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April 14, 2014
House Committees
Meeting topics: 
CWH on Supply (Health) - Legislative Chamber (1279)











4:40 P.M.



Ms. Margaret Miller


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


The honourable Acting Deputy Government House Leader.


MR. GORDON WILSON: Madam Chairman, would you please call the resumption of the estimates for the Department of Health and Wellness and the Department of Seniors.

MADAM CHAIRMAN: We will resume the estimates of the Minister of Health and Wellness and the Minister of Seniors.


The honourable member for Sackville-Cobequid.


HON. DAVID WILSON: Thank you, Madam Chairman. I want to welcome the new Minister of Health and Wellness, a little exchange of hats this year, but I'm pleased to stand today to start our caucus' estimates on Health and Wellness.


We all know that health care affects every Nova Scotian and it is the most important department, no matter what the other ministers say and what the Premier says. I think the minister will agree with me - I believe it is the most important department within government because so many people rely on the services provided throughout Nova Scotia.


I'll get right into it. My first question to the minister is around Bill No. 144, which was brought to the floor of the Legislature a number of years ago. I was just wondering, could the minister update us on the proclamation of that? I know the bill was passed and then regulations had to be created. I'm wondering if the minister is still committed to that piece of legislation and bringing forward the regulations. That was Bill No. 144, the Insured Health Services Act back in 2012, and it was going to take some time to create the regulations.


I know the minister supported it at the time, so I'm just wondering if he could update the House - does he continues to have support for that and when would we see a proclamation date?


MADAM CHAIRMAN: The honourable Minister of Health and Wellness.


HON. LEO GLAVINE: Thank you very much, Madam Chairman. I am pleased to have this opportunity to respond to the member for Sackville-Cobequid and also a former Minister of Health and Wellness. We've been colleagues here in the House for quite a number of years so I look forward to his line of questioning today and areas that he will explore.


Yes, Bill No. 144, when it came before the House, was supported by our Party. It was pretty comprehensive, almost like an omnibus bill in terms of the provisions that it was going to be requiring that we put regulation, and in fact it was a bill that was very strongly in support of universal health care - that probably was one of the themes that was overriding the piece of legislation.


It's one of the areas - and we are not too long, I guess, along in our mandate to have our policy and planning person, Tracey Preeper, who has been tasked to bring that back to our government now and to make sure that we give it an opportunity for review and to see what form it will take over the next number of months.


I guess, as the member knows, we've brought a mandate letter, as all Parties do, to the Department of Health and Wellness and while it was not specifically directed in our letter of mandate, again I think it's a piece of legislation that has a lot of merit and one that I can commit to the member opposite today that we will have something to say as to what kind of timeline - I know the timeline is what is important here.


It was one of those bills that we felt was very much in accord with a lot of our policy and positions; however there were a couple of the asks in the bill that we felt would need some change and refinement from our perspective, so I will give the member for Sackville-Cobequid an update, in the not too distant future, on where we lie with that.


MR. DAVID WILSON: I don't know if I heard yes we still support it but I did hear - and I know the minister stood for some time on the bill when it was introduced and right off the bat commended the government for bringing it forward and there were a number of concerns. I hope, after I ask my next question, the minister will say yes, I support the essence of the bill. I understand that he had some concerns or some issues that they would expand on.


I think it's important. That piece of legislation recognized that Medicare is our system of publicly funded health care in the country and I think it reflects the values the Canadians have, and we don't have to go too far to hear how important Medicare is to our province.


I'm glad to hear that from the minister. I will continue to come back and ask him when, because there has been some time, I know there was work ongoing when I was in his position to get to a point where the proclamation could happen.


My next question revolves around that and it has been an issue for a number of years now across the country. Just last week at the end of March, March 31st, I had the honour to attend a rally here in Halifax that really wasn't a good-feeling rally because it was the end of the contract that the federal government had with the provinces and territories when it comes to health transfers to the provinces and to the territories across the country.


We all know, Madam Chairman, I think, and Nova Scotians should know that for a number of years we had a health accord in place that was negotiated between the provinces and territories and the federal government. Unfortunately, under our government the federal government decided not to take that similar course on negotiating with the provinces and territories, even though the Ministers of Health across the country were talking and trying to engage with the federal government, the need for a new accord. We saw the federal government, through their Finance Minister, impose what the new agreement would look like.


I'm wondering if the minister could maybe give me some details or just a little bit on what his support is for insuring and trying to make sure the federal government understands that our province, for example, Madam Chairman, will get less money in the future due to the population of our province. The new agreement does not in any way look at what our needs are in the province. We all know the demographic shift that we have here in the population; our population is getting older, which means they will utilize the health care system more, and for us to have an agreement that doesn't reflect that hurts the smaller provinces like Nova Scotia.


I'm just wondering if the minister could give me a few comments on what he will do to try to - well, it would be nice, one, to change the agreement we have. I know it would be a federal issue and I'm not sure what his federal Party stance is on it, but I know our federal party has been very vocal in saying that we need a new agreement. We need it to reflect truly what the issues and the concerns are of the provinces and territories. What we will see the future will be more money going towards jurisdictions like Alberta that have seen a spike in population due to workers going to work in that province, and those workers who are going there are younger and they tend to utilize health care system less


I know, and I've talked to many who have made the decision to go out West, that if they become sick they come back to Nova Scotia and we are left supporting them in our health care system. I wonder if the minister could reassure Nova Scotians that he will continue to stand up and fight for a better deal for Nova Scotia when it comes to the health transfers that we get from the federal government.


MR. GLAVINE: Madam Chairman, through you to the member - he asks a very timely question, raises a concern that is starting to pick up greater momentum in our province among all those stakeholders and people knowledgeable about the health accord and also, in particular, our neighbour provinces and many others across the country, maybe with the exception of Alberta and maybe to some degree, Saskatchewan.


Essentially it was one of the very first questions that I asked when I arrived as a Minister of Health and Wellness, and Minister of Seniors - whether or not take a trip to Ottawa just to address the new health accord, which started in place on April 1, 2014. I had a concern right from the very beginning that while it was going to disadvantage us in the amount of money that it was going to provide, as the member pointed out, it no longer took into account the population profile that we have to contend with and we're challenged daily in terms of providing the amount of health care, timely health care for our citizens and especially our seniors and those who are in the queue in long wait times, which we are certainly challenged to constantly address.


To that end, I was told to put it into something we could all relate to and the word I got back on several fronts was that this train has left the federal station, and because the accord was so far along, there really was not going to be a change. As a result, as soon as the House recess occurs, I will be getting together with our three Atlantic Ministers of Health

However, that does not diminish the fact that as Minister of Health and Wellness, and Seniors, I need to find other ways, present to Ottawa timely projects that our province has now embarked, on and that with some additional targeted funding from Ottawa we could make one of several projects advance along on a much quicker and sustained timeline. There are any number of projects, but there are certainly four or five that I feel very strongly about that could easily qualify for getting federal funding and I will mention a few of those.


As I reached out, and actually as a couple of the Atlantic ministers reached out to me, they said there is probably no greater time than now for us to operate as an Atlantic region as we approach Ottawa in terms of health and wellness. So we are going to work on a common front and we will do kind of a one-two or a one-two-three ask and hopefully that will get some realization in the months and years ahead. I look forward to that because I think here - and the member not having left the office very long ago is also very much aware of two or three projects that would really make a difference in our province in terms of the quality of health care that we can deliver.


I hope to have this addressed, well-researched and may even have an opportunity to open that door of communication with the federal minister in May when she will be coming to the province, again for an area where I know they will certainly announce some money and that is in one of the research programs.


When we talk about losing between $90 and $100 million annually from federal transfers, it really has many different impacts - it is going to impact on our research dollars; some of the work of CFIA; and some of that social transfer part that looks after general requirements of health care in the province. But that impact of roughly $93 million - is what I've been hearing - is going to have a pretty immense impact for our province, and it starts to come downward from this April 1st on.


So when I approach the federal minister I certainly look at the need for a dementia program in our province, and again perhaps federal funding could really enable us to put a first-class program, one that - we are the only G-8 country that doesn't have a dementia strategy, so we're very deficient in this area. While we have some very good things going on in our province, we don't have that comprehensive, coordinated, and major singular thrust towards assisting families dealing with dementia, both in early stages at home and later stages in nursing homes. We know now that there is a lot of evidence, a lot of research that, in fact, we can keep our seniors in their homes much longer if we had the kind of supports and programs in place that are becoming very well defined. I believe that is an area that, if we had some federal funding, we could really move this forward, march it forward, in very strong terms, in a very, very short period of time.


The member opposite is well aware of the need for an electronic medical record. This could be an area, for example, where some targeted funding from Ottawa could really help us advance and be one of the first provinces that would have that electronic medical record for our health care system. That would be a wonderfully enabling instrument and more and more I hear our medical practitioners talk about how they wish for and hope to be still in the system when they finally have a fully integrated, one-patient, one-record system.


I even hear from doctors who know and are very much aware of the outcomes of surgery, outcomes of cancer care treatments, but they would like to see a little more of a glance and a view, over a long period of time, of how patients do, and access to that one record would give them those kinds of insights and the kind of review that they would like to have about a patient five, eight, ten years beyond the contact that they had with their specialty area.


I thank the member for that question and I do want to assure him, and members of the House, that I will have some very targeted and directed asks of Ottawa, when the first Health Ministers Conference comes around. In the meantime I will use my opportunity to ask the minister, when she makes her first visit to the province as the Health Minister, I hope to put on the table and open to conversation at that time what some of our needs are. As the member has rightly pointed out, the profile of our population is very different on many fronts compared to Alberta. While we would get about $100 million less a year, Alberta is now in line for $1 billion more every year from this point forward.


I feel very strongly that there needs to be some re-examination of how the federal government can assist our province and others who are tackling the demographic shift that's so very real in our province.


MR. DAVID WILSON: Thanks to the minister for that comment. I think it's great to hear that the minister will be going after the federal government on new initiatives and trying to get those covered, but I hope - and I think I heard this - the minister continues every time he has a chance. Don't let the federal government off the hook on this one - it is going to be a huge challenge in our province and our neighbouring provinces as we move forward with trying to provide the services to our residents, when we see an agreement that we are going to lose in.


The minister stated it right; it's somewhere near $93 million. Alberta, for example, will increase over $1 billion. I have to say that even the minister from Alberta at the time when this decision came down without the negotiations component of it said it wasn't a real fair way of doing things. Here's a minister who was probably quite happy going back to his Department of Health saying we're going to get more money, we'll be able to address more of the issues. Even that minister said it wasn't a fair way of doing it and I hope the minister opposite continues to make sure that the federal minister knows that it was unfair for our province and there are going to be challenges in front of us.


The thing is with the federal minister - and I know we have a new federal minister, Madam Chairman, but the previous minister - one of the things that all the ministers across the country appreciated was the fact that she would sit down with the provinces and territories, that when we had our federal-provincial-territorial meetings, the federal minister was at the table. But that's not where this decision came down, it came down through Finance.


The discussion over the last number of years has been the download that we're seeing from the federal government. It didn't come from the federal Minister of Health; it came from all their colleagues - it came from the Minister of Veterans Affairs, who is looking at getting out of the business of supporting veterans services; we've seen it from the Minister of Immigration, who felt it was time to cut immigrant health programs that the federal government funded; and then the Province of Nova Scotia had to make a decision at times to support those services. There were many others, Madam Chairman, and I don't think they're going to stop.


I know how difficult the job will be for the minister and his department to evaluate those downloads that we continue to see from the federal government. Having an agreement that doesn't reflect that, I think they need to be reminded at every step of the way.


That's not the only download, Madam Chairman. We know that with CETA, for example - that's the new free trade agreement with the European Union - that there are winners and losers in different sectors with that deal. There are populations and organizations in Canada that will benefit from that type of free trade agreement, but there are other areas that will hurt the provinces.


One is in the extension of patent rights for pharmaceuticals or pills. That's going to add some time that companies that create new medication can have to recoup some of that cost that they put out through the research and development process. I think the last number I heard at one point was somewhere to the tune of $100 million across the country. I believe that we'll see an increase. What that would mean, Madam Chairman, is that for example, if a new drug came on stream, that company, whoever makes it - let's say it was Aspirin for example, or Tylenol - they're allowed to have the opportunity to sell that product and recoup some of that money.


But with the new CETA agreement, they'll be able to extend that. One of the savings, or the way we get savings in the provinces and the territories is to be able to move to a generic form of that medication. Those drugs are usually at a higher cost - the brand-name drugs - so the sooner we can, as a province, get into purchasing generic drugs, we save money. We've put a lot of work in over the last number of years, and the country, all the health ministers and the governments across the country - the provincial governments, that is - have put a lot of work in to trying to get that cost of pharmaceuticals down for the residents of our provinces and for the actual government because governments purchase a lot of medication. So we're going to see an increase in that or a time where we're going to have to potentially pay more for drugs, and that's a huge cost for Nova Scotia. I'm not too sure where we are with that.


I'm encouraged to hear the minister talking about regional co-operation. That's something that is extremely important, something that I know that I was trying to move on in the last couple of years that I was minister - especially with our neighbouring provinces. We know, for example, that the 811 system is now being utilized by Prince Edward Island - a great opportunity for them to not have to reinvent the wheel in trying to meet a need for the residents of Prince Edward Island. Of course, they came on board and are piggybacking our program here.


There are a number of other ones over the last number of years. I know we were speaking on and having some discussions with New Brunswick, for example. We know - and I think Nova Scotians, some may not know - the leading role that we play here in Nova Scotia when it comes to health care services. Our QE II is the tertiary care hospital. It's kind of the go-to place east of Montreal, for New Brunswick, P.E.I. and Newfoundland and Labrador.


