HALIFAX, MONDAY, APRIL 16, 2012

 

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

 

4:22 P.M.

 

CHAIRMAN

Ms. Becky Kent

 

MADAM CHAIRMAN: Order. The Committee of the Whole House on Supply will come to order.

 

Shall Resolution E5 stand?

Resolution E5 stands.

 

The honourable Government House Leader.

 

HON. FRANK CORBETT: Would you please call the estimates for the Department of Health and Wellness and also - I do not have the exact number - for the Gaelic Affairs if needed.

 

Resolution E11 - Resolved, that a sum not exceeding $3,861,513,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.

 

MADAM CHAIRMAN: I'll now invite the Minister of Health and Wellness to make some opening comments if she wishes and to introduce her staff to the committee members.

 

 

171

 

HON. MAUREEN MACDONALD: Thank you very much, Madam Chairman. Perhaps I should make my opening remarks in Gaelic but I'll try to restrain myself. I'd like to introduce members of the Chamber to the staff from the department who have joined me here today. To my right, members will recognize Linda Penny, who is the Chief Financial Officer in the Department of Health and who has been in this seat many times before. To my left, I'm really pleased to be joined here by the Associate Deputy Minister in the Department of Health and Wellness, Frances Martin. Both of these individuals will be assisting me in the examination of the budget for the Department of Health and Wellness for the upcoming fiscal year 2012-13.

 

I'm very pleased to have an opportunity to discuss with members of the House not only the budget for the Department of Health and Wellness for the upcoming year but particularly to discuss the work of the department. As everyone will recognize, this is the largest department of government. It represents well over 40 per cent of the expenditures of government. It is an area that is of probably primary importance to most citizens in our province.

 

When you talk to people about what services they most value that government provides, without exception health is the first thing that will come to mind for most people, and with good reason. We have a health care system that we can be very proud of, a health care system that performs very well, but we also are very mindful of the fact that there are many things that we can do to strengthen our health care system and that is precisely what we have been doing, working hard to do and will continue to work hard to do.

 

The budget this year that we will be examining will be $3.86 billion in expenditure. That is a budget that is growing by 2.5 per cent this year over last year. We will spend time here in the budget debates talking about the challenges of holding health care expenditures within the financial capacity of the province to pay for programs. We will talk about how you invest strategically in our health care services. We will talk about how you take resources in the system and use them differently to provide better results.

 

For too long we have seen health care expenditures grow without real planning. We have seen health care expenditures grow without the kinds of outcomes that people expect in terms of the investments that are being made. I think by and large many people in our province, certainly people who work in the health care system and the leadership in the health care system, recognize that we have to do things differently.

 

For citizens who arrive at different points in the health care system looking for services, they want results. They want a system that's responsive to their needs. They essentially want better care sooner. I've been in this Legislature for 14 years and was very interested in health policy before I arrived here and I've watched the development of health policy over this period of time. I remember the Royal Commission on Health that happened way back when - I think it was in the late 1970s, early 1980s. I've seen many, many attempts to reform our health care system and transform our health care system from a system that focuses solely on illness and disease into one that puts more emphasis on health and on wellness.

 

I've certainly seen the Health budget grow over the 14 years that I've been in this Chamber. When I first arrived here in the Legislature, the Department of Health budget was $1.4 billion. That was in 1998 and we thought that was an extraordinarily large amount of money. Since 1998 the health care budget has grown to be, this year, $3.8 billion. That is an astronomical rate of growth in a very short period of time. We have good data and good information about where that growth has been in our system and we also have good data and good information in terms of where the outcomes are, in terms of the health status of the population and the performance of the health care system.

 

It's often said by people who study health systems that, in fact, there is already enough resources in our health care system, that the problem with our health care system is it's poorly organized and we are not using the resources we're spending to their fullest effect. We too often have the wrong provider providing the wrong services and we need to have a more integrated system, one that makes better use of our resources.

 

When I first came to this Legislature, we had four regional health districts and within a few years that had changed and the government of the day made the decision to go to nine district health authorities plus the IWK. So we have seen that kind of change, a change that in some ways brought decision making - with respect to particularly acute care - closer to the community but nevertheless did result in a growth in administration, a growth in duplication of services.

 

We also know from people who study health systems that the real improvement in the status of health in our population hasn't come from our medical system, it has probably come from our public health side of the health care system. It has come from vaccinations; it has come from infection control; it has come from better nutrition; it comes from earlier identification, education, interventions than certainly an acute care system.

 

I'm particularly very proud, and I think we all are - or if we're not we should be - of the public health care system that we have in our province, led by very capable and very dedicated medical health officers in all of our district health authorities, Dr. Strang, as our chief medical advisor in the Department of Health and Wellness, and a very capable team that includes public health nurses across the province.

 

The kind of work that we do, and that they do through the Department of Health, is something that I hope we'll have an opportunity to talk about. We in Nova Scotia, for example, have a flu vaccination program that is a very strong program and it's a universal program; it's universally available to people free of charge, a very important, I think, feature of the public health care system.

 

I want to start by saying that when I arrived in the Department of Health, there were many issues confronting me as a new minister and certainly confronting the department and people were grappling with. As I indicated, we had - you know, I've seen this extraordinary growth in health expenditures over a very short period of time. I've seen the growth in the district health authorities and duplication, an increase in administration. We, in fact, had two Departments of Health, if you will. When I arrived in the department, we had the Department of Health and we had the Department of Health Promotion and Protection.

 

So in terms of just the structure and the governance of who was overseeing the health care system and public health in the province and all those important services, mental health, Addictions Services and so forth, this was the situation. Wait times in a number of areas, particularly the five areas where we have an agreement with the federal government, wait times are certainly too long in many of these areas and wait times work was underway in the department and is still underway. ERs were closed in many small communities. There was crowding in the ERs in many large hospitals. There were doctor shortages - and doctor shortages is an ongoing concern, particularly in rural communities.

 

Nova Scotia, as we know, is blessed with one of the highest, if not the highest, per capita ratio of physicians to patients but nevertheless the distribution of physicians is a challenge in our province, as it is in other provinces across Canada.

 

While long-term care had received attention from the previous government and a plan had been developed to add new bed capacity into the system, the sector still was not integrated into the district health authorities in terms of the devolution of long-term care into the DHAs in spite of the fact that that devolution was envisioned and prepared for in the legislation, establishing the DHAs going back more than 10 years. This, as the former minister would know, was in no small measure due to the resistance of the long-term care sector to be associated into the DHAs. So a great deal of work had to be done to facilitate the devolution into the DHAs and perhaps we will have some opportunity to talk about why that was important.

 

People were living in hospitals in Nova Scotia when I came into the office as minister. We had people who literally could not get discharged out of the hospital and a serious review of why that was and what could be done about it was required. Generic drug prices in Nova Scotia were the highest in the country, perhaps the highest in the world, and many new expensive drugs like Lucentis weren't listed in our drug plan simply because of the financial pressures of doing so and something needed to be done around the generic drug prices.

 

We have had discussions in this Chamber about the wait times for mental health services for children and adolescents and the lack of certain kinds of specialized services. There was no psychiatric intensive care unit, for example, when I arrived as minister and the forensic unit for children, for kids, for adolescents was, in my mind, and in the mind of the experts - the psychiatrists, the psychologists, the clinical people - was inappropriately housed at the IWK. They were essentially begging for an ear to hear their plea that that unit be moved to a more appropriate location for all of the young people involved.

In addition to this, we were challenged with the need to do better planning for health human resources particularly. I've talked about the physician situation but physicians aren't a homogenous group, we have GPs and specialists and the whole AFP model; how we pay physicians, how we pay our specialists, was in desperate need of work to make it more transparent, accountable, to have clear deliverables - an enormous piece of work, a piece of work that really required the involvement of people who have expertise and people who have a stake in this work. We have certainly set out to address these issues.

 

I'm very pleased to say that the medical school, that's so critical in terms of our health human resource planning for physicians, has become more engaged and is taking a much more active role in planning and in delivering and in working with the department in terms of what the long-term needs of our province are with respect to physicians.

 

We also recognize there is a fair amount of crumbling infrastructure in our health care system all across the province that needed attention. I think we also recognize that we needed to have investment in our recreational facilities as well to ensure that they would be there for health promotion and health prevention reasons into the future.

 

Also the conversation needed to shift away from bricks and mortar on some level in our health care system, more to the idea of community-based primary care where you have teams of health care professionals that are available to provide the kinds of services that people require throughout their lifespan and their life cycle.

 

The addition of 811, the building of primary care teams in communities across the province, the adopting of policy to develop community health clinics around the province are all very significant developments in health care and are building the platform for a transformed health care system, one that will see better outcomes for the citizens of the province, better management of chronic disease, an approach that was talked about more than 20, 25 years ago when the Royal Commission did its work.

 

I think the other thing I would say with respect to the work of the department, with respect to acute care in particular, is the important focus that is of growing importance in our department with respect to policy and planning and that is an agenda with respect to quality.

 

Quality is all about patient safety, it's about the best practices, and it's about outcomes. We have built, in the department, a very small but I would say very mighty, group of staff who have expertise in this area, who are completely dedicated to improving quality and working with the districts with respect to improving quality and adopting and enforcing the highest standards of patient safety and patient care that we can possibly offer, and they are a fabulous group to meet with and be briefed by. I've learned a great deal from them and their work will make a significant - and it's already making a significant - difference in terms of the quality of our health care system.

 

The final thing I would like to highlight in terms of some of the policy work is the importance of health promotion and health prevention. You know, we adopted a new tobacco strategy. We're the first province in the country to have legislation with respect to regulating access to tanning beds for young people under the age of 19. We adopted ski helmet legislation, which will significantly diminish the potential for serious, life-altering head injuries for people who choose to participate in a sport that does have its risks. We also have introduced legislation with respect to improving the public regulation of body art, all as important pieces of health promotion and prevention legislation.

 

I think the central piece of work of the Department of Health and Wellness is our plan for improved health care in Nova Scotia, a plan that we call Better Care Sooner. This plan is very much reflected in this budget and it's building on our efforts to focus on the patient, whether that patient is someone who needs mental health services, emergency services, orthopaedic services, or to see a primary care provider because they have an ear infection or a sprained wrist.

 

I'm very pleased to be able to indicate to members of this Chamber that in the work we have done to bring health care expenditures to more affordable levels, we have started by looking at the duplication of administrative costs and we did this in order to help invest in patient care and meet the increased demands for the high quality services that we need to provide but I want to say, I want to respond to the criticism that we have not gone far enough fast enough. I have laid out a very large number of initiatives that we are undertaking in the Department of Health and Wellness and throughout the health care system to deal with all of the inadequacies, the difficulties, the challenges in the health care system that I have certainly seen over a 14-year period.

 

To be able to seriously, competently, responsibly meet those challenges requires a level of leadership and management and administration that is given the responsibility to make the change. We want our health care providers - doctors, our nurses, our paramedics, our lab techs, all of our people who do diagnosis, our physiotherapists, our OTs - we want our health care providers working with patients. We want our health care providers providing clinical services. We do not want our health care providers to have to spend their time in meetings and doing the planning of a reorganization, a refocusing of health care. That is the job of administrators. That is the job of managers. That is the job of project leaders.

 

There's a very interesting study that came out of the U.K., relatively recently, on this very question about management and administration and leadership in the National Health Service. This study was commissioned by - I'm not sure if it was the Labour Government or the Cameron Government that commissioned it, but it was commissioned with this very question in mind. The question was, is there too much administration? Is there too much management, is there too much duplication?

 

One of the things that the authors of the report say is that if you're refocusing your health care system, if you're asking people to do more with less, if you're looking for ways to do things differently than the old ways, be very careful that you don't cut too far, too fast, too deeply in your administration. Because these are the folks who have to manage the change process. They are the ones who are very much engaged. I've heard this in our own province.

 

I want to lay out, while I have a chance, perhaps some of the features of some of the facts, some of the features of what we found in administration when I came into the department. When I came into the department, administration in health was higher than the national average. I can't remember exactly what the figures were at this stage, but I think if you give me a moment I'll find them. The administrative cost in the district health authority budgets was 6.35 per cent. I believe that the national average is around 5.2 per cent.

