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April 15, 2014
House Committees
Meeting topics: 
CW on Supply (Health) - Legislative Chamber (1283)











4:04 P.M.



Ms. Margaret Miller


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


The honourable Deputy Government House Leader.


MR. TERRY FARRELL: Madam Chairman, would you please resume the estimates for the Department of Health and Wellness.


MADAM CHAIRMAN: Before we start the address this afternoon, there has been a request to allow members to be more casual in the questioning of the ministers during the Committee of the Whole on Supply. I thought about this for a little while. As you sit and look at this room and you look at the architecture and the beauty and the balconies, and you see the paintings on the wall of those who have served here before us, it really brings to mind that we can do better, that we don't have to make things more casual in this House.


I believe that the House deserves our best efforts and no less. I believe that it takes no more to address this House correctly and respectfully than otherwise. That said, I would appreciate all members and ministers in the House to please use the correct manner of address in the House. Thank you.


The honorable member for Sackville-Cobequid.


HON. DAVID WILSON: I'm hoping to go through some of the highlighted areas that I've looked at or when I went through the budget to try to get some clarification. I'll give advance warning to the minister and his staff that it's mostly the ones that I've seen a decrease in, and I'll be asking why we see the decrease.


Before I get to those, I understand the minister will be making further announcements around the road with a list of the purchases that will take place and that he needs to have that discussion with the district health authorities. I appreciate that and respect that, but he did mention though that he will be keeping a small reserve of dollars for equipment. So I'm wondering if the minister could advise me, out of the, I believe, $18 million - I don't have it front of me - but the $18 million I believe, what percentage of that is going to be on reserve for the upcoming year?


HON. LEO GLAVINE: The member is right. I think it is judicious and prudent to make sure as any budgetary year as goes forward, there will be the unknown, there will be a breakdown of equipment, and so having a reserve of about $2 million will allow us to meet some of those needs. Very often they can be 75, 25, where foundations will come and carry part of that equipment.


MR. DAVID WILSON: Through the process of determining the purchasing of equipment for hospitals, I know it has been the past practice after the Auditor General had made some recommendations to the department and the department agreed to the process of determining which piece of equipment the department will fund in a given year, knowing the requests exceed the dollar amount every year usually. What the Auditor General was trying to do was ensure there was an open, transparent process on determining what the government, if they had $18 million to spend this year, what they would spend it on.


I'm just wondering if the minister could advise us if that is still the process of determining which pieces of hospital equipment the government is going to purchase in this upcoming year, the process that the AG set out and I know the past government and department accepted for determining what the priority list was for those pieces of equipment.

MR. GLAVINE: When we're talking about limited dollars for the purchase of new equipment, it is important that a rigorous process is undertaken so that we look at making sure there is the strongest priority based upon patient safety and equipment that has the greatest impact on the daily operation of our regional hospitals and our smaller health care facilities. We all know that the X-ray and the scanner in particular are highly used and required day in and day out. When an X-ray machine goes down, it does create those challenges and difficulties in trying to reassign patients to maybe the nearest hospital that can accommodate them. That process does go on.


It's not necessarily a public process because, again, the input from the DHAs on what they see as the highest needs and priorities - just as recently as a few months ago, hearing from DHA 3 that they had three pieces of equipment used in the operating rooms for the anaesthetic, for the anaesthesiologist in their work; three were breaking down, unreliable and a real strong safety issue brought right to the top of the list for replacement. So I respect that rigorous process that goes on with the medical practitioners and the DHA and the department in arriving at the purchase of the right pieces of equipment from time to time.


That being said, we also hear of foundations that engage in a capital equipment campaign where they see a piece of equipment can, in fact, be very supportive to their emergency room, to their obstetrics or whatever area that a foundation has had some request for. Very often it's an additional piece of equipment. We all know that in the medical world, new equipment - and especially with diagnostic imaging - new equipment is coming along on a fairly regular basis. In an emergency room, if you can have mobile pieces of equipment like ultrasound can be a great asset in detecting a number of conditions that a patient can have. That's part of that whole process and rigour that everybody will go through to arrive at equipment in that limited budget amount of $18 million.


MR. DAVID WILSON: I can appreciate those emergency situations that we see. Hence, in my previous question, why the need for a percentage of the $18 million for the hospital equipment to be on reserve - the $2 million. I didn't get an answer from the minister. What I asked - I know the process that the minister has gone through. The district health authorities all provide a list. It's requested from the department of what their equipment needs are for the year, and please prioritize that. That list is compiled within the Department of Health and Wellness.


I'm going to ask the minister, again, if the staff within the Department of Health and Wellness provided a priority list of the equipment needs for the district health authorities, once they gave the department what we would call their wish list throughout the district health authorities?


MR. GLAVINE: Yes, there is a confirmed list. It is based with the highest priority given to safety. That list, once we have the budget passed, then we will be notifying the DHAs across the province that in this fiscal year you will be able to get such-and-such a piece of equipment replaced. That will give them the opportunity to either expand one of their procedures - very often, however, we're looking at a piece of equipment that's really too many years old that they're often replacing.


MR. DAVID WILSON: My next question through you to the minister is, on that list that he was provided this year, was the CT scanner for Inverness at the top of that list or within the, I think he said, 11 pieces of equipment that they're purchasing this year.


MR. GLAVINE: The CT scanner was identified very early on and placed as a priority. It's a pretty essential piece of equipment that will enable and support surgery at Inverness, one of the areas that was very suspect in terms of whether they would keep a full level of general surgery at the Inverness Hospital and the CT scanner, which became one of the priority purchases. $1.2 million will be ready for this Fall with training complete and we'll see that in operation.


MR. DAVID WILSON: I completely understand the importance of the CT scanner for Inverness. But we know, and what I was trying to get at - and I know the minister won't go here with that - is the fact we know it's been a very public commitment from the Premier. During the Premier's estimates, he indicated that yes, there will be a CT scanner going in Inverness.


My concern around that is the fact that there's a process in place. The Auditor General has criticized previous governments for not ensuring a clean and transparent way of providing equipment to district health authorities in a fair way. I don't think I need to dwell on that one too much longer. I think we can say what it is; it was a commitment from the Premier and I would think that the minister fulfilled that commitment, I guess.


I'm going now into - and I'll be looking at the Estimates and Supplementary Detail on Page 13.5. We see here, under "Programs and Services", "Emergency Departments", there's a noticeable difference - not between estimates to estimates but forecast to estimates - in emergency departments of about $5 million. Could the minister give some information on why such a difference from the forecast to the estimate in this year's budget?


MR. GLAVINE: That is a significant increase. We know that one of the requirements during the past year in meeting the general tariff agreement was the fee structure for ERPs went up by over $3 million.


Also, there was increased work in the emergency departments. I know there are times when a second doctor has been called in to work the emergency department in some of our regional hospitals. That's where some of those dollars will translate into.


MR. DAVID WILSON: Just a couple of line items below that, I noticed another increase and it's the "Other Master Agreement Initiatives". There is a difference between forecast and forecast of about $5 million. I'm wondering if I could get some information from the minister why a $5 million increase and maybe the reason why we're seeing a $5 million increase in that one.


MR. GLAVINE: Just to go back to the pervious question of the member for Sackville-Cobequid, one of the other increases when we talk about emergency departments - and I know the member is very pleased to find out that an additional $677,000 went into the collaborative emergency centres. That means that another was opened or again additional hours or just the operation required to make sure that they operating at capacity.


In terms of the "Other Master Agreement Initiatives", one of the areas that we're going to see a considerable challenge with over the next number of years is dealing with chronic disease management programs. Utilization in this case less than budgeted and savings came from the Practice Innovation Fund, so that's where that figure shows up in the budget of this year.


MR. DAVID WILSON: I'm just going to drop down under "Programs and Services". I notice a decrease of about $50,000 for the "Assistance for Low Income Residents with Diabetes". I wonder if the minister could indicate why that has decreased. Is it just maybe an underutilization of last year's budget or is it a reduction to the program overall?


MR. GLAVINE: As the member opposite would know from his experience as the Health and Wellness Minister, there are often times when there are shifts in programs. You may have had a number of our citizens that were getting help through the diabetes program shifted over to Family Pharmacare. Also, there was some underutilization in that program. In fact, one of the areas that I know we have some concern about in the department along the line of diabetes is that the insulin pump program has not had quite the pickup that most of us had anticipated. Many of us who talked about how valuable that program would be for Nova Scotians, we may have to again get out and do some education around that program and its availability to Nova Scotians.


MR. DAVID WILSON: Since the minister brought up the insulin pump program, I was going through some of the material from the Liberal Party's platform - there was a chart, and I know I have it but I just don't have it in front of me right now - and of course I was drawn towards the health initiatives that they were advocating for, around the insulin pump program. I believe in the first year - not the current year but the first year which would be this budget - that that program would be increased to 25. Under the program that was in existence before the new government took over, it was up to 20 and then supplies for young adults from 20 to 25. I'm wondering if that program will be expanded to cover the age of 25 this year as stated in the minister's platform prior to the election?


MR. GLAVINE: The member is correct. That's a program that we plan to expand to 25 years of age. We know that in that age group, we have many young people who are students at universities and community colleges. They're not in the workforce. To be able to provide them with an insulin pump is indeed our plan. We first want to make sure that all those that can take advantage of the program up to 20 - up to 18 years of age and supplies to 20, that in fact we get the greatest pickup possible. In the 2013-14 budget, it forecasts $350,000 to be allocated for the program. Again, we haven't had that utilization, so we're working first. The first phase will be to get a greater degree of uptake of the insulin pump in the younger years.


MR. DAVID WILSON: I look forward to the expansion of that program. I was very glad to be part of bringing that forward. It's so important for diabetes care that especially our young people get off on the right foot and manage that disease.


Again under the "Programs and Services", Madam Chairman, I notice the Seniors' Pharmacare, from estimate 2013-14 to estimate 2014-15, there is a reduction of about $2 million. I wonder if the minister could advise why reduction this year for the Seniors' Pharmacare Program.


MR. GLAVINE: As the member for Sackville-Cobequid is very familiar with, there is a lot of debate now with programs; some start at 55, some 60, some 65. In those senior years, the use of medications or pharmaceuticals is at one of its highest levels. We are fortunate in the province, and really across Canada - we're really starting to realize a program that the former minister is very familiar with and that is the Pan-Canadian Pricing Alliance. We have been able to be the beneficiary of a number of generic drugs that have now come on the list here in the province and it is making a substantial difference in what we are paying through Seniors' Pharmacare, Family Pharmacare and once again this year we will see another four pharmaceuticals, four molecules, that will be brought online for our province.


MR. DAVID WILSON: In that I think I brought up to the minister - might have been in Question Period - the concern our party has going forward around CETA. The ability for provinces and territories to get drugs onto the generic form is important because it reduces your Pharmacare costs. Unfortunately, we see the federal government going ahead with that free trade agreement and that's going to affect that program in the future. I know the ministers across the country have been working hard to try to reduce pharmaceutical costs, so that leads me into another area where I know the minister is quite educated on.


The ability for provinces like Nova Scotia to put new drugs in the mix in Nova Scotia is extremely difficult. I'm talking about the cystic fibrosis drug, and I think it's called Kalydeco. I know that the pan-Canadian group is trying to get the best price for that. I know when the minister was relatively new to his post, he had indicated to Nova Scotians that Nova Scotia would fund that even if the other provinces weren't on board. We know several weeks later the minister came out and made some clarification, which I appreciated - the fact that Nova Scotia couldn't really go on their own because it would be too costly and we had to wait for this pan-Canadian group to try to finish the work that they were doing around this drug.


I'll ask the minister, was it just a mistake that he came out saying this, or was it that he wasn't informed of the process at the time where, I believe, media may have asked him the question around this drug?


MR. GLAVINE: When we get a pharmaceutical like Kalydeco that has an opportunity to at least assist some of our CF patients in Nova Scotia - in fact, it is a very small sub-group that have a very specific gene in their cystic fibrosis genetic structure, G551D. Through a great deal of research, and a lot of it funded by the CF Foundation, a company, Vertex, in the United States has come up with the drug Kalydeco, which in a very high percentage of cases of that sub-group there has been an improvement - in fact, for some, a considerable improvement.


When I first spoke about Kalydeco, I make no reservations in saying that first of all I was really speaking from the heart about one of the - in fact, one of the Premier's constituents, and a very good friend of mine, Tim Vallillee, who has been a wonderful advocate for cystic fibrosis research, getting our Valley community behind him to do a lot of work in support of CF patients across the province. More than that, I hadn't had the briefing to be up to speed on what this pan-Canadian alliance is actually working towards.


We know that it's a very small group in Nova Scotia that can be positively affected, impacted by Kalydeco - seven or eight Nova Scotians - and there is actually a chance that maybe only four or five of those would receive the very strong benefits. It is one of those medications that when a person goes on it, you find out very quickly because the salt content of the body fluids changes and therefore that whole mucous structure in the body - which is, in fact, the problem for our CF patients - starts to change. If it's not effective, you find out right away through a quick test.


We have one Nova Scotian who is very, very young, seven or eight years old, who could benefit from Kalydeco. If we're looking at a lifetime for some of our citizens who can benefit from Kalydeco, we have to have a sustainable price in place. I know right across the country we're getting all provinces - with the exception of Quebec - that are pushing hard to get a deal with the U.S. manufacturer, Vertex. To date, that has not been realized. I know the Minister of Health in Ontario has been starting to again give the soundings that she is disappointed that we've reached now over a year in negotiations and there has been no conclusion and no agreement.


