seats per site - so I'll have a better idea of how many are going to be at Cape Breton University, how many at St. F.X.,and how many at Dalhousie.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, well perhaps - I don't know if the minister would have this answer now or not and if not, perhaps he could provide that with the other details he is taking about - along with where those seats would be located, when those additional nurses would graduate. When is it that they're going to graduate?

The reason I ask that is because the Nova Scotia Government Employees Union has a prediction that by the year 2010, we'll be short by about 1,260 nurses in the system - it's scary but the Corpus Sanchez Report makes a similar prediction as well. So perhaps the minister could tell me if he does know now, and if not will he get those figures for me, please?

MR. D'ENTREMONT: Mr. Chairman, I don't have necessarily those specifics, how many we're going to have trained within that certain amount of time. But just out of the 223

[Page 30]

individuals, those individuals will be trained within two years, which is the LPN program, and of course the RN is the70 new seats that will be trained - I believe it takes four years to go through that degree program.

MR. CHAIRMAN: Thank you. Order, please. We have arrived at the moment of interruption.

The Committee of the Whole House on Supply will adjourn until 6:30 p.m. and reconvene at that time to continue with the estimates of the Department of Health.

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

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

MR. CHAIRMAN: Order, please. The Committee of the Whole House on Supply will now be called to order. We will continue with the estimates of the Department of Health.

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, when we recessed for further debate on another subject, previous to that we were talking about nursing graduates. The minister had indicated to me that some of the numbers, in the years to come, would be associated with LPNs and RNS and the additional numbers that we had within a couple of years, for Licenced Practical Nurses and within four years for Registered Nurses.

I had indicated previous to that, by the year- according to the NSGEU- by the year 2010, there's a prediction that there will be about 1,260 nurses short in the system. That's also the indication that is there within the Corpus Sanchez Report as well. If we were to maintain 100 per cent of the nursing students who graduate, everyone of them would come back and would work in Nova Scotia and it's probably the minister's hope and mine too, but if we were to do that, even then we would likely be about 500 nurses short, in terms of the number.

Is that correct? Would that be your calculation as well? If that wish were to come true, that every one of those additional nurses were to graduate and decide to work in Nova Scotia, we'd still have about 500 fewer nurses in this province than we require.

MR. D'ENTREMONT: Mr. Chairman, it's great to be back talking about the estimates for the Department of Health and the important issue of human health resources, especially when it pertains to nursing in this province.

The member opposite does do a good piece of math if we consider staying at the current model of care, staying in this method of care. As I've said before, with the changing the model of care, by changing the roles and responsibilities of people working on a floor,

[Page 31]

working with a unit, in my estimation, we would maybe change the number of nurses to other staffing ratios and things like that.

If we do today, sure, we probably would be short somewhere close to 500 nurses. If we train-as I said before, 296 registered nurses will be graduating this year, 153 LPNs will be graduating, we'll be retaining somewhere close to 80 per cent of those, so that 80 per cent, projected out five years, and we come up with a number that- of course, we'll be a bit short. But, I believe we're changing that model of care. We will get a tremendous revamping of what that model of care looks like.

I'm just looking at what my deputy is writing here for me. The shortage will be minimized and I believe the projected shortage will be delayed by changing this model of care.

Today, I agree with the member opposite in the way we do things. I believe there's a big change coming that will alleviate some of the pressures that we see, if we don't change.

MR. DAVID WILSON (Glace Bay): I would assume then, if the minister's talking about some big change that is coming and that, without getting too specific, one of the aspects of that change would be what you're going to do with our more experienced nurses. I'll give you an example - I've used it here before, in many previous budget estimates and discussions in this House. One of my sisters, who's a nurse - I've used them many times before as examples of what's right and what's wrong with the system. They're right, the other part is wrong with the system. In this one particular instance, my sister would be soon approaching retirement - I'm not going to say how old, she is in her 50s, we'll leave it at that, she's younger than I am. I know that in her case and in a number of her friends' cases that I've spoken with, they have said to me that when I reach that age, after having worked so long in this healthcare environment and after having done the type of work that I've done - in her case and her friends' cases, they're specialized nurses, they work in ICU - they've gone through enough to the point where they're saying, when I come to the age of retirement, the only way I am ever going to see a hospital again is if I'm going there to get care, that's the only way I ever want to see a hospital again.

I am not saying - I wouldn't say this about my sister, she's not burned out because that would just be the wrong thing to say. When I'd go back to Glace Bay, I'd hear about it. But I would say that in terms of her work experience that she may be approaching that point in three, four, five years, whatever it's going to take in order for her to reach that time of retirement. The nursing initiatives that are going to deal with retaining more experienced nurses, those late-career nurses - I'd be interested in knowing, when you talk about changes that are coming, exactly what changes you mean when you're talking about those more experienced nurses in the system, what you're going to do, and even how much you're willing to invest to use those nurses.

[Page 32]

MR. D'ENTREMONT: Mr. Chair, what I'll endeavor to do tomorrow is have a little more listing of the initiatives that are held within the NSNU contract on addressing the retention of late-career nurses. There is a fair amount of incentive within that contract to do different things with these nurses. One of the items, as I mentioned earlier, is the nurse call line. It's a different way of doing work for those individuals who are burnt out from working on the floor, or working in an ER, or working in the OR. It does give them an opportunity to use those skills that are very important.

The other thing that I think is very important is that as we talk about primary care, I think there's a huge opportunity to take those individuals and put them into community care situations. If we had a nurse, just a regular family practice nurse - late-career or what have you - working in Bear River, that community would welcome it with open arms. There are many communities, like Bear River's, who have looked at that different model of care for their citizens.

I want to commend the individuals at the Bear River Clinic for their perseverance and their work for ensuring that health care continues for those residents. I know the member for Digby-Annapolis has done his upmost in making sure that we - through the department and District Health Authority - help fund the primary care functioning of that facility. I remember someone coming talking, bugging my ear the other day, they were looking for more money to offer more services. I know that what I invest in that facility will reap benefits for the community surrounding Bear River.

I think those are the kind of things, those are the opportunities for nurses in this province as they move on in their careers. There has got to be advancement within nursing in this province. My deputy minister is probably a good example of advancement in nursing. I know she worked on a floor at some point along her career, but she did upgrade herself, continued to work in different places and became administration. Here she is, four years now as Deputy Minister of Health in the Province of Nova Scotia, managing a budget of close to $3 billion for his associate and for his deputy. Yes, she's babysitting a 38-year-old minister, but ultimately that's the kind of thing I am talking about. There has to be opportunity for nurses in this province to advance, to change the work that they do. I think, from that, we will retain those nurses throughout their careers and they will be happy with their jobs. I want to see them happy with their jobs. I know when they started off with this, they were happy in the choice that they made to become nurses or health care practitioners. I want to see that joy come back. They need to be happy with what they do.

