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April 17, 2012
House Committees
Meeting topics: 
CWH on Supply - Legislative Chamber (640)














2:26 P.M.



Ms. Becky Kent


MADAM CHAIRMAN: Order, please. The Committee of the Whole House on Supply will come to order. We will continue with the estimates of the Department of Health and Wellness.


The member for Kings West has one minute remaining in his allotment for the Official Opposition.


The honourable member for Kings West.


MR. LEO GLAVINE: Madam Chairman, obviously with a minute, I'm thinking about and mentally preparing for an hour later on this afternoon and there are still very important topics remaining to discuss. One of the issues that the minister did raise yesterday is that probably more money will be spent on communications in the coming year so I want to drill down on that. Also, in the second hour I will address the concerns of the IWK Mental Health Services.


MADAM CHAIRMAN: The honourable member for Argyle.


HON. CHRISTOPHER D'ENTREMONT: Madam Chairman, it's a pleasure to get up and spend another while asking questions of the Department of Health and Wellness and I think in about a half-hour's time, I'll probably be sharing some of my time with the member for Cape Breton West and maybe even Hants West, if time permits, because I know they have some issues that they do want to bring up with the Minister of Health and Wellness.





Seeing that we do have a few visitors to the gallery, I thought maybe we could ask a couple questions about mental health issues especially when they pertain to the issue of child mental health and particularly the cuts to the IWK. A number of child youth workers are in the gallery and I'm sure they want to get some questions asked about their jobs. Of course, the 22 jobs that have gone missing at the IWK, or at least are being cut from the IWK, and try to complete the circle because I think we basically have a square that we're trying to put a round peg into here - just maybe some thoughts on the child youth workers and how that cut better serves Nova Scotia patients.


HON. MAUREEN MACDONALD: Madam Chairman, I want to thank the member for the question. Before I start to talk about mental health and specifically IWK Mental Health Services, I'm wondering if the member would agree that I table some information coming out of questions yesterday where I said I would get additional information. The member for Kings West had asked a question with respect to the Dalla Lana School of Public Health, for example, and so I would like to provide that information. The Department of Health and Wellness paid the line item that was identified to the school - which is part of the University of Toronto - for salaries, benefits, travel, and other expenses related to the education of two return-of-service physicians. These physicians are community medicine residents here in Nova Scotia. So that was that line item.


There were questions raised about recruitment expenses and the recruitment expenses were for physicians recruited to the Clinician Assessment for Practice Program, CAPP, and other physicians being recruited in the province. The Nightingale electronic medical record - we have 831 providers using this system: 419 GPs, 52 specialists, and there are other providers like social workers, dieticians, nurse practitioners, and so forth. I'll table that information. Those things certainly are there. If there is more information, as I have it, I will provide it.


Let's talk about the very important topic of Mental Health Services. As I indicated in my opening comments, there is new money in this budget for Mental Health and Addiction Services that will be specific to implementing the mental health strategy, which is expected in the not-too-distant future. In this budget there is slightly more than $4 million in new expenditure if you count in the $365,000 along with $3.8 million, the $365,000 being the drug program in terms of methadone and what have you in the Annapolis Valley.


As people here all understand, I have a background working in the field of mental health with young people. I used to joke about being the adolescent social worker at the Nova Scotia Hospital on the adolescent unit. I was pretty close to being an adolescent, I must say, when I worked there. I was in my early 20s; it was my first social work job after graduating from the School of Social Work.


I didn't start my career in human services, though, as a social worker, I actually started as a youth councillor working with troubled children, children in conflict with the law at the Nova Scotia School for Boys as a summer program councillor and I've worked in Truro at the School for Girls and then on to the Nova Scotia Hospital. I used to say that I think I was one of the few people in the province who had experience working in all three kinds of institutional settings that existed at that time for kids at risk.


This is a population that I really care about, not only because of my own experience, although I'm sure that has a lot to do with it, but young people are very engaging and compelling. It's very difficult to walk away from a young person that you make a connection with and you recognize that they have needs. Young people who are experiencing difficulty are a diverse group. Their difficulties can range from problems in a dysfunctional family to problems that have nothing to do with a dysfunctional family. There are kids who live in very functional families but these kids get into difficulty for a variety of reasons.


They may be in the early stages of a psychotic break, early psychosis, the beginnings of the signs of schizophrenia, for example. When I worked at the Nova Scotia Hospital, one of the things that was a surprise to me, I have to say, was the number of young people who ended up being hospitalized in a psychiatric facility who had no psychiatric diagnosis but whose difficulties were behavioural, whose problems were essentially behavioural problems. I was quite surprised by this and I spent a fair amount of time informing myself of what the thinking was around the medicalization of behavioural problems. Certainly there was a fairly significant body of thought, theory and some theory in practice-based writing that questioned the appropriateness of institutionalizing young people with behavioural problems in psychiatric facilities.


Certainly that was an idea that I spent a lot of time thinking about. I think the literature of the day focused a fair amount on the negative impact of labelling, labelling kids and the outcomes of labelling children, and labels that would then follow these kids for the rest of their lives. I know that members here, particularly members who work in the school system, like the member for Kings West, would recognize the thinking around this and the concerns around this.


These are certainly ideas that have shaped my thinking, but not just my thinking, certainly the thinking of a lot of people in the field. There is a growing body of evidence with respect to what are the best approaches to take when providing mental health and addiction services to our population, not only to kids but adults as well. Some of the most effective programs that we see are programs that, in fact, allow young people, patients - not just young people - to treat people in their communities, to treat them on a basis where people are not hospitalized, or they are not institutionalized in residential settings but, in fact, they are treated and they reside in the areas where they will be living in the long term.


I have said on previous occasions and I will say again that when I sat in this Legislature as a member of the Opposition, I was very concerned and very critical of the lengthy wait times for mental health services, particularly for children and youth. When the Premier asked me to consider becoming the Minister of Health, taking on this job, I think one of the very first things that came to my mind was the opportunity to improve mental health services for children and youth. I am very committed to seeing that happen.


We have come into government at a time when, as everyone knows, there has been a fairly significant and damaging recession. The kinds of resources that were available in previous years are not there, so it really, I think, set the stage to think about how you would do things differently, with the same amount of resources. I said yesterday, when we were talking about the Health and Wellness budget, that there are many people who write about the health care system saying that the health care system is not a system that lacks resources, what the health care system lacks is a good use of the resources that we have. What the health care system lacks is the proper use of the resources that we have.


People have written extensively about how in too many times the health care system has been organized not around the needs of the patient, not around what is in the best interest of patients. In the three years that I've been privileged to be in this position, my approach has been to look at what is in the best interest of patients. How do you organize a health care system around the needs of the patients not around the needs of the providers and what exactly does that mean to do things differently? What does it mean to take the current resources that you have and use them in a way that will get you better results than what you're getting?


I don't know if anybody in this Legislature would want to stand up publicly and defend the status quo at the IWK with respect to their wait times and the way resources were used. There was a very good article, an op-ed piece in The ChronicleHerald, written by a gentleman that I've never met but he writes from time to time. He identifies as a mental health advocate and activist and he laid out the fairly astronomical increase in resources to mental health programs at the IWK over the last 10 years. Not only did the problems persist in terms of wait-lists, they got worse.


Now how is that something that any Minister of Health or any government can tolerate? I tell people all the time I'm not spending my resources, I'm spending your resources. I'm spending the public's resources. I expect results. The public expects results. We are going to get better results. If there is one area that I can have an impact on as Minister of Health and Wellness, if I have my choice, it is going to be children and youth mental health.


I was absolutely delighted when my colleagues were all so supportive, through the leadership of the Premier, that a decision was made to invest in programs for children with autism so that all of the children who are diagnosed with autism will get early intervention. That decision, I think, should have demonstrated - it was a signal, we were sending a signal, as a government, that early intervention is where we will put the emphasis.


If you can't do everything then you need to set some priorities, and what are your priorities? Our priorities are better care sooner, early intervention. You do not set up a system where you take your resources and very small numbers of people get access to services and very large numbers of people get nothing. They languish on wait-lists. They have no assessments whatsoever and they do not have the opportunity to be directed to the appropriate services.


With that in mind, I and people in the department have been in conversation with the IWK for some time. It has taken some time for us to get to the point where a new model has been researched, a new model has been identified, where some training has been done, and the process is now going forward. I am fully in support of the decisions that the clinicians at the IWK have made with respect to the model they have developed, which they are adopting and they're going to be implementing.


I want to reiterate, although it doesn't seem to make much difference how many times I say this but I'm going to keep saying it, there have been no cuts in the funding to the children and adolescent mental health programs and services at the IWK. The IWK continues to receive the same amount of funding that they had last year, they will receive the same amount of funding this year, except when we see the strategy, there may be some changes. I'm not sure yet what that will look like because that is still in process.


As of today, the IWK have not experienced cuts in their funding to children in Mental Health Services, but they are making changes in terms of the resources they have and how they will spend those resources. These changes are changes that will result in children and adolescents having earlier assessments and having earlier intervention.


This does mean that there will be a loss of full-time equivalent positions that are youth care workers. I have also said I don't take any joy in seeing anybody in our health care system displaced or have job loss. As a government we have attempted to minimize job loss in the way we have approached the management of the health care system. We have used attrition; we have used various other mechanisms to keep from having to give people their pink slips. However, it's not always possible to move forward with the models of care that are required without having zero impact on people. This is one of the areas where there will be some impact and I recognize that.


I have to look at, and I will look at, what is in the best interests of the patients - patient-centred care. Patient-centred care is about not supporting the status quo; it's about providing a greater diversity of clinical programs to young people. The resources that will be freed up by changing this model mean that we are going to be able to hire additional clinical psychologists, we are going to be able to hire (Interruption) Well, the member for Halifax Clayton Park says that's not true but the CEO of the IWK has provided me with a list of who is being hired, what positions are being created and who is being hired.


I have never known the CEO of the IWK to lie to the Minister of Health and Wellness. So, we see that we have resources being used to hire psychologists, to hire nurses, to hire LPNs, to hire social workers, to look at occupational therapy, which is required in a variety of programs that will increase their capacity not only to do assessments but to provide therapy and treatment. That is my focus. That is the IWK's focus. I've made it crystal clear to them that the model was broken and it needed to be fixed and they have responded in a way that I think is entirely appropriate. At the end of the day more kids will be seen, they will be seen faster, they will be seen more appropriately and the system will be there for people in a way it has not been there for far too long.


I make no apologies for that. No money has been removed from that program and we still have the mental health strategy to come which is a strategy, as I said, that will reflect the kinds of priorities of this government which are: early intervention, community-based services, health promotion and protection, peer support, and all of those kinds of things that are very important.


In addition, I have said and I'll make it clear, we haven't waited for the completion of the mental health strategy to make decisions around other things that are required in the system. The forensic unit that was on the fourth floor over at the IWK has been moved to the facility in Waterville, a much more appropriate place to have young people. There are more recreational opportunities for them and it means that 4 South can now be redeveloped into a more appropriate kind of therapeutic milieu for the young people with more serious mental health disorders. It's an extremely important thing to have done.


Is it enough? As someone who has worked in the mental health system, you know, there is no doubt in my mind, there will never be enough but is it significant and important? It is significant and important. I see the member is getting a little impatient and wants to ask some more questions but all I can say is, you asked for it, so there you go.


MR. D'ENTREMONT: Madam Minister, thank you for that very thorough explanation and ultimately - I mean I see the heated exchanged but it is the Progressive Conservatives asking the questions right now. I know that maybe she's warming you up a little bit in some of her comments but my concern right now is that I think the jury will be out on whether this was a good move or not when we see how patients are treated and how they are able to go through that system. I think time will tell if it was a good move or not but the issue is, my heart goes out to the people who are here today, the people who did lose their jobs, who felt that they weren't consulted through this process, that it was a decision that was made from up here and they seem to be the recipients of that decision.


So that's why I asked you the question and I'm glad you did give it a thorough answer as such and, again, it's going to be, I think, an issue of wait and see, to see if it is going to work because for far too long I think mental health has been ignored in this province. In the three years that I spent as minister in trying to find precious dollars to invest in programming there, it was always extremely difficult with the competing priorities that continued to go on there. I know we'll have another opportunity to talk about mental health services across the province.


The concern from our caucus is the availability of mental health services, not just here in metro but the issue of those kinds of services across the province, and the IWK issue is very important to us because the only real youth service that you can get in Nova Scotia is here at the IWK. It means that parents and families are having to travel from one end of the province to another or into Halifax and some of the decisions that we are hearing might make that a little more difficult, which are issues like 3:00 p.m. pickups, or the availability of in-patient services, and all these things that I think a child youth worker did help in making sure that that happened. So, again, I think the jury will be out on this one and we'll have to see how that goes.


Last night I was talking to you about FTEs and I felt that maybe I didn't get the full answer that I wanted so I'm going to ask more of a general question and maybe the staff can go and work out a document to send me. So I'm not really even asking the minister to answer the question, just could you give me a breakdown of where those new positions are, or which positions do they mean, because I think we were looking at a number of 41 more FTEs, from the forecast, where we were this year, to what we're budgeting to use this year - I think I said that one correctly - but just a breakdown of where those positions are going across the department. My question is, would the minister provide us with that?


