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April 15, 2011
House Committees
Meeting topics: 









10:15 A.M.


Mr. Leo Glavine


MR. CHAIRMAN: I will call the Committee of the Whole House on Supply to order, and we will continue with the estimates of the Department of Health and Wellness.


The honourable member for Hants West.


MR. CHUCK PORTER: Thank you, Mr. Chairman, and good morning. Good morning to the minister and her staff. I had an opportunity yesterday to talk very briefly and got some very good, detailed, lengthy answers, and I'm sure we'll get more today. I've only got a few minutes in this session, but I look forward to coming back after with a couple of other things.


I want to get on to the importance of dialysis, not only in the province - and I understand there has been some discussion, I don't know how many letters and calls, but there are a lot of people in my area who transfer in for dialysis treatment. I have a gentleman who just lives down the street from me who - I don't know, he's travelled for quite a while, and then he went on home dialysis and now he is going to switch back. Home dialysis requires him to be hooked up every three hours and he's a guy who is quite mobile, likes to get out, walk his dog, go to the mail, but he's really strapped by the three hours. I believe he's going to start coming back to Halifax for that three-day-a-week, four-hour stint, or whatever it might be, in an effort to give him a little better quality of life and to be able to use his time more effectively.


I've had other letters from people who - it has gone on for years, we have Dial-A-Ride which is bringing people into Halifax, thankfully. It's a great organization, but it does cost money. People are getting cabs, they're getting family, whoever they can, and a lot of them - as you would know, Madam Minister - from certain areas of the province have been transferred by ambulance, which certainly has been time-consuming as well as very costly to the department and, at the end of the day, I guess to the taxpayer. There are huge, huge costs around transferring patients for dialysis treatment.




My first question is around Hants Community Hospital. We know that we have a facility, we know that we have room, and we know that we have the need. I would ask the minister this morning, is there a potential that we will see in the near future - is there a plan and what is it? - for dialysis in the Hants Community Hospital, where it is certainly needed and would be well used? What does that look like?


HON. MAUREEN MACDONALD: I want to thank the honourable member for bringing a really important topic to the floor for some discussion during the budget estimates for the Department of Health and Wellness. It's interesting - you know I talk about how, as Minister of Health and Wellness, I have a variety of ways to identify what the priority issues are, and certainly correspondence to the minister is one of those ways. You see patterns, you see themes over and over again in your correspondence that alert you to issues that are important to people in the community, and certainly the issues that MLAs are raising from around the province on behalf of their constituents is a way to be alerted to issues that are out there in the health care system that are important.


Dialysis services are certainly an area where I get a fair amount of correspondence and contact from individuals, MLAs, and clinicians, asking for improvement in satellite clinics for dialysis patients. The department had done a review of the dialysis services in the province, and in the budget for this year I know we do have additional money of almost $1 million of additional revenue to expand dialysis services.


Now, the actual places where that will occur, I do not have that information yet. The process is one where the district health authorities will all be looking at their needs and will be submitting plans and proposals to the department, and I'm sure that has already occurred and we will be working through those proposals. Based on the information we have around need, one of the - we talked last evening in estimates about the electronic medical records and what kind of information we'll be able to get from electronic medical records. We already have a fair amount of information and, for example, we know where all of the patients in the province are who require dialysis services - but also population health data, I would assume, would help us predict, as well, where we're going to require services into the future.


The Capital District Health Authority operates ten satellite sites right now and I know that we have other dialysis sites. I visited St. Martha's in GASHA, they have dialysis there and, of course, we have it in the Cape Breton District Health Authority as well as South West Nova - additionally there is a dialysis site at the IWK.


With respect to Windsor, I can't answer specifically that there will be a site in Windsor or an expansion in services, but there will be some expanded services because of the $988,000 in this year's budget.


MR. PORTER: On that, minister, that's good; I'm glad to hear there are dollars allotted for the expansion of service. I do want to stress again the importance of Hants Community not only being able to handle that but I'm sure you know, and I'm sure in the correspondence you've received, and I certainly know from my experience that people with dialysis, I want to say don't get better - it's three days a week to start and then it's four and five days, and trips take a lot out of people, and they shorten that time frame is what it does. If they're not making that long trip to Halifax and they're not having the very long days, they're getting better rest, they're able to be stronger physically, medically, therefore lasting longer before they get stretched out to that four- and five- and six -day period a week of having to be on dialysis.


There are a lot of folks who are actually on this three-day travelling back and forth to Halifax right now and I'm sure that you're aware of that, the numbers, and I know that they are writing you, they are writing me, they are writing all of us - and, rightly so.


I'm glad to hear that there's nearly $1 million in money for expansion. That will be well-received, and it will be better received if we can see something in Hants Community Hospital - it would be great to have it at a lot of hospitals around. We all know that would be wonderful to have and maybe someday we'll see that. I also understand the costs that are associated with it. It's not as simple as the capital purchase of getting the equipment, it's the long-term staff, it's the facility, it is all of that. I think people understand that and they appreciate it as well, what goes into that.


So again, I am glad to hear that there is some of that happening. I don't have a lot of time, but we talked a bit yesterday about incentives for physicians and so on. I want to ask quickly, so that I'm clear - and I think a lot of people aren't clear on as to how physicians are hired and/or paid, minister. I know that depends on emergency, nights and days, hourly versus number of patients. I want to confirm though, I guess for myself and for others, in a clinic situation or in the office situation that patients go in, they see the doctor, and the doctor is paid a fee for service, so by the number. If I see five patients today, I'm paid for five. If I see 50, I'm paid for 50, as opposed to maybe the hourly and/or a combination thereof at emergency departments.


So I guess, yes, just to be clear, the way that doctors are paid in those circumstances, if you will - let's use the QE II emergency which is a busy, busy facility, as we know, and then let's use perhaps maybe Hants Community. . .


MR. CHAIRMAN: Order, please. The member's time has now expired.


The honourable member for Pictou West on an introduction.


HON. CHARLIE PARKER: Mr. Chairman, we're always pleased when we have young people join us in the Legislature, and this morning we have a group of interested young folks from the North Shore, 596 Phoenix Squadron Tatamagouche Air Cadets. They're with us today, taking in the proceedings of the Legislature and our session here this morning. There are about 20 air cadets, as well as Captain April MacKenzie, their squadron leader, and a number of other leaders and parents with them.


We're pleased they're here and I'm going to ask them to rise and to be recognized by the House this morning. (Applause)


MR. CHAIRMAN: The honourable member for Richmond.


HON. MICHEL SAMSON: Mr. Chairman, when the honourable minister stood to say he was happy to see young people here in the Legislature, I thought he may have been referring to me and some of my colleagues, but he was talking about much younger people here in the gallery. I want to extend my welcome as well to 596 Phoenix Squadron and certainly commend their leaders and chaperones for bringing you to the Legislature here today. (Interruption)


No, no, no, I'm sure this is a chance for them to see democracy in action, and just to give them a brief understanding of what we're doing right now is that the government which sits over on that side - we're the Opposition, the Liberal caucus here, and that is the Progressive Conservative caucus just over to my left - the government has brought in a budget. What we now do, as members of the Opposition, is that it's an opportunity to question the government on their budget and on some of the spending priorities and some of the concerns that we may have both locally and provincially.


Right now, we have the honourable Minister of Health and Wellness, who is here to discuss her budget, which is the single largest budget of the government that's being presented. I don't have the total figure in front of me but I believe it's almost $4 billion, which is a significant amount of money to say the least - and the minister has her deputy with her, and I believe one of her finance representatives as well, who are here to assist her in answering some of our questions.


So I will take a few minutes now to raise some concerns. I represent Richmond County, which is on Cape Breton Island, and I will take the opportunity just to ask a few questions about some local issues. Minister, I know you've been at this for awhile now and I'll do my best to be brief in my questions and I would certainly appreciate, as much as possible, if you could be brief in your answers, so that I can get some of the issues that are of concern locally and which doesn't eat up too much time from my colleagues, whom I know have a number of questions as well.


Minister, as you're well aware, St. Anne Community and Nursing Care Centre was one of the sites identified in the Ross report as - it's the care model, I believe is what it's being defined as. As you know, that has caused great concern in our area because of the fact that, if I'm not mistaken, and I've given these numbers to the minister before, I believe the St. Anne Centre emergency room, in the last 15 years, has been closed for 10 days.


So it is not the chronic problem that has been identified in other communities and I can tell you, residents of Isle Madame, Louisdale, and surrounding areas can see Dr. MacNeil on Monday morning if they need to see Dr. MacNeil on Monday morning. The chronic closures of emergency rooms, plus not being able to see your family doctor in a timely fashion, is not a problem in our area, so I guess the message that the board has given, that the community has given, that the local doctors have given is that it's not broken - it is working in our community and we're not sure why monies would be expended to try to fix a problem that doesn't exist.


I know in the budget you've identified Parrsboro as one of the sites that would be under this model. I believe it's already in place but you've also indicated, I believe, there are at least three more sites that are planned for this fiscal year. We don't know what those three sites are, at least I don't know, so on behalf of the community, the board and the local physicians, could you advise us what the intention is of the department with regard to St. Anne and the conclusions drawn by the Ross report?


MS. MAUREEN MACDONALD: I, too, would like to welcome our guests in the gallery.


The question that has been asked with respect to St. Annes is a very good one. I want to assure the honourable member that I have no intention of fiddling with something that's working. If it's working, then I have plenty of things that aren't working that need my attention, and that's where my attention is going to go - it's not going to be diverted into solving problems that don't exist.


I do want to say to the member that I feel badly that I haven't gotten around to visiting St. Annes and it's definitely on my list and we're trying very hard to find a time this Spring to go for a visit - not to be the bearer of bad news, but to just inform myself of the services of the centre. I say this because Dr. Ross spoke very highly of this particular centre; he impressed on me the uniqueness of that centre. He was actually very complimentary of a number of health care facilities on Cape Breton Island, including what they're doing in the Community of Cheticamp. I have always wanted to go to the St. Anne Centre.


It wouldn't be that far a visit from where my parents live, and I've been spending a fair amount of time there over the last little while. Because of my father's illness, I go fairly frequently to that area, but I find it's hard sometimes to fit in a business visit and a family visit and so it just hasn't come together.


But it is my plan, and I think we've identified a potential date sometime in the late Spring or early summer. I do want to reassure the member that the other CECs that we'll be announcing this year, that will not be one of them. We're really very much focused on those communities where people are having a difficult time getting access to a family doctor or other health care provider, where the waits are long, then the traffic is into emergency rooms, putting a burden on those health care facilities that are hard to cope with.


That's not to say that at some point in the future we won't have to look at a CEC in that community, but it's certainly not something that is going to happen anytime soon.

MR. SAMSON: Needless to say, I'm sure the board, the staff and the doctors in the community will be pleased to hear that answer. I can tell you, and I know the minister's family doesn't live too far from Cape Breton, but you are on the mainland so I do want to point out - and I'm sure the deputy would recognize - that in Cape Breton, showing up at the last minute or showing up unannounced is never frowned upon. So don't hesitate; if you do have time in your schedule, even if it's a couple of hours, I know the board, the staff and local doctors will certainly do everything to accommodate the minister on very short notice.


I commend the minister first thing, because sitting in an office here in Halifax and hearing what St. Anne offers truly doesn't give you an appreciation until you walk through the facility, you see the diabetic clinic, you see all of the services that are being offered, and I know there's more collaboration taking place now with GASHA. The fact that they are still a stand-alone entity not under a district health authority, there are those services being provided, there is a great relationship and, ironically, after years of doctor shortages we're actually looking right now at a number of medical students who have already indicated that they are coming to our area. One has already been signed, starting September, and there are at least two or three more who are ready to come, so, for us, we're in the best situation we've been in a long time. Having that stability at St. Anne Centre is a significant part of that recruitment effort and I'm certainly pleased to hear that there will not be any changes this fiscal year.


I would, again, encourage the minister once she sees the facility, hopefully she will conclude that there is no need to make any changes at St. Annes. Because it clearly is working well, the community is very supportive of it, and the amounts of extra services that are being provided both in education and in support for various ailments and diseases is truly incredible.


I also wanted to raise with the minister one of our other proposed health facilities, which would be the Dr. W.B. Kingston Memorial Health Clinic. The minister knows, I've raised this in the House before, and she has received correspondence from the organization. Right now, this group has been working on this for a number of years and the previous government truly gave them the runaround - there's no better way to explain it. They went straight to the Premier and were given nothing but the runaround - I was embarrassed that a government would have done that to a group that was trying to raise money, to send them to visit government agencies that clearly were not in a position to give them any funding at all.


It has been a struggle for them and they're, again, now, at the period where're they are questioning if this project is going to move forward. They have secured the money from ECBC, they have secured the money from the municipality, and local fundraising is going very well, with another major event being planned for mid-May. Right now, the only partner not at the table is the province, which is very unfortunate because everything else is in place. The minute that they hear from the province in a positive way, the project is ready to move forward. This is going to bring medial professionals under one roof, it's going to replace a very old facility which used to be the old home where the nuns stayed that they turned over to the community as a medical clinic.


Could the minister today, as briefly as possible, just give me an indication if there are still ongoing discussions about the province being a funding partner in the construction of the new Dr. W.B. Kingston Memorial Health Clinic in L'Ardoise?


MS. MAUREEN MACDONALD: I'd like to tell the member that he can probably look forward to not having to ask me this question perhaps next year.


A couple of things, Better Care Sooner is very much about improving primary care and about working with communities around their existing infrastructure and their existing health care providers' needs. When you have a community like this one, you know, it is in this situation and they've done all this good work, it's almost like they have anticipated what the government's plan and priority was going to be. Although many of the CECs are focused on small community hospitals and working with those entities to bring them into a more modern health care era, the practice at a clinic or a community health centre such as this one is also a part of that plan, even though it isn't a small community hospital.


One of things I've been concerned about is that we didn't seem have in the department a real infrastructure program to support these kind of stand-alone community health centres, but we are changing that. This particular community health centre, we will work with this community health centre. I understand the correspondence came in to me very recently, in the last couple of days, and I will have a chance to look at that, but we will attempt to do something in this fiscal year to bring this project to fruition and give that community a modern health care centre and support the good work that they have done.


So if your question is about the province being a partner, we will be a partner in this.


MR. SAMSON: I'm certainly pleased to hear that and I certainly want to commend not only the minister, but I know that your deputy, as well, has been working very closely on this. Again, this is not a criticism of the existing government, because previous administrations have also not provided any infrastructure funding for these stand-alone clinics that weren't either attached to a hospital or part of a district health authority. This is something new that is being requested and I understand that there are other communities that have put proposals forward as well, that if there isn't a change in the policy they will not be eligible for any funding either.


What's frustrating is that, when you have the federal government that sees this as a worthwhile investment and yet the province is not at the table, that's what the community finds so frustrating. I'm very pleased to hear that and I believe the correspondence most recently sent to the minister was requesting a meeting. I know they're prepared to come up here to Halifax - I don't think they're looking for much time but I think at this point they would like to hear the reassurances similar to what the minister has given today.


I do hope that we can find some time within the next week or so to try to bring them up here and find some time from the minister's busy schedule that she can meet with them, because I'm sure the minister knows, and doesn't need me to say, these are volunteers. They are people giving freely of their time; they've done a tremendous amount of work. I believe it's fair to say this has been ongoing, for at least four years work has been done on this. They're still hanging in there, money is still coming in from different organizations that want to be a part of the fundraising effort, but right now the missing link is investment from the province. So I'm pleased to hear that and we're certainly more than happy to continue to work with the minister and the deputy to try to arrange a meeting as quickly as possible - as well, anything that I can do to assist in the efforts for discussions that are taking place, I will certainly be happy to do so.