We provide a lot of services here. For example, last week and weeks before, we were talking about labour disputes. It doesn't just affect Nova Scotia - it affects other provinces. I know that for quite some time - some of those agreements had been in place for a long time, and I'm wondering if the minister could advise us if they've been trying to update those agreements to ensure that the costs that are incurred utilizing our system for other jurisdictions like New Brunswick and P.E.I., that we're recouping some of those costs. The taxpayers of Nova Scotia shouldn't be paying for the surgeries that people from Prince Edward Island, for example, come here and get.


One of the things never really recognized was the fact that we had all the overhead costs, for example the maintenance on the hospitals, the clinics. Of course there is a fee to every procedure that is charged, but I think there wasn't a lot done on making sure that we here in the province get that cost recouped from other jurisdictions. Maybe the minister could answer if there has been any recent work done to ensure that they're paying their fair way when it comes to the services that our hospitals here in Nova Scotia provide to other residents outside of Nova Scotia.


MR. GLAVINE: I'm pleased to speak to this issue. It's one that - I guess for our government we're in early days, but work from the previous government needs to be picked up and advanced.


Just to, first of all, speak to the area of procurement. I believe this is one of the areas where we have made some progress over the last couple of years. We're now talking about a cumulative impact of procurement of around $6 million on an annual basis. It's an area that, in fact, as I toured around the province, there were occasions when different practitioners and clinicians talked about ways in which we could even do a much greater amount of savings.


One of the areas I was interested in especially, since part of our plan is to do more orthopaedic work and attack one of the worst wait times in the country - there was talk of our province in fact using five or six different implants just on that one area. If we were to now examine what, in fact, may be the best one, two implants, and again buying across - especially for New Brunswick, Newfoundland and Labrador, and Nova Scotia - procuring together we in fact could perhaps get better contracts just in that one area that was pointed out to me. It just really opens up the door for so many other areas that we can move forward with.


I know in terms of the services provided, and when we talk about the IWK - and I have had this conversation with the both with the CEO and with the financial officer at the IWK - there are some of the services that are provided that really do need an intensive look around what the compensation currently is. Some contracts have gone on for some period of time and there are some of those, and especially some new services, that the IWK - and I'm sure it probably is no different at the QE II, except that I haven't really asked about that area. I know it's one that the financial officer, Allan Horsburgh, is quite concerned about. I think we'll see some movement to make sure that while we provide the services, adequate compensation also needs to be put in place so that we are not in a handicapped position in delivering those tertiary level services in particular.


So it's an important area that the member from Sackville-Cobequid asks about and one I think that since now we're going to work and try to operate in a much more integrated fashion around procurement and around asks of Ottawa, I think we'll see this area explored to a much greater extent.


MR. DAVID WILSON: I'm glad to hear that, it's important to make sure that our neighbours are involved with sharing services but also paying for that. I want to be very careful - I'm not saying let's go and make money on this, especially where my wife comes from Prince Edward Island, as she'll have me answer that if I'm saying let's charge P.E.I. more. But fair is fair, and I think both ministers, over the years that I've engaged with them, recognize that as we move forward we need to continue to look at that.


I mentioned the 811 with Prince Edward Island. I know in more recent months, maybe in the last year or so, the minister from New Brunswick had some preliminary discussions with myself around, potentially, a regional trauma team. I'm wondering if the minister or the deputy minister could give some information to the minister if any work has been done or has there been any request from the New Brunswick Government about creating a regional trauma team? Most of the time those traumas end up in Halifax, and we can share those expenses.

MR. GLAVINE: I know this is an area that while the member was in the ministry, was very much a part of not just his interest, but he saw value for our province and money saved if in fact we can do a pretty significant level of co-operation. We know that, in terms of dealing with a regional trauma team, because we can be involved in the airlift of patients coming into the QE II in particular since we are a significant transplant facility here. The kind of, again, co-operation from really the four Atlantic Provinces on some occasions, but in particular our three Maritime Provinces, a high degree of not just co-operation but also the financial sustainability of the helicopters and the fixed-wing aircraft that can be part of our regional trauma response.


It's not an area that I have had any briefing on other than to say that it continues to be work that is ongoing in the department, but, again, another one of those areas that perhaps having duplication of services. In fact, if we have this regional trauma team, there can be advantages both on the medical front as well as the financial front, and any time we have win-win situations among our Maritime Provinces, it is a better day for health care in our area.


MR. DAVID WILSON: I'm going to get into some of the line details in the budget. I'll be using the Estimates and Supplementary Detail book. I'm going to continue on the same area around emergency health services. We know, and I think Nova Scotians know, how important it is to have and continue to have, I think, one of the best emergency services in North America really, Madam Chairman. I know it's a big part of who I was and continue to be, so we'll start there.


I'll go to Page 13.6 of the supplementary information. I look under Programs and Services, and I notice one of them that caught my eye was around Medical Quality Control, and medical quality control, no matter what area of health care, is extremely important. That's an area where there is oversight on the services provided by our health care providers to the public, and it's extremely important.


I noticed in this year's budget there's what I would call a significant decrease. I have to remember that we're dealing with Health and Wellness and there are always a lot of extra zeroes, but if I read it right, I believe it's about - is it $200,000 less? I believe it is $200,000, if not more. I mean, the estimate was at $1.2 million, I believe, and we have $776,000. I believe I'm correct on the numbers and it's not - so it's going from estimates in 2013-14 of $1.2 million down to estimates for 2014-15 to $776,000. Can you provide any detail on why such, in my mind, a significant change in the dollar amount for Medical Quality Control?


MR. GLAVINE: Madam Chairman, I know the former minister, having gone through at least one budget, I believe - maybe two, but one for sure - he's aware that sometimes dollars remain there but, in fact, will be designated into another program. The major part of that decrease is to move budget for the paramedic college to provincial programs. So that's where the most significant amount of those dollars will now show up.


MR. DAVID WILSON: Also, just one line item up, the Ground Ambulance Operations estimates of 2013-14 were $1.3 million, and it will be just above $1 million, so I'm wondering if that's the same. I can do the math here, but it doesn't look like it would add up to the same, but where would that decrease go - was there a saving on ground ambulance operations from last year?


MR. GLAVINE: First of all, Madam Chairman, I did want to point out in the estimates, Programs and Services on the ambulance subsidy, Ground Ambulance Operations, Medical Quality Control, Provincial Programs, that overall we have moved from $119 million to $124 million. So there is, overall, an increase, and inside the budget there are some changes and the one that the member asked about in particular reflects a one-time savings on the lease arrangement with the defibrillator program.


MR. DAVID WILSON: I will just keep going up - I guess I should have started up and gone down, but that's okay. The Ambulance Subsidy - Payments - if I recall, that's the money recouped from the fees from ambulance services? Is that correct or am I - I'll probably find that somewhere else? I know there is a user fee of about $140. I'm just getting maybe some clarification on Ambulance Subsidy - Payments. We've seen a bit of an increase, but could the minister explain exactly what that subsidy is?


MR. GLAVINE: One of the areas that is reflected in that change and increase - of course we know that a new contract was negotiated, so wage increase - the contract wage adjustment for paramedics - and the contractual increase of Emergency Medical Care, EMC Inc. Those are two of the areas that would be reflected in that line item.


MR. DAVID WILSON: Thank you for that. I read through this and I couldn't find out where I would find that information, but there was a program brought in for low-income Nova Scotians to write off or request to have their ambulance fee reduced or eliminated in total - do you have a cost or a total of what that was from last year?


MR. GLAVINE: It's a program that in fact I gave some information, to an inquiry, on this just a few days ago. One of the questions asked was: Did we consider it a significant uptake on this particular program? I guess those who were taking a look at it thought it would be substantially higher, but as the member opposite would know, it was income-based so there were criteria that did have to be met.


I also, when I looked at it, I thought there would have been a higher usage, but I think it was in the vicinity of about half a million dollars that was written off when Nova Scotians asked to have a waiver of the ambulance fee because of their financial challenges.


As I stated - and maybe the member during his time as a paramedic maybe heard people say, look, I was sick and I really should have called an ambulance, but I didn't feel that I could pay for the ambulance. It really is a position that we should not put any Nova Scotian in, where they have to think about whether or not they're going to call an ambulance because they may not be able to pay for the fees. This was the whole idea of this program.


One of the areas that I know, as minister now, I will do a review of this program because it is relatively new and, again, perhaps educating Nova Scotians that this program is available to them may need some additional work to make sure that all Nova Scotians are aware of that fact.


While we are looking about half a million dollars this year, it does reflect a lot of ambulance calls, but in some ways we thought that it could even have a bigger pickup.


MR. DAVID WILSON: I'm glad to see that. The minister is right - I mean, as a former medic, I did hear that often. You'd go to someone's house and they are gravely ill and you wonder why they didn't call sooner - it was because you saw the stack of bills on the table and they didn't want to have to deal with another bill.


As a medic - and I think I've said this in the House before - I told many Nova Scotians, you call us whenever you want. You don't have to pay those bills if you can't; you'll work something out with the company. That's why, as soon as we could, we brought that program in.


I'm hoping I heard the minister right - how he's going to try and look at this program and see if people can understand it, and more information about it, but he did just say he's going to review this program. So I'm going to ask him : Does that mean it's an official review of a program? Because that scares me and Nova Scotians get scared when they hear we're going to "review" a program - usually it means there's going to be changes and most of the time the program will be eliminated.


Maybe the minister could stand and give his commitment to the program. Maybe I'll give you a couple of questions; so his commitment to this program, we'll continue to see it? And is there a line item in the budget somewhere that has an estimation of what would be written off next year? Maybe I'll just leave it at those two - a commitment to the program, maybe ease my fear around the review of the program, and is there a line item that actually indicates how much Nova Scotians might be able to gain access to or save next year or this coming year with this program.


MR. GLAVINE: Madam Chairman, to the member opposite, I was indeed very quick to tell the media who were enquiring about this issue that it would be a pretty sad day for Nova Scotians, and a day when I wouldn't want to be the Minister of Health and Wellness, if all Nova Scotians didn't think they could call on an ambulance and our paramedics in a time of need.


In terms of any review of the program, it would simply be have we adequately informed all Nova Scotians about the nature of this program and about the form that they would have to send in to get a waiver of these fees. As many members in the House know, the EHS and Medavie are very understanding. If you have a bill of $140, paying $10 or $20 a month is one of the great allowances that they will provide Nova Scotians who can be struggling with paying for an ambulance bill.


I am pleased to say that, right now, of the $2.4 million that is available for general debt around ambulance fees and also this waiving of those, on a financial criteria, it is in place, it will remain in place, and I would very much like to see Nova Scotians be better aware of that program and that the uptake is strong on that.


MR. DAVID WILSON: Madam Chairman, I think that's the key to any program within Health and Wellness. I know first-hand over the last number of years, when you evaluate uptake to a program, you realize sometimes that not enough has been done to make sure Nova Scotians realize there is a support program out there for them.


I know the financial people within the department would want you to be very careful as you implement new programs so that you don't get overburdened. The last thing you want is to say, listen, all the money in the program is utilized and we can't help you anymore. But I think over the last couple of years we started to do those evaluations and realized that there are many programs that, especially in continuing care, the government needs to do a better job at ensuring Nova Scotians know they're there for them and that they utilize them. I would love to see every program max their budget out. I don't think there would be any criticism on this side if we, year after year, see those programs be fully depleted and, hopefully, have them increased if they're utilized. So I'm glad to hear that. I hope that we will start to see some more programs out there that encourage the use of the programs.


I think EMC can be part of that, even if it comes down to maybe through the process of them trying to send out bills - we all know that they generate a user fee and a bill for patients - when they see that they're not getting a response and they get the second or third letter, that potentially in one of those future contacts a sheet of paper or description of the program is in there for them. These individuals whom we're talking about are people who tend to be lower-income and they don't really always have the ability to go on the Internet and look for the program and download it. It's very easy and quick for Nova Scotians to find out about this program. I still continue to get calls and I say, well, have you checked the website if you have a computer - many times I just download it in my office and I mail it to them. It's very quick, but we still have to remind people and there has to be multiple ways for that information to get them to Nova Scotians, not just on the website.


I'm going to move now to an area that is important in all regions of the province, and that's capital equipment and the purchase of capital equipment for hospitals and clinics and health services in general. I'll be on Page 13.18, Estimates and Supplementary Detail, I know from listening to some of the earlier estimates - the Premier was up - and one of the commitments in the last election from the Liberal Party was the purchase of a CT scanner for Inverness. There has been a lot of discussion over the last number of years, I have to say. I know the member with the Progressive Conservatives has brought it up on numerous occasions over the last number of years around a CT scanner for Inverness.


I noticed in the Premier's estimates that he stated yes, there will be a CT scanner going to Inverness. I notice under Hospital Equipment is $18 million. My first question to the minister: In that $18 million, is there money towards the purchase of a CT scanner for Inverness and what is the estimated cost? I know it can vary a bit, but I know they're quite expensive - is it in that $18 million and what would be the cost to purchase that CT scanner for Inverness?


MR. GLAVINE: The member for Sackville-Cobequid raises a really significant question because as we recently toured the province I know the deputy minister had some of those quieter conversations around the needs for equipment in a number of our facilities. I remember in particular - I think it was my very first meeting with a group of doctors in Port Williams from the Valley Regional Hospital - there were at least two anesthesiologists present at the meeting and they both made pretty strong pitches that they had three of six machines that were on the very last legs of operation. Patient safety becomes a very, very big concern for them. So we were very quick to assist and get help for three pieces of equipment for anesthesiology.


The one question that the member has, which was a commitment from the Premier around a CT scanner - I'm pleased to say that inside the $18 million, probably at a cost of $1 million to $1.2 million, will be a CT scanner for Inverness. With the purchase and training, it's on track to be operational by Fall 2014.


MR. DAVID WILSON: With that coming out of that $18 million, does the minister have a list of what priorities or what pieces of equipment will be purchased in the coming year with the $18 million? We know of one right now - does the minister have a list, and can he provide the list to the Chamber?