MS. MAUREEN MACDONALD: Sure, and I thank the member and I thank him for his patience. I recognize it is his time. With respect to the 41 FTEs, we will provide you with as much information as we can, but staff tell me that really it is not 41 FTEs. It looks like it is, but it actually isn't. The result of estimating for full-time positions required within the department on an annual basis, adjustments are made throughout the year. As an employee takes the next step in their career, a position may become vacant and there is a process in filling this position, which can lead to having that position vacant for approximately two months. The position is posted on Career Beacon for two weeks; applicants are screened, interviews are prepared and they take place, and the successful candidate is notified. The position can be possibly vacant for even longer than that if there is no successful candidate.


This year we had, I believe, a fairly high rate of vacancies throughout the year so when you compare forecast to estimate, it looks like there is an increase in full-time equivalents but, in fact, that increase is not real because we had a higher than normal number of vacancies. I shouldn't say higher than normal, I don't know if it was higher than normal, but we had a high rate of vacancies and so we're just reflecting in the estimate what the positions and the requirements actually are. We did, in fact, eliminate 27 or so full-time equivalent positions in the department and as indicated, the deputy minister and I had a conversation about two weeks ago and he told me that we had met the targets we had been given, from wherever we're given them from - that great voice in the sky - so we feel that we're doing what's required of us as a department to help the province get back to balance, but at the same time continue to have the personnel to meet department needs.


MR. D'ENTREMONT: Thank you for that. Like I said, if there is a document that we could get a quick listing of where those positions were left vacant and where they're going for the next year, it would be a nice addition to what is available to us and supplementary information in the budget documentation.


A couple more quick questions - one is the issue of cystic fibrosis, one that has been brought forward to our caucus on a couple of occasions now, and it's the issue of early identification of cystic fibrosis. I don't know if you've got a document or briefing on this one or not, but what we're being told is, because of the cost of hospitalization when it comes to cystic fibrosis, should a child be identified early - and I mean early, so this is in the first year or second year of a child's life - the outcome for that child is much better. The health care costs for that child are much less as they move through that terrible disease. I'm just wondering if the minister has had a briefing or is aware of the early intervention programs or early identification programs that newborns, or others, might get in view of CF.


MS. MAUREEN MACDONALD: It's a very good and a very important question. I'd be happy to see if we could get more information and provide it to the honourable member. I do know that I've had a series of letters from people from around the province, parents, who have written asking why we're not providing this kind of testing, or screening in Nova Scotia and encouraging us to do so. I also know that we're not, certainly, the only province that's not providing that screening at this time.


What kind of an expert review would advise or recommend to me, I don't know. We haven't, I don't think, proceeded that far yet. To have had people who are knowledgeable in this area take a look at it and say whether or not this would be, first of all, an important thing to do with respect to the health status of people, and secondly whether or not it's something that make financial since, as well, in terms of the outcomes, both of those things go into our decisions. We look at what the cost is: can we afford this, what are the implementations - short, medium or long range - for the health care system, as well as for people? What I can tell you is we do have a program that provides drugs for people with cystic fibrosis and right now, 113 people in Nova Scotia access this program. The budget for that program is $1.1 million. So that's the program we currently have.


I know this - not just with cystic fibrosis but with other kinds of genetic conditions, illnesses - is going to be, I think, a growing kind of concern, issue and pressure around our health care system. Many of the pharmaceutical companies are out there doing a lot of research in the area that they call biomedical, I guess, which essentially is looking at some of the genetically inherited diseases with a view to creating products that will lead to earlier detection and therefore, as well, earlier treatment, earlier interventions. It's certainly something that people in the field of health policy and health economics are writing about and researching about because, obviously, the implications for the ability of our health care system to be able to adopt all of these earlier screening tools or techniques, and then the treatment that results from that obviously, have fairly significant implications for sustainability in the health care system.


Certainly, if the member reminds me, perhaps later on in the session, if there is someone in the department with some information on this I'd be happy to arrange an opportunity for him to meet with staff and get fuller information than I have at this moment.

MR. D'ENTREMONT: Madam Minister, thank you for that. Over time we have seen a tremendous change in our treatment for cystic fibrosis. I had a childhood friend who had CF and I do remember Gilbert's treatments and all the trouble that he had culminating in a double-lung transplant at the time and, unfortunately, not surviving. But to see how individuals are surviving this disease into their 20s, into their 30s today, is a testament to medical technology, to the changes in drugs. But if we got it a little earlier, is there something else that we could do that - I'm not saying that we're ever going to probably cure it completely but, boy, a better life for those individuals would be tremendous.


I know that the concern from the department will always be, well, what will that treatment end up being in the end? We can talk about Fabry disease and expensive drugs for rare diseases, and they are tremendously difficult discussions when you look at quality-of-life issues and health issues for many of these individuals. So I thank the minister for offering the services of her department and maybe we can have another discussion later on about this because I think it's another one of those important ones that I think needs further update.


Just going through some of this, thinking about some of your opening remarks, too, you were talking about the distribution of doctors in the province and, of course, still the concern of where doctors are. I know the challenge that we've always had in Yarmouth - and I know many rural areas tend to have the same problem - is being able to access a doctor or a family doctor more specifically. I was just wondering if the minister could provide us with a breakdown of where the vacancies are and maybe an idea of what they're doing to make sure that some of these are getting filled at a - at least sharing what we're able to train or able to get.


MS. MAUREEN MACDONALD: Thank you very much for this question. This is a topic that is, I think, paramount in the functioning of our health care system. First of all, I would like to say that we spend 19 per cent of our budget in the Department of Health and Wellness on physician services. Our budget this year is for $727.661 million and that does not probably capture everything in terms of physician services but it's a fair piece of the pie. So this is quite significant. It is the largest single area of health care expenditure outside of the money we give to the DHAs which, you know, is to operate essentially our acute care facilities, by and large, and that's where nurses and all of the diagnostic folks are and labs and stuff like that.


So it's pretty significant and I don't have to tell anyone here, I know we all recognize that Nova Scotia is blessed with an amazing group of physicians and people love their family doctors, by and large, and with good reason. These women and men are quite inspirational in the way that they dedicate themselves to their patients. I think one of the things that has been the most - it has been the thing that I have liked about this job the most, Madam Chairman, is meeting the phenomenal physicians around the province as they explain to me their practices, their communities. They have great aspirations for how to make the system better and they're constantly looking for those ways. So we are very fortunate.

I know there have been national reports looking at physician supply across the country and Nova Scotia always comes out on top. We have the best patient/physician ratio in the country but we can't rest on our laurels and we can't look at that and think that things are perfect because we do have some very big challenges and these will be ongoing challenges. I don't kid myself that this is a nut that's easy to crack, it's a difficult one.


In 2011 we recruited 103 physicians into the province, in total 69 specialists and 34 family practitioners. Included in those totals were seven CAPP physicians. Now it will come as no surprise to people here when I tell you that the majority - 51 out of 103 of those physicians, half - went to the Capital District and therein lies the difficulty. In DHA 1, which is the South Shore DHA, there were zero family practitioners into that DHA, so this is a concern. I say this all the time: it's not the numbers; it's the distribution that we need to be concerned about.


At the same time, we have physicians who leave the practice. Some leave to go practise in another province or even outside the country, but we also have physicians who are retiring. This is going to be a growing pressure. I have talked here in this Chamber about the physician resource plan that we are developing in the department and some of the preliminary information in that plan indicates that a fairly significant number of our doctors are going to be retiring over the next 10 years and we are really facing what that means. Physicians are like every other profession. There is this big baby boom kind of blip inside the profession, so we need to do our work to plan for this so that we're not left in a position of really significant shortages.


Last year, in terms of reductions of physicians, we lost 62 physicians, 34 specialists and 28 family practitioners; so that gives us a net gain of 41 physicians, 35 specialists and six family doctors. Now you will see by those numbers, with our Better Care Sooner focus increasingly on primary care, we have to really think about that small number of family doctors, in terms of net gain, and how we are going to address that. You will be hearing more from me and the department in the coming days and weeks about the physician resource plan, what the current picture is.


So we've done our homework, we've probably got, not a perfect data set, but a pretty darn good understanding of what the picture is with respect to GPs, with respect to speciality, with respect to distribution. So now the questions become: what are the implications, what can be done about it and how will we tackle that?


As the member knows, as a former Minister of Health, we have a lot of tools in our tool bag for the educating, retention, and recruitment of physicians, but even with those programs, even with the expansion of the seats at the Medical School, even with financial assistance for debt, financial assistance to bring physicians into the rural communities, for site visits, even relocation assistance, even with alternate payment programs, all of these incentives that have been invested in and developed haven't necessarily gotten the job done, gotten the outcomes.


So I go back to the conversation we had around the IWK and the mental health programs. We've spent a lot of money. We haven't necessarily gotten the outcomes we wanted through that expenditure. Is the answer to keep spending in that way but just spend more? Or is it to say maybe we haven't spent wisely, maybe we need to do something different; what is it that we need to do?


I want to say those conversations are certainly going on with the physician community. When I say the physician community, I'm talking about all of the parties that have a stake in this: the stakeholders, Doctors Nova Scotia, the college, the Medical School, and the district health authorities, who all have a very big interest in working to solve these problems. It is a problem. We want to make sure that every person in Nova Scotia has access to a primary health care provider, generally, often, a family doctor supported by other health care professionals, nurse practitioners, family practice nurses, advanced care nurses, and other health care providers. That's our kind of vision, that's our model.


There is a lot of work underway and more work to be done. There is money in this budget to support the development of more primary care teams and an enhanced kind of approach to physician recruitment, retention and all of these things.


MR. D'ENTREMONT: To the minister, if she's comfortable with the data set she was talking about there, I'm just wondering if you could provide us with a copy of that or if you want to wait until tomorrow and sort of wash it up a bit, I'd be more than happy to have that.


I have a lot more questions when it comes to infrastructure and a whole bunch of other things but I know the member for Cape Breton West has a few questions and I thought I would give him the opportunity during this hour of estimates. Madam Chairman, if you could call on the member for Cape Breton West.


MADAM CHAIRMAN: The honourable member for Cape Breton West.


MR. ALFIE MACLEOD: I want to welcome the minister and her staff. I just have a few questions that are of a concern to the people in my constituency and elsewhere.


Yesterday the minister spoke about the shared services of the health authorities and how that was going to save some dollars. I'm wondering if the minister has, on the shared services, some input or idea as to if those positions that are being changed, if the shared services will be shared around the province. Will they be located in different parts of the province? As the minister would remember in the Speech from the Throne, there was talk about diversifying. I know that in the health district that I have the privilege to live in, we have some very capable people there. Does the minister have any idea of what the distribution of those shared services may be?


MS. MAUREEN MACDONALD: I want to thank the member for the question. It is a very good question. I'll start first of all by saying that we have made no final decisions on the distribution or location of shared services, but I'll give you just a little overview of what our approach is and what our thinking is that will contribute to final decision making on this.


As members know, we put a request for proposals out and we had a response from Ernst & Young, I think it was, that did the shared services piece of work. Let me tell members, first of all, the area of the Department of Health and Wellness budget that we're looking at, in terms of administration and what the expenditures are, is quite substantial. I'm always kind of blown away when I look at it. I'm not sure if we have it or not actually, but let me say this: the Department of Health and Wellness budget is $3.8 billion, and out of that the DHAs and the IWK get $1.6 billion. It represents 42 per cent of the entire Department of Health and Wellness budget. I just made reference to physician services at 19 per cent and then we've got our drug programs and they're at 7 per cent; long-term care, 14 per cent. So the DHAs are a big chunk of funding through the Department of Health and Wellness.


Then when you go into the DHA budgets, you can start looking at how much of a DHA budget is administration; how much of the DHA budget is surgery; how much of a DHA budget is the coordinators of long-term care, whatever. Then if you look in administration: what forms administration in a DHA budget? Infection control, the folks who do all of the work to ensure that there are good protocols and procedures for staff to follow to try to mitigate any outbreaks of C. difficile, are in the administration of the DHA.


So when you approach looking at reducing administrative costs, you have to do it very carefully and you have to do it very thoughtfully because you wouldn't want to impact an area, such as infection control, in an acute care facility.


I want to say that this was not a Department of Health and Wellness top-down initiative. This was collaboration between the Department of Health and Wellness and the district health authorities. The district health authorities themselves were full partners in looking for better ways to share or to merge services. The other thing I should indicate to members is that the DHAs already - several DHAs - share services. The Valley DHA and the South Shore DHA share financial services. They have done that for maybe since the boards were set up. I'm not really sure how long but there has been sharing of services in the DHAs for some time - some services.


So the process was one where Ernst & Young identified, within the administrative package, a whole variety of areas that potentially could be merged. They did some preliminary work and they came back to the department and they said, okay, we've identified 12 areas where there is potential for merging of services. We said to Ernst & Young, we want you to go ahead and develop business cases for six of the 12 areas and we identified those areas.


They've been fairly well talked about, you know, in areas like laundry, like IT, like the supply chain, and the idea was for them to go away and do some research, I guess you would say, to identify, well, what could the cost savings actually be in each of these areas, and they looked at what the cost savings could be and they looked at what the impact on staff could have been in terms of displacing people who work in those areas. Then they came back with their report to government and we chose to move forward with a certain number of those areas.


