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March 26, 2007
House Committees
Meeting topics: 

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3:15 P.M.


Mr. Wayne Gaudet

MR. CHAIRMAN: Order, please. Good afternoon. The Committee on Supply will now be called to order.

The honourable Deputy Government House Leader.

MR. PATRICK DUNN: Mr. Chairman, I call the estimates for the Department of Health.

E11 - Resolved, that a sum not exceeding $2,959,112,000 be granted to the Lieutenant Governor to defray expenses in respect to the Department of Health, pursuant to the Estimate.

MR. CHAIRMAN: I will now invite the Minister of Health to introduce his staff to the members of the committee and invite him to make some opening comments if he so wishes.

The honourable Minister of Health.

HON. CHRISTOPHER D'ENTREMONT: I will introduce my budget for this fiscal year. I agree it is a big number and there are a lot of great things we are doing within the 2007-08 budget.

In a moment I will introduce my supporting people, they will be joining me in a few moments. Of course, my Deputy Minister Cheryl Doiron, Alan Horsburgh our chief Financial Officer who will be with me today.


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Mr. Speaker, our government continues to deliver on our commitments to enhance the public health care system for Nova Scotia through collaboration and teamwork, helping Nova Scotians get healthy, stay healthy and protect their health are shared goals of the Department of Health and, of course, the Department of Health Promotion and Protection. Our budget remains focused on ensuring appropriate, effective and sustainable health systems that promotes, maintains and improves the health of all Nova Scotians.

Health care spending has been increasing by an average of 8 per cent per year over the past decade. With yearly revenues averaging 3 to 5 per cent, clearly, we cannot keep up with this rate of growth.

So, this year we have capped health care spending at 5 per cent. That has given us an additional $140 million more to spend this year than last, or a total budget of over $2.9 billion.

This is a difficult approach for the department. It will be challenging to meet all our expenses and maintain a balanced budget, but it is a prudent and much needed step. Good management dictates that we cannot simply spend more than the taxpayers can afford to pay.

At $2.9 billion, the Health Department's budget is the largest, of course, of all departments in the Government of Nova Scotia. Our goal is to work hard to make sure the funds we have are spent wisely, and that we get the best value for our money and, most importantly, that we maintain the existing health care programs and services that Nova Scotians count on every day.

Factors like an aging population, aging or outdated infrastructure, high rates of illness and disability, and the rising costs of care are all converging to create some difficult challenges that must be addressed in the near future to ensure the long-term sustainability of our health care system. Nova Scotia cannot do this alone. It requires federal, provincial and territorial partners working together with our many health care stakeholders or partners to develop plans to begin to address the cost pressures and demands on our health care resources.

Meanwhile, we're always taking steps to ensure access to quality hospital services, the best use of in-patient hospital services, and the most appropriate use of all health care settings. We are proud of our health care system and, at the same time, we know that there is always room for improvement.

This Spring we will receive the final report on the review of the province's health care operations. This review will provide a foundation on which to examine operational efficiencies, to improve service, and to improve system access for patients. The report will form the basis of the development of a strategic plan for the province's acute and tertiary care systems.

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Mr. Speaker, I'm pleased to note that by setting our priorities very carefully we have managed to achieve $16.3 million for new and expanded health care initiatives this year. I would like to highlight a few of those for you.

Of course, our most significant new initiative is the development of our new Pharmacare Program that will be available to Nova Scotians who do not have drug insurance. The department has received $5 million this year to build the technical and administrative structure for this new publicly subsidized prescription drug insurance program. I am sure that over the next number of hours we'll get further questions on this very, very important initiative by the Department of Health.

Regrettably, cancer is affecting more Nova Scotians every year. Cancer Care Nova Scotia's most recent statistical report shows that one in thirty-four Nova Scotians is living with invasive cancer and, as the baby boomers age, the incidence of cancer is expected to increase. We are committed to doing everything we can to ease the burden of this illness for cancer patients and their families.

We've continued to invest more every year in cancer treatment and supports. We've invested in new equipment like linear accelerators and MRIs. We have invested in professionals, including funding for three oncologists for the province last year. We've expanded oncology clinics for Inverness, Antigonish, New Glasgow, and Yarmouth, and are investing in a new oncologist for Kentville - all to help make it easier for patients to receive care closer to home. We've invested in new digital screening equipment and a central booking system to increase access to mammography and to help women get more accurate test results sooner.

I'm pleased to say that this year's budget for the Department of Health will allow us to build upon the investments made in the past and let us do even more for Nova Scotians living with cancer. We will invest $300,000 to establish a colorectal screening program, as recommended by Cancer Care Nova Scotia. The first phase will include the hiring of a program coordinator, clinical lead, and will focus on development program guidelines and determine what the districts need in place to implement this very important program. We will add another $2.7 million, primarily for oncology operations in Capital Health and the Cape Breton District Health Authority. This investment will help us expand our staffing to better respond to the needs of patients and their families - this includes RNs, radiation therapists, social workers and other support staff.

It has been a priority of this government to continue to provide access for Nova Scotians to the right provider in the right place at the right time. Evidence demonstrates that the introduction of other providers in primary care enhances efficiency, health promotion, chronic disease prevention and management, and access. Interdisciplinary teams are a key pillar of a comprehensive and integrated primary health care system. To this end $1.6 million has been committed to increase the number of new and expanded primary health care

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teams - this will translate into eight new teams across the province that will result in the introduction of six new primary health care nurse practitioners. This brings the total number of nurse practitioners to 25 from 19 last year. In addition, some new teams will include family practice nurses, dieticians, and a health educator.

In addition, $150,000 has been committed for a start-up cost related to the operation of the Inverness Community Health Centre and $225,000 for the South Queens Community Health Centre, both under development.

Mr. Speaker, clearly one of our key priorities is to enhance and expand continuing care services through our Continuing Care Strategy. This year the province has allotted $342 million towards long-term care, $172 million to home care and care coordination services. We will spend $11.1 million this year to develop and implement new initiatives as part of the second year of the Continuing Care Strategy. In particular, we will continue to expand our Palliative Care Program with an additional $2.3 million in 2007-08.

We will invest $2 million to develop a caregiver strategy and another $3 million to improve respite options in both home care and long-term care and we will invest $4 million in repairs and renovations to support seniors and people with disabilities living in their own homes. Nova Scotians have a desire to remain in their own homes, to do as much for themselves as possible and to make choices about lifestyle and their care. We want to build on what is already in their communities to further develop local solutions to meet their needs and as their needs change, Nova Scotians want to know that supports and care options are in place when they need it most and this strategy will help them do just that.

This year we will move ahead with RFPs for more than 830 new long-term care beds for the province. This RFP process will begin this Spring with decisions and contracts to be awarded throughout the summer and into the Fall.

In 2006 we were pleased to pass the Safer Needles in Healthcare Workplaces Act. This year we have invested $3.4 million to help the district health authorities, the IWK, and continuing care providers implement this Act. This new law will help protect health care providers from being accidentally stuck with a needle after it has been used on a patient, helping to reduce possible exposure to HIV, hepatitis B and hepatitis C.

Finally, we have also added $432,000 to allow us to waive ambulance fees for low- income Nova Scotians - and I am sure the member for Halifax Fairview will be happy to hear that.

Mr. Speaker, in health care across the country, wait times are a challenge. Nova Scotia has been working on its wait times for several years. Provincial ministers know that from experience there is no single solution to reducing wait times and we can't do it alone. A system-wide approach to improving access takes time and careful planning. Tackling wait

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times needs to be a collaborative effort with federal and provincial governments. In the 10-year plan, we all committed to reducing strategies to improve access and reduce wait times, and Nova Scotia has seen some great success.

The four new MRIs we are opening this year are already helping people get a test done closer to their homes, twice as fast as if they had to go to Halifax - that means that they can seek treatment faster, and by offering tests in communities across the province we are reducing the wait list here in HRM.

We are making inroads in treating cancer patients with radiation therapy, and with the help of the federal government's Wait Time Reduction Fund we bought a new linear accelerator at our largest hospital, and it has helped us meet an increasing number of cancer patients being treated and kept the wait times reasonable for radiation therapy. We invested in more technology to help us with tools like central booking of appointments or diagnostic mammograms and screening. That, in itself, cut down the wait times for checking abnormal screens, and we have been able to get women to keep coming back and have a 93 per cent retention rate.

[3:30 p.m.]

This year we are very excited about the $48 million from the federal government I just announced this morning, and that will allow us to continue to improve wait times and access to care in particular for radiation therapy, orthopedics, and diagnostic imaging. (Applause) Cancer is a terrible burden for patients and their families and we will do everything we can to improve cancer care and help people deal with this illness.

I am proud to know that Nova Scotia is leading the country in being the first province to establish an agreement on wait times for our citizens. Only through new and innovative approaches can we achieve our goal of improving access and reducing wait times for Nova Scotians.

Mr. Chairman, health care professionals are the backbone of our system. We know Nova Scotians place a high priority on their health system and they value those who deliver health care such as doctors, nurses, licensed practitioners, clerks, and lab techs. Investment in people represents three-quarters of the health budget. This investment is a major contributor to the shift in health spending.

In 1998-1999 health spending in Nova Scotia accounted for about 41 per cent of the province's program in capital spending; today that spending has gone up to almost 48 per cent. The Nova Scotia Government is proud to have funded significant increases in wages, health benefits and pensions over the last decade; in fact in most cases our health care workers are leading their counterparts in Atlantic Canada when it comes to compensation.

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At the same time we need to find the right balance between our investment in people and our investment in the other quarter of the health care budget which includes hospitals and nursing home maintenance, equipment, technology, drugs, and research. This year we will spend another $22 million for doctors in the province, including almost $1 million more to staff emergency rooms. We will also spend $45 million to cover contract and wage settlements approved last year for health care professionals including paramedics, nurses, clerical staff and many others. Another $461,000 will be invested to hire more mental health professionals to reduce delays in completing court-ordered assessments for youth.

Mr. Chairman, ensuring that information systems are in place and standardized across the province is important to the efficient and effective running of the province's health system and, to that end, this year we will focus on a few initiatives to help support the workers, the system, and the users of health care. In particular, we will implement the Electronic Health Record as part of our Primary Healthcare Information Management Program and we will continue to develop and implement the health administrative system project which will allow district health authorities to more easily and effectively manage administrative functions such as HR and finance.

Mr. Chairman, the demand for new services, technology, drugs, and treatments continues to grow and the demand for nurses, doctors and other health providers continues to grow, so we have carefully set out our priorities. We have established a budget for 2007-2008 that will ensure that Nova Scotians continue to receive existing programs and services from their health care system. We have also made modest increases in investment in a few key areas. I have confidence in the men and women working in my department and throughout the health care system in their ability to deliver on the goals we have set for ourselves this year.

With those short comments I want to thank everybody for this and, of course, look forward to your questions and answering those questions throughout the next number of hours. Thank you, Mr. Chairman.

MR. CHAIRMAN: Thank you, Mr. Minister.

The Chair will now recognize the honourable Leader of the Official Opposition.

MR. DARRELL DEXTER: Thank you very much, Mr. Chairman. I am pleased to be here today to join in the debate on the estimates of the Department of Health with the minister and his staff. I'll begin by saying that I had the opportunity during the lock-up on Friday, as the budget was being released, to have access to some of the departmental staff, so some of what I'm going to ask I actually know the answer to, but I think for the benefit of the public and for the benefit of the other members of this House I am going to re-ask those questions - anybody with a little bit of legal training knows it is always good to be able to ask a question that you know the answer to.

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I am going to start with the colorectal screening program, the announcement of the $300,000 in the budget. I think this is a particularly important program and a particularly - I think it is, in fact, quite emblematic of the health budget as a whole and of the initiatives this government over the last little while, with respect to improvements in the health care system - and I say that for this reason, and the minister, I am hoping he can confirm this and I think he will confirm it, and I think his staff will confirm it - this particular program is one that has been sorely lacking in this province for a considerable period of time, and it is one that we should understand the importance of because a province-wide colorectal screening program would mean that those people who get early testing would have, I believe the figures are a 90 per cent chance of surviving the cancer if it is diagnosed early enough.

I just want just to look at some figures. I believe - and if the minister knows otherwise he can certainly correct me - that in Nova Scotia last year some 360 people were diagnosed with prostate cancer; I think they died, actually, from prostate cancer. So had that 90 per cent figure - if that's an accurate figure - and those people had been diagnosed early enough it means that more than 300 of them, Mr. Chairman, would be alive today. So we're talking about a program that has a tremendous rate of effectiveness in respect to the treatment of a known cancer and, given all of that, it is hard to understand why we are waiting to put in place an effective treatment program.

The $300,000, as I understand it, and I think the minister has said this, it's for the development and study of the system which will subsequently be put in place in a following year. So, I would just ask the minister to confirm for me - I believe this is correct - not a single Nova Scotian will actually benefit from a colorectal screening program as a result of this investment this year?

MR. D'ENTREMONT: Mr. Chairman, to the Leader of the Opposition, I want to thank him for the question. Starting off with what I figure and what I feel is one of the most important initiatives in our department today, the colorectal screening program, of course should the cancer be found early there are very good outcomes for those patients. We feel, from the recommendations that we did receive from Cancer Care Nova Scotia, back in December, it set some guiding principles and some recommendations on what a program should look like, but it did not give us the definitive design of what that program is going be, nor did it give us the definitive description of what the clinicians, the specialists and those folks are going to need to look like either.

So what we feel is over the next number of months we would hire a coordinator, we would start to build the program, and subsequently I would hope, within a reasonable amount of time, that we can start the program on the road. Now, does that mean eight months down the road, does that mean ten months down the road? I can't really tell you because I don't know what kind of work is going to be required in doing the extra training and, in some cases, maybe doing some recruiting. So it's going to be very difficult to say that we're going to be screening people by this date. What I would do is commit to letting Nova Scotians

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know, letting the Opposition know, exactly where that program is, what our findings are, where we are within that program, and giving Nova Scotians a better idea of when that screening can start.

Again, it could be eight months down the road, it could be twelve months down the road, but I think it's very important to have a program designed and the pieces in place before we start screening people. It's not only the issue of the infrastructure for screening -we know that once we start screening, we will find more cancers. That's just the way it works, and we need to make sure that we have those specialists on the backside - pardon the pun - in order to have them treated for that cancer because, of course, we want to make sure that they can be treated in a short period of time as well.

MR. DEXTER: Well, Mr. Chairman, with all respect to the minister, that was a long-winded way of saying that there will be literally no one who benefits from this program this year. This is not a question that simply fell from the air with respect to the minister - I mean this was a commitment that was made in the last election platform. Nobody can tell me that the Department of Health has no idea what the elements of a province-wide colorectal screening program would look like. That's just nonsense and I don't believe it for second and I don't think anybody here believes it.

But here's the crux of it - the crux of it is simply this: they didn't put the money in the budget to put the program in place. The money is not there. Whether it's a million and a half or $2 million, whatever the cost is, it's not $300,000 - $300,000 does not put in place a program that will benefit the people of this province. The result of that is, very directly, that more people will - the mortality with respect to this particular cancer will be higher next year than it needs to be because the money is not in this year's budget. That's the sad reality of this decision. This is a program that if it were in place this year, we would save people's lives. That's what would happen if we had a proper program in place.

I think this discussion leads very naturally to a discussion with respect to the provision the government has made with respect to certain life-preserving, life-saving, important drugs that are also required by people who suffer from various forms of cancer, but in particular, prostate cancer - drugs like Avastin.

I have asked the minister this in the past, but I think he has more time here to properly address himself to this question, so I'm going to ask it again in the context of the estimates: Why is it that a drug like Avastin, and here you have a drug where it is anticipated that there are probably 100 people in the province who have been prescribed Avastin by their doctors, who will not receive it because it is not a covered drug - they will not receive it - of the 100, about two of them can afford to fund that cost themselves, so what I'm trying to understand, and have tried to understand, this is a drug which has been prescribed to them by their doctors, why is it the Department of Health decides, arbitrarily, that they are going to replace

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the opinion of the prescribing physician with their opinion? Can you please tell us why it is this drug is not being covered.

MR. D'ENTREMONT: Mr. Chairman, what I'll do is address the first issue and then I'll go to the second issue. With all due respect to the member opposite, there are systems that need to be put in place in order to put together an effective colorectal screening program. There is only one jurisdiction that we know of in Canada that has started to go down that road, which is Ontario, so there really is no work done in the Canadian context.

Mr. Chairman, ultimately we will be looking at about $1.5 to $3 million to operate a fully operational colorectal screening program. As I said to the member opposite, we still don't have a full idea of how many specialists, clinicians, we're going to require, whether we have the capacity in today's system in order to offer the services of a full colorectal screening program, which is why we need to get in place the bodies that can work directly and be dedicated to developing this program and making sure it's ready for Nova Scotians as quickly as possible.

We can't go out and spend money if we don't have approvals in the budget. We did not have that in last year's budget - we have it this year, and we're going to get the work done.

On the other issue of Pharmacare - as we talk about Avastin and other life-saving drugs, or life-extending drugs, it's a difficult decision every day within the department of whether to fund things or not fund them. There are thousands of ideas that come to our department that, on the face, they look like very good initiatives. You know what? I would love to be able to fund all of those, but I would be the only department in government if that would the case because there are so many of those projects out there.

[3:45 p.m.]

We can talk a little bit about how the decision not to fund Avastin was taken. We have to go back to the development of the Cancer Systemic Therapy Policy Committee, which was put in place in January. (Interruption) Mr. Chairman, I did not interrupt the member opposite when he was making his comments - I will be happy to answer his question.

