HALIFAX, WEDNESDAY, APRIL 22, 2015

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

4:40 P.M.

 

CHAIRMAN

Ms. Margaret Miller

 

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

 

The honourable Government House Leader.

 

            HON. MICHEL SAMSON: Madam Chairman, would you please continue the Estimates of the Minister of Finance and Treasury Board.

           

            MADAM CHAIRMAN: The honourable member for Argyle-Barrington.

 

            HON. CHRISTOPHER D'ENTREMONT: Thank you very much. I won't be long, just simply maybe to thank the minister for spending time with us and answering our questions as best she could. I don't know if she has any update of the meeting she had with the film industry this morning or whether she can share any of that but maybe just to say that she can do her wrap-up and maybe read a resolution but if she has anything to shed light on that discussion from this morning, I think it would be appreciated.

 

            MADAM CHAIRMAN: The honourable Minister of Finance and Treasury Board.

 

            HON. DIANA WHALEN: Thank you very much, Madam Chairman. Just briefly, because I think it is worth mentioning that again the meeting was held today. It was a long meeting, it went into the early afternoon. It was collaborative, it's really much the same as we left it on Friday. There's a lot of work to be done and there's a meeting set for tomorrow so talks will continue. I think the mood is very collaborative, it's a positive point that we're at. However, there is more work to be done so thank you very much.

 

            With that I'd like to go in and read some closing comments and then read my resolution, I'd appreciate that. Thank you.

 

            I'll close by once again thanking the Committee of the Whole on Supply for the opportunity to speak about the Department of Finance and Treasury Board's 2015-16 budget. I thank Deputy Minister George McLellan and Associate Deputy Minister Byron Rafuse for joining me today and thanks also to the staff who participated quietly from the gallery, making sure that the answers are accurate and the details are available from the whole department.

 

            Nova Scotians are facing a tough budget and economic environment. We're feeling some pain now for a greater gain later. Government wages, beyond what Nova Scotians can afford, have had to be curtailed. We've seen initiatives that haven't achieved what was needed or that no longer reflect our needs. Programs and practices that were not evaluated have now been done so.

 

            The work of government is continuing. I think I spoke at some length about the difficulty of crafting a budget that would see our deficit reduced from what was last year $278 million to bring us down towards a balanced budget. We know it's a long path, a difficult path; other governments have made valiant efforts. I said earlier, it isn't easy and there weren't easy choices and I think that we've heard about a lot of them here in the last seven or eight hours that we had spoken about the Finance budget.

 

            As I said, there were some very difficult decisions made and on April 9^th quite a number of civil servants no longer had positions with government. The kind of structural changes that we were talking about certainly are not easy to achieve and are not done lightly at all on the part of government. We certainly felt for every change and every department, and right down to the Department of Finance and Treasury Board itself having to make those kinds of changes and look for our only program which we had to cut, which was not core to our work, which was the Community Counts program. I know that is of importance to many people and it was important as well to the Department of Finance, it was just something that was also offering the information also offered in other forms from Statistics Canada and we felt we could rely on that instead.

 

            Members have heard more about our work with the tax review and the ongoing work that will continue through the coming year as well. We spoke about putting together a working group to help advise the minister, that will be a group that I will put together in the next couple of months so that we can have another sounding board. I think what we've definitely heard here over the last number of days has been that you need to have good information, you need to have people who advise, it's good to get an outside perspective on different activities, especially something as complex as tax. 

 

I'm looking forward to that and I hope that we will be able to talk about that more in the future as well, either here or any time, if you have questions, I would say that to the members opposite, if you have questions, you don't need to have the House sitting and you don't need to be in Question Period, we're always welcoming questions and happy to provide more information. I know at the time when I was in Opposition we would often contact the Department of Finance to get a more clear understanding because some of the changes had been very substantive over the years, changes to our Public Service pension and so on that required some really in-depth briefing and I know the staff are very accommodating, more than happy to provide that to any members of the Legislature and I would leave that door open for any further questions. I think that's probably not unlike other ministries as well but I want to make sure that you know that the Department of Finance and Treasury Board would like to help you understand and have the information you need as well.

 

            The big issue is that we're taking steps towards sustainability and towards balance and that this year we're seeing a greatly reduced deficit but still almost a $100 million deficit so our challenges continue but we are on the right path. The progress is clear. The ability to reach a balanced budget by next year, by the time we're here next year, looks possible so that we'll be able to report a balance for the 2016-17 year and I think that looking at the four-year horizon is really important as we go forward. 

 

There will be a lot of better days and there will be a time in the future when we have more money and more ability to respond to the many demands that are not only reflected here in the Legislature but are necessary for - and we hear from our constituents and the people of Nova Scotia - things like tax reduction or debt control and reducing our debt. People talk about the programs we need to enhance and I know that right after I'm finished my estimates you will be hearing from the Minister of Health and Wellness. We know that there is a $4.1 billion budget there and tremendous pressures in many areas that we have talked about and you will have a chance to look at more but in order for us to respond and respond appropriately to some of the pressures in health and education we need to get to that point in time.

 

            I will close now by thanking all the members of this committee for your thoughtful questions about the important but not well understood work of the Department of Finance and Treasury Board.

 

            MADAM CHAIRMAN: Shall Resolution E8 stand?

 

            The resolution stands.

 

              Resolution E9 - Resolved that a sum not exceeding $872,612,000 be granted to the Lieutenant Governor to defray expenses in respect of Debt Servicing Costs, Department of Finance and Treasury Board, pursuant to the Estimate.

 

Resolution E23 - Resolved that a sum not exceeding $8,984,000 be granted to the Lieutenant Governor to defray expenses in respect of Government Contributions to Benefit Plans, pursuant to the Estimate.

 

Resolution E28 - Resolved that a sum not exceeding $2,595,000 be granted to the Lieutenant Governor to defray expenses in respect of the Nova Scotia Securities Commission, pursuant to the Estimate.

 

Resolution E29 - Resolved, that a sum not exceeding $1,970,000 be granted to the Lieutenant Governor to defray expenses in respect of the Nova Scotia Utility and Review Board, pursuant to the Estimate.

 

            Resolution E38 - Resolved that a sum not exceeding $175,853,000 be granted to the Lieutenant Governor to defray expenses in respect of Restructuring Costs, pursuant to the Estimate.

 

Resolution E39 - Resolved that a sum not exceeding $150,968,000 be granted to the Lieutenant Governor to defray expenses in respect of the Refundable Tax Credits, pursuant to the Estimate.

 

Resolution E40 - Resolved that a sum not exceeding $90,654,000 be granted to the Lieutenant Governor to defray expenses in respect of the Pension Valuation Adjustment, pursuant to the Estimate.

 

            Resolution E41 - Resolved that a sum not exceeding $426,154,000 be granted to the Lieutenant Governor to defray expenses in respect of Capital Purchase Requirements, pursuant to the Estimate.

 

            Resolution E42 - Resolved that a sum not exceeding $56,401,000 be granted to the Lieutenant Governor to defray expenses in respect of Sinking Fund Instalments and Serial Retirements, pursuant to the Estimate.

 

            MADAM CHAIRMAN: Shall the resolutions carry?

 

            The resolutions are carried.

 

            We'll now recess for two minutes while we wait for the Department of Health to join us.

 

            [4:52 p.m. The committee recessed.]

 

            [4:55 p.m. The committee reconvened.]

 

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

 

The honourable Government House Leader.

 

            HON. MICHEL SAMSON: Madam Chairman, would you please call the estimates of the Department of Health and Wellness.

 

Resolution E11 - Resolved, that a sum not exceeding $4,137,741,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health and Wellness, pursuant to the Estimate.

 

            MADAM CHAIRMAN: The honourable Minister of Health and Wellness.

 

            HON. LEO GLAVINE: Thank you very much Madam Chairman. I'm pleased today to rise in my place and begin the three days of Health and Wellness, and Department of Seniors budgets. On my right is Dr. Peter Vaughan who is the Deputy Minister of Health and Wellness, on my left is Kevin Elliott and he is the Chief Financial Officer with the Department of Health and Wellness. I know certainly Mr. Elliott has been in this role before so he feels right at home here in the Chamber and I'm sure that Dr. Vaughan will have no problems being part of the support here today.

 

            It's my privilege to be here to discuss the 2015-16 budget for the Department of Health and Wellness and the Department of Seniors. With the assistance of Dr. Vaughan and Chief Officer Elliot and the help of several staff who are on standby I'll be happy to answer your questions about these two budgets and as the House Leader noted, we are talking about almost half of the provincial budget, certainly the $4.1 billion.

 

            When our government presented its budget for 2015-16, Nova Scotians were reminded that the province's financial challenges are pressing. Continuing to work within deficit budgets limits our province's ability to move forward. That means making changes. It means stopping some things or maybe asking others to take the lead instead of government. It means making some tough choices so that in the long run we can have the province that we all want and deserve. Within a tight growth year this budget protects the things that matter to Nova Scotia like health care, education, and support for seniors and low income families. Within Health and Wellness this budget builds on the bold work that we have already started. As you know, the Department of Health and Wellness provides leadership to the health system for the delivery of care and treatment, prevention of illness and injury, and promotion of health and healthy living.

 

            Just today, one hour of my time as minister was to bring me up to date on the provincial programs. To get that kind of information and insight on what our provincial programs are doing, gives myself, as the Health and Wellness Minister, a great understanding of the work, the scope that takes place in the Department of Health and Wellness. Yes, you have those programs that require a great deal of accounting and financial work and clerking when you're talking about Seniors' Pharmacare, Family Pharmacare, MSI. But there are ideas into action through those nine programs and a great deal of the work that goes on in the Department of Health and Wellness.

 

            Ensuring Nova Scotians of a quality health system continues to draw the largest portion of the provincial budget. This year the Health and Wellness budget increased by $32.8 million, or about 0.8 per cent. Of our $4.1 billion total budget, some of the largest areas include: 42 per cent, or $1.7 billion, goes to the two health authorities, the IWK Health Centre and a new Nova Scotia Health Authority; 20 per cent, or $809 million, is for physician services; 20 per cent, or $808 million, is for long-term care and home care services; 7 per cent or $271 million is for pharmaceutical services.

 

            Madam Chairman, that tells you about 90 per cent of our budget but yet the health system does so much more. We are pleased to have 35,000 people working to keep our health system running. That includes more than 2,000 doctors, 12,000 nurses, 800 paramedics and hundreds of other health care professionals from lab technicians, pharmacists, home support workers to environmental and clerical staff. Many of them are working in different care settings than they did 15, 20 or 30 years ago. They all contribute to quality care for our citizens and we are pleased they are choosing to practice their skills here in our province.

 

            Nova Scotia has a long way to go to consider itself a healthy province, however. We have some of the highest rates of chronic disease in Canada, an aging population and long wait times for many procedures. One in three children is overweight or obese. This situation is unsustainable and completely unacceptable. Through initiatives like Thrive! we continue to influence and adjust social policies to support a healthier start for children, develop more opportunities and education for people to live more active lives, and plan and build healthier communities.

 

            Changing the way we live and making the healthy choice the easy choice will take time and collaboration. It will take a fundamental shift in how we approach health and wellness in this province. I believe this is a role sometimes that the department and ministers perhaps have not given the greatest attention to. Changing the culture of how we look at our health and promote our health and see it as our strongest value with regard to personal health. It's one that I have spoken to on many occasions and will as long as I am minister, that we do all we can, as Nova Scotians, to change the path individually and with our families and with our communities. I think communities and healthy communities is where we have to direct our resources and our attention and our policies.

 

            Last year we began the process of realigning the health system to better meet the needs of Nova Scotia families and individuals. We are creating a system with a focus on people that will support a healthier Nova Scotia. Mr. Chairman, after a year of thoughtful planning, we have created a foundation for a unified system approach to health service delivery, a system that has good management and leadership.

 

            At this time I can say that I am especially pleased with the leadership team. These were people already working in our health care system who wanted to be part of forging a new way of delivering health care and of seeing how advantaged we could become by looking at the system in its entirety, as opposed to perhaps leading one of our districts or whatever role they had in the past health system.

 

            They are people who have strong leadership abilities, they are people that have proven track records in their health careers but now want to be able to guide a system that they know has many advantages, and many advantages beyond what the cost savings will deliver. So it's going to be much about better outcomes, consistency, standards of care and I'll mention a few of those here in a moment.

 

            A system that engages communities and responds to their health needs is accountable for results. This I know is an area being fostered by the department with leadership from the deputy minister who wants to see: greater accountability for better health outcomes; reduced duplication and value for money; is innovative and seeks to make decisions on best evidence; is accessible and person-centred; measures and tracks its progress against health outcomes.

 

This is a departure in many areas of our current health care system. We do a number of things and we don't have very good measures of how we are doing. We put money into programs and don't measure what difference it made, how it improved individual health outcomes or population outcomes. We need a system that is sustainable for the future.

 

            When we take a look at just the last decade, I could go back further because we've had years with dramatic increases in what was invested in health care. I believe every dollar is an investment and needs to be accountable, however. But we were not on a sustainable path. In 10 years our average was 6 per cent increase in health care. Even with better revenue generation and a better economic and fiscal future, that simply was not a sustainable way to do health care in our province.

 

            The Health Authorities Act provides the legal framework for the newly redesigned Nova Scotia Health Authority along with the IWK Health Centre. I want to emphasize that this new structure, with its experienced executive leadership team, will guarantee a stronger voice for local communities. Nova Scotians have told us they want to have an active role in the delivery of health and wellness in their communities. Strengthening community health boards and community engagement plans would help ensure that.

 

            One of the first people to approach me is the lead of the community health board in my area, Daisy Dwyer, who said, I can't wait for my first public meeting to engage to a greater degree and talk about the health needs of our part of the Valley. This is the year we began to think and act as one system for the betterment of Nova Scotians' health. Some of our specific plans for the year include $2 million more that will help with the long wait times for orthopaedic surgery; that brings it to $6.2 million in these two budgets. We hope to see more EIBI staff in place as soon as possible so as to help more pre-school children with autism and prepare them for entering the classroom in 2016.

 

            One of our government's priorities is to help seniors stay active and healthy so they can remain independent as long as possible and reduce the amount of times some may have to stay in residential care. There is additional funding for home care services and the Caregiver Benefit program now has more funding to help more families cope with caring for a loved one at home. We will support expanded sexual assault nurse examiner services to two more regions in order to reach more victims of sexual violence. We'll be working with the Nova Scotia Health Authority over the coming weeks to identify the sites and I hope to have more to say on that later this Spring.