But I believe very strongly that, as the Minister of Health and Wellness for Nova Scotia, as much as I personally want to see us cover this drug, I know that working for the long-term deal is in the best interest of the use of our funds, and will be in the best interest of those CF patients. Whether or not it's really the tip of a larger breakthrough where in fact we will see perhaps another version of Kalydeco that may help all CF patients. I think getting a good price from this company for Kalydeco is critical to achieve and I'm hoping that's going to be in the short term versus the long term.


MR. DAVID WILSON: I'm a bit disappointed that the minister didn't outright say, yes, I made a mistake, I should have not said that. He has to realize that it's all well that his personal opinions on this - I have personal opinions on these types of medication and if we should or shouldn't cover them - but he is the Minister of Health and Wellness, and the unfortunate situation that occurred after his comments is that there was a lot of hope for Nova Scotians.


The minister was quite correct when he mentioned that the Premier has someone in his constituency that has cystic fibrosis, but so do I. The young girl whom he mentioned, I actually went to school with her mother. They were very happy to hear the comments from the minister at the time, but - I can tell you - extremely disappointed when they found out that, no, they weren't going to go on until the process was done and that's unfortunate.


Hopefully the minister recognizes that he is the Minister of Health and Wellness and when he makes comments - it doesn't matter if it's in his local paper or on the main news station here in the province - that people are listening. It's unfortunate, they're on a roller coaster ride right now, and I hope that the minister is working hard to encourage the Canadian alliance, the group, to come to an agreement and fund the medication. I think it's important, as the minister said, there is only a small number in Nova Scotia that will benefit from it and I think that should weigh in the decision. But I hope the minister recognizes that those people were listening to every word the minister said and currently are quite upset about it.


I'm going to some more line items here in the budget; we're on page 13.11 in the supplementary information book. Of course this week - I don't have my pin on now; I have my pin on from CSG - this week is recognizing organ and tissue week. I noticed in the budget line for Legacy of Life, there is a small reduction, I believe maybe $20,000 or just under $20,000. I'm wondering if the minister could educate us on why there was a drop there. Hopefully, he recognizes the need that we need to actually, if anything, be increasing the campaign around Legacy of Life and the importance of organ and tissue donation here in the province. Maybe just a quick understanding why there is a small drop and encourages and make sure that he recognizes the importance of such a program.


MR. GLAVINE: To the minister - or former minister, the member for Sackville-Cobequid - he raises a really important question when we're talking about organ and tissue donations and the importance of transplants in our health care system. We're certainly fortunate in our province to have lead work on transplants going on at the QE II.


In terms of this $20,000, when it was calculated through efficiencies of administration across a number of departments and organizations like cancer care, the renal program, these were some of the efficiencies that were realized - therefore, not a drop in funding that would impact this program. We know that we have an outstanding kidney transplant program in our province and to see that program and others involved with a number of different transplant surgeries and maintained at a very high level is important for all citizens of our province and across the Atlantic region.


MR. DAVID WILSON: I thought I would start with kind of the smallest reduction, but there are two in that category on this page that I am concerned about. The first one is the Canadian Blood Services. It looks like close to a $1-million reduction in that line item from the 2013-14 estimate to the 2014-15 estimate, so that's significant. I wonder if the minister could advise this committee on why such a reduction for Canadian Blood Services?


MR. GLAVINE: To the member opposite, the department now has concluded one of its significant payments that had to be made to CBS for phase one of the national facilities redevelopment. I think again, except for Quebec, all of our Canadian provinces are partners in CBS - the new Canadian Blood Services that was formed after the AIDS impact on our blood system. There was a redevelopment across the country and each province had these one-time payments to make sure that the facilities were at the standard and at the development stages that are required for a first-class national blood service.


MR. DAVID WILSON: I hope from that answer that it's not a cut on programming and that Canadian Blood Services won't be negatively affected by that. It's my understanding it was a fee or an amount that we needed to provide.


On the topic - I know we're debating estimates but I'll see how closely I can skirt the issue. One of the issues that has come up across the country is the possibility of some private facilities actually paying individuals for blood services, hence a piece of legislation I introduced today that would limit that. I wonder if the minister could advise the committee that, one, he's aware that there are some jurisdictions that are dealing with this going on in their jurisdictions, and two, would he maybe support my piece of legislation? I know the Minister of Health in Ontario has recently brought legislation forward. I just wasn't able to get to it quick enough before our change of hat, so I'm wondering if the minister could comment on that.


MR. GLAVINE: The member raises an issue that has become somewhat topical in the last number of months. We know that in the United States this is a model that they have used where people are paid for blood, especially rare types in particular.


In our province, we are currently fine in terms of the donations made by Nova Scotians. We see a good, strong donation practice of enough Nova Scotians to meet our needs. I as minister and our government do not see any need to go down this road. We will maintain current practices and we hope that the generous donations of Nova Scotians will continue. In fact, many of us have in our communities people who have been recognized for 100 donations and some even higher over the course of a lifetime.


I just want to give assurance to the member and to the House and to Nova Scotians that our practice has been very strong and we hope that it will carry us well into the future.


MR. DAVID WILSON: I thought the minister was going to thank me for the generous donation of a piece of legislation that could have helped with this situation.


I know that it's not going on to my knowledge, and I'm quite comfortable saying that it's not happening here in Nova Scotia, but I would rather see a government not be reactive like we're seeing in Ontario and, I believe, Alberta. To say it's not happening now, we don't really need it - okay, I can understand that to a certain point, but I would think there wouldn't be an possibility if a piece of legislation like what I introduced was on the books. If we're going to stay with the status quo, that means in the future there still will be a possibility. We'll leave that at that. Maybe we'll do some jockeying on supporting opposition legislation. I know the Premier has indicated that that was a possibility.


I'm going to go to something that's extremely important to all of us. I know over the last couple of weeks we've talked a lot about nursing. Under "Programs and Services", the Nursing Strategy, there is a reduction of just over $1 million.


Why such a dramatic decrease to the nursing strategy when we've heard time and time again the importance of having a strategy in place that is going to recruit and retain and maintain the nurses we have? Just recently, I was doing a news interview on this, knowing the sheer number of nurses who are able to retire in the next 10 years is scary. I wonder why a reduction of over $1 million in the nursing strategy in this year's budget?


MR. GLAVINE: The member does raise an important topic in terms of nurses, the recruitment, the education of nurses, the retention of our nurses.


The $1 million that is taken from the nursing strategy this year has simply been moved over to the Department of Labour and Advanced Education. This will now be one of those transition times where we see Advanced Education and our department will be like some others that will get the oversight, the administration and the rigour that are required to be put forward by the Department of Labour and Advanced Education.


The member is also right in saying that we have challenges with the number of potential retirements. We also know that there are nurses, like people in many professions, who are working beyond what was always considered the normal retirement age. While nursing is a very challenging profession, there are nurses as well who absolutely love their profession and will stay perhaps longer than what we anticipate.


I know the member is aware that his Party did actually make a cut to the Nursing Strategy itself. I think it's one that does need the dollars in terms of assisting nurses moving from the schools of nursing into the profession. Some of the money was used for that purpose.


At the present time, we are fortunate in the province to have moved to a much better place in terms of recruiting our nurses. Just 12 or 13 years ago, we were just above 50 per cent of recruiting those graduates. We're now at about 83 per cent of our nurses coming from Dalhousie, St. F.X. and CBU who are entering hospitals and nursing homes, health care centres, private practices, collaborative practices - the whole range in which nurses find themselves in the current model of care.


My hope is that that level of recruitment will continue. We know that nurses really have a pretty open global market in terms of where they can be employed. We know that nurses often move to other jurisdictions, other provinces, to have that first job opportunity, or perhaps to travel and combine their careers at the same time.


As we take a look at the Nursing Strategy, I believe one of the areas will be to look at the area of clinical work-up that nurses have. The summer program that is now again offered through the three nursing schools is showing that nurses in that third year of training who go on to a full-summer program in our hospitals and other facilities come back for their final year of education feeling much more comfortable with the career they're going to enter into.


It also helps them to take a look at what area of nursing that perhaps they have a greater affinity towards. I know I met nurses during my tour of the IWK who, when they found themselves on certain units of the IWK, it was really that moment of awakening - I really want to work here, this is where I see my career. That was very enlightening to hear, especially younger nurses speaking about having found their place in nursing and looking forward to their career unfolding in a particular hospital.


I thank the member for raising that issue. I know there are many aspects of nursing - recruitment, retention, professional development, work environment - all these areas that really have a constant need to make sure that we are providing them with the best opportunities in our province and the best development of their careers.


MR. DAVID WILSON: I would agree with the minister how important the recruitment of nurses is going to be and how important it is currently. He mentioned that the vast majority of our nurses that are hired on come from Dalhousie, which is why - I don't know if the minister himself recognizes the damage some of the decisions his government has made over the last couple of weeks will have on the ability to recruit those nurses.


We know through Bill No. 37 - no matter if it's Bill No. 37, Bill No. 68, Bill No. 110 down the road, whatever it is - whenever there is a labour disruption and a bargaining unit goes on strike, the relationship between the employer and the employees is damaged. It takes a long time to get the morale back to where it should be, encouraging the current staff to speak well of the working environment they're in. That means a lot to someone when they're choosing where to seek a job or what floor to work on, for example, if it's a health care provider.


I know how long it can take to repair those relationships. The main reason I'm here in the Legislature today was when I was on strike back in the 1990s. I can tell you, if you go out and meet any of the medics that were around in the late 1990s, who was responsible for putting us on the street, they'll tell you who the minister was and what Party they were in. That was pushing 15 or 16 years ago.


With Bill No. 37, I think it has done some damage. It's going to be more difficult in the years to come when we need to recruit and the importance of recruiting now when it comes to nurses and nurses coming out of school.


On top of that, the decision of the current government to get rid of the Graduate Retention Rebate. So here we have, trying to attract new nurses to stay here in Halifax, stay here in Nova Scotia and move out throughout counties or across the province, and there was an ability for them to recoup some of the money that they spent and pay off some of the debt that they have from nursing school. Many of them go to Dalhousie University. They have the highest tuition in the province. There are not too many nursing students who come out of Dalhousie who don't have a debt.


We've heard over the last couple of weeks from those young, new students about what we say is a double whammy from the Liberal Government. First, the bill that strips their rights away and really created a bad working environment. The bill did nothing to address the concerns we heard from those workers. But also not being able to receive the Graduate Retention Rebate - I heard personally from a number of them this past weekend at our convention where we had nurses come and speak to our delegates who were not Party members before and explain the impact that the decision of the current government over the last couple of weeks and months will have on them.


It's going to be a challenge for the minister and his staff over the next couple of years to recruit, and at a time when we know there is a crisis looming with a nurse shortage. It reminds me right back to the shortages we saw in the 1990s. It was very difficult for floors, for different departments within the district health authorities to recruit new young nursing students. Many of them went south. Many of them went to the U.S. and that's unfortunate.


What I'll go to now is - we're at page 13.13 of the book and I'm going through some of the districts' estimates. The first one is under "District Health Authorities Spending", Care Coordination. There's a small dip, about $1 million in Care Coordination. I know we don't have much time, but could the minister advise us on why there's a dip there? I had noticed going through there was another reduction in Care Coordination on page 13.16 - I believe it's the Guysborough Antigonish Strait Health Authority - there's a significant drop there in Care Coordination. I believe another one is District 8 in Cape Breton - there's another significant drop from $6.1 million to $4.9 million.


I'm wondering, why such a drop in those line items for Care Coordination in the district health authorities?


MR. GLAVINE: To the member opposite, I've listened, first of all, to his previous commentary about the nursing situation. I certainly recognize and am prepared to meet the challenges that are there in terms of working for the strongest work environment, whether it's at the QE II, the Dickson Centre or any of our hospitals and health care centres right across the province. I think that's what we have to be cognizant of.


I know when the deputy minister and I were in Yarmouth to meet and hear from some of the nursing students who are about 100 strong now in Yarmouth, it was great to see how a school that's 100 years old - and after closing their hospital-oriented three-year program - was able to get the Dalhousie program to come to Yarmouth and provide residence, instruction and clinical practise at Yarmouth Hospital and some of the outlying facilities. Many of them spoke about discovering that they could have a career in a regional hospital in what many would consider a remote part of the province, but how much they liked the work environment of that particular hospital. They were hoping to be able to become employed.


I think the fact that Dalhousie is able to get some of its nurses out across the province is a real advantage. I did use a statistic there that was incorrect in terms of the retention now for graduates. Based on last year's statistics added in over a decade, we're now at a 90 per cent retention of our graduates; it does say there's opportunity. Generally speaking, young nurses are finding themselves in workplaces that they do find conducive to practising their chosen profession and ones where they see good opportunity.


Does it mean it's a perfect world for them? No. But nurses across Canada are finding that when there are challenges in their workplace, staffing committees are the means and the mechanism whereby they deal with whatever - whether it's a nurse shortage, or an LPN as part of the team, either on a one-time basis or regular basis - we're finding that staffing committees are used to sort out those problems.


I'm hoping that kind of work can be done with the nurses who are expressing unsatisfactory conditions and that over time their workplace issues can be addressed in a very, very constructive manner. I think there are few of us in any profession who find ourselves in a utopian situation. Many of us do have find ways to deal with the challenges in all our workplaces. I know nurses are very, very professional and will work to make sure that there is indeed improvement.