During that Cancer Systemic Therapy Policy Committee which was brought in, I believe it was January of last year, they did not have a full slate of people until probably April or May - I am just looking to my deputy for that - the information now is that Cancer Systemic Therapy Policy Committee is made up of clinicians, oncologists, made up of survivors, made up of pharmacists who also look at the drugs, their cost- effectiveness, the effectiveness as well as the ethical side of any of these drugs as they come forward.

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The information that we had across the country as well is that there was very little data that supported this drug, that showed it to be a very effective drug. Also, the information that we had on it just didn't support - the Cancer Systemic Therapy Policy Committee didn't support to fund this drug. I think what the member opposite is looking at is its cost and that we said no for cost, and it really has nothing to do with that because if we look at other similar drugs like Herceptin or we look at Valcade, those are drugs that are very similar that we have funded - same costs.

So what we want to do, as information will change, as more studies are made on this drug and the indications of what this therapy might be able to bring us, as other things change, like costs, we will continue to review it from the Cancer Systemic Therapy Policy Committee - no decision out of that committee is final, as information presents itself. I would like to fund the drug, but I am also going to rely on the experts in the field, and the experts in the field tell us at this point that this drug doesn't do what a lot of people are saying it does. If that information changes, we will forward it through again - as I committed to Jim Connors. Jim did present me with some further information; I presented him with some ideas and we are forwarding that, again, to the committee for further review. So no decision from that committee is final - as information comes up, we will provide it to them.

MR. DEXTER: Mr. Chairman, whenever I think about this question, I think about the person who has received their diagnosis, sitting in the waiting room and hearing from their physician that there is a prescribed drug that they would recommend for that person, and for that person to sit there in the waiting room knowing that there is this drug that their physician is recommending for their use, and for them to know that what stands between them and having the drug that their physician has prescribed for them is the size of their bank account. Because the reality is, if you can afford it, this drug is still prescribed for you. So some people in our province, those who have the financial wherewithal, the financial ability to afford this drug, they still get it. There are simply so many of them who cannot afford it and therefore do not get it.

We look at the comparison between this province and others. Nova Scotia, I think, covers four cancer drugs; Newfoundland and Labrador covers nine; and British Columbia, something in the order of twenty. We seem to be making this decision that we are telling people is not based on the cost of the drug, but it seems to be clearly so, Mr. Chairman. In the end, it's about the individual lives of those people who face this diagnosis and who are receiving one piece of information from their physician, and a recommendation from their physician, but are being told by their government that they not entitled to the medication that they require.

The minister, I thought, was very telling. He actually moved the definition from the life-saving drug to a life-extending drug, and you know, Mr. Chairman, we're all extending our lives each day. Each day, I would suggest to the minister, is as valuable to one person as it is to the next. So I reject the notion that you can, in a cavalier fashion, try to diminish the

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importance of a particular medication by trying to change the definition to reflect something other than it being a life-saving drug - because that is, in fact, what it is.

Mr. Chairman, I think the discussion that we're having with respect to Avastin, and I hope this leads quite logically into a discussion with respect to Pharmacare generally, because what we've seen over the last number months is the decision by this government to increase the cost of Seniors' Pharmacare by some 6 per cent to our seniors. They say in their defense that this is somewhere in the order of $50 a year in terms of the increase to seniors, but you know if you want to put it in some context, just think of it in these terms. The government introduced a program to help with the cost of heat, for people in the province, by taking the HST off, and I heard them talk about what that will average - that will average for most consumers about $200 a year.

Well, from seniors, they're clawing that back. They're clawing back the money that they would save on that through an increase in their Pharmacare payments and if you add on to that all the other increases that this budget heaps on in terms of user fees, it's little wonder why the seniors whom I talk to say they don't really feel like they're any better off as a result of the changes that the government had made over the last number of years.

In this House, in the past, Mr. Chairman, I have presented, I believe the study came from McGill University, and it set out what happens with seniors' populations when the government increases the cost of Pharmacare. When they increase the premium and the copay, they have identified a number of very direct results as a result of the increase. I think this bears repeating - and I realize this Minister of Health likely wasn't here when we had this discussion before - it bears repeating what happens when you increase the cost of Pharmacare, when you increase the cost of drugs, and what happens is that the number, that the regularity with respect to those medications with which the seniors' population takes its required medication falls. So you have a seniors' population that does not comply with the recommended level of prescription set out by their doctor, because they can't afford it.

The result of that, Mr. Chairman, is that more seniors end up in emergency rooms as a result of not taking appropriate levels of medication. So the increase in the burden in our emergency rooms, which everyone knows is under a lot of stress in this province - we have code purples on a regular basis throughout the province, we have some emergency rooms that are shut down periodically throughout the province - and yet the result of this governmental policy is to cause more seniors to end up in emergency rooms. That's the first thing that happens.

The second thing that happens is that as a result of the side effects of not taking the appropriate level of medication, those seniors end up where? They end up seeing their primary physician - they're going back to their doctors so there are more regular doctor visits, which means that the doctors have greater caseloads which means that the expense to the system through MSI increases. I mean if you can imagine, how many additional visits would

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a senior have to make to a physician before the $46, or whatever it was, $50 that the government is clawing back, is used up? Not very many, Mr. Chairman.

The third thing that happens is that as a result of this decision there is an increase on the length of stay for seniors when they get to hospital. They end up in the emergency room because they haven't taken their medication; in many of those cases they end up being admitted and they end up staying for an extended length of time simply because they haven't taken the medication that they should have taken - so this is a direct result of increasing the cost of Pharmacare to seniors.

The fourth thing that happens, Mr. Chairman, and the most regrettable of all of those - and we know this statistically - is that the rate of mortality increases. This is what happens when you increase the cost of Pharmacare to seniors.

What I want to know from the minister and from the Department of Health is why, in this day and age, would you not recognize the efficacy of appropriately funding the Seniors' Pharmacare Program and why you would allow these increases to continue to take place?

MR. D'ENTREMONT: Mr. Chairman, to the first issue again - and I know the member opposite has a lot to cover in his time and we'll continue to talk about Avastin - just one final point on that is, again, the decisions of that committee are not final if more information comes up. I will not be making the decision whether to fund or not to fund Avastin - I will leave that to the experts in those fields and they will base, as the guidelines of the Cancer Systemic Therapy Committee as well as now the National Cancer Therapy Committee, they will look at the scientific changes or the scientific information that is provided to them, look at the cost changes, of course, but also look at the ethical frameworks of going forward with any drug.

These are not just decisions to fund or not to fund, there is a fair amount of information that goes forward. If it is a life-sustaining drug, what qualifies as life-sustaining? Is it two weeks? Is it a month? Is it 4.7 months, like Avastin is an average to give you right now? Most times it is not effective, and in some cases it does give you a wonderful extension.

So, Mr. Chairman, there are some huge ethical issues when it comes around funding these issues and I'm hoping that, and I know that, my committee will be making decisions based on those kinds of frameworks.

To the issue of Seniors' Pharmacare, I would like nothing better than not to have given an increase in that program this year but, Mr. Chairman, we have costs that continue to grow year over year. We have the same amount of seniors who are in that program and yet it grew by 7 or 8 per cent. This year we put an investment of another $11 million into this

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program. I think the total program, costs on that one right now is about $181 million. It is now based from that decision as well, on sharing the cost of this program at 75/25 - 75 per cent the government will pick up, 25 per cent the seniors will pick up. This originally was, I think, a 50/50 program, if you look back at the history of this program and where it was going, but of course government has been able to pick up a huge amount of the cost of this program. I think we will continue to pick up the larger part of the increase in this program.

If you look at who receives payments or who receives the Pharmacare, there are approximately 42,000 seniors who pay full premium, so of course they're paying somewhere around $900 and change for this program, to receive a non-capped amount of pharmaceuticals; approximately 6,000 seniors pay a partial premium; and approximately 48,000 seniors pay no premium, so they are paying of course just the copay. Of this number, 40,000 receive GIS; 4,200 are low-income; and 3,000 are in nursing homes. So there is a huge number, over 50 per cent of seniors in this province, who receive Pharmacare who do not pay a premium on this one. So I would say, compared to other programs in Atlantic Canada, to other programs in Canada, seniors in Nova Scotia are paying far less than their counterparts in other provinces.

[4:00 p.m.]

Mr. Chairman, we will continue in the department to invest in this program. The other thing that we need to do as well is look at the load that seniors are bringing forward. These are the prescriptions that they have. A lot of times they come from different practitioners. A lot of times they are being filled by different pharmacies. What we need to continue to do is look at the effectiveness and we have started a pilot project, I believe in Truro, to look at what kind of prescriptions are being brought in, going back to their physicians and coming up with more effective treatments for the illness that they bring forward to us.

So, Mr. Chairman, in most cases we do see a savings to the senior on reduced lists and in some cases we see better results because they are actually getting the drugs that they require. I know that no increase is good but I am suggesting that we need to have a program that will be here into the future for all seniors. We will continue to invest these large sums of money - $11 million, in my mind, is nothing to sneeze at - and we will continue to make it effective well into the future.

MR. DEXTER: Mr. Chairman, I am just not going to let the minister get away with this. He poses the philosophical question, the ethical question of how long should a life-saving drug be funded and what should be the efficiency of that drug in terms of saving somebody's life. He poses the question, should it be two weeks, should it be two months, should it be 4.7 months, I think he said, with respect to Avastin. How long does it have to be? He poses that as an ethical consideration.

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Mr. Chairman, if it was your life, how long would it have to be? How long would it have to be before it would be important? Every single life hangs by a thread but it is a precious thread and I do not accept the minister trying to justify this kind of decision by simply putting it in the context of what length of time it is that a person's life can be extended. That is not the job of the Department of Health. The job of the Department of Health is to fund effective therapies, to fund prescribed medication, and leave it to the physicians to decide whether or not a person can benefit from the medication. That is who should be deciding and that is not what is happening in this province and I think it is a terrible injustice that we are doing to many people who could benefit from drugs such as Avastin.

I raise the question of the Seniors' Pharmacare Program again, and I understand the arguments around the whole question of how much money the government is putting into the program. There is no question that the cost of drugs continues to climb every year. However, what I am suggesting to the minister is that he look at the efficacy of the increases that he is charging with respect to the result on the rest of the system. I pointed out to him what the four major problems with the increases in the cost of medication are when it comes to the senior population. I pose to him the question of whether or not it is an ineffective strategy to try to claw back a modest amount of money out of the pockets of seniors and have, as a result, the fact that you send them into the hospital more frequently, you send them to the doctor more frequently and you send them into hospital for longer periods of time and some of them don't even get that option because of the increase in mortality. That is the question that is being posed to the minister. Isn't this just an ineffective strategy?

MR. D'ENTREMONT: To the member opposite, what I really feel is that there has to be some kind of predictability in a system. I think the predictability that we have provided for the Seniors' Pharmacare Program - sharing those costs 25/75 - lets seniors make a decision and be able to plan once a year on where those costs will be.

If I had felt that seniors would not be able to pay for this program, I think the outcome would be different. I think, by knowing what the cost will be up front, knowing who will be able to pay for it, who is exempted from it, I think at the end of the day that seniors appreciate having the Nova Scotia Seniors' Pharmacare Program.

If you look at another comment the Leader of the Opposition made, he talks about clinicians making complete decisions on the kind of drugs and effectiveness or efficiencies - efficacies - that certain drugs will give. But if we approved every single drug that came to our department, I would suggest we would have no monies to do anything else. As laudable as that may seem, as important as it may seem, there are things we can do and there are things we cannot do.

I will leave it again to the experts of our Cancer Therapy Committee to make a decision on the effectiveness and the appropriateness of cancer therapies. I am not a clinician

[Page 15]

and I will not make a decision for that group. Again, that group will, as I said, there was never a final decision, we will continue to provide information to them, they will continue to review that and maybe the answer will be different next time.

But, again, the issue is that if we funded everything we would not have enough funding for the other programs that are very important to us - which are of course the hospital system, our seniors' continuing care system and all those other things. So we do have competing priorities and we have to find that balance.

MR. DEXTER: Here is the irony of what the Minister of Health has said. Because what he is saying is exactly what he will not do. Twice, Avastin has been recommended by the very committee that he cites and instead of taking that advice, they have referred it back to the committee. So, my very simple question to the minister is, why won't you take the advice of that committee?

MR. D'ENTREMONT: Again, when the first decision had been rendered not all the information, we felt, the deputy minister at the time felt, had been considered. We did not have a full complement of members on that committee. There were a number of different decisions that happened across the country that we wanted some further information on. That's why the decision was sent. At that time, there was only one positive decision at that time. It was then further reviewed and then the negative decision came forward.

Again, at that time when it was first decided, there was not the ethical framework that we had put in place, there were some other operational pieces that were not in place in that committee. But right now the committee has decided that we should not fund that drug and I will stand with the committee's decision.

MR. DEXTER: So let me get this right - you will accept the recommendation that you like and you won't accept the recommendation you don't like. That is what you've said, Mr. Minister. There was a recommendation, and so you'll take the recommendation of the committee if you feel the makeup of the committee is appropriate, you'll go back and actually look at the makeup of the committee to try to decide whether or not, in your view, you ought to take the recommendation.

I'm not going to beat this one any further. I think the point is made. This, I believe, is a poor decision made by the Department of Health. It's a poor decision that the minister agrees with and all I can do is try to prevail on him to change his point of view with respect to this particular drug.

I want to move on because I talked a little bit about the results of the decision made by the Department of Health with respect to Pharmacare and what I believe is an ineffective response by the department with respect to the increase in Pharmacare fees. It underlines a very interesting question with respect to the next piece of the Pharmacare puzzle, because

[Page 16]

the policy of the government with respect to Pharmacare - and this came about as a result of the election platform of 2006 - was to institute what they have called a working families Pharmacare program. Now, just so we can start this one out, let's be clear that the working families Pharmacare program will benefit not a single, solitary individual in this province in this year because the money is not there. The idea, as the minister said, for this, was to set up a technical and administrative structure so that the program can be implemented in a further year.

I heard the Premier the other day in a scrum say, well, we meant to bring this in on the first of January, so we're putting it off three months, and then he said March 1st, but I assume he meant March 31st, in that area. So the real question here is, we have a system, a Seniors' Pharmacare Program that has a couple of interesting facets to it. Of course it has a premium and it has a co-pay. So if you're going to set up an insurance program for pharmaceuticals, the first thing you have to know is the premium that you're going to charge to people and the co-pay that is going to be expected of them with respect to the draw-down of those drugs. Because that, Mr. Chairman, is what determines the uptake on the program. So, a very simple question, will the working families Pharmacare program reflect the same levels of premium and co-pays as the Seniors' Pharmacare Program reflects today?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I'd like to change the name from working families to maybe the Nova Scotia Pharmacare program, because I think it will benefit way more than just families in this province. There are a lot of single family units and those kinds of things that we do want to extend it to.

Mr. Chairman, the start date seems to be a little bit of a bun fight. What I really want to say is that, again, it takes a bit of time, and computer systems and infrastructure to start offering a program. It is our estimation at this point that we would have the program up and running by March so Nova Scotians will be receiving the benefits from that in this calendar year. The lead time required - and I know the department and, of course, our Pharmacare division has pleaded with us to try to give them the time to do it correctly, and we have given them, we believe, a respectable amount of time to set up this program.

It is our mind that we have to balance this program with two competing programs. One of them, of course, being private insurance, medical insurance, so companies will not be jumping out of their programs and letting people jump into the government's program. Nor do we want the sort of competition between what would be the Nova Scotia Pharmacare program and the Seniors' Pharmacare Program. We don't want it to be a better program, let's say, then the Seniors' Pharmacare Program, and have seniors leave that program to try to be in another one. So it's trying to find that balance of what it's going to be.

So, Mr. Chairman, what I can say at this point - and the final design of what our Pharmacare Program is going to look like has not been decided on but it will be very similar

[Page 17]

to the seniors' one, where it will involve co-payments and premiums. There's a balance between what that's going to be, but it would have to be very similar in cost.

MR. DEXTER: Mr. Chairman, the minister, I guess, speculates a little bit about what that's going to have to look like. Just for the record, their working families Pharmacare moniker was the name that was put on it by the minister's Party during the last provincial election. I didn't make that up. So they're now getting into a discussion of what is a family, and do single individuals qualify under the program, and I understand that. One of the things they did over the course of that campaign was they costed the campaign, and I remember that the initial cost in the first year was supposed to be $25 million. So I'm going to ask the obvious question: Does the minister still believe that the first year of operation of the Pharmacare Program will be $25 million?

[4:15 p.m.]

MR. D'ENTREMONT: Mr. Chairman, to the member opposite. As we've looked at a number of different configurations of what the Pharmacare Program would look like - of course there's $5 million in this year to get the work done so that we can have that program start in the first quarter of 2008 - if you look at what the costs are going to be, I believe it will be quite a few million dollars more than that $25 million. You know, I've seen estimates that range anywhere between $30 million, $36 million, to somewhere in the $40 million range, depending on that take-up, but of course you're doing economic modelling depending on what the numbers are going to look like and how many people are going to subscribe to it and those kinds of things, but at this point our modelling and the work that we've done, the different iterations we've look at at this point, it is probably in the $30 million to $36 million range - the first year.

MR. DEXTER: Well, I don't know if his light was still on when he said that, but he said in its first year - he said in its first year - because I believe I remember looking at the projections that were provided by the Progressive Conservative Party over the course of their campaign that said $25 million in the first year and I believe it was up to $75 million in the second year of the program. So, you know, that depends a lot - the way it was set out initially, was that looked like really a third of a year, the $25 million looked like a third of a year program because it was going to start on January 1st. So, therefore, it would have to be included, for example, in this year's budget it would cost $25 million and a complete year program would cost something substantially more than that.