With that, those are a couple of the issues I wanted to raise. I could go on at length about the caregiver programs and some of my concerns there, but I believe we will have an opportunity, both through Question Period and, hopefully, through other debates to talk about some of those programs. The minister knows well my concerns, especially support for family caregivers, daughters, sons, sisters - those within the family who do provide care, and unfortunately the new programs that are out, again, seem to exclude direct funding to family members, which is extremely unfortunate because I know in my own community caregivers are family.


People don't want strangers; they don't want people other than their family. Asking for someone to care for you is a very private thing. I still have people who won't even take home care, even though they should, because they don't like the idea of a stranger coming into their home. It's a matter of pride as well, so it's always a challenge.


When you see programs come out, that the family members are excluded, it is disheartening and I do hope - I think the minister has indicated that these programs will change over time, so I do hope that at some point family members are eligible. As I've said before, for the most part caregivers are females, they leave the workforce to care for loved ones and now to be told that we respect you as a caregiver, but any financial incentives given will be given to others and not to you - I think it's extremely unfortunate and I do hope that the minister and her staff will continue to work on finding ways of supporting family members who leave the workforce and who give up everything, basically, to become caregivers for their loved ones.


As I said, the minister has heard me go on about this at length before and I do hope to see the day where family members will be eligible for these supports and that those who are receiving care can pick their own caregivers, with family members not being excluded.


With that, I do want to thank the minister for her answers. I'm trying to think of any other health issues that I could get such positive answers about in Richmond County. I will stop at the two very good news that we received today on St. Anne and on the Kingston Clinic and do appreciate the minister's responses on that. I believe my colleague, the member for Halifax Clayton Park, our Health Critic, has some more questions. Thank you.


MR. CHAIRMAN: The honourable member for Halifax Clayton Park.


MS. DIANA WHALEN: Mr. Chairman, I'm pleased to get up again and have some more questions with the Minister of Health and Wellness. As the Health Critic, I've shared my time with other members, as you can see, who have health facilities in their ridings and some questions that they wanted to find out more about.


I would like the minister to go back to the subject we were talking about several days ago and that was Dalhousie Medical School and the funding for the medical school seats. I just had a few questions to fine-tune or to dig down a little deeper into, and I know the minister said the other day that it is a complex agreement that you have, or perhaps a number of different agreements, with Dalhousie. Last year, again just to preface, last year there was confusion around the amount of money that Dalhousie would get for their physician training seats and there was, in fact, a line item in the budget last year called Physician Training. It's not there this year so it's a little harder for us to dig down and find out exactly what is available and whether the monies that we are giving are going to be coming from the Department of Health and Wellness or whether, in fact, they're coming from the new Department of Labour and Advanced Education. The names have changed on a lot of the departments so I have to keep up on those names.


Just to go back to that, I would like to know - and I would also ask the minister if she could be brief, too because I've shared my time with other members, I have a lot of different subjects I would like to go to. So does the Department of Health and Wellness transfer funds to the Department of Labour and Advanced Education for the funding of physician training seats? That would be the first question.


MS. MAUREEN MACDONALD: Mr. Chairman, the answer to that question is, no, we do not transfer funds to the other department for physician training seats. I would just remind the member, when we were talking about this item the other night, we indicated that the line item on Physician Training Seats has been moved to Other Medical Payments. It has been put into that category or it's all in Physician Payment. So that's why you don't see it anymore.


MS. WHALEN: Mr. Chairman, I realize it has been rolled together. I would like to know if there was a rationale for doing that because as we roll more and more items into a big umbrella item, we lose track of where the funding is. Again, there are a lot of people who are interested in how we're funding our medical students. This year, as a result of cuts to the universities, or a change in the MOU, we're looking at what has been announced as a 10 per cent increase in medical school tuition. I understand the government does subsidize medical schools and the tuition of the students but a 10 per cent increase is going to be significant for those students.

So my question would be, again just in the interest of accountability, why did you choose to remove funding for physician training seats as a single line item?


MS. MAUREEN MACDONALD: The decision was made to keep all of our physician-related costs together in one area. What we could do is we could break out those payments in future accounts that would tell you what the various components are that make that up and I accept that probably would be a very good thing to do because then it would allow you to have a clearer understanding of all of the elements that go into that category.


MS. WHALEN: Mr. Chairman, to the minister, I appreciate that and I think it would be good in future years. I know that Dalhousie would themselves be looking for that, to understand it better. So that would be good.


I wanted to go back to the eight seats the minister referred to and I know that I was surprised when we talked about eight, I asked her a little bit more about it. I wondered if you could just say, are those the eight seats for Nova Scotia students that were introduced under the Progressive Conservative Government that were in exchange for a return for service agreement?


That had been something that the Liberals had been asking for. We wanted to see 10 of the seats that were vacated when the New Brunswick school started up. We wanted to see them all allocated to return for service agreements. That is asking the young physician students to sign on to go to areas of Nova Scotia that we wanted. So it's just a question of clarification for the minister, is that where the eight come from, from that agreement?


MS. MAUREEN MACDONALD: Yes, I think that is the case, Mr. Chairman.


MS. WHALEN: My last question on this for the minister is really just to clarify that the amount is in the range of $500,000, or it might be closer to $600,000 but it's in that range, that you have allocated for Dalhousie University this year.


You mentioned that there is a committee meeting now that is looking at the funding of the university. Are you expecting there will be more funds required for Dalhousie as a result of that? Or have you put that in a separate contingency or is there another line item where you have - sometimes we have a line item that captures things like new contract negotiations or things that are uncertain that will come up in the year. Have you put some money aside in the event that that's what the committee decides?


MS. MAUREEN MACDONALD: The amount we have in the line item is $539,800. We are in negotiations with Dalhousie so we do have elsewhere, money, but I'm not, because we are in negotiations, I'm not going to discuss that amount.


MR. CHAIRMAN: The honourable Leader of the Progressive Conservative Party on an introduction.


HON. JAMIE BAILLIE: Thank you, Mr. Chairman. I have a number of introductions I would like to make, if I may. Seated in the surrounding galleries are a number of important people in our province. I will start my introductions with the President of the Union of Nova Scotia Municipalities and the Mayor of Port Hawkesbury, Mr. Billy Joe MacLean, who is in the east gallery. I recognize Mr. MacLean.


I should say, Mr. Chairman, I would like the members on the government side to take particular notice of the people who are in the gallery this afternoon because they are the ones whose agreement was ripped up, they are the ones who now have to implement the dirty work of that government, Mr. Chairman.


MR. CHAIRMAN: Order, order.


The Leader of the Progressive Conservative Party.


MR. BAILLIE: Mr. Chairman, I guess I got carried away, given the gravity of the situation, but I do want the members on the government side to look very carefully at all of the people who are in the gallery this afternoon.


I started my introduction with Mr. MacLean of Port Hawkesbury. I would also like to draw the members' attention to Mayor Peter Kelly of the Halifax Regional Municipality; Charlie Sutherland of the Town of Westville; Allister MacDonald from the County of Pictou; Lee Nauss, the Deputy Mayor of the Municipality of the District of Lunenburg; Martin Bell, councillor with the District of Lunenburg; Basil Oickle from Lunenburg; Allen Dill, a good friend of mine and the Mayor Springhill; Mayor Corkum of Kentville; Mayor Rhoddy of the Town of Stewiacke; Mayor Lloyd Jenkins from beautiful Cumberland County and specifically, the Town of Oxford; Councillor Sandra Statton of the District of Lunenburg. I have approximately 68 of these to do, Mr. Chairman. Should I continue or perhaps I'll table the rest of the introductions.


I think my point is that 46 of the 55 municipal units in Nova Scotia are represented in the gallery today and these are the people who are here to make an important point to that government about agreements and so on, so I'll just table the rest for today. Thank you. (Applause)


MR. CHAIRMAN: The honourable member for Halifax Clayton Park.


MS. WHALEN: Thank you very much, Mr. Chairman, and I'd also like to welcome the many representatives from the UNSM who are here today. I see many people from Halifax Regional Municipality, which is, of course, my municipality, but I do see people from every corner of the province.


We had been speaking earlier in the day and are speaking into Supply, which is about a 45-minute period, the members of the Opposition, both Opposition Parties, have spoken about the MOU and your concerns today. I certainly want to let you know that it's on our agenda. Now we are here because it's the estimates and we are asking the minister questions on the budget of Health and Wellness, which is our number one largest budget item approaching $4 billion.


Through you, to the minister, I'd like to go to the subject of the Tobacco Control Strategy. Today and actually in our previous two days of discussions on the Health budget, we haven't really talked a lot about health promotion and protection, which is now part of the Department of Health and Wellness. The area of the Tobacco Control Strategy is an area where we had made some pretty tremendous gains and I know there had been investment in social media and marketing and money put towards reducing our tobacco consumption and the number and percentage of Nova Scotians who are smoking.


What I noticed was in the most recent figures, we've flattened out on a lot of that. A lot of our improvements have stopped and I think in the area of some of the youngest smokers, the 15 to 20 year-olds and the group above that, 25 to30, has actually risen by 3 per cent, in both of those categories. I know that the Canadian Cancer Society and Smoke-Free Nova Scotia and all of the partners that are in that umbrella group are really keen to know what we're doing now because the former Tobacco Control Strategy ended in 2007 and we have been waiting for a new strategy.


What I was told was actually there was to be one, I believe, by 2009, that it was supposed to come into play, a brand new strategy to fight tobacco. We need to do that because we still have tremendously high levels of lung cancer and deaths associated with smoking, cardiovascular disease and all the other negative health outcomes that come from smoking.


I wonder if the minister could first of all tell me and I'll be specific, where can we find it, what line item can we find the Tobacco Control Strategy?


MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member brings an important topic to the budget estimates today. The cost of tobacco on our society, I think, distresses us all and probably, it distresses Health Ministers probably more than most.


We know that there's a significant human cost to the use of tobacco. Many of us, probably all of us, certainly most of us, have been touched by the loss of a friend or a family member, to a smoking-related illness or death. We know that the cost of treatment for diseases related to tobacco use on our health care system is significant.


I get a lot of material coming across my desk as Minister of Health and Wellness, a lot of different studies, a lot of different proposals, a lot of different plans, strategies. One of the things that I've noticed in some of the material crossing my desk is conflicting numbers. I've seen recently numbers from different studies about what the financial impact is on the health care system of smoking-related illness.


That frustrates me a bit because I might read a draft of the tobacco strategy and it will tell me one thing about the cost and then I might read a draft from the mental health and addictions group and I see a different number cited from different sources, and I wonder why - after all of the years of research, evaluation, and analysis - why we don't have more reliable figures and why there are such, in some cases, fairly substantial differences in the numbers.


So while that's my frustration, the one thing that is clear, though, is that there is a cost and it's enormous. It's a significant cost and while I'm very concerned about the human cost, I'm also very concerned about the financial cost. If we could reduce the burden of tobacco-related diseases, even by 10 per cent, that would result in the savings of millions of dollars in our health care system. Without question, it would result in the savings of millions of dollars. So we're motivated, I think, by a number of things. We're motivated by our desire to get financial costs in the health care system down and under control and we're also motivated by improving the health status of our population.


The other thing that really concerns me is that there seems to be a persistent proportion of the population that are smoking and we're having a difficult time moving beyond that. We did very well under the initial tobacco strategies that started to make smoking an unacceptable practice, not something that was mainstream but moving it into the margins and getting it out of public places and getting it out of our institutional settings and what have you. Certainly that had a significant impact in reducing the numbers of people who smoke. Many people quit smoking. Many people didn't take up smoking and certainly, for a lot of young people, we were able to cut down the numbers of young people becoming the next generation of smokers.


However, it is the case that about 20 per cent of our population continues to smoke and in the young group, they're young adults. There's a group, a cohort of young adults who seem to have - they go through their adolescence and they don't smoke but they take it up in their early twenties. I don't know that we have the empirical data that tell us why this is, who specifically those young people are and what it is that contributes to their being a vulnerable group, in a disproportionate way, to take up smoking.


So my own view is that we do need more empirical research that will help us really understand that last persistent 20 per cent of the population who smoke, to allow us to have a better way of developing our public policy that will go after that 20 per cent. At any rate, in the Speech from the Throne, our government said we would be bringing forward a renewed tobacco strategy and that is our intention and that will be announced publicly in the next little while when I have a bit more time and I'm not here in the House doing budget estimates, for example. I look forward to moving that forward and we will have fuller discussions about it at that time I would imagine.


MS. WHALEN: Thank you. I'm happy to hear the minister say that there will soon be an announcement on a new strategy, because I think this is something that has been missing. As I said, the old strategy was done in 2007. My understanding from reading different information from Smoke-Free Nova Scotia was that a new strategy was ready in 2009, or there was something available to move on. I believe they felt it was a strategy and so we'll be anxious here in 2011 to get that in place.


My question to the minister, and I understand she'll want to leave a lot of the details out for later, is if you have a line item in the budget - I'm sure it's rolled in with other items, but have you allocated funds for this strategy so that we can implement change and implement programs, implement some of the recommendations that are going to be in the strategy you're going to announce, so the first question I'd ask was, which line item can we find funding for the Tobacco Control Strategy? I have asked how much and I'll leave that up to the minister because I'm hearing that she wants to perhaps save some of that information, and that would be my main question.


I'd also like to ask the minister if, in fact, the money was reduced during the year for the Tobacco Control Strategy and, if so, by how much. My understanding and I might as well say so, because I may not get another chance, is that it had been reduced by about $75,000 and then that money was reinstated. So I think the minister again would appreciate that we need to have money in there.


In the last two budgets, we've had a decrease of $200,000 in the tobacco control initiatives and that was over the first two budgets of the NDP Government, a decrease of $200,000 in that item. Now, I understand a new strategy will mean that there should be new monies associated with that and again, to put the context around tobacco control, we get over $200 million in tobacco taxes every year from - I think this year's estimate is $209 million, coming into the revenue of the Province of Nova Scotia from tobacco taxes. On top of that, we had some legal settlements that Nova Scotia was part of, where the tobacco companies had done wrong.


I'm not sure which way, whether it was assisting with contraband tobacco or whatever it might have been, there were legal actions taken and funds were then divvied up among the provinces that were part of that legal action. This year, I believe we got $13 million and it has been over $20 million in the last couple of years. So we've got funds coming in that could be allocated to tobacco control and we have statements by the Premier made when he was Leader of the Official Opposition, stating very clearly, that he felt that funds that came in especially from a legal action, shouldn't be seen as a windfall and just to go into general revenue, that at least a portion should go back into our health efforts, our health and promotion, our direct efforts to help smokers quit that habit.


The context is, you've got a lot of revenue coming into the province from tobacco, how much will be allocated this year for the Tobacco Control Strategy and can you tell us if you'll be reinstating funds that we've lost in the last two years, that are in the range of $200,000. Thank you.


MS. MAUREEN MACDONALD: Thank you very much. First of all, I would like to inform the member and the members, that the monies that we have in the Department of Health and Wellness budget, which fall under the Public Health line item for tobacco control and prevention, are monies for administration.


We, again, remind members that health care in Nova Scotia is very de-centralized and the actual front line services that are provided are provided out in the district health authorities and at the IWK. So they have the $1.4 million for nicotine treatment, for example, in the DHAs. We have a small line item in our Public Health Budget and this is for planning and policy work, it's for administration. There have been reductions in administration, inside our department. There have been reductions in administration across our department. We have been criticized by members of the Opposition for not having cut deeply enough in the administration of our departments; however, there have been administrative cuts. We have fiscal difficulties in the province, we all recognize that or at least some of us recognize that. The approach that this government and this minister and this department have taken has been to protect front line services, in as much as we possibility can and go looking for budgetary reductions at the administration level, at the policy planning, bureaucratic level. So yes, there have been some reductions.