 

In the first year we were able to see a reduction in administration to just below the national average. Our latest data shows a further drop in administrative costs in the DHAs to 4.85 per cent. As you know, this does not reflect yet the merged services project that we announced. We will continue to work on our plan for sharing non-clinical services among district health authorities, including administration. But I want to say in the clearest possible way that the approach we have chosen to take is one where we will proceed, not recklessly, but we will proceed in a very thoughtful way, in a way where we are very mindful that we are asking people in our health care system to make many many changes. We're asking them to do things differently and change can be very difficult in a system, it needs to be managed carefully, it needs to be managed thoughtfully, it needs to have strong leadership. We have to be very careful that we don't find ourselves in a situation where we have removed the very people who are going to be required to steer this process to a successful end. We're very committed to seeing this process steered to a successful end.

 

I want to take this opportunity to thank those folks out in the DHAs and at the IWK for the work that they have done, for the strong leadership they have shown, for the work that they've done with respect to the merging of some of the administrative health care services that have been identified. I want to remind members that through this initiative this year we will see a saving of $7.5 million in this budget, and that's a saving that can be better spent on services for patients.

 

Again, we anticipate that over time these savings from emergency services will significantly add up and will result in savings of $55 million or more which is not inconsiderable. Especially when you consider the kind of need we have to be able to reinvest in our health care system, to upgrade our equipment, our facilities, to adequately recruit and train health care providers, to provide the best, most up-to-date drugs that are available, good equipment and give people access in a timely fashion.

 

We've had an opportunity to talk about mental health services in this Chamber and outside the Chamber from time to time. I'm very pleased to be able to say that this budget contains $3.8 million in new funding for Nova Scotia's first Mental Health and Addictions Strategy. In addition to that there will be an additional $360,000 or $380,000 specifically for the methadone program in the Annapolis Valley, which I've already announced - so bringing the investment in the Mental Health and Addictions Strategy to slightly more than $4 million.

 

Not an inconsiderable amount of money and the details of, specifically, the areas where this money will be invested will be announced after I've received the report from the working group on mental health care and addictions services and have had an opportunity to develop the department's response to that report and our road map to improving mental health and addictions services. But I am very pleased that money has been set aside to support the plan in its early days and I want to assure members of the House, and I want to assure members of the public, that we have certainly heard the concerns of families and advocates who represent people in need of better mental health services and addictions services. We are planning for improvements in those services and I have said before that my priorities as minister, and the department's priorities, are to improve early intervention, community-based services, peer support, health promotion and protection. We have many strengths in our system and we can make these important programs so much better by investing in a targeted way in the services that we already have as well as looking at ways that we can expand services.

 

Now, members will know that, shortly, the Capital District Health Authority will be opening community living units for Nova Scotians with mental illness who need a place to live comfortably while being treated. The provincial government has invested $8.6 million in this project and the end of this project is reflected in the budget of 2012-13. I indicated that there is $356,000 in this budget that has previously been announced for the opiate replacement program. This follows the recommendations of the working group. In addition, we are expanding the Prescription Monitoring Program so that information will be available 24/7, which is a very important initiative.

 

Frequently I am known to talk about the EHS service in Nova Scotia and our paramedics. I'm known to say that the crown jewel in our health care system is often, I think, our EHS service and our paramedics. They are a very amazing group of men and women who are completely dedicated to helping people, often when they are in crisis, when their need is the greatest, when they are the most vulnerable. I have witnessed these very capable people at work and I have met with many of them around the province throughout the time that I've been Minister of Health and Wellness.

 

I am, I'm sure, as proud as everybody else in this Legislature that our paramedics have been recognized for the sterling work that they have done and the innovative program that we have here in the Capital District Health Authority where advanced care paramedics are going into 15 nursing homes and administering care to people in the homes and in many cases preventing our vulnerable seniors and people with disabilities from having to be transferred to an emergency room. Paramedics are also staffing some of the Collaborative Emergency Centres.

 

This budget, as part of Better Care Sooner, will see an increase in investment of $1.4 million for paramedics to work in our new Collaborative Emergency Centres where, under the supervision of an emergency room physician, just as they have contact with emergency room physicians when they are in the back of a vehicle, paramedics will be in the ERs in our smaller facilities working with RNs, working with very capable nursing staff with emergency room training as well. Together they will be providing the kind of triage assessment, working within their scope of practice to deal with emergencies that come in that they can deal with and in cases where it is beyond their scope of practice, will be referring people on to more appropriate health care settings.

 

The first Collaborative Emergency Centre that opened, as most people would know, was in the Parrsboro area. It does consist of an advanced care paramedic working with registered nurses. During the day there is a collaborative health care team available to see people from the community. They have access to same day or next day appointments as needed. There are also appointments that are left open each day for patients with more urgent care needs and at night, as I indicated, care will be provided by the team of a registered nurse and paramedic under the oversight of an emergency room physician.

 

We are developing a model that gives people who live in these small communities peace of mind 24/7, that they have access to the services they need when they need them. In this budget we will be able to continue the expansion of our CECs. We have since opened a CEC in Springhill and we will be opening CECs in Tatamagouche and in Annapolis Royal. We've announced a CEC for Pugwash and as well we'll be coming to Musquodoboit, both the Valley and Musquodoboit Harbour.

 

I'm very excited about the CEC model. I'm getting very positive feedback from people around the CEC model. As I have said before, each CEC will be slightly different in some ways to respond to the needs of the community, but overall it has the features of providing better care sooner for residents in small rural towns and communities throughout Nova Scotia, communities that have struggled to keep their facilities open, to recruit and retain physicians.

 

I'm very pleased that the opening of the CEC in Springhill was a catalyst for a young family physician to go to Springhill because that appeals to a younger generation, a family doctor who is less prepared to work by themselves, night after night, in an emergency room, unsure of what kind of situations they'll be faced with, whether or not they have the capacity to address them and having a quality of life that is pretty much non-existent. This new model gives us not only better care sooner but it gives us an advantage, something tangible that we can put forward to physicians, to new graduates, as a model that will provide them with a good quality of work-life balance where they will be able to practice collaboratively with nurse practitioners, advanced family practice nurses, and others, in a way that they can experience urgent care work, some of the less serious ER kinds of work, as well as primary care. It's a wonderful model and it's working in Parrsboro and it's working in Springhill and it certainly will work in other small communities. It is a significant development and I'd like to thank Dr. John Ross, who helped us examine what some of the options were and helped us arrive at this kind of a model.

I want to go back to the district health authorities for a moment and talk about the challenge that we have in terms of finding efficiencies across the health care system and doing things differently. The district health authorities have worked very hard with the department these past two years. It has been challenging. They have had to curb spending. They have had to examine many of the things that they have done and, as I indicated, I thank them for the work they did and the very heavy lifting. Their business plans were finalized to the department around the end of March and we will now go through a process where these business plans will be brought forward to my Cabinet colleagues for their approval and we will be approving them, hopefully, in the not too distant future.

 

I want to say that it has been my commitment, my government's commitment, that we would do our utmost to have business plans approved at the earliest possible stage. Last year we approved business plans the earliest that they've ever been approved since there have been DHAs in this province and it is a record that I would like to break so that we will be able to approve them even earlier this year. I feel that we are moving in the right direction for that to happen.

 

Let me run through some of the other features of this budget that I want to bring to the members attention. In this budget we are investing $10 million to build recreational facilities and to promote active living. In this year we will be announcing our childhood obesity strategy so that we can give children in our province the healthiest possible start in life; $100,000 will be invested in municipalities to cost share with them so that they can hire physical activity coordinators.

 

We have worked closely with our municipalities and the recreation directors around the province through our regional offices and this will continue. There will be, shortly, a physician resource plan announced and there will be investment in this budget to see physician residents trained in small communities throughout the Annapolis Valley so they can see first-hand the benefit of rural family medicine and the fabulous lifestyle that is available to people who live in that beautiful part of our province. I know that they will encounter many family physicians in the Annapolis Valley who will be inspirational to them in terms of their commitment to residents in that part of our beautiful province. So there's $241,000 in this budget toward that residency program.

 

This budget also allocates $409,000 toward midwifery and as members know, we did a review of the three pilot sites of midwifery. We had an excellent report with recommendations. The department has developed a plan to implement those recommendations and new resources are required and resources are available in this budget to help us start to implement the recommendations from this plan.

 

I know my time is coming to an end and I've talked about quite a number of things. I want to use the remainder of my time, I guess, which isn't very long, to do something a little unusual I suppose in some way, but I have thought about this a lot. I think most people know I lost my dad in January and I want to thank all of the members of this House who sent me beautiful cards and expressions of sympathy. It's a bit emotional for me. My dad was a fabulous man and shortly after that I lost one of my old social work teachers whom I also was very close to. The most important piece of this budget is the investment for seniors in terms of home care and supporting seniors, like my dad and like my friend, my old teacher Joan whom I lost this year, to be able to stay in their own home until their passing. I know many, many seniors who would do anything to be able to remain at home, to avoid having to go into a nursing home or spend their last days in a hospital.

 

I dedicate, in a way, this part of the budget to my dad and to Joan. They represent seniors in our province who in their golden years as they fight through chronic disease and are in the health care system, they need the supports to stay in their own home. This budget, I'm very pleased to say, has $20 million in extra spending for home care and it will allow many seniors to remain at home. It invests $6.3 million in nursing care for people; it invests money for home adaptation funds; it invests money for restorative care. The member who's the physiotherapist, from the beautiful Island of Cape Breton, will be happy to know that being able to expand home care so that we can provide occupational therapy, physiotherapy, those kinds of services as part of our home care program will make such a huge difference being able to draw on the talents, the knowledge, the expertise of a broader number of care providers.

 

There are many other things in this budget, in the health care portion, I would love to be able to expand on and I look forward to your questions. I know we'll have a very good exchange. (Applause)

 

MADAM CHAIRMAN: Before I recognize the next member, I would like to remind all members and visitors in the gallery as well that we must turn all of our electronic devices to silent. I know that sometimes it is easy to get accustomed to hearing the pings but rest assured, the pings are coming through loud and clear. I would ask all members to just take the time to check your own phone. Thank you very much.

 

The honourable member for Kings West.

 

MR. LEO GLAVINE: Thank you very much, Madam Chairman. I thank the minister and staff for being here and being available to drill down on the Health and Wellness budget and the estimates presented.

 

I also want to acknowledge the minister's word of thanks to the members, having lost a parent. I know it was very difficult for the minister, during that period of time, and I know the House always applauds and likes to see that human touch that we all experience from time to time, beyond our life in the Chamber or in the political realm.

 

Indeed, as we know from cradle to grave, our health care system is always being challenged to improve its responsiveness, to improve the quality of care. I believe the minister is indeed, not just centred on the tertiary and the kind of care we have here but what's in the best interest of every Nova Scotian, no matter what part of the province that we do live in. I think that is an enormous challenge.

I live in a part of the province where we have five of the eight communities that have the oldest average age population and we're seeing that the demands are, indeed, enormous, as we see the first wave and the cusp of what's to come in a greater impact on our system because we must do all we can to keep our acute care, our community health facilities, staffed with as many professionals and as many services as will be allowed by the revenues that the province has to work with. We know those are going to be challenged but certainly not at a time where we can add to the facility footprint in this province.

 

I concur with some of the last remarks that the minister made and I think all of us will be looking for ways in which we can deliver good health care in homes. That's simply going to be a requirement, even looking at replacing the Infirmary, should we have a footprint as big as what's there? Perhaps we can make modifications that will better serve Nova Scotians. So perhaps during the next little while we can have those kinds of discussions.

 

Obviously this is budget time and taking a look at specifics and line items is important to Nova Scotians. The first area I wanted to address, and this is according to the Supplement - I want to first of all preface my remarks that in no way does it reflect any negativity or wonderment about the work of the deputy minister. I've had the good fortune to have had a number of conversations, a number of direct requests to the deputy minister and, in fact, very, very positively received by him, knowing the extraordinary demands on him professionally and on his time.

 

However, according to the Supplement, the salary of the Deputy Minister of Health and Wellness was just pennies above $200,000. This is a salary higher than the Premier's salary and the 2011 Public Accounts would have marked the first full year the deputy minister was in place at the department. I was wondering if the minister could please indicate how much of an increase this salary was over the deputy minister's salary from the previous fiscal year?

 

MS. MAUREEN MACDONALD: I do want to thank the honourable member for the question. I want to thank you for, not just the question but the way you arrived at the question, your opening comments. This does give me an opportunity to add a few comments of my own about the deputy minister who might not be very happy that I'm going to say this, but he turned 65 yesterday and it was a very special day yesterday.

