HALIFAX, TUESDAY, APRIL 23, 2013

 

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

 

1:53 P.M.

 

CHAIRMAN

Ms. Becky Kent

 

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

 

We will continue with the estimates of the Department of Health and Wellness. There are 41 minutes remaining in the time allotted to the Progressive Conservative Party.

 

The honourable member for Cape Breton West.

 

MR. ALFIE MACLEOD: Madam Chairman, I just want to say it's a privilege to be able to stand and ask a few questions of the Minister of Health and Wellness. I welcome him, and his staff, back to the Chamber today.

 

My question to the minister is, could the minister give an update as to where the Province of Nova Scotia is in relation to the CCSVI therapy and the research that has been ongoing around the country?

 

HON. DAVID WILSON: Madam Chairman, I know there are so many Nova Scotians who are concerned around MS treatment and, of course, the liberation therapy treatment that has really gone viral around the world. One of the reasons we've seen such an interest in it is because of the availability of the Internet. When you have somebody who has chosen to do that treatment they've filmed themselves and sent that out worldwide and so it has garnered a lot of attention over the last number of years.

 

We know we've been talking about it for a number of years in government. When Dr. Zamboni came out with the study that he had done to open up the veins in the neck to try to see if that could support and alleviate some of the symptoms of MS, we started to discuss it on a more national level. The prior minister had talked about this on a national level because all jurisdictions were hearing the same from residents, from people who had MS, about what can be done in Canada around the treatment of this.

 

We know that Nova Scotians are leaving the province to seek this treatment in other jurisdictions around the world. We are committed to supporting anybody who comes back, who might have complications from that surgery, here in Nova Scotia. I know there have been some recent concerns around individuals who have had the procedure coming back and not being able to get access to a vascular surgeon, for example.

 

I believe I answered this, maybe to the member or another questioner in the media, one of the challenges we have when an individual comes back and is talking with their general practitioner or their primary clinician that they see on a regular basis is that our vascular surgeons here in Nova Scotia don't do that procedure so it's hard to refer them to a vascular surgeon for something that they don't do here in the province. So there are challenges there. The medical field, the medical clinicians who are here in Nova Scotia know that people are going out, so I feel they are more than capable of supporting anybody who might have complications from it.

 

As a province we committed with the other provinces to undertake a study here in Canada that would hopefully either support or not support the possibility of having this type of treatment throughout the provinces and territories in Canada. The CIHR, the Canadian research facilities, the organization here in Canada, took on the responsibility to say okay, let's do a trial. There were calls put out for researchers, for vascular surgeons, who would want to participate in being part of that trial. This was all done through the research association.

 

They had a third-party person or organization look at the submissions - all confidential, nobody knows who actually applied to become one of the areas that would be allowed to do the research - they vetted them and then made recommendations and then, of course, we heard later on that Manitoba, Quebec, and British Columbia, researchers in those three provinces were deemed to be successful. So it's the Canadian Institutes for Health Research, and I met with the president when he was here in Halifax in September.

 

So the Canadian Institutes of Health Research were the ones who chose who would be doing the research across the country. Every province and territory committed to working on a pan-Canadian trial - that doesn't mean that every Canadian has the opportunity to enter into that trial; of course, it's limited to people who are relatively close to those clinicians who are going to do the procedure and the research and the study on it, so Manitoba, Quebec, and B.C. residents, who are right there will gain access to that.

 

The information is going to be shared with all provinces and all territories on the benefits, the pros or cons of the study. I think it was a good response nationally because each jurisdiction was kind of their own for a while when this first started to come out around the world, when the liberation treatment therapy was given that exposure that people had a different option.

 

I know the member opposite's close connection with his family, with your spouse, your wife - it's no secret that it's your wife - and you are both choosing to seek that treatment. One of the things I read a lot on the studies, and there are so many opinions out there on this, and as a former paramedic I know the progression of paramedicine alone has had because of new treatments, new procedures, and new equipment, so very much supportive of new initiatives that come on-board in health care. We're going to have to continue to look in the future.

 

Right around the corner there is another procedure that another Dr. Zamboni will come out with to try to support someone with an illness, or a disease, or a chronic illness. I know the importance of ensuring that we have the opportunity to adopt new procedures, but one of the crucial points and most important thing about it is ensuring that the proper trials have taken place. Even Dr. Zamboni, about six months after this really took off worldwide, stated that more research needed to be done on the trials.

 

I was glad to see we take more of a national approach because what it does is it doesn't peg one province or jurisdiction against the other, we're going to share the information and then we'll make a sound decision once the trials are done. I know it's no satisfaction for someone who is dealing with MS today, who thinks maybe I'll have it done in my own country in the next six months or so, that won't happen because the trial, I believe, is a couple of years before we get the results of that.

 

We are looking forward to that as it goes through its process to see the information that comes out of the trial. I hope something positive can come out of this for people with MS because, I have said this before, you have to have hope when you have a disease and you're trying to find a cure, trying to get better. Having that positive attitude is so important, along with the advancement in technology, the advancement in treatment and hopefully a cure down the road.

 

I know it has been a while since you've asked some questions, so the trials have started in those cities. We will probably get an update, I would think, at our next ministers meeting in September, I think it's in Toronto, the next meeting of Ministers of Health and the federal minister. We're going to look at the data and will make, hopefully, sound decisions into the future on what that study brings and the possibilities of maybe providing that service here in Nova Scotia.

 

MR. MACLEOD: Madam Chairman, I want to thank the minister for his answer. I think the minister and I have had an opportunity on several occasions to talk about this. I think we have to make it very clear that this is a treatment, it is not a cure, it is a treatment that may help people who have this disease - as with any treatment in any disease the people who have the disease have varying degrees of it and when they have the treatment they have various successes with it. I know in my own case with my wife, she's seen an increase in her energy and her stamina. I keep a pretty close watch on her and I believe her quality of life has gone up by about 25 per cent because of what has taken place.

 

I guess the final part of what I'd like to get from the minister, if possible, and he may not be able to answer it today and I understand that, but if you would commit to finding out what the timeline is as to where this is and how long it is before there will be some substantial answers for the pros and/or the cons, as you put it. We don't know, and the people who are going away to get this treatment deserve to know if, indeed, it is something that's really having an effect.

 

The minister quite rightly stated that people with a disease need to have hope. He and I have also talked about the fact that time is not a friend of those who have MS, so if he could make a commitment to sort of share the timeline when you're able to find that out - and I know this isn't an issue but I just want to put it out there that after you come back from your ministers meeting if there will be an opportunity for an update so that the MS community here in Nova Scotia has an idea of what's going on so that they are kept informed, I would appreciate that very much.

 

MR. WILSON: Madam Chairman, this phase of the trial will last about two years they're saying. The patients participating in the trial will be monitored very closely over that two-year period to gather the scientific evidence of the procedure itself. (Interruptions) Yes, that's right. I'll try to get it more specific; they're saying roughly two years. Definitely, if I have any additional information after a meeting, or anything I get in, I'm more than happy to share with all members, especially the public here in Nova Scotia. I know we're not participating directly with the trials, but we are ensuring that we're kept up to date; we want to see what comes out of that trial.

 

MR. MACLEOD: I want to thank the minister for those answers and I'd like to turn over the rest of my time to the honourable member for Argyle.

 

MADAM CHAIRMAN: The honourable member for Argyle.

 

HON. CHRISTOPHER D'ENTREMONT: Madam Chairman, it's a pleasure to get back up and spend a few more moments on the Department of Health and Wellness. As I was last night talking to the book a little bit I think we'll go back and start there. We were on Page 13.5 of the Estimates and Supplementary Detail and were talking about alternative payment plans and other things like that. My first question revolves around the Other Master Agreement Initiatives on Page 13.5, the first table. There is about an additional $9 million being spent there so I'm just wondering, what will that $9 million be getting for the taxpayer of Nova Scotia?

 

MR. WILSON: Madam Chairman, before we get that - we're trying to get the figures - yesterday in questioning you asked about some of the changes, the variance. We had a shift of about $5.6 million, so what I'll do is I'll table some information and get it copied and that will show you the changes that we had - it gives a little more explanation than what is in the book.

 

The increase for various physician master agreement initiatives include such things as the Practice Innovation Fund which is an increase of $2.5 million; the Comprehensive Care Initiative Program which is another $2 million; the Chronic Disease Management is $1.9 million; and the Electronic Medical Records is $1.5 million. So that's all under the Other Master Agreement Initiatives and would account for the increase that we see this year.

 

MR. D'ENTREMONT: Thank you. Probably one of the next lines down, when we talk about Physician Services - Other Programs, the forecast for 2012-13 was about $16 million more than last year's estimates so I was just wondering, what was that variance all about?

 

MR. WILSON: Under that one I think it was yesterday I might have answered a question - it might have been a member from the Liberal caucus - around the academic funding change. In here we see the increases as follows: so the district psychiatry, a new cost centre, that funding was transferred from the Academic Funding Plans, that was $11.9 million; the regional hospital ICUs, a new cost centre, that funding was transferred from the Alternative Payment Plans and that was $3.1 million; clinician assessment for practice program, that was an increase in the Physicians Services - Other Program costs of just under $1 million, $929,000; and then of course an increase for locum programs, and that was just over half a million dollars at about $547,000.

 

MR. D'ENTREMONT: Page 13.6, under Insured Services, if we look at the number in Miscellaneous, could you give us an understanding of what is included under Miscellaneous and why the estimate for this year is about $850,000 less?

 

MR. WILSON: Since he's asking nicely, we will get the information, but no question, I think first comes to mind is being good stewards of the taxpayers' money within the Department of Health and Wellness. We have taken the job seriously over the last couple of years to really try to find savings; try to be more clear to Nova Scotians exactly where funding is coming from; and where funding is going and properly reporting it. I think we're one of the highest audited departments in the government and we take that seriously - the recommendations from the Auditor General. That's why a lot of the figures you see kind of a movement on how they're reported under the budget.

 

The main reason for that reduction, even though we're good stewards of the finances of the province, is federal funding for the Drug Treatment Funding Program is ending - that's a decrease of over $849,000 from the federal government. I think it shows that we're challenged at times. I know I listed yesterday on a number of the programs that we're seeing the federal government back away from - I know the member for Kings West was talking about some of the reductions we're going to see, and that's the challenge we have when federal programs come to an end. Often those individuals who are working within those programs turn to provincial government and ask, can you backfill that commitment from the federal government?

 

So it's really putting the provinces and the territories at a disadvantage because we're all struggling trying to ensure that we have good budgets. I think almost all - other than two, or maybe three now, across the country - have deficit budgets. So it has been a challenge, but that is the main reason that line item has dropped significantly - the federal funding for the drug treatment program is ending.

 

MR. D'ENTREMONT: Well, the next one on the list for Page 13.6, we move into Emergency Health Services, so EHS is probably top of mind on this one. Basically what I'll do, before I really start looking at the lines there, maybe we can quickly talk about the contract negotiations. I know you probably can't say a lot about it, but we are hearing from paramedics across the province that the wage increases might be acceptable, but there are a number of other items outstanding with the agreement - some of them around pensions, and some of them around long-term and short-term disability. I'm just wondering, what can you shed on that one before I ask more specific questions to the budget itself?

 

MR. WILSON: Hopefully the member can appreciate I like talking about paramedics and EHS, and I could probably eat up the next four hours if I was permitted, but I think I have to show the utmost respect of the process that we have. There is a tentative agreement now that paramedics will be voting on, and all I ask is that the paramedics read the possible agreement and make a sound decision when they do vote on it. I really couldn't answer or discuss any of the issues around the contract right now.

 

MR. D'ENTREMONT: Maybe you can line up a couple of dates then - when is the vote going to be happening and when are we going to maybe find out? I don't know where that part of the process is. I know you said there is a tentative agreement before them and, like I said, I know some have been looking at it, and I've heard some good things and I've heard some bad things, but just when are we lining these things up, because what I worry about a little bit is that should it be negative on its approval, what happens then - are we ready for a strike in Emergency Health Services?

 

MR. WILSON: Once EMC comes to an agreement or proposed agreement that the union wants to take to a vote, then it's in the court for the union to go out and seek ratification from their members. It's my understanding they're going to try to do it in the next couple of weeks, but it is in their court and they'll decide when to take it to their membership to have it ratified and have the vote on it. I'm hoping it's going to be soon; I'd like to see this settled either way, and then move forward.

 

MR. D'ENTREMONT: Yes, it does create a little bit of that confusion of who is dealing with what at this point. My question sort of follows up on that - who is responsible for the contingency plan that when things do maybe start to "go south" or not? Put it this way - I hope that there's ratification of this contract, that everything goes along tickety-boo and we're able to trust and count on our emergency health system because it is the best in the world - in the meantime, from a contingency standpoint, how deep are you into that process and how are the discussions on that with EMC?

 

MR. WILSON: EMC have an agreement with the union that they would take this to the membership for a vote. If it is rejected at the time, there will be a start of a 14-day countdown for them to give a 48-hour notice of a strike. We are going to work with EMCs and we're going to work with the district health authorities to make sure we are planning what happens if that happens.

 

I have confidence in EMC and I have confidence in the paramedics that they'll look at this. We've always been supportive of the collective bargaining process, and I would hope that we would see people at the table before you see somebody and people on the street.

 

MR. D'ENTREMONT: It seems like a really long time ago now that I was working as an executive assistant up in the gallery, hanging out with paramedics from my area. (Interruption) They didn't throw me over - actually, the funny part of it is all of them were really good friends of mine. There was a mutual respect on that one. But just to say that I hope the minister is ready if it does go weird - and like I say, I hope it doesn't; this is not something that I want to see for our emergency health system, for that to go on strike, and I know the minister spent some time up in that gallery during contract negotiations, so I'm just wondering if he's ready for the opposite to happen - that the minister or the member who used to be the paramedic might have to be the one bringing in legislation to put them back to work.

 

MR. WILSON: Thank you for that, and I do remember that time. That's one reason why I got involved in politics, I was one of the medics who actually was on shift that evening and had to walk away from providing that care, so it was very difficult then and I know it would be very difficult now for paramedics.

 

One of the things I truly believe in and our Party truly believes in is supporting the collective bargaining process here in our province. I know our two Parties have different opinions on that. I respect your opinion and your position on it. I don't think it's the right position, but I know the government and I know our caucus is very much supportive of allowing collective bargaining to run its course and to negotiate, and I find myself in a strange position today.

 

One of the reasons why I'm in the Legislature is because of a labour disruption in the 1990s, so a very difficult position. That's why I'm encouraging both sides to make sure that they really look at whatever proposal is in front of them - if it's this one or if it's another one they might be able to renegotiate or whatever happens - that they do it in a way that respects the process. I believe both sides have shown that respect and I look forward to hopefully having this contract resolved soon. The last thing I want is paramedics on strike in the province.

 

MR. D'ENTREMONT: I thank the minister for that answer. Maybe this is a little bit in the same stream and one that I spoke to a little bit, but I've stayed away from over the last number of weeks. The member for Kings West has brought it up on a number of occasions - the issue of out-migration of paramedics; the issue of individuals taking those positions in the West. Actually, it was kind of funny, when I talked to a couple of friends who have done that, take it because the jobs are easy in some cases - working on rigs and worksites. One of my friends - I forget which one it was - I sort of had that conversation with two or three of them - the one that did it, he said the one thing he did was pass out a Band-Aid on a whole shift - and I mean, weeks-on-end shift; not just a 12-hour shift. Maybe you can give me an idea of how big this issue is of out-migration of paramedics from Nova Scotia.

 

MR. WILSON: It's not something that's new to our province. When I went through school in 1995 and 1996, we had recruiters at the school looking for new recruits for areas mostly out West to come and join them; not only out West - Northern Ontario. I know there was a lot of interest in Timmins Air, for example. So here would have been a couple new graduates who were very intrigued by the possibility of going and working on an aircraft, transporting patients down to more southern communities that provide more intense care if you're sick.

 

I know many of my colleagues, many of my friends have chosen to look elsewhere for employment. We have had companies recently being very active in recruiting here from Alberta, from the oil sands and northern Alberta, and I think even parts of Saskatchewan, trying to look at paramedics to come out and provide care in what's really a different setting than being a paramedic on an ambulance here in the province, or even a paramedic on the helicopter or on the aircraft here in Nova Scotia.

 

It is very much a more clinical setting and you're not out on the roadside at three o'clock in the morning. A lot of them are through the day, day shifts, on call maybe at night in case there is an emergency somewhere in the clinic, and there are decision makers on should they keep that patient there or should they send them down to one of the local hospitals. So I can see how it's appealing, especially to some of the more seasoned veterans, as we would say. Not saying they're old, but seasoned veterans - those who have been in the paramedic profession for a number of years.

 

It's not an easy job; it takes a lot out of you mentally, physically, emotionally, dealing with death and dying and injuries and car accidents and fires. I mean, it's a challenging job. I can see after somebody spending - a lot of the colleagues I started to work with would be in the business for almost 20 years now - I could see how it would be appealing to get a job offer to come and sit in a clinic and oversee sometimes some of the recreational components of the company, the prevention side of things, and really being there because of their skills as a seasoned paramedic.