So I made this point before, Mr. Chairman, but I'm going to make it again - the way that this is being rolled out by the Minister of Health is in such a fashion that the hill keeps getting steeper the further you go into the program. I realize that doesn't have to do with the appropriations of the estimates for this year, but I can tell the minister we're certainly going to look forward to trying to understand what that program is going to mean in the year to

[Page 18]

come and, as the minister points out, therefore what other kinds of choices are going to have to be made.

The minister himself points out that one of the results of trying to make these kinds of choices means that they have made a decision to cap this year's spending in the Department of Health - and I think he said at 5 per cent. I thought it was 5.6 per cent, but he's now saying "5-ish" - a precise accounting term I believe, Mr. Chairman. But here's the problem with all of that. If it is the case that health spending has increased by 8 per cent a year, and you must remember that the fastest growing sectors within the health care budget - and again I would invite the minister to correct me if I'm wrong - fall into two categories: they fall into the pharmacological envelope, the cost of drugs within the system, which continues to escalate at high rates, in fact well above the 8 per cent rate; and the cost of technology, because there is always new technology coming online and there are always demands from the system to bring more of that technology into the system.

So what happens - and I would point out the Minister of Health knows this, but I don't know that everybody else does - is that those, in fact, are the two pieces of the public health care system that are private. These are the ones we don't have any control over; we are buying this technology. We are in many respects hostage to the drug companies; we have to pay for these drugs if we want them. So we don't have control, from a public perspective, over those aspects of the health care system. The other pieces of the health care system are, in fact, not growing at the same rates, so you can't depress any further your staffing rates or the other pieces of the envelope.

Even though they are some of the biggest pieces of the envelope, it's very difficult to compress those - and here's why. You can't depress those because the result of keeping those down are more emergency room closures and longer wait lists. Mr. Chairman, those are the kinds of results you get if you try to enforce a smaller spending envelope on those areas of the system. So I wonder if the minister could tell us if they have looked at what areas of the health care spending they are going to try to contain, where are the pressures going to come in order to be able to cap the health care spending at 5 per cent?

MR. D'ENTREMONT: Mr. Chairman, in talking to my CFO here, we are at 5 per cent this year - 5.6, I'm not too sure where that number would have come from, but anyway it looks like about $140 million extra for the Department of Health to work on those issues that are growing year over year, as well as the new programs we are talking about. The largest growing component of our health care budget, of course, is wages and wage settlements, three quarters of that budget of course are wage-based, they pay for the human resources to run our department.

I think the issue for me of trying to bring that cap down is to have other dollars available in government to invest in departments like Health Promotion and Protection (HPP) in order to build infrastructure in communities, to look at healthy living, healthy eating

[Page 19]

programs that, at the end of the day, stop people from coming to the acute care system. That is where we need to start to push back and say that some of these investments need to happen in other places in government that will, in effect, make our population healthier and bring the budget of the Department of Health down a little bit because we're not going to be treating them as frequently.

I look back - and I'm just trying to figure out what my numbers are here, I wrote down a note and don't know what it was - just to go back, you started with the Pharmacare Program and sort of finished that thought, and then moved into the issue of the broader piece. In the development of the program, we look at about 142,000 Nova Scotians would be eligible to receive the Pharmacare Program and the modelling shows, from experiences in Manitoba and other jurisdictions, that it takes somewhere between three and five years to be fully subscribed, but depending on the model - we're still just looking at 89,000 or 90-odd thousand people would actually take on the program,who would feel the need for further Pharmacare coverage. So we are trying to work with those kinds of numbers. In a full year, should we estimate that that amount of people take it on, we're looking at a program that would sort of be in the $75- to $80- million range per year.

I think it's important to look at the efficiencies in our system, to sharpen our pencils, because I know that the professionals within, the people who provide us with information, the people who work with our finances on a day-to-day basis, feel that some of these efficiencies and most of these efficiencies can be found. Mr. Chairman, I think the $140 million increase is a sizeable increase for any department of government.

MR. CHAIRMAN: Thank you. The honourable member has approximately 9 minutes left.

MR. DEXTER: Mr. Chairman, I appreciate what the minister was saying but I pointed out to him that we have hundreds of days every year when emergency rooms around the province are closed. We still have long wait lists with respect to a number of procedures - a lot of those being orthopaedic, Mr. Chairman.

We have, in this province, people being treated in hallways. We have people, in some hospitals, who find themselves in patient lounges because they do not have beds. We have seniors who are in beds in hospital who need to be in long-term care facilities and, because of the lack of beds in long-term care facilities, are often sent far away from their family and friends and the minister knows, I have been talking with him and with others, about the whole 100-kilometre rule. As you can see, Mr Chairman, there is a very logical connection between all of these things and the minister knows it and staff know that that is the case.

What I want to know from the minister at this point is, given what he has said about the cap on health care spending this year, I just want to know how, in the context of the cap, is he going to be able to reduce the number of days emergency rooms are closed, how is he

[Page 20]

going to reduce the wait lists in all of the areas in which there are now long wait lists, how is he going to put an end to the hallway medicine that we see happening around the province?

MR. D'ENTREMONT: Mr. Chairman, a number of issues come across there and if you look through the budget documents, there has been some fair investment when it comes to long-term care. If you look at the mitigation strategies that we are putting forward with the district health authorities, they show an added investment of about $10 million to address an alternate level of care in trying to make people more comfortable as they wait for their placements in the long-term care facilities.

You brought up the issue of emergency room closures. We are investing a couple of million dollars on that side to make sure that we can either find the physicians or find strategies to keep those ERs open. Mr. Chairman, we talk about that particular issue. Across the province, in our ERs, we are open 98.5 per cent of the time and that's a number dating back to May 2006. So we do have some hot spots that we need to address and we have put some funding in place.

I think, Mr. Chairman, what we really try to do in this year's budget is sort of do exactly opposite of what the member opposite suggests. The member opposite is suggesting to continue to throw money at things and what we are trying to do is to be focused to find the places where we do need to put investments, to try to bring down these wait lists, to try to have better access within our hospitals, to stop some of the things that are happening. I can say that there is a fair amount of money put in place to do just the very things that the member opposite is bringing forward today.

MR. DEXTER: Mr. Chairman, you know we have all watched while the minister makes, I think, an attempt to try to say that these particular items are being dealt with, but the reality from the long-term care perspective is that funding that exists in long-term care this year is funding the initiatives that are already underway from previous years. So the planned expansions of existing nursing homes and previously announced spending for projects that are underway are in this budget. Will the minister tell me, or confirm, that there is no funding in this budget for new initiatives or new building for this year in long-term care?

MR. D'ENTREMONT: Mr. Chairman, if we go back to the speech that I presented - and I should actually grab that quickly and if I could find my spot in it - where we talked about the extra funding in long-term care. We are spending $342 million this year, I believe, on long-term care. We are looking at a $15 million increase in long-term care spending. Again, if we talked about that, we will spend $11.1 million this year to develop and implement the new initiatives as part of the second year of the Continuing Care Strategy.

[Page 21]

[4:30 p.m.]

I go back to the member opposite who had a press conference sometime last week and talked about the things they feel that we should be doing to try to lessen the impact upon seniors. I can say, looking quite extensively at their list, I look at the things that we are doing and I can say, I had to put a check mark on almost everything they brought forward of the things we are doing or are already in progress.

Let's just talk about some of the expansion things we are doing in this year's budget over last year to continue to meet the expectations and meet what we have been laying forward in the Continuing Care Strategy. We are putting an additional $2.3 million to expand palliative care programs; we're investing $2 million to develop a caregiver strategy which will help family members keep families in their homes; another $3 million to improve respite options in both home care and long-term care. We'll invest $4 million in repairs and renovations to support seniors and people with disabilities living in their own homes.

All I can say, Mr. Chairman, is that their crystal ball must be working well or they've been actually reading our documentation to know the things that this department has taken seriously, and we'll be implementing and continue to implement over the life of the Continuing Care Strategy.

MR. CHAIRMAN: The honourable member has approximately one and a half minutes.

MR. DEXTER: Yes, which is a shame because I would like to pursue this. There's one thing further that I want to ask the minister before he moves from my questioning to my colleagues in the Liberal caucus. I wonder if he can just refresh our memories as to which of the health care professionals in the system received more than a 5 per cent increase last year in wages?

MR. D'ENTREMONT: It would be hard to dig apart, especially out of some of the wage settlements. Of course, there were some professionals who would have received different amounts. There has been an average of 2.9 per cent, which is, I think, what the member opposite is alluding to. Through some of the AFPs we've been putting forward with a lot of specialists here in Capital District, different specialty groups, they have been receiving 5 per cent, in some cases.

Last I checked, specialists and physicians and clinicians are front-line health care workers. We will continue to invest and make sure that we adequately fund health care workers in this province, as we have done; again, three-quarters of our $2.9 billion budget goes towards health care delivery and the people who so gratefully do that for us. We'll continue to make sure they receive the funding that is required. But, Mr. Chairman, we will also make sure we can balance it against the other competing priorities in health care. We're

[Page 22]

looking at 25 per cent of that budget now that does all the other things the member opposite has brought up during his questioning during this hour.

MR. CHAIRMAN: Thank you. The honourable member's time has expired.

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. I think we have a tendency when we get into estimates to try and rush into things and ask everything all of a sudden because you want to jam everything into one big question period because the minister, hopefully, will have a lot of the answers to the questions. (Interruption) The Leader of the Opposition says he didn't get that feeling in the last hour or so. He did stick to a subject, anyway, I will say that.

Mr. Chairman, I wanted to welcome the minister's staff to estimates. I know that, probably, if there are positions in this province that you don't want, one would be the Minister of Health, and those would be the other two right there, in the province. I know how hard the staff works in the Department of Health, and I know that perhaps they don't hear it enough but certainly the people of Nova Scotia and ourselves as legislators appreciate that work and we know what you're dealing with. It is a never-ending challenge that you are dealing with in this field, and I think we all understand that. The deputy minister, in particular, I think is probably one of the hardest-working deputy ministers in this government.

Having said that, I may have cost her her job, I'm not sure. Hopefully not. The minister would realize that anyway.

Mr. Chairman, there are, as I said, in the hours to come a lot of things that we'll be discussing. One of the things I wanted to bring to the minister's attention from the start is a subject that we dealt with back in November of last year and it is a matter that was raised during Question Period. It concerned Mr. Ed MacDonald of Cape Breton, who is currently in Toronto awaiting a lung transplant. As I'm sure the minister will recall, the problem area was an anti-infection drug that Mr. MacDonald would require after his surgery. That anti-infection drug would be in the vicinity of, I believe, $3,000 a month and would be required for a three-month period.

At that particular time after Question Period, the minister brought up the issue of catastrophic drugs and catastrophic drug coverage, the difficulties in funding and so on, but what happened after Question Period that day was that the minister and his staff - I don't believe it was the deputy minister or Department of Health staff, I believe it was the minister's, shall we call them, political staff, policy staff - anyway, two staff members met with the MacDonald family and during that time they were told that the minister and his staff

[Page 23]

would look into things and perhaps they could find a solution to the problem of funding for the drug. It's an antiviral drug, I'm to understand, it's called Valcyte, I believe.

Again, let me remind the minister that that was on November 14th of last year, but since that time it is my understanding - and the same members of the MacDonald family who raised this with the minister that day are in the gallery today - and it's my understanding that since that time, number one, there has not been a response or answer given, and number two, the MacDonald family is actually having problems having the minister and/or his staff even return their calls.

My question to the minister off the start is, number one, I'd like to know what has happened since the minister's staff, at least that day, said there would be some answers provided. I would like to know since that time what has taken place, where we stand with the issue and what is going to happen, hopefully when Mr. MacDonald receives his lung transplant - and he's on the list and we all know that unfortunately it takes time and we know that it can be a lengthy period of time - but I'd like to know when that finally does happen and we all hope and pray that it will be in the immediate future, exactly what is going to happen in terms of covering the drug and what has happened to date and in particular I would like to know why the MacDonald family hasn't received any news from the minister and/or his staff?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite I welcome him to questioning over the next hour and thank him for bringing this issue forward, especially to Mr. MacDonald and of course to his family, I continue to wish them the best and hopefully, an organ donor will come along post-haste and he'll be able to move on with his life.

There, of course, is one drug and it did start with a "V" and I can't quite remember the exact name of that, Valcyte, I think it was. I know there had been one meeting that I did have with the family after they had come to the House and after the member brought them to the House. We had a full-length discussion on the drug requirements of their father, of course their father is in Toronto at this time. I know there has been some correspondence back and forth. There were some further details, I think, that my staff had required and I don't know where the communication breakdown is. I know there has been a meeting set up for next week, I believe, where the deputy minister will be sitting down with the family in order to come up with a resolution for the family. I would have hoped this would have happened sooner, but unfortunately we are here today discussing it again.

To the member opposite, I can assure him this will be discussed and fleshed out as quickly as possible over the next number of days before Mr. MacDonald will hopefully receive his transplant.

MR. DAVID WILSON (Glace Bay): I don't know, Mr. Minister, but I think that meeting may have been arranged today and I was wondering why it took a visit from a

[Page 24]

MacDonald family member again today to spur that meeting into taking place. It has been almost six months since the original issue was raised in Question Period in the Legislature and since the minister was made aware of it. His staff did promise to look into it and you know most of all it is quite perplexing to the family why the minister and his staff said this will be looked into and when they make the phone calls, no phone calls are returned and nothing is done about the problem.

So far, nothing has been done about the problem. The family has even gone as far as to set up a Web site, as a matter of fact. For those who are interested in contacting the family, and in particular Ed, in Toronto, then the Web site address is, that's his nickname, Tappy. They can contact the family there. Here is an interesting point, Mr. Minister, that I want you to be aware of. I will save you the trouble of going on the blog and I'll tell you that what is on there in particular, on the first page, is some writings there by the family.

One of the points that they make, other than the fact that they haven't been contacted again by the department and that they want to know what is going on, is that they took the initiative to do some research - smart Cape Breton guys, okay, they do their research and they want to get their facts straight before they write anything. They probably get that from the fact that they have been connected with a journalist as a father for so long. But they did their research and they contacted the company that makes Valcyte and asked about the sales for the first quarter of 2006. It was just under $2 million. Then they went to Statistics Canada and got the population of Canada, 31.6 million, and Nova Scotia's population at about 913,000.

So once they did their figuring, they come up with, in their opinion, that a year's worth of Valcyte for organ transplant and all other uses would work out to be, for Nova Scotia, in the vicinity of about $231,000. The actual additional cost to taxpayers would be lower, according to their calculations, because most of the Valcyte that is prescribed currently is covered by existing plans, such as the Seniors' Pharmacare Plan - which, by the way, Ed MacDonald doesn't qualify for, he is too young - and also the Community Services plan and private plans.

Now, ironically, and as they have pointed out on their blog site as well, and I will point it out to the minister, I am not asking for your comment, Mr. Minister, but I will certainly point it out to you and your government, ironically, if it costs $231,000 or less, as those figures indicate, to provide that drug to everyone in need of it in Nova Scotia, ironically, that government has no problem - your government, Mr. Minister - has no problem taking $232,000 and spending it on some fancy, glossy advertising to put out to taxpayers to show how great your government is doing. So I guess it's a matter of whether or not you wanted to, what your priorities are and if your priorities are, I guess, to try to get the message across that you are doing a great job, or the priorities are could you provide what we are terming as a catastrophic drug in Nova Scotia, for every Nova Scotian who needed

[Page 25]

it and cost less than what it actually costs to do that advertising on the government, I think it would make people perhaps think twice about where we are going and our line of thought in terms of catastrophic drug coverage.

I don't want to belabour this matter either but you know, Mr. Minister, I think this could happen at any time. Mr. MacDonald could be called to go for his operation, for his transplant. I hope it happens tonight, right now, I would like for him to get the call, but in case it does happen, that is going to be there as soon as it happens. They are going to need that antiviral drug and the cost is going to be there. So I would like to see some sort of resolution to this. I had thought that there would be a resolution to this by now because of the promise that was made there and I was on the steps of the Legislature the day that a member of your staff told the family that they would be getting back to them, that they would be taking care of this matter, and that they would be looking into this matter. I was there when that was said so I would like a commitment from you right now, if you could, that indeed talks will take place with the MacDonald family?

[4:45 p.m.]

MR. D'ENTREMONT: Mr. Chairman, I will commit to the member opposite that the meeting will happen, those days will happen, I'm hoping by next week. I'm not going to point fingers, of course, of probably who didn't call who, or anything like that, but on behalf of my staff I do apologize for the wait that this has taken. I would have hoped that there would have been a resolution to this a lot sooner than now, but I will commit to having that meeting over the next week. The deputy minister I know has committed to that as well. So, hopefully, we'll have actually an answer by the time that meeting rolls around.

There are, again, a lot of drugs out there, pharmaceuticals out there, that don't quite make the list sometimes and sometimes it just has to do with not being aware of that drug or anything like that. So, again, we'll commit to have that meeting early next week or within the week or so. I know the family is here today and I know that we'll have the opportunity to set that up over the next number of minutes. So, Mr. Chairman, I want to thank the member opposite for bringing this issue to the floor.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, hopefully we'll see a resolution to that problem that will please all parties. Let me move on. As I said there are so many topics here that we can talk about. It would take much more time than we're actually going to allocate. Let's start, Mr. Minister, first of all, with what you call the working families' Pharmacare. At least, you know, I'll give credit where credit is due, this program is now getting off the ground. Mr. Minister, I think I'm being fair when I say that it's grossly underfunded and I'm left wondering if it's going to have any real impact. So I'm going to give you a pat on the back for this one and it may be half a pat because we haven't gotten into that full pat yet. I would like to know, in your opinion, what impact this program is going to really have on working families with only that $5 million worth of funding?

