HALIFAX, TUESDAY, APRIL, 12, 2011

 

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

 

2:29 P.M.

 

CHAIRMAN

Ms. Becky Kent

 

MADAM CHAIRMAN: Order, please. The Committee of the Whole House on Supply will now come to order, and we'll continue with the estimates of the Minister of Health and Wellness.

 

The honourable member for Halifax Clayton Park with 25 minutes remaining.

MS. DIANA WHALEN: Thank you, Madam Chairman, we'll continue our discussion that was begun yesterday with that time allotted for our caucus. I know we're going to have a number of hours in the duration of the estimates, so there is ample time to look at what the members of the public, and certainly the members of the Legislature, know is the largest single budget of any department in the entire government.

 

This year we are looking at a budget that is now approaching $4 billion - it's getting close to that - and I realize we've got the smaller budget of Health Promotion and Protection that has now been brought in to this department, but we still have an estimate for this year of $3.768 billion, which is a tremendous budget.

 

I know there has been talk about trying to rein in the increases from year to year, and today I heard of a C.D. Howe study that called it a "chronic spending crisis in health care." Examination of these estimates - I think while every department has a role to play in good government, the Department of Health and Wellness has such important work to do and yet so much pressure on its budgets, so we're going to continue on with some of the line-by-line items that I had begun to ask about yesterday.

 

 

 

127

 

I wanted to go back to a question I asked yesterday, which was about the fact that the estimates don't coincide - they're not the same from last year's Estimates Book to this year when we looked at the year 2010-11. I don't know if you're able to provide the explanation about the Executive Administration that's up $670,000, or Medical Payments which is up $1.668 million - well over $1.05 million - you did give an explanation around the Pharmaceutical Services line and I'd also like to say I really think, because of the departments coming together, we need footnotes because it isn't transparent for members of the Opposition or members of the public who want to look into these figures, or researchers, or anybody else.

 

When they're trying to understand these numbers it's very difficult because you're not comparing last year's number to what appears to be last year - it is masked, it's kind of foggy and I really would like to suggest that in future we look at having some financial footnotes to the statements that would explain it, and I know there would be a lot of them because of the merging of the two departments.

 

I wonder if I could just look for the explanation on those two numbers.

 

HON. MAUREEN MACDONALD: Madam Chairman, through you to the member, I want to agree very much with the point that the member has made. I remember very well being in your shoes in terms of trying to understand the estimates, as presented from year to year, when there are significant structural changes in departments. In fact, going the opposite way, I think I was the Health Critic for my Party in Opposition when Health Promotion was first established as an office, and then later established as a department. It was equally as confusing to try to figure out what that really meant in terms of the budget of the Department of Health when you saw significant expenditures drop in certain categories and you couldn't really tell if there was a reduction in services and programs inside the Department of Health and what was attributed to the transfer. So I understand very well what the member is getting at.

 

I think there was a time when the estimates provided a bit more detail than they do today. It's often not until the Supplementary Detail comes out that we really get an opportunity to eyeball in a much more detailed way, program by program, grants and all of that kind of stuff.

 

Having said that, last evening the honourable member raised some questions - I think this was the Executive Administration section and the fact that there are some differences in the estimates this year versus the estimates last year in this category. I think that's what in 2010-11 - yes, versus the Estimates and the Supplementary Detail - we were saying that the difference was really a movement of some programs internally. So I have more detail on that.

 

Having had the question last night, we've had an opportunity to look at that, and what has occurred is some programs were moved. Infection Prevention and Control was moved at $464,000, and Midwifery Regulatory Council, $206,000, for a total variance of $670,000. This is the administration for Infection Prevention and Control and the Midwifery Regulatory Council and they were moved out of the category of Other Health Care Initiatives - that's the former program area they were in and they now are in Executive Administration. Perhaps that is helpful to the member.

 

Additionally, in the Medical Payments category - and I believe the member had raised the same concern in the Medical Payments category - so in 2011-12, what has occurred is the Physician Resident Tuition and Dalhousie Medical were moved as well from Other Programs to Medical Payments, and Physician Training Seats were moved from Other Health Care Initiatives to Medical Payments, so that accounts for a total variance of $1,668,000. Pharmaceutical Services was the other variance that the member identified and in the budget year 2011-12, Oncology and Exception Drugs and MS Society funding are being moved from Other Programs to Pharmaceutical Services - this represents $10,094,000. I hope that helps the member.

 

The other issue that the member raised last evening was with respect to staffing. We were trying to reconcile those numbers and so I just want to take an opportunity because staff did go back and go through the numbers to try to get some reconciliation there. We had identified that there were actually 148 HPP positions transferred to the Department of Health and Wellness, and four of those positions were eliminated due to the merger, bringing it to 144. Physician Services are getting some additional positions, starting the first of September this year - 2.9 additional services, and I think that's reflected in the estimates.

 

We had talked about the projects, the full-time equivalents on projects that have been completed, of 25.2. So when you deduct the four positions that have been eliminated, you get 144, you add in 2.9 and then subtract 25.2 and the result is 121.8, which is our full- time equivalent estimates in terms of additional positions for 2010-11 - there is also an additional subtraction of 13.7 full-time equivalent positions, which are staff that HPP funded by external agencies, for a total of 108.1. That explains the difference on Page 14.3 between the 2010-2011 Estimate of Total - Departmentally Funded Staff and the 2011-2012 Estimate Total - Departmentally Funded Staff. In the interest of trying to bring some clarity to those questions last evening that explains the difference.

 

MS. WHALEN: I appreciate going back to the staffing numbers because as you remember part of the underlying issue here is the global budget for the government and how we're heading towards some reduction in staff over time in order to save money so that in the next year or two the budget becomes balanced, and the Finance Minister is able to demonstrate that that can be done. I've been looking at other departments as well to see where there are reductions that are going to make a significant difference - and we're looking at over 1,000 positions in that three years.

 

Health and Wellness is the largest department for spending but not for staffing, not the numbers that you show here because the DHAs control most of the people working, they certainly have all of the front-line health care staff. But still we're talking about what shows this year as 505 fully departmentally funded staff or FTEs, full-time equivalents. The 108 does jibe if we take the estimate last year of 397 and compare it to the 505 this year.

 

I'm interested to know where the difference is on the forecast for 2010-11 compared to the estimate of 2010-11, because there's a difference there of more than 60 positions. It would mean the forecast should be close to the actual of where you were as we wrapped up the year, March 31^st, and now looking forward to where you expect to be in this current year at 505. There are quite a number if we're talking 60 positions - that's more than 10 per cent of the positions in the Department of Health and Wellness. I would like to know, and as I say if you are at 500, 50 positions is 10 per cent - we're higher than that and there's just an unknown. I won't say a discrepancy, just an unknown there.

 

MS. MAUREEN MACDONALD: Madam Chairman, through you to the member. I think this is really an interesting discussion and it's certainly one that in a very practical way I, as Minister of Health and Wellness, have had to really think about - and I think about this a lot, on a very regular basis and that is the balance that you need to have in the Department of Health and Wellness between the necessary staff to do the important work of planning and delivering high-quality health care service to Nova Scotians. The staff in my department is tasked with, in my view, one of the most important functions in government - they are what makes government worthwhile.

 

And as the honourable member would know, Madam Chairman, our government is very committed to Better Care Sooner for Nova Scotian families, and Better Care Sooner can only be delivered to families if we have a hard-working, capable, skilled workforce who do the planning and the coordinating of the work that is required.

 

To take a health care system that, frankly, had a lot of gaps in it and that was going in a certain direction and to change that direction, which is essentially what we've had to do, that means investing in staff, investing in the workplace in a way that you have strong leadership; you have the right people in the right place, the right team, and I'm very pleased to say that many of those people existed in the workplace when I arrived as minister - and we've had some great additions to our staff in the department, right at the very top, with a deputy who is not new anymore but certainly walked into the Department of Health and Wellness as a new deputy throughout many aspects of that organization.

 

I have to say one of the things that really quite surprised me when I became Minister of Health and Wellness was just how small the department bureaucracy actually was. If you consider that the Department of Health and Wellness has a financial portfolio of more than $3.5 billion, which was what it was when I arrived in the department, you have a portfolio - the Department of Health and Wellness represents more than 40 per cent of government spending in the province and yet the staff complement to do all of the planning, the policy work, the coordination, the evaluation, was slightly over 300 staff. It's a very, very daunting situation that staff find themselves in, and I have to say I have been very impressed with the willingness of staff to work very hard, to work co-operatively and collectively, to focus on the priorities that the government defined and gave them, in terms of Better Care Sooner - and they continue to do so.

 

We have brought into that mix now the staff from the former Department of Health Promotion and Protection. It does increase the complement in the department by close to 150 staff but, nevertheless, when I look at the challenges of our health care system and the challenges that the government has given the provincial bureaucracy in terms of implementing Better Care Sooner, I have to say I'm very pleased with the dedication of staff and their abilities to work hard and to pursue the policies.

 

I frequently meet people in the community who stop to talk to me about some initiative that the government has announced, maybe it's the collaborative care centre, maybe it's the fair drug price program that we've embarked on, perhaps it's the mental health strategy - people will stop and thank me and say how happy they are. Of course I'm very pleased to get positive feedback, but I'm particularly cognizant of the fact that it is these men and women who work in the department doing the background research, organizing the meetings, bringing stakeholders in, who are doing so much of the good work.

 

When I think about, for example, we were very pleased with the initiative that we were able to achieve with the physicians in the province with respect to putting off their wage increases. This was done through a lot of work - a lot of hard work. It was done by the public service; it was done with people in Physician Services, which is a teeny, tiny little group inside the Department of Health and Wellness. It's so teeny, tiny that, in fact, the doctors' organization, Doctors Nova Scotia, at one point said to me you really need more staff in that unit, minister, because we have so many complex issues and agreements and working groups, and we have a great respect for your staff, but really there aren't enough of them to carry such a complex portfolio.

 

And not just complex, but in terms of the amount of money that is overseen around physician payments you require a complement of staff to be able to do this. I look at the workforce we have and I'm very cognizant of the balance we have to strike with that workforce between the number of people we need to do the work and the cost of bureaucracy. There's a perception, sometimes, that you have this huge bureaucracy that could be a lot leaner - and it's true, we can always find certain efficiencies and we work very hard in our department to maximize the staff as much as possible.

 

I know I've gone off on a bit of a tangent, but I thought it was very important to let the members know a bit of the reality of the staff in the Department of Health and Wellness. I think the member was looking for vacancies, if there are vacant positions, and the forecast in terms of the variants. That, I think, is 63 full-time equivalent positions. These positions are vacant for periods of time. Perhaps we're in the hiring process for some of them - it doesn't necessarily mean that 63 individual positions are vacant. We do some work in the department by using temporary agencies for set periods of time, from time to time, to get work done.

One of the things I've noticed in the Department of Health and Wellness is that I think we have predominantly a female workforce in the Department of Health and Wellness, and we know if you study the labour market and women's involvement in the labour market, you will know that women, because often they have responsibility with respect to children or perhaps even caring for an elderly parent, sometimes have to leave the workforce for a period of time. In a department such as our department we would certainly attempt to have some temporary replacements, from time to time, for people who have to leave to provide care.

 

The other unfortunate reality is the people who work in our department are like people everywhere - people get sick, people get cancer, and this has occurred in our department. We've had members of our staff have to go off on sick leave, and they often go off for a period of time throughout their treatment and perhaps we will backfill those positions with someone on a temporary basis. So there is this variance provided for, in the estimates, for those positions.

 

MADAM CHAIRMAN: Thank you. The time allotted for the Official Opposition has expired, and I now recognize the honourable Leader of the Progressive Conservative Party.

 

HON. JAMIE BAILLIE: Thank you, Madam Chairman. I do want to just say that I appreciate the line of questioning that the previous speaker, the critic for the Liberal Party, was engaged in. It will shorten my time somewhat because we have a lot of similar questions. I just want to acknowledge that she did a very good job in asking the minister about the estimates.