They're coming to Nova Scotia for a reason because they know we have highly trained dedicated paramedics. I mean, all the changes we've done over the last four years within health care and changes of models of care, a lot of it had to rely on paramedics who are more than happy to contribute more to the health care system; more than happy to change the working environment that they're used to working in - so it's not in the trucks on the side of the highway in small communities. Some of them are in Collaborative Emergency Centres, for example; some of them are working in clinics in Brier Island with a nurse practitioner in a different setting; and some of them are going to long-term care facilities with the extended care paramedic program.

 

All along the way, as we changed models of care, as we implemented Better Care Sooner, as we implemented the recommendations in the Ross report, I have to say paramedics were always willing to do that extra job; always willing to be a key contributor to it. I never heard any complaints from them saying we don't want to do that because they're dedicated. So I can see how the appeal of some of the job offers out West in the setting would appeal to people, but also the financial component to it - they are offering bags of money to go out there, and that's difficult to turn down sometimes, I think. People are at different positions in their lives, and I know some of them have chosen to do that because they're about five years away from retirement and this is a way of maybe padding their retirement a little better. Some of them are going out for two weeks, home for two weeks, making very good money - something we cannot compete with in the province.

 

We've come a long way - and I've got to be careful how I say this because newer paramedics who are maybe a few years into the business don't like when I say "well, I remember when." I do remember when - when I graduated. I do remember the work environment I worked in; I do remember the hourly rate of pay I got in 1996 - it was $6.50 an hour, and I worked 84 hours a week to make $28,000. Every second weekend I'd go to work at eight o'clock in the morning on Saturday and I would go home at eight o'clock Monday morning - that was my shift every other weekend. I had every other weekend off, which was great, but leading into it I worked a 24-hour shift. We've come a long way.

 

I know we need to continue to work with our paramedics to ensure that they have a good environment; they can make a good living; and they can contribute to the communities they represent and work in. We do have to remember where we've come from and where we are today. I hope that they recognize the work that has been done over the last number of years, to the respect shown to the profession. It has really evolved over, I would say, 15 years. There really have been significant changes, and we're recognized as one of the best services in North America.

 

I think as we move forward, I'm hoping what we'll see is that we know paramedics are being offered and enticed to leave the province - I believe we had about 24 of them leave last year. I know there are a high number of them who are looking at it right now. When they were actively recruiting in January, there are a number of them - potentially the same number who left last year are looking at leaving and we're four or five months into the year, so it does concern me but, overall, the number of medics in the province has gone up over the last number of years. We're stable.

 

I understand some of the comments and concerns around losing those seasoned veterans because they have a lot to offer the new recruits who come through, the new hires - their expertise. I mean, being a medic, the best training you have is on the job when you do the calls, when you have those - what you would call crazy unexpected calls that really challenge you mentally to make sure you're doing the right thing. You're somewhat of an investigator to try to find out what's going on with an individual.

 

So I'm hoping that with the opportunities now - that were never there when I started my career. You went on the ambulance and that was about it - you didn't move. That was where you went to work. Now we have opportunities in dispatch, for example. We have a state-of-the-art dispatch centre that oversees a system status plan that moves ambulances all over the province to make sure they can fill gaps where there are gaps; if there is an incident where maybe multiple ambulances are used. We have opportunities, as I said, in Collaborative Emergency Centres that were never there before - putting paramedics into a hospital setting.

 

We had that for a while here in Halifax; the old Victoria General ER was the first hospital in the province that actually had paramedics doing the assessments as you came into the hospital. They had a transfer unit themselves in the hospital and then they would work within the ER system to provide care and support for the nurses, for the doctors, for the RTs, for any of them there. So that had been around for a long time and it just took a while to realize that here was a pool of individuals who were highly trained, highly dedicated and can really offer a skill set that can support other skill sets within the health care system. So we can support the dedicated nurses, the nurse practitioners, the LPNs, all nurses in the system who are a key component to delivering health care. They can help physicians, for example, and support them so that they can best utilize their time to support an individual.

 

I'm very proud to see the profession make the transformation that it has made over the last couple of years. I'm hoping with the changes we've made that we won't see that mass exodus of paramedics, but I don't feel any negative feelings toward the medic who chooses to leave the province, it would be a difficult decision for you to do that, for an individual to do that. We know it's happening in other areas when it comes to mining and the oil and gas industry, other workers are doing that. It's new to our profession to see people leaving for that reason. So I'll leave it at that and I'll allow the member to ask another question.

 

MR. D'ENTREMONT: I guess there is a bunch more I could ask regarding this. Let's go to Page 13.6, and I'll try to ask two questions at the same time. The department has budgeted zero for Communications and Dispatch, so I'm just wondering why there's no money for that and who's responsible for dispatch. The forecast for 2012-13 was about $665,000 lower than last year's estimate for Ground Ambulance Operations, so why is that less? Maybe sometime you and I can talk about the extra shifts that have now been created by CECs and the problem we're running into of working subsequent 12-hour shifts. We're finding that maybe the man or woman in power of the system is not available right now.

 

Anyway, those are my two specific questions - and one general question that you and I can talk about maybe at a later date.

 

MADAM CHAIRMAN: While the minister is gathering his thoughts for his answer, I'd like to draw the attention of the committee members to the Speaker's Gallery. We have a very special guest with us today and her name is Shannon Black. Shannon is from Oxford and Shannon is the mom - although she looks like she may be a sister - to one of our Pages by the name of Paige. So Shannon, if could stand and receive the warm welcome of the House by members. (Applause)

 

We welcome you to today's proceedings.

 

The honourable Minister of Health and Wellness has the floor.

 

MR. WILSON: What we did was we again moved the funds that used to be in Communications and Dispatch and we transferred it to Ground Ambulance Operations, so that's the reason for the change. I think your second question is there was lower than anticipated building repairs for EHS communications, so there was a drop in what we had forecast for that, and purchasing some defibrillators, so just because they fall outside the renewal date, I would assume this year it would fall into this budget.

 

MADAM CHAIRMAN: Honourable member for Argyle, you have 20 seconds left.

 

MR. D'ENTREMONT: I can't clear my throat in that amount of time really, so thank you, minister, for that. Again, we'll talk about those shifts that the CECs are now starting to take up. Like I said, the subsequent 12-hour shifts, the paramedics are not allowed to work too many hours in a 24-hour period, so we'll talk about that one later. Thank you.

 

MADAM CHAIRMAN: The time allotted for the Progressive Conservative Party has elapsed. We'll now move on to the Liberal caucus.

 

The honourable member for Halifax Clayton Park.

 

MS. DIANA WHALEN: Madam Chairman, I am very pleased to get a chance to have some questions today during the estimates for the Department of Health and Wellness, which is my former critic area until about a year and a half ago - maybe it's a bit more than that - but I miss it to some degree, it's a complex and very interesting area.

 

I talked to our current critic, the member for Kings West, and I hope I won't be repeating too many of the areas that he has already touched on. One of the very first areas I'd like to go back to is an area that was in the news a lot a couple of years ago and it's about the pilot project around midwifery and what was going on at the IWK and just a couple of other boards - I remember Guysborough-Antigonish had perhaps one, Halifax had a small program, and there was one other board that had a few midwives, but it wasn't taking off in the way that the public would like to see. I know it was in the news when we had a couple of the midwives at the IWK that had left - I think they had left and just left a real gap there. There was some recruitment being done, but the ones who had left actually said they didn't feel it was properly supported or properly really set up. They didn't really like the way it was set up, and so I think there was some conflict there.

 

The women of Nova Scotia, I can tell you, really want to have an expanded midwives program. They want it not just if you live in HRM, but they do want it in other parts of the province. I had the opportunity a number of years ago to be here at the Legislature, out on the street here, when there was a rally of women giving their personal stories of what a difference it meant to them to have a midwife when they'd come from other provinces. They'd had earlier births where they'd had the support of a midwife and coming to Halifax, they had been very disappointed to hear they didn't get it.

 

There was also the difficulty that with the small number of midwives we have in Halifax, if you just happened to be due near the end of the fiscal year you might find that there's no more money allocated for it, or your due date is in the wrong time, that the midwives are all fully booked and can't take anybody else on. So a lot of women seeking the service are not getting it, even here in Halifax. I'd really like to hear how it's going and what funds are allocated for it, and if the minister could tell us what hopes he has for the future of this program.

 

MR. WILSON: Welcome to asking some questions on the Department of Health and Wellness budget. Before I start, yesterday when I was answering some questions from your colleague, I had indicated that I would try to get more detailed information, so I'll table a couple of pieces of information - one is the orthopaedic FTEs so it has a breakdown of the orthopaedic doctors across the province; also, the Wait Time Reduction Fund and the estimates forecast and a bit of an explanation of how we spend that fund. So I'll table that.

 

Midwifery has been something that we've talked about for many years in the House. In my role as Health Critic many, many years ago now it seems - and it was many, many years ago - it seemed to be having a little bit of a cycle of its own where at times midwives were very active and then it kind of quieted down for a while. Now I think we're on the upswing again.

 

The overall amount of money that we put towards the salaries, for example, for midwives in the district health authorities and at the IWK, is $1,075,284. That includes a new position that we have as a midwifery specialist out of the IWK. We recognize having that position filled was important so that they could coordinate midwifery services here in the province. There has been a bit of a delay over a number of months ago - almost a year ago - where we put out the request to fill that position and we hadn't had anybody apply for it, but I'm glad that as of March 4^th of this year we have a midwifery practice specialist - that's the title. Over the next 13 months she will provide some expert leadership and strategic direction to stabilize the existing midwifery services and, I think, move more towards an integration of the midwives working in communities around the province.

 

We know that Nova Scotians want more options when it comes to having a child and the services that are provided. I wish we could say they are in every district health authority, but they're not; we know that. I think the work hopefully that this midwifery practice specialist will do is to try to give us a picture of where we need to put some more emphasis and more energy in, collaborate with those midwives that are practising here in the province now and move forward.

 

One of the things I realized pretty quick, I've met with the midwives, with associations here in the province just after I became minister, very educational meetings where, at one of the associations, they brought their children in with us. One of the things that I recognized was how small the midwifery community is across the country - very small and not a lot of members.

 

I know a number of years ago we passed legislation to regulate midwives and it was interesting - I was in Opposition at the time and when we met with the organizations and the associations pushing for this they really wanted to make sure that they had a self-regulating body and had the controls in place, but they knew by doing that there were going to be some of those midwives who practised in the province for a lot of years who would no longer be able to provide care because they don't meet the standards of the college. In Opposition I said, are you really sure you want to move forward with this? They were saying no, it's what the profession needed - and that takes true leadership. For someone to say I support moving forward on creating an environment where midwives can grow in the province or in a jurisdiction, knowing that it's going to put themselves out of a job, I thought it was quite amazing to see.

 

I'm hoping now with that new appointment at the start of March, that now over the coming year will see the group of midwives here in the province really try to show where we need to move in the coming years and hopefully provide better services so that women in Nova Scotia, who choose to have a midwife or want other options, will have that opportunity.

 

MS. WHALEN: I have a couple more questions to drill down on the midwifery resources. The minister said there is $1.075 million allocated for salaries - could you tell me whether that is the same as last year or up? Even though you did say there was a new coordinator in place I'd just like to know, how does that compare to last year and can you tell me how many midwives we have in our employment and actually where are they? Again, I think it's three DHAs that have them, and to go back to the human side of this, I have talked to women who would actually move to the South Shore because there was a midwife there and they could get into that midwife's schedule, so they would move there - they were prepared to move their family just for the sake of having that support during the birth of their children.

 

Some people feel very passionately about this and the need to expand it to more DHAs is important. I'm asking how the budget compares to last year and if you could tell me how many we have in actual midwifery service.

 

I'm guessing that the new midwifery practice specialist is going to help more in the governance side, as you mentioned, sort of pulling together the resources and giving guidance to the program. I think it did need that because I had talked to a midwife who had gone to Whitehorse after leaving Nova Scotia, and she was quite prepared to talk about what her experience was. She was not happy with the way they were managed and supervised and felt that they were not treated as partners really in the health care delivery. I think there is a sense because Canada has been slow to adopt midwifery. I know the minister mentioned going across Canada and it's still more in its infancy.

 

Other countries in Europe and in Asia have had midwives as very respected members of the health care team, and I think here perhaps doctors and nurses are a little bit more territorial when it comes to midwives and they were new players in the system and they haven't found an easy entry. I think that the idea of a coordinator is a good one because that may help to just smooth the way and have a better plan in terms of how we adopt an expansion of midwife services.

 

I would like to know, if you could tell me, how many actual midwives would be taking patients and appointments, and are there any vacancies? That one, just final one because I know we had some of the positions and I think it was only four at the IWK and there were a number that were unfilled and it seemed to be difficult to hire someone - could you tell me how we've done there?

 

MR. WILSON: What I'll go through is the funded positions that we have. We're trying to find if there are any vacancies. First of all, the budget is the same as last year, and we had budgeted last year for the midwifery specialist because I assumed we might see a bump in this year, but because that went unfilled last year with no applicants the budget is the same. If that changes I'll get you the information, but we believe right now that it is the same as last year, and we're going to check to see if each position is filled.

 

So right now we fund services at the South Shore District Health Authority - we have two FTEs there; the Guysborough Antigonish Strait Health Authority - or GASHA - we have two FTEs there; and the IWK-Grace - we have the five FTEs. One of the things we're trying to move forward on is the progress on the action plan. There has been an action plan set out on steps that we needed to take to move the opportunity for midwifery services to expand in the province - of course, one of them was to hire the midwifery practice specialist, and we did that in March.

 

The other thing is to support what's called "second attendants" - or SAs. A second attendant practises under the direction of the midwives at a home birth, and is a district employee. So a nurse with current experience in labour and delivery can be utilized as a second attendant under a midwife. Really the essence of that is similar to what we're trying to do in primary care is support physicians across the province with other clinicians. We've expanded nurse practitioners or use in nurse practitioners and nurses in collaborative clinics. We're utilizing paramedics, for example, in other settings that were traditionally - they weren't practising like in Collaborative Emergency Centres and long-term care facilities.

 

As we move forward with the action plan, I think we're really going to see a difference in the options and opportunities for women in Nova Scotia to seek, if they choose, to take the route of the utilization of midwives. I know in our own caucus there is a lot of support for that; I know in our Party, very much support of midwives and the utilization of midwives across the province. I think we can utilize them hopefully in those underserviced areas where we see general practitioners kind of moving away from the delivery side of primary care. I know there are areas of the province that don't have the opportunity to have a GP who has the clinical background to deliver their child. I'm hoping we see, with the action plan and the progress with that, the expanded possibilities and services around the province.

 

MS. WHALEN: I wonder if the minister could let me know if the IWK is allowing home births. I know you mentioned particularly - you raised the word "home" birth when you were speaking about the second attendants and that they go out with them. I think one of the conflicts that, again, arose between the patients who want to have a midwife is that the doctors have not wanted them to go home. I think the IWK did not really condone the births at home; in fact, there was a case somewhere of a midwife who was put in a very awkward position where her patient wanted the home birth and it was kind of - I'm not going to the hospital, I refuse to go, and the midwife had a choice to make - did she stay and assist that woman in the birth or did she not because she wasn't really authorized? It put her in a terrible situation.

 

I know that that had come out in the news and I think it just shows again how passionately the women feel. There are some women who are really very determined and they want to have a less clinical experience when they give birth, so some women don't want to be in a hospital. I don't know the current status of that, but I'm hoping the minister knows whether or not that is something that is an option for women in HRM. I think it might be in one of the other, GASHA or the South Shore, but it was in HRM that it was not being offered. Perhaps you could just let us know where we're going on that because a lot of women almost equate having a midwife with having those options of home birth or not. Of course, we know that the midwives will immediately go to a hospital or seek care if there are any complications, that's a given in terms of their scope of practice, but is the option available for them to deliver at home?

 

MR. WILSON: As someone who has assisted in home birth, it wasn't by choice, as a former paramedic and the lady did not want that to happen, but anyway with the training I did participate in a couple of them. I have to tell you even though I had the training, I've done a practicum at the IWK in labour and delivery, I was very nervous to be delivering a child at home, so many things can go wrong. The thing with newborns is they could spiral so quickly from being what seemed to be quite healthy to needing intensive care. So the protocols we do have in place are that there is a requirement to have two individuals at a home birth, and that's why I think in the action plan we talk about the use of second attendants.

 

Within the medical field as a whole there are some who have the opinion that it shouldn't be happening at home because of the potential complications of it, but we know that there are some - and midwives are highly trained and I think capable of providing services, but we want to make sure that the protocols are in place.