MR. GLAVINE: I'm pleased to say that the department has gone through a very rigorous process of reviewing capital equipment costs based on the needs of all of our hospitals right across the province. At this stage where we are in the budget - I guess estimates at this time - we haven't communicated to hospitals. Both regional and smaller health centres want pieces of equipment that they will be getting for this year, but I will be more than pleased to share that with the member as soon as we have communicated to the different DHAs what of their equipment priorities will be met this coming year.


MR. DAVID WILSON: Would the minister be able to tell us a timeline - when would you foresee bringing that list forward? I know it's important to first acknowledge and make sure that the districts know what they're getting, but I'm wondering, could the minister tell us when that list would be provided and when does he plan on telling the districts that they'll be receiving a new piece of equipment or funding for new equipment?


MR. GLAVINE: Madam Chairman, I know this is something that the member opposite would be very interested in because he always wanted state-of-the-art in the back of an ambulance with the kind of work that he was doing. I know there would be provisions made for that kind of update.


The issue here also, the department can have prioritized the needs across the province, be willing to have the 75 per cent covered off, but there are many pieces of equipment that have a 25 per cent provision from the DHA foundation or whatever one of those two means of being able to meet equipment costs. So we're probably looking at Spring to early summer before a number of these notifications are made, because the department does need the 25 per cent provision looked after before the order is firm.


MR. DAVID WILSON: I know I'm running out of time, so I'm going to continue on this in my following hour after the Progressive Conservatives. Maybe I'll ask him right quickly - I have about a minute. In Spring, early summer, will he endeavour to release the whole list at once, or will it be as he announces them maybe in a schedule - so will the list be complete or will it be one-off, for example, of when districts will find out?


MR. GLAVINE: I'm pleased to say that it is desirable for the department to do this as much as possible. Again, while we were touring the province we certainly got notification that nearing the end of the fiscal year there were several pieces of equipment that we would put in the "dire need" category. Therefore, the department wisely keeps some reserve money for making sure that those equipment needs are met when we do lose a vital diagnostic piece of equipment in particular or any of those surgical needs that are there on a regular basis.


As much as possible, that list can be provided for the public, for the member opposite, with the exception of course of what may be kept as a reserve dollar of the $18 million.


MADAM CHAIRMAN: The hour has lapsed. We will now move on to the Official Opposition.


The honourable member for Pictou Centre.


HON. PAT DUNN: Thank you, Madam Chairman, I was just listening to the answers from the minister in the last few minutes and I'm very happy that he has taken the chance to go across the province. I'm sure it's quite a learning curve and he's hearing a whole lot of information from a lot of different areas.


A couple questions I have, and the first one is dealing with Glen Haven Manor. The Glen Haven Manor is a facility that houses a little over a couple hundred residents, and it's located beside the Aberdeen Hospital on the East River Road in New Glasgow. My question to the minister would be: Is this particular facility on the radar with regard to being replaced? I do know that it's reaching the end of the line, if one should say so, as far as its usefulness, and it's an aging structure. There has been talk where they will be building a new one in the future. I guess my question is: Does the minister know where it is right now with regard to what could be happening in the near future?


MR. GLAVINE: I welcome the backup critic - maybe we can call the member for Pictou Centre - I know he has a wide interest in education and health and I certainly look forward to his questions. He raises one that is very much in the theme of the Progressive Conservative critic who was presenting on Friday - that was about nursing home beds and the long list that we do face in the province, a little bit of what our approach to building new nursing homes and replacements would be.


I didn't get a chance to tour Glen Haven when I was in Glen Haven Manor when I was in Pictou, but I know it has a wonderful location, especially, many would say, being close to the Aberdeen Hospital. Again, that availability of either emergency or continuing care provision by primary health care is pretty strong in that area.


The manor is one of the eleven that has been identified for replacement. Just a very short time ago, in fact last week, the Department of Health and Wellness did a pretty strong presentation around the state of all nursing homes in the province and in particular those that are at the top of the list for replacement. That list will be coming before Cabinet probably within the month. One of the approaches that I think probably the previous government was going to embark upon, and knowing our financial position, having the eleven go through a four-year phase and have three or four per year being provided, I think has both - I think there's a lot of wisdom in using that approach, knowing that we couldn't do all eleven perhaps at one time.


The department is actually looking at what is the best option whatever Party was in government. Would it be best to have government design and build and operate facilities? Would it be best to give it to a contractor and a provider, to do everything in that manner? Or, should we have some combination where the department looks at designs, some engineering work, and then hires a contractor, but has a say, perhaps, on the design stage that could save a lot of dollars if we went to somewhat of a common design with particulars based on the relief of the land, the location and so forth? That's being looked at as well.


I think when we come up with that, in fact we may see that we can move on that, move on these replacements in perhaps even a stronger way. Remember, government is already paying for the operation of those facilities, so much per bed. The replacement can probably be done, to a degree, and amortized over a long period of time. But our commitment remains very strong towards Glen Haven Manor.


There are a couple right now that do have to go to the top of the list when we have concerns around fire suppression and code and we're being told by the fire marshal's office and inspections that there are a few that do need to be the strongest priority. Those will be met very quickly and the other ones that, again, as the member has pointed out, probably reaching as well that age where code concern about how old the facility is is top of mind for the residents, their families, and in fact the community. I thank the member for bringing that question forward.


MR. DUNN: Thanks to the minister for that answer. When you look at a facility similar to the Glen Haven and facilities that the minister was just talking about, you run into situations where a wheelchair cannot get access into certain rooms and so on. Again, in a lot of these facilities, we've reached the point where we have to look at them and decide which ones are going to be built first.


With regard to Glen Haven Manor, in discussion with the minister before, there is land, I believe, available near the Glen Haven and near the Aberdeen Hospital as far as a potential site, which is a very scenic site overlooking the river and so on. There's a lot of potential there for an area where this type of building could be erected.


I'm going to move on to a facility beside the Glen Haven, the Aberdeen Hospital, and I'd like the minister to make a few comments on where we are with the phases of renovation and reconstruction at the Aberdeen Hospital.


It's been such a long, ongoing process over the last number of years and people in Pictou County have been patiently waiting for something to happen. Many people have been involved for a long time - the mayors and the wardens of the county and so on, the health board officials. It seems as though it's being dragged out; in fact one time, a couple of years ago, there was even a feeling that we might lose our regional status in Pictou County as a regional hospital.


My question to the minister is, when are these phases going to start, how many phases will there be, and when will the phases be completed?


MR. GLAVINE: Again, that was one of the benefits of doing a tour of facilities and meeting stakeholders and district health boards, community boards, and so forth across the province. I know the morning that the deputy minister, myself, and our team took a look at the emergency department at the Aberdeen - you didn't need to work there to realize that the flow through the old emergency department and what current requirements are, there is indeed a great disparity.


I know that this is a project that may have gotten started a bit earlier if final design work had been achieved, but I know that some changes in the design did take place. I know they wanted to keep the emergency room very close to the diagnostic centre. The two obviously have to work in sync with one another and so I think there was some realignment that had to be done to make sure that that flow was going to be achieved. I'm pleased to say that all systems are pointing towards the first phase being underway this Fall and we know that it's a stage project, over a period of time. I know it's a busy ER, so making sure that patients are well looked after while construction goes on is pretty critical.


If memory serves me correctly, there are two avenues to the emergency. So as they look at construction, I think there can still be a good allowance for moving the patients into whatever area of the emergency room that will be cordoned off during the construction period.


I know that as I met with the physicians, the nurses, the administration of the hospital, they were very excited about this project. I think it will help to make sure that high quality of services remains in place and that it becomes a very modern emergency room inside the 25-, 30-year-old facility, I think maybe around . . .


AN HON MEMBER: Fifty-three.


MR. GLAVINE: Fifty-three? Yes, the oldest part of the hospital, that's right. I think to modernize the ER, we know today that emergency rooms are very, very busy parts of our health care system, our entry into health care. As we all know, the province has struggled with getting sufficient numbers of primary health care providers, physicians, and nurse practitioners, so we know that the flow of patients, the triaging, the diagnostic work that needs to go on when a patient comes in the door can be facilitated by the kind of structure that you have in place.


I think the members opposite, whether they're from Pictou Centre, Pictou East, or Pictou West, they're going to have a modern department. Also, I think a pharmacy is part of that upgrade. I think as it goes along in the stages, we certainly, as a government, will support the reconstruct at the Aberdeen.


MR. DUNN: Thank you to the minister for the answer. That particular facility was first constructed in the very early 1950s, Madam Chairman, the land was donated by the Ross family - and that particular farmhouse still exists. It is south of the hospital. They donated a large tract of land there where the hospital and Glen Haven and so on - there have been many changes in that area since that particular time. It looked more like farmland when the hospital was constructed, but it certainly has changed since that. The former hospital was on the west side of the river, on Hospital Avenue.


I have one last question for the minister. In your travels across the province and talking to various health officials, and I've had the experience talking to many nurses in three or four different hospitals and they often will make the statement, and I just want a reaction from you, there seems to be in many of our hospitals more management than actual nurses working on the floor, and it's not something I've heard once or twice, I've heard it quite often - I would just like a comment from the minister with regard to that: Have you heard the same thing and, if that's the case, do we need a change in that so that's not happening?


MR. GLAVINE: I know that nursing and nurses and the role they play has been top of mind for many of us here in the House as we dealt with a labour issue over the past few weeks. A lot of commentary came through the media - and I always have to be a bit cautious, my wife being a nurse, that I don't go too far here in terms of nurses and not always giving them all the complimentary and kudos that they need and well deserve.


We know that, first of all, the role of the nurse has changed in terms of their position in that team of care at bedside. That being said, some may say that perhaps there are many now who are on the management side of nursing as opposed to being at the bedside, where we all know patients like to have a nurse providing full care in terms of the time that they're in hospital.


One of the areas that I am concerned about is making sure that our Nursing Strategy on a lot of different fronts and levels is what it should be in 2014. One of the aspects that became very prominent for myself and the deputy as we toured the province, but also in hearing from the Nova Scotia Nurses' Union and the nurses in the NSGEU, is that the people now who are occupying the beds in our tertiary care centres like the QE II, Dickson Centre and in our regional hospitals, and as well in our smaller health care centres, that level of patient sickness, the acuity of the patient, is extremely high.


You don't have people in beds today who - perhaps in the past we would say they're in for a number of days for observation. We really don't have that luxury, if you wish, based on the number of beds available. We have very sick people occupying the beds, so therefore the demands on the nurses are very, very high. We know that the training is perhaps different than what the traditional nursing school graduates would go through, their regimen.


The one area that we know has changed is that the scope of practice of our nurses has moved up and they're now doing some procedures and some work at bedside that would have been the work of a doctor. That's how we have seen change go on. The LPN is doing some of the work that was traditionally the domain of nurses. So in terms of whether or not, I guess we could say, management, perhaps we need to be talking more about management of the patient which is a very, very complex daily endeavour for our nurses and the team of clinicians who are looking after our patients.


We have a Nursing Strategy in the province. In the past year, or over the last couple of years, money was moved from there for other needs in health care. I know as a minister now, I'm very, very interested in having a strong Nursing Strategy, one that will make sure that our graduates remain in the province, and that we also have provision for them leaving the school of nursing and making a smooth transition to the workplace. That's very, very important; we are told that definitely needs to take place.


Perhaps it's time also to have that review of nursing training. One of the observations that has been provided - again it was while we were touring; the deputy minister heard this as well - while we were touring the School of Nursing at St. F.X., we heard in very, very strong terms that a clinical summer program, it's not really a co-op, but now a significant number of nursing students have an opportunity to work during the summer in hospital and nursing home settings.


There was a comment that was not lost on me that was made by a couple of the nursing students, as well as the instructors. That is having that concentrated period of May to September where they're paid like a summer student having any job. One of the strongest observations and deductions from their instructors in particular was that they came back to university with a greater sense of the nursing role. The practical hands-on requirement that nurses need every day in their work was much more heightened by that summer clinical experience. Perhaps it is pointing to the fact that that's an area that we do need to take a look at, if you wish, in nursing education to make sure that that's very strong.


In terms of patient management and chronicling everything that goes on, and when we have patients now who are very, very sick, requiring a lot of interventions, making sure that patient management is a significant part of the role of the nurse, and it may present itself as different, but different in this case is of significantly great importance in making sure that everything that is being provided to the patient and the adjustments made to patient care are constantly chronicled, constantly monitored. I think that's, as well, what we're seeing a lot of. If you take a stroll through Valley Regional 15 or 20 years ago versus a stroll through the floor today, you're very quickly hit by the fact that room after room is a very, very sick patient. For that reason, I believe the care of those patients has changed as well.


I take the member's point very strongly as a constructive note that I believe as we look at a refresh of the Nursing Strategy that we have the right number of nurses in all the different settings across the province and making sure that the complement of nurses and LPNs, lab techs and all those who are providing care are a team with great competencies, great abilities to look after the patient, that professional development in the nursing area is a constant and that nurses have that kind of opportunity, an evaluation of the workplace, because we all know that satisfaction in your workplace is one of the greatest ways of retaining people.


I know for a fact that there's probably not a nurse in the province that can't describe a day that was - I know the subject of our dinner table on occasion when my wife would come home and say she literally had a day from hell, the. day meant, as she verbalized that, there were more patients than they anticipated - there were some in the hallway; when she was on Medical Surgical, there were more coming back from surgery than they had anticipated, and the level of care was extreme. She was glad to be home because now she could have a bathroom break, which was not available to her during her day at work. I think every nurse can describe those kinds of days, but it's not what we should have day after day after day. And in terms of getting the right complement, nurse managers, nurses, LPNs - that's a very, very important subject as the demands on our health care teams in our hospitals are extremely high.


I hope I didn't say any unparliamentary word there, Madam Chairman, but some days in a hospital setting can indeed be immensely challenging.


MR. DUNN: Thank you to the minister for that answer. The next question for the minister is dealing with the number of seats we have at Dal Medical School. I've had the experience over the years of meeting and knowing many, many students who have applied to med school across our country of Canada and, of course, having great difficulty being accepted into various med schools. I'm sure it's the same in the province here; there are only so many seats.