Anyway, those are some- but I will endeavour to have what that contact information is, what those initiatives are that we agreed upon with the NSNU, I will have more detail on the Nursing Strategy and the things that we are doing within it.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I am not even going to ask the deputy how many ministers she has been through. (Interruption) In my time, that many as well. The minister also referred to the member for Digby-Annapolis, who reminds me at

[Page 33]

every chance I get that we talk about a health care issue, to remind the minister that they don't have a nurse practitioner in Digby yet and I will do that again. In all seriousness - and this is a serious issue - when you are dealing with late career nurses, I can understand the experience that would be there and the value there would be but I would be more interested and pleased, I guess, if indeed we were doing something today so that they wouldn't get to the point that, in five years down the road, they do face that burnout issue. That, indeed, they would be wanting to get back and play some sort of integral role within the system and contribute toward the - I am trying to get out of the fact that I said my sister was approaching burnout. (Interruption) I am glad the members opposite are keeping close track of that.

If you looked at the Nova Scotia Nursing Strategy, minister, according to that strategy that was released in April 2007, it outlined a commitment to adopt the College of Registered Nurses, late career nurses report recommendations, as they related to work life and to the scope of practice issues, employment, retirement options, respect, recognition and support for nursing work. So I am interested, if perhaps the minister could tell us and indicate whether that commitment that is contained in that report is going to be funded this fiscal year or was it funded in last year's budget?

MR. D'ENTREMONT: Mr. Chairman, we are just trying to confer among ourselves here. The Nursing Strategy, year over year, the base this year for the Nursing Strategy is $5 million. Over and above that, I had listed off a number of items which were - I forget the total amount on that last item- which are over and above incentives and retentions for nurses in this province.

Mr. Chairman, also I wanted to mention the excitement- and I know when we talk about changing model of care, or a model of care initiative, it sounds kind of lip service-ish here in this House, because we don't understand, or I don't understand, the duties and responsibilities and all the things that nurses have to work to. We know that talking about the model of care initiative, setting up the function group that is going to be working on the model of care initiative, that a number of those nurses who have been invited to work on this and other nurses around the province, have delayed their retirement to work on this very important initiative. I think that is really important, because we are taking very experienced nurses, who have been through the system for numbers of years, who are going to be working on this change.

[6:45 p.m.]

This year, for Nursing Strategy, over and above the $5 million that is there year over year, the additional dollars for nursing is $4.9 million. So, really we have almost $10 million in Nursing Strategy items for this year alone.

MR. DAVID WILSON (Glace Bay): One last question for the minister regarding the issue of nursing. It's apparent what the minister is saying - I don't mean to put words in his mouth but what he appears to be saying is that the status quo doesn't seem to be working,

[Page 34]

that things have to change. So within your entire budget envelope, nursing initiative or whatever the case may be, what would you be allocating - how would you allocate your resources differently? For example, would you spend more on recruitment? Would you spend more on retention? Would you spend more on renewal? Would the minister, if you can, share some of that information with us about what you're going to do differently, budget-wise, to try and change the status quo?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. What we're doing differently this year - and probably something that we haven't done a really good job of - is really advertising the profession of nursing to the public. I know there are students out there who are looking to make decisions on their future, who, had they had a little bit of a push, a little bit of an idea that advertising would bring, would go along into that kind of profession.

We do have 20-somethings and 30-somethings who are looking for career changes and I think by increasing our advertising budget, it would make a difference in recruiting. I think what we're doing differently this year is trying to find a balance, not doing one or the other. A lot of years I think we did a lot of retention, but we didn't do anything in recruiting, or we did everything in recruiting and we didn't do anything on retention. Both of those things have to go hand in hand.

Again, the other thing that I think is going to make a big difference in retention of nurses in this province is allowing them to work to their full scope of practice, allowing nurses to be clinicians who really are dealing with the day-to-day well-being of their patients. What we find is happening more times than not is that they're trying to do everything within the department, paperwork, light housekeeping, et cetera, the things that I shouldn't be paying a nurse to do. I should be paying a nurse to be the clinician that they are trained to be. I think by that, patient care will go up, the nursing staff will be happier because they will be doing what they are actually trained to do and I think there will be a huge shift in job satisfaction because of it.

Going back to the distribution of dollars in the Nursing Strategy, you're trying to do - you recommended a new nursing network. There is a union and staff and management, there's a whole bunch of initiatives that are held within it that are going to be changing the way that we treat nurses in this province.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. Just on a related subject, I think when the minister talks about, again, doing things differently, whether we spend money on recruitment or retention or do we do it both or whatever, there's a perfect example that came before this House today in a couple of questions in Question Period to the minister, not regarding a nurse, but a nurse practitioner by the name of Dawn Lowe, who is looking to stay and work in this province.

[Page 35]

If you're going to change, and again by implementing the use of nurse practitioners you are implementing change, but you have to change other things within the Department of Health, within this province. In this instance, you have to change how long it takes to set up collaborative practice. Otherwise, you're going to lose more people like Dawn Lowe. It was a perfect example that was there this afternoon because as was stated in Question Period, of seven nurse practitioner graduates, three of them have already gone to Alberta. One more, who is Dawn Lowe, has been interviewed in New Brunswick and is about to make the trek to New Brunswick to go there. In the meantime, what we're doing is the same old thing. We're making it harder for those people to locate in this province, maybe not harder, it's just as difficult, I should say.

I would suggest that's the kind of thing we have to change and whether that be red tape, or bureaucracy, or whatever at the departmental level, or whether it's at another level, or whether it's with DHAs, or whatever the case may be. Unless we make the change there, then the change is not going to find its way to where it should and make a big difference and that is the recruitment of new people to this province, of new professionals whether they be nurses, doctors or nurse practitioners- unless we start making those changes.

As the minister well knows, it's pretty heavy competition out there in terms of recruiting nurses, or nurse practitioners or doctors. If we have our people, specifically our people who are looking to stay in this province, we have to make it as attractive as we possibly can and one of the attractions is making sure that they work their way through the system as quickly as possible without running into doors that are closed because of bureaucracy. I know the minister knows that is a reality and that it is something he has to work on and I would hope that the next time the minister gets a chance to speak on this subject, that he is probably going to make the announcement that they just hired another nurse practitioner in Nova Scotia by the name of Dawn Lowe, who is setting up a practice and away we go. I would hope that would be next announcement he gets to make, knowing full well that there are more out there like that. It's not just a solitary case, it is becoming more of the norm.

