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October 1, 2009
House Committees
Meeting topics: 

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4:16 P.M.


Mr. Gordon Gosse

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

The honourable Government House Leader.

HON. FRANK CORBETT: Mr. Chairman, we will continue the estimates for the Department of Health.

MR. CHAIRMAN: The honourable member for Clare.

HON. WAYNE GAUDET: Thank you. Mr. Chairman, I want to pick up where I left off last time when I had opportunity to ask the minister some questions - I want to continue with the long-term care facilities. The minister indicated earlier in the House in the committee that the government wants to do everything possible to keep seniors in their own home or in their own community, and I certainly share the minister's opinion on that.

Mr. Chairman, we know that when families apply to place loved ones in nursing homes, in a long-term care facility, there's a policy in place called the first available bed provision - basically individuals can be placed within 100 kilometres from their home. I know especially in Clare in the last several years we've had individuals, especially francophone seniors, who were probably in their eighties or even in their nineties and could only speak French, who were being placed elsewhere.


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I had the opportunity to raise these concerns in the House previously and the government did actually make provision to that policy. When individuals are placed on waiting lists, waiting for a long-term care bed, when their name comes to the top, of course the family receives a call and an offer or a facility is offered to place their loved one in that nursing care. Unfortunately, sometimes it could be there's no family or part of the family doesn't have the means of travelling away to visit their loved ones, francophone seniors have the opportunity now to be placed near their home or within 100 kilometres from their home. So they have the opportunity now to refuse an offer that has been made without losing their place on the waiting list. Something that the people of Clare still have concerns with is when some of our elderly francophone residents are being placed in nursing homes outside of Clare, and I'll explain why.

Not long ago, for example, Mr. Chairman, we had an individual from Bridgewater who was placed in the Villa Acadienne in Meteghan. At the same time we had someone from Clare who was placed in Granville Ferry, just outside Annapolis Royal. Now, of course, many people in Clare do not understand the logic behind this policy. Certainly it would be a lot easier to have the individual from Bridgewater, who was placed in Meteghan, moved to Annapolis Royal and have the person from Clare, living in Annapolis Royal, transferred to Meteghan. And it certainly would make it a lot easier for that individual from Bridgewater to travel from Bridgewater to Annapolis; it certainly would cut an hour or an hour and a half in travelling to visit their loved one in Annapolis rather than driving to Meteghan.

So I've been asked this question many, many times - how come the department does not have a better system, or why in the first place allow this to happen? So my first question to the minister is why doesn't the department switch residents from nursing homes when the opportunity arises to make it easier for families, especially, to travel to visit their loved ones? So, again, my question to the minister is, why doesn't the department basically look at maybe reviewing their policy or switching these residents to make it easier for these families?

HON. MAUREEN MACDONALD: Mr. Chairman, I want to thank the honourable member for his question. I understand the frustrations; I've had them myself, but in a different way. Certainly, I don't represent a unique francophone community. I understand the absolute need of people to stay in their own communities and receive services in their own languages, and it is something that I will be asking our department to look at with a view to doing some community consultation, perhaps meeting with members such as the honourable member who has been here for many years and would have a perspective that would be very valuable, as well as with others - I know there are a lot of organizations in your community that represent seniors and other groups, and of course some of the long-term care facilities themselves in the area - to see what it is that we could do to enhance the quality of services that are available to seniors from the Clare area.

I do know that sometimes it's not always possible, if somebody needs a bed in kind of an urgent situation, a really critical situation and the bed comes open and it's not in the

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immediate vicinity. The single entry point has this process where when your name comes up, you get placed. If there's a need for a transfer, then you're sort of highlighted as a potential transfer.

But, it seems to me and maybe with the devolving of this sector into the DHAs, I see that as an opportunity, hopefully, to build a little more flexibility into the current system. A flexibility that will allow for taking into account the unique circumstances that may exist in different communities around a DHA. I think when you have a provincial system that is centrally designed, controlled and executed, there's probably a greater tendency to adhere to a set of rules in a less flexible a way than you might get if you have that administered in a district. I don't know that to be the case, but I'm just speculating that could be the case.

Certainly, I have the benefit of having had a deputy minister who comes out of the DHA experience and I think he would understand and would be able to advise and inform the department a lot about the DHA perspective around placements, policy and procedures that need to reflect the realities of the communities within any particular DHA. It may not necessarily be the same in all communities.

I think the policies that we have, like all policies, should be reviewed regularly with a view to the question, how well is it working for people? How well is it working for the people who need these services? In my experience as a member of the Legislature, over time, I've advocated for many families. Even here in the metro area sometimes you'll get a family who lives in the North End of Halifax, for example, or somewhere here on the peninsula, who has a loved one who's placed in a long-term care facility in Windsor, because Windsor is in the Capital District Health Authority. For some of us, that may not sound like such a big deal, but it's a very big deal for family members or a spouse who doesn't drive, who doesn't have a car, who doesn't have easy access to getting to Windsor to visit their family member. It has been very difficult for constituents of mine to maintain the contact.

I have a number of senior citizen manors in my constituency in the North End of Halifax and one of those manors is Dr. Samuel Prince Manor. The population of that manor is primarily women - there are some men there, but I would say probably 80 to 85 per cent of the people who live in that manor are women. It's a manor where everybody has their own self-contained unit like an apartment or a condo - you're independent, you do your own cooking and cleaning and what have you.

Some of the residents have lived there for 25 years or more. They went in in their mid-60s and they are in their 80s now. They get home care services and other services. But, from time to time, a resident of Dr. Samuel Prince Manor will end up no longer able to live independently and they will go into a long-term care facility and perhaps they'll end up in the Windsor area. Their whole network, the people they've been living with for the past 25 or 30 years from Dr. Samuel Prince Manor, who they've played cards with, who they've gone to bingo with, who they've attended church with. They know all of the family members of

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the other people. Suddenly they lose all contact with their social network, their friends. I've had residents from Sam Prince Manor approach me as their MLA at different times to say, we haven't been able to see so-and-so. There's no transportation to the Windsor area. We have to arrange this - we're not in a position to do that and we know that this person is lonely and has no family members living here. We've been that person's family.

So I understand this. I understand the issue that the member is raising, and you add into the mix the fact that in some instances, members of the community of Meteghan will be in a long-term care facility where the first language is not their first language. So a review and a way to examine how we can improve services is a valid request, and it's one that we will take under consideration and see what we can do.

[4:30 p.m.]

MR. GAUDET: Mr. Chairman, I certainly welcome the minister's comments that maybe it's time to review the current policy on placement and maybe there's a possibility of improving services in helping place loved ones in nursing homes.

The minister also talked about how sometimes there's urgent placement, and I fully agree. Depending on the circumstances, you need a bed right away and I certainly have no problem with that and I'm sure people in Clare certainly would have no problem with that either. But these are individuals that have applied or families that have applied to place loved ones in nursing homes, and unfortunately when they get contacted, placements are basically offered outside of our area. Sometimes it's at least an hour away. Again, as the minister pointed out, especially for people that have no means of travelling, it certainly creates other problems. Again, I'm glad to hear the minister - that she will take it back to her department and hopefully improve upon the services.

I want to again continue - earlier I had talked about round one, when the government announced, I think it was 832 new long-term care beds back in 2007. I want to return back to that decision. Very few of these new beds are going to Acadian areas, apart from the 22 beds that have been assigned to Nakile Home for Special Care in Glenwood, which is located in my colleague from Argyle's area. As the minister is aware, there's over, or close to 40,000 Acadians in our province with the majority located in areas such as Cheticamp, Isle Madame, Argyle, and Clare, of course.

So my question to the minister is, will the minister consider allocating some new beds to our Acadian communities in the next round of announcing new long-term care beds, whenever that may come about? She did indicate that the government is currently looking at the situation. There's no time frame when that second round may come about, but I would certainly encourage the minister and her department to at least give some consideration to providing some new beds to the Acadian communities.

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MS. MAUREEN MACDONALD: I want to thank the honourable member for the question, Mr. Chairman, and we certainly will consider allocating beds in round two to Acadian communities. I want to let the honourable member know that my colleague, the Minister of Finance, who is also the Minister of Acadian Affairs - certainly he and I have talked as well about his interest in knowing more about the services that are being provided in the health care sector in francophone communities around the province. He's interested in knowing more so that he can be a better advocate, planner and problem solver on behalf of those communities. So this will be certainly occurring.

Also, I don't know if I've ever told the honourable member this or not, I grew up in a small community called Linwood in Antigonish County which is between two Acadian communities, the Acadian communities of Tracadie and Havre Boucher. When I was a young girl and going to school, all of my friends were from those Acadian communities, including Pomquet. I went to Antigonish East in Monastery. Many of the traditions in my Irish-Scottish household have blended quite a few Acadian traditions, I notice at Christmastime, you know, the kinds of food and various things that occur as well as other holidays.

So I always consider myself extremely fortunate and I think Nova Scotians are very fortunate. We have an amazing blend of cultures in this province and, of course, the Acadian people are unique, have a unique, sometimes tragic history. That we still have such vibrant Acadian communities such as the one in the Meteghan area where it's extraordinary, we're extraordinarily lucky to be in this position.

I also want to say to the honourable member, although I don't have a lot of information at my fingertips, one of the first briefings I had - and perhaps the member for Argyle would know more about this - one of the first briefings I had in the department which really excited me was the success that is being seen in the training of some young adults from your communities who are training to be medical doctors in a program that we are cooperating in between our province and the Province of Quebec, I believe. This was not something that I was aware of and it has been very successful in terms of recruiting a substantial number of people. I think it's eight or more, young people in this program who are going on to complete degrees as MDs and very exciting.

The promise then that has, for the future in terms of having physician services in Acadian communities in Nova Scotia, I think, bodes very well. So, anyway, that's just a little aside from your questions but it does demonstrate some of the really good things that are going on as well as some of the challenges we have.

MR. GAUDET: Mr. Chairman, I was pleased to hear the minister say that she will give some consideration in announcing new long-term care beds for Acadian communities throughout the province.

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Mr. Chairman, I want to move to the assessment for placement. I had a situation this past summer and I'm seeking information because I don't really understand how the process or the system works. Anyhow, I'll provide the minister with some details. In this situation, the family had applied to place a family member in a residential care facility - this was back in early April of this year, looking at early May. The applicant was denied, of course, additional medical information sent to the department in late May. So let's begin with late May - new medical information was provided to the department to help them with the assessment of the individual in question and in late August, the admission was approved.

So, of course, throughout that time the family kept calling my office and in return, I called the department several times to try to get some information on the application during this time. Of course, I don't know how many people in the department do the assessments when they come in. At the same time, when you're looking at trying to tell people, basically why it's taking so long- you don't have that information. I didn't know if people were on vacation, so I'm trying to find out for myself and, of course, I'm sure all members of this committee will appreciate finding out, what the process is when an application is forwarded to the department to be assessed for placement.

So my question through you, Mr. Chairman - can the minister explain to me what the process entails or involves in order to do an assessment of an application that comes in to the department?

MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, I can only provide a quite general explanation, if you wish, with what that process looks like, but I would be happy to get you a more detailed explanation from people who are more expert than I.

It used to be the case that if a family had a family member and they felt that, at this stage ,this person required 24 hour care and the family doctor had concerns that there needs to be 24 hour nursing care because of some medical issue, families were free to approach individual long-term care facilities and make applications. As I explained earlier in estimates one day, that some times that people could be on multiple lists. Family members may have had family members on multiple lists, because maybe they would have approached two or three homes, they would have their first choice, their second choice, their third choice. They would hope that they could get in somewhere.