[Page 26]

MR. D'ENTREMONT: Mr. Chairman, what we see in this year's budget is, of course, implementation costs of the Pharmacare Program which, of course, includes the hiring of staff because we don't have the staff to run this program at this date. We don't have the information system that would be collecting, of course, the full payments and premiums and the things that are required for this program that we have to develop, whether that be developed in-house or whether that be developed with Medavie Blue Cross that does offer the service right now for our existing Seniors' Pharmacare Program.

What I can say to you, Mr. Chairman, is as we put the final pieces together of what this Pharmacare Program is going to look like, we will be communicating that with Nova Scotians and we will be communicating that, of course, with the member opposite. It is my best wish to have Nova Scotians receiving benefits the end of February, first of March, 2008, as it does take a lead time. I know we've had a number of discussions around what the model is going to look like, how funding is going to be allocated and those kinds of things. Looking at the sheer work that will be required, we'll be taking that 10-month time, is what we're sort of looking at at this point. I can commit that we'll be trying our best for Nova Scotians to be receiving that funding by March.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, there are a number of topics, Mr. Minister, that I would like to ask you about today during this short hour and among them, I'm glad that the government is finally listening to the recommendations of Cancer Care Nova Scotia regarding a colorectal screening program. There is in this province a lack of gastroenterologists. So I'm wondering, Mr. Minister, who is going to perform the expected increase, I would take it, in the number of screenings that will have to take place? Where are you going to find the resources to do that?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. If we look at the design and what the recommendations are from Cancer Care Nova Scotia in a population-based screening program, we need to look at a bunch of different aspects. The first test which would be administered, I believe, through your lab or at a hospital or being ordered by your family physician, your clinician, would be, I think, a fecal occult blood test. So that would, of course, go in for the first piece. The treatment piece would require the gastroenterologist and other cancer specialists, after that step has taken place.

What we really want to do over the next number of months, as we put the pieces in place, is look at the capacity of gastroenterologists in the province, looking at where we need to focus and do some recruitment to get these pieces in place, and making sure that maybe the gastroenterologist isn't exactly the person who we need. Of course, we need to have probably a few more lab techs and a few more specialists in order to get this program done. Mr. Chairman, I can attest to the department's effectiveness in getting these professionals in this province.

[Page 27]

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. Among the recommendations that came from Cancer Care Nova Scotia, one involved the tanning machines, Mr. Minister. I'm wondering, since you're listening and implementing some parts of the recommendations anyway that Cancer Care Nova Scotia has been talking about, if you're going to listen and implement restrictions around tanning machines, as they've also suggested.

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Looking over at my colleague, the Minister of HPP, I know he has spoken to this issue on a number of occasions at this point, so I think that's a question for HPP at this point on the restrictions or regulations around tanning machines. I believe also the issue of restrictions around tattoos and those things were sort of in that same conversation, but that does fall under the purview of that minister.

MR. DAVID WILSON (Glace Bay): I'm sorry, Mr. Minister, you said the Minister of Health Promotion? Okay, thank you. I'm also assuming, then, that in particular what would also fall under Health Promotion and Protection would be the cervical cancer immunization program. Would that also be there? Is that the case?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. To the member opposite, he's quite right in underlining that that is an issue for Health Promotion and Protection. Of course, it's a vaccine and the immunization program fits under Public Health within that department.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. On the issue of long-term care beds, the announcement is promising, there's no doubt about that; the implementation timeline, perhaps not so much. I don't know how people in this province are going to wait 10 years for those beds to be put in place. We have emergency rooms that are bursting at the seams in this province, Mr. Minister, as you well know, and people waiting for long-term care beds. That does add even more pressure to the emergency room system that needs help all on its own.

Specifically, Mr. Minister, along the issue of long-term care beds, if keeping Nova Scotians in their communities is a priority, what about the 100-kilometre rule? What about those couples who are being separated for long periods of time for long-term care placement? What about the use of transitional units, as well? Perhaps the minister could elaborate on those issues.

MR. D'ENTREMONT: Mr. Chairman, maybe I'll work backwards from those questions and sort of start in with the transitional units. There are a number of those across the province right now and we are looking at, as an interim strategy, trying to expand on some of these and create a few more of them in other jurisdictions. We have earmarked about $10 million, I believe, towards this ALC issue or a further point there so we will continue

[Page 28]

to work with the district health authorities to try to alleviate some of the pressures that they are experiencing on a pretty regular basis now, as I discuss it with the various CEOs of those districts.

The 100-kilometre rule is one that's not because we want to have it in place, it's one that is out of necessity. We believe that Nova Scotians should be safe, they should be in a facility where they are going to be receiving services that they need, that they are going to be in a more homey, I guess is the best way to explain it, facility rather than sitting in a hospital or a transitional unit, as they're called.

It would be my guess and my intention at the end of the construction phase of the first 832 beds, that we would be able to make some changes to that placement policy and shorten that up. Ultimately the two things that we have learned quite often from our seniors as we've discussed it with them is that, number one, they want to stay at home as long as possible, and number two, that if they're to go into a long-term care facility, of course, they want to go somewhere that their loved ones can visit them on a regular basis.

To this point, the way the beds are set up and the way the system is set up, it's very difficult to get that first placement that you want in your local area, but we also believe from a safety standpoint that it's very important to get them into a long-term care facility where they will receive those services.

We talk about the 832 beds across the province and the 721 replacements, there are things that are really chugging along, much to the chagrin of my department in most cases, where they feel they should have a little extra time in order to develop some of these things. Mr. Chairman, I think we are pushing it to the limit at this point, to make sure that the RFP process is in place, which would be about Phase 1 of this process, which will be in place in April. So the intentions, of course, have already been made of what those placements will be. We then can go to that RFP process where developers, whether they be the community groups as we know them today, whether they be private facilitators or private companies, and look at those expansions.

If it's going to be the addition of numbers, where you're adding 12 beds or 15 beds or even up to 20 beds, that process can actually happen and can happen quicker. The ones where we're going to be building free-standing facilities might take just a little bit longer.

So what we're really trying to do is to get those numbers up, continue that work - and there is a lot of work that's ongoing at this point - with the proponents to make sure that they are going to be ready for that RFP process, what they're going to require of that, what the standards are or what we're going to be building and those kinds of things. So there has been a tremendous amount of work done.

[Page 29]

We're also looking at - I'm looking at the deputy's handwriting here - the RFP process, as we understand it today, will be out on April 5th, so Nova Scotians and groups will know the work they're going to do and will be able to submit. So I'm hoping that throughout this process we can get a lot of these facilities on the road and get them running and have them, of course, within our first three years.

The Continuing Care Strategy also, and I did mention it again in a response to the Leader of the Opposition, on the other programs that we're trying to bring in place for our Continuing Care Strategy, which includes our further palliative care program, which includes home maintenance and home improvements, which I think all of us agree is a very important program to keeping these seniors in their homes.

[5:00 p.m.]

You know palliative care, home care in schools, there are a whole bunch of different programs that we are initiating, this being year two of our Continuing Care Strategy, and we'll continue to implement these as funding, of course, is available. But, of course, we'll continue to get them in place, because Nova Scotians and seniors in Nova Scotia so much deserve them.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, there was a case recently - you certainly wouldn't be aware of this, but there was a case recently in my riding. There was a couple who had been separated, unfortunately, because of the availability of beds.

The husband was placed in the Taigh Na Mara long-term care facility - yes, it was, the minister made reference to the Department of Veterans Affairs, right. The wife in that case had been placed in a facility in New Waterford. Now Glace Bay and New Waterford, as you are probably aware, are only 13 kilometres apart, it may as well have been 113 kilometres apart for the family, but one of the things that was brought to my attention, and I'm sure you and your staff are aware of this, is that the problem was solved and the husband and wife are now together in the same long-term care facility.

One of the things that was solved was that the husband who was separated from his wife had been going downhill, so to speak, because of that separation. Once the wife had finally been moved into the same facility and same room as her husband and they were reunited, the husband's health actually improved to a point where there wasn't as much medication required and so on and so forth. I guess if you look at it and then extrapolate it, you would say that would actually be a cost saving to the Department of Health to actually go about doing that, but one has to wonder how these things happen in the first place and how they can be allowed to happen in this province.

If we have reached the stage in terms of the number of long-term care beds that are available would actually result in the separation of a husband and wife at that time in their

[Page 30]

lives, then we've reached the stage where perhaps our system, and in particular our long-term care strategy, is lacking the compassion that should be there as part of that strategy. I think on an overall basis that should be if not one of, then the number one priority in that strategy. Mr. Minister, that's just a comment.

You've explained the beds and so on, and we could go on at great length in terms of a time frame. If you were to put in place all of those beds tomorrow, Mr. Minister, you and I both know that would still not cover the need that currently exists in this province for long-term care beds. Waiting 10 years down the road, as I said, is going to cause some great stress on the system, and in particular the people who are there waiting for those beds to be in place.

Again, let me change subjects here, Mr. Chairman. Mr. Minister, I'm wondering why your department is not keeping up to a promise regarding the stroke strategy and why the promise for an additional $1 million in this year's budget is not there. Is that leaving that strategy currently underfunded?

MR. D'ENTREMONT: Mr. Chairman, as soon as I get some notes down here, I'll make sure I try to flow my answers correctly. Just going back quickly on the placement of spouses, about 15 per cent of our seniors in this category have a spouse and probably a lesser number than that would require placement at the same time, so it's a difficult situation from a system that's really rough on - not rough, but difficult to react to certain circumstances. It is our policy now within the department to place loved ones together and I think the case the member opposite talks about, a placement was offered to them.

If you look at the original piece, I think the gentleman was a World War II veteran and was in a DVA placement. A DVA placement will not accept their spouses, unfortunately, because I think they have some capacity. What we did after we had heard about the situation, we offered a placement in another facility. I think the member opposite mentioned a placement in New Waterford, which is of course about 13 kilometres away from Glace Bay. Of course, the family had said no to that idea. I know at this point they are still working with that family and I think the placement has happened at a facility a little closer to home.

As much as we have to try to stick to policy in order to not impact other people in the system, I know we need to have to be fluid to make sure people are in the correct facilities and are receiving services that they so much deserve.

Also, if we talk about the placement of beds and we talk about the first 832, we're placing those 832 to bring us up to a standard level across the province within three years. Our idea at this point, and our initiative at this point, is to place 200 more every year thereafter so that we will continue the placement of beds, so when you do get to that 10-year piece, all beds will be in place at about a rate of 200 or so per year.

[Page 31]

Going to the stroke strategy, we will continue to work with that stroke strategy. There is $500,000, I believe, in this year's budget to continue funding the stroke strategy for District 2. We will meet that timeline for that stroke strategy. The stroke strategy had a timeline from 2007 to 2011. If you look at the current provincially-led work, it includes, at this point, development of draft stroke acute care guidelines; an environmental scan for stroke rehabilitation; development of post-acute stroke rehabilitation and community reintegration guidelines; a provincial stroke audit; and a provincial, professional education needs assessment. I can say that we are still moving forward with our stroke strategy to have it in place by the timeline of 2011.

MR. DAVID WILSON (Glace Bay): Mr. Minister, it was my understanding anyway that there was $1 million promised in this year's budget for that stroke strategy. There was supposed to be $1 million promised in this year's budget, but it's not there. It's only $500,000. What happened to the other half million?

MR. D'ENTREMONT: I think a part of the exercise this year as we develop budget, as we look at the funding of programs, we had to look at what our objectives were, what the timelines were and what we could fund. I'm really happy that we were able to continue to fund this program for $500,000. At this rate, we will continue to fund that program until it's complete in 2011.

So I think it's about trying to find all the priorities, making sure they're funded adequately and making sure that we have enough funding for other programs that are within the Department of Health.

MR. DAVID WILSON (Glace Bay): I do understand the severe restrictions and pressure that the minister and his department are under in terms of funding.

In terms of diagnostic equipment, Mr. Minister, the province needs additional - I don't know the exact technical word, but I think they're called bone densitometers. Am I close? Anyway, they need additional units to just keep up with the national standard, what the national standard has become. I'm wondering - the minister and his department have been made aware of this for quite some time - will the department fund the seven units that have been requested and that are urgently needed across this province?

MR. D'ENTREMONT: Just quickly, to finish off the stroke strategy piece. I'm just reading here: The multi-year funding will support two years in planning in education followed by ongoing incremental district-led implementation of components of that stroke strategy based on priorities and needs. We did feel the $500,000 was adequate to meet those objectives.

With regard to the bone densitometers, I know we had the opportunity on a couple of occasions now to meet with the Osteoarthritis Society of Nova Scotia in the interest of

[Page 32]

expanding our scanning program. I can say that this year's budget includes the addition of two bone densitometers here in Capital Health where, of course, our wait list is far too long. I believe that the average wait or the length of wait is somewhere near 400 days, which is well over anybody's expectations, especially for a type of diagnostic which, of course, if you can identify the onslaught of osteoarthritis with a course of drugs, can change the outcome for these individuals and on the backside, we do not end up seeing them in emergencies with broken wrists, broken shoulders and broken hips.

So we have worked with the group, but we also said we cannot fund all seven machines at this point. But we do feel we are trying to address our largest wait lists and largest area by the addition of two machines, which will greatly change the way that this service is being offered at this point.

MR. DAVID WILSON (Glace Bay): Mr. Minister, I think in terms of the issue surrounding diagnostic equipment and the issue of human resources that are available to operate that diagnostic equipment, there are some district health authorities, for instance, that don't have MRIs in this province, but I guess it connects with another issue, and that is the lack of technologists to operate some of that diagnostic equipment.

You do have some places - Cape Breton is one of them, I know - where new equipment is sitting idle because of a lack of qualified technicians or technologists. The obvious question would be, what's being done by yourself and your department to try to bring some light or solve some of the problems associated with the lack of human resources in that area?

MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for also underlining this very important issue in health care. As I alluded to a couple of times in my speech, and of course in my answers to the Leader of the Opposition, three quarters of our budget goes towards funding the salaries of our much-needed health care workers, and that includes everybody from doctors to technicians or in this case, when we talk about usage of bone densitometers, would be a radio tech or one of those individuals.

What we're trying to do within the province is that we haven't had a provincial HR strategy insofar as most of these human health resource positions and what we have done through the implementation of an HR person within the department, is we are starting to work on the paramedical HR strategy which will work with the different organizations, different colleges and those individuals on the attracting, the training, the retention of many of these much-needed professionals.

The issue also is no different than most of our professions if we compare it to physicians and those types of folks, is that on a Canadian context that we do have issues in training right across the country. We are in competition with many other jurisdictions and we need to, I believe, have more seats available here in Nova Scotia so that we are training

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more of our Nova Scotians and making sure they do have competitive remuneration at the end of those courses.

[5:15 p.m.]

Mr. Chairman, I know that I'm talking a lot about strategy and looking forward and putting these pieces in place, but I know that if we don't get started on some of these things, we will not be able to staff a lot of the equipment that we are adding to the province, and a lot of the programs that we are talking about implementing as well. So a lot of these things have to go hand in hand, whether it be setting up programs, but it also has to go into retention and attraction of many of these professionals.

MR. DAVID WILSON (Glace Bay): Mr. Minister, you're correct, they do go hand in hand. As you look at providing human resources or staff for the services that are required, it brings me to my next subject, and that is funding for district health authorities. There is only a 5.3 per cent increase to DHAs and they were getting used to 8 per cent increases over the last several years. So with that cut in funding to DHAs, I'm wondering, where are you expecting the district health authorities to cut back?

MR. D'ENTREMONT: Mr. Chairman, if we look at the funding to the district health authorities, you will see that they once again received their 7 per cent non-wage increases. They also received the funding towards added increases as a result of wage settlements. They will also be receiving the normal increases they need through their business planning process. I'm not expecting district health authorities necessarily to cut, although I am expecting district health authorities to work to the number they will be receiving from this department.

MR. DAVID WILSON (Glace Bay): Mr. Minister, that number's probably going to be less than it has been in the past. I'm taking a guess at it anyway. You've made promises concerning an increase to salaries and topping up pension plans and so on and so forth, but again, the question would have to be asked whether or not - where are you going to trim? The district health authorities can only go so far with so much and yet the other funding may be there, but eventually, when you tell a district health authority you're not getting as much as you did last time, where are district health authorities going to trim?

MR. D'ENTREMONT: Mr. Chairman, I think this year's budget and what we're mandating, what we're asking for, is really to work to the numbers that we're going to be providing to them. We're talking about limiting the new programs that tend to crop up year after year, we're looking at a status quo budget in this case. We want to continue to work with the district health authorities to find ways to continue to work together and find some true cost savings in sharing of expertise and working together.

MR. DAVID WILSON (Glace Bay): Let me move on to some issues regarding legislation. Mr. Minister, in particular, the Midwifery Act was passed this Fall, but am I

[Page 34]

correct in saying that as yet there are no regulations and that bill has not been proclaimed? If that's the case, when will we see this?

MR. D'ENTREMONT: I can say there's been a fair amount of work done at this point in regard to midwifery and to regulations that are required as a part of the college and a part of the Act. The multi-disciplinary committee is up and running. They are working on those regulations. Ultimately, we feel these will be prepared and ready to go in November. At that time, as both of them are available, the regulations and the Act will be proclaimed subsequently.

