HANSARD

Printed and Published by Nova Scotia Hansard Reporting Services

Ms. Diana Whalen (Chairman)

Mr. Leonard Preyra (Vice-Chairman)

Mr. Clarrie MacKinnon

Ms. Becky Kent

Mr. Mat Whynott

Ms. Lenore Zann

Hon. Keith Colwell

Hon. Cecil Clarke

Mr. Chuck Porter

[Mr. Gordon Gosse replaced Mr. Mat Whynott for a portion of the meeting]

WITNESSES

Office of the Auditor General

Mr. Jacques Lapointe, Auditor General

Ms. Evangeline Colman-Sadd, Assistant Auditor General

Department of Health

Mr. Kevin McNamara, Deputy Minister

Dr. Ken Buchholz, Physician Advisor

Department of Health Promotion and Protection

Mr. Duff Montgomerie, Deputy Minister

Dr. Robert Strang, Chief Public Health Officer

Mr. Russell Stuart, Director of Health Services and Emergency Management

In Attendance:

Mrs. Darlene Henry

Legislative Committee Clerk

Ms. Sherri Mitchell

Legislative Committees Office

Mr. Gordon Hebb

Chief Legislative Counsel

HALIFAX, WEDNESDAY, SEPTEMBER 30, 2009

STANDING COMMITTEE ON PUBLIC ACCOUNTS

9:00 A.M.

CHAIRMAN

Ms. Diana Whalen

VICE-CHAIRMAN

Mr. Leonard Preyra

MADAM CHAIRMAN: I'd like to ask the members to take their seats; we're going to get started. It's 9:02 a.m. and I do want to try and run these meetings on time and keep us on schedule because there's a lot of questions to be asked today. In keeping with our tradition here, I would like to begin by having the members of the committee introduce themselves and our guests, as well, will introduce themselves, that's important for the record. We could begin with Mr. Gosse.

[ The members and witnesses introduced themselves.]

MADAM CHAIRMAN: Thank you very much. Just by way of background for this meeting, this morning's meeting of the Public Accounts Committee is a little bit different than normal. We're going for three hours rather than two, and that was in order to have both the Deputy Minister of Health with us, as well as the Deputy Minister of Health Promotion and Protection at the same time.

Our topic this morning is the pandemic planning and it follows a report by the Auditor General that was received on July 30^th, I believe it was released. It was to look at the pandemic planning here in Nova Scotia. So we had not had an opportunity to hear from the Auditor General because that report came out during the summer months so as an introduction this morning, our plan is to have the Auditor General give us an overview of the report; a fairly brief overview. We are going to allow a short round of questions, perhaps five minutes for each caucus, if you need that much, to lay the groundwork for the Auditor General's Report and then we will go to opening statements from our deputy ministers and we expect two longer rounds of questioning from the caucuses. So that is the plan for today.

I would like to let the members know that I will be sharing the Chair this morning with the Vice Chairman, Mr. Preyra, because we both want to ask questions but we're going to take turns chairing the meeting as well. At the end of the meeting today, there is some administrative and committee business that we will look at, right at the very end.

With that being said, I'd like to turn the floor over to the Auditor General to introduce us to the report.

MR. JACQUES LAPOINTE: Thank you, Madam Chair. Good morning and thank you for inviting me here today to provide a brief overview of my office's audit of pandemic preparedness. I released this report on July 30^th, several months ahead of schedule, because I believe our recommendations, if implemented, will significantly improve the province's ability to effectively meet the challenges presented by the H1N1 pandemic.

My report was intended to instill a sense of urgency in government. I felt there was no cause for alarm as long as government addressed the deficiencies I identified. Considerable time and effort were expended in preparing for a pandemic and preparing Nova Scotia's health system pandemic plan. However, the plan contains a number of areas in which more work was needed to ensure an effective response to the ongoing H1N1 pandemic. My report contains 33 recommendations and covers a number of areas where action is required.

I will comment briefly today on three areas I consider fundamental to an effective response - leadership, coordination and supply. At the time this report was released, there was no clear overall executive leadership in place to exercise command, control and coordination of government's pandemic response efforts. That was a gap identified, as well, as a problem in the response to the SARS outbreak in Toronto. I recommended Executive Council determine where, ultimately, leadership resides and establish a leadership structure that provides the required command, control and coordination structures.

Coordination of planning was also an identified concern. While the Emergency Management Office had engaged some key non-government stakeholders in emergency planning, no central agency was responsible for emergency planning, including pandemic planning, in critical non-government entities. Adequate emergency plans are necessary to ensure that critical services such as power, water, snow clearing, policing and fire response continue during a time when absenteeism may be high.

Further, few government entities had completed and submitted business continuity plans to the EMO. Such plans detail how these entities will continue to operate in the event of an emergency such as a pandemic. We suggested that all government entities submit these plans as quickly as possible, that the EMO ensure the plans are adequate and complete and that the EMO take the lead in ensuring a coordinated response in the non-government sector.

In addition to the province's overall pandemic plan for the health system, each district health authority also had a pandemic plan specific to its district. The Departments of Health and Health Promotion and Protection had not assessed DHA pandemic plans. These plans are significant because DHAs deliver hospital-based health care services. Without central review and assessment, there is no assurance that the DHA plans are complete and consistent.

An overall review of DHA plans would help identify gaps in the province's overall preparedness. This key step should have been undertaken as part of the province's pandemic planning process. I recommended the departments immediately review all DHA pandemic plans to ensure the plans are adequate, consistent and complete.

Finally, while health system pandemic planning began a number of years ago, there were still gaps in the health system pandemic plan which needed to be addressed. For instance, at the time my report was released, the province had not taken steps to ensure it had an adequate stockpile of medical and other supplies needed for an effective pandemic response.

The recommendations in my report were intended to help the province to be ready with a well-coordinated, effective response to a serious and widespread H1N1 pandemic that many health officials were predicting. Timely implementation, however, is essential. At the time of writing this report, the Departments of Health and Health Promotion and Protection had established working groups and were developing work plans to address deficiencies in H1N1 response.

Government's response to the report was a positive one, indicating agreement with the recommendations and its intention to take action on them.

Thank you for the opportunity to provide some overall comments on my report and I or Evangeline would, of course, be pleased to answer any questions that you may have.

MADAM CHAIRMAN: Thank you very much. We'll begin with a short round of questions for the Auditor General and his staff this morning beginning with the Liberal caucus. We'll have five minutes, if you need that much, for each.

HON. KEITH COLWELL: Thank you very much. Mr. Lapointe, of the recommendations you've made, are you aware of what progress the Department of Health has made on your recommendations so far?

MR. LAPOINTE: I have to say that we haven't - it's a very recent report and we haven't followed up specifically on the implementation of the recommendations, giving them time to proceed. So we haven't followed up. Our normal procedure, as you know, is to go

back two years later; in many of these it's not really applicable in this case. I don't have current information beyond what I would have seen in media.

MR. COLWELL: The reason I ask that is because this is an unusual situation. Typically two years later is a matter of changing things and procedures or whatever recommended by the Auditor General. In this case, it could be a serious problem in the very immediate future - hopefully it isn't, but it could be - and I was just wondering if there was any dialogue between your office and the Department of Health?

MR. LAPOINTE: There has been no specific dialogue on the implementation. We felt that it wasn't really our role to be staying on top and monitoring on a weekly or monthly basis what the department was doing once we put the recommendations in place.

MR. COLWELL: And of the recommendations you've made, are there any really serious concerns that you've identified? I know when you go through these audits, you're always looking for ways to improve what the government does - that's your job, really - or identifying things that shouldn't be operating the way they are. When you went through this process, were you really alarmed about any of the issues you found there considering what the possibilities might be?

MR. LAPOINTE: I would say that the concerns were fairly self-evident in the nature of the recommendations we made and some were quite clearly more immediate in terms of the action needed. For instance, the supply - that needed to be put in place as quickly as possible. The review of the HA plans, you know, that should be done now and others involved more long-term recommendations that could be deferred and updating the pandemic plan in certain areas, you know, in areas that would affect future pandemics. So the concern that we had is that the department go through and risk-assess each of these recommendations and take action on those could be done easily or quickly or those that were more critical.

MR. COLWELL: That's all the questions I have.

MADAM CHAIRMAN: I should mention we've been joined by the MLA for Truro-Bible Hill, so welcome Ms. Zann, just for the record. The next five minutes, if you require it, will be for the PC caucus. Mr. Porter.

MR. CHUCK PORTER: Thank you, Madam Chairman. Thank you, Mr. Lapointe for your opening comments and I have just a couple of questions. One, how many recommendations, I missed that part, were identified and recommended by you in your report?

MR. LAPOINTE: We had 33 recommendations.

MR. PORTER: How many were acted upon so far, do you know?

MR. LAPOINTE: We haven't kept track. It has been such a short period of time and we haven't stayed on top of the . . .

MR. PORTER: So you've done no look back right now at all?

MR. LAPOINTE: No, we haven't.

MR. PORTER: And you talked about establishing leadership structure in that report - I can't recall it, what structure are you looking at here? Is it the DHA solely, the individual structures?

MR. LAPOINTE: The leadership structure we referred to in the recommendations had to do with the overall command and control and that focused on EMO which I believe you'll be looking at later but some action I know has been taken on that. As you know, there have been announcements about a leadership structure under EMO to take an overall view of emergency planning. So some changes have been made in that area.

[9:15 a.m.]

MR. PORTER: You also mentioned, if I heard you correctly, that there was no central agency and if I read that correctly - it was at the time of your audit, obviously, you determined. I would only say this, that in March/April when everything started to come out with regard to the pandemic or ended up being a pandemic, King's-Edgehill was discovered. Of course, I represent that area and live very close but I was involved in that to some degree. I felt that HPP was doing a very good job with regard to a central agency. They met regularly, daily, almost hourly. They were informing meetings at the schools. They were meeting with town representatives and municipal people. I'm a little confused by your statement of no central agency that would handle such a case and maybe I'm misreading it but I would like to hear how you arrived at that point.

MR. LAPOINTE: We were referring in the report to an overall - a command and control hierarchy with legal authority to take overall direction of a pandemic emergency. Not just in the health area but in the other departments and in key private sector organizations like power and so on, and in dealing with municipalities so that overall command and control province-wide and that was not clear and not really legally established. We thought it needed more clarity at that level.

MR. PORTER: Thank you for that. You mentioned as well about, if I heard you correctly, the supply of whatever the treatment necessary might be. Is that correct that you didn't feel that it was adequate?

MR. LAPOINTE: The supplies issue?

MR. PORTER: Yes.

MR. LAPOINTE: What we had identified was that a large inventory of various kinds of medical supplies had been identified as required, but no action had been taken overall to ensure these were in place, not centrally - some efforts made at the DHA level, regionally, but not to ensure that province-wide we had in this province all the supplies that we needed to ensure the safety of the health of people and also treatment . . .

MR. PORTER: Sorry, I know my time is running short, just one more question. If I'm reading it correctly, you would see there being a standard amount of standard equipment that would treat any type of pandemic, by way of being prepared. The only reason I raise that, again in listening to what you said - it could be interpreted as though, you should have enough vaccine on hand for this and for that, but in this case there were no vaccines even available. How could we and I'll use the word "criticize" for the lack of a better term right now, what we didn't have when it didn't exist? So I just want a point of clarity on standard equipment verus my last statement.