 

            We will continue to support the Mental Health and Addictions Strategy and will fund more trauma-informed care training across the system, which was a key recommendation of the Davidson report.

 

            Expanding vaccination programs which prevent potentially devastating illnesses for individuals, and we all know these illnesses cost our health system more in the long run.

 

A great deal of work began last year, and I expect to deliver a new dementia strategy. This year we will begin work with stakeholders to develop a new brain injury strategy, and I must say that we've had considerable pickup from the public who have a loved one or a relative, or someone in their community who has suffered a brain injury and see some of the gaps that do exist in our communities. We've also had an outstanding group of individuals who have come forward to work on the advisory committee.

 

We will continue to support Thrive! and other initiatives that will help support a culture that improves the health and wellness of Nova Scotians - and I spoke to that earlier. A new oral health strategy will help us target our investment in areas of care that will make a long-term difference in children's oral health.

 

We'll work with professional bodies, labour unions, and our system partners to implement an updated nursing strategy which will be unveiled in May; focus physician recruitment and retention efforts on rural communities and hard-to-fill specialty positions; advance scope of practice changes that draw on the best providers to provide quality care; and negotiate fair and affordable collective agreements and contracts.

 

Containing growth means doing things differently. Many are interested in how we will advance some of these initiatives and still manage within less than 1 per cent this year. I have been asked that a few times; it is understandable that some may question our ability to sustain an old system with less growth, and that's an idea I want to turn on its head. The current way of doing things actually costs more, history shows us that - modernization, innovation, and a new approach is our path forward.

 

Madam Chairman, there is no suggestion that a 0.8 per cent growth trend is the goal - far from it. The goal continues to be on providing quality service and I think we can do it within the $4.1 billion envelope with which I am entrusted.

I've challenged the department to approach things differently and to reconsider priorities. They have been very adaptable and I am pleased to see the progress we've made. Let me share a few more details on how we plan to contain our costs. We had some internal transfers and one-time reductions that kept some numbers in check, but admittedly the number alone may raise questions and I'd like to explain a few.

 

The Primary Health Care program is down about $4.8 million; this is not reduced funding but a shift in where the money is allocated. It has been a practice of the department to establish budgets for new and expanded primary care team positions and then transfer them to the Nova Scotia Health Authority and the IWK once they are established in the working environment. This year we shifted money to support primary care team members, including nurse practitioners, family practice nurses, and midwives. Palliative care team members included palliative care nurses and a social worker.

 

Reduction in the Health Information Office of $1.6 million is another shift of resources. Several staff positons were shifted from the HIO to the Internal Services Department. I know you will see a reduction under hospital equipment and hospital infrastructure - I believe we talked a little bit about that earlier today. This is primarily accounted for in delays in larger construction projects in 2014-15 which provided the flexibility to purchase some hospital equipment and complete smaller infrastructure projects ahead of schedule. This allowed us to reduce this budget for 2015-16, but they will be returned to normal funding levels next year.

 

            There is no reduction in the nursing strategy; it remains at $4.7 million as it has the past few years. What you are seeing in the budget documents is a transfer of funding from DHW nursing initiatives budget to LAE to support university nursing seats, which also remain the same.

 

            Madam Chairman, like other departments the Health and Wellness Department also had to make some tough choices so that we could protect the most important services and programs for Nova Scotians. There are a few areas I could point to. The department achieves savings from across the department in administration, travel, and vacancy management. The department FTEs were reduced by transferring some staff to other departments. Staff from financial services and the Health Information Office went to the Internal Services Department, and a few employees in infrastructure went to TIR.

 

            There were programs where utilization was low, so we aligned a budget to fit the use, or we may have made decisions to remove funding from areas where money was carried forward year after year but where no work was happening.

 

            Increased use of generic drugs - in this area we are working with the three other Atlantic Departments of Health to look at Atlantic purchasing and ways in which we can use best practices gained as we share knowledge; we continue to update the provincial formulary based on new evidence and need. Often this allows us to fund new drugs, for example Hepatitis C, and keep up with the cost of things like cancer drugs.

            With the low cost of fuel expected this year we reduced our cost projection for that; savings are expected in home care and long-term care through system reform - the RFP in home care and a group-purchasing initiative in long-term care are two examples; and establishing standardized approaches to care - example, wound care.

 

            Madam Chairman, all of these items are about good management and that extends into our largest single budget area, the health authorities. This year we are bringing district health authority resources together under a unified structure with strong leadership to ensure we can focus our money on health services and less on administration. They are contributing to the overall ideal that we need to find efficiencies, streamline processes, and rethink how we deliver programs and services.

 

            As you know, about $5.5 million in savings were realized through the new executive structure of the NSHA, and we expect more savings to come as the system moves forward; strategic procurement and shared services for things like IT are expected to bring savings also. The department will work with the NSHA and the IWK Health Centre, and communities, to develop the province's first ever multi-year provincial health service plan that will ensure the most effective and efficient use of system resource to improve patient care and health outcomes. By planning provincially and looking at innovative approaches, we expect better care and better health for Nova Scotians in the future.

 

            Another example of this will be our refreshed Continuing Care Strategy that will set the foundation to better meet the needs of Nova Scotians as they age. It will lay out a plan for necessary changes to ensure home care and long-term care services can be more accessible and available when people need them, and provide value for taxpayers' money. That will mean reviewing funding models, fee structures, standards of care, and rethinking how services are delivered regardless of where someone lives. To support this work we also need to look within.

 

            This year the Department of Health and Wellness will review its mandate and structures and will implement changes that ensure it aligns with the new health system and our role under the Health Authorities Act. We need to focus on where we can make the most difference and that is in setting strategic direction, developing policy and standards of care, and overseeing the financial prudence of our health system.

 

            It was my pleasure to visit many communities this winter. Throughout my time on the road it became clear to me that once people came to understand that change can offer something better than they have today, they are willing to embrace that change. I'd like to offer this example - first is the introduction of the previous government's same day/next day appointments with primary health care teams introduced, as I said, by the previous administration.

 

            I acknowledge their work on this file and the progress that was made in those communities that adopted the approach. The evaluation was completed and the benefits were clear - we want to keep that momentum going. We want to see more collaborative teams that improve access to primary care in our communities, but we are not likely to implement the cookie-cutter model that leaves many health providers sitting idle when they could be put to better use. I heard this directly when I visited four or five of the current CEC areas - they do not like sitting around, they want to be busy, and don't be afraid to tweak the system. Now with the review of the CEC model in hand and a new health authority in place we can develop a plan for how we move forward, and communities are looking forward to working with us.

 

            Madam Chairman, this year my department aims to complete a health innovation strategy. Over the past couple of months the department has engaged some of the brightest minds in academia, the health sector, business, and research, to submit their prospectus on ideas that will move us forward. This strategy will explore the potential for increased use of technology in health care, providing greater productivity, quicker and easy access to personal health information, opportunities to better coordinate services, eliminating duplication, and a better patient experience that allows them to take control of their own health. A strategy can help us strategically target and perhaps leverage new dollars to invest in areas of research and development that will help advance key goals of our health system.

 

            Madam Chairman, I haven't spent much time on some other areas of care today but, needless to say, I continue to be passionate about improving access to primary health care, especially those with chronic disease and complex health profiles; advancing in the areas of disease and injury prevention and health promotion, this has to become a major focus; supporting active living initiatives; and improving the Mental Health and Addictions Services. By comparison, these areas of the department are small in dollars, but I believe they are critical to our province's success and quality of life.

 

            The Department of Seniors, given Nova Scotia's demographics, Madam Chairman, government's focus on seniors is more important than ever. We need to ensure this perspective is considered in policy and program development, not only in health but across government. We need to continue working with communities and partners to advance age-friendly approaches, and the small and mighty team at the Department of Seniors is committed to its mandate.

 

Madam Chairman, the budget for this department has been reduced, but its good work will forge ahead. The reduction in funding will be managed by ensuring we prioritize our resources and efforts to those areas that are of the highest priority and will have the greatest impact for seniors and the province. This is guided by our communication and collaboration with our stakeholders in other departments, which will allow us to align our efforts around helping Nova Scotians age and live well.

 

The prime example is that in January of this year the department partnered with 211 to increase seniors' access to information about programs and services across Nova Scotia. Seniors can now turn to 211, which can take calls 24/7 in multiple languages to help them access the services they need. This has actually reduced literally thousands of calls to the Department of Seniors even in this short period of time. I would encourage all of us, as members, to take a little time and go and take a look at the 211 service and how well trained these people are and how specific they can respond to a request of a Nova Scotian anywhere. I was truly impressed with my time there and how they could show me those examples - but, furthermore, to get the positive feedback through my constituency office that I called 211 and they were able to help me the same day with a piece of information that I needed.

 

            The department offers various programs to support community level projects led by municipalities, law enforcement, not-for-profit organizations, and community groups. Madam Chairman, I would like to thank the staff in the department who support these important programs every day. In closing what I anticipated to be about a half an hour, obviously there are many other programs and services that I could highlight. The mandate of the Department of Health and Wellness is vast and relevant to every Nova Scotian as is the mandate of the Department of Seniors, and while I cannot touch on every service and program, I would like to close by acknowledging the tremendous dedication and skills of the thousands of people who keep our health system running smoothly. From the people who perform front-line care to the people in the department working to provide leadership on the policies, standards, and strategies, that guide our health system.

 

            Their caring and professionalism is so important to people who often going through difficult and stressful circumstances when they have to access health care services. And with that, Madam Chairman, I welcome the questions from the Opposition.

 

            MADAM CHAIRMAN: The honourable member for Argyle-Barrington.

 

            HON. CHRISTOPHER D'ENTREMONT: Merci. Thank you so much minister for those opening remarks. There were a few of them, and maybe a lot to think about over the next number of hours as we look a little more closely at the numbers that are before us but also the programs that the minister is responsible for.

 

            First of all, to welcome Dr. Vaughan to this process, I think he has seen it all before and hopefully will provide a lot of sage advice to the minister. Mr. Elliott, good to see you again; I'm sure you'll have a good time.

 

I think I need to apologize, I'm a little rusty on this one too because last budget process I was not the Health and Wellness Critic. For like the first time ever, I was not the critic nor was I the minister, so maybe things went smoothly last time, I'm not too sure. We'll find out. And secondly, is to sort of apologize to the minister because I really feel sorry for the minister in a way because there's not too many Ministers of Health and Wellness for this province that have had, one, two, three, four other Ministers of Health sitting around him asking him questions. Unfortunately, you end up having a number people who might be stuck in the past, but know just about all those programs to ask maybe tough questions or at least know what you're feeling and know what you're going through and the programs that you are presenting to Nova Scotians.

 

            None of it is easy, nor is it simple. Many times I think I've stood here and talked about the health of Nova Scotians and it does make me happy to hear the minister talk about some of the very basic tenets of what the department should be, and the department should be there for the health of Nova Scotians, it should be there for the patient - number one. I think if we always put our lens on the patient and then try to wrap some kind of program around that person to be able to get them well, to be able to make them healthy then I think we're taking it from that correct lens rather than trying to find a patient or patient group to fit a program. We've had lots of programs in the past that maybe missed the mark and weren't doing the things that it was supposed to be doing for the health and welfare of Nova Scotians.

 

            The first one that I want to kick off on is one that I brought to the deputy on many occasions. I've asked questions in this House of the minister as well but it does wrap around the issue of long-term care, it does revolve around the issue of home care and how we are treating our seniors.

 

            We've seen problems within our health care system, we've seen problems with our emergency system, not having the beds available to them because of seniors waiting for long-term care placements, waiting for home care placement or home care service so they can go home.

 

            My first question to the minister really will revolve around - and I know this is a long answer that I'm asking for - when I look at home care, long-term care services going from $560 million to $566 million, so there's an increase there, to find out a little more of what you are going to be doing; and home care services going from $233 million to $241 million, these are huge cost centres that provide, I think, a base service or almost a right to Nova Scotian seniors and we can do a lot better.

 

            My first question really to the minister is, what are you going to be doing with those increases and maybe what our wait times are right now in long-term care and home care?

 

            MR. GLAVINE: Thank you, Madam Chairman. I can clear up the first comment the former minister made. Yes, some days I am always a little wondering what may come from three former Health Ministers. In fact I welcome that, I think it's actually a strength that we have here in the House, that I, as minister, am both challenged with good questions that come from former ministers, I think it makes for a greater accountability to Nova Scotians where they have insights into the department and I actually welcome that. It's not something that I see as in any way problematic. I truly do welcome that.

 

            Yes, this is a big question, as I stated in my opening remarks, currently that area of home care and nursing home care accounts for about 20 per cent of the budget. These are big numbers when you are in the total of around $800 million I believe it is that we are, $808 million.

 

            We know it's a huge investment but it's one that I want to be very clear, we want to provide the best care for those who are seniors, those who are disabled, those who have some kind of trauma and need care in the home. We sometimes associate home care in particular with the frail senior or the senior who is now in early dementia or Alzheimer's. We know that home care in fact provides for an array right across the spectrum of population that will need care.

 

            One of the areas that we outlined very clearly when we came to government was that we would move from a high level of construction of new beds but rather we would place emphasis on care in the home. There are sound reasons for that; first of all, we took a look at the previous probably five- to eight-year period, we added about 1,000 new beds to the nursing home sector. We knew that we couldn't sustain that pace, we could not borrow that kind of millions of dollars to build. In looking at home care we're actually supported by the best research to say that care in the home and a senior or a disabled person staying at home can, in fact, be the location, be the place where the greatest care can be delivered. That's a definite shift for us that we're now engaged in. To that extent, in the budget of 2014-15 we put $30 million more into home care and we've added about $3 million to home care this year and we've also added money to nursing homes.

 

            On the nursing home side, most of the investment there is to wages and there were a couple of sites where we actually added some new beds, in Villa Saint Joseph-du-Lac, we've added a few new beds in those areas. That's only a small number of beds and will not account for all the really - a small increase on nursing homes. What I'm pleased to say is that yes, we are getting a big demand and big pickup from Nova Scotians who want care in their home. They're embracing what they are already experiencing and that is the best place to be is in their own home whether it's an apartment, whether it's living with a family member, whether it's the family home that's second, third, or fourth generation, that's where they feel that they now can bring care to them.