MR. DAVID WILSON (Glace Bay): There were, as I said, a number of issues regarding legislation - the Midwifery Act was one. There was a new Registered Nurses Act and Licensed Practical Nurses Act which was passed in the Fall that also has not been proclaimed. The Massage Therapy Act was passed in 2003 and not yet proclaimed, and the Dispensing Opticians Act was passed in 2005 and not yet proclaimed.

Mr. Minister, would you agree that the time to fulfill the will of the Legislature and the needs of those groups has come?

MR. D'ENTREMONT: Mr. Chairman, when it comes down to it, a fair amount of the Acts that the member opposite brings forward have to do with work that we are doing with respect to colleges and the regulations that they have to bring forward. I would have to offer further information on that one at a later date to figure out exactly what is standing in the way of proclaiming these Acts. I know the registered nurses and the licensed practical nurses, those two Acts are still awaiting some information from the respective colleges as well as the Dispensing Opticians Act. The Massage Therapy Act, I am not too sure where that one is and I don't think we would have accepted that Act. I don't know where that process is. I will get further information for the member opposite on this one.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I was just perhaps soliciting the minister's opinion on this one because I am sure the minister would agree that those are important pieces of legislation which, in some cases, he has brought forward on the floor of the Legislature. They have been debated, they have been discussed thoroughly and the Legislature decided for those pieces of legislation to be sitting around for years on end really doesn't fulfill any of the requirements that he and his government have put forward in terms of taking care of those issues, which have been nagging issues for quite some time. They have been around for quite some time. It's nothing new.

Let me ask the minister again, just switching, I know we don't have much time left for this portion anyway, but let me ask the minister his opinion on portable defibrillators. I think we can both agree that they save lives. As a matter of fact, I read a resolution during the session today which dealt with a gentleman's hockey league in Glace Bay which went about raising the money, some $5,000, to purchase their own portable defibrillator because

[Page 35]

we haven't reached the stage in this province yet where we do that. They have in other provinces.

There was a story in last week's ChronicleHerald that outlined a portable defibrillator actually saved the life of an elderly woman. The same story has been heard at hockey rinks and arenas and community centres throughout the province where, in some cases, the defibrillators are now available. Indeed, Newfoundland and Labrador is starting an awareness program in their schools on actually how to use the defibrillators. The Liberal caucus introduced a bill in the Fall that talked about access to portable defibrillators for everyone.

So I am asking the minister now, where are you with that subject, Mr. Minister, and if, indeed, you wanted to announce right now, it would be great if you announced that the Liberal bill is going to be brought forward.

MR. D'ENTREMONT: Mr. Chairman, I will start off by finishing, maybe, the last thought when it comes to the proclamation of bills that have passed through this House. I don't think it is because we don't want these bills to pass, I think there are further regulation pieces that have to be complete before they are proclaimed and again I will commit to provide information to the member opposite.

Except for the Massage Therapy Act, and I believe, I was just talking to the deputy here about this one, is that I don't think that that Act actually passed third reading. So I have to find some information on that one. I know we have been in talks to bring a new bill forward but it is still sort of in discussion at this point.

When it comes to portable defibs, I believe that's also under the purview of the Minister of Health Promotion and Protection, as I look over to him. The data that we have at this point is that only 2 per cent of heart attacks occur in public buildings so we have to really balance the priority and the funding available. I think the Minister of Health Promotion and Protection is looking at that and I think he actually talked about putting defibs in our recreational facilities. I think he announced that a month ago, is what he has talked about. So, again, that would be a question for that member when his time comes on the floor of this Legislature.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, the minister is putting it in another department, in Health Promotion and Protection. If the minister is saying that the likelihood of public defibrillators is going to occur in Nova Scotia, that's great news but I am not sure that is what the minister said. But if, indeed, they are looking at the possibility of funding defibrillators in public buildings in Nova Scotia, then that certainly would be welcome news, but I'm not sure if that's exactly what's being said. The bottom line on defibrillators being provided anywhere is that they save lives and it's a proven fact now it is a relatively inexpensive piece of equipment which through time has progressed to the fact

[Page 36]

that pretty well anybody can use it, there is no danger associated whatsoever with the devices where they stand right now, and I'm sure technology continues to improve on a daily basis.

I know we're running out of time and I didn't want to just take one last question and throw it at the minister because it's a question that is going to take a lot more time than what he has available to answer it in, but I will throw him this one at the end of my time here today and that is regarding the issue of wait times. It's an issue that the government promised less than a year ago during their last election campaign to concentrate on reducing wait times for medical services, but I can't see where any money has been earmarked for that, not that I can see for that kind of program. I'm wondering, what is the government's plan to fulfill that promise?

MR. D'ENTREMONT: Mr. Chairman, the wait time issue is one that is really all- encompassing in everything that we do at the Department of Health. If we look at every piece of investment or every bit of work that we do, it somehow impacts the wait time. If you look at the announcement we had on Wednesday, I think, of last week where we talked about the expansion of satellite services for cancer, spending some more money on those satellite sites in Yarmouth, Antigonish and Inverness, it makes the adding of a satellite site in Kentville go toward two things, which is providing Nova Scotians with services closer to home, as well as improving the wait times in those aspects.

Today I was very happy to make an announcement with my colleague, the federal Minister of Health, of the investment of $48 million toward improving wait times in radiation oncology or radiation therapy, which would see the purchase of some new equipment, linear accelerators at Capital Health here, as well as the Cape Breton District Health Authority, which would mean the increase of staffing at those two sites. At this point we felt that that was a good place to really start and focus in on, as we have so much prevalence of cancer in this province.

It is a frightening statistic when we think that about 23 people will be diagnosed with cancer today, will be diagnosed with cancer tomorrow, so we're looking at about 28,000 people living with cancer today and that number will continue to increase, so we need to continue not only to address wait times today, but to make sure that we have the facilities and infrastructure in place to meet those wait times tomorrow.

We've also found that we can't do it alone, we need to have the input of other levels of government. We need to have funding from the federal government and I was very happy that they came with that $48 million to help us with this wait time. It also addresses a couple of pilot projects when it comes to orthopaedic wait times, it also looks at the wait time for diagnostic imaging, so we look forward to working on those three projects immediately to improve access for all Nova Scotians.

[Page 37]

We also talked today about the wait time strategy, we had the wait time committee developing some number of recommendations for us and the number one recommendation was, of course, we need a provincial strategy to address wait times. We have done that, that wait time strategy is now available on the Web site and I would think that everything we do in the department, every bit of investment that we put into the department, into the health care system will improve wait times.

MR. DAVID WILSON (Glace Bay): I appreciate your answer, Mr. Minister, and I know the complexity of the problem but the problem most of all seems to be that the government has been given money and has spent money to monitor wait times. It doesn't solve the problem. Monitoring wait times, study after study, and then the whole exercise of collecting data and then you do it all over again and then you collect more data, and people are still waiting far too long for health care services in the province, Mr. Minister.

[5:30 p.m.]

Mr. Chairman, when you have in this province orthopaedic surgeons who become so frustrated that they actually tell their patients, well, you know, if you wanted to fall down the stairs and go to the emergency department then they can operate on you for your bad hip and you'll get treated quicker because if you go into the system and get into that system and get tied up in wait times for orthopaedic surgeries, who knows how long you're going to be there. So that's the problem that we're facing, Mr. Minister, as you well know, and the Auditor General who did a study of wait times in the province made a series of recommendations to improve the monitoring of wait times - which is great. All those things are needed. Those things are required, but to actually reduce the overall length of wait times I think would be a priority and a goal of your department. I'm wondering just how many of those recommendations, for instance, Mr. Minister - and I know that it's hard to hear sometimes in the Chamber - from the Auditor General are actually being followed.

MR. D'ENTREMONT: Mr. Chairman, again, this issue we can talk about for a number of hours and really what we were going to do is talk about it for about a minute. Quickly, a lot of those recommendations are held within the provincial strategy to address wait times. Again, to have that provincial strategy I think is very important. I invite members opposite to download that piece of information to look at what those recommendations are and it will impact our business planning process in making sure that we address wait times at every instance.

So, Mr. Chairman, I think it's very important that we continue to invest in equipment and human resources and only at that time when we have central listings and those kinds of things that we will truly be able to address wait times in this province, but I know we are making a fair amount of headway at this point.

[Page 38]

MR. CHAIRMAN: Order, please. The time for the member for Glace Bay has expired. We'll take a short recess for about five minutes for the minister and his staff.

[5:33 p.m. The committee recessed.]

[5:40 p.m. The committee reconvened.]

MR. CHAIRMAN: Order, please. I will now call CWH on Supply back to order.

The honourable member for Sackville-Cobequid.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. It's definitely a privilege to stand again in this Chamber to discuss the Health estimates. In preparation for this, I think this is the third one in less than a year, so definitely it's an important issue that I think many Nova Scotians look upon government to ensure they make the right choices and that the health of Nova Scotians is taken into account.

It was interesting in my preparation for this, looking through the response from government to this budget. It was interesting to read some of the clippings from the newspaper around what last Friday's budget was all about and what Nova Scotians could expect from it, Mr. Chairman. I'll just read a few of those and I'll refer to them throughout this hour and I think earlier tomorrow. One of the first ones I came across was in The Daily News, and the title was Dreams Deferred Until Another Budget Year. It also stated about broken promises and talked about the mental health tax credit, which was one of the issues that the Conservative Government brought up during the past election. Also it was around to create a Pharmacare Program for low-income families by 2008. We know, because of the budget on Friday, that also won't take place where it won't be fully implemented or fully funded this year with this budget.

Also in there are some of the reactions of those health care providers, those professionals who work in the system and work in health care here in the province. Dr. Rhonda Church, who is the President of Doctors Nova Scotia, said that about 30 per cent of her Bridgewater patients can't afford the medication she prescribes. One patient, she said, pays $200 to $300 a month out of her own pocket for cardiac medication. She said it's disappointing that the program isn't coming in sooner, because $200 to $300 a month over the course of a year is a huge hit for these people and we really need to see government commit to helping them. That was on the 24th, I believe, Mr. Chairman.

Another headline also in The ChronicleHerald, Mr. Chairman, was, Colon Cancer Screening On Hold. I'd like to read just the first paragraph, because I think it really brings home the need and the importance of a colorectal screening program here in this province: Hundreds of Nova Scotians will be diagnosed with colorectal cancer this year and hundreds

[Page 39]

will die but a program to screen for the disease while it can still be cured, remains a year away.

[5:45 p.m.]

Also, in one of the commentaries from David Rodenhiser in The Daily News, he was quoting the Finance Minister, I believe, just after the budget proceedings on Friday: Finance Minister Michael Baker said the increase in health care spending will be held to 5.3 per cent this year, although his budget numbers indicate growth of 6.6 per cent. Also going through that, Mr. Chairman, was the Premier in The Daily News on March 24th., and he stated: We have to make choices.

I think that definitely brings together some of the areas I'm going to try to get some clarification on, and bring awareness around the choices that this government makes, Mr. Chairman, the choices that they made in this budget, the choices they made prior to the last election. They definitely made those choices, and that's what the people of the province have to live with. Especially around health care, you don't have to look far or look at the data around election polling or the opinion of Nova Scotians and, for that matter, the opinion of Canadians about health care and how important it is to them.

So what I'll do is go through a whole list of different areas in health care where we will try to get some answers. One, which I know that the Minister of Health will maybe challenge me on, is around the privatization of health care, Mr. Chairman, and some of the comments made by the Minister of Health, made by his government, and hopefully get some more information around what exactly the Minister of Health and his department and his government want to see in the future when it comes to health care delivery here in the Province of Nova Scotia.

The other area I'm going to cover is a little bit around - I know the Leader of the Official Opposition touched upon drug coverage and the cost of medication in the province, like the drug Avastin, Mr. Chairman, but further on that or piggyback on that is the need for the catastrophic drug plan that I think not only our province needs but our federal government needs. So I'll try to get some questions, some clarity on that issue, of course around the Pharmacare Program for seniors and what we'll call the family working Pharmacare, or whatever the new terminology the government wants to put on that.

There are so many issues in health that we have to try to cover. Of course one of the biggest ones is the emergency rooms and some of the closures and wait times that we see within our emergency rooms not only in the central regions of our province, like HRM or the Cape Breton Regional Municipality, but especially in some of our rural areas, and the crises we see in the waits there, the ability to ensure that there's proper coverage there when it comes to specialists, when it comes to emergency room physicians. Also some of the

[Page 40]

questions I'll be asking the minister and his staff over the next couple of days will be around long-term care, and I think I'll eventually get that after the next little while.

First of all, I just want to mention - I know the member for Glace Bay mentioned it - is that we want to thank the staff in the Department of Health for going through this process, the deputy minister - I know it is definitely a hard event to do, to try to get all the work done in time - but I want to especially thank the health care providers in this province, because I think we do have some of the best health care providers in this province who work extremely hard to deliver health care to Nova Scotians.

So I'd like to start some of my questioning this evening with the minister around privatization, or what I'll call the privatization of health care in this province. We know the Minister of Health has stated in the past a private flair to health care delivery in this province, and around that everything is on the table when it comes to health care. I know that we have limited time, that's why I enjoy the fact that we can come here in Health estimates to get the attention of the minister, his deputy and his other staff, and hopefully gain some insight on exactly what the Minister of Health, his department and his government have planned for Nova Scotia and for the delivery of health care.

So my very first question to the minister is, when you stated that everything is on the table, Mr. Minister, could you maybe advise us, advise Nova Scotians, have you seen anything, has anything come across your table that pertains to the privatization of health care here in the province?

MR. D'ENTREMONT: Mr. Chairman, I thank the member for Sackville-Cobequid for his question and his lead-in. I know he's going to cover a lot of ground over the next hour, and I look forward to the subsequent hours of questioning from him over the next number of days in regard to the estimates of the Department of Health.

We start off with an issue that I think is an extremely important one to Nova Scotians, because as it stands in this day, and what we continue to try to do, is put the patient first. We want Nova Scotians to be, of course, the most important part of our health care system. We want to make sure that they receive the services that they require to make them healthier, to let them get through whatever ails them to get through that system.

Now, back in the Fall, we introduced a bill, Bill No. 126, which is the Health Facilities Licensing Act, and that Act looks at licensing private facilities. As it stands today, there is no such licensing Act; any provider who would be interested in setting up shop in Nova Scotia could do so without government's intervention.

What we were trying to do with this Act and what we will continue to try to do over the next number of months, is look at its function when it comes to ensuring patient safety, to ensuring no queue jumping, to ensure that things are done in one system so the patient

[Page 41]

would not know the difference between any one different system. So when they, for example, need an MRI, I don't think a patient would mind getting that MRI from one facility or another facility as long as they know that other people are not getting that test quicker if they have the money to pay. So what we're trying to do is create one queue, one wait list, per se, and making sure that Nova Scotians or taxpayers in Nova Scotia are paid for the one system, so there is none of this rhetoric about two systems happening in the province.

What we are doing is, we definitely put our ideas on paper, we introduced them in this House of Assembly for debate, but in the meantime, until we get to debate them on the floor of this House, we felt it was very prudent and very important to have some extensive consultations on it. I can tell you that up until now, we've had a number of consultations, whether it be with the respective colleges, with unions, with physicians, with specialists, to see what their thoughts are on private opportunities within our health care system. I can say that some of the meetings have been positive and some meetings have been less than positive.

We'll take that information, we've provided notes of those meetings, information of those meetings, back to the respective groups we've met with so they have a good feeling of what was discussed and what was not discussed, and we'll take that information back when second reading comes to the table or comes to the floor of this Legislature.

Mr. Chairman, I can also say that no huge lineups have happened - which is what I suspected in the first place - of private companies wanting to set up here in Nova Scotia. We have to find a balance of the opportunities for certain physicians and certain specialists to be entrepreneurial, but at the same time we have to be conscious that there is no negative impact on the public system as it stands today.

So, Mr. Chairman, I know the member opposite thinks very passionately about this issue, but I will continue to put the patient first, to make sure they have a system that will respond to their needs. I look forward to further discussion on Bill No. 126 as it comes to the floor of this House at a future date.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I think that's where we'll find a difference, definitely, in our opinions within our caucus and our Party and I think the difference in the opinions and the thoughts of the Progressive Conservative caucus and their Party when it comes to the delivery of health care in this province.

The reason I'm so passionate about this is because here we have the Minister of Health who just said that he's not in favour of queue jumping, I believe is what he was trying to get at or what he was saying. What I don't understand is, if we're going to allow these private clinics to open up here in our province, we're going to allow individuals to go to these private clinics, why would we invest taxpayers' money in these private clinics if there is not going to be any benefit? Maybe the minister can tell me the benefits of having private

[Page 42]

clinics throughout our province, which we're already seeing, because I think the government made the choice many years ago. I know since I've been elected, they wouldn't address the issue of these private clinics coming to this province.

I know we've had debates, my caucus has had debates and our Party has had debates on private clinics, like the MRI clinic that came to Halifax several years ago now. Why would we take taxpayers' money and invest it in the private sector? If we're going to pay for that service, why don't we pay for that service under the public system? Why don't we take that money and ensure that the money goes to ensuring the public system is supported, is secured, and that we don't see an erosion of the public system, especially our human resource aspect of it, Mr. Chairman?

The minister knows that we have an issue here in the province with retention and recruitment of health care professionals. I know that private clinics come with all the bells and whistles. One of the things that they do come with is a bag full of money to entice those health care workers to come to those clinics. I've read the studies down through the States, Mr. Chairman, and maybe the minister has read other ones that contradict this, maybe he can elaborate on that, but I know that they erode the human resource aspect of the public system if we were to allow this.

