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HALIFAX, TUESDAY, SEPTEMBER 29, 2009

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

4:34 P.M.

CHAIRMAN

Mr. Gordon Gosse

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

The honourable Deputy Government House Leader.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, we will continue with the estimates of the Department of Health.

MR. CHAIRMAN: There are 38 minutes left from last night's debate.

The honourable Interim Leader of the Progressive Conservative Party.

HON. KAREN CASEY: Thank you, Mr. Chairman. I will be sharing my time with my colleague, the member for Hants West. If I could go back to the questioning, Madam Minister - my question comes from something that I actually posed in Question Period, and I'm really looking for some more detail on it. It has to do with the decision to call an RFP for the reprocessing of medical equipment that had previously been used. I spoke about the concerns that we had as a caucus and that I had as a member and as an MLA, in fact, for what I consider to be a potential risk here.

I read the comments from one cardiologist in particular, and he used one particular piece of equipment as an example and I believe there may be many others that would be considered as possibly being considered for the reprocessing so they could be used again.

What was really disconcerting was the suggestion that this particular catheter used for ultrasound was one example and I believe his words were, the least chance of reinfection. My concern is that any chance of reinfection is high risk and one I would not think the minister or this government or any member of this House would want to take.

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I guess my first question to the minister on this would be, what was the rationale behind the decision to call an RFP that could possibly contribute to a high-risk decision?

HON. MAUREEN MACDONALD: I'm wondering, before I answer the question, which I'm quite happy to do, if the honourable member would permit me to table a number of documents in response to questions from last evening from both herself and the honourable member for Halifax Clayton Park. Just to let you know what's in the package, we have the distribution of the Telecare nurses from the various communities that they were recruited from, so we will table that. We have a list of capital projects, IT related, which was requested. We have a list here of the electronic medical record, an update on that. We have a contract summary of Medavie, the information with respect to the Blue Cross contract. We also have information on the Colon Cancer Prevention Program, the screening program, the family Pharmacare stats as well.

Mr. Chairman, I would like to ask the Clerk to receive these documents please.

MR. CHAIRMAN: The documents are tabled.

The honourable Minister of Health has the floor.

MS. MAUREEN MACDONALD: The minister has asked a question with respect to the reprocessing of medical equipment and what was behind the RFP that has been issued. The first thing I would say to the honourable member is that the RFP was issued by the Capital District Health Authority, it is not an RFP of the Department of Health. The RFP is an exploration, really, it's not at the stage of making a decision but it's an attempt to gather information and to see what is, in fact, out there.

We had a debate in the Legislature last week on this very topic. At that time I laid out a fair amount of information about what the background was to this entire issue. As I understand it, first of all, there has been a national working group with representation from all of the provinces for some time on this matter, which has included representation from the Province of Nova Scotia and relatively recently - I don't know if the former Minister of Health was involved in that working group or maybe her colleague, the former Minister of Health before her, the other former Minister of Health may have been involved in that working group.

This working group was working with the Public Health Agency of Canada, or Health Canada I think they would probably have been called at the time, attempting to develop a Pan-Canadian policy statement with respect to standards around the reprocessing of medical equipment. That policy statement has yet to be finalized and in its absence the guidelines that Health Canada have in place, and have had in place I believe since 2004, continue to be the guidelines that we in the Department of Health and the district health authorities, that would be subject to looking at what the parameters are, would be essentially bound by. These are

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standards that ask, in the process of looking at the reprocessing of medical equipment, to look at questions of ethics, questions of risk, questions of insurance and, above all, questions of patient safety.

[4:45 p.m.]

I want to say to the honourable member that the reprocessing of medical equipment is a procedure that is in place in many other DHAs in Canada and throughout the United States without any compromising of the quality of health care for patients around the country and, particularly, as we see fewer invasive kinds of surgeries occurring, there is both a belief, but also the science to support the belief, that many of the pieces of equipment - I don't know if many but some - of the pieces of medical equipment in fact, if properly re-manufactured, is the industry terminology, but if these pieces of equipment are properly sterilized, they are quite safe for reuse.

As we all know, there are numerous considerations around going in this direction. Financial considerations certainly are a piece of this because the cost of equipment, supplies and materials has grown exponentially in our health care system and our health care system is under a lot of stress. We need to look at the best practices in terms of everything we do in our health care system to ensure that we are spending our resources wisely. So to explore this possible approach is one that the Capital District Health Authority is looking at but the additional issue I think we have to have in mind is the tremendous amount of medical waste and the implication of that for the environment.

We know that there are a variety of issues but the department has been clear with the Capital District Health Authority in terms of what we would consider to be the kind of rigorous checks that would be required and we would have to satisfy ourselves with respect and it essentially is meeting the guidelines of Health Canada as they currently exist. I know, and I'm sure all members of this Legislature know, that the medical personnel and the administration of the Capital District Health Authority would not compromise patient care and the quality of care that they offer unless, well, they wouldn't, they wouldn't compromise patient care and the kind of rigorous science, evidence, that they will use to scrutinize what's out there, what the possibilities are, I feel very confident around. So that is the basis of what is occurring. Those are some of the issues around the RFP and we will continue to work with the district health authority to see the response to the RFP and where that goes.

MS. CASEY: Thank you, Mr. Chairman, and thank you to the minister for the explanation of the rationale. I took from that that there were really two major considerations - one is financial, and the other that you mentioned was environmental. I also understand that the RFP has been issued by Capital District. I heard you say that Capital District obviously take the responsibility for patient care and patient safety very seriously, as I know all DHAs in the province do.

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My question is this, and it's more related to process, the RFP has been issued by Capital District, and once there is a response to the RFP and there is a selection - if there is a selection - or a recommendation that there be a company selected to begin this practice, is that a recommendation from Capital to the Department of Health, or is it seeking support from the Department of Health? Who makes the final decision?

MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, the process is the RFP is out and information will be received. It will be examined by Capital District Health Authority and no final decision will be made by the district health authority without a lot of discussion and consultation with the Department of Health.

MS. CASEY: If I could just be clear, no final decision will be made by Capital without consultation. Can I interpret that as being "but the final decision is made by Capital"?

MS. MAUREEN MACDONALD: As long as the guidelines are adhered to and the information meets all of the various aspects and the tests, the final decision would be made, but it would be made with a lot of consultation and oversight by the Department of Health.

MS. CASEY: Mr. Chairman, thank you to the minister for that information and clarification. I will with your permission be passing on the rest of the time that I have and sharing it with my colleague, the member for Hants West.

MR. CHAIRMAN: The honourable member for Hants West.

MR. CHUCK PORTER: Mr. Chairman, it's my pleasure to rise today to ask a few questions. I know our time is running short, but I want to talk about the long-term care facilities and the one locally in Windsor, West Hants, that I'm most familiar with. We had the good fortune a couple of years ago to have an announcement to replace the aging Windsor Elms with a new Windsor Elms Village that has been designed. We've got a great team on the ground there working by way of a volunteer committee and the board and so on, but since that announcement, this is a group that has been very aggressive. They were ready, they had goals in mind years ago, ready to start in hopes of this kind of announcement, and when it came to fruition, they were off to the start.

It almost seems in some ways like they've been penalized throughout the entire process for being out of the gate early. Design seemed to be an issue early on. They met with the Department of Health on numerous occasions, and I know that the department and certain people there are familiar with what I'm talking about here. Throughout that process tenders have been an issue, dollars have been an issue. A budget was put in place for this new home. Every effort has been made and will continue to be made by that group who are managing this project to stay within that tender. They realize the importance of that as do I and, I think, as do all the taxpayers in Nova Scotia and certainly locally. They also realize the importance

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of having such a facility as there is great need. We have multiple people waiting in places like Unit 500 and other places in different homes, waiting to get into these homes. Especially one that is going to be a new one and modern and so on and so forth and it is, indeed, a great facility and very well designed.

It seems though, like I said, there have been some issues with the tenders and with the budget and my first question, minister, will be, how did we arrive at $36.6 million to build this home? I want to get on the record some of the processes here for how we get from start to finish and some of those steps. So my first question, how did we get to the $36.6 million for this home?

MS. MAUREEN MACDONALD: Mr. Chairman, I want to take an opportunity to table another document that I missed when I was tabling, which, in fact, is New and Replacement Long-term Care Beds and the schedule for when.

The honourable member has Windsor Elms in Falmouth, I believe, in his constituency and it's a fine facility I'm told. I have never had an opportunity to visit but someday I'm hoping that I will be able to do that and perhaps the honourable member would show me around the facility. Now, as I understand, this facility is looking at 108 replacement beds and we're hoping to be in a position to occupy this some time in 2010. As the honourable member said, there have been some bumps along the road and I have been kept very up-to-date in terms of what has gone on with respect to this particular facility.

This is a not-for-profit facility with a volunteer board. That means there is a lot of community control and interest in this facility. I've worked with a lot of non-profit organizations in my working life and I know how dedicated the volunteer board members are there. I know how difficult it can be for a group of volunteers to manage a project of considerable complexity when you're dealing with contracts and requirements out of the provincial Department of Health, but also building codes and all of these kinds of things.

The process, as I understand it - the former government designed a program, in fact, to allow smaller providers of long-term care to be successful in delivering long-term care, which I think is a good thing. The requirements, though, of the programs, in terms of specifications, can be a challenge for a small not-for-profit volunteer-driven organization.

As I understand the process, generally speaking, there is an RFP - a proposal was submitted to the department to build either new or replacement beds. The beds were awarded. The department made the decision, the former government made the decision, to award beds and the process unfolds with the issuing of tenders, RFPs and organizations that are awarded contracts enter into agreements with architects and project managers and the plan starts to evolve. At some point the shovels go into the ground and the negotiations in the awarding of a facility, so many beds to a community, the government enters into a contract with those organizations. They look at what the costs should be for particular

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facilities based on the proposals that have come in and that's the amount of money that gets set.

[5:00 p.m.]

Now, I understand that sometimes things can change. Things can come up that will make the cost of those projects change. Interest rates may change and you may find an oil spill on a site, I mean lots of things can happen. I would say that in the awarding of many of the contracts that the department has had, most of the projects that have opened so far have come in on or under budget, which is a good thing, but some of the projects have run into problems and they're not coming in on or under budget. When that occurs, we have to sit down and have discussions about what the options are.

We had a question here in Question Period earlier today, Mr. Chairman, about the Nakile long-term care facility in the member for Argyle's constituency. This is the problem that they face. They are finding that they're unable to deliver the project that they were approved for on budget. The Windsor Elms folks have had similar issues and I'm happy to say that the department, the deputy has met with the members of the board and we will continue to work with them to see what it is that we can do to make this project a reality.