 

            We all know that in fact, I believe, that the biggest change in health care delivery is going to be moving care into the home. In a whole lot of ways and areas that we are actually just seeing the beginnings of. I believe we will see less investment in the hospital, in the plant facility right across the country. We will obviously have to replace facilities, we know that we've budgeted the designs for some new facilities, upgrade facilities in the province but we are going to move as much care into the home.

 

One of the programs that I was looking at today, and I know you asked about long-term care and home care, but one of the programs today that I had a chance to look at when I was looking at the provincial programs is that we need to see home dialysis move to a higher percentage and level than where we currently are. We're at about 17 per cent of all dialysis patients that currently get dialysis in the home. We know that that marker can definitely go up. It's an area where I plan to talk about with our provincial renal program, which is a wonderful program and we'll expand again this year.

 

            We've already started strong palliative care in the home. Compared to where we used to be, where we had a huge trend towards going to hospital for final weeks or months and now that care, again, is moving across the province to be delivered in the home. People are coming home quicker from surgeries because we can have nursing care come and look after dressings, wound care. We know that patients can come home with a little bit more elaborate equipment than we had ever seen in homes. I'm very strong on the delivery of good health care in the home whether it's the frail senior or somebody who has a medical condition that requires a level of care for a short or for a long-term period.

 

            We know as well that the rate of putting $30 million a year into home care, home support again is not sustainable based on the current economics of our province.

 

            We have embarked on a very ambitious change. I think we will be ever much as thoughtful as what we were with the restructuring where we had outstanding leadership, great lead team, we put in place a significant number of work streams to help in the process. We've been looking at yes there is a lot of talk around RFP but with the RFP there is a great deal more than just working on the right - and I call that what is the right price point - to make sure, as one of my colleagues asked the question today, about care. You know people don't want to see any diminishing, obviously, in care.

 

            We need to build in to our future high standards, accountability, and a stronger delivery of home care around scheduling, around the number of providers that go into a home. In fact several community meetings that now have been carried out by our MLAs in fact have had those kinds of revelations from the health care providers who have said I travel way too much, it's not very efficient the way my day is currently organized. This is part of why we're going through this process because we want to maximize all those dollars that we are investing in home care in the best way.

 

            We know there is a lot of work over the next number of months before we ever put out that RFP but we are committed to developing a Nova Scotia approach to home care. We are not going to go out and ask a private deliverer from another province to deliver home care. We have people in our system now who are well trained, who are dedicated and in fact we have many people who have said to me - and I bet you there are few MLAs in this House who did not come across people during their campaigning in 2013 who said I am still in my home because of the home support that I get, whether it's two hours a day or four hours a day, it is making a tremendous difference.

 

I believe home care support, that professional home care, a trained CCA, or whether it be on the nursing side, LPN or RN, that's what keeping people absolutely in their homes. We want to make sure that that moves into the future in the absolute strongest strongest way.

 

            We've also had the providers who have said to us look I'm trained to look after the personal care, the needs of somebody who is now confined to their home or need that care because they're an MS patient, they have some kind of chronic disease, they no longer have the mobility that they once had and they need to get help to get their day started. But we also need, in conjunction with that professional care, I think, our families as well are really starting to take a look at what role they will play in the care of their loved one. I think too, perhaps, even a stronger degree than where we have been.

 

            It was amazing the five-part series that The Chronicle Herald did on long-term care, home care that had some very stirring comments and it got many Nova Scotians thinking about perhaps their own future as to when they would need a nursing bed or they would need care coming into the home. I believe we're looking at an area that is certainly triggered by the baby boom generation now moving into the senior years. We have at the current moment about 23.8 per cent of our population that are between the ages of 50 and 64. When you have almost a quarter of your population in one small cohort that will move into the senior years, we know we have a demographic that, by itself, is causing change and causing us to look at care differently.

 

I feel that the changes made are good ones. I will bring, in fact, to the House here today in estimates, one of the changes that started on March 1^st. This will tell all members of the House how poor, how inappropriate in many cases, the current list of those wanting a nursing home is. We can mark this down if you want. We had 100 people who were called between March 1^st and today's date, 100 people who said they weren't ready to go into a nursing home and they were perfectly okay with being taken off the list.

 

            Here's the strength of where we're going. One of those people, a week after they refused to go to the nursing home, fell and had a serious accident, asked to get into the nursing home and within 10 days, because of their high need, they were in the nursing home. That's almost ideal. That's what we want to work towards. Can you imagine calling 100 Nova Scotians who told you in the span of seven weeks, I'm not ready now but my family thought I should get on the list; those are the things that have to change in our system and I think we have to be prepared to make those kinds of substantive changes that will get us into a better place in terms of dealing with wait-lists. I'll stop there and maybe that will trigger something more specific.

 

            MR. D'ENTREMONT: Thank you very much. I guess we're going to have our philosophical discussions as we go along in estimates here - which is fine. I think it does require some thought on many of these items. So, 100 said no, part of my question really was what are the current wait-lists right now? How many seniors do we have sitting in a hospital that have been told they can't go home, that have been told they need to wait for long-term care placement, who are as best as we can say, blocking a bed in the hospital system? Give me the number and maybe it'll roll me into some of the next issues.

 

            MR. GLAVINE: Madam Chairman, I will have to get the list on those who are in the hospital to give you a breakdown. If my memory serves me correctly from taking a look at the list last week, I'm going to say about 200. I don't see them as bed blockers, by the way. We have 200 people currently there. Just to give you an idea of where we're trending, seven days ago, last week, we had 2,200; as of today we have 2,156. It went down 44 in one week and that included people, obviously, who were coming in after being assessed as well. This is trending us and moving us to a very different place than where we have been because I remember in the fall answering questions when we were at 2,556, that's one day that I do remember. At the current time the statistic is actually a little bit better than what I actually had anticipated, we have 141 in hospital right now, 141 who are waiting for placement and we have about 700 who are in different stages of application for a nursing home.

 

            MR. D'ENTREMONT: I thank the minister for that answer. I do use the words bed blocker simply because there are other uses we could be using those beds for in the acute care system rather than just housing those people until they have the opportunity to go to a long-term care facility or be able to go home. It is probably the most inappropriate place to have them, quite honestly. As much as the district health authority has done lots of things to provide some kind of nursing care or seniors' nursing care for those people, whether it's for some kind of recreation, trying to do the things that you would do in a long-term care facility, but it's still not a long-term care facility. It still doesn't have the services that they need to be able to call that place a home. It's still a stepping ground, if you would, to that service that they deserve.

 

            I'm wondering, out of the group of seniors, patients that you've had sitting in hospitals, have you done an identification of those individuals to see if they are ready to go to - I know this is probably a weird question but if you've identified those who are sitting in the community waiting for long-term care placement and took a couple of hundred off the list, are there seniors in our hospital system who are in the hospital and not being discharged to their home? I'm wondering if there's that same correlation between home and hospital.

 

            MR. GLAVINE: We all know that in the past few months we had some of that surge in our emergency room. It certainly became that target area that caused us to take a look when you get people who are backing up and a good number of ambulances are waiting to unload patients. We know what kind of a scene that is.

 

            During that time one of the areas that I think did get some attention because when I met with Dr. Sam Campbell and Dr. David Petrie the first thing they said to me is a lot of people are saying, well we need more beds open. The first flag they put up was, we don't need more beds, it's all about how we get a flow through our hospitals. For example, just in the last week the number actually went from 152 to 141. During that period they started to take a look at who could be released from hospital and therefore have somebody who comes through the emergency and absolutely needs a bed - they've got a cardiac condition, they've got an internal bleed, they need to get into a bed. So that flow is very important.

 

            One of the reasons as well that we have started by identifying a few of our sites across the province, the Dartmouth General with the nurses, the NPs and RNs, able to release patients now, we've started with a couple of our ERs and a couple of our hospitals to allow for again an increase in more timely release of patients from hospitals. So again, doing everything around flow.

 

            We know there are people in the community who are equally appropriate to get into the nursing home but there is, because of what you identified, that they prevent a patient from coming in to have their surgery - we all know that when surgeries are cancelled, many times they're for that reason, that we don't have that recovery bed, we don't have the two-day possible stay for the knee replacement surgery.

 

We have asked for a greater focus on moving patients appropriately through the system, whether it's a regional hospital or whether it's here at the QEII Health Sciences Centre. I believe we've also increased a little bit of capacity and I think those are helping us to a very good degree. I'm not sure of the ideal number across the system, I think that's the kind of work that the new health authority will actually help us identify, what is a number we can live with, allow good patient flow, not have surgeries cancelled, move those who now have been identified in the emergency room that need to go and be placed in a hospital bed.

 

            Whether it be for what we used to do a lot more of in the past and that was investigation, now of course we have diagnostic tests as well that tell us very quickly some of the things we need to know for appropriate health plans and treatment. I think there are a number of things that are developing there and sometimes I believe there are good lessons that can be learned when we have some challenges in the health care system. I think we'll see a number of improvements as a result of that attention drawn to the QEII and getting people out of hospital, especially those seniors who will be going to a nursing home bed.

 

            MR. D'ENTREMONT: I thank the minister for that answer. It brings me off into two different directions, one of them revolves around bed utilization and then we can talk about surgeries and wait times and those things. I'll save that for a little bit later but right now we'll stay on the long-term home care issue.

 

            So, we as MLAs probably hear more than other people, people coming to our office and saying mom or dad isn't well, this is the reason, how do we get them into long-term care? I don't know how many people I've referred to the 1-800 number even in the last number of weeks. How do we do this? Here's how, you need to get them assessed, you need to get them to go through this program, this is how you get there.

 

            A lot of the time we do hear of them just bringing that loved one into an emergency room and basically leaving them there, which is inappropriate for a whole bunch of reasons but that's kind of what people feel that they're forced into because they don't do that work ahead of time. What we end up having are people that are far sicker when they show up - they crash, they fall down and break a hip or have a mobility problem that they didn't have prior.

 

            The system is always in that state of flux. My question here is, there always has to be a balance between those two services. Does the minister feel that we have that balance between that number of beds - we're not going to be building any more beds, at least we don't think we are? We're going to be providing more home care. Do you feel confident with the number of people that are sitting and waiting in hospital now for long-term care that we have enough? I know we've built 1,000 beds in the last number of years, there was supposed to be almost 2,000 beds built by the projections that we had back in 2006. I'm just wondering, can we do it with the resources that we do have, without really looking at the money, I'm just thinking the number of beds versus the home care we're actually offering?

 

            MR. GLAVINE: First of all this a number that the former minister was probably acquainted with or a number close to where we are today. We currently have 7,064 beds in long-term care and this, I have discovered, is in fact the highest number per capita in the country. Also, of course, we do have the parallel development of the highest age demographic as well so that becomes part of that equation that we need to account for.

 

            I believe that yes we will need certainly a bit more education, or re-educating, taking a look back and see how we provided care for our seniors in the past in knowing that, of course, our seniors stayed at home. We also of course have the lessons from some other countries and cultures where there are very, very few nursing homes.

 

            We're going to focus on home care, we believe that there are jurisdictions that are showing where we're headed is in fact the right way and in fact one of the areas where we can utilize our nursing home beds to a great extent is actually if we had that average stay in a nursing home actually come down some. We know that, again, in some countries, in particular the U.K., the stay in a nursing home is really very short. If we could move from the 2.9 years average, almost three years, down to two years, in each and every year we would have 1,000 more beds available to us.

 

            Again, how we utilize our nursing home beds can be a big part of having greater availablity of those nursing home beds. We see jurisdictions that have simply made a policy, a belief, that shorter time in a nursing home, those who need true care, true nursing home care 24/7, that is the appropriate place for them to be.

 

            We've had a different approach in North America in terms of nursing homes. As I was stating earlier, we know that there are some countries, some cultures, that have very few nursing homes, they care for their elderly, those that have disabilities, in their home. I think if we balance all of this over the next while the number of nursing home beds that we currently have, with the strengthening of the home care system, and again families embracing their role that they need to be a partner in care of their loved ones as much as possible. We know that work commitments and sometimes actually some caretakers can actually be seniors themselves.

 

            If we could find that balance of the nursing home and the in home support I believe that we can actually have a model in our province that will serve us very well for that advancing cohort when in 15 years one-third of our population will be over 65 years of age. We need to put in place - and as I look across the way I'm kind of looking in a mirror in a way because there are three former Health Ministers who know the life of a Health Minister, the longevity isn't that great. You get an opportunity and a chance to lay down some foundations for care in our province that will make a difference. I believe that with the advancing demographic we have, we have to change a bit on our thinking around the place and role of the nursing home, the place of care in the home and the providers of that care.

 

            You know I embrace the view very strongly that we often said it takes a village to raise a child, I believe it's going to take our communities to look after those in the latter years of the life cycle. It should not just be for professionally paid caregivers. I absolutely believe that to the core, we've practised it as a family. When, for example, I bring this issue up in our caucus where we have two or three other cultures represented, nursing homes are not part of their thinking, they are going to look after their loved ones in their home.

 

            I think if we blend together those two or three areas of how we will address the future, I think it can be a better and stronger future with great outcomes and care. We know, for example, that our care in nursing homes is very, very good. In fact people who go in as very frail elders, when they get care, when they get the meals they deserve, they actually in fact improve their health and we on occasion find somebody who goes back home.

 

            I think that flexibility and so on in the way we care for our seniors needs to be a model that we cultivate to a stronger degree than we have.

 

            MR. D'ENTREMONT: Thank you to the minister for that answer. You know 10 years ago when we brought in the first Continuing Care Strategy it was looking at those projections and making sure we had the right pieces. We knew at that time that beds had to be built because we didn't have that number and that's why we see Villa Saint Joseph-du-Lac, that's why we saw Bay Side Home, that's why we saw Nakile Home for Special Care and a whole bunch of different examples. These are ones close to me so I remember the names but there's a whole bunch of those across the province that needed to be built in order to accommodate that growing number of seniors.

 

            At the same time we were stuck with a problem of a number of long-term care facilities that were less than acceptable, if I could put it that way. They weren't built for the kind of care that was required of them. A lot of the long-term care facilities, or at least ones that became long-term care facilities, were basically seniors' apartments or seniors' boarding homes where seniors would basically drive to the long-term care facility, they would just sort of live there.