 

Indeed, I feel very fortunate to have had an opportunity to work with Kevin McNamara and I think most people who have worked with him in our department and in our government feel the same way. He's kind of like the Energizer bunny, he is in the office very early in the morning and just works and works and works. That pretty much reflects the work ethic of people in our department. Certainly he demonstrates through his leadership at the top that that's what's expected.

 

As the honourable member probably knows, he came to the position from the South Shore District Health Authority where he was the CEO. I laugh, I tell people my first week in the department I came into the department, the deputy minister at the time told me it was her last week, she had given her resignation for retirement purposes some months before that. She had one week left. There were no isotopes, H1N1 had hit Nova Scotia before any other province and I can't remember what the other minor crisis was but that was kind of welcome to the Department of Health and Wellness.

 

So, Mr. McNamara was seconded to come into the department for a short period of time to help me get my feet wet and get over the hump. He has never left and I'm really pleased that's the case. The salary that you've identified is the salary that existed at the time. There was no increase in salary. That's the first thing.

 

The second thing is the salary for the deputy minister has been frozen as it has been for deputies across the system. I believe that freeze was put in place two, possibly even three years ago. I would indicate that the deputy minister of Health and Wellness oversees a department that spends more than 40 per cent of the revenue of government and makes less money than most, in fact all but one, of the CEOs of the district health authorities. I just want to inform the member and the public that set of facts.

 

MR. GLAVINE: Thank you, Madam Minister, for that explanation. I'm also wondering if there are any associate deputy ministers in the department, knowing that it is a Department of Health and Wellness and knowing of the kind of demands when we're looking at a $3.8 billion budget and also the complexities that are inherent in that department?

 

MS. MAUREEN MACDONALD: I want to thank the member for the question. It does give me an opportunity to explain how we spend resources in the department and how I approach the expenditure of public resources and being accountable for them, as well as the Premier and our government.

 

As I indicated in my opening remarks, when we came to government there were essentially two Departments of Health. There was the Department of Health and there was the Department of Health Promotion and Protection. In the previous government there had been two ministers, one for each department, and two deputy ministers, one for each department. The Minister of Health Promotion and Protection would have had a political staff person, an executive assistant. The Minister of Health always had two, a policy person and an executive assistant because of the size of the department.

 

Within, I think, a year of being in government the Premier made a decision to merge those departments which eliminated a minister, a deputy minister, a political staff person and in addition there have been other efficiencies, I guess you would say, that would result from that as you go down. I think the communications staff between the two departments, if you combine the communications staff, it's a smaller staff than what existed when there were two departments. Our brilliant director of communications works really hard with her staff but there is less staff than there was, for sure. The same is true for policy because there was a combination of policy.

Let me tell you what my thinking was as a new minister in the department. I supported the Premier's approach to this and I knew that there would be some people, in fact I think the former critic before the current critic in the Liberal Party was very critical of the combining of those departments. But I supported this because I realized that we could develop a very strong continuum of policy where the people in the Department of Health would be very much influenced and mindful of the need to do things to promote wellness.

 

That in fact, I think, is occurring but I have to say that one of the very first things I thought, I felt, I perceived in the first months of being in that office, and I'm talking about the Department of Health now, when there were two departments, I was pretty shocked that we had a Deputy Minister of Health and then we had nothing. No associate deputy minister, no assistant deputy minister, we went right to the heads of branches within the department like Mental Health, like Continuing Care and each branch was led by a director. I definitely said to the Premier, to members and colleagues in the Cabinet, that in an organization that is so big, and we were about $3.6 billion at the time, that it defied logic to me that there would not be an associate or an assistant deputy minister.

The reason I felt that, you know, the deputy minister was doing case work, the deputy minister was doing things that you don't have a $200,000 a year leader of a big organization do, you really needed to have a more sophisticated management structure so that you allow that person at the top of the organization some free time to actually do some thinking, do some reading, do some reflecting, and what have you. I will accept responsibility for making a case, and I had to make a case, to have an Associate Deputy Minister of Health created in the department. We were very fortunate to have this position created and Frances Martin, who's here, is in that position and who comes with a strong policy development background.

 

So in the Department of Health and Wellness we have, I believe, the leadership that looks at program and planning and implementation but we have policy. We have the execution and we have the planning and the policy development. How on earth in a Department of Health, and now a Department of Health and Wellness, could you not have sufficient leadership at the management level to really do the things that need to be done? Ministers are not those people.

 

Ministers are the interface between the public and the public administrators, the officials in the department. We are people who should have the pulse of the community, the ear of the community, you know, who can look at the emotion of the community, the aspirations of the community. That's who we are. We need to have in our department sufficient leadership with the kinds of public administration skills to really develop and oversee the development of the options that are presented to ministers so that we can make the best decisions, the most informed decisions possible, bringing together what we know are the aspirations of people in our communities and the people who have given us their trust to try to meet their needs and use the resources they give us, they provide us. I often say to people I'm not spending my own money, I'm spending your money, and I need to be really fully informed.

So, yes, we did come into government with two departments and we were able to do a merger and reduce a number of positions. At the same time I think this very much reflects the approach of myself and our government, it's to try to be thoughtful and reflect on what will make for the best government, what will make for good government and good management in the health care system. I hope that we will continue to use this approach to look at the areas where we can have improvement and I'm sure there's always room for improvement. I don't think we've arrived at the perfect configuration and I doubt that such a configuration actually exists.

 

MR. GLAVINE: Madam Chairman, one of the lines of approach I'm going to use here is dealing with some of the Supplement to the Public Accounts. As the minister and her staff know and realize, more and more Nova Scotians, not just the Health Critics, are taking a look at particular amounts that are designated for spending. One of the first ones I wanted to touch on, not an exorbitant sum, but it shows the Department of Health paying the Dalla Lana School of Public Health in Toronto $92,000 and I'm wondering what that would be for.

 

MS. MAUREEN MACDONALD: Thank you very much for the question. I remember this vaguely. I guess for the benefit of people in the Chamber, I don't know if people are aware that the supplementary report that the member is using is actually not this year's budget, it is money that has been spent in a previous year. So this money that he's referring to was, in fact, I think spent in my first year when I was minister in 2010-11. I should say that this particular expenditure is something we will get more information for the member around, but let me say when I first heard the name of this particular group that did some - they came and they did training of some kind, or they were here doing training with senior managers. It's an institute that's connected to the University of Toronto, I believe, that has expertise in a particular area of health care and they were here, I remember when this occurred. I didn't participate in it myself. We will attempt to get some additional information for the member but it's in the area of public health.

 

I think, if I'm not mistaken - now this is a guess on my part, we'll see how good my memory is - I think this may have had something to do with H1N1 and the assessment, you know, there was an evaluation done afterwards around pandemic planning. I feel that that's what that was but I'll get confirmation for the member.

 

MR. GLAVINE: There are a number of consulting services and they consolidate some of these and give them to the minister to take a look at because although it's the Supplement to the Public Accounts, these have a way of continuing on year after year, perhaps with different consultants, but before I get to a few of the consultants, there is one large amount of $9,604,000 that is a sum of money going to Doctors Nova Scotia. I just wonder again, I know some of the work of Doctors Nova Scotia - what this particular expenditure is sent off for. Is it to run their offices; is it fees, personnel amounts that would be included in that $9 million?

 

MS. MAUREEN MACDONALD: It's a very good question and, again, we'll get you the specific for that line item but it could be any number of things. We have a master agreement with Doctors Nova Scotia, which sets out the remuneration for doctors on fee for service through the fee schedule but if you have seen the master agreement, you would know that the master agreement really is a master agreement. It's a very thick agreement and it may have a number of other schedules in that agreement for remuneration to doctors for doing certain things.

 

For example - and it's not this line item - I know that in the master agreement there are incentives for physicians to do more primary care in a collaborative way and there are also abilities to transfer money for technology, tech change, so it could be any number of things. I'm being told that this does fall under the master agreement and that it covers two items. It covers a retention and recruitment benefit, so it probably would have been, I would think, targeted at certain physicians in hard-to-recruit or retain areas of the province.

 

It also may cover maternity leave for physicians, because they are on a fee for service. If a doctor goes off, you need a replacement going into that physician's office, for example, and they may be paid a little bit differently because fee for service wouldn't give them an adequate salary. Also, a certain portion of that - so the retention and recruitment benefit is about $6,800,000 and the other portion is the Canadian Medical Protective Association, so I'm assuming that's insurance, liability insurance for some of the physicians.

 

MR. GLAVINE: Thank you, and to the minister, I do have a list of a number of companies that have provided consultant services to the department. I know there are a lot of areas that I hope to get to ask the minister about during our time in estimates on Health. What I will do is consolidate those and pass them to the minister.

 

Perhaps in a general sense, for example, Price-MacDonald & Associates Consulting, $1.7 million, which is pretty considerable; Park Consulting Group, $193,000 and on we go. I bring up the question of consultants because the total cost of consultants listed is in excess of $3 million - $3,019,979 to be exact. I'm just wondering from the minister, where she sees consulting, the tracking and trending during her three years as minister, and where she places this consulting, in terms of its value, in terms of its investment and its importance to the Department of Health. Is it a trend line that is a departure from past practices or is it very much in line with the needs of the department because the needs of the department are based on such a complex and demanding sector?

 

MS. MAUREEN MACDONALD: Thank you very much. The honourable member raises some very good topics for discussion. I think that people in Nova Scotia would want to know about the use of consultants in government. It tends to be a flashpoint for many people and it tends to, I think, for people to often wonder - why do we need to go outside and use consultants.

 

First of all, just on the general point that the member questions whether or not we've increased the amount of work that is given out to consultants. In fact, we've been reducing the amount of work that has gone out to consultants. This year over last year it's down about - it's close to $700,000. I know that the deputy minister who we spoke about earlier is a real stickler when requests come from the various branches to use consultants on various pieces of work. I know that he is very hawkish in terms of questioning the various branches on why we need consultants in this case and is it because there is an urgency to get a piece of work done and staff are already fully committed to meeting other deadlines or is there expertise that we don't have in the department that can only be accessed by hiring a consulting firm - again, is it a deadline thing or whatever.

 

We've been prudent; we've been cautious; we've been moving in the direction of trying to minimize the use of consultants, using consultants only where it's really required that we use consultants. There has been a reduction in the amount of money used on consultants, but having said that, again, I think it is important to recognize that you don't always have all of the expertise that you require in the department and sometimes it is necessary to go outside and contract for a very specific piece of work.

 

I think the other thing that I am very cognizant of, as minister, is the vast number of initiatives that we have underway in the Department of Health and Wellness, which I try to give some appreciation for members here earlier, tried to give you some idea of the many ways in which department staff are being pulled into fairly significant pieces of work. What that means is, when we have staff that are fully committed - and it's a little beehive over there in the Joe Howe Building - people are working really hard, but sometimes I as minister might say, well, I'd like to have some options on this, but the staff in that unit are already fully working to get me options on three or four other things I've already asked them to bring options on and there's nobody left to work on the specific thing. We may have a deadline that we have to meet, so sometimes you are put in a position where really your best option - rather than add to your staff complement - is to contract out and hire the expertise to help you.

 

You know frankly, I look at the Department of Health and Wellness and I say, we are a department in excess of $3.5 billion in expenditure. I don't want to make light of $3 million but really, if we're spending $3 million on professional services, you know, for consulting, I would challenge anybody to go look at a big company or a big corporation, you know, the pharmaceutical companies, General Motors, many of these big entities, and find that they are doing everything in-house because they're certainly not doing everything in-house.

 

The use of consulting firms with big organizations is a feature of administration today throughout the world, throughout the western world, and you'll find it in business, in industry and government, it's pretty much a standard practice. That's not to say we should become complacent around it, you know, we shouldn't. We should be mindful that again we're using public resources and we need to be sure that if we're going to outside help, then it's because we really need to fill a gap or we need to meet a deadline. I think that those are pretty much the guiding principles that we use and we will continue to use. There will always probably be some contracting out and I think we should be alarmed if it becomes excessive and we see it's excessive. But I would argue that certainly within the Department of Health and Wellness we are mindful and we haven't lost control.

 

MR. GLAVINE: Thank you, minister, for that explanation and those comments around consultants. We will follow up with some specific consultants to find out what kind of work they were doing. So we'll forward that on to the ministry.

