HALIFAX, THURSDAY, APRIL 14, 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. We will continue with debate on Resolution E11, with the Minister of Health and Wellness.

 

The honourable member for Bedford-Birch Cove.

 

MS. KELLY REGAN: Thank you, Madam Chairman. The Minister of Health and Wellness will probably know what I'm going to talk about now because we've talked about this a number of times. Back in March the member for Halifax Clayton Park, who is the Liberal Party Health Critic, and I sent the minister a letter in reference to Lyme disease - I have a copy of that if the minister would like to look at it now, and then that could possibly be tabled afterwards.

 

We noted that in the past only areas that have been identified as having established populations of Lyme disease-bearing, black-legged ticks had been targeted for public information sessions. In the letter we asked if you would expand the Lyme disease public information campaign province-wide this year because we know that Lyme disease-bearing ticks don't stay within a prescribed area.

 

There is no invisible fence keeping them in - they travel on birds, they travel on rodents, they travel on deer, so we feel it's important for people, not just in the areas where Lyme disease- bearing ticks are endemic but outside those areas, to actually know about Lyme disease because a lot of people seem to think that they are protected by the fact that they don't live in an area where the disease has been tracked, so they think it's not going to be a problem for them - but again, it can be anywhere.

 

 

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I guess my first question is we are asking you to expand the Lyme disease public information campaign province-wide this year - I should mention we haven't had an answer back, so that's why I'm asking these questions.

 

HON. MAUREEN MACDONALD: Madam Chairman, I want to thank the honourable member for the question because it's a very important topic. Lyme disease is becoming, I think, more and more of a public concern. Certainly in the past we have had isolated, or very localized, I guess I would say, not isolated - Bedford could hardly be characterized as isolated, or parts of Lunenburg County as well - but localized, we had identified established populations of black-legged ticks in localized areas.

 

The former Department of Health Promotion and Protection, where Public Health resided, is now in the Department of Health and Wellness, but in the past we worked very closely with the Department of Natural Resources to have surveillance, to try to identify where these particular ticks are. The member would probably know that last year we extended the localized areas to include areas in Pictou County. It is true, I mean my Dad, an old forester, kind of laughed and said to me that you're not going to be able to confine any critters that you have in your province - they may be localized now, but that isn't going to be the case for long because of wildlife, birds, all of these kinds of things that travel.

 

I think we can, indeed, be more certain that although we know we have established black-legged ticks in certain areas, they tend to be more prevalent and we have to be vigilant wherever we are in our province in the summer. I don't know if the honourable member heard the radio this morning, Information Morning, but they have had this very interesting series of interviews, and today Lyme disease was one of the things discussed.

 

I was very pleased to hear the information provided in terms of how do you attempt to protect yourself from Lyme disease. Obviously the first thing you need to do is to try and make sure you don't get ticks on you, if that's possible, and that you check very carefully if you are outdoors, particularly if you are in wilderness and wooded areas - but it doesn't have to be all that wild, these ticks can be in the grasses in people's lawns, really.

I want to tell the member, Madam Chairman, that last year after we got word from Natural Resources and Dr. Maureen Baikie had made herself available to the media and had answered a lot of questions and I had been briefed, I talked with my staff about the very thing that the member has raised, the need to do public information and to broaden the reach of our public information to residents of Nova Scotia and, indeed, visitors to Nova Scotia, so that we are more vigilant and we do our utmost to try to help people, educate people so that they, first of all, protect themselves to the extent that they can, that they do the techniques around checking for ticks, and that they also understand what to look for in terms of if they are bitten by a tick.

 

I had a very good friend, actually, who last summer in the Lunenburg area was, in fact, bitten by a tick and developed the red bull's eye rash around the bite and knew right away - she's a person who keeps herself pretty up to date and informed of what's going on, has a long history of working in the health care system but has retired, but knew automatically and went to see her physician and was prescribed the antibiotics and everything went very well.

 

That's the other thing I really want Nova Scotians to know and to understand - that Lyme disease untreated can be very serious and very debilitating, and has been for some people, but it is very important that people understand that this illness is treatable, particularly if you treat it when you identify that you have been bitten. But it can be treated at any stage as well, when you are diagnosed. Obviously, like most diseases, it is better to get the treatment early.

 

Also, Madam Chairman, I want members and I want the honourable member to know how the system currently works in terms of the provision of services and public health. Everybody here will know that we have a Chief Medical Officer in the province, Dr. Robert Strang, who is an excellent Public Health official and oversees the public health of the province and is empowered to do this through legislation. Under him work a number of Medical Health Officers, and these officers of medical health work in each district health authority, so they are spread around the province in each district health authority. They work very closely with Dr. Strang; they are part of the team.

 

They also work within that district health authority - they work with the Public Health nurses and they work with the physicians. They are very much involved with respect to the local conditions, which vary sometimes from district to district. So perhaps you would have - for example, we've had black-legged tick populations on the South Shore for some period of time. So I would anticipate, and I know that the officer of medical health there has been more engaged around the matter of Lyme disease, and information sessions and the development and the distribution of information, than perhaps the Medical Health Officer in some other district health authority - perhaps to use the Valley as an example, where there hasn't been an established population of black-legged ticks. That's pretty much how the Public Health system is organized around this issue, in a very simplistic way.

 

The other thing I want members to know and to understand is how closely Public Health works with the physicians in the province, as a general population. There are bulletins that go out on a regular basis, on a variety of issues, to physicians and they are distributed to every licensed physician with respect to protocols and advice around various illnesses and diseases and treatments. Lyme disease is part of that rotation of information, so as we get towards the months when people are spending more time outdoors and the weather is improving and what have you, we boost up our information going out to physicians and we remind them of a variety of issues - and Lyme disease is definitely a part of that focus.

 

The last point I will make is specifically with respect to a province-wide campaign. So after the Pictou County surveillance demonstrated last year that black-legged ticks were in that area and I spoke with staff and I said next year I would like to see us beef up the public information that we do on Lyme disease in Nova Scotia, it's obvious that this is now moving beyond one or two localized sites and, given the mobility of people in the province and given that people will, for example, go to more than one camping site around the province - they might be in Kejimkujik one weekend and on Melmerby Beach the next, or they might be up in Ingonish, the next in the Highlands - it's really important, I think, that we have a broader campaign, and so indeed that is being worked on in the department and we will be making that available quite shortly, Madam Chairman.

 

MS. REGAN: Madam Chairman, through you to the minister, thank you for moving on that particular issue. I was talking to Dr. Gaynor Watson-Creed, who had indicated to me that the plan had been to do something more along that line last year but there were so many reports, et cetera, so much surveillance associated with the H1N1 crisis that they just didn't get to it last year. So I'm pleased to see that.

 

One of the things that concerned me last year was when the new population in Pictou County, around Melmerby Beach, when it came out in August I was on vacation and I didn't hear anything about it until September when I happened to go on the site. My concern was - I think a press release went out, so I am hoping to see that we would have more of a concerted effort to get that information out because, as the minister noted, we have tourists in town and we would hate for somebody to go home with an infection, not knowing how they contracted it or what it might be and have them not seek treatment immediately because they don't know what a bull's eye rash is or they can't see it because it is under their hair - my concern would be that when a new population is identified, that there be more of a concerted effort to make sure that information gets out to the population. I'm wondering, could the minister speak to that?

 

MS. MAUREEN MACDONALD: Thank you very much. It is interesting, my parents live beyond the Pictou County line, into the Antigonish County area, and I was actually in that area just shortly after we announced the results of the surveillance in Pictou County. I want to assure the honourable member there was a good deal of information available in Pictou County - it was well-covered in the local newspapers.

 

I know that district health authorities have brochures and these things which they distribute to physicians' offices and family practice sites all around their district health authority as part of the notification. So this is definitely a part of what we do, and we will continue to provide information. It is important to know that much of this information is provided at the local level, at the district level, not out of the Department of Health and Wellness.

 

Because we have quite a decentralized health care system, we sort of set the policy, we do the monitoring, the evaluation and those kinds of things out of head office, but at the district level it's really where a lot of the practical application of that work occurs to help people understand the issues. The Public Health officers are there to educate, to work with the health care community, to disseminate information, to do information sessions and what have you - that's a very effective way to get the word out. It's really working with local communities to inform them and to promote the tick management approaches, wherever possible. This is the process we use.

 

I should have indicated that we are updating for this year the brochure that we do on Lyme disease. We're updating and revising it, actually; a poster will be done as well. We will look at other means of communication - we'll certainly look at spots, perhaps, on radio and maybe again in the local newspapers. That will create a level of public awareness around this issue and help people protect themselves and be more aware of this issue.

 

MS. REGAN: Madam Chairman, I just want to let the minister know that if she wants to do those radio spots herself, I have no objection.

 

I'm just wondering if any new areas have been identified as having substantial Lyme disease-bearing, black-legged tick populations since Pictou County was added last year?

 

MS. MAUREEN MACDONALD: Madam Chairman, I don't think that there have been any new areas, but the Department of Natural Resources actually do the monitoring, the surveillance. I know it was a particular area in Pictou County that there was confirmation of the black-legged ticks and that was in the Melmerby Beach area. I do know that there are other areas in Pictou County that are being monitored, but the surveillance results have not indicated black-legged ticks in those areas - and I would assume that this is the same throughout other places in the province where they are doing monitoring.

 

Right now, in Nova Scotia, we have four confirmed areas - that area in Pictou County being the most recent, but also in Lunenburg County in the Blue Rocks-Heckmans Island-First Peninsula area, and of course Admirals Cove in Bedford, and Gunning Cove in Shelburne. Those are the four areas where there has been confirmation.

 

Additionally, apparently migrating birds can transport the black-legged ticks into an area and they may or may not become established in those areas. So the process is one to really do surveillance that will allow you to confirm with some credibility and certainty that the population is an established population.

 

MS. REGAN: Thank you. Madam Chairman, Lyme disease, as the minister knows, can be quite debilitating for those who have it and don't get immediate treatment. As you know, a recent news story revealed that false Lyme disease test results were recorded for 24 Canadians, including 13 Nova Scotians. These erroneous test results meant the disease was left untreated in some of the individuals affected. We'd like to know if you can provide the number of Lyme disease tests performed in the province last year and, if so, can you also indicate how many of those tests were negative?

 

MS. MAUREEN MACDONALD: To the honourable member, Madam Chairman, I don't have that level of detail with respect to the number of tests that have been done.

 

Again, I should perhaps lay out for the members my understanding of how this works. What occurs is, for example, if I felt I had been bitten by a tick and I go to see my doctor, then there's a blood sample I guess that would be sent, perhaps the tick itself if it is still attached, and this is sent off to a lab, a national laboratory in Winnipeg, where testing is done. The tests, the 20-some tests of which more than a dozen were here in Nova Scotia, were those kinds of tests that were sent off to the national lab for confirmation. However, I understand there is testing that can be done here as well, but it's not the same test that is done in Winnipeg. Treatment can start immediately, they don't necessarily wait because it's a treatment with antibiotics, so this will occur fairly rapidly.

 

Of those folks whose tests were sent and the lab decided, determined that it was negative and now we know that they were positive, all of those individuals were contacted as soon as we knew. Their physicians were contacted, they were contacted and they all have begun treatment, and I understand that has gone very well. Because I'm not a doctor or a scientist, I don't really know exactly what the problem was, why the results at the Winnipeg lab resulted in the way they did.

 

I know there is a lot of controversy and a lot of debate about the accuracy of tests. I met with a physician, in the province actually, who talked to me about the need to explore other forms of testing than the ones that we currently have, that using the specimens that we do don't necessarily - and they give you, in his view, a much higher frequency of a negative outcome - they don't identify Lyme disease when, in fact, people will have had Lyme, in his view.

 

I know it's a complex topic and there's a great deal of debate in the scientific and medical community around this topic. I rely, to a large extent, on the expertise of Dr. Strang and Dr. Baikie, both of whom are very well respected in their fields and stay very current on the literature, on the practice, on the various debates, and are very concerned about the health of Nova Scotians and put those considerations at the forefront of their decision making. I feel that I get very excellent advice from them in these matters.

 

We will continue to do the best we can, based on the information that we have, to protect people in Nova Scotia when you have these communicable diseases.

 

Madam Chairman, I don't want to go off on a big discussion about the environment and climate change, but one of the things that does worry me, and I'm sure it worries many people, is the potential for an increase in communicable diseases that results from a change in our climate and our climate becoming a place that is more conducive to disease-borne bacteria or viruses or whatever.

 

It's not rocket science, I guess, in some ways, to really imagine that we are going to see the occurrence of diseases that we would have in the past confined to warmer climates and places outside of certainly a cold Canadian ecosystem, but this is a result I believe of a number of things, a change in our climate, and of course we travel now so much more than we have in the past as a population, and that mobility has a whole different set of implications for public health practices.

 

I suppose, in some ways, it's not a new thing, if you think about diseases, big public health epidemics in the past, diseases in the past, diseases that were brought home from foreign wars, in other places, little varmints that were brought from one continent to another as a result of colonialism, really, in many respects, so we probably will see and we need to have - and that's why I think it's very important to have a strong Public Health care system and we do have a very good Public Health care system that is staffed and populated by people with not only the expertise in terms of their credentials, but they have a passion for public health and protecting the public interest.

 

MS. REGAN: Madam Chairman, I'm assuming that when the letter is answered, we'll get the number of Lyme disease tests performed in the province last year and how many of those were negative.

 

The other thing that the honourable member for Halifax Clayton Park and I requested was that the department consider removing the requirement for exposure to an area where ticks are endemic as a criteria for doctors who report a case of Lyme disease to Public Health. Since ticks do not remain within the boundaries of identified tick-endemic areas - they travel on birds, on rodents, on deer and therefore can be almost anywhere in the province, so I would like to ask the minister to consider discussions with her Chief Medical Officer about removing that because we think it adds another burden that anyone who has Lyme disease is going to have to overcome to have that disease identified as, in fact, Lyme disease.

 

MS. MAUREEN MACDONALD: Thank you very much, that's certainly something that we will consider.

 

MS. REGAN: Thank you. Madam Chairman, this next series of questions may seem a little odd because they actually refer to something that happened before the minister became the Minister of Health and Wellness and really I'm just looking for some information.

 

The Paul Martin Government sent our province $5 million for cataract wait times in 2005, and I've been contacted by an ophthalmologist, in sort of casual conversation, and he was saying that the ophthalmologists aren't sure that actually went to cataract wait times. In Manitoba it was a line item in their budget, so they know where it went, but they don't have confidence that it actually went to cataract wait times.

 

He said to me, look, if there was something that was more important - it's not that we don't understand, we just want to know where it went. I am wondering - did that money, in fact, go to cataract wait times, or did it go somewhere else? I don't expect the minister to know the answer now, but I am wondering if I can get that information.

 

MS. MAUREEN MACDONALD: Thank you very much. I want to thank the honourable member for this question because I think it is a very important question and it is part of a bigger question and a bigger issue. The provinces and the federal government signed a wait times guarantee a number of years ago - I think it was in fact part of the Health Accord. We came to agreement on five areas where wait times needed to be improved. They were cataract, cardiac, radiation, MRI and diagnostics - I think actually diagnostics is part of that - and the fifth one is orthopaedic.