 

            We know that over time things changed and door sizes were wrong and hallways were wrong and bathrooms were wrong. And you look at some of those facilities that we did have to replace which sort of took our eye off the ball a little bit because you had to do all this replacing before you could build some of those beds, so we see a lot of those replacements in the province. I mean Villa Saint-Joseph, even though there might be a couple of extra beds there, it is really replacing an old CP hotel, or whatever the railroad was there in Yarmouth. They were using that for many years - and thank you to the nuns who ran the facility, they made a beautiful community out of a beautiful old building that was not built as a long-term care facility, with the stairs and the blocks it was terrible to know that we had seniors basically in unsafe conditions. If you look at the one elevator with a whole bunch of people who have mobility problems, there was a whole bunch of concerns that had to be addressed across the province in order to provide them with safe and appropriate kind of care.

 

            This brings me into we're going to have to keep our eye on that ball. It's a big ball to keep our eye on, to make sure that we have that appropriate care available to seniors and those in need.

 

            So we were talking about the big piece of home care now. We talk about that big piece of home care which in my estimation is spotty across the province, we have some wonderful services in the province offered by community groups, I guess non-profit groups that offer the service. We have VON that offers nursing care across the province and we have pockets, of course, of this province that have no service at all. 

 

What does the minister say to those areas that don't have service today and they have a senior that would like to go home but they can't because there is no service and how does that tie in to this whole RFP idea of having one operator for the whole province. By saying that, does the minister mean both services because really there are two different services being offered to Nova Scotians? You have the home care which is the basic trying to keep people at home and of course there's that nursing care that is offered by VON. I know there's a lot to that question but how are we going to be able to do it and how does that new RFP tie in without losing services?

 

            MR. GLAVINE: Madam Chairman, we'll go back for a moment because the member did ask a very good question about why more emphasis on the home care versus building more capacity in nursing home beds. If we take a look at the last five years, home support has grown annually by 10 per cent. Nursing, VON, annual growth in nursing visits is also at 10 per cent. We truly have moved, again, a degree of care away from the nursing home to actually in the home and it is being supported at the current level. One of the areas that I did touch upon in an answer from your first question was realizing as well that putting $30 million, as we did in last year's budget, for home care is really almost looking at what your government, in fact, was putting into building nursing homes, right? When we needed new, needed replacement, codes were outdated, the whole picture, we needed that refurbishment, for sure. Big dollars were put in.

 

            We knew that we couldn't continue that pace; we also can't continue the pace of $30 million a year into home care. That's why we took a look at what we can do differently and one of the areas that we know is very strong in this province and has an enormous tradition is nursing, RN and LPN, care. We also have a district for example, that delivers nursing care. We don't have 100 per cent VON across the province even at the RN, LPN level. We can take a look at what their price point is for delivering the service versus VON and it gave us an indication that we can actually offer that high level of care at a better rate if we had, for example, one of the new management zones that decided that they would take the base of VON nurses that are there now with some retired nurses who want to work part time and put together a proposal. That's very much possible even at the nursing level where we know that we have to have that capability if we're going to have patients come home. If I'm 80 years of age and I'm coming home after a hip replacement, I'm going to need some nursing care when I get home.

 

            The big area that has really taken off is the home support. The home support is designed of course, to help seniors live safely and with some nursing care from a CCA in their home for as long as possible. Within that delivery model, most CCAs also do some house-related work. They're going to do up the dishes, they're going to prepare a meal, they may be doing some respite for example where they're sitting with a senior - a whole array of different services. Many of the CCAs have indicated that very often they're not living up to their training, to the scope of how they were prepared to provide personal care. That's what they would like to do most of the time.

 

            That's why we're taking a look at a home aid category where somebody who needs that care of the house to keep them there and somebody trained to deliver personal care would come in and do that. In some of our remote areas that may remain the same, that we don't want too many care providers in the home and it could be that combination could remain. But we know that there's a category of home aid which would work out very well for some of our seniors. Overall, they can manage themselves, but they need certain degrees of help with their housework.

 

            The RFP is still in development, we've had a consultant who has put together RFPs for health contracts and we're using their service. We're actually going to give vendors an opportunity to react to it before we ever put it out for that final tendering process to see if it covers all of those areas that need to be accommodated within the RFP. We could have a company that looks after one of the four management zones or possibly two. We could have a number of current companies. We have some great agencies currently, I've met with some of them, like those in Victoria County that provide the home care. In fact, we have some that have actually done the work around the greatest utilization of their current staff. Some offer a pretty strong package of efficiency and the right price point that we could live with.

 

            We may have some of those agencies that will come together and say, together we'll form a co-operative and we'll put in a bid for doing one of the management zones. All of those are possibilities. We may get some, we may get a new player provincially that develops. What we know is that those who are currently providing care in the province will be working whatever way that organization of home support, home care comes out when we have the RFP and when it's ready to be implemented.

 

            For example, we know the range that we currently have for home support, the current range is roughly a difference of about $20, one provider is giving us great service at $34, another is giving us great service at $54. We have a lot of money that is not arriving for care at the home. It's just that simple. On nursing we can have a range of I believe somewhere between $60 and $90, but what nurse is getting paid $60 let alone $90? So we have taken a look at that whole area, we've done the analysis, we know we can get a great service for our province at a better price point and that's where we have to be.

 

            We know what's coming at us and other provinces are looking at how we deliver home care, nursing home care, and I've experienced that already. Other provinces have gone to a greater degree of privatization, we know that. We have some provinces that have experienced problems with it, we have public and private service here in the Valley now. We have VON, for example, who will share contracts with a private company - right in the Valley is a couple of companies that VON will parcel out some of their work, they can't handle it all, they don't have enough workers.

 

            We know that a whole number of the current inefficiencies have to be corrected. In fact I like when those who are providing the service are actually telling us, when we have people that spend one-third of their day, and sometimes more, travelling because there is no GPS system that has been put in place to identify those who need the care and could give the care.

 

I like giving the example, and here is a real life example; about five weeks ago I was called to the home of a former student of mine. He's an MS patient, he lives in Greenwood, he is currently getting VON home support. I went at 10:00 o'clock in the morning because first of all, first efficiency, no caregiver had arrived, two hours late, he gets out of bed around 8:00 o'clock. He needs two persons to provide his care, so I went over at 10:00 o'clock and made a phone call, we had one care provider come from Wolfville, one from Hantsport. That's a long ways away, that's a 40-minute and 50-minute travel time for care providers.

 

Meanwhile in the same subdivision is a care provider that went into Kentville to deliver care. This is what we have to change and make a dramatic change in. I will not live with that as Minister of Health and Wellness. We are wasting taxpayer dollars and we need to clean this up and over the next while, yes there may be a little bit of that disruption to the system while we sort all of this out but I know that there will be better care, as I told the member opposite today, we need it more timely.

 

One of the other experiences that I've had as an MLA is somebody passing me their diary, their loved one's diary and seeing that in the course of 30 days they had 23 different health providers come to their home. That is not the standard of care that I want for this province and that's going to change.

 

MR. D'ENTREMONT: I think somebody needs to go have some supper over there. I think their belly is grumbling or something.

 

When we look at the whole issue of reorganization, I mean quite honestly, and we'll get more into this as the hours go on here but the reorganization of the district health authorities, that we still have this reorganization going on of home care services as well. You didn't have a good time going with the unions in the reorganization of health care and I don't think you're getting a good ride either with the unions that offer home care as well. I'll present you with a - I've got a letter that I know it's in my email here somewhere but I'll get it printed out before we come back in a few minutes, I know the NDP will have their opportunity.

 

We already have a number of locals that are concerned for their members about a private company coming in to offer services, buying out the whole RFP and instead of making $20 an hour, CCAs will be making $15 an hour - I'm just picking two numbers out, I don't know what they get paid. But that's the kind of discussion that is going on right now. Beyond that what I will present to you is basically a letter received by a patient, by one of those groups, that creates a whole lot of concern on behalf of that patient that their service is going to be lost completely, and the concern that if a big private company comes up and scoops up all this work that they'll never have the same health care provider coming to their house to provide them with that service - whether it is CCA service or if it nursing care that they require.

 

            So there is a whole bunch going on, and that's what I worry is that we were hearing pieces of this reorganization in home care, but because there is a bit of a vacuum going on here that other stories are being told and might knock you off your game. I just take that as more of you better watch out here a little because the things that I'm hearing aren't that great and you need to be able to take on your line on this one which is to provide better service to our seniors because seniors do deserve that better service in our rural areas and in our city as well. It is a tremendously complicated service and it's all around the province. Yes, it's unacceptable to see . . .

 

            MADAM CHAIRMAN: Order, please. Time has elapsed for the PC caucus.

 

The honourable member for Sackville-Cobequid.

 

            HON. DAVID WILSON: Thank you, Madam Chairman. I want to welcome the minister and his staff to the start of estimates. I believe it will be over the next three days, I don't have any plans to move off Health and Wellness estimates - being a former minister I know how important this department is to Nova Scotians and that's why I'm a bit concerned that I know for a fact in the 12 years, almost 12 years that I've been here that Health and Wellness estimates have either been up at the start of estimates in this main Chamber or at least second in the row of departments.

 

Just so people know it wasn't by our choice that Health and Wellness is at the end and it wasn't even the minister's choice to have the Health and Wellness at the end. That decision, definitely, is in the hands of the Official Opposition and I'm a bit concerned that they would allow Health and Wellness to be put at the tail end of estimates. We're past the midway point and I just needed to make sure that was stated for the record - that this is the first time in my almost 12 years here that we're wrapping up with Health and Wellness.

 

Nonetheless we're here and I look forward to engaging with the minister and his staff trying to go through what is the most important department in government. I know maybe some of the colleagues of the minister might disagree, but until you sit at the table as the minister and realize the impact of the decisions you make affects people's lives and it's important - and at over $4 billion it is the most important department.

 

I'm going to try to get right into kind of direct questions, trying to get some more clarity on what decisions the government is making and the impact it has on the budget itself, especially financial. So my first question to the minister is, with the amalgamation that just took place April 1^st, we saw the Nova Scotia Health Authority was created, there had been talks on the former district health authorities and many of them being over budget, so I'm wondering, could the minister tell us if the former district health authorities were over budget and by how much?

 

MR. GLAVINE: I do welcome the member for Sackville-Cobequid, former minister, to the debate on estimates. The question is pretty straightforward, we were running a high deficit, not unusual from going back in time; in fact I know the chief financial officer took a look back through the years and we were about the same and ran at $22 million over budget this year. It was, however, because of the way in which the budgeting and the financing of the department is done, as the member opposite would know, that was accommodated within the Department of Health and Wellness budget, so that was able to be looked after through that normal process; in fact we had a few areas where some very good mitigations were done to help us arrive at that figure.

 

MR. DAVID WILSON: I'm wondering if the minister can provide us a breakdown of exactly which district health authorities were over budget. If he can't provide it right now, maybe just indicate when he might be able to provide us with that information.

 

MR. GLAVINE: I can certainly provide the member with the figures if he wants the figures. We had District Health Authority 1, the South Shore, $347,000; DHA 2, $1.2 million; Valley was on - oh sorry, sorry I was looking in the wrong column - southwestern was $2.8 million; Valley was on budget; District Health 4, $8.5 million, that would be Colchester, East Hants; Cumberland was $2.5 million; Pictou $4.5 million; GASHA, $1.4 million; Cape Breton $6.2 million; we have a 0 for the IWK; and Capital they were 0. So we had unallocated funding of $5.5 million, which brought it down to the $21.8 million.

 

Again, as we know, some of this counting would not be finished at this point in the year and that final information, certainly, we can make available.

 

MR. DAVID WILSON: Definitely we'd appreciate that - I know I scribbled them down but we'd appreciate if the minister could table that. One of those figures that caught my attention was definitely Cape Breton at $6.2 million, I believe the minister indicated. I know going through that budgetary process there is a lot of information, but there are reasons why you may see some of these districts go over budget. I know we worked extremely hard with the district health authorities to avoid that, so I'm just wondering if the minister knows or can he provide any detail on why Cape Breton, for example, would be, I believe, the highest at $6.2 million over budget.

 

MR. GLAVINE: Mr. Chairman, in terms of the Cape Breton District Health Authority a significant part there, as right across our districts, were the increase in wages, in particular nursing wages. It's also an area that, again, as the former CEO pointed out, maintaining four major facilities has really challenged them in recent years. They are old facilities, and they have had to do some unscheduled repairs. Also, we know that utilization at the regional hospital in particular, we do get some wait-lists there. So it's a combination of a number of areas that led to that figure for this year.

 

            One of the areas that I was apprised of when I visited Cape Breton Regional and I could see for myself, were the number of cancer patients we have. There has certainly been no diminishing of that number; in fact we know that it has the highest rates of cancer in our province. That's why I was pleased to say that we have a new linear accelerator on order for Cape Breton. So it's a number of areas that would make up that cost overrun.

 

            MR. DAVID WILSON: So the minister mentioned wages for nursing. I would assume, then, that may - or it should, I would assume - include overtime costs for nursing. If so, I'm wondering if the minister could provide us with what the overtime costs were for nurses in the district health authority, if they've identified that as the reason for going over budget?

 

            MR. GLAVINE: That's a figure that we're still working on, but we'll have it here shortly for the member.

 

            MR. DAVID WILSON: Thank you, to the minister. The minister mentioned some work that needed to be done as one of the reasons why Cape Breton, for example, may be over budget. I'm trying to find through the capital plan that was released by the government, some of the initiatives under health, and there are a number of them. I'm wondering, could the minister indicate if there's any capital planned expenditures for major projects within the former Cape Breton district health authority - I guess it would be under the new one now - that we would be seeing in the upcoming year?

 

            I know there have been some indications that some of them may be put on hold, but I'm wondering if the minister could update us specifically about Cape Breton, if there are any of those projects that are under the capital plan for 2014-15?

 

            MR. GLAVINE: As the member knows, sometimes pulling that detail out of our binders requires a little bit of time, but we'll have that available for the member.

 

            MR. DAVID WILSON: I would appreciate it because going quickly through the capital plan, nothing stands out to me of any projects coming up that are funded for Cape Breton, especially around health care and Health and Wellness. If the minister could provide information that changes that, I would appreciate that.

