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April 23, 2015
Supply
House Committees
Meeting topics: 
CWH on Supply (Health) - Legislative Chamber (1627)

 

 

 

 

 

 

HALIFAX, THURSDAY, APRIL 23, 2015

 

COMMITTEE OF THE WHOLE ON SUPPLY

 

3:18 P.M.

 

CHAIRMAN

Ms. Margaret Miller

 

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

 

The honourable Government House Leader.

 

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

 

            MADAM CHAIRMAN: The honourable member for Sackville-Cobequid.

 

            HON. DAVID WILSON: I want to welcome the minister and his staff back again today. I want to pick up right where I left off last evening. I was asking the minister - we were talking about nurses and the number of vacancies that are available here in the province and a bit of discussion on that - I was asking some questions around the nurses that were being flown in to cover off shifts, especially, I believe, in the ICU that has been closed. The minister was providing some information on when it started and anticipation of how long that would take.

 

            In my question I asked if the minister could provide us the cost for that and the minister indicated that there hasn't been a cost because they haven't been billed yet, which is fine, but I would assume that there is a contract and in that contract there would be figures of what the estimated cost would be to have these nurses coming to our province. So I'm going to go right back to that, I'm wondering if the minster could indicate if there is a contract and how much is the estimated cost, if they haven't received a bill or an invoice yet, what is the estimated cost to have these nurses who are here in the province from outside.

 

            HON. LEO GLAVINE: Any time we have to go to providing our human resources from outside the province, it is a time when we need to review what practices we are doing to make sure that we have those specialty areas, those areas requiring additional training beyond the RN and perhaps even years of experience. Today in those work environments - and I've had an opportunity to be in a few of those units across the province - it is truly amazing how high-tech those work environments have become so that specialty training is an absolute requirement. You just cannot fill the position with a nurse who may be very willing to fill in.

 

            In terms of the current arrangement, because it's not a long-term contract, there is no dollar figure that is set for the contract. Again, depending on the need of those 15 nurses on an ongoing basis, at some point during their time here, from March until October, there could be interim billing. At the present time there has been no bill that has come forward. We will check, before the House rises, if not sooner, to see if the new provincial health authority has some information and interim billing since now it would be coming to the new provincial health authority.

 

            I think the good news here is that 28 nurses are currently in training to fill those ICU specialty areas, and at the QEII there are several ICU units and they have different requirements. It is certainly now the hope that with 28 additionally trained staff that the future will be able to be well covered by those new trainees.

 

            MR. DAVID WILSON: There must be a contract with the agency. I know that there is an agency that has been putting ads and have been reaching out to nurses across the country. I actually saw some of the correspondence that did go out and it was indicated that there is a great opportunity to head to Eastern Canada for nursing positions so there must be a contract that the minister could give us a breakdown on what the cost is for that nurse.

 

Maybe they haven't received the bill but I would think you would not just say okay send us a bill, whatever it is, down the road; we'll figure it out and we'll pay it. What would be the cost to have that nurse? Maybe it's as simple as a dollar figure per hour, so maybe I'll simplify it down to that. In the contract that they have, I would assume they have a contract, so what is the dollar figure being charged per hour for that one nurse to be here?

 

            MR. GLAVINE: To this question there is, of course, the bigger picture of overtime that would cover off some of this particular area. At the present time, I believe, some of the challenge is around the fact that when these nurses started, they came under the Capital Health District, now they have switched and are employees of the provincial health authority. We will make contact with the provincial health authority and provide the member with at least what is the hourly compensation that they are receiving. Yes, there would be other costs associated with coming in from another province and we will provide that information. They are working on a rotating basis while our new grads are being trained to cover the ICUs at the QEII.

 

            One of the areas that I did look at during this process, to see whether or not we are seeing a dramatic increase in overtime, and the statistics are very similar to - I know the first year or so which the former government took office and there was some improvement made and we're back now to a 10/11 level of overtime.

 

            MR. DAVID WILSON: Madam Chairman, I'm trying to be difficult but I have to say, I would think the Minister of Health and Wellness would know what the cost is going to be to have nurses from outside our jurisdiction come to the province. I don't understand why he can't provide that number. I know he said he was going to try to get it to us down the road, he's going to go ask the district health authority but as minister, I don't believe the district would go on their own and bring nurses in without having a discussion with the Deputy Minister and the Minister of Health and Wellness. I was in that chair and I don't believe that would ever happen. I don't understand why the minister won't provide that. That's fine, if he's not, we will hopefully get that information down the road.

 

The government is supposed to be open and transparent; they have said that. All I'm asking for is how much this is going to cost. It's not a secret that we have these nurses in our province and there is so much information out there that these nurses that are working next to nurses from Nova Scotia are being paid more an hour, so I think it's a very simple question. I think it's a question that the minister and the deputy minister should have an answer for and the finance department in Health and Wellness - that information should be at their fingertips.

 

            I would like to ask the minister now, he did commit and I want to thank him for the information he provided last night. He answered - I guess we're not at eight o'clock yet, so I'm not getting the answers out of the minister yet that I think I should get. Yesterday he did mention that he would provide some information on some of the things that I asked yesterday, so I'm just wondering if he's able to do that at this time.

 

            MR. GLAVINE: If I could have the member repeat the question, we were looking at some data that was coming in for us here.

 

            MR. DAVID WILSON: Thank you, I was just wondering if the minister could provide some of the information that he had agreed last evening to provide to me on the questions. I can get him a detailed list but I was wondering if that is possible.

 

            MR. GLAVINE: Madam Chairman, I'm prepared to table the information on the nursing workforce in the province. That's a detailed breakdown and that's available for the member. This is one of those areas where, as Minister of Health and Wellness, it is certainly not in any way to provide a roadblock on this information. This will all be made available. One the areas that I've really focused on in the department is truly policies and programs, and I know and have been able to experience the tremendous level of operational expertise in our province.

 

When it comes to operational decisions, yes, they were made by Capital Health up until April 1st and now with the new health authority, since then I really work to stay out of those matters, not work to control them. They have the expertise and they have the experience, and when it comes down to whether it's additional monies that a district needed for operations, we would then convene and I would have the two people who are here with me today as key to those decision points. This was a Capital Health decision but it is now in the hands of the provincial health authority. I know we will have that information at some point here.

 

            It is actually still very early, considering that the work began in March and based on the availability of the new nurses and their training to be in the worksite as to how long they will remain in the province, the outside date is October and again, it was not a long-term contract.

 

            MR. DAVID WILSON: Madam Chairman, I thank the minister. I look forward to receiving that information. One of the things that I know the government had indicated early on is the fact that they would develop a province-wide surgical plan. I'm wondering if the minister could indicate if that work is ongoing and is there a cost to that or is that just something that can be done within the department? I know they talked about this surgical plan, I'm just wondering if any work has been done for that.

 

            MR. GLAVINE: Madam Chairman, I'm pleased to say that this is part of the work of the new provincial health authority as they do a clinical review and take a look at what surgical services should be provided where, and whether or not we would take a look at areas across the province that have capacity. We know, for example, that 90 per cent of our surgeries are done within the guidelines so, therefore, it is that troubling 10 per cent that we need to address.

 

It's very interesting, one of the groups that I was hoping to see come together and really work to address what is our most troubling and longest wait-list in the country with hip and knee surgeries, and orthopaedic work in general, and in fact, it was while the member for Sackville-Cobequid was in office that the perioperative committee took the orthopaedic surgeons into a meeting to see if they could come together and develop a provincial plan that would be part of the answer in dealing with this troubling wait time.

 

When I arrived as minister, one of the most pleasing discoveries was to find out that under the guidance of Dr. Kirkpatrick, this work was well underway. There had been additional meetings and they were able to provide to me in around January 2014, now over a year ago, the steps in a province-wide plan. This really was almost a microcosm of what we want to do right across the province. They were looking at how they could tackle this problem, how they could take the five sites, plus Scotia Surgery, and do more work; that they could maximize the capacity of the surgical units so that we would see an improvement in this troubling wait-list.

 

            That plan got underway; last year $4.2 million was put into the plan. They advised that there was going to be a need for a foot and ankle specialist. One of our quite young orthopaedic surgeons wanted to be part of working with Dr. Glazebrook to try to reduce that wait-list. He is currently finishing up his fellowship and in 2016 will be doing those very specialized foot and ankle surgeries. We know that when we start to do work there, it's going to certainly help that wait-list.

 

            Last year - I can get the figure - we had several hundred more surgeries done across the province for hip and knees and now that that plan and a central wait-list and that whole organization that the orthopaedic surgeons have put in place, we are now getting more work done and this year the goal is to have about 400 additional surgeries completed. We know that if we have a perioperative plan for the province, what we see happening in orthopaedic work can now be the example of what other surgeries can see as a model and we would have a provincial approach to surgery and that is where we currently are.

 

            MADAM CHAIRMAN: The honourable Acting Leader of the New Democratic Party.

 

            HON. MAUREEN MACDONALD: Thank you very much, Madam Chairman. I'm pleased to have an opportunity to ask a few questions here in Supply around Health and Wellness. What I would like to ask the minister is for some of the allocations in his budget that are provided for. We don't get a lot of detail in estimates. I have the Supplementary Information to the Public Accounts, the last year that there is Supplementary Information, it's 2013-14, and I want to go through some of the grants and some of the provisions in that. I would like to find out what expenditures were for different line items in this current year and what is budgeted for those line items in years that are coming up.

 

            The first grant or contribution that I would like to know about was to the AIDS Coalition of Cape Breton - $167,500 was provided in 2013-14. I would like to know what is being provided for that group and probably all of the AIDS groups would be reasonable to do all at once. The AIDS Coalition of Nova Scotia that year got $46,000 and I note that there are a few others so if the minister could tell me what is being provided to these organizations in the budget that is in front of us in the estimates.

 

            MR. GLAVINE: Thank you very much and I thank the honourable member for joining the estimates questioning and debate period. I was just asking, was there a page specifically from the Supplementary Information that you were referencing or was it in general? Were you asking about the total grants that are given to a number of organizations that support the AIDS Coalition and that area in the province?

 

            MS. MACDONALD: Thank you. Well, we could start with the AIDS Coalition of Cape Breton and look at the AIDS Coalition of Nova Scotia. What is the provision in this year's estimates for those organizations?

 

            MR. GLAVINE: In the last fiscal year AIDS Coalition of Cape Breton received $167,500, and I would have to check to see if that was a one-time grant or ongoing because that group is not identified as having been cut. They were not one of the organizations that were in the third year of a three-year grant.

 

            MS. MACDONALD: I thank the minister for his response. I just asked the minister if he would undertake to provide me with the information, when his department can provide it to him, whether or not that group is going to receive any grant in the estimates that are in front of us for the fiscal year going forward. I also want to ask the minister about the Alzheimer Society of Nova Scotia. The Alzheimer Society of Nova Scotia in 2013-14 received $20,000. I am interested in knowing what provisions are being made in the current budget for the Alzheimer Society of Nova Scotia.

 

            MR. GLAVINE: That particular budget is still being given at the 80 per cent level for this year. The Alzheimer Society is a co-lead in developing the dementia strategy. The dementia strategy will come out this year and there is obviously a cost to the dementia strategy. There are areas that require actions to be initiated and we know that the Alzheimer Society has had a number of very strong community programs and projects. One of them in the Digby area has worked to keep Alzheimer's patients at home is proving to be very successful and we know that the Alzheimer Society is one that will be supported through the dementia strategy.

 

            MS. MACDONALD: Thank you. If I'm to understand the minister, the Alzheimer Society's $20,000 grant has been cut by 20 per cent? There has been a 20 per cent cut. I want to ask the minister about the Canadian Cancer Society. The Canadian Cancer Society had $200,000 in a grant in 2013-14 so I'm looking to understand what has been budgeted for the Canadian Cancer Society in this budget.

 

            MR. GLAVINE: That is not on the list for a cut this year and I'm just looking through the grant areas and I will have some further information as well on any that you have asked about, what their level of funding was in 2013-14 and what their level will be for the 2015-16 financial year.

 

            MS. MACDONALD: In the same light the Canadian Mental Health Association had a grant of $253,718 and the Canadian National Institute for the Blind, $175,000. I'm interesting in knowing what their grants will be for both of those organizations on a go-forward basis.

 

            MR. GLAVINE: We currently don't have that level of detail here but we have made good notes and we will provide that.

 

            MS. MACDONALD: I appreciate that, I thank the minister, and I'll look forward to getting that information. I noticed in the Public Accounts from 2013-14 there was a very small grant, $13,000 to the Centreville Baptist Church, and it kind of stood out for me when I was going through the grants for the Department of Health and Wellness. I was curious as to why that may have been appropriated for that particular church and I'm wondering if the minister could advise me on what that expenditure was for.

 

            MR. GLAVINE: I want to inform the member opposite that we will have staff give us the detail around that particular grant. It is a good possibility that they were one of the health support organizations that were doing a community reach program but we will get you the detail that you wish for that.

 

            MS. MACDONALD: I appreciate that. Because it was the only church organization that I saw, I was curious. It may be one of those small recreation facility-type, healthy living grants. Caregivers Nova Scotia, as well, has a grant of $331,246 in the 2013-14 Public Accounts and I'm wondering what their grant might be on a go-forward. I will maybe outline a number and then the minister and his staff can help me with these at a later date.