So from what I'm hearing from the minister, I would suggest that maybe Bill No. 126, which he introduced I believe in November of last year, should have been something that this province saw many years ago. Would the minister agree that we're trying to play catch-up when it comes to private clinics and the opening of private clinics here in our province?

MR. D'ENTREMONT: Mr. Chairman, you know, this is a very important issue and one that I'm very happy to discuss. For years, subsequent governments have been, I think, scared to bring this issue forward. I think what we need to do is try to get a real debate going on what a private health care system or private health care delivery is, and what it isn't. I think that the value of introducing this bill puts every idea we have talked about in the department for a number of years, and we're asking groups, organizations, colleges, to come back and provide us with their thoughts and see how we can either incorporate them or not.

Mr. Chairman, I think what it really stands to today, is that the system is wide open, the system has no way of ensuring that if you're going, let's say, for an uninsured service, like plastic surgery, we have no way, as government, to ensure that the facility is meeting guidelines. So what we're trying to do with this bill is provide a mechanism with which to license the facilities that we do have today, that are offering uninsured services, but also looking at the opportunity, if one presents itself, through contract with the DHA, to offer some insured services as well.

[Page 43]

[6:00 p.m.]

We do not see ourselves investing taxpayers' dollars into the creation of a private health care service. What we are doing is trying to ensure that the patient, or Nova Scotians receive the services they require. I think the discussion is an important one. The member opposite brings up the issue of human resources and exactly where they're going to come from. What we've seen from a couple of the experiences we have here in the province now, is that we're finding some late career professionals, whether they be nurses or otherwise, who were retiring anyway, that they have an extension of their careers now, and are able to continue to contribute to Nova Scotia's health care. What we're seeing is an opportunity for other physicians to stay in this province.

If we look at the total number of physicians coming to the province today, you know, we have a net gain of 46. Why are physicians leaving? We probably brought in - the total recruited was 105; the total retained, I think, was about 46 out of that 105. So why are those physicians staying? I think it really has to do with a couple of opportunities that they don't have here in this province: one is academic freedom and being able to do research and those kinds of things; and another way is to provide health services in an entrepreneurial manner, which I think is what a private delivery might be able to provide.

So, again, we are debating the merits of a bill when we're really supposed to be discussing the contents of my budget. But again, I thank the member opposite for bringing this issue forward and to understand the importance and the complexity of what we're talking about, and what we're really talking about and what we're not. It's a discussion that I know is worthy of many hours of discussion, but I look forward to that when the bill gets called again in this Legislature.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, that's what I'm doing, I'm trying to paint the picture of what this government is attempting to do or where they might be going in the future. When we see that health care is the number one issue for Nova Scotians, then I see a budget from this government that actually doesn't provide the funding that what we've seen in the past - the Minister of Finance and the Minister of Health have both stated that we've seen a constant of about an 8 per cent increase over the last decade or so. When I look at a budget and I see health spending capped at 5.3 per cent, that leaves the question, where are we going, where is this government going?

That's why I wanted to mention the privatization of health care. It was actually the Minister of Health who mentioned Bill No. 126, not myself. It's not just the Minister of Health, it's the Minister of Finance who, in recent news, it was reported in the New Glasgow The News on March 9, 2007, he said that tighter financing of health care is important and is required by the Progressive Conservative Government, and that they'll be looking at creative solutions, including private health care delivery within the public system, but he wouldn't offer any details when he made those comments.

[Page 44]

I know the Minister of Health has been quoted several times on this over the last year or so since he became Minister of Health, and I'll again quote another piece that was on CBC Radio, I believe, where the minister had stated that he wanted to do more consultation. I think he stated in this House also in November, with Nova Scotians, to find out what their thoughts are on the privatization of health care or private health care in the province.

I would like to ask the minister, has he gone out and talked to Nova Scotians about their thoughts and concerns around privatization of health care and the issues revolving around delivery of health care here in the province.

MR. D'ENTREMONT: Mr. Chairman, you know, there has been a lot of consultation going on since the introduction of this bill. There was a lot of consultation that went on prior to the introduction of this bill. I can say that over the last number of months we've had the opportunity to do more directed consultation, meeting with the people who will be directly impacted by this, which is really the colleges, the nurses, the physicians, Doctors Nova Scotia, as well as different organizations, DHA boards, DHA chairs, DHA CEOs. You know, there's been a whole bunch of that going on.

At the same time, we've had the availability on the Web site for anyone to write in with their thoughts. I have to say we haven't gotten a ton of those, even though I think we should maybe advertise it just a little bit more that there's the opportunity for Nova Scotians to input. What I would also ask them to do is look at the bill, look at the things that are contained in that bill, to look at, I believe there's a White Paper that accompanies it, to give broader context to the things that we're talking about.

I think what we'll try to do over the next number of months is continue that process. I also envision maybe taking some of those stakeholders and getting them all together around one table and not only have the department try to stand up for each group, but have each other to stand up for each group to see if they can come up with some kind of compromise in this issue as well, because at this point - and I will say it again - the system is wide open, it is completely wide open. There is no, in my estimation, guarantee of safety for the patient.

I know when you talk to the professionals that do have these facilities today, they do adhere to very stringent guidelines and accreditations. But how do I as a Health Minister guarantee that to Nova Scotians, that they are going to be getting that quality of service, that level of safety? I can't, because there is nothing that gives me the mandate to do that.

I think that's probably the most important part of our bill. I think what we're going to continue to do is consult over the next number of months and then finally bring it in here with the stuff we've heard and bring it to the floor of this Legislature. Again, it is wide open at this point, and we want to find a way to contain it, as well, and see if there are benefits to the Nova Scotia health system.

[Page 45]

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, the one thing with the minister's comments, the one thing I didn't hear or maybe he didn't say it or he might say after I ask him, was about the public. The quote I read earlier from CBC was that the minister, himself, wanted to get out and hear from the public. So has the minister himself gone out to the public, to the taxpayers of this province who are going to fund, or whose money is possibly going to go towards private delivery? Has he talked to the public?

Yes, I understand there are interest groups, and I commend them if they've started that, because that's what I think has been lacking over the last decade or more in health care, that those who deliver the service are the last ones to be consulted.

I know, Mr. Chairman, from being a paramedic, from working with other health care providers, that they are the last people to be acknowledged and requested of information of how things should change. So I'd like to ask the minister again, has he, himself, attended a meeting with the public, or is he going to attend a meeting with the public? Are we going to see him travel this province? I think for an issue like this, he needs to allow the public, those people who are going to be paying for the health care service, time to come and talk to him and give their opinion on that.

MR. D'ENTREMONT: Mr. Chairman, I can assure the member opposite that this issue is brought to my attention on a regular basis, as Health Minister, from regular Nova Scotians, people who are concerned about their health care, who are concerned about their wait times and are looking to us for creative solutions. I can say that we have had the opportunity to meet with groups. Those groups represent, as well, regular Nova Scotians. We have met with union representatives, and those union representatives represent front-line health care workers. I think that over the next number of months, the opportunity for every Nova Scotian is to put their ideas on paper and get it in to the Department of Health through our Web site.

Again, every opportunity that I have as Health Minister to get out and present to Nova Scotians and groups, I will continue to ask questions and take the input from them as we go forward with this issue. Mr. Chairman, again, we will continue along this path to ensure that the patient is number one when it comes to the health care system in Nova Scotia. Thank you.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I would agree. I come from a profession that that is entrenched in our training and our thoughts and our actions within the health care system and the delivery of emergency health services in the province. So I would like to ask the minister - he is saying that they are compiling this information, that the public has a chance to go on-line, make submissions to government - I would like to ask him, what are his intentions when he gets this information?

[Page 46]

He mentioned coming to the floor of this Legislature. I know he talked about Bill No. 126 and that dealing with private facilities, but what does he envision bringing back to the floor of this Legislature when it comes to private health care, and what he composes with the results of what input he has gotten on this issue -is there a timeline? What are his intentions when he compiles that information? Are we going to see other pieces of legislation like Bill No. 126? So timeline and what he envisions for possible future legislation on this.

MR. D'ENTREMONT: Mr. Chairman, what we continue to try to do is make sure that we have a publically defined system and a publically funded system to make sure that all Nova Scotians receive the services that they require. Throughout this process, I think what we are trying to do is Bill No. 126 is designed to be a place marker, I guess is what you really could call it, getting the information to Nova Scotians of what we envision or what we think should be in licensing private facilities, or what private facilities should look like. I think the next steps throughout this consultation process, as Nova Scotians have the opportunity to input, is that we have a couple of ways we can address this.

If we feel, as I feel and Cabinet feels and the department feels, that we want to continue with Bill No. 126, we will bring it to the floor, continue its discussion on the floor of the Legislature. We will talk about the changes that we might want to see to the bill; we will present them in the Law Amendments Committee. If we feel that the bill does not address the direction that we are getting from Nova Scotians, we will draft a new bill to be introduced at another time.

Mr. Chairman, I think the importance of what we are trying to do is trying to have good discussion to let the public know what we are trying to do and what we are not trying to do, and then have that true discussion with Nova Scotians. I think, so far, our discussions have been really good. They have addressed certain issues and concerns that we might have had. There are still concerns there by some of the groups where we are trying to find ways to incorporate those in either through an amendment or further clarification or whether they be designed in a future piece of regulation that would accompany that bill - there are a lot of avenues for us to go down in the future. I will ensure that the information we receive from Nova Scotians is incorporated the best way possible in either Bill No. 126 or in a revision of that bill in the future.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, so that brings me to the next few questions I have. Around the issue of the Corpus Sanchez Report that was commissioned or was tendered, I believe, just prior to the last election or just after the last election - we know that the government spent over $1 million to have this report prepared, so I would like to ask the Minister of Health, has the Corpus Sanchez Report been finalized?

[Page 47]

[6:15 p.m.]

MR. D'ENTREMONT: Mr. Chairman, to the member, the facilities review or the PHSOR, as we call it at the department - I don't know who thought up that acronym, but I can tell you the Department of Health is full of acronyms, and I'm glad there are acronyms because sometimes the words are way too long - ultimately what we are really trying to do there is really have a true financial and systematic look at how our health care system is performing. We envision to have a final report come to the department, or a final draft, or whatever the heck they want to call it, somewhere toward the end of April into May, where we can have a base idea of where we should be going. I know the members opposite, I know the Leader of the Opposition has mentioned it on a number of occasions that we need to have a full strategy on health care in the province. I think what we really needed first was a true analysis of where our funds were going, how they were being spent, what kind of programs we needed to make sure we have the correct health care teams in place. There is a lot of detail that has been put together over the last number of months.

We did envision to have the report available a lot sooner but, of course, a number of factors, such as negotiations, unplanned delays and, again, the report we are hoping to have in place by the end of April, first of May of this year, then we can look at those recommendations and see how we can implement them through the business planning process through next year.

MR. DAVID WILSON (Sackville-Cobequid): I would like to just ask the minister, when was the proposed final date for the report to go to government? If it's delayed now, what was the original time of completion for this report?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I think we are looking at about - it was a six-month extension, so it would have been available sometime in December or November of last year. What we did find, as the consultants went from district to district to review the operations, they found that further detail was required. I know that the site visits included over 40 hospitals. They have reviewed all provincial programs, which is a lot of work. I think what this will give us is a really good picture of what our health care system is doing today, what kind of expenditures are really happening out in the districts, but also recommendations on how to better deliver safe health care in this province to better use the HHR that we have today, and to identify those programs and services that can be best managed on a system-wide basis, and try to inform the development of a strategy that will improve the health and delivery system here in Nova Scotia.

MR. DAVID WILSON (Sackville-Cobequid): So what maybe I will do, a couple of questions - six-month extension - one of my questions would be, what is the added cost to government, to taxpayers for that extension, and what were the instructions that government gave to Corpus Sanchez when they were looking at this review? Was it wide open? Were

[Page 48]

they instructed to look at just public system, or the private system? Are they looking at every aspect of delivery of health care that is out there both privately and publicly?

MR. D'ENTREMONT: Mr. Chairman, I can categorically say no, that private health care was not part of their mandate. We expect a number of outcomes. As they started their process, we had to look at the confirmation that resources managed by DHAs and IWK are allocated appropriately, because we always have a discussion, it seems, during business planning with the districts, on who should be getting more money and whether their programs are funded correctly and those kinds of discussions. So we wanted to have a better feeling of that.

We wanted to have an identification of opportunities to improve system access and efficiency. We wanted identification of program services best managed on a system-wide basis informing the development of a strategy to improve the health care delivery system, and the cost of the review identified savings to be reinvested back into the health care system.

Really, to the first question, the extension, I believe was $50,000. There is an added - I think it's called an ER investigation that cost another $50,000. So it's about $100,000 extra for that extra six months that they are investigating the process in Nova Scotia.

MR. DAVID WILSON (Sackville-Cobequid): I know the minister mentioned a few things earlier, was this the delay of the departments they were looking at, or government, or was this a delay on the part of the company, Corpus Sanchez, for them to require a six-month extension?

MR. D'ENTREMONT: To the extension, really, the extension was offered, because as the consultants go down the system and started the discussions with the district health authorities - district health authorities make up about 20 per cent of our provincial budget, so it was very worthwhile to go in to see how those operations were working - there were sets of data that were required that took some time to get. What we have been doing over the last number of months is verifying the data with the DHAs. The data came back. The consultants have applied some information to it to look at those efficiencies and those questions that we have asked. What we have done, what they have done - I keep saying we - what they have done is try to go back to the DHAs to validate the information that they have had to make sure that the DHAs are comfortable with the information that's going to be presented as a part of this report.

We want to make sure that an agreement with the DHAs - we want the DHAs to be as big a part of this process as they possibly can be, because they are the service delivery people for Nova Scotians. So we need to have absolute buy-in from them if we're looking at some province-wide changes, whatever program it comes from. So everybody has to be on board on this one, and that did take some extra time. For the most part, it was really a lot

[Page 49]

of data mining that was required and a lot of work on the DHA level to provide that and to verify it.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, if I recall from my readings of the schedule for Corpus Sanchez, they were doing it in sections, and they evaluate a certain area and then they will go on to another one, and go on to another one. Is that the case? If it is, has your department received the reports of the individual or the areas they were looking at, or are they just going to give you all the information at once? If they have given you the information, is your department looking at it and going through it now?

MR. D'ENTREMONT: We look at this report to be sort of in two parts. One of them will be a main report to the Department of Health that will include a number of recommendations on the fair funding of DHAs, the sharing of programs, the funding of province-wide programs. It will also have a component of reports to each DHA. So each DHA will have an in-depth analysis of how they are spending their money of the services they have within those districts, of their staffing models, and in a view of having some recommendations to help them provide better care to patients. So it's really a two-level report, one to us and the second step to each DHA so that they have a better feeling of what they are doing.

MR. DAVID WILSON (Sackville-Cobequid): So that I can get it clear in my mind, the DHAs, each DHA or section that was evaluated, will receive a report. Now, is that all at the same time, or have those DHAs received that report and are looking at what that report entails?

MR. D'ENTREMONT: Mr. Chairman, again to the member for Sackville-Cobequid, the issue that each DHA was reviewed - and all their programs were reviewed, I believe - they will be receiving a report, actually, right now, I think they have had some components of that. So they are actually looking at their numbers and validating the information as it is being presented. That will be finalized. It will be contained in a province-wide report to the department, to government.

Also, within the main report, I believe, will be a number of recommendations on private province-wide programs as well, as we offer to Nova Scotians. I know the consultants are still busy out in some of the districts and still visiting some facilities to validate those numbers. I can say this has been a very comprehensive program. I know they have done probably more work than we would have expected of them, but I think that will be important to the information that will be provided so that it can be a basis of moving further to improve health care to Nova Scotians.

MR. DAVID WILSON (Sackville-Cobequid): I will look forward to that report - and hopefully by the next sitting of this Legislature, if the budget passes and we are back here in

[Page 50]

the Fall - because that is an area that, I think, may show what your intentions are when it comes to the delivery of health care here in this province.

So now I would like to turn to the retention, recruitment of physicians and other health care providers. We know that it's a huge issue here in the province. I've said it earlier, my feelings around opening up more privatized clinics, that it would erode the public system of just those individuals - the health care providers. So one of the things I've advocated many times in the House is the use of nurse practitioners. We know several years ago there was initiative to hopefully entice some of those more senior veterans of nursing. What I mean by senior veterans of nursing are those highly-skilled nurses who have been working in the system for many years to go on and upgrade their education to become nurse practitioners.

We all know that nurse practitioners can, I think, play a huge, huge role in the delivery of health care here in this province, not only on floors in the QE II or down in Colchester Regional Hospital or down in Sydney, they can play a role especially in some of our rural communities. We know how important they work with the community, especially around their scope of practice and what their abilities are.

I know the government's initial initiative, when they try to attract or increase the number of nurse practitioners in this province, they allowed them to go to school to upgrade, become licensed nurse practitioners in this province, but then it seems to fizzle out, Mr. Chairman. It seems that the opportunities for nurse practitioners are limited here in the province. I know the minister will probably mention a few of the locations they have worked on over the last couple of years. I think they have underestimated the importance of these professionals in the Province of Nova Scotia and where we can utilize them. My question to the minister is, why are we underutilizing our nurse practitioners here in the Province of Nova Scotia?

MR. D'ENTREMONT: Mr. Chairman, I think this year's budget talks about - I'm just looking at my CFO for what he can find in here - looking at 25 nurse practitioners in the province as a result of this budget, I think prior to that there were 19, so we are looking at an increase of six. I know it doesn't seem like a lot, but ultimately it's to place these professionals in places where they can work with rural communities, where they can work with communities.