I'm not sure precisely when we went to the single-entry system, but we went to system where there is a 1-800 number - there is also a website that you could go to - and you can call and start the process. So everybody goes into sort of a centralized entry point, shall we say. Although having said that, as I understand it, there are still regional offices where care coordinators reside who do assessments. They don't necessarily all reside in a centralized place. So, you make contact and make a request for an assessment and an assessment is done and a care coordinator would conduct a home visit and also there is a lot

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of documentation that's required, including a medical assessment from the family physician. After the information is gathered a determination is made, based on the information, what level of care is required.

Now, we've made reference here over the past few days from time to time about the MAPLE assessment. This is a standardized assessment tool that is used throughout the western world in doing assessments, and it's not only used for doing assessments for long-term care but it can also be used to determine whether or not a person requires home care and what kind of home care - do they need nursing home care or do they need light housekeeping, homemaker kind of home care? Some people require very light levels of care and other people require basically institutional care and that's the range.

[4:45 p.m.]

The assessments are done by assessors who are trained in the use of the assessment tools. These folks generally have degrees perhaps in nursing or social work, family studies, gerontology, a variety of backgrounds that is then also augmented with some specialized training that's done with respect to the assessment tools.

Is this system a perfect system? There are no perfect systems. Are all assessments 100 per cent accurate without any subjectivity? There is no such thing as assessments that don't have some subjective elements. For that reason then, there can always be a request for a review or for additional information.

I've seen situations in my own constituency, when an assessment has been done and a critical piece of information wasn't provided just because the right question wasn't asked or a critical piece of information wasn't provided because maybe a family member didn't think it was relevant, and then in a discussion with a neighbour or something a couple of weeks later would realize that was relevant, and I should have said that this is something - my mother has been falling, she has had four falls in the last six months and never received any hospital attention for it, but this has been going on now on a repeat basis and maybe this is information we need to provide.

MR. GAUDET: Mr. Chairman, I want to thank the minister for that information. I also want to add that during my numerous inquiries to the department, especially throughout June, July, and August, staff who responded to my inquiries were very helpful and very patient with me, and I certainly thanked them along the way. But from the family side, when I heard from a member who was looking after her sister's application and was asking me questions and I really didn't have the answers - why was it taking so long - I just kept on calling the department and along the way they were extremely helpful. I certainly appreciated the help that they provided.

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Mr. Chairman, I want to move to a different topic, I want to talk about the caregiver allowance. There has been a lot said so far in this Chamber. When this program was announced in late summer, I can tell you the people of Clare certainly called my office, and I will share with the minister some of those details.

The minister talked about the department was looking at helping around 740 caregivers under the new Caregiver Allowance Program. My question to the minister, or various questions - I'm trying to find out how the department is going to make those decisions. Does the department - are they looking at dividing this total throughout the province? Each health district - have they been given an allocation of how many they are allowed to approve? Is it first- come, first- served?

I guess I'm trying to get a better understanding in terms of the individuals who will qualify and who will be approved under this program. I'm just curious if the minister could elaborate on how the department will determine what caregiver will receive approval under this program.

MS. MAUREEN MACDONALD: I thank the honourable member for the question. As I've said before, the Caregiver Allowance Program was designed by the previous government, after having done a pilot project for a couple of months in several districts. The pilot project had a requirement that in order to receive the allowance you had to be on the wait list for long-term care, a long-term care facility. Additionally, you had to agree, if you were going to receive the allowance, that the person you were caring for had to agree to come off the list in order to receive the allowance. That's in the pilot project.

The pilot project was in the Department of Community Services. There was an evaluation after a period of time. Now I can't remember exactly how many people received the allowance, it was under 200, I think - it was like 100-some-odd people. In fact, there are still about 27 or 29 people still receiving that allowance as it existed under the in-home support pilot project.

Now one of the things that the department found when they analyzed that pilot project, they found in fact that there were some problems with the requirement that you come off the list to go into a long-term care facility. Why would that be? Well, why that would be is because you would have gone through an assessment with a lot of medical information that would have said that you require - that your care needs were at the level where you required 24-hour, round-the-clock care, with a nursing component.

Removing those folks from the long-term care list was probably not in their interests; not a good idea. In fact, many people who had gotten the allowance and came off the list, in the end really had to go into long-term care. So it didn't, in effect, keep people in their own homes at all.

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The decision of the previous government was to transfer that program from the Department of Community Services to the Department of Health and to redesign some aspect of that program, to redesign the aspect of the pilot project that required you to be on the list for long-term care.

So what that meant was there would be no previous assessment already done when you applied for the caregiver's allowance. The caregiver's allowance as announced in August and - as I said, the only difference between the previous pilot project and the existing program now is that that requirement to come off the long-term care wait list has been changed. We didn't make any changes to the former government's program. We announced the program. We said it was a targeted program. We said that people who were eligible would receive the allowance, and we explained that the program was targeted to people with high need and very low income and some other criteria.

The budget that we are currently examining, the Department of Health budget for this year - because the program didn't come into effect at the first of the fiscal year, $2.7 million is allocated for the caregiver's allowance. If we were to have a full year, it would be $3.5 million, and that would allow for 737 people to receive the care allowance. Now, your question is if we hit the ceiling, if we hit the maximum, what happens if there are more applicants? As I understand it, if that were to occur, we would have to sit down in the department and look at whether or not we have spending - let's say in another program that is underutilized - that we could move in to accommodate more people, or just say, well, first come, first served.

We haven't made that decision in the department. We haven't set a limit, that this is how many people we are assisting in this program and no more. As I indicated in Question Period today, we feel we are on target in terms of the numbers of people who have applied and been assessed and who have met the criteria. We understand that there are people who are disappointed that they didn't qualify and feel that they should have qualified. As I've said, we continue to look at this program, but also to learn from this program in terms of this government's commitment to introducing an in-home support program, which was part of our platform and planned for the coming fiscal year, after this one.

MR. GAUDET: Mr. Chairman, earlier today the minister provided the House with numbers on how many people have applied for the Caregiver Allowance Program. She told us that 140 caregivers were approved, 286 are still on a waiting list, and 276 don't qualify. Can the minister, or does the minister have a breakdown of these numbers by health district? If she doesn't have them, will she undertake to table those numbers by health district?

MS. MAUREEN MACDONALD: Mr. Chairman, I think it certainly is possible to get those numbers by health district and I would undertake to do that. In all seriousness, it wasn't an easy chore to get these numbers. It wasn't an easy chore because so much of the care coordination is decentralized, it's out in the districts, and while I'm more than happy to

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ask for the breakdown, the people we're asking to provide this information - and I want to thank them for providing me with what I have right now - when we ask them to take time to provide us with numbers, sometimes that means an assessment doesn't get done. They work very hard and I know the members know this. If you would be patient - I'm not saying we won't get you the numbers but what I'm saying is, be patient in terms of us getting them. We won't get them to you today or tomorrow but we can give you the breakdown from the districts, eventually.

MR. GAUDET: Mr. Chairman, I appreciate the minister undertaking to provide those numbers to the committee. I know in Clare, in our constituency office, we've had close to 75 individuals who have contacted us for information on this Caregiver Allowance Program since the government announced it - I think it was early August - and plus I have to include the individuals who have contacted the Continuing Care office directly for information.

[5:00 p.m.]

When I see these numbers, there's something strange with them. Maybe the minister could explain to us, are these numbers up-to-date? Do these numbers cover a certain period, the first two weeks after the announcement was made? I'm just looking at the volume of calls that I've received in my constituency office, and I know Clare is just a tiny little piece when I look at these numbers, and immediately I'm telling myself, I don't think it really matches what I've been hearing, especially on the ground. At the same time, does the minister know how many people from Clare have applied and how many people in Clare have been approved?

I know my time is coming to an end so I will leave those questions with the minister. I think there maybe a few minutes left.

MS. MAUREEN MACDONALD: Mr. Chairman, first of all, I can't tell you specifically how many people from Clare applied, but let me say this, I know this is a very popular program. I know that there were many people who were very interested in knowing about this program. We got many more calls than the numbers you see in front of us but it doesn't mean they were applications or referrals. We got many calls into the line, we can't tell you how many because there were repeat calls. Some people called multiple times. We don't count multiple calls. We don't count people who don't meet the income criterion. They call and they say, I'd like to apply to the Caregiver Allowance Program, I'm looking after my mother and when it's checked into what their income is, they don't even come close. So they're not considered an applicant, they're an inquiry. There were many inquiries into the line around the caregiver program and visits to the website as well.

I've spoken to people, I understand what the member is saying. I spoke to a lady who called the department and she was very upset and her income was significantly beyond the low income cut-off for this program. Her basic position was that we should change the

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income criterion, that the income criterion was wrong, so those calls aren't reflected in these numbers. Thank you.

MR. CHAIRMAN: The honourable member for Argyle.

HON. CHRISTOPHER D'ENTREMONT: Thank you very much, Mr. Chairman. Thank you very much for the questioning by the member for Clare. I appreciate the questions that he had when it came to the 100-kilometre rule, the issue of the francophone policy. Maybe at a later date I'll ask some more questions around that one too. One that I had to wrestle with over the bit - of course the policy is one that I worked on when I was Minister of Acadian Affairs, I believe it was Angus at the time, when he was minister, that we were able to make that adjustment and, of course, took a lot of questions from the member for Clare when he was asking questions quite often for his constituency and making sure people received service in that area.

I'm going to defer off a little bit on that one and maybe ask a few questions more specific to some budget lines and, more specifically, budget lines or differences in budget from the May 4th budget to this budget - basically our budget and your budget - and see how some of those things match up, so Linda should be able to get that paperwork ready.

The first thing that I want to talk about is the travel program, the travel program for people receiving surgeries and what have you outside the province, like the lung transplant program, other transplant programs that are out there. There's basically a difference in the program. I believe our line item was somewhere around $250,000 and I believe you're adding about $500,000 to that, for a total of $750,000. So I'm just wondering what kind of criteria we're going to be using for this fund. Again, I know how difficult it is because there are so many people asking about this program.

MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member is correct in terms of the financial information with respect to the program. His government had allocated $270,000 toward this program and we've added approximately $500,000, which was our commitment in the election campaign, to have a $750,000 travel program.

The staff in the department are busily working on finalizing the details of a program, but I don't mind talking about the general features of that program. Mr. Chairman, from time to time - it doesn't happen a lot, but from time to time a resident of our province has a health care need that cannot be met in the Province of Nova Scotia by anybody. The service that is required to treat that condition does not exist in our province.

Now, the former Minister of Health will know that some people will get that confused with having to wait for a procedure that is available. If the procedure is available here in the province, even if you have to wait for it, this policy will not apply if you decide

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on your own to go to another province and get medical health care because you can get it quicker.

Our department has a policy that if you cannot get the treatment you require here in the Province of Nova Scotia and the treatment is available somewhere else, that we have a process you go through - your doctor provides medical information, it is reviewed in the department by physicians, a determination is made, and a pre-approval has to be sought and given. Then the medical costs of that procedure will be covered by the Province of Nova Scotia.

So our government has committed to not only covering the medical costs when that occurs, but to assist in the transportation and the accommodation costs associated with having to seek treatment outside the province. We were looking at what would be reasonable in terms of providing associated costs. We have had many discussions between staff and myself in the department and we're looking at what is done in other jurisdictions. Newfoundland and Labrador has a policy, but they are a little bit different than here because many procedures that need to be done there often have to be done out of province.