My question to the minister is, basically, what is the set-up like at Dalhousie - how many seats are there for students from Nova Scotia, how many for foreign students, and are there any other seats available outside of that at the med school?


MR. GLAVINE: I thank the member for Pictou Centre for that question. As we all know, in our province the number of physicians and having a family doctor is a pretty critical piece of our health; in fact I subscribe very, very strongly to having a family doctor as the cornerstone of good, lifelong health, if you have a doctor who is monitoring and constantly supporting your desire to be healthy.


We are fortunate in our province to have a medical school. I know in recent years that we were very fortunate to have a leader come to the Dalhousie Medical School at perhaps a very critical time. Dr. Tom Marrie has provided outstanding leadership to the school because when he came there were some challenges that he had to face and correct. I'm pleased to say that work, for the most part, has been very successful.


In terms of the number of seats, we are looking at, as of March 4, 2014, 367 med students are at Dalhousie. Of those 367, about 90 per cent stay in the province, so again there's that very strong connection of being educated here, whether you are from Nova Scotia, Prince Edward Island, New Brunswick, or wherever in Canada, you may come to the province for your medical education. The chances of staying are, in fact, very, very strong.


Adding to that picture that I believe is going to help with a lot more local or regional recruitment is the fact of the residency programs. The residency program in the province has now been expanded to Valley Regional and, as of this July, there will be residents going to Yarmouth. I would have to say that when we were in Yarmouth, there was cause for enormous celebration because they saw this as a wonderful asset of five residents to be in the regional hospital, being able to apply some of the training where they currently are, but to receive the wonderful mentorship of a strong team of physicians, surgeons who would in fact commit to be their mentors.


So that is one of the key ways in which we meet the annual sum of the requirement that we have in our province for physicians and surgeons. There are, as we know, some other ways in which we will get doctors into the province. The International Medical Graduate program, the CAPP, which gave us 13 doctors this year, and that was one of the largest annual numbers - these would be foreign trained doctors who come to the province and have to go through a very stringent credentialing program and process before they can practise, and as they practise they come under an established mentor/doctor. They can only take on about hundred patients at a time as they built up their practice, and again that is another one of the ways.


We also have a CaRMS program, which is a Canada-wide program through which residencies are provided through Dalhousie and physicians will come from other med schools from across Canada into Nova Scotia, and we 10 or 11 through that means. I believe, however, we need a pretty robust way of recruiting doctors to the province. We know doctors are being trained, and Nova Scotians, in fact, are being trained outside the province. Getting them back here, however, is a challenge. This is why in the first 100 days of our government we set in place a physician recruitment and retention team that would take a look at what could be the strongest measures that our province could implement to make sure that we recruit probably three, four, maybe even 500 doctors over the next decade. I think it will be more in the 200 to 300 range.


We are now finding doctors go through a phase down in their career and many continue to practise a number of days a week, a number of hours a week, and hold on to a good number of their patients well into what many of us would consider prime retirement years. Many of our doctors continue to practise and I think perhaps they were people who were drawn to the life of a physician, whose care of their patients is primary, so many do stay into advanced years and I know a few of them in our area.


This recruitment and retention team headed up by Dr. Celina White from Amherst is going to be a wonderful opportunity for our government, and perhaps successive governments, but certainly for the next decade, and will be one of the best ways to attract and keep doctors in our province. In fact, that team of people were meeting today and I was hoping to check in and see how things are progressing with them because they are now looking at some final stages. They have been at this work now for a couple of months and so I hope to check with those in the department who are on that committee to see how that work is going.


Will we meet the challenge of having enough doctors? Well perhaps looking to the current chairman who is running estimates at the moment, the member for Clare-Digby, represents a community that has had about 15 years of being challenged to provide a number of doctors. I remember the former member for Digby, and I can now say his name, Junior Theriault, who brought doctors down and found ways of putting them up at Digby Pines to spend time in the community helping out, but also to take a look at whether they would come for a period of time or locate there. The community has had a significant challenge.


However, as we take a look at how the next generation of doctors are going to practise, it really is an insight into how we are going to recruit them because starting in the next week or so - I'm not sure if ground has been broken yet (Interruption) - ground has been broken in Digby, I'm told, and that's pretty exciting because as minister, I was able to assist in providing some of the financial requirement to build a collaborative health care centre. In that collaborative health care centre - not even built, just a design on the board - Digby is going through a very positive phase of recruiting doctors with one arriving in July, one arriving in August, and looking like another next January.


I think it's a wonderful clue and a wonderful insight as to how the next generation of doctors will practise not only in our province but probably across North America, and that is as a team of doctors, where they support one another professionally. They would have a great avenue of collegiality. They will be able to cover for one another in terms of holidays, sickness or family time, because that work-life balance is a critical component, as doctors look at their career.


I am confident that we are finding ways to recruit doctors and I think, working as a team in conjunction with nurse practitioners and nurses, having that team in a collaborative care centre where we are now seeing - and the deputy minister and I were able to see an example in Berwick, Nova Scotia, where in fact it was a mental health provider working with a team of doctors that, as they saw patients who were needing mental health attention, they were able to pass that patient on.


We all know that total health is becoming one of the areas that our department is giving greater focus to. Having a dietitian, a physiotherapist, any of these people as part of a team is going to mean that we can have better health outcomes in the long run. The member for Pictou Centre is aware, in New Glasgow, of an extremely strong collaborative health care model. In fact, as we toured that facility, I looked at many of the advantages and the positive features and how they have been able to assemble a team of clinicians who are so committed to their patients and to having it as a vibrant centre for family health care.


The member asked a great question about the Dalhousie Medical School - again, just to reiterate, 367 in the school. We have actually added some seats over the number of years. The 17 medical schools across Canada had actually lowered numbers for a while because they were turning out the number of doctors that they needed and, in some cases, too many. Some of the specialty areas now actually have doctors unemployed. So it's more than just numbers of doctors, it is having the whole surveillance, if you wish, or inventory of what doctors are needed, and when they will be needed.


I know Doctors Nova Scotia is keen to have a sense of retirement plans, a sense of doctors moving out of the province for another professional opportunity, knowing that well in advance provides lead time to be able to do the recruitment for our province.


I think there are a number of very strong initiatives that are currently happening, but we all know there are communities with doctors well into their 70s who are very close to their final months or years in providing health care to their community. There are some wonderful examples across our province where if we were to start profiling our doctors - and I forget the exact date in May, it may be May 6th, but it's a way for Nova Scotians to speak about their family doctor. There are going to be six locations where doctors will be meeting the public and talking about their work. It's a way for Nova Scotians to engage with family doctors about the work that they do.


On a given day, there are many Nova Scotians who would love to give a public testimonial to what their family doctor means to them and has meant to their personal health and the health of their family. When we talk about doctors, we also need to bring that front and centre, as to the role they play in our health care system. I know as minister I will do all I can to make sure that families have a family doctor. The challenge is huge in some of the areas of our province, but I believe there are models now of care that are emerging that will allow us to have more people using the health care centres, collaborative care centres, where their health needs will be met.


MR. DUNN: It was mentioned that about 367 students are attending Dalhousie as of March 4th and 90 per cent of them find employment throughout the province. My question to the minister: Of that 367 students, how many are first-year students, and is that number a number that stays pretty consistent from year to year?


MR. GLAVINE: I want to correct one statement that I made earlier; I was looking at a wrong statistic. When we look at retaining graduates from the Dalhousie Medical School, I had used 90 per cent, but that's the general area of nurses in the province. I'll have to check and see the doctor complement that we retain from the Dalhousie Medical School.


We're roughly in the 80 to 90 per cent - and I don't have the exact figure for the current year, but if we're in the year one of med students, we're in that category. I believe this year 89 per cent is the figure.


MR. DUNN: Mr. Chairman, there is always a financial burden for students leaving their undergraduate degrees and heading off into med school. I know from experience and I can give a couple of my own children as an example. My son Mark is first year of dentistry at McGill University in Montreal and when he went to the bank with regard to securing some funds, the doors were wide open - basically, how much do you want?


My daughter, Krista, who is a science graduate from McGill, wasn't, up to this point, successful in being accepted to a medical school in Canada but has been accepted down in the Caribbean - Saba and St. George's are both schools there. In her case when she entered to get the financial support she needed, the doors were closed because of the fact of where she was going. I do know over the last four or five years about 30 students fell through that crack in the system where they are from Canada and want to attend a med school in Canada. They were not accepted; they tried a second year and still didn't get accepted.


Knowing these students have the credentials to be accepted and then heading off, perhaps outside the country if they can afford it, the problem occurs, for example in Saba and in St. George's, U.S.-based schools, trying to back into Canada. I guess my question to the minister is: What is happening in the province now to bring back some Nova Scotia students who are attending schools down in the Caribbean? I think you were alluding to that earlier with Dr. White, but I'll get you to expand on that for a couple of minutes.


MR. GLAVINE: The member for Pictou Centre asked a really important question. We know that with 80 to 90 seats at the Dalhousie Medical School, it is limited in relation to the numbers who aspire to become physicians. Many have gone off-shore to study at the medical schools in the Caribbean, Saba in particular. I know three doctors in the Valley who went through medical school there and are now back practising in the province and, certainly, their med school years have qualified them to pass the Canadian medical exam and the American Medical Association's exam in terms of qualifications to come back to the province.


One of the areas to first of all help out financially - and this was an area that for a number of years wasn't perhaps as big a concern - was the cost of tuition at med school. If you are studying year-round as a med student, to go to med school for five years is a pretty costly endeavour and you come out with a high debt. The med school tuition has constantly gone up to a significantly higher level. For that reason, one of our platform positions, and one that we have in our budget for this year, is that we will provide med students who have done their residency and are ready to practise, and if they practise in Nova Scotia for a five- year period, we will look after $125,000 of their med school debt - and I think that will be a good incentive when they are coming out with a significant debt. That's one part of the member's question.


One of the challenges for students who go to the United States or to the Caribbean to attend med school, the problem is coming back into the province. I've been through that with a couple of former students I thought would be a wonderful addition to the physician complement in our province but I realized that getting them back through the residency program at Dalhousie was very limited, and limited pretty well to the CaRMS program which is a national selections program to give us maybe six GPs and five specialists in a particular year, what is determined, to be based on needs of our province.


It is an area that we have asked our recruitment and retention team to take a look at. Is there a way that we can appeal to CaRMs and get more students back on annual basis to the province, or do we have to find some other mechanism? One of the first provinces to challenge getting students who were foreign trained back was B.C. - British Columbia had probably a couple hundred students in a given year who were being trained outside of their province, outside of Canada, and they wanted to bring more of them back because the need was there. So I think we're probably raising an issue that is very timely and one that I believe we absolutely need to address.


There was an excellent study done, and it is a great companion document as we look at physician recruitment, and that is the Physician Resource Plan for the province that catalogued the number of GPs, the number of specialists, we would need over the next decade. Now that constantly needs some fine turning and information entered in to make it a living document, but it is a great template as to the direction we need to be going.


When we look at the total number of doctors, we will have to use some other means than how we are currently providing the number of doctors in the province. What that will be, and what will it look like it? I think we will have some very good suggestions - or perhaps more than suggestions - directions that we can pursue as a government and as province to make sure that we have the right complement of well-trained doctors for the future of all Nova Scotians.


MR. DUNN: Thank you for that answer. Just following that up with a couple of comments. Recently I had a former student of mine, from Trenton High School, who attended med school outside Canada, at Trinity Medical School, and she has completed two years of her studies but has reached an impasse because, financially, she cannot go any further and it's unfortunate. This particular student, Julie Anderson, is a very dedicated, enthusiastic person and I know that she would be a wonderful doctor if there was a way that we could help her financially to finish her med school requirements and bring her back to Nova Scotia.


At this moment I'm going to pass the questioning to my colleague from Pictou West.


MR. CHAIRMAN: The honourable member for Pictou East.


MR. TIM HOUSTON: I think we're running a little short on time here, but I will just say that when we come back the minister will not be disappointed to know that I have a few more questions on Glen Haven and also the Aberdeen Hospital. I don't know if we have time even for one question at this stage.


MR. CHAIRMAN: A minute and 20 seconds.


MR. HOUSTON: Yes. Well, when we come back, I'll give the minister something to ponder while he's talking to my colleagues from the NDP, but I do have some questions around the Glen Haven.


You mentioned that Glen Haven will be on the list of 11 priorities for replacement and my questions will be around are they actually prioritized from one to 11 and the strategy for three to four years - is that actually something that's in the budget? Those will be my questions on Glen Haven, and on Aberdeen I'll have a few questions on just what is in the actual budget for the redevelopment of the emergency room/pharmacy and then over what time frame. I just want to expand on those couple of things when we come back.


I guess at this stage I'll pass to the NDP, and we'll come back. Is that fine, Mr. Chairman? Okay, thank you.


MR. CHAIRMAN: The honourable member for Truro-Bible Hill-Millbrook-Salmon River.


MS. LENORE ZANN: Thank you very much, Mr. Chairman. Yes, it gives me pleasure to rise here today and ask a few questions of the Minister of Health and Wellness. Did you say that your wife was a nurse at one point in time, and is she still practising now or is she retired?


MR. CHAIRMAN: Order, please direct your questions to the chairman. I know you like to converse - a good question.


MS. ZANN: Mr. Chairman, I have been wondering if the minister's wife was indeed a nurse, which he has nodded to say that she was. I asked if she is still practising, which it seems to me, by the shaking of the head, she is now retired.


I have just a few questions regarding Bill No. 37. Since the minister's wife was a nurse, and the essential services legislation recently brought into law by the majority Liberal Government, in spite of 200 or so health experts and nurses and other workers showing up to Province House to oppose it in Law Amendments Committee, and then the huge fight that erupted about that, many people are still talking about this out in social media, on the streets, in the newspapers, so first of all I'd like to ask the minister: What was his wife's attitude and response when she first found out about Bill No. 37?