We have chosen to move forward with, I think, four of the six areas to begin with, starting with the supply chain. Now, what is the supply chain? For people who don't spend every day working in the health care system, the supply chain is where supplies are ordered into the district health authority. It can be all kinds of things - not drugs; it's not drugs but it is other things in the district health authorities. Drugs, as far as I know, is fairly much centralized - not centralized; it's already done through one entity rather than across each DHA.


So to have an office where people are actually dealing with suppliers and ordering for the whole DHA system and receiving invoices and paying for products that are coming in, theoretically that could be centralized; theoretically, it could be centralized. It could be, but centralization doesn't have to mean it has to be put in Halifax. Centralization means it could be in New Glasgow, one entity there, or it could be further, it could be in Louisbourg. So, you know, we recognize that.


The other thing is, because district health authorities store a lot of stuff, there is also a requirement for warehouses and all of that kind of stuff that goes with a supply chain and that wouldn't make sense to have in one place. You might need - and I think Deloitte talked about the importance of looking at maybe multiple, at hubs and places where supplies could be gotten easily to all parts of the province where distribution is required. So that's one area where we are going to be doing a merger of functions that are out in the district health authorities but how that is actually going to be done, where, that work is now part of the work that is underway.


Laundry services, you know, theoretically I suppose you could have one big laundry for the whole province. The member is shaking his head; I did say theoretically.


What we decided in discussions with the district health authorities was to look at having laundry services more centralized within a DHA, and even possibly having DHAs look, if there are two DHAs close beside each other - because there are - and it makes sense, perhaps, for the capacity of one DHA to provide into the other, then that's something that certainly could be examined. But again, no decisions have been made.


We are now doing the detailed work that will actually help us determine what makes sense. It all goes back to using the health care dollars we have, more effectively, getting better outcomes with the money we have without having to continually put in more and more money to get the same old outcomes. We need to see improvements for the money that we are investing in our health care system.


The merging of services is an 18-month project so this work will occur over 18 months, over the lifespan of this particular budget, and into the subsequent budget year. In this year we estimate that we will see savings of roughly $7.3 million, although maybe a little more than that would be nice - I'm told it's $7.5 million, in this year - and over the course of the next few years we can see as much as $55 million in savings through the merging of services.


The areas are: the supply chain, laundry, general administration, and finance and payroll. There has been a lot of interest in what the government is doing with respect to CEOs, vice-presidents, directors, and what have you, and there will be a reduction in the number of vice-presidents throughout the DHAs and that process has already begun. I don't know, members may have noticed that the South Shore announced last week that their CEO, Alice Leverman, a lovely woman, is retiring, a well-deserved retirement after many dedicated years in the health care system. Their board has decided they are not going to go out and recruit a new CEO, but the current vice-president of Medicine in that board, Dr. Peter Vaughan, is going to assume the CEO's position as well as the position of VP Medicine, and without any additional cost to the DHA.


So with the DHAs, we are doing the work to decrease the costs of administration in the boards and free that money up to be redirected into patient care and protecting patient care. The breakdown I was trying to explain earlier around DHA budgets, administration in the DHAs is about 5 per cent of the expenditure in the DHAs so we give the DHAs $1.6 billion - the DHAs and the IWK - and $96 million of that is in administrative services, which is 5 per cent. I indicated that that doesn't necessarily mean that there are functions there that are superfluous to the operating of a proper health care facility, far from it. Many of those functions are critical.


Ambulatory care in the DHAs is $544 million, or 27 per cent, and surgery in the DHAs is $257 million, or 13 per cent. The DHAs are big entities and they have worked very hard to meet the government's direction to decrease the amount of administration and find efficiencies, and they continue to do that. I thank them for their hard work and their co-operation, and I expect that we will continue to work with them in this vein. I will keep the honourable member's interest in where those services could be located as we do the planning for shared services.


MADAM CHAIRMAN: Thank you. The time allotted for the Progressive Conservative Party has elapsed for that one-hour period.


The honourable member for Halifax Clayton Park on an introduction.


MS. DIANA WHALEN: Thank you very much, Madam Chairman. I have the pleasure to introduce some of our guests in the gallery today. They are actually in the east gallery and a number of the people that are there today I had chance to meet when I held a public town hall meeting on adolescent mental health with Dr. Stan Kutcher, who is well known to the House as an expert at the IWK. I'd like to introduce who is with us today and if you could stand as I introduce you and then we'll give you a warm welcome at the end.


Kathy Macphee, Shawn Wood, Amy Tucker, Tammy Golden, Lynn Lawrence and Leanne Warren are all youth care workers, some of whom are laid off and some are not. Conner MacLellan is there, and Conner is a former patient who actually attended my town hall as well; he's a great spokesman and he's been very active in supporting the ACT program. Mary Jane Hovey, she is a parent of an affected youth from the ACT program. We also have Kelly Murphy, an NSGEU board member, and Robert Tupper who is an NSGEU activist and also lives in Clayton Park, so Robert and I have met before. I hope that all of us will give a warm welcome to the visitors in the gallery, thank you.


MADAM CHAIRMAN: We welcome all our visitors today and hope you enjoy today's proceedings. We'll now revert to the Official Opposition.


The honourable member for Kings West.


MR. LEO GLAVINE: Thank you very much, Madam Chairman. First of all I want to thank the minister and her staff for providing responses to the questions that weren't finished off fully yesterday.


First of all a few general questions - Page 13.11 of the Supplementary Detail has four programs listed under Other District Health Authority Programs, one of which is Mental Health Programs. Could the minister please explain why the forecasted dollar amount for Mental Health Programs is anticipated to come in under spent to the tune of $156,000?


MS. MAUREEN MACDONALD: We're just having a look here to see if we can find some of the detail. I would say to the member that there are a lot of things that could account for the under spending in any line item in the budget. We may have a staff member go off on sick leave, maternity leave and not have a replacement, and that could result in an under expenditure. So let's see if we can find out a bit more here.


The department holds a certain amount of funds, centrally, that we grant to non-profit organizations and DHAs on an annual basis but most of our mental health program funding is embedded in the DHA budgets, the member would know that, but we have a branch inside the department, a mental health branch, that works very closely with the DHAs and they hold this small number of funds.


In the past, funds were used for bursaries for people, sometimes a high-needs client - and I would imagine perhaps a person with a psychiatric diagnosis might be looking to be able to further their education. This says high-needs clients, psychiatric and psychological bursaries. I know that the central fund was used to help train the workers who work with kids within the autism assessment and early intervention program. Some funds would have been held for the self-help initiative. So expenditures in these programs vary from year to year depending on the uptake, so the applications that come forward and the needs of the mental health system - $190,000 was transferred to other programs within mental health and no spending was forecasted in this year for psychiatric and pastoral bursaries, as well as initiatives related to the implementation of the children and adult mental health reviews, which resulted in a surplus of $179,000.


So that explains it and just so the member knows, we're dealing with a very small amount of money. The department does not have a lot of money for mental health services inside the department so it is that very small amount that you see, but what we provide to the DHAs is as follows: we provide $128,892,000 in this budget to the DHAs; of that, the IWK receives $25,586,500 and Capital Health gets $54.529 million, and so on. The amounts are smaller in the other DHAs. So about 5.1 per cent of our budget - no, that's not accurate, forget I said that - I was going to say goes to mental health, but it's actually a little higher than that.


MR. GLAVINE: Madam Chairman, in terms of the IWK budget, $25 million is indeed pretty significant. However, looking at Page 13.17, it shows the IWK mental health budget forecasted to be under spent by about $391,000, which I think is fairly significant. Why would this be the case?


MS. MAUREEN MACDONALD: We'll see if we can get that information.


While staff are looking for that information, I just want to provide an update on the IWK recruitment efforts. The IWK is currently advertising for social workers and psychologists. They're in the process of interviewing social workers, psychologists, and occupational therapists and they have, to date, secured several of these professionals. They are actively recruiting in the mental health and addictions program to support the outpatient services, which I talk about three full-time equivalent social workers, three hired internally in community mental health, and replacements currently being hired to backfill from some internal movement.


The same thing, three full-time equivalents in psychology, one hired internally and an external applicant, and they will be posting a full-time equivalent OT. This is part of the reorganization that's going on and a number of other supports for group therapy sessions will be required which will include nursing staff as well as the social work staff.


The difference that the member is pointing to is as follows - this is the EIBI program, the program for children with autism. The original EIBI budget allocation by the Department of Health and Wellness was preliminary only. The subsequent analysis of patient need by district resulted in a reallocation of the available funding across the system. What I would take that to mean is that money would not have been under spent, so to speak, money would have been transferred from the IWK to other districts to meet the requirements elsewhere, while still allowing children served by the IWK to continue to be served.


MR. GLAVINE: As the minister is well aware, I'm passionate when it comes to the availability of appropriate mental health programming, especially for children and adolescents; that was a big part of my career. For me it is disconcerting when financial resources are moved to deal with wait-lists and it comes at the expense of laying off mental health youth workers, especially when it's clear we don't know the needs of the patients when these numerous assessments are complete, and we've heard that in certainty. Why did the minister approve the IWK DHA business plan last year that proposed taking dollars from programming in order to pay for assessments?


MS. MAUREEN MACDONALD: I think I was fairly clear about the concerns that I had about the dysfunction of the mental health program over at the IWK. I've been clear in Opposition, I have been clear with the IWK administration on becoming minister; I haven't changed my position today and I'm not going to change my position either on this one.


We can agree to disagree and we do disagree. I think the member for Argyle indicated that it's only over a period of time that we will probably see the results of these decisions. However, what is crystal clear, what is indisputable, is that that system was seriously broken and that system needed to be fixed. A system that provides services to some, a very small number of people, and gives everybody else nothing, is not a well-functioning system. It is not a system that's making good use of public dollars. It is not a system that's responding to the real needs of people out there and, I think, nobody has the market cornered on caring for these kids. I care for these kids. The honourable member cares for these kids. The people at the IWK care for these kids. People who work with these kids care for these kids. Their families care for these kids. We all care for the children.


We have to find a way to look at models of service delivery that are effective. We don't just sit around and dream these things up in a bubble; we look to other countries, we look to other provinces. We look to many jurisdictions that have models that are significantly different than what we've been doing here with greater impact and better outcomes. I know that the clinical staff at the IWK did this and I trust that they did their homework and used their professional judgment in looking at what can they do to fix a broken system.


It's very hard to quarrel with a process now where contact is made with the IWK for an assessment and an assessment is received within a suitable period of time. It's hard to quarrel with an approach that is putting clinical services into programs that have been unable to respond to what families and kids require. So this is a model that after a great deal of thought, a great deal of research, and a great deal of discussion has been arrived at.


The IWK was moving in this direction last year but had not done sufficient groundwork to actually implement where they were going. As minister, I asked that more work be done to get us to a place where I felt the groundwork had been done and we could move forward. So this has been, as I said, three years in the making pretty much from the point where I had an opportunity to tour the IWK, to talk with the CEO and other members of the senior leadership team about my concerns around the wait-lists and the physical therapeutic setting, for example, on 4 South, and asked for a change to be made. But as Minister of Health and Wellness, I don't tell people what that change needs to look like. There are a lot of very capable, very experienced clinicians and managers whose job it is to survey what are the various models and how to adapt or adopt into their system a model that will work.


So we will monitor this change. It's not like you make this change and you pack your bags and go to Portugal for the next four or five years and not pay any attention to what's happening. I will certainly monitor what's going on at the IWK. I'm absolutely dead serious that we cannot tolerate a system that does not respond to the families and children, who need services in this province, and that's what we had. Our hope, my hope, my desire is to see that change, that we will have a much better system, and I have great respect for the people who are providing those services at the IWK and indeed throughout the province.


There are other DHAs in this province that are looking at what the IWK is doing. They are looking at this model and they are very hopeful that this is a model that they could adopt and would have greater impact in their community. This is an important development. Somebody - well, I shouldn't say somebody - everybody who writes about health care talks about how difficult it is to make change in the health care system. Nobody knows better than I know about how difficult it is to make change in the health care system; 70 per cent of our health care resources are health human resources. Every decision you make impacts people in the health care system and people have difficulty sometimes seeing the change. I understand that and that's fine but this is a change where we need to build a patient-centred health care response to children and youth with mental health.


People tell me about what a great program the ACT program is. I have no difficulty with that. The ACT program is a great program. These programs are great programs; yes, they are. They are great programs if you can get into them but very few people can get into them. So what do you say, what do I as Minister of Health and Wellness say to all of those families on the wait-list? Too bad, so sad, you just sit on that wait-list, somebody will get around to you in two years' time. No. So we will try a different model. We will have a model that will come at this in a different way and we will assess and see how this all works out. It's the right thing to do. We can no longer cling to an approach that has demonstrated deficiencies and inadequacies for kids.


MR. GLAVINE: Thank you very much, Madam Chairman, and you know, there is a fair bit of detail in what the minister has said but I guess what I would have liked to have seen happen is perhaps more of an evolutionary approach like the minister has talked about in terms of DHA administration, where thoughtful cuts over the long term will take place. I think when you have very good and very capable people in the system, you take an evolutionary pathway and you don't dismantle, what you have described as a very wonderful program, the ACT Program, but as you say, difficult to get into it.