We have had assistance available for people going to Ontario for lung transplants, I believe. So there is a program in place, but basically you have to be away for three months before that program kicks in, where there are circumstances where people might have to go just for two or three days. So we're certainly looking at a wide variety of scenarios, trying to look at the resources we have with a view to finding something that will really make a difference for families that face these situations. When that policy has been completed, we certainly will be announcing it and promoting it. If the member has any suggestions, I would be happy to hear from him on that.

MR. CHAIRMAN: The honourable member for Halifax Citadel-Sable Island on an introduction.

MR. LEONARD PREYRA: Mr. Chairman, in the east gallery are two students from the Teaching English as a Second Language program at Saint Mary's University, Khaled Aljeaid from Saudi Arabia, and Manami Kanata from Japan. These students are working to raise their proficiency in English to a level that will enable them to study at an English-language university. They are accompanied by their teacher, Bill Colpitts. I ask them to rise and receive the warm applause of this House and the encouragement of this House. (Applause)

MR. CHAIRMAN: The Chair welcomes all visitors to the galleries and hopes they enjoy tonight's proceedings.

The honourable member for Argyle has the floor.

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MR. D'ENTREMONT: Mr. Speaker, I too welcome our visitors tonight. This is a good tune-up for the regular proceedings in the House, which are done in a more conversational manner with the questioning to the minister. Normally during Question Period, definitely it is more heated and quicker - snappier, I guess is what you would call it. I believe in Japanese it would be konnichiwa and in Arabic, marhaban, or whatever, but welcome to the House of Assembly.

I thank you very much for your answers on the travel program. It was one that I did wrestle with towards the end of my mandate in the Department of Health, when it came to travel costs outside. When we really brought forward the issue, and it really was brought forward by the Liberal caucus and the member for Richmond when it came to a couple of his constituents who were having to live in Toronto, awaiting a double-lung transplant. For a double-lung transplant you have to sit there, you have to be ready, you need to be within a certain distance of the hospital and you could end up sitting there for months and months, if not years.

What was happening, of course, with these constituents from Richmond, was their money was coming to an end. They had to quickly make a decision whether they move back home, where their expenses wouldn't be so high, and forego the double-lung transplant that the patient needed so badly.

I was very happy to provide them with some funding, within the scope of dollars that we did have which was, again, a very difficult story to come up with. We really wrestled with the pre-flights that we're going to have to do because you will probably have to visit the hospital on two or three different occasions prior to acceptance. You would then have to fly there and move there and stay there, and of course the post-operation, the post-follow-up that still has to happen, in Toronto in this particular case. So there are a number of flights, a number of living hours, a number of times.

When we looked at it in context of the budget that we had, we decided that we would pick the living cost itself, the rent and some ancillary costs that would go with that, to try to knock down - so we didn't really look at the flight piece and I'm very glad that you are looking at that because that can be a very substantial cost as well.

The other issue would be the transfer of loved ones as well. It's not very much fun sitting and waiting for a transplant in Toronto with nobody you know. A lot of times, to have a loved one come is physically and mentally good for the patient, to keep them as well as possible before that transplant actually happens. I'm very happy to see that addition to the budget for the Department of Health.

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[5:15 p.m.]

When it comes to the application process, I know it's going to be a very difficult one, one that will have to require some medical expertise because I can tell you, things like that, that came to the department through the minister's office, there was always a debate and a number of sleepless nights that always went with it.

I want to move on to the announcement during the budget, during the presentations from the Department of Health officials. The number I have is out of the budget presentation, the budget overview, that was done by officials, the PowerPoint presentation that they gave. It talks about a spending increase of $216.3 million, which is salary and benefit increases for DHAs, and implementation of the Telecare program, et cetera. So I'm just wondering, what comprises - maybe a better breakdown of that $216.3 million extra.

MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the honourable member. The big items: $103.3 million for wage increases, $28.8 million for capital grants and $84.2 million for operations. I can give you a bit more detail, I can break that down a bit.

There was an increase of $5.6 million for fee for service, so utilization, I understand that is always an issue - or it can be an issue - so there were increases there; Seniors' Pharmacare payments, a $5.4 million increase there; $2 million internal transfers, health transformation and care coordination; some smaller amounts of money for human resources, they're quite small - I'll try to look at the larger ones here; Emergency Health Services, a $5.3 million increase; a $4.4 million paramedic wage increase, for example. Other health initiatives, provincial programs, that's quite small.

Okay, a $6.3 million increase in the IS-4 project. This is the HASP and the electronic health records operating costs. You know sometimes we have to spend money to access the federal money. So, again, $2.7 million wait times - this was related to an increase for electronic health records operating costs.

DHAs, a $93.5 million increase, acute care being the biggest piece of that; $84.5 million, mostly due to contract increases - the cost of covering wages that had been negotiated in earlier collective agreements, I believe. The Nova Scotia Association of Health Organizations pension, yes, a $9.9 million increase for contributions there. Mental Health Services, a $6.1 million increase, and again, wages being the largest piece of that $2.8 million, as well as some increase for non-wage funding increases for psychiatrists and psychologists, what have you.

Home care, a $5.7 million increase, primarily related to the Health Human Resources Strategy for LPNs, more classes and additional seats to try to address the nursing shortage. Long-term care, a $44.2 million increase and, again, contract increases there and $3.8 million for the pension contribution. Capital infrastructure, a $28.9 million increase; $14 million of

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that was for emergency medical equipment and $10 million in equipment to assist the DHAs, $9 million for repair and renewal, and $3.5 million for energy retrofits for the DHAs. These increases were partly offset by reductions in federal medical equipment revenue. So those are probably the biggest elements in that $216 million. Half of it is for wages.

MR. D'ENTREMONT: Thank you very much, minister, for those numbers. So these are numbers that are different from May 4th to now, or at least that's just more of a breakdown of the increases that we see overall that would have been included in ours and yours kind of thing. Thank you very much for that clarification on it, and I'm going to maybe have a quick look at some of those numbers as we flow along.

You mentioned some dollars in order to match up with some of the infrastructure issues, maybe some federal funding dollars in that. Maybe it would be a good opportunity to sort of ask how the bigger wait time project, which was the addition of the radiation therapy over at the Capital District Health Authority - exactly where that project is, because there had to be construction of a linear accelerator and all that, bunkers and all that fun stuff. So I'm just wondering where that project is at this point.

MS. MAUREEN MACDONALD: Mr. Chairman, through you to the honourable member, our commitment - as you know, the former government made a commitment to reduce wait times for radiation therapy, which requires an investment - I think it's an investment of roughly $10 million, but it wasn't possible to do the construction this year. So the $10 million that was in the budget in May has been taken out of this year's budget. The revenue required for the architectural work to design the bunkers has been allocated and in fact, I think the DHA has that work underway or certainly that directive has been given to them that they can go ahead and do the planning. It's something that we will look at for next year's budget, so that was a $10 million mitigation.

MR. D'ENTREMONT: Mr. Chairman, originally the project could have flowed, I believe, up to $24 million for a project there. What happened towards the end of my mandate, and probably moved over into the member for Colchester North's time there, was beyond the addition of kind of, oops, we forgot about the renovation of the Dickson Centre, because with the addition of the radiation therapy, of the radiation machines, that we actually don't have enough patient flow, patient space, in order to flow people through there. So there was sort of an "oops" at the end, and that's more of a warning to you.

It seemed that as hard as we worked to get those numbers correct, and we go back and forth so many times making sure numbers are right, it always seems, at the last minute, that there's always a way to find more dollars or to all of a sudden ask for more dollars. It always tended to be my frustration when it came to capital construction, especially with the Department of Health, that there were always some "oopses".

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I thank you for knowing that there are still some dollars there to complete the design work and to get those bunkers in and to make our - I believe we had made a commitment to the federal government to try to reduce the wait time. It was kind of a funny thing because we knew our wait time was actually within the benchmark at this point but we knew, with the incidence of cancer in the province, that we needed to have the extra capacity in which to add that. If I remember correctly, too, there was also a unit to go into Cape Breton and I believe that one is actually in place.

I'm just wondering maybe at this time, where is that wait time? Are we going to be okay in trying to meet that wait time or not?

MS. MAUREEN MACDONALD: Mr. Chairman, I understand that in November the Health Ministers from Atlantic Canada will meet and we're working toward the signing of a memorandum between ministers to move that forward.

MR. D'ENTREMONT: While we're still on wait times and maybe working with our federal counterparts, they do have - well, they did have, I don't know whether they still do - a very aggressive target to move wait times in those five areas. Maybe just to understand the pitfalls - and one that I tend to see as a pitfall that I tried to bring forward as minister in working with the other provinces and working with the federal government, is that as you're focusing on one, two, or three of these wait times you can't forget about all of the other lists that are actually sitting there - either getting longer or shorter, depending on what kind of flow is there. So I know you'll take that as a bit of constructive work there to make sure that we don't forget all of the other things that are going on around us.

The issue of our longest wait list will revolve around orthopaedics and orthopaedic surgery. I'm wondering, is there a new proposal coming from the Capital District? I know they were working on trying to bring their wait time down. I know there have been tons of discussions within this House when it came to Scotia Surgery and those kinds of things, so I'm just wondering where the minister is at this point on the wait time for orthopaedic surgeries and maybe her thoughts on how we're going to get that one down.

MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the member for his question. Wait times are certainly of concern to this government and to myself as minister and to the department. We have a fair number of things underway to attempt to bring wait times down. I will ask the Page to make a copy of this when I'm finished, and then table a copy for the members here, of wait-time improvements in New Brunswick.

The reason I want to do this is it's a wonderful little chart that shows a significant decline in wait times for certain kinds of surgery in New Brunswick following the introduction of the wait-time management system that they have there, which we have recently launched here. I had the opportunity to be in New Glasgow, at the Aberdeen last

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Friday, to announce the beginning of this program in that DHA and all the DHAs will have this in place by July 2010. It essentially is a system that's quite similar to New Brunswick's.

[5:30 p.m.]

One of the things that I was asked when I was in New Glasgow is, well, if this has been done in New Brunswick, has it made a difference? This particular release by the New Brunswick Government on September 29, 2009, shows what a difference it has made. I'm really looking forward to similar results in this province.

As you know, there are areas where we are within the national average, there are areas where we're very close to the national average, and then there are areas where we're a long way from the national average. Sadly, not so long ago - I can't remember which group it was, whether it was CIHI or somebody else - but there was a report and Nova Scotia got a failing grade for our wait times and, I think in particular, orthopaedic surgery is one of those areas where people wait much too long. I'm convinced that we can, indeed, do better than we are and we are working hard to get there.

The Capital District Health Authority is certainly working hard to get us there too, I believe. The department has been in contact regularly. The DHA has submitted some new plans and we're assessing them and we will work with them to improve wait times so that people aren't off the job longer than they need to be, they're not in pain, they're not in stress, and all of the kinds of stories you hear regularly about the long waits.

So we also, in our platform in the election, made a commitment to investing in pre-op kinds of programs, because there is a growing body of evidence, I would say, that suggests that many people who are waiting for surgery, if in fact they had access to pre-operative services, perhaps some physiotherapy, different kinds of services, they may see a fundamental reduction in the pain that they experience and the difficulties that they're having, which would make the time between the diagnosis and surgery more, you know, something that they could stand a little better without being in constant pain and agony.

So these are the kinds of things I know that have been identified as best practices in other places. From time to time I'll hear a really interesting documentary generally on, I'll put in a little plug for CBC Radio here, but it tends to be the place where you'll hear interviews, have that great series with Dr. Brian Goldman on a regular basis. (Interruption) That's right. So quite often they talk about some of the techniques that have been used in other provinces. In some ways we're not unique at all around the challenges around orthopaedic surgery, in particular. It seems to be a problem in many provinces and, you know, different provinces have tackled it in different ways. So we try to look at what the best practices are, what our resources are. Always keeping in mind that we need to put patients first and we can do better than we have done in the health care system to date.