 

We know we have various opinions within the health care sector itself when it comes to home birth, but we know that's part of it, I mean that's where I think midwives come from, it's not delivery in a hospital setting, it's delivering at home, so I know that the protocol we have in place is to have two attendants there. I know no midwife in Nova Scotia would ever want to jeopardize the mother or the child in a birth, and I know that as soon as they would look at or see that there was an indication there was an issue I'm sure they would take the appropriate steps, through 911 or through paramedics, or through LifeFlight, they would proceed on to get support.

 

I think the key is making sure we have opportunities for Nova Scotians to gain access to services they want, through midwives for example, making sure - and that's why it was so important to have the college in place - that those people providing care in the province have the clinical training and competency to deliver the service. It is so important to have the colleges in place, the oversight, so that they're trained. We know they're trained, we feel confident that they're trained but, more importantly, having other support.

 

I know over the years there have been a number of stories and issues. I hope now with our ability to have - and I have to keep looking at the name of it - the midwife practice specialist in place at the IWK now, we can work through any of those opinions that might be against home birth, but support women who decide that that's an option they want to investigate. It's not for everyone and it's a major decision to decide that, it's similar to those who choose to have more of a natural birth with no medication or anything like that - I don't know how they choose to do that, but I think we need to make sure that we have an environment where people can have those options. I hope the nurse at the IWK now can hopefully facilitate any issues that might arise around the province.

 

I think I answered where they are all located, right? Okay.

 

MS. WHALEN: Again, I think it's important just that we have that discussion and that this issue comes up during Health and Wellness estimates. I know that with the Department of Health and Wellness there are just so many different areas and practices and diseases and specialties. It's a huge thing so it's hard for us to touch on everything, but I think that you've given good answers today on midwifery and I appreciate getting a sense of where it's going. There is a sense of urgency for the women who are not being able to get the services.

 

I think just before we close it off, it is worth mentioning - and I know the minister gave a nod to their professionalism, which I think is very true that they're well trained - at the same time, they give a different kind of care than you would get from an obstetrician or your family doctor because they will not only be with you at the birth, they give a lot of prenatal care and they give a lot of post-natal care. Ultimately your long-term progress and outcome is probably better because you have somebody who has the time and sees it as part of their professional practice to give that additional support that I think any mother can use.

 

Any mother, even when you've had the advantage of a lot of education and so on, it's a whole new realm when you suddenly have children or new baby at home. Having somebody who can advise you on things to look for and how to care for your child is really important too - and how to care for yourself. I think there is a demand and a need, and I'm glad to see that we're working on the culture because - and it's not the first time we've had new professionals entering into that medical realm - it's important that we make space for those different professionals.

 

In the same vein, I'd like to ask the minister if there has been any discussion around the introduction of physician assistants; this again, another category of professionals. They're used in the military. I believe they actually call them physician assistants, so they're used in the field and to provide medical care for military families and people. When people who have served in that role come out of the military, there isn't a similar title or role in our - at least here in Nova Scotia.

 

I do know they exist in New Brunswick and I'm sure in other provinces - maybe not all of them - and the context in which I ask this is really an area I'd like us to explore a bit today and that is the international medical grads and opportunities for us to integrate people who have a lot of high level experience and training, and are facing a lot of obstacles to get into the system, if you could say if that is something that is being considered or where you are.

 

MR. WILSON: There is a provision under the Medical Act that allows for physician assistants to work within our system. Saying that, we know we want to explore all the opportunities. I've said it over and over again that for us to move forward in health care we need to maximize the health care providers we have in the system now - utilize them to the best of their abilities, to the full scope of their practice. I think we've shown a commitment to do that where we're utilizing other health care professionals in different environments - paramedicine is a key example over the last number of years of how we've expanded that.

 

There are limitations over the last couple of years in regard to our financing of the province and that's why it is important to get back to balance, so that as we move forward we can look at all opportunities. I have to say, personally, I'm very supportive of the concept of physician assistants. I know people who work in that field in the military and they're very supportive, from the physicians in the military and the work they do, and the work they do overseas or wherever our military is stationed.

 

We've worked hard over the last couple of years to increase nurse practitioners first. So I think we have a duty, before we start bringing in new professions, to ensure that we're supporting the ones we have - so utilizing nurse practitioners for example. I yelled about it on the other side of the floor over here with the previous government about the lack of utilizing nurse practitioners to their full potential. I mean, we had nurse practitioners trained in the province who couldn't work as a nurse practitioner.

 

I always gave the example of the Cobequid Centre. When nurse practitioners were really starting to get recognized and they were starting to do some training on it, we had a nurse at the Cobequid Centre who worked in the emergency department; went and did the training. It's very difficult to do. I mean, here you are working full time - and I know she had a family, went back to school and became an NP. When she went back to work at the Cobequid Centre - and I don't believe the deputy minister was there at the time or I would have wagged my finger at him; he wasn't there - the rules stated that she could not work as a nurse practitioner because the way the system was set up they had to work directly under, usually I think it was a general practitioner.

 

We had emergency room doctors who were there and they were coming and going, and there was nobody to oversee her in her role, which in my mind was a little bit ridiculous because she's trained; she has a scope of practice; she's licensed under the college - she should be allowed to do the job she's trained to do.

 

I say that because I come from a profession that we have a scope of practice; we have protocols in place as paramedics, and it doesn't matter where you are in the province. It didn't matter if you were on duty or not on duty, if you came across someone who was ill, I could perform the duties as trained as a paramedic. So if someone wasn't breathing I could intubate them or give them an IV - well, if I had the IV. I didn't carry IVs around with me, but say if an ambulance came that had lower trained - there are some people who carry the bags around, but I was never one that had those; I carried a medical kit, but never the IVs and stuff, I left that for when I was at work - if an ambulance came to a scene that had maybe just primary care paramedics on it, I could, in my civilian clothes jump in the ambulance and go because I was trained in the province. I had a licence to do it.

 

I couldn't understand why that wasn't offered to nurse practitioners. We've changed that and now we see nurse practitioners, some who are working - I look at the young nurse practitioner who is in Hantsport, for example. There have been some issues over the last couple of years with keeping the doctor there. The doctor was leaving, the nurse practitioner was left. The nurse practitioner was running the clinic for months on end, seeing thousands of patients or supporting thousands of patients. So we've come a long way.

 

I think before we say, yes, let's move ahead right away with the physician assistants, we ensure that we're supporting nurse practitioners; we're supporting paramedics, for example - but very supportive of the physician assistants. I think in the future we have a lot of opportunity where we can explore and even work with the military to see if maybe they can work in both fields in both sectors - in the military and then maybe support our system in Capital Health or wherever they're stationed.

 

I know we've been doing some work on the nurses and some of the doctors who are working at the QEII, for example, or military trained, are in the military. I see in the future the possibility, but right now I think because of the limited resources we need to make sure that the nurse practitioners and nurses and paramedics are supported in expanded use of their skills, but I foresee that it's an area that I would like to explore in the future and, potentially, the benefits of utilizing physician assistants.

 

There's another one too. I know recently - I don't want to take up all your time - anesthesiologist technicians, I think they're called. They're big in the U.S. where they support those physicians in the O.R. and lessen the burden on an individual physician. There are many options I think we can continue to look around - especially to the south of us - on the possibility of utilizing different professions.

 

MS. WHALEN: I'd like to continue on with the subject of the international medical grads. I know the deputy minister was here at the Public Accounts Committee about two years ago almost, a year and a half ago - in the Spring I think it was - so two years ago when we had the College of Physicians and Surgeons here. We had somebody who was working or representing ISIS - the immigrant settlement association - and talking about their work to collaborate. I think they have a round table of people from different perspectives who are trying to find that avenue to integrate the foreign-trained doctors. It was a big enough issue that it was here at the Public Accounts Committee.

 

I can speak for my riding that we have a lot of newcomers in Clayton Park. I know we do in HRM in general, so maybe there are other members who have talked to doctors; I'm sure there are. I get a fair number and I would say in the question of immigration and immigrants who come to visit me, the majority of them are doctors; sometimes pharmacists. I've had a number of them come in, but it's doctors who are frightened, discouraged, overwhelmed by what they need to do to return to their practice, if at all, in Nova Scotia.

 

I really do get worried that there are other provinces that are opening paths and avenues for them and we are not doing it. I just hate to think that there are other provinces that are opening paths and avenues for them and we are not doing it, and I just hate to think that there are other places that are just smoothing the way and making it easier.

 

I have a doctor I'm working with right now - the minister might be interested to know - who is an internist or an internal medicine doctor, and I understand we have a shortage of internal medicine doctors; he was trained in England, actually, and I've spoken to the College of Physicians, to the registrar, about this individual. But here comes an individual with European training, with his residency in England and lots of training in England, coming here and we're not seeing him as a professional or specialist and we're not making room for them. As the minister knows, one of the big worries is that there is something like five years that a doctor is allowed to be out of practice before they are really not eligible to re-enter, to begin practice again - so the clock is ticking and particularly if they come here without the language to begin with.

 

If they arrive in Nova Scotia and have to learn English and then learn the professional language, get familiar with the culture, they can be a number of years here before they're able to start taking the tests that we offer and the avenues that we offer. It is a really big issue and it's a loss of human potential and capital that we have here. I don't think we should ever be allowing that to happen. I think as much as possible we should be paving the way and working with the college and any other professional groups to try to make way for these newcomers who have been trained in other countries.

 

I'm speaking particularly of the immigrants; I know it also includes Canadian grads. I understand there's something like 1,000 - I've heard the term 1,000, it can't be Nova Scotians, but there are a lot of Canadians studying overseas in schools, in the Caribbean and Europe and we need ways to bring them back home too. My question to the minister, to be more specific is, could he comment on efforts to integrate international medical doctors? Could you tell me how many have taken the CAPP last year - I realize that is family doctors and not specialists - but could you give us an idea of the funds allocated toward the CAPP?

 

Maybe we can just start with that and I might have a few more questions to go beyond that.

 

MR. WILSON: We realize the importance of recruitment retention of physicians and giving every opportunity for those foreign-trained physicians who come to Nova Scotia, hopefully get some of the additional training they may need but, more importantly, to stay in Nova Scotia. That is why it is so important to have other departments working to ensure that we create an environment that is welcoming to new immigrants to the province, especially those who might have the skill sets as a physician.

 

We do have the CAPP, which I know recently I had been down to Yarmouth and they have been very successful in utilizing a number of immigrants to gain access to the health care delivery system here in Nova Scotia through the CAPP. The budget this year for CAPP is $5.5 million roughly and that is an increase of $929,000, so almost a $1 million increase, due to the increase of physicians and program costs. We have 24 right now in the province under CAPP, and we're continuing to work to see if we can get more physicians into that program. Of course, you need the support of local physicians to sponsor them, and really the community to rally behind them. And the community really does - Yarmouth, for example, has been very good at receiving international students, making them feel welcome and really welcoming them to that part of the province.

 

We have discussed this on a more national scale in our FPT meetings, our federal-provincial-territorial meetings, as Ministers of Health, this is an area we've talked about for a number of years now, trying to get a grasp on physician resources across the country. For far too long we have all worked in our own little silos to try to recruit physicians, and we realize even though we're still competing we still want to ensure that Canadians have access to the doctors they need.

 

We know the number of doctors have decreased over the last decade or so, but one of the things we have done is there has been a committee created of deputy ministers and deans of medicine in which our deputy minister and our dean, at Dalhousie, both sit on. It is chaired by Manitoba and their initiative is to look at physician resources. This was really driven by - I wish I could say me, but it wasn't me - it was driven by the deputy ministers of each province, because they knew the ministers kept talking about it; they knew it was important for each jurisdiction. So that committee meets - our deputy minister and the dean at Dalhousie meet to try to figure out how we move forward, and how we ensure that we give anybody an opportunity to at least explore the possibility of coming to Canada to practise medicine.

 

There are challenges. It was interesting you mentioned physicians could be off for about five years before they lose their licences; for paramedics it's only three years. I don't know why there is such a short timeline for them. (Interruption) There is that, but one of the things that is of concern and really what jurisdictions need to make happen is ensure that the training that these individuals go through is comparable to the training that is required and that is delivered here in Canada.

 

We hear - and I hear - from many, not only in the immigrant population, but from Nova Scotians who go to foreign schools for training. One of the more prominent ones for our region is Saba, down in the Caribbean. I've had colleagues who are paramedics who were down there for some reason or another because of wait lists or were unable to get access to Dalhousie. I think I said this in one of my other answers from one of the other members - Saba is a very appealing area to go to; it's down in the Caribbean - but even though it's down in the Caribbean, I don't think it's any walk in the park, or on the beach, to go and take your medical school there.

 

There is a requirement and students who go there need to understand - if a Nova Scotian student is deciding to go there they need to understand that it's not just as simple as coming back to Nova Scotia and you can start practising. There are hoops that you need to jump through to get certified for some of the residency programs here for example, or even afterwards get into Nova Scotia and Canada as a whole. They're limited - the residency programs and seats - across the country. It's a national program, so when you decide what area you're going to practise in, you apply for your residency program and then there are options for you. You could end up in B.C.; you could end up in Newfoundland and Labrador; you could end up in Halifax.

 

So there are requirements for those individuals who go to Saba for example, that they need to be mindful of, trying to make sure that they fill those gaps. Often I get the call - I've gotten them in Opposition; I've gotten them as minister that - oh well, I need to go back in a month and I can't get into any programs here because I don't have this. I need to emphasize to all Nova Scotians who are deciding to do that, to leave our jurisdiction to go get trained, that you know the ramifications and any additional training you need to have.

 

Our deputies, our deans of medicine are working on a national approach to see how we support physician services and how we try to ensure that we can get foreign-trained students and foreign-trained doctors - not even just students, but doctors who are medically trained in other countries, because we know Canada is very appealing to people; they want to come here. You always hear about the stories of immigrants who come to Canada who come from a country, they were engineers, doctors, lawyers, and they're not able to work in those capacities here in the country. It's a shame, but they're so glad to be here.

 

Some of them drive cabs. I think all members take cabs and I'm always intrigued on where these individuals come from, what their lifestyle is or what they did or their profession. I've run into some who were physicians, lawyers, and engineers, but they're so glad to just be here and work.

 

We need to try to work on a more national level because of the entry requirements from the colleges for example, or the College of Physicians and Surgeons, so that there are opportunities for individuals to come to Nova Scotia to set up a practice or even get the support from other physicians.

 

That's where we are - the picture on that. I think we're moving in the right direction. One of the things that we are doing is we're not protecting our own; we're having an open dialogue nationally, which hasn't happened for many years. People were very reluctant to share some of the successes we've had in different jurisdictions because you didn't want them to start taking your resources. I think we're all on the same page nationally now, the deputy ministers and the deans of medicine, and hopefully there will be some good things come out of the committee as they move forward.

 

MS. WHALEN: Madam Chairman, I have a few questions for the minister around the resources that we're going to dedicate to this. Again, I really appreciate the discussion and knowing that our hearts are in the right place - let's put it that way. We all want to see a system that can integrate people with their skills.

 

My understanding, if we can look at just a couple of the avenues that a doctor has, one avenue is if you're a family doctor you write your exams and so on and then you have to pass that CAPP OSCE test. I think OSCE is the term you use when you have simulated patients and you go through a simulated day in a clinic, so you see a whole bunch of different patients presenting with different symptoms and you are being watched by a doctor or somebody who can measure your response to each of these cases. The pass rate is very, very low in that test - and perhaps the minister might know what the most recent one is, but two years ago, I believe it was 36 people that went through the OSCE and six were successful, and I would really like to know if you have any updated information.

 

I think the limitation here might be that it's conducted by the College of Physicians, but I believe that the province helps in some way to fund that, although the immigrants pay a lot of money, they pay $6,000 - that's where it was a few years ago - each to sit that exam with a pass rate of 20 per cent if they're lucky. Six out of 36 was the last that I had heard. I'm wondering if you can say - my real concerns, we've got this CAPP that I'd like to know if you know the numbers on, how many are sitting it, do we provide any funds toward it and then the amount of money you told me about, the $5.5 million, which I'm really glad to see it has gone up, that might be largely because of doctors fees, but it's up almost $1 million, so it's probably above any increase in their pay so it must be an expansion as well.

 

You said there are 24 doctors now working under the CAPP and that's where we take them in, I guess, under our public health system and we begin to pay them and we pay doctors, as well, who are supervising them. So 24 at the moment and that would be over a number of years - it would be the people who were successful in writing those exams and doing well on the OSCE exam as well, and I'm wondering, is there any plan to expand the number of positions that we would offer each year?

 

I strongly believe, although I have no proof to this, there's a correlation between the number of people who pass the OSCE - if we can call it a pass - in that exam and the number of places that are available each year that the province is funding. I think the College of Physicians is reluctant to give a pass to more people than they can accommodate in the system. I think it may be that it's not so much or not entirely those who are not qualified, but they just pick the best six or the best seven based on the amount of money that the Province of Nova Scotia is putting in. I would just like to know whether we are going to expand the number of places the province would pay for, because I think we would see a corresponding increase in the number that are available to take those placements around the province.