MR. LAPOINTE: We were really referring to more standard supplies for patient treatment that a hospital would have, like gloves and gowns and that sort of thing, that you would require in larger quantities if there was a sudden increase in the number of patients.

MR. PORTER: Thank you. So you're looking for that to be centrally located, one-stop shopping province-wide or at least organized to some degree here, that is your recommendation there?

MR. LAPOINTE: Yes, as well, orders placed to ensure that we were not competing with other jurisdictions if a crunch came down and there were shortages.

MR. PORTER: Thanks very much.

MADAM CHAIRMAN: Mr. Preyra for the NDP Caucus.

MR. LEONARD PREYRA: Good morning, Madam Chairman, and good morning Mr. Lapointe and welcome. I thank you very much for this report. As a political scientist I've always had a great deal of respect for the Office of the Auditor General and if we need any more of the importance of this office, I think this report is it. It just demonstrates how timely and important a report can be.

I understand that this report is unusual in that your audits are much more disciplined and that you start at the beginning and you end at the end and there is a sequence that followed. But the H1N1 pandemic intervened and the report then became a report about pandemic preparedness and H1N1. I'm wondering if you could tell us something about the end of the report and where it was going when the report was submitted - it was three or four

months early. What follow-up or what recommendations would you give to direct us to go in the future?

MR. LAPOINTE: The state we were in when we were doing this audit was that we were partway through, as you know, auditing preparedness for a future pandemic when, in fact, a pandemic struck. So it changed the dynamics considerably and we thought that the urgency of our recommendations - if we're going to effect any improvements, we needed to go out more quickly. So we simply set up the entire process to be able to report very fast as opposed to going a more routine process that would have allowed us to report later in the fall.

We didn't short circuit, I guess, any of the core work that needed to be done. We wanted to focus on the critical areas so we, in fact, made recommendations that would affect not only the current situation but some that would improve future planning for future pandemics. So we do have a number of recommendations in terms of how the pandemic plan should look and how it should evolve to ensure that in the future we are in better shape. So I say we have recommendations dealing with a number of areas that are more long term than just the immediate.

MR. PREYRA: And those recommendations will be forthcoming at some point? I'm not sure, what is the process for follow-up from the Office of the Auditor General?

MR. LAPOINTE: Our normal process is to issue the report, to then give the department two years to implement, and two years later we will then go into a formal review of the status of implementation, in the hopes that by then - that should be enough time for the recommendations, if there was no dispute about them and they were accepted - they should be, in fact, implemented by that time. Then we report on that to the House as well, in a report, and we will be doing that in this case.

So we have 33 recommendations. We will, in fact, in two years, go back and examine the status of pandemic preparedness. I would expect that the majority of these recommendations would be in place because most of them are dealing with urgent issues. As for the ones which are long term, we'd take a close look at those as well, but that's our normal process in two years.

We don't really have - to be honest, this is a one-time-only situation - so we don't have a process specifically dealing with an urgent report that requires action in a matter of months, on a lot of recommendations, rather than later.

MR. PREYRA: In fact, the departments and the ministers seemed to respond almost immediately to your report given the urgency of the situation and I'm assuming that you've seen their responses.

MR. LAPOINTE: Yes, the response from the department was very rapid and, I must say, took it very seriously. The minister's response was to simply say that the recommendations were accepted and they'd be taking action to implement. In fact, I have to give the departments their due, that by the time the report was issued a lot of actions were already underway because, as you know, we work with the department on it and we're reviewing the report as we write it. Certainly a lot of action was underway with work groups in place, dealing with these issues, by the time the report came out.

MR. PREYRA: Just another couple of questions. The report refers to but doesn't say a lot about non-governmental organizations, particularly large institutions like Nova Scotia Power, and other private institutions and their capacity, and some of the district health authorities. I know there is a section in there that talks about it. Do you have anything more to say about those other - I wouldn't say non-core because they're really important.

MR. LAPOINTE: I agree on the importance of these organizations and that's something we did stress in the report, that while we were focusing on our audit, on the health system pandemic planning, that, in fact, there was preparedness required in all the other departments of government that dealt with core services and that there were other non-governmental agencies that had a large role to play when including municipalities, for instance. But our concern there was addressed primarily through the need for a central command and control structure that would monitor what was going on in the rest of the province in the non-governmental area and that was focused on the EMO and a joint committee that would ensure that the province as a whole was ready and that there were no gaps in major services like hydro.

MR. PREYRA: Thank you, Madam Chairman.

MADAM CHAIRMAN: Thank you very much and that would conclude that round of questioning. I should mention to the members, I know we have new members on the committee, that at any time if you have a question for the Auditor General, at all of our meetings we do have the Auditor General with us and he is available for questions during any of our rounds, if there is a need.

I also wanted to mention that next week on our schedule we do have the Emergency Management Office coming in and it is a continuation of the same theme, talking about pandemic planning and the non-governmental side of the Auditor General's Report as well, so that will be here. You'll have another chance to do that next week.

I'd now like to turn to our guests this morning to get some opening statements. I think perhaps we'll begin with Mr. Montgomerie who is the Deputy Minister of Health Promotion and Protection and just making the point that we had both of you come today because of the coordination that you indicated is very key to your approach, so we're looking forward to having both of you here today and welcome.

MR. DUFF MONTGOMERIE: Madam Chairman, we'd like to thank you again for allowing us to come together, it's very helpful.

Dr. Strang says I'm old enough that I don't have H1N1, just an old-fashioned cold, so I apologize for the voice.

We take the Auditor General's Report very, very seriously and it's really important for us to point out - for example, you have the actual tracking document that the Departments of Health and Health Promotion and Protection use to track the Auditor General's Report and our progress around it. You have that with you. It should be in your packages, just to let you know that.

I think it's also important for me to remind the members that really what the Auditor General did was audit a plan, and while he was auditing the plan a pandemic World Health Organization Level 6 occurred. So what we're responding to is the plan, not how we manage the outbreak, and sometimes the lines get blurred. If I can, as an old sport person, use the sport analogy, it's kind of like - in the summer you prepare for the Super Bowl. You prepare your plans and your tracking and you really work hard. You coach, you train for the Super Bowl, and suddenly you're in the Super Bowl and everything changes because the other team is trying to beat you and they're going to do everything they can to change their approach and so on, so you have to adjust as a coach. It's kind of like being in the Super Bowl and people keep asking you about your plan back in September and we're trying to win a game. So I have to tell you it's a little frustrating sometimes because those lines do get a bit blurred. Again I do re-emphasize the planning advice that the Auditor General has given us is absolutely exceptional and both Kevin and I are and have been absolutely committed to making sure that they get implemented.

I'm going to ask for a little indulgence to give you a little context of what the first five days were like and what actions were taken when we first became aware of H1N1. On Tuesday, April 21, 2009, the Public Health Agency of Canada arranged a call with the provinces and territories. This was the first of what were to become daily calls regarding the possibility of a new flu strain emerging in Mexico. On that initial call they made us aware that they, along with the Centers for Disease Control and Prevention in Atlanta, had been asked by Mexico to carry out lab tests due to a recent flu outbreak in that country. They shared with us that the test results confirmed the emergence of a new flu virus named Swine Flu, now called H1N1. Anecdotally, they were also hearing it impacted young people much more severely than the elderly, a characteristic that, by the way, has remained consistent since the outbreak.

Dr. Strang immediately made his team aware of a potentially-emerging public health threat. I briefed the Minister of Health Promotion and Protection, the Honourable Pat Dunn. I also briefed Deputy Minister to the Premier and Clerk of the Executive Council, Bob Fowler, and also the Deputy Minister of Health, Cheryl Doiron.

On Wednesday, April 22^nd, PHAC further made us aware of confirmed cases of young people testing positive for H1N1 in two states in the United States. I then made the same folks aware of that update.

On the morning of Thursday, April 23^rd, Dr. Strang and I had a discussion where we both agreed that this was clearly an emerging public health threat and it would not be long before it came to our shores. In response to this public health threat, we ordered the situation room for the Department of Health Promotion and Protection be activated. Dr. Maureen Baikie, Deputy Chief Medical Officer of Health, was placed in charge. It was at that time that Capital Health advised us, through our normal public health process, that King's-Edgehill School was experiencing a flu-like illness - potential flu-like outbreak.

[9:30 a.m.]

On Friday, April 24^th, our situation room was activated and fully operational. Although we had no evidence of the illness in Nova Scotia, Dr. Strang met with the media to answer questions they had surrounding this new, emerging flu strain. It was following the media availability that we were advised by our own provincial laboratory that they had five samples from the King's-Edgehill outbreak and that there was a potential link to what we were seeing in Mexico.

These samples were forwarded to the national lab in Winnipeg for further testing, but our own lab people told us they fully expected those samples would come back as H1N1. Therefore, that afternoon we convened a meeting at 4:00 p.m. with the Premier's Office, the Ministers of Health and Health Promotion and Protection, the Minister of Emergency Management and appropriate deputies. I assert to you, command and control was now firmly in place. We advised them of the strong possibility that we will have the first cases of H1N1 in Canada, and Dr. Strang briefed them on what to expect.

On Saturday, April 25^th, the situation room was operational and the following working groups were up and running - surveillance, public health measures, health services, emergency management, and communications. We also established linkages with partners including First Nations Inuit Health Branch and the Department of National Defence. It's now midnight on Saturday, which was a call Dr. Strang and I will well remember, when Dr. Butler-Jones and lab officials from Winnipeg called us to advise us that, indeed, four of the five tests were H1N1 positive.

On Sunday, April 26^th at 7:00 a.m., we deployed our team to respond. Between Dr. Strang and myself and the CEO of Capital Health, Chris Power, we briefed the headmaster of King's-Edgehill, Mr. Joseph Seagram. To assist the school, Capital Health dispatched additional communications support while public health began to interact directly on a regular basis with King's-Edgehill. I would be remiss if I did not say to the members of this House that Mr. Seagram and his team, and the students and parents at King's-Edgehill, were

absolutely incredible. They were totally calm, cool, asked all the right questions, and they were an inspiration to us on a daily basis as they dealt with their own media deluge down there.

Premier MacDonald, Minister Dunn, Minister Casey, Minister Morse of EMO and other officials were briefed by phone. They gave us their full support and from there Minister Dunn called to brief the federal Health Minister. Dr. Strang and myself briefed EMO officials province wide. We also briefed the Opposition. Communications staff then worked to have Dr. Strang available to the media as soon as possible.

In the meantime, Dr. Butler-Jones called me to advise me that British Columbia will also be announcing positive test results later in the day. From there on in, because of Dr. Butler-Jones' heads-up, communications staff were in regular contact with the Public Health Agency of Canada and the Government of British Columbia. By 2:00 p.m., Dr. Strang advised Nova Scotians and Canadians that H1N1 had arrived in Canada, and he articulated to Nova Scotians what this may mean to them. At 3:00 p.m. British Columbia held a similar press briefing in Vancouver, and at 4:00 p.m. Dr. David Butler-Jones held one in Ottawa.

The messages from three top public health officials in Canada were absolutely the same. Nova Scotia received more than 100 media calls during that piece and I have to reiterate the kind of co-operation that we saw that very first day within the system between the Public Health Agency of Canada and our provincial/territorial colleagues has been held the standard to this very day. It has been absolutely exceptional. I think one of the fun moments we had in the middle of all this on Sunday is when one of the communications folks said we've hit the big time, The New York Times would like to speak with Dr. Strang.