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MR. D'ENTREMONT: Mr. Chairman, you know, what I found, too, was you had about four different orthopaedic programs. You had people who were referred to probably two or three of those programs. You had no idea of who was on the list or how many people were on it. That's why we were very happy to bring in that assessment clinic. I believe it's in Cobequid, there's a central referral now, where you don't just go to your favourite orthopaedic surgeon, you end up going to the referral clinic and there you're seen by nurses, I believe. Nurses are extremely important in our system.

Once in awhile I believe there's an oversight by an orthopaedic surgeon that sort of monitors what's happening in that clinic. I don't know what - because I left soon after that got going, so I don't know, maybe what the impact has been to individuals. What we were also seeing is by the time you had your first referral, and that was even before you were ever being booked for that surgery, is that your condition continues to get worse. A lot of the people who were being referred off, you know, probably could use some physiotherapy or other kind of intervention rather than a knee replacement, or a hip replacement, or what have you.

I'm just wondering how the assessment clinic has been working up until now, is it fully up and running yet? Is Capital District fully utilizing it? Is there an opportunity for the other districts to start using that as well? I believe this was for the Capital program and I'm not too sure if it was the New Glasgow one. I know Kentville wasn't part of it but, you know, we were hoping that they would slowly get into that system as well.

MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the honourable member for the question. I can't give you any statistics at this moment but I can tell you that the clinic here has had an impact in terms of, from the time that you get referred until you see a specialist, that time has improved. That wait time has improved but my understanding is that from the time you see a specialist who recommends that you have surgery and having the surgery, that time hasn't changed. So that still is, you know, it's pretty much the same as it always was. It's too long. People wait 16 months to 18 months, to 24 months, and that's significantly longer than the benchmark that has been established and that's what we need to tackle.

MR. D'ENTREMONT: Which is why, Madam Minister, the addition of the OR Management System was sort of the next trick to try to create a more efficient OR system, to be able to have the information available to you so that each OR is using its capacity. Many of our ORs are not used to capacity. We didn't necessarily have a handle on what kind of human resource we had to have available at all times in order to do that one or two or three extra surgeries, in order to make a difference to the wait time, because there are a lot of people who end up sitting and waiting.

The other piece, if I remember correctly, was the patient portal and the patient portal was where you finally got that referral to surgery, to know where you were, because the

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added frustration that I heard a lot was not the issue of 18 months, of course, that was an important one, but during that 18 months you had no clue when you were going to get a phone call from the hospital saying, okay, tomorrow's your day, be in Halifax a certain time, we're going to get you ready to go into surgery.

I'm just wondering, has there been any movement on that patient portal so people have an idea where they are in that process?

MS. MAUREEN MACDONALD: Mr. Chairman, that's a level of detail I don't have but I can undertake to get it.

MR. D'ENTREMONT: Thank you very much and if it's forgotten somewhere, please push for that one because information is extremely important to the patients, which is why I'll move on to the next issue. The OR system that you announced the other day is sort of a basis for EMR. It is not the complete medical record but it's a pretty darn good start of having that record. The frustrating part of electronic medical records, or the lack thereof, is that I can see my physician in Pubnico but if I get sick in Halifax, they have no clue what kind of treatments I'm on, what kind of medicines I'm on, or whatever.

I went to a number of conferences where we talked about the electronic medical record and they likened it to the airline industry and you wanted to go to Vancouver, let's say. So you showed up at the airport and said, I want to go to Vancouver and they say, well listen, I can get you to Toronto. They put you on the airplane to Toronto, boom, you get to Toronto, and then you've got to do it all over again and go in, see someone who reintroduces it - bring your passport, bring your information, pay your bill, and maybe hopefully get on a flight to Winnipeg and then have to do it all over again.

You would think, after all this time, that the country would have a record that can be seen in Halifax, it can be seen in Vancouver, and likewise. In my mind that is an extremely important philosophy and programming that we need here in Nova Scotia. We have the start on it, the program you announced as well as the PAC system, which is a very good example of really starting to work collaboratively where I can go and get my - for example, I've got a cardiac issue that I'm dealing with right now, non life-threatening, so if anybody's worried about me, I'm sure you're not, but there you go. (Interruptions)

Basically, I can go and get my echocardiogram in Yarmouth when I'm in my constituency, when I'm in my area, and I know that my doctor here in Halifax, my specialist, can see that echo in a matter of minutes. (Interruptions) I've given myself permission to talk about this one. So if I have issues, I know that Dr. Nick is going to be able to give me a call and say, listen, I need you in here and I need you in here now. That's the kind of health care we need. We need a health care system that - I always got frustrated with it. We are like a pizza company where we expect to have everything in 30 minutes. We can't, but if we have the right systems in place, God knows what we're actually going to have in the end.

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So those are just my thoughts on the electronic medical records system, making sure that we have that availability there. I'm just wondering, maybe just to pick your brain a little bit, if you've had some discussions around that and what you see as the future in electronic medical records.

MS. MAUREEN MACDONALD: Thanks very much. Well, the honourable member is right about the importance of the electronic medical record. It's really - for this day and age, that we don't have it is kind of shocking, and it is certainly something that we really need. I don't know if the honourable member has any influence with his federal counterparts, because now would be the time to use it, honourable member. As you know, Nova Scotia's strategy really - because this is extraordinarily expensive, to start to build an electronic medical record in all of those places where we need it - physicians' offices, in our acute care facilities - everywhere, really.

[5:45 p.m.]

We've been using our own resources, along with resources from the federal government under Canada Health Infoway, and we have incrementally been building our system and putting the pieces in place. I think quite sadly, Mr. Chairman, we just learned last week that the federal government has withdrawn or they are not providing a huge amount of investment - something in the magnitude, country-wide, of $500 million or something like that for the remainder of the year. This is not good news for where we want to go. We are strongly supported by Doctors Nova Scotia, who understand the need, and they understand the value of building an electronic medical record.

So with the shift in the federal government's focus - because at one point they were very keen on building an electronic medical record - with the shift in their focus, you know we're still committed but we have to find dollars. As I was saying the other day, it would be great if money was no object, but money is an object. It is something we have to concern ourselves with, the financial situation that we're looking at.

We'll get there. I have great hope and a belief that we will get there and we will find the resources, but this is certainly a setback.

MR. D'ENTREMONT: I thank you very much for those comments. I'll try my best to influence the federal government. I don't know how well I'll do, but I certainly will call the number of people that I do know - of course, Dick Alvarez with Canada Health Infoway is a phenomenal individual. The second he calls to see you, please see him, because after you meet him you just feel all energetic about moving on with things, even though you don't have a cent to do it with. Dick also, I know, has the best interest of all of Canada to try to work with.

[Page 113]

It's a bit upsetting that maybe the feds have pulled away $0.5 billion when it comes to funding for Canada Health Infoway, by the sound of it, so maybe we're going to have to talk to Leona - the Honourable Leona Aglukkaq, the federal Minister of Health - and maybe try to push her into working toward it.

I know Leona understands it as well because, of course, during my tenure as minister she was minister of Nunavut at the same time that I was, before she moved on to federal politics, so I thank you for that. Like I said, it's a very important thing, it's one that makes sense, but it's one that comes with tremendous cost. You talked about your increase, the $6.3 million for HASP or more - I'm sort of looking over at Linda, but that's a computer program which makes sense as to why you put it in. But the implementation of some of these programs continues to escalate far beyond anybody's wildest expectations.

It would be really nice if we could find - I'm going to go on a tangent for a little bit - it is always interesting to find a consultant who actually gives you a number that makes sense. They seem to fish with you and I see the deputy minister shaking his head with it, because I know he's been part of some of these fishing expeditions. It seems like a fishing expedition on behalf of a company, with a certain price they hook you, they pull you in. Then all of sudden you can't pull it in any more and you need a higher test line in order to pull these things in. So it continually goes completely out of whack. That's why many provinces are not in as far as they need to be when it comes to electronic medical records or why we're not in as far as we need to be, because anything we tried to do on one side escalates and you can't get over to where you need to be.

My final question will try to revolve around some infrastructure dollars. When I was minister we continually heard about infrastructure, especially in the districts. Whether it was renovations to places like Queens General or whether it was the construction of hospitals like the one in Truro - a continually frustrating process. Right now in Nova Scotia, as we talked about during our infrastructure process, there was - what? - $3 billion worth of infrastructure deficit and $1 billion of that is really attributable to the health care system in Nova Scotia.

I do notice in the numbers that were provided to us during budget, there is a variance as well, a decrease of $32.5 million in infrastructure. So I'm just wondering, what makes that change between - and I believe that's our budget to your budget - just where that change is, that $32.5 million?

MS. MAUREEN MACDONALD: Mr. Chairman, the biggest part of that $32 million decrease is the Colchester Regional Hospital and that's because it can't be completed this year. I believe that the last RFPs that came in were very significantly over budget so they have been put out, they have been re-tendered. So that's part of that. Yes, the radiation therapy bunkers, we talked about $10 million. So when you combine Colchester and those bunkers, you come close to the $32 million, and there are a few other little minor things but nothing close to those two big ones. That accounts for it.

[Page 114]

MR. D'ENTREMONT: I thank you for that breakdown, which leads me to the second part of my question. With the issue of Colchester, Colchester was a tremendous consternation to us during our time. That project ballooned from - I believe the original OIC allowed somewhere near $100 million for the construction of the Colchester and that ballooned to me allowing them $155 million. So it was a number that completely defied any sense of reason why a facility would end up costing that.

Then it was the sort of discussion here through my process of working with Jed - God rest his soul, I'm sure he's rolling over on this one too - Jed Ritcey, who was the chair of the district at that time, who did pass away a number of months ago. Once we had the $155 million, all of sudden everybody is asking for the MRI, which in my mind, we had let the doctors and the system decide, well listen, maybe we don't need an MRI there. There's one in Pictou and New Glasgow, there's one in Halifax and maybe we don't need one there. Well, the $155 million all of a sudden became $160 million because you have to find some dollars for the MRI that would go in the hospital.

I'm just wondering, I know there's a problem in the cost and I believe it had to do with heating or the air-handling system, or whatever it is - could you give me a breakdown, or idea, of what that is?

MS. MAUREEN MACDONALD: Yes, it was the electrical and mechanical systems that came in way over budget. We think what's driving this is the infrastructure projects at the same time, but I know what you're saying when you say, once you're in you're in so deeply, how do you get out? That's the problem. Not that you want to get out, but how do you stop this train, is what I'm saying. It's very difficult. That project is definitely an extraordinarily expensive project and it ain't done yet.

MR. D'ENTREMONT: Thank you very much. Also, after we're done with estimates and the budget's approved and all that fun stuff, it would be nice, once in awhile, to get an update on how that project's doing. I know the member for Truro-Bible Hill as well as the previous member for Truro-Bible Hill are very interested in making sure that project continues to move forward. It looks like a phenomenal place so far from what you see as you pull off into Truro. It seems like an awful lot of work going on there, structurally it looks really nice, but it's not a hospital yet and it's not a hospital until the specialists, nurses, doctors and everybody else who works there are in there to provide service to the people of Colchester.

There are a number of other projects going on around the province. I believe there was the renovation to Inverness hospital, there was some work happening, and I know there were some discussions at the Bridgewater hospital. I'm just wondering if there are any other projects right now that are truly going forward and maybe what their level of completion might be at this point.