The member had asked about the amount of money that was now - I think it amounts to about $3.3 million. That money primarily affected DHAs 7, 8 and 9 in the Continuing Care budget. This money was moved to the department for greater provincial coordination of home care support and as the member is very well aware of, during his government's last year in office, about $22 million more was put into home care. Also this year, I believe it's about $18 million additional that will be put into home care, home support. It's a growing area. But also to have it coordinated and to have standards and consistency across the province is a pretty important part of that program, so there is somewhat of a shift in how those monies are used for coordinating programs.


MADAM CHAIRMAN: Order please. We'll move on to the Progressive Conservative Party.


The honourable member for Hants West. (Applause)


MR. CHUCK PORTER: I don't know what that's about, Madam Chairman. You'd think it was the first time I ever stood in my place. Something to pass the time, I guess, for them as we work through this. They all know me too well.


It's good to have the opportunity again for a little bit to question the minister throughout the course of the estimates. I want to go to a bit around long-term care. I know we touched on it briefly over the last day or so. It's more about policy and maybe what might have changed or is about to change or shouldn't have changed.


Dykeland Lodge, which I think the minister is probably familiar with, in Windsor, is a long-term care facility that also has attached apartments to it where residents, although they live at Dykeland, are quite independent actually. They signed in a number of years ago, some of them - the one that I'm referring to about 15 years or more ago, in fairly good health, quite independent, able to look after herself, as per a four-page agreement, which I'll table once I've spoken to it. Basically it states on the last page that residents who are living there independently, when they reach that point of needing more care - and I'm going to paraphrase it instead of reading it - but needing more care, have the opportunity to move upstairs, if you will, into what is known as the more long-term care and the around-the-clock sort of care.


Recently, a constituent has done that. She has lived there for about 15 years. She now requires more nursing care and more help with a number of things. That agreement would allow her to move - basically, when a bed became available - to transition right into Dykeland upstairs. The change that seems to have occurred, or a question around this is - Health and Wellness has gone in and done their assessment, like they would for anyone else, I suppose, who wasn't in a facility, and has determined that she is indeed a number level higher of care and requires longer, around-the-clock, 24-hours a day care, but are adding her to a wait list as opposed to following the last agreement that was in place.


I'd like to get to that by asking the minister if he or the department are aware of changes to this as this was - I'll table it - this was a binding agreement on March 10th, 1998, and I'll just touch on one piece of it:


The landlord agrees that should it become necessary to terminate a lease because of declining health, the tenant will have the opportunity to move to the upstairs as soon as we have an opening in the proper section, provided the level of care required is not beyond our capability of handling.


Which, of course, in this case it's not. They are a full-care facility, but instead she's being added to a wait list. Families understand there can be lengthy waits, but in this case, this lease - does it supersede what's in place today or vice versa? Is new policy going to dictate this lease is really null and void? That is my question. I'll start with that.


MR. GLAVINE: I don't know if the member opposite has been tipped off that I'm actually going to Dykeland Lodge tomorrow evening. He had no idea? I guess that's a little bit of telepathy here that's going on between myself and the member opposite.


He raises an important issue where, in our nursing homes, people can transition from very independent living to some more of an assisted living arrangement to full nursing care. We know as we try to utilize the 7,200 nursing home beds as well as we can through assessments and through the criteria that are presently in place - it is an area that I'm presently actually preparing to take a look at, and that is the criteria, as I spoke the last day, about who gets on the list and what is the assessment that is done.

I would say in this case the needs are looked at in that general area of 100 kilometres and trying to place those that have the greatest need for a higher level of nursing care. Hopefully that, in many cases, doesn't end up as too, too long a wait. From the experience that I have in the Manor in Berwick and Heart of the Valley in Middleton are areas that - sometimes Evergreen Home in the Coldbrook-Kentville area - are areas that I'm able to track through people who call my office.


For this elderly citizen and her family, hopefully the wait won't be too long.


MR. PORTER: I guess I just want to clarify - what I heard the minister say was the lease that was signed at that time basically would be null and void, and she, in this case, would fall under whatever new policy by way of assessments that are in place. I'll just give the minister a chance to clarify that for the record please.


MR. GLAVINE: To clarify, it is obviously difficult for me to speak to individual arrangements, contractual bases, when somebody came into a nursing home. Again, if I hear from a family, that's the point at which I would certainly be prepared to take a look.


MR. PORTER: I thank the minister for that answer as well as the clarity.


I have a number of things I want to bounce around to. I'm going to go to a couple of statements that were made in the Minister of Finance and Treasury Board's budget statement a week or so ago. I'll just quote a couple of pieces and perhaps you can speak to them.


On Page 9 of that document she states, under Health and Wellness, "Increased health-care costs are driven primarily by wages and use of the health-care system." Now that's no shock to any of us. I'm just wondering what percentage of that is actually driven by exactly that, the wages and the health care system itself - of the budget? I'm not looking for an exact number, but just the percentage.


MR. GLAVINE: Madam Chairman, I thank the member for that question. You know, even in early days, I'm starting to realize that holding the line on Health and Wellness will be a great challenge. However, having just really been there a short time and to find myself in January approving last year's budgets literally meant that we went about 10 months without mitigations that certainly could have helped us.


When we take a look at - again, no surprise to the member - $75 million of that increase came from utilization, those demands from an aging population in particular are really showing up now on a very, very constant basis.


This is why looking at doing some things differently, in particular around chronic disease management, is going to be one of those areas that I think we can find ways to be able to do this in a more effective manner. For $65 million of the increase of about $194 million, that came from wage increases because we know that we had a 2, 2.5 and 3 per cent for health care workers pretty well across the board. Those two areas alone used up a great deal of the increase.


Also there is almost $30 million that are new initiatives. When we take a look at the monies that will be there in the budget for tuition relief for medical graduates to work in the province and again those increases, for example, insulin pumps going from 18 to 25. So we have a number of new initiatives that did take up $30 million of the $194 million increase. Just to reiterate, utilization and wages were the two big impacts.


MR. PORTER: I thank the minister. I want to read another piece of the statement here; our answer may sort of be a decent segue into that. This paragraph is short but it covers a lot and it's a fairly bold statement, to some degree: "By keeping our focus where it must be - on patients and their families - we will reduce wait times, improve outcomes for Nova Scotians living with chronic disease, and work to ensure that all Nova Scotians have a family physician."


Now each of those two or three statements that are in that paragraph are very important to those who suffer with a chronic disease, or await a family physician and can't find one, or are waiting for some kind of surgery to be done or other treatment or further testing or whatever. I'm curious - as I had written beside it - how will this be accomplished? It's a pretty short question on quite a bold statement. I'm interested.


I know that you were down my way back a number of months ago, not long after becoming minister and making an announcement with regards to a physician coming. We certainly were appreciative of that and look forward to many more of those, knowing that I have a handful who will probably be retiring in not too many more years. They have been hanging on, I think, because they too are aware of the situation and their health is good and they are able, but I know that they certainly must be thinking about retirement as they have been physicians for a long, long time - decades, probably 30-plus years, four or five of them.


I'm really interested and I get a lot of questions about - as I'm sure the minister does and all members for that matter - how are we going to grow this family physician piece in and around rural Nova Scotia? It's not so bad in the city. Probably not too bad within that hour's circle even maybe where we have physicians that work the queue but come out home to Hants Community and probably work clinics around as well. But a really key piece of our health care system of interest of our constituents is, where are the doctors going to come from?


MR. GLAVINE: The member references again one of the most important questions that I think that can be asked, and that is, how will we provide that complement, that requirement of family physicians? If the member doesn't mind for a few moments, just going back to taking a look in my own area. I remember very well in my first and second campaigns I got to every door of the PMQs in Greenwood. It's one of those areas where many of the spouses were unable to get a family doctor when they came into Kingston-Greenwood or living in Middleton to Berwick area.


I was amazed at the number that asked me that very question - how will you as a legislator at least be advocating for us to get more doctors? Over the last number of years, we've been able to find some solution by having a community health centre developed right on the base. We all know from the Physician Resource Plan that we will need 300, 400 doctors perhaps over the next decade. Many of us know a doctor in our community or nearby community that perhaps is in a phasedown period of their career, they have reduced their practice perhaps somewhat.


I'm very encouraged by the committee we have put in place - the Recruitment and Retention Committee - that I believe is going to be able to give us a number of very, very strong tools, if you wish; the kinds of instruments that will allow us to perhaps do a stronger province-wide recruitment program. We have announced through our campaign and also since coming to office that we are putting monies into new graduates. After completing their residency, if they stay and work in Nova Scotia, we will provide $125,000 of debt relief towards their time in med school and for return of service and especially to our rural communities.


I feel very strongly that that will be a good addition. I know that we've increased the number of CAPP physicians. Generally we are around nine or 10; this year we had 13. In fact, one went to the member opposite's riding, and I know the day we went there for that announcement how welcome it was. Again, as he builds up his practice under the mentorship of a local doctor, a good number of patients will enter his practice.


But I think we have to look at all of the ways in which we can recruit in a very competitive marketplace, especially for GPs. I know that British Columbia has started a very strong ask of the Canadian system of matching graduates - called the CaRMS system - to requirements in provinces. For example, B.C. is saying we have a lot of young British Columbians who are studying in other med schools, particularly in the United States and the Caribbean, but they aren't able to get back to our communities, especially our rural and northern and coastal communities. That's the problem that we are facing.


It was never so clearly put to me than by a family physician in Neil's Harbour, when we were doing the provincial tour - we had him by video conferencing connected to our meeting in Cape Breton. He would be a doctor probably in his 70s and he said, who is going to come here to replace me? That is now the real challenge that we will have so hopefully a commitment by where we can support a doctor, pay for their med school, or a good portion of their years in med school, for a return of service. We're hoping that like the military model - and I know the military has used that model in many of their small communities. They used it when they had the small radar bases across Canada and smaller size bases to make sure that the military personnel did have a physician. That's what we're hoping to capture.

We know that the collaborative care models of practice are showing great signs of an ability to recruit. We now have examples of a few communities, Digby being one of the prominent ones. We saw the same in Barrington, which just opened their collaborative care centre. We hope to be able to say the same, shortly, for Shelburne, where a collaborative care centre will be built. That's going to be one of the models that we'll see in terms of practice and again, it will be a way in which we will be able to attract doctors to more rural communities.


MR. PORTER: Thank you, minister, for that detailed answer. One of the scenarios - fee for service, hourly salary - I'm not sure when it changed but I think it changed to a greater degree, and a lot of people who were working around health care at the time would have blamed it so much on the way that doctors were funded or paid, whatever terminology you want. Can you break down the percentage of those or talk a bit about how that is done?


I know there is a mixed bag there, depending on the sort of arrangement they go into. People are often curious about that. They're asking, and perhaps your CFO will get a little work after all; I didn't actually anticipate too much by way of numbers.


I'm looking for even a couple of examples by way of a clinic model, like Hantsport as an example versus the QE II and emergency, as opposed to a rural hospital where they work, or a GP. How does that break down and are there benefits to one or the other when it comes to try to recruit that physician to a rural area of the province? I think it probably plays a role, no question. It has an impact on whether a physician may decide to go there or not and what kind of agreements are made and how they are funded. I'd like to hear a bit about that, if you would, please.


MR. GLAVINE: To the member for Hants West, we know that the model of paying physicians is contained in the Master Agreement and I believe it's around June 2015 that we will be coming up on a new Master Agreement. In the meantime there is the standard fee for service that doctors still utilize. More and more, however, in the collaborative practice models, it is the alternate payment system where they are on a salary. We also have with some doctors - who are teaching, doing research and also clinical work - a different model of paying those doctors in place through an alternate payment plan. There are these different models that are used and I can give a little bit more to this.


Currently in the province we have 922 doctors who are getting fee for service and we can see that the alternate funding types are increasing with 566 on alternate funding and fee for service with other combination of payment types is about 1,000 and that represents about 2,500 physicians in our province. There is quite a distribution that is now taking place and we are seeing a significant pick up on the alternate payment plan. There are requirements for doctors in terms of the number of patients they are required to see if they are on salary.


I was surprised to find that we actually have some of our specialists who are on the alternate payment plan. In speaking to a few of them, they are prepared to do more procedures when the OR time is available, to support our drive and desire to reduce wait lists right across the province.


MR. PORTER: I thank the minister for that. I wonder, does the department or the minister have a preference to one over the other - is there a difference - as we head into a recruitment phase? We are going to be replacing some of the ones who have been around for quite some time as we've been talking about, is there a model that works better, one or the other, the alternate or the fee for service? Maybe it matters only with regard to where they're working around the province. Maybe you can go into that a bit for me.


MR. GLAVINE: We are finding that doctors now have more of a choice, as opposed to one model which used to exist, except for those who were teaching at the Dalhousie Medical School and doing some clinical work. There is no question that one of the models has been growing in the province is the collaborative practice model and that seems to lend itself strongly to the alternate payment plan.


I don't think we're moving in any rapid fashion toward that. In fact, in the last year there was a small increase but it has been a pretty steady number there. For doctors who come from some of the European countries where they've had the alternate payment plan or salaries of their physicians in place for quite some time, it's just a continuation of what they've been used to. It's not a matter of myself as minister saying one over the other. We know that Doctors Nova Scotia work with all physicians across the province to support them and to assist, whether it is a start-up or whether it is a doctor who is moving from general practice to a specialty area. Doctors Nova Scotia does a great job in an array of services for our physicians. We'll see, on an individual basis, doctors finding what really works for them.


The one area that will probably see the alternate payment approach used maybe stronger could be through those who are at the Dalhousie Medical School. That looks like it is getting pretty cemented as the best approach for them.