 

            Connection Clubhouse, $8,000 grant; Direction 180, $193,771.91; and I noticed that the Duke of Edinburgh's Award gets $30,000 from the Department of Health and Wellness. The Ecology Action Centre, $151,000; Halifax Sexual Health Centre, $117,340; Health Association Nova Scotia, $1,590,396.60; Heart and Stroke Foundation, $179,500; Heartwood Centre for Community Youth Development, $100,366; Injury Free Nova Scotia, $121,566; Laing House, $240,000; LOVE, Leave Out Violence Nova Scotia, $100,000; the Lung Association of Nova Scotia, $50,000; the National Sport Centre Atlantic Canada, $168,532; the North End Community Health Centre, $25,936.86; Nova Scotia Hearing and Speech Centres, $14-plus million; the Nova Scotia Yachting Association, $65,000; ParticipACTION, $250,000; the Schizophrenia Society of Nova Scotia, $31,000; Self-Help Connection, $237,698; Sisters of Saint Martha, $984,027.86; Smoke-Free Nova Scotia, $87,310; The Epilepsy Association of Nova Scotia, $20,000 - I think that was also reduced by 20 per cent.

 

The Lesbian Gay Bisexual Youth Project Society, $167,400; The Marguerite Centre, $174,310; I have a couple of other questions about - there are at least two law firms, which maybe I'll ask some more detailed information around; and the Independent Living Nova Scotia Association, $190,000.

 

            Those pretty much are the grants and contributions that I'm interested in knowing more about, the NGO in health charities sector, and what is happening to their budgets in this particular budget.

 

            So that leaves out some rather large programs that I want to talk about. I notice in the Supplementary Information that the IWK Health Centre, back in 2013-14, had $221,225,224.22 under Grants and Contributions. I'm wondering what the line item is for the IWK in the year that we just completed and then in the year that we're looking at estimates for.

 

            MR. GLAVINE: First of all, I want to thank the member for inquiring about those organizations in terms of their grants. As the member knows, we pay out about $27 million in grants in the Department of Health and Wellness. The ones that did have the 20 per cent cut were ones that had a three-year plan to assist them so many of those organizations would be coming up for a review or a resubmission in this particular year.

 

A number of the organizations that the member mentioned, as well, were receiving two grants - the Schizophrenia Society being one of them - so one grant is entirely maintained at 100 per cent; the other grant was part of a three-year program. We will have to break that information down for you in terms of providing what I would call core funding type of grants. For example, I know that Laing House is getting the same $240,000 as they did receive in the last fiscal year.

 

So there are a number that are exactly the same and there are some others that were part of projects and initiatives that would require three years to get established or maybe for those organizations, a one-time pilot or a one-time program that the organization was offering.

 

            I know any time there is a change, these organizations that have something in place that they are delivering to the public and very often, as the member knows, some of our most vulnerable groups of citizens, so we will get that breakdown to show what is absolutely maintained 100 per cent and ones that were affected by the 20 per cent cut.

 

            In terms of the IWK which was the last area asked about - this is on Pages 14.14 and 14.15 of the Estimates Book - the 2014-15 estimate was $199.178 million; the forecast, $201.089 million; and the estimate for 2015-16 is $209.024 million. So that would be Administration, Operations, Inpatient Services, Ambulatory Care - all of those areas.

 

            MADAM CHAIRMAN: The honourable Leader of the New Democratic Party with 30 seconds.

 

            MS. MACDONALD: If I only have 30 seconds, I'm not sure that I'm going to be able to make much use of that. I gladly hand my time over and I thank the minister and his staff, maybe we'll come back.

 

            MADAM CHAIRMAN: We'll move on to the PC caucus.

 

The honourable member for Pictou West.

 

            MS. KARLA MACFARLANE: I just have a couple of questions, not with regard to finances or anything. Active Pictou County is concerned with regard to - they have secured money, I believe $30,000, towards our Hector Arena in Pictou under Health and Wellness. I'm just really here to confirm that that money is still going to be going to them towards that.

 

            MR. GLAVINE: I'm pleased that the member for Pictou West is concerned about the couple of ongoing issues in her riding. I think that you are asking about a proposed recreational grant, in other words we have facilities improvement grants up to $150,000. It generally means that the organization already has their money in place when they apply and then the department works to provide that funding.

 

            We have had a percentage cut from the 99 proposed projects. It is an area that as minister I was very concerned about because it is really our arenas, our ball fields, our soccer pitches, and our outdoor summer pools - all of these recreational facilities will help us work to developing a healthier population.

 

            It is an area that as we looked at all of the grants in the Department of Health and Wellness, which totalled over $27 million, and in trying to develop some fiscal restraint, we worked to distribute the cuts over a wide area. At the moment what I have done is have a look at those grants. Some of the 99, while the organization had the money, the permits for the projects and that kind of detail were not fully in place and the regional directors were able to say that we could look at doing those projects in the next fiscal year.

 

            However, I've asked for our department to have a conversation around what percentage of those grants or which grants we could do full for this year. I met with our director this past week, Stephen Gallant, and I gave him the directive of taking a look at if there are a number of these projects that we can do in full this fiscal year and some others that aren't quite ready to go, maybe more towards the end of this fiscal year, then could we put those in a holding pattern for the next 11 months?

 

            What I will tell the honourable member is that as soon as I have that information, because we sent no information out to the communities around the 99 grants as to whether they are 100 per cent go or we're able to give you 70 per cent of funding in this particular year. The other aspect about that grant is that it has a total amount of money in the Health and Wellness budget each and every year so we cut the total down and now it's looking at how we can distribute it over the application of 99 grants. Some we will be able to do fully, others on a percentage basis.

 

I'll give the member a really good example in my home community. In the ice season of 2011-12, in a 37-year-old arena we had a number of pipes that broke at the same time and a day before it was to open, we had the first amount of glycol come through the ice. They repaired that very quickly and everything looked fine, then the pipes broke in two more places, which was really telling us that we had a bigger problem. This was at the Western Kings Arena, which is now known as the Credit Union Centre. What they did was they applied for the $150,000 to replace the floor, new piping, and they were able to get $85,000 one year and then they got the remainder in the next fiscal year.

 

            Those are grants that I'm very conscience about seeing communities get. As soon as I have a final figure, I will make sure that the member opposite is supplied with that information.

 

            MS. MACFARLANE: Madam Chairman, I would like to thank the minister for his answer. My next question is around a situation of doctors in Pictou West. We have a young couple, a husband and wife team, and the concern is that he is actually in the Pictou clinic and his contract is up this August. His wife has been desperately trying to get a position and has not even been able to be given an interview. I know that there have been some situations where there have been sponsors to get doctors.

 

I guess the real threat here is that as a young couple, they want to stay in Pictou County; they want to have kids and stay there, but the threat is that his contract ends in August and he is claiming that if his wife cannot be hired on somewhere, they will be picking up and moving on. They can't continue. It is two years now that she has been trying to find a position or a placement. I'm just wondering if you could help, give me some information to better understand how the process works, and if there is anything I can do to help them and secure that we not only have him here as a doctor but her as well.

 

            MR. GLAVINE: If the member could just provide me with one detail before I respond. Is this a position as well in the health field? Is it a doctor? Is it a nurse? If you could just provide a little bit of detail on what the partner requires in order to stay in the area.

 

            MS. MACFARLANE: Sorry about that, I should have been clearer. She is a doctor and looking for residency. She's even willing to - she said I don't mind if they find me a spot way up in Cape Breton or in Yarmouth but I want to be able to stay here and go through my residency here and know that in a year or two I can come back to Pictou, be with my husband, and start our family.

 

            MR. GLAVINE: What I will convey to the member opposite is to get a bit more information in terms of - was the doctor foreign trained and had received a sponsor to come here to the province? Has she cleared all the requirements and so forth? That's something that I'm prepared to take a look at with the member and just to get a sense of whether the husband for example, if it is the husband in this case, that they'd get the first job and maybe there was a four-year commitment of return of service to the community. Very often the foreign trained doctors who come to the province have to do a return of service; they also have a mentor doctor once they are assigned a particular community. So we will have to get just a little bit more information.

 

One of the big facts that always comes into play in a particular area is the physician resource plan for the province and whether there are enough doctors currently in that area to provide service. We know that there are probably always some patients that don't have a family doctor but in some areas there is the right complement, the right number of doctors that can be in a community. Maybe as you stated, focusing on another community where there could be an opening would be something that would need to be investigated.

 

            One of the areas, too, now that I believe is going to help facilitate this whole process is with the one provincial health authority because credentialing of doctors will be carried out in a provincial way for each of the four management zones. This is, again, a case that may be able to be supported. I can't make a commitment on a job but to investigate and to see what is possible, and we can get the information and see what is taking place.

 

            MS. MACFARLANE: I look forward to speaking to the minister afterwards and providing the information on this young couple that truly are a wonderful addition to our community and we really want to see them both be able to stay.

 

            My last question is with regard to the Sutherland Harris Memorial Hospital in the Town of Pictou. As we know, as well, there is a veterans unit there and there have been some concerns about what will actually take place. Our veterans our decreasing; we're down to, I think, 19. There are some concerns just with regard to: has there been discussion that those beds would turn into more restorative care beds within that hospital? As you know right now we do have a wonderful restorative care unit there too. We're just wondering if there have been any discussions around what would happen to the veterans' beds.

 

            MR. GLAVINE: I did have a tour of the Sutherland Harris Memorial Hospital and as she pointed out, the restorative care unit there is truly impressive and the work that takes place. I met a good number of the medical staff, also those who provide an array of services to the veterans at that site.

 

            This is a question now that is hitting our province, probably on a proportional basis, perhaps one of the most significant provinces in Canada in terms of veterans when you think of the number from Nova Scotia who were in the Second World War and the Korean conflict, because of being a very strong naval port, so we have a lot of veterans here.

 

As the member rightly said, it has really been quite noticeable over the past decade and one of the barometers that I use is The Chronicle Herald. When you look at the obituaries, beneath the picture or at the top of the obituary is that Canadian flag to identify them as a veteran or a member of the Forces. When I speak on Remembrance Day, for me it's one of the ways in which I used to be reminded daily of the great sacrifice of our veterans but now I'm finding there is less, actually, on the pages of the newspaper to remind us of our veterans who are passing. We know that the youngest from the Second World War is probably around 87 or 88 years of age.

 

            So those beds are becoming and will become available, whether it's in Lunenburg at Fishermen's Memorial, Soldiers' Memorial in Middleton, Camp Hill here in the city, Sutherland, and other places across the province.

 

            That is going to be, first and foremost, a federal government decision on whether or not they are going to utilize those beds and continue to pay the per diem and the care for our veterans. In fact, just during the last couple of weeks I made a comment to the media around that, as MP Stoffer has been pushing the federal government to look at a class of veterans who took park in actual conflict, like Bosnia, like Afghanistan, as opposed to the general forces.

 

            That's an area yet to truly be decided. It is one that could provide us additional capacity in terms of nursing homes or some type of restorative care. All of those become possibilities for the future but I know that it's happening very quickly and I'm sure those discussions between the federal government and the provinces will in fact take on some degree of urgency in the next couple of years because we will have, in some sites, beds that become available.

 

            MADAM CHAIRMAN: The honourable member for Pictou East.

 

            MR. TIM HOUSTON: Thank you, Madam Chairman, and I thank the minister for his time this afternoon. In the budget there is $4.2 million allocated to work to meet the national standard for hip and knee replacement wait times. I wonder if the minster can just provide some insight on how that $4.2 million will be disbursed. What is the actual plan? Is that mainly for - I'll leave it at that, I guess, and maybe the minster can just elaborate a little bit on the plan for that $4.2 million.

 

            MR. GLAVINE: I welcome the member for Pictou East to the debate and to estimates this afternoon. The member asked a very good question considering our orthopaedic challenges here in the province. He does live in an area that has one of our five centres. I have met a number of the orthopaedic team at the Aberdeen Hospital. I don't have the number in front of me but I know, because of the $4.2 million that was put in the budget last year, they did execute more surgeries and more procedures last year.

 

            I don't have a breakdown of the Aberdeen site but last year in terms of hip replacement, 131; knee replacement, 288; and pediatric spinal surgery, 12 - for a total of 431. We will add an additional several hundred this year. That came from the $4.2 million and now we're at the $6.2 million as a result of the budget this year.

 

            In terms of the orthopaedic work, I can give a little further breakdown - $1.2 million for additional foot and ankle surgeries. We have a number of our orthopaedic surgeons who are sometimes very specialized: one may do only hips, one may do only full knee replacements, some may do partial knee replacements, and obviously foot and ankle is a big area.

 

            We now have a number of our orthopods who are doing small surgeries on foot and ankle, those that are less complex, considering - and maybe the good doctor will correct me on this, but I think it's about 212 bones in the foot so you can see the complexity of a surgery dealing with a foot and ankle. So $4 million for additional hip and knee replacement surgeries and $1 million to begin a multi-year effort to design and implement efficiency and quality process improvements across the orthopaedic patient continuing of care.