[Page 115]

MS. MAUREEN MACDONALD: There are four projects that have recently been completed: in DHA 3, the Annapolis Valley Regional Hospital redevelopment; DHA 4, the Lillian Fraser Memorial Hospital; DHA 8, an ER expansion at the Cape Breton hospital; and of course, DHA 9, the Halifax Infirmary expansion.

In terms of DHA 1, that DHA is embarking on a master facilities planning process and so the Queens and Bridgewater work that the honourable member referred to will certainly be part of that process of planning. We know we had discussions here on the floor Tuesday about the VG site in Capital and the Dartmouth General Hospital, we didn't talk about Cobequid, but the honourable member for Sackville-Cobequid, if he were on that side of the floor, he certainly would be talking about it - he talks to me about it all the time. So there are lots of issues with respect to our facilities and we have that very much top of mind.

We also, I think, to bring a balance, I give a little pitch here for Health Promotion and Protection. I am very pleased to have both portfolios because I also say to myself, at what stage do we make a decision to stop investing so heavily in bricks and mortar and when are we going to start investing in people in their communities and doing things that will improve people's health so that the pressure on the health care system and the need to have all of these big, expensive facilities will be somewhat less of a magnitude than it is now? So in some ways that's my challenge as I look forward to where we're going to take these two departments.

Thank you, Mr. Chairman, and with that I'd like to adjourn the estimates.

MR. CHAIRMAN: We will recess until after the late debate.

[5:59 p.m. The committee recessed.]

[6:32 p.m. The committee reconvened.]

MR. CHAIRMAN: The honourable member for Argyle.

HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, I want to more specifically talk about transformation - and I'll probably take an hour at a later date, but maybe just quickly talk about some opportunities that we had in community clinics and collaborative practices. I thought it would be a good opportunity to allow the minister maybe to speak quickly on the North End Community Health Centre and maybe her experience with that, and maybe her philosophy on trying to replicate that kind of success in different parts of this province.

We know that that's definitely a model, and the model that is happening in Annapolis is another wonderful collaborative model. It seems like in places where we have really been able to pull this one off the communities are much better served and they're much happier

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in the services that they receive. So I thought I would give the opportunity, in the last couple of minutes in my hour, to let the minister speak to that one.

HON. MAUREEN MACDONALD: Mr. Speaker, that's very kind of the honourable member. I think there are lots of groups and organization I love to talk about from my riding, as we all do, but the North End clinic has to be one of those that is highest on my list, I would say, for a whole variety of reasons. I had the privilege of being a board member at the North End clinic; I've had the privilege of being an employee of the North End clinic; and I've also been a patient of the North End clinic. So I kind of have all the basis covered in some ways.

Mr. Chairman, the North End clinic is getting up there in age in some ways, it has been around for quite a long time - it must be close to 30 years, I would think. It's kind of unique in many ways because it started as an initiative out of the community - a small number of people sitting around the kitchen table really. It has had quite an interesting history, and it has had a huge impact in terms of the inner city in North End Halifax and beyond. I can point to any number of initiatives . . .

MR. CHAIRMAN: Order, order. The time allotted for the Progressive Conservative Party has expired.

The honourable member for Halifax Clayton Park

MS. DIANA WHALEN: Mr. Chairman, I'm pleased to be back on my feet to ask some more questions and have more dialogue with the Minister of Health.

We've had many hours of talk here already on health issues, but there are so many subjects at least I haven't touched on yet and I don't think have been raised to any particular degree here in the House. I have a quite a few different subjects and I'm hoping that we can touch on them all - I'm not sure we'll get to the depth that perhaps the minister has for us.

My first question that I had was just a follow- up to my colleague for Preston who had asked you about the contracts for the cleaning, and I just wondered if that was a commitment, either you had it today or could you table it, because I assured him that I would ask again about that question. We can get them later if you have them here or perhaps you would like to speak to that first.

MS. MAUREEN MACDONALD: I thank the honourable member for reminding me. It probably would have slipped my mind, although Linda would have reminded me, that's for sure.

We do have some material here for the honourable member. The reason why the honourable member couldn't find the copy of the contract was that last year it was agreed

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that copies would be provided for the honourable member to review, but not to take away. What we have done is, we copied material that the honourable member can have - let's put it like that - but there is also some material here to be looked at and not taken away. That's why I wanted to provide that explanation. Certainly, we have this material here and I can send what we have that's available for the honourable member that you can keep, and if the honourable member would like to arrange to see this other material, then that's also possible. Maybe at a later date - you can let him know that.

MS. WHALEN: Mr. Chairman, I appreciate that from the minister, and I'll make sure that your message is passed on to the member for Preston so he can review that and look at the other items as well that he not free to take away. I appreciate that - it looks like quite an extensive amount of information.

I wanted to go back to a subject that we started with the other day and had touched on to some degree and that was the IT budget - the amount for information technology. What I wanted to explore a little bit was the federal money, particularly because I think I may have missed part of the answer that you had given to the member for Argyle. I heard you say that there was a setback or some disappointment that had come up along the way. I don't know if that was to do with the federal funds because you were talking around federal funds. I believe it was for information technology and I wonder, could you give us a quick recap on that?

I understand there is a fund, and you referred to it the other day, called the Canadian Health Infoway. I believe there is an amount of money in one of these budget lines that would probably correspond to that. I want to know, really, if you could tell me something about that fund - how much is left is in it, how many dollars are left in that from the federal government, and will it expire any time soon? Are we looking at a deadline on it?

MS. MAUREEN MACDONALD: Mr. Chairman, it is a little more complicated than a fund. We have a number of different initiatives underway in which federal funding flows through the Infoway program, I guess - I don't know if I can call it a program, but the federal initiative to assist provinces to become more modern in terms of their electronic medical records. The federal government had held back, and I don't know if the honourable member remembers some controversy around the person in the Province of Ontario who was heading up their initiative to do the electronic medical records there.

So there is some thinking that possibly that situation created some problems for the program - the result being that the federal government have decided not to release $500 million that people anticipating.

But, as far as I know, we don't have any contracts, let's say, to get our share of that money, but it's all subject to negotiation and working out agreements on each little project that you have planned. As I indicated earlier to the member for Argyle, we have been

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utilizing - we've sort of been incrementally building pieces of our system. You would develop a project for a piece and you would probably submit your plan, your application, to the feds, and there would be some toing and froing and some decisions would be agreed and you would be granted a certain amount of money to implement that aspect of the proposal. That big pot of money, $500 million, has gone away now so this will, in the future, certainly have an impact. It will slow us down in terms of some of the work that we may want to do.

MS. WHALEN: Certainly that is a setback if $500 million is being frozen. I would ask the minister, does she see this as something that will continue in the future on a sort of case-by-case individual negotiation for each upcoming project - you know, piecemeal? Will we still be in a position to negotiate for federal funding to help us move forward on just modernizing our technology here in the health system?

MS. MAUREEN MACDONALD: The impact of the federal government's decision now for us here - and I think we just learned about this yesterday or the day before - we have to regroup, we have to reassess where we are, where we want to go, what the assumptions were that we had made with respect to the projects we thought we would be able to move forward. We will have to look at that.

Additionally, I can assure the honourable member, Mr. Chairman, through you, that we will continue to talk to the federal government about the need for their participation, and we won't be alone in that. I would assure the honourable member that we'll have an opportunity to talk with the federal minister and, additionally, when the Atlantic Canada Health Ministers meet, this will be as much of concern to my counterparts in the other three Atlantic Provinces and we'll look at how we can collectively bring our voices to attempt to impress on the federal government the importance.

The federal government have been on side around an electronic medical record. They understand the importance of the technology for reducing wait times. The wait times initiative has come out of the federal government, really, and they have pressed the provinces to adopt some standards across the country - and Nova Scotia, we were the first province to sign on to that.

So this very important and we will continue to make sure that we get the federal government back involved, I would say.

MS. WHALEN: Mr. Chairman, I appreciate that we will have to regroup. This is very new information. If, in fact, our government has only been notified of it really in the last day or two, so I think that is important for us to know as members of the Legislature as well.

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[6:45 p.m.]

Just through you to the minister, Mr. Chairman, I wanted to ask specifically around the drug information system. The other day I mentioned electronic prescriptions and having them not be handwritten, and in some jurisdictions they're already implementing this and using it - I gather actually Prince Edward Island is the province that has gone far ahead in terms of a complete drug information system. The final piece, if you're doing it in a step by step was to have electronic prescriptions. I've learned a little bit more about this since posing the question the other day - I have done a little bit more research. But one of the benefits of that - and it could be done in isolation, we could go straight to the electronic prescriptions - is I had mentioned about errors in filling prescriptions because of not being able to read them properly. But what I've actually been informed about, by talking to pharmacists, is that the bigger problem is not only the time spent by the pharmacist - in every doctor's office, our physicians are taking time every day to return calls to the pharmacy to clarify what those prescriptions really are for. There is usually a backlog of calls into the doctor's offices, and then at some point in the day the doctor has to take the time to call back and sort it all out. The pharmacists are, in fact, very cautious; if they can't make it out, well, they put a call in to the doctor's office. So it is an area where there are probably significant productivity gains to be made if we could sort that out and provide an improvement to that system.

I had been thinking more along the lines of - as I say, about errors, and also about the drugs that are being used illegally or people who are getting multiple prescriptions, but I understand that we have a prescription monitoring program which is in place for those drugs - the highly addictive drugs like your painkillers and oxycodone and so on, that are being monitored. So where we had a justice issue around that, we seem to be able to put a program in place, but we haven't done it for all the other drugs and, I guess, the vast majority of patients who could benefit for having better drug records. Just going back to that piece, I wonder if you could talk about that and maybe our discussing it might make it more of a priority?

MS. MAUREEN MACDONALD: Mr. Chairman, I agree with the honourable member that having a fully automated drug information system would be of great benefit in a variety of ways, and particularly with respect to patient safety and catching any kind of errors that unfortunately do occur. Unfortunately, all of these various pieces of an electronic medical record cost a tremendous amount.

We talked about this the other evening. The honourable member was a little bit skeptical about some of the investment we were making and whether or not it had payoff. I argued that we really needed to modernize and we really would see benefits, health care benefits, if we continued to invest. So I'm very glad she agrees with me and she sees the very practical example in the area of drug information. We have, again, a variety of projects underway. We will have to reassess but not our commitment to implementing the projects that we have currently underway -those we will complete. If we have lost federal money, I

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would think that the implication of that is that we will continue to move ahead to completion with those projects, but the time frame may change just because all of the revenue will be ours and we'll have to find that.

Then it means reassessing where we go next. Unless the federal government decides to re-engage with a new program - and that may be possible - they may decide that the program they had was too rich for their blood, given what the circumstances are, and they may bring out another program that would be helpful, but not to the extent that this other one is.

We did in fact ask the Canada Infoway to advance $9.5 million to allow us to work toward implementing a drug information systems program. It is on our radar, it's an important piece of what it is that we want to do. It's freeing up the revenue and completing the projects that are underway and taking on a new piece of really important work. So I thank the honourable member for her question.

MS. WHALEN: There were some aspects of the technology investment I wasn't sure about, but I think we agree on that one being a priority, and I'm pleased we could learn something about the setback that you've just been faced with. I know you've got the commitment and we have other dollars already in our own budget, so I would hope that these will move forward and that you will be strong and voice your concerns with the other Health Ministers because I'm sure that affects everybody.