 

Money was allocated, transferred to provinces to assist meeting benchmarks - an awful lot of work had to be done, and work is actually still being done, and we get reports relatively regularly on the wait times, on how we're doing.

 

Nova Scotia has been able to meet our wait time benchmarks in cardiac and in radiation, but we have not been able to meet our benchmarks in a number of those other areas, particularly orthopaedic and cataract. When the reports come out, Health Ministers lie on the floor and hyperventilate in Nova Scotia because we were at the bottom of the pile going in and we still are. It's very, very difficult to overcome the long-standing handicap we've had with respect to where we fall on the wait times.

 

The CIHI wait times report came out not so long ago - I probably have it here some place - I sat down and read it very carefully because usually, to be honest, when it comes out I get time to read the executive summary and the four pages of briefing notes which is a summary that my staff prepare for me, but this time I read it from cover to cover and I'm really glad I did.

 

What I began to see is that Nova Scotia is not the only province that doesn't meet the wait time guarantee; in fact on orthopaedics, for example, none of us are meeting the wait time guarantee. We've been unable to achieve that. Although we have probably the worst - we're the last in terms of meeting the targets, the spread isn't that far apart between us and the next worst and actually the province that is doing the best. The spread is really quite narrow, although I concede we still are at the bottom of that heap.

 

Now cataracts is an interesting question in terms of its area on its own. Cataract surgery - well, the honourable member is a lot younger than I am so maybe you don't remember this, but cataract surgery is a lot different today than it was 40 years ago. I remember when I was a young child my grandfather having cataract surgery. It was a very big deal to have cataract surgery - a long procedure, a long recovery. Today, my mother had cataract surgery a few months ago, I think in January, and she was in and out in 15 minutes. It's a completely different animal than it was when people actually went under anaesthetic and all that kind of stuff.

 

So with respect to the $5 million that Nova Scotia received for cataract surgery, I can't categorically stand here today and say, yes, all $5 million went towards cataracts but my gut instinct is to say that we probably spend more than that; we probably have been spending more than the $5 million additional dollars to try to improve cataract surgery in Nova Scotia. We didn't track the wait times money in that way. The wait times money came to us in a chunk for all of those five things and went into general revenue in the Department of Finance and then came out of the Department of Finance to the Department of Health and Wellness for our various budgetary requests which would include physician payments, where the cataract money would be, for the most part, because physicians perform this procedure in their offices or in a clinic in a hospital.

 

We are, as provinces, preparing for our next round of negotiations with the federal government with respect to 2014 and we are going back and unravelling, if you will, the paper trails of money so that we can in fact have a very clear picture of where the money went. I can assure the honourable member that monies transferred to this province to improve wait times in the health care system to improve wait times.

 

The radiation treatment would be an example of where every penny of federal money that we got went into radiation therapy, and more - we probably tripled that on a provincial level. It's a challenge, both bringing wait times down is a challenge and demonstrating every nickel that you get and spend toward that amount. Health care is so complex, it's not a simple business enterprise - and there is no such thing as a simple business enterprise, but certainly the health care system isn't a simple business or financial enterprise, it's very, very complex.

 

It's always interesting though, there is a fair amount of competition within the health care section I find. You find sometimes that certain specialities kind of feel that maybe the monies that have been allocated to them aren't really coming to them. It looks like those guys over there are doing a little better, they're getting a little more operating time and their wait list seems to be a little better and what have you. It's just natural, I think, in a system that's as big as our system. Frankly, it's a system where these doctors and specialists want to be working to their full capacity and they want their patients to get the best quality care they can as quickly as possible. They want to hold the government, and the bureaucracy behind the government, accountable for how money is being spent, and I understand that and I accept it. If there is some way when the information is available, then certainly I will make it available.

 

MS. REGAN: I might also suggest that maybe this next round, in the interest of transparency and openness, if we do get a chunk of money for a certain procedure that that would be a line item in the budget - as it's done in Manitoba. Because then everyone can see where's it is going and I think it might make easier when we're trying to figure out afterwards where did the money go. I realize that the minister was not the minister when this money came to this province, and I'm certainly not quarrelling with her answer - and I do appreciate her offer to give me that information.

 

I'm just wondering, in terms of midwives, this was an area that I began hearing about not too long after I was first elected because there was a couple in my riding who could not, despite registering immediately upon conception if not sooner, to have a midwife, could not get in despite trying a number of different times to access that particular issue, and I'm just wondering in terms of the midwife program at the IWK, has there been any progress after that program just, I don't know, imploded or . . .

 

AN HON. MEMBER: Came to a halt.

 

MS. REGAN: Came to halt. Has there been any progress on that file?

 

MS. MAUREEN MACDONALD: Midwifery, as the honourable member and other member's know, it's taken a long time to get to the point where government has in three DHAs piloted midwifery services and that is in GASHA, the Guysborough-Port Hawkesbury-Strait-Antigonish area, and on the South Shore under the deputy minister, I might add, who was the CEO there at the time, and here at the IWK - and really it's not a very well-established program, it's still a very new program.

 

The program at the IWK only started in the Fall of 2009. There were, as you know, difficulties and the program was suspended. So the program, it was only fully staffed by the Fall though - it started, they didn't have a full complement of midwives and they continued to recruit; they got a full complement and then it sort of ran into its difficulties.

 

As well, the other DHAs, I think GASHA had difficulty recruiting a second midwife, but they have a second midwife there now. The members would be familiar with GASHA. GASHA is a very large geographic DHA - quite spread out. It's certainly the kind of geography where you would want to be able to provide midwifery services to the whole district and, particularly, to women who live in some of the more sparsely populated parts of the district.

 

The implementation of the midwifery program did not occur under this government, it was initiated by the previous government, and it was a program that we certainly supported and believed very strongly in, believed that midwifery is an important piece of health care service. So the program was initiated under the previous government.

 

The entire program costs about $1 million, $1,041,165 to be precise, and it was always the intention to evaluate the program and to then extend the program into other DHAs, based on other DHAs being ready and on lessons learned. The program has without a doubt seen some bumps, and in particular there have been bumps at the IWK. There have been some difficulties with the program at the IWK. I've met with various points of view around that, people who work at the IWK in the maternal care team, and with midwives and with the midwifery coalition, and with different groups to try to understand the various perspectives and hear their point of view and to work at how we can get this important, I think, program on track for women who live in the Capital District Health Authority.

 

What we said was that we would do an independent review of midwifery services, not only at the IWK, but also in GASHA and on the South Shore. We have recruited a team; we've just finalized the details of that team who will do the review. The team is comprised of a mix of health care providers who have experience. We have a midwife from Ontario who is very well-known and she will lead the review team; we have a midwife from Manitoba; and we have a family doctor who will be involved in the review, as well as a manager of maternal care from Manitoba - the family doctor is a doctor from British Columbia.

 

It's interesting; I met with many people. There's a wonderful doctor, whom many of you would have heard on the radio, whose name is Dr. Heather Scott. She was over a the IWK - she's gone off to the World Health Organization in Geneva right now to pursue research that she's doing on midwifery in the health care system. She brings a lot of expertise and balance to this issue - and as well an internal group did a review in our primary and maternal care section of the department.

 

We're getting good advice and we are going to proceed in a way that will help us strengthen the two programs we have on the South Shore and in GASHA and that we get the capital midwifery program moving forward in the direction that we want it to go. I have made that commitment to the various parties. I have essentially made it clear that until I feel confident in what it is we currently have in the three DHAs, I'm not prepared to expand this to the entire province.

 

The point of having some pilot sites is to learn from those sites. Until we've completed that process, I think it would not be advisable to do an expansion; that's my view. This government remains very committed to midwifery services, so we will take our time and work through this process and I'm very much looking forward to the team who will be here doing the review and working with us.

 

MS. REGAN: I'm just wondering if the minister can indicate what the timeline is for that review, because of course women who are expecting babies or hoping to be expecting babies are on a very different timeline, they're on a nine-month timeline and if they want to be involved in that program it would be good to know when this might happen.

 

MS. MAUREEN MACDONALD: I think our expectation is that we will have the report prepared by the end of June. The leader of the review team will be here this month and the full team will be in the province in mid-May and then we're hoping they will be able to complete their work and get it to us by the end of June.

 

This will be very useful and it will help; I think it will dovetail nicely with some other work we're doing in the department on primary care.

 

MS. REGAN: You mentioned the budget number for this program is $1 million. I'm wondering if the money that was to go to the IWK is still going to the IWK even though the program there is suspended?

 

MS. MAUREEN MACDONALD: Yes, absolutely. There has been no reduction in the amount of money allocated to the program. As I understand it, the IWK has advertised the positions and I haven't had a recent report on the status of those job openings.

 

Certainly we are looking forward to working with all of our DHAs that have midwifery programs and, as well, continuing to work with the various stakeholders who have worked so hard to get us to the point where we have midwifery programs. I want to reassure them that they will continue to have a role in this process as we move forward.

 

MS. REGAN: One of the issues when I had the couple in my riding who weren't able to get a midwife - they were told various things at different times about why they weren't in the intake stream, I guess, for that particular program. One of them was around the whole issue of when their baby was being born. They were told that - their baby, I think, was due at the end of March - they couldn't take them in because they would have vacations then and there would be too much overtime previously, so they weren't going to be taking in patients who were due to deliver during March, at the end of the fiscal year.

 

I want to bring that to the minister's attention because I think - I understand the need for budgetary concerns and everything but, on the other hand, a baby is due when a baby is due, and I'm not convinced it's any more expensive to send a person to a doctor to deliver, we're just moving numbers around. I want to bring that to the minister's attention and I'm just wondering if she has any comment on that.

 

MS. MAUREEN MACDONALD: First of all, there is a bit of a fallacy, I guess I would say, a misconception, there is a misconception that midwifery is a lower cost alternative to maternal care than other forms of maternal care. That isn't necessarily the case. I, myself, am more likely to be swayed by arguments, not economic arguments around midwifery - you know, we should have midwifery because it will save us money - I am more swayed, persuaded, by arguments that tell us that midwifery will help us have healthier children, healthier babies, and healthier pregnancies, particularly in lower-risk situations. For that reason I think that is reason enough, that should be reason enough to pursue midwifery and have it as a piece of our health care system. We want healthy babies, and healthy mothers who have successful, healthy pregnancies. We want mothers to breast feed, for example, and we want less surgical interventions and procedures.

 

I know that many groups and organizations think they've got to make economic arguments to government because that's what moves government, that's what sways a minister, persuades a minister, persuades a Cabinet, persuades a government. I kind of say on this one, don't come and talk to me about money, come and talk to me about healthy kids, healthy mothers, and a better pregnancy and you'll probably get a lot further, although I do recognize that there is a cost to doing these programs. The other thing is it's just not the case that introducing midwifery into Nova Scotia saves money, it actually is an add-on to our health care system. So we, as a result of having midwifery, don't have less beds in maternity hospitals, we still have the same amount and all of that kind of stuff.

 

So it's not a straightforward kind of proposition, but the important point for me at least, the person who is standing in the shoes of the Minister of Health and Wellness today, is what is good in terms of healthy babies and healthy mothers and getting higher rates of breast feeding, less surgical interventions and those kinds of things, which will result in better health. The evidence has been there for a long time that midwifery is all of those things, so I think that's really very important.

 

The thing I struggle with, to be perfectly frank, around midwifery is how do we get midwifery services to those populations that need them most, rather than the member for Bedford-Birch Cove for example. So I'll be perfectly frank . . .

 

MS. REGAN: I'm not having any more. (Laughter)

 

MS. MAUREEN MACVDONALD: It's the socio-economic question, how do we get midwives working with younger moms, perhaps lower income, less formal education, and to bring good information about maternal health and care to those women so that they have better awareness about their diets, about alcohol and tobacco use during pregnancy, and not just during pregnancy, but beyond, and breastfeeding, healthy birth weights - what are we going to do to ensure there is a healthy birth weight and all of those kinds of things?

 

It's interesting. I think a lot of the research does show that people who are more likely to use midwifery services are women who are better educated, they are a higher socio-economic status and they might be the women who would do a lot of the practices that you want done anyway - breastfeeding, all of those kinds of things. So it is how do we, really, make this a program that is universal? It's going to be available to parents and women who are having children, but how do we make sure that women from more disadvantaged populations have access and make use of it in a way that will really make a difference in their maternal care? So that's a challenge and that's something I think about and we struggle with - and we probably will continue because there isn't an easy answer to that.

 

Again, I'm very excited about the team that has been put together, they are stellar. The composition of that team is exactly what the composition of such a review team needed to be, because they bring all of the perspectives, plus they bring a lot of experience and they have the right balance in terms - you know, we have a couple of midwives, so I don't think they are in a situation where they would feel that they are marginalized in any way by other providers.

 

MADAM CHAIRMAN: Thank you. The time allotted for the Official Opposition has expired.

 

The honourable member for Victoria-The Lakes.

 

MR. KEITH BAIN: Thank you very much, Madam Chairman. I'm certainly pleased to stand here this afternoon to ask the minister a question that I know she is probably anticipating anyway. I'm just going to be kind to her today and ask the one question and will turn it over to my colleagues.

 

Madam Chairman, this time last year we were standing here, during estimates, talking about the Highland Manor in Neils Harbour. At that time, there was a great deal of concern expressed by the Fire Marshal's Office as to whether or not the licence for the manor would be renewed. I must say that I want to thank the minister and her deputy, who visited the site last summer - and I had the pleasure of being there when he met with the administrator and board of Island Manor.

 

Most of those issues have been addressed, and again I want to thank you for that, but one key thing in the Fire Marshal's report was the lack of space within the existing facility. During the meeting at that time, the deputy did say that nursing homes were being reviewed for expansion or construction, and I guess what I would like to ask at this time is whether or not the Highland Manor, in Neils Harbour, is being considered for an expansion? I ask that because I know that the Municipality of the County of Victoria has purchased an adjoining property to allow for that expansion to take place. So I would like to hear what the minister has to say.

 

MS. MAUREEN MACDONALD: Madam Chairman, I knew when I saw the honourable member get to his feet exactly what he was going to ask me about, and I'm pleased to know that many - not all, but many - of the issues that were there this time last year have been resolved, and that's a very good thing to know. I'll tell you this community certainly fights hard for its residents and for its seniors - and that's a good thing.

 

So the manor is a 19-bed facility and we have quite a number of small facilities like this around the province. The first phase of the Continuing Care Strategy built new beds and it replaced beds that no longer met the standards. We have been going through a process in the Department of Health and Wellness - and I don't know that it's completed yet, but we certainly have the process well underway - to go out and look at the remaining facilities around the province that are of a certain age to get a better understanding of what future replacement facilities are required.

 

So at this stage that work hasn't been completed and I can't answer the member about whether or not Highland Manor will be expanded as a result, but what I can say to the honourable member is that we are looking at the other facilities that have space needs and whose facilities no longer meet current standards. When we get a better picture of the totality of what is required around the province, I will have a much better idea of where Highland Manor stands within that picture. I would be happy at that time, once I have the information, to sit down with the member and have a more fulsome discussion with him around it.