 

            One of the areas definitely that has been on the capital plan for a number of years is the Aberdeen Hospital in Pictou County and the ER expansion and definitely the pharmacy redevelopment. I know throughout the process it has been a challenge but I think in the end the investment made there will better serve Nova Scotians in that area, for that matter, potentially, Nova Scotians from across the province because definitely there is some mobility that is taking place. When you see surgeries for example, now being able to move around and get surgeries elsewhere.

 

I'm wondering if the Aberdeen Hospital ER expansion will be finally in a stage where it will be moving ahead totally and if so I wonder if the minister could give an end date and when Aberdeen's expansion and redevelopment will be complete.

 

            MR. GLAVINE: Mr. Chairman, the member asked about a very important project that is in the works for Aberdeen. Having toured the Aberdeen and having experienced some of the patient flow in the ER we know that improvements are definitely needed in that area as well. The member has identified the pharmacy, that is currently in the design stage and we are hoping that as the new Health Authority decides on the priority projects - but we have put money into the budget for this project and expect it to move into construction in 2015-16.

 

            MR. DAVID WILSON: I'm just wondering how long, I mean the minister, I know, and I'm not trying to make any light of this, but I believe that was the point it was at when the election happened so it has been 18 months. How long has it been in the design phase of the project and am I hearing you correctly - sorry, through you Mr. Chairman - am I hearing the minister correctly stating that this project, that there is no delay, it's in this year's budget? Oh, it's in 2015-16 budget so it's not in this year's budget. I'm wondering why it would be in the capital budget plan for 2014-15 if that work's not going to take place. Was there a decision made since the release of the capital plan to push that project off until next year's budget?

 

            MR. GLAVINE: I know when I toured the facility and looked at the proposed project and we know the formula is 25 per cent coming from the local, generally a foundation, fundraising locally, there was a very definite holdup on the fact that there was going to be required a substantial project around the new electrical requirements for the redevelopment of the ER. As a result, it got into one of those to and fro situations; is that something that the department should handle 100 per cent, should it be part of the cost ratio 75/25 and I can tell you that was part of where that project started to encounter some delay.

           

MR. DAVID WILSON: I'm wondering if the minister could give us an updated projection of the estimated cost of this project, both the ER and the pharmacy redesign.

 

            MR. GLAVINE: This is a $30 million project and again when it was I guess conceived and developed at the district health authority level there were discussions on taking it on as one full project or whether or not it would be a phased project.

 

            The current total project is a $32 million project and it is going to be a phased project over the next three to four years.

 

            MR. DAVID WILSON: Thank you, minister, for that. I don't think the residents of the area are going to welcome the news that this project is another three to four years out from completion. I mean, by that point you are going to be looking at maybe six or seven years since the start, if not longer, for that project.

 

            The other area I know of concern for many Nova Scotians is the Centennial Building, just down the street from our Legislature here. There had been significant work done, especially in the design and what was needed for replacement for that. There is mention in the capital plan but I'm wondering if the minister could indicate if that project is also potentially on hold or are we going to see some movement this year on what will happen to the Centennial Building as a replacement, which is much needed?

 

            MR. GLAVINE: Just to relate back to the Aberdeen Hospital, this was a decision point with the previous health authority, that they could manage terms of their funding arrangement, also with keeping the hospital functional through the work; phasing it seemed to be an acceptable approach to this project.

 

            In relation to the Centennial Building, I'm not sure if the member in fact was minister at the time when talk on the Centennial Building began. I'm not sure if he was there for the completion of phase one design. We've now moved into the phase two design and of course when we're talking about a building of probably $400 to $500 million, roughly in that area, it probably goes even into a third detailed design plan. So when we're building that state of the art Centennial I think we're on track to where the fundraising will be launched and phase two design will bring us to I think a point where an announcement will in fact be part of the releasing of the plan for the build.

 

            MR. DAVID WILSON: So on both of those projects, first on the Aberdeen cost, it's roughly about $32 million and then the minister mentioned $400 million, maybe $500 million for the replacement for the Centennial Building. With that cost, will the foundations be required?

 

I'll do the Aberdeen first; will the foundation in that area, will they be required to come up with 25 per cent of that $32 million?

 

            MR. GLAVINE: When I say $400 million that's likely where we'll be. It was a few years ago when it was pegged at $380 million, so $400 million, in that category.

 

            I met with the foundation and they certainly know, as many of those who work there and those who go there for their care know, that it was a building that should have lasted longer. I consider it as part of the 1967 syndrome buildings where we put some of them up, perhaps in a hurried fashion so that they could be opened in 1967 for centennial year. There are many older buildings in much, much better shape than the Centennial Building but it is on its way with the design two phase and the foundation that I have met with are keen to bring to our province, for our citizens and for the region, a state-of-the-art facility, one that will have many more flexible components for patient care than a traditional hospital. The foundation will embrace in both cases the 25 per cent requirement.

 

            MR. DAVID WILSON: I know through history that when government, especially a Department of Health makes these decisions it is a challenge for the foundation and I'm wondering, with such a large project, will the foundation in Halifax, for example, will their feet be held to the fire on such a large cost? Even in Aberdeen at $32 million it's going to be a challenge and what I don't want to see is delay of the projects due to the possibility of the challenge that these foundations may find themselves in.

 

            With the Centennial Building it is a significant cost and we recognize that and I recognize that. There has been talk and I'll ask the minister - I don't know if there has been talk, there's been people talking outside government - will the government be looking at a P3 model for the replacement of the Centennial Building?

 

            MR. GLAVINE: It's very early days for this project in terms of - yes, it's one we could say is maybe needed tomorrow but we know it's some years out. At this stage we'd be looking at what's sustainable in terms of costing it out and having the province put up the much needed Centennial replacement. We would certainly investigate all of the options available to us. I've talked some with the foundation about how we need to present more -  the Centennial Building, in fact, the Queen Elizabeth Health Sciences needs to be profiled and seen very strongly as our provincial hospital and in many ways our regional hospital as well.

 

            That's why I liked moving away from the Capital District to a nondescript central zone and really profiling the QEII Health Sciences. We need to make sure that we're presenting and profiling the work that goes on each and every day so that Nova Scotians can embrace this project as well. While it is a significant, monumental fundraising task that the foundation will take on, but we know its need and I believe it will be embraced by Nova Scotians because each and every day there is phenomenal work that goes on in saving lives and in restoring people back to health. Our citizens deserve nothing less than a state-of-the-art building.

 

            MR. DAVID WILSON: With the capital plan that was released, if I calculate it correctly there are about 16 projects under the heading of Health and Wellness. Of those 16 - I know I've just asked about two of them; Aberdeen we hear will be phased in and will be put off, which is delayed, I would consider that one being delayed. Out of the 16, the other 15, but the 16 total, can the minister indicate how many of those capital projects are delayed and I wonder if he can provide us information on which ones will be delayed. With that then we'll know which ones are going forward.

 

            MR. GLAVINE: What I can inform the member and respond to the question is that in 2014-15 we did have some significant delays, however, those projects are now all being advanced, are all being worked on so those will carry into 2015-16. Those that are in early stage work for 2015-16 are where they need to be, in fact in a very short time we'll have an announcement on one of those.

 

            MR. DAVID WILSON: The reason I'm asking these questions is that the government comes out every year, and this year is no different, very early on - and I'm trying to remember when this came out, I don't know if it was in November or prior to that, before the budget process. What it does is it gives a snapshot and a picture to Nova Scotians on what is going to happen over the next year.

 

            In this capital plan an investment is over half a billion dollars, $535 million. I know the minister indicated some are delayed so I'll ask again if he can provide me with a breakdown of which of these projects will be delayed into another year. So if they're not going to happen in 2014-15 that's what I would like to know because in here, if you read through it, Nova Scotians who read through this would look at it and say okay that's going to happen in this year's budget.

 

            I'm wondering again if the minister could - and he doesn't have to provide it now if he doesn't have it - but to provide us with the breakdown of which of those 16 projects are now pushed off into next year's budget and I would assume we'll see it in next year's capital plan.

 

            MR. GLAVINE: What I can provide the member with in a general way, first of all when we now go about the development of a project, whether it's a renovation project, a new bill, we will be stage-gating all of the projects and therefore many will have the design work completed, we'll know what the cost is going to be and that's when we will be announcing some of these projects.

 

            The ones that are being delayed for any reason I will provide a list of those to the member.

 

            MR. DAVID WILSON: What I was trying to get is the minister's schedule for the next six months or so because what will happen now, once the budget is passed, the minister will have announcements around the province, but I appreciate the minister indicating that he will provide me and the House a list of those projects that will be put off next year. I know we'll hear about the ones that aren't when we see the new releases going out.

 

            I want to go quickly, and I know I have about 28 minutes left in this section, just on something the minister mentioned in his opening comments. He talked about a health innovation strategy, so I'm wondering if the minister could tell us what the cost will be to create that health innovation strategy.

 

            MR. GLAVINE: Madam Chairman, I'm pleased to say that first of all there has been a public announcement on a Deputy Minister of Seniors, and sport and innovation comes to the Department of Health and Wellness. We want to make innovation a stronger part of the work that we do across Health and Wellness. It is a field that is advancing with new technology, in particular all forms of ehealth, needs some dedicated attention if we're going to really lift that part of how innovation can change health delivery in the province. Simon d'Entremont is now in that role and at this stage with the work that we have ongoing, it is within the department budget for this year.

 

            MR. DAVID WILSON: So, I assume there must be a ballpark figure and maybe the minister can give us that. Also, I know he mentioned the new deputy minister will be leading that I understand. Is there a list of any other participants that the minister will call on to create this strategy and will it be a broad sector of maybe experts who work within the field? I'm wondering again, if it's within the budget, there must be a cost, and if he could list who the participants may be that the government is going to look upon to come up with this strategy.

 

            MR. GLAVINE: Madam Chairman, in fact some of the, I guess, start points for looking at more work dedicated to innovation in the health care system really came from a federal initiative, that they were looking at provinces that would engage in an ongoing program and initiative and so there is waiting for the federal panel to provide participants because it will be a federal-provincial initiative. This will in fact be one of the areas the federal government, we're hoping, will in fact add some dollars to our Health and Wellness initiatives. It will obviously be coming from the academic community, coming from business, health leaders, and there will be those on the federal side of research that will make up this initiative.

 

            When I met with Minister Ambrose some months ago, she saw many good initiatives happening in our province. At any one time we have about 15 lead projects in the country taking place here. We are really going to capitalize on some federal opportunity and I'm pleased to say that it's an area, again, where our deputy minister - deputy ministers in this case, are dedicated to seeing us play a much more active role and, in fact, be able to bring some of our innovation experience to the national table. We have that kind of work that is currently going on in the province and I believe once we get that panel in place we will be in a position to speak to some of the actual projects that will roll out.

 

            MR. DAVID WILSON Madam Chairman, I look forward to the minister giving us a breakdown on that, and that initiative going forward. Going back to a few minutes ago when I mentioned and asked around the deficit that was seen by the district health authority, I think you gave me a better figure, it was about $22 million but $21.8 million, I believe. That deficit we see across the districts - and we know now with the new amalgamated health authority that there had been severance paid to people who were working under the old system - so under that deficit that the districts had were they required to put into their budget the cost of the severance? I believe the last figure we heard was about $4.8 million, maybe $4.5 million - so were the districts required to account for that severance that we've seen with people who used to be in the old system who no longer are working in the one amalgamated health authority?

 

            MR. GLAVINE: Madam Chairman, the payout of around $4.8 million, I think there were one or two positions that were still being finalized. Many of these items, for good or not so good, go through the legal requirements and so on of contractual arrangements, so there are a couple to finalize. We are probably going to be into the $4.8 million range and that was not accounted for through the DHA budgets, it was out of the general Department of Health and Wellness budget 2014-15.

 

            MR. DAVID WILSON: Madam Chairman, I'm wondering if the minister could provide us with a breakdown of what that cost was in each district and the positions that were eliminated, and what was the cost of eliminating those positions? We know that the minister had indicated that there would be supposedly $5 million in savings in future years - I won't get much into the debate that we've had pretty much over the last year on the costs - so that's pretty much close to what the savings were going to be, so $4.8 million, maybe a little bit more if there are two outstanding. I wonder, could the minister give us a breakdown of what those costs were and the positions that were eliminated?

 

            MR. GLAVINE: Madam Chairman, what I can provide the member with is the total for CEOs was $1.5 million, VPs, approximately $2.86 million, EAs $1.2 million, and if we were to break it down further we would obviously be pretty well identifying some of the individuals involved, and so that was the compensation of the executive structure that was paid out. It was actually, to correct my last comment, done through restructuring through the Department of Finance and Treasury Board.

 

            MR. DAVID WILSON: Madam Chairman, I think for over a year now I have been asking for that information and I'm not overjoyed, definitely, because I see that as money that is not being able to be reinvested in front-line services. I know I've been quite critical of the minister over the last year and a half and especially the last couple of weeks on some of the organizations that have been affected by this year's budget. I can't help think what $4.8 million would do to help the organizations that have seen a cut over the last couple of weeks since the budget was announced.

 

            When I looked at the cuts that we saw from, I believe now, eight organizations within Health and Wellness, we're not talking about a lot of money in the overall picture of the $4.2 billion. Those organizations like Self Help Connection, for example, and I asked the minister about this, the Eating Disorders Nova Scotia, their overall budget that they receive or the grant they are receiving from the province is $49,000 and they were reduced by 23 per cent. This organization, I know, provides an amazing amount of peer support for those impacted by eating disorders and that's why I'm not overjoyed about hearing that last figure of $4.8 million in the breakdown, $1.5 million going to CEOs, when an organization that helps young people, especially young girls who find themselves, I think, more likely having an eating disorder.

 

The numbers that you hear and the stats on just that one organization, I mentioned to the minister today, over 10 per cent of those individuals who have an eating disorder commit suicide in the next 10 years and that's hard to understand. Maybe a little later in our questioning of the budget I'll ask the minister and maybe when I wrap up here, the rationale behind that $1.5 million to CEOs and you cut - and I'm trying to do the math - 23 per cent of $50,000 - $10,000. It may be a small amount of money when I say it, but to those organizations it's a huge amount of money and it means cutting programs, it means cutting peer support groups, it means cutting education to adults and counselling, and it means cutting information that they can provide these people - and that's not the only organization.