 

I want to see a way that we can expand the number of opportunities because we literally have over 100 doctors, I know it might be 200 or 300 that ISIS is aware of that work with ISIS and with the immigrants, and yet we only have something like two opportunities, two places to get into third-year medical school as a bridging program, we have only a few that get through the OSCE exam, we have a few lucky people who might get on with a DHA. By and large, a handful of the foreign-trained doctors find an avenue and the vast majority don't and they go to Newfoundland and Labrador, where they seem to have a better system. Could we just get a little bit more on the CAPP and the number of positions we fund that might help to increase the numbers that are getting through the OSCE?

 

MR. WILSON: For the member's information, we do fund the positions at Dalhousie for the opportunity for them, one of few jurisdictions across the country. When it comes to CAPP, of course, the number moves as people try to pass the exam. Over the last number of years we've had as high as 56 individuals in it, currently we have the 24 and the increase that I talked about, almost the million dollars, only about $109,000 of that has gone to the increase in the wages, and $820,000 of that has gone to the increase in the program itself. The majority of it is to go toward increasing those numbers.

 

Out of the 36 registered to write the exam, eight passed, and all eight are working now in rural Nova Scotia. I think it's important that we have those exams in place. The last thing I would want to see in the province would be any changes to allow a variance of allowing people who might not meet the standard in practising in the province. We're very concerned that they need to have their competency, and that's why we have the program set up the way we do. It would be expensive, there is not a lot of opportunity for us to support an individual to come in and try to take the additional training - we find it extremely difficult to sustain what we're doing now.

 

If money was no object, yes, maybe we could invest more in those doctors who come over, who are trained in foreign schools. Right now what we need to ensure is that we have a process in place that at least allows them to register for the exam, hopefully through the CAPP they will get support of local physicians who mentor the individual and hopefully prepare them to be able to pass that exam.

 

I understand where the member is going and some of the concerns; we have them also. But we provide over $200,000 to the college each year for the administration of the exams, so we're supportive of the exam and we're ensuring that we're supportive of ensuring there is opportunity for people to write the exam. Would I like to see more of those individuals, the 36 who wrote this year, be more successful? Yes, my hope is that all 36 could pass and all 36 would be working in the province, in mostly rural communities.

 

There are stringent requirements to ensure that people are competent within the health care field; it's the same for any profession. I know as a paramedic, after I got accepted into school, the pass mark was 75 per cent, and I thought 75 per cent, I have to make sure I do really well, but I think it was for a reason. Who wants to have a professional, especially a health care professional, only know 50 per cent of what they were taught in delivering service? I don't know what it's like in other professions, but I know there is strong testing that is required for anybody who is entering the health care field. Thirty per cent of the physicians in Nova Scotia are international medical graduates, which is a high percentage, I think, overall for a small jurisdiction.

 

I think we've shown we've done well at trying to get foreign-trained doctors here to the province. As I said, 30 per cent of the doctors we currently have in the province have been trained outside Canada, so it is a high number. We are going to continue to try to fill the gaps and, as a minister and as an MLA, I'll continue to try to help any of my constituents who find themselves trying to get access - and I would be more than happy to help the member opposite, if there are people who are contacting her to see what we can do to help, to see who they can get in touch with to make sure they have all the opportunities and the best opportunity to pass the exam and then get licensed here in the province.

 

MS. WHALEN: I appreciate the offer that you just made about perhaps allowing them to get in touch with your office. As I said, I have somebody who is a specialist who is looking for access into our clinical practice here and I did call the College of Physicians and Surgeons and had a good discussion with their registrar. But I think that there might be avenues and I really feel that even though we tried to clarify it through the Fair Access to Regulated Professions Act - it has a name like that - the minister will recall when we were in Opposition, and he was also in Opposition, I had actually introduced a bill that took one tiny part of the Immigration Act in Ontario when they did a very big immigration Act. They had one on making the regulated professions, requiring them to map out their process for immigrants - how you go about getting licensure in all these various professions.

 

I brought that as a Private Member's Bill here and I can tell you that just those few years ago - it would have been about 2006 - the minister may be surprised to know that even in 2006 there was resistance from the College of Physicians and Surgeons at that time to be required to do that, to make their process clear and transparent. What I heard at that time was from all of the different medical professions, they didn't know what was required and they'd jump over one hurdle and another and write this exam and that exam, and then they'd be told, oh yes, but now you're back over here, you've got to do these 10 things. They could never see the whole process and they didn't know where the end was. The professions have now done that. My bill wasn't passed, but another one was brought in that included trades, as well, and has really addressed that whole area, and I think it's better in terms of at least understanding what is required, so we're one step ahead there.

 

But I mention the fact that when I brought in the Private Member's Bill - even though all of us know when you're in Opposition, chances are your Private Member's Bill isn't going very far - I was contacted and I was told that the college had the full jurisdiction and that they thought they were doing fine. I felt there was real resistance to change, and I think it behooves us to accept that they have to keep us safe with good standards and make sure that the public is safe. I appreciate that, but they also need to be trying to look at ways to look beyond cultural differences, languages, and recognize when people have the right stuff, if you like, to be doctors in our province.

 

I'd like to ask if the minister would just say something about Newfoundland and Labrador. You mentioned there's a deputies and dean of medicines program. I've met people in my community, doctors who are up and leaving for Newfoundland and Labrador and places like that - there is a six-month program where they could sign on with a doctor - I think under the supervision of a doctor - work six months and then my understanding is they're free and clear to work wherever they like under their own steam, as long as they get a rating of approval. I wonder, is the minister looking at that at all?

 

I'm glad that the different provinces are now sitting together and talking because, again, maybe their need is greater than ours. But I know from speaking to the member for Yarmouth, he said the shortage of doctors is his biggest need, other than the ferry - I better say other than the ferry - but we're talking health today. If you could just have a minute, I'd like to know if you're looking at that at all.

 

MR. WILSON: I'm not familiar with exactly what Newfoundland and Labrador is doing. I will look into seeing what they've been doing over the last couple of years. I'm confident in the committee that has been put together, especially with Manitoba being the lead, or the chairman, of it because of course Manitoba, I think, is one of the most successful at immigration. Really over the last - well, I think they've been involved in that for well over 10 years, and they've really seen an increase in the immigrant population there. They've been very good at attracting and retaining immigrants to stay in Manitoba, so I know that they have a good track record on it.

 

I'll try to find out about Newfoundland and Labrador - I'm not too sure what they're doing over there. They are a much smaller population base than our province. They, I'm sure, have some challenges with some remote communities all on their own. One of the things I noticed as minister when we talk about rural delivery of health care, when you get out and see some of the other barriers that other jurisdictions have, Newfoundland and Labrador is one of those that has challenges within the health sector; and Saskatchewan, Manitoba, those more northern communities where you can only fly in, trying to provide health care services there is quite amazing.

 

This year, with the additional almost million-dollar increase towards the CAPP - last year we had 36 individuals in that program and we're hoping to move that up to 48 this year. So that's what the additional resources are for. I'm hoping that we attract those foreign-trained physicians who have a good opportunity to pass the exam and I look forward to filling, hopefully, all 48 of those positions.

 

MS. WHALEN: I know I have just a couple of minutes left, and I wonder if the minister later could tell me - it doesn't have to be now - who a person would call if I was to direct somebody to call someone in your department to get more information about how they might get certified; what else they can do. That would be great if I could get a name. Also, if you could give me the name of somebody who could just explain better to me about the CAPP, about the numbers - just the 24 that are currently in and the 36 you had funded; I just kind of want to reconcile that. I'm really happy to hear there is an expansion - I want to say that very strongly.

 

One last thing I'd like to ask the minister about - we probably won't have any time for a big answer, but just to signal to you that this is really important, and that is the culture of drinking and binge drinking. We haven't talked anything really here about wellness. You're now both the Minister of Health and Wellness, and I have a grave concern about the number of emergency room visits, injuries, sometimes deaths - certainly violence and accidents that occur as a result of a lot of drinking and binge drinking, and a lot of times it impacts young people. I'd just like to raise that and ask - maybe in a minute or two you could say if there is somebody working on that file in the Department of Health and Wellness because I think it has a very negative impact, and even as we speak here today, we know that there have been other social problems that we have been talking about in Question Period and otherwise where alcohol plays a factor.

 

I'm not at all a teetotaller, but we know that drinking is very damaging if it is done in a binge way or if it's irresponsible. So on a health side, could the minister maybe just take a couple of minutes to answer that? Thank you.

 

MR. WILSON: We do have a recruiter - Joanne MacKinnon - who is a physician recruiter within our department, so we can get you that contact later. We do have a Physician Resource Division also within the Department of Health and Wellness. Joanne MacKinnon is our physician recruiter who works extremely hard to find people to get into those areas that we find gaps in, so we can get that to you.

 

Thank you for bringing up the wellness side of things often forgot about. Well, not forgotten about, but overshadowed with tertiary care and the other important things that we do within health care. That's why earlier this year we brought forward the Thrive! strategy. I know our public health has worked hard over the last little while to have the conversations in the community. Dr. Strang actually did a report for St. F.X. around binge drinking, which studied what was going on down there; did a report which gave some policies and recommendations for other universities to look at to see if they would adopt those policies.

 

St. F.X. has been really out front and centre on this, requesting Dr. Strang to come in and evaluate some of the policies they have in place and see how they can improve them. I believe they adopted almost every single - if not every single - recommendation Dr. Strang had in his report. I know our time is limited; maybe we can get back to this. (Interruption)

 

We know that it is an area we need to work at. When I was in university I know that was a concern - not for me, but maybe for some of my friends. But it's always a concern and we need to make sure that we have strong policies in place and try to have support systems that create a culture that recognizes the dangers of that.

 

We had a recent campaign around mixing pharmaceuticals, or prescription drugs, and alcohol. Not only as a province have we taken on some of the campaign and media campaign on that, but more on a national level because we know mixing prescription drugs and alcohol can kill you. Young university students need to know that - not to say that they're all doing it, but we hear time and time again about the death of a young student who was a good athlete, a good student, a good person, who ended up at a party maybe or consumed alcohol and popped a prescription drug that ended their life. That's so tragic.

 

I think we all would agree that we need to do whatever we can to ensure that there are awareness campaigns going on and ensure that people are educated in the dangers of that. I know I scared the heck out of my two kids. I have a daughter who is 14 - going to be 15, going into high school, and I've talked to her. I know they're scared, but I think they're educated and we have that dialogue. I have a son in Grade 6 - and I know they're doing some education in junior high; they're doing education in elementary - we need to do more.

 

I know from talking with my colleague, the Minister of Education, they start as low as Primary, just talking about pills aren't candy, don't play with a pill bottle - something simple like that so it's in their heads, and we need to continue to work on that.

 

We do have a couple of deputies, who are looking at the issue of binge drinking within government, who are going to make some recommendations to government to see where we can go. I know the new mayor, through his campaign recently in Halifax - this was a topic of the race to become our next mayor - I know that he is committed to work with partners in law enforcement, the province, our public health officials to see what we can do to increase awareness of the dangers of binge drinking and those areas. So I look forward to our deputies bringing forward some recommendations to myself or anybody in government to see where we can go with that.

 

MADAM CHAIRMAN: The time allotted for the Official Opposition has elapsed. We'll now go to the Progressive Conservative caucus.

 

The honourable member for Argyle.

 

HON. CHRISTOPHER D'ENTREMONT: Thank you, Madam Chairman. It is a pleasure to come back for another hour. More to the point that the member just brought up - we did have an unfortunate death; I think it was at Acadia. Something pings my brain that there was something at Ste. Anne's as well, so this continues to happen. It seems like every year there's some other sad story about it. It's not just universities within our communities; people really just don't know. They think they can do it; they think they can take it, and don't understand the signs. And even further, that people around don't understand the symptoms or what's going on, so just an awareness for everybody to make sure that binge drinking, alcohol consumption, doesn't get to the point that it takes another life.

 

Let's go back to where I left off. I think we were talking about paramedics, EHS and all that fun stuff, but the next one on my list, we go to Page 13.8. Here we're talking about Addiction and Mental Health Programs. The budget for addiction programs has increased by more than $2.6 million this year. What does that look like in practical terms - what kind of programs is this going to be funding and what does this mean for access to the mental health system in Nova Scotia?

 

MR. WILSON: Thank you to the member opposite for asking questions in an area that I think is very positive; we're seeing an increase in support from $6.9 million to $10.3 million. We've had a strong commitment over the last four years to improve access to mental health and addiction services. It's something that we have seen the need to do for a long time in Opposition. We talked about this, so as soon as we got into government the former minister knew that we needed to first have a kind of foundation and really a plan and strategy to look at where we needed to go. So we're glad to introduce the province's first Mental Health and Addictions Strategy for Nova Scotia. I think over the last couple of years we've really seen more awareness put on mental health, not only as a province and as a government but as communities, as the public had demanded it.

 

We've seen a lot of support from businesses out there and I'll refer to some of the campaigns that are funded. I don't want to pin one against the other, but the more recent one is Bell - they had a Let's Talk initiative where they managed to bring forward Olympians who talked about having and dealing with a mental illness. That's so important to kind of break that stigma of mental illness, break the fact that we just never talked about it because nobody wants to admit and talk about the fact that they, or a loved one, or a friend is dealing with a mental illness. So we're very glad to bring forward the Mental Health and Addictions Strategy. It really gives us a road map of where we need to commit funds, where we need to support organizations into the future and it was, I think, long overdue.

 

We have seen an increase, most of the increase is due to the recovery houses moving from Community Services over to the Department of Health and Wellness where I have said in this House that I think it is the best fit for that service in Nova Scotia. And I say that because often many, if not every single individual who gains access or utilizes the services of a recovery house in the province has used health services wherever they live and I think it's a good fit. So that was a transfer of $1.3 million.

 

As well, we've seen an increase in the funding for the Mental Health and Addictions Strategy and standards and that's a $1.025 million increase, and also we've seen an increase for community placement programs of $500,000, and there has also been reclassification of the problem gambling programing for administration and that's $1.379 million. These increases are partially offset by transfers from district health authorities and that was for $460,000, home care for $250,000, and that pretty much covers that increase. Some of it is dealing with movement, but some of it is investment in other areas of the budget - we're increasing funds towards mental health and, I don't know, maybe we'll get into that in future questions.

 

MR. D'ENTREMONT: It was interesting, the awareness issue is one that is always difficult. I remember we had done a bit of an ad campaign on mental health during my time as minister, basically trying to find a couple of champions for mental illness, that it's okay to talk about it; it's okay to seek treatment. If I remember, the individual was, I believe, a cop, which we would accord to be a big, strong personality who did have problems with it and so happily spoke to it, talked about the stigma around it and how going and searching for treatment options was one that truly helped out.

 

I also remember during our time the frustrating construction of the community living bungalows at the Nova Scotia Hospital site and the tremendous problems we were having in trying to find those locations. I know that when I drive by there now I see the building constructed and, of course, being lived in. I think those are tremendous steps forward.

 

I've stood in this House on a number of occasions through a number of estimates and talked about the mental health strategy and commending the previous minister on that - that it was time for it and I think our communities are ready for it. I think the government needs to move forward in bringing it forward. Maybe I'll let the minister speak for a few minutes on the mental health strategy; where he sees it going over the next year and what kind of new programs we can expect, or at least support for programs that are currently in place.

 

MR. WILSON: First of all, the total budget for the mental health for this year is $140.6 million, and then of course the budget for addictions is $42.4 million, so a total of $183 million is in this year's budget for mental health and addictions services. In that, a lot of funding goes to different programs - the mental health standards that we have in place.

 

One of the areas that I was glad to make the announcement just recently was the Mental Health Crisis Line. That program was offered just here in Halifax; it wasn't 24 hours a day, seven days a week - it was a limited time. It was back a number of months ago now, I had the opportunity to announce that we were going to fund the Mental Health Crisis Line 24 hours a day, seven days a week, but also expand it across the province so anybody can gain access to that crisis line. It's important, I think, that people who are finding themselves dealing with a mental illness have an opportunity reach out - and it could be as simple as making that phone call and talking to someone on the other end about the situation that they're in.

 

Often it doesn't take a lot to give some support and reassurance to somebody who is having a mental illness episode or breakdown or having some kind of issue that they feel they can't deal with. Often, as a medic, we would be called to a house with really no description of chief complaint and you kind of knew, okay, this sounds like it is not a normal call. Often individuals found that was the only way of maybe reaching out for support, so they call 911; they say that they may harm themselves, and of course then that triggers sending an ambulance, often sending a police force, RCMP, or town police.

 

Often when we got there, there was no real chief complaint. You could see as soon as you go in and you do your rapid assessment of the scene, and then of course going to the patient - they're in distress even though it's not something as easy to figure out what was going on because I've said this often, in the health care sector or health care field a lot of things, you recognize the illness or the seriousness of the illness by physical findings. And what I mean by that is if you're having chest pain, for example, I can feel your pulse or hook you up to an EKG and I can feel that your pulse is irregular - that's not normal, it's weak or strong, then you can say okay, they're in a position where they need some support.