 

Two other areas I just want to touch upon and perhaps as the first hour is getting a little closer to completion, but I wanted to take a look at a couple of other line items around recruitment expenses and, secondly, communication. There are two separate line items, one on Page 145 of the Supplement and one on Page 148, one expense of $57,000 and the other, $138,000; so $200,000 on recruitment expenses. I'm wondering if this was targeted towards going to national conventions for recruitment purposes or is it part of the operations of a recruitment specialist? I'm wondering if the minister could perhaps at this time, as good as any other, bring us up to speed on the recruitment work that is currently going on in the province?

 

We know that some happens at the local DHA level but we also know that there are real challenges around recruitment and providing again Nova Scotia communities with the right complement of specialists and GPs, perhaps even nurse practitioners, who we'll talk about a little bit later on as well, but if the minister could provide a little overview of recruitment expenses?

 

MS. MAUREEN MACDONALD: Again, I would have to get the member more specific details. The practice in the department generally speaking, as I understand it, is if there are vacancies in senior management positions, we advertise locally. We attempt to recruit through the normal channels and if we're not getting applicants or if we're not getting qualified applicants, then we may engage an external head hunter or whatever and the recruitment efforts are expanded outside of the province.

 

I'm told that our executive director of policy recruitment process was just such a process that it required more extensive work to find the right person. It's a very senior position and a difficult position to fill with the right skills.

 

I don't know what other positions are reflected in those two line items. We can get that information for you but there are a couple of things that do come to mind. We have been trying to recruit the right person to lead the Drug Management Policy Unit, or whatever we're calling it these days. That, as well, is a very specialized, particular kind of position and may be reflected in these numbers as well but, to the best of my knowledge, we haven't flown staff to recruitment fairs in Ontario or anything like that, that hasn't been part of what we do in the department. We're a very home-grown kind of department and so we'll get you additional details to help you understand those line items.

 

MR. GLAVINE: Madam Minister, on the Communications Nova Scotia expenses from the Department of Health and Wellness found on Page 146 of the Supplement to the Public Accounts, a total of about $905,000 - so I'm just wondering, a couple of questions. Do communications officers constitute Support Services, as the Support Services have a total of $695,000, as indicated on Page 146?

 

MS. MAUREEN MACDONALD: Before I answer this question, could I just go back to the recruitment question? I've just forgotten what I was going to say - oh yes. Again, I don't know this for a fact, and we will check and get the member the correct information, but I rather suspect some of those recruitments, we had - I don't know if you remember but the Auditor General identified Medical Officers of Health in the DHAs, we had a number of openings and we were having difficulty filling Medical Officers of Health.

 

We also hired an epidemiologist, I believe, in Dr. Strang's shop, we strengthened that shop with a person who is a physician who came from out of province. I believe there was a Canada-wide search for that specific position and perhaps it required additional resources, it wouldn't surprise me. That is because of the highly technical nature of the job and the uniqueness. It's not a position that we have very many of in the department so that may be it.

 

With respect to the question you just asked me we have in the department in 2011 nine Communications Nova Scotia staff and we reimburse Communications Nova Scotia, we pay them, it's their own cost centre and then we pay them back for those costs and we have two non-CNS staff in our communications division.

MR. GLAVINE: Looking at the 2012-13 fiscal year transfers to Communications Nova Scotia, how much has the department budget - and I'd like to take a look at some of these individually - in terms of advertising, how much would the department have budgeted to transfer to Communications Nova Scotia in order to inform Nova Scotians about programs that are available to them?

 

MS. MAUREEN MACDONALD: This, I think, is a very important topic with respect to the work of the department. I want to first all tell the members about the very first board meeting I went to at a DHA when I became minster and that was in the Capital District Health Authority. I remember very clearly being at the board meeting and there is a physician who is an orthopaedic surgeon, Dr. Michael Gross, a non-voting member on that board. I think he represented the staff association.

 

We had quite an interesting discussion that night and he told me, he said as a physician he felt very frustrated that the government, and the Department of Health and Wellness, did no public education, is how he put it, public education/advertising, with members of the public about our health care system and health care services. He said to me we have, in his view, a very poorly informed public about our health care system. People show up in the wrong place for the wrong service with the wrong provider, not through any fault of their own but because we don't educate people about our health care system. He said we do a really crappy job of helping people know about how our health care system works and how to use it.

 

He told me and the board - he's originally from the U.K. - he told us about this campaign that the National Health Service had done in the U.K. around what is a hospital, to help people understand the kind of services that you would get in a hospital versus the kind of services that you would get in the community at a community clinic or in other kinds of settings.

 

He got me thinking, that meeting started me thinking about this problem. I thought, you know he's right, as Minister of Health and Wellness I get correspondence every day about people complaining about an experience they've had in the health care system. I'm reading their letters and I'm thinking, you know, I get they are frustrated, I know that, but they were in the wrong place. They could have gotten a different service in the right place. How do we get people to know that?

 

So it was very clear to me that what Dr. Gross was onto something that I needed to think about. Then Dr. Ross, if you remember Dr. Ross did his report to government and one of the things he says in that report, and he has said over and over, is communicate, communicate, communicate; that government and the Department of Health and Wellness in particular, are crummy, historically. We haven't communicated well with people and we need to change that. We need to do a better job of communicating with people.

 

I remember sitting down with the deputy minister, probably one of my first budgets, and asking, how much money do we put aside for communication? I was pretty shocked to find out that we really didn't put a lot of thought into communicating with the public in the Department of Health. That wasn't what the Department of Health was about and I get that. The Department of Health was about planning and delivering the best health care system they could.

 

However, where on the planet do you have an organization that spends $3.5 billion-plus, annually, with really important products and services, and you don't tell people about them and how to use them and how to get access to them? So it struck me then all of these were kind of like the little seeds being planted that we needed to do a better job in communicating. I feel very good about the communications work we have been doing and we are going to do more of it.

 

We've done campaigns around vaccination and flu season to encourage people to get their flu shots. We are advertising, if you want to call it advertising; we are doing communication; we are doing public education around the 811 dial-a-nurse line. When those little cartoonish-type vignettes are running on television, the calls to the 811 line go up by about 30 per cent. It literally helps people know where to go and to call that system. That's what the system is there for. Our preference is that somebody calls the nurse rather than show up at the ER when that's not the place they need to be.

 

There are many things we need to do to improve our communication and to help people understand this big, massive dinosaur called the health care system and where to go. We have a Better Care Sooner advisory committee made up of people from around the province who work in the health care system, who have worked in it in the past or who are just citizens. They say to me, you need to do more communication and this is the kind of communication you need. You need to be showing people in Tatamagouche, in Parrsboro, in Musquodoboit, in your communication, the people that they recognize working in their communities. You need to be using the paramedics and the nurses and the other care providers, the family doctors, and help them understand the system, help them understand what is the right door to go to.

 

I am fairly committed to this idea that we do have to communicate better, that we live in a world of mass media where people get their information through the mass media. I'm not a believer in word of mouth, especially around our health care system. I really think we have to help people understand the services we have and how to get there.

 

In terms of what we budget in the Department of Health and Wellness, we do have a small communications budget in the department. We have revenue for social marketing, for example, $200,000 in this year's budget. Social marketing is the stuff we do around the dinosaur and the tobacco strategy, you know, the drinking and mixing of prescription drugs, all of these things that we've been doing around tobacco use and other things. In addition to that, Communications Nova Scotia does things for the department as well that aren't part of our budget but are part of their budget. So I don't know if that kind of answers the budget question that you asked me but maybe you could ask it again if you didn't find me . . .

 

MR. GLAVINE: This question probably will finish things off. I was looking to break it down a little bit. I know that the minister talks about, you know, the mass media and in terms of communication but each area would serve I think particular purposes. To go into a doctor's office and to have a pamphlet on a particular illness and so forth, I think can be very informative. So, you know, there's graphic, there's print, support services, video production. I'm just wondering is there a balance of these, is there again an emphasis now on video so that it could be picked up especially for TV production?

 

MS. MAUREEN MACDONALD: Again, I think what we'll have to do is we'll have to do a little more research and break that down. It's so hard to, I suppose, answer in some ways. The department staff who have been dealing with, for example, young people in the tobacco strategy have developed a very sophisticated knowledge of what things tend to work better with young people than not. So we spend money on Web sites and we spend money on putting things in those areas where young people tend to get their information. That isn't necessarily the same choices you would make if you want to have people more aware of 811 and call the dial-a-nurse line.

 

So my perception, my understanding in the department - because I ultimately have to kind of sign off on each of these campaigns - is when I'm presented with the concepts and the plan, part of the plan is always what mediums these messages are going to appear in. I'm generally given the rationale for that. We're going to do a media buy in the movie theatres because we know that that's where this age group is going to be. Or, this is going to be on the prime time television channels for this period of time because our target audience are families with young children, seniors, or whatever.

 

So the mediums tend to be different for the different services that we're promoting, 811, we're looking at, that particular ad, if you think about that ad, we're trying to get male callers, you know, we're trying to get men in the province to use 811 more. We're trying to get a more diverse population comfortable with that particular service. We're trying to get seniors to be more comfortable with dialing a nurse. I think the early users of the 811 line tended to be women with young children, and that's great. We want them to be using the system, but the system isn't only for women with young children. We really want other people to recognize and identify that it's a service that's there for them that they can rely on, that it will provide them with the kind of information that will be very helpful. The ads are developed with that thought in mind, tested and then put into the market, into the appropriate place.

 

Again, we work closely with CNN around much of this and from time to time we contract - there is a good example of when we might contract some work out to an agency that has expertise in helping us meet a deadline or whatever.

 

MR. CHAIRMAN: Thank you. The time allotted for the Official Opposition has now elapsed. If it is agreeable with the minister, I would like to suggest that we call a five-minute recess to allow us all to stretch a little bit and get started. The time is now 6:24 p.m. and will reconvene in five minutes.

 

[6:24 p.m. The committee recessed.]

 

[6:29 p.m. The committee reconvened.]

 

MR. CHAIRMAN: Order, please. We will now continue with the estimates of the Committee of the Whole House on Supply.

 

The honourable member for Argyle.

 

HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, it's a pleasure to stand and speak for a little bit. (Applause) Thank you to the member for Antigonish for that round of applause there. I know the member for Guysborough-Sheet Harbour is right behind him there too.

 

It's a pleasure to speak for a few moments and ask some questions to the Department of Health and Wellness. First of all, of course to welcome the minister here, for taking the time for this and as well as for her support staff that are here today. Linda, it's always good to see you. Frances, it's always good to see you as well, providing support to the minister. I do know the minister has a lot of information available to her right there and I think if she is anything like any previous ministers, she has got most of the answers ready to go anyway, so just welcome you here. I know there are probably a number of people up behind me who I can't see or maybe just watching at home, making sure that answers are done correctly and information is available to us as we go along.

 

I know it's only a number of years ago that I was there and had my deputy minister with us and it already seems that Cheryl had moved on. I think we're almost on two years now that Cheryl took a retirement and I know that she was a wealth of information during these sessions as well. Of course we all do miss her.

 

I thought we would maybe start off with long-term care because during your opening remarks you talked about home care, long-term care and some of those issues. Of course I would be remiss if I didn't first of all mention my long-term care facility and we'll get that one out of the way to begin with, which of course is Nakile Home for Special Care. I haven't had an update on this one in quite awhile. Maybe I'll let you get the information ready there and give me an update on Nakile Home for Special Care that I might be able to share with folks back at home.

 

MS. MAUREEN MACDONALD: Mr. Chairman, it's great to have an opportunity to answer some questions for the honourable member. I'm not surprised that I'm looking forward to the day where we don't have to talk about Nakile and it's coming. It's coming.

 

We anticipate that Nakile will, if everything goes well, be opening their new beds on April 1, 2013. It has been difficult for all parties, I would say, but I want to reassure the member that we were always committed to working with Nakile and I think they were always very committed to working with the department as well to try to meet the needs that exist in their community. They're a facility of long-standing in that community of real importance to that community. I'm sure that you're finding, like all members in this House are finding, we really see the aging of our seniors in our communities.

 

Although I spoke about the desire of many seniors to remain at home, and my desire as minister to support that to the fullest extent, there will always be a need for long-term care beds. Because we have an aging population that is a growing proportion of our population, we will need to add capacity into the system. This is occurring, we're still moving forward with the beds that were commited to in the long-term care strategy.

 

We're at a stage now in the strategy where we're doing a review and we're looking at what's occurring in the population around the province, what is it we know about our wait lists, what is it we know about our alternate level of care beds in our hospitals. We have, in a way, this very odd situation in Nova Scotia where we have home care but we don't have a lot of home care. We have home care kind of at a preliminary level and then we have nothing intermediately. You go right from here into a long-term care facility.