 

I do have a couple of brief remarks to set up my own line of questioning, Madam Chairman, and I would like to start by acknowledging, first of all, the work of the minister, the deputy minister and, through him, his officials at the core Department of Health and Wellness. I think it's a safe assumption that they were not placed in the jobs that they hold today by the Premier because he felt that this was an easy assignment. The minister, the deputy and all of those who work in the core department are placed there because, in fact, it's a very difficult assignment at times. So I just want to acknowledge the hard work that I know is done by officials in the department and will, as we get into the questioning, keep that in mind.

 

I also, in my own riding and in my travels across the province, meet with many of our front-line professionals, whether they're family physicians, whether they're specialist doctors, whether they're nurses or licensed nurse practitioners, and a whole variety of people, paramedics and others who make up our delivery system. I have come to appreciate the level of hard work and professionalism that is provided directly to Nova Scotians at a time of some stress, not just in our own province but obviously I think we should keep in mind that all provinces are struggling with delivery of health care at a time of financial restraint and so on, and that is why I know that there is a great expectation on the part of Nova Scotians that the system will evolve to meet modern day needs, to meet modern day financing ability and so on.

 

I think we all agree, or certainly everyone in the Progressive Conservative caucus and I'm sure in this House agrees, that we are committed to the five principles of the Canada Health Act to a publicly funded and universally accessible health care system, one that all Nova Scotians know they can rely on whether it's for emergency services or for ongoing primary care, or for their special needs and interventions as they sometimes come up.

 

Having said that, Madam Chairman, there is this crying need to adjust the health care system to the needs of today, and I can't help but note that one of the recommendations in the Dr. Ross report, Recommendation 19, was that we should communicate, communicate, communicate, where we are going with health care reform. Dr. Ross' report has been held up as an example of what we can do in emergency services and, in fact, in my own riding, in Parrsboro last week, we made a start. The government made a start in the emergency service reform through the announcement of a Collaborative Emergency Centre for Parrsboro.

 

It is a far cry from what was promised to Nova Scotians in the last election - and I feel compelled to point that out because if you compare it to what people were told they were going to get, it is well short of that. Having said that, that promise and the scrambling to get away from that promise is well documented and I won't dwell on it. The important thing is that now that we are where we are, we show Nova Scotians what the real plan is. We did take a step, the government did take a step in that direction last week in Parrsboro and Dr. Ross was there and so on; however, using Dr. Ross' own rule that we should communicate, communicate, communicate, I just want to convey to the minister and to her officials that there are an awful lot of unanswered questions yet in Parrsboro and in Cumberland County, and as this rolls out across the province I'm sure those same questions will remain.

 

We know in general terms that the plan is that people will be treated in an emergency situation by "an appropriate level of health care provider". Specifically what that means when you want to do a traditional emergency visit, whether you have a broken arm, whether you have a headache, whether you have tightness in your chest, whether you have an irregular heartbeat, there are a lot of specifics that remain unanswered at this point and I think it's important that we not just roll out part of a plan, but we be prepared, that the government be prepared to answer these questions when they come up.

 

In the specific example of Parrsboro, in Cumberland South, people are confused about when they go to the new CEC, what time of day, when they go to All Saints, for example, in Springhill to a traditional emergency department, when they go straight to the regional centre in Amherst and when they go to a unique specialist in Halifax. In an emergency situation a resident of Parrsboro does not have, yet, a road map to guide them through those decisions.

Perhaps the plan is that they all go to the CEC and they are triaged appropriately there and then sent on, but these are things that residents of Parrsboro need to know, that residents of all Nova Scotia, as this rolls out, need to know. I only bring this up in the spirit of Dr. Ross' own recommendation on communicate, communicate, communicate.

 

One of the elements of the new plan that was presented to the citizens of Cumberland South, which I'm sure will be part of the government's sales efforts around the province, is that although this new plan does not mean there will be a doctor in the ER necessarily when you get there - there may be one available by telephone, but there won't be a doctor there after hours which, again, is a disappointment, I'm sure, to Nova Scotians.

 

One of the selling points that the government raised was that that will free up our doctors to be available to see more patients and do other things. Of course that remains to be seen, Madam Chairman, because in the plan, as we know it to date, there is no way to measure that, there is no proposed incentive plan to ensure that doctors actually do take on more patients and are compensated for it, or spend their time in other areas of health care delivery, this free time that they now have freed up. Some doctors remain on fee-for-service, others have been put on alternative forms of payment, like fixed salary.

 

I can tell the government through you, Madam Chairman, that in other provinces they have mixed results in this area. In Ontario, for example, in B.C., they've discovered that in order to make this work you have to match up this freeing up of doctor time with real incentive payments to make sure that time is returned to patient delivery in other ways in that way.

 

The plan, as we see it, as far as it has been unveiled to date, doesn't go in that direction, so one of the things we'll be wondering is what the plan is to make sure we capture that spare time that the government is creating for our doctors. These decisions should be made on the basis of evidence. It's great to say in good faith that doctors will take on more patients and provide other services, but this is something that truly remains to be seen and we need to know - again, as Dr. Ross would say, communicate, communicate, communicate.

 

Madam Chairman, I do want to move on to the setting of real targets for population health and for measuring our health care system. I raise this so that we're not only talking today in the estimates about the dollars and cents of health care delivery. We spend a lot of time on the specific dollars, which is important - this is 40 per cent of the total budget, it's moving up to be half of our spending, 93 per cent of the estimates are grants and transfers to others, like our DHAs. In business I would say this is our greatest area of risk, so Nova Scotians want to know, in real measures, what are we getting for this expenditure of total dollars?

 

So as much as we're going to ask a few questions about the budget itself, what is clearly missing, particularly in the areas of population health, are real targets. So when a government wants to eliminate a financial deficit, it sets targets. Why not apply the same energy and zeal to population health outcomes, like childhood obesity, diabetes and other chronic diseases, smoking in young people and in our population as a whole? These are targets we should not be afraid to set, so that we know when we make dollar investments in these areas that we have something to measure it against.

 

One of the bills introduced by our Finance Critic, which I won't get into in detail here, talks about requiring that programs have targets so that we can measure the benefit and our progress against those targets for the dollars that we're spending.

 

I know Nova Scotians are concerned that we're reaching the $4 billion mark in our small province on health care dollars, but in the absence of true measures of how we're doing in keeping the population healthy; how we're doing with wait times - which has been a constant struggle and that's not new to this government, I will acknowledge; and how we're doing in patient care, we have nothing to compare that massive expenditure of dollars to.

 

It would be to the benefit of the minister, it would be to the benefit of the department, and it would be to the benefit of all Nova Scotians if we could create some of these measures, publish them openly, and then compare our progress against them over time. I just want to call on the government to move beyond the creation of ever more strategies, because we have strategies on top of strategies, on top of strategies - some have been promised two and three Throne Speeches in a row. We don't have them all; there were 14 in the most recent Throne Speech. Let's move beyond the strategies and into some real targets and areas that are important to Nova Scotians, like these areas.

 

Madam Chairman, I mentioned a moment ago that 93 per cent of the health estimates are taken up in transfers to others, primarily our district health authorities, which are half of the total budget. That is 93 per cent of $3.5 billion, clearly well over $3 billion is transferred to others and I think it's important that we have the same level of transparency, the same level of detail, the same level of rigour in the examination of where that money goes as we're going to apply here today to the Department of Health of Wellness.

 

Yet if we look at the reporting of our district health authorities, it is very difficult to trace that money to where it ultimately goes. When we're talking about $3 billion- plus, that is a lot of money. Many of the district health authorities produce annual reports that break their expenses down only into five areas: acute care, mental health, addiction services, primary care, and care coordination. It is impossible, with such summarized reporting, to know for example how much is being spend on administration, on executive salaries, on benefits, on travel and so on, when those numbers are buried in with those five general areas.

 

How did we let half of the budget go into this dark hole and not have more detailed reporting? I think the department itself, the minister herself should be very concerned to be on top of where that money goes, and yet we are left with summarized reporting. Some of the DHAs go for more than two years without producing an annual report. The Capital Health District, which is half of the total transfers to the DHAs, is not providing this kind of detail on a timely basis, nor is it breaking it down in a way the departments can do its job of staying on top of where that money goes, or that the House of Assembly can properly do its job of tracking down where that money goes.

 

Madam Chairman, literally billions of dollars are not facing the scrutiny they deserve because of the way that the DHAs report the results to the Department Health and Wellness - and that should not be acceptable to this House, to this committee, to the officials of the department, or to the minister herself. So I'm hoping that when we get to this point at some future day that we'll be able to examine in detail the administration, the executive salaries, the travel, the consulting, all those things that go on at the DHA level that we aren't able to examine sufficiently today. If we can get to that point where we're actually measuring results for the dollar spent and knowing that every dollar that can possibly get to front-line care is there and isn't caught up in administration - if we can get to that point, I'm sure we would all agree in this House that we have made a major step forward both in terms of where the dollars go and what Nova Scotians are getting for their money.

 

So with those brief comments, Madam Chairman, I will actually launch into a few questions for the minister and, if I may, I will start on this theme of where the dollars go.

 

We know from the announcements, before the budget, by the government that DHA transfers are frozen for this year. We also know that the government set targets for all departments for real reductions at the departmental level, 5 per cent and 10 per cent reduction scenarios in dollars and FTEs. Honestly, Madam Chairman, in the estimates I cannot see where that has been achieved in the case of the core Department of Health and Wellness. I'm wondering if the minister could share with us the department's progress in meeting its own budget reduction target and reconcile that progress to the estimates that are before us, whether that is a calculation that has been done and is available in print or whether the minister could just walk us through where is the minus 5 per cent, which, I guess, in greater detail is meant to be a multi-year target, and by the government's own target setting it was meant to be minus 3 per cent in the first year and then minus 1 per cent, and minus 1 per cent in the years after that - can the minister enlighten us on where that shows in the estimates for the upcoming year?

 

MS. MAUREEN MACDONALD: Madam Chairman, we certainly have a menu of issues that I'm delighted to have an opportunity to have some dialogue with the honourable member on, starting with the first point he made about Dr. Ross' recommendation to communicate, communicate, communicate. I was hoping I would have an opportunity to speak to that issue, actually, at some point here through the debates.

 

I want to start first by again acknowledging the excellent work of Dr. Ross and thanking him for his work. He is a delight to work with and, as with so many health care professionals, just completely dedicated to improving health care services and constantly looking critically, and I don't mean with criticism, I mean analytically, at what it is we're doing - what are we achieving by doing things this way? Can this be done better? What would that look like? What is it we need to do to get to better health care for our patients and for the public at large for our province?

 

As members know, Madam Chairman, Dr. Ross went around the province and he met in every ER throughout the province with health care providers and when he came back to myself, the deputy and the department, he did in fact talk to us about the importance of communication with people around the province.

 

Again, I'm going to make an observation, a little confession perhaps. The challenge for myself, the deputy and other members of the staff in the Department of Health and Wellness, is to find that balance between getting out there in our province, meeting people, listening to them and learning from people in communities about the real day-to-day challenges that they face in getting and receiving health care services. I will tell you, it's an excellent way to be in a leadership position and have an opportunity to shape the direction of health-care - you absolutely have to do that. You can't do that on the 4^th floor or the 8^th floor or the 12^th floor of the Joseph Howe Building.

You have to get out in the community and meet with people, and a number of things happen when you do that. For me what happens is I learn so much about the reality, the complexity, but the thing that I often learn the most is I'm inspired. I see the men and women who work in our health care system just rising over and over to challenges - challenges sometimes that haven't even occurred to me.

 

Not so long ago we announced the paramedic program here in the Capital District Health Authority where the paramedics will go to the 15 nursing homes and provide care to, generally speaking, frail, elderly people who require care rather than taking them to an emergency room, rather than having them wait on a stretcher for long periods of time. To hear the paramedics who have been doing this here in metro was very inspiring. I'm always inspired by those men and women - I say that, at my peril, I suppose, because there are so many wonderful health care providers in the province but I can't help but say, and thank, often that the EHS service is the crown jewel in our health care system. The paramedics in this province have the most can-do attitude and culture that I have ever encountered. It is extraordinarily inspiring and it's just very heartwarming to listen to the stories from paramedics, but more importantly from patients, with respect to the work they do.