 

MR. BAIN: Thank you, Madam Minister, for your remarks. I guess I can't stress enough the importance of that facility in the North Smokey area. It's not just serving one community, and I think if geography is taken into consideration the importance of an expansion of a facility of that sort, and in that area, is very important. Our population is aging and when you consider that the nearest home would be in Baddeck, which is at capacity now I believe, Highland Manor, a 19-bed facility today, could be easily a 40-bed facility and still have a waiting list just from residents of the area.

 

So again I can't stress enough, Madam Chairman, the importance of serious consideration, and hopefully, in the not-too-distant future, an announcement of an expansion of Highland Manor in Neils Harbour. Thank you.

 

MS. MAUREEN MACDONALD: Madam Chairman, just to provide a tiny bit more detail to the honourable member, the review taking place will review all nursing homes and residential care facilities that are older than 15 years that have not had a major renovation, so Highland Manor will fall well within that parameter. This information will be used for future planning for renovations, expansions, or for replacement funds. The assessment, I'm told, for Highland Manor hasn't yet occurred but will be occurring sometime this Spring.

 

You can let the administration there know, give them the heads-up that they can expect a visit sometime this Spring for an assessment. Then, as I say, we're doing this right across the province and a report will be prepared and will hit my desk at some point and then we'll see where it goes from there.

 

MADAM CHAIRMAN: The honourable member for Hants West.

MR. CHUCK PORTER: Madam Chairman, I'm glad to have the opportunity for a few minutes this afternoon to ask the minister a few questions, and I want to start on a positive note, certainly, with saying how pleased we all are - the administration, the staff, the residents' families, to have the Windsor Elms Village in Falmouth completed It is a fabulous institution, well-built and serving the good people of the province well.

 

There was always a waiting list, I guess it is probably safe to say, minister, but there's an incredibly long waiting list now because, as we all know, single rooms, new facility, everybody wants a piece of that. They all want to be at the Windsor Elms, which is a great thing. I'm glad that we have that done and I want to thank you for seeing that through. It wasn't easy, I know, there were many meetings with some difficulties in trying to work things out and to stay on budget, which is always key. We've very happy to have that done and the work that went into that, members of your staff and yourself as well.

 

I do want to talk a little bit about the Pharmacare Plan, the Fair Drug Pricing Act, just some comments on that that I've had from pharmacists - they are not jumping up and down as I'm sure you can imagine. I'm not sure exactly - I know there is a cost saving of $6 million that you referred to in there that I'd like to hear a little more detail on - are there real savings, I guess is what I'm thinking, are they going to see it at the counter when they go to buy their drugs? That is what people are wondering. That sounds like it's a good thing. Obviously any time you're saving money on the cost of drugs - we all know the cost of prescriptions and drug plans and so on, but even the price at the counter is very important.

 

What are we going to see at the counter? Why wouldn't this be beneficial to the pharmacists? Why aren't they interested in seeing this? They want to see it delayed is what I'm hearing, that they don't want this rushed through. There's obviously going to be a number of them come in to the Law Amendments Committee, I guess, to speak to this. I'm not sure of the downside so there seems to a bit of clarity here that I'm looking for, that I'm not 100 per cent certain on why this - it all sounds good, so I'll leave it to you just to enlighten me a little bit as to why there would be issues with it or it's actually as good as it all sounds.

 

MS. MAUREEN MACDONALD: I want to thank the honourable member as it's a very important topic. It's one that's very important to me and my government and, I know, to all members here. Nova Scotians pay too much for generic drugs - period, full stop. We all think of generic drugs as being the cheaper knock-offs. You have the brand name drugs that the former Progressive Conservative Prime Minister gave patent protection to, extended patent protection in Canada to the brand name drugs, for 25 years, I think.

 

We, as consumers, all believe that when those patent protections expire and generic drugs become available, we're able to get drugs much more cheaply, except - guess what? - we haven't gotten generic drugs more cheaply at all. We've been paying anywhere, on average, around 63 per cent - but higher than that in some cases, maybe 70 per cent or more, for some generic drugs, and it's just not right. That's not what we should be paying for generic drugs. The cost that the generic drug companies have to invest in generic drugs isn't anything like the cost that the brand-name manufacturers have had to put into the research and development.

 

There's a lot of research that suggests that the reason why generic drug prices are so high is that, in fact, those prices are inflated to cover the costs of marketing the drug, retailing the drug, just getting it into the hands of consumers. So we're paying through the nose for these drugs and it's not fair, it's not right - and not only that, it's not sustainable. The amount of money that we spend on drugs annually in the Province of Nova Scotia has climbed exponentially much faster than the growth in revenue to support our drug programs. Our Pharmacare Programs today are $258.6 million and I think they are the fourth largest item in the health care budget, after salaries for doctors, the physician payments, long-term care and acute care of the DHAs.

 

It is the drug part of the Department of Health and Wellness that's growing the most rapidly. Other areas are growing rapidly but it is drugs that are growing the most rapidly. So if we're going to keep our Pharmacare Programs affordable, then we need to look at ways to get better deals for taxpayers and for beneficiaries.

 

So you had a number of questions in your opening comments and you talked about at the counter - will the consumer at the counter see a reduction in their costs? You understand, government, we've said that we anticipate a $6 million reduction in the amount of money we spend on drugs as a result of our fair drug plan, so what about consumers at the counter? We anticipate that members of our drug plans will see a reduction of $1.6 million at the counter as a result of the drug plan - and how does that work? Well, that works this way - when a senior goes to get a prescription, they pay a co-pay at the counter up to $300-some odd and, depending on what drug they're on, their co-pays, you know, they will be able to get a better deal. And people who are in the Family Pharmacare Program, although it works a little differently - before they get the benefit of the program, they have to spend so much on drugs - they, too, will realize some savings.

 

We had - and I don't have it with me right now and perhaps I can get it and table it for tomorrow - a couple of examples when we announced the fair drug plan, one for a senior in the Pharmacare Program getting a certain drug that per prescription they would save so much and over a year we anticipated they could save about $300, and the same thing for a family getting a particular drug, they could save more than $300. So this is money back in the pockets of Nova Scotians; it is money in their pockets at the pharmacy counter. And it is money in their pockets in terms of taxpayers - we don't have to raise taxes to sustain our Pharmacare Program because we've been able to get a better deal and a fair price for generic drugs.

 

Now let me talk a bit about the process we've used because I want people to be absolutely crystal clear that this has not been a rush job; in fact I took a little bit of heat last year in the public when Ontario went out and did their announcement on what they were doing. Why weren't we rushing ahead and doing the same thing? The reason for that is we're not Ontario; we're a small province. The drug portfolio in the Province of Ontario is way bigger than our entire health care budget. It is unbelievable; it's in the billions. They spend billions of dollars on their drug plans and so the Minister of Health in Ontario can stand up and say we're going to save $153 million with our drug strategy - $153 million they anticipated they would save. That's more than half of what we spend on drugs and what they're saving is just a tiny little fraction of what they pay on their plans. Their plans are in the billions.

 

We wanted to do a number of things. We wanted to get it right. We wanted to have a process where we did lots of consultation with all of the parties who have an interest in this - and those parties are pharmacists, owners of pharmacies, generic drug manufacturers, consumers, seniors in particular, members of private plans - we have a number of very large private plans in the province - and just your garden-variety Nova Scotian. Any citizen who wanted to comment on fair drug prices was certainly welcome and free to do so.

 

We went through a process. We had a very small, very tightly focused discussion paper that outlined a number of questions and we circulated that in a targeted way to the stakeholders; we put it on our Web site; we announced we were doing this consultation, and we did it in a very concentrated and tightly planned period of time so that it didn't go on forever; and we met with people. We had excellent response, a very good turnout, good level of participation and we were pleased with how that all went. Then we got all of the information back and we organized the responses and we made the responses public. We put them up on our Web site, and we put a release out and we said here is the result of the public consultations - who we heard from, here's what we heard, and here's what they told us. We made it clear that we were moving forward with our plan to get fair generic drug prices for Nova Scotians.

 

Last week I announced the features of that plan and what it is we intend to do. I introduced a bill here in the Legislature, and the draft regulations we released as well. We did that because we're moving forward with this plan and we're very committed and very dedicated to getting fair drug prices.

 

What do we think fair drug prices should look like? Well, they shouldn't be 60 per cent, 70 per cent of the brand drug, number one. We've also, in addition to the consultation that we've done, we have done our research and we've looked at what are the policy positions of every other province in the country. We're looking at what are they doing in B.C. on this, you know, people in B.C. don't want to be any more fleeced by the generic drug companies than people in Nova Scotia frankly, and they're doing pretty much what we're doing.

 

It is the same thing with people in Alberta, Manitoba, and Saskatchewan. Saskatchewan launched their strategy last week, put it up, and they're doing pretty much what we're doing. What these other provinces are doing, they're capping the price of generic drugs and they're capping the price of generic drugs at 35 per cent of brand. They're not doing it immediately and neither are we - we intend to phase that in over a year. So we have legislation here on the floor now and our plan is that on the 1^st of July of this year we will cap the price of generic drugs in Nova Scotia at 45 per cent of brand and then, six months later, in January of 2012, the cap will move to 40 per cent of brand. Then on the 1^st of July in 2012, we will cap the price at 35 per cent of brand.

 

Now, I've been asked why we didn't go to 25 per cent, which is what Ontario did. Here I think there are lessons to be learned by really assessing, watching what a big player like Ontario does and give them some time to put it in place and assess it and determine whether or not that's what you want to do. To be frank, in Ontario there are so many drugs that have had exceptions, some people say because the cap is at 25 per cent it went a little too far. If you have a lot of exceptions made to the cap, that requires a certain amount of bureaucracy to do the assessment of the appeals - gather the information, hold the meetings, all of that kind of stuff. The savings that you think you are going to get, you eat up pretty fast in having to construct a whole bunch of bureaucracy to enforce a 25 per cent cap.

 

So we decided 35 per cent seemed like a reasonable level to arrive at. We certainly will see significant savings; the consumers will see significant savings; and taxpayers will see significant savings. Hopefully it will avoid the problem of exemptions and a lot of difficulties, and at the end of the day we will be able to know that we've gotten a good and fair deal on drug prices for Nova Scotians. When I look at other provinces, the 35 per cent cap is what they've arrived at as well, so we're in very good company.

 

Now, there are a number of other things that we're doing with our made-in-Nova Scotia plan that Ontario did not do, or that Ontario did and we decided not to do. Ontario abolished rebates and there was a fair amount of discussion about rebates in the media back in the Fall when Ontario did their plan, and I think the average person had no idea such a thing existed. In fact, you'd have to pretty much be in the know in the industry to know that there was such a thing as rebates in the pharmacy business, for the most part. So I think this came as a bit of a surprise to many people, that manufacturers pay pharmacies to stock their product. It's a common industry practice in a lot of retail-type businesses. It occurs in the grocery industry and it occurs in quite a few industries in retail, so pharmacy is no different. Ontario made it mandatory that pharmacies report their rebates for a period of a number of years, and they started a process to eliminate their rebates. Rebates would be completely eliminated.

 

Some people say - and I don't know, we'll have to wait and see - that capping the prices of generic drugs will ultimately lead to an elimination of rebates, or at least a reduction in rebates. I don't know if that will actually be the case, but that's not our objective; that's a business practice that goes on between the industry and the retailer, and that's up to them to sort out. Our concern is not around their business practices and the transparency of their business practices, our concern is fair drug prices for Nova Scotians. Our concern is that Nova Scotians shouldn't have to pay unreasonable prices for generic drugs - they should get a fair price for a generic drug. If it's a generic drug, we expect to have a fair price.

 

Certainly, that's the thrust of our legislation, and the intention and the focus and the mechanisms that we've built into that legislation.There are probably a number of other things I could say about this legislation. It's very complex, as most things are in the health care system. As we move this policy forward, we want to make sure that Nova Scotians have access to their community pharmacies. We recognize how valuable community pharmacies are to people, especially in rural communities, but in all communities, including urban and small-town Nova Scotia.

 

Members will know that we're also doing work to expand the scope of practice for pharmacists. There are some members who would like to tie that work in with fair drug prices, and I've been reluctant to do this - fair drug prices for Nova Scotians on generic drugs is an important enough issue, a reasonable enough focus of public policy, to stand on its own. We also want pharmacists to more fully participate in collaborative health care practice. Our health care system is changing into a more collaborative model; it's changing into a model where we are using the knowledge, the training, and the expertise of the various health care providers.

 

Before I was elected to this Chamber I was a member of the Faculty of Health Professions at Dalhousie, and Pharmacy is a school in the Faculty of Health Professions, and pharmacists are really an amazing people as a profession. Professionally, their knowledge base is really quite remarkable and very, very interesting. They know so much, not just about a drug - what in particular, I came to value a lot about pharmacists was their knowledge about the interaction of different drugs. In today's complex medical world, you want the people who have that knowledge to be very heavily engaged in health care decisions.

 

I have a great deal of respect for what physicians know and can do, but physicians do not have - and they'll tell you themselves - the same degree of expertise and training about the interaction of pharmaceutical drugs. That's why we need pharmacists to be more directly involved in the collaborative care of our population, especially where we're now managing complex chronic diseases. We have been working with the College of Pharmacists to expand their scope of practice to recognize their expertise and their knowledge, to give them a greater role in the provision of health care. This is a process that we have initiated and we will see through to completion.

 

The idea that I, or any member of the government, will negotiate tariff agreements in public or around the fair drug pricing plan is not really going to happen. This piece of legislation that I've been talking about will focus strictly on getting fair and better prices for pharmacists, for Nova Scotians. The way we expand pharmacists' scope of practice and bring them into the health care system is another conversation. It's one that's underway and it's one that we will negotiate fully and fairly, as we do with all of our health care providers.

 

I want to take a moment to table for the members - I had made reference to a couple of examples I had on what people will save under the fair drug plan. These examples show a senior who has a single prescription in the Seniors' Pharmacare Program for a particular kind of medication for rheumatoid arthritis - with the cap set at 35 per cent, the senior would see an annual savings over the year of $382. That's the copay. I have an example from the Family Pharmacare Program of an individual on a drug for bipolar disorder who would realize savings, when the cap is in place, of $70.13.

 

This will result in money in the pockets of Nova Scotians as consumers, as patients, and as taxpayers. That's a good thing, Madam Chairman, we think.

 

MR. PORTER: Thank you, Madam Minister. That was a very detailed answer to what I thought was a fairly simple couple of short questions - I won't get many questions in my hour, I can tell that already from your very detailed answer, which I appreciate, I do want to say. . .

 

AN HON. MEMBER: Go faster.

 

MR. PORTER: I'm not going to go faster, no.

 

I guess I would say at the same time, thank you, you certainly have the ability and know your department well enough that you're able to be on your feet and speak extensively on topics that are important, like the drug plan, and I do believe it is important. As I said earlier on, the pharmacies - and I have not spoken to my local pharmacist, but I do have a call from him and there is some anxiety around all of this. I'm not sure what those details are yet, but there is talk that they're going to need to change their business model, et cetera. I don't know what that means exactly, either. I'm aware of the manufacturer's rebate, as you called it, and how that has gone on for years and worked.