 

Again, it's building that system that is going to be a more appropriate system to really support people throughout their lifespan, their life cycle, particularly in those last years of people's lives so that they have the comfort of being in familiar surroundings, close to their loved ones, safe, secure and as happy as we can make people. I think that's the objective we all have.

 

MR. D'ENTREMONT: Thank you minister for that answer. There are a couple of components within that answer that I want to address. One, when it revolves around the issue of Nakile Home for Special Care, I don't think ever that I have sort of pointed at whose fault anything was, I think there was just an ongoing issue of negotiation and maybe some misunderstandings along the way. I think the department has always worked in its capacity to make sure they're making the right decisions for that community. It's good to hear that, fingers crossed, toes crossed and arms crossed and anything else I think I can cross I'll try to cross to make sure those beds are open in April of next year.

 

I think they're well needed because it goes to the next issue about long-term care because it seems - I agree with the minister that we sort of go from this beginning issue of home care, the personal care issues, the light housekeeping, trying to create a few meals that the senior who is living at home can deal with. Then we have a gap that over a certain amount of time what happens is - and this is what I've been hearing as I've been going out talking to communities and people in the community - there is really very little identification of the individuals who are in that community.

 

What ends up happening is that as families are trying their best to keep their loved ones at home, what is actually happening is that - they're not professionals and they can't necessarily identify where things are getting too acute, where Mom, Dad, loved one, is too sick to be staying at home. They don't realize it until all of a sudden something drastic happens, an ambulance comes along, they have to go to the emergency room, the loved one is so sick that they're actually staying in the hospital for really long periods of time in order to get better so that they can either go back home, hopefully, or sit on the waiting list waiting for long-term care placement.

 

I know it's more of a lob there and I said I wouldn't send lobs today but I thought - what is the thought of the department right now on trying to identify these individuals who are in the communities right now, to make sure that they are identified sooner so that they don't come to an emergency room or they don't crash and take so much time of our hospital system?

 

MS. MAUREEN MACDONALD: I thank the member for the question. You know one of the things that staff in the department tell me is that there are many people on the wait-list for long-term care who - I mean many people, like a very large number of people on the wait-list for long-term care - who have never had so much as an hour of home care. They are going right from - it obviously demonstrates that there's something going on, there isn't that kind of progression. There isn't that kind of, you know - you start by doing an assessment and providing some light housekeeping, as you say, whatever the services are that are required.

 

There's something missing in that picture so as I indicated, the staff in the department are right now in the process of going through a very detailed assessment of wait-lists and helping us get a more complete picture of what the situation is.

 

It's interesting, again, when my Dad - I learned a lot. It's not a bad thing being a Health Minister with elderly parents going through the health system because you learn a ton. One of the things - and I've heard this from other people and I'm told this by staff - is that quite often what happens is the family doctors, who are fabulous, family doctors in a situation know that this elderly person, over time, is going to need a higher level of care than they can currently get at home. So they say to the family, like two years ahead of time - this happened in our case - you need to start the process now. You need to get your father on the list now so that there will be a bed when he needs it.

 

This is something that is occurring because we haven't made the system accessible when people need it. We have to jump start it a year and a half or two years ahead of time, in case, in the hope that it will be there when you need it. What that means is that first of all, it doesn't give you an accurate reflection of those lists and what really those lists are all about. It makes it difficult to plan the number of beds you actually need, so there's a distortion there. Imagine if we had a system where family doctors didn't have to tell people that, because, in fact, they knew that if your mum or dad ended up in hospital, and no matter how much home care you put into the home, their care is too heavy to go home but they would be able to get into a long-term care bed in a reasonable period of time and they didn't have to hedge their bets a year and a half, two years in advance. That's the thing that we need to figure out and most jurisdictions need to figure that out. We're not unique in this situation, so that's one thing we need to figure out.

 

We also do very much need to figure out the - again, I was speaking earlier with your colleague about the diversity of home care services that we need to provide people with. So many seniors become frail, fall, go into hospital, get services, maybe OT, physiotherapy, and then they go home and they get very little, when what they really need is to have ongoing physiotherapy, occupational therapy. They need to be able to keep their strength up. They might need some oversight of their diets and nutrition, a review of their medications.

 

I hope this budget is the beginning of that process to strengthen our home care system to provide not only - and not to denigrate or diminish the home support workers and the nursing staff that go in, but to also see that we have occupational therapists, some nutrition work, physiotherapy with seniors. It will allow us to have a much more robust home care system and it will allow people to stay at home and be healthier longer. That will divert people from repeatedly having to go back into the hospital and then on to a long-term care facility.

 

There are other things that we really need to think about as well. I think there are more and more innovative ways to house seniors in clusters, to use technology to be able to monitor how people are doing, to build seniors care into community planning, for example. I look at some of the countries - I know that there are geriatric specialists here in Nova Scotia who are really interested in the Netherlands and what they've done. In fact, the paramedics going into the nursing homes really comes out of that context of providing a different mix of health care professionals in nursing homes. Well there's nothing to prevent us from developing programs where paramedics can go into the home.

 

So if we can improve the turnaround times that paramedics have in offloading their patients at the QEII, for example - free up time - we will have another level of trained health care provider who would be able to go into the homes of frail, elderly people and check their blood pressure, do some work around catheters, maybe. There are certainly any number of things that we could be doing with our health care providers in people's homes that would result in much better care.

 

Now, I think that we also need to work with the seniors' community, you know, the Group of IX, I meet with them. The Minister of Community Services certainly meets with them as well, she's the Minister of Seniors. We meet with them and we talk about the services that they see as being important. There are a number of really significant groups around the province. There's the group that really has oversight of the community links, they're the group that have oversight of the falls prevention strategy. So I think we need to continue to work with seniors' organizations and harness their ideas and involve them in policy development.

 

We're certainly trying to do that but again my hope is that this expansion, it's significant, a $20 million expansion in home care services in this budget will result in a much strengthened program of home care services for seniors. They will be able to stay at home where they're comfortable, they find their surroundings familiar, they have their privacy. They're able to maintain their privacy, their dignity. Although many of the new health care facilities are palatial in many respects, they're lovely place, they're still not home and for many, many people, it's not necessarily the beautiful surroundings, it's being where you're comfortable, where you're familiar, and you have your family around you.

 

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and thank you, Madam Minister, for that as well. I'm very interested in your comments too because I know there were a number of incidences, whether it was North of Smokey and I know we talked about that one when we were talking about having an extra ambulance, I think the original question was North of Smokey. But what we really ended up doing is getting the paramedics out in the community, going to visit Mrs. Smith or Mr. Smith and taking blood pressure, have you taken your pills today, you know, let's have a look at your pills to make sure that you're taking them correctly, and those kinds of things go a long way in keeping seniors in their homes for longer periods of time.

 

I mean I look at people in my community, I know we all have them, you know, 92-year-olds and still driving cars. My grandmother is 98, I mean God bless her, she's 99, sorry, and living at home but we have an aunt that helps her out a whole bunch but, you know, relatively healthy. Just a little bit of health goes a very, very long way and I think any bit that we continue to help - but I agree with the minister too, is that we still have to have better identification of these individuals.

 

I don't think it's good enough that a doctor says, you know, geez, we need to get your mom or dad on the list because in two years time he or she is going to need it. I think through a whole bunch of issues that the doctor should identify that for a follow-up with whatever that new organization is. I don't know who would get contracted to do it, maybe the district health authority, whether it be the home care agency, whoever that person is to continue and do an assessment, to follow that individual along through their needs as they continue to age and need services.

 

So I think there's a number of things that we can intervene on to make sure that they stay healthy and then we would have a better idea of how many people are actually waiting for a long-term care facility. I think our numbers, the last time we asked it was like still in the 1,500, 1,700 person range, but is that a true number? Are there a lot of those folks who just happen to be on the list because two years down the road they're going to need it, or is it an actual list of people needing that level today?

 

I just want to maybe ask this one as well. Just what is the outlook for new bed constructions? We know we got ourselves to a decent mix across the province on this because the original build-out on long-term care facilities was at least to give places like Colchester, for example, some long-term care beds, which they didn't necessarily have, and just try to balance that off across the province. The next step was to start to build that out a little bit. What is the department's thought on further building because I didn't see that anywhere in this year's budget to build anything new so I'm just wondering where that is right now?

 

MS. MAUREEN MACDONALD: Thank you very much, it's an important question. In 2012-13 the forecast is as follows for beds opening: we anticipate that in May of this year, Inverary - I think that's in Cape Breton, Inverary Manor, must be in the Baddeck area I would think - 71 beds will open on the 12^th of May; Miners' Memorial, 13 beds; and Glades in Dartmouth, 66 beds; for a total of 150 beds opening. Next year the beds under construction to be completed are: Nakile, 12; Maple Hill, 13; and Villa Saint-Joseph du Lac, 79; for a total of 254. That will complete the construction of Phase 1.

 

The amount of investment in this budget for 2012-13 is $8 million. It's for new and annualized operating costs for long-term care. Now, as I said, we are doing this review in the department before we go forward. The Continuing Care Strategy was a 10-year plan, a multi-year plan. It, I think, looked out until 2016 so we are a little more than halfway through. There have been some learnings, I guess you would say, along the way. Certainly staff in the department have learned from that process and before we proceed - it has been very expensive, as the member knows, a very expensive undertaking - so before we move forward we want to assess where we are. What are some of the learnings? How would we apply that and, again, what are the current conditions? What are we looking at in terms of the numbers?

 

The member talked about the wait-list and in spite of the fact that more capacity has been added into the system - I think there are about 1,000 more beds in the system than there were - the wait-list, in fact, has pretty much doubled, or something like that. It has outpaced the growth of new beds.

 

It's really quite funny, I was at the opening of the new facility in Duncan MacMillan out in Sheet Harbour not so long ago, about two or three weeks ago, and I swear there was a woman there who wasn't much older than me who came up and told me that she and her husband had gotten themselves on the list, it is such a beautiful place. I keep running into people who tell me that, and I'm thinking you're not going to be ready for this place for another 25, 30 years; what do you mean you're on the list?

 

The new places are very beautiful. I can see why people would be tempted to want to get on the list but we really need, again, we really need to have good data, we need to know what those lists really mean, we need to know who is on the list for the eventuality that's two years ahead and who needs a bed right now and to be able to sort that out. We also need to be able to answer the questions, what does a continuum of care look like that provides so you don't have to go from zero to long-term care with nothing in between?

 

That work is underway. As the member would know, the Continuing Care branch in the Department of Health and Wellness is a very capable group of people and they work very hard and are passionate about providing the best services possible to people in continuing care. I don't know if the member knows, but the devolution of long-term care to the district health authorities is pretty much complete now, just very much in its infancy I would say. Service agreements have all been put in place. One of the CEOs, I think it was John Malcom in Cape Breton, told me that where they had service agreements in place awhile ago, they saw a marked increase in their ability to move people who needed long-term care out of hospital into these beds. It was astronomical how much more quickly that was occurring.

 

Really, that's what we need; we need a system that is integrated, a system that is effective, a system that opens hospital beds for people who need to be in a hospital bed and places people who need to be in a long-term care bed. It has been a long time coming and I'm sure it will not be without its bumps. There's very little in health care that isn't without its bumps, but really, I think it's a significant development in the provision of care to people. Many other provinces have had an integrated continuing care system in their provinces for years. Not that it has solved all of the problems, in fact it will probably create a few new ones but nevertheless it does make a significant difference.

 

I think there's quite a bit more work to be done in this. We do have an aging population, we do have the proportion of people who are over 80 growing as well. It's great, people are living longer, but that means they have a different set of requirements in terms of their residential needs, their health care needs and so we have to very much keep our eye on that.

 

I'm being told that our current wait-list shows in excess of 1,800 people. The wait-list is very, very long but as I indicated, we don't really know what that means. Does it mean 50 per cent of that wait list is just in case in the next two years I might need and it's an insurance, it's get on the list for insurance, or is it immediate and how do we sort that out? That's work that's underway. Thank you.

 

MR. D'ENTREMONT: Madam Minister, thank you for that answer. The issue of devolution or integration or whatever you end up calling it, I remember a whole bunch of discussions around that one. If you talked to the DHAs, they wanted it, it's time we open our eyes or at least get rid of that firewall so we can see what's going on on the other side. Then you would talk to the long-term care folks and they would say, please don't do that because the DHA is going to take away all our money. I think at the end of the day, let's just knock down the silos, let's get rid of the firewalls; let's all see what everybody is doing because, at the end of the day, it was all for that one patient, or those patients, to make sure that they had the services they actually required and not necessarily the ones that were haphazardly picked, one over another.