 

            It's not just a matter of putting more dollars, it's how we're going to spend those and this is why the perioperative committee, which is the surgical committee for the province, have started with the orthopaedic group to make a plan for the future. I know the previous government did a little bit of what I call March madness. They had some money at the end of the fiscal year and they bumped up the number of surgeries through March, and maybe into April, but it will only be a strategic plan involving the orthopaedic teams across the province that are really going to make a dent into that wait-list, that way-too-long wait-list.

 

That is now well underway and what is really great about it is that the orthopaedic surgeons themselves said, look, we're branded with the longest wait-list; we want to do something about it. They came together and so their initiative now has led to this plan here. This is a case where the Department of Health and Wellness and government, as the funding for this work, are really just a part of the catalyst to execute more work into the future.

 

A part of this, too, is that there are also now pre-surgery clinics that are helping patients manage pain better. Some may have to do some weight reduction prior to surgery and there may be some other therapies that will benefit people, and in fact those that may have been on a list will get some other therapeutic work that will help them and may in fact become something that will sustain them with their medical requirements around orthopaedic work.

 

I think this is really one of those exciting opportunities that can be accelerated by the one provincial health authority. One of the areas we sometimes forget is that our doctors are business people. I know they all had their individual list of planned surgeries and they all realize that unless we work here, collectively, we're not going to make the big impact that is needed and so I see over the next number of years us cutting into a wait-list that grew over at least a 10- or 12-year period. I know it was one of the questions that I asked when I first came to the House in 2003, so this issue has been around for quite some time.

 

Despite the fact that 24 per cent of our population between 50 and 65 is that big cohort that's coming at us, as that tends to be the age group requiring orthopaedic work, just simply by how they have lived, what they have done for work, and so forth, I'm very optimistic that we are going to cut in to the big wait-list. As you can see the money is distributed in a number of ways right across the orthopaedic world.

 

MR. HOUSTON: There are five orthopaedic speciality zones across the province and as the minister mentioned, one of them is at the Aberdeen. Now I understand that some of those speciality areas have dedicated beds for orthopedics. The Aberdeen does not have dedicated beds and that causes problems because they may have some surgeries scheduled, show up in the morning, people are there waiting, maybe they have some relatives with them to take them home, sometimes relatives even fly in to provide care; then they get to the hospital and they find out there are no beds, so we have to cancel your surgery and reschedule it.

           

My question on that initially is, there is obviously a huge social cost to that and family issues and things like that, but is there a financial cost to the province for those kinds of cancelled surgeries? Do the doctors get a minimum fee to show up and be ready or is it just the social cost? That's my first question on that issue.

 

            MR. GLAVINE: That's a very good question. The answer in terms of the orthopaedic surgeon is they are getting paid per procedure or we do have some - and I know that I met with one of the orthopaedic surgeons here who is actually on salary. He said even though I'm all salary, I'm committed to improving the wait-list in the province and I'm prepared to do another procedure if I have the surgical time, each and every day that I have surgical theatre time.

 

            Yes, the big cost and the big impact is when a patient is preparing, when we think about going into a surgery, the preparation that is done, the requirements for family support, coming home, and the care that is needed. As all of that is lined up, and that procedure does not take place, it's more than disappointing to say the least.

 

            This is one of those areas that, again, it's very early days in terms of the provincial health authority but I can see, as we take a look and do the clinical review, that could be one of those areas where we do say - if we're going to keep the volume of hip and knee replacements going at the level that we had last year and want to increase this year, it will be some dedicated beds and better flow that is required.

 

There may be, whether it is one of the smaller community hospitals that could now take a particular type of patient, somebody, for example, whose diabetes is out of control, maybe one of the smaller community health centres could be designated to look after such patients who often come in and do get hospitalized.

 

I believe in finding that right complement of beds for particular procedures and supporting mechanisms that need to be in place. I think the clinical review will certainly help us achieve greater flow and greater utilization. The member makes a good point here because this was one of the areas that the Auditor General said, because we were looking at it, he wanted to see greater utilization of the surgical theatre, better scheduling, on time for surgeries, maximize that surgical day.

 

It's the same way when we talk about the impact of that one-day strike of nurses here at the QEII. I signed off several hundred letters from people who had lost their procedures because you start to ramp down. You're going to bring somebody into hospital if there aren't nurses to look after them; in this case if there aren't beds available you can't proceed with the surgery. It's a good point made, thank you.

 

            MR. HOUSTON: I think dedicated beds is an important part of the solution to wait-lists, so I'm glad to hear that is obviously something that is on the minister's radar as well. I think the scheduling of the surgeries and having the surgical theatre, and the bed available to make them happen, is very important.

 

            It is difficult because if you dedicated some beds to the ortho department at the Aberdeen - and I don't think they would want many, eight or 10 beds - that's really eight or 10 beds that aren't there because they are already full.

 

            In terms of the whole issue of the length that people stay in the hospital, the average length of stay in the hospital, there is probably a metric for that, and different hospitals may be better than others at getting people in the hospital for the correct amount of time, whatever that may be, for whatever ails them.

 

            I think there are some hospitalists, doctors across the province just dedicated to being in the hospital and discharging people and taking them out when they're healthy enough to go out. I believe it's the case that there are some hospitalists in the province, but I'm not sure, so I pose that question and then I would just offer the minister a chance to give some comments on whether he sees the hospitalists as a necessary profession and a necessary part of solving the bed crisis we have in some areas.

 

            MR. GLAVINE: I thank the member for the question and it is a very good one. This has become part of the standard of care in a number of our hospitals across the province where you will have a doctor who is dedicated to looking after the patients. In fact, now we have a lot of our GPs who do not have privileges at the local hospital, at the regional hospital, and they have given that over to a hospitalist. There are many benefits of having a hospitalist who is very much aware of the process, the procedures, if there is a hospital infection, for example, how to best look after that patient with the pharmaceuticals that will work best and so forth, because that is their dedicated work.

 

            The member raises a point that I'd really like to make and I think it's going to be one of those areas that province-wide, as we do the clinical review and we look at best practices, this was one of the areas that I found really fascinating when last year I spent a good part of almost four months touring the province. I know this is one that our deputy minister is aware of because he was CEO of the South Shore Health District and there were often best practices that were like a hidden gem sometimes and sometimes you'd have the opportunity to share those as CEOs met, other clinical members of the team, but lots of times we have not shared and put in place best practices.

 

            One of the latest stories or accounts I made of hospitalists compared to a GP who comes into hospital to look after their patient, when I was at Cape Breton Regional Hospital - and I'm sure the member for Northside-Westmount would know Dr. Andrew Lynk, or certainly would have heard of him. He was telling me about those patients who come under the care of the hospitalists and the GPs who come in to look after their patients. At Cape Breton Regional they have a team of three who do the 24/7, 365 in looking after in-hospital patients. The hospitalists' patients spend 22 per cent less time for the same kinds of conditions and so forth, and so lots of times it's even getting in the hospital to release the patient. This is why we now have a pilot with our NPs, our nurse practitioners, and our RNs going on in about four or five sites across the province that will give them the authority to release a patient. That's going to be another way to help patient flow.

 

            When we had some of those crisis days at the QEII, when we had an enormous number of patients going to the QEII for care, our central emergency centre, when I went to visit, the doctors who run the QEII emergency, Dr. David Petrie who looks after the entire district - the central district now - the first words they said were, minister, I know you're hearing from the Opposition, from citizens of Nova Scotia that we need more bed capacity. The first thing he said, he put his hands up, do not build more beds. We have to have better patient flow in the hospitals.

 

How we manage patients, even at the point where they are picked up at a home by EHS, there may be a better location for them to go than the QEII. We have to look system wide as to how we create better flow in and out of our hospitals, both our regional hospitals and our smaller community hospitals, because we have to work as a system and we have to integrate as a system. The question around the hospitalists is a very good one and it can help us to greater efficiencies.

 

            MR. HOUSTON: Madam Chairman, I thank the minister; I found his comments to be very interesting. I know the GPs are under tremendous pressure because they know all the moving parts of a person's life so I know that has to play into their decisions. It's interesting to hear that statistic of 22 per cent less and interesting to hear that you are hearing that from doctors, just on the patient flow. I thank you for that.

 

            Now, at the Aberdeen, we do have some beds that are dedicated for mental health patients, and mental health issues are of a great concern for me. There are a lot of people in the community with mental health ailments. I've heard a lot of rumours about the dedicated mental health beds at the Aberdeen being moved away from there to another facility; Truro is the one that comes up a lot. I was wondering if the minister could comment on his thoughts on the need for dedicated beds for that purpose in the community and then specifically the future of those beds at the Aberdeen.

 

            MR. GLAVINE: Thank you, member, for that question and the issues around mental health both in terms of acute services, crisis intervention, and long-term care to create mental wellness of patients who may be unstable is a very, very big area. The fact that Aberdeen does have some dedicated beds is very positive for that community and the area of Pictou County, and at the present time there are no plans to change that. As we look at delivering and building a province-wide system, that will then receive some change. At the present time there is absolutely nothing on the radar to indicate change.

 

            Interestingly enough, just recently I was at Northwood for an announcement around a geriatric mental health initiative involving seniors being involved in a community gathering to discuss their issues and to participate in gardening as a means and a mechanism for them to deal with depression and anxiety and so forth.

 

While I was there I was chatting with one of the new VPs for the health system and I said one of the areas that I had wondered about when I went up to take a look at the new plans for the emergency department at the Aberdeen, there was wonderment if there would be a room dedicated in the emergency ward for somebody coming in in a crisis mode because we know that the appropriate setting, the appropriate environment - perhaps having a nurse practitioner with psychiatric training may be the best person to look after them as opposed to an emergency room physician who may be needed to look after a level one or two crisis patient.

 

            It looks like that is going to be incorporated into the new bill and I think it's a part of the future. One of the areas when we had the flashpoint of the crisis at the QEII was that we had a number of patients who came in, especially seniors with early dementia having behaviour issues, and they were there in the midst of an unbelievably busy - patients coming in in the highest degree of trauma. It probably wasn't the best setting and the best place for them to be.

 

Looking at how some of those mental health patients, seniors who are experiencing behaviours that family members can no longer deal with, having those proper settings, I think we have to have them in all of our regional hospitals. I believe there are some core services for our regional hospitals and I hope to see that provincial plan make those kinds of accommodations such as you are seeing in the new Aberdeen emergency department.

 

            MR. HOUSTON: Minister, you had me at no changes. You kept going and got better with possible improvements so I thank you for that; that will be a big relief to people in the constituency and through the family support network. It's really important to our community so I appreciate that you recognize that. I thank you for that.

 

            The minister may recall, we had a chance a little while ago - I appreciate that the minister came up with the former Energy Minister, and we met with some of the Hillside group, Peter Boyles and his group and some of the concerns that they had. At that time we had talked about maybe a pilot health study for the area, and that hasn't really got off the ground just yet. Notwithstanding that, I don't know if the minister has his calendar with him today but I wonder if sometime over the next couple of weeks the minister would be willing to meet with myself, Peter Boyles, and Dr. Boucher, who is somebody that the Hillside group relies on for a lot of stuff. I wonder if maybe the minister would just commit to meeting with that group sometime - it could be here in Halifax - maybe within the next couple of weeks or something. I'll leave that with him.

 

            MR. GLAVINE: Yes, sometimes there are issues that linger way too long in terms of looking at any environmental issue that can be detrimental to a population. This has been a long ongoing issue. I guess what we would say we're in the process of executing here at the moment is taking what data is available. There have already been some population studies done and we know because of Pictou being a strong industrial community perhaps, certainly at one time compared to where we are today, so there have been a number of studies done.

 

We have actually asked Dalhousie to take a look at whatever small, large population studies that have been done, to take a look at whether or not there are some identifiable trends in that particular community and area. I will find out where that analysis is and if we have it available, certainly having a meeting would be a good idea to be able to share that information.

 

            Trying to maximize every dollar in health care to get into an expensive study, if we already have information available and this was one of the areas, as we know, when dealing with the unsettling problem of last summer with pollution from the mill that affected the Pictou area, the Cancer Society had a good amount of information available to us.

 

            MR. HOUSTON: Madam Chairman, I thank the minister for that answer. That makes sense and that sounds like that could be a worthwhile and productive meeting, for sure, that would be a good starting point. I just have one more final question and it's about the renovations at the Aberdeen, you referenced those renovations, that renovation project going forward. I just wonder, it wouldn't even require too much detail in response, but it would just be a simple question, is the renovation progressing at the pace you had expected? Are you happy with the way that renovation is unfolding?

 

            MR. GLAVINE: Madam Chairman, I thank the member for the question. Yesterday was the official date of 18 months in the office and it probably comes as no revelation to say there are a lot of days when I wish things would proceed a little quicker than what I sometimes like to set as targets. I know that this is very complex work and sometimes we are in design and, again, better information in terms of how an emergency room can best flow, based on the general volume of patients that come through the Aberdeen emergency and so the status of this project, and the information that I received today, is that we should see some activity in May of this year.

 

            MADAM CHAIRMAN: The honourable member for Northside-Westmount.