 

I'm also aware, as most members in this House probably are and have been for a very long time, the cost and the struggles that people have trying to buy those drugs even paying what I guess is deemed to be the small amount of copay - it's not so small for some people, based on what percentage that is.

 

I guess there was a lot in the answer that you gave me. I guess $6 million in savings is what I was getting at, which is fine, and you used the word "we" an awful lot. I'm going to assume that in this case we means government and those you support by way of purchasing drugs, and that's the "we" that you're referring to - but what about those who are out there who are still going to pay that copay? So if I go to the drugstore, and you may buy the drug cheaper overall as a province, as a government, but my copay is not going to go down. I'm still going to be expected, as a senior - they're a better example - who has to pay $382 a year before they're rid of the copay, their copay is still going to be $10 or $20, or whatever it might be, for their percentage of that drug.

 

I see the savings I guess, in purchasing and to government, and that's great, but where does that get passed on to the senior end or the taxpayer? I don't see that yet; they're still going to have to put that money up front. I guess I was thinking that perhaps their percentage of their copay, that there was an opportunity here to reduce that. Then you have a savings directly in or out of the pocket, depending on how you look at it, to the purchaser at the counter. That's where I was going with this.

 

That does not appear to be the case. There's no direct savings when I go to the counter to buy my drugs as a senior. There's no reduction in the amount of copay that I'm paying, or whoever's on the Pharmacare plan, they're still paying based on their income and how it's set.

 

Before you go back to an answer, I want to move on to an example of that. I have a man and a woman. The lady is 62 years old; she's on the provincial Pharmacare plan and was just renewed and given a price based on the family income. Her husband is 68, I'll say. He's a senior, and he's paying $382 already. So what she can't understand, and I guess I have some trouble with it myself, is that even though she's the only one on the Pharmacare plan and he's already paying and been assessed - because he's a senior and paying $382 and he gets the GIS, et cetera - that's already determined; the rates are set. She's got to pay $700-some because the income is based on both hers and her husband's - hers is about $4,000 a year.

There's an issue there. You talk about fairness and drugs - she can't even afford to go to the drugstore and get drugs that she needs. She's a lady who has had a stroke in the past, who needs her Lipitor, who needs a number of drugs, as you can appreciate, that are expensive. So she has to go to the pharmacy. We're calling the pharmacy, trying to work a deal of a payment plan, but the pharmacy is saying, no, we can't do that, we don't do that for people - and her drugs are like $500.

 

So here's a lady who's stuck. You talk about a fair drug plan, and here's a lady stuck with a bill somewhere about $500, depending on how many prescriptions she gets, and she can't get her drugs. She's going to go without, because there's no other means of getting them. She goes to Community Services, and no, she's not a client because their income is around $28,000 a year, even though they've lived for the last three months without a furnace. You just have to really know this entire story to appreciate where I'm going, but you can sort of get the flavour of what I'm saying and where these people are. They're not alone. They're one couple - an example of many around the province - but I don't see a direct link to a savings at the gate, if you will, in the purchasing of your drugs.

 

I guess I'm either not understanding it clearly, and I don't know how far we can go with a bill on the floor of the House, as far the debate goes. I know it's a line item in the budget and the chairman has been very lenient as far as the amount of discussion on this piece of legislation . . .

 

AN. HON. MEMBER: She spoke.

 

MR PORTER: She did speak, okay. But at any rate, I don't see the direct savings and I think that people are going to struggle, Madam Minister, to see that direct savings if they're still going to the drugstore and having to do the same old process and there's no savings that they're seeing. So again, if you want to spend a few minutes on that, just to maybe simplify for me what I'm missing here, because I don't think I'm alone.

 

MS. MAUREEN MACDONALD: It's a great question and I would think that lots of people would have this question, so it gives me an opportunity to explain a bit. The copay is a percentage of the cost of the drug, it's not a flat rate. I know that we have Blue Cross, as members of the Legislature. We pay into it and if we have a prescription we pay a flat rate, $9 and something for a prescription.

 

The Pharmacare Programs that we have don't work like that in the province, so they don't have a flat rate for a prescription, they have a percentage. They pay 30 per cent, a senior pays 30 per cent of the cost of their prescription, until they have spent $380-some dollars and they reach the maximum in copay. So if the generic drug price has come down, then their copay, the per cent that they pay, will also come down. That's why they will pay less. This works in the same way around the Family Pharmacare Program.

 

It is a valid question and it is the explanation for how we look at savings to people at the counter.

MR. PORTER: Thank you, Madam Minister. I do understand that part clearly. I guess at the end of the day we'll use that same senior as an example. That's great that we're getting a discount on the price of drugs, if you were capping it at whatever the fee is, but the $382 is still the $382, I guess is what that senior will see.

 

It's being pitched at $6 million, I don't think that the public is really clear on it, especially the seniors who are on fixed incomes or the other clients who are on the Pharmacare plan, regardless of what their maximum - whether it is $382 or $1,000. I understand fully how that works, I understand where the discount is. Obviously it's on the price that we are purchasing the drugs for, but at the end of the day it's just maybe one week less in the year or one month less. They reach it sooner I guess, if you really want to look at it, they may reach their $382 - no, they would reach their $382 later on, not sooner. Sorry, I had my math backwards there for a second. I see the deputy had a quick thought there.

 

You're right, it's stretched out, it takes a little longer to get it paid for, but they're still paying the $382, so I'm not sure that they're going to say - it all sounds good, the $6 million that you're talking about saving. I would be probably more supportive of the idea that the $6 million would go back into something which I'm not hearing much about. Where are they going to see the savings? Where is the senior going to see the savings or where is the Pharmacare - where is anybody in Nova Scotia going to see the $6 million saving in an $8 billion-plus annual budget? Six million dollars is $6 million, in my opinion - $10 is $10, in my opinion, but every bit of savings is a saving.

 

You have to clearly understand that Nova Scotians want to see a saving, they want to see what they're getting for their money. If you listen to them talk, and I know you do, everyone complains about the same thing, I get nothing for my money; the tax dollars I pay, I get nothing for Although if you travel around the world and have a look at how some other maybe Third World countries live, you might understand that you're not doing too bad in some cases. We do and are fortunate enough to have a Pharmacare plan. I would jump up and down and support that wholeheartedly. I have had the opportunity to travel to some places and as far as I'm concerned, we live in the best place in the world, right here in this very province, let alone in this country.

 

We're always going to have taxes; I think that's probably fair to say; we're always going to have rising costs for things, and I think that's fair to say. It's great when politicians stand up and say we're doing this and we're doing this, but people want to be able to really read something into it, and they want to see something for their money that they're getting and I think, I'm not sure that they're really seeing it face on here. Maybe I guess they'll see it, as you've said, when they go to the drug store and they pay that percentage - 10 per cent of $35 is better than 10 per cent of $65 or whatever the cut, just as a very rough example might be.

 

I'm not saying that that's not a benefit, I believe that it is and I look forward to that cap coming into place, if that's the case. I'm also interested - and I know I'll be coming back again after I hear what the pharmacists have to say. I need to learn more about what that is.I'm sure that you're going to hear a lot about that in the coming days and weeks as you negotiate and as you debate this bill and as it makes its way across the hall.

 

I'll leave that for now. I want to get on to a little bit about the doctors - and what's my time, Madam Chairman?

 

MADAM CHAIRMAN: You have approximately 14 minutes.

 

MR. PORTER: Thank you. Doctors' salaries, it's a never-ending issue of we can't find enough doctors in the province and we're not doing anything about recruitment. I know in my area, in Hants County, Windsor specifically, most of the doctors are located there, not all of them but most of them, and they're not getting younger and they'll tell you that. They've been around there for as long as I've been around - a lot of years. They're thinking about retirement, but at the same time they're thinking how I am going to do that, there is nobody to come in and take over. We're fortunate to have a clinic three nights a week, but it's for two hours. It's busy, but they're quick, and people who are there are the people who should be there, they're the ENT stuff, the ears, the nose and throat, they need a prescription for this - and this is a very good thing, the expanding of that clinic is something that would be very well supported.

 

You talk about emergency rooms and I've had an e-mail, I've had calls and we've had rumours for years, oh, Hants Community Hospital is going to close - fortunately it's still open. I can't remember a time when we've gone without a doctor for a shift in the ER, day or night. That is because of the dedicated individuals, the three or four of them, who are so committed to staying there and making sure that that doesn't happen even if it's working day after day after day. Some people would call them crazy - they might call themselves crazy, but they're committed to the people of the area and they're committed to keeping that facility going because they see what happens around the province, Glace Bay, Springhill, South Shore and a whole variety of places have issues with doctors. It doesn't get better once it happens the first time, it just seems to keep going because, oh, we survived it the first time, we can go a second time.

 

This has gone on for years as you well know, and certainly from my past I well know what that means to a community. I also know what our little hospital out there in Windsor means to our community and I realize that it's in the Capital Health District. We have an interaction with the Valley Regional and, personally, I think we have the best of both worlds. We have the resources all around us, we're close to town here and we're close to the Valley, and we have good working relationships within all of that corridor. There are some worries about cuts to this facility - and you never hear about the facility, you hear about capital district and that the number of staff and the number of dollars being cut out of capital district. Again there's this download from the provincial government that says we going to go to the district and say you've got to do this and you've got to do that. They're the ones who are actually responsible for reorganizing, re-evaluating, cutting - use whatever word you want, it doesn't matter at the end of the day, it means the same thing and, potentially, that's a decrease in service.

 

Our hospital is very well served, it's busy, whether it's in the morning, the blood work lineup and X-rays, or whether it's emergency, it's steady. I'm sure that it's been assessed; I'm sure that there has been some discussions about emergency being opened through the wee hours and I think that's probably taking place across the province and how we're going to manage that. We all know where EHS has come in and how it's come in and the part and the role that they play. I think that's a wonderful thing, by the way, and I know I have a bias coming from there, but I've seen it work, and I can stand here and say that it works very well. We have one of the best ambulance systems anywhere in North American in my opinion, if not the best. I've been part of that, I've been a part of watching it grow and helping it and support it wholeheartedly.

 

I think that there is a huge role for paramedics in this province to play by way of health care, not only emergencies and in the streets. I believe that there is a role for them to play in the hospital. It is not new, it was done here at the VG solely for years, medic's work. It's now done at the QE II, and we've seen that expand to different places around the province. For years - this is not new - paramedics have been in hospitals when doctors have not been able to be there, not only to treat but to transport as needed to a higher level of care facility that is open. That's a good thing, that's something that we could not count on 10 to 15 years ago - that would not have even been heard of, and we've come an awful long way. It's a resource that we have to continue to use.

 

Of course, you've heard me stand in this House and talk about nurse practitioners - there's a huge role and we're fortunate we have Dawn Lowe - and I know the people in this House are certainly familiar with her and the work that she's doing for Dr. Iona Wile. I'd take another half a dozen Dawn Lowes. If you can afford them, we'll take them tomorrow. We have room for them, whether they be in the clinics, whether they be in emergency or wherever they might be. The paramedic roles have to be thought of and expanded. There are lots of them out there, there's room, and we can all argue about costs, but a doctor or a nurse practitioner or a doctor and a paramedic - not that one is any less valuable than the other, but we can provide service at high levels.

 

If you take a paramedic today, they can do more than a nurse can do for you in the emergency, in all honesty. In the street they're giving drugs, clot-busting drugs - they've been doing that for years - and defibrillations. You know all of this; I don't need to tell you. They are very well qualified, and if you have any hope, you have it there, at that level, on the street and in your home. You have it right there today, in your hands.

 

That costs us a lot of money, I'm aware of that. I appreciate it very much, but what the people are getting in return is of great value. I do hope there are plans to expand that even more, and we've heard of all kinds of things, whether it is about drawing blood or whatever it is. I do believe there's an expanded scope there that has not been tapped yet. Again, I don't say that coming from my background as a bias, but I believe it's an honest bias and a true bias that's relevant as we move forward in the health care system.

 

I do want to say as well that we need to find a plan to do doctor recruitment. I know we've talked about opening spaces at Dalhousie, as an example. That takes a lot of years, though, and I'm not saying it's not a good thing, because you have to start somewhere and somewhere down the road hopefully that will be beneficial.

 

I wonder, minister, has thought been given to - and I'm going to use the word "incentives" because a lot of doctors getting out of school don't want to go to rural Nova Scotia where there's not a whole lot happening, where they don't have all the new and up-to-date gear by way of the greatest technologies - although the world is becoming smaller and smaller by the day, in my opinion, with regard to the advancement of technology - is there some consideration being given to incentives to doctors to get out there, whether that be paying tuition fees at schools for part of it or all of it or buying them houses? I don't know what they do in all of the - but you know yourself, minister, you hear all these stories about how we bring doctors into certain countries and provinces, and I'm not saying it's the right thing or the wrong thing to do, my question is more out of curiosity - what are we doing by way of incentives, or are we doing anything? Maybe we can't afford incentives, I don't know.

 

If you talk to a lot of people, especially the seniors - we're not there yet, but before you know it, in a blink we will be seniors - those are the people, you talk to them on the street and in their homes, they're worrying about where they're going and they're worrying about the long-term care of their health. It's great that we have a new Windsor Elms Village, but it's the same number of beds that we left off with in the old Windsor Elms. It's a wonderful place, but it's not serving any more people, it's just serving them better than it ever did before, which was great at that point.

 

I'm curious, is there a plan? And, if there is, what kind of dollars are around it? Maybe there are none, I don't know. I'm sure that you'll let me know. What else are we looking at in the same vein, along with that? I'm sure you'll talk in detail about all of it, but the EHS piece of it, the nurse practitioner piece of it and the incentives for doctors to come to Nova Scotia - specifically rural Nova Scotia, because I don't believe that the emergency is actually - or not the emergency, that's not fair - that the HRM facilities, the core facilities, are struggling as much. I may be wrong on that, and you can enlighten me as well if I am, in numbers of physicians, family physicians, that are out there. I'd be interested to hear a little bit on that if you want to just touch on it.

 

I know it covered a lot, but it's basically on the focus of the expansion of the system with those that we already have in place and incentives to maybe make it a better place to be here in Nova Scotia, by way of care. Thank you.

 

MS. MAUREEN MACDONALD: With respect to physician recruitment, I mentioned it earlier today in Question Period to questions from members about the situation in Cape Breton. The department has, a little while ago, about a month ago or so, put out a request for proposals to develop a physician resource plan for the province. This will provide us with a 10-year plan for both specialists and GPs. It's long overdue to have such a plan.

 

What we've done until now - actually, several of the DHAs have their own plans, but we need to have a very good, comprehensive provincial plan for the province that will allow us then to redirect resources into more effective ways of recruitment and retention.