I'm going to go quickly to a couple of other issues. One is foreign credentials, and as the minister knows, I've been the Immigration Critic. I'm not now the Immigration Critic, but have been since we first named an Office of Immigration and had a minister for that. I feel very strongly about it, and I feel that we are not doing nearly enough here in Nova Scotia, compared even to our Canadian counterparts. I don't know if the problem lies with our professional societies and that they have more of a closed door than some of the other provinces do, but I'm sure I'm not alone in saying that in my own constituency I have been called by people who have told me that they could get a license right away in Ontario but cannot be recognized here in Nova Scotia. It's completely counterintuitive. We need people.

I'll give you an example. Just recently, somebody who was from China had called - it was actually through a friend. The person would like to live and work in Nova Scotia. She is an expert in diabetic disease and she has been a speaker in international conferences and is sought after for her information on diabetes and her knowledge in that area, and she would like to come here and practice as a specialist. She was told never - you might possibly after a period of time with other work be a family doctor, but you will never become a specialist in Nova Scotia, it's too difficult. At the same time, she's told that Ontario will take her. They'll assess her, and if she's missing anything they'll do it - they would love to have her. I can't for the life of me understand why we wouldn't. If we don't have the capacity to assess

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her, why wouldn't we pay Ontario to assess her and say, great, come to Nova Scotia? She really has a preference to be here.

Just as one little piece - I know this is an anecdotal story, but it's a window into the sort of closed door that we have in Nova Scotia, taking one person's experience. I would just add to that, that a call to the Department of Health gives a complete hands-off answer, which says, you know what? We have nothing to do with that, it's the College of Physicians and Surgeons, we're not involved. Basically hands-off; they don't take any responsibility at the Department of Health.

I think that recognizing our need for qualified people, recognizing that we want more immigration, that we want to encourage people to come and settle here and bring their families - if they've been sold on our message of come here because it's a beautiful province, why wouldn't we bend over backward as far as we can to help make them warm and welcome here and helping to bridge to whatever it is they need to practice?

MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the honourable member for raising this topic in particular. I'm very glad it has come here, because it is a very important topic. I've met with people who have come here with medical credentials from outside of Canada and have had great difficulty in negotiating the process of being assessed, and I know other colleagues have as well.

First off, I want to let the honourable member know that there is money allocated in the budget - almost $6 million allocated in the budget for a program of clinical assessment. It's called - one of the things I've learned is everything in the Department of Health has an acronym - CAPP, Clinical Assessment for Practice Program. Under this program, internationally-trained family physicians are assessed and tested in order to obtain their licenses to practice in Nova Scotia, and once they pass the assessment they are mentored by licensed physicians for approximately 13 months and then they go off.

The other day I had an opportunity to talk about the warm reception I received when I went to the Southwest Nova District Health Authority and was at the Yarmouth Regional Hospital, and this wonderful doctor who is there, Dr. Lahey. She had - and one of the things she talked to me about - she had two of these internationally-trained physicians working with her, and she had a very positive experience and she was mentoring them, and this is really important.

Now, I think this program is relatively new. It's only been something we've been doing in Nova Scotia since around 2006, and the first group of physicians to be hired - there were 10. The second group, there were six and the next group were six. So from October 2005 to April 2006 there were 10. From May 2006 to June 2006 there were six. From December 2006 to February 2007, six. From December 2007 to January 2008, four. The fifth group, three physicians available - the anticipated hiring was from December 8th to March

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9th. The budget for this program has grown by about $1 million from the previous year, so this is something, but I agree with the honourable member that we need to do more.

At the same time, I want to say to the honourable member that we have in Nova Scotia, believe it or not, probably the highest ratio of physicians to population of any province in the country. However, the distribution of where physicians practice is problematic, so we don't necessarily have enough physicians in the communities where we need them, and this is something that we're certainly going to look at.

We also, I think, have to be very ethical in how we approach the supply of doctors the world over. The idea of doctors from outside of the country writing us and saying they want to come to Canada is very understandable, but very often the countries that these doctors are in really need them at home, is what I want to say. They need those doctors at home. Now, if we have doctors who have come here, they've immigrated here - they come here and they arrive and they can't get employment, then I think we really need to improve our situations. I think we have to, from my perspective, be very careful about how we go about recruiting and to always apply our ethical lens around those countries of origin and the needs of the people in those countries and the investment that the people of those countries have sometimes made.

When I studied in the U.K., I had a very good friend in my program from Zimbabwe, and Zimbabwe at that time was quite a bit different than it is today. It hadn't been ravaged and become an impoverished country, and there had been a lot of investment by the Mugabe Government early in their tenure to invest in a health care system and to train doctors. They put a ton of money into training doctors, and then all of those doctors left Zimbabwe and they went to practice in the U.K. and throughout the Commonwealth. The result of that was that health care for the people of Zimbabwe didn't improve, even though the investment that people made.

[7:00 p.m.]

I'm always keenly aware of trying to find a balance between our own needs - being responsible for the health care providers that come here and find that the doors are closed, and we need to do more to use those health human resources that are here - and at the same time, using an ethical lens with respect to the countries that they originate from. (Interruption)

MR. CHAIRMAN: Order, please. Order please. The honourable member for Halifax Clayton Park.

MS. WHALEN: I'm sorry to interrupt the minister but the question that I really want to know is, why we can't be more proactive when people are knocking not just on the doors of our province but on other doors in our country to say, well I'll go to Ontario then. We

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know that Ontario gets, in an average year, about 150,000 immigrants so they're far more conscious, I think, of how to roll out the welcome mat, how to integrate and accept people. Maybe they have bigger systems in place to analyze and make sure that they meet standards of quality.

I understand standards of quality are very important, protecting people's health. I appreciate the ethical issue. I was going to say I've often heard Alexa McDonough talk about the ethical issue around immigration and drawing the best and brightest from other countries, so I have heard that as well. I just feel there's a frustration if we cannot, as a little province with our own needs, take advantage of people who want to come here and make this their home. We don't have the systems in place, neither does the Department of Health take any responsibility for it. I wondered if I could just hone down that question and Mr. Chairman, I do apologize for interrupting without your help.

MR. CHAIRMAN: Thank you for your assistance. The honourable Minister of Health.

MS. MAUREEN MACDONALD: Mr. Chairman, I understand that the honourable member feels very strongly about this and I have no difficulty with the fact that you have strong feelings about this. I commend you for that and I do agree with you, we do need to do more. I do agree with you that we lag behind in terms of the way we approach foreign-trained physicians and integrate them into our system. I think we haven't had the experience and so therefore Ontario is a much more multicultural place in some ways, particularly in the bigger centres, so perhaps that accounts for why we lag behind, but that's not an excuse it's an explanation and we can't rest on our laurels, we need to do more.

Nova Scotia has signed on with the other provinces for transferability of recognized professions, including physicians. It's still being finalized. There are still a few things that need to be worked out with the appropriate colleges, but this will allow for physicians who have come to other provinces and gotten licenses in other provinces to come here and have their licenses recognized, so that removes a barrier as well.

I think that we have done some things, we have allocated resources to continue to do these things and we're always very open to having the discussion about what the other things are that we can do. We have a good relationship with the College of Physicians and Surgeons and they are very responsive to the issues we raise with them. We have a good dialogue with them and I'm really looking forward to my time in the department and an opportunity to work with them and work with other colleges as well.

It's not just physicians who experience difficulties in terms of getting their credentials recognized when they come. There is a host of professions in the health care field and we certainly can do more and frankly, some of the other professions are professions where we have serious shortages, very serious shortages, where we really could do a better job than

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we're doing now with people who are arriving and maybe not have the same kind of ethical dilemma around the question of taking those resources out of other countries. I welcome an opportunity to talk about this in an ongoing way with the honourable member.

MS. WHALEN: In a similar vein, Mr. Speaker - I want to stay with foreign-trained professionals. I wanted to mention to the minister that there is an association of internationally-trained physicians. I have had the opportunity to meet a couple of their members and they are not yet qualified here. They are very good advocates, I would say, and they would be a good group for the minister to meet at some time.

I know how busy she is, but if you met them, they could really outline the difficulties that they face. There are a lot of costs to be involved in the CAPP program - they have to pay for a lot of courses they're taking, and they're here at a point in time with no income, by and large, so it's very difficult sometimes for them to pay the $5,000 or whatever it is for the next stage. I know that's one of the difficulties.

I just mention that they have an association. They've begun to come together and talk about their common interests. I think that's always easier for government as well, to deal with an association rather than with many, many individual cases. So that's just to let you know that they are out there, if you have not yet met them.

I wanted to talk to you about foreign-trained nurses for a moment. I had a group come to my office in Clayton Park, who are trained in the Philippines, so they are Filipinos. They've come to Canada to work in long-term care facilities - they've come to Halifax to work in long-term care. They are here as temporary visitors - temporary work permits, I guess is what you call it. Generally those were originally thought of for the Canadian Government for agricultural workers.

I know there have been stories in the press about a lot of areas where there are skill shortages; people are bringing in the workers under that category. They're coming for a year and more, and it's rolling over to a second year and rolling over to a third year. While they're here and sending money back home, they are also trying to train to get the Canadian certification so that they can be seen as nurses. They are fully-trained nurses in their home, but when they come here they work as LPNs, so they're not regarded as full RNs.

They are doing courses while they are here, but I guess there's no support in any way for that, even though their longer-term plan is they would love to apply and stay. Have you heard of this group, and do you have any plans or suggestions that might make it easier for them? They are definitely trying to lobby. There are quite a number of them - there are dozens.

MS. MAUREEN MACDONALD: Mr. Chairman, I thank the honourable member for raising this issue as well. A number of months ago - I don't want to say a year or so, but

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I know that I try to touch base with people at Northwood, which is in my constituency, on a regular basis, and I had an occasion to speak with the folks over there in administration about their health human resource needs and whether or not they were able to find an adequate supply of health care workers to work at Northwood.

Northwood, as you know, is very large; I think it is probably the largest long-term care facility east of Montreal. They told me that they were having difficulty getting an adequate number - a stable labour force to provide care, and they were looking at making an application to the federal government under this federal program which allows an employer to recruit offshore and bring in workers from outside the country. They told me that their plan was to bring people in from the Philippines, if they were able to get the - it's a kind of exemption they have to get, so that they can actually do this.

So I am aware that this is a concern and has been a concern. I have not met with any of the workers who have come, and I was not aware that they had a group. I would be very happy to meet with any group that makes a request for a meeting with me.

I also want to say to the honourable member that with respect to nurses and workers who work in long-term care - registered nurses, LPNs, and the continuing care workforce - we have a nursing strategy to recruit nurses and retain nurses. We also have invested a fair amount into the community college system to improve the number of graduates coming out of community college with the continuing care certificate. The demand for that program has grown exponentially. Many, many people are very interested in getting into community care, which is excellent. We need people in that area.

Back to the nurses who are here from the Philippines - it's interesting, when I lived in England, the health care system there was a system that relied very heavily on nurses from the Caribbean. They also went through periods where they didn't have enough local people or residents to staff their hospitals and their facilities. I think the history of health care and nursing around the world is one where you see that this is a labour force where there have been large numbers of workers drawn from other places.

What the federal government's program requirements are and how they would - I guess whether or not there is any kind of prohibition, is what I'm getting at - is a question I can't answer. Is there a prohibition in terms of the federal program, that people who come here are not permitted to look for landed status or permanent residency? I know, because I lived in the Annapolis Valley for a while, near the farms that were using Caribbean workers, that they had a prohibition as part of that contract and it's right across the country. It's the federal government's expectation that when you bring people in, they're like migrant workers, and it is something that we would have to look at, and look at what the federal requirements are.