 

            MR. EDDIE ORRELL: Thank you, Madam Chairman, and I welcome the opportunity to ask the minister a few questions and a lot of questioning is going to be focused on some local issues that we have in the Cape Breton area, specifically on the Northside. As the minister knows, over the last number of years we have had real concerns and problems with the emergency room closures and being open at specific hours for the last little while, subject to availability of physicians, nurses, and/or beds in the facility to house people after they have had an admission into the emergency department.

 

            My first question to the minister would be, knowing that the emergency department is difficult to staff with both physicians and nurses, and we've talked in this Legislature about the possibility of other options of staffing and keeping the emergency room open, I wonder, can the minister give me an update on where the plans are and what the deal is for the emergency room at the Northside and if that is still planning on moving forward?

 

            MR. GLAVINE: Madam Chairman, again, this is one of those ongoing issues that the Cape Breton District Health Authority was starting to develop a plan. What are the best services to provide in the three support hospitals for Cape Breton Regional? What is best to have in New Waterford, in Glace Bay, and over at Northside?

 

            Right now the new provincial health authority is looking at what will be the best health services to be provided at Northside. The requirement first and foremost is to have the strongest primary care in place. A strong primary care will eliminate a lot of trips to the emergency room. Having the concept applied of same-day, next-day care is one of the areas that we know in this area will go a long way to deal with the issue.

 

            Whenever we see in communities that our doctors have a higher than average number who are in the latter part of their careers and are maybe working fewer hours in their office and maybe not as keen to subscribe and work to a new model of care, this was one of the areas that Dr. Ross had identified that could really benefit from a very strong primary care model, using the existing facility or perhaps even supported by collaborative medical practices out in the community whereby doctors, nurses, a dietitian - any of that collaborative model that could be put in place.

 

            This now is what is being looked at. I don't have a timeline but perhaps very shortly we will know what the actual plan is to execute. We know that it is troublesome for a population to move from what they have expected to continue, perhaps forever and a day, and that is a full emergency room service. We know now we don't have the doctors who want to carry out that service. If you have ERPs who are the highly-trained emergency room specialists at Cape Breton Regional, there are many of the traumas that come in that, in fact, that's where they should be going anyway.

 

            It is that lesser care of patients that we need to get right and we need to be able to say to the community, as we've done in eight or nine centres across Nova Scotia, these are the hours when there will be a physician or a practitioner who is available to see patients. We're in the process now of getting that defined so that it can go ahead and here's the model. We've been able to do this in a number of centres across the province and I believe, based on the volume that will come into Northside, we can find the right number of hours and physicians that will staff. We know that a couple of the local doctors have started with the concept of the community health care centre, and that may be exactly what will work for Northside.

 

            There are a lot of services that are provided at Northside. To have a dialysis unit there, to have some long-term care as well, in a building that in 2015 would probably not be built for the size of that community because the model of care has simply changed so dramatically. Now to be able to utilize what is there while providing strong primary care is where I see Northside in the future.

 

            MR. ORRELL: Where I was going was that I know from personal experience, from both having an ill family member and from working in facility at the Northside and Harbour View in Sydney Mines, anyone who needs emergency care has to go to the Cape Breton Regional Hospital because the emergency room at the Northside General is not open, it's not staffed. When the Cape Breton Regional Hospital was built it wasn't built to handle the volume of patients that serviced that industrial Cape Breton area: Glace Bay, New Waterford, Northside, and Cape Breton Regional.

 

            I know a couple of times we have had the unfortunate experience of having to use the emergency room with family members. At one time when the emergency room was closed in the Northside, we were being diverted to Glace Bay for emergency care for a person for whom time was of the essence. Fortunately the paramedics, who are excellent, who have been really good, and I know personally a lot of them on the Northside who provide great care, were able to convince the Cape Breton Regional Hospital that this was an exact emergency that we could get there.

 

            In saying that, the average person then would have to go to either Glace Bay or New Waterford at the time, and that's a 45-minute drive. When you don't have the facilities or the amount of people to handle the amount of care that is needed in the outlying areas to come in to Sydney, that is disturbing to a lot of people, especially an older person who may take themselves there, if that was the case, or have a loved one take them there because an ambulance wouldn't be as quick or they weren't available because they were in Glace Bay with a patient.

 

            So it's a real concern when they are told that the emergency room is not open. I think the big thing is the people in Northside want to know that there is emergency care there when they need it. We know that not all emergency rooms can be staffed 24 hours a day. We know that. That's not something anyone is questioning. Right now we're open from 7:00 a.m. to 3:00 p.m. in the daytime; for emergency care, probably one of the worst times to be open because doctors are in their offices. If they need a physician or if they go to the office, they could get the care started there.

 

            I guess I'm just looking for a solution to make sure that proper hours with the proper staffing could be obtained for - and not just Northside. I know Glace Bay has the same difficulties we have, as does New Waterford, who are working on some change. They want to make sure that when an emergency comes, they can get the care and not have to be in line, or waiting, or people who have minor injuries that require emergency treatment - not necessarily a life-threatening emergency, but don't have to wait for a length of time.

 

            I guess I'm asking, are there any other programs or any other models of care or anybody who may be able to do a little bit of looking into what the best times are to be open - when were most of the emergencies brought in? Can we go back to the days when a doctor got called in when there was an emergency happening or they were on call and ready to be there? The biggest thing that people are concerned about is the length of time it takes to get there. I know you're looking at CEC models and I know that Dr. Bernie MacIntosh has started a walk-in clinic in the evenings, which will take a lot of stress off a lot of people who don't have a family doctor and they need minor ailments treated, but for actual emergency care, to wait in a regional hospital for that length of time, a lot of people just don't think that's acceptable.

 

            Is there a way we may be able to look at something that would be workable for all in the community, especially the older population that we have on the Northside, because as we know, people are leaving, moving back to retire? I had one couple that was not going to move back because they couldn't get a family doctor and they were concerned about the emergency room care. I'm wondering if you could just comment on that.

 

            MR. GLAVINE: The member opposite has prodded me in several directions here with that encompassing question that is put forward. I do appreciate that the member has been both consistent and persistent on this issue. I know he wants what is best for his community. Again, Northside has become one of our conundrums in terms of the change that has gone on when there weren't the doctors to cover the emergency room requirements there.

 

            I want to say this is an opportunity for us to say what will be the best level of service that can be provided to the residents of Northside - what it should look like. We know that in New Waterford they have an outpatient department and you can go and get some diagnostic work done there; they also have the mobile service that is offered to residents. It certainly doesn't have the pickup at this stage that we would like to see that service because, again, while underutilized, when it is in service and provides the kinds of care that a family will need, the strong evaluation is coming back that it is a very, very good service.

 

            The question that is asked is, what will be best? And that's really now not for me to give the answer, but rather to say the provincial health authority is committed to looking at a health services plan for Northside that will look at what can be and should be delivered looking out the next 10 or 15 years. Let's get something in place that the residents are comfortable with. I agree those hours after a doctor's office is closed in fact are very often the troublesome hours - as to, look, I've got this unknown pain and I really need to get it checked out, do I have to go and sit at the regional four or five hours before it's going to get looked at?

 

There's no question, you know for our elderly population, which is a growing part of the cohort in Cape Breton - as we all know a great place to retire and so there are more who are coming back who made their living and their life in Ontario or out West and are now part of that fabric of the community there once again, but very often, and it's really interesting, we've all probably, or many of us in the rural part of Nova Scotia, have heard people say I moved to such and such a place because of a condition that I have, or I could get a doctor. Those are very, very big decision points for people and that is why the emphasis on strong primary care.

 

When we look at communities that struggled to have enough family doctors and then to put in place a collaborative medical model and medical care whereby you had maybe three physicians who perhaps could collectively look after a population that was struggling to have individual doctors, you know, where they're able to cover off for one another, they're able to work as a team, somebody comes in, it's a nurse practitioner who is going to look after checking your vitals, and now they can renew a controlled substance prescription. So as we develop and expand our collaborative models of care it is going to be, certainly, part of the answer for the Northside population.

 

So getting the right practitioners, the right model, the right hours, I have great faith that with the guidance of Dr. Ross, who has served our province well, not by building and opening more or trying to keep emergency centres open but by giving same-day, or next-day, care as the model. When I went to where these models of care opened - whether it was Springhill, Tatamagouche, Annapolis Royal, or a couple of the other communities - we have very satisfied doctors because they're now able to adequately look after patients. They're not into burnout mode, which many of them were, and we have patients who really couldn't wait for the doctor to give them an appointment seven days down the road. They needed to see a doctor today and that's what changed when they could be offered, almost 100 per cent of the time, same-day or next-day care.

 

            That has to be a model that we expand, develop, and promote across the province and we are seeing our well-trained physicians and nurse practitioners part of those teams. I'm sure we will get the model right for Northside. I like the fact that we're not going into Northside and saying here's the model, here's the template, everybody join in and make it work. We're going to do that real fine tuning as to what's best for Northside.

 

            MADAM CHAIRMAN: Time has elapsed for the PC caucus. We will now move on to the NDP.

 

The honourable Acting Leader of the New Democratic Party.

 

            HON. MAUREEN MACDONALD: I am looking in the Estimates Books and I'm having a difficult time finding the budget for the minister's own department or administration office. First of all, could the minister tell me if I've missed it in the estimates? Most departments do break out the Office of the Minister and they give a picture of what the expenditures are in the minister's own office and they help us understand whether or not there has been a reduction in FTEs or an increase in FTEs and what the budget is. I'm asking the minister about that.

 

            MR. GLAVINE: I thank the member for the question. It is on Page 14.4 of the Estimates Book. For 2014-15, the estimate was $3.13 million; the 2014-15 forecast was $2.949 million; and the 2015-16 estimate is $2.932 million.

 

            MS. MACDONALD: I notice that what we have is a global figure there for how many FTEs are in the Department of Health and Wellness with respect to all of these various divisions, but we don't have a full account here of how many FTEs are in the minister's - I guess that would be general administration?

 

            MR. GLAVINE: The number for the Office of the Minister is 2; Deputy Ministers, 2.08; Associate Deputy Minister, 10; Communications, 2 - for a total of 18.08.

 

            MS. MACDONALD: I want to ask the minister, two communications people is a small amount of communications people in a large department. Having been in the department I know we had quite a number of people in communications. Can the minister tell me how many communications people are in the department beyond those two, because I think that is probably not the full complement?

 

            MR. GLAVINE: The member is exactly right. There are two who are central to the work of the minister, but the total from Communications Nova Scotia would be six additional for eight FTEs doing communications work associated with the minister, the deputy, and associate deputy minister. I would have to check and see, but I believe it could be down by one FTE.

 

            MS. MACDONALD: Eight FTEs is a lot of FTEs in Communications, in my recall, I have to say. What I would like to know is the total budget for Communications in the department, what was the number of FTEs in the prior year, and what is projected for this year?

 

            MR. GLAVINE: The total budget for Communications this year is $1,141,400. There is no change planned for the 2015-16 budget year. We will have to provide the member with the previous year or two years - whatever the pattern was there during the last few years.

 

            MS. MACDONALD: I would like to ask the minister if he would tell me about the - he said in his office under General Administration there are 4 staff for the minister, then 2.08 for the deputy, 10 for the associate deputy minister and 2 for communications - if he would break down the 4 for the minister, the 2.08 for the deputy, and the 10 for the associate deputy minister.

 

            MR. GLAVINE: To start off with, in my office there is a secretary to the minister, a senior adviser, a special assistant, and a senior adviser to the minister. With the deputy minister there is an executive secretary, of course the deputy minister position, and a senior adviser. With the associate deputy there is an admin support clerk, a Secretary 1, a correspondence coordinator, special adviser to the ADM, executive office manager, the associate deputy minister position, a Secretary 3, special adviser for mental health, strategic project executive, and director of culture change and leadership - that really all comes under the administration of the associate deputy. Just as an example, the special adviser that the former minister perhaps would have worked with at the same time, Patricia Murray is in that position.

 

These are long-standing positions that have been in the Department of Health and Wellness. That's the organizational structure associated with minister and deputy and associate deputy.

 

            MS. MACDONALD: I think I'm a little confused and maybe the minister misspoke or I didn't hear it correctly but the four positions to the minister's office: I have secretary to the minister, a senior adviser, a special adviser, and then another senior adviser - two senior advisers?

 

            MR. GLAVINE: That's correct. One would be my EA for example, one of those positions, and then there are two adviser positions to the minister.

 

            MS. MACDONALD: Thank you. I'm wondering if the minister can tell me when those positions were increased because that is at least one more FTE than was there previously.

 

            MR. GLAVINE: One of those positions, traditionally, was charged directly to government whereas we have embraced it under the department's budget and I am told that this same structure existed, just where they have been located in terms of budget is the only difference.

 

            MS. MACDONALD: Thank you. I do not understand the explanation. So the budget has always been for four positions but, in fact, one of those people didn't work in the department, in the minister's office? I just don't understand what I'm being told.

 

            MR. GLAVINE: I think that the member is quite familiar with this position; there has always been a health adviser, health position in the Premier's office. We have incorporated that into our health advisory team and that is why the four positons, as explained in terms of the department budget.

 

            MS. MACDONALD: Thank you, that is helpful. What I'm now going to ask the minister is with respect to the expenditures of the department in terms of legal fees. How much money last year was spent to law firms specifically related to the development of legislation or advice around labour relations?