 

One of the things that I've recognized is we have more incentive programs in the department than you can shake a stick at to get physicians into rural and hard to-service communities. So I have questions about why haven't they worked - why haven't they worked in Yarmouth, why doesn't this attract physicians to wherever? Why is it that we had an incentive program that gave incentives to physicians to locate in Timberlea, Chester, Hubbards, and Enfield, for example? That existed; that was the case. You kind of go - remote areas, Enfield and Timberlea? It's not all that remote. I could be wrong.

 

So there are a lot of things that existed in the past, and I'm sure if I was sitting in that chair in the past, there would be an explanation, perhaps a good explanation for why that occurred, but we are looking at this with a new pair of eyes and we're going forward. We're looking to develop a very comprehensive physician resource plan for the next 10 years and then we'll look at all of those incentive programs that we have - and we have a lot of them - and we will redirect and redesign them in ways to get us the results that we require for those plans.

 

It's never easy, you know, we see a lot of physician couples. So you have a need, for example, for gastrointestinal specialists in a community and you go out and you recruit and you find somebody who really wants to come to Amherst, or whatever. They have a partner who has some kind of area of practice that we don't really do in that area, don't have maybe a huge demand for what have you, but, to get that one physician, a position gets created for a second physician. It's very complex and it's hard to manage your limited resources in a very businesslike fashion when you're dealing with human beings who have all kinds of other dimensions to their lives. So, it's complicated.

 

The seats at the medical school were expanded twice. We haven't realized all of the graduates from those expansions yet, but when I look at the recruitment of physicians in the last little while into the various DHAs - and I talked about this the other day - we continue to see the Capital District Health Authority get a very large number of those folks and the more rural DHAs have a harder and harder time recruiting. And you can see it - it's very clear when you look at the numbers.

 

Now, one of the things that's going on is Dalhousie is developing residency programs, with our support, into rural DHAs. For example, I think there are residents who are going to be in the Annapolis Valley. This will lead to, we believe, residents going into those DHAs and doing their residency there and developing professional relationships with other physicians and other health care providers. Realizing what a great lifestyle the Valley offers, for example, at the end of the day we think that will result in people wanting to stay and practise in those communities.

 

The biggest problem we face, in some ways, is that the health care system is like the rest of the world: we have a very large baby boom in the physician population. We have a lot of physicians in their early and mid-50s in this province, and getting on, and who are planning for retirement. They're slowing down; it's not as easy to work the long, arduous hours as you get a bit older. These are all pressures, but these are things we will capture in our physician resource plan - we'll have a better appreciation of the numbers of people who are planning retirement and when they're planning retirement. We will talk very much with the physician population; we may get a better understanding of people who would work part- time or semi-retired, but stay in the system.

 

A lot of the labour market research about the future of work and skill shortages in other fields are telling us that there is a growing appetite for people to bridge into retirement, not necessarily just walk away from their profession at some magic age. There are people who like to wind down and keep their hand in the workforce, so to speak. We need to get a better understanding of that, and I think that will help us considerably.

 

MADAM CHAIRMAN: At this point I think I would like to suggest, if it's agreeable with the minister, that we take a five-minute recess to stretch our legs, and perhaps a washroom break. We'll stand for five minutes, please.

 

[4:42 p.m. The committee recessed.]

 

[4:47 p.m. The committee reconvened.]

 

MADAM CHAIRMAN: Order please, the time allotted for the Progressive Conservative Party has expired.

 

The honourable member for Yarmouth.

 

MR. ZACH CHURCHILL: Madam Chairman, I would first like to thank the minister for making herself accessible to me and constituents of mine who have had issues and concerns about certain things in our health care system. The minister has been very accommodating to those individuals and, like I said, has made herself accessible to chat with folks from my area and myself on a number of different issues, so I just wanted to thank her for that and let her know that I appreciate the approach that she has brought to the office.

 

Madam Chairman, as the minister knows, because we have talked about this in the House before, there are a lot of folks in my constituency of Yarmouth and I believe across the province who are faced with no access to family physicians right now. I believe during the last session in November I tabled a petition signed by over 2,200 people, I believe, who were without a doctor in the Yarmouth area. This includes seniors, children, people who are sick and require medical attention on a consistent basis. There is a lot of concern in our area about the shortage of family physicians and the access that people do have to our health care system that we all value so much.

 

This shortage of family physicians is added to increased pressures on our ER system. The emergency room in Yarmouth is full all the time with a lot of people who are in there for emergencies, but also people who are in there to have their prescriptions filled and to have a service provided that should be done by a family physician. I have heard stories from seniors who are waiting 14 to 17 hours just to have their prescriptions refilled in the emergency room, folks who, because of their condition and their age and their health, sometimes can't be sitting in a room that long waiting for emergency services. I understand the triage system works, that that needs to happen, but it all comes back to the pressures that are put on the ER because of the lack of family physicians.

 

I'm wondering, from the provincial standpoint, if the minister can provide some insights into what the province is doing to address this doctor shortage issue, which I know we are all aware is a reality in our province and, specifically, I've heard that our provincial incentive programs haven't been reviewed within the last decade and I'm wondering if there are plans to review those incentive programs and see if, as a province, we're competing to recruit and retain doctors here.

 

I know that our local people who do doctor recruitment in Yarmouth do a fantastic job and do the best they can do with the tools they have. I'm very proud of Shirley Watson- Poole and her colleagues and their ability to recruit doctors.

 

We have an issue with foreign-trained doctors or foreign doctors. They come in, they are excellent doctors, they are great citizens in our community, but statistically a lot of those doctors who come in will fulfil their four-year commitment, through CAPP I believe, and unfortunately many of them will leave for reasons outside of a lot of people's control, whether it is places of worship in Yarmouth, access to transportation so they can go to bigger cities or other countries to see their family, and all those sorts of things.

 

We don't blame those doctors for wanting to leave and be elsewhere - I'm wondering what else can be done to train, recruit, and retain our own doctors here in Nova Scotia, especially those folks from rural communities who would be more likely to go back into a rural area like Yarmouth or Digby or wherever, to practise.

 

My first question to the minister is what is happening - are we going to look at reviewing our provincial incentive programs to make sure we are competing as a province to recruit the best and retain the best, and are there plans in place where we can bolster the training of our own population here in Nova Scotia, so we'll have a larger group of people who we can rely on to service our citizens in rural and high-need areas?

 

MS. MAUREEN MACDONALD: Madam Chairman, I want to thank the member for his questions and I know how important this is to people in his community. I think as Minister of Health and Wellness I receive letters from all over the province, and it is clear I get probably the greatest bulk of the letters that I receive from Yarmouth about not having a family doctor, not being able to find a family doctor. So I often judge what is going on on the ground by the correspondence I get from Nova Scotians, and I certainly understand that this is a problem in his community.

 

Let me start and just tell members about the entire province. It is slightly less than 6 per cent of the people who live in our province who don't have a family doctor. Now that's still way too high. I think we have this terrible term, actually - I didn't invent it, thank Heavens, somebody did - there is this term called "orphan patient" in the health care system. Somebody is an orphan patient when they end up in a hospital and that means they don't have a family physician, they don't have a treating physician and they are known as orphan patients. If I could perform one miracle it would be to eliminate the fact that people have no family doctors when they end up in a hospital; there would be no more orphan patients.

 

I think there will probably always be people who perhaps, even by choice, don't have a family doctor, but the fact that people want a family doctor and can't get one is unacceptable in our province; it's just simply unacceptable. We're working really hard to deal with that and I think in terms of the finance people in the Department of Health and Wellness - we call them "unattached patients" - we have allocated close to $0.5 million in this budget to ensure that although they don't have a family doctor that they get the treatment they need.

 

Now with respect to the honourable member's DHA, South West, when I look at the number of physicians who were recruited in 2010, your DHA has done better than any of the DHAs. I think this reflects the priority that has been placed on getting physicians there, it reflects the hard work of the DHA, and it also reflects the commitment of the government and the department. Of the physicians who have been recruited into that DHA, there are eleven in total new physicians, five specialists, and six family practitioners. Of those eleven, two were foreign-trained doctors, the CAPP doctors. I think Pictou County is the only other district that comes close and they had seven, total. So you have four more than Pictou County and, of course, that excludes Capital Health District that had 52 in total. You can see where the problem lies - 14 family practitioners in Halifax and 38 specialists.

 

So it is a challenge. What can we do, what tools do we have? As I said, we have a lot of incentive programs that we use to make it more attractive to practise in some of these hard-to-recruit-to or underserviced areas. In our budget we have $1,364,000 allocated for retention incentives in rural communities. We also provide what are called alternate payment plans, so that the rule of thumb is often that you need, I think it's 2,000 patients on a fee-for-service basis to have an average salary for a physician but if you're in a community that doesn't have the population to support let's say four doctors, 2,000 patients each, we have these other plans where we will pay people. They don't do fee-for-service as their pay, we pay them a salary to provide services.

 

So we have a variety of incentives to get people into underserviced and small communities, not that Yarmouth is small, you have a substantial population in that area. It may be a little spread out, but some very good facilities. So as I said, it is a challenge and it's a bit of a mystery on one level when we have so many incentive programs. I asked the people in the department why is it that these programs work some places and they don't work in others - what's the explanation for that? We are currently doing a 10-year physician resource plan where we will look at what the needs of the population are, what the current physician complement is, what retirements are going to look like in the future and what have you, and we will develop a plan. It is after we have that developed that we will look at our incentives and how we need to refocus them or restructure them to get the results that we want to implement our physician resource plan.

 

We have a physician recruiter in the department and, you know, she is active all the time, going to conferences and doing all kinds of work where physicians are, meeting with physicians around the country to see if we can attract physicians from other provinces and other jurisdictions. But it's not enough to go outside and recruit from outside. I think the member has raised a really important issue and that's about training people from our own province and then retaining them here.

 

One of the things that I ask about and we're trying to understand better is how many Nova Scotians aren't training in Nova Scotia but are training elsewhere - students who are

at McGill, U of T, other medical schools, American universities, Australian universities. We hear about, sort of anecdotally we might hear we may have a Nova Scotian student nearing the end of the fourth year of their program, looking for a residency back in Nova Scotia. I think we need to have a better way to identify and track Nova Scotians who don't necessarily study here, and make sure we have every opportunity we can to get them back home to practise.

 

As I said earlier, and I think I was able to give the honourable member this information last year in one of our Question Periods, Dalhousie Medical School is starting to place medical school students as part of their practicum in the Yarmouth area. DHAs are looking at setting up residency programs outside of metro, around the province in other DHAs. I mean it's not going to happen in every DHA because there is quite a substantial cost involved, but we will look at residency programs in rural DHAs that will allow that DHA to connect with local medical students and have a greater potential then to recruit them and retain them at the end of their residency.

 

There are a variety of things that we have, there are some new things we are trying and the work of the physician resource plan that we're doing are all parts of this puzzle. Madam Chairman, I think one of the greatest tools that we will have for recruiting and retaining family doctors in rural communities is the Better Care Sooner plan with the collaborative care centres. This is going to promote teams of doctors and nurse practitioners, advance practice nurses and other care providers in settings where the pressures will be taken off the family doctor to work collaborative models and the pressures will be taken off the family doctors from having to work all night in the emergency room and come in the next day and provide care throughout the day.

 

Already I'm hearing from doctors who are working in collaborative models who were diametrically opposed to any such form of practice, could not imagine moving in that direction, were just absolutely unmoved by arguments about why this would be a good way to practise medicine, who can't believe they felt that way now that they are working in collaborative teams. They love it, their quality of life has been improved, the work they do in the medical settings has improved and they thoroughly enjoy working collaboratively and find it very invigorating and it has kind of renewed their passion for practising family medicine.

 

It's great, it's really quite inspiring to go out and meet with many of these doctors and hear from them and have a little laugh. Many of these people I am meeting for the first time and they are explaining to me how opposed they were to this model some time ago and how it really has changed their view of practising. They are really excited about it so it is kind of infectious. I have to say I enjoyed that thoroughly.

 

Our commitment, as a government, is to take pressure off the emergency rooms. I was in the emergency room in Yarmouth, I think in the first month that I became minister, and it was on a hot summer day we went down to open the cancer centre which is a phenomenal facility with a beautiful view, one of the most beautiful views from any health care facility that I've been in, but before that event the staff at the regional hospital took me on a very comprehensive review of the facility, including the ER, and it was packed. It was very busy both in terms of people whom EHS have brought in on stretchers, you know, with very serious cardiac situations, as well as the people sitting in the waiting room waiting for prescriptions.

 

So I understand entirely the problems. The problems have eased a bit, as I said, in Yarmouth. You still have too many patients without a family physician but there are less patients there without a family physician today than there was last year. You have some phenomenal, experienced family practitioners in that community. Dr. Shelagh Leahey is very well known throughout the province and, you know, you're very, very lucky to have someone of her calibre in that community and she has mentored many, many physicians in your area and beyond your area, and outside of the province as well.

 

So you asked the question, what can we do about foreign-trained doctors? They come under CAPP and they stay for the term of their contract and then we often lose them. It is a challenge and a conundrum. I was struck when I was in Cape Breton at the ability that they have in that district to retain - it's like a mini-United Nations. When you go to their medical staff association, there are physicians there, both specialists and family practitioners, from probably every country in the world. It's just amazing.

 

I want to say I've been in a lot of the other DHAs, and I haven't met with the medical associations as such so I don't have, you know, a group of 70 or 80 doctors that I'm meeting with, but the evening I was in Cape Breton, the kind of collegiality and camaraderie between the physicians was very obvious. They like each other, they get along, they work together, and they kind of socialize together. They have quite a good relationship and it was very, very apparent.

 

I spoke with Dr. Naqvi, who is their medical director, and he has worked very hard at building a very collegial, accepting, open- team environment where people feel included and, you know, I think that his leadership and his wisdom, he's very wise about what makes people feel included in a community, and I don't know if it would be possible to have an opportunity to have him in your district to talk about just his very long experience.

 

When I was first a member elected to this Legislature 13 years ago, Cape Breton was experiencing serious shortages and I remember being in Cape Breton, I was my Party's Health Critic, and Dr. Naqvi took me around the Island to the various facilities and talked to me about what his recruitment plans were and the difficulties. He was very inspiring. He was very passionate about Cape Breton and about what they had to offer people.

 

When you go there now, you see the end result of his work and, you know, he's very low key but he's quite persuasive. I'll tell you a little story they actually told me that night because I made a note of what an amazing job he had done bringing people into that district health authority. One of their newest recruits told me that Dr. Naqvi had met him at a conference. I think he was an American, actually, and he had met him at a conference and he started telling him about Cape Breton and telling him he should come to work in Cape Breton. He got the doctor all of his contact information and after the conference was over, Dr. Naqvi went back to Cape Breton and he called this gentleman, this American doctor. He called him pretty much every week and his wife would answer the phone and hand the phone over to her husband. Finally, one evening she answered the phone and she handed it over to her husband and she said, for God's sakes, will you tell that guy we're moving to Cape Breton so he'll stop calling. He's very persistent and persuasive and it shows.

 

I mean, it really does show the medical association of Cape Breton is, again, populated with people from all over the world and a lot of the recruitment there is directly attributable to the efforts of one individual. And sometimes that's what it takes - it's the dogged persistence and the vision and the leadership, commitment, passion of one individual that can change things. He's a very generous man, and I'm sure he'd be more than happy to talk about what has worked and what doesn't work so well.