 

When we launched that particular program, there was an elderly lady and she talked about - I think she had a minor fall and had sprained her wrist and the paramedics came in and she didn't have to go to the emergency department, she was taken care of. It was all wonderful hearing this story, but I what I learned wasn't about the good care, it wasn't only about this new system we had - when the paramedic spoke, he talked about the frustration that paramedics frequently feel when they're in the ER with a patient like this lady with a minor problem that they know that they have the ability to deal with within their scope of practice, yet our system and the way it was structured required that they only transport and then stay with this lady perhaps for three or four hours or more before she would get to see a treating physician, and how now that they will actually be able to use their skills.

The kind of empowerment that has meant for them and the easing of the frustration that they feel, that aspect had never really occurred to me and I would never really have known that if I wasn't there listening to the paramedics out in the community - and this happens over and over and over again.

 

Because of the Dr. John Ross report, I had an opportunity to go around the province - and I've been from New Waterford to Annapolis Royal, Lunenburg, Tatamagouche, Springhill and several other communities, Canso, talking to health care providers in many of our small community hospitals. I have to say, I am a bit disappointed in the remarks by the honourable member with respect to what he feels are shortcomings of the Collaborative Care Centres and the fact that he thinks that this isn't a good solution, or the solution that people, or perhaps he, thought was planned.

 

Madam Chairman, we've always been clear that it's our intention to provide 24/7 ER coverage in communities, which is what we are doing; that we would begin that process by hiring an ER advisor, which we did; that as Minister of Health and Wellness I would introduce an accountability Act on ER closures, which I have done; and table a report and then work to find a sensible plan to address the very real problems with the uncertainty and instability that communities have faced over and over again all around our province when family doctors are unavailable to staff ERs 24/7, and where people in communities are unable to get to see a family physician for their primary care, their regular health care needs for perhaps an earache, flu, infections, renewals of prescriptions, all kinds of things, because we were working those people ragged in terms of trying to stretch their resources too far.

 

The solution we have in terms of opening Collaborative Care Centres where we can staff those centres with a health care professional such as a nurse or a paramedic in the off-hours when the demand for services is very low, which is based on evidence, which is based on the data that we have in the department, over many years, that will show us the patterns of use in those departments, this is such a sensible, practical and good solution for people. I can tell you that in communities where they are doing this, for example Musquodoboit, this has been well-received by the community.

 

Let me tell you, if the honourable member says that the people of Parrsboro are confused about what is going to happen, where they should go and when and what have you, their confusion will not last long - and for a number of reasons. We do intend to communicate, communicate, communicate. We have already started that process with respect to being in the community and making the announcement, but we will be sending to every resident of that community, information about their health care services and how those services are going to work.

 

I want to tell members, Madam Chairman, about the meeting I had in Musquodoboit with members of the community. I asked members of the community how they found the collaborative care model working, and this one lady says, well, I'll tell you, yesterday morning I got up around 8:30 a.m. and I wasn't feeling very well and I called up here to the centre and at 9:10 a.m. I was sitting in the office seeing someone. You can't do any better than that, she said.

 

So the consensus of people who attended that meeting I had in Musquodoboit - these are residents from the community; I don't know these folks; I had never met these people before - their consensus is that they want faster access to a health care provider when they need it. They don't want to have to go sit in an emergency department to get health care unless they have an emergency.

MR. BAILLIE: I would like to use this moment just to be clear. Although I do believe that the new model is not what Nova Scotians were promised - I think many Nova Scotians would agree with that - I have not expressed my disappointment in it or criticized it unduly other than to make that one point. In fact, I do want the minister to know that I've gone out of my way, both as MLA for Cumberland South and as the Leader of this Party, to say that never mind what was promised, now it's two years later and we are where we are, we have to move forward. I've actually said, and it's been reported, that this is a practical step forward.

 

I only say that just for the minister's own benefit, to know that is where we are. Starting from where we are today in emergency services, this is a practical step forward - I've said that publicly and I want to share it again with the minister. My point on communicating is that we have the announcement in the case of Parrsboro, the new CEC will be up and running in July and there are some unanswered questions, and this is why we ask these questions in estimates.

 

The minister shared today that the plan is to, by way of a mail-out and other means, address these questions with the residents of Parrsboro and Cumberland South; I'm delighted to hear that. Hopefully we will get to that better day where confusion isn't the case, where people know exactly what they are going to do to access this new form of emergency services, and I'll be glad when we get there.

 

Having said that, I just want to remind the minister, through you, Madam Chairman, that my question actually was helping me reconcile the self-imposed target of a 5 per cent reduction over three years in the administrative costs, in the department level costs - 3 per cent this year, which is the year that the estimates cover, and 1 per cent and 1 per cent after that - with what appears to be an increase in administrative costs according to the Estimates Book when you combine the Department of Health and the old Department of Health Promotion into the new Department of Health and Wellness.

 

I am sure she was going to get to that shortly in her answer - I will just remind everyone here that was the question I had asked, and I am looking forward to hearing the answer to that question. Perhaps until I get a signal from the minister that she's ready to proceed, I will add to that question.

 

I had raised, in my opening remarks, a concern about the level of reporting at the district health authority level - that's reporting to the department and then through the department to the House and to all Nova Scotians - and whether she as minister is satisfied with the level of reporting at the DHA level given the significant amounts of money involved, and has the department considered taking steps to increase the detailed reporting that we get at that level so we can evaluate the DHA progress as meeting cost containment targets at the administrative level? I think I'll stop there and take my place.

 

MS. MAUREEN MACDONALD: I want to first start by correcting the number that the honourable member was using with respect to the amount of money that DHAs receive from the department - it's approximately $1.6 billion, not $3 or $4 billion. It's $1.6 billion.

 

However, having said that, point well taken, it's a lot of money. It's a lot of money that does go to the DHAs. The member raises a question with respect to accountability. I don't know if the member was here when the Minister of Finance introduced changes in the financial reporting of the province with respect to these agencies, boards and various groups, but the Minister of Finance has introduced legislation that extends, considerably, the information, including salaries and these kinds of issues, executive pay, in district health authorities.

 

The member, Madam Chairman, asks about whether or not, as minister, I'm satisfied with the information that's provided by DHAs to the department and let me say that this year, in terms of the business planning process, we have an intention to have greater accountability in the business planning process in terms of detailed information. So we are requiring much more detailed reporting.

 

I know that we already receive a fair amount of information in the department with respect to the provision of programs and services, but I think it would be fair to say that we are beefing up the information that we get from the district health authorities and the IWK with respect to travel, consultants, executive salary - those are all things that we very much feel that we should have more information around and there needs to be better accountability around the expenditures in this area. So that speaks to the question that the member has asked, or the comments around the DHAs and the reporting of DHAs.

 

The member asks, Madam Chairman, a question about our own expenditure inside the Department of Health and Wellness and what kind of restraint we have put ourselves under. If we're going to ask the DHAs to have no increase in their budgets this year, then what have we asked of ourselves, what have we done of ourselves, and I think that's a fair way of looking at what the member has asked, so I want to outline for the member the budget that we have in terms of - utilization is a very big item in our expenditures in the Department of Health and Wellness and utilization I think, if I'm correct, captures physician payments, it captures diagnostic testing. And utilization is growing. It grows every year and it's a challenge to contain those costs and to ensure that people are getting the services they need and require, but they're getting appropriate services, that we're not over-diagnosing - we're not sending people for unnecessary tests, all of that kind of stuff.

 

So it's a balance to make sure people aren't being denied access when they truly need it, but at the same time - and you hear a lot on Dr. Barry Goldman, is that his name? White Coat, Black Art, he does this program on (Interruption) Oh, Madam Chairman, the honourable member doesn't know that series on CBC Radio? It's fabulous; it's fabulous. You need to go to the CBC Web site and click on White Coat, Black Art and Dr. Barry Goldman. I think he's probably the best-known physician in the country. He has just written a wonderful book on working in the emergency room. CBC repeats that program, so they will play it at their regular hour but they repeat it. It's a fabulous program; you learn so much. He takes complicated topics from our health care system and makes them accessible and it's very informative.

 

He often talks about utilization and cost drivers in the system. He recently was here in Halifax and actually was very complimentary to the Province of Nova Scotia and the Department of Health and Wellness in terms of many of the things we are doing - and that's always very nice.

 

At any rate, utilization in our budget - we have budgeted for a 1 per cent increase in utilization. We have also (Interruption) - oh, sorry, let me try that again. Our budget is increasing this year, unlike most departments, let me start there. Our budget is actually increasing, but it's increasing by 1.2 per cent. I mentioned that in my opening remarks. So we're going to realize a budget increase of about $45 million. Now, to the average person, $45 million sounds like a lot of money and it is, it's a lot of money. Last year our budget increased by $212 million and I'm not sure how much the budget of the Department of Health and Wellness increased in previous years, but I would bet that $212 million was probably the least amount of increase that the Department of Health and Wellness had in probably five or six years.

 

The Department of Health and Wellness budget, when I was first elected to this Chamber in 1998, was $1.4 billion and today it sits at $3.7 billion, so a budget increase of approximately $45 million is a very, very modest increase - and to quote a former Minister of Health, Jane Purves, I think on CBC Radio, she indicated if we could get this budget to 1 per cent or zero per cent, it would be close to a miracle. So we're in that range, I have to say.

 

We have budgeted for an increase in utilization, we have put in the government's commitments for this year, which amount to about $5.5 million - not quite $5.5 million, and the departmental reductions are about $63 million, so we have put ourselves under scrutiny, we have looked at everything we do and how we do it, and we've questioned do we need to do this, is this something we should be doing? We've asked ourselves, could we be doing this better, but differently, with the same resources? We've asked ourselves, could the resources we're using for this particular thing be moved and better used somewhere else?

We've worked very, very hard to find budget reductions inside our own department. Madam Chairman, what we're asking of the DHAs we're asking of ourselves in terms of reducing travel, looking at administration first and, really, how we can work smarter to take the resources we have and make them go further and make them get better results. That certainly is top of mind and I've sat in many meetings when staff will come in for a briefing with the minister and the deputy will ask how we going to pay for this, and people are sent away to problem solve. We're not looking at new resources; we're looking at the resources we have.

 

Perhaps that at least starts to answer the member's question.

 

MR. BAILLIE: I do want to thank the minister for that answer - and for the new information on this wonderful show on CBC that I've been missing all this time. So I certainly appreciate that I've learned something here in the estimates today that I'll have to try and tune in to at some point.

 

I'm wondering if the minister would agree to provide us with some further detail on her calculation of utilization in the 1 per cent increase over last year - it's not necessary to do it here this afternoon, but if there is some documentation of that that's available I would be personally pleased to receive it. Secondly, in the area of departmental reductions of $63 million- I struggle to see that reflected in the Estimates Book, but the minister has referred to that number and I'm wondering if we could also receive some further information on that.

 

For example, looking at the Executive Administration part of the budget - and I will say I recognize we're combining two departments into one here, so I do want to be fair about that - it does show a $21 million increase over the forecast for last year, the actual amount that the government's forecasting it will have spent. Now clearly $15 million of that is related to the combination of the Department of Health with the old Department of Health Promotion and Protection, but that still leaves what appears to be an increase not related to that combination. I only say that so when we get that further analysis it'll square with the Estimates Book itself.

 

Madam Chairman, if I can go off script just for a moment. Having been in government when the original Health Promotion and Protection office, and then department, was created - it was a first in Canada, it was designed to focus us on one of the ultimate long-term solutions to our health care funding issues and delivery issues - that department was created to get at the issues of chronic disease and childhood obesity, or obesity generally, and smoking and so on. It was kept separate from the Department of Health because it's a very different function than the fix-em-up Department of Health, if I can put it as sort of crassly and simplistically as that.

 

Although I'm in favour of finding cost savings and efficiencies wherever they can be found, I am disappointed to see the Department of Health absorbed or be merged with the Department of Health Promotion and Protection. I realize there are two deputies and two leadership teams, but the end of the day, to me and many members of the government of that time, if anything, the natural connection between Health Promotion and Protection with another department was with Education, not between Health Promotion and Protection and Health. In fact, the best practices of that time, all of the literature and data of that time showed that it was best to keep Health Promotion and Protection separate from Health because it will always be a small percentage of that much greater Health pie and will lose out as a result.