The administrative unit, of this particular part of my department, has had to share its share, just like every other unit has had to share its share of getting the province back to balance. But I frankly don't think that that has detracted from the work of that unit and their ability to deliver the programs that need to be delivered in terms of overseeing our Tobacco Control and Prevention. They are not involved directly in nicotine treatment, for example, because that happens in the district health authorities and those funds have remained unchanged. So these programs will continue to be there.


I will remind members that Nova Scotia is the second highest province in Canada per capita in terms of its spending on Tobacco Control and Prevention. The province of Quebec is the only province that spends more, per person, than we do. We're a small province, with a limited amount of resources and abilities to deliver services sometimes but yet, we have placed a significant priority and that continues to be the case.


I also want to say that this business about there was a strategy ready in 2009 - Mr. Chairman, when I came to this legislature in 1998 with the Liberal Government, there was a tobacco strategy. I remember the Minister of Health in the John Hamm Government standing here, telling me that when he went into the Minister of Health's office, the one thing he found in the drawer when he opened it, was the tobacco strategy that was there under the Liberal Government that they did nothing with. I understand that the honourable member is very sincere and very committed to this issue but I hardly think that there's anything written in stone about timelines. It's not the time that's important, it's the quality of the strategy, it's about doing something meaningful and also having a strategy that is realistic, a strategy that will get you results, a strategy that will move you forwards. It's important to have the components of that, developed realistically, so that you can in fact see results.


I go back again to the huge burden that tobacco use places on individuals and their families, our communities and our society and our health care system and its significant. I think we're all very concerned that tobacco strategies across the country have seen the numbers plateau. We've hit a plateau, we've been able to see movement around the decrease in tobacco use, but now, as I said, we have this persistent 20 per cent of the population that we're having a difficult time moving. In that, we see certain features of particular groups that are showing us particular attachments to tobacco smoking. We're trying to understand that better.


The other thing that we see and we really have had difficulty around is the growth in the illegal trade in illegal tobacco and the underground economy around tobacco. I see that all the time in my own constituency. It's a concern, it's a frustration. I know that police departments have talked about the increase in activity and criminal activity that they have to divert resources into, to deal with the illegal trade in tobacco and contraband and what have you.


These things are all very complicated, they're concerning. We have to be able to strike a balance in terms of our public policy that will move us in a direction where we're not doing things to have unintended consequences. We continue to be very committed, to doing what we can, to realistically bring down those rates of tobacco use. As I said, the tobacco strategy will be coming forward soon.


MS. WHALEN: I appreciate the discussion and I really am sincere about us moving on this and directing some of the funds that are coming in from those people who are legally purchasing and paying the taxes on tobacco and how can we direct them to a healthier Nova Scotia? 20 per cent, as the minister knows, is still too many people to have in the category of smoking, especially with some increases being seen in young people.


When I suggested that there was a strategy ready in 2009, I am taking that from correspondence from Smoke-Free Nova Scotia. They said that very clearly - it's right here with March 8th as the date on it and it said very clearly that a strong, renewed strategy was ready to be launched in 2009. Even if there was a strategy in the 1990s, we know that a lot of legislation has come in around smoking in workplaces, not smoking in cars, with children in the cars. We've brought in legislation, along with pricing and taxing, that has helped as part of an overall strategy, to reduce smoking since the 1990s.


We're not really here to throw or cast aspersions, I don't think on perhaps the slow movement of earlier governments because there was some significant gains made in the earlier 2000s and the five year strategy ended in 2007 and there is a new strategy available. Again, I'm only as well informed as the information I have before me, which comes from Smoke-Free Nova Scotia. I wanted to mention to the minister, it actually suggests that our funding per capita is below the national average.


I know the minister said we're second only to Quebec, but from the same document from March 8th of this year, they say under adequate funding for tobacco control, they say it is critical. They had footnotes, as well, going with this that said Nova Scotia's tobacco control funding of $2.62 per capita is below the national average of $3.50 per capita. They have footnoted an Ontario tobacco research unit, 2010 study and they had another one on the state tobacco control spending and use smoking is another one of the studies that they use. They said the national average is $3.50, but we're spending $2.62. I just want to mention that because again, as the minister said, she gets different figures on what the cost is of smoking and probably what the incidence is and maybe there are different ways of totalling up what we're spending. I hope what the minister means is that the new strategy will see us second only to Quebec, perhaps there's a positive indication that we're going to be making strides.


I don't think we need to belabour it now, because we'll have a chance to see this strategy, I hope very soon. I know that the minister is very concerned about the impact on smoking in the province. We have talked some about it, a little bit about health promotion, but I think that that document would be in the minister's office as well and I would be happy to share what I have there.


Some of the groups that are part of Smoke-Free Nova Scotia include our DHAs and their addictions units, and they're asking for an increase in the tax on the licensing fees for tobacco. Actually, I'm glad the minister mentioned the contraband, because I believe it's through Service Nova Scotia and Municipal Relations that we tried to actually monitor and control the illegal tobacco but perhaps the minister has been in contact, as well, with some of the small retailers, the corner store and some of the service stations that have stores, and they have been pretty active in trying to create a coalition that's fighting contraband tobacco, because not only does it take revenue out of our province that can be put back into health promotion but it certainly harms their business as well because they are trying to legally sell tobacco and enforce that it's not sold to young people as well.


When you have contraband tobacco, you've got no control over young people smoking and I think that's a big concern as well. In fact, in my riding, I was visited by them and the minister may know they have a petition asking that you're opposed to contraband and tobacco and I have signed that petition because I think that, you know, it's just obvious that we should not be promoting illegal sale of a product that can harm young people.


I know we don't have a lot of time in this round, I believe it's five minutes, Mr. Chairman. (Interruption) So in the five minutes that are left, I would like to ask the minister just really a fairly quick question and it's more for context. We will be discussing a lot of pharmaceutical costs and I know there will be a debate on some of the bills coming up around pharmacies but I wanted to ask if the minister and her department had any information on what the pharmacists are calling the true cost of dispensing fees?


I know that we've all had meetings with pharmacists. They are saying that through PANS, their Pharmacists Association of Nova Scotia and other groups, and individual pharmacists I've talked to, they are quoting a figure of $15 and some cents as the cost of dispensing, whereas our plans and our Pharmacare Plans, allow for $10 and some cents. So they say there's about a $5 differential in the true cost of dispensing and I would just like to know, and I think the members of the House would like to know, if there is any information at the Department of Health and Wellness that might help us put that in context and whether that is a figure we can accept.


MS. MAUREEN MACDONALD: Mr. Chairman, I want to go back on the tobacco strategy and questions that the member raised around tobacco control and allocation of dollars and what have you. First of all, the $200,000 figure that the member is using as a reduction is not accurate; $185,000 in social marketing was moved into another category. Additionally, there was another small amount of money was moved as well. So there hasn't been a $200,000 reduction and I don't know where she's getting that information, but it's not accurate.


The other thing I would say is that the information with respect to Nova Scotia's per capita funding being below the national average as well was based perhaps on old outdated data. It's no longer the case. Only Quebec spends more per capita than Nova Scotia. That is accurate. We have communicated that to Smoke-Free Nova Scotia quite recently. I believe they were really happy to learn this but I guess they haven't had an opportunity to correct their information and let the members of the Opposition know that that's the case. So I did want to make that clear.


With respect to what the Pharmacy Association is saying with respect to their dispensing fees, Mr. Chairman, we're in negotiations right now with the Pharmacy Association of Nova Scotia with respect to the tariff and dispensing fees. I would expect them to say that the current fee is not enough, that's what negotiations tend to be about. If the honourable member needs more context than that, perhaps we can have a chat outside the Chamber about the context; I'd be delighted to do that. Thank you, Mr. Chairman.


MS. WHALEN: Thank you very much. It's hard to get into a new subject at that point in time but perhaps just a quick word, we certainly didn't have the updated information but the report given to us by Smoke-Free Nova Scotia is dated 2010, so we'll have the discussion and I'm glad to hear that if it is updated, that we are among the larger spenders on tobacco control.


I did want to go back. I've got lots of questions on foreign-trained doctors and nurse practitioners. I don't think I have time to get into them at this point but we have one more hour coming in the next round. Again, I would ask that the minister just continue her work on the tobacco control and that we see that strategy as soon as possible, hopefully as soon as the House rises, because the minister said, when she has a bit more time and can catch her breath, she'll be releasing that strategy.


I think that for all of us right across the province, working in health and health promotion, it's very important that we do that because it ties into - the minister mentioned mental health. I thought it was interesting to note that the number of people who suffer from mental illness have a much higher level of smoking. That was just from my reading around the strategy and the preparation for this, so there are particular groups . . .


MR. CHAIRMAN: Order, order.


The honourable member for Argyle.


HON. CHRISTOPHER D'ENTREMONT: Thank you very much, Mr. Chairman. It's good to be standing once again in estimates for the Department of Health and Wellness. I'm going to pick up a little bit where the member did leave off and that's in around the Canadian Cancer Society, some of the great work they are doing.


I was going to ask you a question about the Lodge that Gives but I see that you do have an announcement with the Premier this afternoon, and I'm not really going to ask what that announcement is going to be, but I'm just wondering - not wondering, just to sort of back it up a little bit - the majority, or a big portion of the people who end up using the Lodge that Give are, of course, individuals from my neck of the woods, I wouldn't know the actual breakdown of people coming up from the Yarmouth, Digby, Shelburne areas who come up for treatment, whether it be radiation therapy or other.


I'm just wondering what services you are looking at expanding when it comes to cancer care. Maybe we'll get a discussion after that with BTO, which is, of course, the travel program and drug program for individual with cancer. So the Lodge that Gives, the good work that they do and maybe give you an opportunity to talk about the great work they and doing and maybe T-up your appointment for this afternoon.


MS. MAUREEN MACDONALD: Yes, I am very pleased that the member has raised the question about the Canadian Centre's Lodge that Gives. As probably many members will know but perhaps some members don't know, the Lodge is a residential program that the Canadian Cancer Society, Nova Scotia Branch, operates here on South Park Street. It's a fabulous place, really, because it's more than just a residential place, it's more than just a place for people to stay when they are in Halifax having cancer treatment. It is a place where they get support and encouragement and really they make lifelong friendships when they are there.


I tried my darndest, after I became Minister of Health, to go and visit the Lodge that Gives. I had received a very lovely invitation from the executive director and the chair of the board of the Lodge That Gives to come over and tour the Lodge and see firsthand the facility, get a better appreciation of what it is that they do, and also meet staff and residents. They've been challenged. We all know that cancer has grown as an illness and a disease in our province and treatment for cancers often means, particularly from outside of the metro area, coming to Halifax to see specialists and to have very specialized treatment.


It's very expensive staying in a hotel, and for families, even people who have fairly good financial means, it can place an additional stress and burden. If you don't have resources, it's really very difficult. The Lodge That Gives is there and they accommodate quite a substantial number of people. They have a waiting list, and they can't accommodate all of the people who need their services. They are certainly looking to expand and be able to provide a more modern, less cramped facility and what have you.


The services they provide are fabulous. I don't know how many times we had scheduled a time to go over, and many of them got cancelled, but I was really pleased that this winter I finally made it over for a visit and had a tour. I met with a number of cancer patients who were staying at the Lodge and it was a very moving experience. I'm hopeful that I might get over there this afternoon to be with the Premier. Absolutely, it's an organization that deserves a lot of public support.


They have a tremendous amount of public support. The cost of operating the Lodge is 100 per cent borne by the Canadian Cancer Society Nova Scotia branch. They raise all of the money for their operating budget, for their staff, and for the cost of operating, accommodations, and what have you. They raise that money, which is really quite remarkable.


Lodges exist across the country. In other provinces, the Canadian Cancer Society do this. The Nova Scotia division of the Canadian Cancer Society, in their fundraising, they do raise money to support people who are going to the cancer centre in Cape Breton, where they do not have a lodge; they do support people who require being near the Cape Breton Regional Hospital for cancer treatment when they need to stay in the Sydney area.


They pay great attention to issues of equity around the province. Primarily, most of the residents who are at the Lodge are individuals who have come from the far outlying parts of our province. I would imagine that the honourable member would have people from the Yarmouth and Argyle areas staying there, for sure. I don't know what the numbers are.


MR. D'ENTREMONT: I forget the number. I did have the opportunity to tour the Lodge That Gives just the other day. It's funny, after three years of being minister I never did once get over there because of the same issue, where it's booked and something comes up and you never actually make it. I was very happy to have gotten there a few weeks ago. The first person I met was somebody from home. He was at the end of his treatment and was looking forward to head home for good within a few days but he had been up there for, I think it was for something like seven weeks of time he had been there. He put it in a way that he said this is my home, this is a home away from home, and the folks that were standing there with him, other cancer patients, it was nice to see how that community really supports one another.


I think that's very important, you know, when you do get the diagnosis of cancer, it definitely impacts you mentally. I've been touched with it myself with my mother but with lots of friends who have had cancer over the years. To be able to see how within this lodge that everybody gets to talk about their issues, which are all very similar. It gets them through, it provides them with sort of another level of faith that they're going to be fine as time rolls on and they get through their treatments.


The Canadian Cancer Society, of course, is in the midst of a capital campaign for The Lodge That Gives and I'm hoping that people who are listening to this, or do have an opportunity to see Hansard, or what have you, do look at it seriously and give some dollars because we are, at this point, the only province that doesn't support The Lodge That Gives. I'm hoping maybe this afternoon that might change a little bit. They still need the operating funds because at the end of the day it's a nominal fee that is charged to individuals to stay there. It really does not cover the full expense of that stay and, like I said, it can be weeks and weeks and weeks of staying at The Lodge That Gives.


The next question I have, still sort of in the same vein, is the issue of oral chemotherapy drugs. I haven't seen necessarily anything in the budget that would point you in that direction at this point. So what has been happening as medical technology has changed and drugs have changed, there are a number of chemotherapy drugs on the market and as far as I understand, at this point in time, none of them are being covered by the government. All of them are sort of on user pay because they're not being administered in a hospital because right now the chemotherapy drug is a hospital-borne expense. So if you're sending people home with pills, I guess it's a little bit different. So I'm just wondering some thoughts around oral chemotherapy drugs?


MS. MAUREEN MACDONALD: Mr. Chairman, I'll just briefly go back to the Canadian Cancer Society. I would like to also mention to the members that we do have the Boarding, Transportation and Ostomy Program. It was established in 1956. It provides financial support for low income individuals for ostomy supplies, boarding and transportation costs associated with cancer treatment and that's about $310,000 a year. It's an important program as well, I think, for people who have cancer and we administer that, of course, through the Canadian Cancer Society.


Cancer drugs is a very difficult question and I'm not sure that I entirely have, probably because I'm not a medical person, I don't entirely understand how it works, and I've been trying really hard to do this. I have a member of my family who has a particular kind of cancer who is, in fact, getting cancer drugs at home, taken orally, and they're covered under the Seniors' Pharmacare, but from time to time I hear from people who can't get their drugs covered and they have to go to hospital to get drugs covered. We've also, in the department, looked at palliative care drugs and the fact that you can get your palliative care drugs covered when you're in hospital but you can't get palliative care drugs covered at home. So we've actually done some work around that.