MR. PORTER: I may not have asked that question as clearly as I could have. When I spoke about the minister's preference, I was thinking along the lines of trying to stay within a certain budget line more than anything else. Is there a preferred method there that might work better for trying to stay within, albeit we know there is growth?


On top of that, I would just quickly ask the minister as well if there is a preferred method from the physicians who are coming out. Do they favour one - if that's the right word - or see advantages, maybe more than another?


MR. GLAVINE: First of all I would say no in terms of a preference. That's a professional decision of our doctors and those who graduate and come into the profession. The one certainty that I think we have discovered the last number of years, and was made very clear to us recently at conference, is that in a recent survey at the Dalhousie Medical School - in fact almost to a person - they wanted to practice in some type of team or collaborative practice. That does tend to lend itself towards the alternate payment, but it's not necessarily a preference of the department. It's just really what seems to work best for everybody.


One of the questions asked earlier around why the budget went up by $194 million. If we see utilization having gone up and increased costs of $75 million, a good part of that was for physicians, nurse practitioners who are delivering primary health care, specialist care, to Nova Scotians. It is part of reflecting those years, probably from 60 on, in the lifecycle where chronic disease catches up to people and more visits, more tests.


In fact, there is a movement now being promoted in the province by Doctors Nova Scotia with physicians, taking a very strong look at the question of whether the patient needs a certain test. In other words, they're working on a little more time with patients, greater clinical observation. Some of our tests are very expensive; every time we send somebody off for X-ray scan, MRI, any of these are very costly. It's a movement to make sure that patients' needs are met while not creating an overburden on the system. I know as minister, making sure that needs of Nova Scotian citizens are met and that's one of the reasons why our budget numbers are where they are.


MR. PORTER: Thank you for the detailed answer on that. You talked a bit about a variety of different models there. One model that works very well - at least where I come from that I like a lot - is the clinic model. We have a great clinic in Hantsport, which I am sure the minister is certainly aware of and how that has been a struggle at times over the last couple of years. At this point in time it is moving along nicely with patients down there, of which there are somewhere around 2,500. It's hard to believe but they have a lot of patients in that area and the town itself proper is only about 1,100 residents but it captures quite an area by way of services. It's a good model.


We also run our clinic behind the hospital, which you may be familiar with as well. Each evening or in the mornings on Fridays, I think, there is a clinic open and available for an hour or so. It's hard to believe how many people go there and how quickly they are served. It's that minor ENT stuff where you need to be looked at for five minutes, a script or whatever you might need to get fixed up. I think it works very well and the doctors who are working that, who I speak with, which are most of them, like it as well and tend to agree with it.


I've never asked but I assume that would be the alternate payment schedule model that they would go into there. Given the fact that we have the needs around the province for doctors and physicians - not just where I'm from but all over the province - for families, I would see the clinic model probably growing, perhaps. Certainly getting busier.


As you are also aware, we have an emergency department over there and people have gone there and I've heard over the years and witnessed myself, many hours of waiting for what would be something that could be addressed at the clinic in 15 or 20 minutes, probably. They do end up there for issues outside the clinic time frame.

The question is kind of two-fold, I guess, as I think about it. Over the years I don't know how many times I've heard the rumour that the hospital is closing. Well I have yet to see that and I'm glad. We have also been very fortunate that unlike other emergency departments, from Digby to Sydney and around - not necessarily to Sydney but Glace Bay and a variety, Pugwash and others, have all spent time closed because no physician was available. We have not had that happen and that is due, certainly in part, to those few physicians, that handful who have been around for a good many years, making sure. They will work extra to keep it going.


Again, it is also our proximity to Halifax, I believe, that allows those doctors to go out and service our area accordingly. That is a good thing. I have heard oftentimes - and again we've never seen it, I've never seen anything seriously on it - about emergencies closing. I would ask just for the record, is that anything that would be something that would be being considered? I think back to the Ross Report - and I know Dr. Ross, certainly as a paramedic, and he has taught us many things - having gone through that, there may have been some indications that some emergencies could close from midnight to 6:00 a.m., when numbers were way down or things like that.


I'm not sure when you took over where the recommendations were, minister, by way of those sorts of things. I think it's worth bringing out at this point in time, early on in your mandate, what the plan is around hospitals as they sit today and I'll ask specifically about my own. I am going to assume, but I'll ask you for the clarity, that we wouldn't see much by way of changes to the emergency hours at Hants Community Hospital.


Maybe on top of that, if you want to take a couple of minutes as well to talk about building on the clinic hours in an effort to service even more people who will wait to go there. Specifically they may wait a day or two, knowing that they have an ear infection or something rather minor that can be serviced at the clinic. Are there any thoughts around expanding the clinic hours or assisting those physicians who are working and being funded through the alternative method, an opportunity to expand on the clinic hours? Thank you.


MR. GLAVINE: I think for all MLAs here in the Legislature, their community hospital, their health care centre, their community clinic, whatever facility we have available for primary health care is of the utmost concern. I do appreciate that question that was asked.


The member does reference his community hospital in Windsor and like several other smaller hospitals that I've been able to visit over the last couple of months, in some ways the fact that their emergency room never closes is really a credit to a team of doctors who have made a particular stand and statement to the community that we are going to do everything possible to keep our facility open and available 24/7. To discover a number of those and to meet some of the physicians and nursing staff who keep them open is something to be commended. I know as minister to send out kudos to those who man these emergency rooms 24/7 is a great service to the people of the province.


In terms of Windsor, Windsor serves in many ways as what I would call somewhat of a relief valve for the tremendous demand on the Cobequid Centre in Sackville, Dartmouth emergency and especially the QE II. As patients are triaged in an area, there can certainly be a range of medical services that can be provided in the emergency department in Windsor. There certainly is no question about making sure that facility does stay open.


We do have a number of our hospitals, and I think of the member for Northside-Westmount in Cape Breton - the hospital in North Sydney has been going through a very difficult time in terms of their emergency department being open. It's one where the CEC model may work very well, having the Cape Breton General, a very strong emergency department there.


The challenge still remains. Dr. Ross laid out a wonderful plan to allow a number of facilities across the province that were creating great anxiety for residents in areas where the question was, will the emergency room be open tonight? That's a very uneasy place for residents to be. Fortunately, as the member knows, our EHS paramedic service does a great amount of overlap to our emergency departments and is always a comfort to Nova Scotians, knowing that it is available over the entire geography of Nova Scotia. One of the first true provincial plans that we see executed each and every day with one of the highest level of services in North America.


What Dr. Ross discovered, what he probably knew very well - there were a couple of examples and Springhill was one of those facilities that really became a bit of a beacon as to how they could stay open but not necessarily have ERPs, have the emergency room doctors there all the time but rather a GP that would provide primary care. There are many who go to our emergency rooms and it's not what would be classified as a trauma but rather it's an elevated temperature, a baby or a child in pain and we need to know what the symptoms of pain are telling us about the condition.


Keeping them open and offering primary care, same day or next day, has been a wonderful way of providing comfort to many citizens who saw their emergency rooms closing on a regular basis, availability of doctors in the community.


We still have a number of these to work through and it's our government's commitment to make sure the strategic location of full, equipped and emergency room doctors providing to the communities that need that service and then working to cut down on the number of closures that we see in some of our facilities. I want to let the member know that Windsor is providing a wonderful service, keeping their emergency room open is a local goal as well as our goal in the department.


MR. PORTER: I thank the minister for that answer. We capture quite a large service area, actually, and I'm not sure what the numbers are. I used to know at one time, they used to quote around 25,000; I think it's probably larger than that though when I look at the geography.


One of the things that was going on there for a while, and I think the Eastern Shore had it going on as part of Capital Health also - there were some minor surgeries being transferred out there at one point, and I don't know if that's something that's still going on or not. They took the opportunity to use that facility because at one time they would have done a lot of those minor surgeries over the years and had obstetrics there at one point in time as well. That's all since moved on.


I know we only have a couple of minutes left until the moment of interruption, 6:00 p.m., but I do want to turn to something that I know the minister is quite passionate about. He stood on this side of the House for many years, and in more recent years, and talked a great deal about prescription drugs and the issue around that. Knowing that this is still quite a problem and still much work going on, unfortunately we also hear there are still a number of incidents that are taking place around prescription drugs. Since taking office, I am wondering what has the minister initiated or reviewed and your level of content maybe for lack of a better word - I don't want to say that you're happy with it because I know you're not. Unless it disappeared I don't think you'd probably be happy, having witnessed your passion on this very subject in this House. I would ask, what has taken place since you became minister? What have you been able to do?


I know the College of Physicians and Surgeons have been trying to do some things to improve how they prescribe and I think that is something that has been going on for some time. Is that something you're working on, even implementing more changes by way of how those prescriptions are written? I'll give you a few minutes to talk about that, since becoming minister, what might have changed or is about to change.


MR. GLAVINE: I thank the member for the question; he expresses a note of concern in asking what is currently taking place.


In terms of prescription drugs, I believe that we're on a path of incremental improvements. I don't think we're going to reach the goal in a short term. I think we have to play the long hand here and make sure that each year we add another program, another initiative. Some will be of a small nature and others will be a bit more significant.


One of the very first statements I made, because it was one of the areas that when I was on that side of the House I put a lot of questioning to the minister of the day, and that was a strong education program in our schools and one that addressed those very vulnerable areas of junior high. I am pleased to say that in September 2014, in the 2014-15 school year, there will be a program for middle and junior high students on education around prescription drugs, around prescription opiates. I believe that's going to be another one of those valuable, incremental pieces that I think will give us dividends, will be positive for us in the long term.


One of the other initiatives that has just recently come about is Doctors Nova Scotia now are asking GPs to take a very quick historical look at a patient's record, in terms of their past pattern of having been prescribed . . .

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


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


[6:20 p.m. The committee reconvened.]


MADAM CHAIRMAN: The Committee of the Whole on Supply will come to order. We will resume with the Progressive Conservative Party.


The honourable member for Hants West.


MR. PORTER: I'm going to pick right back up, the minister was about two sentences in, I think, to the answer to the question. I'm going to go right back to him to complete that thought. It was on prescription drugs, and at the time the minister was talking about what sort of coming into place that he and his department may have planned by way of an improvement and how physicians were monitoring or writing their prescriptions and so on. I will pass that back for you to complete that thought.


MR. GLAVINE: To the member for Hants West, like all members of the House with a strong interest and concern on this issue, as I said earlier, the education piece will come along this September. We have a strong prescription drug monitoring program in the province. It does, however, have that allowance for a 30-day entry of information into the system, so sometimes that lag, as the member would know, does create some problems for us.


There is a new system that is underway. It is more of a just-in-time system, and that is all prescribed medications will go into that system and be able to provide a doctor in an emergency room, in a walk-in clinic, in any of our settings of entry, doctors can check and take a look at the individual's record in terms of prescribed medications, which would include narcotics; that, plus the recent announcement by the College of Physicians and Surgeons that now is requiring doctors to look at the history of a patient. Sometimes that can be somebody who comes into the province, somebody moving from another area or presenting in a number of ways in which patients can enter through the health care system, that they actually take a look at the history of the patient in terms of previous prescribing.


Also, the College of Physicians and Surgeons have a program that is looking at the physicians who have a very high prescribing rate among their patients. This is going to be another avenue, I believe, in getting some measure of control over prescriptions.


We all know the prescription drug problem is actually coming from a very legal substance that, as we know, is important to severe pain management. I use that term because in many ways, the movement of OxyContin into our system by Purdue Pharma started that whole, I guess, greater acceptance because it was presented as a narcotic that in fact was not addictive. We know that its widespread use led to, first, significant problems in Glace Bay - Cape Breton was really kind of one of the first areas of the province that gave that evidence of a pretty significant and growing problem. Then we had a number of deaths in a very short time in the Annapolis Valley. That's where, again, a number of people started to take a look at - what is this going on in our midst where we have a legal medication that is in fact causing trauma, in some cases, or in the worst case of course, death?


So now we're at the point of getting that understanding that in Canada, we move between first or second in the world in prescription narcotic use. So a whole wide range of initiatives that I have pointed out - I believe the work of the Canadian prescription drug strategy now will also be another assist. We are seeing our police association, again under the leadership of Mark Mander, who is on the national strategy committee, again has invested a lot of time, a lot of education around the whole prescription drug and also diverted methadone. These are areas that police now, law enforcement, are giving a greater amount of work and surveillance to. I think when we take a look at what is taking place and however it points to what else needs to take place in our province.


One of the other areas that I will mention, as the member asked, is we will have Dr. Bowes who is the - I'm trying to think of his title - medical examiner for the province. He is going to put in place again the kind of information that can show trends where there are deaths from overdoses of prescription drugs. He is one of the significant people to provide insights on deaths from overdose.


I have not met with Dr. Bowes yet, but he is one of the people whom I plan to meet and again take a look at the pattern that has existed over the past five or six years, to see if, in fact we are making some improvements. Are we reducing the annual number of overdose prescription drug deaths?


One of the other areas that I think has provided a lot of information is the fact that we went through a period of time where some of the deaths were not investigated by police. It was an overdose, here was the death, a death certificate produced from the Medical Examiner's Office and recorded, yes, after the autopsy, what the autopsy revealed, but not really a police investigation that could lead and help them in identifying somebody in a community who was diverting prescription drugs onto the street.