Here is the next subject that I wanted to talk about for the minister and it is one that, unfortunately, I get to talk about way too much. Last year, in 2007, across this province, the emergency rooms in this province were closed dangerously close to the equivalent of one full year. There were 6,299 hours, or 262 days, of emergency room closures. It represented a 60 per cent increase over the previous year. Now in the $1.1 million report on transforming health care, there is a recommendation that district health authorities should develop district emergency services models that will utilize staff across DHA sites as required. Physicians and nurses would provide coverage at sites, alternate to their sites, in order to address the temporary shortages or maintain sufficient staffing levels, at the ERs that are having problems staying open.

So I would like the minister to indicate where and how much has been allocated in this budget to enable district health authorities to implement those service models.

[Page 36]

MR. D'ENTREMONT: Mr. Chairman, let's talk about last year first. We invested $36 million in payments to physicians covering ERs and recruiting more than 30 new and replacement physicians to rural parts of the province. There has been a phenomenal amount of work that has been done in keeping the ones open that we have open. ERs, as a total in this province, are still open somewhere close to 99 per cent of the time. There are areas that have chronic problems of ER closures, Digby being one of them. I would like to see that nurse practitioner hired. I know the funding has been allocated. The district health authority is trying to recruit a nurse practitioner, but we are still having trouble in getting the nurse practitioners to go work in Digby. At the same time, we have nurse practitioners looking at setting up in places like Hantsport. So we need to have, I think, a more strategic method in placing nurse practitioners in this province.

If I were a doctor and I - doctor is the wrong example but if I'm a nurse and I say I want to work in this area, maybe I can't. Maybe I have to move to another location in order to practice my education. That is the challenge that we are really coming into with nurse practitioners. Just by saying and putting in a practice plan, doesn't mean that the Community of Hantsport needs a nurse practitioner. I'm sure the Community of Hantsport wants a nurse practitioner. I'm sure the community of Digby needs a nurse practitioner. I know the member for Hants West has talked quite often about this issue when it comes to Hants and the nurse practitioner who does want to work collaboratively with the doctor there and we are trying to find a solution to make that work. In the back of my head, I still have two vacancies in Digby, you know, how do I fill those positions? So that's a huge challenge for me.

I can't necessarily talk of the dollars that will be available to ER doctors, closing in on those barriers, open up those barriers, for practising and basically having a rotating pool of doctors who could work in a district and work at some of those other ERs because some of that information is contained within the master agreement that was approved by Cabinet today, that is going for ratification to Doctors Nova Scotia over the next number of weeks. So, I can talk globally that this year's increase, or over the next five years, the increase is somewhere in the vicinity of $108 million. Held within that are a number of initiatives that will allow the district health authorities to better manage their pool of money and, therefore, the pool of doctors who can work in some of these rural areas.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, there are a number of things that I can say in reply to what the minister has just said but, firstly, Mr. Minister, with all due respect, one of the solutions to filling those positions is to stop saying that 99 per cent of the emergency rooms in this province are open. It doesn't do anyone any good in an area that has frequent emergency room closures; it doesn't do anybody any good in an area like Digby, where they're still waiting for the nurse practitioner when the ER is closed, or the example that I gave you today at Fishermen's Memorial Hospital; or New Waterford Consolidated Hospital, which is closed more often than not; Glace Bay's ER Department, which is closed frequently; and the Northside Community General Hospital, on the Northside, which suffers from the same problem.

[Page 37]

We can say and you can say that I don't think the figure is as high as 99 per cent, but if you're going to keep using that as an excuse, with all due respect, stop saying that and get on with the job of trying to find a solution to the problem of a lack of physicians, nurses and so on in the ERs that have the problem, with all due respect. I was asking you, as the service models that are there under the transforming health care report that was recommended, I did not get a direct answer to that, how much money has been allocated in the budget but, anyway, perhaps you could answer this one, have you had any requests from the district health authorities with regard to the creation of those service models and if you have had any requests, what DHAs did they come from?

MR. D'ENTREMONT: Mr. Chairman, you know, I know the member opposite is advocating on behalf of each individual hospital and I can't just specifically think of one hospital at a time. I have to think of a system and how that system reacts to the health care needs of all Nova Scotians. I know that at 99 per cent, or whatever that number is, that all Nova Scotians, whether it be through the ER or whether it be through the EHS system, have access 100 per cent of the time to emergency care. I cannot say that any more clearly than that. All Nova Scotians have access to emergency care, whether it be through the ERs that are open around this province- there are a number of ERs around this province. I forget, what's my total number of ERs? There are 47 ERs across this province or somewhere close to it.

There is an emergency health system and ambulance system that are providing a service to this province that is second to none. At the same time, I need to look at, do Nova Scotians have the best that we can offer and I can say yes. We're doing the best that we can with the resources that we have. If an emergency comes up, they will be helped the best we possibly can with the professionalism and with the utmost training that we possibly can offer.

[7:00 p.m.]

I agree with the member opposite, it doesn't necessarily solve the issues for communities like Tatamagouche, or places like Glace Bay, or places like Digby. We also need to find, I believe, a model of care for those communities, whether it be for the interim, whether it be for here into the future of treating those people who are going through those doors in the first place. Mr. Chairman, 75 per cent of people visiting all ERs today, all ERs, whether it be the one over here on Summer Street that's got a $17 million expansion going up beside it, whether it be the one in Yarmouth, whether it be the one at the Regional in Cape Breton, 75 per cent of the people going through those doors are not there for emergency reasons.

The model of care changed at some point from an outpatient facility to an ER. There was a time when outpatients really was a community clinic where people went in to get their health care needs addressed. We need to go back to some kind of model that provides those outpatient services, those primary care services, if you see where I'm going here. We need to provide another model for Nova Scotians to have their health care needs addressed and let

[Page 38]

ERs become ERs, not community clinics. I think, through our nursing strategy, through our recruitment initiatives, through the new master agreement that is now being presented to Doctors Nova Scotia, I think we will see those changes and have better health care for all Nova Scotians.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I didn't mean to start back and forth between myself and the minister, but since he has continued it. Those ERs, I'll agree with the minister, various reports have shown that they're not used for exactly the purpose. The ERs, I know in my area anyway, are used as that other purpose that the minister says is community clinics, because people have nowhere else to go. There are no community clinics open at that time, there are no community clinics in the community as well. In some cases, I know in Glace Bay right now, there's a shortage of family doctors. I know of cases where people who are suffering from, for instance, diabetes, who have had to go to the emergency room and wait for six hours so they can get a prescription refilled because they have no family doctor to go to.