MR. PORTER: Thank you Mr. Chairman, and thank you minister for the answer. I guess I may not have totally finished all of the question, or added enough to it, or articulated it very well, but the $36.6 million that has been allotted for that project, you didn't really speak to what I was looking for. How did you get to the $36.6 million? Now, my understanding is that's per diem based and we'll get back to that, I'm sure, we've got a lot of time to go through, but on that, you talked about the board. We have a board - and it is difficult sometimes for volunteers who are community based, who may not know all the ins and outs of a project with such a large scope as this - I can assure you that the group on this board and this committee are professional people, have been professionals in their life, engineers and so on, and are very familiar with how a project like this should work and does work.

Again, they started out early and it was almost like they've been penalized for being out of the gate early and having ideas. There was a model that was initially intended but that has changed scope as well along the way. There were even some discussions, from my understanding, that suggested the design should change midway through. Well, Madam Minister, I would suggest that it's pretty difficult, and I think the folks in the department realize as well, it's pretty difficult to make changes once the foundation is laid but there were discussions also from my understanding that perhaps they could use lesser of this or a lesser standard of that. That raised a flag as well. When I heard about that, I was very concerned about where would you cut corners. We're talking about $1 million, maybe $1.5 million right now that is projected to be over budget on this project.

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I am aware that the deputy - and I appreciate it very much - has met with that group and they continue to work through. I know following that meeting there was another piece of correspondence that came from the department that really didn't reflect what came out of that meeting from what I understand and has since maybe been corrected. Some facts were sent back in by members of that board who I think clarified the position that they had and some of the other issues that were raised, maybe in error for lack of a better word right now, but I would like to think that has been taken care of.

The biggest concern that the Elms has, from some of the documentation that has been exchanged of course, early on there was a clause that was in the service agreement. Service agreements, as you know, and the deputy would be aware probably and others in the department, were a long time getting signed. There were some issues back and forth again with correspondence and they felt like they were being forced, maybe, into signing something that they didn't want to initially and then remove that.

A large issue here is the overrun, there's no question, and it's hard - minister, you've alluded to it already, things change, and it can be a whole variety of things that will change the course of a project, especially one that lasts over maybe two or three years in getting done. Now they have a goal of being completed, certainly, in 2010 and on time and moved in.

There have been changes. We've gone through some fairly tough economic times. We've gone through a period of fuel costs that were through the roof in this province, which changes pricing and tenders, and I think that that's realized by the department as well, but there doesn't seem to be, at least at this point - I don't believe that the board that is managing this project have a feeling of comfort that we're committed to this project as a government. They have a feeling that anything over $36.6 million dollars is the responsibility of the volunteers and the board at the Windsor Elms to come up with the balance of that money.

So my question is, who funds this home? My understanding is that as a non-profit, this is fully funded 100 per cent by the Province of Nova Scotia, and that being the case, how could we put up $36.6 million and not cover the cost of a potential overrun? And on that, how many other projects are out there? Now, minister, you mentioned that there have been other homes that have been constructed either on or under budget, that's great. Every time that happens that's a great thing, but we also know that there have been projects that have not come in on budget. I think that although they're working hard - due diligence is being done, the design models are being looked at, they've made every effort - they don't have a feeling of comfort that the government is standing behind them and the good folks, the residents, that require this home.

At the end of the day, the question is, will any cost overrun be covered by the Government of Nova Scotia, Department of Health?

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MS. MAUREEN MACDONALD: To the honourable member, it would be lovely if I could stand here and say money is no object, but I'm certainly not in a position, nor is this government in a position, to say money is no object. Money is an object, you know, it is. There is one taxpayer in this province and the investment in the long-term care sector is considerable. I've seen tables in our department that show that the costs for the long-term care beds might be anywhere from $195,000 a bed all the way up to close to $400,000 for a bed, depending on the facilities that are building them. So this is not an insignificant investment in the long-term care sector. It's a very significant investment and it's very important that we attempt to exercise some fiscal discipline in this process.

If we allow projects to spiral financially out of control, the end result will be more debt for the province and higher per diem costs for residents in the facilities, because a part of how you amortize is looking at what the daily costs are that you can levy then, when the facility is open, a portion of which the families themselves pay for. I certainly, in my brief time at the department, have heard from numerous people around the province who are very concerned about the per diem costs that are levied on families.

We do have our focus on good quality long-term care facilities in communities where we can keep seniors in their local areas, where they will have access to their families and their networks, their churches, their clergy, their social groups for as long as possible, but in that planning process, we have to exercise some financial discipline and attempt to bring projects in on time and on budget.

The vast majority of the long-term care projects to date have, in fact, come in on budget. In a few cases we have seen slight savings coming in under budget, but very close to the anticipated amount. We're not raking in a huge amount of revenue as a result of that, most projects are coming in on budget.

The member asked who actually decides on the amount of money as being a proper amount of money for a particular project and I want to assure the honourable member that we have our own expertise available to us in the department. An engineering firm that specializes in construction is there to consult with people in the department and to ensure that we are getting the value for our dollar in terms of the proposals and the construction costs of these new beds and that firm is Hanscomb and they're a reputable engineering consulting firm.

MR. PORTER: I want to be very clear, I don't think that there's this big open pit of money that's there and you can reach in and grab whatever you want. I want to clarify for the board as well, because I've seen the correspondence that has been exchanged, they are not of that belief. They certainly do not wish to just spend at will and freely as possible and have the best of everything, but they do need to get the project completed and completed on time.

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You mentioned a couple of things about amortization and so on and you mentioned about having a group of engineers work for the department and that's all wonderful. I'm sure that they're doing a wonderful job as well, but at the end of the day, the same question still exists. There will be a cost overrun in all likelihood. Part of this issue is the tender letting as well. Tenders have been held and I know the Deputy Premier would be aware of this because of his meeting. Tenders have been held. There's a process that it has to go through and I think that they're fine with that, as a matter of fact. It's good that somebody is overseeing at the department, they have no issue with that, but they also can't control that. On a project this size there are only so many bidders out there that can bid on such a project and you can't control those tenders coming in the door.

At the end of the day there will still be, maybe, it could change, I guess, really - we don't know until the final tender is in, it could still come in very close or under. We would certainly hope that it comes in under or at least on budget, but at this point in time the projection would not say that it will. There's this $1 million-plus dollars still hanging about. Where will that cost overrun come from?

It seems strange to the board and to myself and probably to the residents and taxpayers if they knew all the ins and outs and the details of this, that the Government of Nova Scotia, they, the taxpayer, would put up $36.6 million and not $37 million if that is what was required to build a home such as the Windsor Elms that needed to be built, serves a great purpose and we don't have to get into that. We all know the importance of said homes around this province like the Elms and others.

There have been other homes. Have there been changes to their per diem rates? Have there been changes to other homes in this province with regard to per diem rates to offset the cost of getting the job done on budget?

MS. MAUREEN MACDONALD: Mr. Chairman, no, I have no knowledge that per diems have been changed for anybody else to help them with cost overruns. My information is that all of the projects that have come in to date have come in on budget and, you know, as I said to the honourable member, in the department we have had a meeting with the Windsor Elms board and we're prepared to continue to work with the organization but, again, money is an objective.

[5:15 p.m.]

Bringing projects in on budget is extremely important. The province faces significant fiscal challenges and there aren't even cushions on the couch in my office that I can look behind to see if there's anything there.

MR. CHAIRMAN: The time has expired for the Progressive Conservative Party at this time.

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The honourable member for Preston.

HON. KEITH COLWELL: Mr. Chairman, I'll be sharing my time with the member for Bedford-Birch Cove as I go through the process here. First of all, I don't know if congratulations or condolences are the best thing to say to a new Minister of Health. It's probably the toughest job in the province and it will probably get worse as time goes on as the issues get more and more and the costs get higher and higher. Anyway, with all that said, I want to discuss an issue that I have brought up at the Legislature here before.

I'll give you a little bit of background again. My wife was recently admitted to the emergency again at the Dartmouth General for cellulitis. It's a very serious infection. Fortunately, this time we knew what it was. The last time we didn't and if it would have been one day longer before we actually went to a doctor, she might not be with us today. Now, the doctor indicated at the time, her family doctor, that it might have been - and I stress might have been - as a result of the original operation she had for cancer. This is the second time she has had this.

Now, lo and behold, on Sunday she goes to a shower and a friend of ours who has had breast cancer as well, she said to my wife, I've got a red rash, it must be from the radiation I had a year ago - definitely not - she also had cellulitis. So it appears there might be some pattern. So one thing I would ask the minister, and this I know you wouldn't have an answer on, period, if maybe you could check with the cancer centre to see if there's a connection between those operations and cellulitis, to see if there is, and if there is, it really leads to the topic I want to talk about today.

The other thing I want to say before I raise any issues here, the care my wife has received at the hospital is second to none. The staff is courteous, they're professional and run off their feet quite frankly. The last time we were in there for treatments, they forgot that we were done and didn't tell us to go home, which wasn't a bad thing, they were that busy. So I really want to commend the staff, the doctors and the nurses in the hospital and that has been the case every time that my wife has been admitted to the hospital and I would like you to pass it on to the staff, if you would, from your department because I think we have some of the best medical people in the country right here in Nova Scotia. A lot of times they get chastised and that's unfortunate because they are really professional people, they work hard, and they do what they have to do to make sure that people get well as quick as they can.

Now, an issue that I brought up before was cleanliness in hospitals. I personally don't know how the staff can work in these hospitals. They're the worst mess I have ever seen and it's getting worse. The first time we went to the emergency it was relatively clean, obviously clean, you know, I don't say medically clean, I say obviously clean. The last time we were in there it looked like somebody hadn't done their housework in about six months. So the situation is getting worse and when you see those sort of situations, it leads to the question,

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how clean are the medical procedures? When I say the medical procedures, I'm not saying the doctors and nurses and that part of it but the people who clean the facility.

Last year the minister was kind enough to give me a copy of the contract here and I would ask the minister, because I misplaced mine, if she could provide me with another one, probably tomorrow, if that's possible. I asked the former minister if he made any progress with this problem and he said he'd worked on it and I believe that he did, but hadn't made any progress on it.

When you look at the problem of cleanliness in a hospital, if the floors aren't clean and if the garbage isn't emptied, if all those things aren't done, it leads to the question, are the bathrooms being sterilized? Are the operating rooms being sterilized properly and all the things that the cleaning contract would do? I'm talking about a cleaning contract here and I'm not blaming the people who physically do the work because I believe they're doing the work to the contract.