 

With those remarks, Madam Chairman, I'll take my seat.

 

MR. CHURCHILL: Thank you for answering some of those questions. I do have some questions that came up as a result of those. I know you mentioned that there is a 6 per cent number of Nova Scotians who are without family physicians. It does seem that for some reason in my area that percentage is higher. We spent some time collecting data and, as I mentioned, I tabled a petition in the House which listed at least 2,200 people without family physicians and I think that number is much higher than that. That would be about 14 per cent alone - 14 per cent of our population in Yarmouth County, which would be my constituency and the constituency of the member for Argyle.

 

You mentioned that there is half a million dollars to help patients get treatment who are orphaned patients. I would be interested to know how that money works, if there are any systems in place or processes in place where individuals need immediate assistance, need continual care and service from a family physician, if there's some sort of process that these people can access so they can get the service that they need. I'll tell you, there seems to be a few major issues in Yarmouth right now and the lack of family physicians is the one I probably get the most calls about, other than the ferry. I believe that there does need to be some immediate steps taken to address this issue. I think it's very important and I would urge this government to move to review its incentive programs immediately so we can see if we're competitive, see if we can do better to compete, recruit and retain doctors, and compete for the most talented physicians out there. I also know that you need to put forward a long-term vision to ensure that this is a situation that doesn't go on for a long time.

 

I'd also be curious to wonder about the - I believe you said $1.5 billion, I'm not sure, in terms of the retention incentives. I'm wondering, are those dollars all used?

 

MS. MAUREEN MACDONALD: I'm sorry, I missed that.

 

MR. CHURCHILL: I'm curious about the - I think it was $1.5 billion. I could be mistaken on the number you gave for retention incentives - I'm just wondering, is that money used every year? Is that actually getting out to doctors and physicians to actually recruit them? Is the money being used? You can always have money sitting somewhere, but if the folks aren't actually getting it, then it's not going to do what it's intended to do.

 

I'm encouraged that you mentioned collaborative practice. I think this is an area the province should definitely be moving into; I know we have in certain districts. I remember reading an article in Readers Digest about some groups doing collaborate practice in Ontario. A physician went from not being able to service 3,000 clients under the regular model to moving to a collaborate model, and she was able to successfully service with her teammates over 19,000 clients. There is some hope in looking at some of the other models that are out there, and I think those are things that we need to move on immediately.

 

In terms of ERs its seems the long-term solution is to recruit more family physicians so there is less strain and pressures on the ERs, but there does need to be something done immediately to help with that congestion. I have weekly calls and e-mails about people who are frustrated with the wait times and I don't think it's any fault of the physicians or the nurses there, it's because of the system we have in place and its deficiencies. I'm not sure how you address that concern immediately without the family physicians to fill the spots, but I think that needs to be an immediate goal of this government, to look at that issue and try to address it the best way it can.

 

I'll pass it back to you to answer some of those questions and if we can be brief then I can get to the next round of questions that I have on a different topic as well. With that, Madam Chairman, I'll pass it back over to the minister.

 

MS. MAUREEN MACDONALD: The member asked about the money that I mentioned earlier for unattached patients. That's for unattached patients if they end up in a hospital, to cover the cost of physician services, to incent a physician to see an unattached patient who's not theirs.

 

The bigger question is getting sufficient family physicians and other health care providers in collaborated practices primary care in the places we need them around the province. That will do a great deal to cover all the people in the province. We have in this budget $1.5 million for additional nurse practitioner's support and the thrust of Better Care Sooner is to get collaborate care centres up and running and get primary care working in a way that will take the pressure off ERs.

 

I know the honourable member has three ERs inside the DHA in the community that he represents, Digby, although that's in the riding of the honourable members from Digby, Shelburne, and the Yarmouth Regional Hospital.

 

One of the things that Dr. Ross talked about in the Ross report was he recommended in the Department of Health and Wellness that we look at the flow of patients in the ERs. There is a lot that you can do to improve people flowing through the ER and we need to consider doing that in our regional hospitals and that is certainly something that we will be doing and have started doing.

 

But clearly in a community where you have a physician shortage and the kind of shortage that you've indicated, if people can't get to see a doctor to get a prescription filled and they have to go to the ER that places a huge burden on the staff in the ER who need to be seeing emergencies. That person who comes in wanting a prescription is going to sit for a heck of long time if there are cardiac people in front them and broken bones and what have you, because of the triage system.

 

Let's be frank, this isn't a problem that's peculiar to Nova Scotia, the ER problems are problems right across the country; the lack of access to primary care is a problem right across the county. The fact that we have a model of medicine we have developed, we have allowed to develop, we have supported in developing with the way we fund and what have you is a model that has allowed family practice to happen Monday to Friday, 9:00 to 5:00 and then you went to outpatients. The emergency room became the default for not having access to primary care in the evenings or on weekends.

 

That's what we're changing. We are transforming the fundamental model of medicine, taking pressure off ERs and getting people into primary care clinics and practices where they can see a health care provider who's going to be able to meet their needs at their scope of practice. There are other things we're doing to assist family practitioners. Expanding the ability of pharmacists to prescribe, to renew prescriptions, these kinds of things are going to make a big difference in terms of people not having to go to an ER to get a prescription renewed.

 

I guess what I would say is that help is on the way for our system. These measures aren't things that you can do at the drop of a hat; they require a fair amount of detailed work and consultation and involvement of the whole continuum of health care providers. People need to buy into the change that's happening in our health care system, and they are. They are because I think everybody has recognized the question of the sustainability of the old system and the fact that people weren't getting the services that they needed and they wanted under the old system. These things are certainly changing.

 

I want to end by again saying we will be doing the physician resource plan. It is a plan that's going to look out 10 years. At that time, once we have that, then we'll have to look at achieving that plan and taking the various programs we have and refocusing them to achieve the implementation of the resource plan.

 

It's not that far away actually. We expect that we will have our physician resource plan completed, I think, by the end of the summer. We'll be moving fairly quickly after we get that.

 

MR. CHURCHILL: I'd like to thank the minister; that information is helpful. I'm glad the province is moving forward. I'm still interested in terms of the monies that are allocated for our incentive programs now - if they are being used to their full potential, if the research around those, or the tracking of those incentive programs, would indicate that they're effective?

 

I think perhaps they're not because they haven't been reviewed in over a decade and I think it's time the province moved to review those incentive programs to ensure we're competing and that the programs we're offering are doing what they're intended to do. I also think it's important to look immediately at what we can do to recruit and retain our own people. Perhaps that could be a number of financial incentives to get our young people into the system.

 

One more thing I think we can look at is Canadians who are actually studying in medical schools offshore. According to the Canadian Resident Matching Service, there are about 3,500 Canadians who are studying offshore. In a survey done in 2010 there were about 105 Nova Scotians out of 1,000 in 1982 who responded who were studying offshore. I think another area we can look at is facilitating integration of those future doctors back into our system as quickly as they can get in to ensure they have the credits and the licensing or whatever they need.

I've heard from some people my age who are studying offshore and they find it very difficult to get back into Canada and to practice here despite the fact they're studying in England and Australia and the U.S., places that we wouldn't think would have an inferior medical training system in place. That's another area where I do think that we need to look at as a province to ensure we are facilitating that engagement and that involvement from those people who are studying abroad.

 

Another topic I did want to discuss is the Models of Care Initiative that I know we put forward. From what I understand, this is designed to alleviate the strain on RNs, I believe, and to allow RNs to play more of a supervisory role with a wider group of individuals. Now, I've had some concerns brought to my attention from health care professionals from my district, people who are actually involved in the health care system. There are some concerns around this, whether it's the fact that perhaps in certain cases LPNs don't have the qualifications needed to care for specific health - related issues with patients, which perhaps might be putting the patient in jeopardy. I'm not saying that LPNs aren't trained, but from what I've heard from some people in the field is that this practice might be putting some patients in danger.

 

I realize that the province has re-evaluated the Models of Care Initiative from a team perspective to see how the services are being distributed from a health care team perspective, but I'm just wondering if we've evaluated it from a patient care perspective and that we're ensuring that patients who are utilizing health care services have the attention that they need from the level of professional that they need to address them so we aren't putting our patients in jeopardy.

 

I'm also wondering if this is going to lead to less RNs being hired in the province or less people who are trained to be RNs actually getting the pay that they should get, but being an RN and having them remain as LPNs. I think it's an important question to ask. Are we going to lose RNs in this province because there are not enough jobs for them here? Are they going to go to other provinces? Are people going to want to train to be RNs in this province? Will this model of care initiative impact the number of RNs that are being hired are in the province? I'm wondering if we're going to lose any. I don't think that's something that I would like to see, health care professionals at a level of an RN actually leaving the province to go somewhere else.

 

These are concerns that have been brought forward to my attention by, like I said, health care professionals who are concerned about patient treatment, patient care and who are concerned about their own jobs and whether they want to stay in Nova Scotia with the training level they have if they're not going to receive a designation and the pay that comes along with that specialty. The question is again, have we evaluated this model from a patient care perspective and are there concerns from the department standpoint of us not providing the level of care that's required for some patients, and if we're actually going to lose some of these trained people to other jurisdictions because of this model?

 

MS. MAUREEN MACDONALD: Madam Chairman, I'm very pleased that the member has asked this question because it gives me an opportunity to talk a bit about the models of care and what that's all about and what the evaluations are telling us this far.

 

I've talked earlier about making sure that we are using our health care workforce in the best possible way, so to use a really simple example - we don't necessarily want to have our four-year-university-trained nurses making beds. That's not a good use of their training; not a good use of their skill. You want to have the right health care provider doing the right kind of care. If you're going to pay someone $50,000, $60,000 or $70,000 a year, then you're not going to pay them to be providing, you know, services in a care setting that I, who could never take a temperature, could do. I'm not qualified to do so, but I can make a bed. So this is what the models of care is about. The models of care is about making sure that we have the staff performing the duties for which they have the training and the skills and that we then pay them at that level.

 

So there are I think about 15 or 16 sites in different settings across the province where we have introduced the models of care. The models - and let me speak to the question about putting patients in jeopardy and danger, and what have you. This Health and Wellness Minister is definitely not going to go down a path where people's lives are put at risk in our care facilities because they're being treated by the wrong provider whose scope of practice does not permit them to do the things they're doing.

 

In our system, nurses who work in our system have to be licensed; they have to meet the educational qualifications that are required and they have to meet the professional qualifications to acquire a licence; and they have to continue to maintain those qualifications and those standards to get a licence. It's not different for many other care providers in the facilities, in our acute care facilities, and as the member indicated, LPNs are very well trained and they're very well qualified. They have the capacity to do the scope of practice that they are licensed for and that they are required to do in our facilities. We would not have them work outside their scope of practice and we would not have them do things that would put patient care in jeopardy or result in any danger. I think it's very important that people understand that.

 

The Models of Care Initiative was developed with the full participation of the College of Registered Nurses and with the bodies that represent other groups, other groups of health care professionals, and it's overseen by the vice-presidents of patient care in our acute care facilities. I want to remind members of the House that our acute care facilities are accredited facilities and they have to meet standards. They have to meet national standards that have been adopted and are accepted as the standards for operation for acute care facilities across the country. We would never do anything in our facilities in terms of staffing that would put in jeopardy the accreditation of our acute care facilities.

 

So let me assure the members of this House that we keep quality and we keep patients' safety in the forefront of our considerations when we implement any changes in our facilities, but we are very much looking at staffing and we are very much looking at enriching the job satisfaction of our health care professionals. We want to make sure that, for example, our RNs are doing what RNs are trained to do, what they're skilled to do, and what we pay them to do - the same for LPNs and other care providers.

 

The early evaluations from the models of care are excellent. The RNs are very satisfied, the level of satisfaction for the nurses who are working under the new models of care is very, very high. I've spent some time looking at the evaluations and they've been very interesting to read. As is the case with LPNs and Certified Nursing Assistants, we will continue to monitor how this is all being implemented and what the impact is.

 

I want to reassure the honourable member again that our evaluations have been excellent from the perspective of the satisfaction of the staff. In terms of patient safety, in terms of dangerous practices, the issue of patient safety and quality is always utmost in our thoughts - it's utmost in our thoughts for all of our health care providers. We want to make sure that our most highly qualified, experienced surgeons practise quality medical care. We're working very hard with surgeons in this province to adopt the surgical checklist.

 

It's really interesting, in aviation safety, it's a well-established principle - when pilots get on a plane and they have the lives of all of those people on the airplane in their hands, the aviation industry has developed a checklist that pilots go through. One of the things they do on that checklist is they introduce themselves to one another. They don't necessarily always fly together and they don't necessarily know who their co-pilot is and what have you. They go through a checklist. The aviation industry is one of the most safety conscious industries in the world and they have developed - because of human error that has resulted in the tragic loss of many, many people - these procedures.

 

It's incredible to me as a layperson that our health care system in our surgical settings, for example, hasn't developed the same level of structural, regulatory safety. That's what the surgical checklist is intended to do; in fact, I think many of its features are brought in from the aviation industry.

 

Let me tell you in terms of what's going to happen to patients in the OR, in the intensive care unit, on the wards - patient safety and quality is a concern for every profession. It's a concern of the Department of Health and Wellness and it's something that we are working really hard to beef up and make sure that we enforce and promote.

 

I can assure members our models of care will not take us down a road to put patients' lives in jeopardy or have them in any form of danger. I would reject that characterization.

 

MR. CHURCHILL: Madam Chairman, I just wanted to reiterate that these were concerns brought forward in my district to me from health care professionals in the field that feel that perhaps we've moved too far in terms of an acute setting, putting nurses in those situations, that they might be spread too thin and then might feel that their ability to provide the service that's required, you know, perhaps might not be sufficient in certain cases. So because these concerns were brought to me by professionals in the health care field, I strongly urge the minister, while tracking the developments of this model, that we pay particular attention to the patient care outcomes and to what our nurses on the ground are saying about this model and how comfortable they are with it, and how they believe the level of efficiency is with it.

 

So all I can say is it's very important from my perspective to track those things and to continue to include and engage those vital health care workers that we have out there in the field in a meaningful, continual dialogue about these changes to ensure that it is doing what it's intended to do. If I do have these concerns that are brought forward to me, I will commit to the minister, Madam Chairman, to share those with her via the House or via any other avenue we have to communicate.

 

I thank the minister again for her time in answering my questions and I'm sure we'll be able to have this conversation again in the House or outside at some point. Thank you very much, Madam Chairman, and I'm going to pass the time along to my colleague.

 

MADAM CHAIRMAN: The honourable member for Halifax Clayton Park.

 

MS. DIANA WHALEN: Madam Chairman, I had intended to share this hour with my colleague, the member for Yarmouth, and kind of unfortunately, the answers have been very, very thorough, very detailed and somewhat long, and so I'm going to ask the minister when I do get back up after we have our late debate, if we could be focused in our questions a little bit and our answers. I'll try to be focused if she will, too, because it's just that the time is going to elapse for estimates and we have so many areas to explore. Right now I have only five minutes left in this hour, so I'm going to just raise a couple of issues because the minister, probably you may get to say a few words about this when we come back.