 

            MR. GLAVINE: What I can provide the member opposite in terms of legal advice and that area in terms of developing the Health Authorities Act in dealing with the labour file, I know with the meetings and so on that I would have had that this was handled internally. I will run a further check to see if there was any support to our internal staff in the Department of Health and Wellness and if we have used services of Department of Justice in developing the Acts in particular and the labour negotiations. What we have accounted for in our budget is what took place internally.

 

            MS. MACDONALD: I appreciate that answer from the minister. I want to ask about a couple of other areas that are near and dear to me, and one area would be the midwifery programs. I think there are three sites around the province where there are midwifery programs. I would like to know what the budget has been this year and what is projected for next year and if you could break out those sites, I would appreciate that as well.

 

            MR. GLAVINE: Mr. Chairman, I thank the member for the question and also for her keen interest in this particular area of our health care. I'll just duck back for a moment; we did check the file here relating to the previous question. The only external money that we paid out was to the arbitrator. Those are the only monies that took place externally during our work on transition, during the development of the labour negotiations and file.

 

            The member is correct, we do have three sites where the midwifery program is part of the practice of prenatal and delivery and postnatal care. Currently we would have a total of $1.261 million in the midwifery program. We'll have 2 on the South Shore, 2.5 positions in GASHA, and we have 6 positions at the IWK in the midwifery program.

 

            MS. MACDONALD: There's no change in the funding from this year to next year? That's very good to know. Mr. Chairman, I want to ask the minister some questions about the community health centres and their budgets. We have a number of small, maybe not so small, community health centres. I asked earlier about the grant or the funding to the North End Community Health Centre that is in my constituency but I know that there are others in the province; there's one in Cape Breton and one in the Valley, I think, on the Hants shore, and so I want to ask what the funding is for those community health centres and for the Federation of Community Health Centres, both of those things.

 

            MR. GLAVINE: We are working to get that information on the budgets for the community health centres. In terms of the role they play, we know that the North End Community Health Centre has played and is playing an extraordinary role in our community here. I've become familiar with the work that does go on there and some of it has been quite transformational in terms of improving population health - the dedication of the staff there all the way through all of those levels. I did have one of those great insights by going out on the street with the community nurses and spending an evening with them during the winter to do that kind of service to those who live on the street, those who live in the shelters. Presently we have a request before the department to extend the nursing service to a full seven days.

 

            The community health centres that are currently in existence will be supported. It is a model of care that really works to help a population meet its needs very close to where they live. This is one of those areas that I think we need to look at, making sure that even some of our small hospitals take on that umbrella of services that we would call a true community health centre. We have two or three great models already here in the province and I think for some of our smaller towns or villages, this is one that does need to be cultivated. I will get those budget figures for this year and provide the member with that.

 

            MS. MACDONALD: I want to ask the minister about how much money is being allocated for mental health programs. I see that there is a line item here for Addiction and Mental Health Programs but I also know that's nowhere close to the full amount of funding that actually goes into mental health services. If the minister could provide that to me, I would appreciate that.

 

            MR. GLAVINE: The total budget for mental health for this year is just slightly under $148 million. That is broken down into the provincial, the IWK, and centrally-held mental health services. If you want a further breakdown I can provide that for you. What we will have for the provincial health authority is $111 million; the IWK is $27 million; and the centrally-held, which is probably the crises - that is a department which is $8.9 million.

 

            Just to add, in terms of the $8.9 million that is part of the department, it is part of the mental health strategy that is delivered province-wide.

 

            MS. MACDONALD: Thank you, minister. I want to ask about the reduction in addiction programs for the province because I understand there is a reduction of about $200,000 and I want to ask the minister, where is that mitigation coming from?

 

            MR. GLAVINE: That is in the discretionary grants. As I reviewed the grants, many of them were for a three-year period and many of them are in their last year. That is where that reduction will come from.

 

            MS. MACDONALD: I would like to ask the minister if he would provide me with a list of those groups that are in their last year of funding discretionary grants, who they are, and what amount of money is associated with those grants.

 

            MR. GLAVINE: Mr. Chairman, to the member, those have all been identified; they've been corresponded with and we will provide that full list.

 

            MS. MACDONALD: Mr. Chairman, is the minister saying that they don't know yet that they are receiving these notices? I would like to ask the member, when are they going to find out they are going to be losing this funding? Because here we are, the purpose of these estimates is to go through and find out what is in the estimates and who is going to be getting funding and who is losing their funding and what have you. I think it's somewhat irregular that we are unable, through this process that is designed to get information and it is the only time we have an opportunity to scrutinize the government's budget, to get that information.

 

            MR. GLAVINE: These organizations that have been affected in the third year of a three-year grant program, they have received correspondence as to how it would impact them and we are close to the 80 per cent level for funding those particular grants. Any other reduction in terms of Addiction and Mental Health would be in relation to salaries and an FTE that is not being filled.

 

            MS. MACDONALD: This doesn't tell me who. Who has received - so now they have received their letters? Who has received their letters? Who isn't going to be continued on in the discretionary grant area? Who is seeing 20 per cent reductions? That's what I'm asking. I'm asking to know what organizations are impacted by this decision.

 

            MR. GLAVINE: That list can certainly be provided to the member. I thought her colleague had that list, especially of those three-year grants, I think he made a reference to them last evening, but if the member is without them, I certainly can provide that list to the member.

 

            MS. MACDONALD: I don't know if we're talking about the same thing but I'm making reference to the addiction services mitigations, that's what I'm looking for. Not maybe some of the other ones that we have already talked about, the eating disorder, Alzheimer's, I know about those, but this specifically is focused on what addiction service programs are receiving reductions. I would like to have that level of detail forthwith; if not tonight, tomorrow.

 

            MR. GLAVINE: I can provide the member with that information tonight. We have that list here and we'll make it available to you.

 

            MS. MACDONALD: I'd like to move to another area. The minister, in his opening comments, talked about how in the estimates it appears that primary care has been reduced by $4 million, but in fact this is not the case, which is very good news indeed.

 

            What I would like the minister to do is to give me a bit more detail than he provided in his opening comments about where that seeming reduction of $4-plus million actually is being applied so that I can follow the money through the Estimates Book.

 

            MR. GLAVINE: That money that was traditionally allocated to primary care is now shifted from districts into the IWK and the Nova Scotia Health Authority. That money is simply a transfer in terms of the new one Nova Scotia Health Authority budget.

 

            MS. MACDONALD: This allows the new authority to be a little more agile than the department was in working out arrangements with physicians, et cetera, in reconfiguring, let's say, primary care delivery in a particular area. Is that how I would understand this?

 

            MR. GLAVINE: As the former Minister of Health and Wellness knows, it was during her time in office that these collaborative health teams really started to be formed across the province. This is money that was in the department that now the Nova Scotia Health Authority will have available for the development and formation of these teams across the province. We always know that in some cases there was recruitment that will have to go on to fill out these teams. The next centres are now being identified for the new collaborative medical practices in the province.

 

            MS. MACDONALD: I want to ask the minister, this money is earmarked for primary care, it has to be used for primary care, it can't be taken into some other area of expenditure in the new authority, is that correct?

 

            MR. GLAVINE: As we know, one of the areas of focus for the new Nova Scotia Health Authority is to make sure that these teams that have developed can be expanded to include another clinical person, a new site - we have a number of sites that are currently in development. I think of the site at Digby, which is currently being finished and getting ready for occupancy. This is just part of the total amount and it can be found on Page 14.14; Page 14.14 of the Estimates Book will give the total primary health care dollars.

 

            MS. MACDONALD: I'm going to turn the rest of my time over to my colleague. I want to thank the minister and his staff.

 

            MR. CHAIRMAN: The honourable member for Sackville-Cobequid.

 

            HON. DAVID WILSON: I want to continue on with Page 14.2 under the Department of Health and Wellness in the budget document around Programs. I want to go to Pharmaceutical Services. Under Pharmaceutical Services, we notice when you go into the details that there is actually a decrease of $3.5 million for Seniors' Pharmacare. I'm wondering if the minister could explain why that decrease is seen for the Seniors' Pharmacare line item.

 

            MR. GLAVINE: This is an area that former Health Ministers were very much involved with and that was seeing the advance of a greater number of generic drugs. In fact, the number of prescriptions used by seniors went up over the past year and that trend has been going on now for quite some time. As we know, we have now gone down to 18 per cent of brand. It may be one of the last years where we'll see those big gains from the use of generic drugs.

 

            It's interesting that as part of the prescriptions that do go out, seniors seem to have a greater uptake of generic versus the brand. We know co-pay is involved, so a high degree of generic drug use would be the basic answer.

 

            MR. DAVID WILSON: I'm definitely quite aware of that initiative. I know my Leader and the former Minister of Health and Wellness had the fortitude to take on the pharmaceutical companies and work with her colleagues across the country to come up with a plan to reduce pharmaceutical costs for our province and, for that matter, across Canada. I hope that working relationship continues on with our counterparts across the country because it's important, especially in health. If we can find areas where we can work together and we all agree and take on something like pharmaceutical costs, because ultimately those costs are really hard to have a handle on because they are provided by private companies that provide pharmaceutical services for each jurisdiction.

 

            I want to continue on with that. I know that with the Seniors' Pharmacare Program that it does generate funds from that program. There is a co-pay that is calculated, depending on the income of a senior. I'm wondering if the minister could tell us, what is the amount of revenue generated from seniors in last year's budget and what is the forecast of revenue that will be generated - with the premiums and the co-pays - in that program this coming year?

 

            MR. GLAVINE: In terms of those figures, we are currently looking them up here and we will have them available. The funding alone is $3.5 million and it's another $2.9 million for the other items. We have forecasted just under $53 million for the co-pay portion of the Seniors' Pharmacare, and basically unchanged.

 

            MR. DAVID WILSON: Unchanged from last year? Okay, excellent. We also noticed an increase in the budget of about $5 million for special drugs. I wonder if the minister could break down or give us some detail on what that $5 million will go towards.

 

            MR. GLAVINE: That $5 million - as the member is aware, we have seven patients who are receiving Kalydeco, and that is a cost of $1.8 million. We happen to have a disproportionate number of that subset of the gene compared to other provinces in Canada. I think there are about 100, if you can imagine, for the country, or a little over 100; we have eight here in the province; seven are receiving provincial funding and one is covered by insurance.

 

The remainder there are new drugs. Hepatitis C will receive some coverage, we'll start with a drug Harvoni and that is now starting to be rolled out. Of course it will go through the hepatitis C clinic to the first patients receiving during this year. We all know that there are other new drugs that come along each and every year so that is where coverage is coming from. So it's hepatitis C, Harvoni, it's Kalydeco, and then some additional new drugs that have been added to the formula for coverage this year.

 

            MR. DAVID WILSON: Being a former medic, I know trying to get the names of some of these medications out is difficult but I'm wondering if the minister could provide us with the names of those drugs if possible. I'll leave that one for now. I want to go to the Dartmouth General. I'm wondering if the minister could tell us how much money in this year's budget is earmarked for the development, and I would hope the expansion, of the fifth floor of the Dartmouth General Hospital.

 

            MR. GLAVINE: I know this is a long-standing issue with the member for Sackville-Cobequid. We have work getting underway on the third and fourth floors. This was work first identified by the Auditor General that required that - in fact, pretty substantial work will be carried out on the third and fourth floors. During that work, the initial work for the fifth floor, there will be some structural issues that are part of that first expenditure and we will have some further detail very shortly about the full nature of the work for all three floors that is coming shortly.

 

            MR. DAVID WILSON: I wonder if the minister could provide - is there an actual dollar figure in this year's budget earmarked for the fifth floor? I understand that there is some work going to be done, renovations on the third and fourth, but is there any money in the budget, somewhere in the $4.1 billion range, earmarked specifically for the fifth floor at Dartmouth General?

 

            MR. GLAVINE: This has been a project that has been earmarked, talked about, certainly publicly in our early days in office that we would commit to this project. Money is in the budget for three and four; that has to be absolutely carried out before the work on the fifth floor. In terms of the extent of work in the 2015-16 budget year, it is going to be announced shortly, and all citizens and Nova Scotians will know what will take place.

 

            MR. DAVID WILSON: That was the longest "no" that I have received from the minister, I believe, so there is no money in this year's budget for the fifth floor. That's fine, I think the minister needs - it's not fine, I'm sure I'll have something more to say about that down the road but the third and fourth floors, I understand, there's funding there so maybe I'll ask, how much money is earmarked for the third and fourth floors in the budget, since there is no money earmarked for the fifth floor in this year's budget?

 

            MR. GLAVINE: We are looking up the exact figures for the spend for this fiscal year. I know that in terms of the fifth floor, final design work is part of the budgeted amount of money for this year. You can't proceed with any physical work for the fifth floor until the reconstruct of the third and fourth floors actually takes place, which will take place during 2015-16.

 

            MR. DAVID WILSON: Okay, we'll try it again. There is money in the budget for the design work for the fifth floor and I wonder if the minister could provide us with how much money in this year's budget is earmarked for the design work for the fifth floor.