The issue comes back to the contract. Somebody who is negotiating this contract certainly doesn't understand how clean these hospitals should be and that's where I have an issue. I have a serious issue and that probably lies with the Department of Health, maybe with the Board of Health. I'm not sure and I would ask the minister to, if she doesn't know the answer, then investigate and let me know.

It seems to me that we have to look at this very closely. I can tell you from being a former Minister of Fisheries and being in the commercial fishing gear business for a number of years, a fish plant has a lot more rigorous cleaning regimen than a hospital. Think about that statement. Think about it. That's a scary thought. The fish plants are inspected to no end, which they should be.

One of my friends who has a fish plant said we have to change the chemical concoctions every day to kill the bacteria because bacteria adapts that quickly. They have to have approval to do these things from the Canadian Food Inspection Agency and also from the provincial Department of Fisheries and Aquaculture.

When you look at that and then you look at the possibility of, maybe, the infections that my wife had, and I just say maybe, I have no medical proof of this and I'm not a doctor or anybody that has any knowledge in this, if it's tied back to the hospital not being cleaned properly for an operation or the facility itself, as taxpayers, that's costing us a fortune, an absolute fortune for the time the people have to go back for secondary treatments that they wouldn't have had to go back for, the pain and misery that goes along with that.

Although on the surface it sounds as though there are a few dust bunnies on the floor and the garbage can hasn't been emptied, that doesn't sound too serious. But when you really look at the whole picture of this, it is very serious. It's a workplace problem too for the

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people who are working there. You have nurses there and doctors who work long, long hours and they want to go into an environment that is at least clean.

Some of the patients are very difficult to deal with. I was a witness to that when I was in the hospital. It's unfortunate because the people are doing everything they can to help people and this is not a hotel. These are not hotels that people are in, these are places that people go to hopefully get cured. The people there doing the work are doing an excellent job and they should have the courtesy of dealing with the staff in a lot better way. Again, that's individuals and nothing you can do about that and I can't do anything about that. It's so important.

I'd like to get the minister's comments on that and if there has been any progress made because visually there is none.

MS. MAUREEN MACDONALD: First off, I want to start by saying to the honourable member that I hope your wife is doing well and if you have an opportunity, please convey to her my very best wishes. I thoroughly enjoyed meeting her when we were on the Public Accounts Committee together. I miss having an opportunity to chat with you on the Public Accounts Committee, but maybe we can rectify that here someday.

The honourable member brings up a lot of really important issues. I, first of all, concur with him that we have some of the best medical staff you could ask for. Every time I'm in a health care setting, I'm blown away by the passion, the compassion, the dedication of so many of our medical staff, nurses and doctors and all of the other health care providers who are in those settings.

I also want to take a moment to talk about Cancer Care Nova Scotia specifically and the work that they're doing with cancer patients is just fabulous. We were pioneers in terms of having patient navigators to help people through the system because it can be very complex. Sometimes when you're dealing with a cancer diagnosis it is so frightening to so many families. So Cancer Care Nova Scotia, which has celebrated 10 years, which is hard to believe that it has been around for 10 years.

I had the privilege, one of the first things I did as minister was go to their - they had a recognition of the various people, teams of doctors, volunteers, other professions in the health care system who have been such strong health care providers and advocates for people who are dealing with a diagnosis of cancer. Their work is inspiring, it was very inspiring to hear about all of the people who are involved with Cancer Care Nova Scotia.

The honourable member raises questions about some of the side effects that patients, particularly breast cancer patients, have to deal with sometimes. I'm not a medical doctor but I try to stay as informed as I can about particular illnesses that seem to be so prevalent. Certainly breast cancer is one of the things that has entered into our public awareness now

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in a way that didn't exist maybe 20 or 25 years ago. We've made great strides in terms of prevention and treatment, and hopefully, in my lifetime we will see further developments that will see the reduction, if not the eradication, of breast cancer.

I know so many women who have had breast cancer who deal with a variety of side effects from the disease and from the treatment of the disease. The issue that the member has raised is not one I have a great understanding of. Because he has brought this here, I will speak to people and gather some information and inform myself and see what it is that the people with expertise have to say about the origins of this problem.

I will spend some time considering if there is something that, in fact, we can do, even if it's about providing better information so that women who have breast cancer who have this experience will be aware of what's happening, will be aware of what they need to do and getting to emergency rooms and all that kind of stuff so I will undertake to do that.

Now the honourable member, Mr. Chairman, has also raised questions about the cleanliness of our hospitals and has requested a contract that we have with the cleaners. We will certainly provide you with a copy of the contract and we'll try to have that here tomorrow for you. If not tomorrow, for sure we'll get it by the end of the week.

About the cleanliness of the hospitals, this is a really interesting question. Not so long ago I had a family member who was in St. Martha's in Antigonish and you could eat off the floors in that hospital. I remember being there one Sunday with some other members of my family and saying, I'm looking at this room and how clean this room is, this is just amazing, and I don't want to go home to my own house now, tonight, because now I see what a really clean environment looks like. But that's not to detract from the concerns that the honourable member has raised, Mr. Chairman, because I, too, have heard people talk about their concerns about the cleanliness of our health care facilities and we should never take these matters lightly.

[5:30 p.m.]

I believe that our health care facilities do take the question of cleanliness very seriously. However, we can never let our guard down. I think it's really important that we keep our standards high, very high, in these facilities. We know that infections are a big piece of being in a hospital setting. You're in an environment with a lot of people who have a lot of different diseases and sometimes diseases that are contagious, viruses that are contagious. This gives me an opportunity, Mr. Chairman, to put in a little plug for the importance of hand washing in public health.

To be honest, the thing that we can most do, every one of us, to prevent the spread of infection and the spread of a diseases, is wash our hands and wash them often. Health care providers themselves have had campaigns, there have been campaigns all across this country

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in hospitals reminding health care workers, nurses and other health care providers, wash your hands, wash your hands, wash your hands, wash your hands as often as you can. Go into a room, wash your hands.

In some ways, although I'm not implying that we can have dirty rooms in our health care facilities, I'm not saying that, but in some ways the materials that are in our rooms are sometimes the least of our problems. The real problem that you have in terms of infection is what's right here on your hands and under your fingernails and between your fingers. So, we need to keep our standards in our health care facilities high. We need an adequate work force to be able to keep those standards high. We need to treat the custodial workers in our health care facilities with respect. We need to ensure that their morale is high. We need to ensure that they see themselves as part of the health care team and as fundamental to the operation, the good operation, of a high quality health care system.

I want to tell the honourable member, Mr. Chairman, that I haven't had an opportunity to visit a lot of the DHAs, but I went to Yarmouth, the South West Nova DHA. It was a very quick trip because I was there to open a new cancer care unit, a beautiful new unit, an amazing unit. The folks at the DHA had an itinerary for me to tour the DHA, the regional hospital, before the official opening of the unit. So I literally stepped out of the car in the parking lot and just raced from one part of the regional hospital facility, one floor to another, to another, saw the MRI, was in the area where they have supplies. I was in the area where the little babies are, met some of the health promotion people who do home visits with mothers with young babies. It was a wonderful orientation to that DHA in many respects, and I enjoyed myself thoroughly and I learned a lot.

I left really inspired about that particular DHA and their commitment and their dedication and all of the interesting things they're doing in that part of the province, and I had a better understanding of what their challenges were, but I left with one regret. My regret was that I didn't meet with any of the maintenance or the kitchen staff. I said afterward, when I got back to the department, that in the future tours I do in other DHAs in the regional hospitals I intend to make it a point to ask that part of my opportunity to meet and hear from the people who are providing health care services will include, not only meeting with the nurses and the doctors and the administrators and the board and all of the technologists and all of these very important people, but I want to meet with the people who maintain our facilities, who clean and who provide food. They are as much a part of our health care system as anybody else and I, as Minister of Health, want to hear from them. I want to understand their issues, I want to hear their concerns, and I want them to feel that the Minister of Health is the Minister of Health for all of the workers in the health care system and not only for the professional and semi-professional groups.

The member brings a really important issue here with respect to hygiene and high standards of cleanliness in our hospitals, and I take his concerns very seriously. I've heard

[Page 67]

them from other members, and certainly this is on my agenda as an issue that will go into the mix of all of the other things that we are concerned about.

I don't know if that answers the member's concerns but I would be pleased to hear other questions from the member.

MR. COLWELL: A couple of things - number one, I want to make it very clear that I don't have an issue with the maintenance workers, none at all. Actually, when you're doing any kind of job, you usually have - when I say "contract," I believe this is contracted outside the Civil Service. I believe it is at this point. There's not a thing wrong with that, I think, the cleaning, but I'll wait until the minister gets back to me with the information. If an individual isn't given the tools or the training or the requirements that are needed to do their job properly, they can't do that job properly. I think that's where the issue is, and if I remember from the contract - and I apologize for misplacing it - but if I remember from last time, the contract wasn't very explicit about how you do many of the important jobs that you should, and if a person is doing that work and they're not given the tools because the contract doesn't say they should be given these tools, they can't do the job. That's really my issue.

I would also like to see the contract for St. Martha's Hospital in Antigonish, to see if it's the same contract or if it's a different one. That might actually shed some light on that, and possibly the one from Yarmouth, too, to see if the contracts are all the same or if they're written differently. I think that would be a really good exercise for us to go through. So if the minister could provide those I'd greatly appreciate them.

She went on to talk about hand-washing. I totally agree with that - that's a really serious issue. The problem is, if the sink that you're washing your hands in - and I know there's a process for that, because I've gone through all this in the hospital when my wife was in isolation and when my father was in isolation - there's a whole process you go through, but if the sink is so filthy that you can't really clean your hands properly, you'll probably do as much damage after you wash your hands as before you washed your hands. So you really have to provide the tools for people to do the things in order to protect their health. I think that's an issue and the more the minister talks about this the better we will be and the fewer infections we should get.

The other thing I've always wondered about and this is a real health issue but it's not a health issue, why don't we have mandatory automatic doors in all commercial facilities, and that's something that can't happen overnight and I realize that, automatic doors so that people don't have to grab that door handle that you're going to get those germs from. Why don't they make it mandatory to have the automatic taps in public washrooms, so that when you put your hands under them the water comes on and the water stops. Because again, if you're going to wash your hands and if you don't turn that tap off with a clean piece of paper towel and you touch it with your fingers, you're contaminated again. You're contaminated when you put the paper towel in the paper towel holder and you're contaminated when you

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open the door again. So you might be as bad or worse off when you leave than when you came if everything isn't done properly.