But it's interesting that just three years ago government gave ACT $1.3 million to expand, due to evidence-based research. The same clinicians who conducted that research now say the need is not there and has closed the expansion. Also, in a report conducted in 2005 by the IWK, who hired a third party to conduct a review on in-patient mental health, Recommendation 11 states: The skill mix of child mental health workers and RNs is in keeping with most of the pediatric in-patient psychiatry units in academic health centres in Canada, and the rate each staff group utilize seems appropriate. It was interesting at the community meeting this is exactly what Dr. Stan Kutcher said, and gave evidence, works the best. I don't think we'll find nurses wanting to spend hours at the bedside of the ACT patients. Now, in that particular program, these cuts are going to mean that there won't be those youth mental health workers in that particular unit. I think that is what is disconcerting here.


I think it's time, also, for the minister and senior management at the IWK to provide the evidence-based research which says that this is a model that has better outcomes at the end of the day, better clinically observed results. The research that I have had, two mental health workers - and I'm talking about Ph.D. types - they can't provide me with tremendous amounts of research. I think you owe it to the staff, you owe it to those people to say the way we are now going, yes, it's going to look after some assessments, but what will be the clinical outcomes at the end of the day?


As we know this is a very difficult and a very complex area but we need to see that happen. We know that in some of our regional hospitals people go in crisis and you're given a medication and out the door, and hopefully the rest will take care of itself. We know in all too many cases we don't have the supports in the community, we don't get that backup that is so required.


I think the message that I have heard - and I sat down with Anne McGuire on this issue. She is not happy with a number of the current practices and so much fermenting continuing to go on and realizing that we don't have a program, or a series of programs, that are meeting all of the needs. These are things that, I think, we need to have answered here. Show us all the research which says that, outside of assessments, we're going to have much better outcomes. I think that's important to Nova Scotians.


MS. MAUREEN MACDONALD: I have to say I kind of laughed when, no disrespect to the member, but when the member said he talked to a couple of Ph.D. types. Being a Ph.D. type myself, I know that that will do you absolutely no good because that is the whole nature of Ph.D.s, I'm afraid, is to split hairs and see things from multiple vantage points. The probability of finding two Ph.Ds and get them in a room to agree on anything is not a probability that I would want to be a betting person around.


With respect to the model at the IWK and with respect to the idea that there is no evidence, there are programs elsewhere in the country that have moved to this model, and with great success, to the extent that there are people who know about these things. I understand that Dr. Brian Goldman, who does White Coat, Black Art, made reference to this very shift at the IWK and lauded it in his program, saying that this is the kind of thing we have to do more of.


This approach is very much the approach that people who work in the health care system have argued for 25 or 30 years - not only in mental health, they have argued for this approach to health care delivery right across the health care system. They have argued for more community-based services, more day programs, and more outpatient programs. They have pointed out that - and there are significant bodies of research to support better outcomes for this kind of health care delivery, not only in mental health but in health care more generally, throughout the western world and western medicine. There is a significant amount of research around the problems that are associated with building your health care system around residential programs and bricks and mortar, as they say.


This is not some kind of experimental theory that has no basis in practice anywhere else. Quite the contrary, this is the way that health care is going and it doesn't take really a genius or a Ph.D. to see that; this is where health care is going. Health care is moving away from bed-based models of care into outpatients and more clinics, more community-based delivery. That is very much in keeping with what is happening here and there's all kinds of research and evidence to support this as a more cost-effective model and one that also has excellent outcomes.


It may be the case that there are certain kinds of psychosis that certainly require hospital-based and then residential-based treatment. Eating disorders come to mind as a possibility but certainly I don't know - in the area of depression, in the area of behavioural disorders - where you would find research that says that is the best practice. So I would challenge people to demonstrate to me that that is the best practice because that's not my understanding or it's certainly not my reading of the literature, although I don't spend every waking moment reading Psychology Today, I do have a working knowledge of some of the thinking in that field, as I say.


The member said that we owe it to the staff and I want to go back. I have the greatest amount of respect for people who do this work. I've been there, I've done this, but my job is to think about patients. My job is to build a system that responds to patients. My job is to respond to all of those letters and phone calls and e-mails I get in the department, written to the Minister of Health, from families who cannot get an assessment. They can't get anything. They get nothing. They get referred and that's it. They go into the abyss with nothing.


We are changing that. Families are getting a response. I had a member of the NDP caucus here come to me and tell me about a person in his constituency, a mother, who came to see him and told him she couldn't believe the difference in the response that she has received for her child as a result of the changes. That's the kind of thing I want to hear. I want to see change. I want to see people who have sat on wait-lists see some action and get some response and see this system change.


I look at our government. Our government was elected to bring change to this province. That's how I understand our election into government. We were elected to do things differently. We were elected to take a look at the things that were broken and to fix them. I will spend whatever time I have - that's the opportunity of a lifetime in my view - to come into the Department of Health and Wellness and make some positive change for children and families in this province.


I don't know what I'll do after this very interesting and exciting life that I lead, but I may go back to work with families and children and I can't tell you - I think about this sometimes - I think about how good it will feel to be back in the field working with families and kids and know that I helped create a better health care system, a better response to those families, where they don't go into the abyss, where they do get the early assessments, where they do get sent to the appropriate programs in a timely fashion. There's no reason in the world why we can't be doing this, particularly with the amount of money that we've invested in the health care system. It is not about the money because we have more than doubled the amount of money without doing one darn thing about changing the problem - one thing.


That has to stop. People in this province need to stop accepting mediocrity from public services when they could have something that is quite spectacular and can meet their needs. They have to insist on it. Nothing is more important than providing good mental health services for kids and their families, in my view. The status quo is not an option. We need to make change. It's very important and on some level that's how I understand and that's my commitment to what the IWK are doing.


MR. GLAVINE: Thank you Madam Minister. I know that you're sincere around this but when I get a "just in time" kind of letter from a parent watching proceedings, it makes one take a look at how things are really going today in the ACT program.


I'd like to read this into the record: My daughter is in the ACT program. I have learned that the hours of the psychologist at ACT have been greatly reduced with a redistribution into the community, resulting in new admissions who will not be receiving their one-on-one therapy sessions with the clinician at ACT during their entire stay. My daughter is seeing her clinician once a week and these reduced hours have impacted her greatly as have the youth care worker cuts, so much so that I have feared that the program she so desperately needs will not help her. We have used the outpatient services of the IWK in the past without success. ACT was created for a reason and is needed by youth and their caregivers alike. Not every child is suited for the outpatient care offered by the IWK.


Since the ACT program was cut on the weekend, the kids are being admitted into 4 South, taking away a bed for an emergency case that would arise because of these cuts. Parents must pick their teens up at 3:00 p.m. on Fridays and can only return their children at 3:00 p.m. on Sunday. If an emergency arises, there is the IWK Emergency Department which for my daughter is not a positive or viable option. We have been there many times over the years and it doesn't work; ACT does.


The honourable minister may be convinced that Anne McGuire of the IWK isn't lying to her but the IWK is certainly spinning those cuts in such a way that I find deeply disturbing as a parent. I know the changes are having a huge impact on the kids, staff and parents alike. We are talking about people's lives here. My daughter has been greatly affected by these cuts as have the other cuts in the ACT program. Their focus is on saving the jobs of the youth care workers and not their own needs. They are so vulnerable and my fear is that three months into the program my daughter is in no condition to leave and she is due to be discharged on June 8th. I know she's not ready but really is the changed programming really working now?


To say I'm upset is an understatement. My daughter lost her father to suicide two days before she was admitted into ACT in January of this year. My family knows all too well how deeply mental health cuts run in this country and we will continue to lose more people, adults and children alike, who simply aren't getting the care they need and can no longer fight. I would love to talk to you further about this . . .


MR. CHAIRMAN: Excuse me, honourable member; I'm just wondering if you identified who that was from and if you will table it.


MR. GLAVINE: Yes, Mary Jane Hovey is the lady who conveyed those thoughts to me today.


MR. CHAIRMAN: And you will table it?


MR. GLAVINE: And I will table it. I'll need to get a copy and I'll table it.


MR. CHAIRMAN: Thank you.


MR. GLAVINE: So we can also work to make rates in programs look like there isn't a need that is really there and really apparent. I worry that perhaps, you know, we are not making the kind of changes again here in the thoughtful manner that the minister does reference and does commit herself to. So in terms of monitoring this program and the changes, are there intervals at some point where there will be an objective analysis and look at what is taking place and where needs are not being met?


MS. MAUREEN MACDONALD: Mr. Chairman, I want to start by saying that, you know, we're in a transition time period from the old model into a new model. I think it is too early to draw any conclusions. My understanding is that really, we've gone into this new model on April 1st - it's April 17th now, so I think we need to give it a little time before we declare that it's a dismal failure.

For families who have anxiety in this program, while their children are in this program, I know that many families have anxiety regardless of whether there are changes in a program or not. When you entrust your child to somebody else, you do it often with both a great sense of relief and reluctance. You have very mixed feelings. That has been my experience working with families. They are often desperate - please someone, help me, take some of this stress and burden and concern and help me figure out what is going on here and how to help my child. It's a great relief to have people there, but at the same time, families are filled with feelings of worry, guilt, what-ifs - are they going to be okay? Will they get the kind of care and attention that I would be providing? How will they react? How will they accept this?


These are very difficult times. So I can only imagine if you were a parent with a child in this program, going through this transition period and with all of the publicity around this, I don't doubt that that lady at home - and I don't know who else - would be watching and would be very concerned.


I was very concerned when I saw the publicity campaign - I make no bones about it - with a child who looks like they're four years old. I don't know of any four-year-old who is in the ACT program over at the IWK, but that kind of scared me, looking at that thinking, oh my soul, this poor child, look at this poor little child. I think we have to be responsible in the way we have a discussion about what is going on here. I think it's very important to reassure parents, particularly parents whose children are in this program, that their kids will continue to be the focus and they will continue to get the absolute best service that we can provide and that they require.


Children who go home on the weekend to their parents or their guardians, their caregivers, from the ACT program, will not be abandoned for the weekend. The emergency department is not the only service that is available to them. Our government has invested, quite significantly, in the mobile crisis unit. That will be available. During the transition period at the IWK, I have asked that the IWK ensure that there are resources available and that families are aware of those resources so that they can be reassured, because I recognize that this is a period of transition and transition, on top of the regular stress and anxiety that families have, puts an added burden. So that requires some additional attention; we have asked that the IWK build that in.


I think people need to be clear. Psychologists in the ACT program don't work nights and weekends. They're not over there providing one-on-one therapy sessions Saturday evening with the children. We're not cutting and taking away those services. We are providing what people will require in that program based on what the clinicians decide is necessary, not some politician. We are making decisions based on what the clinical providers determine is required. That's as it should be.


With respect to the monitoring, the assessing, the evaluation of these changes, we will give this model an opportunity to work; 17 days is not an adequate period of time to give this model an opportunity to work. This is the model that has been approved; it is the model that will be implemented. I want to reassure members that I have contact with the IWK, and the staff in the mental health branch of the department have regular contact with the IWK with respect to all of their programs. We will watch this very carefully.


As I said, it's a priority for me. It was a priority for me when the Premier asked me to take on the job of Minister of Health and Wellness. That hasn't changed. I'm not walking away saying "job done." Job hasn't been done. Frankly, in the mental health field, the job is never done. The member talked earlier about where's the evidence and what have you. There isn't enough research for the area of mental health. You talk to people who work in the field of mental health; research is something that we really need to support - not necessarily around this particular model or approach, but generally. We don't know a lot of things. We don't have a lot of information. We need to do more; we need to have better research.


We do have some pretty interesting researchers, Dr. Stan Kutcher being one of these people. The work he's doing in the schools, I think, is really exciting. It's work that needs to be supported. In the not-too-distant future, the Mental Health Commission of Canada will be launching their mental health strategy, their national mental health strategy, and I'm anticipating that will contain some pretty interesting recommendations.


Some very prominent Nova Scotians are involved in the Mental Health Commission of Canada. It's led by former Senator Michael Kirby, who is well known to people in this province - I believe he was a chief of staff to a former Premier - and Louise Bradley, a psychiatric mental health nurse who set up, possibly, the forensic services in the Capital District Health Authority and has been very active in developing mental health services in the whole Capital District Health Authority mental health strategy that they adopted a number of years ago. Both of these people are leaders in the Mental Health Commission of Canada, and their work will be coming to fruition fairly soon.


We'll never have perfect knowledge and perfect understanding of such a complex area. We can only keep working at it.


MR. GLAVINE: Thank you, Madam Minister, and I know she does need to get a drink there, I think, speaking for a long time today. As I look back, not a very long time ago, being in school administration as late as 2003 and being a senior high VP where you have a lot of contact with your guidance department and you're looking at cases that move from school to the IWK, I'm wondering if the minister could outline for all of us when this enormous list emerged because I don't remember this kind of list for assessments as late as 2003, in contacting the IWK.


Something has occurred here, I think, to give us this enormous list and in contacting just four schools, as a little bit of my own personal inventory, all four had students still waiting for assessments. I know the hope is that this is going to change fairly dramatically but I'm wondering what brought about this emergence of a tremendously long wait-list and when we saw these numbers grow into the hundreds, and well over a thousand, that was put forward this Spring.


MS. MAUREEN MACDONALD: The wait-list was at 900 about, I would say, a year and half maybe two years ago, and it was roughly around 900 when I became minister. Then there was some growth; it grew, I think, to about 1,100. It's not just the numbers which are concerning, it's the length of time.


MR. CHAIRMAN: I wonder, would the minister like to have a little break? We'll take a five-minute recess and continue on when we come back.