 

            MR. GLAVINE: What I can tell the member this evening is that there will be an announcement on Tuesday of this week. It has been cleared from Finance and Treasury Board so the member won't have to wait too much longer to get final numbers and final details.

 

            MR. DAVID WILSON: Well, Madam Chairman, we are debating the budget today, not next Tuesday. I can't ask questions at the announcement next Tuesday. I'll be happy even if I get an invitation to the announcement next Tuesday. I don't understand why he can't give us the figures. He has indicated there is no money for the construction of the fifth floor so all I asked was, is there an amount in the budget for the design work? It sounds as though there isn't because the announcement will be about the third and fourth floors. I'm not going to beat that one down too much, I'm going to go on to something else.

 

            There have been talks - and I've been recently contacted by someone who works at the Dartmouth General - is there a reduction of beds happening over the next several months at the Dartmouth General?

 

            MR. GLAVINE: During construction we will not have the same capacity of beds at the Dartmouth General. However we are now able to use some of the beds at Camp Hill. At the QEII capacity has been added to make sure that during the construction period, those who need hospitalization will be able to be housed and cared for there.

 

            MR. DAVID WILSON: I wonder if the minister could provide us with the number of beds that will be displaced. Is it 30? I've been hearing numbers as high as up to 30. I'm wondering if the minister could answer to the number of beds that will be displaced during the renovation phase of the third and fourth floors.

 

            MADAM CHAIRMAN: The honourable member for Dartmouth East on an introduction.

 

            HON. ANDREW YOUNGER: Thank you, Madam Chairman, for letting me butt in. In the Speaker's Gallery, probably without permission from the Speaker, is my very long-serving and suffering - oh, now she's in the east gallery - my long-suffering wife, Katia. I think we all understand how much the spouses go through and sometimes don't know what they sign up for when they get here. I invite people to welcome her to the gallery. (Applause)

 

            MADAM CHAIRMAN: The honourable Minister of Health and Wellness has the floor.

 

            MR. GLAVINE: The number that we're looking at is 33 beds.

 

            MR. DAVID WILSON: So I wasn't far off. I thought it was 30, but 33 beds. Those 33 beds are temporary. Are there any additional beds that may be closed over the next little while or are they the only beds that will be affected over the next several months, to the knowledge of the minister and the department?

 

            MR. GLAVINE: I've had a couple of tours of Dartmouth General and I've had the work explained to me. There is no question that during the magnitude of this construction, patients would have to be moved off-site in order to make sure that there was no interruption of care. That's the number that they will be able to work with during the coming months of construction.

 

            MR. DAVID WILSON: I want to go to another topic. I'm wondering if the minister could indicate how much money - or is there any money in this year's budget to establish a chronic disease innovation fund?

 

            MR. GLAVINE: The amount is unchanged from last year at $300,000.

 

            MR. DAVID WILSON: So if I'm not mistaken, there is $300,000 budgeted and it is unchanged from last year. Does that mean you spent last year's money or is that just a carry-over that is there? I understand it might have been $300,000 last year, but if it's a carry-over then why wasn't it spent last year or is that new revenue, a new $300,000?

 

            MR. GLAVINE: There is going to be $300,000 annually for that chronic disease and we will see more details this year on how that's going to be given for long-term management of chronic disease. There will be further announcements as to where it will be directed. We are obviously looking at some of the organizations that currently do chronic disease management.

 

            MR. DAVID WILSON: If that is annually, was that spent last year? That's what I'm trying to get at. I don't believe the $300,000 was spent last year, and if it was in the budget last year, why wasn't it spent? Is there a delay in coming up with the criteria for where these funds are going? I wonder if the minister could enlighten us a little bit more. Was the fund depleted last year? If not, why was there a delay? I wonder, if that is the case, will it be spent this year?

 

            MR. GLAVINE: One of the groups that we started work with last year was partnering with the Arthritis Society; last year we took the year to map out what organizations were prepared to do some innovative work around chronic disease management, and the Arthritis Society was one of those. The money was not spent last year. It is an annual figure that we will see in the budget and this year that money will roll out.

 

            MR. DAVID WILSON: I was not the Finance Minister so I don't know the mechanism of that. I would assume that money would have gone back to Treasury Board or wherever the money goes, to Finance - I think it's Treasury Board; they're the ones with the hammer.

 

            I want to go now to how much money has been allocated for this year's budget for a dementia strategy or the development of a dementia strategy. Is there any funding in this year's budget that will go towards that strategy?

 

            MR. GLAVINE: I just wanted to make a few initial comments around what is a very significant, very important development. The department had a co-lead with the Alzheimer's Society in developing the dementia strategy. We were very fortunate to get some of those top geriatric specialists, those who have been working at the Centre of Aging at the Mount for a number of years, to join this provincial effort.

 

            We know that there are some provinces that have a dementia strategy, not all provinces. I don't feel in any way that we are late to the game here. It's a strategy that is very much needed, but when we do unfold the strategy, we are hoping, along with Alberta, to become a co-lead to convince the federal government that we have the basic tenets and holdings of developing a national strategy and we think ours will be that strong when we unfold it. I'll be receiving the plan next week and in this first year - as the member opposite knows, it takes a while to activate a program - we have sufficient resources within the department to look after the early-phase implementation. There will be more details around that when we release the plan to the public as to what we will do in its first year of inception. It will be a program that will need some time to build and reach the potential that it is designed to do.

 

            MR. DAVID WILSON: I don't know if the minister recognizes the theme I'm on but he should be familiar with the list I'm going from. It is actually from the platform of his Party and I'm trying to make sure and keep him accountable. I have a few Xs by some commitments so far, which I'm sure I'll talk a little bit more on as we have more time.

 

            I forgot about a question that I had about Dartmouth General, so I will go back there quickly in the last minute. Are there any patients at the Dartmouth General that you are aware of who are waiting for long-term care placement and are they going to be some of the patients who are moved out to the Camp Hill who will maybe help relieve some of the bed issues at Dartmouth General?

 

            MR. GLAVINE: I used to have a time in MLA life when I would check in once a week at Valley Regional and know exactly how many patients were needed for long-term care and what we'd have to do is get that level of detail from the Nova Scotia Health Authority. Certainly in our regional hospitals there are always a number of patients who require long-term care. What I am very pleased to say, in a general sense, is that since January - in January we were at about 200 in hospital waiting for long-term placement, and as of yesterday we were at 141. We have made some very significant and very good gains there and that is a statistic that is available through the Nova Scotia Health Authority.

 

            MADAM CHAIRMAN: Before we proceed to the PC caucus I would like to take this opportunity to offer the minister a moment's break if you would like. You're okay? Okay, then we will move on to the PC caucus.

 

The honourable member for Northside-Westmount.

 

            MR. EDDIE ORRELL: Thank you, Madam Chairman. Yesterday I heard the minister say that when he taught he never took recess so I guess he's not taking recess this afternoon. I always got kept in at recess so I can't say anything about that. When we left off the last time, we were talking about the emergency room closures at the Northside General and Cape Breton hospitals in general, and the minister gave a nice answer, a good answer, to what the plan is going to be at the Northside General. Dr. Ross is going to come in and they are going to use some of the people in the area to try to develop a program to fit what meets the community's needs, and I appreciate that.

 

Before I move on to the next question, I just want to offer my assistance, if needed or if I could be of any assistance, I would be more than willing to help develop a strategy there through contacts in the community, contacts in the health care system, to see what we could develop that would fit the needs of the area and make sure that we get the best possible health care, emergency care, long-term care for the residents of the Northside. So I do offer my assistance there if it is necessary.

 

            I guess my next question would be, a while back, late last year, the minister came down to the Northside and we were having some pretty heavy discussions about closures and changes in the lab, closures to the ER. At that time I attended a few meetings about changes in the lab area and no changes were going to happen; changes were going to happen. The CEO said there wasn't going to be point-of-care testing happening. The machines had already been ordered. They were down in the basement waiting; they weren't coming up; they were going to be - I just wonder if the minister could give me an update on what the plan is for the lab of the Northside General. I'm told that if there are changes in the lab, there could be changes in the OR, how it operates with blood banks and type crossmatching and so on and so forth. I wonder, could the minister give me an update on where the point-of-care testing machines are, if that is still a plan, and how that may roll out with the changes in the emergency room and/or changes to the operating room?

 

            MR. GLAVINE: Madam Chairman, as the member is well aware, the lab became one of those flash points last year for what is going on. Is there an agenda? Is there a plan? What happened with the lab was that there was a flooding issue that derailed the use of some of the equipment there and so the point-of-care testing came in simply because they needed to get blood tests done and results as quickly as possible. At the present time, we are still looking at where Northside is in terms of the provincial planning and what sites in Cape Breton will have a full lab, a partial lab, who will go to point-of-care testing. It is really part of the modernization of testing. We know that point-of-care cannot do all of the required tests that are required for a number of surgeries, procedures, but again, that final decision for the lab and its future is still a work in progress. It is still part of what health services will be offered in each of the sites across the province and that will take some time.

 

            If you remember just 24 or 25 days ago we operated as nine very distinct entities in the province. In fact, we had a service next door because of the geography of a district that actually could be shared by both districts, but everybody operated independently. Today with the borders, with those barriers down, we are able to move across and do things on more of a provincial scale, sharing services. That is going to become part of a modern health care system. So what is needed for Northside, for New Waterford, for Glace Bay, is part of that health service model that we will see rolling out over the next number of years.

 

            MR. ORRELL: Thank you for the answer. If I am wrong when I say this, the point-of-care machines, to my idea, weren't brought in because there was flooding in the lab. The flooding that happened at that time was in the emergency room and that was one of the reasons given why it was closed for an extended period of time. The point-of-care machines were brought in because some of the shortages in the lab personnel had to be transferred over to the regional hospital because the regional is regional and can't be closed and needs the services. I think a lot of the problem at that time was there was a shortage of lab personnel and people who would be graduating from lab courses - medical lab assistant programs through the community college.

 

I believe at that time, and I'll ask again, are there any plans to have a discussion with the Minister of Labour and Advanced Education, and the community college system, to try to increase the number of personnel that community colleges graduate as medical lab assistants so that the care that is needed and the personnel that are needed to keep these places open and viable so that we can have viable emergency rooms? Yes, it's only next door, but if you have an emergency room that has lab personnel who can do a test right away on a specific blood type, that that could be done and it wouldn't interfere with the surgery. I guess my question is, are there plans to expand that program for a couple of years to see if we can get the number of personnel necessary to keep the labs viable the way they are?

 

            MR. GLAVINE: I thank the member for giving that detailed explanation as to why the lab facilities underwent a change at Northside. This whole area of doing work that has been very traditional to a full lab in a hospital, and the member is well aware of the services that used to be at Northside as a very stand-alone hospital for that area, that change has been going on for a number of years and we know that some of the change is really being brought about because there is almost a quantum leap in the technology of doing analysis. In fact, in our regional hospitals now that have new state-of-the-art analyzers, they are doing more in the regional hospitals than they ever did. A lot would have come into Halifax to the major lab for the province.

 

            So there is a lot of change going on and where Northside will end up and what service level will be there - and I know there is a great concern around the support for surgery, and that is part of having a plan for the next 10 years and beyond as to what service level will be provided at Northside.

 

            At this stage when we talk about any provincial plan, we have had a number of provincial plans that have done very well, whether it's the renal program for dialysis - that is a full provincial plan and the same way with surgery, the perioperative program will become a provincial program. Our lab and blood work, all of that will be part of that provincial plan. So it is very early to say what may be taken from Northside, what is necessary to be there to deliver services is still part of ongoing work.

 

            MR. ORRELL: I guess my big concern there is that the people who work in those facilities are asked to participate in some of the decisions that are made there. Most people don't mind change if they are a part of the change. It's just when they were told that this is what is going to happen without the consultation and without the - I guess the advanced notice that this is going to happen and it shows up one day and we're told there are no machines, but they are already there in operation, the lab person - anyway, that's a whole other story.

 

            My concern, as you well know, is the Northside General does mostly urology work, O.R. time. They have a lot of general surgeries that get done there that would never get done if we had to rely on just the one institution at the Cape Breton Regional. So I want to make sure that the citizens of Cape Breton Island - not just the Northside - have those services available so that service can continue because without it, there would be a lot of people going without and we would have wait-lists on all other surgical times.

 

            I want to switch gears a little bit right now and go to the new nursing home strategy for admissions and how people get a choice and can refuse or not refuse. I guess my biggest question is, has there been any thought given to the fact that with having to make a decision, pretty well immediately, if you do or you don't go, is there any indication that that may cause more relatively healthy people to take that bed in the nursing home because they may not be as healthy down the road, and allow for more people to be at home who need care maybe a little more than someone else does, and if there is money going to be allotted if that does happen to make sure that people get the care at home?

 

            MR. GLAVINE: I thank the member for the question. He is well aware that this has been a problem for a number of governments, and that is dealing with a growing number of patients on a wait-list to get into a nursing home and to get into a nursing home actually close to where the senior lives. That wasn't always possible so the 100 kilometre rule came into effect to say within 100 kilometres we would get a placement for you - you could have your priority one, two, and three to get to a nursing home.