The issue of ERs closing again is a little more complex than saying you shouldn't use ERs for any other purposes except an emergency. If I'm a diabetic and I need a refill on my medication for diabetes, I consider that an emergency, that I don't have a family doctor, or any doctor. The person I'm talking about in particular, who I spoke to, went to many family doctors and asked to be taken on as a patient. They said no, we can't take you on we're strapped and suggested that they go to the emergency room and did wait for six hours to get a prescription filled for a medication that was absolutely necessary. In his case, he thought it was an emergency. So, I'll agree to a certain extent with the minister that yes, we have that problem, but, if we have that problem, I'll ask him now, does he have any proposals that are now before him and his department, that would immediately help address the issue of emergency closures?

MR. D'ENTREMONT: I can tell the member opposite that if I had a true proposal that would stop this, I would be implementing it yesterday. We don't have that magic bullet that is going to keep these ERs open on a regular basis in the next number of months. Going back to that, and I don't mean to start a go-between between me and the member but, quite honestly, I'm trying to look at things from a different angle. We need to look at things differently. That's why we have this House of Assembly, you know, we can sit here with differing views but, at the same time, come to an agreement on issues that are important to our communities.

What I am saying is that, through our rural health strategy, the rural health strategy that will begin public consultations in the Fall, I'm hoping in September, we will look at these very issues that we talk about here in the House, that we hear of on a regular basis as MLAs, because in my estimation, it is the communities that better know their communities and know the solutions. Bear River knew what their solution was and they went for it and we need to have more communities like that who basically take on the future of their communities when it comes to health care.

[Page 39]

But to the point of the people visiting the ERs, you know, there were from April 1, 2006, until March 31, 2007, 715,136 emergency room visits. Each one of those people who visited those locations were seeing the most expensive part of our system. It is the most expensive part of our system. Wouldn't it be best if we could take 75 per cent of that list and see them in a more appropriate method? If a diabetic comes in and has to wait six hours for medication, wouldn't it be better for that individual to have gone to a pharmacist and had an extension put on his prescription? Do you know what? Those are the very things that we need to address. They can't do that now. That's what we need to change. We need to change - even the model of care for pharmacists, is what I'm proposing, is what we're talking about in a model of care changes, is what we're talking about in a rural health strategy.

If I could take 75 per cent of people out of that 715,000-person list and treat them more appropriately for, I don't know, half the cost, wouldn't it be better to take those dollars that I'm spending on ERs today and invest it in mental health, to invest it in some other part of the system that would better meet the needs of other Nova Scotians? So I don't mean to be standoffish on this one to the honourable member and I appreciate his comments on this one but, at the same time, it is a large, complex issue that is being attacked by a bunch of different fronts.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I appreciate, I really do appreciate the minister's comments, but this is not something that occurred overnight. I mean, you know, the minister didn't wake up yesterday and say, oh my, I think I'll go to work today, hi everybody, hi staff, oh my gosh, there's an emergency room crisis. Emergency rooms are closed for almost a year. Since I've been here, since I've been here over the nine years and how many Health Ministers - this is a problem that existed back then when I first came here, a problem that has continued to worsen, and a problem that there seems to be- I don't know whether it's a reluctance or not accepting some of the solutions that have been put forward out there to try to solve this problem.

Now, the minister knows that one of the recommendations of the $1.1 million Corpus Sanchez Report, and I think there's 100-some recommendations, to which the government said, we accept all. We accept all the recommendations of the Corpus Sanchez Report. One of those recommendations was to initiate an immediate detailed review of emergency department services and facilities outside of the regional hospitals and the intent was to identify operational efficiencies and care delivery improvements. I'll ask the minister, has that review been initiated?

MR. D'ENTREMONT: Mr. Chairman, that review has started and I look forward to reporting back to this House, if it's still in session at that time, or I will present it directly to the member opposite on the findings of that report.

Again, Mr. Chairman, what we have tried to do over the last number of years, knowing the human resource crunch that we've had, trying to find individuals to work in those areas, we have made changes at the ER that serves each region. I know that in Cape

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Breton- and I commend the Cape Breton District Health Authority for the work that they do in making the best of a bad situation - I know that if Northside is closed that the Regional is there backing it up. I know if Glace Bay is closed, the Regional is backing it up. I know if New Waterford is closed, Glace Bay is backing it up. So there has been a tremendous amount of work that has been done to ensure there is enough back-up within the system that Nova Scotians are being covered and can be treated as effectively as possible.

Mr. Chairman, the other issue is, there are a lot of people working within this system, there are a lot of expectations of communities. I think it has taken until now for everybody to be ready for change. Everybody is ready to look at some new ways of doing things. Only until everybody is on board are we going to be able to make these changes. Again, I am very excited about what can happen and what is going to happen to maintain these ERs and to make sure that they are open as much as they possibly can be open.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, another couple of questions. We will ride along with that theme of change, Mr. Minister. Under the primary health care initiatives there is an increase of about $8 million or so. How much of that budget increase is being allocated to a 24/7 call line that's going to be staffed by nurses?

MR. D'ENTREMONT: Mr. Chairman, I apologize for using up a little bit of the time there but I want to make sure my numbers are right; $3.9 million will be utilized and set up for the nurse call line and the $3.9 million will also cover, I believe one-quarter. We hope, endeavouring to get this off the ground, it will take us until January to get it going. So we are looking at, again, some capital costs, some organizational costs of $3.9 million, where a quarter of that will keep it running from January to March. We feel that the annual operating cost of this call line will be somewhere in the range of $6 million per year.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, so with that $3.9 million, I'm assuming that you are going to hire nurses and so on to work on that initiative and that 24/7 call line will be operational in January you said, okay. With a review of emergency departments that you say is underway, that has been initiated, let me ask you this as my final question, I would expect an honest answer here, Mr. Minister. Let me ask you, is it your intention, and the government's intention, to take that 24/7 call line, staffed by nurses, and will that call line replace smaller emergency departments that you are going to close in this province?

[7:15 p.m.]

MR. D'ENTREMONT: I could give it a short answer by simply saying no. What the member is talking about there is absolutely preposterous.

SOME HON. MEMBERS: It's fear-mongering.