The same with the paper towel dispensers. That technology is available and it is something that the government could put in the provincial Building Code to ensure that that is in place. It could be done over a five to 10 year period for older buildings to be retrofitted and again help reduce the spread of disease.

That should be everywhere. In the buildings where we work in, even this building, when you touch the doorknob when you come in today, there are a lot of people in and out of here, people may be ill who don't even know that they are ill. Indeed they might be passing on some serious infections or illness of one kind or another and not even know that they're doing it, quite frankly, and nobody would unless they're ill.

So those are issues that I think maybe the department should look at in co-operation with, maybe, the Department of Labour and Workforce Development, which I believe is responsible for the Building Code. But it is simple things that could be done, it won't cost a lot initially and over time when you build a new building, you just do it like you put wheelchair accessibility into a building. It's that important.

So I think if we can look at some of these things, maybe I could get a commitment from the minister to look at the possibility, or at least consider some of these ideas, to see if we can cut these problems down. Automatic doors are simple things today. They're not like they were 25 years ago, with modern technology and they should be every place where, say, if they have over 10 employees or 20 employees or so many people visiting, be some standard set that would be appropriate to really look from the standpoint of preventing the spread of disease.

If we stop the spread of disease, like I say, by washing hands, then our health care system costs us less. There is less pain and misery. That over time can accumulate and stop this escalating cost in health care. I know when I was in Cabinet many years ago that the cost of health care was spiralling out of control. As our population gets older, as it is now, especially in Nova Scotia, we're going to have higher and higher costs and we may even have fewer people working as everybody retires, and who is going to pay for it? So that becomes a serious issue too.

So I would ask the minister, first of all, for a commitment, on the record, of those two cleaning contracts. I know you will supply them and then maybe some comments on the issues.

MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, we will be able to provide the CDHA contract tomorrow and will check into St. Martha's and the

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Yarmouth Regional Hospital and if we can provide them then we will tomorrow and, if not, we will provide them, for sure.

The honourable member has made mention of the installation of various things that are much more technologically driven, automatic doors and taps and paper towel dispensers and what have you. I believe that one of the things that we will be seeing, and I actually heard a program on CBC not so long ago about it, is that hospitals now in the United States have significantly different standards than they used to. The industry standard is changing as there are more superbugs, MRSA, these kinds of infections, and so there are - for example, we're all very familiar with hospitals 20, 25 years ago where you would have wards with maybe 10 or 12 beds, and our standards in the 1950s and 1960s changed and they've continued to change. We've gone to arrangements where you might have four people in a room, and now three people in a room, and the new industry standards increasingly are about having one-person rooms, having washrooms in that hospital room, and having a lot of these new gadgets, if you will, that will contribute to a lessening of the transmission of infectious diseases. Of course, they will cost a tremendous amount of money. Meeting the standards for new facilities is very expensive.

[5:45 p.m.]

One of the things that I'm aware of is that more and more hand sanitizers are being used and mounted throughout our health care facilities - and not just our health care facilities, but certainly in the health care facilities' elevators and outside the rooms of patients, outside the common areas, the washrooms, a common kitchen, these kinds of things, and so we see these now every place. They're becoming more and more a part of the standard hardware in our hospitals and in our health care facilities, in our doctors' offices, and now in our retail sector, in our supermarkets, in our drug stores. Again, we have a changing level of awareness and a desire to practice good public health, and I think we'll probably see that continue.

I'm sure, in future years, any new capital construction, we will see a change in the standards in terms of the provision of these various components of bathrooms and the rooms, the kinds of taps. You see in the new airports now, the washrooms are all very automated in terms of the plumbing, and the health care sector, no doubt, will move in that direction and probably already is in places where new facilities are being built as we speak.

MR. COLWELL: As I said, some of these things will be done over time, and actually a sink with one of those automatic on/off switches - a motion sensor, a heat sensor, however they work, I'm not quite sure - probably will save a lot of water. The first place I think I remember them was at McDonald's restaurant, and they don't do anything unless it saves them money - and rightfully so, on something like that - but it had the side benefit that it meant that you didn't have to handle those taps and all the other things. Those are things that are expensive but you can do them over a long period of time. You could take one area and do one tap set on this floor and another tap set on another floor, and the same with the paper

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towel dispensers. With the volume that the Department of Health has, whoever supplies the paper towels would probably give you the dispensers free with the large quantity of paper towels that they're talking about.

I'm not only talking about hospitals and health care clinics, I'm talking about commercial buildings. When you go into most of the retail stores, they have automatic doors now and I think that's probably so they can facilitate more people through the doors faster, and that's fine, but it has the side benefit of helping to not transmit communicable diseases.

You go over to the buildings, all the buildings right around here, you've got to grab that door handle and open that door. As soon as you do that, you have a potential problem. Then you've got to grab another door handle to get into the building. Five years ago we wouldn't even be having this conversation but in these big buildings where there's a main entrance, to change those to automatic doors is not a huge expense for the size of the building and the overall value of the building. We're not talking huge expenses and the same with the washrooms, they could do one floor a year in these big buildings, or two floors a year, and change these taps, put them in place and encourage people to do it.

I would like to get a commitment from the minister - if she can do that, and I stress if she can do that - to talk to, I think it's the Department of Labour and Workforce Development that looks after the provincial Building Code, to see if they will look at that and maybe work toward getting a government policy that would encourage the installation of these sort of things and, again, if it's done properly, and over time, it won't cause a financial stress on businesses because we don't want that either but on the other hand, if their employees get sick, if they're not producing any products for their employers, no matter what the product may be, that costs the employer a whole lot more than it would cost to change a few paper towel dispensers and some taps.

Again, the taps will probably save them enough money to pay for themselves with the water costs, especially in the city here where they get city water that is getting very, very expensive for other reasons that I won't go into today. So I would just like the minister's comments on that and after the minister is done, I'm going to turn the rest of my time over to the honourable member for Bedford-Birch Cove.

MS. MAUREEN MACDONALD: I'll be really quick to give the member time for her question. In terms of moving forward with the suggestion from the member, I would be very happy to speak with folks in the Department of Labour and Workforce Development about this. Additionally, I would be happy to speak with Dr. Bob Strang, our chief medical officer, who's responsible for public health and see what advice he gives me as well with respect to the best way to proceed.

As the honourable member knows, Mr. Chairman, my area, my domain if you like, my remit is fairly specific to health and in the Department of Health we do have $3.5 million

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in this budget allocated for some energy retrofit and it's also conceivable that we might look at something like using some of that for the kind of water-efficient taps that the member spoke of. So good points and there are some avenues that we might be able to explore.

MR. CHAIRMAN: The honourable member for Bedford-Birch Cove.

MS. KELLY REGAN: Mr. Chairman, I'll be sharing my time, if there's any left over, with the member for Halifax Clayton Park. Might I make an introduction, Mr. Chairman?

MR. CHAIRMAN: Please do.

MS. REGAN: I would like to recognize in the Speaker's Gallery the councillor for District 21, Tim Outhit. Tim, stand up, please. (Applause)

I would like to ask you some questions surrounding Lyme disease. This has become an issue in my riding and, in fact, we had three human cases in one subdivision. I'm wondering, first of all, how many cases are there in the province? (Interruption)

MS. MAUREEN MACDONALD: I think the former Minister of Health would like to answer that, actually, based on what I'm hearing. I think I heard him say he knows what the answer is but, Mr. Chairman, through you to the member, I don't have that information but I will get that information for the member.

MS. REGAN: There are a variety of testing methods for Lyme disease that are now being used in the United States and one of the things I was hearing from residents in my area is they're concerned that the testing methods we are using are not sensitive enough.

My question is, has the Department of Health investigated the kind of testing that's going on in the U.S. and is there any chance that we could be looking at those new methods?

MS. MAUREEN MACDONALD: Mr. Chairman, I do have an answer for the honourable member on the number of Lyme disease cases that we have diagnosed in the province - it's three confirmed cases.

With respect to her second question, I really would have to consult with Dr. Robert Strang to find out what he thinks as the Chief Medical Officer for the province about this.

MS. REGAN: Mr. Chairman, I'm wondering, what is the Department of Health doing to alert citizens to Lyme disease, and maybe you could sort of outline some of those steps?

MS. MAUREEN MACDONALD: Mr. Chairman, I know that there was a meeting in the Bedford area not so long ago - the honourable member was there and I believe that a Department of Health staff member attended that meeting, and prior to the meeting I had an

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opportunity to speak very briefly with the staff member who advised me that he would be in attendance at that meeting and bringing back any of the concerns and information to the department.

We are, in the Department of Health, very responsive to community concerns. I want to assure the honourable member that one of the things that I most admire about the staff in the Department of Health is their complete and absolute dedication as public servants. They believe in public service and they respond to the citizens of the province when they have concerns. They take their duties very seriously. They look at research - we have a policy unit that gathers information and provides information to people in the department. We have a number of physicians who work in the department and provide medical advice. It's not surprising to me because I've always been aware of this, but to be so close to this very dedicated group of women and men is very heartening.

The concerns around Lyme disease are well known. We've been, I think, fairly fortunate here in Nova Scotia. We haven't seen huge clusters or anything like this and, as I said, we have three cases that have either been confirmed or are possible Lyme disease cases.

MS. REGAN: Mr. Chairman, in fact, those three cases are all in my riding. They're actually all on one street and that street borders a municipal park, which borders DND land. So we now have three levels of government that are involved in this particular area where Lyme disease is present. So my question is, what are we doing with those other two levels of government to ensure that, in fact, the people in the Eaglewood subdivision are not bearing the brunt of Lyme disease and that their cases are being dealt with?

MS. MAUREEN MACDONALD: I want to thank the honourable member, and I want to say to the honourable member that the issue she raises is really more of a public health issue than it is of a health care system issue and, although I am the Minister of Health, I'm also the Minister of Health Promotion and Protection and I think we will have an opportunity to have officials from my other department here to respond to questions and because this is more of a public health matter than a health care system matter, if the honourable member would like to pose those questions again, she will probably get more satisfactory answers.

[6:00 p.m. CWH on Supply recessed.]

[6:31 p.m. CWH on Supply reconvened.]

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

The honourable member for Bedford-Birch Cove.

[Page 73]

MS. KELLY REGAN: Mr. Chairman, I have some questions now surrounding cleanliness at the Victoria General Hospital. I have a neighbour who just died from lung cancer - she was diagnosed in June just as her daughter was graduating from high school and she died a week after her daughter left for university. She spent a good deal of the time in between those two dates in the Victoria General Hospital. After her death, when I went to see her husband at visitation, he said how disturbed he was by the bad conditions in the hospital where she had been staying, specifically he mentioned that she could not shower and that she couldn't drink the water. My question to the minister is what's the problem?