MR. GLAVINE: I welcome the member for Truro-Bible Hill-Millbrook-Salmon River to the questioning process.


I would have to say I have the highest regard and respect for my wife's opinions. Perhaps there are still some days when she would still like to be nursing, but she had very, very significant health issues, and when she couldn't give the 100 per cent she decided that the profession and the career demanded with each and every day that she went to work, she has retired from nursing.


Her view was that - having been a nurse at one time teaching pulmonary care and LPNs at the sanatorium in Kentville; having done the emergency department at Blanchard-Fraser Memorial, the ICU as well there; having worked on air flights, air emergencies from Labrador to St. John's or Montreal; having worked at Soldier's Memorial in many different capacities including some administration management work, she had a very broad involvement throughout her career and her view, having had to, in some of her positions, assess the acuity of patients and the safety of patients, she believed very strongly that the decision-making process belonged on the floor to a nurse manager to decide that there was a need for extra help.


She also read a number of the documents that I provided her on taking a look and working to hear both sides of the argument, whether it be Australia, New South Wales, or California. She likes the flexibility to be able to decide on the right complement of nurses on a given day, in a given shift, in a given unit. That's what she experienced throughout her career so she still feels strongly that even though the role of a nurse has changed considerably, if you look at the complement of skills that a nurse requires, she was one that felt that judgment, decision-making were key components in determining, for example, at 3:00 a.m. in a small community hospital, do you call a doctor in as a patient is getting sicker and experiencing some considerable difficulties?


Whether it was the patient, the number of patients, the kind of care required, her assessment is that it's one of the wonderful learned skills of a nurse, which may not be there, as she said, in her first year or first couple of years, but as she gained knowledge and experience in the nursing field she felt very comfortable taking on that responsibility of decision making on the right number of nurses. At any given time you can have a first- or a second-year nurse who is still very much in a learning setting. She's very comfortable in terms of that kind of management setting.


MS. ZANN: Thank you for that answer. I'm still not quite sure whether he answered my question about whether his wife actually approves of Bill No. 37 but, as I said, it's still being talked about a lot out there in the public. In fact, Halifax Media Co-op printed a very interesting article recently and many of the union presidents and executives are very concerned about their members.


For instance, Vernon Martell, who is on the executive for Unifor Local 4603 which represents many workers in Cape Breton, he is concerned that this is just the tip of the iceberg in terms of what the government intends to do. He feels that this is just a sign that what the new Liberal Government intends to do is to bust unions. He says he's concerned about all unions, not just these particular ones.


Bill No. 37 doesn't really seem to make much sense to many people given that, for instance, Susan Gill who is the president of Unifor Local 4500, which also has approximately 1,250 members in Cape Breton, says that she is concerned because she thinks there is more coming and that whatever Stephen Harper is not going to clean up, this Liberal Government will. She remembers that at one time, several years ago, there was a strike that was a possibility, but the strike never happened and in case it was going to happen the union offered to provide workers available, of each classification, and she said what's frustrating is that what they offered was actually more than what the employer was ever willing to deem essential on holidays or weekends and that none of that was actually given consideration when this legislation was written.


She said she knows that the public would be upset if a life was lost because of a strike. They know that; it could be one of their family members too. However, it's imperative for people to know, and for this government to know, that safe patient ratios is really something that they support and that they support what the unions here were doing, and that it could very easily have been them in Cape Breton.


So in communities like Cape Breton, these nurses are so important and obviously the nurses are very important here on the mainland as well. I'm hearing from many of them - many young ones - saying they are going to leave the province. They don't feel there's anything for them here and, in fact, as we've mentioned before, some nurses who are now graduating and were going to use the Graduate Retention Rebate, now don't even have that to help them pay off their student debts.


There is a lot of concern still out there in the public about Bill No. 37. Would the minister like to give us a little bit of a respite and make us a little less worried about the fact that hopefully there are no more of these kinds of bills coming down that would be union-busting-type techniques?

MR. GLAVINE: Madam Chairman, to the member opposite, any time you bring in a new piece of legislation there is always a starting point, and many saw this as, obviously, nurses going back to work and not permitting a strike to occur, but as the nurses and any other health care sector - or in some provinces it could still be other professional caregivers, caretakers, whether it be firemen, policemen, et cetera - that would work through essential service legislation. Yes, there is always that difficult start point.


Many, however, see that it is something that we work through. We know exactly at some point in time that 70 to 75 per cent, whatever is required to make sure that safety and provision of services in the health care sector are in place, and once they are in place then nurses, LPNs, clerical, maintenance, home support workers all would have a chance to strike, if they so choose, they could still do that. It's just that the current point of implementation is seen as probably quite problematic.


Other provinces have worked through essential service legislation and, for the most part, one province, perhaps, has been characterized by a little bit more labour disruption for whatever reason - but many provinces have now worked through 10, 15, 20 years of essential service legislation with going through that absolute process of strong collective bargaining, outlining what would be required to be put in place through essential services, and on occasion get close to the point of striking, but are able to find a resolve.


One of the very clear indicators that came out of the last disruption - and I think it is a strong message for any government and all governments, and I believe it has a lot to do in our province with the fact that we are currently just a percentage point away, 1.5 percentage points away, actually, from having 25 per cent of our population 60 years of age and over. I believe the strongest message that came during the disruption is that our senior population want absolutely zero disruption to their health care services.


I guess perhaps there may be a stronger way to express it but it was the one message that was certainly left on my desk in many different ways - they want us to work at resolving difficulties and differences at the bargaining table and through the negotiating process.


I know that in my view - and I am expressing my view - that when we take a look, whether it is nurse ratios or work environment, there can be some dimension of that inside of an agreement, but it is very clear that across Canada - and I look to other jurisdictions as to what are best practices, what is the research actually saying, what is the direction that it is pointing - as I checked across Canada, when there are staffing issues, whether it's the Montreal General, Toronto Sick Kids, Vancouver General, staffing committees are the ones that are right there, in the hospital. In the hospital is where you resolve those workplace troubles, difficulties, in terms of the environment in which people work, day in, day out. That's where management, that's where the clinical team must work to resolve the kinds of challenges they are faced with, whether it's a day event, a week event or some trend where high acuity or two or three more surgeries than normally scheduled are now showing up each day and through a week.


We know that in a tertiary care centre there is a great deal of demand on nurses, LPNs and all who are part of that team. Any time when you go into a hospital like the QE II, you realize that technicians are a pretty critical part of that team as well. When we look at the amount of monitoring equipment, pumps and life support systems, and all of these have to be maintained, so it is a pretty knowledgeable, well-trained team that allow for our hospitals and good health care to be delivered each and every day.

MS. ZANN: Thank you for that answer, minister. In your opinion, would you consider cooks, housekeeping, dietary workers, and service engineers, essential?


MR. GLAVINE: I guess to the member opposite, if no food arrives on the third floor of the QE II today, I'd say there would be a lot of patients in trouble.


MADAM CHAIRMAN: I would remind the honourable member to please address your questions to the chairman.


MS. ZANN: Yes, well actually as I already said, Susan Gill, who is the president of Unifor Local 4600, with approximately 1,250 members, in Cape Breton, says that the last time a strike was even thought about, they already had that taken care of and they had already offered to the people who they were working for - they had offered the opportunity to have certain people in place so that those kinds of things wouldn't become an issue. She was really surprised and frustrated that what was offered was actually more than what the employer was even willing to deem essential for holidays or weekends.


In fact in Local 4603, which mainly looks after Cape Breton, all members of Vernon Martell's local, without exception, are affected by Bill No. 37. These are mostly hospital service engineers, cooks, housekeeping, dietary workers. These people certainly don't feel that they should have been included in this bill.


Again, Madam Chairman, I would say that there is a lot of concern out there among the public, among the workers themselves and among the unions, who are feeling that they are now under attack by this government, and unfairly so, because it's such a wide and sweeping net that takes in so many people.


I'd also like to ask the minister, while I have him here, what he is actually doing. I know he was very concerned about addictions and about the prescription pills problem, especially in the Valley. I also know that there has been a problem recently in my area too with some methadone users who are no longer using the methadone, but they keep getting the methadone and then they've been selling it to other people. In fact there was recently an overdose case of methadone - but the person didn't die. However, it's very, very disconcerting and concerning that this is still going on.


So I'm wondering if the minister could speak to what his plan is to try and stop the addiction problem with prescription pills and also with methadone in the coming years.


MR. GLAVINE: The member opposite raises a question and comment that is certainly of concern to me and to more and more Nova Scotians and, unfortunately, some families who have lost a son or daughter or even an older loved one through prescription drug overdose or abuse.


I've looked at this issue now. I would say we're getting close to about three years since we had a number of unfortunate deaths in the Annapolis Valley that certainly brought the issue to my office, to my desk, and what I brought here to the Legislature - and I prefer not to visit perhaps the fact that it took some time to get the attention of the government of the day that this was a pretty serious issue; however, I was at that point, and continue to be, most concerned about the directions that we take as a province.


We are fortunate to have already put in place - and a lot of it came as a result of the prescription drug overdose working group that started with a nine-point plan - to have those kinds of positive changes and impacts for our province. A good number of those now have been implemented. We, in fact, had a pretty significant voice in developing the national strategy, in which we are partners with other provinces in taking a look at this issue on a national level - that was having Police Chief Mark Mander, Kevin Fraser and Carolyn Davison, who works in the Department of Health and Wellness, having pretty significant voices in terms of dealing with this issue.


One of the big areas that we had to challenge right off was the fact that we were doing an okay job in the province with detoxing those who had overdosed or who were on prescription narcotics and wanted to receive help, or family members brought them to one of our detox centres, whether it be Yarmouth, Lunenburg, Middleton - Springhill, I believe, is maybe one of those centres as well. We have a number of these across the province.


One of the real deficits that came to light was that the medical detoxing was there five or six days, but the true change in the individual really did not - because they did not have a rehab program, they were then going back into the same environment. On many occasions, there was pretty well an automatic relapse. This is why now in the province we have more of a rehabilitative program available to more of our citizens. It's not determined by a 14-day program or 21; in fact, it's determined by the progress that the individual is making and the kind of change that is going on in the person's life and equipping them for supports when they do leave the centre. I believe that has been a very strong improvement.


As the member pointed out, for some people dealing with their addiction through getting illegal prescription narcotics and using breaking of the law for break-ins and so forth to feed their habit is an enormous cost to the system. There are a number of ways in which we need to be dealing with the prescription drug dilemma. I know that methadone has worked wonderfully for a number of people; for others, it has been sometimes diverted. This is why, I know, our police associations have more and more people trained in this regard and are looking for those signs in their investigations and in communities whereby they can interrupt that process.


One of the other supports or replacement therapies for prescription narcotics is Suboxone, and Suboxone is presently being looked at by the department. It's much more difficult to use in an abusive way than methadone and also doesn't have the trauma and tragic consequences of a death from methadone - because it can be very deadly indeed. In fact, we all know that when a person goes into methadone treatment, they are in fact under a doctor's care to see what tolerance levels and appropriate levels of number of milligrams of methadone they should be receiving each and every day.

However, there are a number of other really good things that are emerging. We've had some accidental deaths as well where young people have not known the danger of mixing Dilaudid or Percocet with alcohol. When you get depressants impacting on our cardiac and pulmonary systems, they, in fact, can be fatal, and we've had those kinds of episodes as well.


Next September, in the schools of Nova Scotia, we will have the first education program at the junior high level that will be educating Nova Scotians about the dangers of prescription drug abuse. In the education setting for junior high, I believe that is going to be a very, very strong asset for us.


When we take a look at what now is accumulatively developing, one of the initiatives just introduced about a week - ten days ago - by the College of Physicians and Surgeons is another strong approach, where before a GP or those in a pain clinic will give a prescription narcotic, they will have to review the history of the patient. It won't be just what they're hearing in front of them; there must be a review through prescription drug monitoring. We have been collecting data on prescription drugs for some time and this is going to allow the GP to take a look at what the history is. I think that will be another strong assist.


We are also working on all prescribed medications going into a system developing a just-in-time information data system, meaning that every one of the prescribed medications that will go out through a pharmacy will be monitored. You will be able to provide an emergency department, a GP's office - any of those ways in which patients are accessing the health care system, in time we will be able to get that kind of immediate information. Currently, pharmacies do not have to enter that data. They have up to 30 days to enter that information. With this system that is now underway, relatively early days is another significant piece.


I still believe one of the areas where there is still work to do - and I applaud Doctors Nova Scotia and the College of Physicians and Surgeons with the kind of professional development they are doing because, remember, we are dealing with a perfectly legal substance and one that, when used in the right way for the right person, can be absolutely critical to pain management.


I believe the whole area of pain management has been a neglected area in our medical schools. I know that when I met with Dr. Tom Marrie, the dean of the med school, making sure that this whole area of pain management through narcotic use, because it once was not the purview of a GP to use narcotics for pain control - it was in a very different hospital-type setting that we used it, and then we have this great proliferation due to how pharmaceutical companies were advertising and using them in a very general way through the hands of our GPs. The med school, Doctors Nova Scotia, the College of Physicians and Surgeons are really doing a professional education of all of our doctors to prescribe for the right person for the right needs.


I think change is underway, but I think it will be slow. When we move to either first or second place - you know, we're back and forth with the U.S. in terms of the usage of prescription drugs in our country, in our society. When we see Scandinavian countries, that use only about one-third of the amount we use per capita in Canada - the U.K. is very low as well - it is cause for concern in relation to prescribing patterns.


I like the fact now that the College of Physicians and Surgeons have a program that is looking very closely at high-prescribing physicians to make sure they are being used at the right time and in the right place. I think over the next - and it is going to be a wonderful development next week that the member opposite will be very interested to see become public, another piece of work that I think will go a long way in dealing with prescription drug abuse.