The Deputy Minister of Health, Cheryl Doiron, ordered the Department of Health Emergency Operational Centre to be activated for Monday, April 27^th. Both Deputy Doiron and I agreed that we now needed to activate what we call the Joint Emergency Operational Centre, which is co-run by the health deputy and myself. That would be activated on Tuesday, April 28^th.

I want to give you what Tuesday, April 28^th, looked like because that's what our day was going to be like for the next three weeks. On Tuesday, first thing, I briefed Deputy Fowler and Minister Dunn, while Deputy Doiron briefed Minister Casey. Additional activities that day included our surveillance, and consistent communications with specialists and infectious control experts throughout the health system was ongoing. On a daily basis, starting on this Tuesday, Dr. Strang and I would review the challenges, the resources needed, and prepare for national calls later that day.

Department of Health officials reviewed the challenges from their perspective and work that needed to be done in the Health side of the system. There then was a joint EOC meeting chaired by myself and Deputy Doiron to review the day's activities, so that meant

the two departments worked together on a daily basis for an hour around what we were seeing as emerging issues and issues that we had to deal with because at 4:00 p.m. we then went on a call, on a daily basis, with the CEOs from the district health authorities, the IWK, and other key representatives from the health system.

Dr. Strang and I then took a National Special Advisory call, and I think yesterday was our 53^rd call. Experts in various capacities were now fully engaged to help deal with the outbreak. These calls were, and continue to be, where the major recommendations are made to deal with key issues surrounding the outbreak from a national basis.

Then there was a health system call, co-chaired by, as I mentioned earlier, myself and Deputy Doiron, which involved the DHAs, but also on a daily basis involved EMO, the Emergency Health Services - the ambulance service - the Department of National Defence and the First Nations Inuit Health Branch, and then, at the end of the day, I briefed Deputy Fowler and Minister Dunn while Deputy Doiron briefed Minister Casey. I thank you for bearing with me as I outline the events of the first few days. I did so to help put context around this morning's discussion and again to remind the honourable members that the Auditor General is evaluating our pandemic readiness plan and has been doing so before the outbreak occurred. He was not auditing how we handled, and continue to handle, in its 23^rd week, the outbreak.

Nova Scotia is very fortunate to have a strong team working together at both departments to ensure a solid pandemic plan for Nova Scotians. We're also fortunate to have a team of talented and skilled public health and health care professionals in our districts who have shown nothing but absolute co-operation and professionalism, since April 28^th. At this stage our priority is to manage the response of the pandemic. I think it's important to remind you of a phrase Dr. Strang uses often, and it's one I use often when talking to decision makers, what we tell you today may change tomorrow, that's how fluid this outbreak is. I can only say this to remind you of that.

Finally I would like to close by saying that I've had the opportunity to be involved with the health file since 1999 and in that time I've been at every minister's conference, First Ministers Conference, any discussion you want to think about in health care including sitting in on the SARS calls. I have to tell you that first-hand, this outbreak - the exceptional level of sophistication, collaboration and openness from the Public Health Agency of Canada, under the leadership of Dr. David Butler-Jones, has shown time and time again his and their willingness to listen to advice and to work hard to achieve a national consensus around key issues.

The number of Canadian experts that the federal government has been able to engage in co-operation with the provinces and territories - because many of those experts are from Nova Scotia - to support our efforts and decision making has been unprecedented. It has actually been a privilege for me to sit in on the National Advisory calls and meetings where

I get to see how Dr. Strang and Dr. Butler-Jones, and their colleagues, wrestle with the science, which is often uncertain or incomplete, and then assess the risk in every effort to reach a national consensus that supports the safety of Canadians. I thank you for your indulgence for the length, Madam Chairman, and I turn it over, with your indulgence, to Deputy McNamara.

MADAM CHAIRMAN: That was about 15 minutes so that is okay. I hope that Mr. McNamara can do the same and keep us to that. I would like to ask for the opening comments at the same time so we get all the comments at one time from both departments. So I'll turn the floor over to Kevin McNamara who is the Deputy Minister of Health.

MR. KEVIN MCNAMARA: Good morning Madam Chairman and members of the committee. At this time I would like to introduce Russell Stuart who is the Director of Health Services and Emergency Management and reports to both departments and who is supporting us and behind us here. We would also be pleased to answer any questions you might have regarding the Department of Health's pandemic preparedness, the health system's response to H1N1 flu pandemic to date and preparations for this situation as it evolves.

As Deputy Montgomerie has discussed in his remarks, the Departments of Health and Health Promotion and Protection continue to work very closely together, and with the larger health system, to prepare for and respond to the H1N1 flu virus since the first case in Canada was confirmed at King's-Edgehill School, in Windsor, in April. Together and in close co-operation with district health authorities, the IWK Emergency Health Services and HealthLink 811 system as well as the Public Health Agency of Canada, we have managed the public health and health system response to H1N1 flu pandemic, in this province, as it evolves.

Nova Scotia's Public Health Service and health care systems have effectively responded to this situation to date while working hard to prepare to respond to a potentially more severe Fall flu season and the more severe cases of H1N1. We have a strong health care system in Nova Scotia with highly skilled, caring and dedicated professionals who work hard every day to provide the best care possible to Nova Scotians. Nova Scotians should feel confident in the ability of our health care professionals and the health system to respond to the current pandemic. The Auditor General released his report in July. Our departments greatly appreciate the time the Auditor General's Office took to understand this very complex issue in order to provide us with recommendations that are enhancing an already effective pandemic planning process.

While the response to the current pandemic has been strong, the Auditor General's review is helping us enhance what is working and make improvements where necessary, all with the ultimate goal of protecting the health and safety of Nova Scotians and providing the best health care possible to Nova Scotians.

Through a process established to assess our initial response to H1N1, our departments have and continue to identify areas for improvement based on lessons learned. We have a rigorous process in place to prioritize these issues and ensure they are addressed in a timely fashion. Many of these areas were also identified by the Auditor General in his report. Work is well underway and significant progress has already been made in addressing issues identified, not only through the Auditor General's review, but also through our own rigorous internal process, which is supported by tight timelines.

At this time, I'd like to share with you some highlights of the progress that has been made. The recently-established HealthLink 811 system launched this past summer is supporting our province's response to H1N1 by allowing Nova Scotians to get information and health advice in a timely manner in both French and English. When it comes to supplies, we are in good shape. We have increased our stockpile of critical supplies of personal protective equipment, including N95 respirators and surgical masks, and continue to receive shipments of supplies for our provincial strategic reserve. At the same time, district health authorities are also increasing their own supplies.

The provincial stockpile is a reserve supply that can be drawn on if there is a surge in demand. There is also a federal stockpile, managed under the Public Health Agency of Canada, that can be drawn from if requested by provinces or territories.

We have a regular delivery schedule in place in which we will receive supplies on a monthly basis. This schedule is in place to ensure we have a sustainable stockpile of supplies to meet both business-as-usual needs and fluctuations in demands on an ongoing basis. At this time, there is no indication from suppliers that there will be any challenges in receiving supplies that have been ordered.

We are also in the final stages of completing a thorough assessment of intensive care unit capacity and needs in this province. As part of this, we are enhancing ventilator capacity and implementing a province-wide intensive care bed management program. Through this work we have the ability to collapse the province's ICU system and manage it provincially should the need arise. This will allow us to provide the care required based on the situation at hand while still providing needed care to those patients who require regular ICU.

In close collaboration with district health authorities, we are in the process of reviewing and monitoring district pandemic preparedness and plans, and you'll note we passed out an updated chart this morning from the initial information, which shows that all plans are in except for two districts on business continuity plans. At the same time, districts are working in close collaboration with each other and our two departments are responding to the current situation as a health system. Districts also have extensive experience in responding to emergencies that affect the health system, and that can be drawn upon.

[9:45 a.m.]

As we manage the health system response to this pandemic, we are also further refining our provincial pandemic plan. The lessons learned from this experience will be extremely valuable in informing the next revision of the plan, which will be more advanced than we had originally anticipated.

The work and investments being made now will help protect Nova Scotians today and in the future. Nova Scotians should have confidence in the health system's ability to provide the best care possible to patients. We're working very closely with our health system partners, the DHAs, the IWK, EHS, and HealthLink 811, as well as other government departments and our federal, provincial, and territorial counterparts, to ensure we are in the best position to respond and ensure the safety and well-being of Nova Scotians as the situation evolves.

Thank you for the opportunity and we will be prepared to answer your questions.

[9:40 a.m. Mr. Leonard Preyra took the Chair.]

MR. CHAIRMAN: Thank you very much, Mr. McNamara. How do we proceed next? Do we go with - we will begin with a 20-minute round of questions, beginning with our chairman who now is a Liberal critic, sitting for the Liberal Party. Okay, it is 9:46 a.m.

MS. DIANA WHALEN: Thank you very much, Mr. Chairman, and welcome again to our guests this morning. It's certainly a very vast study that we're looking at here today and I appreciate your comments. I know we allowed longer than usual for the opening comments but it is important to get the context and understand just how much has changed and how fluid the situation is, to use your own words.

I think it is important to note that it was unusual that the Auditor General was in the departments looking at the plan while, in fact, you were responding to the plan. But, at the same time, we also know that what we experienced in the Spring was the first round. Having a plan and having every piece of it in place is very important for people's peace of mind and knowing that we're doing the absolute best we can to be ready for a second wave. Certainly the news is full of what has happened in other parts of the world and what is happening around the country so we're all very concerned. This was an issue that we wanted to bring forth as our very first topic for the new Public Accounts Committee because of that.

I wanted to jump in, there are so many different aspects of this planning but I'm glad that all the key people are here today so you can decide who may be best to answer each one of these questions. I think my first one, on the immunization plans is where I wanted to begin, and I think it's probably for Dr. Strang. Just to put it in a context, this is one of the areas that has been very fluid in terms of who might be immunized, what we're doing in

terms of what was the regular flu season and how we would normally, in any given year, have our vaccinations and now what we're doing with regard to the H1N1 vaccination.

What I understand most recently from our Chief Medical Officer is that we're going to have the flu shots for seniors who would normally receive it and that could begin next week. Then we'll be doing H1N1 vaccinations for the targeted groups, I guess, beginning in November when the vaccine is available, then going back possibly to more flu vaccinations after that, if I'm not mistaken. I know it has been different in different parts of the country; there have been a little bit different approaches perhaps taken in this. One thing that I think the public likes is when there is some unanimity in terms of our approach, when there is agreement on what the right approach is.

I wanted to reference the fact that there had been a Canadian study that had shown that people who got the seasonal flu shot in previous years seem more likely to get, or are more susceptible to, the H1N1 virus. I'm wondering if you could tell us, really, whether or not we've changed our protocol as a result of that unconfirmed - or I guess that study that hasn't been completely substantiated?

DR. ROBERT STRANG: Thank you and yes, I'm going to take a few minutes just to go through. That was one factor and I just want to re-emphasize that that is a preliminary piece of evidence; it has not been confirmed. There's a lot of work going on nationally and internationally. The World Health Organization is contributing their experts and other countries are contributing vaccine experts to try to understand this study and it may take some time to ultimately determine if that finding is true or not. But given that, we don't have the luxury of waiting so we are taking that into account.

There's a number of factors that led to our decision to change our vaccine programs and while there's not complete consistency, the most provinces have gone where we have gone, which is to scale back seasonal flu and offer it to seniors and residents of long-term care facilities. Quebec has decided to delay their whole program and New Brunswick is the only province that has decided to go ahead with their full program.