We've taken a number of measures in the province. We are now looking at Suboxone as one of the replacement therapies that can be in addition to methadone. Again, there's good success with Suboxone especially among young addicts and also really reduces the diversion of Suboxone. It's also nowhere near as lethal as methadone that gets into the wrong hands.


I feel that we've made a lot of inroads in addressing the issue, but there's still considerable work to be done. I know one of the areas that Dr. Tom Marrie, the dean of the medical school, when I met him a couple of years ago, he talked about the very limited amount of education to GPs in terms of pain management. There are many degrees of pain management that doctors should have their patients going through before they arrive at a prescription for Dilaudid or Percocet or Hydromorph - any of these narcotics that get diverted onto the street and illegal and abuse.


One of the other areas that has clearly demonstrated the amount of narcotics that are in the medicine cabinet at home - we had a provincial program that's now part of a national program. That campaign encourages people to turn in their unused prescriptions. Last year there was something like 40,000 pounds of prescription pills across Canada that were turned in. It may even have been higher than that, but it was really just so substantial.


We're addressing this issue on a number of fronts. I think Nova Scotia has a chance to be a leader in this area. In each of the nine community meetings that I've attended, particularly with Amy Graves; Dale Jollota, who lost a daughter; John Munro, who lost a 21-year-old daughter - have also been part of the community meetings. They have put out that plea that we all engage in doing something to reduce, alleviate and get some measure of control.


I've usually finished off those meetings with the challenge to make Nova Scotia a leader in Canada in dealing with the prescription drug issue. I look at the work now in the department under Carolyn Davison, Mark Mander and also Kevin Fraser, who is now working here in metro having moved from the Valley and is on the national strategy committee. So I see a lot of good things that have taken place, but it's really a journey as opposed to reaching an endpoint. I'm certainly in it for a long stand to see an improvement in this area.


MADAM CHAIRMAN: The honourable member for Chester-St. Margaret's.


HON. DENISE PETERSON-RAFUSE: I just have a few little quick snappers here for the minister. The first one, I know he had confirmed to my colleague that the commitments that were made previous to the election were going to be kept. As you know, I represent Chester-St. Margaret's, and one of the facilities there that is supposed to have a rebuild is the Shoreham senior citizens' home. I do understand that they're part of the second phase, but I know also there are a lot of questions. You can understand that prior to the election, it was great news for staff members, the members of the community and the management that Shoreham would have an investment to rebuild. It desperately needs expansion and rebuild.


I don't know if the minister has had an opportunity to tour Shoreham Village, but I would encourage him to do that. It's a fabulous facility. But what he will find is that when it was originally built, the rooms were built on the assumption of only one individual per room. As the minister would appreciate, with our increasing aging population, that moved along very quickly and most of the rooms, probably 98 per cent of them, had to double up. So you have seniors that are moving into a long-term care facility normally from their home, that they've had a lot of room to enjoy their life, and then they're suddenly in a senior citizens' home. It's necessary for them and their family, but they're in with another person with very, very little room, so the rebuild is necessary.


I'm just wondering if the minister would be able to provide me with some timelines. I know it's the second phase - but not only the timelines, but when there will be communications with the management and the staff to explain to them the process. I think the communication is key because of the fact that they're all in a situation where they don't know what's going on; they're not sure. Some of the discussion too was the fact that Shoreham may not be able to be rebuilt on that site, that the community and the staff would have to pick another site.


There are many factors that are involved and complications, but the community and the staff members and the management are really left up in the air right now. I'd really appreciate if the minister could give me some more finalized details and when the communications and discussions will take place with the members of the community staff and the management.


MR. GLAVINE: Indeed, the replacement of nursing home beds is an important program. We know that our nursing homes are inspected. In fact, there is a planned inspection of all of our nursing homes as well as one unannounced inspection of our nursing homes right across the province. So we know they are safe, but as the member has pointed out, some are in need of refurbishment, in need of replacement and that's why a number have been identified.


I have not visited Shoreham. I know where it is; I've been down. I met with people from Chester who are looking at a new health centre clinic for the community of Chester, but I will, at the conclusion of the House this Spring, I would commit to the member if she could join me on a tour and meet the management and hear not just the concerns, but that we can have a beneficial discussion on the plans that the department has.


She is right, it is in that second phase, but I think sometimes even taking a look at the condition of a facility may, in fact, be that kind of lead which says look, we need to look more imminently than what a plan may have.


I know that it was strong criteria that determined that these 11 would be replaced. Our commitment is towards replacing, and again, we've had a major briefing on these replacement beds. I know when we're looking at a facility that has 91 seniors in it, it needs to get the attention that it deserves. So that's my commitment to the member and I'm sure we can do that here in late Spring.


MS. PETERSON-RAFUSE: Thank you very much for the invitation and I will take you up on that. I think that as I was mentioning, it's a concern factor of the unknown for the staff and the management, so I really look forward to having a tour and I'm sure there will be questions in terms of timelines. There were some that were given prior to the election, so that's what is embedded in people's minds. They'll want to hear that those timelines are still the same timelines as the discussions before the election.


I know the minister just mentioned about the collaborative health care centre - shortened they call it OHC. It's for the entire Municipality of Chester. There's a hard-working group that have dedicated themselves to raise quite a bit of money to have the build of a collaborative health care centre in Chester Municipality.


It is greatly needed, in terms of the number of doctors that are in the municipality, it is very limited. We do have one doctor, I think - well, I went to him when I was a little, tiny girl, when I was born and he's still there. I think he's in his 80s. He's a mainstay of the community, but there's going to be some day that he's going to need to step down. The community is forecasting a shortage of doctors, which we already have. Those pressures are there in the community. I'm very proud that the community is working so diligently and raising in the millions of dollars to build a collaborative health care centre that has a holistic approach and that will bring in a variety of different services. It's actually at the road going into Shoreham Village where the collaborative health care centre will be located.


My next question about the health care centre is, as the minister knows, the NDP Government had committed $500,000 to the project. There have been discussions; I know that he has met with board members and has had those discussions. The question is that they really want to be able to get started, be shovel-ready. They have raised the millions of dollars that they need. There's still some dollars, of course, that need to be raised, but they want to be able to start the project.


We're here now, just finishing off with our terrible winter, so the question is - I know there were criteria around the distribution of the funding and I believe they have met those criteria, they've been in discussions with the Department of Health and Wellness. So what is on everybody's minds in the Municipality of Chester is when those funds will flow through so they could actually start the project. Thank you.


MR. GLAVINE: To the member opposite, she is right; I've met with some of the board members to take a look at the plans for OHC - Our Health Centre. Very simple but very telling in terms of what they want to put in place, not just for Chester but rightly for the municipality.


The department is committed to having that $0.5 million moved to the health centre board. I even believe that in terms of looking at the design and the plans, I'm pretty sure that everything is fine there.


I guess when we hear that it's getting underway, the department would follow through with its commitment.


MS. PETERSON-RAFUSE: I guess I'd like to be able to pinpoint more of a time - if you could possibly ask your staff who are here if they can indicate when that $500,000 will flow through. I think that's very key for the people who are involved in this project and the community.


As the minister can understand, it takes a great deal of dedication and effort to raise millions of dollars. People are very tactile, they like to see something happen and they've been working on this project for several years now. I think they're at the critical point that if people aren't seeing that it is being built, their source of fundraising can dry up because people are thinking it's never going to happen. They're really working very hard, they've done a lot in terms of public relations, keeping people informed, but the key element for them right now is to get that government funding.


As I said, I believe they've crossed their t's and dotted their i's on the criteria that were put in place for them to meet. What they're really waiting for is the actual date, that I can go back to the constituency and to the board of directors and say that the minister has confirmed that you will see your funding in April or May or June - if I could get some time frame. Thank you, minister.


MR. GLAVINE: I'm pleased to inform the member that all of the criteria for this project have been approved by the department. Shortly after we pass our budget that money will be advanced to the board for construction that I know could be getting underway very shortly. That is ready to be released to the board.


MS. PETERSON-RAFUSE: Well, I'll be thrilled to take that back to the community because it does sound like you said after the budget and shortly, so I would probably expect and hope it would be in sometime in May so they'll be able to get started this summer. I notice that the minister is nodding his head, so I hope that's confirming my date of May.


One last question for the minister - this one is a little bit tougher. I'm hoping to see that this extra money may be able to flow to the health care centre after they receive the $500,000 and start the construction of it because it will be a multi-year progress in order to actually get it built. During the election, as you know, all of us attend debates. The candidate that had been running for the Liberal Party at the debate - it was in the Chester area at the Legion and a full house - said that - a question came from the floor on our health care centre about the $500,000 from the Department of Health and Wellness and the commitment of the NDP and that the Liberals would commit to that. But what he also said is that the Health Critic, who was the minister at the time, also said to the board of directors that this project was worth more than $500,000 from the government and should give more funding.


I know that the minister can't control what somebody else says, but I do also understand his follow-up is that there was a retreat by the Liberal Party at the Atlantica in the Western Shore-Gold River area in August. At that time, there was discussion with the board members and both the Minister of Labour and Advanced Education and also now the Minister of Health and Wellness said the same thing directly to board members, that if a Liberal Government was elected, they would most likely receive more than $500,000.


I didn't make this up - it has come to my attention and I've been asked to ask the minister directly for that extra funding and when they could expect conversations around that extra funding and how much that extra funding would be. Thank you, minister.


MR. GLAVINE: The statement in a general conversation was - this is a good project, and if we formed government, we would commit to the $500,000 ask. We can always say every project deserves more when we talk about health and we talk about the requirements. When you come into government and you take a look at - your 2013-14 budget was overspent by $400-plus million; this year around $287 million; I think we've made a reasonable and a strong commitment and that money of the $0.5 million will be going forward shortly.


MS. PETERSON-RAFUSE: This is my last question. The minister referenced - when you come in government and then you see your budget - I do understand that for this upcoming budget - but I'm asking also if he would commit to this extra funding in the years to follow because they will be in your mandate, so by the end of the mandate, more than $500,000 would have been invested in the health care centre. That's the expectation that was provided and the perception of the board members and many in the community and they're very aware of that.


I realize that it's very difficult for this budget year, so I am very patient. I know the people of the constituency are patient also. So if we could get that extra funding some time during the mandate because that's the understanding that the community has, that the minister had expressed that, if elected, those extra dollars would come forward because it was a very good project.


MR. GLAVINE: To the member for Chester-St. Margaret's, in terms of beyond the $0.5 million, we know that projects - we hope they get supported fully by the community, by the municipality. We actually didn't make a commitment of doubling the $500,000. We basically were saying that it was worthy perhaps of additional funding, but there was never a commitment towards that made - just stated it was a great project and if the past government saw that half a million was a great contribution from government, we also see that as a great contribution.


MADAM CHAIRMAN: The honourable member for Queens-Shelburne.


HON. STERLING BELLIVEAU: It is certainly a pleasure to have an opportunity to address the Minister of Health and Wellness in the budget process. I have a few questions basically regarding the constituents of Queens-Shelburne. I just want to bring the minister's attention to the proposed Shelburne medical clinic. I've spoken with the Minister of Health and Wellness in a private discussion and I know that the minister has done a tour of our beautiful province since becoming government.


I certainly respect the position that he's in, but I'm deeply interested in the Shelburne medical clinic and the retrofit which has been planned for a number of years. Just a brief history - the previous government, which I was part of, made a commitment. If the numbers are accurate now, it was $658,000 - the previous government made a commitment to that retrofit of the Shelburne medical centre. I also understand that there was $200,000 from the Municipality of Shelburne and an additional $100,000 from Roseway Hospital Charitable Foundation.


Now I know it has been some time, Madam Chairman, and I give the minister an opportunity to update us and the members of the public, in particular the people of Queens-Shelburne would like to have an update on that retrofit which is extremely important to the constituency of Queens-Shelburne.


MR. GLAVINE: Madam Chairman, to the member for Queens-Shelburne, yes, this is a facility that I am familiar with. We spent half a day in Roseway and going through what is getting to be a pretty old facility, almost like - I guess not really a Collaborative Emergency Centre as we know it, but rather a building with some doctors' offices, I guess would be the best way to describe it, and a few other clinicians who have worked out of there.


The commitment here is for $428,598. That is firm. The need is certainly very, very strong here. There was some back and forth from, I guess, the board or the construction committee with the department. There seemed to be some differences coming from the community about the final design, so that's one of the factors. I think the member is aware that that was part of the reason why it hasn't moved along as smoothly as one would want to see this.


This is really important on a couple of really pressing accounts. Number one, as Dr. Keeler well articulated, it's going to be one of the great improvements in helping to attract new doctors to the area. He's a doctor who went to Shelburne and now has ended up spending his career there. He would like to have a facility in a Collaborative Emergency Centre that would attract the next generation of doctors to that area.


That being said, they have a great opportunity in the coming months and years because there will be a Dalhousie residency program starting at Yarmouth Regional in July. Those doctors will go out to some of the other health centres and the collaborative care practices in that area. It's going to be an opportunity, if you've got you know a modern, good flow-through, functioning, Collaborative Emergency Centre, to look at attracting the next doctor or two to that area.


It is an area that I can commit to the member that we do need to take an immediate look to make sure that this project gets back on track and it can be a summer build this year and that it doesn't go beyond because, again, the money is committed from the province. Perhaps over the next week or so, I can find out for the member a little bit more of an exact timeline when this project will be moving forward.


MR. BELLIVEAU: Thank you very much, Madam Chairman, and to the minister, I am encouraged with the comments of keeping this project on track and getting back to me. I really appreciate those particular comments and I'm glad I had the opportunity to raise this question.