MS. ZANN: Thank you for that answer. I also would agree that pain management is very important and for many years has been misunderstood. I know a lot of people who do have pain constantly and they've had problems when they've gone to try and get help. On the other hand, there are people who unfortunately have a car accident or some other type of incident where they have to take some pain medication and then they become hooked on it and become addicted to it. That's the other side of the coin.


I would say that as somebody who has a lot of experience with addiction and with my 18 years of sobriety as of Saturday, one thing that I (Applause) Thank you, I appreciate it - April 12, 1986-87 - one of the things I learned early on in the piece is that 28 days really isn't enough. They always say 28 days, but really it's about three months. It's about 90 days before you get whatever it is out of your system. It's not just getting it out of your system, but it's becoming accustomed to a new lifestyle where it's not a crutch and where you don't recognize it every time you see something that triggers whatever your addiction is.


Many people who quit drinking, for instance, if they smoke a cigarette it tends to make them want to have a drink - or vice versa, if they're trying to quit smoking and then they have a drink, that triggers their desire for a cigarette. In their minds and in their bodies, the two go hand-in-hand.


The other thing about addictions, I think, to remember is basically once an addict - it's genetic, really. For alcoholics in particular, most alcoholics, if you look at your background, you'll see there are other alcoholics in your family whether or not you called them alcoholics at the time or not. Back in the old days, they used to be shoved away in an insane asylum or shoved up in the attic or, oh, Auntie Jenny or old Uncle Charlie, oh they're just a little crazy, don't mind them. People really didn't want to talk about it.


These days we recognize it as a mental health problem and it does fall under the umbrella of mental health. I think that we're making some strides, but we need to get rid of the stigma attached to it; we need to get rid of the shame that is attached to it. That's one of the reasons why I speak out, and have from the beginning, about my own addiction to alcohol and how it's a fine line between being somebody who drinks on a daily basis and somebody who just doesn't drink anymore.


Many people say, oh well, you need more willpower - just use the willpower, just have one drink when you go out to a party. Well, for many people who are alcoholics, they can't do that. People may even say, well, just don't drink hard liquor, drink beer or drink wine - it's still alcohol. Or for those people who say, I'm doing really well, I didn't drink any rum or anything, I'm just drinking beer now. It doesn't matter - it's still alcohol, and the problem is that you can't predict when you're going to go off on a binge and when you're going to just have one or two. That is the ethereal nature of addiction - you just can't count on when you're going to go off and when you're not.


Unfortunately, right now for those of us who suffer from this disease, the only - not even cure - but the only way to keep it controlled is by abstention. You have to abstain from using even one drop. It's very much like gambling addicts - they say even putting one quarter in a machine is the same as spending $200; it sets off something in motion which is a compulsive feeling. It doesn't even matter if you win or lose. They say people who put the coins in the machines, whether they win or lose doesn't matter, it's the anticipation. It's the feeling of excitement - am I going to win or lose? - and it sets off this adrenaline in your system, and you get addicted to that feeling.


It's a very strange disease and it can change from one thing to another. For instance, you could be an alcoholic, quit drinking, stay on the straight and narrow path for a while, but then you may suddenly go, I might put a quarter in that machine and try this - and then the next thing you know, you're hooked on gambling. In my life, I've seen that happen with a few of my friends. It's very sad because it's almost like the person has two personalities - one when they're sober, and then one when they are in desperate need of that fix, whatever that fix is. They will do anything, they will be friendly, they will smile, they'll be - please just lend me $20 - until when you keep saying no, and then they'll become vicious and they'll attack you over trying to get the $20 for whatever it is their addiction is.


I happened to live in Vancouver for a number of years. There, in Vancouver, it's very different than even here, whereby if you leave anything in your car - this is a large cost to society - if you leave anything - it could be an empty CD cover - in your car on a front seat or a side seat, anywhere someone can look in the window and see it, I can guarantee you will come back and the window will be broken and that will be gone. Somebody is looking for something that they can sell in order to buy drugs.


Having worked on the Lower East Side in Vancouver and seeing the very sad cases there of people who have made their way to Vancouver from all over the country, partly because it's warm there and they can be homeless and they can just get their fix in the alleyway and people walk right by. There's a lot of prostitution, a lot of all kinds of things - anything they can do to get a fix.


This is the case in most addicts. The truth is we lie, cheat, steal - we would do whatever we have to do to get whatever that is that gives you some relief at the time, until you actually hit bottom - whatever that bottom is for you. It's different for everybody. For some people, it's an emotional bottom; some people, it's a physical bottom; some people, it's that they get in a car accident and almost kill themselves or another; and some people, it takes them several times of that kind of behaviour before they actually realize they have a problem, and can admit it to themselves that they have a problem and can't control it.


Most people feel - they don't want to feel that they're out of control. They do not want to admit that I'm powerless. Most people would like to feel they have power of some sort. But when it comes to addiction, you are powerless over the addiction until you get the help that you need and until you stop the behaviour. Once you've actually stopped the behaviour, it's like an iceberg - it is just the very tip of the iceberg - underneath that is so much emotion and so much pain buried that you then need to deal with and unless you deal with it, I can guarantee you, you will use or drink again.


That's why I think the programs are so important to be available for Nova Scotians. We know, Nova Scotians - like Australians, where I came from originally - they like to drink. Many times people will profess their manhood or womanhood over who can drink who under the table first. Advertisements also push this kind of fact about - oh, get out there and drink and you'll feel better.


So it is a societal problem and until we address this and address the root causes of it and realize it's a disease and people need help, it will continue to be a growing problem for our youth. Many young people whom I've known personally, and parents of young people, have died after drinking binges at a party. They go home, they don't quite make it up the stairs, they fall asleep, but their heads are tilted in a certain way and they drown on their own vomit. Very, very sad - I had that happen to a friend of mine, her daughter, about a year ago just before Christmas time, a 22-year-old, young aspiring actress, had her whole life ahead of her, and now she's gone. So I really commend you on everything that you're trying to do for addictions. Anything I can do to help, I certainly intend to do so.


I just like to end my piece and then I'll hand it off to my colleague in front of me. I'd like to read a little part of a letter from a registered nurse who is concerned about Bill No. 37. She's only been a registered nurse for about a year and she says that over the last 10 years, she's also been an inpatient in Halifax area hospitals.


She says she hasn't forgotten what it's like to be in the bed as well as at the side of the bed. She says:


At the end of many shifts, I wrestle with crippling guilt knowing that, due to inadequate staffing, I was unable to do what I promised to do when I took the honour and privilege of placing "RN" after my name. I know too well what it's like to be a patient and to hand over your well-being to strangers you trust only because you see those same letters on their nametag. It's terrifying.


Now it's not just patients who are afraid, but over 33,000 health care workers in this province. The passage of bill 37 means health care workers will lose their ability to strike effectively. Patients' voices will be silenced because their caregivers will not be able to advocate on their behalf.


I believe deeply that the most important duty of a nurse is to advocate for people who are unable to speak for themselves, whatever the reason. Disease, old age, homelessness, food insecurity, poverty, abuse and the ravages of addiction place 31,000 Maritimers in QEII hospitals each year. And that's only those who are admitted.


It's also worth mentioning that, by their own numbers, the QEII treats 70,000 people yearly in its emergency departments and reports some 375,000 ambulatory clinic visits.


Each and every one of these people needs an advocate.


They need someone to speak up for them as they navigate the complicated and intimidating world of health care.


It is my duty to protect, guide and witness the suffering and healing of those people.


I do not take this responsibility lightly.


Inadequate staffing levels make it difficult, sometimes impossible, for nurses to carry out our duties with confidence.


When I need to treat eight patients - three in heart failure; one with cirrhosis; one actively dying and in dire need of pain control; two with diabetes facing amputation and another whose wife is crying because he doesn't recognize her - I am unable to do my job. I cannot educate my patient's wife about the progression of Alzheimer's disease. I cannot hold the dying woman's hand as she struggles to leave this life with dignity. I cannot offer a shoulder to cry on, or lend an ear when it's desperately needed.


I can do the bare minimum, and that simply isn't good enough.


It's not good enough for me, and it's certainly not good enough for the people I promised to watch over. We have an ethical obligation to speak up.


The Canadian Nurses Association code of ethics tells us "nurses support a climate of trust that sponsors openness, encourages questioning the status quo and supports those who speak out to address concerns in good faith."


When we strike for safe staffing levels, we are advocating for vulnerable people who need someone to shout on their behalf.


Nurses shouted for me when I was vulnerable, and now I am shouting.


Safe staffing levels are the best way to help alleviate this problem. We need less overtime and more regular staff. Lower nurse-to-patient ratios would help prevent medication errors, improve the quality of assessments, increase time at the bedside and allow nurses to do what we are trained to do.


When I need to treat four patients I am able to do diabetic teaching; walk with someone to help improve their mobility; explain what medications are needed and why. I can get to know my patients and their families. I can be a more effective advocate, and I can be a better nurse.


The safety of our patients is at risk, and when bill 37 was passed, so was that of patients served by the thousands of other health care workers affected.


We currently have very little power to advocate for our patients, and without the right to strike effectively, we will have almost none. Bill 37 is not only an attack on organized labour, but also an attack on the Nova Scotians that need us most.


Our right to strike protects patients.


It's that simple.


With that, Madam Chairman, I pass it on to my colleague.


MADAM CHAIRMAN: I ask the honourable member if she would please table that document.


MS. ZANN: I will.




The honourable member for Sackville-Cobequid.


HON. DAVID WILSON: Madam Chairman, I'm going to pick up where I finished off questioning the minister. We were talking about capital equipment, hospital equipment, specifically the CT scanner. I always seem to point this way, to the member for Inverness, because I know he is very engaged in this issue.


The minister acknowledged that in the $18 million under Hospital Equipment that $1.2 million is there for the CT scanner in Inverness. Along with that, Madam Chairman, we know that there needs to be training and the ability for staff and those who are within the health care team in Inverness to be able to work on that.


I'm just wondering, could the minister advise us if the staff, in Inverness, is trained to utilize a CT scanner?


MR. GLAVINE: Madam Chairman, to the member for Sackville-Cobequid, when a hospital is getting a new piece of equipment, we all know that the training and making sure that that diagnostic piece of equipment is able to be - the information is able to be interpreted in the best interests and the safety of the patient - training is imperative for sure.


This piece of equipment, the CT scanner, is going to be a wonderful assist for Inverness. As we know, Inverness was looking at perhaps losing their surgery. We now know that the information that the CT scanner will provide is going to again enable surgery, enable better care and direct interventions for patients. I know that this is one of the reasons why we we're not saying early summer, but we're saying Fall will be required to make sure that staff indeed are well trained. Also, of course, when bringing a new piece of equipment into the Inverness hospital, some renovations are part of this as well. With getting everything in place and making sure the training is up to the standard required, that's why we're looking at a Fall start for the CT scanner.


MR. DAVID WILSON: That definitely is a key component to this announcement. Maybe when the minister, when I finish with a few comments - I'm not too sure if there are physicians there now currently available or trained that can order these tests, but I know this has been an issue for a number of years. I believe there was a demonstration here some time ago about the need for this. At the time, I had indicated to those I met with - I personally met with many of the residents, but also, I believe, a physician from the area - that at no time did the past government say that that was not priority for them, but the sheer number of requests from all over the province had that priority down a little bit. Right at that moment we couldn't look at it. The funding wasn't there, mainly because we knew of the aging of the current CT scanners in the province. I believe last year we had maybe funded two - or the department had funded two replacement CT scanners - it might be more, but I think the Capital area had one and maybe Yarmouth, I believe, if I'm not mistaken.


Can the minister maybe tell us, within the $18 million, are there any other CT scanners that are going to be replaced? The current ones we have are extremely important. I know the replacement one in Capital last year was high on the priority because of the sheer number of CT scans that they do on a yearly basis. I'm wondering if the minister could advise if any other of the current CT scanners will be replaced, because after a certain amount of time, especially in health, technology changes rapidly. These pieces of equipment are important and sometimes the new technology can see more patients, which is a bonus for patients. Are there any other areas that will see a new CT scanner, either a replacement or a brand new one?


MR. GLAVINE: The member for Sackville-Cobequid is quite right. When a piece of equipment like a scanner, or like we had just a bit over a week ago in Cape Breton Regional when the MRI machine went down and required a pretty considerable piece of equipment to get it back up in running, it creates that delay in appropriate surgeries and interventions and so forth that do require good diagnostic imaging.


At the moment, what other capital equipment will be ordered this year is part of that overall plan that I presented earlier. I'd say the member opposite is looking for a CT scanner for the Cobequid Centre maybe. But anyway, that being said, it's important that we notify the hospitals across Nova Scotia, the regional hospitals and smaller health care centers that have ordered equipment because of the aging of their equipment, the number of breakdowns they are experiencing, we need to notify those facilities and DHAs first and foremost what they will be receiving, and of course making sure that we do have a reserve for that time when a piece of equipment breaks and we're able to assist the facility to get a new piece or an upgrade as quickly as possible.


MR. DAVID WILSON: I think maybe I have one minute or so, so I won't get into that. I tried maybe a backdoor way to try to get the list from the minister - I know he has it and I know he said he will provide it to Nova Scotians and then hence myself, but I was trying to see if he would give us a little more detail on that. That's the challenge the department has - I know I only have about 30 seconds and I know our friends in the Progressive Conservatives will get up and talk on this, so maybe when I come back in estimates, probably tomorrow now, I'll look at getting into a little bit more on the needs of the health equipment.


MADAM CHAIRMAN: The honourable member for Pictou East.


MR. TIM HOUSTON: I don't want to disappoint the minister, so I will carry on with my questions about Glen Haven Manor and the Aberdeen Hospital. The minister referenced earlier that there are eleven facilities on the list for replacement, the Glen Haven Manor being one of those. I'm just wondering if the eleven have actually been prioritized one through eleven, or if they're just kind of in a group yet to be prioritized, or what is the status of that?