There's a lot of factors that go in here and there's no absolute right or wrong and no black or white, so each province has to make sense of the information and make the best decision for themselves. We wrestled long and hard trying to achieve, as close as possible, national consistency.

If you see what has happened in the southern hemisphere where they've just gone through their seasonal flu, during the winter months, what they saw was a predominant circulation of the H1N1 strain and very low levels of the seasonal flu so we likely can expect to see the same. That's not definitive. Again, we can't make 100 per cent predictions based on what we saw in other parts of the world but it certainly helps inform us.

Along with that, what they have seen is that amongst the seasonal flu strains that are circulating, one of the types of flu that's starting to appear is somewhat different from what's in the seasonal flu vaccine, so we potentially could have a mismatch and a not full protection from the seasonal flu vaccine against what may be out there circulating if we get seasonal flu.

Along with that, we understand that the groups that were most at risk of being affected by H1N1 were school age children, followed closely by younger aged children and what I call working age adults - 20 to 45 or 50. Those are the groups that were most affected. So if we understand where we're at with that piece, knowing that we don't typically see seasonal flu here in the province until January and it's usually February or March before we get our peak of the season, it's quite possible we're going to get the second wave of H1N1 well before that and we're now starting to see some signs in the western part of Canada that we may be starting to be on the uptake with H1N1 again. So it's quite possible we're going to see that sooner.

So if you understand who is at risk from what virus - people over age 65 are at low risk for getting H1N1 and they're at greatest risk for severe complications from seasonal flu. So we made the judgment that it was important to protect them against seasonal flu as soon as we had the chance to do so. For the younger age groups - even if they have underlying chronic diseases - they're much more at risk from H1N1, they're much more likely to be exposed to H1N1 and they're much more likely to be exposed before Christmas to H1N1. So we made the decision to hold off on seasonal flu, partly because we don't want to put them at risk. If these studies turn out to be true, the last thing we want to do is to immunize them against seasonal flu, perhaps put them at increased risk and then have increased H1N1 disease in October before being able to protect them with H1N1 vaccine.

So we said we're going to hold off for them with seasonal flu, we're going to cover the seniors to make sure they're given the greatest protection against what they're most at risk from, cover the rest of the population as soon as we get H1N1 vaccine and protect them against the disease they're most at risk for. Then we'll come back to look at, reassess the seasonal flu for the rest of the population, probably in January, because if it's needed we could get it into people before we get large amounts of activity, likely. It takes two weeks to develop immunity. But we also want to have more time to assess, are we even going to need seasonal flu vaccine? How much seasonal flu activity could we expect? What's the match between what's going to be out there and what's in the vaccine? So there's a number of pieces of information that it would make sense to wait on.

Are we putting people at risk? I would say there is certainly some low level of risk. We could have an early seasonal flu season. That's much less likely though than having an early H1N1 season. So there's balances of risks and benefits in all of this. That's why I'm saying, it's not black and white, but I feel we have made the decision, which is protecting Nova Scotians against the most likely risk and immunizing those who need the vaccine with the right type of vaccine first.

MS. WHALEN: That's good, thank you. That was a lengthy answer but I know that it's something that has been on your mind and lots of changes being made as we go along. Part of my concern is a fear that some of the seniors may not want to take the regular seasonal flu shot if they think there's a link to a lower immunity to the H1N1 if they've been taking the shots. Are you worried that some people will not want to take the seasonal flu shot that are in that older age group?

DR. STRANG: Well, we always have issues around less than what I would call adequate uptake of seasonal flu vaccine. It's best in seniors but on a good year still only 70 per cent of seniors get immunized. We absolutely have a communications challenge. It is a complex and confusing year; I'll be very up-front about that, but I have a very good communications staff and we have good communications people in the district health authority so we are working very hard to try to simplify this as much as we can and get good, understandable information to the public but it's hard to distill a complex situation like this to a poster or something like that. So, yes, we do have a communication challenge but we're working hard on that to get the best information to people and to our front-line providers including physicians. I'm in the process now, we sent them a letter about this on Friday, I've got feedback. I'm in the process of sending them a more detailed letter in the next few days so they understand the issue and the complexities, understand where we ended up and how we made the decision so that they can support that when they're seeing their patients.

MS. WHALEN: So the intended rollout is as you describe it? That would be our immunization plan right now?

DR. STRANG: Yes. Starting next week or this week we're getting vaccine out to primary care physicians, Public Health offices and long-term care facilities. For seasonal flu, we'll be starting that next week. We're still on track for getting our H1N1 vaccine in probably the first week of November and likely rolling out an intense campaign in the weeks after that. I say likely because there is still some possibility that if we need to and we get a lot of H1N1 activity in October, knowing that tomorrow is October 1^st, we could speed up some of the regulatory process and perhaps get some vaccine by mid-October.

MS. WHALEN: Okay, I'm wondering now about the supply of vaccine, whether you anticipate any difficulty in having enough vaccine, particularly the H1N1 vaccine?

DR. STRANG: No, not at all. When we had to place our order a few months ago, at that point, we anticipated having to give all Canadians two doses of vaccine. The evidence is now showing that probably, except for the younger age groups, and we're not sure what that age cutoff is yet, but for most people they'll only need a single dose. So we're going to a have more than ample supply of vaccine. Our challenge is to get the general public to take this seriously enough to come out and to get immunized.

MS. WHALEN: You referred in your remarks to cover the rest of the population, you said, are you looking at every person getting a shot?

DR. STRANG: We are, we have vaccine for all Nova Scotians and we're going to be targeting all Nova Scotians to get immunized. I know there has been discussion around priority groups, those are most relevant if we run into a shortage - which we do not anticipate at all - but we had to say who gets the vaccine now. It will help in our messaging around who is at most at risk from H1N1 and who should be up in the front of the line getting immunized. The reality is, when we have public clinics, community-based clinics, if you have a child, say under two years old, who is one of the risk groups, if the mom comes along with the two-year old, we're not going to say to the mom, well, you'll have to wait until next week. That makes no sense. So, we'll be rolling this out and making it available for everybody. Our public messaging will be focusing on specific groups about trying to really encourage them to get out, but we will be encouraging all Nova Scotians.

MS. WHALEN: Okay, I think that's important as a message as well. I wanted to ask you about some of the human resource side of this. During the election I think all of the candidates and all of us here, as MLAs, would have been approached by pharmacists who are talking about an expanded scope of practice for their profession. In the same vein we have seen in New Brunswick just recently that they have made some changes in legislation which do expand the scope of practice for pharmacists and that included administering vaccinations. So my question would be whether or not you've been approached by your ministers to consider expanding the scope of practice for pharmacists here in Nova Scotia? Just a short answer on that would be good, just a yes or no even.

[10:00 a.m.]

DR. STRANG: I haven't been approached by the minister but we've certainly had discussions on several occasions with the Pharmacy Association of Nova Scotia, Dr. Buchholz and myself. The reality is that to work that through and get people who have previously not had, as part of their practice, immunization, competent to immunize is no small task. The judgment that we have made in discussion with the Pharmacy Association of Nova Scotia at this point is that there are a number of other areas that we need to work at first to get additional human resources to support public health immunization before we would look at getting to other professions, such as pharmacists, who have never had immunization as part of their scope of practice at this point.

MS. WHALEN: So you have recommended to government that they consider allowing pharmacists to administer vaccinations in future at some point?

DR. STRANG: I've been a supporter of that when it was first brought to me by the Pharmacy Association and my understanding is within the Department of Health that it is

working through the normal process. We haven't looked to speed it up at this point in time for the reason that I've stated previously.

MS. WHALEN: Yes, with the coming prospect of immunizing every single Nova Scotian you don't think that will be necessary, to look at other medical professionals that can help you do that?

DR. STRANG: What we're looking at first of all is streamlining and prioritizing work in public health so as many people who work in public health are freed up to support mass immunization if our model is based on mostly having large mass clinics. There are lots of people now, there's public health work that we will stop for a period of time, and they can either work as immunizers or do logistic support for clinics. The next step is the discussions that are happening right now within the district health authorities, so who else in the district health authority can work alongside public health staff to support clinics, including family doctors. Whether we give it to doctors in their office or have them come into the clinics, we're working through that.

The third piece is, we're ready to go at any time now with mass advertising to retired nurses and LPNs. If they have retired within the last five years, they can very easily get a temporary licence - the district health authorities have said they would pay for that temporary licence, and bringing in - we have 3,000 or 4,000 retired nurses and LPNs who are within that five-year category - bringing them back into the system to work to support immunization.

That's why I'm saying before we go to other professionals who would require a fair bit of work to get up to speed, we need to - I guess it's essentially putting our attention to areas where we have the most payoff. The other issue we have to consider, I'll use pharmacists as an example - there are shortages of health care professionals everywhere. Pharmacists, if we get a lot of flu activity, are going to be very busy in their pharmacies giving information to the public. I'm not sure if it's a great idea to look at pulling them out of that work to support immunization. We could invest a lot of time and energy with a very low return.

MS. WHALEN: I wanted to go - I only have a few minutes left in my round of questioning, I believe, so -

MR. CHAIRMAN: Three, to be exact.

MS. WHALEN: I want to go to the shortage of staff. When the Auditor General's Report was written, there were four medical health officers who were not in place in the province and we were short epidemiologists and some other specialists. I think there were about six that were named.

In your response document, which we received as part of our package, the first page talks about how you're looking to recruit these people and that positions under active recruitment, following up on both short and long-term opportunities. I'm not sure what the short-term and long-term means and I'd like you to give me a quick update on where we're at with those vacancies.

DR. STRANG: I'll speak to the epidemiologist first. We're very close to signing off on a manager of surveillance. We're in the last stages of discussion on that. We're very close behind that with another senior epidemiologist. We're also looking at some discussions around a junior epidemiologist, so I anticipate in the near future adding those three individuals. We already have the support from Department of Health and they've seconded a data manager to us for one year. So those are positions we're looking at putting in place.

I will take the opportunity now that we have been allowed to do this within this year's budget, but all this to sustain these positions into the future will create budget pressures for FTE dollars for our department to continue these beyond the H1N1.

Around medical officers of health, there is a shortage of medical officers nationwide. We have two postings out and I'm about to go out - we're kind of rejigging things - and go out with two more postings. I have some medium-term things in place. We have supported a community medicine resident, a family doctor, to go back and do public health training, and he will be coming back to us January 2011. We have funded that position. We're working through the details to get another individual in the same position who, if we finalize this, would be back to us in January 2012.

MS. WHALEN: Could I interrupt for a minute? Some of those dates are quite a way into the future, and what I'm asking is, what would the risk be if we don't have medical health officers in each of the DHAs now?

DR. STRANG: Well, we are covering and have been providing Medical Officer of Health coverage for the DHAs for a number of years. They provide the ability to respond to the day-to-day urgent issues around environment, health, and communicable disease. What the shortage means is that we don't have the Medical Officers of Health to deal with other longer-term health issues, but we do have enough on our team to respond to urgent needs. We've had Medical Officers of Health doing work around H1N1.

Adding to our epidemiologic team, because what we had to do in May was actually have two of our MOHs working directly in the epidemiologic world. Building that capacity will free up more of those two individuals to actually do MOH work. So that's the short-term solution; I don't have any magic solution to pull another MOH out of the air. I wanted to go into a bit of detail saying we're working on that, I have some medium-term opportunities, but we are competing across the country, if not internationally, for MOHs.