What we do know is that in Nova Scotia it's a very rare occasion when somebody will not be accommodated to get their drugs. Again, because so much of the actual front-line service is decentralized to the DHAs - the DHAs are very amazing. They're very good at being able to develop their services that are tailored toward the individual. But I have to say I agree with the honourable member that what we really need to do is have a province-wide policy and system in place that will assure families and health care providers that they don't have to try to figure out these incredible machinations to be able to get drugs to people who in need them in the right place. You shouldn't have to take somebody into a hospital bed in order to get them their drugs. Somebody shouldn't have to come to a cancer centre to receive a medication that's available orally and they can very much take it at home. It's different if you're doing intravenous treatments that need to be supervised by health care providers, but oral drugs are quite a different thing. We're seeing more and more oral chemotherapy treatments all the time. This is something we're still very much working our way through.


I want to tell the members, Mr. Chairman, that I had a very excellent letter from the Ontario Minister of Health, Deb Matthews, who I had the opportunity to meet first in Newfoundland, and then I happened to be in Toronto on a federal-provincial announcement and I met with her. She subsequently has written me with a proposal around more collaboration across provinces on our approaches to both listing chemotherapy drugs and then the procurement and distribution, all of these things. I think it's an excellent initiative, and it will be something that we will certainly pursue.


That's the other thing you hear quite often: well, I can get this drug or my cousin had this form of cancer and that drug was covered in Ontario or they were able to get it in Alberta, but it's not done here or whatever. I keep going back to the idea that we're all Canadians and we should all have the same access to a Canadian health care standard and system, but the only way to get that is if we worked more collaboratively across provincial jurisdictions. So we do fund oncology drugs; we do that to the tune of $9.1 million annually. We also have a small drug program, which is a cancer assist program that provides support for people who might not have a drug plan that covers certain kinds of drugs, and that's $823,000. The oral chemotherapy program is funded through our Pharmacare program, and there are no deductibles or premiums on it. That's the information I have for the member.


MR. CHAIRMAN: The honourable member for Halifax Citadel-Sable Island.


MR. LEONARD PREYRA: Mr. Chairman, on behalf of the MLA for Halifax Chebucto, I would like to make an introduction. In the east gallery today, we have students of adult education and students of English as a second language who are from the Quinpool Education Centre. With them are their teachers, Lena Golding and Kelly Cormier, along with students - and you'll have to excuse me if I mispronounce their names - Elias Nashmin, Mohammed Ali, Mina Sayed, Hema Amorita, Elana Amin. I'd like them to rise as they have risen and receive the warm applause of the members of this House. (Applause)


MR. CHAIRMAN: The honourable member for Argyle.


MR. D'ENTREMONT: Mr. Chairman, I too welcome our special guests to the gallery. I think it has been a great day for visitors. Normally on Friday it seems to be a pretty mundane affair, but we've had all kinds of visitors today.

I thank the minister for that and around oral chemotherapy because as I said, as technology changes there are more options for patients who are suffering from cancer. Just like The Lodge That Gives provides us with a home, well what better place to be than in your own home as you're receiving that. It was always confusing too because a lot of times that people were going to receive their cancer drug intravenously, some of them actually had the pick line and had these little pressure nodules and were sort of carrying them around with them as that was being injected into them. It would only make sense that maybe some kind of oral drug would make sense on that.


You did touch for a few moments on the BTO Program. There is a change though in the number that you quote of $310,000, which I think there is a change of - that's down from $336,000. I'm just wondering why the change in the BTO Program this year.


MS. MAUREEN MACDONALD: Mr. Chairman, it has been adjusted for the actual amounts that we are projecting to spend.


MR. D'ENTREMONT: Okay, that makes sense. I got lobbied on a number of occasions or you got lobbied on a number of occasions from the Canadian Cancer Society to put more money in it and to expand it or turn it into something else along the way. I hope at some point that we will find a better way to help out other individuals who are of lesser means to be able to receive that kind of program again; the transportation, the boarding the ostomy supplies, those kinds of things after surgery or to receive some kind of treatment. I do hope that does happen.


You talked about working with Deb Matthews, the Ontario Minister of Health and I think we've always had a little bit of success working with Ontario on this one. If we remember the whole Fabry disease issue. I know your deputy minister is very well aware of it. It was with the support of Ontario that really we were able to get at least a pilot program in around Fabry disease to provide some of these life-sustaining drugs for the patients down in South Shore. I'm just wondering where that program is because if I remember correctly, this was sort of a three-way payment here; one from the feds, one from the provinces and one, of course, from the manufacturers of the drugs. If I remember correctly there was, I think, a withdrawal from the federal government at that time. I'm just wondering how our patients on the South Shore are doing with Fabry disease and if there is any continuation of that program in Nova Scotia.


MS. MAUREEN MACDONALD: Mr. Chairman, indeed the program on Fabry disease is continuing and not only is it continuing, but we've had to pick up increased costs because the federal government withdrew their financial support in this program. It will cost us an additional $280,000 this year. This is something that the provinces, including Nova Scotia and Ontario, aren't real happy about, that the federal government withdrew their financial support, but nevertheless, we recognize that it's something that we had to continue to support.


I want to go back just quickly on the BTO Program. We forecast $228,000 for this year, so when I said that we've adjusted, it's based on our forecasts. We know that it's not necessary to carry a bigger amount, due to that.


MR. D'ENTREMONT: Thank you very much for that further clarification around BTO, but even with $310,000 you're still providing a little bit of padding there, just in case something does happen, so it's good to know. The Canadian Cancer Society would say that your limits are off, so you do actually want to have more people get in by moving the access number of $15,000 - so if you're making $15,000 a year and under, then of course you access the program. If you're making above the $15,000, you are no longer eligible. Maybe there are some changes there that we could continue to help more people.


Still on the issue of EDRD, which is expensive drugs for rare diseases, I'm just wondering, because this is an age-old issue, and while we're talking about the federal government - who of course are in the middle of their election campaign, and maybe this is the time to be asking for stuff - there was the whole issue of the National pharmaceuticals Strategy that was talked about for a long time, which was a provincial Ministers of Health-led initiative. That sort of fell to the wayside for some time, but there was still always the discussion of EDRD, which is a catastrophic program at least for those drugs that are going to be super-expensive.


We were hearing stories of $300,000 a year, $1 million a year for certain genetic diseases that were happening, so I'm just wondering, in your discussions with the other provinces and maybe with the federal minister, has there been any discussion around a national program of that sort?


MS. MAUREEN MACDONALD: Mr. Chairman, I think it's fair to say that provinces are all very interested in pursuing a more coordinated and collaborative national approach to drug coverage, and also to have a more robust involvement from the federal government with respect to either a national drug program or catastrophic drugs. I think that the focus went to catastrophic drugs when it was clear that there wasn't much buy-in from the federal government around a national Pharmacare Program, but frankly, there doesn't seem to be much buy-in around catastrophic drugs at the federal level either.


I think at some point the whole issue of pharmaceutical care will be galvanized, and perhaps this could happen around the 2014 Accord. It's still too early to say, but increasingly, the public has become very cynical about the pharmaceutical industry. They are cynical about big pharma; they are cynical about governments, federal and provincial, and our ability as governments to deal responsibly and effectively with the pharmaceutical industry and the public - that's what they are expecting of their governments. The public are expecting to have access to these treatments that are required but they want governments to ensure that they're getting a good price and they want governments to also be sure that they're getting effective treatments.


There is a growing cynicism, I would say, based on just discussions I have. I go almost nowhere publicly when people don't want to engage around drug coverage and either their concern is access and costs or they're concerned about practices, business practices in the pharmacy industry. As more and more information comes out and more and more reports are published in very reputable places, like the New York Times, for example, big exposés - and as a former Health Minister, you know yourself you can't paint a whole industry with one colour. It's like anything else, and it's unfortunate because people who practice in those grey areas, they can give a whole industry a very bad reputation. In my position, in our position, you have to say to the industry what's your responsibility in terms of dealing with the renegades and the people who are operating on the margins of ethical considerations here? You have an obligation, not just a social obligation, but you have an obligation to your industry. You have an obligation to your professional reputation to do something about this.


So I think that this is a very big area, huge area. It's a huge area because financially it's such a huge area. The drug portfolios are growing all the time. Industry people will say, oh, you know, drug manufacturers are saving Health Ministers, we're saving you all kinds of money. All of these people are not getting sick because our drugs are helping them lead more controlled chronic disease situations and not having heart attacks, not being in hospital beds, not requiring all of these expensive interventions. It doesn't work quite like that but anyway, as we see more and more drugs, as the member points out, available for all kinds of diseases and genetically-oriented situations, then we certainly will see I think a much more robust public discussion about this.


Now, we have in our budget this year, money for exception drugs and as the member knows, these would be dispensed by the Capital District Health Authority for people living in the community. We have allocated $26 million, a little more than $26 million, $26,121,600. It will be providing drug coverage for a total of 3,938 people and these are people who have HIV/AIDS, MS, renal failure, organ transplantation, and one other condition that I'm not going to attempt to say. So it's substantial, the amount of money that we spend, and as the member knows, we spend close to $250 million annually on our Pharmacare programs, Mr. Chairman.


MR. D'ENTREMONT: As much as I want to go on on that topic, because I always find it a very interesting one, I think I'll definitely give my time to another member. Maybe next time I get up we can talk about mental health for a little bit, but I don't know if I'll have that opportunity. Maybe we'll talk about it some other time. But I give the rest of my time to the member for Hants West.


MR. CHAIRMAN: The honourable member for Hants West.


MR. CHUCK PORTER: Thank you, Mr. Chairman and honourable colleague, for giving me another opportunity to ask a few more questions. Minister, I'm not sure if you recall where I left off.


MR. CHAIRMAN: Order, please. The minister would like to take a break, so we'll take five minutes and resume. Thank you.


[12:01 p.m. The committee recessed.]


[12:08 p.m. The committee reconvened.]


MR. CHAIRMAN: I'll call estimates back to order, but before the minister responds, I would recognize the honourable Leader of the Progressive Conservative Party to make an introduction.


HON. JAMIE BAILLIE: Mr. Chairman, I do wish to make a friendly introduction to this House. It is my great privilege and honour to draw the attention of all members present to the Speaker's Gallery, where we are visited today by a distinguished gentleman: a Canadian, a senator, the honourable Reverend Don Meredith. I ask him to rise and receive the acknowledgment of the House so assembled.


With Senator Meredith is his wife, Mrs. Meredith, who is beside him. Dr. Les Oliver, a friend to all members of the House, is also with the senator. And we ought not to leave out staff in this situation, Mr. Chairman. Julie Flannery is also travelling with the senator and is here.


I would just like to add for the benefit of members of the House that Mr. Meredith was appointed to the Senate a few years ago by Prime Minister Stephen Harper. He is an entrepreneur and business person. He is a pastor at the Pentecostal Praise Centre in Maple, Ontario. He is also the executive director of the GTA Faith Alliance.


What that all means, Mr. Chairman, is that Senator Meredith has committed himself to the cause of youth, to the diminishment of youth violence in particular, is setting up youth centres across his province and indeed across Canada. I know that Speaker Gosse is particularly interested in that kind of work, as are many other members. I just want to thank him on behalf of everyone here for the work he's doing particularly with young people and welcome him to Nova Scotia and welcome him to the House of Assembly. Thank you. (Applause)


MR. CHAIRMAN: The honourable member for Hants West.


MR. PORTER: Mr. Chairman, I, too, want to welcome the senator and from another good Pentecost. It's nice to have you here in the House visiting us today and Les Oliver, as well. It's good to see all of you here and I hope you enjoy your stay in Nova Scotia while visiting, and thanks very much.


Minister, you may recall or may not - it has been awhile - where I left off on my last questioning, it had to do with doctors salaries, and that breakdown of how they were paid, the clinic versus emergency and so on, and maybe a rural/urban, I don't want to call it a vibe but a rural/urban flavour to that. Just what kind of differences there are, where we see the benefits of either, if there are any, and what new direction, if any, that you are going by way of recruitment and trying to attract positions here.


MS. MAUREEN MACDONALD: Mr. Chairman, I'm wondering if the member would indulge me before I answer his question which I intend to do by making a little presentation to my deputy whose birthday it is today - so happy birthday to you. (Applause)


MR. CHAIRMAN: That would be appropriate in light of the long hours.


MS. MAUREEN MACDONALD: Absolutely, absolutely. We won't talk about how old we all are but getting older by the minute.


Mr. Chairman, the question that the member asks is with respect to remuneration for physicians and the first thing I want to do, I want to take a moment to acknowledge that the physicians of the province. I'm very grateful to the physicians of the province for their decision to suspend their increases, their wage increases, in the master agreement for the next two years as their gesture, more than a gesture, a significant gesture, to assist the province in getting back to balance. This will result in almost $16 million in savings in the Department of Health and Wellness' budget this year and additionally next year we will see a significant reduction in our budget as a result of their decision.


I want to acknowledge Doctors Nova Scotia as an organization and the leadership of their executive team and particularly their president, Dr. Jane Brooks, who is a very strong leader, a very hard negotiator I have to say, and I am very grateful for the work that they did.


Now, the question of remuneration for physicians is a very complicated question. There are many, many different ways that we compensate physicians and payment to physicians in the health budget represent, I think they represent the second largest component of our health care budget and it must be close to $300 million, I would say. (Interruption) It's $800 million approximately, just under $800 million I think for remuneration for physicians. We have close to 2,500 physicians, GPs and specialists in the province, I believe.


In 2009-10, we had approximately 2,400 physicians in the province and of that 785 physicians were on fee-for-service payments. What that means is, the care that physicians provide is broken into units and monetary amounts are assigned for the various procedures and units that are done, they bill MSI and they receive payments on that basis. In addition to that we have a number of physician's that are on, what we call, alternate funding plans and they receive remuneration that is based on clinical services that they provide to patients but additionally, we built in a component for administration and for teaching. They tend to be our speciality physicians providing specialist services. In the case of many of the physician's here in the Capital District Health Authority who are specialists, they also teach in the medical school. They are on the faculty there and they work with the students and they work with residents as well. They often have research programs and they may have administrative functions as well, overseeing a department or a particular unit.


In terms of the emergency room physicians, to work shifts in the emergency room there are hourly rates of pay. It's a very complex formula and we pay physicians based on the facility and the type of facility that they work in. So the physicians here at the tertiary facility at the Queen Elizabeth as well as doctors who work in regional hospitals, they make a particular hourly rate. The total envelope in the Department of Health and Wellness budget for ER physicians is $45.3 million. That is an increase over last year, particularly since we have negotiated a new AFP with our ER doctors. I know that there was an increase in their pay as a result of that, it was an increase of $2.6 million over last year.


MR. PORTER: Thank you minister for that detailed answer. It wasn't so much I wasn't looking for figures - by way of this is what Dr. A salary is - it was more about the functionality of hourly paid in the clinic and there's a benefit to that. If you go to any clinic, and I'm sure you've been - I'll just speak for the good clinic that we have there in Windsor that goes three nights a week for a couple hours. You get there at 5:30 p.m., there might be a whole line-up down the hall but they go through in a flash because it's simple stuff. It's clinic stuff - it's the ears, eyes, nose and throat et cetera, and need a prescription, good, bang. Those docs working there are experienced, that's their forte, they're good at it.


Expanding on that and building that is what I want to see. I think a lot of Nova Scotians would want to see that because if they go to emerge and they're sitting there for six hours with an earache, what are they? They're upset. They're already sick when they get there, they're tired, they're cranky, and they're worse when they leave because they've had to sit there for three or four hours - and reasonably, because there are emergencies coming in the back door, whatever, on the ambulance, and stuff like that. At the same time, they're cranky because they don't have the ability to just go to a clinic.