MR. GLAVINE: I want to assure the member for Pictou East that that process is well underway and that these replacement facilities that have been identified are going through a review. I know there was a pretty lengthy discussion around replacement facilities and there may have to be three or four a year over the next three or four years that will be identified.


As I spoke earlier, when we have facilities - one in particular that is without a fire suppression system, and after the tragic consequences of what we saw in Quebec this winter, we know that that's the area in which we must move first and foremost. Glen Haven Manor is an old facility; it is certainly a safe facility, but I know as we take a look now across the province and you go into one of the newer facilities, especially some that have been built in the past five years, some of our older facilities certainly seem to be wanting of an upgrade or a total replacement.


One of the areas that I still think needs a look at - and it may not be for the eleven that are being put on the books for replacement, but maybe the member for Pictou Centre is aware of a few schools in his area that had a major retrofit, where inside the envelope we put a 21st Century way of carrying out education. I'm one that, instead of a $20-million replacement, if we could have a $10-million refurbishment of a facility it may be one of the avenues that our province needs to look at and, again, we can get a lot more work done on that kind of basis.


I don't think it's one the department has used extensively. I know in cases where there were physical plant demands that the department addressed those, but I think if we could get two old facilities absolutely upgraded for the price of one replacement, it may be an avenue that we need to pursue.


MR. HOUSTON: In terms of the possible strategy of the department, looking at three or four of these facilities a year, it just wasn't clear if that is the way forward or if that's something that is being contemplated. I guess my question would be: In the estimates for this coming year and the budget for the coming year, did that allow for three or four facilities or some number of facilities to be either replaced or renovated? Is that in the budget for this year?


MR. GLAVINE: Madam Chairman, when we look at eleven, we can basically say three per year for the next four years is the model that we are looking at. We know there are two for sure that must be replaced this year, and what other one now will be presented to Cabinet in the coming weeks. The issues committee have really done a lot of work in terms of preparing a recommendation because, again, we're in the process of making sure that at least two with high priority are being addressed and the planning in relation to the capital budget will be coming before Cabinet very shortly.


When I took a look at the priority list - and I know it was announced three days before the last election - I have every assurance and, in fact, a criteria construct that the nursing homes went through right across the province, and those that are in the upper 25 per cent, in a short term they will need to be addressed, and then from there down, again, in the future some of those will certainly be looked at as well.


MR. HOUSTON: Now just in terms of the strategy of the department where it comes to replacing the facilities, I'm just thinking of, I guess, the two. I want to ask about those just so I can get a sense of maybe the strategy of the department - would the strategy be towards more facilities but smaller, or fewer facilities but bigger, just in terms of the two that are being replaced? Are they being replaced with the same bed size or are they being shifted to smaller ones? - I guess that would be my question.


MR. GLAVINE: It is getting to be a long day, isn't it? Anyway, when we're talking about replacement we need to view it from the perspective that the operational dollars for 202 beds at the Aberdeen are what we would continue to be looking at. Once we - you know, if there are no downward population shifts or needs - and I don't think that's going to be the case when we look at the aging demographic of our province - that is the number indeed that will be replaced.


This will be a year, really, when we'll be doing a lot of planning, because we need to take a look and see whether the department is going to go down the road of doing a design that will be able to be adapted to a number of different areas, with some modifications based on the area where the nursing home will be placed. A great deal of planning certainly will be in this year so that that rollout will indeed go along, I believe, in a relatively smooth fashion for the next number of years.


Overall, I believe perhaps other governments would not be much unlike where we have arrived, and that is looking at, I think, what can be the highest quality of care, and that's care in the home. That will be our central direction while doing the necessary replacement and refurbishing that is required.


MR. HOUSTON: Thank you very much. I should apologize to the minister; I fully intended to offer if maybe he would like to take a 10-minute break, for any reason - we'd be more than willing to offer that.


MR. GLAVINE: Well, I think it was about 30 years ago today that I ran the Boston Marathon. I still have some of that staying power, so we're good to go. (Applause)


MR. HOUSTON: To say I'm impressed would be a severe understatement. Okay, that's good, I appreciate the response there and I actually appreciate the minister's ability to read between the lines on my question as well, so thank you very much for that.


Just to take a page out of the book of my colleague for Pictou Centre, and I suggest that I am getting towards my last questions, but I do have a couple of questions on the Aberdeen Hospital. A couple of years ago, I think at this stage, the Treasury Board did approve funding for the Aberdeen Hospital emergency department and pharmacy services redevelopment. My initial question would be: How much is in these estimates for that project?


MR. GLAVINE: The project, as I stated earlier to the member for Pictou Centre, will get underway this Fall. I think it's a very much-needed project and it's one that is going to modernize the emergency department, as well as the pharmacy and some additional upgrades.

The total project is $32 million. The DHA's share of that will be $24 million and the department will have $24 million. DHA and the community will be at $8 million on the 75-25 per cent split in 2014-15, and we are getting along, of course, in the construction year, but this year $6.5 million will get that first phase underway.


Our government is committed to "Stage-Gating" the project so that we go through design - which of course in this case has been approved - and then the first stage, second stage, to make sure we're on budget, the quality of work that will be desired has been met before moving to the next stage of work. But once started, it will be a continuous progression towards completion.


I know that Valley Regional Hospital - probably 25 years old - again, went through a major renovation of their emergency department. At lot of it was due to the fact that the flow-through was very weak, big open areas that didn't meet the current requirements, and when you are transforming an emergency department it has to be a thoughtful, calculated, strategic approach for sure, so we'll go in those stages over the next few years.


MR. HOUSTON: I think when this project was approved it was approved under - and I think I got the terminology right - a protracted project schedule. So in other words, this was a project that, at the time, was estimated to be completed in 2018-19. I think it was approved a couple of years ago. The schedule was drawn out a little bit. Ordinarily, one would expect that a project of this size would be about a three-year project, so just to be clear on that - it would be expected to be about a three-year project and they budgeted for six years.


I wonder if the minister was aware of that aspect of the project and if maybe within the department there is any kind of analysis that looked at the risks and implications of extending the timeline out, because obviously when you take a project and you extend it out over time, I'm sure there are pros and cons to that, but some of the cons would be there's more risk and there are probably more costs in terms of people and management and stuff like that, so I'm just wondering if the department has looked at the risks and the implications of continuing with the protracted project schedule as opposed to just kind of getting on with it and doing it in what one might expect to be a standard time frame of 36 months.


MR. GLAVINE: When I was at the Aberdeen and went through the facility there, I actually had an opportunity to chat with at least two of the emergency room doctors; there may have been a few others at the meetings I attended. They didn't see a problem with the plan from the department, or at least that was never voiced by the emergency room doctors. They were very familiar now with the design. This was built into the design, as to how they would go about a pretty transformative physical project to the hospital. I think in order to manage the work that goes on day-to-day in an emergency ward and to have a rebuild at the same time, this seemed to be quite acceptable.


I've had no reason at this point to have a reconsideration of a shorter time period. I know when I think of the Valley Regional that went through the same kind of project it seemed to be, to me, a very slow process of accomplishing the work that needed to be done. So I think the department and the DHA have worked very closely to make sure that what is required and the timeline in which it will be constructed have been both in agreement. At this point, I've had no cause to bring the parties together and ask if there was need for a different approach.


MR. HOUSTON: I certainly have no reason to dispute some of the minister's comments, although I will say it's easy to find opinions on different sides of things. Probably in this House right here, you probably could find 51 opinions at any given time on something. I've certainly heard talk that doing it on a quicker basis would be more efficient. I've seen analysis that suggests that it would be in the range of $2.5 million cheaper to do it quicker. I'll just leave that as something for you to consider, but I am happy with what I'm hearing about the project from the minister today.


I don't have any further comments, but I will be passing to my colleague, the member for Inverness. Thank you.


MADAM CHAIRMAN: The honourable member for Inverness.


MR. ALLAN MACMASTER: It is a pleasure to have a chance to ask a few questions this evening. There is one matter that is near and dear to my heart and you can probably guess what it is - the CT scanner for the Inverness Hospital. I know the government has committed to it - can you give us a little update on the CT scanner? I'll let you have a chance to comment. Thank you.


MR. GLAVINE: Madam Chairman, we have the member for Sackville-Cobequid drilling down on the CT scanner, and now we have the member for Inverness, so I guess we all want to share in this good news and we all want to feel that we're part of bringing this very worthwhile project to fruition. It is, in fact, very, very good news.


It's good news from the point of view that getting the scanner in Inverness I think really solidifies other work that can go on in the hospital. It really says for the people of Inverness that we want to make sure there's a strong future for the hospital in one of your communities that you represent.


Really what it says as well - and I know in my time as minister, seeing strengthening of the system right across the province is our goal. I would have no interest in being the Minister of Health and Wellness if moving to one health board and four management zones wasn't going to strengthen the system right across Nova Scotia. I know in two or three years' time what will be in Yarmouth that's not there today, what will be in Amherst that's not there today, and what will be with a refurbished ER at the Aberdeen, and so on right across the province.


Nova Scotians have said to us that they want strong health care delivery as close to home as possible. Your community said it pretty strongly when your surgery was in jeopardy. As good as it is at Cape Breton Regional or at the Antigonish regional hospital, what we can do in our community 365 days of the year is critically important to us. I believe our government is responding to that need and I look forward to what we're going to be able to do from one end of the province to the other. The scanner in Inverness is part of that bigger picture.


MADAM CHAIRMAN: I would remind the honourable members to please address their comments towards the chairman instead of each other. I know it's getting late and sometimes it's easier to talk to each other, but it's not strictly parliamentary procedure.


The honourable member for Inverness.


MR. MACMASTER: The minister is certainly responding and his government has responded. Actually, I was kind of surprised that the member for Sackville-Cobequid would be interested in this matter, because I know he always told us "no" when we asked for the CT scanner.


I was very happy and the community was very happy, Madam Chairman, when the government did make the announcement that they would provide a CT scanner. We do have strong hopes for the future of Inverness Hospital and continue to have surgery there. To have a CT scanner there is important because it's two hours away from the closest regional hospitals, and I think that's 45 minutes more than any other non-regional hospital in the province.


There's a strong culture of professionalism at the hospital. I'm sure there is at every hospital in the province, but I know that they've had a pretty good record of success at Inverness. If we keep empowering the hospital to have those services, it will help with physician recruitment and it will keep a bright future for the hospital.


Through you, Madam Chairman, could the minister provide us with a timeline? I know we were expecting maybe to hear something more about six months after the announcement. Could the minister provide us with a timeline for when the professional staff at Inverness can expect to start either seeing a CT scanner on the premises or a schedule for that CT scanner?


MR. GLAVINE: To the member for Inverness, we are looking at a timeline of the Fall of 2014. We know there are some, I guess, probably some smaller renovations, but there are some renovations that do need to be carried out and training of staff is imperative, so that when it is brought to the Inverness Hospital that those accommodations and training have been carried out.


I'm hoping to get down to Inverness this Fall and, hopefully, we'll have an official moment to recognize what really is responding to the people of your area. That's one of the great benefits of our province - whether it's my community a week or so ago engaged in Kraft Hockeyville or whether it's something more important, and that is the health and well-being of citizens in a community that can benefit from investment in some of the latest equipment for diagnostic work.


MR. MACMASTER: One final question. If there are health professionals at the hospital in Inverness who wish to ask questions, perhaps a little bit about the training and the modifications that need to be made to the hospital, the renovations, is there a person you could identify at the health authority or within the department that they would best speak to leading up to your visit in the Fall? And I look forward to seeing you at that time; I'll certainly be there when you come down. Is there somebody who can be identified, again, within the department or in the health authority who could act as a resource for the health professionals in Inverness?


MR. GLAVINE: Deputy Minister Frances Martin, to my left, has been a great source of help, of information and, literally, daily communications in my work. I could give her the assignment, but it's actually more appropriate for you to be in touch with the Director of Communications for the District Health Authority, Greg Boone. He'll be working with the department and so he in fact can give you some very specific information on timelines and so forth for the scanner, the training, and perhaps even a date in Fall.


MR. MACMASTER: Madam Chairman, I'd like to hand over the remainder of our time to my colleague from Hants West.


MADAM CHAIRMAN: The honourable member for Hants West.


MR. CHUCK PORTER: Thank you, Madam Chairman. I'll do my best to address my comments through the chairman as you are continually reminding us for some reason. It's fairly relaxed in here though and I think it works well, so I do appreciate your reminders.


I thank the minister again and I'm happy to be part of the debate. I thought I was going to be up a couple of hours ago and a number of my colleagues say they want to get a minute or two here and a question, and here we are almost at the end of four hours - you're probably happy about that, minister.


Anyway, there are a number of things that I do want to cover. I'm going to jump right to the breast screening unit, the mobile breast screening unit, something I'm sure you're familiar with. It has travelled around the province in the last number of years. Previously there was discussion about reducing the number of days or weeks that it might visit certain areas. I can tell you - although you probably already know - I think when it was in Windsor at the Hants Community Hospital it was extremely busy. I'm not sure, but I think we might even hold the record for the most number of days or weeks that it actually visited a particular site.


Given the service area that it captures, the numbers are phenomenal. I think that's why there are extended periods there; it's our local community hospital, but it's sort of that regional base for that unit to situate itself and the good work that goes on there, you know, when we think about the prevention piece and we know the success of that unit. Can you just tell me, and the members of the House tonight, and maybe those watching at home, I know who are interested as well - what is the status of that going forward?


MR. GLAVINE: I welcome the critic for the Progressive Conservative Party to the questioning and discussions this evening. That, as the member has pointed out, remains a very critical diagnostic part of making sure that women across the province are screened in as timely a fashion, as timely a manner, as we can. We know there has been an upgrade with digital mammography and that is a better service for women of the province.


The specifics around the time when the mobile breast screening will be in communities, length of time and so forth, I don't have that at my fingertips. I'm prepared to get it for the member. Windsor is in the natural catchment area of Capital Health and we know that now, with the breast health centre at the IWK, many in Capital Health are able to access the work that takes place there. It's another wonderful professional service for our province. I will get that information if he's interested in when and the length of time that it would be at the Windsor hospital - we can get that.