 

It's the same as high blood pressure, if your blood pressure is 220/110, that's pretty high, that's something physical I can figure out by taking your blood pressure and then I know what acuity level you are and off we go. If you have laboured breathing, I would listen to your lungs, and if your lungs are full of fluid I know you're ill and you need some treatment.

 

The health care system is geared around physical findings to figure out how quickly that person needs to progress to the next level of care that they need - if it means drug treatment, IV treatment, respiratory treatment. But when you're dealing with mental health and mental illness, you don't have that physical finding so it's very challenging. I've always said how much I respect those health care providers who work in the field of mental illness. It's a challenge to try to figure out exactly where someone is on that kind of acuity level, on what the next step will be.

 

Is this person okay to leave at home? Maybe they said they were going to harm themselves and they were just saying that. It's very difficult, and I respect immensely anybody who works within the mental health field for the dedication they have to their patients. It is a difficult job, and to this day I don't know how they can figure out how serious the issue or the mental illness episode they have is and how to go to the next step. That's always a challenge. We have dedicated people who are there.

 

When someone reaches out we need to make sure we give them every opportunity to do that in a number of fashions. I've said calling 911 is one opportunity where you might get a paramedic or a police officer who will engage with that person and then they will do a quick assessment, and usually if it's to a point where it's over the skill level of that person, if it's a police officer they will call the paramedics and if it's the paramedic and they realize this person is in serious need of support then they usually transport that patient to the hospital where you can get some of the psychiatry trained individuals to deal with that.

 

Allowing for the expansion of the Mental Health Crisis Line is important, especially in the rural communities. If you're having an episode where you're dealing with a mental illness and you're in a remote rural community, most likely you're not out socializing with people, you're in your own home, you're very private, and you are trying to deal with that. We've seen some recent commercials about that and some awareness around that, so having a number like this, having access to just a simple number where you could call 24 hours a day and just discuss it with somebody, is important.

 

We have that expansion, and of course 811 is another avenue that people can call out for support or help and get a trained nurse on the line and they can talk to that person and assess them and really give them some direction on, yes, you should see your family physician in the morning or maybe we should call the ambulance now, or maybe you could get yourself to the hospital ER, and that nurse will call the hospital saying this patient is coming. There are a number of areas where we've increased funding over the last number of years, and the Mental Health Crisis Line is one of them.

 

Another area is anti-stigma discrimination initiatives. As I mentioned, we need to make sure that people feel okay - I want to say "comfortable" but I don't know if anybody will ever feel comfortable coming forward with their issue, but feel okay that they can discuss it with a friend or a community person, a clergyman or someone in their clergy, or someone at work, for example. I mean, right now I think a national organization has put ads on about someone calling in sick at work - they are working every day and they leave the message saying I'm not in today and then they're at home by themselves.

 

Those campaigns are so important to try to ensure that that stigma is taken away and I have to say from the day I stepped into this House I've always talked about mental illness and calls and experiences I've had, and I know it can get quite loud in here at times when you're debating and answering questions or asking questions about it, but I know that every single time that I started talking about my experience with people who are having a mental illness or breakdown it gets very quiet in here and everybody is very respectful in the House. And I've appreciated that because I think we all realize that we have constituents who call us on a regular basis trying to get the support for an individual, a loved one in our communities.

 

The Mental Health and Addictions Strategy this year we're looking at a strategy forecast of spending $1.4 million. That includes the school health policy regarding mental health and substance use and gambling, that's the enhanced methadone maintenance treatment that alone is an investment of $570 million. The prescription drug surveillance in Nova Scotia working group we're going to provide $90,000 for that; the peer support system, we're putting $118,000 in this year's budget; municipal alcohol policy, I know we talked earlier from the last member asking questions, that we're putting in $140,000; and the youth mental health clinicians for SchoolsPlus, we're putting $320,000 in there.

 

I know we've all talked about the fact that if we can get in and get in contact and have those relationships and those connections with young people in our school system early, and picking up early signs of someone dealing with a mental illness, I think the outcomes are much better. It's like any aliment - early detection, early treatment, better outcomes in the end. Also the client information system, we're putting $95,000 into that this year - the network model connecting health care providers, that's the key because we need to work with, in collaboration, so that people, if it is over their heads, maybe as I would say, over their heads in their training or their ability to support an individual, then they can hopefully know that they have other individuals who can support them.

 

I've run through some of those, but I think it shows that we're committed to it, we're continuing to put funds into the mental health strategy and I look forward to our partners who are providing support in the community and they're not all asking for government money, a lot of them just want government support or opportunities to showcase some of the good work that is going on in the communities across the province.

 

MR. D'ENTREMONT: Maybe a quick follow-up with the model of care that went with the detox centres that we've been hearing some issues from - I think it was the Cape Breton one where there has been some discussion, especially around its connection with Talbot House. But the change, what happened at the Yarmouth detox, of course there are some concerns from some of the people who were offering the services before and of course the change went to, I believe, RN staffing and other staffing. Just wondering what the experience is on that one and how it's going at the detox centres across Nova Scotia and, of course, we do need more detox opportunities for people.

 

MR. WILSON: Before I get into that I just wanted to bring attention to the peer support system to improve workforce credentials. We had a budget last year of $500,000 and we've doubled that this year, so we're going to spend over a million dollars just in that component of the strategy alone, because it's so important to ensure that people have the credentials and access to continuing education, for example. The other area where we see a significant increase - we've talked about this - is definitely under youth mental health and the clinicians for the SchoolsPlus who can identify problems early, and I talked about that earlier. They can treat mild to moderate problems and refer to the formal system if necessary - so, again, referring them on to more highly trained and skilled individuals.

 

Last year we invested $320,000 in that program; this year we're increasing that to $1.4 million, so more than doubling, more than tripling the investment in that area because we know if we can get that early detection and early support there are better outcomes.

 

When we're dealing with addictions, it has been area where each district health authority has addiction services available to Nova Scotians. I've said in the House when we took over recovery houses that the best possibility for someone to get the support and kick an addiction is to have as many options as possible. Often one certain way of trying to deal with an addiction isn't successful. I know there are statistics out there that people who have a recurring addiction problem and if it's not gambling it goes to alcohol or it might go to prescription drugs; it might go to illegal drugs.

 

So addiction services, that's why it's part of our mental health strategy because we know there is a high percentage of those Nova Scotians who have addictions also have some mental illness or it's associated with it. Those individuals who have mental illness have a higher percentage of addictions, too, or have addiction issues - I'm not saying all of them.

 

It's an important area that we needed to invest in and we needed to look at the model of care. I said this before - we need to make sure we're getting the outcomes we desire with the investment we're putting into health care and, if we're not, then we need to kind of look at how we do things better. With addiction services, we're putting in more money and I recently - I'm trying to think when I did my tour of the Valley and the new addiction services. I think it was in the Fall or just prior to our last session, September-ish. I went down and met with clinicians who are working within addiction services along the Valley and they've changed the model delivery in that part of the province, which I think is starting to resonate across the province.

 

What we had before are like 21-day programs and they offered a number of them. I believed they offered - if it's 21- or 26-day programs a year, and so if you had an addiction and you were in the Valley and you wanted to gain access to one of these programs, if they were at day 17, you had to wait four days before you could get in. If they were in day 5, you had to wait more time to get into a program for an addiction. But when you have an addiction and someone is calling out for help, telling them to come back in two weeks isn't going to do them really well, I think, in their outcome.

 

So they're changing the model down there so that if you come in, no matter what day it is, there are programs running 52 weeks a year now. You can come in and gain access to a program; they'll slot you in. You might not be with people who have been in the program for two or three weeks, but now they have opportunities to get into the program immediately and have the support you need.

 

During my visit down in the Valley - I can't remember at which hospital I was - I met a nurse who had spent well over 30 years in addiction services. The nurse told me that she was retiring. I congratulated her and thanked her for all her work, but she says, well I'm retiring, but I'm coming back part time. I said, you're coming back part time? She said, yes. She's so excited about the changes that she's seeing in addiction services that she wanted to be a part of it even though she was retiring. I think that says a lot about the change in the program, the attitude towards the model of delivery change, and the changes are positive.

 

In the Valley what is interesting is often general practitioners, if you have a patient who has an addiction, it's very hard to treat that patient if they come in and they're on drugs or alcohol. In the Valley now, a general practitioner, if they have a patient, they can refer that patient to the addiction services where they can come into the program that they have there. They have physicians on staff; they even have the use of a pharmacist who is part of the team, works in one of the pharmacies in the Valley, and what they'll do is try to stabilize that person enough so they can now request the general practitioner to take that patient back, and usually GPs have been reluctant because of the high caseload they do have and it's very challenging to take care of someone who has an addiction.

 

Now those patients can go back and be a patient of that general practitioner. If something happens where they fall off the wagon, as we would say, they can come right back into the program, the general practitioner in their office knows that patient is being taken care of and then they can gain access to the program.

 

I know that there have been some concerns in Cape Breton around some of the workers who work in addiction services. I've said it in the House and I'll say it again, I don't want to see anybody losing jobs, but in that case in Cape Breton, what they've done is they've changed the makeup of who they hired so they have different skill sets. That's unfortunate, that means some people are out of work. It's my understanding through some of the work of the district that some took retirement, and we might have been down to three individuals who were looking at other positions within the district and it's my understanding they all found work. I believe there were six. (Interruption) Eight, yes, were displaced at the original change.

From my knowledge that I have they've all found other areas to work in and it shows that we need to move forward on making sure that if you have someone come into one of those programs, that you have someone who can provide care for them and really get that person the help they need.

 

So I think I'll end there on that one.

 

MR. D'ENTREMONT: I appreciate the answer, as well, but we did go through a wholesale change out of staffing at the Yarmouth detox. It's kind of the same thing that's happening in Cape Breton right now. I just want to make sure that with the Yarmouth one there were a number of retirements, people moved and I think there were a couple of people who got left out in the cold a little bit. For the most part, whether or not the model is better or not, I'm not sure because the service that was being offered there before, you sort of had some consultants or counsellors that sort of had been through it themselves. I know a couple of them and they're wondering whether their kind of counsel will be lost in that process. Hopefully, I haven't heard anything bad since the changes happened, but ultimately, I hope it is a better way to do it.

 

Let's switch gears for a little bit and talk about the wellness side of your portfolio. I've said before that I still kind of wish the Department of Health Promotion and Protection was still there because it sort of delineated where the responsibilities were actually between your two departments. Even though I know that under the Health wing it's a separate entity.

 

Maybe you could talk a little bit about physical activity and sport and recreation - how is that programming going? I see COPS Implementation is getting a bit of an increase. I see the big drop in the Development and Support, Recreation and Sports Organizations. Can we talk about the importance of the other side of the coin? Many times when we talk about health, truly we're talking about sickness and disease management. When we talk about health we all of a sudden think that we're trying to make our society better, we're trying to avoid going to the hospital. I'm wondering where the mind is for the next year or so on the Wellness side, the sports and recreation side of your department, where we're going with that.

 

MR. WILSON: Even though we did make the decision a couple of years ago to bring in what was Health Promotion and Protection under one umbrella, it was still under Health - they still worked closely with Health. I think it's a key towards moving forward and ensuring that we create an environment here in the province that allows for people to live a healthier lifestyle or maybe change your lifestyle.

 

We've talked about this on a national level. Many, if not all, of the Ministers of Health are the sport and recreation ministers or whatever different jurisdictions call it. We know the close relationship that needs to happen between what we do under a health department and all the divisions and what's done under wellness. There has to be a connection there because creating those partnerships is so important. Thrive!, for example, our strategy to try to gear towards getting Nova Scotians - especially our kids - more active and giving them opportunities is a prime example of how we are utilizing partners to try to succeed in really reducing the need to use the health care system.

 

It was one of my first releases as the new Minister of Health and Wellness to launch the Thrive! strategy and we were down at Pier 21 or one of those areas to do that. It was amazing to see the turnout. We had hundreds of people in all different walks of life there to congratulate us, I'm not here to say how good a job we are doing, even though we are, but congratulating the fact that government came forward with an initiative that they see as a way of partnering with government.

 

Thrive!, in my opinion, allows for our government and, especially, our departments to work together. I remember we had, I think, five seats up on the platform. We had the Premier there, myself and the Minister of Education, and then as we got closer to the event, most of the front bench wanted to be there - even to the Minister of Transportation and Infrastructure Renewal who said, well, I want to be part of this, I want to commit my department to be supportive of this strategy. It just showed because - of course some of the investment that the Department of Transportation and Infrastructure Renewal can do and active transportation, ensuring that when they're paving the roads of the province that a lot of their requests are paving a little extra on the side so the cyclists can use it. So it showed a lot of commitment from our front bench that they wanted to be part of this and that they wanted to move forward.

 

There were a lot of partners - a lot of organizations - in the crowd that saw this as an opportunity to partner with the government. I think I used this example the other day - government a lot of times shied away from promoting any businesses or that if they didn't directly fund something. So if a business wants to go and do an initiative, let them go and do it; if we didn't have involvement in it then we wouldn't be part of that, but what we asked from the public, businesses and organizations is that we want to be partnered with you and if we can promote you we will.

 

I recently attended an event at the Shannon Park arena on the base; had the base commander there, the chief of the base, but had a representative from Canadian Tire, and a neurosurgeon was there. What Canadian Tire wanted to do - they didn't want a speaking engagement; they didn't really want to be recognized that much, but they wanted an avenue to say thank you and give back to organizations that took a good stance on an issue of preventing injuries. It was on the arenas that chose to have mandatory helmet policy in place. The Dalhousie arena was the first one in the province and there are a number of them now that have taken that policy and brought it forward.

 

Canadian Tire wanted to give them, 10 arenas across the province, $500. We had arenas from all over - Cape Breton, the Parrsboro area, down the Valley way, and they're committed to doing it again next year - all they wanted to do was promote those arenas and ensure that we can promote the fact that they did this to prevent injuries. That's why we had the neurosurgeon there, and I was there and I was glad to do that. I'm very proud to support good corporate citizens of our province who take up initiatives like that and I have no problem stating that they are good corporate citizens when they do things like that.

 

We have a lot of opportunities to partner with a lot of people and organizations around Nova Scotia. One of the other areas in Thrive! I'm glad that we're partnering with and one of our partners is the Aboriginal communities - along the same lines as the helmet policy. The Premier and I recently were down in Membertou, had a great day skating on their outdoor arena with the chief, and one of the things we were there for was to support them in their ability to have physical activity coordinators in Membertou and in other First Nations communities so they could play a role in trying to get their residents more active, more involved, and it was a great event.

 

It was funny to see the Premier there with his Montreal Canadiens jersey on. Chief Paul was there with his Blackhawks jersey. I think one of the pictures in the media showed them there side by side. I did tell the chief that I couldn't support him any longer because he was a Blackhawks fan, but we had a good day and the kids were so appreciative. One, of course, they were out of school for the afternoon, but so appreciative of the work that Membertou has done to encourage an active lifestyle.

 

Some of the funding for physical activity in sport and recreation activities is important and we're continuing to support them. One of the things is ensuring that there are community-based programs out there so that kids can go and be active after school. This year we're providing $155,000 for a Learn to Swim program. I think it's a great opportunity for communities to ensure that kids have exposure to different activities. Not everybody's a hockey player, some of them can't because of the sheer cost - hockey is extremely expensive. Swimming is another option for people and it exposes them to physical activity possibilities. The physical activity coordinators for the Mi'kmaq community, we were putting in $25,000 for each community - also, the other thing is free facility access program, trying to ensure that people can gain access to rinks and pools and other activities and facilities around the province.

 

We have seen a big reduction - and I know I answered this in a previous question, because the member has been very polite in asking - the major reduction is the B-FIT money. It was a program that was supposed to last 10 years and we had to wind that up last year because there's no money left; it was all accounted for. I'm going to leave it at that.

 

It's a shame that program can't continue because we know the demands in a lot of our communities around the aging infrastructure for recreational facilities. We took all advantage of the federal government's infrastructure campaign over the last number of years where they went around spending hundreds and hundreds, if not billions, of dollars in communities across the country to stimulate the economy, and one of the things that we had to do in order for us or community organizations to get the money was to match the funding. Not all provinces could maximize what they could do, but we did our part and we knew that if we didn't support some of those programs that communities would be left out without the infrastructure. I think that contributed to a healthier lifestyle.

We spent a lot of money in that program and the B-FIT program was supposed to be there to support those larger projects. We have a program now under Wellness for facilities and recreational upgrades to trail development, playground equipment, supporting arenas, but one of the things I'm realizing, and we got to list of requests now where we have a program that the ceiling, the maximum is $150,000. I always hate putting a maximum on it, but it seems like whenever people are looking for funding they always ask for $150,000.