HON. MAUREEN MACDONALD: Mr. Chairman, first of all I would like to extend my sympathies to you for the loss of a friend. I'm not sure where in the health care system this individual was - you said the VG site, but inside the VG there are a number of different floors and units. Some of the floors and units are places where the transitional care unit is, and this is sometimes a location where people who are awaiting placement in a long-term facility are after they no longer need to be in an acute bed receiving acute care services. Sometimes they are there waiting for maybe placement in a residential care facility of some kind of a small options facility, and I've known of people who were there because they were stuck and had no community placement to go to.

If it were the transitional care unit at the VG, there have been many concerns expressed over a fairly significant period of time - I think the former Minister of Health at one point said that the unit should be blown up. I believe that was his quote. I have a fairly good memory as well sometimes, and I remember reading the newspaper and that member when he was Minister of Health said that unit should be blown up. I'm not going to say that unit should be blown up, but there are a lot of inadequacies on that unit. I certainly, as Minister of Health, have expressed my concern about the physical standards on that unit to the Capital District Health Authority.

Now, I'm aware there are other units in the VG - there's a unit where water has some form of contamination. I'm not really sure precisely what the problem is, but water is not used for patients and bottled water is brought in. The Capital District Health Authority has some significant facilities challenges. They have them working on a master plan, and in the coming months and years very serious consideration will have to be given to the adequacy of existing facilities and the need for other facilities, more appropriate facilities, or different options for care for people who are on one of the floors at the VG right now.

I'm aware of the issues that the member has brought forward. I've raised these issues in my department and they've been raised with the DHA. In all of the things that we're dealing with they occupy a certain level of priority.

MS. REGAN: My concern is that these concerns about the water at the Victoria General first seemed to come to light several years ago, and I would have thought that in the intervening couple of years we would have seen a plan. My concern is that there doesn't

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seem to be a plan, we don't seem to be dealing with it - it seems to be band-aid solutions. My concern is that these are people who, in all probability, have compromised immune systems. So we are saying to them at the sickest point of their lives, hello, you are now going to stay in a unit where you cannot drink the water, you cannot shower, you can't do anything like that.

Where are we in the planning sequence? Are we in the middle? Are we near the end? Are we at the beginning? Saying that we're working on it probably worked a year ago, but I'm concerned that there doesn't seem to be any movement forward on this issue.

MS. MAUREEN MACDONALD: I would say to the honourable member, with all due respect, that this may have been a problem for a number of years, but it was a problem under a former administration. What I have said to the honourable member is, I have raised this issue in the brief time I've been in the department, with people in the department and with the DHA. In raising it, what I have specifically said is, I want to know if there is a plan and if there isn't one, can we start the process of getting a plan to deal with this problem?

MS. REGAN: So when you asked the question, I want to know if there is a plan and if not, can we get one - what was the response?

MS. MAUREEN MACDONALD: Mr. Chairman, as I indicated earlier to the honourable member, the Victoria General site is part of the Capital District Health Authority facilities. They have been working for some time now on a master facilities plan, which would include dealing with the problems with respect to the Victoria General Hospital, as well as some other things. They are in the preliminary stages of having developed a plan; they have a vision for what their needs would be into the future, over a period of a considerable number of years.

At this stage - it's very early stages in terms of a master facilities plan for our largest DHA. Having said that, it is not inconceivable that problems in the system, facilities-wise, can't be worked on. I guess basically what I'm saying is you don't have to adopt an entire plan to work on some aspects of your facility needs when they are apparently in need of being addressed.

So, as I said, I've been on the transitional care unit in particular at the VG, but not only on the transitional care unit. I have been concerned about the conditions on that unit. I have met with staff who work on that unit. I have read all of the newspaper accounts over the past number of years and listened to the media accounts before I was on this side of the House.

I represent a part of the community on the peninsula of Halifax where many residents of my constituency have either family members or friends on the units there or who have worked on the units there, so I'm very aware of the shortcomings of that particular facility.

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I have neighbours who work in that facility and I couldn't be more concerned that we need to get on with an action plan to deal with the problems at that facility. So I share the concerns that the member has raised and I'm now in a position, hopefully, to be able to do something about it. I've used the short period of time in the position I'm in to ask that we start moving forward on addressing these problems.

MS. REGAN: Thank you, Mr. Chairman. I have no doubt that the honourable minister is concerned about this and that she has done her research. My concern is that being concerned is a state of being - it is not a state of action. We need to begin taking some steps, and I'm not hearing anything about an action plan.

The other thing that concerns me greatly is that, as the mother of three children, my husband and I together spend a lot of time teaching our children about taking responsibility. One of the things that we like to quote back at them when they start giving us excuses and saying, well, you know I couldn't make it in on time because of whatever, we just look at them and we say, "I am responsible."

What concerns me about what I'm hearing from the opposite side of the House is that we're not seeing ministers taking responsibility for decisions they have made. That concerns me greatly about this program, about this particular issue. It also concerns me about the program we were discussing earlier, about the care workers. My concern is you can stand up and say "they" designed it or "they" supported it, but the fact of the matter is, you are the one who implemented it and I want to know that we're going to see some changes on this and that we're going to see some changes on it soon - sooner rather than later.

We've heard that we're open to some changes, but we don't know what those changes are, we don't know when it's going to happen. In my view, if we want to be good role models for our children, we need to be saying things like, I am responsible, not pointing across the room to the people who set it up. If you didn't like it, then you didn't have to implement it, but you implemented it and you need to take responsibility for that.

[6:45 p.m.]

MR. CHAIRMAN: Your time has expired.

The honourable member for Argyle.

HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, this is my first opportunity to stand and ask questions, during estimates, to the Minister of Health, as the previous, previous Minister of Health. This is definitely a different place to be than what I'm used to. I'm used to sitting with that staff, except for the new Acting Deputy Minister. I welcome them to the House. I wish them well. Miss Penny, it's always good to see you. You have a wonderful staff at the Department of Health who are a wealth of knowledge, have tons of

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information and the ones who should be listened to closely. Of course, you have to make up your own mind on stuff but definitely the information they provide is the best that they can.

This is our first estimates really without the previous minister or previous Deputy Minister of Health, Cheryl Doiron, and of course she has gone off to retirement and we wish her well in it, but we know that when she was in this House, helping us answer questions, that she was an absolute wealth of knowledge as well when it came to the estimates of the Department of Health.

Of course, I have wished the new minister well in her new role as Minister of Health. The Department of Health is a wonderful place. It's wonderfully interesting, it's wonderfully frustrating but it's wonderful. I miss it actually, to tell you the honest truth. As many people say, how could you have possibly survived three years there? But quite honestly the three years flew by quickly and I'm sure you'll find the same thing, the three years will fly by quicker than you anticipated.

It only takes those one or two people, even during the course of the year who say, thank you for this - there are so many good stories that we can talk about within the Department of Health - but it only takes one or two of those to let you keep going for months and months at a time.

The first things I want to bring up, and thank the minister for as well, are basically two announcements that I participated in with her, of course, which was the opening of the cancer centre in Yarmouth, one that I was so proud to have worked on and brought forward, that the minister had the opportunity to come and open - I believe it was in, I'm just trying to think if it was in July or if it was in August - but a couple of months ago now. Really, the reason for the cancer centre in Yarmouth was that services for cancer patients in Yarmouth were scattered here, there, in the hospital so you went to see your specialist down in one cubby hole and you went and got help, and the library was in another one, and then you went for your IV treatment in another part of the hospital, which was very small and dingy and if you were lucky enough to have the one chair by the window, you were qualified as lucky.

Mr. Chairman, when the minister saw such a wonderful place on, I believe, the 4^th floor of Yarmouth Regional Hospital, that not only has a number of offices, a library and exam areas, but probably has one of the best views for people who are going to be receiving their infusions, looking down at the harbour. If they're unlucky enough, of course, to be there, they do have a wonderful, serene place to sit during that time.

Mr. Chairman, the second one was of course HealthLink 811, which was a process that was long, one that took a lot of thought, one that took a lot of lobbying before Cabinet and before my colleagues, and one that I was so proud to start to bring forward and, of course, the previous minister, getting that off to tender before the election and of course you being able to bring that forward. Again, I was very happy to be there. Unfortunately, I think

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on the first one, you didn't see me at that one, and I know that you came to me after and apologized for it and I know that you came to me after and apologized for it and I know, at the second one, I was there too but - anyway, I know that when I was minister I made sure that I acknowledged everybody so I know that it was just an oversight on your behalf.

The first real issue that I want to talk about and ask questions around and probably knew that was coming, was Nakile Home for Special Care because of its timely predicament that it happens to be in. I'll give a quick rundown at this point of where I think - well I know where the process is, but how we sort of got into this really weird place. Nakile Home for Special Care was approved for a 22-bed expansion. It was first a 12-bed, then became a 22-bed because of some bed issues with Villa St. Joseph-du-Lac at the time because of fire marshal issues. We had a number of beds that sort of had no home. We needed to find a place for them so that seniors could be taken care of in the area. So they became a 22-bed expansion.

The work was done by their architects. Their architects provided a number, I believe, of something like $4.2 million, or something like that, for construction. That $4.2 million for construction is then worked on by the department and then a service agreement is drawn up. That service agreement is then signed off as that calculation also is based upon the capability of the department and the long-term care facility being able to pay that back as a per diem over a longer period of time. We know that as these facilities are built, that the funding is taken up by the Mortgage and Housing Corporation through Department of Community Services. So there's a mortgage and the department will end up paying that mortgage and a per diem rate.

So $4.2 million was decided upon and the concern that I have already is that apparently the numbers were about two years old when they were brought forward and signed off by the volunteer board and the administrator. Tenders went out with those numbers and then the tenders came back significantly higher. When asked why they were so high, of course the board asked their architect and project manager, where did you go wrong in the development of these tenders? I think admittedly, sheepishly, the architects admitted that, we were off, maybe we made some mistakes. We asked for them to get a better look at what that price is.

The question is, as those tenders came out - not necessarily a question to the minister yet but a question that overall we had to ask is, as those tenders came out, are they a true representation of the project or is it the estimated cost of $4.2 million? I think the tenders came in, I believe, at $6.8 million, sort of in that range or $7 million.