 

I think that was really important and I know that probably through our discussion, the member for Hants West will get up and talk about single-entry access and his feelings on it, and I won't go into any depth on that, but I know he has never been a supporter of it. I think there are some tune-ups there that probably need to be done which is, of course, the computer handling system for all of this as it flows along and the identification of it. Then it rolls into the issue of the cost of the whole thing.

 

We know that as we put the long-term care strategy together, it was built on the best data of the day, the stuff that we could put forward and, you know, I think even with all the best data that we could possibly get, it still does not give us the look into the future that we needed, or the crystal ball that we needed, because we see how, maybe, some of those projections weren't quite correct and we've seen that population continue to change.

 

It's not straightforward anymore - life and death cycles as it flows along. We are looking at average ages being quite a bit higher than they used to be and we are looking at, from a health care standpoint, people going in for multiple cancer surgeries, multiple times. We're being so much more successful in many other domains in health care that of course our seniors are lasting a heck of a lot longer than they used to and I hope that I'm going to be that lucky as well to move on into my senior years, but then again, with this kind of job, who knows? It makes it all that much more difficult - maybe we all need to be on the list there right now.

 

I do remember - I mean it's true, as we build out the system - I remember sitting in on a number of meetings on Bayside - and I know the Minister of Fisheries and Aquaculture can appreciate this - it came down to a discussion on the size of the hallways and the sizes of the rooms and how big the closets were going to be and those were things that I know you would feel that, as minister, you shouldn't be dealing with, but those were the blocks as we built a lot of those facilities. If there's anything that I can add to that one is, the mistake we did there is we should have provided a box. Here's what the box will be rather than providing such an open sketchbook, I guess is what you would call it, on the construction of those facilities.

 

I've been to, not all of them, but I've seen a heck of a lot of them up until now and no wonder people want to be on the list for them. Heck, I wanted to move into a couple of them at this point because the facility that they are, they're wonderful. Do they always need to be that wonderful? Well, yes, I think they do because it's home for those individuals and I hope that everybody has that opportunity as they roll around. Are there cost savings there? I think there are. I think there's a lot of work that we, as a department, as government, as Opposition members, can push for something sensible as we continue to move on these facilities.

 

Let me move into something I was going to actually talk about as I started off and ask a little more specifically and give Linda and Frances a little more of a workout here because I'm going to ask for a little bit of the book stuff here. I want to go to the FTE account. Last year the department had budgeted for 465 full-time equivalent positions. That's on Page 13.3. Last year the department overshot that by making an estimate of 505 FTEs, I believe, while the latest forecast shows only 424. So I'm just wondering around FTEs, why is it still estimated that we'll need 41 more FTEs than we needed this year?

 

MS. MAUREEN MACDONALD: Thank you very much, it's a good question - hard to understand from the Budget Books for sure.

 

The first thing I would say is just to remind members that an FTE isn't a person. We may have part-time positions, we may have people on leave or whatever, job-sharing, I don't know, different things. We eliminated 35 FTEs in the department, in administration. Then, in addition to that, we had vacancies and it takes a while to fill vacancies, which would be reflected in the forecast. It would look like you didn't have people but, because you didn't have them, you had vacancies, but it doesn't mean that we don't need people. We need to fill those positions. That's why you see that discrepancy from estimate to estimate, estimate to forecast.

 

MR. D'ENTREMONT: Thank you very much, minister, for that. The reason I use this is that a lot of time what we see is the time it takes to put it in. What ends up happening is the department, in some cases, can use that unfunded FTE for other things, as it rolls around, I think maybe as a relief value is how I got it explained a number of years ago.

 

The issue is that this year we made it with 424 positions and we are now estimating that we're going to be needing 465, so the best guess how we ended up at the end of the year in the forecast was the 424, and then we're asking for 465. I'm just wondering - where are those positions going or what programs will these folks be filling?

 

MS. MAUREEN MACDONALD: So each month a position is vacant, the FTE is adjusted downward, so it's not necessarily people, once again, you know. That's the explanation for that.

 

MR. D'ENTREMONT: I think that's the issue, too, and I do remember some of this work being done when we were government, the issue of head count versus FTE, in a lot of cases, how many actual people are working in the department, versus someone else. I thank the minister for that answer.

 

Maybe she's got more to add after that but if we go to Page 13.10, we get into funded staff number there. Last year the department estimated a need for 6 FTEs, apparently the forecasts showed a need for 14.3, and this year they have an estimate for 19.4. That's an increase of 13 positions so I'm just wondering, maybe that's the same kind of adjustment that needs to be done. So if you're adding 13 FTEs, but there seems to be a decrease in the estimate for programs. Can you try to explain that one better than I can understand it there?

 

MS. MAUREEN MACDONALD: The numbers that the member is focused on, this is the explanation for that. There are six new FTEs for the Drug Information Systems and 6.88 new FTEs for Emergency Medical Records. These two projects are TCA projects in which the increase in FTEs is offset by an increase in recoverable FTEs; one new FTE for Legacy of Life, which is the organ donor program; and a 0.5 FTE reduced for wait times as the project is completed. So that explains what those specific things are for.

 

Earlier when you made reference to some of the earlier numbers, we set up a quality control unit inside the Department of Health and Wellness. We did not have a quality control unit, which is a serious oversight. It's a small unit but we set it up, hired an executive director. It took a while for her to develop the unit, how many staff were needed, and so you'll see that reflected in the change of FTE numbers between estimate and forecast and then estimate.

 

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and I thank the minister for that answer. It also brings me, as we move off FTEs for a minute - and I'm looking at the programs and services, provincial programs and initiatives - I was looking for HITS-NS or anything that would talk about the electronic medical record. You did mention a little bit there and I'm just wondering where that is and what are we spending on that?

 

MS. MAUREEN MACDONALD: It is on Page 13.10, Information Technology Initiatives Projects. That's what it is, it's just named differently.

MR. D'ENTREMONT: I'm also just wondering, again this is a larger question than anything specific here because we're, of course, seeing an expenditure there of $41 million, almost $42 million for this year, where is EMR as it stands today, as we talked about doctors' offices utilizing electronic medical records, which probably goes back to our question of identifying people for long-term care, identifying people for different kinds of medical situations and the gamut, I'm just wondering where EMR is in that number of the $41 million. I know it's not just that because we talk about PACS and there's a whole bunch of other programming that goes in there.

 

MS. MAUREEN MACDONALD: Mr. Chairman, the member asks, I think, a very important question around the electronic medical records. Most people would know, but some people might not know, that we, like most provinces, have been working toward getting our patient medical information from clinics and hospitals and other medical services to be stored in an electronic health record. It will make such a huge difference in terms of the efficiency of our health care system and the reduction in mistakes, in not having duplication of tests and so many things as a result of having an electronic medical record.

 

We have a long way to go but we are making progress and we continue to work toward the goal of having all of our patients' medical information on a medical health record. Of that $41 million in the estimates, $8,240,000 is allocated for the electronic medical record. The member may have noticed that Nightingale, for example, Nova Scotia is the first province in Canada to have that particular system achieve certification as having met particular standards, which is, I think, a great achievement and I'm looking forward to great progress on seeing this initiative province-wide.

 

We are partnering, of course, with Canada Health Infoway and anything that the member can do, anytime he's speaking with his Member of Parliament, to encourage the federal government to stay involved and support this initiative. It's very important to a province like Nova Scotia that we have a willing partner in the federal government to help us change the methods in which a patient's information is stored and exchanged. It will certainly help our health care system.

 

We're hoping to add 200 doctors to the system in this year. We have about 1,730 physicians using the system now, plus some others as well. As I said we've made some progress, we still have a ways to go and it's a very important initiative.

 

MR. CHAIRMAN: I wonder if the honourable member for Argyle would permit an introduction.

 

MR. D'ENTREMONT: Absolutely.

 

MR. CHAIRMAN: The honourable member for Halifax Atlantic on an introduction.

 

MS. MICHELE RAYMOND: Thank you very much Mr. Chairman and I really appreciate the indulgence of the member for Argyle and the Minister of Health and Wellness. We have joining us, actually, some young people who have come from all over the country to Nova Scotia and I'm very privileged that they actually have taken up residence in my riding of Halifax Atlantic while they are working as volunteers with the Katimavik project.

 

They have come from Ontario, Manitoba, Quebec and from British Columbia to help with a whole variety of projects here. The theme that they are working on this time is Environment and Healthy Living, which I know is very close to all of our hearts and in the course of this they are working with Sackville Rivers Association, with the Edward Jost Children's Centre, with the Ecology Action Centre, Chebucto Families and all sorts of other things.

 

They are bringing not only their incredible enthusiasm but also the experience of other parts of our country's culture and I think we should give them a very, very warm welcome. If everybody would stand as I introduce you, that would be wonderful. We have with us Ashley Davies, Katelyn Vandersteen, Orissa Miller, Luke Goldsmith, Grainger Talgoy, Miranda Day, Dylan Kent, Leah Rousseau, Charles Rondeau, Leanne Cleary and their housemaster, I guess I'd say, Adim Hébert. So if everybody would give you a very warm welcome.

 

MR. CHAIRMAN: The honourable member for Argyle with about 10 minutes left in this round.

 

MR. D'ENTREMONT: Thank you very much Mr. Chairman, and of course, welcome to our guests in the gallery today. I just want tell them that normally it's not this congenial, this is probably the best discussions that you will see. We try to, of course, ask questions of government in this process and, of course, I'm thanking the minister for her answers on this one as we go through the budget process.

 

I was wondering - and again thank you for the comments around Canada Health Infoway and anything that I can possibly provide to this one I will try my best. It's funny, as I sit here in Opposition I don't necessarily have that same stick that I used to have, but I will make a few phone calls if that is what needs to be and if the minister wants to provide any specifics that she would want me to pass along, I'd be more than happy to do that as well.

 

Maybe just to finish this issue off too, it's the issue of getting everybody onside. There was probably a twofold challenge when it came to electronic medical records, which was one, the availability of Internet across the province. Some of the rural areas where doctors were teaching or were practising, Internet was not available. I'm hoping that we're almost there, that everybody does have some kind of access to it. Maybe the bandwidth isn't exactly what people were expecting is what I've heard from some of my local docs. I'm wondering, everybody's adopting Nightingale and the 200 docs that are still to come on, how many does that leave us with to bring it online?

 

MS. MAUREEN MACDONALD: The staff looked for that specific information. I just want to go back on to the HITS question. From that Information Technology Initiatives Projects, about $25 million of that is specifically for HITS - I don't know what the number is - I was thinking that we were about at 50 per cent of our doctors but we're maybe not quite there yet on the electronic record. We have more than 400 family doctors on and about 50 specialists on. If we bring another 200 on we'll be more than 50 per cent.

 

MR. D'ENTREMONT: I thank the minister and the staff for that. It just shows that we still have a fair amount of work to do in selling the issue maybe even to some family doctors. It's very difficult because we do have family physicians in this province who have been practising for a long time and are very happy with their paper systems and know that they can grab information as quickly as they can off of those paper files. I know what my paper file looks like and I would sure as heck like to see that in some kind of electronic format. I've told my physician a couple of times on that but to no avail. Apparently she does want to stick to that.

 

In today's world, I'm not using this as a prop, but I do have my iPad here. In the world of electronics, it always frustrated me to see the complexity of Nightingale, the complexity of the server systems, the complexity of user access, what kind of levels of access you're allowed to have, et cetera, how complicated this actually is rather than just providing a computer to a doctor. It still frustrates me at this point that we're only about halfway through the physicians at this point, knowing that my information is not available - if I have an event here in Halifax, if I get sick - that my file from Argyle is not available to the specialist or to the attending physician here in Halifax.

 

Or, if I did get sick or any one of us did if we were in Vancouver or anywhere else on a meeting or what have you, that there is still no access, that we still have to hope that the information can be faxed, that we're able to get the doctor's office to begin with. I don't know if you've tried to call your doctor's office lately but it's still a hard thing to do; trying to get that information disseminated is very, very time consuming and difficult when a lot of times in a medical emergency, time is of the essence.