MR. CHAIRMAN: Thank you, Dr. Strang. Ms. Whalen, your time has expired, but before we move to the Progressive Conservative caucus I want to welcome Mat Whynott, the member for Hammonds Plains-Upper Sackville, who has returned to the committee, replacing Gordon Gosse who was replacing him. I call next on the Progressive Conservative caucus to begin their 20 minutes, and the time is 10:07 a.m.

The honourable member for Hants West.

[10:07 a.m. Ms. Diana Whalen resumed the Chair.]

MR. CHUCK PORTER: I'll just start off with a few comments. First I want to say that it was interesting, back in April, representing a community that was involved with Windsor and King's-Edgehill. Windsor has the slogan that they've always used, "The Little Town of Big Firsts" - although I think this is one that they probably didn't want. I want to commend the group, the department, the doctors, and everyone who was involved, because it was something very new to us in this province and in this country. People had a feeling of comfort though. I know that the media was in town, they asked people on the street and they were pretty passive, they weren't too excited about it, and that was a good thing - and I think part of that was with some of the information flowing, it helped to keep that where it needed to be, you know, with the excitement and so on.

Also in meetings with Mr. Seagram at the school, and the town, the minister and deputies and so on, the information flowing was very good and we were very happy with that, and I know the town and the mayor and council and so on who were involved were happy as well. We continue to talk about that and that sort of leads into my first question - given that King's-Edgehill is alive and well and people come from many countries around the world to attend there, are we doing follow-up specifically with a place like King's-Edgehill at all or is it just status quo since the Spring?

DR. STRANG: We haven't followed up directly with them - I'm not sure, follow- up, with individual students or . . .

MR. PORTER: No, sorry, I should have been more clear, I meant with the school as far as procedures go. I know that Mr. Seagram is probably doing everything, they've probably got the handwashing and all the education, I'm just kind of curious as a department, where it started here, where it's a place where hundreds of kids come to from multiple countries, are we following up to make sure that King's-Edgehill is doing their communications piece?

DR. STRANG: I think we've been working with the Department of Education and with the school boards to get good appropriate information across the education system - and that would include the independent schools such as King's-Edgehill - around what are the appropriate prevention measures they should have in place such as encouraging

handwashing, keeping kids away from school and staff when they're sick, those kind of things. We've put together a school tool kit, you know, we've had that circulated around at the local level; Public Health Services is working with local schools and school boards; myself and Dr. Baikie have met on several occasions with the Department of Education and school superintendents - so we haven't focused specifically on King's-Edgehill but we've done a lot of work across the whole education system.

MR. PORTER: Thank you for that, and the reason I ask this is just where they're coming from multiple countries and this is still very much alive across the world, and I'm just kind of wondering, with kids coming in, are there any special concerns that the department has, or the government, or yourself? I suppose it wouldn't be a whole lot different than coming to universities and so on.

DR. STRANG: Yes, we have people coming from all over and I don't think there's anything that would indicate that one part of the world is any greater risk than another. There's just as much risk with somebody coming from Ontario as coming from Thailand, potentially. So the basic prevention measures in schools, and we work with universities as well, are what we need to focus on rather than putting something special in place for people who may be coming from another part of the world.

MR. PORTER: Are people required to report if they are ill when they come into the country to the school system, whether it be university or King's-Edgehill, do you know? I'm not sure what - maybe there is no policy on that. So I'm just thinking - well, let's just use Thailand for an example because you mentioned it - a child is coming from there and going to attend King's-Edgehill, what's the health piece there coming into another country to go to school, where you're going to live for the better part of a year?

DR. STRANG: The federal government has specific requirements around medical examinations for someone coming on a student visa and that would require examination for certain diseases, more longer-term ones, the most relevant one may be tuberculosis. But there's no screening at the point of departure, to look whether somebody has influenza or whatever. And just because somebody is sick when they leave the airport, it may not mean they are not going to come down sick with something in the next few days. The real process is to have good procedures in place around general hygiene, but also around identifying students or staff who are sick and then treating them in the appropriate way.

MR. PORTER: You talked about numbers a little earlier, the flu season, it may be January before the flu sets in, but you could see it earlier, and we talk about who should get vaccines, who shouldn't, the age groups, and there seems to be a lot of science here that maybe we are not aware of - but where does all this start? How do we know for a fact, or do we, is this best guess - you know what we hear in the media last year if you get the flu shot, maybe now you're at a higher risk. Where is the science that proves that that is actually the case and how specific is it - if you are 10 years old and you have a history of asthma or some

other medical problem, you're now at a higher risk, and that's proven, we're seeing that in certain quantities that quantify the number - or specifically say this is fact, or do we not have those facts?

DR. STRANG: Are you speaking specific to the study?

MR. PORTER: I guess you could refer to the study if you wanted. We're talking about who is going to get vaccinated, who should or shouldn't here, the risk is, to me . . .

DR. STRANG: We have continued from the very beginning of H1N1 - one of the key pieces has been to make sure that there's good flow of information between countries and between provinces, so we understand the epidemiology and it is the analysis of the epidemiology that really helps us refine who is at greatest risk, what are the groups that we need to focus on more than others.

Again, this is an evolving disease and the epidemiology evolves and it's not complete. It may well be a year or more before we, you know once we're past this, before we can then look back and go okay, now we have the complete epidemiologic picture. So we work very hard to make the best decisions with the best information available, but that information is continually evolving, and that's the basis of my statement. What I tell you today may be different from what I tell you tomorrow because I may have new information tomorrow that changes the picture.

MR. PORTER: That was kind of leading into my next piece of this - do you ever see it being complete?

DR. STRANG: The typical picture, what we expect to probably see is that this H1N1 strain will then become one of our seasonal flu strains that we then see and we deal with it in a normal manner, as we do with seasonal flu vaccine. Already the World Health Organization is recommending that flu vaccine for next year, that the H1N1 component that's in there now be replaced with this new strain of H1N1.

We'll have more information as time evolves, over how different - if it's different at all - is this current H1N1 from previous flu strains.

MR. PORTER: Thank you. On the vaccines, you talked about trying to communicate to people and encourage them - are you recommending that everyone get the H1N1?

DR. STRANG: Yes.

MR. PORTER: Without exception?

DR. STRANG: Yes. Except for those who have a legitimate contraindication for getting influenza vaccine - and those numbers are very small - people with severe egg allergies, that is really the only risk group, people who have had a previously severe reaction to flu immunization, but those numbers are very small. So for the general public, my statement is everybody should get the H1N1 vaccine.

[10:15 a.m.]

MR. PORTER: And we had recommended that throughout the years with the annual flu shot as well . . .

DR. STRANG: Well, it's different. We recommend the seasonal flu for a variety of risk groups. Ontario is the only jurisdiction in the world to date that has had a universal seasonal flu program.

MR. PORTER: What do those folks do who have the allergy? This is quite significant, as we speak . . .

DR. STRANG: I have to emphasize that those numbers are small, very small. Those people would need to focus on other ways of prevention. That's an individual clinical discussion and there may be a role for antivirals from a preventive aspect in certain circumstances if there are extremely high risks. I do want to emphasize, again, that those numbers are very small.

MR. PORTER: And of what, just under a million people I guess in the Province of Nova Scotia, how many people do we know get the annual flu shot?

DR. STRANG: Well we typically order - of seasonal flu - 350,000 doses. We ordered a little bit more this year, another 35,000 doses. We produce a report every year. The coverage rate for seniors is around 70 per cent, for health care workers we achieve around 50 per cent on average, although there's a lot of variation in there. For the general other groups, people under 65 with risk conditions, we don't do a very good job there and it's probably at the most, it's probably about one-third of those who get immunized.

MR. PORTER: The numbers aren't very high in comparison then, so your recommendation is that everyone gets the H1N1. Now, let's talk about the reality of this. How many will get it, in your opinion? Do you think it will go consistently with the 350-400,000ish or will we even get that high? I think that there are people that are fearful, Dr. Strang. For whatever reason it's the same, I think, with the annual flu shot, people say, I don't want to get that because I'm going to get sick.

DR. STRANG: I'm not going to speculate on numbers. I mean, we are planning our clinics with a capacity to deliver large amounts of vaccine but we also have some flexibility.

So if we're not getting the number of people out that we anticipate, we are able to revamp and readjust and refocus our messages to try to get more. But, at the end of the day there may not be people coming out so we may have to make a decision based on uptake. At some point we're going to scale back our clinics because we don't want to continue to invest money if it's just not working. But it is a challenge, there are people out there, I think, who underestimate H1N1. They hear that it's typically a mild disease -so why am I risk. They don't understand that even though it's generally basic-flu illness that in itself makes people sick, we have really no way to predict if you're the one person who is going to get that severe illness that could end you up on a ventilator for several weeks.

So we need to continue to emphasize to people to try to overcome some of those barriers. There are concerns around safety because this is a new vaccine but I want to emphasize that this is going to go through the same clinical-trial safety assessment that any other vaccine goes through. There's a lot confusion out there as well so, absolutely, we have a communications challenge but we have, as I said earlier, processes in place to get the right information out to folks. At the end of the day, how many people will act on that message? I hope a significant proportion of Nova Scotians do.

MR. PORTER: Thank you. We're currently at the highest level still. How many countries around the world are affected right now? Do you know that number?

DR. STRANG: I don't have that number in front of me. It's spread worldwide.

MR. PORTER: And it's still growing. You talked about perhaps western Canada seeing another go of it right now.

DR. STRANG: Yes, the southern hemisphere has gone through their flu season and their first wave. They might anticipate their second wave at some point, maybe in a year's time, their next flu season, maybe earlier. We're just on the cusp of our, you know, Fall/Winter months and so we certainly expect to see our second wave in the northern hemisphere and we are getting some early signs that we may be getting that quite soon.

MR. PORTER: Just on the level, do we have an idea - will we see this level drop?

DR. STRANG: The WHO pandemic level?

MR. PORTER: Yes.

DR. STRANG: At some point, when it goes back but that's based on the epidemiology.

MR. PORTER: Considerable ways out than probably a year or two maybe, we would say, would you think?

DR. STRANG: At some point it'll become most likely one of the circulating flu strains and they'll drop the level back but that's not anywhere in the near future.

MR. PORTER: Maybe a question or two for the Deputy of Health Promotion and Protection. You talked about the communications piece and it being a challenge. How are we going to take that on? What's the investment here? Because it is important, we're seeing people actually dying of this, it's quite severe, it's important. Dr. Strang has already said his recommendation is 100 per cent, barring those with allergies and so on but that number is small, so your percentage is very high. How are we going to get that out?

MR. MONTGOMERIE: That's a really good question and there are a couple of responses to it. First of all, at the national level, through the Public Health Agency of Canada, our communications folks have been working on a national social marketing campaign and you may have seen already some ads, Dr. Butler- Jones and others. That's the first part, which basically is indicating how to prevent getting H1N1. But also here in Nova Scotia, our communications folks are well engaged around a major social marketing campaign that we will launch, making sure people are aware of the need to get the vaccine. That will twin with the next phase of the national campaign.

So it's a very integrated approach, which is kind of nice to see. You're getting a national campaign and then our own campaign will support that.

Our key issue is, as Dr. Strang has continually reminded us, we need to make Nova Scotians aware they need to get the vaccination.