 

            We have had people on the list who weren't ready to go into a nursing home. Now when a patient is assessed, there is a well-researched, well-documented set of criteria; in other words, an assessment tool for whether or not that person should have 24/7, 365 care or could they get home care - that Home First Funding Program - any of those kinds of supports, a caregiver. We also have a small program, much like the VIP program, where a senior can get some help shovelling snow and yard work in the summer that will help keep them in their home. So there is going to be very strong criteria.

 

We have gone through part one of two significant changes. The first one is the current list that has people on the list - it's there, it's in place, and that will remain so. We are always assessing additional people for nursing homes but the criteria and assessment, I would say, are going to be a stronger measure of who needs to enter a nursing home.

 

            Part two will be a list that has priority. In other words, I think the member opposite has heard me say that risk and need will be a big part of how we have that list together for each of the areas that would allow somebody to get placement within 100 kilometres. Maybe the member wasn't in the House when I gave the example and talked about a number of people who have been called since March 1st and told we have a bed available for you, but they weren't ready to go. They weren't upset at being told that because part of the conversation was that when a time of high need comes, you will be in the high-priority category. One of the people who refused to go is a great example. Shortly after they had refused they had a fall, had medical treatment, and was assessed as a high priority and within a matter of days was able to get into a nursing home.

 

            If we have that true wait-list of people both in hospital and in the community who have a high need for a nursing home bed, that is exactly who we should be responding to. I don't worry about people getting on the list anymore who perhaps should not be there, who can still live and function very well in their home, I don't have that concern. That second part will go into effect in the Fall. We wanted to bring the two most significant changes in, in a gradual manner, and that is what's underway.

 

            MR. ORRELL: Obviously the people who were on the waiting list before that had been assessed as need for the nursing home but their needs were being taken care of at home by either a family member or a home care person who would have decided, I can probably do another six months or a year or whatever and they take that and refuse that bed and maybe still needed it, but the family member was still able to take care of them. If something was to happen to that family member, that person would still have that same amount of need but they would either need more home care to fill in for that family member that couldn't provide it, or they would then have to go to the nursing home but if they refused and their status really hasn't changed, my impression is they have three months before they can go back on that list again.

 

I have had a few people concerned that that was actually going to be the case, that they would be off, still needing it, but the caregiver wouldn't be able to provide it so they would be in limbo and then the family would either have to pay more or there would have to be more home care.

 

            The concern is, if that actually happens, would the money be available or the personnel be available to provide the home care that the family is providing? I also noticed in the Budget Speech that there is about $1.8 million more for caregiver benefits to support another 385 families. You talked earlier about mowing grass and shovelling snow or whatever it would be.

 

The other part of that is that there is an allowance that is available or was available - I don't know if it's still available - for the family who provides the care at home. I know some people who have tried to access that money who weren't able to access it because there was no dementia involved in the person who was at home or there were no mental problems or the person wasn't screaming in pain all night long where they would have extra personnel come in and help, and the family could take the person home but just needed that little extra - I think it was $300 or $400 a month that was enough for the family member to provide that care at home.

 

            I know a lot of people who couldn't access it because of the dementia part. I had talked to some people in the Department of Health and Wellness who said that was a concern they had as well, that it may be looked at in the future, changing so that money would be there for a caregiver if the person needed the care, didn't really need the home care but needed a little extra and that would be available for the caregiver or the family member or the household, actually, for that. I wonder if that has been changed or if it would be looked at being changed because I know there are a lot of people who would like to access it and we could keep a lot more people at home longer.

 

            MR. GLAVINE: In fact, what the member describes is really the $1.8 million in the caregiver program, which is the $400 a month to assist the family. We have expanded that to 385 more families being able to access that.

 

            I would have to inquire to see whether the criteria have changed. I know there were a lot of concerns expressed about inability and so on to access, but in most cases it's a program with a defined amount of money. It isn't an open-ended program so living within the cap that is on that amount of money is also one of the problems, also one of the reasons we have added money this year to that program. It has had great uptake. There is a separate program that provides just summer work or wintertime shovelling. The $400 is true care to a frail parent who wants to stay in their home as long as possible. It has been a very wonderfully used program.

 

            One of the areas that in trying to put all of these pieces together around nursing home care and home care, we need to keep in mind that our 7,060 nursing home beds are the highest number per capita in the country. One of our challenges has been around the length of stay of a person in a nursing home. Here in Nova Scotia the average stay is close to three years. There are many countries that are substantially below that and I almost have a little fear of what some countries do because it does mean they are going into a nursing home in a very frail and very sick time in their lives.

 

            If we could move from about three down to two years, on the average, some people will go from a hospital bed, they are quite sick but they can be given the nursing care they need in the nursing home and they transfer there, but if we could get that 1,000 more beds available through bringing the number down of close to three years' average to two, then with a robust home care program, I think we could move to getting a greater, a more timely access to nursing home beds when people truly need them.

 

            The more we can afford to do with care in the home then that's going to be our answer; that is going to be sustainable home care and elder care for the future. The path we were on was not able to be sustained. I think getting all of those components together is going to be our answer. We're very fortunate in this province to have what I call a good, sound Nova Scotia mix of rural and urban information that the Centre of Aging collects at Mount St. Vincent. That is helping us guide the dementia strategy, the continuing care strategy, and I think that is what is going to help us form and deliver great care.

 

There are a lot of eyes on our province because we do have the oldest average age population in the country and I believe we have to get it right over the next decade to prepare - a decade to two, for sure - to prepare for when we have a very significant part of our population that is 80-plus years of age, no longer just 65 or 70 years of age. We already have about 42,000 Nova Scotians who are 80-plus years of age; that number is going to grow substantially. That is the number that will need home care, nursing home care, and how we sift and sort and come up with the best combination, those are the foundational pieces that we are currently putting in place. That is why we had to change how people qualified and significantly changed criteria to get on the nursing home list and also have more responsive home care available.

 

            MR. ORRELL: Thank you, Mr. Minister. You talk about the average stay in a nursing home is three years and you would like to get that down. I hope that is by bringing people in later and they are older when they get there so that it's not that they're in there for three years and it's time to do something, or at two years, let's get them out of here. I know the average stay is three years because of the great care that the people in these facilities and the health care system provide. With all the advancements in health care and medicine, people are living longer; there is better medication, better warning signs, and there is better nursing care to notice those signs so people do last longer.

 

            I will move on from that. You brought up home care. I know in the last two weeks, three weeks, or month, I have been getting a lot of home workers in my office concerned about the direction that home care is about to take. They are concerned that if some of these facilities go for-profit that they will be more concerned about profit than actual care, that they wouldn't have the number of home care workers to provide the care that is necessary because the fear is that if they take on more home care patients with less, or people leave the profession and they take on less, they would have to do a lot more with a lot less resources.

 

So my question is - and we have talked about it already - can we guarantee that if a for-profit company wins an RFP to provide the home care to the citizens of the Province of Nova Scotia that the standards of care and the level of care would be as good as now or better? We are having a problem recruiting nurses now to home care because we have a shortage of them, and if people leave because of the extra work, we're going to have a real problem. If there is a shift to just for-profit, do the job and get out of there and not provide the actual care they can, more people will leave the profession so I would like to know that if that is going to happen, will we guarantee that the standards of care will remain, the level of care will remain, and we will not lose professionals because companies are in it to make profit and not provide care to the people as necessary?

 

            MR. GLAVINE: The honourable member poses not just a good question but a very important question that we frame through the RFP the kinds of accountability to make sure that we have that quality care. If we take a look at current contracts, no matter whether they are - I know the private companies would have their criteria of what they want to deliver no matter who the company is but we don't have accountability built in to our contracts that we currently provide through the Department of Health and Wellness. We know that we're getting good quality care to our citizens that are disabled, come home from the hospital and need care, or are elderly and need care.

 

            We know that the picture generally is very good. We have some gaps in providing service. We also have some scheduling problems. We have too many providers in some cases going into a home. Many of those issues exist now. I believe that if we're putting in place a strong accountability and one that we will be able to evaluate and measure on a continuing basis, I have every reason to believe that we will have a high quality of home care in our province.

 

            The change is really in many ways - even just taking a look at the 2014-15 budget year, when we put $30 million into home care, it was used up and went into care, yes, but again, was there strong criteria for people getting the home care? What were the margins that were given to companies that are really for the most part, we would say, not-for-profit, but we have home support? I think the highest level of pay in the province is $54 an hour. The range is somewhere around $34 to $54. That $54 is certainly a long way from what the care provider would be getting so there is a great deal of money tied up into administration and in the execution of the home care.

 

            We know that in order to balance out getting a better price point, we are taking the advice of the Auditor General and essentially saying we'll put out the RFP. It will be one that the providers will be able to take a look at before it goes out. It doesn't have all of the measures in it that are needed that line up with the values, with the criteria that companies currently use.

 

            I was fascinated by what took place in Cape Breton in terms of home care when I got my first insights as a minister into home care delivery because in some parts of the province there was one agency. It may be a not-for-profit agency, but there was only one that you can call and get home care provided, unless you're going to go to a private company and pay for the entire service. There are about seven agencies that provide home care just within CBRM. They all seem to function side by side. They know their geography and they deliver home care in those areas. I met with four or five of them all at the same time and they seem to have a wonderful working relationship to look after the area in which they provide home care.

 

            So whether or not, for example, in that area, those agencies will go together and put a bid in to cover a larger area, how that will unfold is really a work in progress. For anybody to draw conclusions or put conclusions out there as to what may happen is very premature. All of the vendors are going to have an opportunity for input in what will become the RFP that they will at some point finally put a bid in on.

 

            There may be a bit of a groundswell now that the private delivery will not be as good. We have seen an editorial recently from a number of private providers in the province that work independently, a 100 per cent paid for service. We have private caregivers who currently get subcontracts from VON We have a lot of different variations of companies and of VON contracts and how they are filled currently going on in the province.

 

I think there are some very quick and easy gains and improvements that can be made in home care. I gave a number of examples last night that I've experienced. In the Valley we have five communities where already 25 per cent of their population is over the age of 65. Kings County went through a period of time where they promoted the county as a retirement area and it has drawn people from parts of Canada that have no family relationship there, no former work or education relationships to the Valley; they just saw a great opportunity for a place to live. We are already living through the challenges of providing enough home care.

 

            Right now the Valley may have the highest number of unfilled hours of home care. We have home support workers telling me directly that I currently spend one-third of my day travelling between locations to deliver home care. That is totally inefficient, unacceptable, and that is what will change when we go to this new model of delivery. In fact, the home care providers - I had one in my office this past Monday morning and she said: I have a picture of what's going to be coming and I asked my supervisor to give me - I forget now whether it was five or six patients in a day - and she said I love the people I'm providing care for now; I have a strong relationship with them; but I know what the future is going to look like and I am going to be looking after people in a very small geography so that I'm not travelling 100 kilometres in a day or sometimes quite a bit more than that. She asked for a very tiny little geography to look after five patients.

 

            She said, I am able to deliver better care because I'm not on the road as much and I will focus on that area that I now have been assigned to. Some are seeing the future and they see it as a much better model for them as home care deliverers, and I believe it will be even much better and stronger for the elderly receiving the care.

 

            We have a lot to work through. We have about 2,000 home care providers. I, as minister, want to see them continue 100 per cent in their careers, go through the transition. We know that if a company gets care in an area, I'm sure a union will be part of their future and collective bargaining - that's all part of what we see for the workers of home care. There is a lot to work through in the coming weeks and months.

 

            MR. ORRELL: The problem that I believe is that yes, they could be doing that stuff more effectively but in areas that we come from, the member for Sydney River-Mira- Louisbourg lives 45 minutes outside of Sydney. If someone in his community needs home care, 45 minutes is lost each way in travel time so there's the concern that we have as much as coordinating it into one area. I understand that; it's just the caregivers are really concerned that because of that, that person who is out in his area may not get the home care because it's not an effective use of the caregiver's time or finances to get the person to and from. That person would then end up in a nursing home because of pure geography, and that is the fear. Whereas a person might come in to work in Sydney from where he lives and then go back, and coordinate it that way, which would take a little extra.

 

            I am going to stop at that. I just want to make one comment and then I'm going to let the honourable member for Sydney River-Mira-Louisburg take over. I appreciate the $2 million that has gone into the orthopaedic care. I hope there is enough money allotted so that care of physio, recovery room beds, recovery room nurses, nurses, OTs are all factored into that to increase those 450 more surgeries because if they are being done, they have to have the care afterwards. I know that you reduced the time that people stay in hospital, and appreciate that, I just hoped that that has been looked into. I'm glad to see that there has been some money towards it because in the near future I will probably be drawing on some of that myself, so I will leave that time and I'll let the member for Sydney River-Mira- Louisburg take over. Thank you.

 

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

 

            HON. ALFIE MACLEOD: Thank you very much, Madam Chairman. Thank you, minister, for the opportunity to ask a few questions, and welcome to you and your staff. I would like to start out first by thanking the members of the Cape Breton District Health Authority that were in the management there and the work that they have done over the years. They have supplied good guidance to health care in our area. We may not have always agreed but their heart was always in the right place, and I think it is only right that we thank the people who are no longer in those positions but who indeed have had an impact on the health care in our community. I just want to make sure that you knew that, Mr. Minister.