 

We can't fund a lot of those. The arenas are very expensive for the upkeep and maintenance of those, so when something goes wrong in an arena it's usually $200,000, $300,000, or $400,000, so it has been a challenge over the last couple of years not having a program like the B-FIT program to go to for those larger capital expenses.

 

The program we have now is really meant to support local community associations who want to do a playground, for example. I have a couple of them that are asking for $8,000. Trail development, there is an area in my riding, Second Lake Park Association and Friends of First Lake, that have done a number of trail development and upgrades around Frist Lake and around Second Lake, so they're asking $15,000, $20,000, $30,000 so really that program that we have now is the best fit for the smaller projects. Where we're struggling is how we pay for some of these bigger infrastructure asks that the municipality has, that the community groups have when in the last four years we've been struggling, trying to get our finances in order - there is not a heck of a lot of new money.

 

So the program funding has kind of remained constant over the last four years so now not only are we trying to address the community wants for those smaller projects, but on top of it all the requests that used to go to the B-FIT program now end up on the request list for this smaller program. Over the next couple of years we're going to have to try to figure out how we address that and how we get around those larger capital projects without wiping out all their money in one project.

 

I was disappointed with the former government; the former Progressive Conservative Government spent all the money, we don't have any money left in that big program and that program wound up last year. So I'll leave it at that.

 

MR. D'ENTREMONT: I'm fully aware of the B-FIT program and the uptake was tremendous. If we look at the rinks and recreation facilities that we had across the province that had in our time, prior to our making government, been neglected by a previous government as well, so the demand was far higher than we had ever anticipated, that the Liberal Government had completely shut out and forgot about. Anyways, I'll leave it there.

 

I hear grumbling behind me even from the good member for Cape Breton North, but there you go.

 

Public Health Programs, Page 13.10, Chronic Disease and Injury Prevention went $3.4 million over budget last year and I'm just wondering what influenced this and maybe what additional program will account for the increase again this year - Public Health Programs, Chronic Disease and Injury Prevention $3.4 million over budget, what precipitated that again on Page 13.10?

 

MR. WILSON: Just for clarification on the B-FIT program, that program was supposed to run to 2017, and of course we had to wind that up last year, so I'll leave it at that.

 

We're going to go now to public health programs. One of the things - and I know we've talked about this and the realignment and moving the funding and programs to the right line item. The change is that it was accounted for in one area that we spent in the other. If I've got this wrong, it's vice versa. It was under Community Health and we had the funding come from Healthy Development, right? (Interruption) We did the spending in Community Health, but it actually came from Healthy Development, so we realigned that. The biggest portion of that was $2.1 million for the Healthy Eating Program funding that was reclassified from other areas of public health. Really, that takes up the biggest portion.

 

Also, we did the Healthy Communities Program funding reclassification also from other public health line items, so that was almost $1 million, so right there over $3.1 million. There were some small ones on Be Active and Safe, Protect Your Noggin, which was a great initiative. One of the first things I actually did and we provided $200,000 for that program to provide helmets for those kids around the communities that might interact with police officers, firefighters, and paramedics. A very simple program - a paramedic who is usually on shift for 12 hours in a community, especially in rural communities, they know the community. They're usually out and about on a nice day and if they come across a child who doesn't have a helmet, they can give them a helmet; police officers the same way. So that was the change in those numbers.

 

MR. D'ENTREMONT: That explains my next question, which was the $1.5 million from Healthy Development, but that does sort of move that stuff around. My last prepared question, I would call it, revolves in Page 13.11 - Provincial Programs and Initiatives, the Nursing Strategy. I did remember there was a bit of a discussion one evening here about that Nursing Strategy, but maybe you can give us a quick rundown of why that has been cut by $5 million. Knowing that I have about 10 minutes left, I'm dangerously asking you to do that - I have a couple of closing comments maybe, because I don't know if we'll get an opportunity to get back up - so Nursing Strategy.

 

MR. WILSON: I'll try to be quick - I say that with a smile. Last year we had $14.2 million, so what we did is we moved out $5 million of that to nursing initiatives. We transferred that to the Department of Labour and Advanced Education. We moved grants for nurse practitioners of $150,000; we moved the funding for the St. F.X. nursing seat, that's $2.4 million; the CBU nursing seat, $1.7 million; and the Dal nursing seat, $747,000 - a total of about $5 million transferred to the Department of Labour and Advanced Education. That leaves about $9 million.

 

The $9 million goes towards the Nursing Strategy - so the nursing program at CBU, we still fund $800,000 to that; Dalhousie, $2.2 million; Yarmouth School of Nursing, $1.296 million; and other expenditures about $13,000. So that's $4.3 million in the total nursing program.

 

Also under the Nursing Strategy, to make up the remaining $4.6 million, is employment orientation. For example, long-term care is $355,000; the employment orientation overall is another million; continuing education for district health authorities - IWK, VON and long-term care is $1.5 million; the co-op learning for third-year students is $1.1 million; new grads transition support of $150,000; and other initiatives about $420,000 - that makes up the $9 million and the other $5 million that was transferred out.

 

More funding will be transferred to the Department of Labour and Advanced Education in future years, to better align who utilizes the money and to better account for where the spending is.

 

MR. D'ENTREMONT: Now that I've put that stuff aside, maybe I'll talk about a couple of things that are important to my constituency, things that I hear on a regular basis when they revolve around health. Maybe I'll thank Linda for doing that - I'm not going to ask any more questions out of the book, as much as she's got the big book all cross-tabbed and stickered; she does amazing work.

 

A couple of things, and the one thing that I hear about the most is long-term care. We've talked about that one at length over the last number of days. I hope over the next number of weeks we'll be hearing that the tender for Nakile Home for Special Care was successful that there is somebody that took the tender at the cost that's been offered and that construction gets there for the 12 beds that are going to be offered there.

 

Number two that I hear about on a regular basis is the availability of doctors. Most of these revolve around - people I speak to mostly from the Yarmouth constituency because we've had a number of retirements from that area, but it sort of flows over into my constituency because people just travel to Yarmouth for it - and if we can continue to focus on recruitment and having options for them. The options that they are revolves into the third piece that I talk about, which are the clinics that we have in Yarmouth and Argyle, that there can be an availability of operating dollars that keep those two clinics open, understanding the concern of those two clinics, that they're still not working the correct way for the constituents of Argyle. They're okay, we don't want to lose them but if there's a better way to do that and you guys can help fund to get them there would be okay.

 

Probably the last thing that I hear about on a regular basis from the constituents in Argyle is the "GD" emergency room in Yarmouth. I don't know where to start nor do I know where to finish on that issue. Some people go in there and they're in and out in no time; others, and this is from watching the Facebook feed and the Twitter feed and getting phone calls from constituents, is the eight-hour waits and the 12-hour waits and all this length of time when it seems you can go to another emergency room not so far away and get seen almost immediately. I think the challenge that Yarmouth emergency room has is that I can get in my car, drive to Shelburne in 45 minutes, see a doctor and be home in less time than it would be to sit and wait at the Yarmouth one.

 

In Yarmouth, even when I was minister, we had an operational review done of them, provided them with a number of options on how to speed up the operations of the Yarmouth emergency room. I think of the recommendations provided to them, I think they implemented one, they didn't do any of the other ones. I don't know whether it was that people didn't want to do them, I don't know what it is, but please, please, please, in your capacity as minister, put a little pressure on them to make it a little bit better. I don't know what a little bit better is, but I've been to a number of emergency rooms around the province for one reason or another - it really doesn't matter why, nor is it important to this discussion but you know you're served by nice people, the nurses are wonderful, the practitioners are wonderful, I know the doctors are great but the wait times are just bonkers when it comes to the emergency room in Yarmouth, and like I say it's hit and miss.

 

Those are the things that I hear of on a regular basis at my constituency and with the last few minutes that we have in this hour, maybe you can talk to them - of course, my question around Nakile is probably the most important one and we got to 38, I think, to complete this hour.

 

MR. WILSON: I'll go to Nakile first because I could talk a little bit on the GP stuff and the importance of all programs in place and how we address that. I heard you loud and clear. Nakile Home for Special Care, it has been an issue for a while, I think August 2007 which I believe the member opposite may have been the Minister of Health at the time so it has been a while. There have been a number of issues around Nakile and I think we're at a point now where we have a good road map forward. The tender for the 12-bed addition is closing Friday, I think, April 26^th of this year, and once that closes there will an evaluation and then all expectations are to move forward, so I hope that that is some good news to the member opposite.

 

When it comes to general practitioners I mentioned a number of initiatives that we're doing down in his area where we do have - I know the utilization of the CAPP worked well down there with those foreign-trained doctors coming in. We also have the new residency program in the Valley that will have a complement of 10 GP residents this June in that area for the full two years - our hope is they enjoy a rural type of practice.

 

We also fund the physician seat in Sherbrooke for a French-trained physician, which is important. Recently I attended an announcement over in Dartmouth where they were able to recruit a French-speaking physician for a practice over there and I know it's very popular because we want to ensure that people can get access to health care in their first language. When I was in Ottawa at the French health conference, I met a lot of health care providers who worked down in your area, very proud to be working in health care, but more proud of working in health care and providing that service in French. With that I know time is up.

MR. CHAIRMAN: That concludes the time allotted for the PC caucus to ask questions and we now go to the Liberal caucus.

 

The honourable member for Bedford-Birch Cove.

 

MS. KELLY REGAN: I just actually have a few questions on a variety of different topics, so I hope the minister doesn't mind if I jump around a bit.

 

The first question I wanted to ask you about was in terms of wait times for people to access the pain clinics in the province, because I am hearing that wait times are considerable; in fact, I heard in January that they can be several years long.

 

MR. WILSON: I think we all over the years, any MLA who has been here for some time has been contacted by an individual who might be suffering from chronic pain and trying to gain access to some of the pain clinics that are around. We know that there are some long waits and it's an area we need to emphasize, to spend some time on, some energy on trying to alleviate the backlog that we see. Interesting enough - and I won't say who I met with - I met today and we discussed this specifically on what the future holds on different treatments and styles of treatment and how we move forward with that. It looks very promising. There are a lot of dedicated health care providers who are working in the field of pain management, who are offering new innovative ways to try to deal with someone's pain management.

 

What's interesting about what we discussed today, it's in hope to get people off the narcotics, the inflammatory medication that all have side effects. Anti-inflammatory medication is good; it works for the aches and pains, but when you're on it for a long period of time there are complications to that. Also, of course, the ramifications of being on a high or on a narcotic, and we know the concern around the addiction qualities of narcotics and having people who are on those drugs and some of the problems that can stem from that.

 

A very hot issue - especially on the federal side - is the use of medical marijuana. I don't know where the federal government is going with it. It's no secret that we've talked about this for many years. I would think our Parties may align a little more than the Third Party when dealing with the use of medical marijuana, so it's a challenge when the federal government oversees the regulations on that and the changes that I foresee, which will have an effect on people. I hear the good stories about the use of it, and it's not for everybody. What's interesting is I think people have a perception of what they envision someone who might utilize marijuana as a medical use, and it's not that stereotypical person.

 

There is some work that needs to be done there. The future is uncertain in that area with the federal government, but we know we need to do work in pain management and the wait times for that. We're continuing to work to see what options we have as we move forward. That's one of the reasons I think it's important for us to get back to balance; I've said it a number of times over the last couple days. It allows us to look at options and look at what new treatments are out there to support someone who needs support of the health care system. Pain management we know - chronic pain has inflicted a lot of people, especially those who have been injured. I know WCB are utilizing clinics now that are private clinics to try to see if there are some benefits to that. We're going to move forward - hopefully have an impact on it. It's a challenged area that we need to try to figure out how we best address the long waits.

 

MS. REGAN: I would urge the minister to examine both the long waits and the medical marijuana issue. I actually had a doctor that I was talking to about the medical marijuana issue saying to me, oh, I never prescribe that - it involves smoking and that's carcinogenic. I thought, well, that's easy for us to say because we're able-bodied, but I often think that for people who have chronic pain on its own or chronic pain and nausea, possibly because of the drugs they're on, medical marijuana can make a big difference.

 

I did want to also talk to the minister a bit about the loss of brain researchers over the last while that we've experienced in this province. We have some extremely highly thought of researchers. I note there was, I believe, a conference this past weekend and a Bedford resident, actually, has discovered - I think it's the part of the body that helps you walk and move. So we have some significant research going on here, but I have to say when I see the brain drain - when I see researcher after researcher leaving the province for greener pastures or because of perceived personality conflicts or whatever, that makes me concerned. I was wondering if the minister could speak to that.

 

MR. WILSON: Maybe we'll disagree on this. I don't think we're seeing a huge out- migration. No question, I think both of us will probably recognize the work that Dr. Mendez has done with the Brain Repair Centre here in Nova Scotia. World-renowned, recognized as one of the best in the world and I know recently he chose to take on a new role out West which is a very important job that he is going to take. The positive thing with having Dr. Mendez set up shop here so many years ago and have the Brain Repair Centre here in Nova Scotia is, yes, he may be gone and his expertise is gone, but his legacy is here for Nova Scotians to benefit from.

 

The work that he has done has been amazing and I think because of the sheer work that they do, these neurosurgeons and researchers are - I mean they're highly intelligent individuals who live to the challenge and live to make sure that when they leave a place that they, I think, leave a legacy. I know Dr. Mendez has done that, I believe there have been three medical neurosurgeon researchers who have left recently for different reasons, but as I stated in my opening, the legacy that is left, the infrastructure that is here didn't go with them.

 

Yes it's a great loss. I met with Dr. Mendez - I don't know if you had the opportunity - we had a presentation in caucus with his robot, and I can't remember what he called it, that was up in Labrador. Here we are in caucus meeting, he fires up this robot - I think it was Molly - he fires up Molly in this clinic in Labrador and he has his headset on, his laptop in front of him, and the computer goes down the hallway and as people are walking by the nurses are saying, oh hi, Dr. Mendez, just like he was there in real time, and went in to say hi to a patient and that was some of the advancements in Telehealth, telecommunications and the legacy that he has left our province and really the pedestal he put our province on when it comes to research and development.

 

I think it's something that not a lot of Nova Scotians know about, our capacity to do research here is amazing for a number of reasons, one is the number of degree-granting institutes here in our province is a lot and the proximity of a lot of the medical school and the training to the hospitals that we have in Halifax and being a tertiary care hospital is a good environment for research to happen. I understand there are some concerns around the recent loss of a number of them, but I think we're in a good environment; we have a good, solid foundation to continue on with the legacy that Dr. Mendez and others have left in Nova Scotia, and I think our capability of doing the research is positive. We have a good mix of population, it's small, a lot of research doesn't need to have a huge population base like Toronto or Montreal - some research does but a lot of it just has to do with having a good control on a smaller population that you can do good research in.

 

I've promoted this before and it's not just in the field of neuroscience that we do research and we have pilot projects and we do testing. Paramedics for example have contributed a lot over the last number of years on different apparatus on the truck, different programs and I look to the clot-busting drug, for someone who is having a heart attack, our paramedics in Cape Breton, for example, were utilized a number of years ago to test the possibility of them delivering a clot-busting drug in the house, in the back of the ambulance, when someone is having a heart attack.

 

The pilot went really well, very successful to the point where we made the announcement last year, maybe a year and half ago that that will be available on all ambulances as long as there is an advance care paramedic there, and access to that. So if you have a heart attack patient and you're a primary care paramedic, you can call one of the other advance trucks nearby or even meet up with them on the highway and have that clot-busting drug delivered.

 

I think we're in a good position in the province. Yes, I was concerned that a couple of them have left, but I feel that we have a strong foundation for research and development here in the province that we'll continue to have success in the future.

 

MS. REGAN: I just hope we don't see any more leave because I think there have been enough go.

 

Not surprisingly, my last set of questions will be around the issue of Lyme disease. I'm wondering if we have any new numbers because the last numbers that I was given a year ago were for 2011 so I'm looking for the 2012 numbers. Also, have there been any new areas that are being announced as being endemic for Lyme disease-bearing blacklegged ticks?

 

MR. WILSON: We were anticipating that question; I know the member has been involved with a lot of organizations and individuals concerned about Lyme disease and I know the region in her riding where there was a high level of ticks and individuals who contracted Lyme disease. I know it comes from personal experience with constituents of yours.

 

As we move forward, it's important that we have good responses, prevention is the key. I believe over the last number of years we worked in the member opposite's area of her constituency with some baiting stations I think they're called, with the medication that tries - and I think it's a study, I believe it may still be going on. It's a partnership with the federal government because they oversee the chemical, I think, they're using in it. I remember the former minister had to sign off on the use of it, I think. I'm not too sure right now where that one is or what's involved in it.

 

We continue to monitor the areas for blacklegged ticks. We currently have six known areas that include Queens County, Yarmouth County, Shelburne County, Lunenburg County, Halifax County, and Pictou County. On our Web site we do show some areas in the province that we're concerned about, that people should take extra precautions. I want to ensure that people should take precautions anywhere in the woods hiking, hunting, fishing, or just out and about in our woods. We do have ticks and you want to prevent that. On our Web site we do have areas, there was an area in Queens County and that was recently added and that would have happened in October. We did a news release on that, alerts were sent out to the district health authorities, it's on our Web site and it's around the Liverpool area and Moose Hill, Great Hill, and Milton area. If you go on the Web site you can see. I can table that; it shows some of the more concerned areas.