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MR. D'ENTREMONT: It is preposterous, Mr. Chairman. It is atrocious. (Interruption) I can't imagine that the member opposite, knowing full well that I have said that rural ERs will not close . . .

MR. CHAIRMAN: Order, please. It is very difficult for the chairman to be able to hear the Minister of Health. I am sure he doesn't need help from any members. The minister has the floor.

MR. D'ENTREMONT: Mr. Chairman, no I really don't need the help of other members but I do appreciate the occasional nudging along. I do want to make sure, and I will say it again for this record, we will not be closing rural ERs, any ERs, I'll even go as far to say, as the member for New Waterford is telling me here - Cape Breton Centre, New Waterford makes a better sounding, never mind, rabbit tracks and I'm getting stuck in them now - ultimately I have said, and the Premier has said, that no ERs will be closing. Mr. Chairman, I look at the nurse call line as being a very good and smart initiative for the health care of Nova Scotians.

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

MR. DAVID WILSON (Sackville-Cobequid): Where do we go from here? There's so much material, there really is. There's so little time and there are so many concerns. I know the minister just mentioned his government's commitment to keep all ERs open here in this province. I hope those words don't turn around and bite them. That is so important and it's such a concern with rural communities and the residents who are serviced by our hospitals like Roseway Hospital in Shelburne. That facility services so many people down in that area and they're concerned. They've been writing letters, they've been calling MLAs, informing their member on what they've been hearing and some of the fears that they have. Also, in New Waterford, members mentioned the ER there many times and I know that they have been struggling with closures. I believe last weekend they closed that hospital.

The numbers speak for themselves. I know the minister likes to quote the percentage of ERs that are open throughout the province in a given year, but over 6,000 hours, ERs are closed in this province. That's a staggering number and it's not spread out to the 40-some or whatever number of ERs. It's concentrated in certain areas of this province like Shelburne, like Digby, like New Waterford. All over this province, rural communities seem to have consistent problems in certain ERs. It brings me to some of the questions that they have in these smaller ERs about their emergency rooms and the possibility of closures, not only their emergency rooms but the services they have in them like X-ray and lab services. They're concerned that those areas in health care are at risk of being phased out in these smaller, rural communities. So, my first question is, can the minister confirm that X-rays and lab services - and I'll mention two areas of the province, in Canso and in Sherbrooke - will not see a reduction in services in the next year, or even the next two years, for X-ray and lab work in those facilities?

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MR. D'ENTREMONT: Mr. Chairman, there is no plan within our department to reduce services of that sort to communities like Sherbrooke and other communities around this province like Shelburne, served by the Roseway Hospital. Things that we do need to work on, and I've said it before, is that we need to have a newer model, one in which the health care of Nova Scotians can be addressed in a more appropriate way. Like I've said before, we can't expect 75 per cent of those patients going through the door - what they need is maybe a walk-in clinic, a clinic with a nurse practitioner, or a $4 million clinic like they're building in the Community of Meteghan, Mr. Chairman, in your riding, a phenomenal facility that will better serve the needs of those individuals rather than taking the trip to Yarmouth, or what have you, to the ER, to see those doctors.

There are other models and other investments that we have to do, which I believe we will hear and we'll be able to enact from the Rural Health Strategy on this. There will be, because of the HHR crunch, there will have to be some rationalization of some services. The best example that we have today is lab services right here in HRM, right here, even better, within 1,000 feet on University Avenue, two fully serviced, fully staffed labs. Why do we have two fully staffed, fully serviced labs on the same street, serving the same population? Just because one was IWK and the other one was VG/Capital Health. Both of those organizations sort of went, what the heck are we doing? We know that Capital Health won't have its full staff complement because they're going to have to go and train some more. IWK wasn't going to have the right number of people in order to serve so why don't we take all our resources and put them together, and not only that, use technology in a way that can better serve the patients?

I think what we see is a good model for other parts of the province that are going to have that very same HHR crunch. I've said this, I think, before in this House and I've said it before in other areas, that medical laboratory technologists - we're going to have a bit of a crunch there, where over half of those individuals by 2015, I think was the time, will be ready for retirement. So, we need to find mechanisms and I believe they're there. They're there technologically, they are there human resources-wise to better serve the individuals in those communities. So does it mean that somebody in Sherbrooke is not going to be able to go get blood tests in Sherbrooke? Absolutely not, they're going to be able to go to that facility and they're going to be able to get their blood test. Does it mean they're not going to be able to get their X-ray? No, it means they're going to be able to go and get their X-ray for the use of technology and other practitioners within the system, we just need to change the way we do things.

MR. DAVID WILSON (Sackville-Cobequid): I couldn't agree more about the need to change the way we do things, but it didn't, and it shouldn't have taken $1 million of taxpayers' money in the Corpus Sanchez Report to wake up this government to look at the changes needed. We had the commission on the future of health care in Canada in 2002, or the Romano Report, which was the most comprehensive commission and report on health care that we ever had in Canada. In that report, in that commission, Mr. Romano said we need to change the way we deliver health care. In there, other parts that I have taken out of

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it, is the fact that we need to support the public system. What we can't do is allow it to be eroded and head down the private sector and private delivery.

Why I brought that up is the fact that government should have known that we needed to change the way we've been doing things for years. It shouldn't have been a $1million report like the Corpus Sanchez and at one point I believe - I don't know how many reports on health care that this province has done prior to your government and your government. If I'm not mistaken, there have probably been 100 reports in the last 15, maybe 20 years, on health care costing millions of dollars and they all say the same thing. We need to change the way we deliver health care in this province and I agree with that. What we need is a government to act on that.

With respect, it's too late in some circumstances. We're in positions that will take us many years to try to turn around the delivery system in certain respects in health care. That leads me into some of the other questions I'm going to ask. The minister stated something that was quite evident, the fact that we have two labs doing the same thing. What I'm going to ask about is the fact that we have the old Victoria General Hospital, which we all know is an old facility. We've outlived that facility. We need to change that facility. We've heard the minister state that that's an option we're looking at. So maybe my first question is, in this budget year, has any money been allocated to - and I know it probably has and I don't know where it is - but how much money has been allocated to looking at the need for the replacement of the Victoria General Hospital?

MR. D'ENTREMONT: Mr. Chairman, just to go back to maybe a beginning comment, you know, yes, there have been a lot of reports and studies done of our system. There have been a lot of reports and studies done in other provinces across this great country of ours looking at the very same issues that we're looking at. The difference, I think this time, and where other strategies and studies have lost, is that they set a vision, they set a strategy, but they never set a state of readiness. People within the system, you know, we, as humans, don't like change and I can say that in the past, people have been very reluctant to change. Why has the health system in Nova Scotia been reluctant to change?