 

            We had Split Rock Learning Centre Association from Yarmouth, their grant was $29,000 and 23 per cent of that was cut - again, not a huge amount of money in the overall picture of $4.1 billion; the Free Spirit Therapeutic Riding Association in Berwick, again, cut 23 per cent; Immigrant Settlement and Integration Services in Halifax had a grant of $73,000 and 23 per cent of that was cut; the Schizophrenia Society of Nova Scotia had a grant of $60,000 and 23 per cent cut to that; Chebucto Connections, in Spryfield, had a $23,000 grant and that's reduced by 23 per cent; and the St. George's YouthNet Society, their grant is $45,000 and that was reduced by 23 per cent.

 

In those eight organizations alone, a very small amount of money being cut overall, but for each and every single one of them it's huge - 23 per cent of their budgets or the grant that comes from the government is being taken back this year. And when I hear even just the one figure of $1.5 million in severance paid to CEOs, I really have a hard time understanding the rationale.

 

            I know the minister doesn't have an easy job, I was there and I know we went through organizations, and funding, and grants, and services and it's very hard to make changes in Health and Wellness. I don't think there's one program there that is not there to benefit someone or try to improve their health or their outcome of whatever ailment or disease or illness they have. But really, to go after these eight, and there are probably a few more - we'll get into this, I haven't even talked about the Mental Health Association - to go after these organizations for 23 per cent, to me I don't think Nova Scotians would expect these groups to play a huge role in trying to get finances back in order. When you do the calculations it doesn't come anywhere near the $1.5 million given for severance for CEOs. The rationale, I don't know where that is.

 

            I don't' recall when I was minister that staff, when they were preparing the budgets, when the district health authorities were preparing their budgets, ever came to me as minister and gave me a list of organizations like the Eating Disorders Nova Scotia, like the Schizophrenia Society, like the Alzheimer's Society and say we should cut some of their grants, we need to save money. I don't believe that happened to my colleague, but I'm not here to speak for our Leader and my colleague. I don't recall them ever coming to me to look at savings there. If I did the math now with the amount of money and you refer to the $4.1 billion, it will be 0.000001 per cent probably. I mean, even $5 million in savings is 0.0012 per cent of the overall budget - and that amount of money is not even near a million dollars.

 

I can't understand where that came from, and maybe the minister can enlighten me; maybe the minister can give me an answer that will change my mind. I doubt it, but to look at the amount of money that's being taken from these groups, that is so important to them, but when you look at it in the larger picture it will not make a huge difference; it won't make any difference in the Health and Wellness budget.

 

We used to comment that you could blink as the Minister and Health and Wellness and there goes a million dollars. I remember signing off on things at the end of the day and having to double-check and look at it to say really was it $180 million we just signed off today.

 

 I know there is a little bit of time, and I just need to maybe ask the minister, what is the rationale? And it can't be to spread the pain out across the department and across services because these organizations, I think, should have been looked at as they get small amounts of grants, and we need to look in other areas where savings can be found. I would think with a $4.8 million severance cost to the province, could we have found it in there? I don't know.

 

So I'll sit down, but I'll ask the minister if he could give me the rationale why the eight groups that I just mentioned were targeted in this budget to come up with a very small amount of money in the overall picture of a $4.1 billion budget?

 

MR. GLAVINE: First of all I wanted to speak a little bit to the area where the member went first and that was in regard to the payout of the $4.8 million, or roughly in that area of payout. Actually as we were looking at that we made some mitigation through the year, we changed their contracts partway through their final year. We gave notices to 73 people, 27 were hired back and reassigned, a number of people with contracts expiring was 12, and those eligible to receive severance were 34 people. That's how we were able to reduce what could have been a pretty significant payout, and so we were able to work through the year.

 

Look, it's a point for me in estimates here to depart for a moment and without question or hesitation, and I know the deputy minister who monitors the work of the system and the work of the former CEOs in the districts, and they all embraced those last months of a system that was going to change dramatically in terms of the administrative structure, agreed to sign those new contracts, and in fact work off part of the severance that they could have received.

 

It was a pretty strong severance but, again, we know the work, and the three former ministers certainly know the responsibilities that our CEOs have in the day-to-day managing and making sure that our health care system is as responsive as it possibly can be to many, many needs across the continuum of care. So I applaud them and thank them for their commitment to make those last months work as they had for a number of years in most of the CEO and VP cases. We are fortunate to have a number of people now who are part of that leadership team going forward.

 

            I am pleased with the fact that we did not have to look beyond our province, and I think the three members opposite who held the position of Minister of Health realize that we have been blessed in the province through a number of fortuitous hirings, whether it was somebody from another part of the country who came in to head up the QEII, or for personal reasons came to this province, so they certainly have made a great contribution and I am pleased that a number of them are guiding the new health system.

 

            In terms of making cuts, which we have done in many areas in this particular year, we know that we couldn't continue to have anywhere from $200 million to $300 million deficits in our province; we can't continue to add millions of dollars to the overall debt of the province. It is our government's goal to keep that total debt at $15 billion and we all hope for a day where we'll start to reduce that figure. We want to have fiscal health; I believe good fiscal health will lead to greater opportunity to do more in the health care system. We decided that the cuts would be distributed across all departments. We provide about $27 million through our grant system in the Department of Health and Wellness - and those cuts that we made were very tough to make.

 

            I know the work of some of these organizations, and I know over the course of the year I've already made a commitment to sit with those organizations and take a look at the work they do. Can there be some other alignments, again, in the community, other ways in which they can bolster their financial position to carry out the work that they have been doing?

 

            I am, however, encouraged by a meeting that I had today with the head of psychiatry for the province in taking a look at all of the work that goes on in the mental health field and how, in fact, a number of the programs at the IWK and especially the Trauma-Informed Care now is going system-wide. In fact, I believe some of that work is going to reach, in a very substantial way, into more communities of our province and that is part of, as we know, Together We Can, the mental health strategy brought in by the previous government.

 

            While some organizations have to kind of regroup around some of the work that they have been doing, my goal is to see some of that $5.5 million saving on just the first level of administrative change - there will be more to come. I believe we have kept it at a pace and with a plan that will serve our province well. We could have cut deeper in administration, but we decided in this first phase around the CEOs, the VPs, and their assistants, and to have $5.5 million from just those two areas of administration that will go forward each and every year to do the required work on front-line health care.

 

            We are advancing, I believe, an area that is a lead in the country. When we look at the SchoolsPlus Program, it is absolutely a lead. I've been fortunate, in my whole community of schools, SchoolsPlus covers every school in my riding and many of the schools I am intimately familiar with as a teacher, administrator, my children went to those schools, my grandchildren now go to those schools and we're seeing where SchoolsPlus is already making a significant difference.

 

            Dr. Jana Davidson pointed out it was a lead practice and in many ways I don't see any work being done in the name of mental health as having duplication, but I know this front-line health is going to make a huge difference in our province. During the course of this fiscal year I will have an opportunity, as I said, to get to know the work of these organizations and will be meeting with them over the next while to see perhaps some other possible arrangements to make sure that these organizations stay vibrant and continue to do the work that they're doing so well.

 

            MADAM CHAIRMAN: The time has elapsed for the NDP caucus.

 

            The honourable member for Argyle-Barrington.

 

            HON. CHRISTOPHER D'ENTREMONT: Madam Chairman, as I said when I left off we were talking about home care and we were talking about the RFP possibly going out. I was talking about some of the debate or concern by union members and now that's time to roll into the clients. I will table this, this is sort of my last piece on this topic, but it's NSGEU, "Home support workers play a critical role within our healthcare system. . . . care for the elderly & people who are sick or recovering from illness, and help them stay in their homes, rather than go into hospitals or long-term care. Government wants to allow for-profit companies . . ." to take over our home care support services.

 

            On the backside it says: This won't be good for vulnerable Nova Scotians who count on the care home support workers provide. Those companies are in it to make money. These companies will bid low to land a government contract and slash workers' wages and benefits to make a profit. This means home care support workers will have less money to support their families and help them stay in our communities. There will be increased shortages of home support workers due to decreased wages and benefits. That's a real problem. Our wait-lists for home care services have grown by 80 per cent. Nova Scotia has the oldest population per capita in Canada and the proportion of Nova Scotians age 65 and older is expected to increase from approximately 17.7 per cent to 25 per cent by 2026. The vast majority of our clients are seniors. Please help us make sure your home support services are protected. Talk to your MLA and Minister of Health - then your name, sir, and a few phone numbers and your email. This is going to clients of home care service by one of our unions. I just wanted to give you a minute to comment on that.

 

            MR. GLAVINE: Madam Chairman, you know this is something that in my approach as an MLA, and as minister, I welcome all points of view and all perspectives. We know any time change comes about worst-case scenarios are put out there. I know, for example, that with our health restructuring it is very early days, but, look we are already seeing many of the potentials of improvement and of providing the right care, the right place, making the services accessible to all Nova Scotians across the province in a more timely way. We're just in the beginning, literally hours of what we can do, we've set in place a foundation for health transformation that will go on for the next five or eight years.

 

            Change is always difficult, there is no question about that. However I've been overwhelmed by the number of people who are embracing what we're doing, knowing that this work will make a real difference.

 

            When I take a look at some of the areas of health care where we were in absolute last place, a laggard in the country, and where we brought in a provincial program - you know we can start back about 20 years ago, I remember in my community having a pretty good ambulance service run by the funeral home, and my gosh when we're going to go to this province-wide ambulance system the sky is falling, this is the worst day for emergency care that our province could experience. Well, we know where we are today. We know where we are today, and we will be saying the same in terms of our health care structure.

 

            We had some of the worst outcomes in about 2006 for heart attacks and stroke and we changed that whole model of care and now the outcomes have dramatically changed in our province.

 

            When we put standards of care in place that all Nova Scotians, if you're living in Argyle and you can go and get that care at Yarmouth Regional, in a regional hospital, that is lifesaving, that's the difference. I can go through a number of those provincial programs where substantive improvement has been made by saying here is a target that we want to reach, we're the second worst in the country now, we want to eventually get to the middle of the pack and maybe become a leader.

 

Today I had that opportunity to take a look at where we were, absolutely last in the country - we were last in the country on deaths from breast cancer; we absolutely had the worst outcomes. We now, on a per capita basis, lead Canada in breast health survival - what a story. (Applause)

 

These are the stories we don't tell and talk about in our health care system near enough, and I feel the same way about home care because we'll all be there at some day and some point and I know that improved health care delivery will make a difference. What I do know is that we can't have a price point for home support ranging from $34 an hour to $54 an hour. We can't have $60-something an hour for nursing care ranging up to $90 an hour because we said here's the contract, go do the work. We're not talking about care here, we're talking about, again, administrative dollars.

 

We know, for example we talk about VON as being not-for-profit, well there's a lot of profit going somewhere. There is a lot of profit going somewhere when you're paying. There is no nurse in this province getting $60 an hour, let alone $90 an hour and that's why if we're going to have sustainable home care delivered in a timely fashion we absolutely have to change. There is a lot of rhetoric that goes on about what may happen and that's exactly it, because we don't have that final picture of how collective agreements can be married to another provider. But what I do know and what I can tell the members and all Nova Scotians, is that those who are currently working in home care, who want to continue to provide that great service, will be there, but it will have a different structure after the RFP. We have to put in place and keep an eye on sustainable practices for the future.

 

            We have some parts of the province where I can tell you the VON service, or another provider, have no wait-list. They've already done a lot of logistical work around efficiencies. They will have a health care provider go out the door and they're looking after five people in a very confined geography. In the previous hour I gave you some of the worst examples of what does exist, that has to change so that when that cohort that will eventually become almost one-third of our population as seniors, or at least over 65 - and 65 is not really that old, is it? We know that we have to change this picture and sometimes these changes can go relatively smoothly; other times there may be some of those adjustments that we will all have to make.

 

I'm willing to change for a better day, a better delivery of service. I don't want to see 700 hours or 800 hours of unfulfilled home care because we don't have the people or we're paying way too much to some of the providers now, and I think that kind of levelling of the service across the province will stand us well into the future.

           

            MR. D'ENTREMONT: Madam Chairman, and of course, minister, there's very little in there that I would disagree with you, but what I've been trying to illustrate with that is the issue, Bill No. 1 was a bit of a big debate. I don't want you to lose sight of if you lose the debate, regardless if it's right or wrong, people will believe one way or another. So, just to be careful on that, that in fact there might be a vacuum on your side of the story for what you're trying to do if we somehow convince people that patient care will be interrupted, that patient care will not be happening, then you will lose that debate for all the wrong reasons.          

 

I want to switch over just a little bit to pharmaceuticals, and if we quickly look at the budget lines on that one, which is probably the third largest line number if not the second which is a $270 million item where we have the assistance for low-income residents with diabetes and Nova Scotia Family Pharmacare Program and Seniors' Pharmacare Program and Special Drug program. A number of great programs for Nova Scotians in this. We see, I wouldn't call it a large growth, but it's a pretty big growth compared to other line items on this one, so I'm just wondering what you attribute that growth to - and then maybe we can talk about pharmacist services as I was just visiting with them a moment ago.

 

            MR. GLAVINE: Madam Chairman, first of all I want to thank the member opposite for bringing to my attention the precautionary principle as we move forward in changes in home care. That's right, it's important that both sides of the story are well presented and I have no problems with people providing opposition, contrary views, et cetera, that's part of eventually disseminating what will be factual and what will be important for Nova Scotians to know.

 

            In terms of our pharmaceuticals there are three areas that I can touch upon here. First of all we, again, are impacted by the makeup of our population currently and higher utilization is one of those areas that we are seeing. We also know of course that there are new pharmaceuticals that come along each and every year. For example, during the past year we know that in our province there were eight patients who could benefit from the cystic fibrosis drug Kalydeco and seven of those are being looked after by our Pharmacare Program. One was on a trial and the company is continuing to cover that, or private insurance, one or the other. There's a few there that were into the trial coverage.

 

            If we take a look at that drug alone that's probably, you know, seven times close to $300,000 a year, which gives us some idea of the cost. I think it's around $1.8 million for Kalydeco.

 

            Also what's interesting is that we get some other provinces that only have one or two patients in that subset of cystic fibrosis with that, I think it's 511G gene that's part of the cystic fibrosis genetic makeup that can positively benefit from Kalydeco. That's just one example.