MR. PORTER: A lot of people, as you know, go that's great, they might not read the papers, they don't pay attention to TV commercials, that's when they're up getting their soda or sandwich for a snack, this is important, we have to reach these people. Are we looking at a newsletter going out to the homes? Are we looking at social media like Facebook, e-mails, Twitter and all of these other things? Because as we know, that age group that the doctor talked about, 25, 18, 19 to the 45-ish, that's a key group that's alive and well on the social media circuit, for lack of a better term. How are we reaching these people because they're not necessarily always paying attention to this stuff?

MR. MONTGOMERIE: We are looking at all those approaches, quite frankly, to maximize Internet, all those kinds of things. The other thing is we have an exceptional relationship with the schools, through the Department of Education and the superintendents. It's a relationship we are going to continue to build upon because, to your point, we need young people with their parents and vice versa.

MR. PORTER: That was my other question, I was going to ask what about the schools, will we send newsletters home or whatever you want to call them, I know I get them from my kids. Is that part of the plan this Fall as we maybe move early in? It would be nice

to see that coming home, as an example, so that there's one more piece that every parent is getting. We know not everybody has the Internet, cable and all of these things and it's important, I think, that we communicate to every level possible.

MR. MONTGOMERIE: I was actually briefed last week by our communications folks, both from Communications Nova Scotia and our own department and all the areas that we are talking about here, they are working toward. I just don't have the specific response and I anticipate that within the next week to 10 days.

MR. PORTER: Any idea on the cost?

MR. MONTGOMERIE: We've looked at a maximum of $500,000, but again, depending on how this pandemic goes, we may or may not need it. It is put away and until our communications folks come back to us with more specifics because they're engaged with the firm now, I won't be able to be more accurate around that.

MR. PORTER: And media is not cheap, advertising. In all honesty, things like taking out an ad in the ChronicleHerald is not cheap and $500,000 sounds like a lot of money, but in a campaign like this it may be nowhere near enough.

A couple of other questions , while I have you, the supplies. We talked about having adequate supply of vaccine which is good. The turnover of your stockpile of other supplies, you talked about the N95s, gloves, masks and so on, what is the turnover for that stuff? That stuff should have a shelf life of a fairly long time, but if there was another episode where we see huge numbers, which we could, what's the turnaround to get restocked?

MR. MONTGOMERIE: I'll refer that to Deputy McNamara, if that's okay.

MR. MCNAMARA: Just on our supply situation, if you look at N95 masks, for example, the normal use per year throughout this is about 25,000. We have a stockpile that we'll have in fully by this November of around 800,000 extra that will be on the provincial stockpile to deal with that issue. In terms of surgical masks, we'll have in our stockpile about 14 million, that, again, is in addition to what is already in each of the DHAs, who also are building their own stockpiles.

In terms of ventilators, we had 174 originally, we've added 80 ventilators to the DHAs around the province as well as 10 for transport. This number of ventilators was arrived at after a team of our individuals from the Department of Health, expertise from Capital Health and others met with folks in Winnipeg who had gone through the experience there dealing with the Aboriginal communities. They came back with the best evidence on the correct number of ventilators we should have, as well as ensuring that we can staff the ventilators we will have, so that's how we arrived at this number. Those have been ordered and are on target to be in place.

In terms of other supplies, we believe that we are in good shape both in our stockpile, as well as having access to a national stockpile if necessary.

MR. PORTER: The N95 that you speak of - and I've got a little bit of background in health care and so on - N95s are a special fit mask to be effective. How do we possibly make our way through that? I know health care workers - I was one once upon a time - you have to go in, put the hood on and be fitted, that's a time-consuming thing. We have 25,000 that you mentioned, are these people in the health care field - and I'm going to assume that they are - all being specially fit for their masks?

MR. MCNAMARA: Not all staff will be fit-tested, not all will be necessary to be. It will be those on the front-lines, those in the ICUs, emergency departments and in those areas where patients who will be confined, that will show up with the flu.

We also recognize our other staff who it's unnecessary to do fit-testing for, but we're also working with those in continuing care, those in long-term care and others, so there will be enough staff fit-tested to be able to deal with individuals who require it. As well, I think Dr. Strang can speak to this better than I, I understand surgical masks, in many cases, are just as effective as the N95, but there are individuals who, for their own belief, want the N95 as they believe it's a higher protection.

MR. PORTER: Thank you. I think my time is about to expire so thank you for now.

MADAM CHAIRMAN: I'll turn the floor over to the NDP caucus and Mr. Preyra.

MR. LEONARD PREYRA: Thank you. Welcome again, it's certainly been a very thorough response to the Auditor General's report. I think a few of us are going to be asking questions in general about the Department of Health's response and in particular, Health Promotion and Protection.

I want to begin by going back to the origins of the Auditor General's Report utilizing the audit of the pandemic plan itself, which was released in January 2008, which is currently, I think, underway and that this pandemic response is going to inform that other plan. Where is that plan at the moment? Is it just set aside?

MR. MONTGOMERIE: We're in the third iteration of the plan. It got interrupted during the pandemic. As I understand it, both Kevin and I have asked Dr. Strang and Paul English, one of Kevin's top people, to co-lead a committee called the Pandemic Leads. I'll just refer Dr. Strang to the detail part. They are continuing to monitor that piece.

DR. STRANG: What we're doing, as Deputy Montgomerie has said, we had version two of the pandemic plan, which the Auditor General was auditing. We had already made

the decision - we were very close to producing version three of the plan - but we didn't have a lot of that finished off, so it couldn't be audited, when we got hit by H1N1.

What we're doing now, and all the things we're putting in place, are very specific response plans to H1N1. At a later date, all the things we're learning and documenting will then feed into - it's probably going to be taken up to version eight of our pandemic plan which we'll then have for any potential future events.

MR. PREYRA: Pandemic fighting seems to be like putting your fingers in the dike, one crack appears somewhere else just as you're about to address another one. I just want to make sure that planning is still underway as we prepare for this one.

I have some questions about lessons learned. There was a recent outbreak in my constituency, mostly of mumps, for example, and we had SARS earlier. There was some question about our ability to identify a group and to reach that group in fairly short order. What lessons have we learned in general from that experience - I know you talked about King's-Edgehill - what lessons have we learned from that that have helped us prepare for the general pandemic plan and also for this particular pandemic?

DR. STRANG: Certainly some of the lessons learned from mumps - one of the main ones was that while it may appear to start as a public health issue, where it really starts is at the primary care level where a primary care practitioner identifies somebody with an infectious disease. It highlighted the need for a much more robust relationship between public health and primary care. We have continued to focus on that and I think a main piece of our success around H1N1 has been because of the recognition of that need for a very close link.

The mumps also highlighted the need for us to have stronger relationships with our infectious disease experts and our experts around infection control and occupational health, so again, where we have a capacity for more of a systems-approach response. Every event we go through - mumps, listeriosis, now H1N1 - we take the lessons learned from those and apply them to the next situation.

[10:30 a.m.]

MR. PREYRA: Thank you. I have some more specific questions about the Auditor General's Report. Let me start by asking about human resources. There is a concern in the Auditor General's Report that health care professionals will fall ill, that the demands on the system will be pretty significant. My question really is, what provisions are being made to deal with that kind of surge in demand? I know that there are agreements being negotiated at the moment and I wonder if you could comment on that, along with your general preparedness in terms of dealing with the human resource issue.

MR. MCNAMARA: Thank you very much for the question. Each of the districts is working through a business continuity plan, and part of that includes manpower planning, what do we do in the case of shortages of staff. We have to recognize that in the case of a major pandemic we will have to change some of the activities, reduce some that we normally do - which occurs any time we run into these types of issues - as well, as mentioned earlier by Dr. Strang, as being able to have individuals who have re-licensed and who we can probably bring back in and hire on a casual basis. So it would be streamlining with the staff that we have.

It would be also taking some of our staff who work part time and casual and asking them to take greater shifts to work through it. So our belief, with the staff that we have, with the number who are casual and the number who are part time and the ones who we can bring back into the workforce, is that we'll be able to manage appropriately.

MR. PREYRA: Has there been any broadening of the scope of practice for people who are currently in the system? Have there been agreements with other health care organizations to allow for that to happen?

MR. MCNAMARA: In working with the colleges, we have an agreement: first, on how to get people back into the workforce who have been out of it; secondly, there has been a lot of work over the past number of years in broadening the scope of practice of existing staff. For example, the models of care, which is going on through the transformation, has changed the scope of practice for LPNs, who can do more than they could do in the past - for example, the administration of medications, which was not a norm a couple of years ago. The same with registered nurses and nurse practitioners - their scope of practice has broadened widely from what it was in the past.

I should say, to add in terms of manpower - it ties into mainly the administration of vaccine, but I'm sure we can avail ourselves of that, and help if it becomes necessary is through Doctors Nova Scotia, that medical students and residents will volunteer to assist in the vaccination program. I'm sure if we need them we can call on them to assist us in that way, as well as the physicians who have also volunteered to assist us. We will make it work with all the manpower available to us.

MR. PREYRA: Thank you. I have a question about supplies as well. One of the concerns raised in the Auditor General's Report is about getting ready immediate and effective access to supplies. Is there a plan in place now, and are you satisfied that we have lines that will allow a flow of supplies in and out fairly quickly?

MR. MCNAMARA: On two fronts. First, each of the district health authorities or other health care providers are also adding to their own supply, so they have some available locally. In addition, in HRM we have developed a warehouse where we've brought in a provincial stockpile which can then be sent to DHAs on request and as required. For

example, the N95 masks will be a provincial stockpile, as well as surgical masks, as well as gowns and other supplies that are necessary. So we're very comfortable that we will have the necessary supplies either in the local DHAs or on a provincial basis.

MR. PREYRA: So the stockpiles are currently there and you have ready access?

MR. MCNAMARA: And will be mostly in place by November.

MR. PREYRA: Another question, more about the hospitals themselves and possible surges there - the need for beds, possibly beds for young people. Are there provisions in place for hospitals or perhaps other institutions to be used in case of a surge, a surge that goes beyond the capacity we have now?

MR. MCNAMARA: My understanding is that the main need for beds will be either in the emergency room areas or in ICUs. That is why we have developed a provincial plan with all DHAs to be able to have ICU beds supplied province-wide. For example, if we have a number of ill patients, then the supply can be determined by the appropriate specialist, whether it is using a bed from the Valley or Halifax or wherever is the most appropriate need. By using that rationing process, there will also be a process to triage the patients using specialists to make sure that the most appropriate patients can utilize those beds.

MR. PREYRA: Could you tell us something about the monitoring of developments as they happen in the course of the pandemic, you know, epidemiology reports, hospital bed availability, regional outbreaks, is there some kind of real-time monitoring to attract responses?

DR. STRANG: One of the work groups we have reporting to Pandemic Leads of which I am the co-chair is exactly around this, around metric, Public Health surveillance information locally, provincially and nationally, will feed into that. We're also developing information. Much of it is already in the system about bed availability, all that kind of information. So if things really started to ramp up and we had to reopen our emergency operating centres, we would have that full suite of both disease surveillance and how the health care system is coping information, in front of us on a daily basis, to be able to make the kind of informed decisions that we would have to make provincially. The district health authorities would have the same information for their responses as well at the local level.

MR. PREYRA: Just a final set of general questions, are you generally satisfied with our level of readiness in these areas in terms of dealing with surges, dealing with supplies and dealing in terms of human resources? I mean what kind of supports do you see yourself needing now and as we move along into this? I know Dr. Strang says he can give us a different answer tomorrow but how comfortable are you with where we are?