Well, they tried to change it back in the early 1990s. I think there was some merit in what was going on there, but the system itself got very frustrated with what was trying to happen there and it has taken until now to talk about change again, to say, you know, listen, we're not going to repeat some of those oversights or some of those mistakes. We're going to try to do it differently and I think the system and the people within the system are ready for that change. I think that's what's fundamentally different than what the Royal Commission was, than what any other report is across Canada. So I'm very, very optimistic about this transformation process on where we're going to be going.

In regard to infrastructure - a tremendous issue that I'm sure has made my CFO grayer than he should be - we continue to estimate, we have an ongoing study right now to find out really, you know, how much of an infrastructure deficit we have. The biggest piece

[Page 44]

of that infrastructure deficit that we can see, on a daily basis, is the Victoria General Hospital. That hospital was originally built - well, the Centennial was built in 1967, the original part was built in 1950-something. Anyway, it served Nova Scotians very well, but it's way past its life expectancy.

What we need to do is figure out, through this transformation, what services are held within that hospital that should not be held within that hospital. I can tell you that there are a number of - there are in-clinics, diagnostic pieces and those kinds of things that really should be in different places. They should be, maybe, at the Dartmouth General, they should be at the Cobequid Health Centre, they should be in Truro, they should be somewhere else other than in the core. They should be more accessible to more Nova Scotians. It's getting to be a challenge for individuals to visit from Dartmouth to get over to the Victoria General to get some kind of diagnostic.

[7:30 p.m.]

So we need to look at what kind of services we need to have in a hospital and which ones we don't and get those services out into the community where they can serve people better. Then we can look at the requirement for a new Victoria General Hospital, you know, what it's going to look like, what it's going to cost. The district health authority is responsible for that planning and we're expecting a report we hope by the end of summer, I think is what our target really is on that one, to see what they're going to do with their aging infrastructure. Like I said, we have a provincial study going on looking at our infrastructure across the province and what we're going to need.

Mr. Chairman, this really helps me in talking about something that is important to this government, which is the issue of strategic infrastructure partnerships, which is why, through the Minister of Transportation and Infrastructure Renewal, they've taken the issue of the Victoria General Hospital and put it through the tests through Partnerships B.C. to see if is there an opportunity to address capital in that method. You know, ultimately, who knows what that report is going to show us in June. It could probably throw it out on its ear and we're going to have to look at something else. It might say this is probably something we should do but, anyway, it will be based on the needs of Capital District, it will be based on the needs of the patients, but it will be all under the consultations, CDHA is going out to the public. It is doing public consultations on their master plan and I think that master plan will show us what we're really to do with that estimated $500 million to $700 million building to rebuild. You know, it's a true infrastructure dilemma that we have with that facility.

MR. DAVID WILSON (Sackville-Cobequid): The reason why I brought this up, Mr. Chairman, is quite evident, it is about the cost of delivering health care. When you have to duplicate something, as we have today - here we have the new HI down the road here. We have ORs in there, we have recovery rooms, intensive care units. Maybe a kilometre down the road we have the old VG where we have OR rooms, recovery rooms. I mean we're duplicating everything. I know that there has been something sent off to Partnership B.C.,

[Page 45]

so I would like to ask the minister if he or his department made recommendations or support the construction of a new VG? Is that a priority for your department and did you give any indication that that's really what you want to look at, how much it will cost for a new VG Hospital?

MR. D'ENTREMONT: Thank you very much and I wish I had some more information and really maybe that's a bigger question for the Minister of Transportation and Infrastructure Renewal of exactly what was included in that package on what we're talking about replacing but, in my estimation, as I talked about, there are services in the VG that don't need to be in the VG, number one. Surgical services make no sense and from a cost standpoint, it makes no sense to be offering two surgical programs in two different locations, which is why I'm hoping from the master plan that they will underline this issue.

We need to move ORs - which were impacted not so long ago with the flood - we need to move those ORs to a central location and, in my estimation, it should go over to the Infirmary site. We are constructing a brand new $17 million ER which is basically a standoff building and as far as I understand there are some ideas and some preliminary plans, anyway, that would incorporate those new replacement OR suites on top of that building or built in some way into that facility.

I fail to understand, and I do need to talk to somebody about this because it has bothered me for a little while now, why did they build that brand new hospital and not amalgamate the services. We could have had the VG doing one thing, we could have had the Infirmary site doing something else, but that wasn't done back then and I fail to understand. I talked to the surgeons there and, you know, if you're doing a surgery over at the VG and all of a sudden you need an intervention with cardiac, well, cardiac is over at the Infirmary site, and you have to get somebody from the Infirmary site to get over to the VG site and you might lose your window of opportunity by having those two programs in two different places.

So, it's something that has confused me of why, you know, back when that building was built - which wasn't really that long ago, it's 15 years old now, or somewhere in that range- why weren't those surgical services looked at? Anyway, going back to your question, we need to see, through that master plan, what services need to be built into the new VG site and what don't need to be in. I think there are some services there that need to go down to Cobequid, which is a better place to access. It can be accessed by anybody in the HRM rather than having to go all the way in here to the peninsula. There are other services that can go over to Dartmouth. There are other services that can go to different parts of the province.

So, I think, as we rebuild that building, which we're going to have to do in the next 10 years, that it is going to be a different facility than what it is today.

MR. DAVID WILSON (Sackville-Cobequid): Well, I can't believe I'm going to say this, that I couldn't agree more with the minister, I really couldn't, but, minister, to stand here

[Page 46]

and tell me, I guess I have to talk to somebody, that concerns me because decisions are being made now. Money needs to be allocated now. We have - I don't know what you spent to send off to Partnership B.C., over $200,000 I think, on 10 projects for them to look at. My fear is we're going to go down a road where we're going to have opinions, architects tell us here's this nice new hospital we're going to build for $700 million, which will probably end up costing us $1 billion, when the right thing to do is just what you've mentioned, is the fact that we need to centralize ORs. Why the heck we have ORs at the VG and at the new HI, I don't understand, and I hope you start talking to somebody tonight, tomorrow and the next day about the fact that we need to have those ORs in the HI all together, and we have cardiac cath and one section we have services for the hospital. They don't need to be there - build a complex next to it. I know you have talked to similar people that I have talked to. Build a building next to it. You just have to take a walk through the HI and wonder, why are all these clinics and offices here when they could be housed in one office building. It doesn't make sense to me and I hope we're not down the road too far that we can't backtrack - or the government can't backtrack - because that is the way we should be going, not seeking P3 solutions to replace that hospital.