What we did, in order to substantiate those numbers, the department, through the architect, asked for a Hanscomb estimate and the Hanscomb estimate, when it came - and I have a copy that I'll table as well- total construction estimate excluding contingencies is $7.3

[Page 78]

million, according to Hanscomb. Now maybe that number is a little high but it's a heck of a lot closer to the tenders than the original sign-off is.

My question to the minister is, is there an opportunity for Nakile to re-look at the service agreement? That's where the confusion started, is that because you're signed off on a service agreement from the start - can we go back to that service agreement in order to find those extra dollars that are obviously going to be needed for the construction of that home?

MS. MAUREEN MACDONALD: Mr. Chairman, I want to first say to the member for Argyle, I felt so bad on the 811. I was still on the job learning and it was my first really big announcement and I was a bit of a nervous wreck. I knew the second I left that room that I hadn't acknowledged and I felt really bad and it won't happen again, I assure you.

Let me go back to the question of Nakile and the difficulties that are being faced now in terms of getting this project to move forward. We are committed to seeing long-term care beds. We know that they are required. I know very little about Nakile on a personal level, but everything I've heard has been very positive. I know that this is a facility that we, the department and the government, would very much like to see succeed.

The people in the department who are reviewing the numbers, and what's occurring here, will do everything in their power to work with that organization and to look at all of the avenues that may be available, including whether or not there were any liability issues or insurance issues with respect to the initial design and some of the problems that have occurred as a result and are now resulting in these cost overruns or escalations that we're seeing.

I know that doesn't give you an immediate response and the time is ticking with respect to this one contractor who, I understand, has opportunity to build other facilities and because so many beds are being constructed around the province at the same time, and particularly in a geographic proximity to your area, they may be pulled away. I know the organization would like to see that particular contractor, for a variety of very good reasons. You will know, as a former minister, that when we're dealing with public money, we have to do the due diligence, the process, to try to do the best we can to be very fiscally responsible and prudent. We will have to balance the need to be fiscally responsible and prudent with our desire to assist this particular facility to get this project moving ahead.

It may not occur as rapidly as we would like and it may have an impact on that particular contractor. I can assure you that we want to do the right thing for the seniors, for the community, for this organization but we also have a duty and a responsibility to the people of the province in terms of our stewardship over the resources that we're committing to this project that aren't our own, but belong to the people of the province.

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MR. D'ENTREMONT: Mr. Chairman, I know the minister is aware that this tender does expire tomorrow. Basically, there had been an extension on behalf of Delmar Construction, which is the lowest bidder. So it expires tomorrow and from the many discussions that the board has had, the administrator has had and I have had, the contractor says that any bid will come in higher. So, should we retender it at a future date? Because that was a thought that maybe we could retender it and bring the price down, but any indication at this point would say that it is going to be higher. So, by not locking in, it is going to cost the province more money.

The other issue is that Nakile Home for Special Care has incurred about $600,000, if not more, of cost for paying the project manager, paying for the architect, paying for the Hanscomb numbers. So right off the bat there is a tremendous pressure on the day to day operations of the Nakile Home for Special Care. Of course, being in my mind, the best home in the province - and I'm sure other members will say that theirs is the best - but this is definitely a really good home and they don't want to see an impact to the care of their seniors.

[7:00 p.m.]

I'm going to table an e-mail that I received from Bertha - Bertha Brannen is the administrator of Nakile home - that she sent out to her board and, of course, a copy to me. It goes a little bit like this and I'll table a copy of this as well:

"Hello All

Tomorrow's deadline to secure funds to expand Nakile will not be met. I was able to contact Keith Menzies this afternoon and he has informed me that there is no available $$ in the other budgets (emergency & Capital) that might have assisted in reducing the expansion cost. He was aware of our meeting with the Minister and regrets 'that this project (Nakile) is presenting unusual cost issues that we cannot address in the near future.' He added that some options might be to wait & see if there is capital $$ left over once the other provincial beds are completed OR having an Order in Council reduce the order to 12 beds (recognizing that the cost for only 12 beds . . ." is probably the same as 22 beds because of the scope of the project. "Obviously both options will not be reconciled in 2009.

Bertha also says, "I feel that Nakile Board should meet ASAP . . ." and I know they were trying to get together this evening ". . . to address the existing contract with Gantline. I made Keith aware that Nakile's priority is recovering the $600,000+ (plus cost of recent Hanscomb study) that we have committed to date. He understood that this financial burden is a daily threat to the operations of the existing facility. Keith has assured me that DOH will maintain their commitment to reimburse Nakile . . ."

[Page 80]

Mr. Chairman, and to the minister, I don't know if Mr. Menzies has the authority to make that decision, because I know that decision is yours to make, in the future direction of this project. I don't know, - as much as it's nice to say that we're going to try to get that $600,000 back, I know that the residents of Argyle want the 22 beds in expansion to the facility. I'm just wondering what your comment around this e-mail is because this was received, I believe, at 3:35 this afternoon.

MS. MAUREEN MACDONALD: Mr. Chairman, at 3:35 this afternoon I think we were just starting Question Period. I would say to the honourable member that you're providing me with information that's new to me because I've been here since that period of the day. Of course, when I'm here, the staff in the department are carrying out the work of the department and the directions of the minister. They're acquiring new information, and they'll feed that to me and we'll have more discussions about this.

What I will say to the honourable member, Mr. Chairman, is that I can assure him that tomorrow we will be having discussions about this. We're not going to drop the ball in terms of Nakile, we will try to work our way through this but, again, I would say to the member, it probably isn't going to be something that's going to happen quickly. It's the nature of the beast. You exchange information back and forth, you throw out suggestions, we consult. As I indicated earlier, we have our own consulting expertise available to us, the engineering and construction consultants, and this is a process that needs a great deal of consideration. Our financial advisors and people in Finance will be crunching numbers but our commitment is that we will continue to work with Nakile and at this stage that's the most I can say.

MR. D'ENTREMONT: I thank the minister for those comments. The only "but" that would go with that is that for almost two months now the tender has been available to us, has been available for review for the department, and the challenge that you're going to have, minister, is that the person who should be reviewing this file is actually off on vacation. So it creates a whole bunch of angst on behalf of the board. So I thank you for that, and I'm very happy that I was able to use this forum to bring it forward, but we need to have - I hate to say by some point tomorrow, but we've had two months to come up to this, some point tomorrow, and whether it's a go or no go.

I know you're talking about utilizing the dollars to the best of our ability, you know, we do only have one taxpayer, these dollars only come from one place, but it's going to cost more money as this continues to go forward, continues to escalate. I saw that when I was minister when things were brought forward.

The member for Hants West was talking about the Elms, it was an issue then of trying to come up to some kind of agreement with that board and basically, exactly what's going to happen. Like I said, I worked on it almost a year ago and the department still hasn't been able to resolve that. I just don't want this to happen to Nakile Home for Special Care, that

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it's going to be in flux for another year. In the case of the Elms, I think the building is almost half done. I know they're probably at a point where they can't expend any more dollars but there's significant expense at this point. If you're really dropping that on the shoulders of a volunteer board - and I know my board members, some of them are listed off there as a copy of the e-mail, they're very frustrated. A lot of them are feeling that, maybe, what am I doing on this board anyway? They don't need this headache, as retired civil servants, and what have you, on this board.

All I can say is that I hope tomorrow we will come to a head, exactly the appreciation of what we need to do. If the board had better numbers they probably would have negotiated a higher number and maybe the department should have caught the oversights within the design. Apparently, from talking to the board and talking to architects, they forgot some stuff. I fail to understand how you forget things that they list off, and I'm not going to talk about them tonight, but there were substantial issues forgotten in their pricing.

I thought that when we set up the building group that they would have some kind of oversight or review of architectural drawings, engineering drawings and those kinds of things, not just having to send everything off to Hanscomb, but somebody could have quickly looked and saw some of these oversights. So right from that point, when they signed off on that service agreement, they would have had better numbers and would have probably agreed to a higher number. Now, I don't know what the per diem really boils down to or maybe that's maxed out at that price too, I'm not sure, because I wasn't privy to that piece of negotiation.

I'm going to move on from that one and I know that I have a commitment from you to continue to look at this. I really have faith in that we can come up to a solution quickly but I really don't want to lose that tender tomorrow. I know that Delmar Construction, like I said, is the lowest bidder. I know he has taken the opportunity to bid on the one in Barrington. That funding came to tender as well, so some really exciting projects for the southwest, but we're going to lose one of our companies maybe to go - they might be the lowest bidder at Bayside so they might move their stuff all over to Bayside. I feel bad for them, too, because preparing a tender is an expensive process for them as well. They did weeks and weeks of work and it probably cost them $3,000 to $4,000 - for a small construction contracting company and they've been more than helpful in providing us with more numbers, maybe some ideas of cutting costs on the project and those kinds of things.

That was the other point that I wanted to talk about too. I know I said I was done with this, but I'll keep going because the ideas keep coming to my head. Some of the projects, like Bayside, as they came and presented things to us, some things were too much square footage, too much this or too much that, very extravagant and those kinds of things. I know that finally Bayside is going forward, that we've got a package that everybody can live with. I think Nakile provided something that everybody can live with but the overarching issue of

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water and the added issue of the generator, which is an odd oversight as well, is a tremendous challenge that overarches the issues for Nakile.

I'll leave that one there and I'm sure we'll talk about this a little bit tomorrow and I do have a copy of the Hanscomb estimates that I can also table for the House as well. It's 39 pages worth of estimates but the first page, of course, gives you the quick elementary cost summary of the Nakile Home for Special Care.

I want to move on to some questions around the issue of Code Census. I know that today it was reported in the news that the Infirmary site had a Code Census. It ended up being an emergency room that had been overcrowded. I'm just wondering, with your work with the Capital District Health Authority, what kind of staffing issues are you seeing in emergency rooms? A plan was presented to me - I know it was presented to the previous minister and I know it will probably be presented to you - of a better flow chart, a better flow at the Infirmary site so that these issues don't continue to happen. But there have been four times, I think, in the last two weeks, so there's an issue happening here and I'm just wondering, what is your take on the Code Census at the Infirmary site today?

MS. MAUREEN MACDONALD: Mr. Chairman, I think my first day in the department was a Monday, and I believe the Capital District Health Authority - or it was close to the first day - they extended an invite to come and tour the new emergency room before it opened. It was opening at eight o'clock that night and they said, if you can - this is real short notice, you're probably booked to the hilt with people wanting to brief you on all kinds of things, but if you can come for an hour, we would love to show you the new department. I said, absolutely.