If we were to expand that, I think you would see a whole lot less time with people sitting around emergency - emergency beds, hospital beds, et cetera, whatever, being used up. You're looking for efficiencies, and I think the clinic is one way of getting them. I've talked to a local physician who works in the clinic - I don't know if he has any ownership in the building or not, but he told me the other night when I spoke to him briefly that there are three offices there now because we've lost physicians who used to rent space in this building, which is where the clinic is. It's a medical centre, I guess you'd call it, but it's a clinic at night. They're gone. They're obviously looking for physicians to come there, but we only had a chance to speak briefly on the clinic being expanded.


We're wondering, what's it going to take to make that happen? It sounds as though when you say, what's it going to take, you're talking about dollars and cents. When really, is it or isn't it? It's just a matter of having a physician to work in the clinic. Are they coming from Halifax? They do, and they work in our local emergency department and they see the same thing. Would they perhaps be better served coming to the clinic and seeing - you would never have a backlog, I don't think, of any kind, because they go through so quickly. Based on population and where you are in the province, that probably changes a bit, but I would think there are still efficiencies in the clinic model.


I guess that's what I was getting at by way of salaries. I'm not looking for dollars and cents. I don't care about that - it's the difference in them. Where's the savings? You must see it. You're the minister, you know you have the clinics here in town and around, the walk-ins versus - I'm thinking about the efficiency being the number of people who can be seen in a timely fashion. We talk about wait times and - what's your slogan? Better Care Sooner, or whatever it is, and that's all good. I'm not taking anything away from that.


I'm saying it's one thing to say it, it's another to do it and create those efficiencies. People don't want to wait, because we've spoiled ourselves by being so accessible and providing such good care to people. It's almost created something backward, in a way. We're taking away now because the expectations are so high. That's good too; we're lucky to live in a place where we can have those expectations and we can be serviced.


As far as any of the true emergencies, cardiac-related emergencies, strokes, and so on, there are no wait times. I've seen it firsthand. People are in; they're in quickly; they're treated quickly. I can't think of a case right off the top of my head in all my years where anybody waited. If they needed to be in, they were in. They were looked after quickly.


You talk about cancer care and stuff too. We've all known people who have had those problems and have had family members all in those things, in all likelihood, but even at that, they're not waiting for their treatments. Within a week or two they're getting called, appointments are made, you're in for your chemo or whatever it might be. You need only walk in that clinic down there and you can see it's never-ending. It doesn't stop, all day long. The number of people is just absolutely unbelievable, how many people are in there waiting for treatment, chemo or whatever it might be, or radiation, what have you.


We are fortunate. We are providing good service that way, I honestly believe that, and we have for many years. I honestly believe that we've done that as well, regardless of what you hear about the wait times. I understand the wait time piece, the knees and the hips, and yeah, there's probably work to be done there. There's no reason why anybody should have to wait eight months or a year or two years, even, whatever it is, to get a new knee or - I'm sure there's a better way. I'm sure there are better ways to become efficient in that, and I know it all costs money.


There are expectations that must be met too, as I spoke to. I'll go back to the clinic piece again. Without the dollars and the cents, et cetera, actual dollars per salary, do you see the benefits in the clinic? Do you see the opportunity for a place like Windsor, as an example, to grow the hours of the clinic, to get more people in and through, as opposed to having to send them to emergency? Even a Saturday or a Sunday afternoon, or - three nights a week, two hours a night, is great, but it's nowhere near enough. If it is, the data must be there somewhere to support that it is.


So I just wonder how much we're doing outside of the HRM here, in rural areas - and I'm going to speak specifically to mine - about growing those clinic hours? Is there a potential for that, and if so, how do I go about it? How do the doctors, the locals there, go about that?


MS. MAUREEN MACDONALD: Right now what we have is a kind of health care system, as I was saying yesterday, our health care system kind of evolved and it probably did it because the way we fund it encouraged it to evolve in a particular way into a model where physicians work nine to five, Monday to Friday in their offices. For any of their patients who experienced non-emergency need, but a need for health care would be told to go to the emergency room or out-patients, as it's called, creating a lot of pressure on emergency rooms and very long waits for people in those settings.


What we're trying to do with Better Care Sooner is to improve and change primary care so that people will work in their offices longer than nine to five, Monday to Friday and that it will take pressure off the emergency room. The collaborative care centre we're setting up are centres that will operate Monday to Monday, seven days per week, 8:00 a.m. to 8:00 p.m. and primary care will be available all of those hours; people won't have to go to the emergency room. They may not necessarily get to see their family doctor, but they will get to see a health care provider. I would assume that many of us here in the House - most of us - probably have a family physician; I would hope so. There are times when, particularly as members of this House we may get a flu or something may happen that we need to see a doctor and you're not going to necessarily have time to get to see your own family doctor.


I had a situation there last Spring where I developed an eye infection. I wasn't sure what was going on and I was able to leave the Legislature, a very sore eye, get up the next morning, go to the North End Clinic in my constituency at 9:00 a.m. At 9:10 a.m., I was seeing one of the doctors; not my family doctor, but one of the doctors. That's the kind of situation we would want for people, that people would be able to get quick access to a health care provider. I would have been very happy to have seen the nurse practitioners. I just went where they sent me and the fact that it wasn't my family doctor wasn't a big deal. The person who looked at me knew what they were doing, gave me the advice that I required and I left and within a short time my eye infection was cleared up.


It's interesting, a few weeks later I had a complaint from an individual who is a bus driver for Metro Transit who had the very same problem. He had an eye infection and it occurred while he was at work; it was getting worse and worse and he got off work and he had been in communication with his wife and she had called their family doctor. The family doctor had no time to see this gentleman and told him to go to the emergency room and he went and sat for five hours in the emergency room and he actually walked out. He is one of those walk-outs from the emergency room. People who go to the emergency departments, sometimes the walk-outs are people like this; people who really need a family doctor.


With respect to the clinic, I don't know the clinic that the member is referring to in the Windsor area. There are many clinics all across the province, but I would assume that the clinic right now in that area probably has a group of physicians that are fee-for-service physicians. There's nothing to stop the fee-for-service physicians in that clinic, or any other clinic, from deciding to open their clinic in the evenings or on the weekends. There are no rules and they would be compensated for the people that they see, just like they are compensated for the people that they see during the day.


We do have quite a few physicians around the province who do offer weekend and evening services and we had members of the Official Opposition today talk about a couple of clinics in their areas where, in fact, that's the very thing that they're doing. I was saying, in those areas, these physicians had already made a decision years ago that they were going to provide better care sooner to the people in their communities. There are sufficient numbers of them living in those communities that they're able to spell each other off in terms of night and weekend work so you don't have one or two physicians trying to do all of that, because that is humanly impossible. In some of our small communities, that is a problem.


Madam Chairman, what we're doing here in metro - and I think one of the realities of the Windsor area is Windsor is close enough to metro that you're still getting physicians who actually live in metro going out to Windsor. One of the things that we really have to look at is a physician resource plan for the province. We need to be able to look at where physicians are locating, where we have them right now, where we need them. We need to look at the programs that government has, then implement a physician resource plan.


As Better Care Sooner is rolled out, we're obviously starting with some of those communities that have had the most difficulty in recruiting and retaining physicians and getting stable medical care, and will stabilize those situations first. I would assume that we will start moving toward looking at other communities that haven't seen ER closures and they haven't seen the same kind of doctor shortages, but they sure have some particular challenges, including the length of time people sit in an ER for basic health care, and we need to change that. ERs should be ERs. They should be places where our very highly trained ER staff are dealing with people with serious problems and able to deal with people who are coming in with cardiac situations, accidents and things like this, and have the prescription refills and minor illnesses dealt with in the settings that are appropriate for them.


We certainly are aware of that. That was really the core of Dr. Ross' report on better emergency health care in the province. It will take us some time though to move the entire health care system and the entire province to a more expanded primary care model, but I'm confident that there's a desire now in the public. I guess this train is rolling and I don't see turning this train back, really. The public are very enthusiastic wherever they have expanded access to primary care and they understand the concept, they understand that it is better care for them and more convenient. It does raise expectations in many areas, but I think it will raise expectations with the care providers as well.

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


The honourable member for Halifax Clayton Park.


MS. DIANA WHALEN: Madam Chairman, I am very pleased to be able to continue our discussion about the Health estimates, that being the budget and the amounts that are allocated for so many of the services that are provided in the health care system. I think the minister actually finished off reminding me that a lot of the delivery of service is elsewhere; although your budget is almost $4 billion for the Department of Health and Wellness, at the same time much of it goes out in large grants to the DHAs, and the detail of that is not available to us here in the House.


I may have said so in my first few opening remarks, but I do think we should be asking for the DHA business plans to be before us at the same time or soon after we get the budget so that really we can compare where so many millions of dollars go out to the nine DHAs and the IWK for the work that they provide on the delivery side. We'd actually been talking about the Tobacco Control Strategy and how the funds that actually help people with nicotine addiction are administered. It's $1.4 million, the minister said, but it's split up among those nine and possibly at the IWK, as well, they may have some of that for teenagers who smoke. It makes it hard for us to talk about programs because when we look at the line items that the Department of Health and Wellness has, as the minister said, it's primarily policy and planning, research activities, and trying to direct the very large delivery of health.


One of the things that I wanted to ask about - and I've got a list of a few of these that I wanted to delve into - takes us back to the fact that we don't have a lot of line items to separate all of the different funding arrangements and grants that are given from the Department of Health and Wellness. The one I'm interested in first is the Health Research Foundation, which as we know is, I believe, conducting all of the consultation around your Mental Health Strategy. I believe that has been an involvement that you'd asked them to take on. They'd been talking to psychiatrists, to mental health consumers, to agencies that help in mental health delivery. I just wanted to be able to look at this budget and see - and not just around the Mental Health Strategy - how much we're giving to the Health Research Foundation this year. The question is, how much money is allocated in this budget for the Health Research Foundation?


MS. MAUREEN MACDONALD: Madam Chairman, I'm really pleased to have an opportunity to talk about the Health Research Foundation because I sometimes think I had a little something to do with the setting up of the Health Research Foundation. When I was newly elected, this had been a commitment of the government of the day, which was a Liberal Government. It wasn't in the budget when the budget was introduced, and I very enthusiastically was going through the budget trying to identify what was there and I identified that this was a campaign commitment that had been made but hadn't been kept. I raised this over a period of several days and, in fact, some money got put into the budget, which doesn't happen very often. I think at that time it was $1.4 million or $1.5 million that ended up being appropriated into the budget to establish the Health Research Foundation.


I remember Dr. Lynn McIntyre, who is the Dean of the Faculty of Health Professions, coming down to the Law Amendments Committee and I think - I'm trying to remember who the Dean of the Medical School was at the time. I can see his face but I can't remember his name (Interruption) Yes, Dr. Ruedy, that's right. This was when the Act was introduced setting up the Health Research Foundation, and there was a great deal of discussion around the foundation and what its mandate should be.


At any rate, that's a long time ago - 13 years ago - and I'm very pleased to say and I know all members are pleased that we have such a strong Health Research Foundation; small but mighty, I like to think of them. They are a small group but they punch well above their weight in terms of the work that they do, in my view. They primarily offer funds to researchers of which we're relatively blessed here, I think, because of the universities. Not only Dalhousie, which is the university that has our Medical School and our Faculty of Health Professions, but we have very strong science and social science programs, nursing programs, in a number of our other universities - St. F.X.


So they provide seed money to health professionals, academics mostly, in our other universities that allow small research programs to be established. That often allows researchers at that level here in Nova Scotia to develop that kind of research program that they can then use as a platform to apply for serious research grants nationally. Without this seed money it would be hard to establish your program of research, so the Health Research Foundation is very, very important in terms of that aspect of its budget.


We have allocated $4.846 million for the Health Research Foundation for this year. There is a slight reduction in their funding but it's very slight, and it would be at the administrative level rather than at the level of program grants - you know, the grants that they have available. I understand that they actually had a small surplus fund of revenue that they had not been expending, so certainly at a time when government is looking to get back to balance, we've looked at all of the areas of our budgets.


We've looked at any of the entities in our departments where they might be carrying a trust fund, an investment fund, or whatever. You will find this item on Page 14.11 under Grants and Assistance in the estimates. As the member indicated, it's the Nova Scotia Health Research Foundation which is overseeing the development of the Mental Health Strategy and they've been able to do that by absorbing the costs of the development of that strategy and they are doing a very good job, I must say.


MS. WHALEN: I think last year we could see that item for the Health Research Foundation. I have a note that they had received $4.994 million last year so they're down a little over $100,000, maybe $150,000. I appreciate that if they have other funds that will continue to support their activities. Certainly what we would like to see is that they not be in a position where our grants have to shrink because, as the minister pointed out, Madam Chairman, we have some wonderful research facilities and researchers who are choosing to do their work here in Nova Scotia and are, in fact, attracting wonderful researchers to come and work under their projects and because of their reputations.


I know we can all name a number of them who are doing fantastic research. I know I went to a reception a couple of years ago - and I'm thinking of Dr. Rockwood in autism and dementia, which is going to be a huge issue for government in the future as our aging population is coming into a time and an age where dementia becomes quite common. There have been a number of articles in the national papers and so I'm pointing out that this is something we have to prepare for. Hopefully, here in Nova Scotia, we'll play a role in some of those improvements - brain research as well - so we're head and shoulders above.


So I don't want to see anything less go to them because I think when we provide some of that funding, the leveraging is tremendous, that the federal government or other research foundations across the country find money to come in and match and support those efforts. So we are very lucky for a small province to have the number of universities and the number of researchers that we have, and the minister mentioned a number of them.


I would like to move into the area of obesity and mention the nutrition department at Mount Saint Vincent University that is doing a lot of research right now about childhood obesity. They are doing studies with young and healthy children who come in. They're between the ages of nine and 14 and they are participating in a lot of studies around activity and eating. One of the studies that I found particularly interesting was that they have the children in little booths and they're watching something on a screen. They either watch television or play video games - something very sedentary like that - and then they are given various snacks and they fill out scores about how satisfied they feel, or actually how much they want to eat.


The graduate students are working there, as well, with a Dr. Bellissimo, who has come to us in the last couple of years, and they get a lot of their research money actually from food companies and, you know, I had asked them how they were funding this research. But I think it will have some very pertinent outcomes that might help us as we look at the activity level and the food consumption of children.


That brings me to the question of the obesity strategy. We, again, have been talking about that for a number of years and I noticed there was actually a Healthy Kids study that was done under the Progressive Conservative Government. In looking up my file on obesity I came across it, from about 2004 or 2005, and it had to do with getting our kids more active. It seemed to be a detailed, lengthy strategy; it had targets and aims in there. I had forgotten about it, quite frankly - I wasn't the Health Critic at the time and wasn't as tuned into this - and I wonder if the minister could tell us if that has formed the basis in any way for our next step, because I don't think we had really made much headway under that previous initiative and I would like to know if that has been part of the groundwork for the new one. Again, if we could find out, my specific question would be, is there money in this budget dedicated for the implementation of the recommendations?

So I know the minister will probably have a little bit to say, but I hope we can stick to the obesity strategy and just kind of hone in on whether or not you've put money aside for it.


MS. MAUREEN MACDONALD: First of all, I want to say all members in this House should know that Nova Scotia has across this country the number-one reputation for the healthiest food policy in schools of any jurisdiction in the country - province after province after province - and that is to the credit of the former government. Every time I attend an event that has to do with Healthy Kids, without exception, people look to Nova Scotia for our school nutrition program. It's recognized nationally as being the best practice.