 

So I say this not in a form of a question because it's done, but just as a point of information that if we are truly to move the needle on population health, on health outcomes for Nova Scotians, which ultimately does lead to savings in the Department of Health and Wellness, then we have to be ever-vigilant to protect that which was the Department of Health Promotion and Protection, to make sure that it has its own budget, its own goals, its own people, its own targets if we're going to get to that better day.

 

I'll just say that before moving on because I do want to ask the minister about other recommendations that we're wondering where they stand with the Department of Health and Wellness. I think we've covered, for the most part, the Ross report - and I agree with the minister that Dr. Ross has done a very good job of examining our emergency care system and providing some recommendations.

 

But we also have outstanding the Corpus Sanchez report, which was a very comprehensive report that is now three years old, that included hundreds of recommendations not just in emergency care but across the whole health care delivery system. The previous government had indicated it was going to accept all of the recommendations of the Corpus Sanchez report in order to get us moving towards that better day where we have an effective but reformed health care system across the board.

 

I believe we're due for an update on where the department stands - overdue for an update perhaps on where the department stands with regard to this comprehensive report, the Corpus Sanchez report, which forecast better delivery and millions and millions of dollars of saving as a result. I would just like to ask the minister if she can provide us with the report today, or if she's anticipating a report to this House at a future day, on where the government stands with regard to the Corpus Sanchez report.

 

MS. MAUREEN MACDONALD: Madam Chairman, I think I probably have shared this with you - I don't know that I've shared it with everyone in the House, but I know that you and I have certainly talked about health care and we've talked about what I felt was a somewhat daunting set of circumstances that faced me when I walked into the Department of Health and Wellness. One of the things that faced me when I walked into the Department of Health and Wellness was, I think, 28 working groups coming out of the Corpus Sanchez report - my head spun.

 

I know the honourable member likes to poke a stick at the government for the various strategies we have underway but, let me tell you, the number of strategies we have underway with respect to doing the research and the planning and the necessary foundational pieces to move toward action pales in comparison to the number of working groups that existed with respect to the implementation of the recommendations coming out of Corpus Sanchez.

 

I remember in one of my very early meetings saying to the senior leadership team in the department that this is ridiculous, 28 working groups is just not manageable. It felt like chaos to me and I asked that they go away and rethink the work plan and what they were working on and to reduce those down to something that both gave you a sense of priority and possibility.

 

I have worked with many, many organizations over the years and I know how organizations can get completely sidetracked by planning, and planning and planning and planning, for some future endeavour that never comes because the work becomes an exercise in planning.

 

So I think it's fair to say that there are pieces of the Corpus Sanchez report that we continue to pursue and we have incorporated in some way into the Better Care Sooner plan. But this government has a focus and it has priorities in the Department of Health and Wellness - our focus is to get Better Care Sooner to Nova Scotians; our focus is to establish a strong system of primary care, collaborative care practices across the province; and to ease the burden on our emergency departments, big and small, in the province; and to use our precious health human resources more pragmatically and more fully. We have in that mix a priority on mental health care, and we have the working group now looking at a mental health strategy for the province, and this work will have to be layered in to the primary care collaborative care work that is going on.

 

In addition to that, of course, is the fair drug price piece of work that we're doing, and a Drug Management Policy Unit which will help us around the utilization of drugs and improve drug utilization. We continue with electronic patient records and other IT initiatives which are really essential to helping pull us into a modern-day health care system that will be better managed.

 

The member talked earlier about population health. It is through the use of technology that we will have better information with respect to the health status of the population and will help us identify where we need to most invest precious resources, because we've got good data and good information that will help us do that - and in some things we already do have that. I mean everybody who gets health care services in Nova Scotia does so because they have a health card and we're able to really look at patterns of use. We're able to establish where there are high rates of particular kinds of disease, perhaps diabetes, or people who are having dialysis. For example, we have a very good understanding of where people throughout the province who require dialysis services currently live, and we can do some modelling and project what that's going to look like over the next five years, or perhaps the next ten years, and it allows us to do some planning for services in those areas and this is very important.

So, you know, we continue to do small pieces of work - I shouldn't say "small pieces of work", but there are pieces of work that continue to be done that were identified and addressed in the Corpus Sanchez report. But this government's focus is around Better Care Sooner, and we have defined what it is that we intend to do in the health care system in the course of our mandate. And we're setting about to do that and we will resource our health care system for that - and in addition to that is the very real constraint that we face with respect to the finances of the province.

 

So the challenge - and I say this when I go out and I meet with people - the challenge I have as Minister of Health and Wellness is to improve people's access to health care, the quality of health care, and the diversity of the needs that exist in the province at a time when resources are extraordinarily limited, which means we have to be very strategic about where we invest, and we have to have some clear priorities. Not everything is a priority and can't be a priority - although everything is important, we do have priorities and we need to stay focused and be clear and work hard to stay on the path of providing better primary care to people, and access beyond the emergency rooms.

 

I think this is a fundamental shift in the way health care is being delivered in many respects, and we're very committed to seeing that shift. The population will benefit and our health care providers will have a much more satisfactory work/life balance themselves, and it will be a tool that will allow us to both recruit and retain health care workers, particularly in our rural and hard-to-service communities. That's our focus and I'm pleased that that's our focus.

 

MADAM CHAIRMAN: The time allotted for the Progressive Conservative Party has expired.

 

The honourable member for Halifax Clayton Park.

 

MS. DIANA WHALEN: We're certainly exploring lots of different aspects of the department today. Looking again at the Department of Health and Wellness and recognizing what a huge budget it is, I feel like we're just trying to uncover some of the layers that are buried within a lot of the line items - and I think the previous speaker from the Progressive Conservative Party was definitely pointing out that the level of detail that we receive, certainly as members of the Legislature, is far too high-level to really dig in and know where some of the important figures are for the coming year.

 

I was interested around the issue of the medical seats, the residencies - I'm just looking for my note on that - but you had indicated that was now in physician services, I believe - Medical Payments, it was buried in the increase in Medical Payments. I wonder if we could talk a little bit about that - perhaps the minister could help me understand what the situation is at Dalhousie. I would like to talk to you about the Dal Medical School and about the stresses that are being felt at the medical school.

 

We know, and the public read very loudly, a big headline screamed out that the medical school has taken on ten students from Saudi Arabia. I think I understand why - they have the capacity and they needed funds. Overall it was a way to add to the budget of the university and of the medical school, and they definitely needed to look at some way that they could generate funds. I realize those seats are fully paid for so we're not subsidizing them here in Nova Scotia and I think, from my understanding of it having spoken to the dean of the medical school, it doesn't take anything away from our students who are still getting a top-notch education and the university is doing all it can to maintain its standards - and even strengthen its standards.

 

I think I may have mentioned here before that my father had graduated from that school in the 1950s, and although it's a fair distance from myself, nevertheless I'm pretty proud of it and glad to see them keeping their standard because it was a school that was recognized and, I think, still is recognized all over the world - you can travel anywhere with a degree from Dalhousie Medical School. So I think it's something to be proud of and a school that we want to maintain at the highest level, but my concern is where the money went, and the minister will remember last year there was a little bit of a back and forth and confusion around a decrease in funds to the medical school.

 

It might have been just over $2 million that had been allocated the year before, and suddenly it looked like $300,000 was all there was left there for Dalhousie Medical School and you asked, I believe, the former Deputy Minister Hogg to go and have a look at it and examine the funding because there was some confusion around the Department of Education perhaps providing funds to the school.

 

I know that there was a compromise - at the end of the day more funds were put into the medical school because it was needed, and without it really they would have been severely hampered. Now we see this increase - the amount increased by 1.668. I don't think that was the only item that was in that increase and I wonder if the minister would have a look and let the members of the House know what is included in the increase that we're talking about - again, it's focusing on Dalhousie Medical School.

 

MS. MAUREEN MACDONALD: Madam Chairman, I think what I indicated earlier was that in this fiscal year 2011-12, in the budget for the year coming we have moved Dalhousie Medical School and the physician/resident tuition from Other Programs - they were in the Other Programs - to Medical Payments. So they've been moved out of that, and physician training seats was moved from other health care initiatives to Medical Payments.

 

I think of all of the complicated issues - and there are many of them in the Department of Health and Wellness - the one that has been the most complicated is on the various arrangements that have been made with Dalhousie with respect to the physician seats and various payments. It would make your head spin trying to figure out all of the arrangements - and I'm not really sure why that is. It seems to me it should be very straightforward with good documentation, but I wasn't there and neither were any of the folks who are with me, so it can be a bit of a challenge to sort out.

 

First, I would like to speak to the question of the ten seats, that Dalhousie has established a relationship with Saudi Arabia. Just for clarity for people here, Dalhousie had twenty medical school seats for students from New Brunswick paid for by New Brunswick. A number of years ago the decision was made to move those seats to an off-site program in New Brunswick. At that time, the medical school and the Department of Health and Wellness here in Nova Scotia were well aware that this was going to occur at a future time. As I understand it - again, I wasn't here - the administration of the day decided to purchase ten of those seats and that became the expansion of Nova Scotia's expansion of having ten additional seats in 2008.

 

The ten additional seats were then available. Dalhousie had the resources, the faculty, the classrooms, all of that kind of stuff, but the Nova Scotia Government had already purchased half of the available seats and at that time felt that's what was both perhaps required and affordable. There had been an expansion a few years earlier as well and so, as the honourable member said, now students from Saudi Arabia will be taking those seats, and those seats are not subsidized in any way by the Nova Scotia taxpayer. They weren't seats that we ever had real access to - they were always seats that existed at the medical school and they were dedicated to students from New Brunswick.

 

Last year we gave Dalhousie Medical School $2.575 million for medical school seats and this year there is an allocation of $540,000, and we have a review that is currently underway between the Department of Health and Welfare, Education, and the Dal Medical School and they are reviewing all of the funding. We expect that there will be a report to us in the next few weeks and it will assist us in our decision. So this is the current situation.

 

MS. WHALEN: I have no doubt the minister's right that any one of us would find our heads spinning if we actually got into the details of this. Definitely the Department of Health and Wellness is a very complex department I will say. As the critic for this area, and I don't have a medical background at all myself, I found there is an awful lot of detail and components and a lot of complexity, and on this education piece I am kind of surprised it's the most complex, but nevertheless things have developed over time.

 

I want to just clarify, you gave us a clear figure for last year of $2.575 million and you said there is an allocation of $540,000. I don't understand, or it's not clear to me, is that an increase, is that a temporary payment while you wait for the report that you referred to? A report is coming, you said, in the next few weeks and it is being developed by the Department of Education, Health and Wellness, and Dalhousie University. So what is the $540,000 allocation? I'm just little uncertain about what you're intending that to be - again, is it an increase or is it maybe just a partial payment while we figure it out? I hope the minister has that.

 

MS. MAUREEN MACDONALD: I think it's fair to say we're in discussion with Dalhousie with respect to the funding for this year for the medical school seats.

 

MS. WHALEN: Thank you very much, I do appreciate that. I guess in terms of the amount of money, again I would like to look because you've got 1.668 - just going back to the Medical Payments increase - and that increase of 1.668 was physician/resident and Dalhousie, and I think the physician/ resident, would you not consider that part of the medical school as well, or perhaps not, and could you break those two down for me?

 

AN HON. MEMBER: They probably graduated.

 

MS. WHALEN: They have graduated, but are they considered part of your medical component? They are still studying. Certainly Dalhousie Medical School, when they look at how many students they'll take in, how they will accommodate their students, they are very aware of the residency places and they see it as a continuum of the education of those students.

 

Again, that's just clarity for us, because I didn't see the word "Dalhousie" anywhere in these estimates at all, so I'd just like to know if you can break that down around physician/resident and Dalhousie University.