I was there. It was a very interesting experience; it was pretty amazing, because what they did - and I had the privilege of being escorted by Dr. Sam Campbell, who is the head of that emergency department, and he's phenomenal, and Sandy - I'm going to get the last name wrong, I want to say Cook, but she was our librarian who retired, so Sandy - who is the head nurse, the nursing coordinator, and they work as a team, this doctor and this nurse - they work as a team organizing that emergency department, staffing it, the scheduling, everything. They were very excited about the fact that the new emergency department was opening that night.

What they did, Mr. Chairman, was they took me first to the old emergency room, which was being used, and they said, we want to start by taking you through the old emergency department and explaining - we want you to see and we want you to understand what the problems are in the flow in this department before you see the new department. So we went through the old emergency room.

In the old emergency room department, there were a lot of beds in areas that were curtained off all around the nursing station. A lot of people are aware of that - they've been

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there. So they said, this is the way the system is set up: you come, you register, you sit out in here in this big waiting room and you wait and you wait and you wait. You get frustrated when there's no movement; you're never called, you see other people being called, ambulances come in once in a while, people go through on stretchers, but in the emergency room people are sitting there waiting to get through that first door and then they're into one of these beds, onto a bed with a curtain for a long period of time and then they wait and wait and wait again. So we went through that old emergency department and then they brought me into the new area.

The new area has been designed quite a bit differently and I don't know if you've had the opportunity to have the tour. It's so interesting. Dr. Campbell, he's so exuberant and, you know, he's a problem solver and he talked about how they had a problem to solve and their problem was solving flow, you know, through that emergency department. So what they have now is they have, first of all, a lot of areas where there's privacy for the patients. They're not in curtained-off areas. They're actually in glassed-in areas with way more privacy.

They have an area for people who come in who are psychotic, who are experiencing psychotic breaks, serious mental health disorders, so that those people can be treated with a degree of sensitivity and privacy that wasn't possible in the former emergency department and this is a feature. They also have advanced paramedics at the very far end of the emergency department and those paramedics are capable of doing a whole number of things, including sutures, for example. So people who come to the emergency department, right at the very beginning are seen by paramedics who assess the presenting symptoms and they make a determination about the most appropriate flow.

[7:15 p.m.]

They may move those folks to the back to the advanced paramedics to have sutures, for example, or other kinds of procedures - this is at the emergency department at the Queen Elizabeth II - or they may move people into - they have set up probably two areas where they have these very nice comfortable chairs. Actually I had a call from one of my constituents who complained that the new emergency department was too much like a hotel. I thought in a way that might be a good thing because hotels tend to be fairly comfortable but they have these sitting rooms so you're not sitting out front waiting. They'll move you in closer to the action and the idea is that you don't need to be in a bed. Many people who come to the emergency department can sit. In fact, maybe it's better for them to be sitting up and they can be taken in fairly quickly.

Now, it's a beautiful physical space. It has been designed to flow people through as quickly as possible. They have added some additional staff in terms of the advanced practice paramedics. They have spent many, many hours analyzing the flow of patients into that emergency department. So they were able to show me graphs for different weeks over a long

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period of time when the use would peak regularly, maybe on a Friday night or a week, whatever. They used those patterns of utilization to determine their staffing needs.

Now, having said that, it's a remarkable place to visit and the intellect of these two people who are in charge of staffing and managing that unit was very apparent. But even the best minds with the best information are not able to predict surges that occur and what's driving those surges. Are those surges from outside the region? Are those surges from inside the Capital District Health Authority, is something going on? So now we have this new modern facility, updated facility, with some additional resources for staff, but we're still seeing problems in that emergency department. So we need to embark on the next phase of analyzing what's going on.

You know, we're having surges. Last night, I understand, was an extremely busy night in the OR, busier than usual. We have had a couple of days like that in the last couple of months. So what does that mean? What does that mean for staffing and resources? The other question I would have is, what is going on in the floors above that's changed or what's happening there?

The Capital District Health Authority has the administration, and the staff have been instituting various changes, internally, to try to move people on those floor upstairs out, with appropriate supports and services, as rapidly as possible. We're very aware that we still have problems and that we need to analyze the source of these problems, carefully, and we need to be prepared to address the problems and our government certainly is.

MR. D'ENTREMONT: You do have a career in radio I think, after this one, or maybe some advertising. I don't know what the member for Glace Bay would say about that, but maybe he'll bring back TALKBACK or something.

Thank you for those comments. It was always a challenge where the Capital District Health Authority wanted to come forward with a new emergency room, just from the sheer number of patients that it saw. Back in 1989, I believe, or somewhere in that range, it was brought in, it was only made for a certain number of people and we're seeing so many more people today. So it just didn't work. I've been through the emergency room as a patient and I've been there as a minister as well. Structurally, it just can't see that kind of patient.

Unfortunately, I haven't seen the new emergency room. Of course, I had the opportunity to do the sod-turning, but through all the discussions of having the dollars available for the capital construction of it, was making sure that the staffing level made sense for that size of emergency room and making sure that the policies were in place for the flow of patients to the floors or where they needed to be within the Capital District in order to be taken care of.

[Page 85]

I remember one meeting that I had with Dr. Ross at the time, he talked about the time for consult, making sure that if you have a cardiac issue that was presenting itself at the emergency room, that the cardiologist comes down to the floor, or whatever consult is needed, making sure that happens in a timely basis. That has been not just a policy problem but a cultural issue within the hospital, that it did take time to come down to the emergency room to do that work. I know that the Capital District will do its work to get that done, but unfortunately it's hard to see a Code Census, Code Orange, or whatever you want to call it, happening in that brand new emergency room.

The other issue that presents itself, I believe, is the transfer of patients from other districts. I know that your acting deputy minister can speak to it - and I know the frustration that CEOs have on this one too - that every patient who is admitted to Capital District, or at least was, had to be seen at the emergency room before they were allowed to flow upstairs to the floor that they need to be in, even though they had been seen by professionals and referred by professionals in the districts.

I'm just wondering if you've heard that issue and maybe how we can better use the whole system. Not only is it Capital District, but the feeder hospitals of Kentville and Bridgewater and Truro, making sure they have access to the facilities as well.

MS. MAUREEN MACDONALD: I'd like to say to the honourable member that the deputy has had a conversation as recently as last Friday with the CEO of the Capital District Health Authority about this very issue. We've very aware of it, I'm aware of it on a personal level. I have a really good friend who was a professor of mine a number of years ago and she's an older lady now with some health problems. She also has very little sight, basically no sight, and no family.

I just felt so terrible because she needed to get into hospital, her specialist wanted her admitted and told her she had to come to the emergency department at 6:30 a.m. Monday and sit there because she wasn't a critical case. This was all about getting admitted, getting a bed in the hospital so she could have some procedures done. Given her situation at the time, it damn near killed her, frankly. This is a problem when the emergency departments are the entry point into beds sometimes. I'm very much aware of that.

There are some other issues that the member would know and that's the whole question of seniors who are in long-term care who get into medical difficulty in the long-term care facility. They need to be transferred to acute care and go in through the emergency room and sometimes are admitted, quite often are admitted, to become stabilized and what have you.

I remember meeting with a physician at Camp Hill who also practises in the Capital District Health Authority and is a specialist in geriatrics. He was really promoting the idea of having physician-based, long-term care programs that would alleviate, prevent problems

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before they got to a point where a resident of long-term care had to be transferred and admitted to acute care. I know that Northwood, which is in my constituency and I'll put in a little plug, the best long-term care facility in the province as we all say about the ones in our own constituencies. Northwood certainly has the pilot project, the nurse practitioner pilot project, which I understand has been very successful.

Additionally, they are starting a program now with physician care, a different model of physician care: rather than each resident maintaining their own family doctor as their primary caregiver, more regular care from a physician overseeing the medications, the vitals, Those kinds of things, I think, will hopefully result in less transfers and less pressure on the emergency rooms.

It truly is a system and to do one thing with one part of the health care system, often has an impact on other parts of the health care system. We have to not just look at the flow in the emergency room, but we also very much need to look at what's occurring outside emergency departments. Of course, there is that perennial problem of family physicians, family care, primary care, no access to primary care sometimes and people bypassing the family doctor's office because it's not open when you really need care and landing in an emergency room for something that can more appropriately be treated in a family physician's office.

We know what some of the issues are, we know what some of the problems are. It's about making that whole big ship turn around in the right direction in enough of a coordinated way that you see the impact that you want. I believe we have some good things underway that will see results.

[7:30 p.m.]

I know that Dr. Ross is very aware of the difficulties in our Queen Elizabeth II emergency department, works very closely with the folks there and will bring us, I think, many good suggestions and we'll be listening very carefully to what he has to say.

MR. D'ENTREMONT: Thank you very much and I thank the minister for that and also sort of making the switch from acute care to long-term care and how they are so interdependent. You know we talked about - and I know the new government has talked about it too - that continuity of care, regardless if you're an infant right up to the time that you are on your last days. How you flow through that system is extremely complicated but it should be patient-centred, not hospital building, facility-centred. So how to make that happen is, of course, how this whole thing will succeed.

My next question - while I'm still sort of in metro, I'll continue to ask questions around this - is sort of on the issue of transitional care unit. I'll stand today and admit this to

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be probably one of my largest failures, is to continue to have that transitional care unit in Capital Health.

A couple of years ago, to give you an idea of this frustration, we provided Capital Health to take care of the alternate level of care people, the ALC people, in the hospitals and directly to close this facility. I got the tour of 4 South, or wherever the transitional care unit is, and I was so put off on that one. It was just a place without dignity, it was one that had flies, it had smells, it was just not a very nice place to visit. So I can only imagine what it was for the seniors to live there.

I failed that one and I admit that I failed that one. We provided the dollars, we gave the direction and it did not close. So I'm wondering, maybe today, what kind of ALC issue is still sitting in Capital Health and I'm just wondering, what are your thoughts around the transitional care unit?

MS. MAUREEN MACDONALD: Mr. Chairman, I'd like to tell the honourable member that I have met with the board of the Capital District Health Authority. They were gracious enough to invite me to come to one of their meetings. They had prepared quite a long list of questions for me which I attempted to answer as best I could. I also told them that I had some things that I wanted for them, as well, to be thinking about. Certainly the closing of the transitional care unit is something that was weighing heavily on my mind because I, too, have been to that unit and want a better situation for people. I believe that we can get a better situation for people.

The honourable member would know, Mr. Chairman, that Northwood is building a new facility in the Sackville area, and one of the things that we certainly are considering is the possibility of having that facility house the people who are right now having such a difficult time moving out of the transitional care unit and moving to a situation where we can close that unit. It's very difficult to do, I understand that.