If you look at the training of a nurse practitioner and if you look at the effectiveness, and I just have to go with the experience of the member for Digby-Annapolis, he talks about his nurse practitioner - he calls it his nurse practitioner, but I think it's the whole community's nurse practitioner - on Brier Island, and what they have been able to provide is really a level of service that hasn't been seen for many, many years. What the nurse practitioner really does, I think, in the Brier Island context, is they get out to households, they visit and they have more of a wellness mandate where they want to make sure that the

[Page 51]

community is living well, to make sure they can sort of prevent anything adverse happening to their patients.

So I think it's working really, really well, because I know the member for Digby-Annapolis speaks quite proudly of the work and is looking for some expansion to that.

[6:30 p.m.]

If we look at the use of nurse practitioners in the province and current breakdowns: DHA 1, South Shore, has two; DHA 2, southwest, has two; DHA 3, which is Annapolis Valley, has three; DHA 4, which is Colchester, has one; DHA 5, which is Cumberland, has four; DHA 6, which is New Glasgow, has two; DHA 7, which is Antigonish, or GASHA, which is the Strait, has two; DHA 8, which is Cape Breton, has three; and DHA 9 has two. So we're trying to evenly distribute those professionals across our system.

The other issue that the member opposite has brought forward, is using them maybe in different settings, using them in particular to try to address some of our ER shortages in the province. The issue with that, and the difficulty we're going to have with that, is that they have to work in concert with a physician. There has to be a physician somewhere just in case - I mean, most times it's just in case, because I do feel these professionals have wonderful training and make some great decisions, but just in some of those specific cases they need to have that collaboration.

I can go back to Digby, because it's the one that the member for Digby-Annapolis speaks to me about on a regular occasion, and that is maybe staffing the ER with a nurse practitioner on those days that it's off, but the problem was in the first place that we couldn't find a physician to work there, and the added problem is that we wouldn't be able to find a physician to back up that nurse practitioner if they were doing some emergency medicine at a facility.

So this year we continued our expansion of nurse practitioners in the province, providing, I think it's $1.2 million additional to continue to expand our complement of nurse practitioners in the province, and we'll continue to work. If you know the bill that we did pass forward, the Registered Nurses Act that passed in this Legislature I believe in the Fall, did expand the - not the responsibilities, but the scope of practice for these professionals, to give them some more responsibility to (Interruption)

I thank the member opposite for filling in that word because he knew I was having trouble with it. I find sometimes, as an Acadian, that I'm thinking of French words, and I know they don't necessarily go so well on the floor of this Legislature, which I know has happened to me on a couple of occasions. So I want to thank him for filling in on that "scope of practice" issue. I know I got into some real trouble when I did use another word one day

[Page 52]

that I'll probably never, ever use again. (Interruption) No, you can stay away from what I used. Anyway, you put it in context of why I said it.

Again, $1.2 million more for additional nurse practitioners, and we'll continue our investment in that manner.

MR. DAVID WILSON (Sackville-Cobequid): I think the minister hits it right on the head when it comes to what we need to see here in the province, and it is dealing with the scope of practice for health care providers. We've just increased, through legislation, LPNs' scope of practice, which, as I stated, they accept and they want to see. I think it's important that we recognize we need to look at all professions, especially in health care, on where we can expand that.

The minister mentioned Brier Island, the nurse practitioner who is there, she does a great job and I think the community is well served by that individual being there. We have other examples where an increased scope of practice has benefited the residents. We look at Tancook Island and some of the paramedics in that area who have an expanded scope of practice, who deliver a service that's important and needed, especially in the rural communities, those remote areas here in the province. I think that's important. I have to remind this minister and the government that they haven't been treating, I think, the nurse practitioners, as a profession - or haven't been giving them the opportunity to make that profession thrive, or designation as a nurse practitioner.

I've given this example in the House before and I'll give it again, I come from an area where we have the Cobequid Community Health Centre, where we had one of these nurses who took it upon herself to go back to school to upgrade to the level of a nurse practitioner, but she was unable to get a position here in the province. They were limited. Part of the problem they are finding now is that they can't do enough practicum or enough time to keep their scope of practice and their qualifications to the level they need to keep that status as a nurse practitioner.

That was one of the problems with this individual that I mentioned, she couldn't find an area that would accept her so that she could keep those qualifications that, potentially, down the road, we could use her as an important component of health care in the health care service here in the province. Regrettably, I have to say that this nurse is now working in Moncton at the Moncton Hospital in the emergency department. The one thing she wanted - and I tried, and I've asked the former Minister of Health, I've asked the former Premier several times in this House about the use of nurse practitioners in our emergency rooms. We don't have to just look at rural communities, we have a crisis here in HRM and in Sydney, with the long waits.

A perfect example is the Cobequid Centre. Here we have a facility that is not open 24 hours, but has many services provided there, and one is an emergency department that's

[Page 53]

open from 7:00 in the morning until 10:00 at night. With her shifts there, she was unable to work - I think it refers a little bit back to the requirement of a physician - to her full potential. So here's an individual, here is a nurse, who is actually working in triage at the Cobequid Centre who could actually divert, I would say conservatively, 30, 40, maybe even 50 per cent of the individuals who go to that emergency department from having to see a physician. That's a huge number.

You don't have to take my word for it, there are many studies out there. I've read in the past where the number of patients who can be diverted or be treated by a nurse practitioner is huge. I think that would go a long way with reducing some of those stresses and some of the pressures on the emergency room, on the number of patients requiring admissions to hospitals.

So I would like to ask the minister if he's aware of a limitation of what physicians in this province can oversee or overlook nurse practitioners. From my understanding, an emergency room physician, for example, an ERP, cannot have a nurse practitioner working under him or her, it has to be a general practitioner. I'm wondering if the minister would know, or maybe the deputy minister could advise him if that is actually a current policy, that an emergency room physician cannot have a nurse practitioner working under them because of regulations or policies or rules of health care here in the province?

MR. D'ENTREMONT: Mr. Chairman, there is no policy with regard to the utilization of nurse practitioners under an emergency room physician. We are developing, at this point, a policy to have that happen. What we've been trying to do at this point is utilize a nurse practitioner as a primary health care provider, so community-based, trying to do the things that I feel are extremely important, which is population health-based, having better outcomes for lifestyle, those kinds of things, so we actually slow down the visits to ERs and other instances.

The member opposite also underlines a bit of the issue, I think, and the challenge that we've had in bringing nurse practitioners into our system. I think it's going to be kind of the same issue we have in bringing LPNs into full scopes and to certain settings that we're going to have in utilizing - I'm looking for the word, I'm looking for the word, birthing (Interruptions) There you go, midwife, that midwives are going to have in integrating into our health care system. It's funny how you have a brain episode like that sometimes, you can't come up with the right word.

Ultimately, as these professionals who work in our system and the other professionals become comfortable with them, they tend to start working to their full scope. I think that's been the challenge up to now, where physicians - and I'm not going to pick a fight with physicians at this point, but ultimately they have been slow to the mark of wanting nurse practitioners to be sort of in their domain. I think what it is now, they're realizing the importance of those individuals and are actually including them in primary health care teams,

[Page 54]

knowing that if there's a nurse practitioner working with you, they can do this stuff, I can do this stuff, and we can see that many more patients and impact communities even better.

I think that will happen with midwives, as well. As midwives come on-line, hopefully in the Fall, moving into winter, how they will be integrated into the current system, how they will be utilized and how they will be regarded by nurses, how they will be regarded by physicians, and how they will be used as part of that very important primary health care team, or in this case birthing team.

Just to conclude my comments on this, we'll still continue the progress we're doing with primary health care nurse practitioners, but also to expand the utilization within districts to come up with that policy of how they work under an ER doctor and how we could use them in cardio care settings, how we could use their expertise in emergency rooms and other places where we do need extra help within our health care system.

MR. CHAIRMAN: The honourable member has approximately 40 seconds left.

MR. DAVID WILSON (Sackville-Cobequid): Hopefully I've made my point to the minister, and maybe to the deputy, the importance of looking at nurse practitioners. I think if the government is committed to it and they help and assist nurses and those who might be thinking about going to upgrade, it would go a long way. I think the government missed the mark years ago, after the initial program, to help educate the nurse practitioners, and we lost several of them because, after that initial support, government wasn't there to get them through those growing pains.

MR. CHAIRMAN: Order, please. The honourable member's time has expired.

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. It's good to be back, Mr. Minister. It's good to see you still here. I always appreciate following the member for Sackville-Cobequid, there's just something about that guy I like, I don't know what it is.

Mr. Chairman, let's continue on with some questioning for the minister. When I finished my questioning earlier, we had just broached the subject of emergency rooms and closures, and so on. Certainly, the problem is not going away, the problem is as recent as today, at the Northside General Hospital. Today in Cape Breton, there's a closure of that emergency room tonight. The emergency won't open again until tomorrow morning. So it's an ongoing problem, and that's an example of it.

We can't ignore the fact that ERs across the province are closing on a frequent basis. I guess people are left wondering, is it a lack of doctors, is it a lack of staff to maintain basic hours of operation? I think everybody will be in general agreement that it's time to address

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the issue of ER closures. We've seen those ER closures mounting over the years. As a matter of fact, if we look back the last several years, we're looking at almost 5,000 hours of closures - that's almost seven months of closures. Mr. Minister, my question would be - and perhaps a detailed answer may be in order if you can, Mr. Minister - what is this government's plan to try to stop this rather alarming trend of ER closures in this province?

MR. D'ENTREMONT: Mr. Chairman, I had mentioned, I think in my last hour with the member opposite, the member for Glace Bay - and I know this is a very important issue for him, as the member for Glace Bay - the Glace Bay hospital has been experiencing a number of closures over the last number of years. I can say that we've done a fair amount of recruiting around the province. Over the last 18 months we've seen an increase of 188 doctors, but if you also look at our retention rate, it's not as stellar, but we have a net gain of about 64 physicians across the province, or on a yearly basis. This is a challenge we're having right across our system, from a Canadian context. A lot of time it really has to do with a physician's expectation of lifestyle, that they want to have the opportunity to take vacations and spend some time with their families, as well.

[6:45 p.m.]

If we look at the closures in the province - maybe I'll give a listing for the record: DHA 1 has been open 99.8 per cent of the time; DHA 2, which has three ERs, has a total of 97 per cent opening - Digby, of course, being the problem - and 81 per cent of those closed hours has to do with Digby and Shelburne; DHA 3, 99.7 per cent open, has a little bit of issue sometimes with Middleton; DHA 4 is open about 94.2 per cent of the time and their issue, of course, is Tatamagouche; DHA 5 is open 98 per cent, and Pugwash is the issue sometimes; DHA 6, wow, they're open 100 per cent of the time; DHA 7 is open 99.8 per cent of the time, and their issue sometimes is that Port Hawkesbury is closed; and DHA 8, with eight ERs, is open 96.9 per cent of the time, and Glace Bay is 46 per cent of those closed hours, New Waterford is 25 per cent and North Sydney is 29 per cent. So the smaller hospitals, compared to the regional, do close on occasion. DHA 9 is 100 per cent and IWK is 100 per cent, so the two main tertiary care emergency rooms in the province are open all the time.

What we really need to do, as well, is to continue to work with the DHAs and to try to speculate - I guess is the best word - or try to envision when those closures might happen. I think part of the problem is that we're finding out too late that a closure is going to happen or that a physician has to go for - whether it be upgrading, whether it be family time, or whatever, that we're too late in getting the locum program into place and getting a replacement to work in that ER. Then, in most cases, it's closed for a day. It's very difficult to get someone to come spend time in another jurisdiction for a day. If it's a week, then sometimes an opportunity shows up that we can get someone to come and fill in.

[Page 56]

I can also say to the member opposite, when the member for Sackville-Cobequid was talking about PHSOR and, of course, the extra time, and I talked about the extra time taken to complete the process which was costing us $50,000 and also talked about $50,000 for an ER evaluation, what I've asked Corpus Sanchez, as a part of PHSOR, is add an ER piece to help us develop an ER strategy that will help those communities have those emergency services. So I look forward to that report coming out, I believe sometime at the end of April, in order to help us decide on how we're going to address the issues of closures of ERs, like the one in Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, it is interesting to hear the minister bring up the issue of planning. That, perhaps, is one of the biggest problems that is being encountered in keeping ERs open. Certainly no one would begrudge a physician a holiday or a day off with the number of hours that physicians put in in this province, but if some of that planning, some of that foresight is there, then perhaps these closures could be totally avoided.

No one is arguing that the ERs are open a good amount of time. The amount of the closures, the numbers of closures have been mounting. I guess it depends on whether or not you need an ER, and if you go there and that emergency room is closed, then it wouldn't really matter to you whether or not it has been open 97 per cent of the rest of the time, it only matters if it's closed on the day you go there and you're no longer able to access that emergency room.

Which brings me to a question, why are so many people actually going to emergency rooms in the first place? I'm wondering if the government has bothered to ask that question. Perhaps it's because of a lack of family doctors. There are over almost 50,000 Nova Scotians who are still without a family doctor, and that number is growing on a daily basis. So perhaps the minister would outline exactly how he's going to address that problem and if, indeed, it's connected, if the lack of family doctors is one of the reasons that our emergency rooms are actually bursting at the seams.

MR. D'ENTREMONT: Mr. Chairman, as I've talked about in a number of answers to questions in this House over the last week or so, and prior to that, over the last 18 months over 188 new doctors began working in Nova Scotia. Of course, we haven't retained all those 188, and I wish we could find ways to keep those folks practising in our province. What we are also seeing is that there is a need, a trend for those physicians, of course, to try to situate themselves in more urban settings, looking for different opportunities for their families. So it makes it a challenge to get physicians to locate into places like Glace Bay, places like Digby, and other relatively rural areas of our province.

At this point, if we take our total number of physicians in the province, Nova Scotia has more doctors per capita than anywhere in Canada. So how does that roll itself off into having so many ER closures? Recruitment numbers have been edging up over the last few

[Page 57]

successive years, so we are having more and more success in retaining these individuals, but we still have some challenges in certain of our ERs. I think what we also need to do, ultimately, we need to find a better way to entice these physicians to some of our needed areas, whether they be through incentive, whether they be through community work.

I've talked to a lot of physicians in the last number of months and why they go to certain areas. It really has a lot to do with how the community accepts them, how they integrate into those communities, especially if we're talking about some of our international graduates who come here. If you're from, for example, Pakistan, we've had a few Pakistanis, and we do take medical graduates from a lot of places around the world, how do they integrate into a place like Digby, or how do they integrate into a place like Glace Bay?

I think we, as communities, have to do more work. I know that through the CAPP that we've been addressing some of those issues when it comes to training of these specialists as they come to the province. I think if you look at Yarmouth, they've had a good strategy going in trying to entice these physicians. I know Clare has had some results in the last number of months working with some individuals, and it's about community and making them feel a part of it.

When it comes to ERs, again, we really have to look at the effectiveness. The last thing that I want to do as a Health Minister, and I know government doesn't want to do, is try to have ERs open that are unsafe. So we need to make sure that we have the correct teams in those facilities to offer the services that Nova Scotians expect. With that, I know within areas of the province, we do have a phenomenal EHS system and, ultimately, I would want to keep people, from an emergency standpoint, going to where they're going to get the best service. Like I said, we've done a phenomenal job, I think, in the last 18 months, of getting physicians to come to rural areas.

I think that we have to sort of maybe back off a little on our expectations of what physicians can do for us. I think there is a lot of common knowledge that has eroded over the last number of years on how to treat certain things from a home standpoint. I know when I had a fever, my mom gave me my Tylenol and said go lay down. They used to do some things at home, and you don't see that as much anymore. I know even from my experience, when your kid has a fever of 101 degrees, you don't think of some of these things. So what's the first thing you do? You're heading off to an emergency or you're heading off to see a family physician for diagnosis, and all they're going to do is give you Tylenol and tell you to go home and lay down.

So I think we need to re-educate the population on, basically, home medication and how to treat and how to take care of these particular ailments, and try to keep some of that load off our ER, but at the same time we know there are still going to be challenges as we go forward.

[Page 58]

MR. DAVID WILSON (Glace Bay): I know, Mr. Chairman, that the minister knows that certainly those problems, they aren't going to solve themselves and they're not going to go away. You listed a number of them, including the fact that perhaps what we should be doing is looking at things such as foreign credential recognition legislation, perhaps, in this Legislature. We have doctors and health professionals coming in from other countries waiting much too long to have their credentials recognized. So are you considering moving ahead on that sort of issue?

MR. D'ENTREMONT: Mr. Chairman, we have been working quite extensively with the College of Physicians and Surgeons over the last number of, I think, a year or two years now, on what will be qualified as the CAPP , or another acronym that I'm not too sure what exactly the words are. But ultimately, through the CAPP, it's basically evaluating these foreign-trained physicians to see what their capabilities are to help them with further training so that they can have a full licence here in the province.

I can say that two of the cohorts assessed in 2005, that 21 candidates were successful, and 16 of these individuals have been recruited to and are currently practising in Nova Scotia; of the cohort assessed in 2006, nine candidates were successful, and eight of these individuals have been recruited to Nova Scotia, seven of whom are already practising in the province. So there's sort of, I would qualify it as almost a return for service for these individuals, that they get the further training here in Nova Scotia, that they can go into a community here in Nova Scotia and provide us with the service for a set period of time. Of course, what you hope, is that at the end of the day they get integrated into those communities and feel that they should be staying.

The other thing that we really need to do, beyond working with foreign-trained doctors, which - we can't necessarily depend on that stream forever, because really what we're doing, in some cases anyway, is stealing away some of these physicians from other areas of the world that probably need physicians as well. I think the concern that we have is . . .