Madam Chairman, through you, if I can just switch to another part of the constituency, the Liverpool hospital, as you know, most recently in the last few months, there was an issue regarding staffing issues, particularly technicians, and I am not a medical person so I apologize for not having the accurate terminology. To me these are technicians, professionals who are used in blood collection - lab technicians - that's probably the closest.


These were lab techs who were actually professionals who were shuffled - and I use the word shuffled - from the Liverpool hospital to the Bridgewater hospital. I know we've asked this question to the minister before and the assurance was that there was not going to be any loss of service to the Liverpool hospital. What I'm raising here is that the public wants to be reassured that there's no erosion of services from - I coined it as robbing Peter to pay Paul.


If you go to the Tim Hortons in your community, this is the concern - that those lab techs will not be robbed from the facility in Liverpool to accommodate the Bridgewater setting. My question to the minister, through you Madam Chairman is, will there be any erosion of services in the Liverpool hospital and can the minister assure us that this service will be permanent?


MR. GLAVINE: To the member opposite, he raises a good question. Anytime there's a change in community in terms of what we would see as a very basic, essential service - that is the taking of blood samples, providing analysis, test results in as timely a manner as possible - we know that some of these changes have occurred around the province. I've been in a few of the smaller hospitals and health centres where this change has gone on.


There are actually a couple of reasons from my understanding. Lab technicians and the number being trained now may not be coming together in as timely a manner as what we would need. Also, we can only put the latest and most sophisticated equipment of blood analysis in the regional hospitals and I saw some of the modern equipment in a few of our regional hospitals. What they're able to do, the amount of samples, the number and range of tests that can be done there is really a dramatic improvement. There are now very few blood samples that will go out of the province. It's only for very specific diseases that may need to go to the most specialized centres. That's part of the reason.


What the residents of Liverpool and all of those communities that have seen the lab technicians move to a regional hospital is that core service of getting a technician taking blood is guaranteed for Queens and other similar facilities across the province. In some ways it is a sharing of some of the top level resources, lab technicians that we have available in the province.


MADAM CHAIRMAN: The honourable member for Sackville-Cobequid.


HON. DAVID WILSON: It's great that some of my colleagues have a chance to question the minister on some of the issues that are concerning them in their areas. I'll carry on with that. I know my colleague, the member for Sydney-Whitney Pier would love for me to ask the minister if the government is committed to continue to support the replacement of Carefield Manor in Cape Breton. I know the executive director, Tom Donovan, is very passionate about the work he does there. I know the member for Sydney-Whitney Pier and myself have met with him in the past. Can the minister confirm the Liberal Government's commitment for this project and maybe a timeline on when we may see some work being done?


MR. GLAVINE: Madam Chairman, I had better start speaking through you to the members. I've been wandering a little bit here as the day goes on. I guess maybe I need to get back on track here.


Carefield Manor I know is a facility that the member for Sydney-Whitney Pier is very familiar with. It does have 12 beds, 12 residents, but is extremely important to that area. It's one of the facilities that I haven't had a tour of but do hope to get there. It is in the plans for the 11 committed replacements. We are doing a phased approach to deal with those replacements and this hasn't gone before Cabinet for finalization. We've had discussions through the Issues Committee and hopefully shortly we'll be able to say where this facility is on the replacement list.


MR. DAVID WILSON: Well that's good to hear. I don't know what the Issues Committee is. I don't know if that's an internal committee in the department or the government itself but I hope that the minister will champion these facilities. They are much needed, long overdue and I know the member for Sydney-Whitney Pier and our caucus will support the minister as he goes forward. If he needs any support in Cabinet, we'll come right along with him and make sure his Cabinet colleagues support him as he moves forward with these important projects.


I'm going to move to - I know in the Budget Speech there was mention of a retention incentive for physicians. I wonder if the minister - and I tried to look through it, I know it's probably in here somewhere - what the cost of that is and how many physicians does the government expect to take up that program?


MR. GLAVINE: Madam Chairman, to the member for Sackville-Cobequid, this will become an important part of our recruitment of doctors, especially doctors to rural Nova Scotia, because it will be a fee paid to residents coming out of medical school, in exchange for service of five years to a rural community. We have pegged the amount at $125,000 per physician, $750,000 I believe a year, about $3 million over a four-year period.


Now we do have a recruitment and retention team that is at work. In fact they had a meeting this week. They're closing in on most of that inquiry, taking a look at what, in addition, can be strong recruitment and retention means for the next decade of physicians for our province, since we do have a good outline through the Physician Resource Plan as to what we will need in the coming years.


That is one of the tools that will be in the tool box, available to use. I know of one community that has already approached government that has two physicians on the hook for their community. They want to know, when the budget is passed, if they will be able to access that fund to cement a deal. Until the deal is cemented, it is difficult to speak to it in exact terms.


We already are hearing that the cost of medical school, over the last number of years in particular, right across Canada, all 17 medical school fees are going up and this is becoming a significant incentive for doctors to come to our province. We are hoping that over the next four or five years they will see this as a valuable support to them when they come to Nova Scotian communities.


MR. DAVID WILSON: So if I'm correct, $125,000 per physician - so it's similar to a rebate. Is that $125,000 up front or is it over the length of the contract? How much would they be able to get back and is that a direct cheque from the department? I wonder if you could explain a little bit on that.


MR. GLAVINE: The actual amount that we proposed to the committee and we had in our platform is $120,000 - so a few dollars less there. We commissioned the committee to take a look at how the $120,000 would be structured and the contractual agreement that is a very significant part of that requirement to work in a Nova Scotian community for five years. Those details will be available when the committee makes its final report to us in - probably we are looking at May now.


MR. DAVID WILSON: It's interesting though - I mean, this is a retention program and I think we all in the House realize the importance of having such a program in place. I have to say, it's interesting to hear on one end of the spectrum that when we had a retention program for graduated students that the current government did away with that program. We had the Graduate Retention Rebate, which, similar to what the minister is talking about with physicians, it allowed for graduated students to recoup funds over a number of years, up to $15,000. I know this is $120,000, but $15,000 is a lot for a recently graduated student. We have heard from those students who have taken part in that rebate and it's important to them to pay down that debt.


So it's interesting to see - and I know it wasn't under the minister's department, it was the Department of Finance and Treasury Board that got rid of a retention program, yet introduce one in the Department of Health and Wellness. You have got to wonder why it wouldn't be good for students who graduated with a BA or a science degree or a social worker or any of those other important degrees that we have and it will work for physicians. I guess the government will have to explain that to graduates as time goes on and one set of graduates will be treated differently than another set.


I'd like to turn now to something that we've been very strongly supportive of, over the last number of years as a Party, and that of course is what has really changed the model of care in Canada when it comes to the emergency room. That of course is the Collaborative Emergency Centres. We are looked upon here in Nova Scotia as a leader when it comes to this model of care change. We know it stems from Dr. Ross and the report that he provided the government at the time on how to address the chronic closures of the emergency rooms throughout Nova Scotia. We see jurisdictions like the Liberal Government in Prince Edward Island adopting this model, the Government of Saskatchewan, and I know there are a number of jurisdictions that are very interested in the Collaborative Emergency Centres.


I know throughout the last number of years that the Liberal Party, at times, has criticized the program. I'm not 100 per cent sure if the current Minister of Health and Wellness is 100 per cent behind this change of model of care and the utilization of Collaborative Emergency Centres, so I'm going to give the minister an opportunity tonight to be very clear to Nova Scotians and to Canadians if he supports Collaborative Emergency Centres and will he commit to continuing to put them in place where they would be beneficial?


We all know that you can't put a Collaborative Emergency Centre in every emergency room across the province. There needs to be specific situations and an environment to make them successful. So does the minister support them, the idea of this change in model of care and approach to emergency room care? Will he commit to continuing to expand the number of CECs we have here in Nova Scotia?


MR. GLAVINE: To the member for Sackville-Cobequid, I know he challenged a little bit around his opening comment there on the Graduate Retention Rebate. The real difference here is that we can point to probably 30 or 40 communities in Nova Scotia where a doctor can go to work. We have many graduates of Nova Scotia colleges and universities who will not be finding a job in our province, unfortunately, this year. The critical piece here is having a job.


One of the areas that I was very interested in taking a look at, when I became Minister of Health and Wellness, was the function of the CECs across the province. As the member has stated, it has been the dawn of a new day for primary care, same day or next day. The criticism, as the member can relate to, is that it is not emergency care, and the residents in those communities know it isn't emergency care, but it is the care that they need at a particular time of day, knowing that their child's 102 degree temperature can be checked out or the next day they can have a requisition for a blood test, an X-ray. So it is providing care that would keep people out of emergency departments at nearby regional hospitals.


I think it has been a very sound model of care. It is one that we will support. It is one that we will see some expansion of over the next three or four years across the province but, at the same time, we are doing an evaluation, looking at it in terms of what patients have to say, what physicians have to say, in terms of utilization, standards of care that are provided.


I believe it's important, in all of our programs, to do that kind of evaluation. We all know that we want the same standard of care in our emergency departments. This was an area that I heard, as I went across the province, that they wanted to see the provincial program like the paramedic program, Cancer Care Nova Scotia and they wanted to see, as we roll out a surgical program, a clinical program, that these standards are right across our province.


When we take a look at CECs, they are providing, in those communities like Tatamagouche and Pugwash, the kind of care that citizens absolutely require and deserve to have and it is available as a 24/7 service. We know there is only one of those that has an advanced care paramedic, so it is not emergency care, it is primary care in those facilities, but it is doing exactly what Dr. Ross said it would do for us, is that it would relieve the burden in emergency rooms in the nearby regional hospitals. I think it's a model of care that is here to stay and we will look now at two or three of the ERs that are going through the same challenges, whether it's Annapolis Royal, Pugwash, any of these communities that could no longer provide emergency care. There will be a few other communities that we're in the process of looking at, over the next two or three years.


MR. DAVID WILSON: I just want to emphasize to the minister, he mentioned that patients would not receive emergency care in these CECs. The last time I checked with the paramedic training that goes on in this province, primary care paramedics provide emergency care to Nova Scotians every day. Advanced care paramedics provide emergency care for patients every day in this province.


You can go into an emergency room around this province, and they may have an emergency room physician, or just a physician, because there are additional training courses for ERPs, for example, emergency room physicians, but there are physicians who work in emergency settings daily around this province. One physician could potentially be able to crack open your chest and do cardiac massage, for example, right there in the emergency room. Some doctors don't perform that but there is emergency care being delivered.


I would hope that the minister recognizes that those primary care paramedics do provide emergency care. Nurses who have been working in ERs for years do provide emergency care.

My next question would be - and I thank the minister for being open and ensuring that the government will continue to look at expanding the use of CECs but, again, he mentioned that there is a review going on. I mentioned this in our earlier comment from the minister that any time I hear a review is going on, the antennae go up, because the potential to change the program or close it down is always there and it's not just in health.


I wonder if the minister could indicate if he, or the Premier, or anybody in Cabinet has discussed with him the possibility of closing the Collaborative Emergency Centres and creating something different. That's the question. Has the minister discussed with the Premier, with anybody in Cabinet, with anybody in his government, in his caucus, the possibility of closing a Collaborative Emergency Centre here in the province?


MR. GLAVINE: Taking a page out of the previous government's manual, Better Care Sooner, an evaluation was called for, so it is an evaluation of the program. In my view, the evaluation will be to strengthen the program, in areas where that can take place. I believe over the coming weeks and months, as Mary Jane Hampton goes across the province to take a look at the CECs that are in place, hopefully that is the kind of guidance that will strengthen what we have and point to what we should place in communities where this can be a way of dealing with closures.


I know, for example, the member opposite here has the facility of Northside General, which is struggling with keeping their emergency room open 24/7. It is one of the ones that as a government we have to take a look at and perhaps now it could be the CEC model that will alleviate some of the challenges that that community is currently facing.


MR. DAVID WILSON: Thank you for that. I am reassured with the minister's review of programs, since we implemented it before the last election, so I am more comfortable with that.


I would like to turn now to an area where there has been a lot of discussion over the years on the floor of this Legislature. It is pertaining to outsourcing services at Capital Health, for example. Specifically, I want to ask the minister if he is going to support the outsourcing of laundry services, cafeteria services and potentially closing down the Tim Hortons in Capital Health. I'm wondering if the minister can reassure Nova Scotians or tell Nova Scotians what his intentions are.


I know the district health authority has, a number of times, come to government, come to the Department of Health and Wellness, asking for this and I'm wondering if the minister will give the okay for them to do that.


MR. GLAVINE: Madam Chairman, I'm pretty sure the member opposite is indeed aware that food services, quality of food, preparation practices in all of our facilities across Nova Scotia are currently getting a strong focus. We know that there has been that real challenge in terms of having Tim Hortons - four of them actually at the QEII - and to have them losing money is of concern to Capital Health. I know just a short while ago, I think lots of coffee is still being churned out every day, but I'll take a dialysis unit in one of those four locations, looking at the need we have for dialysis across the province.


It is not our government's intention to put services out. I think what we can do in-house, in our facilities, as much as possible, is again a way of making sure that local procurement is part of what we would have to serve our patients, patients who are obviously ill and in our hospitals need good quality food. That is sometimes a concern that the district health authorities will hear.


I think the review that is going on to focus on standards across the province again can have very good results for our institutions.