 

I do thank the minister for those comments. I know you said HITS are $25 million, EMR sitting at around $8 million. What other electronic initiatives are still there? Is there still a build-out on PACS or the X-ray program? What else is new out there that I'm maybe not aware of?

 

MS. MAUREEN MACDONALD: We're very close to the end of the patient medical record archival retrieval system. There is a very small amount of money in this budget to complete that project but it will be completed this year. Some things are drawing to an end.

 

This budget has the Drug Information System as part of that line item - $4,576,000. This actually is a very significant development. This system will track drugs prescribed to an individual within the province. It will establish a record of adverse drug reactions for the individual and it will support other services that require pharmacological information with respect to the individual. It's going to be of very great benefit in a variety of ways. It will have great merit for people who are legitimately receiving prescriptions and it also will help us with respect to any potential drug abuse as well. It is a significant investment. Last year the estimate was for $3,170,000 and this year is $4,576,000, so it is significant.

 

I was just saying to staff that I'm a techno-peasant. I'm terrible with technology and this is probably the part of my job that I least like. My eyes tend to glaze over when people talk to me about technology. It's very bad. I realize this is probably my big weakness, my big Achilles heel because it's so important, especially now in our health care system, it's extremely important. I'm glad you asked me the questions and make me a little less complacent, pay a little more attention to the health information stuff. Maybe the people over in the department who toil away in this area will feel a little less neglected by their minister as a result.

 

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

 

The honourable member for Kings West.

 

MR. LEO GLAVINE: I just had one question to finish off around the area of communications, or a few questions around that one area of communications. When we finished off, I was drilling down a little bit on the type and so on of communications. One of the areas that Dr. John Ross talked about, as you yourself said, was to communicate, communicate and continue to do more.

 

One of the areas that he specifically referenced was when he referred to communities impacted by changes to the Collaborative Emergency Centre model to actually have consultation process and information process. We do have one of these collaborative practices now in Parrsboro; we have others in the planning stages. I wonder if that kind of communication, that kind of consulting - not the best term - but at least educating the community about how this will shift from the full emergency care, which in the communities identified has been inconsistent at best. Have those kinds of deliberations actually taken place and what is planned so that people know exactly - as you've talked about - where to go at certain times to get the right care in as many occurrences as is possible?

 

MS. MAUREEN MACDONALD: I want to thank the member for the question. I think that as we open Collaborative Emergency Centres, we learn each time we open a new centre. We try to improve on any of the lessons from the last centre.

 

To give the member a little idea of the process, for example, Annapolis Royal, which I know is close to the member's backyard - not precisely in his backyard, but close. I have been to that community several times and have had meetings with, as well as the deputy minister and staff from the department, we've met with the Friends of Annapolis Royal, the doctors and the nurse practitioner who work there, so the health care providers. I know that Dr. Ross certainly was there.

 

As the work continues, the DHAs are very much involved in developing the CECs. We continue to work with the DHAs but the DHA staff are more on the ground, in some way. What we did in Parrsboro was to send leaflets - I wish I had brought with me a copy of them, I may have something here in my bag; I'll root around, if I can, between questions and see. We had a leaflet, a Better Care Sooner leaflet that introduced the Collaborative Emergency Centre to the residents of the community.

 

We sent that to each and every household, we did a householder. We sent it to each and every household in the community telling residents of the change, telling residents of the opening of the Collaborative Emergency Centre and giving them some information. You probably have seen the ads that have been in the newspaper around Springhill, the opening of the CEC in Springhill. We've done some advertising like that. We, by radio, I believe, invited the public to come to the Collaborative Emergency Centre for an information session of some kind.

 

As I say, every community is different. Some communities have a Friends of Annapolis Royal and other communities don't; they don't have an organized group of citizens whose focus is on the future operation of the health care facility and so we have had to find different ways to communicate with people. With the CEC in Annapolis Royal, not so long ago I met with the Friends and one of the things that I offered in the discussion - because they really wanted to be involved in communicating to the community; they see that as being their role and that is a role they have played. They've organized some public meetings and they have some kind of a vehicle for communicating with people.

 

I said to them, we have the resources to put a leaflet on every doorstep in that area around Annapolis Royal as a CEC. We agreed that they would participate in the development, in the information that went in there. I know that certainly has occurred.

 

With Tatamagouche we'll probably do the same thing with maybe some little variation. They have a very active community health board in that area. No doubt they will be able to help inform us of the right way or the best way to help get the word out and communicate with people. I'm not sure exactly what we will do when we get into the Musquodoboits but I know that my colleagues, both of the members who represent Musquodoboit Valley and Musquodoboit Harbour will both be very helpful in informing me and the department about the ways we can best communicate in those areas.

 

We try to take advantage of anything that we can, every little group and every little opportunity on the ground. It may be doing some local advertising in the local newspaper, maybe using the ChronicleHerald, maybe using promos on the radio, householders definitely, we definitely will do householders to every citizen, every household in the user area.

 

We've been doing, as I indicated, a lot of public information, public education around the Ross report and Better Care Sooner to have people become more familiar with the various things they can be doing to take greater control over their own health and improve the responsiveness they get from the health care system. That may be, you are probably aware that we sent fridge magnets to every household around 811, the dial-a-nurse line. We provided households with that little thermometer that showed them from when the situation is less serious where to call to when they needed a 911 kind of call. It's all about going back to creating awareness and helping people get to the right place, find the right door, not waste their time, not waste the health care provider's time and the resources in the system.

 

The better informed public we have, the better it will be for us all with respect to the best use of health resources.

 

MR. GLAVINE: I raised that because we did have an example in the Valley, not so much around a change of an emergency room to a Collaborative Emergency Centre but rather with the closure of, or the dramatic reduction of hours at the Berwick out-patient clinic. It was an example of where lack of communication actually created enormous problems for the community and the area where there was very little or no consultation, very little communications. In fact, now in a follow-up meeting with the DHA they obviously realized that they had a very poor communications and public relations job in doing that.

 

My hope is that there has been a learning curve for our area and the DHA that has changed and we expect more change to come. That's going to be the nature of good health care delivery going forward. I'm hoping that we have made some constructive change that will allow for the community to engage, not as a reaction after the fact, but as part of the process.

 

I think that is what I took from the report of Dr. John Ross, not just around emergency care but any time you deliver immediate but less urgent care, that's what's taking place to a good extent with the appointments. We know that if the community had been involved I think we would have had a little bit more of a natural evolution as to what the community wanted. The current situation is found wanting from the point of view that the average number of cases that aren't seen are somewhere on a daily basis of seven to ten people who are turned away from the Berwick clinic. You have to get there early, get one of the 20 places.

 

Unfortunately, it's also because of that construct that is there, it becomes very limiting when some additional patients could perhaps be seen. Sometimes you only need five minutes to refill a prescription for somebody who doesn't have a family doctor. I think a little bit more flexibility built into that situation would have been strong for the patient but also it wouldn't have these people now going to the emergency in Middleton or to the emergency at Valley Regional. Fortunately there is triaging at Valley Regional and they don't have to get in the queue for those who are in trauma situations; a doctor can see those patients.

 

Do we have the best use of our personnel all the time in terms of the system that's in place? That's more of a comment than a question to the minister that I see as part of what was a prescription by Dr. Ross in terms of implementing change to the health care system.

 

I was going to go on to staffing and full-time equivalents and I was outside the Chamber and I know the minister was dealing with some of this, so my apologies if there is a repeat of some questions here. I was looking at Page 13.4, it outlines an increase of 40 employees in the administration of the Department of Health and Wellness when you compare estimates this year to forecast. How many current staff do you have working in the department in the area of administration as of the present time?

 

MS. MAUREEN MACDONALD: The staff in the Department of Health and Wellness are all administrative staff. That's what the Department of Health and Wellness is. We don't see patients; we don't provide counselling, well, we counsel the minister once in a while, but outside of that, the staff in the department are administrative staff. They are all administrators.

 

They fulfill a variety of roles from senior managers, people who oversee policy development and their support staff. A lot of the senior managers have people who work under them and clerical folks and people who answer the phones. We have receptionists and what have you. Those are the numbers that you see reflected there.

 

I'm told there are a small number of adult protection workers in the department. You will remember that Continuing Care was a division of the department and the first thing that happened was the care coordinators, who used to be department staff, were devolved to the district health authorities but there are a small number of people who do adult protection. Outside of that, that would really be the only folks who do case work, if you would. Everybody else is involved in the administration of the health care system.

 

MR. GLAVINE: I was going to come back with that question to at least get even a ballpark of where we are today with numbers in the Department of Health and Wellness.

 

MS. MAUREEN MACDONALD: We're at approximately 464.9 FTEs today. I know that the deputy and I had a conversation about a week or so ago when we were getting ready for budget estimates with respect to targeted reductions. I know that we have reduced by 39.3 the number of positions in the department. We have met the targets we were given by the Department of Finance, and that's where we are at the moment.

 

MR. GLAVINE: Are these reductions across the department or are there particular areas that the minister and deputy and department officials will target in order to reach the desired number?

 

MS. MAUREEN MACDONALD: The member is correct, they are across the department and they reflect a variety of circumstances, including attrition, vacancies, not filling vacancies, et cetera.

 

MR. GLAVINE: I note in the minister's budget on Page 13.3 of the Supplementary Detail, that there is a staff complement of 29 being funded by external agencies, eight more than the estimate in 2011-12. Could the minister indicate what positions these individuals are filling and the respective external agencies that are funding them? For example, the minister's senior policy adviser is from Health Canada and there is a communications officer from the South Shore District. So I'm wondering where are these people - are they funded by the department or by the agency or area from which they would come?

 

MS. MAUREEN MACDONALD: They are funded from the area from which they came. We would have to get you a more specific list of positions throughout the department but yes, it's true, I know that we do have a communications person who is probably on a secondment or a term of something, from the South Shore District Health Authority.

 

The senior policy adviser to the minister is a secondment from the federal government, from the Public Health Agency of Canada and there would be other people throughout. It's not uncommon I guess that from to time we will have someone come in from the district health authority. I can think of a chap in the department who has come from the Pictou County District Health Authority and, yes, so sometimes we may have a term, somebody is away and we have a term opening and someone from out in the region will apply to come in and fill that term, and that would be reflected in these numbers.

 

MR. GLAVINE: Madam Chairman, if these positions are then carried over into the next fiscal year, do they then come under the Health and Wellness Department budget or the administration unit, or do they still remain as part of the budget from the district health authority that they would be seconded from?

 

MS. MAUREEN MACDONALD: I believe it depends on the arrangements with the individual, you know, and each case can be different. Most of the recoverable positions are IT positions and secondments.

 

MR. GLAVINE: The minister in answer to a previous question around staffing said there would be overall reductions of 39.9 positions but yet on Page 13.10 it shows an increase in funded staff of 13.4 employees estimate over estimate. So which of the programs and services listed on Page 13.10 will see an increase in staff and what will be the nature of the work for these people?

 

MS. MAUREEN MACDONALD: So let's have another little go at this. There are six new full-time equivalents for Drug Information Systems, 6.88 new FTEs for Emergency Medical Records. These two projects are TCA projects in which the increase in FTEs is offset by an increase in recoverable FTEs. There's one new FTE for the Legacy of Life, which is the organ donation program, and 0.5 FTE reduced for wait-times as the project is completed.

 

MR. GLAVINE: So I guess then we can say we have both increases and decreases but overall you've outlined where we are. So go back then to Page 13.4, administration for Financial Services is increasing by $982,000. Why would that be the case and I'm wondering if the minister could refresh my memory but I believe this is one of the merged services. So we're having merged service but we do have an increase here but maybe it is in the short term? So perhaps if the minister could explain that.

 

MS. MAUREEN MACDONALD: The explanation for that is that there's a transfer of funds from TIR for the lease at Barrington Towers. I don't know if members are aware but the Department of Health and Wellness will be leaving the Joseph Howe Building. In fact, I think the first group of staff has already moved into Barrington Towers over in Scotia Square. They were the folks who were down in the former HPP Department, down on the waterfront, and so they've been relocated. The rest of us will be going in stages over the next few months. This represents a transfer of funds from TIR with respect to the new lease arrangements for the premises there.

 

MR. GLAVINE: Policy and Planning administration is increasing by $319,000. Does this mean a staff increase or incremental increases for staff or additional hirings? Could the minister provide an explanation of that particular increase?