MR. CHAIRMAN: Order, please. It is very difficult to hear the honourable minister.

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, I'm sort of losing my train of thought here.

Ultimately, there's sort of a return for service for this individual. We don't want to be stealing them from other jurisdictions that so need the physicians as well. So we need to be conscious, as well, of the locally-trained physicians, those who are going through Dalhousie Medical School, who are going through other programs in Canada such as - actually the francophone students we have right now in Sherbrooke, the upcoming program that will be in Moncton as well. I think there has been success actually, Mr. Chairman, in your riding, in the riding of Clare, where there is actually one, or two, or three of those

[Page 59]

people who are going to the Sherbrooke site who are looking for the opportunity to come back to Clare. They're not necessarily asking for more money, or those kinds of things, what they want is a medical centre they can work collaboratively in.

So the old days of one physician seeing 6,000 patients is sort of gone, like I know Dr. d'Entremont has done on many occasions. Actually I'm going to take my opportunity here to wish Lionel very well. Dr. d'Entremont has been having some health problems and I know is going through a very trying time. I know that the community of Clare is very concerned about their physician. This is one of the older-type trained physicians, and being a d'Entremont, I kind of know what his work ethic is like. I think he saw somewhere close to 6,000 patients. It's phenomenal. So it will take two or three of these new physicians in order to take up that kind of complement. Again, to the effectiveness of a community really working with its own to help them with their training, to get them back home, to provide them with the opportunity to practise medicine, I think has done really well.

[7:00 p.m.]

We really need some kind of program on a return for service, for lack of another word. That if you are, and I don't know what the enticement, or what we're going to pay for, but if we pay for a certain part of your training - and I know the Minister of Education has some great ideas, as well, on this one as she comes forward debating her budget - to really help these physicians go through their training, which is very expensive, but get them to come back to Nova Scotia, or stay in Nova Scotia, and provide, let's say, five years in a community and, again, what you hope is that these people get very comfortable in their communities and end up staying.

So, you know, there are a lot of initiatives going on. As I said with the CAPP, we continue to work with family physicians. Family practitioners, just as an example, in 2006-07, there were 43 family physicians recruited to the province; 17 left the province, for a net gain of 26. So we do have 26 new family physicians practising in various locations across Nova Scotia. Those are the kinds of numbers I think that look good. We need to do a little better job, and we need to find ways to entice them to go to places like Glace Bay, in this instance, where I think one more physician would make a world of difference in keeping that emergency room and keeping that community that much more healthy.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I agree with the minister that we're not where we used to be in terms of family physicians and perhaps in some aspects, if we returned to the days of family physicians who saw 4,000 or 5,000-plus patients per year, everybody would have a family doctor and everybody would have an ER that was open. The good old days, I guess we'll have to refer to them as, because they don't exist any longer.

Having asked the questions I wanted to ask on that subject, I wanted to get back to the catastrophic drug program, Mr. Minister, and in particular, there is no apparent money

[Page 60]

that is being put aside to fund catastrophic drugs, and with this province among the worst in the country for the number of high-cost life-saving drugs that are being funded, it does seem one would think rather unfair, and in some cases inhumane, to prevent people from accessing the drugs they need to simply survive because they might live in the wrong Canadian province because we don't fund that particular drug. I know the minister may have alluded to this a little bit earlier, but I'm wondering, what does his government intend to do to help those people?

MR. D'ENTREMONT: Mr. Chairman, the issue of catastrophic drugs is one that is very important in the Canadian context and is one, as provincial ministers, we have worked quite extensively on developing the Canadian Pharmacare Program. I don't remember exactly the name of the report now, but ultimately one of the big parts of that pharmaceutical program is catastrophic drugs. What we have done is taken the information that we've learned there - and I give a lot of credit to our Pharmaceutical Services of the department, Dawn Frail, who has been working on the catastrophic drug working group for that pharmaceutical strategy, the National Pharmaceuticals Strategy - and ultimately taken the information that she's had there and try to build it into the model we're looking at for our Nova Scotia Pharmacare Program.

Basically what we're really trying to do within this model is look at those Nova Scotians who don't have access to a Pharmacare Program today. So those are the people who aren't working for a large company. Those who are working for a large company have a private health care plan, or lower-income ones receive their service through Community Services.

So we're looking at that group in the middle. What we're really trying to design here will be reminiscent of a catastrophic drug program as well. So those folks who are of modest means, or even of not so bad means, I'm starting to look at the folks who are in sort of that $30,000 range, but if they have some kind of catastrophic disease and have a high drug cost, they should have a system that's going to help pick them up. So any drug plan that we're trying to design here will have that catastrophic drug, a component built right into it, so we're not talking about both things at the same time. So I think the commitment we have this year is through that $5 million to have the set-up of our program, and my hope is to be helping Nova Scotians in that first quarter of 2008.

MR. DAVID WILSON (Glace Bay): Mr. Minister, we all know, I guess when we talk about the issue of catastrophic drugs or many of the other issues that surround health care in this province, we talk about, it's easy for us to sit here and say, why can't you provide the funding, why can't we have the money? We all know that we're approaching, if we're not there already, we're fast approaching what you would consider to be an unsustainable health care system. If you're going for 50 per cent of the provincial budget, then you're getting there pretty quickly, and if you're going up at 8 per cent, or whatever the case may be, every year,

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and looking at a budget of $2.9 billion that we'll be looking at this year, you know that you can't sustain that kind of spending much longer.

So I know we've broached this topic before many times, Mr. Minister. I've stood in my place in the Legislature many times before and said, back in 1999, the then Premier of the province, Dr. Hamm, said that health care didn't need any more money, it just needed better planning; better planning is what was required. Well, if you look at us now, you can say that maybe - I guess you could make an argument, have we had the planning, you can make the argument that costs are spiralling out of control. You can make a number of arguments.

Anyway, in the Fall of last year, the government introduced legislation that would protect the public health care system, for the protection of the public health care system, and some people saw that legislation as opening the door to private legislation. The minister will remember the debates that took place afterward and the interviews and so on. I'd ask the minister now, and give him the opportunity to respond to that accusation that was made, and ask him, how does he respond to that? Was that the case? Has that been the case, and with that legislation that was introduced, what has been done, to date, and where does it stand at this moment?

MR. D'ENTREMONT: Mr. Chairman, the member opposite brings up a number of good topics that we can speak to for quite a long time. Let's talk a little bit about health care growth for the first couple of minutes here that I'm going to speak. Health care growth has been one that is a Canadian phenomenon, if not a worldwide phenomenon on the growth of health care, and it has a lot to do with utilization. One, as our population gets older we're seeing more and more complex cases; as a matter of fact, we're seeing people come back for second or third treatments of whatever ails them.

I think back in 1999, to the credit of that Premier, he looked at a system that was having difficulty. He was looking at the system that had seen a number of reductions over the last few years and was trying to find ways in order to organize it better, to be able to have a reporting system that worked. We've been challenged in trying to find that reporting system that we, as the department, can really have a good feeling on what's happening in the system, how expenditures are happening, where the funding is going. Seeing where those funds are going, it can be indicative of the services that are being provided. So we didn't necessarily have a good way of evaluating the system as it stood. Plus, what we did back in 1999 was take that regional system and create a few more district health authorities and basically change the system quite drastically from what it had been prior to 1999. So we really had no base, that I can see, the base to evaluate the system on.

I think through PHSOR now, through our facilities review, that we're starting to build a model and know what our numbers are and where the expenditures are happening and to see how our health care teams are working, and maybe look at what they're doing and seeing

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how they're being effective or not effective. I think from that information that we're going to be able to really produce a strategy that will ensure that we have the best patient care possible with the dollars available to us - $2.9 billion is still a number that I have trouble with. There are too many zeros in that and it's really hard to envision how many dollars that really is. I don't think Nova Scotians really can have the complete understanding of how large that is. I mean, when you put it in a simpler context, it still doesn't make sense, because it's $88 a second, or how much an hour, I forget - it's like $300,000-and some-odd an hour, or something silly like that.

Ultimately, there are huge numbers that we continue to deal with, and we have invested and we will continue to invest in this health care system. We have done up to almost 9 per cent a couple of years ago. We did 8 per cent last year. The question we could ask is, did it get us better health care? I can't categorically say that it got us better health care. It sustained the system as it stood today and people still receive the services they required. They might have had to wait a little longer, but the systems were there and the emergency system was there in place.

So what we really need to do is have a good feeling of where our base is and making sure that we're funding DHAs and services appropriately. But we can't fund everything, which I think the other component here is that health care has evolved dramatically over the last 30 years of what health care is. I know the member for Glace Bay mentioned the good old days, and it's hard to go back to the good old days, and I don't think we'll ever be able to. Back in the 1970s, let's say, back in the 1960s, the health care model was a fair amount different, and it did have physicians in it. I will bring physicians up in my discussions quite often that I think the physicians are victims of their own success, where Nova Scotians and Canadians felt they had to go to physicians for everything that ailed them, and I think that's where we go a little bit into our problems.

Ultimately, building up to - I know the member opposite sort of tries to put a correlation between all those things that are going on in the growth of health care to the Health Facilities Licensing Act, Bill No. 126, on how that will save us money, and I don't think we envision that will help us save money in the health care system. I don't think we're going to find huge savings in the health care system. What we need to continue to do is ensure that we have means to provide the services that Nova Scotians expect. So I think that's how that will build into that equation.

If we look at the costs, and it's more than in the acute care system, the costs have gone up in home care, long-term care and also in pharmaceuticals, I think, it's going to be a challenge to find the balance between those. I think we have a lot of good work going on that will help us provide that base to know where we can go into the future.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, the minister raises an excellent point as to whether or not if you continue to fund health care at the pace that you're doing

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it now - but are you really getting your money's worth? Are you really getting better health care in this province? A lot of people, I would think, today, are wondering about whether or not, with that money going into health care, they're worried about not only where the money is coming from, but they're worried about whether the health care, itself, is going to be there, and how we can actually do that. How can we afford to continue at that pace?

I'll tell you, I know in my riding, anyway, the minister would probably know the same from across the province, it's a real worry. Some people are very concerned with the fact that this province is headed in that direction, where we're approaching 50 per cent of our budget going toward health care. You don't have all the answers, I understand that, Mr. Minister, nor would your staff. I guess most people are concerned, and I'm one of them who is worried about if we're going down that road of wondering what can we do, then exactly where is that road leading us and where is it going to end up? I think that's where the debate ended last year at this time, and that's when the questions started being raised, and that's when the legislation came about.

[7:15 p.m.]

I'd be interested in knowing, and perhaps you can explain it to us, that it would be extremely important that the stakeholders in health care are being consulted at this point, and how much are they being consulted and how much input will they have toward perhaps a final solution?

MR. D'ENTREMONT: Mr. Chairman, I alluded to it a little bit in my last answer. We have to really design a system that is responsible to the needs of Nova Scotians, but we really have to have a better understanding of what is expected by Nova Scotians. From a managerial standpoint, from a DHA standpoint, programs keep coming to us because we have this subset of the population that wants this kind of service, and we try to be everything to everyone.

I think what we really need to do is continue to help out as best we can on that side, but also invest some money in primary health care, in wellness, and we're trying to do that through the Department of Health Promotion and Protection. It's only recently that we've had mechanisms in place to really analyze health outcomes, to know what that patient outcome is going to be, what Nova Scotians or what the patients expect. It's only through that kind of base knowledge that we can effect any change in the future.

If we look at that growth, which is somewhat inflationary, which is somewhat trying to respond to needs that are brought forward, it doesn't match up with the growth of our provincial revenues. I think this year what we really tried to do is make some of the money available within the system, and I mean the provincial system, that money can be available to departments like HPP so that they can invest in rinks, in sports facilities, in those kinds of things that really help our communities in being healthier. I think it's only after that

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societal change that we're going to see any real change in the cost of delivering our acute care system. I don't know really how to effect societal change, all I know at this point is that it's going to take us a lot of time.

MR. CHAIRMAN: The honourable member for Glace Bay has approximately nine minutes left.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. I agree, Mr. Minister, I don't know how we come about that in a compact period of time either, I have no idea. In the meantime, what you're left with , as a situation, is just straining and straining - what you are left with, for instance, is you're left with in Inverness right now, there are no obstetric services that are available right now. Some people are forced to travel a couple of hours in either direction to obtain obstetrical services. In other areas you have ERs that are closed for a period of time - all of these issues that we've already gone over, over the past several hours.

I do know that what's required is some sort of vision that has to be there on behalf of government. I'm not saying wake up tomorrow, Mr. Minister, and have the cure for health care in this province, but that vision has to be there, agreed; granted, over a long period of time, that vision has to be there so that finally, at the end of the day, you can see some light at the end of the tunnel. You can say that in five years, 10 years, whatever the case may be, we're going to reach that goal of finally coming to terms with health care in this province and perhaps even reducing the overall costs of health care.

I'm sure the average Nova Scotian will agree that no matter how you obtain that in

terms of - if we're going to start along the lines of health promotion or whatever, most Nova Scotians will agree we can all do better at that and we can all contribute more, but at the same time I think that every Nova Scotian would agree that public health care has to stay exactly as it is. It has to be offered to every Nova Scotian without hesitation. That has to remain as part of your vision on behalf of this government.

I know we don't have much time left and there are a number of other questions that I could ask according to some line items that I have. I'll save that for another day. I just wanted the minister's thoughts on perhaps where you see that, and what you see as your government's vision, so to speak, of where we're going to be in the next five years, in the next 10 years in terms of health care or the overall budget, in terms of what we're offering everyday Nova Scotians in health care for them, what it means for them and what it means to the minister.

MR. D'ENTREMONT: Mr. Chairman, through you to the member opposite, I think the challenge up to now has been that if we can look at our expenditures on a year-over-year basis and see the money we're spending, but we really haven't had the opportunity to look at what our service delivery is, where exactly all those dollars are going, and be able to have

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a base so that we can build that vision for the future. I think what we've been doing through PHSOR, and I'm really hoping that the information that we provided through them will really give us that base to measure what those outcomes are and really give us some ideas on how to provide better provincial services with a respect for the regional differences.

I think over the next number of years, we will continue to invest in primary health care, working with our wellness programs, continue to invest more money over at the Department of Health Promotion and Protection to ensure that we have better opportunities in communities. Not only does that help us be healthier, but it's also an attraction tool for physicians and other practitioners who we might want in Canada.

The other thing that has to happen, I think, congruently, is that the Canadian health care system has to sort of evolve and change with us, because if we're doing our changes here and trying to reform health care, and it's not happening in either Prince Edward Island or New Brunswick or Ontario, people will look at the way we're doing things and compare it to how they're doing things, and it will just get all wonky. There's a good word for you tonight - wonky. We need to continue to work with our provincial and territorial colleagues on further reform. We have to continue mental health reform. We have to continue pharmaceutical reforms. There are so many things that all have to work together in order to effect true change to our health care system.

I'll conclude just quickly here, as well. I was talking about our costs in health care and trying to put a better mind to the expenditures in health care, $2.8 billion. It's a 2.8 with lots of zeros, or with a billion "word" after it, with a "b" - I'll try to draw this explanation out as best as I can - $2.8 billion in context, of course, is 49 per cent of our total budget, and if we don't do anything that addresses this, it will be 50 per cent, it will be 51 per cent, it will be 52 per cent, it will continue to grow until the Department of Health will be the only department of government. I don't think I'd like that because then all the decisions would fall on that poor Minister of Health.

Ultimately, if we don't make some changes in the short term and get a real feeling of where we are and to make those changes in the short term - and I need to look to the Minister of Energy, of what his department would be or what we would be without his department, where we would be without a Department of Agriculture, or a Department of Fisheries and those kinds of resources, the Department of Justice - I know the Minister of Justice sometimes would like to take it on. Ultimately, without further funding from other sources, whether it be from the federal government or whether it be shutting down some of our baseline departments, we're not going to be able to address the health needs as it goes forward.

So we do need to effect some of that change and get it to a point where it's manageable or at least consistent with our provincial growth. Which is why, this year, we took the different approach of trying to cap that growth. Of trying to say, listen, we'll

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strategically invest in the places we know are going to have some effect on the bottom line, but we're also going to cap some of these things. We're going to say that growth is not about a whole bunch of new programs, growth is about the natural progression of existing programs, so status quo pressures.

I think what we're going to try to do, as well, is continue to invest to the health indicators. What is education, and how that works. What the environment is doing to the health of Nova Scotians. What income is doing to the health of Nova Scotians. Focus in on those sides of it rather than the acute care piece of really investing money on that side, because I continue to think that the more I look at it that it's sort of this bottomless pit that you just keep throwing money at and it doesn't necessarily give you a healthier population. It does address the issue, but where does that get us?

I think, as a minister, I need to step back a little bit sometime and look at how that system is responding, what are those outcomes and try to address some of those income issues making sure that they have the means for them and those kinds of things.

I don't know how much time I have left before - basically, I'm going to end it this way and I look forward to some questions at a future day. We spend $88 a minute or so. We're spending $5,629 a minute, we spend $338,000 an hour and in the course of questioning over this last four hours, the health care system would have spent $1.3 million of taxpayers' money. It's an issue we have to, and must, address over the short term and well into the long term. Thank you.

MR. CHAIRMAN: Thank you. The time allotted for debate in Committee of the Whole House on Supply has now expired.

The Deputy Government House Leader.

MR. PATRICK DUNN: Mr. Chairman, I move that the committee do now rise, report progress and beg leave to sit again on a future day.

MR. CHAIRMAN: Is it agreed?

It is agreed.

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

The motion is carried.

[The committee adjourned at 7:26 p.m.]