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MS. WHALEN: Mr. Chairman, what I will do is perhaps see if we can have those nurses meet you at a time when the House isn't sitting - maybe we could set an appointment in the future - because I think their understanding is that they could perhaps through the Provincial Nominee Program - that they could apply through that avenue. They're taking the time and spending the money right now to upgrade their skills, to be recognized in Canada, at the same level, and I don't believe they would be doing that if they didn't believe that there is an opportunity to stay. The thing is, they have no status here; as you say, they're considered migrant workers. They're not recognized. So there might be something the minister could do in that regard, because even today they're filling a very important role in our long-term care facilities.

I'm going to go to another program, and it is one of the diabetic programs we have in the line items. I'm on the Supplementary Detail, Page 14.5, and it's assistance for low income residents with diabetes - that's the one. The minister may be aware of the bill that I introduced recently, which was for insulin pumps for people who could benefit from that. This one is a little different - it's a program that has been in place for a number of years, but my point in pointing it out here today was to have a discussion with the minister, if we could, around why it has gone down so much in that estimate of 08-09. It went from $2.4 million to only a little less than half a million spent, and this year coming up it's only budgeted for $450,000. So it definitely has gone down from a program that had been over $2 million just two years ago. I wanted to know if you could let me know what's going on there, and I think there may be a tie-in to Family Pharmacare. I wondered if we could have that discussion and you could give me some insight?

[7:15 p.m.]

MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member is exactly correct when she says there is a tie-in to Family Pharmacare. The honourable member will notice when she looks at the line item that the actual expenditure is considerably lower than what was estimated - by $500,000 or so - and so that is one reason why it was decided to adjust. But the other is that families are moving to the Family Pharmacare Program.

In fact, the number of people who have moved - the participants who have moved to Family Pharmacare as of March 2008 were 1,408 and the number of participants who have moved to Family Pharmacare by March 2009 were 784. So it represents a significant transfer from one program to another.

MS. WHALEN: I wonder if the minister could tell us how many individuals remain in the assistance for low-income residents with diabetes?

MS. MAUREEN MACDONALD: The total number enrolled as of March 2009 is 848.

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MS. WHALEN: I'm just wondering if the minister could say if there are plans to eliminate this program given that it is down, from my figures - I know you mention it's down $500,000 - but on mine, in the supplementary detail, it shows that last year it was $2 million less than what was budgeted. It went from $2.4 million down to $480,000 that was spent and then this year's budget shows roughly $450,000. So, it definitely seems to be one that's getting replaced and I wonder if there is a plan within the department to completely phase it out?

MS. MAUREEN MACDONALD: I don't know that there is a plan to phase it out. In the briefings that I've had around the drug plans in the department, we have talked about whether or not there would be any efficiencies to be gained in having - not necessarily an amalgamation - but having a different form of administration, a more joint administration.

Certainly no decisions have been made to do that, just questions that have been raised. I think the bottom line though, from my perspective, is that we want to make sure that people who have needs get those needs met. What program they're in to get those needs met is really more a matter of what's available to them, making sure they know what's available to them and supporting their choice in where they think their needs would be best met.

That's really what I would say at this time, but no, no decision has been made to phase out at all, that I'm aware of.

MS. WHALEN: The minister has told us that in one period of time 1,400 people had switched into the Family Pharmacare and then a further almost 800, 784. I wanted to explore if we could - and I'm hoping that you and the other members of the department who are here will be able to answer whether or not the programs are the same. Is there a co-pay if you're on the diabetic assistance plan?

MS. MAUREEN MACDONALD: Mr. Chairman, there is a co-pay of 20 per cent on the assistance for low- income residents with diabetes, so it's cost-shared with participants. There is a deductible based on family income and a 20 per cent co-pay with no co-payment maximum per year, so it's not capped either.

MS. WHALEN: Could the minister just say how that compares to the Family Pharmacare Program? I will say that the reason I'm asking this is that my understanding was - and this is more from constituent issues that come up - that there had been at least one person who felt it was too expensive to move to the Family Pharmacare and they wanted to remain on the Diabetic Assistance Program, which makes it important that we leave that program in place if there is a difference in the requirements or perhaps in the cost for some low- income Nova Scotians.

MS. MAUREEN MACDONALD: I'm not really sure we're going to be able to answer that quickly. It's very complicated because there is such a large range of possible

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incomes and then a very large range of possible drug costs and what have you, so I would say, just off the top of my head, based on my own knowledge of how some of these programs work, that so much depends on the unique circumstances of an individual family. Some families will be better off staying on this program, which might account for why we still have 800 and some there, rather than switching to the other one, whereas the families who have switched, perhaps they're better off on those, depending on their circumstances and their incomes.

Take a family that has two children, let's say, who have diabetes, or a parent and a child with diabetes, their circumstances will be different. It may lend them to move to the Family Pharmacare Program. I think it's very hard to know - you have to look at it more on a case-by-case basis, I would think, which might account for why we still have the two programs as well.

MS. WHALEN: Perhaps the minister could, if she's able to, let me know at a future time if the department is aware of any requests for people to return to the Diabetic Assistance Program, to leave Family Pharmacare and go back, and if that has been recorded anywhere in the department. I think that would be great - and I don't expect you to know that today. So if we could ask that to be looked at, that would be very helpful. I'm going to set that one aside for now.

On the same page there's a line item. I'm on the Supplementary Details again, just to let you know. It's still that page, but it's a different program I wanted to look at. Special Drug Programs, that's the one. If we could look at Special Drug Programs on page 14.5. It's under Program Expenses, and it's gone down by $2 million. I know in your opening comments on Monday, I believe it was, you mentioned covering of Fabry's disease drugs and I think other drugs like Avastin. I'm just wondering why it has gone down, because of drug costs going up and the number of programs that we're covering have gone up. So it has, in fact, the figure for this year's estimate is $30.5 million.

MS. MAUREEN MACDONALD: So $2 million of that is the diabetes program, as the member, Mr. Chairman, has indicated, and $2 million is with respect to consideration of introducing a co-pay on some special drugs.

MS. WHALEN: Mr. Chairman, I have only 10 minutes left so I'm going to ask the minister if we can perhaps go through some quick questions and quick answers. I haven't had time, and I don't know that the other members have had time, to ask about the Corpus Sanchez report. It is huge and there is an awful lot in there.

I wanted to look first at one thing in particular and that was the public health renewal strategy. It called for a Primary Healthcare Leadership Task Force. I wanted to ask whether that task force has been struck. Let me see if I can find the exact thing. It is in the Corpus Sanchez Report and here's the quote from it, "That the DOH work collaboratively with the

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DHAs/IWK to establish a Primary Healthcare Leadership Task Force to confirm system-wide priorities to provide primary healthcare through new and innovative models. . ."

What I am looking for is if the minister can confirm whether or not a Primary Healthcare Leadership Task Force has been struck and if it has, who is participating, who is sitting on the task force and have they reported back to the minister with any recommendations? So a three-parter and I think it is one of the important recommendations in that report.

MS. MAUREEN MACDONALD: Mr. Chairman, I was wondering if any of the members would raise Corpus Sanchez while we had an opportunity here in estimates. So first of all, I would say to the honourable member that yes, that working group has been struck and is working. There is no report as yet, the work is underway though.

Indeed, there are a fair number of working groups. As I mentioned in my opening statement on Monday, there are a fair number of working groups in the department and outside of the department where the folks who are involved in the working groups aren't only department staff. We're drawing on people throughout the health care system who have expertise and knowledge and a lot to offer in the various working groups. Reports will be generated and as they're generated we'll have an opportunity to assess recommendations and move forward on some of these recommendations, Mr. Chairman.

MS. WHALEN: Thank you very much and I appreciate now knowing that there has been no report as yet. I would ask, can the minister tell us when they might be bringing back some recommendations from the Primary Healthcare Leadership Task Force and, at the same time, perhaps you could tell us if there's a rural health task force in place as well?

MS. MAUREEN MACDONALD: We don't have a hard date for a report back. What we are doing is, there are a number of working groups, they're all working with the idea that we need to expedite the work as much as possible so that we have some recommendations to consider as we go forward. Certainly after this budget is passed we'll be looking forward to where we're going in the Spring. That will require the setting of priorities that will come out of the work of some of these working groups.

As the honourable member indicated, she sees primary care as an important priority and so do we.

MR. CHAIRMAN: The honourable member has approximately five minutes left.

[7:30 p.m.]

MS. WHALEN: Our time is going fast. I wanted to ask if the minister could give us the total figure for mental health services this year. I was at a conference on the weekend -

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it might have been two weekends ago, actually - but the figure was said that in our province we spend less than 4 per cent of our health budget on mental health services. As the minister will know, yesterday we had a panel of mental health advocates who were here at Province House, each one telling a different story of their aspect of mental health, and I know you have been a strong advocate and proponent for more help in the mental health area. Something like 90 per cent of the sick days or long-term disability days are actually because of mental health issues like depression, it was said yesterday. We know that it has a huge cost - physical and mental anguish cost. Can you tell us the amount of money?

MS. MAUREEN MACDONALD: While the staff are digging out the figures, I want to thank the honourable member, Mr. Chairman, for raising this particular issue and yes, it is an issue that is of great concern to me and has been for many, many years. I've had the privilege of working in the mental health care system, particularly with adolescents but also with adults. I was, I think, heartened a number of years ago - not so long ago, I think it might have been, and the honourable member would have been there - at Public Accounts when the former deputy minister appeared at Public Accounts, perhaps her last appearance in front of the Public Accounts Committee, or close to her last appearance. She indicated that she didn't think that we did enough, that the province hasn't done enough for mental health consumers. This is a point of view that I share. I shared that point of view at that time and I share that point of view today.

I know that we have financial challenges ahead, but this would be a priority issue for me, to be able to improve on the mental health services that we have and to improve on the situation for people who have mental illness and their families, in fact. It is a priority for our government. I think I saw something - I don't have a chance to look at the government wire very much, but I think the honourable member for Dartmouth South-Portland Valley announced today a curriculum in the school system with Dr. Stan Kutcher, to introduce more information into the school system for children and youth with respect to mental health and mental wellness. I think that this is just terrific. It was something that our Party was very committed to in the election - that we would do more for children and youth.

I know that yesterday I wasn't able to attend the member's press conference, but during the election I think pretty much the same group who organized yesterday's press conference had a press conference at the Bloomfield Centre on Agricola Street to discuss their desire to see a mental health strategy developed for the province. I took time away from knocking on doors to attend that press conference, and I was the only candidate that did that. I know how busy everybody else (Interruption) I know everybody else was very busy and I don't fault people for not being there. But it was great to go and to hear people who are working on the front lines, who are family members, who are consumers in the mental health system. I know we need to improve on our programs and I'm convinced that there is a lot that we can do.

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The total mental health funding is $119 million, or slightly higher than that - $119,599,400.

MR. CHAIRMAN: Order. The time allotted for the Liberal Party has expired.

The honourable member for Victoria-The Lakes.

MR. KEITH BAIN: Thank you very much, Mr. Chairman. I have just one question I'd like to present to the minister before I turn it over to my colleague, and it is concerning the ambulance service in the North of Smokey area. That's the North of Smokey area of Victoria County - although it's very low in population, it is quite large geographically. As a matter of fact, in perfect conditions, I guess it would probably take an ambulance about one hour to go from Bay St. Lawrence to Neils Harbour and Buchanan Memorial Hospital.