 

            One of the big, growing areas that we hear a lot about today is oral cancer drugs. You know to be able to get that therapy at home by oral medication is a phenomenal improvement. But again, those are very, very expensive pharmaceuticals. We have in Nova Scotia a combination of coverage, whether it's Seniors' Pharmacare, Family Pharmacare, some again from private insurance. We also have, which is a very good news part of the story around the pharmaceutical companies that make oral drugs, they have compassionate programs. I think almost all of them, right to a T, have that kind of support as well. That's really a couple of the areas that have caused that line item in the budget to go up.

 

            We've had a bit of offset by increased generic drug use but we are actually closing in now on the number of molecules that we can probably benefit from. We're at that 18 per cent now so 18 per cent cost of brands so we're getting probably as low as we can in that area. It will be the changeover for individuals, for hospitals, to a greater amount of generic use that may help us hold the line on this growing budgetary cost.

 

            MR. D'ENTREMONT: I thank the minister for his answer on that one. Let me get into some more questions around this one as there are two really big programs here and a couple of little ones. One I think should be phased out but I guess it's still up and running, the assistance for low-income residents with diabetes.

 

            From your Pharmacare budget, how many prescriptions were written in the last fiscal?

 

            MR. GLAVINE: Perhaps if we weren't doing estimates and we were at the PANS organization event this evening, we could probably ask the Pharmaceutical Association for that figure. It's one that we can provide but we don't have it in our repository of information here.

 

            MR. D'ENTREMONT: I was just at PANS so this belongs to you, minister. Can you pass this off to the minister please? I figured since I had the opportunity that I'd pick up a little grab bag that PANS normally has. Maybe you don't have all the information here but I'm going to ask and give it a try. How many prescriptions were generic and how many were brand?

 

            MR. GLAVINE: Thank you very much for the question from the member for Argyle-Barrington. We did find this information and I think it's worthy to perhaps provide some detail. It's a great question. Why we're working policy in the province but we've also, and again which is important to note, we've actually signed an agreement with the three other Atlantic Provinces on five areas of co-operation; five areas where we will set out to collectively work together and this is one of those areas with greater utilization of generic drugs.

 

In the brand drugs, you can write this down, we have 1.7 million prescriptions. That constitutes 30 per cent of all prescriptions. Generic drugs were prescribed at 3.9 million and that was 67 per cent of the prescriptions that went out. Here's the catch. We only have 30 per cent of brand but the cost was 57 per cent of what we pay out and we had twice as many generic prescriptions go out and it was 36 per cent of the cost.

 

            Again, if we can stay on a path and a program where it's appropriate then that's again, one of those areas where we can make cost savings but not impact in any way negatively on patient care. So it is a great question that you did ask and that's why, if we can reduce that 57 per cent cost, again, it will allow us to do more for Nova Scotians whether it's in the pharmaceutical area or another area of health care.

 

            MR. D'ENTREMONT: Thank you for that answer. You understand the size of pharmaceuticals in this province. It's a tremendous cost item but a requirement for the health of Nova Scotians. You signed an agreement with the other provinces, maybe you could expand a little bit on that and try to explain the pan-Canadian purchasing or pharmaceutical alliance and how that goes in on that bulk buying of generic drugs.

 

            MR. GLAVINE: I just wanted to move back for just a moment. The great strides in terms of cost benefits to the health care system in Nova Scotia and across the country was the pan-Canadian Pharmaceutical Alliance which really worked together to help us achieve monumental gains for patients who use the public system or their insurance plans or just have to go and pick up something in a one-off without any kind of insurance whatsoever, there's now real benefits from that pan-Canadian work.

 

            In terms of the provincial co-operation, the agreement is around the MOU because we're just starting this, we just met recently, the deputy ministers are following up with very specific work but it's obviously in the area of generic drug use. Overall procurement for our health care systems. Very costly items like linear accelerators, if we can buy whenever our dates come up for renewal, they have a life cycle of about 15 years. In this budget year we have money for four linear accelerators - one for Sydney, three for Halifax. Once they are installed, at least for a few years we are projected to have the most modern radiation delivery system in Canada. We will have the latest version of linear accelerators. That's very exciting to look forward to for those people who will need that kind of treatment.

 

            Those are three areas that we're working in the agreement on and again I should speak to the fact that I met very early with a couple of the Health Ministers from New Brunswick and P.E.I., we had a second and a third meeting, we invited Newfoundland along, they were pleased to be part of this Atlantic effort. What we signalled as Health Ministers and something I profoundly believe in and the deputy minister will carry this work on much of the detail and minutia that needs to go on, but what we wanted to really embed in our Health Departments was that no matter who was minister, what Party was in office, that we needed to look to a long-term co-operation among the Atlantic Provinces.

 

            I'm finding excellent co-operation as the minister for Nova Scotia and I know that collectively we can bring better results and especially in the procurement area to our province. But I think even perhaps we can collectively have a voice at the national table on one or two areas that can make a difference for our province. Especially at a time when we've gone to per capita funding and we need to be looking at what other ways we can, as an Atlantic quartet, get the support of other Ministers of Health to approach the federal government on a couple of areas. I've spoken to one of those areas publicly around Pharmacare which you happen to be asking questions about at the moment.

 

            I think the early days of this Atlantic co-operation signals some good results for the future.

 

            MR. D'ENTREMONT: So, the pharmaceutical alliance, or pCPA, the Health Care Innovation Working Group from the Council of the Federation negotiated 49 brand-related negotiations, 14 commonly used generics, collectively this saved the provinces an estimated $315 million as per the Council of the Federation website. Of the $315 million saved how much did Nova Scotia receive and where did you invest that money? Did it go back into purchasing more pharmaceuticals or did it go into general revenues?

 

            MR. GLAVINE: I'm actually informed that it's difficult to separate that out; however, the savings - and any savings we make we know are pretty quickly directed into, whether it's more of the cancer drugs that we will pick up. For example in just the 18 months that I've been minister there is a waiting list of pharmaceuticals, especially for oral cancer drugs that are ready to be advanced as soon as we have the money knowing that there will be 135 people or whatever number can benefit. We know that much of that money actually went back into the pharmaceuticals required, especially through Family Pharmacare, Seniors' Pharmacare. Any other savings would have again been advanced into our general health care requirements.

 

            MR. D'ENTREMONT: Knowing full that still we're talking about a lot of money and hopefully it gets reinvested into better pharmaceutical programs and better access for Nova Scotians. The savings from the pCA activity over the past number of years are only a fraction compared to what the province does pay for pharmaceuticals over that time. Many believe that utilization and adherence programs will equate to bigger savings. So what's the government's thought on this, are there better ways for Nova Scotians to use drugs? Should doctors be prescribing better, should pharmacists be taking care of this a little better, are there more access programs or monitoring programs that could be put in place to make sure that we're actually getting the best bang for the dollars that we spend?

 

            MR. GLAVINE: It was a great question posed by the member and in fact all of those areas that you listed are actually part of a better model of how we use our pharmaceuticals right across the life cycle, if we have compliance.

 

            This was a topic when the Health Ministers met in Prince Edward Island and we had one full day hearing from whether it was the people associated with the pan-Canadian Alliance, pharmaceutical companies, and those who are promoting brand versus generic and the other way around. In fact there is an organization that just deals with generic drugs because there also have been a few problems with generic drugs as we know as well. Sometimes we know that they can affect some people a little differently, you may not have all of the quality control measures depending on where they are made, where they are produced.

 

            We know that Doctors Nova Scotia, again, are doing strong education programs, for example, around the appropriate use of pain killers, the opiates in particular. We know that having a patient get the right prescription, having patients who will use their prescriptions in the right way for the right length of time so that they don't have lapses that cause them to go to outpatients, for example. We know that over-prescribing has also been a problem. These problems are not just confined to Nova Scotia, they're really Canada-wide.

 

            I think there's a whole range of ways in which we can educate our population as well as those who do prescribe drugs and I know that's an effort that the College and the Doctors Nova Scotia both take very, very seriously as part of professional development in particular.

 

            MR. D'ENTREMONT: One of the important things that I think was discussed just now at the PANS reception was the issue of scopes of practice. We've seen an expansion of those scopes, especially with pharmacists over the last number of years especially when it comes to giving immunizations; that has been I think, I would call it a success where more people have access to those vaccines in the province. There was some debate around I think how they were compensated for it and I think that has all been ironed out over time and I'm just wondering if the department sees a further expansion of those scopes of practice to try to better monitor how prescription drugs are used in this province. 

 

            MR. GLAVINE: Again, another question that as we know in the last few days has been playing itself out a bit publicly because again, we have allowed the scope of practice of pharmacists to pick up three areas. Those three areas, flu shots and all the work that we do will go through an evaluation process to make sure that we have the rigour in place so that it is again, of the highest quality of care. 

 

We know that thee team concept of providing primary care is expanding. I was recently at one of our collaborative medical practices here in the province, in fact it was on the South Shore, and I asked them, I said, if there was one practitioner that you would like to add to your team - and they had, I believe, five doctors, two nurse practitioners, a family practice nurse, a physiotherapist - and without hesitation, we would add a pharmacist to our team here. The changes that are going on in that pharmaceutical world, they are the people who are keeping up to date. In fact, we now have occasions where the doctor will prescribe something and the pharmacist will come back and say look, here's a version that may suit your patient better. That's their job, is to be fully up to date on that.

 

            We know that if we have people who are being trained for seven or eight years to allow them the full measure of their scope of practice, in our view in the department, it is the right way to go. However, we are doing this in consultation, in concert with Doctors Nova Scotia. Yes, there may be some criticism and critical reviews but as a department, we don't move and say we're putting this in practice and so be it. We have done these changes, scope of practice with Doctors Nova Scotia. We'll evaluate whatever we do bring forward, but take for example where the member lives, we have a number of communities in Nova Scotia where there is no doctor, hasn't been a doctor for a long time as they've moved to larger centres. The person who has the medical background is the pharmacist and the pharmacist is called upon to answer a lot of questions and they work to direct the person to where they need to go. They may not be able to provide the help needed and direct it accordingly. They certainly have a key role to play in our health care system.

 

            MR. D'ENTREMONT: I agree with your comments, I've always been impressed with the pharmacists that I've interacted with, whether it's Jim MacLeod at the pharmacy in Yarmouth, whether it's Monica Taylor at The Medicine Shoppe right next to my constituency office now, a lot of chance to talk to her, Jenny Prouty at the Pharmasave in Pubnico. All of these are extremely well versed and go-to people when you really have a question that you didn't have a chance to get off to the doctor, you couldn't get an appointment, you really weren't going to go to out-patients in order to see someone, they were your point of contact. I think they can be a bigger point of contact as well in the system.

 

            The next question I would like to ask, I have two of them, one is about a national Pharmacare strategy, I've been hearing that rear its head again. Or the Seniors' Pharmacare 25/75 split on the cost. Maybe I'll talk about the national Pharmacare program because that may be a little quicker and easier but it's something that I talked about as the minister and we had a number of provinces that were onboard and we had a federal government that didn't want to play with us at all. It basically died after Ontario dropped out. Is that starting to rear its head again with the Council of the Federation or is there discussion going around about a national Pharmacare strategy?

 

            MR. GLAVINE: I thank the member for raising that question. A national Pharmacare program was a topic when you were Health Minister, it has kind of been reduced in attention and in possibility in recent years.

 

            I would attribute the recent resurgence to a couple of reasons. One of the three major messages that CMA President Dr. Danielle Martin, in her time as president and she continues to be a reporter with CBC's The National, she is a strong proponent of how taking even 20 pharmaceuticals would dramatically improve the health of Canadians, if there was full access to 20 pharmaceuticals.

 

            That has caused a great deal of discussion and possibility for the future. When you have our largest province, Ontario, also starting to make noise and I have had a couple of conversations with Dr. Eric Hoskins who is the Minister of Health for Ontario and he is feeling a tremendous weight of the cost of health care in his province. He's looking for some relief and he is starting talks about how this can be of benefit to all Canadians.

 

            I can see in the next minister's conference that this will be there. I think it will surface during the federal election period once a Party's made known what they're prepared to do. I think there is great value in us having a national Pharmacare program and especially as some our pharmaceuticals are such a cost driver in our system. We are going to the per capita funding over the next 10 years. That will take a billion dollars out of health care in Nova Scotia. A billion dollars we can't afford to give up. When I met with Minister Ambrose, it was one of those areas that I said that perhaps the time for discussion is passed because it was really over about a three- or four-year period.

 

            I said look at other ways that you can advance health care in our province and this is why I was pleased to talk about innovation because the federal government wants to see provinces that can take something that is working well, let's say the microcosm of a small province, or any province, and then see if it advance nationally. We have a few opportunities in our province to take innovation to getting some federal support for and then perhaps have it advance nationally as well. Pharmacare, in particular, I believe, should be one of those areas.

 

            MR. D'ENTREMONT: Just to tell a quick story on that one. As we sat around our table talking about a national pharmaceutical strategy, one that all provinces were buying into at the time, of course bringing the feds along was always a little tough and will continue to be tough, regardless of the Party in power. We, Newfoundland, Nova Scotia, and Ontario, were to make a public announcement and we were set up to do it in Toronto, we were at the University of Toronto just downtown, and we were to have three ministers there and the minister from Ontario didn't show up to our announcement. It was one of those. It almost got going and then it sort of fizzled out very quickly.

 

I hope and I wish this government, whoever the federal government is going forward that this debate still continues along because for a country the size of Canada not to have a national Pharmacare strategy I think, is a bit of short-sightedness and we can blame a whole bunch of governments over a whole bunch of years for this one but maybe it's something that we really need to look at especially in the idea of per capita or dispensing money per capita. There must be other ways the federal government can participate in health care of Canadians as well, maybe a little bit like Canada Health Infoway worked and how if they liked the innovation and the way innovation worked. The PACS program across Nova Scotia wouldn't have happened without the partnership of the federal government. There are ways to work together and try our best to come to the same place.

 

            My other question that I wanted to forward to you is the whole idea of the 75/25 split on the Seniors' Pharmacare Program, that seniors would not pay more than 25 per cent of the cost of the program. Not so long ago I remember a press release or a regulation change that you made that changed that formula, that changed that ratio. So maybe I'll give you the opportunity to explain why you changed it and what the new ratio is.