[4:33 p.m. The committee recessed.]


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


MR. CHAIRMAN: Order, please. Before the adjournment, the honourable Minister of Health and Wellness was answering a question.


The honourable Minister of Health and Wellness has the floor.


MS. MAUREEN MACDONALD: Thank you very much. I thought you were going to say she was choking, Mr. Chairman, because I kind of was but, first of all, there's a veritable candy shop in this Chamber. I'm amazed at how many people have Lifesavers and peppermints and all kinds of things, so thank you for that, and a good old-fashioned cup of Cape Breton tea doesn't hurt.


The topic that we're on is around Mental Health and Addictions Services, specifically the ACT and the COMPASS programs over at the IWK and the change in the model there. I just want to, once again, bring information for members of the House in terms of all of the programs that are provided by Mental Health and Addictions over at the IWK. I had an opportunity quite some time ago, a couple of weeks ago here in the Chamber, to table a copy of some information I had compiled because I felt that it's important that members here - I know that we often have families come to our constituencies at their wit's end, looking for assistance and how to access services, so I thought that this might be a useful way to help members here in the Chamber understand what the various programs are and what the access points are for the IWK.


Just to reiterate, you know, there is a crisis team over at the IWK made up of social workers and psychologists. Their hours of operation are 24 hours a day, seven days a week, and they provide mental health assessments and crisis intervention to children, youth and families through the emergency department. I was also making reference to the mobile crisis service, which is a partnership between the IWK, Halifax Regional Police, Capital Health and EHS. Again, this service is a service we expanded a budget or two ago; I think maybe in last year's budget we expanded it to a 24-hour, seven-day-a-week program throughout the Capital District. This is a service that will help individuals of any age experiencing a mental health crisis and again, the mobile teams are made up of social workers and crisis interveners; plain-clothed, specially trained police officers. It is a really important and significant program.


In addition to this there are many outpatient and day treatment services for families with children and adolescents throughout the metro area. We have community mental health clinics in Halifax, Dartmouth and in Sackville. These clinics are multidisciplinary teams made up of psychologists, social workers, youth care workers, psychiatrists, admin assistants. They certainly provide really important services and this is an area where I think we need to continue to look at expanding and providing services for people.


We have a Child & Family Day Treatment program out on Bayers Road and it's serving kids and families throughout the area. They do group, family and individual counselling in a day treatment setting. They have a very large staff with psychiatrists, psychologists, OTs, social workers, nurses, teachers, developmental workers and youth care workers. Again, these are treatment programs that make a significant difference in the lives of people, and of course we have in-patient services.


As I indicated, 4 South is one of the units where children within the IWK get in-patient services and any young person from the ACT program that is unable to be discharged for the weekend, because of the level of care requirements, will be accommodated on 4 South. This is something that has been, again, determined by the clinical team at the IWK as an appropriate way to provide support to certain young people who aren't able to go home.


I understand that in the last little while there have been quite a few empty beds on weekends because kids in the program were - and certainly when I worked in the field it wasn't unusual. We tried very hard, as a matter of fact, to have people go home holidays, weekends and what have you, because these are the environments where people will be spending their lives, facing the challenges that need to be confronted and overcome, trying to prepare young people with the best tools possible, to have the resilience to deal with whatever it is that life throws at them.


So, again, I would just reiterate my commitment to fixing a system that was broken and my commitment to seeing that we do more programming in the community, that we provide more services on an outpatient basis, that we intervene earlier and do earlier assessments - but not just assessments. Earlier assessments are what allow you to get earlier treatment. This is very important and ultimately we will all benefit from a system that is more responsive to people, unlike the system that was in place when I arrived in the Department of Health.


We will be able to do it with a relatively modest kind of change in resources. This is what some people like to refer to as innovation in the health care system. Innovation is often code for doing things differently, for finding new ways to provide better care with the same amount of resources.

MR. CHAIRMAN: The time allotted for the Official Opposition has now expired. We will now turn to the Progressive Conservative Party.


The honourable member for Argyle.


HON. CHRISTOPHER D'ENTREMONT: It's good to be back for a few more questions as we go along.


It's great, during the hour we have a little more, I think - well, maybe we can get further information on one thing or another as it rolls around. When it comes to the physician resource plan - I think it's what we were talking about when I finished up my hour - I wonder when the plan itself will come out. Is it a month away, six months away? Where is that resource plan and when is it going to be released?


MS. MAUREEN MACDONALD: Before I respond to the member, the member had asked me to share the information around physician recruitment and retention and I'd like to table that for members to have.


As I indicated, we have been working on a physician resource plan in the department and we're getting very close to finalizing that piece of work. I'm very much looking forward to sharing that and starting to have the public discussion around how we move forward to address physician retention, recruitment and meeting the needs of people from one end of the province to the other.


I anticipate that will happen fairly soon, probably before the Victoria Day weekend, but I don't want to say with absolute certainty. A lot of things could happen between now and then. My objective would be if we could move forward before this Legislature rises so that if there are questions that members have, they'll have an opportunity to take them up with the government during Question Period or in debates.


MR. D'ENTREMONT: I appreciate that answer, especially as a lot of times we think things are coming soon and I remember a previous Premier who used to use that one a lot but it's nice to know that maybe by Victoria Day weekend we'll have something near. If it takes a little bit longer, that's fine, as long as the information is correct. Any effort from the department is a good move forward on making sure that distribution, and to understand the situation we are in to move forward to try to fill some holes in physician resources.


Further questioning from the last time around, or maybe a little bit different - in April 2011, about a year ago, the department announced $5.5 million in new investment, including $4 million over two to fully fund EIBI. I'm just wondering what the breakdown is of the other organizations, individuals that would be receiving funding through that $5.5 million - the $4 million doesn't quite add up to the total amount.


MS. MAUREEN MACDONALD: Mr. Chairman, while the staff are looking to see if we have that information, I would say a couple of things. First of all, I think we all, everybody in here, shared real excitement in finally seeing that the lottery system to get assessment and treatment, early intervention for kids with autism, was finally being addressed. I think the member may have been at the announcement and I think I will never forget the excitement, and really (Interruption) Yes, people literally - there were people who cried, they were so pleased to know that finally.


Now, at the time of the announcement, we recognized that implementing this program was going to take a bit of time simply because we didn't have enough therapists trained to be able to walk in the door the next day with these children. So it was kind of a staged implementation, first of all to get enough EIBI therapists. So that work occurred and I think this year is the year, right now as we speak, maybe back in the Fall, finally all of the children who require these services are getting them.


Earlier I indicated, perhaps to the honourable member for Kings West, he had identified what appeared to be an under-expenditure in one of the line items and it really was a transfer from the IWK for EIBI into the other districts to be able to meet their need. So last year we budgeted $2 million, which reflects the fact that there weren't sufficient staff trained to provide this service, but in this year's budget the whole enchilada is there, it's $4 million. The bulk of that goes to the IWK, close to $1.6 million goes to the IWK and then Cape Breton, $630,500.


As the member would know, this is the behavioural therapy, intensive behavioural intervention helping children with autism develop their functioning skills, including communications and social skills, behaviours and what have you. So when they arrive at the school system, they're much more ready to participate. Many families just cannot believe the difference in their children, having gone through this program, and they see dramatic changes.


We in the department continue to - I think in the past we held a bit of money from this program, centrally, and we used that to support training, primarily, but now that we have that behind us, I think that this money is pretty much dispersed into the DHAs and it's a wonderful program. Just a little anecdotal story I would like to tell. I had a social work student who did his field placement in the minister's office two years ago, or something like that, and his dad is a psychologist - this student is from Ontario, studying at Dalhousie - and his father came to spend a week or so visiting the Maritimes. They had never been here and while he was here I had an opportunity to meet his parents. His father works with kids with special needs and specifically children with autism. Carl brought his mom and dad here to the House and I had a little chance to talk with them outside.


His father is here on his holiday visiting the Maritimes, where he'd never been before, and what did he do? He visited all of the autism organizations in the province. I said to him, you sound like some of the social workers I know. He said to me, he was so impressed with Nova Scotia and what we had for kids with autism. He told me that in his part of the world, in southern Ontario - not in Toronto but in small-town southern Ontario - they didn't have anything anywhere close to the support and the services that we were providing, both in the health care system and in the school system.


I have to say first of all, I felt really good about that of course, but I also thought, we often see ourselves as not having certain programs, being lesser, having less access. But this isn't necessarily the case. We have quite a few areas where we actually lead the way and I would think that we could go toe to toe with any province in terms of what we're providing to families with autism. I say to the member opposite, it was your government that initiated the program, recognized that this was a really important gap in our services to families that needed to be addressed. I'm really pleased that our government has been able to take and build on that program now so that we have a program that leaves no child behind and people can feel very good that we are providing services that don't necessarily even exist in a much wealthier province like Ontario.


MR. D'ENTREMONT: EIBI has been a tremendous success. I think it's one we all can be proud of as it provides the services to those families. As much as most of us don't know for sure exactly what it's like to have a child who has autism - I know my wife, who is a resource teacher at the school level now, can't get enough learning when it comes to autism. As a matter of fact, this Friday and Saturday she was at an autism conference here in the city. Every opportunity that she has she tries to get it because she sees the impact of different ways of teaching these kids, how it helps them out, how they learn, how they don't learn. I think it's a tremendous issue.


Right now she is seeing the ones that did not have the opportunity to go through EIBI. Hopefully, at some point, she'll be able to see a lot more of the ones that have had that early intervention and I think it's been a tremendous asset for students or children in our province.


I'm going to move on a little bit to a couple of other issues before the member for Cape Breton West can get up and ask some questions. One is a silly question but I'm going to ask it anyway. It revolves around details of an expense - this is still with the EIBI funding allocation - there is a Holiday Inn $17,164 expense. I believe this was in the 2011-12. I'm going to guess that's a conference. Was it training? Perhaps the minister could explain the training.


MS. MAUREEN MACDONALD: I think staff are saying that it relates to training. As I indicated, I know that when I first came into the department and I had my first briefing with the mental health section, I remember the director explaining to me how the EIBI program was working and how it was funded and the money that the department held internally. On a regular basis - I think on an annual basis - the people who are providing the therapy across the province would be brought together.


I don't know if people really understand this - I know that the member does, but I don't know if every member of the Chamber understands that the EIBI program is a Nova Scotia, home-grown program. It's a program that was developed with a professor at Dalhousie, Dr. Susan Bryson - close, maybe not precisely the last name. So it was developed with this expert at Dalhousie and part of the approach has been to evaluate and test it all the way along. It was very important to have consistent training of the people who are delivering the therapy and on a regular basis these folks were brought together as part of that process, a kind of debriefing, but also feeding into the evaluation program.


The line item that the member refers to, in all probability, relates to that. That would be our best guess. I don't think we have any specific information on that, but we can look to provide that to you.


MR. D'ENTREMONT: If the staff does want to have a quick look, I'd be more than happy. If they can't find it, that's fine too. I want to move over a little off of that on to the issue of Capital Grants and Healthcare Capital Amortization - Page 13.17.


Last year we were critical of government for not allocating anything for hospital equipment. We see through the forecast that $6 million or $6.4 million was spent and that this year we are putting in $15 million for hospital equipment. I'm just wondering what the comments are from the minister. I understand how hard it is to manage that file because every hospital has a list as long as my arm for replacements and equipment and those kinds of things. I'm just wondering - we had nothing, we spent $6.4 million; we're now going to have to spend $15 million - I'm just wondering if $15 million is actually enough to start working with the lists that I'm sure the DHAs are providing the minister.


MS. MAUREEN MACDONALD: I want to thank the member for the question. Who says we don't listen to the Opposition over here on this side of the House? We did spend last year - although there was no line item in the budget - a little over $6 million last year. This year we're projecting - our estimate is $15 million. The member is correct, there are many needs for capital investment in our acute care facilities in particular. One of the things that we have developed in the department is a very good process for prioritizing the capital requests from the DHAs. The DHAs are asked to provide their list and they're asked to put a priority on their list and then the staff in the department do an evaluative process. They go through an evaluation and we arrive at what we think is a reasonable response to the requests that come from the district health authority.


So as the former minister would know, the requests are generally significantly greater than what we arrive at at the end. We had requests, close to $40 million in requests, but as we go, we go through a process and we assess. You can see, just in terms of what we spent this year, realistically - maybe the DHAs, they're like everybody else, they have wish lists that are not necessarily that we need to get this in, like, tomorrow, but we do need to start planning for it. We do need to have some way to determine what the priorities are and I feel that we have put in place a process that has helped us establish a realistic picture for what is required and certainly when we have a realistic budget, at the end of the day it works in everybody's favour. It means that we haven't underestimated and we haven't overestimated and this makes my buddy, the Minister of Finance, very happy when that happens.


MR. D'ENTREMONT: It was always a challenge because the list is so long. I understand the prioritization that the department does in really looking at the equipment that is out there. I mean many times there is truly broken-down equipment and things that do need to get replaced, but at the same time, if we don't stay - I wouldn't call it being on top of things, but at least trying to get some replacements going along, trying to get repairs going along. Some of these pieces of equipment, if they break down, they're tremendously expensive to replace and the added frustration that I had was it didn't seem every time that a new piece of technology came along, the price was the same. You would hope that an MRI would go down in price but, no, because not only do they have version one that you have just paid $50 million for, version two just came out, well, that was $50 million too, and it just continued on like that. So there's always that challenge of the technology of things that is tremendously difficult.