 

The message from public health and our public health officials is that we want all Nova Scotians to take precautions when they're out in the woods to prevent any ticks from landing on them. We do have a statement for managing Lyme disease in Nova Scotia, it's a document developed by the infection disease expert group. It's on our Web site and I encourage anybody to go to the Web site and they can read and learn a little bit more on it.

 

One of the other things we're trying to do is work as a department with Doctors Nova Scotia and partner with them to make sure their membership have access to the produced articles about Lyme disease in their monthly newsletters. We want to ensure that as many physicians as possible are aware and keep educated on changes for any ailment, including Lyme disease.

 

I think I'll leave it at that; I think you may explore this a little more and I'll allow for more questions.

 

MS. REGAN: Am I to understand from your answer that we don't have the number of infections from last year?

 

MR. WILSON: I can't find it right in front of me right now, we're of course trying to see if we can produce that, and if we can I'll give it out. Even though I know estimates will end tonight, if we can find that information I will get it to the member as soon as I can.

 

MS. REGAN: Yes and Question Period will begin tomorrow.

 

I did want to sort of make a little bit of a plea here, minister, in terms of prevention. One of my hobby horses has been that we need to have more education for people, people need to know about Lyme disease, they need to know the symptoms, and they need to know what they can do to protect themselves. Last year what I thought was an excellent ad came out early in the Spring, I haven't seen it yet this year and I'm wondering if you could speak to what kind of educational efforts are going to take place this year. I was happy to see that ad come out, but I have to say I was pretty disappointed that that's all there was.

 

With all the advertising going on in this province I was surprised to see that none of it was focused on Lyme disease and just letting people know - I mean a lot of us like to go out to hunt, camp, fish, kayak, and all of that, and we're trumping through the woods. I do worry about people who think they don't live in Bedford or Queens, or whatever the endemic area is, and they think they are protected. I don't think that's the case and I think we need to be doing a better job of alerting people to that.

 

MR. WILSON: I would agree so we'll do what we can to try to bring more awareness around it. In 2012 we had 50 human cases of confirmed Lyme disease that were reported in the province.

 

MR. CHAIRMAN: Order, please. We have reached the moment of interruption.

 

[5:57 p.m. The committee recessed.]

 

[6:34 p.m. The committee reconvened.]

 

MADAM CHAIRMAN: Order, please. The Committee of the Whole House on Supply will come to order. We will resume the estimates of the Department of Health and Wellness. The Official Opposition has 40 minutes remaining.

 

The honourable member for Bedford-Birch Cove has the floor.

 

MS. REGAN: Just back to Lyme disease - no surprise there - in terms of the numbers. I was just taking a look at what it has been over the last number of years. We had 50 cases last year; 54 the year before; and then we dropped way down to 17 in 2010; 16 in 2009; 13 in 2008; and then a further halving of it previous to that. My concern is we seem to be having more cases per year. I know anecdotally just talking to medical professionals that there are a lot more tests being performed. But I guess my concern is - it's clear from my discussions with Infectious Diseases, Lyme disease is here to stay; it's spreading across the province.

When I talk to doctors they say there are seminars available on Lyme disease, but it's on, say, Wednesday night at X o'clock. I'm just wondering if, in fact, what the department could be doing is putting those on-line so that doctors could access them when they have time available, rather than forcing doctors to try to make the Health and Wellness Department's schedule - whether it could be made more flexible for doctors.

 

MR. WILSON: I know we gave you the report last year of the cases. We have from 2002 to 2011, 120 lab-confirmed reports of Lyme disease in the province. One of the things that I tried to go through after your first round of questions was to see what kind of material we do have.

 

In the Access Nova Scotia centres across the province, and also in the public health clinics across the province, we have brochures and posters around Lyme disease. If people are going into them - we know they're highly-used centres, especially Access Nova Scotia - hopefully we have the material there to catch somebody's attention. I like the suggestion that you made about maybe having an on-line opportunity, so we'll look into that.

 

I meet regularly with Doctors Nova Scotia - interestingly enough, I met with them this morning - to just have a dialogue on what issues are out there and talk about different areas of concern - not only for Doctors Nova Scotia, but for the department itself. I've utilized that relationship to talk about ensuring that their members have the most accurate information. I've mentioned that over the last little while they have a newsletter that goes out to all their members, talking about different areas and trying to make sure that their members are as up to date as possible on new findings or any concerns in areas of the province. As I indicated, I think it was October when we announced a new area in the province that was concerned around the high number of ticks down in the Queens County area.

 

So we're very visible on-line. As I said, Doctors Nova Scotia, we utilize them to get notices out to their members so that they can keep that in the back of their mind if they're treating patients in their offices. I know Lyme disease is not one of the ailments that I think GPs or any health care providers will jump to right away. Health care providers are very much like an investigator: they try to figure out what the symptoms are and what ailment they may have. It's trial by error sometimes: they try medication and they might go down one path.

 

So the more we can engage clinicians on the most up-to-date information, I think it's better for their patients. We're going to continue to do that and we'll look into the possibility of expanding what's available - not only for doctors, but on-line for us. In this day and age, it's very easy to get on your iPod - I'm still a BlackBerry person - or on your BlackBerry and look up information; very quick access for clinicians. So if we can do that we will and we'll continue under public health to push the awareness campaign of not only Lyme disease, but other ailments that people need to take precautions, especially those who are out in the woods hiking, fishing, going to the camp, or just out for a leisure walk.

 

MS. REGAN: In terms of public awareness, having those brochures, which are good brochures at Access Nova Scotia locations, that's great, but I have to confess I'm not there a whole lot and I think I'm sort of an average person. The last time I was there was when my 16-year-old son got his learner's permit. I don't have much occasion to go in there and I suspect a lot of people don't as well. The one thing I did like about what was done last year is there was an ad in The ChronicleHerald and that was great, but I really think there should be more information out there around this.

 

When you look at the symptoms it does indicate that - I always thought if you had Lyme disease most everybody would have the bull's-eye rash for example, the erythema migrans, or the flu-like illness. On the very front of the report that was given to us last year, only 70 per cent get flu-like illness and only 82 per cent get erythema migrans or some other rash. For a lot of people those can actually be under their hair, in their groin, or on their head and they may miss it, so I really think that having people know that if you get a flu-like illness or you get this weird rash after you've been out in the woods or in grasses or something like that, you might want to do that.

 

I think it's really important that people learn about this because we do know that the earlier you get treated the more likely you are to recover completely, and that sort of leads me to my next area of concern: people who have chronic Lyme disease - and it is actually a complaint I hear a lot of about - feel that they are not getting the appropriate treatment, the treatment they would get elsewhere, if they went to the States. There's a continuing reluctance among doctors to prescribe antibiotics. I'm not a doctor, I don't pretend to be but what I hear from patients is that they are not getting treatment here in Nova Scotia that they need, they have to go elsewhere, out of the country. I'm just wondering are we sending our GPs to any of the Lyme disease conferences that are around in the U.S.; is it only Infectious Diseases that are getting the information or are GPs getting that as well?

 

MR. WILSON: I think general practitioners or physicians similar to other health care providers all work towards CMEs, or continuing medical education kind of components to their licence. We don't direct physicians that they are required to do certain training. Physicians under Doctors Nova Scotia, under the college, there are certain requirements that they need to meet as they continue to practise for their licence, for example. I know there are a lot of physicians out there that try extremely hard to make sure that they're well educated in new procedures, well educated in new findings. I would think you would appreciate the sheer magnitude of development in the health care sector when it comes to such things as new ways of treating an illness, let alone adding on to all the new treatments and ailments and procedures that can support them.

 

Dealing with the transformation of the pharmaceutical industry and new drugs, we know there have been concerns over the years on how physicians get the best information when it comes to the use of pharmaceuticals in treating their patients - pharmaceuticals go hand in hand.

 

I'm confident the structure that allows physicians to look at CMEs as they move forward is in place. I would think there is more awareness now in the public health system, and we'll look to see if we can run another ad. I remember seeing The ChronicleHerald ad last year, more awareness brought around it and as we see the reported cases, I think that will also drive physicians in those areas of the provinces that are circled on the map that I tabled a little while ago, that's on our Web site, that where is a higher volume of ticks that physicians in that area are aware that there's a higher percentage of individuals who might have contracted Lyme disease there through the ticks.

 

The district health authorities, as soon as our public health division found out about an increase in the Queens area, the first thing they did was - I think it was the deputy minister, or it might have been Dr. Strang - they called the district health authority down there, talked to the CEO to make sure that they knew, okay, the area that you cover has now been identified as more potential for possible Lyme disease.

 

I feel confident that we have a structure in place that allows physicians to get those continuing education components and sessions, and I feel confident that we have dedicated physicians in the province who want to learn as much as they can about new procedures, new techniques, and as a department we're always continuing to monitor that, we're always looking at what's new out there but the push really needs to come through those experts, through the health care professionals who are in the system.

 

When I give an example of the expanded Newborn Screening Program that we just announced in this budget, where we're adding screening for cystic fibrosis, sickle-cell anemia and eight other tests that are going to be included on top of the 13 that we do, I don't feel - and I don't believe that whoever the Minister of Health is should be just making those decisions, saying let's do this. It needs to come from the health professionals who are working, who provide the care for people with cystic fibrosis, for example, to say we need to expand screening.

 

That's kind of how we transitioned to the decision we made is that we allowed for a committee of experts to review the reproduction program that we have at the IWK, look at the Newborn Screening Program and say, okay, should we expand that, and then they make a recommendation. I feel, of course, it's the minister's responsibly in the department and the government that once we do get those recommendations, how do we fund that and move forward?

 

Any changes within clinical practices and services need to come from those experts in the field. There needs to be a push for change in maybe policy or change in a program, or support of investing in a new program. I'm confident that we have that system in place and I rely on those experts on a number of fronts to ensure that our public policy as a government, as a department moves in the right manner to address concerns within the health care sector, and that includes dealing with Lyme disease. There is a lot of information out there, and it doesn't matter what it is. We talked earlier about the liberation treatment, there is all kinds of material that says it's the best thing that they've seen in a long time; unfortunately, there's a lot of information that says it just doesn't hold up to what some had reported.

 

We rely on studies, we rely on the experts who work in the field to come forward and really guide where the policy should be when it comes to service delivery in government. So I'm confident that I think there's a mechanism in place that doctors can get that additional training and I encourage all physicians to make sure that they are up to date, as much as they can, on a wide range of diseases.

 

MADAM CHAIRMAN: The honourable member for Kings West.

 

MR. LEO GLAVINE: I'm pleased to be back to join the discussion on estimates, I guess finishing off estimates. I did have to share some time with my colleagues who are extremely interested in health care. I do need to duck back just for a few moments. Last evening I did request a breakdown of the 358 medical residency positions in Nova Scotia, in particular I was looking for the number of family medicine residencies that are incorporated into the 358. I think that piece of information, to know that we are fostering every opportunity around family medicine for our graduates, to give them the best exposure, the best residency experience, and I think that number can also reflect the pickup that we will get in the province for those med students to look at family medicine and hopefully practising in some of our rural communities.

 

MR. WILSON: I know you just started, but just to kind of wrap up what your colleague was talking about regarding Lyme disease, I was saying I feel comfortable that we have a structure in place, I feel comfortable we have strong leadership within public health around Lyme disease. Dr. Strang works tirelessly in that capacity to make sure that we're as educated as possible on future developments and how we move forward.

 

When it comes to residency, the breakdown, there are two line items where we think the family medicine residency individuals fall, and we've figured out that 62 of the total number are family medicine residents or GP residents.

 

MR. GLAVINE: The second request for an update was on the Tobacco Control Strategy. The minister indicated this budget is disseminated out to the districts; however, you do have a manager of tobacco control in your department so presumably this individual is provided a budget to do what needs to be done both centrally and in the districts. I'm asking, how much money does the manager of tobacco control have to allocate to the districts this fiscal year and how much does the minister's manager of tobacco control have for a central campaign, or central work, central education that comes out of the department?

 

MR. WILSON: Madam Chairman, we're going to try to pull out that figure. The implementation for the strategy falls under the district health authorities, so we do have an inspector who reports to Dr. Strang under public health, who gives advice and policy direction for the department. The district health authorities are dealing with the day-to-day operations of that. We'll try to get that number - I don't know if you have more questions - and if we can do it, we'll provide that by the end.

 

MR. GLAVINE: The other area I wanted to duck back to was when I was asking about the EIBI program. The minister indicated $4 million is spent on that program and I just wanted to reconfirm that. Also, is there additional funding that goes either to the IWK or the district health authorities to assist with children who have the autism spectrum? I guess he may not be able to provide all of the details about that but, again, a dedicated $4 million just to the EIBI, is there additional funding that supports children through the whole age spectrum to deal with this?

 

MR. WILSON: Madam Chairman, with the EIBI program, of course, I know we gave the figure of $4 million, which really concentrates on that program. But there are a lot of tentacles attached to that program - I guess you could call them tentacles, a lot of arms that lead out from that program that get support from certain areas. Through the IWK you have clinicians who work within mental health, but in other areas that support individuals - if you have an individual with autism, there are a couple of different areas, of course, that they can get support in.

 

The EIBI program, of course, is deemed to try to get that individual, that youth ready to go to school prior to Primary and it's our commitment through our investment - and our continued investment through that is to make sure - that every child who needs to get into that program gets into it before they attend school. We knew there was a long wait-list before and there was, as I've said, a lottery scheme that the former government had which I think was quite unfair; by no means, I don't think anybody would want to have access to a program just by the luck of a draw. So we're proud to be able to make sure that we have everybody possible gain access to that program.

 

I think I said this to you maybe in a previous question, there are some concerns. I have a letter from someone who has a two-year-old, who wants to get in the program now. They may have to wait a little bit, but it's our commitment to put in the resources necessary to make sure that every child, before they go to school, gets into the program.

 

So we work with the district health authorities under mental health in a number of areas. The EIBI autism program, we see an additional $261,000 in there, on top of the $4.1 million for the central program. So there's additional money that's associated with it, that is kind of one of the numbers I can pull out. I know there's more in other line items and other services that are available for families and patients. So there are other opportunities for funding and support, and we look forward to continuing to increase that support over the coming years.

 

MR. GLAVINE: Also last evening, on Page 13.18 of the Estimates and Supplementary Detail, it shows a reduction of some $18.5 million and the minister referred to that, in fact, the Colchester hospital came in under budget. But the 2013-14 budget item is, of course, what will be spent this year, not what was related and came in under last year. I'm just wondering if you can give some overview of the $46.1 million hospital infrastructure budget for 2013-14, if there's a possibility to get something there, or if you can provide at a later date an overview of that spending forecast.

 

MR. WILSON: The funding for the Colchester hospital is done, so we don't have to report that, so that's why the reduction. Hospital infrastructure has been a concern for many years. We know that recently the Auditor General had done a review and made some recommendations on how we address hospital infrastructure in the coming years. We have implemented the changes that were indicated in the Auditor General's Report on how we have more of a transparent review of the priorities that are provided from the district health authorities on the requirements or their wishes.

 

We all know that we don't have the capital or the investment to cover every single infrastructure need in the province. There has been a long history of putting off, I think, infrastructure requirements within hospitals for a number of years. They've just put it off to later years, which is unfortunate because we did have some years where we had the revenue coming in and I've mentioned it before around - I think it was 2008 going into 2009, or 2007 going into 2008, one of those years, our revenue for just offshore royalties was well over $450 million; this year, I think we're just hovering around $20 million. If we could only get that $400 million back, we could address a lot of the deficits. I don't know if my colleagues would allow me to spend it all on infrastructure.

 

So what we're going to do is try to look at this, pull it out, and I'll give you some examples of what the hospital infrastructure looks like for the $46 million.

 

MR. GLAVINE: Just as a follow-up, if we're going to have an $18.5 million reduction in the hospital infrastructure budget, there must be some significant project or work that will not be accomplished this year that will go into a delay process. I'm wondering - discussions would have taken place to determine what was on the list that will not be advanced in this particular year. I'm wondering if that is one or two projects, or is it across all of the districts?

 

MR. WILSON: Just so I'm very clear - there's no reduction in our commitment to ensure that there's infrastructure money there. There's a reflected reduction because we had to account for the sheer amount of money that was spent on the Colchester Regional Hospital and that was funded over a number of years. We had the program and the funding; on top of that was the Colchester Regional Hospital. We finished that last year so that just comes off the books.

 

Programming has been stable for hospital infrastructure over the last little while, and an example of what we're doing is the Dartmouth General renovation. It has been in the media recently. We're committed to ensuring that the use of that fifth floor happens. It was built, I believe, in 1976 where the fifth floor was vacant, and we've had many, many years of governments that just left it vacant. So I'm proud to say we're going to do something about that. That's part of the infrastructure money.