This government is building on that policy and shortly there will be a new Healthy Kids nutrition policy in our child-care centres. I want very much to stress that this is not to say that our child-care centres are unhealthy and they haven't been doing their best to have healthy, nutritious food for kids because many of them certainly have. But it's our intention to have a uniform policy across the province that will promote healthy food for children in the very early years of the child-care level. This is something that we have been working on and it is very close to being finalized. Details on that will be known shortly.


This budget has allocated $500,000 for the prevention of acute and chronic disease. Some portion of this will certainly be part of the policy that we intend to have with respect to healthy children and healthy weights for children. I don't know if it's in this venue, I was able to talk about the research that looks at what has occurred with children's weights across Canada over time.


Health Ministers, when we met - I can't remember if we met as Sports Ministers or if we met as Health Ministers - but in one of those meetings we had this amazing presentation by a national body that has been tracking the weights of children over a 30- year period. It's quite dramatic; it's quite stark what's happening with respect to the growth in weights around kids in an unhealthy way. It is right across the country and it cuts across all socio-economic groups.


There are many provinces now that are developing strategies to deal with this because we're very concerned that we're seeing growing rates of diabetes, type 2 diabetes in children, for example, asthma and other chronic diseases and illnesses that are unknown. Dr. David Butler-Jones, the chief public health officer for Canada, often says that we may very well be looking at the first generation of children that will not live as long as their parents as a result of unhealthy weight and sedentary lifestyle.


The problem has grown; it has developed over a 30-year period or more. There are no quick fixes to this. It is a problem that we are going to have to address over a long period of time. Our approach is to be able to make healthy choices the easy choices. The reason we have seen these trends develop are pretty apparent. They have developed because we eat differently than we did 40 years ago, we have different foods available to us than we had 40 years ago. The foods we have available to us now are more processed; they have more salt, sugar and fat content. They're fast and they're everywhere, they are readily available.


The unprocessed foods and whole foods, fresh foods, locally-grown foods are harder to come by. It is hard to find carrots from the Annapolis Valley in the grocery section of your supermarket at this time of year, for example, and sometimes at any time of year. So the change in the food industry is definitely a piece of this, the high sodium contents of foods are definitely a piece.


We all had on our desks today a magazine from the Canadian Restaurant and Food Association. If you look through that, I had a chance to just briefly look through that, they actually have a big section in it on sodium and the growing concerns of the public and public health officials with respect to the sodium content of food. That's a piece of solving this puzzle; it's not the only piece. Thirty, 40 years ago children walked more, they were more active, they walked to school, perhaps, the schools were in their neighbourhood, they weren't dropped off in the minivan in the morning and picked up at night.


This is a change that we've seen, we have had urban sprawl, our communities have been built around the automobile and we have families that have two and three automobiles in the family, it's a central part of family and community life, four-wheel transportation rather than two-legged transportation, this is something that has changed dramatically.


Additionally, we talk about all of the time, there are many pieces of research that talk about the amount of time that young people spend in front of screens, television screens, the Nintendo screen, the computer screens. We know that, for example, on weekends the amount of time that kids spend in front of screens is unbelievable, really. We have growing sedentary lifestyles as a result of technology and the forms of technology. These are all elements of why we are seeing a change right across our country.


I think we have to recognize that some children in our population are more vulnerable than others. First Nations children - and when we look at the research that shows us that kids who live in northern and Aboriginal communities, First Nations children - are tremendously vulnerable to the diseases that come with unhealthy weights. We need to ask ourselves what special measures might need to be taken because the incidence is so much worse in some communities than in other communities.


So putting together public policy that will address all of these very complicated, cross-departmental, cross-jurisdictional issues - sodium in foods is something that the federal government has the power to deal with, not the provinces. The federal government had a sodium working group and to the deep disappointment of this minister and many other ministers, that sodium working group has been disbanded.


The federal minister - I've taken this up with her, as have other Health Ministers across the country - has told us that the work will continue but we are very concerned. Nova Scotia, at the table with the federal ministers, was very concerned that the federal government is reluctant to even have a discussion about targets for sodium reduction; mandatory targets. We can look at countries that have had voluntary programs for sodium reduction and they have failed dismally, full stop. All you have to do is look at the empirical evidence and it's there, it's stark.


We really need to consider this. When I look at Nova Scotia, I look at the incidence of chronic disease in our province. It's very high, hypertension in particular. It's one of the reasons why I will focus a bit on sodium and salt - it's because hypertension is probably our leading cause of death in Nova Scotia. It places a very heavy burden on our health care system and it's preventable. This is the thing that's so incredibly galling, I suppose in some ways, this is something that is so very preventable. We could reduce costs in our health care system and our human costs significantly and improve people's quality of life.


Madam Chairman, with respect to the strategy around healthy weights for children, we have assembled a very small but very mighty little team of two or three people in our department - the former Department of Health Promotion and Protection, now Health and Wellness - and they have done a number of things. They have done the scans, for example, to look at what has been done elsewhere and to learn as much as we can about the problem first of all, the solutions, all of the policy options. They're pulling all of that together. I meet with them fairly regularly and they brief me on where they are and they get direction from where to go next.


The plan is to build a collaborative process to arrive at the strategy that has many, many people buying into it, so that means involving many, many people in the building of it because, as I point out, this crosses departments, it crosses jurisdictions. It means we need to bring to the table Agriculture; Service Nova Scotia and Municipal Relations, around planning our communities; we need to look at active transportation; we need to look at our education system, how much physical education our young people are getting during the school day, and also how we're using our schools at the end of the school day in that very critical period between the time that school ends and the time that children are sitting down with their families at the supper table.


We need to engage across departments. We need to engage across governments. We need to involve our municipal partners in any strategy because recreational services are delivered at the municipal level and really the planning, the land use planning, community planning, transportation - the actual implementation of transportation policy all happens through the work of the municipal representatives and municipal government and staff. Of course, any regulatory powers and features need to go on at the federal level with respect to the food industry.


The other day out on the street I ran into Luc Erjavec with the food and restaurant folks and he's very interested in being at the table and being involved in looking at what they can do in the food and restaurant industry. This is the approach that we are taking. It will be very collaborative and it will be one that will take the ideas of many groups and many participants and turn them into an action-oriented strategy with a long-term vision for what is required and the steps to get us there.


MS. WHALEN: That was a very good description of the work that's taking place now within the Department of Health and Wellness. I appreciate that window into the sort of partnerships and collaboration that you're looking at creating. You're absolutely right, we won't solve this problem if we look at it just as a health issue alone and we don't look at the other players that are feeding into it and abetting the current behaviours could be part of the solution.


Having been a city councillor I know that we do create neighbourhoods that rely on cars. Mine is suburban, you can walk in my area, but we certainly have big acreages as we move further out of the city that you cannot even service with buses because it's uneconomical. We have to create neighbourhoods where people can live more healthily. I think the evidence is clear as the minister lives in an area where the homes are fairly close together and the evidence is that older neighbourhoods like that actually have better health for the people who live in them.


When you can draw that line and understand that the amount of walking and health that people get because they live in a very walkable community with services within walking distance and so on, it makes a huge difference. I do hope to see where that leads, it's something I'm very interested in.


On the issue of strategies, you did give us the cost that there's $500,000, not just for the obesity strategy but you said it's in there for prevention of acute and chronic disease. That's the one window we have into the budget and how that stands right now. I'm sure with the announcement of the plan, which I hope will come in the next few months, that we'll get a little bit better idea of that.


Because we're talking about chronic disease, I wanted to touch on the insulin and diabetes, I'm thinking of insulin pumps. I know that provinces are moving on that and I know we had a chance to talk about it here in the House, even in the last two weeks. I would like to know if there are any plans or any funds in the budget relating to any expansion of services for diabetics? My major concern is really children with diabetes but I think there are others who could benefit.


When we're talking about the insulin pump, we know it's not for everybody. There are certain diabetics that it won't work for and it really is type 1 diabetics to begin with and there are other health requirements to see that they are a candidate for an insulin pump. We're not proposing that everybody with diabetes in the province would then be a candidate for this. The numbers are fairly limited of the individuals in our province who would be candidates for that.


I've just been so moved by the compelling stories about how people's lives have been utterly changed as a result of their children or a family member getting an insulin pump. It's usually children, and I'm sure the minister as well, is generally talking to parents who have the full responsibility for managing their children's disease, for helping to ensure their children don't have visits to the emergency room, to try to keep them stabilized and keep them healthy. When you introduce an insulin pump into that dynamic, it's much easier.


I know our time is limited and I wonder if the minister could just let us know - the real point of my question - within her planning if there's any budgetary item this year that might relate to, if not insulin pumps, an expansion of any of the services for those with diabetes which would be a chronic disease which might fall under that $500,000 you have in the budget?


MS. MAUREEN MACDONALD: Madam Chairman, the issue that the member raises is of concern to me and it's something that I am attempting to assess in terms of what are the things that we can do and make sense to do. I know that my deputy has been in contact with the deputy in New Brunswick with respect to that government's decision to fund insulin pumps for children. We will be exchanging information with them as they implement that program, particularly with respect to some of the cost savings that might be associated with that. I would like to see a cost benefit analysis done that would help me understand the costs and the benefits. I do as well understand the various benefits of these devices for families.


I've heard, as well, many compelling stories from people about what it has meant for them and for their children. It's not that I have a heart of stone and I'm not unmoved by those stories but I think the truth of matter is I hear stories about other devices, there are many other conditions where we do not provide technical aids and devices. So it's kind of difficult sometimes, you have to make sure to build a very strong case to help you establish that because we're talking a significant amount of money. It's not an insignificant amount of money. To have these devices covered for just kids with diabetes in Nova Scotia amounts to about a $4 million cost, I think, over three years.


The devices themselves can cost anywhere from $4,000 to $6,000, the supplies are $3,000 or so a month, the lifespan of the devices is something like five years. We're talking about a significant investment on a very small population who are currently getting treatment, it's not like they have no options available to them, they do get treatment. This does, I accept, improve their lifestyle unquestionably. There must be a benefit in that way but is there a benefit beyond a lifestyle benefit? Is there a benefit in terms of the status of their health and their wellness and the management of their disease, does the management of their disease improve?


Ultimately I have to have some criteria to make very difficult decisions and I think that, as Health Minister, it's probably incumbent on me that that be the test - does it improve the health status? Does it improve the health outcomes in a significant way that actually justifies the significance of the investment? I mean we look at Lucentis, Lucentis will keep someone from going blind and in some cases will reverse, and that's empirically based, it is evidenced based. I know that personal testimonies from people are important, we want to hear from people, and I do hear from some people. But I need to look at the global picture as well because I'm spending the public's dollars, I'm not spending my money. I'm spending public money and I am accountable for the expenditure of that money, I'm accountable for the choices I make and the implications of those choices, and why did you choose to fund this for this group and you haven't funded this for this group. So sometimes it's a difficult situation to be in and I try to have a balance between my head and my heart, that I'm informed by both of those things as I make these decisions.


So with the insulin pumps, I know, I understand, I've heard from many people who talk about the difference it has made to them and to their kids, and I accept that. I have no reason not to accept it. They are living with type 1 diabetes every day and they know that much better than I do, or I ever could, but I also additionally need to know about the wellness piece. I need that to be somewhat established in, you know, a solid way, not just an anecdotal way. So this is I think where I am, as Minister of Health and Wellness, right now on this issue. My commitment to the member and to other members is to attempt to answer that question. I don't have the answers and we're looking at provinces. The best way for us to establish that is to look at the provinces that are already doing that and they're not a majority by any stretch of the imagination - they're a handful of provinces that are doing this. We will see what they say.


Now, in terms of diabetes care, we have a Diabetes Care Program. It was established in 2001 and it's located throughout the nine district health authorities, once again, and these programs provide a lot of education and work with people with diabetes, diabetes clinics, people go regularly, they bring their little records of what their insulin levels have been, and they give them advice. They have them see the appropriate health care provider and it's a very important program. The people who work in the Diabetes Care Program are amazing. They know a lot about the disease and they work in a very holistic way, not only in terms of treatment but certainly in terms of management and also some prevention.


This budget has about $1.5 million in it to expand dialysis which is needed for people who have diabetes when it leads to kidney failure. There is, in addition to these items in the budget, in the master plan with physicians, there's $4 million for chronic disease management. It includes working with patients with diabetes and, you know, this money is a very important piece of front-line services to people with diabetes.


MS. WHALEN: Madam Chairman, I appreciate that. I had a couple of just quick questions to ask you that I hope we can do, I think we only have about 10 minutes, and this way I can mention a few programs. One thing I would like - and I don't expect an answer today but I wondered if I could request some information today and perhaps the minister and your staff could get that for me. I wanted to talk about the electronic medical records being introduced into doctors' offices. I understand that there is something like $9,000 a year as one of those extra programs. I heard you speaking to the member for Hants West about physician services and how there are different methods of payment, different special incentives and programs that we want to see change in doctors' offices. We give a premium to a doctor that will move in the direction of adopting an electronic medical record and you have a team of people - I think they're called the Primary Health Care Information Management team, PHIM - who are working with physicians, trying to get them to do that.


It's a rather large subject so what I was wondering is, could you give me information - or provide it to all the members, the members of the other Party as well - about the number of doctors in our province and the number that have adopted this and the number that are using it fully, because it has different components; it has the lab and the billing and the pharmaceutical records. Are they using it fully and do we continue to give them funds each year as they continue to use it or is it just the year that they adopt it? There are a few questions in there and since we're here talking about estimates, how much money is allocated to continue the work that PHIM is doing to get our doctors on-line?


I think there is a goal of 2013, I was told, a goal to have a uniform EMR in place. We're within two years of that goal date so I think when the team was set up you had an idea to get there at a certain time. With that, I can just put those questions aside. I don't expect it immediately, but if we could have it in a little while, maybe the team could report because I'm sure that team keeps all those records. That would be very helpful.


Just on a couple of other issues. The EIBI is a great announcement and I wasn't up at the centre on Brenton Street, but I understand the details of the announcement and the work that's being done with the Department of Justice as well. This is something that I've heard the minister speak about in Opposition over the years - what a travesty it has been that we have a lottery system for children; infants and preschoolers who are identified as having autism and that their name has to go into basically a roulette wheel to see who is going to get the services and be able to make progress. The fact that you're doubling that amount with the government in this move is great. I was going to ask you, it's over a two-year period, I wondered if you could answer whether it's coming in equal instalments, are we going to pick up $2 million this and $2 million the next? It's a pretty pointed question and I think a quick answer would be great.


MS. MAUREEN MACDONALD: I want to thank the honourable member for raising EIBI. It is a great announcement. It's one that we're all very pleased about and I want to thank the deputy for his work on this, as well as staff in the department who deserve a lot of credit for their tenacity in continuing to put this on the front burner.


The $4 million is over two years, equally split, so $2 million each year. It will allow us to recruit and train. We were very aware that it would take a bit of time to get us up to the capacity. Doubling it will take us the two-year period just because of manpower resources, as much as anything else and having to train people and what have you. We're very much looking forward to that.


MS. WHALEN: Madam Chairman, I understand there are 12 minutes left so we don't have a lot of time left in this discussion, so I'm going to ask for another little bit of information, if I could, to have presented to us later. That would be the breakdown for nurse practitioners. I understand you have $1.5 million extra in the budget for nurse practitioners and they are going to become an important part of our collaborative care model. They are already in the places in the province where they are working. The last numbers I saw, there are actually fewer nurse practitioners in the province now than there were quite a number of years ago when we first started to recognize them. I'm not really worried about where we're going; I'm hoping that $1.5 million is going to give us a lot more of them.