MR. DAVID WILSON: I thank the minister for that. I know when he was on this side of the House he was very critical about that. What was told to him at the time was - and I believe it's still the case - I believe there is one Tim Hortons that does have a deficit, one makes money. The cafeteria service, for example, the challenge that Capital Health has within cafeteria services is the fact that they implemented healthy choices for patients and for families and that does cost more, so I am reassured with that.


I know I have a few minutes. I'm going to jump right into another topic that has been talked about quite often on the floor of this Legislature, and that is involving the Dartmouth General Hospital and the fifth-floor expansion. I'm wondering if the minister and his government are committed to expanding and completing the empty fifth floor at the Dartmouth General Hospital.


MR. GLAVINE: I think I made an announcement last night actually, through estimates on the budget. The fifth floor of the Dartmouth General now is really beckoning for a program to get that long-awaited facility where it needs to be. I think, in the coming weeks and months, all members of the House are going to hear something pretty firm around the fifth floor.


We know in the Department of Health and Wellness, and our government is hearing from a number of sources, whether it's administration, or from the wide range of medical practitioners, that the QEII is really at capacity and having greater capacity in Capital Health and executing more procedures, more surgeries across the province as our population ages. It really has hit me, since coming to the department, more than I had really given thought to as the Health Critic and as a person who has always had an interest in having a high quality of health care, access to health care, making sure that those universal components of our health care system are held strong in our province.


I had really no idea, in many ways, of that whole burden of disease, the whole impact of an aging population, those significant wait times that we do have to address. Every briefing that I go to in the department that relates to elements of care of our citizens, I come away realizing that it's not 10 years down the road, it's not 20 years down the road, dealing with the degree of illness that our citizens have. Some areas of the province - as the members from Cape Breton know - have a very high incidence of cancer and that's the kind of acuity level now that is filling our hospital beds, and trying to make sure that our citizens get the best care possible in as timely a fashion as we can is indeed an enormous challenge.


Making sure that our facilities and our hospitals are updated, and a place like the Dartmouth General is able to reach its capacity over the next number of years, are challenges for our government, but it's one that we're now taking a very significant look at. We'll see in the coming months where that project will fit our plans to make sure that access to quality care, and especially tertiary level, here in Capital Health remains very prominent.


MADAM CHAIRMAN: The honourable member for Sydney River-Mira-Louisbourg.


MR. ALFIE MACLEOD: Thank you to the minister and your staff for the opportunity to ask a few questions during the Estimates of the Department of Health and Wellness. First I'd like to start off by officially congratulating you on your position as minister. I think so far you've been very busy and I see you are moving around and trying to get a handle on what is a very busy department. We know that it takes up a lot of the resources of the Province of Nova Scotia and it's a very important department, indeed, for everybody who sits in this House of Assembly.


One of the things that seems to be a crisis in a lot of areas these days is nurses and the fact that more and more nurses are getting older and deciding to retire and get out of the profession. As we see that happening - I heard you earlier discuss doctor retention but I really wonder where we're going as far as nurses and hiring of nurses.


I know there are some great institutions here that provide nursing studies for people and they're coming out and CBU seems to be able to - all those students they put out seem to be able to get work at some point somewhere in the system so it just proves the need that is already there, before all of these other retirements take place. As the nursing population ages, I wonder if the department has a plan in place to address the shortages that will be coming in all hospitals right across this province. Some of the things that we've heard in the last little while in Law Amendments Committee talk about people who are thinking about moving out of the province. I'm just wondering where the department stands on that whole strategy of nurse retention and what the overall plan is and if there's any type of line item that is going to be put into that retention program.


MR. GLAVINE: Madam Chairman, I welcome the member for Sydney River-Mira-Louisbourg to the floor to ask some questions around health care. I know every member in the House could get up and ask questions about some elements of health care. He is right, nurses are such a significant component of the health care teams here at the QEII, the IWK, regional hospitals, our health care centres, collaborative care practices, VON nurses. We look at the many, many ways in which public health nurses have many different roles in health care delivery in the province.

The member is right. Looking at recruitment and retention is of importance to our government but also important to Nova Scotians, that they know that over the next decade we will have the complement of nurses that we need. The quality of nurses that come from the Dalhousie School of Nursing, St. F.X. School of Nursing and CBU, in fact, are second to none. There are many provinces that certainly are quick to welcome our grads.


I'm pleased to say that at the present time, based on the Class of 2013, we've retained 90 per cent of our nursing school graduates. I've only been to the one nursing school so far and that was at St. F.X. but I do plan to get to the other two schools. I was pleased when I was at St. F.X. to be guided through - the deputy minister and I and the team - to be guided through the department. It's an old, cumbersome building converted, Mount St. Bernard, which was the home or the residence for girls and the sisters for many, many years.


They've made do with the premises there but inside an old facility they are updating with simulators to make sure that their students get the best training possible - an unbelievably dedicated staff. They are so welcoming of the summer clinical program that many of their students engage in for four months over the last few years, and that number is rising.


It was interesting that the nursing students who guided us and the students we saw going through practicums are talking so positively about their future careers, the training they are receiving. I think as they get out and spend that third year summer - and I say summer, it's May, June, July and August - they're really getting the sense of the hospitals and the nursing place that they really want to start their career in.


Over the next while we have started to take a look at the nursing strategy, to make sure, again, - do we have more seats available, for example, or necessary to make available? We have seen, over the last number of years, that again we are training more physicians because the call was that many provinces had shortages.


I think we're able to respond, is what I would say, if that need for nursing training is there. It's a profession that is highly valued and regarded. When we do have a challenge like we faced here in the House this Spring and it points to a workplace that may need some improvement around staffing and finding a flexible way to make sure that staff complements and working environments are strong, that's all part of what we see as a robust and vibrant nursing strategy for the province. The commitment at the nursing school level is second to none to meet those challenges.


MR. MACLEOD: I want to thank the minister for that answer. I think the nursing challenges are going to be something that we're going to be witnessing for the next number of years in Nova Scotia so I would hope, and am fairly confident, that the department will be keeping an eye on that, but I think it is something that we need to keep a very, very close watch on.


I'd like to move on, if I could, Madam Chairman, to talk a little bit about - earlier today we had the minister talk about Mental Health Week here in Nova Scotia. One of the problems that I think I hear from time to time from my constituents and others is the perceived lack of services for children and adolescents when it comes to mental health services and the wait times that are put in place.


It's a very concerning issue because for someone that young to have those types of challenges and have to wait for weeks and sometimes even months before there's an ability for that person to get any kind of appointment, let alone actual treatment, is something that I think needs to be addressed. I think today when we listened to the minister speak about mental health issues and young people, I think it was a very telling thing, how important an issue this is in the Province of Nova Scotia.


Again I know from my own constituency, and I'm sure others have the same challenges in theirs, there just doesn't seem to be enough people involved in that. Of course they are our future so we need to be looking after them quicker than I think we have been.


I'm just wondering if the minister has any plans or any strategies within his department as to how they're going to move forward when it comes to dealing with the mental health of young people and adolescents.


MR. GLAVINE: To the member opposite, today he raises a very important question and observation, especially when we have a day when all Parties contributed to thoughts around providing strong mental health services in our province. I'm pleased to say that while there are deficiencies and some wait time issues, as minister I have put out, publicly, those wait times across the province. I think facing any deficiencies in health care, acknowledging them, is part of the pathway to see improvement.


One of the areas that has really drawn a lot of attention in our province is adolescent and youth mental health. It is a very, very different time for our young people and many of the challenges that they face in their developing and maturing years, there are many who need professional services or many who need supporting mental health providers in their communities.


I know I was critical of losing one of the strong programs, the ACT program delivered by the IWK. Because of the demand when we see suicides that have been very prominent in our communities and across the province and the number of traumas and the crisis response team and how often it is used, we know that we do have to address it in a different way.


I think as we develop more resources in our communities - and it's not where it needs to be, I'll acknowledge that to the member, it is not where it needs to be - I know that the Mental Health and Addictions Strategy has had a good number of its initiatives acted upon, in fact 28 of the 33 are in some degree of progress. I think it will take some time before we really see those kinds of results.

There are children who will come to the IWK; they'll get wonderful, professional treatment. However, sometimes when they go back to their communities, they don't have access to the level of professional care and help that they will need to continue their therapy, their support and professional counselling. However, doing more in taking some of the most immediate of recommendations for youth mental health in the province, Dr. Jana Davidson gave the IWK, and the department, and really the province, some of the smallest number but maybe most significant actionable items in the 14 recommendations that her report gave us. It was in the wake, in the aftermath of the Rehtaeh Parsons suicide but it was actually looked at in a more global sense to take a look at mental health across Nova Scotia.


It was interesting to see that we definitely had a couple of very strong initiatives going for us. When the previous government was in office, the SchoolsPlus program was initiated and now we're seeing the need to expand it. We're seeing it as a very viable program and one that even Dr. Jana Davidson in her review and in her working with clinicians around the province, were identifying moments of intervention, ways of intervening with children and adolescents who really could have gone in a different course and a different pattern with behaviours resulting in incidents that could have done harm to themselves. That's one of the programs you'll see in this budget year.


We are expanding, more guidance counsellors in our schools. I know one, and I'd have to check to get up-to-date, but a very top-notch clinician from the U.K. dealing with very specific adolescent maladies has been brought to the IWK, will be involved in clinical practice as well as training of other clinicians.


I believe now we're up to the training of 55 family physicians as part of a randomized, controlled trial. Many of our doctors have not had some intensive training and work in terms of early diagnosis with mental health conditions with our adolescents. Being on the front line, they are a wonderful avenue to that early diagnosis, early interventions that make all the difference. Many of us can probably point to adolescents who had a very entrenched mental health illness before any help came along.


We now know that our research is telling us that 70 per cent of many of the conditions that could be a condition with us for a lifetime, can be observed and diagnosed through the adolescent years and early 20s. Brain development and development goes on until about 25 years of age so in those years we can do a great deal in terms of making sure that we get the kind of supports for our adolescents.


One of the recent developments is through the Craigmore location here in the city. A number of the programs like CHOICES are all being brought together and this is seen as an advantage in delivering strong adolescent mental health.


While we have deficiencies that the member has pointed out, I think some very strong work is going on. Very often adolescents who have addiction problems, whether it's drugs or alcohol, there is also a very strong relationship to mental health issues and some of the programs in our communities that are getting underway, such as the Municipal Alcohol Project, is another strengthening of a larger number of resources that can provide the kind of supports and help in our communities.


I think that community model of care - I know in my community the Community Health Board has been doing a mental health tool kit. They started with adults; now in the same manner they are taking adolescents and giving them the mental health tool kit to support possible family members, peers that they will have daily contact with. Those of us in the House here who have had an opportunity, as the member for Pictou Centre, the member for Lunenburg, and a few others, who dealt with children on a daily basis came in contact with those who needed help. We all know that good front-line, community-based mental health care is one of the real strengths that the mental health and addiction services, over time, will put in place in our communities.


If that's sufficient for the member opposite, we can call it a start to a really important discussion. I know during my time as Minister of Health and Wellness - and we all know that wellness and mental health wellness are critical to good development of our youth, so putting that kind of emphasis over the next while with the kind of investment that will need to be made is part of continuing to advance what is already, I think, a strongly developed strategy.


MR. MACLEOD: I guess the thing I'd like to say to the minister is that time is not a friend of anybody who is suffering and challenged with mental illness. Although there are 28 recommendations started out of the 33, there is a reason why there are 33 recommendations. Resources are tight, but when we're talking about young people who need help and they need it now, I could only encourage you and your department to look at it with the quality that it needs as soon as possible.


I know of cases where there are some good programs offered at the IWK, but people from Cape Breton are asked to do those programs by phone. If you try to take a seven-year-old or an eight-year-old or a nine-year-old and put them on a phone doing some kind of therapy, we all know the challenge presented by that.


I know that the challenges of the budget are there, but I also know that the challenges for young people are getting stronger and stronger with the way our lives are and the way in general how our lifestyles are. I could just encourage the minister to really emphasize this over the time that he is the Minister of Health and Wellness in this government because there is nothing, I think, that you could do that would help this province more than to put the emphasis back on our children and make sure that their mental health is looked after and is something that they can move forward and be active and positive people in our communities. They need our help, we need to give them our help and we would like to see you do as best you can on that level.


I'm going to move on now to another source that the minister knows is kind of near and dear to my heart. I'll make the disclaimer now: my wife has MS, so when I ask this question, some of it is self-serving, but there have been a number of people who I've met across this province because of that who have MS. I know when the Minister of Finance and Treasury Board sat on these benches she was very passionate in her discussion about where we should be going and what we should be doing when it comes to tackling the issue of MS.


I'm just wondering if the minister could give us an update as to where the department is when it comes to MS, the CCSVI treatment and the testing that's going on. I do know that there have been some negative comments on some of the tests that have been out there, but I would really like to know where Nova Scotia is and what Nova Scotia is doing for those people who have MS, because we in this province have one of the highest rates of MS in the country. I would ask the minister to see what he can do to address that question.


MR. GLAVINE: I know how passionately the member opposite spoke in the House in the past about the need for support and a range of services for MS patients. At the present time, the province has placed a very strong reliance on the national research. I know with the liberation treatment in particular, taking a look nationally at those results, we know that there has also been the introduction of medications, pharmaceutical products that have helped some MS patients more with the symptoms that they have.


At the present time, the province hasn't been doing a tracking of those who went out for procedures. We're tied into the national analysis and research that is going on. We know there is an opportunity annually for patients to come. I know many come from around the province for a workup, to take a look at how they are working to manage MS. We know that some of those interventions are helpful, but we know, again, how debilitating MS is for those who suffer from that disease.