 

MS. MAUREEN MACDONALD: It's a combination of a transfer in from elsewhere, a new position that was created. I had spoken earlier about - we had the combination of the two departments, each with a policy shop, and so there has been some rebuilding, I guess you would say. There has been a reorganization of Policy and Planning from those two departments. As well, as the member would know, we're nearing the end of the 2014 Health Accord and so in order to do the work with respect to supporting the minister and the Premier around the negotiation of a new accord and the features of a new accord, it has been necessary to look at the capacity in the department to do the analysis and the policy work.

 

MR. GLAVINE: We all realize that will be critical work as a new accord is formulated. We know it could, from early days, have far-reaching implications for the province so that is important work indeed.

 

The next area of Quality, Safety and Wait Time Improvements, that budgetary line item is decreasing by $268,000, estimate over estimate, and I am wondering if there is something specific that is targeted for cutting. We all realize that that is an area that when we take a look at the nature of that particular work, the minister talked about enhancing quality in the system, certainly making sure that safety in facilities was of paramount importance and we all know there are many areas of wait-time improvements still required throughout the system. I was wondering, is there a specific targeted area?

 

MS. MAUREEN MACDONALD: That's an excellent question. As I indicated earlier, when I came there was a wait-times unit in the department, but there really wasn't a quality unit. We recruited and set up a small quality unit in the department and initially about $190,000 was used for consultants, in the early days, but that consultant work is no longer required and so we are able to reduce the expenditure because now we have a fully staffed unit.

 

In addition, I think it is really important to say that the role of folks in the quality and safety improvement area is - they operate as an oversight, as a resource, as a clearing house. These are people who have great knowledge and great skills. For example, when the C. difficile outbreak occurred in Cape Breton, they were up there as soon as they were aware. They quickly identified what some of the requirements were. They worked very closely with the district health authorities. They are people who have a great capacity to help us and work with the districts. It's important to recognize that the districts do have quality control people in their district but these folks play an oversight, a support role, a resource role, a clearing-house role in terms of knowledge around what best practices are and how to move really quickly and how to get the resources from the department if required.

 

MR. GLAVINE: One of the areas decreasing is Public Health Office administration. While the minister talked about that, systems have a way of growing administration and that her government's plan is to have a long-term view of reducing administration at the DHA level and perhaps at the department level.

 

Public health, as the minister talked about early in her introduction, is an area that when done well, when executed with a plan with targeting some of our significant areas, can have a good cost benefit to Nova Scotians in the long term. We know that when we have good prevention and preventive medicine programs, when we do things like targeting an area like southwestern Nova Scotia where we have four or five counties where we have the highest incidence of stroke, not only in the province, but some of the worst statistics in the country, if we do good public health around prevention, then we can have better outcomes and hopefully cost savings to the system.

 

Is some of this going to be downloaded to the DHAs to carry out or is there good rationalization for changing the work going on with the Public Health Office?

 

MS. MAUREEN MACDONALD: I want to reassure the member and other members that reductions are targeted at administration. They're not targeted at program and services, even in Public Health. Public Health, like the rest of the Department of Health, has had to shoulder some of the burden of admin reductions. We have seen and we will see reductions in travel expenses, we will see and have seen reductions around meeting expenses, and we expect that admin in all of these areas will have to tighten up and see some reductions as admin in other parts of the Health and Wellness budget have had to do as well.

 

There will be a postponement, I guess I would say, of the filling of some admin vacancies. It will not and it should not have an impact on public health. We have a strong public health component of our health care system in our province. We are blessed, we are very fortunate with excellent personnel in the area of public health and excellent leadership in the area of public health. I have been very pleased to be able to have done some small initiatives but I think initiatives that have attempted to demonstrate my commitment to public health, and this government's commitment to public health. Such as, you know, removing user fees for flu shots and making that universal. People I hope will understand that the cost of doing that is not solely the cost of the vaccine. In fact, the cost of the vaccine is very small in the overall scheme. It really is about paying providers, you know, the kind of health care worker cost that's associated with having a more universal program.

 

So I think that we are committed, I think we've demonstrated that, that we are committed to public health, to a strong public health system. Public health, I can tell members of this Assembly, public health was hammered - it was more than hammered - public health was disseminated in the mid-1990s with the cuts in health care. The very first thing, the first line of health care cuts in this country back in 1995 when Paul Martin introduced his budget that took billions of dollars out of the health care system, it resulted in the dissemination of public health in this country from coast to coast to coast and this province was no different.

 

The government of the day with the reduced transfers they were getting from the federal government, essentially, pretty much destroyed public health care. That system had to be rebuilt. We're still rebuilding that system. We are still today trying to find resources to rebuild that system. So I'm very aware of the history of the funding of public health, the public health piece of the health care system, and how important it is to buck up and make sure that we protect the provision of public health as a component of our health care system.

 

MR. GLAVINE: Madam Chairman, two areas as well, and I guess it looks like two areas again with decreases; Physical Activity, Sport and Recreation admin, Addictions/Problem Gambling and Drinking admin. So I guess it's very similar to the previous area of the budget where hopefully administration is getting the strong look and cut but, hopefully, we won't see from these programs any less impact. These are two areas, as the minister is well aware and I think supportive of seeing that we need more positive outcomes for Nova Scotians. Again, along the lines of generating cost-savings in the long-term investment here will pay those kinds of dividends. So without going into a lot of detail and examples, I just kind of want that assurance that much the same process is going on here in these areas.

 

MS. MAUREEN MACDONALD: Yes, and again I would say to the honourable member I know these are areas that he values and sees as areas of priority as well. I share those concerns and it is the case that our approach, my approach, the department's approach is to protect to the fullest extent that we can, the face-to-face provision of services and programs for people who need them and to look at ways in which we can reduce expenditures on the administrative side - it can be tough but we will.

We look at our travel budgets, we look at participation in conferences and some of those things. We look at vacancies that maybe haven't been filled for awhile, if that can be put off, admin vacancies, for a little while longer. We try to find the roots that will have the least amount of impact on that face-to-face kind of contact between the public and people, especially vulnerable people who require services and programs to be there for them when they need them. The last thing they need to be doing is arriving at a door to find a "gone fishing" sign.

 

MR. GLAVINE: Thank you, minister, and that is one way of putting it indeed. The minister has budgeted approximately $14.5 million for Contracted Administration, could the minister please break down this line item.

 

MS. MAUREEN MACDONALD: As the member would recognize we have contracts with Medavie Blue Cross and with Quikcard, the dental program. So that line item reflects those contracts. As I indicated, the Department of Health and Wellness provides very little direct service to customers and patients. We deal with some major entities that oversee certain parts of the health care system and its administration. Certainly, those three, particularly Medavie, are fairly big and they're a big part of the administrative side of the health care system so that I think is what is reflected there.

 

MR. GALVINE: Looking at some specific program spending, line item by line item in the Estimates Book, Page 13.5 of the Supplementary Detail under Physician Services, fee for service has increased by $1.87 million. Now that may not seem like a very large amount based on the kind of fee-for-service total amount that we would have in the province but it is an increase. It begs the question, in fact, is alternative payment systems now at a stalled practice? So I'm wondering what has happened to keep this moving on an increase, is it just simply the annual inflationary amount or are there some changes in the number of people subscribing to the alternative payment?

 

MS. MAUREEN MACDONALD: I think if we looked at Estimates Books over time we would see this kind of trajectory for future service payments. The way I understand it, it is around utilization. It's simply a matter of the way our health care system has evolved. There are more tests now available but generally you have to see a doctor and they order them and that kind of stuff and they have a billing code for that. So, you know, utilization drives a lot of the increasing costs in the fee-for-service system rather than other things, but it's also very complicated. You can get ups and downs, right. So it is how does it all kind of balance itself out following patterns of utilization and, believe it or not, there are data sources and there are people who have expertise who watch this stuff in the department and they know a lot about utilization. It scares me sometimes how much they know about this stuff . Generally speaking, if we went back and we looked at the Estimates Books over, let's say the 14 years I've been here, you would see that kind of increase, sometimes maybe even more than this kind of increase in the fee-for-service lines.

 

The member might be interested in knowing, you know, just for a point of information, that Doctors Nova Scotia has been asking for a review of the fee codes. We have, like many other provinces, very outdated fee codes and they've gotten very complicated. The whole system has become really, really complicated because apparently once there's a code for something, it never comes off, it just stays there forever. So even though it might be a procedure that no longer is even done, it's still in the fee code. So we have made a commitment to do a review of the fee codes and to engage physicians around the province in that process. The work is in its infancy but, again, it's another significant undertaking in the department that will help bring some stronger rationale to the current system and help us do better planning and have a better system at the end of the day. One that, you know, doctors will feel less frustrated with and ones that we, as a government, can rely on in terms of their usefulness.

 

MR. GLAVINE: Madam Chairman, one of the areas that had a fairly substantial decrease is the Academic Funding Plans and it's budgeted to decrease by $2.8 million. Which specific funding plans have decreased and why - being nearly $3 million?

MS. MAUREEN MACDONALD: Academic Funding Plans are probably the most complicated area imaginable to mankind. As the member would know, there have been I think one, possibly more than one, Auditor General Reports around Academic Funding Plans. Academic Funding Plans are the way we pay specialists, for people who don't know what these are, so this is how we pay specialists. They also teach at the medical school, they also frequently do research and they see patients, they do research, they teach and they often have administrative responsibilities. We don't pay them to individual specialists, we pay them to groups of specialists. There was a surplus, there was more money in the AFP for surgery than was spent, than was required. So the budget more accurately reflects that reality.

 

I want to say to the member, we hired Deloitte, they did a review of the AFPs, they came in with lots of recommendations. We've had fantastic collaboration and co-operation between the medical school, the Capital District Health Authority, Doctors Nova Scotia, the department and I think probably the college as well, looking at AFPs, looking at a new model, a lot of work has been done and more work will be required.

 

The reduction that you see there is just reflecting more of the actual, there hasn't been an AFP that has actually been cut, let's put it like that. It's reflecting more of the situation that currently exists, as I understand it.

 

MR. GLAVINE: Thank you, minister. The next line item I wanted just a little bit of a breakdown on is a pretty significant budgetary item, the Emergency Departments funding for physicians. It's about the same as last year, down by just a few thousand, very small in terms of a $45 million budget item.

 

In terms of its breakdown to the QEII, the tertiary hospitals, regional ERs and rural ERs, is there a change there? We see overall not much change in the ER picture but I'm wondering as we break it down are we expecting more of the regional facilities, in terms of emergency care, where our highly trained ERPs, of course, are and less going out into I guess the more isolated communities that do have small ERs around the province.

 

MS. MAUREEN MACDONALD: Staff are looking to see if they can help me with this one but just off the top of my head, I don't think we anticipate any shift from the current situation, with respect to patterns of use in ERs. We know that ERs are, right across the country, under pressure.

 

Dr. Ross called the emergency room the canary in the coal mine. What we are doing is we are working very hard not only to support the emergency departments but to get primary care in place, so that people who have no alternative but to go to an emergency room to see a doctor, are able to get to see a health care provider without going that route.

 

In some areas this will make a big difference but in other areas it's not going to make a big difference. The current head of the ER here in the Capital District is a very interesting and very brilliant individual, Dr. Petrie. He spends a lot of time thinking about this and looking at the data and thinking about the characteristics of the patterns of use and where people are coming from and what their presenting problems are and what's driving that. Not so long ago he was in a meeting that I was in and he made the distinction between the emergency rooms outside of metro and the emergency rooms here in metro, particularly Dartmouth and especially the Queen Elizabeth II. He explained it so well, to someone like myself, as a non-doctor, a lay person. It was crystal clear, I thought well, that's absolutely right that this idea that primary care is going to take the pressure off these particular emergency rooms is unlikely. We suffer the big urban centre syndrome that you see in Edmonton, that you see in Vancouver, that you see in other major cities' tertiary care facilities. I think very much this presents a different set of considerations in terms of how we deal with those emergency departments.

 

I don't mind saying we've only scratched the surface. We've done some things in the emergency room here but we have a long way to go and more things have to be done. There is no plan and these numbers here don't reflect some policy decision to shift the patterns that we currently see in our emergency departments.

 

I'm just reminded that Cobequid, the expansion of their ER hours is definitely something that we continue to work towards.

 

MADAM CHAIRMAN: Order, please. The time allotted for today's Committee of the Whole House on Supply has elapsed.

 

The honourable Government House Leader.

 

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

 

MADAM CHAIRMAN: Is it agreed?

 

It is agreed.

 

The motion is carried.

 

[The committee adjourned at 8:29 p.m.]