 

MS. MAUREEN MACDONALD: We have $647,000 for physician/resident tuition and then, in addition to that, we have the $540,000 that I indicated for physician training seats and, as well, $480,000 for the eight additional seats - so this is all around those additional seats, or some of this is around the expansions for the various seats.

 

MS. WHALEN: I wonder if you could - it's not usually like me to ask the minister to elaborate because that could go on - I'm doing it a little hesitantly, but I wonder if you could elaborate on those eight additional seats, just give us some clarity on what they are. I mean you certainly talked about where we were, that we had lost twenty seats when New Brunswick set up their satellite school for medicine. We got ten new ones that the previous government picked up. I think we have sixty-three spaces for Nova Scotia students - what are the eight additional seats? And I'm sorry if I missed that in an earlier answer.

 

MS. MAUREEN MACDONALD: Fair enough. It's a fair question and, hopefully, this will help - I find it difficult myself, to be frank. In 2003-04 and in 2008-09 the government requested that Dalhousie increase the number of medical school undergraduates, the number of seats, and funding for those seats was provided through the Department of Health and Wellness. In 2009-10 the Department of Health and Wellness gave notice to Dalhousie that it would continue to fund only the eight medical school seats that were not already funded. If you remember, the issue was if they also were being funded under the Education Department's funding formula when the new MOU was negotiated? That was the question.

 

Dalhousie did not agree with the department's interpretation of the funding for the physician training seats and the funding commitment, so Bill Hogg did an independent review and he concluded that there was a commitment and we gave the $2-plus million last year to the medical school. However, there was an agreement that we needed to put together a working group to try to sort out the whole issue of funding medical school seats on a go-forward basis, and that working group is meeting and it will report in several weeks, and for that reason it hasn't reached any conclusion. So the question will become, how many of those seats? (Interruption) That's right. How many of those seats and what is the cost of a medical school seat. If you read the Hogg report, it is quite complex and there are a number of unresolved issues we would like to reach some conclusion to, and some agreement on, before we finalize this.

 

MS. WHALEN: The eight then really refers to the eight that the Department of Health and Wellness felt were legitimately funded through the department at this point in time, of those additional seats. So I guess I get where that's coming from, and I know there's a big difference in the amount that each province is paying for seats. So, hopefully, this will clarify it when you get the working group results back. I don't have it before me, but I think that Nova Scotia pays considerably less per seat than the Province of New Brunswick and the few seats that are held for the Province of P.E.I. Isn't it like $20,000, $30,000 and more?

 

I don't know if the minister wants to even mention it - I think we're the lowest of the funding of each of the seats although the Nova Scotia Government has the lion's share of those seats - and I'm glad we do because we all have constituents who would like to apply there and would like to get into the school.

 

So it is an important thing that we have this school here in Nova Scotia, but I guess that will have to be worked out because the university feels, I think, under a lot of pressure to maintain its credentials and maintain its standards, where I was speaking about those earlier. It's pretty important when a year ago we had them questioned in terms of their accreditation and there were steps that had to be put in place in order for the medical school to just reassert itself and ensure that it was meeting all the curriculum that was required, and I think it would be a crisis really if that were to be threatened at any point.

 

I realize you have the working group coming back, but I would like to see where we go with that in the future, and unless the minister wants to speak to that, I think I'll go on to a couple of other questions about financial things and if the minister would like to add a comment, a summation on Dalhousie, we can go there.

 

I think the residency seats are equally as important because I understand that's the big holdup. We could have taken more Nova Scotia students or more Maritime students in those ten seats that Saudi Arabians have taken, but we also have the problem of not enough residency spots to ensure that the students are going to be looked after in the next step. And apparently they won't go beyond a certain number if we don't fund more residencies - that's a concern as well, and I would hope that at some point the government will be able to fund more in the areas that we really need, you know, focus not to the areas perhaps where even students are flocking but the areas that are underserved, where Nova Scotia could benefit and our needs here can be met, which I think has to be the government's number-one concern.

 

Certainly we're going to talk more, I know, about physician recruitment and rural physicians. I know that the member for Yarmouth has some questions particularly about his area; the Valley has been an area where we've been concerned as well.

 

I'd like to go again, if we could, back to Page 14.4, which has a list of various line items one by one. The top one is the General Administration which seems to have jumped up by 50 per cent - it's up to just over $3 million and last year it was forecast at just barely over $2 million. So even having merged two departments, part of the benefit should have been that we would actually see a shrinking of administration. You're not just rolling both of the hierarchies together, you should actually, I would imagine, have done that not only for some internal efficiencies but also for some financial efficiencies.

 

Through you, Madam Chairman, I wonder if the minister could let us know what is accounting for a $1 million increase, a 50 per cent increase, in General Administration?

 

MS. MAUREEN MACDONALD: I would like to close off the discussion around the Dalhousie Medical School and the seats and the whole question of residency positions and what have you. I think in a perfect world we would have the ability to just have as many seats at the medical school as there are people who want to go to medical school, who have the necessary qualifications, and then all of those residency placements afterwards.

 

I don't know if people recognize that the seats at the medical school are heavily subsidized by the Government of Nova Scotia and that the residency placements are also heavily subsidized by the Government of Nova Scotia - we pay the wages of people who are in residency positions and we pay their tuition as well, and a number of other costs. So the sad reality is that we have to look at our ability to pay for an expanded medical program. We're very fortunate to have Dal Medical School - without question, it's an excellent medical school and it graduates many excellent physicians and I'm very cognizant of that, as are people in the department.

 

We are very fortunate in Nova Scotia to have seen two expansions to seats at the medical school, and many of those students have not yet graduated, so we're still not realizing the benefit in the practice world of those expansions. I do remind members that in Nova Scotia we have more physicians per capita than any province in the country, more specialists per capita than any province in the country, but the distribution of our physicians tends to be the problem.

 

The Department of Health and Wellness has embarked on a physician resource plan, something that is very, very long overdue - much like a number of other initiatives that we have going on in the department. To me, it's hard to believe that we were expanding medical school seats and we didn't have a physician resource plan - we didn't know where the doctors were, we didn't know what the future looks like in terms of planning for retirement and all of that kind of stuff. So this is such a critical piece of work to help us determine how many doctors we need and where we need them, and we're in conversations certainly with the medical school with respect to this.

 

At our medical school right now we have 256 seats that are allocated to Nova Scotian students. It's interesting and I want to share with the members, Madam Chairman, that I had a discussion with staff in the department who are the experts on this, and I was trying to understand how this all works and understand from them just how many seats we actually have and it became clear to me that it's very complicated. I understand, for example, that P.E.I. purchases five seats, or something like that, but last year, or perhaps this year, they didn't have five applicants who met the criteria to get in. So that doesn't mean that the medical school then will leave a seat open. They might fill that seat with a student who's from Nova Scotia who meets the criteria - so there is some flexibility. It's somewhat fluid in terms. So it isn't this rigid- there's a Nova Scotia seat, you have to put a Nova Scotia person in that seat.

 

The other thing I don't think that we have a very good handle on - and I don't know why we don't - I think there has to be a way to get better information on, what about all of those Nova Scotian students who go to McGill, or the University of Toronto, or even to an Australian medical school, or a medical school in Ireland? We have a fair number of Nova Scotian residents who go and study medicine elsewhere - how do we take advantage of that situation? How do we ensure that we have some way to identify and then attempt to bring them home? From time to time I certainly hear from students and from a family member perhaps of a Nova Scotian student who's studying elsewhere.

 

I think it's also important to note that Dalhousie Medical School has a certain number of seats that are for students from out-of-province, from other parts of Canada, and I'm not, to be frank, entirely sure how the funding works with respect to those seats. So university funding is complex, and medical school funding is very complex. Physician resource planning then, for the needs of the population, is very interesting; it is a very interesting process. But what I can say is we have, and we attempt to have, as good a working relationship as we possibly can with the university and with the medical school and we very much value their work.

 

The other thing the member talked about was the difference in funding, that we don't necessarily fund the seats at the same level as other provinces. I think we have to recognize that you're not necessarily comparing apples to apples, that there could be other features. For example, we have AFPs in this province, the alternate payment plans for specialists and part of the funding that we give to different specialties, let's say the cardiac folks or the psychiatric folks, portions of that are for teaching, for administration, for research, as well as for clinical practice. I don't know if you would say it's an indirect way to fund the seats because these folks, who are all on the academic staff at the university, are having some portion of their remuneration built in, which really is the whole point of funding seats. So it's complicated. It doesn't mean that we aren't funding medical school seats here in Nova Scotia at the same rate as Saskatchewan that has one medical school and no other universities either - this funding of seats is interesting.

 

The member, Madam Chairman, asked me about the rising costs of general administration in the Department of Health and Wellness. The costs that are associated with these increases are for a number of things. We have put in place an individual who is in charge of implementing Better Care Sooner - this is a person who has been a staff member in the policy unit in the department and is in this position; there are some associated costs for professional services with Dr. Ross; we are doing some work and we've given some priority to the whole question of diversity and inclusion for workforce planning in the department. As members will know, we face the real potential of labour shortages in skilled work in the province, and in the health care sector we need to be very concerned about this and we need to do a lot of work for good workforce planning.

 

One of the things that I think all members in here would recognize and would be concerned about is that we can do a much better job than we have done with respect to diversity and inclusion in terms of our health human resources. I'm often struck by the fact that women have made great strides with respect to their participation in the labour force; in health care, for example, you will find a very large number of women who have risen to managerial positions and seem to be well represented throughout the health services workforce. But that's not the case for other groups - it's not the case for African Nova Scotians, for people from First Nations communities, people with disabilities, and even newcomers who have very significant employment histories in the health care field, so we are increasing the diversity and inclusion component of the Department of Health and Wellness to a level where there will be a better ability to do workforce planning with this in mind.

 

Additionally, there is an increase reflected there of $200,000 for the social marketing division, which has been merged from HPP. So you will see this. We have an increase in secretarial support to the minister, to the deputy minister around correspondence. We have a significant amount of correspondence and I'm told that we are seeing more correspondence than is normally the case in the department. I attribute this, frankly, to the phenomenon of social media. I think, actually, I heard Dr. Brian Goldman a few weeks ago - or someone else - talk about social media and its role now in advocating for drugs, for new treatments and new procedures. It has meant that the existing staff have really been challenged to get the correspondence responded to in a timely fashion - and that's something that I'm concerned about, so we have introduced assistance there.

 

I think that essentially covers the larger items. There also is an increase in the salaries for Communications Nova Scotia employees, the professional services. I would think that reflects - and the member may have heard me discuss this with the Leader of the Third Party - the government's intention to communicate, communicate, communicate, with respect to Dr. Ross' recommendation that we need to do a better job of communicating with people in the province around health care services and how to access health care services.

 

I would say to the members that if there was one thing I heard from people when I did my consultations around the province, people said they did not know and they felt that people in their communities didn't have enough information about 811 and that we needed to do more to promote 811 and, additionally, to let people know about 911, and how qualified paramedics actually were. I remember meeting with the board of the Capital District Health Authority and one of the physician members saying to me that we really needed to consider doing some public education about what a hospital is, so people would understand the difference between physician services in an office and other health care providers and perhaps coming to a hospital. At any rate, that does account for the increase.

 

MS. WHALEN: Certainly that was a very detailed answer. I don't know if it's possible for the minister just to get that one page, the breakdown on the General Administration, just so that we can see it. Yesterday, we definitely heard that the number of Communications people is down and I gather they've been reclassified then if their salaries are up, so we went from twelve to nine - and I agree, we have to communicate and have the public understand what's available.

 

Could the minister tell me about her own office, the administration for the minister's office, could you tell me what was the forecasted amount last year and what is budgeted for this year to adequately serve the public? I would agree with the minister, I think the Health Critics are getting lots of the letters that are directed to the Health and Wellness Minister. When we are copied on them, we don't need to provide that primary response to the same degree.

 

I've been inundated this week with a whole lot of them coming from another lobby group asking about the Canada Health Act - I think I counted 135. Mind you, they're all the same, they're not individual stories. Sometimes they're very different stories that we're getting, and people telling compelling reasons why we should look at their issue or try and respond to their crisis very often. I can only imagine how emotionally difficult it is to be the Minister of Health and Wellness at times, with the crises that people do find themselves in when they turn to the minister.