MR. MONTGOMERIE: If I could, to the honourable member's question, what's really critical is from the very first day that we're aware of the outbreak, the co-operation from the centre of government has been incredible. So where Dr. Strang or Dr. Buchholz have identified the need for resources to either Deputy Doiron or McNamara, or myself, we have gone in a planned way to Treasury Board and other places to get those resources. The same with the district health authorities in their workings. It has been, quite frankly, a very collaborative and effective process and we still are engaged on a weekly basis, both Deputy Minister McNamara and myself, with the CEOs on regular system calls, as we call them. If I can, again on a weekly basis, Kevin and I are updated by our finance people on the pressures they're seeing in various places like social marketing, like HR, how we're doing, what kind of pressures and what kind of answers do we need. So I'm very, very confident that we're in good stead.

DR. STRANG: As the co-chair of the pandemic leads who has been given the responsibility to lead this by both deputy ministers, I'm very comfortable that we are dealing with the right issues and we have been dealing with them for the past months. Those issues are moving along in a good time frame and we're still on track. When we brought this group together in June, we said we need to have things in place by the end of October. We have hired, we have both internal and external project management support and they're reporting to us and my co-chair and I are both comfortable that we have the right issues and we're on track with meeting that October 31^st deadline.

MR. PREYRA: Just relating to partnerships, I'm assuming that you've got them but I want to ask you anyway. Partnerships with First Nations communities and African Nova Scotian communities and other, you know, hard to reach communities, are those in place now so that we can make sure that everyone has access to information and to service in a pretty difficult situation?

MR. MONTGOMERIE: From the very first, almost the first day, we involved, for example, the Inuit and First Nations Health Branch from Health Canada. In hindsight it's almost like it was a prophecy because little did we know that Manitoba would see a high proportion of their population engaged. Also, early on through our colleagues in Aboriginal Affairs and others, Dr. Strang met with the chiefs and Dr. Strang is going to meet with First Nations again on October 26^th. Again, as we target different populations, we really rely on the epidemiology - what have we been seeing, who has been most impacted - and because there was such a high circumstance out West in First Nations, we absolutely recognized that it was important to talk with our own First Nations community.

DR. STRANG: If I could add to that. At the local level, district health authorities, both public health and primary care and others, they know their communities best and I'm fully comfortable in talking to my Public Health staff. So, for instance, how do we access homeless people? Well, I know that Public Health in Capital Health are working very closely with North End Health Clinic and the homeless shelters, to make sure that we are addressing

those populations, the same as the African Nova Scotian populations. So at the local level, the DHAs know those populations and are accounting for them in a robust way.

MR. PREYRA: What is the state of partnerships with non-governmental organizations like Nova Scotia Power and the universities and some of the larger employers? Is there a mechanism in place for addressing those communication lines as well?

DR. STRANG: One of the early commitments that I got at the deputy minister's table was that each department has their own kind of stakeholder group. Education has schools and the commitment was that for Health and Health Promotion and Protection we would be able to focus communication through those government departments. For instance, on the broader workforce, Labour and Workforce Development has gotten a lot of information on the health aspects of H1N1 out to workforces across the province. The same with schools and universities.

For the non-health aspects, that really is in the purview of EMO to coordinate that. As a health system we're responsible to ensuring that the health system is appropriately responding and we're getting the right health information out to the general public and to other sectors.

MR. PREYRA: Okay, one final question. Just in response to the Auditor General's Report. I heard the Auditor General say that the response has been very prompt and there has been a great deal of co-operation between the two offices. Is there some ongoing follow-up on the recommendations of the Auditor General in terms of checking them off and making sure that all of this is tidied up? In part the Auditor General's Report seems to talk about the general issue of pandemic preparedness and something else might sneak up on us when we're addressing this one. I'm just wondering if that side of it is going to be tidied up as well?

: MR. MONTGOMERIE: Two responses to that. As I indicated earlier, Deputy McNamara and I have made sure that there is a tracking device that matches the Auditor General's recommendations. On a weekly basis Kevin and I are briefed and if there are challenges we ask staff where there are challenges because our minister, obviously and ourselves want to make sure that the Auditor General's recommendations are acted upon. There are some in there directly to EMO, so obviously, when EMO is here it is best to ask them their response. But both Kevin and I feel very comfortable that we're on a timely basis moving on the Auditor General's recommendations.

MR. PREYRA: Thank you, Madam Chairman.

MADAM CHAIRMAN: You actually have about two and a half more minutes. Do you want to post another question or if another member of the NDP caucus would like to go, you have until 10:47 a.m.

MR. PREYRA: We have plenty of questions, I thought I had until 10:44 a.m.

MADAM CHAIRMAN: I'm sorry, no, I had that down.

Mr. MacKinnon.

MR. CLARRIE MACKINNON: Madam Chairman, I was very pleased that the Auditor General's Report included a look at the Pictou County Health Authority, to go beyond, to use a sample health authority beyond the Capital District. I think it was very important to do that. Maybe to editorialize for a moment, I think it would be very useful to this committee to have the Pictou County Health Authority appear before it as an example of a health authority and the readiness and so on.

One of the things that I believed the Auditor General was concerned about was that there be a review of all district health authorities' pandemic plans and to identify missing components. I'm just wondering how far along is that? It must be an almost ongoing thing to be reviewing what is happening out there with the health authorities.

[10:45 a.m.]

MR. MCNAMARA: As in the chart that I passed out, it identifies that we have received pandemic plans for all the district health authorities. We've also just in response to the earlier question, received all hazard plans for all district health authorities, and we've received business continuity plans for most of them. We are in the process of reviewing each of those plans right now and sharing best practices between them, as well as having an opportunity to give them advice when we think there's suggestions that can improve their plans, and that will be an ongoing process. A lesson we learned through the Auditor General's Report is that this will be something for the future that's done on a regular basis.

DR. STRANG: If I can add to that, I do want to distinguish between the pandemic plan in a binder or piece of paper and the actual response to H1N1. As we have established through Pandemic Leads, work groups on a whole range of issues, we have made very clear to the Chairs of those different work groups that they need to make sure that they have a direct link with the appropriate people in each of the district health authorities. So as we're working through an issue - I'll pick one - around intensive care units; that wasn't just done by a few people in the Department of Health, that was done with an absolutely direct link to the appropriate people in all the district health authorities and IWK. So we're planning the H1N1 response as a system response and the DHAs are absolutely linked into all the aspects of work that we're doing to make sure that both the provincial and the local level pieces are moving ahead.

[10:47 a.m. Mr. Leonard Preyra took the Chair.]

MR. CHAIRMAN: Thank you, our time has expired and I'm back in the Chair to allow Ms. Whalen a chance to start another round of 20 minutes for the Liberal caucus.

MS. WHALEN: I'd like to go into a round of questioning about the costs and the amount of money that's been dedicated to our pandemic preparedness and being ready for this Fall. In the Auditor General's Report, on Page 19, it actually says there that we do not have adequate stockpiles of supplies, and this report did just come out only in July and it said that the existing stockpiles are valued at $1.7 million, and that is a shortfall of $5.8 million from the total required reserves. Would you agree with that? I guess this would probably be for Mr. Montgomerie.

MR. MONTGOMERIE: Early on we had identified some stockpile shortages and moved to address them before the Auditor General's Report came out, and Kevin can speak to where we are at the present time. I think you talked about it earlier, Kevin.

MS. WHALEN: Well, he did, but I'd like to talk in a general term. I mean, that was a big shortfall, if you had $1.7 million in supplies and you were short $5.8 million worth of supplies. It looks like a really big imbalance. The report also talks about the difficulty in getting - because the whole world is preparing for this pandemic, if we suddenly put in an order for masks, gloves, or other items, what's the chance that we don't end up in a year-long or two year-long queue? So we're hearing some reassuring things today, but I wonder if in a general sense you could address that big shortfall and where we're at today.

MR. MCNAMARA: In terms of ventilators, we have authorized an expenditure of $5.3 million to purchase the ventilators that will be here by November. In addition, there were a million dollars in supplies for masks that have been authorized, and all of those will be onsite within the next two months. In addition, each of the district health authorities, as I mentioned, will be purchasing supplies to stockpile their own areas. I can't give you the dollar value of that because it will be part of their inventory. It's not a cost issue until utilized, but it is an issue in terms of them having the ability to purchase supplies.

The other thing is that government has indicated to us that if there's additional supplies needed and we need money, that we have the ability to get it. In terms of getting supplies, in talking to our suppliers, we're not having any difficulty meeting the timelines on the orders that we've placed.

MS. WHALEN: That's reassuring to know that that is not occurring, that there aren't delays in delivery. One of the recommendations - I think it's Recommendation 14 - said that DOH and HPP - Health Promotion and Protection - should request immediate approval of funding required to purchase all identified supplies stockpile requirements, and that's really in context. It said here that the Auditor General found that the request for funds was

inadequate, so in the original budget documents that had been prepared, there hadn't been and asked from both your departments for the kind of financial resources you need to get ready. Has that been addressed? Perhaps you both could speak to that.

MR. MONTGOMERIE: In actual fact, on May 15^th, we briefed our minister and we briefed the centre around what we were going to see as emerging pressures. From May 15^th on, Deputy Doiron and I ensured on a weekly basis that our finance officials meeting with the co-leads of the pandemic would identify real and emerging pressures. We would then identify them to our Treasury Board officer. The present government has moved to formalize that. It is now a standing item on a weekly basis with Treasury Board. So, for example, if I as deputy hear from Rob and so on, you need - let's do social marketing - social marketing pressure is going to be $367,000, our finance people make Treasury Board aware that that will be an ask on the next week's agenda.

Let me give you another example of how fluid this is. When we were dealing with the H1N1 vaccine, it is now going on a $4.5 million cost based on Nova Scotians having 75 per cent of the vaccine available. We're now hearing if it is two doses or only one dose we won't need as much. As a matter of fact when we were giving the funding to the Treasury Board on a weekly basis, we first started off, we may have to pay 100 per cent, then we said it may be 50/50 and finally the ministers negotiated 60/40. So it is fluid and changes almost on a daily basis.

MS. WHALEN: Are you telling us that you're getting support right up the chain of command in terms of getting the funds you need to be ready?

MR. MONTGOMERIE: Absolutely at all levels, our Treasury Board officers have been absolutely excellent, the deputies, the ministers, both governments quite frankly have been very solid.

MS. WHALEN: I think that's important for Nova Scotians to hear that we do know what a priority this is.

I wanted to go back again to this Page 6 of your update and I think these are all the recommendations of the Auditor General and how you're doing. It is interesting to note I think every one of them is in progress. I don't think any of them have been completed, everything is a work in progress. But on that financial one, Recommendation 14 is also a work in progress. I wanted to link that to the Budget Address. Last week the Minister of Finance indicated that the budget contains a restructuring fund of $54 million and within it there is a budget for H1N1. We don't know what component is restructuring for salary adjustments and so on and what is actually identified for H1N1. The Premier is on record as saying that the province will spend as much as is required, so I'll give him that, in order to prepare for H1N1. Can you tell us really how much has been spent on some individual items? I am hoping that you have the financial information with you today, but I wanted to

look at what you got in the mass immunization supplies, for example. Have you got an adequate amount and is that also in that $54 million?

MR. CHAIRMAN: Sorry, could I just interrupt on a point of order. That issue that is currently before the House is subject to estimates and Supply and hasn't been approved yet, so it's not a proper question for the Public Accounts Committee yet. Once it has been approved, then it could be but at the moment it is not.