Madam Minister, up until about three years ago there was only one ambulance that served that entire area, and the government in its wisdom then decided to put a second ambulance in place. That ambulance was strategically located to serve the area. As well, Madam Minister, of course patients at Buchanan Memorial at times require transportation to the Cape Breton Regional Hospital for treatment and testing and surgery.

Over the past, concerns have been expressed by the low number of calls that the ambulances in the North of Smokey area receive. I think it's imperative that along with looking at the number of calls that are made, the geography of the area has to play a very important part. If there was only one ambulance and, again, prior to three years ago, there was only one ambulance in the area, EHS was strategically pulling ambulances from the other area to serve. But again, realizing the geography of the area and the fact that the North of Smokey area of Victoria County is surrounded by mountains on each side, and especially in the wintertime, I feel it's important that the two ambulances remain in the area.

So my question, I guess, Madam Minister - and I'm not sure how familiar you are with the situation and, again, I can't stress enough the importance of maintaining that second ambulance - if you could comment on the ability of keeping the second ambulance in the area with the funding that has been given to EHS. Thank you.

MS. MAUREEN MACDONALD: Mr. Chairman, I welcome the honourable member to the floor to ask questions on estimates. I wouldn't say I'm an expert or anything on the scenario that you raised, but I'm certainly familiar with it, I've been in the House and I've heard this issue raised in the past.

As you know, we have a fantastic emergency system of ambulatory care. I can certainly understand why the people you represent, and particularly since large parts of your constituency are very isolated and very beautiful, but very isolated in many respects, and the conditions that you point to - the department has no plans to remove the second ambulance

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at this time. We have a contract with Emergency Health Services, though, and we're constantly in contact with them about the needs and where the needs are and how things are changing or not changing, but we can certainly understand why people in your constituency would want good, effective emergency health care services and we want for people in your constituency to have good, effective emergency health care services, too.

MR. CHAIRMAN: The honourable member for Argyle.

HON. CHRISTOPHER D'ENTREMONT: Thank you very much, Mr. Chairman. It is a pleasure to stand once again for a little bit and ask a few more questions before I hand it over to the minister for some closing remarks on the health care side of her portfolio.

Just to sort of continue on a little bit on the question from the member for Victoria-The Lakes - there was also an added issue there because they felt that paramedics really weren't that busy, I mean it is there as a support to the existing ambulance in a lot of "just in case", because the area is so large and it is cut off by Cape Smokey on one end and, of course, around the cape on the other end of the Cabot Trail - the issue was to work with EHS and EHS had made a proposal at one time to try a little more community paramedicine of maybe utilizing the paramedics to do site visits, meet up with folks who need a little bit of extra, you know, dear Mrs. MacDonald - I'll pick a MacDonald up that way - have you taken your pills today, how are you feeling? And going to check some blood pressures and things like that. So I would just suggest that maybe that's a really good thing to pursue for the folks North of Smokey.

I want to go quickly through some of these questions, and the transformation - I thank the member for Halifax Clayton Park for bringing that one forward - it is a very comprehensive document, one that has a lot of recommendations in it and I think we were very proud to get a lot of the legwork done because getting the transformation office up and running, to convince the district health authorities that this was the right move to do, and I know your deputy can speak to how many hours I ended up having to speak and, of course, his predecessor, Cheryl, had to speak as well to continue to keep the district health authorities on side.

The one that I'm most familiar with right now was the nursing model, the one that, basically - and I think there was one unit in Bridgewater that was put together and I'm just wondering what the effect at this point has been of trying to change some of these models, and has there been other concrete examples of those recommendations being put in place in the health care system?

MS. MAUREEN MACDONALD: I want to thank the honourable member for the question. There are a number of initiatives that are indeed moving forward. The work on the lab between the IWK and CDHA, that work continues in that area. Models of care, of course, continues to be an area of considerable interest and work, and continuing care, of course,

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devolving continuing care into the DHAs, which is a really big piece of work - not that the others aren't, they're all significant pieces of work but that one is truly a big piece of work - so the work in those areas continues. And that's not to say that there isn't work in other areas as well, but those are certainly three priorities and significant movement in that way.

MR. D'ENTREMONT: The funny part of that transformation document that Brad Campbell and, of course, Corpus Sanchez International brought forward to us was sort of - there are a lot of things in there as a health care group that you could say, duh, those make sense, we should be doing them, but we weren't, and as to how to basically change the culture within the system so that they can offer a safer, better quality system. So the exercise that the transformation document provides to us is not only a dollars and cents issue, but was a better quality of care for Nova Scotians.

[7:45 p.m.]

The realized savings of this document, once you would have everything in place, is really a guess - is it truly going to save us lots of money, are we going to be able to curb the beast that is the health care system? Because right now - and I remember doing my speeches and I hope you use it in yours too - when you talk about the $3 billion health care system you spend, what, over $1,000 a minute in order to maintain it. But if there's anything that I can suggest, it is continue the work that's happening. The transformation group is a large one at this point, and I know that I could probably ask for line items on that one, but they're there for a reason - they're there because of all those task groups, and once those recommendations start flowing you've got to have a group of people taking those extra recommendations and putting them in practice and working with those district health authorities. So it's a very exciting piece of work and I look forward to watching that one as it goes along.

Before I ended last time, we talked a little bit about community clinics and I know that's sort of in the transformation documents and recommendations as well. Another suggestion that I would have, one I was able to do as minister, was provide some of these clinics with some funding. A lot of these organizations, let's say the Bear River clinic, are very, very grass roots. They were providing everything from Chinese acupuncture to a doctor visiting a couple of times a week. We ended up, in order to keep that service there, and this was right after the clinic actually had burned down, to provide them with about $40,000 a year to help with administration - basically to keep the lights on, have a central booking person there and then everything else sort of flows in on top of that.

We were also able to provide some dollars to the clinic in Clare. I think the clinic in Yarmouth got some dollars, and the new clinic in Argyle, I believe, is getting some dollars - and there were some other ones around other parts of the province, but these are the ones I'm most familiar with.

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There's not necessarily a program in the department, though, that covers these things. It was dollars that were being brought through acute care, I think, and flowed to the district health authorities to then pay those costs to those clinics. So I just urge the minister to maybe keep your eye open for that one because I think there's tremendous benefit for keeping those communities well. It sort of fits into that health promotion side as well because they were providing such a benefit. I'm sure, as I did - the member for Digby-Annapolis will invite you down to Bear River to meet the folks at the clinic in Bear River. It is a very wonderful place, actually.

The member for Clare spoke of francophone services. We sort of touched that one a little bit. Maybe I didn't do it enough, but I'll do it for the record - I want to really thank Brenda Payne for that. Brenda, I know, was a very, very good advocate for francophone services in the health care system. We talked a lot about it when I was Minister of Acadian Affairs in trying to find ways through our federal-provincial agreements to find dollars to continue to expand upon those services. The health system on the Web site still has that listing of francophone services available to the population. I hope you continue that work and make sure that continues to expand.

A quick question around that is that I know we had a really good agreement with the Université de Sherbrooke to make sure we had some seats there. I think it's three seats there, but there's a bit of a complicating factor because of the new medical school at Université de Moncton. I'm wondering maybe if you had any information on how our students are doing in Sherbrooke and whether there's going to be any work done with Moncton which, for some of our Acadian students in our area, would be a definite benefit, rather than having to go all the way to Quebec.

MS. MAUREEN MACDONALD: Just a couple of things. On that last point that the honourable member raised, we don't have an answer for you, but I will look into this and see what I can find out. Earlier I was saying to the member for Clare that one of the first briefings I had in the department, when we were talking about physician supply, certainly I received information there the number of francophone students from your communities - I think it's like eight or nine now - and I was very pleased to hear that, but I don't' think anything was raised at that time about the Université de Moncton. It was all that they are at the Université de Sherbrooke. I think federal dollars help us train them there. I think that's fantastic.

I guess you're saying there's a program now in Moncton that we could also be looking at. That's worthy of exploration, and I'll try to get some information. I'm sure it exists in the department.

I want to go back to the points the honourable member was making about the community health clinics. I, well obviously, I have a bias because of the North End Community Clinic. It's the oldest community health clinic in the province. It's the first community health clinic in the province. All community health clinics have their own unique

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characteristics but some people - the model of community health clinics that the North End Community Clinic represents is sort of the original idea of what a community health clinic would be, which is a team. The North End Community Clinic was way ahead of its time. The people who conceived and got that clinic going, were well ahead of where we are now. They understood the value of having a health team. They understood the importance of having a variety of perspectives that would work with people and utilize a health care provider, like a doctor, who is highly trained and quite specialized in some ways for those things for which a doctor is best to be used, have nurses do things for which their scope of practice allows them to best use their skills, and a social worker to do the things that they're best skilled at.

So this idea of having a team surrounding a patient and working with all aspects of what a person needs to be well and to be healthy, is an idea that was the foundation of the North End clinic and was the way that they attempted to practice health care 25 years ago. Again, I was saying earlier, I can go throughout the community and find other programs that originated as pilot projects out of the North End Community Clinic and then moved out. The Mobile Crisis Team is a very good example of that. That started as a little project funded by the federal government through a Health Canada grant to the North End clinic and on and on.

So community health centres are really important. I know that there is no core funding available in the department. Everything comes through the DHAs. I grew up in Antigonish County, there's a little community health centre in the community of Havre Boucher. It's invaluable for people who live in those communities to get access to a nurse, a dietician. We need to be able to build into those community health centres more than a family doctor as well. I mean, not that that's not important but to become truly a community health clinic you need the team approach. That's my - not just my bias, but I think that probably the empirical evidence would support that that's the best way to deliver health care.

So I would take those issues that the members has raised and his advice as well around the working of the health transformation process and I thank him for sharing his insight as his time as Minister of Health, with me.

MR. D'ENTREMONT: Mr. Chairman, I'm going to finish my questioning on the Department of Health. I'm going to look forward to maybe asking some questions tomorrow on Health Promotion and Protection. I wish the minister well in her endeavour as minister. As I said when I started, when I first took my position as Minister of Health, everybody went to me and said, oh my God, how could you have possibly accepted something like that? It's a horrible job. It is quite the contrary. It's a joy, it's wonderful, it's exciting and I hope you have as much fun at it as I did during my time there. Of course I wish your deputy minister well. I know he's only here for a short time but I know it's going to be a fulfilling time so he's time, I'm sure, and, of course, Linda Penny, she can work miracles when it comes to the dollars and cents of that department. So make sure you work with her. I really don't know who's standing up behind me, but I know there are a number of great members of the staff

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of the Department of Health and, of course, I wish you all the very best. With that, I thank you very much.

MS. MAUREEN MACDONALD: I'll be very brief, Mr. Chairman. I want to thank the deputy and I want to thank the chief financial officer for the department for providing support, as well as the head of communications for the department, who's in the gallery. (Interruption) Absolutely.

I know that I'll have a fair amount to say about the programs of the Department of Health and all the good work we're doing over the coming weeks that we're here to debate all kinds of issues, and I look forward to that. I thank the honourable members who have joined in the examination of the Health Estimates and I hope you've gotten from my responses as much of the information as you've sought, as we could provide. If we have forgotten anything we've committed to provide to you, please let me know and we will do our best to accommodate your requests.

At this point I would like to move the adoption of the estimates of the Department of Health, Mr. Chairman.

MR. CHAIRMAN: Shall Resolution E11 stand?

Resolution E11 stands.

The honourable Government House Leader.

HON. FRANK CORBETT: Mr. Chairman, I move you do now rise and report progress.

MR. CHAIRMAN: The motion is carried.

[The committee adjourned at 7:57 p.m.]