The next line down on that one is Hospital Infrastructure itself and the estimate for last year was about $72 million. The forecast came in a little above that. We're now going to be budgeting a number under that, about $64 million or $65 million. So I'm just wondering, knowing full well that hospitals across Nova Scotia are in need of various pieces of work, whether it's water infiltration, roofs, windows, or new flooring, et cetera - the list on that one is extremely long as well - could the minister provide us with an idea of the actual infrastructure costs or requirements from the district health authorities?


MS. MAUREEN MACDONALD: Madam Chairman, just back on the other in terms of an assessment, how we sort out what really is needed and what maybe can be put off for a bit, we look at the age of the equipment that's looking at being replaced. We look very much at the patient impact. I mean that's the number one question - what is the impact on patients? And we look at the population that's being served. We want to make sure that the equipment that is being ordered is the right size for the population that's being served so that we don't necessarily need, in a small location, an MRI that would serve a population of half a million people, or whatever, so those are all considerations.


The member has moved to the capital grants area and has identified that there will be less expenditure in that area this year than in previous years. There are explanations for this and they tend to be that some fairly significant projects are coming to completion. For the Colchester Regional Hospital, last year we had in our budget $45.531 million in our estimates. That will be completed and that's a variance of $21 million. This year we still have to complete that project, $24 million, but nevertheless it's cut in half because we're getting close to the end.


The same is the case for the Inverness hospital. We had a major expansion in Inverness and that is coming to completion. The community bungalows at the Nova Scotia Hospital, those are essentially completed. Overall, the capital budget has increased the bottom line by $9.570 million. We do see some big projects being completed. We have a number of smaller projects around the province now that we're going to be able to do.


I'm really pleased with the amount of work that's going on. As you know, the pent-up demand for capital improvements is just an ongoing thing in the health care system. It's very hard because all of these projects and proposals are worthy. There's validity to many projects and proposals that come forward. I can almost hear the member for Guysborough-Sheet Harbour sitting behind me asking me, where's the Guysborough hospital?


It's true, I toured the Guysborough hospital with him a while ago and it's a facility now that is outdated and it offers challenges to the nursing staff to ensure that their occupational health and safety is considered in the work environment as well as what patients require. There are many, many things that we can do now that some of these other bigger projects are coming to completion.


I'm being told that the $17,000 that the member asked about before was all new EIBI team members attending a five-day training session; five to eight families were included. When training was completed, the team members were able to begin teaching children immediately, just to be clear about what that was for.


MR. D'ENTREMONT: I'll just close out before I pass it on to the member for Cape Breton West. I thank the minister for that and I do understand the challenge. It will be good to see a few hospitals complete. I had a chance to tour the Colchester hospital not so long ago and it is looking pretty good as it gets closer to its completion date, which we hear is sometime in October-ish. I think I still have the scars on that one and I always will.


The bungalow issue - it's nice to see the bungalows coming to fruition. If we all remember, when that happened, it was one of the first announcements I made as minister. After about a year, we found the location that they had chosen was the incorrect one and we got into a little bit of a dust-up with the Department of Economic and Rural Development and Tourism, because apparently they wanted to keep the site. Once we got that figured out we had to tear down an old nurses' residence. Once that was all torn down we could finally start building the building.


Unfortunately, it never made my time as minister so my last ask to you will be that when the opening of the bungalows happens, I'm hoping to receive an invite to make sure that I get to see these things, because I announced it in what seems to be an eternity ago - but knowing that mental health patients will have an opportunity to live in a safe environment as they move on in their treatments and into the broader community.

With that, Madam Chairman, I pass my time over to the member for Cape Breton West.


MADAM CHAIRMAN: The honourable member for Cape Breton West.

MR. ALFIE MACLEOD: Just seems like an hour and a half ago that we had a chance to exchange some ideas and thoughts. In that exchange, Madam Minister, you answered the question about the location of some of the services that might be taking place, and you mentioned Antigonish as a possible site. I suggest to you that further east would probably be a good site, as well, because earlier today you read a resolution in this House talking about the accomplishments of the Cape Breton District Health Authority and how they were leaders in Canada and now we have an opportunity to see them be leaders here again with this program and I understand they were an active partner in doing this work.


Of course, we have John Malcom, the CEO who is going to be retiring soon who, I think, is a leader in his category and is somebody we are dearly going to miss when he leaves the Cape Breton District Health Authority. Along with that we're going to have Dr. Naqvi retire 30 days later and he has been an extraordinary individual in getting physicians to locate here in Nova Scotia, in particular in Cape Breton Island. Those are going to be two gaps that are going to be quite hard to fill.


I guess I'm putting my oar in the water to say to you that I think with all the qualities of the Cape Breton District Health Authority, we could easily handle some of the shared services that are being talked about moving around.


But now to my question, and it has nothing to do with that DHA, it has to do with the subject I'm sure you've been waiting for me to ask. I would just like to get from you Madam Minister, if I could, an update as to where the Province of Nova Scotia now stands with the CCSVI treatment.


MS. MAUREEN MACDONALD: Thank you, yes I was hoping we'd have a chance to have some conversation about MS liberation therapy and where that stands. Just before we do this, I too will very much miss Dr. Naqvi and John Malcom out of the district health authority in Cape Breton. They both have served not only the district health authority up there, but the province very well.


I always remember when I was a new member in this House, I was the Health Critic for the NDP and I went on a little tour to familiarize myself with the different services around the province, the different DHAs. Dr. Naqvi put me in his four-wheel drive vehicle, on probably the most bitter day that you could ever imagine in February, and drove me all over industrial Cape Breton, every facility. I was to Glace Bay, to New Waterford, North Sydney, I was in the regional hospital, and people up there laughed because they couldn't believe that I had trusted my life to Dr. Naqvi.


It's true, he's so animated in talking about what the needs were for people in the community. I mean, I sat in the front seat - I joke with him when I see him now, I ask him if my nail marks have ever come out of the seats because he's telling me about how many doctors they need over here and what pieces of equipment they need over there and how they've changed things over here, and I don't think he spent too much time watching the road. He's a remarkable man - not the best driver on the planet but just a wonderful person, and he's made such an incredible contribution to health care in Cape Breton.


He has invited me a couple of times to meet with the medical association. They have an annual meeting and the doctors up there - it's like going to the United Nations and it's fabulous. He has recruited doctors from all over Canada and all over the world. The countries of the world are well represented. There are Australians, Americans, Africans, people from Middle Eastern countries - it's fabulous. I feel fairly confident in saying that there's nobody in our province like Dr. Naqvi when it comes to recruiting physicians and being very convincing.


With respect to the question around liberation therapy, we are waiting for an update from the federal government with respect to their call for research. The Minister of Health, with the Canadian Institute for Health Information, back I think last summer, toward the end of June or in that ballpark, they launched a request for proposals for clinical trials, essentially for the first step in clinical trials. The deadline for proposals is - well, it's here actually. We were expecting the federal government and CIHI to announce who the successful applicants were to do clinical trials in Canada. We were expecting that research team would be announced sometime in March, and as the member knows, sometimes these things take a little bit longer than anticipated, but applications were submitted. They called for researchers and research proposals and they've undergone the kind of peer review that's required before research is awarded. They will be selected on the basis of criteria that were developed by CIHI.


I'm as anxious as the member to find out who the research team is, what their proposal was and what opportunities there are for Nova Scotians to participate in clinical trials based on the successful research proponents, so that's where it is right now. I assure the honourable member that as soon as I have information, I will be sharing it with members and I will make sure that the honourable member knows.


MR. MACLEOD: Unfortunately, these things do move slowly and we see that here in our own province as well. I guess my biggest concern is that time is not a friend of a person with MS and we've had this discussion on many occasions. I'd like to know if the minister could show me in the budget what resources have been allocated toward this project once it is approved by the federal government.


MS. MAUREEN MACDONALD: Until we have a better appreciation of who the research team - who the successful proponents are, where they're located and who they're accepting and how they're accepting into the clinical trials, we would just be stabbing in the dark at raising an amount of money. So there's no money specifically allocated in this budget for participation in clinical trials, but that does not mean that there won't be a commitment to participate in clinical trials.


The Premier has been very clear on this, as have I, that Nova Scotia will participate in clinical trials when the scientific community is ready to move to clinical trials and has the necessary approvals. That has yet to be determined, and as I said, we're just awaiting the results of the process through the federal government to establish clinical trials, who the research team will be, and how it will proceed. Once we have that information, we'll be able to do an assessment of what the implications are for Nova Scotia and what the costs would be in terms of being able to participate.


MR. MACLEOD: I guess, Madam Minister, this has been two years. It was two years in November since this treatment was identified by Dr. Zamboni. It's probably two years around this time that it has been brought to the floor of this House and talked about. The Premier was adamant that as soon as we had federal approval, he and Nova Scotia would be onboard, and you have said the same thing. The federal government has come onside. They have moved their system forward, and I have to be honest with you, I'm a little disappointed to hear that there have been no resources identified for something that you had said was going to be a priority for this area, because there are so many people who are affected by this.


We see it in Saskatchewan where there is funding put in place to help people go and get this treatment in areas. We see it in New Brunswick, that has a deeper and bigger problem than we do as a province, and yet they put money aside to help people to go and get this treatment, because there are - I know you and the Premier keep talking about your scientific evidence, and I'm sure scientific evidence is important, but all you have to do is talk to some of the people who had the opportunity to get this treatment.


It's a treatment, Madam Minister, it is not a cure, and to hear today that there is no funding even considered for allocation is really very disturbing, because I, like so many other people who were here and heard the Premier and yourself talk about this, was sure that you were sincere about trying to move forward, and in order to do that, you needed to identify some things. You could have been identifying some spaces. You could have been making a register of the people who have already had this treatment and had them come forward and be looked at by neurologists so that when the tests start, we would be closer to knowing who would be the ones who would qualify for this.


So maybe instead of doing a whole bunch of commercials on radio and TV, maybe we could take some of that funding and put it toward a cause like MS so that the people of the Province of Nova Scotia who expected their minister and their Premier to come forward with something would do that. With that, Madam Chairman, I'm going to turn my time over to the honourable member for Hants West.


MADAM CHAIRMAN: The honourable member for Hants West. (Interruptions) Just one moment, please. I'm going to defer to the Clerk for a moment.


Order, please. At this stage I think what I'm going to suggest is that the honourable minister would be able to offer her remarks at a time either in her closing remarks or with the indulgence of the next speaker, if he would allow for it. I'm going to go to the next speaker on the Opposition side.

The honourable member for Hants West.


MR. CHUCK PORTER: Madam Chairman, yes, the minister will have an opportunity maybe in her closing time for comments. I know I have a number of things I want to address and I'll take a few minutes to do that now, and in the coming minutes, to make a few comments on some issues that are certainly near and dear to the people in the Hants West area, and I'm sure province-wide, when it comes to health care, the spending, the budgets and so on that we've seen over the last year since we were here and talked about budgets and expenditures and what has transpired and certainly going forward with what's important to all the people in Nova Scotia. Specifically I want to get into some items around home that mean quite a bit to people there. I know that it's not specific to my area, but I will be specific to my area of Hants West.


I want to start - and I'm sure this will be no surprise at all to the minister - some of my comments today will be of no surprise whatsoever. I'm going to start with dialysis and I'm going to work through some things, and none of them will probably be a surprise at all to her. She's heard them before; she has had questions. I want to talk about dialysis. We stood in this Chamber last year in this very place and I asked questions about what kind of money will be invested in the coming year in the dialysis program across the province. I know specifically at that time it was with regard to the Capital District Health Authority of which the Hants Community Hospital, at home in Windsor, is part of. I did learn later on there was a figure of $998,000 that would be spent within the Capital District Health Authority.


In trying to get answers at that time of what portion of that - or would there be a portion of that invested in Windsor - I was unable to obtain that until after the estimates were over. At that time, I did learn that there would, indeed, be no money spent specific to dialysis in our area of Hants West and specifically at the Hants Community Hospital; it would all be spent in Halifax and Dartmouth. So what's it going to be spent on?


We have a community - and I don't know if she's familiar with that; I know she knows what's going on down there and I'm not going to take a lot of time on that, but we have a community that came together to do a number of things to raise money. We know that all of these things - it's easy to stand here and ask and ask for things - they all cost money. I think that everybody I've ever spoken to on the topic, and especially the people at home who have been involved in this specific dialysis fundraising issue - the need, the want for this, the desire to have this closer to home for the many people - and we do have a lot of people who travel either to Berwick right now and/or to Halifax for treatment. They understand that these things cost money so they said, we're not one to sit down and do nothing and just ask with our hand out; we want to be part of the solution.


The solution, of course, was hopefully to put dialysis machines at the Hants Community Hospital where we feel we have a wonderful facility. It has been there for years and has the space and has the people. People have come out who have worked there and said, we'd be willing to be part of this because they know what the patients are going through. Some of them have actually had family that have been part of this travel bit to dialysis. Of course, that can only go on for so long.


There have been a number of fundraisers and some big fundraisers. Last Fall, I think we raised over $30,000 in one day; I think somewhere in the vicinity of $150,000. There are other commitments right now that are outstanding if we ever had another commitment to actually go forward and move and spend some money.