I guess I'm disappointed that we haven't come further in the years since we've begun to talk about nurse practitioners, but I think they have a great role to play and I know there are some great examples. Parrsboro has one, you mentioned that; and Tatamagouche, there are some places where they're very much part of the team. I look forward to seeing where they're going or what the intent is with that $1.5 million. So if I could get something from the department that would be great.


I wanted to mention the CAPP and the foreign-trained doctors. I know we have more of them in the province. Actually I wanted to commend the minister; you talked about Dr. Naqvi in Cape Breton and what a United Nations they have, really, a mini-United Nations at their medical facilities there. When you met the physicians, they were from all over the world. I think Dr. Naqvi has been a leader in the province and I think sometimes you need a mentor or a leader who will be more willing, I guess, to extend that hand of friendship and welcome those newcomers. When you are in an environment where there isn't as much diversity - I think you talked about diversity earlier, too, and a diversity plan - we need to be more open and we need to be more accepting of newcomers. I know that hopefully we'll have a chance to talk to the Immigration Minister at another time.


I think that with the foreign-trained professionals, we're really in a difficult situation because there are so many who could be part of this system, if we could just extend their credentials, if we could just address the gap. Having been over at the Dalhousie Medical School talking to the dean there, they feel they've got, I think, two positions for third year, where they bring in doctors and allow them to upgrade. That's very few, given the number of applicants. I think for the newcomers, they are applying for every little window, but it's just little cracks that they see they might be able to get in and there just are not enough places.


As the minister knows, Clayton Park is home to, I would say, our own mini-United Nations. I don't think anywhere in Nova Scotia is really multicultural to the extent you'd see in Ontario, maybe in Toronto or Montreal but as Nova Scotia goes, our area in Clayton Park, I think, is an example and a great model for other communities to see just how wonderful it is to have people from around the world coming together and being part of our community and being active members of our community and our schools. We're very proud of that, I think it puts a stamp on Clayton Park that makes us not just any suburb; we feel we are a unique part of Halifax, a unique part of HRM and an example to other communities.

As a result of the fact that a lot of people have come to Clayton Park and they have come as professionals and they've bought homes and they're trying to establish themselves here, I'm in a position where I meet quite a few who have professional credentials that aren't recognized. I'd like the minister to say what we could do, if she's got any working group - we've got an awful lot of strategies and studies and working groups - is there one, please, that is working on foreign credential recognition and some way for us to extend that?


Because I don't think I'll be on my feet again in this round, I would like to ask the minister one other special favour, so I've raised the CAPP and foreign-trained doctors but the favour I'd like to ask her is one that's to do with an individual and that individual has been in touch with your department over quite a long period of time. She is a resident of Kings West, she is in the riding of the member for Kings West and her issue is around varicose veins and the EVLT laser surgery that anybody who can possibly afford it chooses over the old vein stripping and traditional way of dealing with varicose veins.


I have to say that she has extenuating circumstances. I'm sure the minister and the deputy minister are aware of it and I think that certainly - I don't want to say how you feel about it but she hasn't gotten success. I want to be careful in this but she really would desperately like to speak to the minister. I don't know if the minister has seen all of her information but she asked many months ago, actually, through the member for Kings West. She then approached me after that, some months later, I had written to ask if we could come and see the minister.


She is very articulate and she can certainly explain the complications she has that make her not a candidate for traditional vein stripping. She has been very sick in the past; she heals very poorly from any surgery, so the EVLT is the only answer for her. I really am, frankly, very worried about her not having that laser surgery because I believe she is in a very critical situation with the condition she has. I'd like to ask the minister if perhaps you could meet her or you could speak to me about meeting her later, I'll leave it up to you. I just feel this - and I know the minister has many compelling cases that come to her attention. This is one that I have found very urgent, very worrisome, and I think she has a very strong case.


Those are my last two questions. Thank you, Madam Chairman.


MS. MAUREEN MACDONALD: I have a wee bit of information around the Primary Health Care Information Management system; I think that was the first question that the member had. We have money in the budget and we expect to add a number of additional providers into that system this year. We have put money in the budget to bring another 141 providers into the system. I recognize that's not very helpful because it doesn't tell you how many are already there and what's left to come, it's just a number but at least it's a number.


Here is a bit more information: we currently have 479 licensed providers using the Nightingale EMR software, which is the electronic medical record that the department is promoting. In addition, there are 82 other electronic medical records in the province with other health care providers, for a total of 479. We're on target in terms of what the three-year goal was to bring new providers in, there hasn't been a reduction and I want to assure members we're not looking to reduce this even though we have budget constraints and considerations. The electronic medical record is something that we feel is very important, it's got to be a priority and we're sticking to our project targets which weren't overly ambitious, they're pretty doable even at the best of times.


With respect to nurse practitioners and teams, we have allocated in this budget $6,375,800 for nurse practitioners and teams. I think in addition to that there may be money somewhere in the budget for the nurse practitioners in long-term care, that's going to be another budgetary item. It's important, again, to remember that we have DHAs that have nurse practitioners as well, and I think there is funding that you don't necessarily see for nurse practitioners that occurs at that level. I absolutely agree with the member that nurse practitioners are a very important part of the health care system and we need to be working to introduce more nurse practitioners into the system and indeed we are.


I don't know what numbers the member is using to establish that we have less nurse practitioners now than we have in the past, if it's just licences at the college, if that's where those numbers come from, but it's something I certainly would be concerned about and would look into. We're constantly looking for nurse practitioners and finding ways to bring more nurse practitioners into the system and we certainly will continue to do that. I think we will see significant change, as well, in the coming years in terms of the responsibility that nurse practitioners have in the areas in which they're working. Having nurse practitioners added into four DHAs for long-term care is, I think, a significant development and it will result in better care for residents of our long-term care facilities. It also may ease the pressure on emergency rooms a bit, as well, given that people may not have to be transported to the emergency room.


With respect to the CAPP, the Clinical Assessment for Practice Program, that program has seen - a great number of people have gone through that program. Close to, well, 47.6 full-time equivalents have entered the program since it was first set up in 2005-06. There still are quite a number of CAPP doctors left in the program. We, in fact, have 25.6 remaining in the program and, you know, we have budgeted to continue these folks through the program.


We are, again, doing our physician manpower plan for the province. That request for proposals has gone out, it has been responded to, and we quite shortly will be announcing the results of that. The time frame for doing the physician manpower plan, or Physician Resource Plan for the province, which will be a 10-year plan, will be by the end of the summer, I think, and it will help us assess what our needs are and at that time it will give us an opportunity to look at what the future for the CAPP should be. Until we have that, it's something that I can't really comment on anymore.

I know that the Minister of Immigration is talking about our Immigration Strategy and we always think about our manpower needs and also the whole idea, if people are coming, that we are able to integrate them into the labour force, that we ensure they find a place here, not only on a personal level in their community but in terms of the labour market, and that they are able, inasmuch as possible, to continue on in their profession.


The deputy and I have talked, and we've talked about other health care professions as well, not only physicians, but we have people who come to Nova Scotia from all over the world who have been health care providers. They may have worked in labs, they may be dentists or they may be dental assistants, they may be nurses. They bring a lot of experience. They have training that is very important and we've been working with all of our colleges to encourage a more flexible - we always want to maintain the rigour to ensure that we are getting the same quality of health care providers as people but, you know, we really need to bring the barriers down and assist people to use their skills and to be part of our workforce. We have labour shortages throughout so much of our health care system; we really need to continue to find ways to improve on access.


The budget for the CAPP for this year is $4.6 million, and on the final point that the member raised about the individual case, my practice is to seek out all of the medical information that I can about an individual when they are requesting that the department deviate from the standard practice with respect to access to procedures and medical coverage. In this case, I certainly asked for all of the documentation in the department and I was given a substantial file and I reviewed it very carefully. I had meetings with medical advisers in the department and I questioned them quite strenuously, I must say, which I tend to do. At the end of the day, in this case I supported the decision that had initially been made in the department. I've been known to overrule a few and I've been known to support a few. In this case, I supported the decision that had been made.


To be honest with you, I don't think a meeting would result in a different decision and so for that reason, I have such limited time, I tend to take my time and use it in a way that will get a different result than the same results so I'm going to decline a meeting, certainly, because the decision has been made and it is final. With those words, I'll take my seat.


MADAM CHAIRMAN: The time has elapsed for the Official Opposition.


The honourable member for Inverness.


MR. ALLAN MACMASTER: Thank you, minister, and departmental staff for providing a chance this afternoon to ask a few questions. My questions centre around Avastin and Lucentis and there are essentially three that I'll be asking. One is comparing the two and, perhaps, substituting Avastin for Lucentis where appropriate; consideration of a Maritime buying group as a means of obtaining these drugs more cost effectively; and lastly, access in rural areas.


I had a letter from an individual in my constituency and this woman spoke about the need to travel to Halifax to get treatment. This is kind of what first put it on the map for me when I realized that there are people in rural Nova Scotia who have to travel great distances to get treatment for macular degeneration so that they don't go blind. You can imagine somebody from Inverness County who might be travelling, say, two hours to Antigonish to an eye doctor, but then who can't get the treatment there so they must travel a further two hours to Halifax and may have to do so on a regular basis. Of course, there's the time, there's the cost of travel, cost of overnight stay and while I respect that those costs aren't financed by the Department of Health and Wellness, they're a cost to people. That's what brought it up and there have been a number of people who have written me on this matter.


I'll mention the good Dr. John Hamilton who is a very well-respected man in Antigonish. He does great work with people, he's a good man, and people have a lot of trust and faith in him and his abilities. I had a chance to speak with him a bit on this matter as well. I know he has tried to advocate for it.


I know you know about this, but just to put it on the record; 30 per cent of people over 70 can get macular degeneration and I know that's people who have a background from European ancestry, which in Inverness County, most of the people would be, save for our Aboriginal population. That's a good number of people. We know that it is caused by the retina not getting enough oxygen, which leads to scarring and leads to blindness.


We know that Lucentis works and I know - as I understand it - it's approved now as of, I believe, January of this year. When it's injected into the eye, it helps to regenerate the blood vessels. The cost of Lucentis, I believe, is about $2,200 versus Avastin, which is about $1,400, so Avastin is cheaper. Its success rate I don't think is quite as high, but apparently it's successful in about 50 per cent of the cases. So where it's successful, this might be a way for the province to save money and to help people so that they don't become blind.


I know one of the other issues behind this is research. It was expressed to me that a lot of the research we depend on comes from the pharmaceutical industry, and they may not always have the common good in mind. They're out to make profits for their shareholders, and we can't begrudge them that, but if we're depending on research, I think it's important that we ensure we're getting something that's unbiased. If there's a chance that we could be using Avastin, it may make sense to do so, and if we do, maybe we can improve access to the drug as well.


So I just want to make that point: should we be considering the use of Avastin going forward? I also mentioned before about the idea of maybe using some kind of a Maritime buying group. Maybe there are ways that we could be combining with the other Maritime Provinces to purchase these kinds of drugs so that we're getting better rates on them through buying higher quantities.


Finally, access in rural areas. In the case of Dr. Hamilton, I think one of the issues is - and perhaps the minister can clarify - hospitals don't always have the capacity to prepare the smaller doses from the main bottle of the drug, and therein lies an issue, because you need people who are able to do that to be able to provide appropriate dosages. If we are able to do that in a place like Antigonish, and if a doctor who's a specialist is capable of doing it and they can find a means of doing it, that means people from Inverness don't have to drive four hours with a potential overnight stay in Halifax. They can drive two hours, and if they're doing it on a regular basis, that makes a big difference. Even at that, that might be for a two-hour trip, a one-way trip. So you're looking at four hours of driving.


It's an important issue in my constituency. It has been raised to me by a number of people. Minister, if you could provide some clarification on why things are the way they are, or perhaps if you envision something different in the future that might address some of the concerns that I've raised here today?


MS. MAUREEN MACDONALD: Madam Chairman, the honourable member raises a very important series of issues. Let me start first with just the Maritime buying group issue. We already do a fair amount of co-operation and collaboration between our provinces, in terms of sharing information about drug pricing and all of those kinds of things, so that as we negotiate and do our work as a province, we have the benefit of knowing what a competitive situation is. However, there is more that we could do, and we certainly are exploring a question of more collaboration in terms of buying on an Atlantic basis, actually, with Newfoundland and Labrador as well. So that's a piece of work that still has to reach fruition but is underway.


I want to talk about the Avastin and Lucentis question. I'm not a pharmacist, nor am I a retinal specialist of any kind. So I've been given a lot of information on these drugs, Avastin and Lucentis, but I'm reluctant to go too far down the road of talking about the differences between them and whether they're interchangeable. My layperson's understanding of this is as follows: the drug has essentially been developed by the same drug company - both of those drugs, Avastin and Lucentis - and the retinal specialists here at the Queen Elizabeth, I think their preference is for Lucentis for this particular condition.


They do that based on their practice, but they also base it on clinical trials and the outcomes of clinical trials. The drug company that manufactures both of these drugs has never taken Avastin to clinical trials for this condition, so therefore we don't have any information that really tells us the ethicality of this drug, the benefits and the risks. That makes it a little difficult to make a determination about whether or not they're interchangeable.


Independent of the drug company, however, there are some clinical trials being done, a very large study, I understand, an American study, and the results of that study are not known yet but are anticipated sometime this year, maybe later this Spring or this Fall. It may give us some means of answering the questions that you raised about whether or not they are interchangeable or the effectiveness of Avastin. We are very interested in these studies, obviously, because one dose of Avastin costs $20 and a dose of Lucentis costs $945. If, essentially, they have the same impact - and we don't know that to be the case - then there's quite a difference there, isn't there?


Let me say that what we have to do is - and I've heard from people who had been administering Avastin to their patients who have this condition, and they say there is no difference. They say that it is as effective but we don't have the research, we don't have the clinical trial research that will answer those questions. The retinal specialists, they know with certainty because they have the clinical trials on the Lucentis, but they have nothing else to compare it to or to say. That's where that sits so we're still waiting to know more, I guess is what I would say, we're waiting to know more.


I remind members, before the province listed Lucentis and Avastin, people were going to see their eye specialists and they were paying for this privately, if they were getting Lucentis they were paying $2,000 a dose, an injection. If they were getting Avastin they were paying, I think, $500 - the correspondence I saw said $500. We now are covering both of those things, Avastin and Lucentis. What we pay is $945 for Lucentis, not $2,000, and we pay $20 for the Avastin. We set that program up and developed that program in a way that was affordable; we've added $4.4 million to this year's budget to cover this. We announced it beginning the first of January of this year and we said that the coverage for this drug would only be through retinal specialists. The retinal specialists are all here in the Capital District Health Authority, at the QEII primarily, in the eye clinic there.


At the time I launched the program, I was very aware that there were at least one or two other places in the province where we had eye physicians who were delivering Avastin and Lucentis on a fee-for-service basis - charging the patient - who probably would not be really happy that we were saying we're covering it, but we're only doing it in Halifax. We did it because we wanted to make sure that, first of all, the program was delivered by retinal specialists who will make the decision that this is the best treatment.


I met with those retinal specialists before we set up the program to talk to them about it. I asked both them and my department about eventually moving this to other parts of the province - how difficult that would be, what would be required. I'm very aware of the burden of having to come into the city from parts of the province for health care for some people. It's both more convenient and less costly for people to be able to get care closer to home. It's something that we will work toward and we are working toward, getting this care closer to home.


I would say a couple of things. I would want to wait and see what the results of the clinical trials on Avastin are, for one thing, and I want to see the program that we had established on January 1st - it's only three months and a bit - a little more established before we start looking at satellite or looking at moving that outside. It's not something we've said we're not going to do or that it's always going to be the way it is now. In fact, when we launched the program, we said, this is where we're starting it, but our plan would be to look beyond Capital.