 

            MR. GLAVINE: Madam Chairman, I'm pleased to speak to this issue of changing the formula which was 75/25 ratio where government would pay 75 per cent and those participating in Seniors' Pharmacare would pay 25 per cent. I'll have to check to see if plus or minus 3 per cent was there originally. It was there originally. We know that it started to creep up to the 28, a bit over the 28. So in many ways - when it was started around 2006 I believe is the year, you know there should have probably been some accommodation for looking at a review process. That was not there. The formula was no longer working from the perspective of government because we've been adding 35 seniors a day turning 65 in our province. So if we pick up that 28 per cent or 29 per cent or whatever, that would lead to again extra costs for government to provide the service. We're able to distribute the cost among I think about 120,000 seniors in Nova Scotia, which means that we can keep the premium and the co-pay at the same rate. So that allowed us to again get some benefits from the number that are currently joining now each and every year.

 

            MR. D'ENTREMONT: Of course the discussion continues or used to continue with the Group of IX, a number of seniors' organizations that would sit down, you would have this debate and discussion mostly about Pharmacare. There were a lot of other issues I think under the Department of Seniors that they were interested in but you would always get back to this.

 

            We made a commitment back then that we would not change that ratio one way or another without their agreement or their understanding. So I'm just wondering how you do that now, if there's really no Group of IX, if they are sort of all participating with the Department of Seniors. I know that this is more of a Department of Seniors question than it is Health but it is a health program.

 

            I'm just wondering how you consult with the seniors' groups to make changes beyond the 75/25. You really didn't - maybe I wasn't listening but what is the new ratio on the Seniors' Pharmacare Program?

 

            MR. GLAVINE: The very first group who are sensitive to any change, the Group of IX of course are seniors, they are on fixed incomes and they are a great sounding board. They give great advice, great reaction, great presentation of the needs of seniors because they represent nine different organizations of seniors.

 

            I've enjoyed every meeting with them. In fact I remember the day that I spoke to them about changing the formula because we had every space at the Department of Health and Wellness filled up and we had to find a boardroom at the NSTU office in order to hold our meeting. When they understood that we're all part of making a collective impact for fiscal health and it wasn't going to change what they would pay for premium or co-pay, they were okay with it. As I said, my commitment is to keep that premium and co-pay because we do have and will have a big seniors entry and we're getting a very high percentage of pickup right now.

 

            We had some people who didn't sign on to Seniors' Pharmacare but I think we keep the actual rate itself at a good place. Of course we have the program whereby if you are receiving the OAS and the supplement, it is no cost to you to join Seniors' Pharmacare. Again, I applaud previous governments who made that arrangement for our low income seniors.

 

            I think if we can keep that cost point at the place where it is that's certainly the goal but I just was doing a little quick calculation today on projecting senior populations and right at the very moment 24 per cent of our population, that's the true baby boom cohort, 24 per cent are between 50 and 65. So we have this huge entrance that is coming in so if we stayed at the formula then we saw where the cost driver, again, for Seniors' Pharmacare was going to be.

 

            MR. D'ENTREMONT: So what I hear is a commitment from the minister to make sure that the premiums and co-pays don't go up but at the same time knowing full well that the cost of that program is going to continue to rise. I just hope I have the assurance from the minister that those seniors that need it will be receiving it at that lower cost because they are on fixed income, they really have no way to pay more for anything. I'm quite amazed by many of the seniors in my constituency looking at their cost pressures, I mean there they are living in their homes, a lot of them are running a car and buying groceries and buying oil, and we all know how that can be. They're running old houses that are probably not that energy efficient and they really don't have any extra money at the end of the day.

 

            It was kind of funny we had that meeting about dialysis not so long ago where David Cleaver had sort of done a little accounting of what it costs to go to dialysis in Yarmouth versus if you were owning your house or actually just renting. Every cent of the Old Age Security was taken up by just normal living, just hopefully nothing is going to happen, God forbid that you need a new roof or a new furnace or your car breaks down or any of those other expenses that we all know come along, but there is no capability for our seniors to pick those things up.

 

            A lot of our widows and widowers in our area try to do that on their own, I really don't know how they do it, and it's always an amazement to me so I hope I have the minister's assurance that they won't be paying any more than that.

 

            MR. GLAVINE: I'm not sure if the member wants a written document here or what, but this is an area that is very important to our seniors. We know that demographic, and I think we've got about 46,000 seniors over 80 years of age, they would be some of the higher users of pharmaceuticals so our commitment as a government is to work to make sure that if we change the formula, the premium for now, and co-pay is at a good rate, we've got huge pickup of seniors coming into the program, we hope many of them will stay healthy and not need to be a cost driver to the pharmaceutical program but it's there for them. We want to maintain what I think is one of our top-notch programs to assist seniors in the province.

 

            MR. D'ENTREMONT: I thank the minister for that answer but we'll have to be vigilant to make sure that it does stay affordable for seniors. 

 

Maybe I'll switch gears before we end up my hour and hopefully pick it up after the end of it but it really revolves around the nursing strategy and we've had a lot of questions around that in the House of Assembly over the last number of weeks around the availability of nurses in many parts of our province, some of them as a result, I think, of the uncertainty around Bill No. 1 and how the new District Health Authority is going to roll out, and how nurses are being treated. I'm just wondering when to expect to have your nursing strategy come forward and what kind of dollars are being allocated to that to make sure it happens - so that will be my kick and then I'll hopefully pick it up on the other side.

 

            MR. GLAVINE: I hope the member opposite is available the day we release our strategy. We haven't picked a place and time yet, but it will be in the month of May and we know that Nursing Week occurs in the month of May - that's a possible time to bring out the nursing strategy.

 

            It is one of the pieces of work that has been on the go now for some time and I can say at this stage it's one that I'm very excited about. It has enormous possibilities. We know that the projected number of nurses required in the province will actually be at its highest level over the next 10 years, again paralleling the current cohort in the province where we have 24 per cent of our population between 50 and 64, 65 years of age, and so we know we will have a lot of retirements. 

 

            The nursing strategy will address a lot of the areas that have been of concern to the current group of nurses no matter how long they've been in the profession, and those who will be our future nurses, those students who are looking at the nursing profession. At the present time the amount of money that is in the budget will look after the nursing strategy for this fiscal year, so it won't be too much longer and we'll be able to have it available during the month of May.

 

            MADAM CHAIRMAN: The time has elapsed for the PC caucus.

 

The honourable member for Sackville-Cobequid.

 

            HON. DAVID WILSON: I'll continue on, I think, on the same tune as my colleague with nurses, but before I do that I know I ended with asking the minister around the rationale about the cuts to the grants and I didn't get the rationale behind the decision. But just so I can put it in context I did some math with my hour off here and the cuts to those eight organizations that I talked about is $79,120. That works about to about 0.000019 of the health budget. My thought and my statement on that is, is it worth it to go after those organizations for that amount of money?

 

            Anyway, I'll move from that. I'm sure through Question Period and other avanues I'll be questioning the minister on that. When we're talking about nurses, definitely they are really the backbone of delivery of health care in the province, and that's coming from a former paramedic but I know how instrumental nurses are. There are a large number of them and they play an important role in the delivery of health care.

 

            I know the minister in recent questions in Question Period threw out the number of nurses - we have the highest percentage of nurses in any jurisdiction. I'm wondering if the minister could give us the number of nurses that we have here in the province, but not just the total, I would like a breakdown, and if he can't provide now maybe by the end of the estimates or tomorrow - a breakdown of the full-time, part-time, and casual nurses. I'm wondering, could the minister provide that information to the House?

 

            MR. GLAVINE: I thank the member for that question. It is one that we'll be able to provide that information from the department because it is a very good question around taking a look at how nurses, you know, the amount of time, the number who are full-time, those who are part-time, casual.

 

            You know it is interesting, we have a number of nurses in the province who are 70 years of age or over. When I met some of them as I went around the province, it absolutely amazed me from a couple of different perspectives - one, at how much they absolutely enjoyed their career, gathered each and every day inspiration from a very purposeful career, and again at 70 years of age having continued professional development. A number spoke to me about getting their degree in nursing through the programs, especially at St. F.X. and perhaps the other universities have extension degrees as well, but a number who got their degrees very, very late, after 60 years of age, which I found quite amazing.

           

We have nurses who do continue full time and part time you know for very, very long careers. That's one of the real benefits that some nurses also discover, that they can do part-time work while raising a family and keep their professional skills at a very high level.

 

            As the member opposite knows, it is really that combination of full-time nurses, part-time or casual, those who extend their careers beyond what would have been a normal retirement. These are all part of that makeup that allowed a system to function very well.

 

            We know that at times we will have some gaps because specialty training is required if you are working in ICU, if you are in an ER; we know that they require some extra training. That's really where the gap from time to time can exist.

 

            MR. DAVID WILSON: I thank the minister. I'm wondering, when could the minister provide that - is it just a matter of tomorrow or is there a longer period? (Interruption) So, tomorrow? I appreciate that.

 

            The minister mentioned about meeting nurses and their age, which I won't go anywhere near that topic on the ages of our nurses - that would definitely be sensitive. One of the things we do know over the last while is that there has been what I would consider a higher number of retirees or those nurses who have retired over the last year or so.

 

            The end of the year now has happened, and I wonder, could the minister provide us with the number of retirements that took place within the nursing profession over the last year?

 

            MR. GLAVINE: The number of retirements for the current year is 341.

 

            MR. DAVID WILSON: I'm going to try this. I know it doesn't pertain to this year's budget, but how does that compare to the previous year - does the minister have that at his fingertips or does he know? I believe he probably does know - how does that compare to the year previous?

 

            MR. GLAVINE: I'm going to say it was around the high 290s, 300, but I'll get the figure and firm it up for him. I'd been looking at that pattern of the past 10 years but, more importantly, looking at projections of retirements. There was a breakdown in each of the districts, actually, as to projected retirements.

 

            When you are looking at right now the largest single cohort in the province is between 55 and 65, we naturally have - and we're talking about 78,000 people between 60 and 65, I think it's 75,000 between 55 and 60 and that's anywhere from 5,000 to 10,000 more than any of the other cohorts, so it's only natural then, by extension, we will have a significant number of retirements.

 

            This is why when the former governments decided that we had to increase the number of seats in our nursing schools and we went from about 300 to 401 seats in our three nursing schools and so the tracking looks good - we're retaining 92 per cent of our nurses who graduate and so our tracking looks very good.

 

The total number of nurses registered in the province at this time is at the highest level that we have had. Of all those statistics, probably the one that I've been most impressed by - here's the statistic that I've been most impressed by - 138 nurses came from other provinces, not to work part-time, not to work casually but to work full-time in our province. That says a great deal, I believe, about how the profession is looked at and the environments generally in which they work.

 

            We know we have some very challenging work environments but overall we are at a very good place when it comes to nurses, and the nursing strategy is going to build on where we are currently.

 

            MR. DAVID WILSON: I appreciate that response because I have a lot of questions just in that response. I'm glad to see the number of nurses coming to our province at 138, probably due to the competitive wage package and benefits that we have. We know we've heard from the government that that is in the sights of this government. I want to remind the minister of that, that we do have a competitive wage package. I know when we didn't have one, what was going on in the province and that was in the 1990s when friends of mine, when I chose to go to paramedic school, chose to go to nursing school, but then right after that chose to go to the U.S. and other jurisdictions. So be mindful of that and I think that success says a lot about the benefits of the packages here, that we are being looked at in other jurisdictions.

 

            I'm wondering, we have 401 seats in the nursing, what is the vacancy - I wonder if the minister could give us the number of vacancies now in nursing here in the province and maybe a breakdown of where those positions are?

 

            MR. GLAVINE: There are currently 135 vacancies in the province. That's from Sydney to Yarmouth, Amherst to Bridgewater, to look at the east, west, north, south alignment. Some of those are posted because retirements are pending. It doesn't actually mean that a person has vacated the job, but there are 135 currently listed.

 

            MR. DAVID WILSON: I don't know if it's because it's late at night but I'm getting a lot of answers from the minister from questions I've been trying to get answers to for over a year now, so maybe we should have estimates at 8:30 at night for Health and Wellness. I'm going to remind myself of that next year.

 

            That brings me to the next question and, hopefully, he'll answer this one just as easy as he answered the last one. We know that the province has, for the first time in many, many years, seen a closure in ICU beds in ICU units. I wonder if the minister could tell us does he know the last time that happened, and I know I only I have a few minutes so could he give us a quick status on the ICU closures and what's going on to fix that problem.

 

            MR. GLAVINE: With how much time remaining? (Interruption) With five minutes remaining, as I used to say to the Minister of Finance and Treasury Board five minutes that will be used up clearing your throat but, anyway, here we go.

 

Obviously hiring nurses to come into the province in that emergency type situation is certainly never our first choice and the former Capital Health District, now part of the nondescript Central Zone, there were 15 travel nurses that came through an alternate procurement process. They began work in March and they'll work on a rotating basis possibly as late as October.

 

            It's not part of a long-term contract and the area that I know the member wanted very clearly was what would be the cost, and it actually turns out that we haven't been billed at this stage. They are probably working perhaps under the auspices of the agency; we have agency nurses that fill in, of course, from time to time.

 

            What I'm really confident about is that we currently have 28 nurses being trained for ICU work and those are primarily going to be orientated here in the Central Zone. Of course, these will graduate at the end of May.

 

            That's where we are. I think the last time nurses came into the province was through the Cumberland Health Authority and that was in 2010. I'm not sure who was in government then, but there were nurses who came in during the 2010 year.

 

            What I do know is astounding, but I do know that during the time we had closure of the ICU there were nurses who were part of the NSNU who reached out to say they were available - could they work at the QEII?           

 

            Could the NSNU nurses work at the QEII? We know that was not possible and that was true, and so it wasn't done. We know that we can solve this problem right here in our province and we need to look at mobility of nurses. I believe nurses, NPs, and RNs, can help us expand primary care in this province to a very, very high level. We know that physicians will leave a community and I believe in taking a look at the work of our nurse practitioners and RNs across the province. We know that they can fill roles in primary care; they're demonstrating that very clearly now . . .

 

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

 

The honourable Deputy Government House Leader.

 

            MR. TERRY FARRELL: Madam Chairman, I move that the committee do now rise and report progress and beg leave to sit again.

            MADAM CHAIRMAN: The motion is carried.

 

The committee will rise and report its business to the House.

 

            [The committee adjourned at 8:45 p.m.]