I also had a very interesting conversation with the former Head of Surgery at Capital District Health Authority, Dr. Bonjer, before he left. He was delightful to talk to. He had a lot of very interesting ideas. He had a vision for health care, not only in the Capital District, but I think for the province. What I've come to learn is that people who work in this field all have a passion and they have many great ideas, and we've got to harness these ideas. We really do, we have to harness the ideas, we have to get people working collaboratively, and I think if we do that, we can make some significant changes.

I asked him about the Victoria General and he said to me, well, don't get the wrecking ball out just yet. He actually talked about his vision, his ideas for the transformation of that particular facility into a kind of day hospital, where just day surgeries would be done, and a scenario where you would continue to use the facilities but nobody would be actually living there on the wards; you would be utilizing the facilities for a variety

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of things daily. So people would come to work in the morning and leave at night and we wouldn't incur the cost of shutting down a facility and building a new one and all of that other kind of stuff.

As he talked about this, he had sort of a plan, he had ideas for how you could then - because that would have an impact elsewhere - how you would just start to re-utilize your space all around the Capital District Health Authority, including the Dartmouth General Hospital that the honourable member for Dartmouth East spoke about last evening. There's underutilized space there. Stadacona - and we do have some partnerships with Stadacona, and there's capacity there that we can exploit in some ways, we can further the working relationship. The Cobequid Multi-Service Centre is a fabulous facility, but as the member knows it's not a 24/7 facility.

We need to look at, perhaps, our existing facilities. We need to look at the capacity in the Windsor hospital; I understand that there is greater capacity in the Windsor hospital operating room than we currently use. There's one operating room that's basically not in use, I think, if memory serves me right.

There are things we can do without taking down all of the facilities we have and investing heavily in brand-new infrastructure. Perhaps we really need to take a page out of the Coady International Institute that opened their new digs at St. F.X. on the weekend, where they refurbished and did an amazing job with buildings that were condemned when I was a student at St. F.X. in 1971. Anything is possible if we allow ourselves to have a bit of a dream and have a vision and work collaboratively.

MR. D'ENTREMONT: Mr. Chairman, I'm really enjoying the discussion and I can't believe we've got about, what, six minutes left before we have to move on. I'm just watching the member from Cape Breton, he keeps making funny hand signals. (Interruption)

Dr. Bonjer was a tremendous benefit to us. He had tremendous insight on how to run a system and I was very upset the day we heard he was moving on. I look at the work that he did on the training centre over at the Victoria General site and the old nurses' residence downstairs where people can get some live training without impacting a patient or getting those skills up to snuff in conjunction with the Medical School and his ideas around utilizing Stadacona, the issues of using Dartmouth General, and the list goes on of the ideas that Jaap had for the system here in Capital Health.

The frustrating thing that I always found in the department was that all these ideas were wonderful, and you could always see that if I do this, then it frees up this, this patient is going to get taken care of in a better way and you're going to free up some dollars to move over here, because there's no such thing as savings in the health system. There really isn't because as soon as you see - and I'm sure Ms. Penny can attest to that - the second that there's something freed up, there are another 10 things in line to gobble up that dollar. But

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again, we need to be patient-centred, we need to look at the patients and how they're going to be taken care of in a faster way, in a better way.

Let's say just Dartmouth General, for example, to take that floor, we had looked at the possibility of turning it into another transitional unit, designing it so that it can be a long-term care facility. So we sort of gave that away and said, okay, you guys come up with a plan for - what is it, the 5^th floor of Dartmouth General? - come up with a plan for it. All of a sudden it comes back that they want another surgical floor and the surgical floor is going to cost $15 million. So it's like you're scratching your head, oh, my God, what have we just created? So we need to really watch some of these ideas and how they get grand at times.

I think the Victoria General site is a wonderful site, yet I don't know with the issues of Legionella - and I'm sure I'll ask you a question on that later too - with Legionella in the water in this system, you do have to strip that building, one end of it to the other. Maybe you can preserve the beams and the cement but everything else has to be changed. I'm not a construction specialist and I don't know what those things cost in the long run. Whether we can preserve it or not, I don't know.

The other issue that he brings up - he's talking about making it a day surgery site which is wonderful. That's a great idea but what we need to do and one that I urge you to look into is taking the surgical program that's at the Victoria General site now and getting it over to the Infirmary site. Right now we basically have two teams of surgeons, nurses and anesthesiologists working at two different sites. That's really inefficient.

I talked to Jaap on a couple of occasions where there was a cardiac issue. Well, as they were operating on this individual, there was a cardiac issue. Guess where the cardiac person was? The Infirmary site. By the time they were able to get the cardiac person to the Victoria General site, the patient had expired. So you have a tremendous problem in trying to amalgamate those services in one site and then utilizing the space you just freed up for that better service that I think we all want to see.

I thank you very much for the hour of questioning and I thank you very much for the answers and I look forward to taking my next hour in a bit of time.

MR. CHAIRMAN: The honourable member for Clare.

HON. WAYNE GAUDET: Thank you, Mr. Chairman, I'm pleased to have an opportunity to raise a few questions with the Minister of Health. Tonight, with the few minutes that are available, I want to start off with long-term care facilities.

Back in February 2007 the government announced an additional 832 long-term care beds by 2010. Also in that announcement, the government indicated that nine or 10 existing

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long-term care facilities would be replaced. So my first question to the minister is, is the department still on track for these new beds to be open by 2010?

[7:45 p.m.]

MS. MAUREEN MACDONALD: Mr. Chairman, earlier in the estimates I tabled a list of new and replacement beds. It shows right where we are. I have some additional copies here, if the honourable member would like to have one.

MR. GAUDET: I certainly welcome the minister to provide me with that information. In that announcement, the government also allocated some beds to the southwest area. In that announcement made back in 2007, 52 beds were allocated to the southwest area.

My question to the minister is, can the minister confirm if the southwest area is still going to get those 52 new beds? The second part to that question is, where will these beds be allocated?

MS. MAUREEN MACDONALD: Mr. Chairman, I'm looking at my list here. I see a number of replacement beds in DHA 2, Tidal View Manor, but I don't think those are the ones that the honourable member is referring to.

There were beds, Bayside in Barrington - 40 beds. I'm just trying to identify from this list which ones would be - Nakile, 22 in Glenwood. Perhaps that's the - well, that's 62 new beds. So I'm not really sure. There are 62 new beds that have been announced, Nakile and Bayside, for number two, so they amount to 62 new beds, not 52.

MR. GAUDET: Wonderful, thank you, Madam Minister. As the minister is aware, and I'm sure you are aware as well, Mr. Chairman, many rural areas of the province like Clare have an aging population. I know in Clare - and I'm sure this is not unique to our area of the province - there's a desperate need for additional beds, long-term care beds for the increasing number of elderly people who do not want to, and should not be expected to, leave their communities.

I know that Villa Acadienne in Meteghan has said that with 10 additional new beds, they would be able to accommodate our francophone seniors and other individuals at home and receive services in their own language. Unfortunately, Clare did not receive any new additional beds in round one.

I did have an opportunity to raise this with the former minister. He did indicate at the time that this will certainly be looked at in round two. Now, we know that when the government made the formal announcement back in 2007, they also announced round two. So in round two, the government was looking at announcing an additional 500 beds by 2015.

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My question to the minister is, is the government still planning to go ahead with round two and, if so, can the minister indicate to myself and members of this committee when the government is planning to make a formal announcement with regard to the second round of additional long-term care beds?

MS. MAUREEN MACDONALD: Mr. Chairman, I'd like to say to the honourable member that a fair amount of planning work would have to be done. We're not there yet, and we will be assessing the bed capacity that we get out of this particular version - I guess, round one. We're still, as the member would know, dealing with one or two of the smaller projects in terms of trying to get them in on time and on budget, and we will be having discussions about the additional beds in the future.

MR. GAUDET: Mr. Chairman, the Municipality of Clare has forwarded a proposal to the Department of Health to replace the Villa Acadienne with a new facility. Villa Acadienne opened in 1974. It has 86 beds with two respite beds. The fire marshal has raised some safety concerns with the existing nursing home in Meteghan that need to be addressed. Also in the first announcement, with the replacing of nursing homes, Tideview Terrace in Digby has been announced to be replaced along with Tidal View in Yarmouth. Both of these nursing homes will be replaced.

The fact is that these nursing homes that are being replaced opened at approximately the same time as the Villa Acadienne in Meteghan opened.

My question to the minister is - I know that the Municipality of Clare has not received any formal acknowledgement from the Department of Health with regard to the proposal for a new facility. So my question to the minister is, will the Department of Health give full consideration to replacing the Villa Acadienne in round two?

MS. MAUREEN MACDONALD: Mr. Chairman, I'd like to say to the honourable member that the department will certainly look seriously at any of the proposals that come forward. We're learning a lot about the capacity of smaller communities to bring new and replacement beds in on time and on budget. We've had great success in many cases with this current round. This government is very committed to keeping seniors in their own communities, close to their own families, close to their own support networks, available to their roots and their cultural traditions, their language. So all of the issues that the member has raised certainly form part of the values that we have with respect to the respectful treatment of seniors in their old age. We would certainly look at any proposal that comes from your community with every serious consideration.

MR. GAUDET: Mr. Chairman, I'm glad to hear the minister talking about the government being committed to keeping seniors in their own home or within their own community.

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I want to shift a little bit, talking about placing francophone seniors or other individuals outside of Clare in a nursing home. Mr. Chairman, there has been some progress made to current placement policy to allow French-speaking seniors or other individuals to wait to be placed in his or her Acadian community, or near their community, and request an exception to the first available bed provision without losing their place on the waiting list for placement.

Mr. Chairman, everyone understands that in order for a bed to become available, a resident needs to be hospitalized or transferred to another nursing facility or, sadly, pass away. However, the general public at home, especially in Clare, doesn't quite understand some of these placements. For example, in Clare we had some - and I say some - seniors in Clare at times who are being sent outside our areas for care. At the same time, we have people or we have residents from outside Clare who are being placed in nursing homes in Clare. At the same time we have people from Clare leaving our community, being placed outside, and at the same time we have people from outside who are coming into our nursing homes. Many people in Clare can't quite understand the logic behind this.

Mr. Chairman, with the lateness of the hour, I move that we adjourn the debate for today.

MR. CHAIRMAN: Is it agreed?

It is agreed.

The honourable Government House Leader.

HON. FRANK CORBETT: Mr. Chairman, I move that the committee do now rise and report progress.

MR. CHAIRMAN: The motion is carried.

[The committee adjourned at 7:57 p.m.]