 

The minister has told us, and I'm pleased to see that she is chairman of the Federal-Provincial-Territorial Health Ministers Committee and that you meet on a regular basis and, in fact, if Nova Scotia and our Minister of Health and Wellness is the chairman, that you can help to set the agenda for those meetings and determine what should be on them.

 

I had the opportunity to read something just recently around food and wellness, and I know the minister is looking at an obesity strategy. This actually was a newsletter that comes out from the Centre for Science in the Public Interest and I know that the minister is interested in science in this. They're talking about things like additives to foods that are known to increase hyperactivity with the ADHD, artificial dyes that are in foods, and they're asking that the government should have those either eliminated completely or very well marked on labelling. They're talking about sodium content; they're talking about trans fats and I remember that the Speaker of this House brought in a bill as a private member, probably in about 2004, calling for our government to do something about trans fats and I realize whenever we talk about any of the labelling or food additives, we're a very small market with less than one million people in Nova Scotia and we're not going to have a great influence on Kraft or any of the big food companies out there - Nestle, and whoever else owns all of the big food companies.

 

A lot of the food that people consume these days is - and it's probably unfortunate for our health - a lot of them are processed and refined and, you know, we're buying canned foods and foods that have been prepared for us. They have a lot of additives in them and just this one quick newsletter referred to it and I thought, you know, that the link to ADHD where we have so many children on medications and the cost to the system, the cost to their parents, the cost to the education system, and the really difficult times for those young people who are dealing with attention deficit. We're medicating them and I think a lot of times if we could look at their food that they're eating, we could have a big impact. I know families actually, and parents who are very cautious and work hard to control the food their children eat and that does control that condition that their children have - at least to a degree it controls it.

 

So I'm asking whether that is something that we could have on the public agenda and I think that together the Health Ministers from across the country would have the muscle and the strength to lobby the Health Minister of the country.

 

This newsletter - do I have just a couple of minutes? - yes, this newsletter which I said is just a note from that organization actually refers to a Globe and Mail article that said that the Minister of Health had decommissioned a group that was studying sodium in food. That was in early December, it said, which prevented the group from pressing the government to implement its sodium- reduction strategy. The minister - and this is the federal government we're talking about here - the federal government Minister of Health had decommissioned that group. The minister also bowed to food industry pressure to weaken its sodium targets, the paper noted.

 

With sodium, we know it's very closely linked to stroke particularly, and I think some of the Scandinavian countries had reduced sodium content in their food 20 years ago and they have seen a marked decrease in the number of strokes. I mean it's exactly linear, you can map this, so why wouldn't we be doing that to try to save ourselves the costs and the suffering related to that? It just seems to me we don't have a federal government that's moving very strongly on any of this. We know we have a big food lobby and we have Health Ministers from across the province - not our province but across the country, who are at this moment led by Nova Scotia, and perhaps we could put these issues squarely on the agenda as well.

 

The trans fats would be one; the sodium content which I just said, and it appears that we've lost ground on that; and, again, another one would be the severe allergies that people have to nuts and shellfish and some other products. This article was saying that we have no regulations to make bold warnings on products that contain that - it may be in the label; you may have to search in the fine print but they're saying why wouldn't we make those very bold warnings so that people who have these conditions could get proper warning and will have fewer anaphylactic issues?

I think our time has elapsed for the moment. Thank you.

 

MADAM CHAIRMAN: The time allotted to the Official Opposition has expired. It is my understanding that it is the prerogative of the minister, if there was a request for a response, at this point.

MS. MAUREEN MACDONALD: I would just say to the member that absolutely she raises a good point and it's one that has been on the agenda of the federal-provincial-territorial ministers, particularly the Sodium Working Group. The provinces aren't real happy. We will continue to push for that and I would love to see a copy of the material and I would be happy to take this forward to the FPT Group.

 

MADAM CHAIRMAN: The honourable member for Argyle.

 

HON. CHRISTOPHER D'ENTREMONT: Madam Chairman, it's a pleasure to stand for a few moments. I believe that we're going to have our moment of interruption at six o'clock as per normal so that gives me about 12 minutes to ask a few questions. I know I'll probably get one or two in before the time expires. (Interruptions) Yes, I think I'll get one question in by then, knowing how it works here tonight.

 

I neglected to do something last week, or when I was speaking the last time, and that was to basically acknowledge the good staff who are in the House today - Linda Penny, who is our numbers person. I know the work that she does is absolutely phenomenal, so, Linda, thank you for all your hard work again this year and, of course, for your support for your minister. Kevin McNamara, our deputy minister, it's a pleasure to see Kevin again. I did have the opportunity to work with Kevin when he was CEO of the South Shore District Health Authority and I know he did phenomenal work for them and I know he'll be a phenomenal deputy minister for the Department of Health and Wellness as well. So welcome to them and I know there is probably a whole bunch of people up behind me, whom I can't see, providing support, but I do welcome them to the Legislature and I'm sorry I neglected to say anything last time - I maybe just got quickly into my questions.

 

Madam Chairman, I'm going to move a little bit, basically back to where the member for Yarmouth was talking about Yarmouth, the ER services and, in particular, when it comes to the doctor shortage that we are experiencing in that area. Here's the challenge and I'm going to - a number of weeks ago, almost two months ago, I was in Cape Breton. I was going to a meeting in Albert Bridge and not paying attention to where I was walking - I think I was probably paying more attention to my BlackBerry or to my iPhone. I didn't have the right shoes on for the conditions - it was snowing a little bit, a little icy, and I fell down on my right foot and sprained it. Luckily I didn't break it, but I'm sure I heard a pop. I'm sure something popped - maybe it was just something shaking loose in my head.

 

Luckily, some folks who were at the meeting decided that they didn't really have to listen to the meeting, that they would bring me to the Cape Breton Regional and have my leg looked at by the attending physician, and maybe a couple of X-rays to make sure that I hadn't broken it.

 

When we got there the emergency room was full, but I can say that I was triaged quickly, given my number, my name and everything was taken at that point. We sort of found a little spot to squeeze in the wheelchair that I was sitting in at the time, and waited for some time.

 

Now, my experience in an emergency room in Yarmouth is that I probably would have been there eight hours or more because, of course, I wasn't hurting too bad. I couldn't walk on my foot, but it wasn't hurting and I wasn't bleeding and I wasn't having a heart attack and I wasn't having any breathing distress, so I figured I'm toast here for a number of hours.

 

One of the nurses came out and basically - get this - I'm just talking to the member for Yarmouth, the nurse comes out and apologizes. She said we're sorry for the backup that is happening here at the hospital, all the other ERs are closed at this time and everybody is here at the regional hospital. What we're going to do in order to get people through is we're going to call in another doctor and we should have people moving in a decent amount of time.

 

Madam Chairman, within two hours I had been through triage, I had my X-ray, I saw the attending doctor, my leg was strapped up, I was sent home - well, not home, but over to the Delta where we were staying that evening. I couldn't believe it - within two hours I had seen a physician, been triaged off, everything was done. Compared to what I normally would have dealt with in Yarmouth, it was phenomenal.

 

So my question is how can we get the ER in Cape Breton moved down to Yarmouth, or how do we get the Yarmouth one to work like the one in Cape Breton?

 

MS. MAUREEN MACDONALD: Madam Chairman, as the member was talking I turned to the deputy and said our directives are working. This is great. After Dr. Ross gave us his report, one of the first things that I said was why is it that Walmart can communicate better with people, or when I go out to the Department of Motor Vehicles to get my licence renewed or my vehicle renewed, why is it that I have a better idea of how long I'm going to be there and what's going on than when I go into an emergency room? It makes me crazy.

 

In the last year and a half I've been in our hospitals' emergency rooms with someone who has been a patient, so I know how frustrating it is. It's wonderful - I'm really pleased to hear that.

 

So we sent a directive to CEOs and we asked them to do some work on the customer service piece, to start thinking about better communication with people in the waiting rooms of emergency departments. If people have to wait, we need to communicate, and that doesn't mean a sign on the wall - that does not mean some little neon thing telling you how triage works. It means taking time to communicate with people, and elderly people in particular. We need to let them know where the services are, where the bathrooms are, that they can go and they're not going to lose their spot if their name is called, all of those things. We just need to use better common-sense customer relations practices in our ERs.

 

With respect to Cape Breton, I'm not sure why you're questioning how we can get that service happening in Cape Breton.

 

MR. D"ENTREMONT: No, no in Yarmouth.

 

MS. MAUREEN MACDONALD: Oh, you were in Cape Breton when it happened. Got it, okay. Cape Breton has done a tremendous amount to improve the flow through their emergency department. They set up a rapid assessment process on their own without additional resources from the department and it made a huge difference in a very short period of time - and it improved the quality of job satisfaction of physicians, nurses and others who work in that department.

 

Prior to doing that, they were very, very disheartened and demoralized and we were losing staff.

 

MADAM CHAIRMAN: Order, please. I'm sorry to interrupt. We are approaching the moment of interruption. We will now recess for a couple of moments so staff can leave.

 

[5:56 p.m. The committee recessed.]

 

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

 

MR. CHAIRMAN: I call the Committee of the Whole House on Supply to order. The Progressive Conservative caucus has the floor for another 42 minutes today, I believe.

 

We'll continue with the honourable member for Argyle.

 

MR. D'ENTREMONT: Mr. Chairman, it's a pleasure to spend a few more moments talking on the estimates for the Department of Health and Wellness. Before we took our interruption, we were talking about emergency rooms and talking about my experience at the Cape Breton District Health Authority at the regional hospital - how well I felt I was served and, basically, finding that's not how I would have been served at my own home emergency room in Yarmouth.

 

I find I'm getting a lot of e-mail, a lot of Facebook, a lot of contacts from constituents and others with continued complaints about the emergency room in Yarmouth and the time that people are waiting. I'm just wondering, does the minister have some other information when it comes to the flow at the Yarmouth emergency room, more specific, how are discussions going with the South West District Health Authority on trying to make things better for the constituents of Argyle and Yarmouth?

 

MS. MAUREEN MACDONALD: Mr. Chairman, earlier we had quite a long discussion with the member for Yarmouth with respect to this very important topic. I think one of the problems with the long waits in the Yarmouth emergency room have to do with the fact that there is a doctor shortage in Yarmouth. It is very difficult for those patients who really have minor health care needs, but they can't get access to a family doctor or other care provider and have no other alternative but to get their health care in the emergency department. That means they go and they sit and wait for long periods of time.

 

We've worked very hard and the district health authority has worked very hard to recruit more physicians into the Yarmouth area and that DHA has seen the largest number of doctors go there, outside of Capital Health, last year. They had 11 additional physicians recruited last year. I can't entirely remember what the breakdown was between - here it is - GPs - there were six family practitioners and five specialists, and of those family practitioners, two were CAPP physicians and that's substantially more than any other DHA. Some DHAs only saw two physicians come in, in total, but then the South West DHA really needed additional physicians, without any question.

 

One of the things that I'm very pleased about is the fact that we were able to recruit a physician into Shelburne and this has made a great difference, but the answer is to implement the Ross report.

 

MR. D'ENTREMONT: Here is what I hear from the community. There have been a bunch of different ones that I've heard of. It's not just that I need to have my prescription filled so I'm going to go sit there for a number of hours to get it. I have heard horror stories, and I don't know whether they're true or not - that's the problem with the way Facebook works, and other things are that people say I sat there for a long time or this is what was wrong with me and no one saw me - many things like that. So people are going in with possible drug overdoses and are not being seen by a rapid reaction group or being seen by mental health or anything like that. I think there are some flow issues that are happening there and they're not handing off to the correct groups within the hospital, but that could be because those divisions within that hospital - or it's not there, maybe mental health was not available to the emergency room when it needs to be available to them, things like that.

 

It does fall to the issue - and we talked about that previously - of communication, because what happens, more particularly in the Yarmouth emergency room, is that there's a wall. There's the little triage room that people go in when they see the nurse to get triaged off to whatever level they're going to be, and then people have no further access to see what's going on. All they can see is, well, I saw the nurses walking around, or Jeez, I just saw the doctor just sort of sitting there talking to the nurse. So I think it's a communication problem that Yarmouth has, and if you do talk to the chief of emergency there, he does talk about not having the manpower that he needs to perform the services. But I don't know whether it's funding or whether it's actual bodies, actually trying to find people to fill those positions. I remember a time, not so long ago, when we were in government, that we did provide Yarmouth with some extra dollars to hire a physician to come in and at least try to clear the backlog, to see those low-priority folks and to get them on their way.

 

I question today, does that triage tree - whatever that triage Level 1, 2, 3, and 4 - if that truly works, because a lot of times a doctor could probably see four or five of these patients quickly, the nurse at the triage could probably see these patients really quickly and send them on their way, or the nurse at the triage could actually order an X-ray. These things are not happening at the Yarmouth Hospital, in what I'm hearing from my constituents or my experience and I'm just wondering, is there some resource that we could absolutely provide to them to make the flow at the emergency room in Yarmouth work better?

 

MS. MAUREEN MACDONALD: I think that, again, there are so many things that are going on in our ERs to improve the ERs. The member has touched on a number of really good points. John Ross said "communicate, communicate, communicate" to the Department of Health and Wellness, but he also said that we really needed to do a better job in our ERs in terms of making people comfortable - particularly seniors, but not just seniors. Looking at the flow, it's not always about funding and resources - it also can be about using what we have better and smarter.

 

One of the things that they've done in Cape Breton in their emergency department is they've introduced this process of organization that comes out of the U.K. called Lean, where a number of things happen. First of all, they organize their supplies very differently - believe it or not, a huge amount of time can be saved in being able to just find the right supplies for the right procedures quickly and effectively and that kind of stuff. It's all about the way the rooms are set up, and staff not having to spend additional time running around trying to find things. Also, a piece of what they do is getting diagnostic testing done more effectively and efficiently, and this makes a huge difference in terms of moving people through an emergency department.

 

I also think in some ERs they're making better use, or they're making use of advanced practice paramedics and nursing staff to be able to do certain procedures that I think don't necessarily have to be done by a doctor. All of these things take pressure off the doctors, allowing them to deal with the more serious problems.

 

One of the things that we are doing is ensuring that the practices of the various ERs are being shared across DHAs to help improve - so people can learn from each other. Because we have all of that very rich data about how long it takes from the time somebody enters the ER and is registered, until they leave, we can track from day-to-day, month-to-month what the flow looks like and get a very good picture of which emergency rooms are functioning more efficiently than others and really spend some time understanding that.

 

I think that one of the things I talked about the other evening in estimates was Dr. Brian Goldman's radio program, White Coat, Black Art and he did a program not so long ago on an ER in Ontario that I think he went to as a patient; he may have been in this ER as a patient. At any rate, I believe there's an ER in Ottawa where electronically, like on your BlackBerry or your Smartphone, you go in and you register and they actually constantly update you on how much longer it's going to be until you get seen by someone.