In addition to the $4.4 million for Lucentis and Avastin coverage, I want to point out that there's an additional $800,000 - oh, it's included, I'm sorry. So $4.4 million in physician costs and part of that is $800,000. There are the drug costs, and then there are the physician costs in terms of the injection and any other fees that might go along with that.


That's my explanation for all of those three questions. I hope that answers the honourable member.


MADAM CHAIRMAN: The honourable Leader of the Progressive Conservative Party on an introduction.


HON. JAMIE BAILLIE: I just want to take the House's time for a moment and draw the members' attention to that gallery - I'm now officially confused on which one is which - the west gallery, where my friend Curtis Moxsom, owner of Curtmar Farms in Colchester County, is visiting us today. I'd like Curtis to stand and receive the warm welcome of the House.


MADAM CHAIRMAN: Thank you, and we certainly hope he enjoys today's proceedings.


MR. MACMASTER: I just have one other question, Madam Minister, before I turn it over to one of my colleagues, and that's about the waiting lists for people getting into nursing homes. This is always a challenge, because the demand always exceeds supply.


One of the concerns raised to me, if I could just focus on one aspect of it, is that people have three chances. They get to refuse three times. An interesting point was raised to me, that sometimes things can come up, good reasons why the person maybe chooses not to. They want to get their name on a list in case, but maybe things are going along fine at home and they don't really have to go into the nursing home right away, so they refuse a couple of times. When the third time comes around, they're faced with, do I refuse again because it might be the right decision to make, because if I do - the problem is they don't get another chance, or I presume there's a period of time that must go by before they get to have another chance.


That made a lot of sense to me. It seemed reasonable. I know sometimes there are conflicting opinions between specialists and, say, a general MD or family doctor, on whether or not the person should go into the nursing home. In one case, a specialist's opinion was ruled out in favour of the family medical doctor. So if you could offer some comment on that? I don't think I'll get into it any deeper than that. If need be, I may come to speak to you about it sometime, but if you can offer some thoughts, that would be great.


And perhaps, Madam Minister, sort of an aside question: we had a chance to speak the other day, so if I could have an update on the nursing home in Port Hawkesbury, the expansion there as well as the expansion in Inverness, if the hospital and the new nursing home beds - certainly something by way of paper copy would be fine on that - an update on the budget and what's expected for activity over the coming year?


MS. MAUREEN MACDONALD: Madam Chairman, when I was first elected here 13 years ago, the province did not have the single entry system. I've heard people - I know the member for Hants West, he's not a big fan of the single entry system. If the truth be told, there are probably many things we still need to do to improve on access to continuing care, but there was this huge, huge waiting list for nursing home beds.


The truth of the matter is that nobody really knew how many people were waiting for a bed. What would happen would be, you know, my parent would be getting a little bit forgetful, maybe early stages of dementia, and I might be thinking ahead to a time when my parent could no longer be at home. I might go to Saint Vincent's Nursing Home and make an application, and go to Northwood and make an application, go out to Glades and make an application, and lo and behold, my parent would be on everybody's list - on all of those lists. So the lists looked really bad. When you combined those lists, there were thousands of people waiting for nursing home care in the province. That's one problem.


The other problem is, how does the Department of Health and Wellness plan the number of beds that they need? Well, they plan them based on the waiting lists. If you see that you have 4,500 people on waiting lists, then you know you need a lot of beds, but what if 1,800 of those people are actually on multiple lists? You're counting them two and three times. Part of the rationale, really, for a single entry system was to have one provincial list that would then allow for better planning, but also for better management of those lists. We still have work to do on the management end, without any question, but we can tell you with absolute accuracy how many people are waiting for a bed in Nova Scotia today and where they are. Are they at home? Are they in a transitional care unit? Where are they? That information didn't exist when each nursing home kept its own lists.


There are still many nursing homes and many nursing home administrators who are running homes that were part of the old system, which they liked a whole lot better, and I understand that entirely. They had a lot more control over their own domain, if you will, and probably they were a little more agile than a centralized - that's the trade-off. The trade-off is that we lost some of that agility that you get in a highly decentralized, individual home-by-home in the interest of having better information for planning and all of that kind of stuff. That's the trade-off. So what we need to try to figure out now is how to take advantage of people's ability to be more agile out in the community and build that into the system that we have, which gives us the better information for planning. That's kind of my simplistic idea of one of the things we need to do.


People in our province are no fools. People in your constituency up in Inverness, they're no fools; they know they want to get on a list, just in case. I like the way the member put that. You want to be on a list just in case, and we know that, we know a lot of people get on lists just in case. That's the other thing that makes it a little tough, though, if you're a health care bureaucrat or you're a health care planner or you're a health care minister. We try now to make our system lean and actually meet the actual need, not having all this excess capacity. We want a continuing care system that's going to be there for people when they need it, not when they might need it. You can have an awful lot of capacity in your system based on, well, you might need it. You've got to have a little bit of "might need," but perhaps we've gone too far the other way, because we haven't necessarily built in the capacity that you might need.


I want to be clear, though, that what people lose if they refuse three times is not - it's not that they don't get another chance. What they lose is their place on the list. That's all they lose: their place on the list. So if they've been assessed and you come to them and it's not a good time, there's something going on or whatever - let's say they're in hospital. That can happen. You can have your name come up to go into a nursing home and something has happened and you're actively being treated in hospital. You can't leave; you can't get up out of your hospital bed and go. We don't want that bed in the nursing home to be open, so you do lose your place on the list, at least for a period of time, until you're ready to be discharged and go into a long-term care facility.


What will happen is people will lose their place on the list, but if they meet the criteria to go into a nursing home, if they need nursing home care, then they will get care. It will be based on the medical opinion, the assessment, that is done. If I decided tomorrow that I need a little break - and I've seen some of the new nursing homes. They're quite beautiful; some of them are very spa-like - it might be tempting to go spend a little time there, but I wouldn't be able to get the supporting medical opinion from my doctor that I need 24-hour care with nursing staff. This is the criteria: it's medically based. You go into long-term care based on a medical assessment. The assessment is very thorough, and it's based on clinical criteria that are applied by people who do this all the time. People will be placed on a list and they may lose their place on the list, but they will never be refused nursing home care.


Now, that may become a concern to people because they hear that the waits are so long and, yes, the waits can be long but the waits also can be fairly quick. I know many people who actually get moved into nursing home beds within two and three months of applying. So a lot depends on the turnover in nursing homes in an area and it depends on people's flexibility with where they will go. If somebody only wants one - I want that one home, that's it, I'm not going anywhere else - then that makes it tougher, especially if it's a small facility with not a lot of turnover.


The member asked about Port Hawkesbury. There's a 12-bed addition scheduled to open in June in terms of six nursing home beds and six residential care beds and that's in addition to the 54 beds that are already there. That's a very fine nursing home. My uncle was in that nursing home and I went to visit him many times. It was as homey as you're going to find in a nursing home - a very good organization - and the staff are superb. They're caring and they're like family to the residents. So you're very fortunate to have a facility like that in your constituency.


In Inverness there's a replacement facility replacing 71 nursing home beds. The new facility, which hopefully will be opened and ready to roll in November of this year, there are no new beds being added but 71 replacement beds, and based on what I've seen in the other homes, it will be beautiful. You should pick out your room now because there will be a long line looking for it I suspect. The Inverness hospital will get you some information on that in writing.


MADAM CHAIRMAN: The honourable member for Hants West.


MR. CHUCK PORTER: Thank you, Madam Chairman, and I'm glad to have the few minutes that are left today to talk about a couple of things. It's interesting that the minister should mention the single entry system. She does know how much I love to hate it, I guess, is probably the best way to put it. I just want to go back briefly to where we had left off previously and that was around the clinics to make sure I'm clear on that, and I think I am, and that is there are no rules around the doctors and their hours. They can open as much as they want, as many days as they want, it's just a matter of recruiting enough doctors or working out a schedule, or what have you, opening the clinic and doing their thing as they are doing now three days a week, a couple hours a night. So they can do that as much as they want.


I guess the only reason I was a little curious about that was there would be more costs obviously associated with that but I guess that is acceptable regardless, it wouldn't make any difference. From day to day the doctors' offices are open, obviously Monday through Thursday. I don't think there are too many doctors who are open on Friday but there are some. So they're busy anyway. You call your family doctor up and, yes, come on in in a month and we'll see you. I agree with your comments, it doesn't matter really, I think, to most people whether they see their own family doctor or not for those types of situations. Unless there are some follow-ups - cardiac, cancer, whatever they might be, and a little more maybe personalized things but, anyway, that's fine.


Hopefully, we'll be able to continue to work on that and grow that philosophy and that clinic availability but I did want to talk about the single entry system. It was interesting that you brought that up. To me, it's still something that is not working and you've mentioned that it's not working. There are some ideas. It was interesting to hear you talk about some of those. The one single point is the issue that I have, it's too narrow. It's one point for too big a number, you know - obviously you support the health districts which, again, I'm not too fond of having nine of them. I could see that reduced but, you know, perhaps there's a way to build on that by that single entry being, you know, western, central, Cape Breton, northern, sort of broke down where those things are done. I do understand what you talked about, by way of - I think the example you gave was going to three local nursing homes and putting your name on it. There's no question that that creates a problem in and of itself.


At the same time, if the database was generated correctly, it wouldn't matter where you were. You'd know where you've applied. I think a lot of people that call me - and I'm dealing with one today, as a matter of fact - the Elms, Dykeland and Haliburton; I have the three that are relatively close. Everybody wants into the new Elms, that's a given. I can understand why, but Dykeland is a fabulous place, as is Haliburton; all of them, for that matter.


There has got to be a better way that you can manage the people and the numbers. We know what they are, we know how many people are there, as you said, but maybe it's simply more people working that system. We're still hearing stories about these homes that I've mentioned, and going days and days before it's turned over. That's what I've been speaking to over the years, is that there were not days and days of beds being vacant in that system before. The same rule still applies. If Mother dies and she's in the Windsor Elms, they're asking you, can you come tomorrow and clean it out? I know you've gone through a tough time. But we know that going in, that when the time comes and you're leaving here, there is an expectation that you're going to turn it over pretty rapidly, because there is a waiting list that's lengthy.


We're doing that piece. I think that the people, the families, are certainly co-operating. They're aware and they're getting the room cleaned out, doing the best they can, but at the same time that bed is not getting filled because of the backlog or inefficiencies at managing the system. I don't think there are enough people, obviously. You talk about how many people you have working in government and you talk about reducing that number, and that may be fine in some areas, but areas where people are waiting and beds are available should probably have an influx of one or two or three more.


I mean, I've heard stories where there has been one person for the entire province because it's vacation time and there's nobody to fill in. There are other times when I hear stories that there's actually nobody at the office, nobody answering the phone at all, so you can't even get information. That's troubling. How are you supposed to go back to the family?


I've got a woman today: she's 92 years old, she still lives at home; she's been on a list since last July. She is on the list for the Windsor Elms. I find out today that she's number seven on the list. Well, we know there's only one way to get into a nursing home, generally speaking, and that's if somebody passes away, the bed becomes available. What's the turnover time? It's still fairly lengthy, maybe, depending on a number of things; obviously how quickly the paperwork can be processed, and all of these things. It's really too time-consuming, and we need to invest more in that.


As much as I use the words "hate" - that's a strong word - "dislike," "would like to see something different," that single entry system has been a real killer when it comes to people's waiting times. I could never understand, there's no reason - I know you say the old way wasn't a good way, but the doctor could pick up that phone and he could call over to the local nursing home. The example you gave about being on two or three or four or whatever multiple lists, I never really thought about too much because I've never experienced it, I guess.

Maybe it's more so now, we see that, but in the days gone by, I never noticed it because they would be in the hospital. That is generally where it would be determined that there would be a need for a long-term care bed. The doctor then got on the phone and called Dykeland, talked to the administrator, for example, and said, look, I've got so-and-so here, do you have a bed? Yes, sure, bring him right over. It was quite rapid. Paperwork was done, an assessment was done, there was no appointment scheduled. We waited for a social worker or somebody to come two, three, or four days down the road - or whatever it might be, I don't know - an assessment is done and then that's, well, I don't know. It's really interesting how it works because even the assessments aren't - I want to use the word "true," but accurate.


I remember when my mother was waiting for a home and she was being assessed. The social worker came in, they would ask her all of these questions, and Mother would say, oh yes, that's right, and I'm sitting there saying, no, that's not right at all - hence the reason we're on the list trying to get to more long-term care. I guess what I'm getting at, as funny as that sounds, that's the reality and it's happening every day. They're assessing individuals by themselves a lot of times, and they're saying, well, it's not so bad, maybe their priority is not as high. There's an issue of the accuracy.


Before - I guess what I'm getting at "before" is that the doctor had done that assessment. Mrs. Porter was in the hospital, the assessment was done, it was determined she needed long-term care, he gets on the phone and he calls Emily at Dykeland and says, look, do you have a bed over there available? Great, bring her over and we'll have the paperwork. It's all charted, and there was a whole piece that was missed or omitted or wasn't needed at the time, and it did seem to be very efficient. So somewhere in the middle of that and where we are today there must be a ground that works. There must be something there.


I think having the database, knowing your numbers - and you need to know the numbers, in all honesty I agree with that, to plan out the future of expenses for beds, needs, et cetera, and so on. I think that's fine, but I don't think there are enough people. If you're ever going to regionalize anything, I don't see anything wrong with moving some government jobs to Windsor if you like, that's fine too. I'm sure anybody would take them, maybe to break it down a few more people. The database doesn't have to be reflective province-wide, but regionally, maybe that example. They could still be on a list and they are still on a list today, the lady that I'm referring to today, she'd like to go to the Elms but she would take Dykeland if it were quicker. That's what it's to now because she has been waiting since July.


Is that fair? No because she lives home alone. Of course, neither she nor her family can see that it's fair but the reality is, there's a single entry system in the province, she's on a list, she applies, she's assessed and then she's forgotten - that's how she feels. Not true probably, you know, the health care provider would never say, the social worker, no, they just forgot about you. I don't think that's a fair assessment either, but it's the perception. It's one we're struggling with and have for a long time, as you know.

You also know that I've stood here and I've said it hasn't been right for years. Long before you got into that seat, I still argued that it was not the system that has worked and maybe long after you're gone I'll still, hopefully, be standing here or not and there may be arguments made as to what's the right system and what isn't. But much work, in my opinion, has to be done.


There are examples of nearly a month going by, 29 days I heard one time, in my local area, with a bed empty and I have a waiting list for unit 500, besides, that's full all the time, which is basically a holding area for people that are sick waiting for long-term care at the hospital. I know you know the numbers, I know that you know they're out there and I'm just one example across the province that I'm giving this afternoon. But I wanted to take the time; I want to stress the importance of moving these people as best we can and looking after them, because they deserve it.


You're the Party that stands up and said we're "a better deal for today's families." You talk about Better Care Sooner and that's all great language, that's all great terms that anybody can use. Governments can stand up and brag about and say we're the best or we want to be the best or we're going to be the best, but until you're the best, we're not there yet. There's a lot of work to be done to get there.


I don't think that anybody will ever be the best, I don't think that any one Party - and we've heard this before - has all the right ideas. I think there are a lot of good ideas on both sides of this House. I don't know that they're considered as often as maybe we'd like them to be but I do want to say that I think there are some issues where 52 members in this House have to work as a team for what's right for Nova Scotians, especially in the health care side.


MADAM CHAIRMAN: Order, please. The time allotted for Supply for today has elapsed.


The motion is carried.


[The committee adjourned at 2:23 p.m.]