 

If you could answer me on the minister's office expense last year and this year, that would be great.

 

MS. MAUREEN MACDONALD: Madam Chairmen, yes, it's an interesting time, I think. I suppose every person in the Department of Health and Wellness in the minister's office might think that, but I think it is a very interesting time because of the growing use of social media in particular, and Facebook and Twitter and these particular new tools that people have for communication. I think what that means is a member of the public - one of the things that even in my brief time in the department I've seen is that an individual who is dealing with the health care system and encounters a particular issue that they want to explore, can raise that and send it to all of their friends, who can send it to all of their friends. Then, suddenly, I can literally have hundreds of contacts from people, not just from Nova Scotia but from all over the world, really, who have an interest in that particular topic and can suddenly flood our mailboxes with ideas and comments and what have you. So it is a new era, for sure, in communicating with the public, and it's very interesting.

 

Now, Madam Chairman, the member has asked about the cost of general administration in the office of the minister. The budget last year was $316,000, the forecast is $301,200, so we are hoping to come in slightly under budget to about $15,000, and next year we have budgeted $320,900. So it's pretty stable, I would say.

 

MS. WHALEN: I'd like to move on to the area that the minister actually referenced herself around the physician, I guess planning - planning for the numbers and getting a handle on that. That is a question I've asked on a couple of occasions here during Question Period, often because anecdotally we know in certain areas of the province when there's going to be a number of retirements or we know when people are moving or they've only made a commitment to stay a couple of years, so the people in a community will be able to forecast and say that they are concerned that there's going to be a sudden shortage of physicians.

 

The Valley is the area I think of particularly. They have a number of doctors who are carrying full caseloads and patient loads and yet they are well past retirement age. These are people who are just committed to their patients and their community. But we know the Department of Health should have a handle on where the needs are going to arise and exactly how many young Nova Scotians do we need to stay in the province to fill those positions, the large investment we make to train those young people and very often they may leave our province unless we've targeted and helped in some way to entice them to stay here.

 

The question I have right now - because the minister mentioned it as an ongoing study at least on the physician side, you have a line item called Health System Workforce and that line item is the bottom one on Page 14.4 and it's actually gone down by about $2 million. It was forecast last year at $3.78 million and it is estimated right now at $1.97 million, so just about $2 million on the estimate. Health System Workforce is what it's called, and so with a decrease of $1.8 million I was wondering where it went instead and whether that was the health physician resource plan - maybe that's been buried somewhere else.

 

There was a tender - and just while the minister's looking, and I know the staff you have with you are searching that out - our staff did give us the tender that was called in February I believe. The closing date was February 23^rd and that was the RFP for a health physician resource plan. This is something the minister may be able to speak to as well, to let us know if it has been awarded because you did talk about work being underway. Is the cost of that RFP part of Contracted Administration?

I did want to explore a little bit with the minister about consultants and special projects, so I'm wondering where the cost for that RFP would be located. I don't see what the value of that RFP is at all. I see five companies are listed there; maybe those are the five you invited to tender. I would be interested to know what the project is tendered at and whether there's a deadline for when we'll get the plan back. I know that the minister is being briefed, but I'd like to know more about that RFP - when we'll see it back, what the value was, who's doing the work, when are we going to get an answer, and whether or not it's connected to the line item Health System Workforce, which is actually down instead of up?

 

I have an idea it's not connected to that, but I'd like to know about that too - I think somehow the two components may be interrelated. If the minister is ready, I'd like to turn the floor over to her.

 

MS. MAUREEN MACDONALD: First I'm going to talk about physician recruitment. The information I have indicates that we had a net gain of eight physicians, family practitioners, last year and twelve specialists - a total of twenty. We have seen four physicians retire, four specialists retire - no retirements that we know of in terms of family practitioners, but five family practitioners simply became inactive in terms of their licences, I suppose. We did see twenty-four family practitioners leave the province, thirty-one specialists leave the province; however we had fifty-seven specialists recruited and thirty-nine family practitioners recruited, for a total of ninety-six. So the net gain was eight family practitioners and twelve specialists.

 

We've also had a number of new CAPP doctors, seven new CAPP doctors in the province. I think the interesting thing sometimes when I look at these numbers is where the distribution is. In the Capital District Health Authority we had fourteen family practitioners and thirty-six specialists, for a total of fifty. But then you look at other DHAs - Cape Breton, three family practitioners, three specialists, for a total of six. It's quite stark. GASHA one new family practitioner, one specialist, for a total of two - oh no, that's not GASHA, that's Colchester, I think (Interruption) yes, it is GASHA.

 

Now mind you, those numbers are very small, too, in GASHA, but then again I ask myself, GASHA has a very stable number of physicians in the Antigonish area, in the Guysborough area and what have you but, again, this is why I think the physician resource plan is very important.

 

With respect to the request for proposals, I have no additional information to give the member at this time. Decisions have not been made with respect to the awarding of that request, and I don't feel comfortable, really, having a discussion about that until we move forward with it. so the information, Madam Chairman, that the member and all members would have access to is what you actually have.

 

With respect to that budget item, Health System Workforce, there is in that line item a Health Canada project on health human resources that was a $1 million item on its own. Then, in addition to that, there are a number of much smaller projects for the most part, and items that are small amounts of money that make up the additional reductions.

 

There was a budget error, for example, around workers' compensation that is in the amount of $100,000. I mentioned the diversity and the social inclusion position that was moved into General Administration - that came from this line item in the past, so this is where that resided.

 

The Health Canada project has ended and this is why that has resulted in a reduction in expenditure. That's right. In addition to that there was a term position removed for an HR consultant and a student, $29,600, a health strategic initiative's position which is finishing and is classified, I think, at the Secretary II level, for $31,000, so there are just a number of small items. That's right, it's the $1 million for that Health Canada project that really constitutes the largest reduction, but there's a good explanation for that.

 

MS. WHALEN: Again, Madam Chairman, I understand if the RFP hasn't been awarded yet that you can't say more about it. I guess following up on questions from last year and probably last Fall, I would just say I think this is one of the glaring areas where the department can't tell you where you are - and if you don't know where you are, you don't know where you're going and you haven't surveyed those physicians to find out their plans for retirement or moving or career progression.

 

The minister said it herself, so I am really repeating the minister's thoughts that we're at a disadvantage in this province if we can't get a handle on those kinds of numbers. So I'm just saying, it closed February 23^rd and I think it is an urgent matter and I know you can't say even how long the work takes. I used to be a consultant and I know to do a decent job you can't be asked for a report in a month because you have to get out and do the footwork and gather the information, and talk to people and write a coherent report. I would hope that we can find something and have some information perhaps within six months that would be useful to all of us here in the House, the individual members and so on.

 

We need more information. There's an awful lot missing in the Department of Health and Wellness. I think we only have about five minutes to go on this round - perhaps a little bit more - so it's difficult to get into too much here. One of the things that I would say that concerns me is that we can't find out the cost of procedures in our hospital. We can't compare whether a new procedure is a better way than an old procedure. When I contacted Capital Health District, which would be the one for my area, in my riding, they can't tell you what the cost is that they would associate with a particular procedure. That makes it really difficult then.

 

The minister, particularly when she first was introduced to the department, became the minister, I often heard you talk about evidence-based - I shouldn't say "you", through you, Madam Chairman - that the minister wanted to base all of her decisions on good, solid evidence, research, and so on. That is, I think, something that we would all support and all of us are at a disadvantage if we don't have good information. I don't know if the minister can, in the last couple of minutes, talk about whether there is any move afoot to try and get a better handle on the actual cost of care in our hospitals because it's a bit of a runaway train without that kind of information. There are options and there are different ways of treating certain diseases and certain conditions. We should know whether the outcomes match the costs and whether we can even put a cost on what it is to bring them into the hospitals.

 

I often hear members of the public tell me that when they are acutely ill, when there is an emergency, when they're very sick, they really have nothing but high praise for our health care system. When it is an emergency and they need to have an operation or care immediately, they get it. We do have a lot of other conditions that languish, where people remain in pain, people remain immobile or unable to get around because they need certain operations or care and the system can't respond then as quickly. I just wonder if the minister could give us a little bit of background on trying to get a handle on the costs of individual procedures and surgeries and so on.

 

MS. MAUREEN MACDONALD: Madam Chairman, the member brings up a very important issue. It's quite incredible to not just me, but a lot of people about how probably the biggest, most important public service that we have is so lacking in technological capacity. You still can go into physicians' offices where people are using paper transactions - that's not the situation in our hospitals; they are very highly computerized. However, we have a long way to go with respect to our information systems. We're in the very early stages of doing some of the work to help us gather information with respect to these items. We can, I think, in the department identify units and there are probably some processes that do exist to help us define the cost of care for certain procedures.

 

I know if you're from another country and you come here and you happen to have a heart attack and you end up in a hospital here, there is some kind of standard rate that you will be billed for being in a hospital. There are rates if you're in a private room versus - but whether or not they accurately reflect the cost of the actual care that is provided, I really don't know. These are things that we probably should know and need to know if we're going to do better planning in our health care system.

 

So, again, there is a great deal of work underway to build better information systems, to help give us quality information that will allow us to do better planning. But are we there yet? No, we are not there yet. The federal government has been very much a player in terms of supporting provinces adopt new information technology - that hasn't always been a smooth rollout and there have been a few little bumps along the way in that a small province like Nova Scotia does rely on federal dollars to help us build that kind of infrastructure. At any rate the work is underway, but it's at the very early stages - there is quite a significant way to go.

 

MADAM CHAIRMAN: Seeing no other speaker for the Official Opposition, I will now offer the floor to the Progressive Conservative Party.

The honourable member for Cape Breton West.

 

MR. ALFIE MACLEOD: Thank you, Madam Chairman. I want to say it's a privilege for me to be here today and speak a little to the Minister of Health and Wellness about some issues regarding health care in the province of Nova Scotia.

 

It will probably come as no surprise to the minister that some of my questioning today will be towards MS and the Liberation Treatment. The minister has been responsive to questions in the past, and I just think it's a very important topic that many Nova Scotians are affected by - there are over 3,000 Nova Scotians who are affected by MS and in this province and there have been a number of those who have left to get the Liberation Treatment. They've gone to different countries; they've gone as far away as Poland and now they're going to New York and other areas to have the treatment done.

 

This MS treatment, the Liberation Treatment as it is known, is as much about the quality of life for the individual as it is about trying to find a way to live better. In past times here in the House the minister has agreed that if a person has gone away and had this treatment done and they come back to Nova Scotia and they need treatment in Nova Scotia that they will not be refused. I certainly want to thank her for that statement and the decision, because there are some provinces that don't do that. I give her full credit for being forward in that way. However, we hear a lot about waiting and doing and listening to what's going to be done on a federal basis. We all know that health care, although there's a mandate by the federal government to supply funding, actual dollars spent are spent by the provinces here in Canada and they are spent with the discretion of individual provinces.

 

The minister has spoken with her colleagues on many occasions she tells us, and I believe her, that she's talking to them about MS but the reality is this is a disease that time is not a friend to. The reality is that we need to take some action sooner than later. As the minister knows, and I'm sure the members of this Houses know, it is an issue that is very close to me because my own wife suffers from MS, so that some of these questions become closer and nearer and dearer to my heart.

 

So my first question to the Minister of Health and Wellness is indeed there has been some movement by the Provinces of Manitoba and Saskatchewan, been some talks between those two provinces that are working together, each of them putting $5 million toward research of the Liberation Treatment. And I must say the Liberation Treatment is that - it is a treatment, it is not a cure for MS, and it's important that people understand that it's not a cure. But I would wonder if the minister could explain where we are, as a province, in relation to actually doing something and not just waiting and waiting because, as I say, for those who suffer with MS, time is not their friend. We need to be more proactive as a province and as members of this House. So I would ask the minister that.