We know that the biggest cost here is not necessarily purchasing the machines. We know that there's a cost for setting up and putting machines in place. We know that there are certainly operational costs that include staff, training and so forth. We've even had people who are already trained working in Capital District and in other areas come forward and say, we'd love to come to Windsor and work; you don't need to train us, we're already trained. We're from here, we'll come back, we'll work here; we live handy here. We'll come back and we'll work here. We would love to service our local people who could use this.


Now, we have not been successful, as the minister well knows, we've had no commitment from the Department of Health and Wellness and government for the machines, so we're going to continue. They can say no all they want. Last week we had the Department of Health and Wellness in front of us and I specifically asked the deputy minister, does he ever see a plan in the future whereby dialysis would be in Windsor and supporting the local people there and the answer was quite bluntly, no, we don't see that, we have no intention of investing in the people in Hants West when it comes to putting dialysis there.


Okay, that's fine, things change over the course of years. Governments will change. Answers might change, too, we don't know. We'll wait for that but we're going to continue to do what we've been doing. We're going to continue to fundraise because we believe that's the right thing to do. Again, we don't believe in just going and asking and expecting that government is going to dole out all the cash. As a matter of fact, the Hants Community Hospital Foundation and Auxiliary have been raising money, in our area and for that hospital, for many years, by many people, in many ways, and have put in place on the floors things that government can't necessarily afford - special items: crash carts and the like and so on like that, which are important to the people who are serviced by that hospital.


That hospital area services over 20,000 constituents - not just in my area; some of the folks in East Hants, some of the folks in Kings County, on the other side of Hantsport and the border area, are also coming. I know that the minister is aware of what that takes in, and certainly out toward the Lunenburg County line and so on, they come our way.


So it services a great area and they do great work and we've got great people there, but dialysis is a huge issue in our area - a huge issue. We've got people who have been travelling for years, some of them for 15 years, if you can believe that. We've got people who are on dialysis who are quite young, unfortunately, and we know that that's a problem. We know it's an ongoing problem and a growing problem with regard to diabetics and so on and so forth, and we know that that number is going to grow.


I know of a gentleman who just lives down the street from me. He's 72 years old, I think, and maybe older than that now. He travelled into Halifax three days a week by himself because he was too proud to say, when we offered - he's a good friend of ours - we said we'll take you in and we'll make arrangements, we'll drive you. No, no, no, he said, I can do it. So he would get up in the wee hours of the morning and he would make his way to Halifax for dialysis. He would stop and he would do his thing at 6:00 a.m. and he would get hooked up and he would go through his dialysis here and then he would pull over on the way home and he would have something to eat to get a little energy built back up and maybe a little nap, if needed, to get him the rest of the way back to Windsor - three days a week. Those are the real stories. That's a real example, and as I said, there's a gentleman who for 15 years has been travelling - 15 years is a long time.


There are others who have given up, just can't do it anymore, can't do the travelling, and we know the end result of what happens when you give up that treatment - you can only go so long. Unfortunately, people do choose, whether they're getting on in age and it becomes more and more physically demanding and difficult for them to make the journey, it really does; it's hard on them.


So I know the minister can appreciate why every hospital would probably like to have their own dialysis so the people who are travelling from all over, different areas around the province, could do it closer to home. So far, as I said, we've had no luck with that but I want the minister to know we're not giving up on that just because the department is unable to finance that at the present time or make a commitment. We will not give up on that. We will continue to ask, and as long as I'm the member representing that area, she knows, I'm certain that I'll be standing here asking about this very issue as we go forward - not only through estimates, through Question Period, outside of this House and every other mechanism that we have at our disposal; we'll continue to do that.


I know that the government has made investments in home dialysis and I want to talk about that for a minute. Home dialysis does work for some people; it doesn't work for everybody, and we've seen that too. There are some issues with home dialysis. There's also a very large cost with home dialysis that people aren't all that aware of.


Now, I was told recently by a gentleman - we had a fundraiser for him the Thursday night just before Easter, April 5th, we had a fundraiser for him at home. He's not on home dialysis, he's travelling. He was telling me about some of the things that he has learned over the course of travelling in the last year, about where the money goes, how dialysis works and, of course, when you get this, you probably study it in the greatest detail so that you understand what is actually happening physically with you because it does affect you physically; it affects you mentally, I'm sure, as well. It's very tiring. All of those things are impacted in everything that you do. Life has changed. Life is over the way that you knew it and there is, unfortunately, only one cure and that is, of course, a transplant.

Some people have had the ability to get a transplant done. As a matter of fact, the older gentleman that I spoke about a few minutes ago who lives down the road from me had a transplant. Since he's had that just prior to Christmas, he's had some difficulties with infection and that's fairly common from what I understand. Anytime you get an organ from someone else you know there will be issues regardless of what the organ is. We've all seen other examples, whether lung transplants, kidney transplants or what have you. There have been some unfortunate circumstances that go along with that. There's a risk in doing that.


You have to decide where will the risk be? Will it be in getting the transplant and going through and fighting off infections and maybe worse? Or will I stay on dialysis? It's a tough decision for those people who have to make it. I know the minister understands that those are tough decisions. Again, the question comes up, why can't we have this closer to home? We have a wonderful hospital there, we have the staff there. You try to explain and we do explain in all honesty, we take the time, we say, government is saying no but we're not giving up, we're going to continue to fundraise. People believe in that. They see a day when that could happen.


That's a good thing, there's nothing wrong with that. There may be a time, too, when government can say, we do have money in our budget, maybe we can invest in it, maybe that makes sense. We won't give up on that at all. We're going to continue down that road.


I want to go back to home dialysis for just a minute about some of the costs associated with that and some of the things I learned from that. I'm told from those patients that it's fairly expensive to get set up - tens of thousands of dollars - they come in at about $33,000. I don't know if that's accurate, we'll get into that after a bit maybe for clarification later. Not only that, if it doesn't work - well, before I get to that, in setting up you have the training, you have family training, you have things you need physically.


Home dialysis is different, you need to be hooked up at certain periods of the day, sometimes they're all night. The gentleman that I spoke of a few minutes ago was actually on home dialysis and it didn't work for him. He was on every four hours or something trying to get things regulated. It never worked out real well, they had to start travelling.


Anyway, in getting back to the cost of this, what I found very interesting was that if it didn't work out at home, you have all of this stuff that you're supplied with and you almost have to have another room to put all of your supplies in so you have adequate supply for doing the dialysis at home and so on. What happens if it doesn't work out, or the unfortunate happens and folks become unable to carry on with it and they come to the end? I'm told that here we have all of this equipment and you can't bring it back, now it's waste - many, many dollars being wasted. It can't be transferred to somebody else.


Is this really the best way to treat people on dialysis, or is the investment better made in a place like Hants Community Hospital, as an example, where people can come and they don't have to worry as much? They don't have to worry about the sterile technique, training, they have assessments that are done on the fistulas and so on that are examined every time they're hooked up and looked at. Blood work can be done if it needs to be, whatever tests might need to be done outside of the norm can be done, temperature-wise.


A lot of things can be done to manage these patients. They need a lot of care. When they're a little bit younger, a little bit healthier you'd never know for the most part some people even have a problem. You'd be surprised when you look at some of the people that are on dialysis the shape that they are, fortunately, in that you wouldn't know they were driving to Halifax from Berwick or in our area, three days a week and getting hooked up for dialysis. You really wouldn't know it.


Some of these people are working. They're still out. One gentleman I spoke of a few minutes ago, he works every other day that he's off and he's in construction. He's actually out physically working, that is a good thing. (Interruption) Oh, a moment of interruption, thank you, we'll get to that. Thank you, Madam Chairman. He's working construction and you wouldn't know outside of that. I'm sure by the end of the day he's tired, there's no question it probably takes a lot out of him that day in between and certainly on the weekends where you have maybe a two-day haul from that Sunday, Monday and then back Tuesday again.


By the end of the second day if you're working, I'm sure it's taking quite a bit out of you. That's to be expected when you have dialysis, he realizes that. But the extra travel over and above that takes that much more out of him. We all know what the cost of travelling these days is and they know and they will also say we know we're getting some mileage compensation here but it's not doing anywhere near enough. It's not so much that piece of it, as it is the physical aspect of it when it comes to the travel part of it.


Again, why have it at home? There's a reason to have it close. How many people will it service? You wouldn't do that financially, you'd look at this and say we can't do that for 10, 15 or 20 people. We are in an area where you could service many people - 40, 50, whoever you'd like to service. We are just located perfectly for that. Again, one of the reasons that we think it's of great value to have the system at the Hants Community Hospital is not every place has the opportunity where there is an organization that is willing to fundraise to help offset costs over the long term - not just in the short term but over the long term, if that's what it takes. But, unfortunately, we've not been able to get anybody to the table to have that discussion.


I know that we're reaching the moment of interruption and I will adjourn debate for the time being here and look forward to coming back. I'm not sure what time I have left but I look forward to coming back and - what do I have left for time, Madam Chairman?


MADAM CHAIRMAN: Ten seconds for the allotment to the Progressive Conservative Party.


MR. PORTER: Okay, well, I guess I'll look forward to coming back in the next hour for the 10 seconds that we have available to us. Thank you.


MADAM CHAIRMAN: Order, please. We've reached the moment of interruption and the Committee of the Whole House on Supply will now rise and report its business to the House.


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


[6:27 p.m. The committee reconvened.]


MADAM CHAIRMAN: Order, please. The Committee of the Whole House on Supply will now come to order. We will carry forward with the estimates of the Minister of Health and Wellness.


The honourable member for Kings West - you have one hour.


MR. LEO GLAVINE: Madam Chairman, there were just a few other questions that I did want to finish up with in regard to the IWK. The minister talked about the mobile crisis unit. I know it is getting good reviews in its work. However, I'm wondering, is this available just in the Capital Health District, or is it used in rural Nova Scotia as well? Does it connect to EHS in some significant way?


MS. MAUREEN MACDONALD: Madam Chairman, I thank the member for the question. You know, the mobile crisis unit has an interesting history and it goes back a number of years. In my constituency in the north end of Halifax on Gottingen Street is an organization near and dear to my heart that I have spoken about in the past: the North End Community Health Centre. The North End Community Health Centre was one of the first community health clinics in the province, and it must be more than 30 years old now. The North End Community Health Centre can be credited with a lot of very interesting and innovative health care programs throughout our city here, and the mobile crisis centre was born out of the North End clinic.


Under the auspices, the leadership, of a fabulous person named Johanna Oosterveld - she used to be the coordinator, the executive director, of the North End Community Health Centre - Johanna for many, many years was a health activist and an advocate for more primary-based health care, more community-based health care, less bricks and mortar kind of health care. When Johanna was the coordinator for the North End clinic, probably I would guess back in the 1990s - back in the early 1990s, I'm guessing - the North End clinic recognized that patients of the North End clinic frequently required services outside of banking hours and that the emergency rooms weren't always the right place for people to get services, especially people who were in crisis and particularly any kind of mental health crisis.


So the clinic applied to Health Canada for funds that Health Canada had available for demonstration projects and they were successful in getting funding to set up a mobile crisis unit as a pilot project. The mobile crisis unit, at that time, I think, only provided services two or three days a week and a very small number of hours. They tested this crisis unit and they were able to demonstrate that this was a very effective way to divert people in crisis from the emergency department and provide the crisis intervention that is necessary for people who are perhaps in danger of harming themselves or someone else in a very quick and effective way.


This project was so successful that it was adopted by the Capital District Health Authority and for a number of years it continued to be funded through the DHA but not as a 24/7 service. Eventually that service was expanded and it was built on. I think the bringing in of the specialized police officers is another level of service, a really important feature of this crisis service, because we know that police are frequently out in the community. They may be called to a household where there is a domestic dispute or there may be some other altercation going on and they have at their disposal a crisis unit that can come into a household with them, people who have the right skills to assess the situation and help diffuse what may sometimes be a very dangerous kind of situation and really then do the follow-up with the individuals and ensure that they get the right care.


So the mobile crisis unit - that's kind of its history. It's just a phenomenal service and all of the evaluations were so positive around this service that it was a no-brainer in terms of the expansion of that service to 24/7. That service now, as I indicated, also includes the IWK as well as the Capital District Health Authority. The Halifax Police Department and EHS also are involved. Protocols exist between these various agencies and the service in terms of how people get called and what level of care is provided by whom and when and where, and it is a service that is available only in the Capital District Health Authority.


Other DHAs have looked at the service. They look at it, probably with some envy, and there are DHAs that are considering whether or not they have sufficient need in their districts to adopt similar services even at a modified level. I know that the mobile crisis unit is certainly of interest in the Cape Breton area. It's certainly of interest in the Truro area and, if I'm not mistaken, I think I have heard that in the Annapolis Valley there may be an interest in some features or some aspects of having a mobile crisis unit.


To the best of my knowledge, we have not had proposals come forward from other district health authorities for mobile crisis. I can't say that with absolute certainty, but I don't think it is the case. It's a service that I have a great deal of respect for. When I was doing my Ph.D. thesis, I did some shifts at Bryony House, overnight, and I saw the mobile crisis unit in action. We had a woman who had come into the transition house who suffered a psychotic break while she was in the house at 2:00 a.m. There was, on staff that night, one transition house worker, one of the crisis counsellors, who had to answer the phone, answer the door and deal with residents in the house, and myself, who really was there more as an observer than anything.