 

You can go in and you can find out it's going to be an hour and 45 minutes before you're seen so you can go off and do something if you're there for something that's not hugely serious and come back. While you're gone, you can get an update on what's happening, whether somebody has come in requiring more urgent attention that's moved you back and what have you. It's incredible.

 

If you think about what the technology gives us the capacity to do, I don't think that Facebook and Twitter is only going to change the way the media cover the stories of the day or the way politicians represent their constituents and the public and the issues. I think it will, if you allow yourself to think about this, these kinds of changes in technology could really change the way we practice in our health care system. We need to figure out how to use that technology, I guess I'm saying, to actually be more beneficial for that communication for people who are in the waiting rooms of our ERs.

 

I'm not sure what you have in the Yarmouth area. I'm hoping to get to Yarmouth when the weather is nicer and the House isn't in because it's been awhile since I've been down in that area as Health and Wellness Minister. It's overdue I think. I would like to go again and talk with people.

 

With respect to walk-in clinics and extended hours - I know a new medical centre opened and I know you have some new practitioners in the area, and that's great, but we also need the expanded hours of practice, we need the collaborative team, we need advanced practice nursing and nurse practitioners to augment that. We need that model to be accepted and to develop in the area - it will make a significant difference for recruitment, for retention, for patient satisfaction, patient access, and it will take pressure off the emergency room.

 

So we can recruit doctors in the way that we always have and we can put them in services like we've always had, but if we don't change the model of those services we will repeat the problems that we have which is the kind of revolving door, the exhausted physicians, and it's not a sustainable situation - it's not satisfactory for people or for our health care providers.

 

I'm very committed to seeing that model change and so are the folks at the Department of Health and Wellness. So I would be interested sometime in having a conversation with the member, who knows the area so much better than I do, about what he thinks are the kinds of things that we could do to ensure that there is acceptance of this approach and this model, and that we really do get it in place in a way that will make a huge difference for people.

 

MR. D'ENTREMONT: Madam Minister, anytime that you want to come down, I would be more than happy to speak to you, to show you around and let you meet some people. You would get a better feeling of exactly how things are actually happening. You know, you're quite right, I'm going to the doctor who took over the practice of the doctor who was my mum's doctor, when she had me. So it's sort of that same system that continues to roll on through time.

 

Change is difficult I think for any area. When I was Minister of Health, we provided the district with some direction during the time that we were doing the PHSOR report. During that time we provided them with sort of an addendum and a little extra time saying, you know, here's how you should change your flow, here's how you should do things. Nothing ever happened, nothing ever happened, and that's what really gets my goat, that you try to help and nothing happens, and you get 100 reasons of why you can't do something versus, well maybe that might work, or it might not.

 

So I'll take you up on that as soon as we get out of here and we'll find some time and get you down, and we'll talk about some of the issues that are important to lots of folks. And it's not just about the number of people, it's how they're doing things that sort of grates on me sometimes, that can be done so much better. We don't have to do the same old thing all over again.

 

So I'm going to change a little bit from ER to a little bit on the wellness programs. I know we haven't had a chance to really talk about that right now but, well, let's talk about Sport Nova Scotia just for a few moments. It is good to talk about something completely different for awhile. It's still money, but we won't talk about it. This is an issue I know the Minister of Finance and the Minister of Acadian Affairs is aware of, and that is next year we have the opportunity to be the hosts of the Jeux de l'Acadie in southwestern Nova Scotia, in the Argyle area. The Jeux de l'Acadie are, of course, the Francophone Games where they do a number of different sports from soccer to track and field, to badminton and handball - I'm just trying to think of all the other sports that are actually done, and this takes kids from all over Atlantic Canada to come and participate in the southwestern area.

 

This is only the second time that the grands jeux will be actually happening in Nova Scotia. The first time was here in metropolitan HRM which I think was four or five years ago now. People had a great time and it was a wonderful thing. So southwestern Nova Scotia has the opportunity to actually do this. But there are a number of requests before Sport Nova Scotia, not Sport Nova Scotia, but before the wellness side of your department. There's going to be a request, I believe, for some track, to basically develop a track in the area. We don't have that kind of infrastructure. So I'm just wondering if you're aware of the Juex de l'Acadie that are coming to southwestern Nova Scotia and how your department might be able to help us in getting some of that infrastructure ready for next year.

 

MS. MAUREEN MACDONALD: Well, to be honest, I had no idea. I do know about these games, though; I think they were in Moncton a year ago or a couple of years ago. The first time that I've really taken note of them was when they were in Moncton, because there was a lot of television coverage and it was very impressive. I thought, wow, that's really wonderful. I hope we'll have an opportunity to do that. So I would be very happy to sit down with the member and talk with him about the proposal, where that's at, what it is that they're looking at, because I haven't had a chance to do that.

 

MR. D'ENTREMONT: Just to give you a little more background on it, of course, there's - I guess you would call them the regular Jeux de l'Acadie. Basically, you take all the francophone students from across Nova Scotia and they have their tournaments. This year it's happening on the May long weekend in Greenwood. The winners of that tournament will then be able to represent Nova Scotia in the grands jeux. The same thing happens in New Brunswick and in P.E.I., and there are actually some Newfoundland and Labrador teams that end up participating in this. Well, all these folks come down with their coaches and their team people and parents that want to go along. It's a really good economic piece for the area, but at the same time it's talking about healthy lives and being able to participate in those communities.

 

I know there is always a base grant that I believe comes through Acadian Affairs that does help the organizing committee - sort of the big group - but like I said, there are a number of smaller projects that, I think, had been requested through Debby Smith in Bridgewater, but what I'll do is I'll try and get some of those pieces together for you and make sure that next year when the grands jeux are here, not only the French-speaking Minister of Finance and Minister of Acadian Affairs but also yourself and other members are more than welcome to come to Argyle and partake in not only the sporting, but there are a number of cultural things that happen that are phenomenal.

 

MS. MAUREEN MACDONALD: It sounds good to me. I've got my schedule here, and I think I should get those dates reserved. I don't know if the member knows, but I grew up in Havre Boucher, in Antigonish County, so I can't tell you how much I enjoy Acadian activities. They are always just the best times going. It sounds good to me.

 

MR. D'ENTREMONT: I'll make sure that that's booked off. It's actually kind of funny - my kids have played soccer and have done things, but this year my 12 year old decided after school one day that he was going to try out for the soccer team. Up to now he is going to be to be on the soccer team as they go on for the regular jeux, as long as he continues to listen to his schoolteacher and doesn't get grounded too many times in order to get there. But I think we've had a great opportunity. The Jeux de l'Acadie are a wonderful thing, and I'm glad that I know that your department does support them in one way or another. I think it's a great partnership between Acadian Affairs and the Acadian community in doing that.

 

I know I probably only have about 10 minutes left here - maybe a little less?

 

MR. CHAIRMAN: You have 18 minutes.

 

MR. D'ENTREMONT: Eighteen minutes? Okay. Then that gives me two more questions, really, or two more pieces.

 

I was wondering maybe where the electronic medical record is - this may be going a little more pan-Canadian now - but the issue of EMRs. I know we've done a lot of work in the department to prepare for electronic medical records - the addition of the on-line digital X-ray system, the diagnostics on-line, and all kinds of stuff like that. So I'm just wondering, the next steps of electronic medical records - where are we and what kind of investment might be in this year's budget?

 

MS. MAUREEN MACDONALD: While staff is looking for the financial details of that, I think it's one of the big pieces of unfinished business in our health care system. We lag so far behind in many respects. Canada Health Infoway and the money they have been able to provide to Nova Scotia is absolutely essential to us developing better IT systems.

 

I know this is an area that, no matter who the Health Minister is, we always get into a little trouble around because it is so expensive to build these systems. People wonder what in the world we're doing spending this kind of money when people have long waits, et cetera, but the electronic medical record will make sure that we don't duplicate tests; that people will flow much more readily through the system; that when you see a specialist, all of the information will be there when you come back to your family practitioner; and the team who are working with you, they will be able to see the information.

 

It makes such a difference in terms of allowing people to have a better, more effective experience. It also allows us to do better planning as a health care system. So the IT is very, very important, it is very expensive and we continue to invest.

 

In this fiscal year the total project costs that we are doing are $8,892,200 and of that, $4,856,200 is provincial dollars and the balance comes from the Canada Health Infoway. So over three years the total cost to the Province of Nova Scotia is about $14.3 million.

 

We continue to do this work and we have a year to go but we're getting there, we're almost complete. Mind you, you are never complete when it comes to technology, I've learned, but what a difference it will make when we'll be able to have that electronic medical record in place.

 

MR. D'ENTREMONT: Thank you very much, Madam Minister, for that. No, it is hard to justify sometimes when you are looking for doctors, trying to pay for this, trying to pay for supplies, there's a whole bunch of things that the health system is expected to pay for. One of the best explanations that I got was trying to compare our medical system to the airline industry. What would happen in a world where you would, basically, show up at the gate, buy your ticket and you actually wanted to get to, let's say Vancouver but the closest you could get would be Toronto. You would fly to Toronto, get off the airplane, grab your bags, go and buy another ticket and then maybe get to Winnipeg and then get to Vancouver.

 

You are dealing with all that information, when really you could have bought just one ticket so that information would have followed you to Vancouver. That's our medical system right now . . .

 

AN HON. MEMBER: That's Air Canada.

 

MR. D"ENTREMONT: That's Air Canada, too, yes. There you go - the deputy minister is getting a few jokes in there as the day is getting a little longer.

 

But that is what our health system really is when it comes to the sharing of information, where if I can see a doctor in Cape Breton, my doctor in Argyle should be able to see the information or should see it in a timely manner. If I happen to be in Vancouver and I have some kind of medical intervention or I fall sick, they should be able to type in my name or medical card number and, boom, my information should show up. That's really not happening in Canada. It's good to see that that investment is there, but I'm wondering what information our system is supposed to be having. I know we had the tests in radiology and all that stuff that's available. I'm wondering what the system is and what it's called - I just don't remember all the acronyms that go in around this one anymore.

 

MS. MAUREEN MACDONALD: Well, I'm not sure that I totally understand the question, and I'm not sure that I totally - IT is not my strong suit, I have to say. I confess that when the techies tell me about all the features and stuff, my eyes kind of glaze over and I tune out. I tell people that when I first ran for election in 1998 I still had a rotary dial telephone - that appalled my campaign manager, that I didn't have a Touch-Tone. Technology is definitely not my strong suit.

 

This is technology that will allow the sharing of information so that it's a much more seamless process. Today we have people in the province who have to go pick up tests and bring them with them when they go to see a specialist someplace. It's not only inconvenient, but it's incredible that in this era we don't have the technology systems in place that will allow tests to go seamlessly from the site where they're done to the person who is going to either read the results or make treatment decisions about the clinical plan for the patient and then back to the provider.

 

We need to be able to have a system that will allow a patient's medical information to be available from any place - from the family physician's office or clinic, the hospital, the specialist - and to have the appropriate provider able to access what it is they need to know from wherever they're located, so that they can improve the treatment plan and do their part in the treatment plan.

 

Some patients and some family doctors' offices, for example, have electronic patient records, but many don't. We still have many doctors in Nova Scotia who only have paper records. A piece of this is moving doctors to electronic patient records, but it's also about having DHAs able to communicate across boundaries. We have many people who have to come to the tertiary care facility here in Halifax to see specialty services or subspecialists, so it's to be able to have that happen.

 

If I'm not mistaken, within the tertiary care setting the electronic communication is very good. You can have somebody have a MRI and the information is transmitted pretty instantaneously to the specialist who has ordered the MRI, and they will be looking at it on their screens, on their laptop or whatever. We still haven't completed this piece of having all of the DHAs linked up, having all of the various services, and then certainly getting down to the level of physicians and smaller facilities.

 

I think a part of the electronic medical records process now is, in fact, to address the sharing of health access across jurisdictions. For example, we have this project that will allow health care providers to get health care records regardless of where in the province they are being cared for, whether it is in an emergency room in Shelburne or a specialist office in Sydney. This is part of the plan to implement fully.

 

The other piece that it's important to recognize is the Drug Information System project. I think it's a really critical and important project. It will allow pharmacies, when they're prescribing medication to a patient, to really look at the history of that patient and be able to identify things like allergies, allergic reactions, drug interactions. It will allow us to reduce medical mistakes, adverse reactions, and those kinds of things. Again, it's all about safety and quality health care, and it will make a significant contribution to improving the patient experience in the health care system.

 

MR. D'ENTREMONT: I only have a few more minutes here to go.

 

MR. CHAIRMAN: Four and a half minutes.

 

MR. D'ENTREMONT: Only a few minutes to go, and so much still to ask.

 

The issue of the EMR is paramount too, when it comes to the sharing of that information. I know the privacy issue has been interesting, because you only want part of that medical record seen by certain people - the diagnostics, mental health capacity issues, those kinds of things can only be seen by certain people - but the drug issue is a huge one. I know the member for Kings West was here talking about the drug issue in the Valley. So many of these things can be caught if the prescribing system is such that it's electronic and things are able to be caught, so at least that side of the equation can be covered. That's what I think the EMR can give us.

 

The other issue that EMR can give us is the issue of data mining, knowing that across your province, here are the things that you're seeing, here are your levels of diabetes, here are your levels of cancer - maybe you're seeing some kind of virus showing up in a certain area. From a public health aspect, you can actually react to possible public health emergencies much quicker because that information is available to the department.

The final question that I'll ask on this one is understanding the incentive for doctors to get into the EMR system. I know my chart number at my doctor's office; I used to have to tell her every time. I think they know what it is now when I do walk in, but the paper system that is there is humungous. My other doctor friend in Argyle, Dr. Loveridge - it would take a heck of a lot of convincing and arm-twisting to get him on an electronic system. So I'm just wondering what kind of incentives are there to make sure that this does happen in a relatively timely fashion. We know we can't do it tomorrow, we know we can't do it next week. It will take a number of years before we are there, but is there something there to provide that kind of electronic system to the doctors in our area?

 

MS. MAUREEN MACDONALD: Mr. Chairman, we do have, first of all, some money allocated in the budget, $4.5 million allocated in the budget to support the electronic patient record. I don't have it at my fingertips but I know that is intended to bring more than 300 physicians into the electronic patient record this year. I think I remember a briefing note on that and the $4.5 million is in the physician master agreement and that is untouched - that's there; that's available.

 

There are probably some older doctors in the province who may never join the electronic patient record, but certainly the newer physicians who are coming into the practice are all very electronically oriented, very savvy when it comes to it. What a difference it makes for the way they practice. I think my own - the North End Clinic in North End Halifax, I mean when they had the nurse practitioner program one of the little perks that went with that was getting the electronic patient record for the clinic and what a difference that makes because if you are a patient and you have to go get blood work . . .

 

MR. CHAIRMAN: Order, order. The time allotted for consideration of Supply today has elapsed.

 

The honourable Deputy Government House Leader.

 

MR. CLARRIE MACKINNON: Thank you, Mr. Chairman. I move that the committee do now rise.

MR. CHAIRMAN: The motion is carried.

 

[The committee adjourned at 7:14 p.m.]