 

MS. MAUREEN MACDONALD: Madam Chairman, I thank the honourable member for what I think is a very important topic. Certainly it's one that I, and my staff, really grapple with in terms of what is the right thing to do and what is our responsibility. I want to start by saying that I have never once said that we are not actively pursuing Liberation therapy at this time for financial reasons - I want to say that emphatically right now, once again, because for me this is not about dollars and cents, this is about safety and this is about an effective treatment that will make a difference for people.

 

It's a very difficult situation that we have, as non-medical people, who take our advice from medical people when you find, not necessarily competing medical information but different points of view in the medical community. If you have different points of view in the medical community how do you, as a layperson, make a decision about what is the right thing to do for people?

 

This has been a challenge; this whole issue has been a challenge. It's been a challenge for a variety of reasons. There are more than 2,000 people in Nova Scotia who are living with MS, and I have tried very hard to understand as much as I can about MS. I've tried to do that by meeting with people who have MS, by meeting with people who have studied, worked with and treated people with MS for all of their medical careers, like Dr. Jock Murray, a retired former Dean of the Faculty of Health Professions at Dalhousie, and other people.

 

I had an opportunity when I was in Newfoundland and Labrador with the other Health Ministers to have a presentation by a panel of experts who the federal government had assembled to do a presentation, and on that group was a vascular surgeon, as well as neurologists and some other people. I have read Dr. Jock Murray's book on the history of MS. It's fascinating, I had no idea, it is just fascinating, my own family doctor actually was his research assistant when the research was done for that book.

 

This is an issue that I have attempted to understand with my layperson's set of eyes. Reading as much as I can and really trying to understand the information - where is it coming from and how do I conduct myself in an ethical, caring way around this issue? It's hard.

 

I heard a gentleman on the radio this morning on CBC who, almost a year ago I think, had gone to have this treatment and he talked about the very great benefits that he feels has accrued to him as a result of that treatment. I'll tell you, it's hard to argue with that kind of personal testimony of somebody who has actually been through the treatment.

 

However, I also believe very much in the importance of a process that establishes evidence, that does it in a way that's reliable - I guess I would say I believe in the scientific process, and perhaps that reflects my academic background. But these processes have been developed over a period of time for a reason - they have been developed actually to protect the public; they have been developed to ensure that we, as members of the human family, are not put at the mercy, I suppose sometimes, of people who may not have the knowledge, the capacity to be able to be really helpful. Sadly, we do know you can go all over the world and get treatments for a whole variety of things - cancer patients can go to Mexico for the cure for cancer, and for $15,000, $20,000 you can go through all kinds of procedures that have no scientific support and, ultimately, do not result in any change in those diagnoses.

 

I met with Dr. Murray, he's a very interesting man, very considered in his approach, and he said it's important that the scientific community does not dismiss this treatment out of hand. We have to keep an open mind; we have to explore the very real potential that this may result in something that is of benefit to people with MS. That, I would like to think, is the way I will approach this. Keep an open mind, be hopeful that we can build that scientific, evidence-based foundation that will lead us to the information we require to know that this is a safe and effective treatment.

 

I think that the measures that the Health Ministers took as a group in Newfoundland and Labrador with the federal government will bring us there. First of all, there are these seven studies that are underway throughout North America and these studies are, first of all, they're studying in an attempt to establish the link between MS and blocked veins - and that's an important link to establish. You know, you talk to the neurologists and the vascular people and they say that they don't know for sure. I mean, is it MS people who have blocked veins; are there people who don't have MS who have blocked veins; and does this have implications for other neurological diseases like Parkinson's and other diseases? There needs to be some basic science that establishes that link, and that link has still not been proven. That's the first step and that's where the studies are right now.

 

I think the study out of Quebec is looking at children with MS, and studies elsewhere are looking at adults. There are also questions around the stages of MS - is it a treatment that you require only at an early stage; would it lose its effectiveness at a later stage? There are many, many questions that I certainly can't answer and neither can the clinicians in our health care system. So we need to establish the parameters and we need to get the basic information.

 

We, as Health Ministers, asked that the scientific community fast-track the research. This is unprecedented, by the way - there is no other example in living memory where Health Ministers across the country, with the federal government, have established a scientific panel and have said get research up and running and answer these questions as quickly as you can. That has never occurred before. So while I very much appreciate the frustration of people who have MS, who want to see this treatment implemented like yesterday, we are acting in an unprecedented way to actually make resources available, to get studies underway, to get answers as quickly as is humanly possible inside a model that requires some period of time to observe people with MS and to establish what the basic biology, physiology, or whatever, is of that situation and move that forward, and so that is occurring.

 

Now, I also more recently - and I follow this very carefully, any time I hear there's going to be a conference I ask my staff to please follow the newspaper reports, the media reports, from that country; will there be Canadians in attendance; and let's find a way to keep ourselves informed about what's going on. So I understand that, first of all, the status today of clinical trials in this country, there are none - there are no clinical trials in Canada today. So I don't know what the thoughts are of the Saskatchewan and Manitoba Governments, or their process in terms of establishing clinical trials, but the Premier of Saskatchewan announced clinical trials about a year ago - he first announced clinical trials at least a year ago, maybe a year and a half ago, a year ago. Today there are no clinical trials in the Province of Saskatchewan, and why is that?

 

Clinical trials require a certain process and they require a research design. You have to design your research and you have to do it within some rules so that the results, when you get results, are reliable. Because, if you don't design it properly and you publish your results, they will have no credibility; they'll be attacked by everyone because you haven't done a certain number of things.

Doing research design, I can't imagine what that would be like in a medical context - I've done research as a social scientist and I know how difficult that process is to anticipate all of the problems that can arise, and all of the ethical questions. Generally when you design research as a researcher, you have to take your research proposal and submit it to an ethical review. In medicine you have to really observe medical ethical guidelines, you have to be sure that people are participating fully informed; you have to be sure that you have anticipated all of the difficulties that could arise; and you're prepared to be transparent and accountable and abandon the research if anything goes wrong, if the findings that you're starting to get indicate that there are safety questions. Believe me, the rigorous review that people will be subjected to in terms of just their research design is substantial.

 

So it's not possible to rush right out and do research. The Premier of Saskatchewan can announce clinical trials today, but it will take a fairly significant period of time to be able to actually do a clinical trial. There are no clinical trials in Canada right now, but I understand that clinical trial research is about to begin in other places. I think one of the things that I would like to encourage people who decide to put themselves forward for clinical trials is to protect themselves. You need to understand that if you're going to participate in a clinical trial, don't allow yourself to be charged money, for example, to do that. That needs to be part of the process of the clinical trial - your participation and the costs associated with that, for example, should be part of that, and people don't pay to participate in a research project.

 

At any rate, this is the situation that we have. We have a seemingly new treatment that has a potential benefit for some, perhaps all, perhaps not all, some group of people with MS, and we are attempting to establish what the parameters of that looks like. What is the connection between the blocked veins and MS; for whom would this treatment be safe and beneficial; and how do we know that, and how would we move forward to actual clinical trials that then will help us understand and answer in a much more complete way those really important questions?

 

I have said - the Premier has said - that when clinical trials are able to move forward in this country based on the scientific evidence and the advice of the scientific panel, we in the Province of Nova Scotia will participate. Until we have that certainty, then I will not take the responsibility frankly, as Minister of Health and Wellness, of approving a treatment that I have not been given the assurance that it is safe and it is beneficial. And that isn't just with respect to MS, it is with respect to any experimental treatment.

 

You know I have letters, and you have letters, you have received letters from the islet - insulin diabetes experimental treatment that is going on in Alberta, and that's basically the same position that I have taken on that. Until there is an accepted recognition of a particular treatment by the scientific community, I really feel that it's incumbent on me, as Minister of Health and Wellness, to be cautious, optimistic, and very hopeful that we will arrive at a place where we will have the information that will allow treatment to proceed - but we're not there yet. In the meantime we will attempt to do the utmost that we can for people in this province who have MS, with respect to what it is that we do have available and things we can do.

 

I spoke with a lady not so long ago, whom I actually met the night that I was at the MS Society, who is caring for her husband who has MS and his MS has progressed substantially. The issues that she raised trouble me in terms of the capacity of our health care system to offer services and make people at that stage in this disease comfortable. Her husband is not mobile anymore and hasn't been able to go to the MS clinic for some time. In some ways he has virtually lost all of his services. People don't do house calls anymore.

 

We have to change that; we have to ensure that people who become incapacitated because of illness and disease still have access. You shouldn't have to go to an emergency room and wait hours for care, really. That's something I can do something about, while we're in the process of getting the scientific information that will allow us to proceed to clinical trials. Perhaps it's not enough, but it is a commitment that I can make. I can make a commitment to do work to improve the services we have for people who are living with MS and for their caregivers, services that they require in their homes.

 

One of the things we did was we expanded the Caregiver Benefit. The Caregiver Benefit, one of the things we really noticed when we introduced that benefit was that it was people with MS, a lot of people with MS, who were being cared for at home, who weren't eligible because they didn't quite make that MAPLe 5, but they still had a significant need.

 

We've expanded the benefit and it has captures some of those folks, and I'm really glad for that. Perhaps it hasn't captured enough, but it's an incremental approach - we will do the best we can with the resources we have, as we find resources. I am, and I know that staff in the department is, very mindful of people with MS and their needs.

 

We have a small drug program in the Province of Nova Scotia that assists people with particular illnesses, and we have a specific small drug program for people with MS who do not have drug plans. Quite often MS is a young person's disease, people aren't necessarily of retirement age when their diagnosed with MS - quite the contrary, it often is a diagnosis they receive while their young adults or in mid-life and they don't necessarily have a drug plan. So we have a small drug program and about 673 people are enrolled in that program at a cost of about $8 million annually - and the number of people who are in that program has risen marginally between this year and last. Our commitment is to continue that program and certainly that was one of the things that the MS Society and the clinic folks wanted to know from me when I went to one of their meetings last year.

 

I don't know if the member has any additional questions with respect to the government's position on MS.

 

We also fund the MS Society about $242,000 a year. I very much appreciate the work of all of these health charities, but especially the MS Society. They've had a difficult and challenging issue presented to them - a new therapy that has potential and a divided membership with people who are very enthusiastic and want to try the treatment, and as well, I know because I met with their membership and I hear from people, there are people who are skeptical. So there they are a voice, a representative for people with MS and they have divided viewpoints on a very complicated issue and it puts them in a difficult position sometimes.

 

They're a volunteer organization, and they're there because they care about the issue. They often are people who have MS or have family members who have MS, or they work in the field with people who have MS. It's a challenging subject, but we live in challenging times. I think the common ground for us all in this has to be hope, that we will keep moving forward to examine this treatment and that we will keep an open mind. Dr. Murray, he's a recipient of the Order of Nova Scotia and, I think, quite a wise individual - keep an open mind, do not close the door on this therapy, but do the work that's required to determine what it all means.

 

MR. MACLEOD: Madam Chairman, first and foremost I want make sure everybody understands that I would never question the minister's commitment to health care in the Province of Nova Scotia or how she goes about her job. There are very few people who are as committed as she is to making her department work and work successfully for Nova Scotians. I have no problem saying that.

 

The minister says that this is not about money, and yet when she replied she was quoting dollars that are being spent - and these are programs that are very important to the individuals; the minister said that this is about hope - and there is no question it is about hope; and the minister says that we need to talk about scientific evidence - and that's important and I would not be one to say that it is not. But there is another side to that coin for someone who suffers with MS - imagine being with a life partner who has been diagnosed with MS, going to a doctor's office, sitting down and being told by that doctor that the medication you're on is no longer working, that there is nothing else I can do for you, go home and have a happy life.

 

Imagine how one would feel, and then when somebody goes and has a treatment, experimental, different, challenging, whatever you want to call it, and there is a difference in that person's life - that person's quality of life has risen. And that's not just an experience that I've had; it's an experience that many Nova Scotians have had, and many people across this country.

 

The minister talks about a meeting that was held in Newfoundland and Labrador where they talked about this issue. I remember her talking to us about that previously here in this House. That was an important meeting - I think it was one of her very first meetings and at that time she became chairman of the health ministers across the country, and that's a good thing for the Province of Nova Scotia. But I can't help but wonder what the Minister of Health in Manitoba knows or the Minister of Health in Saskatchewan knows, or even the Minister of Health in New Brunswick knows, because all of their governments have decided that MS Liberation therapy is worth doing.