I know that's not a full answer for the member and it's one that - I haven't been over to meet the clinicians who deal with our MS patients, but it's again one based on my own community and several who have MS. It's one that, as minister, I hope to become more familiar with and take a look at our program here in the province and make sure that we are supporting our MS patients as fully as possible.


MR. MACLEOD: Madam Chairman, I want to thank the minister for that answer. I guess I'd like to go one step further, though. I'd like to ask the minister if indeed he would go back to the department and get a report as to where we are within the process. This has been going on now for three or four years that we're involved and we're tracking and we're moving. I think the MS patients across the province would appreciate an update as to where the Province of Nova Scotia is and how they're going to react to that.


It's interesting you talk about the drug therapies that are in place because just on the weekend, I happened to be at a home show, my wife and I, and we ran into a gentleman there who has MS. We started talking and his concern about his drug therapies that he was getting through his drug plan was that he was told that when he turns 65 and goes on the Seniors' Pharmacare Program, those drug therapies would no longer be covered.


I would ask the minister to also look into that because that would be devastating for anybody with this disease to find out that when you are 65, somebody has said - oh no, you can't get that anymore. I know from our own personal experience that these drug therapies can cost thousands and thousands of dollars. If you are on a fixed income and on a pension and you are struggling as it is, to have that extra cost and that extra strain put on you, it would not be something that would be healthy.


I know that there are constraints within our program, our Pharmacare program, and it's costly, but there's also a great cost when these people end up having to be hospitalized and get treatment there. So somewhere along the line, we have to be there to give them the support; if the support isn't through CCSVI, as least the drug therapies that have been recommended by the doctors who are giving them the care and the neurologists who are trying to help them out.


I wonder - and I don't think the minister would have an answer right on the tip of his tongue, but I'm sure that he has some thoughts about what I've just mentioned and I'd like to hear those if I could, Madam Chairman.


MR. GLAVINE: Madam Chairman, I thank the member for pursuing this in a little stronger fashion. First of all, currently there are 806 registered in the province and getting clinical support for multiple sclerosis. That investment by the province amounts to $12.8 million. So the member is right; any kind of medication and drug therapy is very expensive. As a neurological disease, there are different responses by different people, as the member well knows.


The second point I would make is that there does seem to be some anomaly with the MS sufferer that he described and not getting the coverage that he needs. (Interruption) That's right, when he turns 65. We will take a look at that to see if it's information that is perhaps not quite what he needs, we'll make sure that that's conveyed.


But also, the member is right; very often, we give kind of a State of the Union address, but there are people with diseases who are constantly looking at - is there something more that will support? Are there some developments that are taking place? Giving an update here is one that I will commit to the member to give an overview of what is taking place in the province and what information the Department of Health and Wellness has in terms of MS. While the province is obviously committed to care by providing $12.8 million to the 806 recipients, I'll give that broader view of what the programs do entail.


MR. MACLEOD: I want to thank the minister for that commitment. I think that those 806 people that we're talking about, and many more that are in our communities that probably don't even realize at this point that they are affected by the disease, will be glad to get a better understanding where the Province of Nova Scotia sits when it comes to this issue. It seems strange for me right now because this is twice tonight I've used this line, but time is not a friend of those that have MS. The quicker we can find and talk to people and find out where we are and what we can do for them, the more chance we have that people who are suffering from this disease will have an opportunity to get better.


As I said earlier, because my wife has it, I've had an opportunity to meet many Nova Scotians from across the province, and actually many people from across Canada, who are suffering from this very serious disease. It strikes and it's not a friendly disease. It can happen to many different people in many different ways. The minister was so correct when he said the effect of the disease is so different. It's like when people talk about CCSVI and the treatment and cleaning out the veins that you go from one end of the scale to the other as to the effectiveness of that treatment. But if you look at people who suffer from the disease, you'll know that indeed that's how it affects people.


There are people who have a tingling in their hand and there are people who have no mobility left because of the challenge that the disease is. So it would only stand to reason that the therapy that is used to treat that would also have different effects depending on where the person fit on the scale. I do know a relative of mine, a cousin, who woke up in the morning and had a tingling in her hand, and by suppertime was paralyzed from the neck down. It was a very fast-acting type of MS. So when I say time is not a friend of people that suffer from MS, I say that with a little bit of surety.


My wife and I were fortunate enough to be able to see her get the CCSVI treatment. It has made a difference in her life, in the quality of life and in her strength and endurance. That's what it's all about; it's about doing what we can. So whatever the minister can do to make sure that people who suffer with that very mean disease - let them know where the province is and what a future plan might be because if we sit down as a group and we talk about how we can move forward, I think that will serve a number of Nova Scotians in a good way. I would love to be able to stand up and herald the minister for the work that he has done on this project, because I think it has an impact on a great number of people.


As I said, I'm a little bit selfish on this one because I've seen what it can do to somebody. But I've also seen other people who aren't as fortunate and don't have advocates who can help them when it comes to this disease, so it is something that I hope that we can see a little more of and talk a little more about as time goes on.


At this point, I don't think I can go any further, so I'm going to turn over the rest of my time to the member for Northside-Westmount.


MADAM CHAIRMAN: The honourable member for Northside-Westmount.


MR. EDDIE ORRELL: I'd like to thank the minister in advance for taking some of my questions. What I'll start with, I guess, is an area that I've been quite accustomed to working with over the years until I changed careers. I noticed that in the statements that we've gotten, the hip replacements - there is a 17-month wait in the province. I know that some surgeons don't want to do surgery on people who are a certain age and some people don't want to do some on a certain lifestyle, but I know myself, who is waiting for a hip replacement, it comes down to a quality of life thing. I guess my first question is, there is a 17-month wait-list. Can we get a breakdown on how many patients that actually entails and where the largest region of the province is that has the biggest wait-list?


MR. GLAVINE: To the member for Northside-Westmount, I'm pleased that he's joined the questioning, discussion and debate here this evening. As I said earlier, every member in the House could get up and ask questions around health care - I'm certainly not encouraging my caucus to come at me as well, but that being said, the member asked a really good question around orthopaedic surgery, orthopaedic wait times. I'm hoping it will be a very different day in a few years' time in terms of the wait time for hip and knee replacement.

We have really struggled with this in the province. We've heard the statistics, one again here tonight, around 17 months. If it's very specialized foot and ankle surgery, we know that the consult is much, much longer - five, six years. The surgical time is a bit shorter than hip and knee because we have the one surgeon; he basically doesn't put people on a long wai- list for surgery, but rather tries to connect his consult with his surgical times.


This year, which will be the first of a number of years now, our investment in more surgeries, an additional foot and ankle specialist, will be one of the avenues to attack the long wait-list. It is my understanding that we actually have the longest wait-list in Canada. Capital Health and the Valley District Health Authority, of the four sites that do hip and knee replacements, have the longest wait time. The Aberdeen and Cape Breton Regional have shorter wait times.


With this investment, we will be able to see some of the smaller procedures done in some of the other regional hospitals like Yarmouth, Truro, Antigonish. This will help to alleviate that particular wait-list in those areas, which will then allow, hopefully, for more surgical time at the four centres where we have the hip and knee replacement surgeries taking place. It's a moment where I actually need to commend the orthopaedic surgeons for coming together as a group to say they want to be part of reducing this wait time that we have struggled with. They're prepared to see, facilitated by the one provincial health board, they and patients could move across districts in terms of providing service. We will see in the coming months that more surgeries will be done, hopefully, in all of the centres. The surgical theatre time will be available and we will go head-on with that wait-list.


I think it's the beginning of what we will see in time, an improvement because as the member knows - especially for people who are out of the workforce because they can no longer stand on the floor of their work site because of the pain they're experiencing. So to get them back in the workplace as quickly as possible has to be one of the goals, as well as seniors whose lives go into a holding pattern because they're in pain, they're trying to manage their pain with an array of painkillers. It's an area that I'm pleased to say our government has made a very strong commitment to making a change in those wait times.


MR. ORRELL: Thank you for that answer. I guess my next question is - the problem most surgeons today will tell us and tell myself is the wait times for surgical time. I guess OR time in the hospital is a competitive thing. I know the Cape Breton District Health Authority has five very good quality orthopaedic surgeons. A lot of them have specialties that they deal with - one's a shoulder specialist, one does more hips, one does more hands or knees and so on. They are competing with thoracic surgeons, general surgeons, for OR time. The specialty of the nurses that are able to take place, to work in the ORs, and the ability to clean the instruments in between surgical procedures or have enough to do the procedure so that the time to do it is there and they can do it quicker.


The minister talked about people going within different jurisdictions because of the one district health authority. I believe that you're able to do that now, within reason. If we could push those people through, because the OR times are greater, will other OR times suffer because we're trying to improve the orthopaedic standards? If not, with the amount of beds we have in the hospitals today, the amount of beds that have been closed because of nurses and because of the inability to house people in our facilities, if we're able to do more surgical procedures in other surgeries as well as orthopaedic surgeries, where are we going to put those patients for one, recovery, and two, post-surgical care?


MR. GLAVINE: Thank you to the member for Northside-Westmount. He makes several really good points here. I want to say first and foremost that putting in place a provincial plan for orthopaedic work is going to be one of the real enablers to reduce the wait times as we do work across the traditional nine districts in a stronger fashion.


I wanted to point out the basic premise that we need to keep in mind here as to whether other surgeries may get shunted out of the way. We currently in Nova Scotia have 97 per cent of our surgeries within the directed guidelines for the Canadian standards, so we're at a very high rate there.


It's really a matter of finding not a great deal, but an amount whereby if we were to take our surgeons and each one were to do another or two procedures every week, even with the aging population, we would start to, I think, see the kind of results we all desire.


I know a couple of the e-mails that I had when we had the disruption of the wildcat strike day and then the legal strike day, there were orthopaedic surgeries cancelled and being cancelled for people who were waiting nine, 10, 12 months. That's a day that they'll remember and now their surgeries have been put off for some time in the future. That is the one message that I think became clear to all of us, that our senior population wants a zero disruption in the health care system. That is very, very strongly impacted on all of us.


We'll get those numbers back on track again. I believe one of the - as the orthopaedic surgeons came together, there was a discovery that in, for example, one of our hip and knee replacement sites, there's actually a month in the year in which little or no replacements took place because they did their summer holidays in unison. So if we could keep some of them going through August and having surgeries done through that period, which is generally a slower time, I think those are the kind of accommodations that the orthopaedic surgeons have agreed now need to change. Really, the orthopods are giving us the plan and the answers. With our investment and our commitment to change the wait times, I think we'll see some pretty strong results because we're enabling them to put their plan into effect.


MR. ORRELL: Thank you, Mr. Minister. I guess the other part of that question I asked was that after surgery, people do have some amount of recovery time. Those recovery times have decreased over the last number of years as the surgeries have become better - they're using better equipment, better procedures. The time in hospital has decreased, obviously.


But if we're going to increase those surgeries, we're going to need increased beds to handle the patients post-OR. Plus, the ability to do their physio and their OT and whatever other follow-up they need to do on a rehab unit or a restorative care unit is going to have to improve or increase.


I guess my question is, is there money out of that $4.2 million that is going to be allotted to allow the hospitals to open more beds and hire more nurses and/or physios, OTs, et cetera, to enable them to accommodate the increased workload that they're going to have to take on?


MR. GLAVINE: Looking at a breakdown of the $4.2 million investment this year, $800,000 will go for additional allied health professional staff, case management staff, equipment or operating costs for additional volume, pre- and post-operative additional costs.


I think that's going to be part of that whole process. As the member opposite - I think he may have a close association with somebody in the orthopaedic community, so he is speaking from a knowledge base here that I am quick to recognize.


One of the other developments in this area that I find very fascinating is that what had been a guaranteed week-long stay in hospital, in some cases now is down to 48 hours. I know there are some U.K. orthopaedic surgeons - I find it hard to fathom, to be honest - seeing knee replacements as a day surgery. It's something that I find kind of difficult to comprehend when you look at that kind of invasive work.


Nevertheless, less time in hospital is a reality. This is where I was really pleased to hear and to see, in some cases, where the smaller community hospitals, especially the regional hospitals where the surgeries are not done, prepared to take patients back in a quicker fashion as well because again, the $800,000 will support them coming back.


The other recognition by the orthopaedic surgeons, which again I was pleased to see, was surgeons realizing that many of the people who are getting orthopaedic work done are elderly, absolutely. For example, I know some of the surgeons in Kentville now will go to South Shore and to Yarmouth and spend a day doing procedures. This is taking pressure off a busier regional hospital, going to Yarmouth and getting some of the smaller procedures done in a quicker fashion. There's really a very coordinated approach, even down to sharing on call during the weekend to deal with the hip fracture and the replacement as the result of a fall or some trauma.


This wonderful coordinated effect of 22 orthopaedic surgeons I think also stands as a model. It really is just part of the surgical plan that we will see for the province and it really is going to be one of those significant changes for seeing greater distribution of surgery right across the province. Knowing what that plan now is starting to look like as the pieces come together, it will be welcome in Yarmouth, in Amherst, in Antigonish and our regional facilities.


MR. ORRELL: Thank you, Mr. Minister, for that answer. I do agree that post-surgical times have decreased secondary to the skill of our surgeons who are now I'd say second to none in the province and I will throw out a hee haw for the surgeons in the Cape Breton District Health Authority because as a physiotherapist working with them, I did find they do exceptional work. And yes, with the right patients . . .


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


The honorable 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 now rise and report its business to the House.

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