MR. PORTER: Madam Chairman, I would appreciate that and yes, absolutely, I would like to have that information whenever it's convenient for him to get it.


We continue to have those who advocate, and rightfully so, for that unit, realizing as well that the facilities now have the digital mammography unit there. What has been explained to me, and probably to you over past years as critic, is that there is a comfort level that these women have going to be tested, for whatever reason, at this mobile unit and that they would not necessarily go to a hospital to have that done. I'm not sure what that is, but part of that explanation has been that there is a level of comfort with that and the work that they do to get them out. They know it's there.


I really hope that it is still available. I know that there was talk about cuts in the past to this unit, and I'm not even sure to what degree - maybe totally at some point. I do know that there is a strong group and I believe - I don't know if it was last Spring or maybe the Spring before, I even tabled a petition in this very Chamber on that issue. So I do appreciate your input on that and your willingness to provide that information.


We were talking about a CT scan a few minutes ago. We have not been looking in the Windsor hospital for a CT scanner, although the convenience would be wonderful. Something you know very well that we have been after for some time now is a dialysis unit. This is a bit of an interesting piece because we weren't even asking government or anyone else to pay for it - money was raised and it still sits there ready to make the capital purchase. I realize that there are ongoing costs that go along with that, with regard to staff and set-up and so on. We've been advocating for some time. It's not going to go away any time in the near future - something that you would certainly be familiar with were the potential changes that are upon you now, as minister, to review.


I think I may even have asked the question last Fall, when you first came in, around this very subject and the potential around the opportunity as I see it and many others see it, instead of moving from Berwick to Kentville and spreading the wealth on down through to Windsor where we have quite a bit to participate in by way of funding and support and so on - and I asked this question in Public Accounts last week of your deputy and she didn't really answer the question, and I understand and appreciate that, probably knowing full well it was going to be coming up this evening or at some other point during the estimates. I would appreciate where we are on that.


What I did gather from your deputy last week, if I'm not mistaken, was nothing has happened yet or no final decision has been made on Kentville. I don't want to put words in her mouth and I may have misconstrued something there, but I think that's what I took from it. I certainly would look for your clarity around that and your comments on where we are with the review that we talked about in Question Period when I posed the question to you last Fall, and you did assure me we would certainly look at it. I appreciate that, as do all those from my area and the many who are travelling. You are well aware of the hardships that go along with dialysis and what that means, and if you want to take some time on that I would appreciate it.


MR. GLAVINE: First of all I just wanted to duck back to your previous question around digital mammography. There are eleven fixed sites that have been upgraded over the last while. We do have a strong program in the province, but you are right in making sure that we still have community visits and that is a significant part of that whole program.


We all know that with our aging population, the very high incidence of chronic disease, of diabetes, we know the relationship to organ failure and the need for kidney dialysis, renal dialysis, is very strong in the province. Over the last while we have seen an expansion to some other sites, and currently we are very close with a Valley site. Whether that would change the travel, because of the geography of some of the residents in Hantsport-Windsor area, is yet to be determined.


As I did tell the member last Fall, we were prepared to do a review and by June we will have work in the Windsor hospital to determine whether or not it could be a next site. The member is well aware of the dialysis program and the standard of care given to dialysis patients is one that is run by the QE II. I have had a great briefing from Dr. West and his staff with dialysis. I have visited the unit at the Dickson Centre and the demands there are extreme - I would classify it that way. I think there will be an additional site coming on shortly. I'm very pleased to see that one of the Tim Hortons sites is going to be converted to an additional dialysis unit, so that's good news at the QE II and that's emerging.


But to take a look at Windsor, as we look at the number of new patients requesting dialysis and if you sit and talk to a person going through dialysis, I actually heard a member from one of your constituents today about that very question, and so we know they already have a challenging medical condition that is not going to go away. Some are fortunate and we do have a very high rate of kidney transplants in this province; in fact, on a per capita basis, if memory serves me correctly, one of the highest and one of the most successful in the country and that is the blessing that some will receive a new kidney.


But that's not for everybody and we all know that dialysis in the home is also increasing as our patients get educated and there are now many more committing to home dialysis, but that is in contrast to the high number of transplants. We have a percentage that can actually increase significantly with getting dialysis in the home.


Over the next while we hope that we can give you at least a more certain answer, positive or negative. I know there are many in your area who would like to see dialysis closer to home. I believe the Valley dialysis unit, when it is determined to start, will be a construction that will go on there adjacent to the hospital so they have physicians readily available to deal with any effects or requirements that dialysis may pose at a given time. Hopefully, by June we will have something to say.


MR. CHAIRMAN: I was reminded by our good Clerk that we are supposed to not address the members opposite as "you"; address the questions through the chairman, please.


MR. PORTER: Thank you and we will do our best, as I said earlier, to go through you.


Through you to the honourable minister, thank you for your answers on that and I know the people will be anxious to see where we go from there.


With my background and so on, I understand the need to have something handy if that need arises. We say that is one of our assets, Hants Community Hospital having an emergency centre there and a doctor there around the clock as well. We do have that as an asset and I could not put that in there of course as I continue to lobby and I know it's an easy thing to always ask. We are also very realistic at the same time, but appreciate the continued support that you can see this project.


You mentioned home dialysis. I have known a number of people who have attempted it, and it has not worked out quite so well. Again, it's not for everybody, it's a struggle. Families generally struggle, as it is, to deal with the situation by way of getting back and forth, and that has its own burden. There are many still travelling, but what's really unfortunate, I think it's only fair to point out, there are some I know who have given up. They have, over my few years - I've been here eight years in this House and I don't know for how many we have been lobbying for dialysis, but for a few now, probably four or five or more - there have been a few I have known who have just called it a day. They couldn't do it anymore; they couldn't make that trip.


When you think about that, it's not all that far. They are still in Capital, although they are on the edge. It's still an hour's drive for them and it gets more tiresome as the days and years go by; it takes its toll. One of the things, when we make these tough decisions, is taking all that into consideration and I know that your staff and you as well certainly know that. It does happen and you are quite correct as well


MR. CHAIRMAN: Order. I've been asked please if you could address the minister as "the minister" and not "you."


MR. PORTER: And it's only Monday. Thank you and I'll do my best not to address anyone as "you." Anyway, this has usually been very casual, and so it should be, very relaxed as the quorum is in this House. That's fine, I appreciate it and your comments - and maybe you have taken me right off my train of thought there too at the same time. That's okay because there is a lot to cover.


Anyway, you talked about transplants, we were referring to transplants, through you, Mr. Chairman, to the minister, we were talking about transplants and yes, we have a decent number that seem to be getting done. Residents in my area have also been very fortunate, a couple of them successfully. One who was 72 years old and in very good shape, had a transplant and is doing tremendously well. You wouldn't think that would be possible but it is quite possible, so there hope with that transplant going on as well and we can only hope for more of that to take place, as that is really the only cure, and we look forward to that.


There are a lot of things to prevent it, as we know, and we need to continue to work on that prevention. I know that you've had your share of comments, Mr. Chairman. Minister, you as a minister have had your share of comments, both on this side of the House and on that, with regard to prevention. Although some may not be widely regarded as favourable, I think a lot of them were taken seriously, as we do have a responsibility as individuals to look after our health and to continue to do what we can. That's tough in a day and age like we're in now. It's too easy to hit a fast food restaurant because we're too busy working, two parents working to keep a household going. Things are busier than they ever were, certainly busier than they were in my parents' time.


Life is different, we know that, and they all have an impact on things like childhood obesity, and adult obesity as well. Again, that whole prevention piece around we should all work a little bit harder and if we realize the numbers of what it costs to continue to fight that prevention and the other issues, once we've reached the problem, we may all have a clearer understanding of what that really does mean, as we watch the provincial health budget grow in this province to, now, near half of the provincial budget - over 40 per cent I do know.


We need to do something about that and whether we can or not is yet to be seen. That will be a lot of what you and your government - or minister and his government - see, this isn't easy, Mr. Chairman, you think it is, but it isn't - do to continue with programs and to be serious with programs and development opportunities for all Nova Scotians to be more aware of and to take part in.


Again, I want to thank you for the comments with regard to dialysis and at least a potential date of June for some kind of decision. I could only hope that would be favourable in some way. I would also state that we are open in Hants West and to the foundation and all who have been working on many ideas as to how this could happen, or maybe it's down the road, but still, even if it doesn't happen at this point in time - and again we're hopeful that some plan will come about, that we're not forgotten because of our sheer numbers. It's hard to believe how many travel out of Hants West and surrounding areas, off to the Valley or to the city here on a daily basis - it's a lot.


On that very subject, I might just ask, does the department know how many dialysis patients are being treated daily in the Province of Nova Scotia?


MR. GLAVINE: Thank you for the preamble in terms of your understanding and commitment to work for better population health in our province. Each time over the last number of months that I've had a briefing, I walked away with disconcerting numbers of people for this chronic disease and certainly that burden that we have in this province is exceptionally high. We are all challenged to do our small part. We don't have to be fanatical, but rather we have to be consistently working towards better health outcomes.


I know I am especially concerned about the youth of our province and some of the health concerns that are being raised now by physicians, by teachers, and many others across the province, that we need a renewal of health initiatives for all of our population. But to have good life habits, very often they need to start with our youth.


You did ask me about the number of patients on dialysis and I don't have that number, but it is my second response that I will find out for you. The day that I toured the dialysis unit at the Dickson Centre, and just recently Berwick, which has a very small number of beds and a restricted dialysis program there, again the numbers, when you're looking at I believe about three shifts of 30-something now that will go through the Dixon Centre, tell us about the need. And then we have Cape Breton, Yarmouth, Antigonish, so we have a number of other centres that are part of the QE II program, and in addition those on home dialysis, we know that there is a considerable need in our province, but for my own interest as well I will find out the number.


MR. PORTER: I guess even in describing your tours around your visits, what is understood clearly is there are many. The number is quite staggering, actually, how many people are being treated every day in this province for dialysis.


I want to move on - and you touched on it briefly there with regard to schools and educators and you being one of those former long-time educators - there were some changes in recent years with regard to what was available in our schools by way of foods and healthy snacks and so on. That was a program and I am not sure whether any data has ever been collected after those changes were implemented or not, if we saw any significant changes by way of the outcome of health which was, of course, our goal at the time - to create better health opportunities and better foods.


In your mind as a former educator - and I know it hasn't been that long but it's been a while now since you've been here and now in the role, one of the most important that you hold in this province - would you see new ideas coming forward around this early on, whether they are working with the Department of Education and Early Childhood Development to create something other than a change in maybe the dietary needs or the food program at the school? You can't even buy a hot dog now. When we were kids of course you could, and even up till recent years, just as an example, maybe on a rare day or something like that it is offered, but on a daily canteen opportunity or option, along with other things, that's just one example.


Outside of that were there any measurement tools that were put in place, or are in place, with regard to - has this been successful at all? I'll ask you that part, along with: Are there any new things coming along that will also - given your comments over the last number of months - anything there new coming along that would suggest more changes to educate our youngest citizens?


MR. GLAVINE: To the member for Hants West, I did gather, through the means of modern technology that my assistants are permitted to use, there is probably somewhere between six and seven hundred Nova Scotians who are getting dialysis at the current time. If I get an exact from Dr. West and his team, we will pass that on to you as well.


The member opposite raises a really important question because we can talk about the rungs of the stool, if you wish, that lead to wellness, and when I speak about wellness it's physical health, mental health, social health, spiritual health; it's really all of those components together. We know that living in a fast-food society, sometimes we do compromise perhaps a little more than we should. There is nothing wrong with a treat if you wish, with eating out and fast food, and many have also taken pretty strong measures to actually give a more rounded complement of items on their menus, so that is a good thing.


I think what children learn in that school setting day after day, year after year, is something that can become cemented in a practice that will go forward. I know in some schools where this has been a practice for 10 to 15 years, we get children actually educating their parents. I know one of the real challenges for some families, week in, week out, is to be able to have the financial means to be able to provide a good quality of food.


I know that some school boards have taken this on as a very strong initiative and to work across all of the schools in a particular district. One of the measures that the last government brought in was the program Thrive! And Thrive! is a very, very comprehensive program to look at health and wellness. It is an evolutionary program where different initiatives are coming forward. The Department of Health and Wellness is now working on a more robust policy in conjunction with the school system and I think we will see an enhanced program coming forward.


It's interesting that what started out in many schools - and many of us are familiar with - is the Breakfast Program, because all of the research is pretty absolute on this one and that is that first meal of the day, to kick in our metabolism, is the important one. I know that as a teacher, I simply had to eat breakfast to have the energy, the stamina, and meet the needs of a strong, daily routine in school - and I think that is true for pretty well all of us.


The Breakfast Program now has moved outward to bring into our classes at the high school level a program that is working to use local ingredients in the preparation of our food in what used to the be the traditional Home Economics classes, and the COM/PAL class for example, is to bring in local ingredients to be able to show students that even with the climate constraints that we have in the province, there are a lot of items that are healthy that we can integrate into snacks or in the preparation for a meal.


We actually had the kickoff of a program in the Fall where one of the banks is involved with helping to fund this project in a number of schools. I think there is really some basic work that has been done that we can build on, and I know families that make a strong case to make sure that there are healthy snacks. Children learn that a carrot stick, a piece of celery, an apple cut up, all of these are in fact part of just eating healthier on a regular ongoing basis.


MADAM CHAIRMAN: Order. The time allotted for consideration of Supply today has elapsed - perfect timing, minister.


We will wait for a few minutes for the subcommittee to finish as we'll call a short recess.


[8:39 p.m. The committee recessed.]


[8:44 p.m. The committee reconvened.]

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


The honourable Deputy Government House Leader.


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


MADAM CHAIRMAN: The motion is carried.


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