Your government just spent $300 million leading up to the end of the year, minister, and I know that's not all on your shoulders, it's on the Premier's shoulders, but my Lord, if that's what we need to do and it would save us money, then acute care should have been looked after on your spending spree and do something like you just mentioned. I hope the Premier was sitting here listening to you because I think you need to have a discussion with him to make sure he understands the importance of centralizing the ORs and maybe he should have a talk to the same people we've talked to about that. I think that is where we need to go with it.

The new ER, we're spending money to expand it and I understand that we can build on that building, it's a great site, we can add floors, put an OR there and you can close it at 5:00 o'clock. I know Dr. Bonjer, who is head of Dalhousie surgery, is very ambitious around addressing the wait times in surgeries, especially surgeries here in the province and the wait times and the guaranteed wait times that they're trying to obtain over the next two years. So I hope it's not too late and we don't go down the road too far where we can't get out of potentially entering into an agreement to replace a hospital that might cost us near $1 billion by the time we finish all this.

So, I'm glad to hear some of those comments from you but I hope you take it seriously and that you have those serious talks with the Premier and the government and your staff and the deputy minister.

One of the things, I know the member for Glace Bay mentioned it too, I mentioned it to you today around nurse practitioners. I'm going to go back there because I'm going to try to get a clearer answer. I understand the fact that we have areas in the province that have openings, like Digby, for nurse practitioners, and elsewhere. I understand that, but we can't force people to go there and my concern, especially when we see a nurse practitioner like

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Dawn Lowe, who is in Hantsport, which is a rural community - it's not downtown Halifax - I think they and the physician she has been working with can service a great number of individuals in that area.

Really, why has it taken so long? This started back in July when Dawn Lowe and the physician came to Capital Health with the idea of this collaborative practice. Why does it take so long for them to obtain permission and a contract from your government? Quickly, are you going to approve a contract with them and when can we see that?

[7:45 p.m.]

MR. D'ENTREMONT: I'll answer the last question first and the first question last. I see approving a nurse practitioner in that way, but we need to be strategic. There are a lot of communitities - five years ago or eight years ago or whenever it started, I know the member for Digby-Annapolis would better have the numbers for this - but when a nurse practitioner was given to Brier Island/Long Island, the community was completely up in arms - oh my goodness, why would you give us this second-rate person, we want a doctor. You know what, if I went today and tried to pull a nurse practitioner out of Long and Brier Islands, there would be World War III, because they are that well respected and that well needed.

So there are communities around this province - every community around this province has asked me for a nurse practitioner. We have to be strategic. We still don't have the millions of dollars to give everybody one so we need to be strategic. Now, in this particular case I became aware of it about a week ago, maybe two weeks ago, when the member for Hants West brought it to my attention, we are still trying to gather up why this has happened and what the collaborative practice is going to look like and how we can make it work. I don't have all the details yet. I know that we are looking into it and over the next number of days I am hoping to have a true answer so that the nurse practitioner, Ms. Lowe, can make a decision. I would hope that she would make the decision to stay around a little longer until we have this issue resolved.

Going to the other issue, I don't believe we should replace like for like when it comes to the infrastructure that we have. If we are talking about transformation, let's truly transform what we see as facilities. I know the member opposite sees a fund of $200-some odd million as an amount of money that we could have put towards a new building but the accounting principles don't let us do that either, where we can't pay a building forward. This building, through design and study and consultation would take longer - would probably take somewhere close to five years to build so we would lose those dollars.

Mr. Chairman, I am very happy with the investment we did make in March on the issue of education because it helps me out as Minister of Health because it talks about debt relief, it talks about incentives, it talks about the cost of tuition for the students that are health

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care students. So I think there is a true investment for health care in what we did and I'm very proud of what we did.

Mr. Chairman, again, to the member opposite, when it comes to the nurse practitioner for Hantsport, and to my honourable colleague, the member for Hants West, we will endeavour to have a solution for that one as soon as possible.

MR. DAVID WILSON (Sackville-Cobequid): I'm glad, Mr. Chairman, that the member for Hants West brought this to the attention of the minister because I told her to call the member for Hants West and I don't know why two weeks ago was the first time you heard about it. I wrote to you about this last year. I wrote to you in October or November around this issue. I have to commend someone like Dawn Lowe who said, I want to talk to people, I want to bring awareness around this. I understand the minister's statement that we need to be strategic when we do this and have a strategy around it but we are going to lose these nurse practitioners.

The member for Glace Bay said, there are seven this year; I think he said three went to Alberta. I don't know if that is true or not but I would think it probably is. Dawn Lowe is another one, New Brunswick has just announced they are going to hire about 40, I believe. P.E.I. has said they are going to announce seven, and Dawn Lowe has been up to the Miramichi area for an interview and has already been given a contract if she wants it. Will she go? I hope she doesn't.

I understand the fact there are some areas in the province where you need them but when you have someone like this lady - who is well trained and willing to work - waiting almost 10 months, if not longer, it just adds to their decision making to leave this province. Once she leaves she is not going to come back for any amount of money because she is going to remember the experience she has been through over the last 10 months. I hope that you expedite that initiative.

I've mentioned this year after year in estimates around nurse practitioners and I don't understand why we don't utilize them more, especially in our ERs. I believe I mentioned it last year to the minister, the fact that at the Cobequid Community Health Centre, we had a nurse practitioner who took advantage of a government initiative to go back to school and upgrade. She was working in the ER at Cobequid Community Health Centre and was unable to work to her full potential, to the scope of practice she was trained in, she wasn't allowed to. So here's a lady who was triaging patients and knowing, because of her training, that she could treat them and send them on their way, but she wasn't allowed to.

I'm going to ask again, why, if we have nurses who are trained as nurse practitioners working in the system now, are they not allowed to work to their full scope of practice? If it's policies and regulations we need to change within the regulatory body, then why aren't you making those suggestions and changing them? Let's do it, let's get these nurses practising so that we don't lose them, so that maybe that nurse at Cobequid, who now is in

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New Brunswick working, maybe she could work in Cobequid and then when an opening in an area like the pilot project in Long or Brier Island comes up, you might be able to get that individual to go there. She is already working here.

That's when incentives work, when you say listen, we love the work you're doing, we need someone with your expertise in Long or Brier, in Digby, in Shelburne County. I have to say, the people of Long and Brier Islands and those areas that have been serviced by the nurse practitioner and the extended scope of practice of the paramedics there, they're well served and their opinions of that service that they are receiving is high. I hope the minister understands where I'm coming from with that.