Colchester Regional Hospital was under budgeted in the years as we were leading into the construction. It was really over budget, and I'm thinking to the tune of $80 million - somewhere around there - tens of millions of dollars. That wasn't budgeted, which we had to put on the books so that's why you saw that reduction.

 

Some of the other infrastructure needs that we're going to look at: we're continuing to look at Collaborative Emergency Centres - North Cumberland Collaborative Emergency Centre; we're also looking at the Guysborough Memorial Hospital master plan - I'm looking at the member for that area, I haven't heard him cheer; we announced the provincial satellite office for the dialysis in Kentville to try to provide better service; and we have the Sutherland Harris remediation.

 

Also, we've committed to improving the clinic on Long and Brier Islands. Another one is the repairs and renewals on emergencies throughout the province - so if there's a need, we have some specific funding dedicated to that; there's $15 million in that. Also, the Collaborative Emergency Centres development fund - so as we move forward, if there's a need in Collaborative Emergency Centres, we can meet that.

 

The thing about Collaborative Emergency Centres is that there have been additional costs, but not to the degree where people think you're spending an extra hundred million dollars on Collaborative Emergency Centres. Really, the additional cost comes from adding maybe the paramedic, for example, because the nurses who were working there and the doctors who were working there were already being funded by the district. Really the new cost is the paramedic.

 

Also, we know the flow to an emergency department and a CEC is extremely important, so we have some funding in the infrastructure funds so that they can have a better flow in the Collaborative Emergency Centre. I don't know if the member opposite has been in any of them, but it was much needed. A lot of these facilities were very aged and needed an upgrade. So those are types of projects that we are moving forward with in this current budget year.

 

MR. GLAVINE: According to Page 13.10 of the Estimates and Supplementary Detail, the budget for Healthy Development has been cut by $1.5 million, and again I'm wondering if this has simply been moved into another area or what the reduction in this budget line item actually entails.

 

MR. WILSON: It is a realignment, so if you look at Healthy Development, we've moved that up to community health, under that line item. Just quickly to go back to one of your previous questions on tobacco control prevention - that is in public health. The costs that we have attached to that are, of course, in salaries which are $103,000, and then operating is $129,700 - so a total of $232,700. Hopefully that answers a previous question.

 

MR. GLAVINE: I wanted to move very quickly to home care for a moment; I'm just looking at one particular area where the user fees were increased in the budget for the home support user fee, the fee that is charged to some home care clients on an annual basis for supports such as housekeeping. The old fee was $11.43 per hour and was capped annually at $605. The new fee is set at $12.10 per hour, a 6 per cent increase, and it makes no mention of a capped annual charge. Could the minister please confirm whether there is a maximum cap for the new home support fee or was the cap removal causing another challenge for seniors?

 

MR. WILSON: We're trying to find exactly on the cap. Of course, the fee increase, that was one of the increases we saw in the user fees across the province in different services. We know it's a challenge for some; that's why we have a program that hopefully addresses low-income Nova Scotians so that we can realize that they need more support.

 

I have to say in the time I've been minister and the time I've been in Opposition, there hasn't been a big outpouring of concern of people paying some costs of the home care. I have to say I don't think I've ever gotten that as an issue in my office and I've been elected 10 years, just as long as the member opposite. We know cost is a concern for people; that's why we have program tailored to address mostly low-income individuals.

 

The categories change and are adjusted for CPI and they've done that since 2005, that was the last adjustment, and adjusted the hourly rate by CPI. This will mean more low-income seniors will pay less so we've increased what we call the threshold - more will qualify because there hasn't been a change since 2005 for adjusting to CPI - knowing that there was an increase for some but realizing the impact of any increase to people that we increase it so more seniors will be able to have less of a fee, if any, associated to that.

 

That's why we put an emphasis on home care. We know it's important for people to have access to some of the programs, and I've gone through some of the initiatives that we had with the increase of $22 million last year. We're putting in another $2 million this year, a two-year increase of investment of over $24 million, so we can target those individuals who need the support at home. Many seniors, if you talk to them, one of the reasons I don't think I've had many of them, or any of them, come to my office and say, oh, I can't believe I have to pay a portion of long-term care or home care, is because they all understand - especially seniors - they realize they need to support and pay part of their way.

 

So a lot of the changes that we've made over the last little while are really geared towards those low-income individuals, trying to make sure that CPI is applied for home care so that more seniors can qualify for a reduction in fees or eliminating the fees. That's why we looked at long-term care and we've readjusted how we calculate what the daily rate is so that if there is an individual who is staying in long-term care, and someone is staying at home, they can split their income. It used to be their daily rate was based on a 50-50 split - so you would take the household income, split it 50-50, and you would take 50 per cent of that and calculate what the daily rate would be. It's determined by the amount of money that they take in.

 

We made the changes to allow the individual, the loved one who is staying in the community to keep more money, so now when we calculate the daily rate, 60 per cent of the family income stays with the person staying in their home. We'll calculate the daily rate on 40 per cent of their family income so more can stay there. We've also increased the rate that those individuals who are in the nursing home can keep for themselves because we realize that it's expensive to keep a house going, and when you go from an income and you split that and one person is no longer there, it's important that we do that. So the maximum home care fee is $605 based on 50 hours at $12.10. So there is a cap and I don't know if it was just left out in printing or something like that.

 

MR. GLAVINE: I guess we're down to the last moments here and perhaps the minister may need a final word, so I want to thank him and the deputy minister. (Interruption) Okay, anyway, from our perspective I want to thank the minister and the deputy for their responses during estimates, so thank you very much.

 

MADAM CHAIRMAN: The honorable member for Cape Breton North.

 

MR. EDDIE ORRELL: Mr. Minister, I just have two quick questions and they don't have to be long answers; then my colleague, the member for Inverness is going to take over. Last year you announced a pool of physicians that were going to be available to service some ERs that may be having difficulties with physicians on call. With the growing closures at Northside General, New Waterford, and Glace Bay - Cape Breton in general, I guess - I'm just wondering how much was that physician pool utilized and how many times was Cape Breton using that service?

 

MR. WILSON: We're going to try to find if we have a breakdown because that program is actually offered through a partnership with Medavie who have done all the leg work around ensuring that physicians can get into those under-serviced areas. Part of the challenge in the past and why we've seen challenges trying to cover those emergency room shifts, for example, is that each district health authority licenses physicians, so you could be practising in the Valley and if you don't have credentials in Cape Breton, you couldn't practise there. So that has been a barrier and I think it's a barrier for physicians to try to go through the paperwork and try to get all that information. That's why this program was brought to us, to try to facilitate that and make it easier for physicians to transport around the province to work in emergency departments. So we're going to try to get the coverage.

 

I think the program through EMC is a one-year contract, so it's a trial to see if it will work. I know we've had - and I've seen it through my briefings over the last little while - a number of successes. It hasn't stopped closures in your area of the province, I know that. I'm hoping now with the opening of the CEC in New Waterford - hopefully soon - that it takes off some of the pressure in the other hospitals around the member's area.

 

We're going to continue to look at opportunities to try to recruit physicians to some of those under-serviced areas. We do have a challenge - I know I've said it in the past - where we have a high ratio of doctors per capita compared to the residents we have here but we have a high number of them in HRM, for example. What we need to do is try to encourage those physicians to get out in the under-serviced areas, and some of our work in providing an appealing work environment through collaborative practices is one of those avenues to try to do that, so that it's as easy as possible for a physician to go to Northside, to an under-serviced hospital, or to an ER and work a shift there.

 

This emergency department coverage program, I think, has had some successes and I don't have the numbers in front of me, but I'll try to get them to you. But we're working hard to have programs available in the province that expose physicians to rural practices. I know that the medical school, one of their practicums is to at least get them into a rural setting. We have the general practitioner residency program in the Valley, which I talked about earlier, but I'll stop there and allow the member to ask more questions.

 

MR. ORRELL: I just have one question, and then I'll turn it over to the member for Inverness. Last year or the year before, or in and around that time, there was some talk about the possibility of physiotherapy departments that treat patients on an outpatient basis being eliminated from the health care system and the hospital system. I know some extensive consultation went on with the department heads of physiotherapy departments across the province and it ended up that it didn't happen. I'm just wondering if that was under consideration for change - is it a consideration in the future, are those physiotherapy departments going to be saved to provide the services necessary for people on an outpatient basis?

 

MR. WILSON: Quickly, to go back, I did find some numbers, but it doesn't give specifics on the shifts for that ED program. But as of the end of February 2013 the program filled 150 emergency department shifts which would have otherwise resulted in a closure of an emergency department. I don't have with me exactly where they are - I'll try to get that for the member - but 150 shifts filled in that program. There's no intention right now to move those services outside of the settings that they're in now, so I'll leave it if you have more questions.

 

MADAM CHAIRMAN: The honourable member for Inverness.

 

MR. ALLAN MACMASTER: My first question - and I've asked the minister in Question Period and the deputy minister has been here before the Public Accounts Committee, and the hospital in Inverness is something that is near and dear to my heart. I've been serviced there a number of times and my body is still ticking. The hospital is in a unique area geographically and if you look at the western side of Cape Breton Island, while it's not a regional hospital, it's certainly serving a region that's very large and far away from the regional hospitals in Sydney and Antigonish.

 

There has been a lot of discussion, minister, as you know, and I don't know how you make the volume of decisions you have to make in the Department of Health and Wellness but I know some of those decisions are shared with the district health authority. I know you've said that a CT scan is really the decision of the district health authority, and apparently the CT scan is number two on the list of infrastructure for them. We also know that the community has raised upwards of $2 million for use to partner to buy equipment for the hospital, which for a small rural area is a significant amount of money.

 

That CT scan is very critical for the physicians who are at the hospital and I've mentioned about strokes, the high incidence of strokes for the age of the population that's served by the hospital - the value that CT scan will bring in terms of saving money, not just in transporting patients to Sydney but also in diagnosing and addressing the issues associated with strokes at the earliest possible point in the response.

 

Minister, I want to hear your comments - can you give me any hope tonight, should I get down on my knees and beg? In all seriousness, the question remains unanswered. It keeps getting asked, could you give us some indication when we might expect to get the CT scan for the hospital in Inverness?

 

MR. WILSON: Thank you to the member opposite. I know he's very passionate about the services in his area. I know he has asked me, and he has asked the deputy in Public Accounts I believe.

 

The Auditor General recently did an audit of infrastructure needs and how those decisions are being made. One of the recommendations that he did make was to make sure that the process of where we allocate funds to infrastructure like equipment and all that is done and the decisions that are made are the most appropriate and really based on evidence, based on need and really based on the decisions coming from those who deliver the service.

 

We created a committee that has representation from the district health authorities to look at all the projects now that are put forward by the district as priorities to be considered for funding. We have that in place. Those CT scans now are all located at regional hospitals and they're there for a number of reasons. I know you mentioned in your question around strokes, and we have what I think is one of the best stroke strategies in the country. We have stroke centres so that if a paramedic, for example, picks up a patient in your area and they recognize that individual is having a stroke, they do everything they can to get that person to the stroke centres that are located throughout the province, to get fast access to the care that someone who has a stroke needs.

 

That expertise isn't available in every hospital in every community. I know that's not the answer the member wanted, I don't foresee in this budget that they will receive that, but I do want to relay that to the member and hopefully he can relay that to the foundations that have been raising money for the hospitals. They are extremely important. I have one in my area - the Cobequid centre, the Cobequid foundation - and they support a number of initiatives. One of the things that we needed to have over the last number of years is to make sure that the district health authorities, as they move forward with initiatives that they want to move forward with, have priorities that the foundations that support hospitals have similar alignments to the priorities.

 

You'll have an ask from a foundation that they want to raise money for a piece of equipment, for example, but yet if you ask the district or the hospital themselves, their priorities might be in another area. We're encouraging the foundations and the district health authorities with the hospital administration to make sure that when they come forward they're working on projects that they can support together, because there are limited funds.

 

I know the member for Hants West, who sits right next to you, had a similar request around dialysis. Their foundation at the hospital in his area said that they would pay for the equipment, similar to what you have presented. That's great and I wish it was as easy to say, well, that's not a cost we need to bear - let them do it. There's a lot more connected to saying yes to that than just letting them buy the equipment, so you need to make sure you have the expertise and the clinical expertise to run a piece of equipment, for example. If it's an MRI or a CT or a dialysis unit, there are operating costs that continue and that puts pressure on the district health authority to ensure that they have that in their budget.

 

It's a challenge and what we're trying to do is make sure that people have access to the most up-to-date equipment. When we're talking about CTs, they're extremely expensive to not only purchase - sometimes that's the easy thing, just to purchase it - but it's the maintenance, the upkeep, and the technology that goes along with it needs to continue to move, but then also the support that goes with that to implement the testing to make sure that there are professionals trained in that field.

 

I know it's not the answer you want. I know this is your third try, but it is a challenge for us. As we move forward, I think by implementing the changes that the Auditor General asked us to do by having this committee that we're going to have better decisions on what projects are funded in the districts across the province. We are limited in our capacity to address the shortfalls and the lists that we see across the districts and across the province.

 

I appreciate the work that the foundations have done across Nova Scotia and the communities to support hospitals and their endeavour to make sure that their patients and their residents in the communities that they represent get access to the best possible care. The unfortunate thing is we can't have those big types of purchases like CTs or MRIs in every single hospital around the province. We just don't have the manpower to run them. We need to make sure that when we do have them that we can afford to have the best possible technology, similar to the investments with the digital mammography that we just went through - getting away from the old analogue equipment so that the testing is better, we can address wait times quicker, and hopefully provide the services that we can.

 

MR. MACMASTER: I have one quick question on MediBus. Could you give us an update on MediBus?

 

MR. WILSON: It's interesting that you ask about MediBus. I know Dr. Buchholz has been a strong advocate for MediBus. I actually just met with him at 10:00 a.m. this morning to get a little more insight on what they're doing and some of the work they're doing - just off topic very quickly - so I'm more aware of what's going on. His passion for ensuring that people gain access to services is important and I look forward to future discussions with him on that.

 

Interestingly enough, in the cumberlandnewsnow.com, you know how they give a little snapshot of 50 years ago - and I just have to read this and table it - it says 50 years ago, April 23, 1963: Overcrowding conditions at hospital prompt study. Amherst: A comprehensive study will be made soon of the long-stay patients at Highland View hospital with a view for correcting overcrowding conditions at the institution, town council decided last night. The discussion came about in a letter received from the chairman of the board of commissioners of the hospital, who said the need for nursing home facilities was a pressing one.

 

It's interesting - 50 years ago, and we're having the same debate. (Interruptions) So it's interesting - and I'll table that.

 

MADAM CHAIRMAN: Order, please. The time allotted for consideration of Supply for today has elapsed. That also concludes the 40 hours of estimates.

 

The honourable Chairman of the Subcommittee on Supply to report on the subcommittee.

 

MR. CLARRIE MACKINNON: As Chairman of the Subcommittee on Supply, I am pleased to report that the Subcommittee on Supply has met for the time allotted to it and considered the various estimates assigned to it.

 

MADAM CHAIRMAN: Shall all remaining resolutions carry?

 

There has been a request for a recorded vote.

 

Ring the bells. Call in the members.

 

[7:31 p.m.]

 

[The Division bells were rung.]

 

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

 

The motion is that the remaining resolutions shall carry.

 

Are the Whips satisfied?

 

[The Clerk calls the roll.]

[8:32 p.m.]

 

YEAS NAYS

 

Mr. Landry Mr. Gaudet

Ms. More Mr. Glavine

Mr. Smith Ms. Whalen

Ms. Peterson-Rafuse Mr. McNeil

Mr. Corbett Mr. Samson

Ms. Maureen MacDonald Mr. d'Entremont

Mr. Wilson Mr. Baillie

Mr. Paris Mr. Bain

Ms. Jennex Mr. Porter

Mr. MacDonell Mr. MacMaster

Mr. Belliveau Mr. MacLeod

Ms. Zann Mr. Orrell

Ms. Conrad Mr. Younger

Mr. Preyra Ms. Regan

Mr. Parker Ms. Casey

Mr. MacKinnon Mr. Colwell

Mr. Steele Mr. Zinck

Mr. Epstein Mr. Theriault

Mr. Estabrooks Mr. MacLellan

Mr. Prest Mr. Churchill

Mr. Ramey

Mr. Skabar

Mr. Whynott

Mr. Morton

Ms. Birdsall

Mr. Burrill

 

THE CLERK: For, 26. Against, 20.

 

MADAM CHAIRMAN: The motion is carried.

 

The honourable Government House Leader.

 

HON. FRANK CORBETT: Madam Chairman, I move that the Committee of the Whole House on Supply do now rise and report these estimates.

 

MADAM CHAIRMAN: The motion is carried.

 

[The committee adjourned at 8:35 p.m.]