 

The minister made reference to the fact that, indeed, there are no actual clinical trials going on in Canada right now, and that is a very accurate statement; however, if we keep waiting and waiting, when will the individuals who are afflicted with MS be able to get some kind of answer? I can't understand, and the many people I have met who have MS - and I have had an opportunity to meet a lot of people across this province - can't understand why, indeed, we can't be more proactive. Why this minister, as chairman of the health ministers in the country of Canada, couldn't call a meeting and have that meeting held here in Nova Scotia to discuss where we are? A year has passed, so it's not inconceivable to think that after a year we should have knowledge of where we need to be. We've seen government after government saying that they want to get more involved.

 

Would the minister consider - I guess is my request - trying to get a Ministers of Health meeting together to focus on MS to find out where we have been since that meeting a year ago, and where things are going and why is it that governments like Manitoba and Saskatchewan are now investing in the Liberation therapy?

 

MS. MAUREEN MACDONALD: Madam Chairman, I understand how strongly the honourable member feels about this issue. I very much respect his tenacity and I know it comes from a very sincere place and a very caring place, but I want to say that while it's true that Saskatchewan and Manitoba have made announcements about clinical trials that haven't happened yet, while it's true that New Brunswick has talked about some financial support for people who do decide to leave New Brunswick for the procedure, I want to say that Ontario, Quebec, Alberta, British Columbia, Nova Scotia, and P.E.I., are all on the same page, at least so far, on this. We all struggled at the meeting in Newfoundland and Labrador around this issue, even Manitoba and Saskatchewan.

 

Now, the member asked the question about convening a special meeting of provinces on this issue. What I would say to the member is this - in the not-too-distant future there will be the next meeting. So let me start by saying that the next regular meeting of provinces is, I think, not going to happen for some time. We're probably looking at the Fall, which I feel is too far away for discussions on this matter with the other provinces. However, we do do conference calls on a fairly regular basis and there will be one fairly soon. We have an opportunity to set the agenda for that call and I certainly am prepared to ensure that this item is on the agenda for our conference call.

 

I want to tell the honourable member it would have been on the agenda without having this discussion, because until this issue reaches its next logical conclusion, I think it is incumbent on myself, on all Health Ministers, not to allow this issue to disappear from the national conversation - and it won't as long as we have an opportunity to be chairman. I can assure you of that, it's an important issue and it's an important issue to get some follow- up. We have these studies underway. It would be a very opportune time to get some results and find out at what stage we are in terms of getting information out of those studies, and that will allow us to really formulate and start planning ahead for clinical trials. I see nothing wrong with that; I see nothing wrong with starting to think in that direction and look at what is the information that is coming forward. So I think that is the most realistic.

 

This is a very important topic and I don't want to be disrespectful around the topic or the request that the honourable member has made. Part of the problem, frankly, of meeting any time sooner than the Fall is the number of provinces in this great country of ours that are going to the polls in the Fall. We get to host the next federal-provincial meeting here in Nova Scotia, and just trying to find a date has been a bit of a challenge I think in some ways because of the fact that so many provincial governments have fixed election dates and are going to the polls. So it's very, very difficult to engage provincial Health Ministers during such a time.

 

There will be a meeting eventually and this no doubt again will be a part of the agenda. Additionally, there will be discussion about a number of really important items by teleconference and we can certainly move this forward on the agenda. That's something that I can undertake to attempt to happen, Madam Chairman.

 

MR. MACLEOD: I want to thank the minister, and I would strongly encourage that during that telephone conference call that indeed MS is a subject, and I would ask if she would consider bringing a report back to the House or to the different caucuses afterward with relation to the discussions on MS and where that is. I know there will be many topics that we will probably not be able to share and we understand that, but if we could get an understanding of where the provincial Health Ministers in Canada are standing right now on the MS situation, I think that would serve MS patients here in the Province of Nova Scotia and other areas very well.

 

I want to thank the minister and her staff for the opportunity to ask these few questions - and I'm going to share the rest of my time with the member for Argyle.

 

MADAM CHAIRMAN: The honourable member for Argyle.

 

HON. CHRISTOPHER D'ENTREMONT: Thank you, Madam Chairman. I do want to thank the minister for her thoughtfulness and her thoroughness on the issue of MS. I know that our member for Cape Breton West does wear his emotions on his sleeve a lot of the time, and I know it's important not only to him but to our caucus and, I think, everybody who sits in this Legislature as we meet with constituents on a regular basis about this treatment and many other treatments as well. There isn't a day goes by that many of us haven't a contact from someone that touches Health in one way or another, whether it's something happening at the hospital, whether it has to do with a treatment, whether it has to do with something to take care of our parents or our children.

 

I'm going to run a few quick snappers because we have until 5:55 or . . .

 

MADAM CHAIRMAN: Until 5:57 p.m.

 

MR.D'ENTREMONT: Until 5:57 p.m., so I thought I would ask some questions, basically about some continuation of projects that were started under our government and I'm just wondering where they're sitting today. The first one I'm going to ask about is the issue of radiation therapy and the cancer centre at the Victoria General - just where that is in the process. I know there were some dollars - that a linear accelerator had been purchased, but there's still some work to be done to the hospital and I'm just wondering, where is that project in sequence right now?

 

MS. MAUREEN MACDONALD: While the staff is digging out information on that, I want to thank the member for raising this issue because it is an important issue. Construction at the Capital District Health Authority began in December 2010, it's expected to be completed during the fourth quarter of 2011-12 fiscal year, and three radiation therapy units are expected to be purchased during 2011-12. We have new money in this budget for that.

 

Last year, I think we put in $10 million for this. The member would know that the Province of Nova Scotia was a signatory to the radiation wait time guarantee that was signed between the federal government and the province. While there was some federal money in this, it's mostly provincial money that's in this. I think one of the first things I did as minister was to have to make a decision about going across the street with my hat in my hand to the Treasury Board and making the case for why we needed an appropriation of an

Additional - I think it was close to $10 million, because it wasn't there in the budget. It hadn't been budgeted for, even though that commitment had been made.

 

You know it's an important commitment to keep. Rates of cancer in our province continue to grow and they are projected to continue to grow for some time. It's a multi-million dollar project. We also upgraded in Cape Breton as well.

 

One of the things that I'm very pleased to talk about is the fact that we are meeting our wait time guarantee. This will allow us not only to meet them, but to continue to meet them as there's a growth in the need for cancer treatment. There's nothing more difficult - and I know I'm preaching to the converted, the former Minister of Health is well aware of what it's like to have a phone call or an e-mail or a visit from someone who is experiencing a cancer diagnosis and they are waiting for treatment and they want your help. So anything we can do to ensure that people get timely access - and the great team over at the cancer centre here and in Cape Breton, they are just phenomenal people.

 

MR. D'ENTREMONT: Thank you very much, Madam Minister. Madam Chairman, it is definitely a project that has taken a number of years to really pull forward. If I remember the whole rundown on things, money from the feds was available to help purchase the equipment and then, sort of at the 11^th hour, we were told that there had to be a renovation to the hospital in order to accept those facilities - they didn't in one minute, and in the next they did. I thank the minister for going with her hat in hand and finding those extra dollars to make sure that it does happen.

 

I had the opportunity a few months ago to visit the Cape Breton Cancer Centre with the CEO from the district, John Malcolm. What a wonderful facility, and he talked about the challenge of working with an old machine and that's kind of what we have right now, a few old machines.

 

These are very resourceful technologists, technicians, who keep our machines running. John told the story - listen, I was working my best to try to keep that machine running until the new one was in place and then once the new one was in place, then I could sort of catch up. But I guess it wasn't soon after the new one was turned on that the other one had to be shut down and go for a full refit because, ultimately, they had used it so much to treat patients in the Cape Breton area. So it was just-in-time delivery, I guess, is what we're trying to say. I'm hoping that as the project comes to its completion in 2011-2012, that we don't have any mishaps with the machines we do have today treating patients. So it's good to have the update on that.

 

There is the added piece to the Yarmouth Cancer Centre and I just want to talk to the minister a little bit on how successful that one is. I've talked to many patients who have had the opportunity to visit a cancer centre in their own hospice facility and how they find that to be much more comforting, much easier than having to take that long trek here to Halifax. Really what's happening, even though it is only a medical oncology unit, is to be able to do it there is phenomenal.

 

I know you've had the opportunity to visit that site, but I would probably guess it has the best view of any unit that we have anywhere in Nova Scotia. It actually sits on the end of the hospital and overlooks Yarmouth Harbour. There would have been a time that you would have seen The Cat go up and down the harbour, but it doesn't today - maybe someday, we'll hope. And I'm looking over at the Minister of Economic and Rural Development and Tourism as well.

 

The next question I have is around Lucentis and I know it's not going to give us a lot of time to talk about this one, but I'm just wondering, because we've gotten a couple of letters in around the availability of that service in other areas, and my understanding up to now is that the only opportunity to get the Lucentis injections is here at Capital Health and I know there has been talk about expanding that. What I've heard is there are individuals in, I believe it's Antigonish, who have the equipment in order to do that, but they're not being recognized to be able to do those injections. I don't know about the Cape Breton district, but anything that we can do to sort of stop the travelling - somebody from Cape North has to drive all the way to Halifax, it's a long way, and even if you could cut that in half and let them go to Antigonish, I think is a phenomenal piece. So I'm just wondering if there's an expansion to the Lucentis program to allow that injection to happen in other sites other than Capital Health?

 

MS. MAUREEN MACDONALD: Madam Chairman, I really want to thank the honourable member for a number of things. He reminded me of how beautiful Yarmouth is from the cancer treatment centre there at the regional hospital - unbelievable - great staff, and it has been too long a time since I've been to Yarmouth. So I'm glad he reminded me of that.

 

With respect to Lucentis, Madam Chairman, you'll know how hard we worked in the Department of Health and Wellness to get this treatment to improve the quality of lives of people who have wet macular degeneration. It's a very expensive drug and by delivering it in the hospitals, we found a way to afford this drug. I want to reassure the honourable member that right from the get-go, when we looked at this, I talked to staff in the department about how we might decentralize this treatment in the longer term, because I recognize that it's not easy for some people to drive from parts of the province to Halifax for treatment.

 

I do know that the majority of people who were receiving Lucentis treatment were, in fact, getting it here in metro from the retinal specialists. So when we established the program the 1^st of January of this year, we started with the retinal specialists here at the Queen Elizabeth in the clinic. We wanted to see how that would go and I have had probably the same correspondence that the member has from a few people, particularly from a few people from the Antigonish area. I know that the staff is working, we have looked at what this might mean elsewhere, but we're still, frankly, establishing the program here and working all of the little bugs out of it.

 

As the member knows, Madam Chairman, as a former Minister of Health, the best of intentions can often have their little sidebars, and this one is no different. So we'll work our way through those issues and then certainly we will look at what else we might do, but right now I think we are doing the best we can to get this. I've had, in addition to the one or two letters I might have had from the Antigonish area, letters from people all over the province saying thank you, thank you, this has taken such a burden off us. People were paying $2,000 an injection for Lucentis.

 

I know it can be expensive having to drive, especially these days, we're watching the price of fuel shoot up week over week. But just the same people are, in fact, saving a real amount of money compared to what it was that they were paying. It is a drug that does make a significant difference - it's quite incredible really that it can actually reverse the condition for some people. You have to see the importance of this particular treatment and the improvement it can make.

 

I assure members that we will very much keep in mind the additional burden this places - as well, the other thing we're watching is wait times to get into the clinic here. If you're bringing everybody in from across the province you want to make sure that they have timely access and they can get in and that waits don't become unmanageable and what have you. We will work with people around the province, both people who are delivering this treatment as well as the retinal specialists who are here at the Queen Elizabeth hospital.

 

MADAM CHAIRMAN: Order, please. The honourable Government House Leader.

 

HON. FRANK CORBETT: I move that the committee now rise.

 

MADAM CHAIRMAN: The motion is carried.

[The committee adjourned at 5:57 p.m. ]