What she decided to do - and this was in the middle of the night - was call the mobile crisis centre and they arrived at the shelter, at the transition house, and they came into the living room area and they spent, I would say, at least two and a half hours with the woman until her distress had kind of been reduced. We were able to have her stabilized and then determine that the next day - she was in a safe place for the rest of the night and there was no need to have her removed from the shelter - the next day we were able to get her to see her own physician who was very familiar with her medical history and was able to provide her with the kind of health care that was appropriate at that time. It is a very important service.


Staff have indicated to me that as part of the 2012-13 budget and as part of the Every Kid Counts commitment, our government will establish 24/7 mental health mobile crisis teams with special training in the prevention of youth suicide, starting with expanding the service throughout the HRM, because if my memory serves me correctly, we have the service here in the urban core, but in areas such as Musquodoboit and maybe some of these more outlying areas, the mobile crisis unit is not fully functioning and so we really need to look at the needs of the entire community and what our experience is with respect to our emergency rooms, our various crisis lines and what have you.


Discussions will be held with EHS and our other stakeholders around this service and as we move forward with improvements in mental health services, this certainly will be an area that will receive some focus and attention.


MR. GLAVINE: That certainly is a positive development to hear that it is well anchored in the core of HRM and being looked at to pick up some of the outlying areas. That model may be an area that, perhaps, we can look at in appropriate places throughout all of Nova Scotia.


One of the areas that was touched upon today by the family who contacted me and some of the IWK workers - the ACT program used to have two psychologists working with the clinical team, now there is one and one is working on community-based programs. I'm just wondering if the minster could provide some sense of how she and the Department of Health and Wellness view the current mental health resource base. This is one of the areas that I keep hearing - we really still have many needs in our communities and if we're going to be providing, as the minister says, more professional help, more ongoing support outside of bricks and mortar in our communities, this is why I like the mobile crisis unit, the flexibility and so on it provides.


I know along the way I've had several discussions, at different years, with Dr. John Campbell who I have a very, very high regard for. He does provide a sense of where they are, at least in the DHA in the Valley that I'm most familiar with. They have recruited two or three additional people recently, as two or three retired. But I'm just wondering how the department sees itself in terms of a plan to move more services into a community-based model.


MS. MAUREEN MACDONALD: First of all, earlier I spoke about how resources have grown, investment in mental health services, specifically at the IWK for example, have significantly grown. One day I asked people in the department if they could tell me of all the resources we spend on health care, what proportion we spend on mental health, because you always hear that conversation about how mental health services are shortchanged.


So I went looking, actually, to try to find out what you should be spending on mental health as a proportion of your health care system, what is that magic number and where does that come from, the idea that you should be spending this proportion. As far as I can tell the World Health Organization is kind of the purveyor of the idea that countries should spend about 7 per cent of their health care expenditure on mental health services. Here in Nova Scotia we spend about 6.55 per cent of our health care resources on Mental Health and Addictions Services.


There are some expenditures we'll never be able to really figure out because, for example, physicians will see people on fee-for-service that is not necessarily delineated in a way that we can identify but we can break down mental health administration, the pharmaceutical costs related to mental illness, specific mental health program funding, anything that goes into alternate levels of care, long-term care and what have you.


So we do have the capacity to do that and using those numbers we are able to say that we're not quite where the World Health Organization's standard is but we're getting very close as a province. I don't know how that would compare if you looked at other provinces. I haven't really done enough research on that and looking into it.


In terms of community-based mental health services, we all know that whether or not someone has supportive housing, housing at all, whether or not someone has a job, whether or not someone has adequate nutrition, all of these things are features that contribute to good mental health and mental wellness. So, again, it's very difficult to actually - this is such a big, you know, when you start trying to really unpack and look at what the Minister of Community Services does and her department, how many people are being housed in public housing, for example, social housing at subsidized rates - because that's what social housing does, it gives you affordable rates of housing - what percentage of those folks are people who have mental health disorders and you figure this into the equation of what you're investing in mental health. But without question, the health care system cannot address mental health and mental wellness on its own.


The health care system requires that the silos between departments need to be taken apart and there needs to be more collaboration. The Department of Community Services and their approach to housing needs to be factored into what the Department of Health and Wellness is doing, as is the Department of Justice. We certainly saw, in the Howard Hyde case, the intersection between a number of different agencies across departments.


We need to harmonize our policies, our approaches, our training, our understanding, and then we have education which is a big piece, especially with young people, especially in terms of - well, today I think there was a focus on cyberbullying and just plain old-fashioned bullying and the impact of that on children who are more fragile and not as resilient and in some cases, as a result of the bullying, require services and perhaps in some cases there are kids who perhaps have a learning disability, some little thing that singles them out as being a little bit different and makes them targets for these kinds of activities on the part of other children. We've all seen this, and kids can be mean to each other with a terrible impact.


The health care system is not able to deal with this stuff all on its own. It really requires collaboration, coordination, co-operation between a lot of different departments. This is the approach that we have attempted to take. We see the SchoolsPlus program expanding. It's a program that in some schools offers the kind of services - early intervention and assessment services, the health care system coming out and being more readily available and accessible in schools. Things like the teen health care centres, a very important feature of doing wellness and mental wellness in the school system. As well, the Minister of Community Services and I talk, as do our officials, and are working very closely around a housing strategy that will have, as a feature of that strategy, attention to the needs of people who have mental health disorders.


We know that already in many cases a large portion of the housing that is provided is housing for people who have mental health disorders, but does it have that supportive component? Does it have the kind of services that will be readily available to help identify when a tenant in a housing situation is getting into difficulty, and have the capacity to move quickly to ensure that it doesn't develop into a crisis that requires hospitalization, the acute care system, the ER department, or whatever? There are many, many things that we can do in the community, but from my perspective in the Department of Health and Wellness, that needs to be done in a very collaborative fashion with other departments and we need to look quite broadly.


The last thing - and our focus so much has been on discussing mental health for children and youth, but a huge area that's growing exponentially is mental health for seniors. The whole early onset of Alzheimer's and of dementia and the components that come with illnesses of the brain very often are mood disorders, serious depression, and in some cases significant personality changes.


We are just beginning to think about what it is that we have to be doing, and not only to address the needs of the senior population. How do you support their caregivers? How do you support the families that are dealing with and providing care? Once again, we haven't had much opportunity to talk about the $20 million of investment in home care for seniors and whether or not some components, any components, of that can be used not only for the physical well-being of seniors in their homes - what about the mental wellness of people in their homes? What about the cognitive abilities of people in their homes? How do you ensure that there is enough respite for the caregiver who is caring for an elderly person who may have some psychiatric symptoms as a result of whatever illness they may be suffering through?


MR. GLAVINE: I think the Minister of Health and Wellness perhaps elaborated and touched somewhat there on what may be components of the mental health strategy. I am sure it will be a youth to seniors look at the kind of mental health needs that we have in the province and the kinds of plans and programs that can help reach the desired goals and outcomes of better mental health, better wellness for all of our citizens and we know some of the deficits.


That being said, I just wanted to take a look at Page 13.11 under Mental Health Programs. Is this the line item where we find the money being set aside for the mental health strategy, knowing that it soon will be released? Sometime during this budgetary year, we will know the look of the mental health strategy. I think the minister is indicating that there will be monies; there will be funding to get some of the initiatives in place. I'm wondering if, in fact, this is the line item where we find the money being set aside for the mental health strategy.


MS. MAUREEN MACDONALD: The staff are going to help me out here a little bit because I'm losing my memory. Yes, we have in this budget $3.8 million set aside for the mental health and addictions strategy and in addition to that, there's the $356,000 for the expansion of the addictions treatment program in the Annapolis Valley District Health Authority. It's approximately $4.2 million in new expenditure for this year and, as the member indicated, the details of that will be released when we release the strategy and the work - people are scurrying to try to get that finished.


The folks who worked on the mental health strategy did a terrific job. First of all, the advisory group did a terrific job. They held public consultations all over the place. It was stunning really to learn how many people they heard from. It was well over a thousand people who came out to meetings. They added additional meetings in order to be able to accommodate all of the people who wanted to appear in front of them.


In addition to the consultation, there was some commissioned research and the commissioned research wasn't concluded until the Fall - sometime in September - and this accounts for the delay in being able to bring forward a final product. It will be coming forward very soon.


We have set this amount of money aside. It will be to start doing some of the preliminary work on implementing a mental health strategy. Again, I have to say, the more time I spend in the Department of Health and Wellness, the more time I'm convinced that money is not the conversation we need to be having. The conversation we need to be having is effective models - models that will give us outcomes that are based in evidence.


We have not been able to do enough in the community because we have been tied into models that have absorbed too many resources, which you can never get away from in kind of beds, bricks and mortar. So the more we can do upstream, early, community-based, the more likely we are going to have a healthier population, a population where mental wellness is a greater feature of their lives, and so I'm very much looking forward to the mental health strategy and then really doing a fair amount of heavy lifting to see that it moves forward in a way that really does make a difference.


MR. GLAVINE: Thank you very much, Madam Chairman, and as well, we'll welcome the mental health strategy when it does come forward. I wanted to take a look at some of the other program spending line items. In the Other Master Agreement Initiatives that have been budgeted for, $21.8 million, I was just wondering about a sampling of specific initiatives that are included in this budgeted amount; in other words, just taking a bit of a breakdown on $21.8 million that is part of the Other Master Agreement Initiatives?


MS. MAUREEN MACDONALD: As I was saying the other evening, the master agreement is very complex and there are a lot of different components to the agreement and ways, essentially, to reimburse our family physicians for particular kinds of changes that they themselves will be making in their practices. So probably the biggest, in fact the biggest change is the emergency medical record and we talked the other evening around the electronic medical record. To be honest, I don't know the difference between the emergency medical record and the electronic medical record but it's certainly something that I can check on and let the member know. It's $4.5 million. It's a significant initiative. (Interruption) Yes, that's right. Staff have just told me it's an incentive for the physicians to go on an electronic medical record. So I'm just not sure why we call it an emergency medical record but I'm sure there's a reason for that.


There are a number of other features and one of the big ones that I am very keen on and so is Dr. John Chiasson, the president of Doctors Nova Scotia, a family doctor from Antigonish, is the chronic disease management incentive. This is just fabulous, and as you know, we have very high rates of chronic disease in Nova Scotia and we need to be able to have our family physicians spend more time with patients who have chronic disease, doing education, and really providing them with support.


We see people who go into - and I know every member in here has had somebody call them in their constituency and complain about the physician's office that they went to that had the sign on the wall that said you are only allowed one thing for one visit, per visit. That is the antithesis of chronic disease management and we've set this up in the way we remunerate, the way we pay physicians. We've set it up so that that is the result that you get, that that's the kind of medicine you get, but that is not the kind of medicine that we need. We need medicine where people are able to go in and they have a variety of issues that they need to raise that are generally connected because of a chronic condition. We have incentive and an initiative in the master agreement of slightly more than $4 million to address that.


Just going back to the first item, it is indeed the electronic medical record - an incentive. I think last night we talked about how we have planned for 200 more family physicians to be on electronic medical records this year. That's our objective.


In addition to that, there are a number of other things. I know the member would be very interested in knowing that in the master agreement there is a rural specialist incentive program. It's in excess of $3 million, so this is targeted not at GPs but at getting the right specialities into rural communities. For example, psychiatrists - as the member would probably know, we have a really difficult time getting psychiatrists in our rural communities. We're able to use these little pools of money to incent and meet the patient needs throughout our province.


We also have a Collaborative Practice Incentive Program, and it's a $3 million program as well. As you know, collaborative practice is something that we want to encourage, and we will be setting up more collaborative practices around the province in the coming year. The ones that we have are working very well, and people are very happy in them.


We also have some money in that pool for continuing medical education. This is, of course, very important for physicians. The world of medicine, like the world for the rest of us, is changing very rapidly. We need to provide our doctors with an opportunity to stay current in their fields of practice and be up to date on all of the latest information that is coming out. The physicians take great advantage of these incentive programs. Dr. Chiasson, the president of Doctors Nova Scotia, was relating to me how pleased he was and how pleased the physicians he practised with are that they have so many opportunities in the master agreement to change some of their practices - more satisfactory for them as physicians and better for their patients and, as well, to have opportunities for continuing medical education is extremely, extremely important.


There also is a line item in this pool for Comprehensive Care Incentive Program. I'm not entirely sure what that consists of, but staff will help me here. I was going to guess it would be care targeted at seniors, and it looks like maybe in part, but not exclusively, for sure. So it's financial incentive for GPs to provide a comprehensive breadth of services for their patients, such as nursing home services. So it means having physicians see their patients when they're admitted to a long-term care facility as well as hospital care, obstetrical deliveries, and visits to newborns. So this is another piece. All of those things together more or less add up to the $21 million that the member was making reference to. Again, the master agreement, as I indicated the other evening, is a very big document. This particular range of features in the master agreement is a drop in the bucket really.


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


The honourable Government House Leader.


HON. FRANK CORBETT: Madam Chairman, I move that the committee do now rise, report progress, and beg leave to sit again.


MADAM CHAIRMAN: Is it agreed?


It is agreed.


Would all those in favour of the motion please say Aye. Contrary minded, Nay.


The motion is carried.


[The committee adjourned at 7:11 p.m.]