I'd like to go now to some of the line items that we have in the estimate details. I'm going to Page 14.6 of the Supplementary Detail, yes, sorry. One of the questions I have and these are kind of quick questions, maybe you can just give us some insight on what these line items actually contain and why they're here. One is out-of-province hospital payments and we have the estimate this year of $29 million. What exactly is found within that line item, out-of-province hospital payments? Why do we see that line item there? Why are those payments being made?

MR. D'ENTREMONT: Mr. Chairman, that is simply the Nova Scotians who travel outside the province, who need hospital care. It is the individuals who do have to go out of Nova Scotia to get some specialty treatments that are not offered here in Nova Scotia. I know the number does seem large, $29.491 million, but we also receive more patients in Nova Scotia than we actually pay for outside the province. I think there's actually a negative amount if we look at - I don't exactly have that number, I don't think - it's recorded elsewhere because of the new revenue policy, so it is actually listed separately, I think through the Department of Finance. Ultimately, we do pay for those individuals to go outside to receive care.

MR. DAVID WILSON (Sackville-Cobequid): Do you break that down to what we're paying other provinces, or the States, or wherever and the amount we pay for individuals who can't receive a service in Nova Scotia? So what I'd like to see is that breakdown. Do you have an amount that we pay other provinces because we don't perform those procedures, or we send them to other jurisdictions outside the province?

MR. D'ENTREMONT: Mr. Chairman, we don't have that detail with us tonight but I will have that as soon as I can have it for the honourable member.

MR. DAVID WILSON (Sackville-Cobequid): So now, of course, I'll go to Emergency Health Services and the line items we see there. I noticed under the Ambulance Subsidy, and then there is Ground Ambulance Operations. So the $78 million, roughly, I would assume is the amount of the contract that we have with EMC. Maybe, I would like to ask why is the second line item of just shy of $1 million there, ground ambulance operations,

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why are there two lines there? Maybe you could give me the reason why the lower number of about $1 million under ground operations, is there.

MR. D'ENTREMONT: Mr. Chairman, I am just digging through the book here. You are correct on the first one, the $78 million or so is the contract with EMC. The ground ambulance operations, I don't have it broken out but I will try to get that for you tomorrow.

MR. DAVID WILSON (Sackville-Cobequid): So one of the things I do notice is the contract payment is up a little bit and I'm sure that is because of increase in wages but the ground ambulance operation is down quite a bit from last year's, close to $600,000. One of the things I know, and I found this out through doing some work on the cost, when an ER closes in the province, of course the minister, when we question him on it, first thing is, you know, 911. We have a great ambulance service, and we do. They are there to pick up the slack, really, when a community ER, especially in the rural communities, is closed.

It's my understanding that with EMC and their responsibility to provide ambulance service, that additional pressure on them, they don't bear that cost. So I'm wondering if you could tell me, and you might not have it on you now, but where would I find and how much is the additional cost that we see when emergency rooms are closed throughout the province and EHS have to put an additional vehicle on, or additional personnel, in the emergency room?

MR. D'ENTREMONT: Mr. Chairman, I know the example the deputy is talking about here. Even in Capital Health we pay for an extra three ambulances to cover the extra times. We have talked a number of times of the speed of the ER sometimes ambulances are being stuck there for a very long period of time. So we pay, through the health authority, for three extra ambulances to be on call during those peak times. Also, we will try to provide him with a little more information on how those dollars are spent out.

MR. DAVID WILSON (Sackville-Cobequid): Specifically what I am looking for is what is it costing the province to provide that additional coverage when emergency rooms are closed. I know you mentioned Capital Health but usually we don't have too many emergency room closures in Capital Health. So it's mostly the rural communities. If you could provide that, that would be great.

One of the things, of course, that is going to happen in a couple of weeks or a week is the changeover to Life Flight. I know you have come into agreement with the EHS to provide that. Is there a separate line item in the estimates that show that cost? Why is it not under EHS because it would be assumed by them, the additional cost, for providing Life Flight in the upcoming year.

MR. D'ENTREMONT: We are just trying to find which line item that did fit under because there is no change in costing from the old model to the new model for it. There we go. It's funny how that is working now, becoming 38 is making changes to my eyesight -

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$2.936 million is the funding for the air ambulance and those dollars pretty much remain the same, regardless of whose responsibility it was. So those dollars would be transferred to the new management team.

Just to reply to the ground ambulance issue, the cost is for releasing the defibs, medical supplies and running SAP. So those are the other added that we're covering on behalf of EHS and EMC.

MR. DAVID WILSON (Sackville-Cobequid): I know I don't have too much more time left so I won't go into other things. I'll concentrate on this for another minute and, hopefully, I know that some of your staff is here that might be able to get this information.

My concern around the ground ambulance operation and trying to figure out why that is there, is because we have, on the line item, $673,000 less this year than last year. So that's the question I'm asking, what the ground ambulance operation pertains and why is it such a drop in it? I guess the other thing is, why wouldn't LifeFlight fall under the Emergency Health Services in the budget line items under that heading.

The other thing, with the last minute or so, I just wonder if the minister is aware of a situation with Life Flight and the takeover to EMC, around the LifeFlight nurses and the paramedics who are working on that aircraft. It's my understanding that several of them, many of them haven't been asked, or haven't gained employment under EHS. So I'm wondering why these individuals, and I believe it might even be seven Life Flight nurses, I'm not too sure about the paramedics, why did these LifeFlight nurses lose their jobs because of a change of authority over who is going to run the LifeFlight in the upcoming year?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I'll make this one quick; when the transfer happened, there were job offers that went out, that you had to apply for those positions. There were a number of the flight nurses who did not apply for the new management of LifeFlight, so I'm uncertain why that happened.

I know there is one new paramedic who has been hired for that service. With that, I know that time is becoming short. I do want to table one document, maybe for the benefit of the member for Sackville-Cobequid. Again, it is a picture of the Northwood site in Sackville, in Hammonds Plains Road-Bedford, but it also has on the back of it a diagram and a map from your house to the facility, so you know how to get there. So again, thank you very much for this evening.

MR. CHAIRMAN: Thank you. Order, please. The time for debate on Supply has now expired. The honourable Deputy Government House Leader.

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MR. CHUCK PORTER: Thank you, Mr. Chairman, I would move that the committee rise and report progress.

MR. CHAIRMAN: Is it agreed?

It is agreed.

[The committee adjourned at 7:58 p.m.]