 

            As I mentioned to you on a couple of occasions, one of the things that I have an interest in - and I am going to admit my conflict of interest here right now, my wife suffers with MS - so the whole regime of how MS is tackled in the Province of Nova Scotia has always been something that is near and dear to my heart, and not a surprise to the minister or any other members in this House. Over periods of time, the now Finance and Treasury Board Minister has stood on her feet many occasions in this House of Assembly talking about MS and where we need to go. I need not tell you, Mr. Minister, time is not a friend to those who suffer from MS and the challenges that they face. The services that my colleague, the member for Northside-Westmount was talking about, home care and things like that, are things that make it possible for them to stay in their home.

 

            I am just wondering where we, as a province, now sit when it comes to MS, the research that is being done federally, I think we were part of that program, and I was just wondering if you could give me, and more importantly, people who are challenged with MS across this province, an update as to what the Department of Health and Wellness is doing and what you see in the future for those who suffer with MS.

 

            MR. GLAVINE: Madam Chairman, to the member for Sydney River-Mira- Louisbourg, I've heard the member opposite speak to this issue on a number of occasions, speak passionately about what we're doing, what we need to be doing, and how we can improve care for the MS patients. We also happen to be a province which has a very high number per capita. Hopefully research will help us understand why, in our particular population - is it part of our links to our Celtic heritage? There is a lot of that work we know is part of the domain of research.

 

            I know we went through a lot here about a new procedure, liberation therapy, and we know that federally there is some research and work going on, continuing in this particular area. It certainly hasn't achieved the results that many had hoped for. One of the areas is the clinic we have here in Halifax that deals with MS patients and they are constantly in touch with the department if there is another pharmaceutical that seems to be providing very strong support to alleviating some of the early symptoms, especially, of the disease. We approved a new medication last year that a whole number of patients did switch over to, which is one of the reasons it's so easy - as the former minister asked the question, where did the $5.4 million you added to pharmaceuticals go to?

 

            MS is one of those areas on the radar. It's one that I will honestly tell the member, I haven't gone over to the clinic to take a look at what the workups are actually like when a patient comes in. One of my former students who comes into the clinic tells me that one of the areas he would like to see improved is when he is dealing with multiple conditions - it could be pervasive and part of his MS condition or separate - it is a long trip for him to come in here to the city, to the clinic for an annual workup, but then maybe a month later he's coming to see another specialist and he would love to even see coordination of his appointments. That would be a wonderful support to him in treating his condition.

 

            What I will commit to the member before we adjourn the House this Spring is to see if there are any more recent developments that their longitudinal studies, even on the patients that come in from Nova Scotia, that they are able to say what's working a little better, what is helping a patient maintain their current levels of mobility and so forth. For example, currently that area alone of MS, we fund $14 million on an annual basis towards working to support those who have MS.

 

            I think the member opposite can tell me much about those pharmaceuticals and a history that he is all too familiar with, unfortunately. That is a very strong level of support but is there more we can be doing in terms of what other provinces are doing? That's a scan that I would have to take a look at.

 

            MR. MACLEOD: I want to thank the minister for his answer. He's quite right when he talks about the clinic here in Halifax and Dr. Bond, I think he's probably the leading specialist we have in the Province of Nova Scotia, probably in Atlantic Canada. He is a very compassionate individual who does well. There are hardships for those who suffer with MS. It would be appreciated if we could find out where we are in the national scale when it comes to CCSVI treatment.

 

            My wife and I were fortunate enough that she was able to get the treatment and it actually made a difference in her life. Her quality of life went up 25 per cent or 35 per cent by my estimation because I live with her and by the same token, she was not on drugs from that period on and she just recently started a new drug that seems to have helped improve her walking and her independence.

 

            We are fortunate. We have the resources to be able to come to Halifax on a regular basis and do these things, but there are many who aren't that fortunate.

 

My plea is not all about my own family; it is about the many people I have had an opportunity to meet because of our family being affected by it and there are people in this province who truly need the help of the specialists. When you go back to travelling, if you are travelling from Cape Breton to Halifax, then it's a four-hour drive, fuel, food, it may be overnight accommodations, and all of those things lead to extra strain on a family and the resources they have and sometimes some family members just don't put their own good at the forefront; they worry more about the obligations they have at home.

 

            Anything you can do to find out more for the people in our province who suffer with MS and where we are federally would be greatly appreciated by a number of people. I look forward to you doing that undertaking and I have no doubt that it will be done.

 

            I want to continue on a little bit about home care and the whole issue of home care. I'm just wondering - we as a province spend millions of dollars, as much as an extra $30 million last year - at this point in our province, do we have a standard of care that is expected to be delivered by the agencies that are doing it? Is there a standard that goes right across the whole province and if there is, could you explain it to us a little and table that document in the near future?

 

            MR. GLAVINE: I thank the member for that question. I think it is a central question as to why we are moving in the direction that we are. Any time we have looked at a new policy and change in health care, we know that you can't continue to add 6 per cent to the budget every year. That is just not possible. Do we have to invest in health care? Absolutely, and we certainly will.

 

            We know there are great efficiencies that can be obtained from putting a good structure in place. I'll just give you one quick little one here for everybody's edification, maybe you have heard this one already. This year, because we have had each district doing ordering for a pacemaker - and I would say that probably in all of our regional hospitals we would implant a pacemaker - on the purchase of pacemakers this year, we will save $1 million by provincial ordering. That is so needed.

 

            I look at - and as the deputy minister often says - cost and quality are two sides of the same coin. While we are working for cost efficiencies, we want to make sure our policies and our programs have very high quality. I gave a few examples here in the House yesterday of how our provincial programs have enhanced enormous gains around quality. When it comes to home care, right now the standard of care would be what each of our agencies has put in place and what they would educate, what they would have for professional development with their providers.

 

            If we are talking about Revera, We Care, Northwood, Ocean View, Careforce in the Valley, VON - all of these at the moment, we don't have that provincial criteria there for home care. This is what we want to develop. The RFP that will come out is not just about a price point for delivery. It will have built-in standards and accountability measures as well. We know that some of what our patients, our home care recipients, receive can be improved upon, and that's the goal. That's why we are taking home care in a different delivery model.

 

At the end of the day, if I didn't think that we would be providing better home care, I would have great reluctance to go down this road. I have been hearing for 12 years - 12 years, through my constituency office - about the deficiencies of home care. I know that I've actually - look, again, it's probably a collective that has said that we can make improvements.

 

            When we had full centralized scheduling - I don't know, maybe it was being done by hand, or maybe it was being done without the use of a map - we've had very, very poor scheduling and way too many providers going into a home. Those are two basics that I feel must change. We will be able to change that with our new model of delivery. It will be one of the standards of care that will be in place.

 

When I pick up one of my constituents' diaries - and I don't see him as a very difficult man at all - and over the course of 365 days, he's had 100 different providers come into his home, there is something very wrong with that service. GPS tracking alone can make an enormous difference. We have to modernize how we deliver health care. We can move into the 21st Century in very short order if we embrace technology as an assistive tool. We're not going to put in R2-D2 to go and deliver home care, as one of our members opposite likes to reference. We're going to have caring, compassionate, well-trained - as we currently have, but doing it in a much more efficient manner than we are.

 

            When a nurse contract right now is for $90 an hour, and we have a good idea what a nurse is being paid, and that's a not-for-profit organization, there is a lot of money going somewhere that we don't have an accounting for. That's what we will change. The taxpayer will be served better by this new model of care.

 

            MR. MACLEOD: Madam Chairman, I appreciate the answer of the minister, but I have to say I'm a little shocked that we're putting out millions and millions and millions of dollars to many different organizations and we don't have a standard as to what we expect for the service. If we go and buy a service for our own home, we would expect that there is a certain standard that should be met. The very fact that we're spending millions of dollars on home care and not having a set of standards as a province does disturb me, I have to be honest.

 

I do know a number of individuals who work in home care. I think they're very capable and qualified people and they deliver a good service. They're very compassionate and they care about what they are doing.

 

            I would hope, minister, that when we're looking at these standards that you are talking about, we will actually do consultation beforehand, not after, like another situation which we have just gone through. We need to do consultation with the clients.

 

The other thing I think I understand, but I stand to be corrected on this: if you're going to apply for a job as a home caregiver and you tell them that you're in a course and receiving the training, you can actually get the job without completing the training. I think there is something wrong with that type of standard. I would expect that everyone who comes into my home or into the home of a loved one to supply home care would have a minimum set of education and standards that they have to meet before they're even allowed to do that. The care they provide to individuals, as you know, is something that can help all Nova Scotians.

 

            Those ideas about where we are with home care, who delivers it - I'm not all caught up on who delivers the service. Private or not-for-profit, none of that really bothers me. It's the quality of the care that the client receives at the end of the day from good, well-trained individuals who are getting a fair wage. I believe that's what you said to me.

 

Yesterday you told me in Question Period that home care was going to be better than it is today. You were very emphatic about that. I wonder what you mean by that.

 

            MADAM CHAIRMAN: Time has elapsed for the PC caucus.

 

We'll now move on to the NDP caucus, and our finishing time is 7:18 p.m.

 

The honourable member for Sackville-Cobequid.

 

            HON. DAVID WILSON: I know we only have about 13 minutes, so I will try to go through a couple of these.

 

Under provincial programs, I was looking for pain management. It seems to no longer be on the list. It was around $949,000. Am I missing it somewhere? Was it moved out? Or was that allocation for pain management no longer funded under this year's budget?

 

            MR. GLAVINE: If the member opposite would allow me just a quick correction here. The member for Sydney River-Mira-Louisbourg asked me about standards, and there are indeed standards through a policy for home care. What I had been looking at were a couple of the providers in my area that do have standards, and I would think they would have incorporated those that are part of the provincial policy as well for their delivery of care. So there are standards, but I know that through our continuing care refresh and as we go forward to make sure we have very strong delivery of the best home care, those certainly will be part of what we will advance, for sure.

 

            Just to identify for the member for Sackville-Cobequid, it is under Primary Care Programs, and it is $949,000 for pain management.

 

            MR. DAVID WILSON: Thank you to the minister. I want to go quickly now to health care capital grants on Page 14.14. We notice a decrease of about $13.8 million, a decrease in hospital equipment. I know the minister stated some information earlier about that, but also a decrease in hospital infrastructure of about $4.3 million. I'm wondering if he could elaborate on that $4.3 million decrease in hospital infrastructure. Is that just a cut, a reduction to that budget? Maybe just some detail on why that figure has been dropped by that number?

 

            MR. GLAVINE: We had a higher than normal expenditure in 2014-15, so this is about on par. The amount that it's down this year is about that average envelope for expenditure. I'm sure the member opposite would remember the replacement, for example, of the IWK generator - a one-time expenditure. That was included in a bump up, and there were several other more urgent requirements that got put into that envelope last year.

 

            MR. DAVID WILSON: I know that the department is provided with a list of requests for infrastructure dollars every year by the district health authorities. I'm wondering if the minister can provide the list of the requests - most likely won't be able to, and I understand that - but a percentage of the list. Were you able to meet 50 per cent of the requests from the district health authorities around the hospital infrastructure and monies that go along with that line item?

 

            MR. GLAVINE: As the member would appreciate, that's always a long list that comes in from the DHAs, and the department goes through a prioritizing process. We will now have that carried out with the one provincial health board being able to provide that list for the province and also work continuously on a priority process.

 

We will have to take a look at the last year or two, perhaps, in terms of what an average is. We're going to be able to quantify that much more easily under the one provincial approach when it's all gathered into one number of projects required and how many are able to be funded in a particular year. These are generally projects that are under $1 million, and each year a significant number of those are carried through.

 

            MR. DAVID WILSON: I know he can't give me a number or a percentage. I'm wondering if the minister could provide us with a detailed breakdown of what projects are approved for this year under the $53.347 million that's allocated for hospital infrastructure.

 

            MR. GLAVINE: I can go through these projects and then may perhaps have to finish them off during our next hours tomorrow.

 

            There's a hospital emergency generator replacement, the provincial dialysis service, and the planning for the South Shore and Dartmouth General. The Collaborative Emergency Centres will continue this year. The Digby Primary Care Clinic is on its way to completion. The Shelburne Medical Clinic redevelopment is in this year's plan. The Aberdeen Hospital expansion, which I've spoken about at length with the member from Pictou - should be underway in May. Mental health program consolidation and the Purdy Building demolition; provincial dialysis service, the Hemodialysis Unit at the Halifax Infirmary; the North Cumberland redevelopment in Pugwash, and the provincial dialysis services expansion into Kentville. The Guysborough Memorial Hospital redevelopment project is underway.

 

The IWK Adolescent Centre for Treatment (ACT) and CHOICES mental health, and the IWK child day treatment and Compass program; the IWK eating disorder day treatment services, the VG and Centennial redevelopment project design - that will be a second design stage. South Shore Regional Hospital, expand emergency and ICU, and the conversion of natural gas. I believe the conversion to natural gas is three or four more of our regional hospitals.

 

            MADAM CHAIRMAN: Order, please. The time allotted has elapsed.

 

The honourable Deputy Government House Leader.

 

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

 

            MADAM CHAIRMAN: The motion is carried.

 

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

 

            [The committee adjourned at 7:18 p.m.]