MR. MONTGOMERIE: Mr. Chairman, I can speak to the principle, I won't speak to the amount, if that's okay. Really, to answer the honourable member's question, we are a bit like wages, we don't know what the costs are going to be. It wasn't possible for Kevin and I to recommend to our minister a line item, H1N1 will be this. So quite frankly we're very comfortable, it is in another place. It is really important that we're able, on a weekly basis, to make representations to the government about what we need. And to answer the honourable member's question directly, supplies on mass immunizations right now, we've spent $1.4 million. We'll probably spend more as Dr. Strang and his team bring focus on how we're actually going to conduct the immunization program. But we've got the additional needles, syringes, coolers, waste management and those kinds of things.

MS. WHALEN: Okay, very good. I wonder if Mr. Hebb, who is our legal advisor, if he could just comment on whether it is inappropriate to ask anything on the current budget to our witnesses today?

MR. GORDON HEBB: I'm sorry, but I'm not sure that I can answer that question off the top of my head. I'm not sure whether the rule that would normally apply - that rule is usually applied in Question Period when questioning ministers and I'm not sure at all if it applies in this context. So I would have to look to be sure of an answer to that.

MS. WHALEN: Thank you.

HON. CECIL CLARKE: Mr. Chairman, specific to any debate, especially in the House, but I think we followed the procedure, the question is about the number that was forecast and budgeted as opposed to whether it's approved or not approved, subject to debate is not the matter at hand. I mean very clearly there are questions. There have been budgetary matters that have been expended and I think asking that question of what was derived as a portion of that, that is in the estimates. It's no different than a question that could be asked during estimates. So I don't think it's out of order.

MR. CHAIRMAN: I think I heard Mr. Hebb say that he was going to look into it and report back.

MR. HEBB: Yes, although I tend to think that Mr. Clarke is correct and, as I said, I believe the rule is relating to Question Period and dealing with asking questions of ministers

who are before the House in another forum. I'm not sure how this applies but I've just said I wasn't prepared to give a definitive answer although I tend to agree with Mr. Clarke. I tend to think that that is the answer.

MR. CHAIRMAN: Well, I would appreciate clarification but I think the question has been answered to the extent that the principle is addressed there.

MS. WHALEN: Yes, thank you, Mr. Chairman, and I would ask that you add a couple of minutes to my time allotment because we had to have this discussion but, you know, I just wanted to note that I disagree with the ruling from the Chairman this morning and we will ask those questions in estimates. We'll certainly get an answer to them. I would like to know as well, and I have a series of financial questions, you've answered the one on the mass immunization. I would like to know about the continuing care infection control supplies. I don't know, I think that's a line item or a group of items, continuing care infection control supplies and, again, how much has been expended and if you have adequate supply? That's the question.

MR. MCNAMARA: From the Department of Health there's approximately $170,000. In addition, the Department of Community Services are providing money for the facilities that they're involved with as well but I don't have those amounts.

MS. WHALEN: So there's more from Community Services, okay. I wanted to go to the N95 respirator masks, if I could.

MR. MCNAMARA: Sure.

MS. WHALEN: Are they called respirator masks, I think so. Anyway, those ones were requested by the unions. I understand the Nurses' Union was preferring to have N95 masks. I know you had a brief discussion with my colleague here from the PC caucus about those masks and how many were ordered but I wonder if you could just comment on how many are needed again, if you could just clarify for me the number that are needed and whether or not you have an agreement with the Nurses' Union that the people who require them, you know, that you come to agreement on who requires them?

MR. MCNAMARA: We basically have come to an agreement with the Nurses' Union on the requirement for masks. One of the things in working with the Nurses' Union is that we intend to meet, as a minimum, the guidelines as suggested by the Public Health Agency of Canada. That's just a minimum. In addition, we'll be following all the appropriate legislation, occupational health and safety. I should also say that in providing safety protection to employees, we also have an expectation of RNs and other staff that they take all precautions to protect themselves, including taking the vaccine, and I think taxpayers would expect the same. So the immunization will be an important part of them protecting

themselves, protecting their families and protecting, most importantly, the patients that they would be providing care for.

MS. WHALEN: No, we understand that and, of course, every Nova Scotian is going to be inoculated now so definitely our health care workers are in the priority group there. Could you tell me the cost for the H1N1 immunizations themselves - how much has been expended and the total cost you expect?

MR. MONTGOMERIE: The vaccine costs are $4.5 million and that's based on a 60/40 agreement reached at the political level between the two levels of government.

MS. WHALEN: Are we 60 per cent or are we 40 per cent?

MR. MONTGOMERIE: We're 40 per cent. Every once in a while you win a percentage point. It doesn't happen often. So that's a $4.5 million commitment from us.

MS. WHALEN: Very good. Ventilators, I would like to know, I understand we have 80 that were ordered, is that right, 80 that were ordered at a cost of $5.2 million, but you also mentioned 10 mobile ventilators. I'm wondering if that's part of that $5.2 million or is there an additional cost?

MR. MCNAMARA: I think it's $5.3 million and that includes the 10 for transport and this is for transporting patients between facilities.

MS. WHALEN: So the total cost for ventilators that's there is $5.3 million.

MR. MCNAMARA: That is correct.

MS. WHALEN: In your opinion are there some other items that will require spending approval that I haven't touched on here?

MR. MONTGOMERIE: I think again, what we have on a weekly basis is a sheet of proposed or potential pressures. What we're giving you is what's real. We know exactly the cost. There are probably 15 other items on that sheet that we're tracking on a regular basis. Social marking is another one. When we're ready to make our recommendation to Minister MacDonald and then we take it across the street, it will be a specific number. There are several other areas that we continue to track.

MS. WHALEN: Have you a total figure for the preparation? I preface it by saying we have every confidence that the right steps are being taken, we want them to be taken and we support proper preparation, so I'm not trying to be negative in asking a total figure.

MR. MONTGOMERIE: I appreciate the way the honourable member is asking the question. I would be very reluctant to speculate with you what the total cost may be because quite frankly, as Dr. Strang says -and the vaccine is a prime example - if we end up with only one dose versus two doses, we're already looking at a different dynamic. So I would be reluctant to try to speculate with what the final figure might be. Simply to add up what we have here, we're close to $11 million already, I think, and I think we gave you copies of this sheet, I'm hoping.

MS. WHALEN: So we can ask you again next year about the total cost. I would like to ask you again about if, out of the $54 million, is there a figure you can provide, just one figure that's buried in $54 million?

MR. MONTGOMERIE: Not really because we continue to deal with the centre, they totally get that this is totally elastic, it can change on a dime. I say it's almost like wage negotiations, you just don't know where it's going to go.

MS. WHALEN: I'd like to go to another question, still on costs, but I understand you've talked about your social marketing, this would be a communications consultant who has been engaged? Is that right?

MR. MONTGOMERIE: It'd be a combination of things. First of all, the Public Health Agency of Canada, with the Government of Ontario, has done some phenomenal work so the consultant who we've hired, one of the first things they'll do is plug into that process to minimize the expenditure in Nova Scotia, but to maximize how we go forward with the vaccine campaign.

Part of the consultant's job will be to recommend to us methods of how we do that and that's when the costs would become more specific.

MS. WHALEN: And that is actually given in the chart on Recommendation 28. In referring to that, one of my questions would be, we know from estimates the other day that there are seven communication officers in the Department of Health and I understand five in the Department of Health Promotion and Protection, why is it necessary to go and hire somebody additional?

MR. MONTGOMERIE: If I can, the day-to-day responsibility of our communications folks is incredible - there are issues, and Kevin can speak to Health, in Health Promotion and Protection, I think, Dr. Strang and I were chuckling the other day, we have five different issues that our communications folks were managing around public health alone.

They do that kind of thing as well as help our internal staff do normal communications with our stakeholders and so on around issues. But in this one we need a different level of support and we've gotten it from Communications Nova Scotia. Their

managing director has been tied to the hip with our two directors of communication. They've brought in additional resources where we've needed them.

MS. WHALEN: I wonder if you could tell me what the consultant will be paid? I understand it's a part-time position.

MR. MONTGOMERIE: We'll endeavour to get that for the honourable member. I'm not sure if we have it specifically yet.

MS. WHALEN: Perhaps that could be given to the committee as a whole. That would be good. Will it come out of the existing departmental budget?

MR. MONTGOMERIE: Yes, it will, but in the context again, when we know exactly the cost we're going to predict, what that campaign will take, that will be one of the things, on a weekly basis, we would take to the Treasury Board and say here's a pressure of x number of dollars, we need your approval to go forward.

MS. WHALEN: Okay, very good. I want to switch gears if I could and go to school boards. I note that school boards are also creating their own pandemic plans. I guess this might be for Dr. Strang, but have you requested or will you receive and approve those plans?

DR. STRANG: No. We have given schools the appropriate information around what they need to do in terms of focusing on surveillance, when they need to report to public health around the rate of absenteeism, information around hand washing and the other prevention measures. I don't feel I need to audit their plans. They know their business best. We're linked in with schools. At the local level we have a public health nurse attached to each school. We have Regional Medical Officers of Health and other staff to work with school boards and at my level working with the departments and the superintendents.

MS. WHALEN: My concern would be that the school boards themselves don't have the expertise. You mentioned they have got a public health nurse, but I'm wondering how they would go about providing a plan and what confidence we can have that they're consistent plans, if you haven't provided them with any overview or framework. Is there any template that you gave them?

DR. STRANG: We have provided them a school tool kit. Remember that from the health aspects, in terms of preventing or minimizing transmission of H1N1, it's not a complex issue. All of the other aspects of their pandemic response are around their logistics and how they can continue to deliver education and all of that kind of stuff, and that's their purview. We have provided them the information around promoting hand washing, around messaging around keeping students and staff home if they're sick, around enhanced cleaning. I feel that's our role, to provide them that information; they have to take that and fit that into

their broader environment that they understand. It wouldn't be appropriate for me to try to tell them how to run their business.

MS. WHALEN: Do you know if each of the school boards has a pandemic plan today?

DR. STRANG: I haven't asked them if they had specific plans. I do know that they are taking this very seriously and they're all working very hard on taking our information and making it work at the local school level. I'll just use the example of my deputy's wife, who brought that to me very early on when we had the tool kit. She said in her school they had a kid sick with flu-like symptoms, and the principal said, what do I do? He turned to the school kit and figured out what to do.

MS. WHALEN: So that tool kit would help them identify whether or not it was H1N1 or more serious?

DR. STRANG: No, basically the thing is, you have a kid who is sick, they need to be isolated until they can call the parent and get sent home. What I'm illustrating is, we have very practical information that the schools can then use to make decisions in their environment.

MS. WHALEN: Okay, that makes sense. Lessons learned from Australia and New Zealand - some of them closed schools. I think in Australia, they did try to close schools in some areas. Was that successful, and have you looked at that as a possible approach?

DR. STRANG: No, closure of schools would only be in a very extreme circumstance, and I'll use the example of - it was Argentina and Chile, and I can't remember which one. One of those countries closed schools and closed mass gatherings - I think it was Argentina, and then Chile didn't. Basically it made no difference. The point being, and this is where I made this comment when the World Health Organization said countries should consider closing schools, unless we do something to control the movement of those people once they're out of the school setting, which would essentially mean keeping them at home for weeks on end, it's not going to be effective and we've created a whole other host of child care issues. People that we need to be in the workforce in health care will no longer be in workforce.

MS. WHALEN: Can I have one last question? I understand I have one minute left, so I wanted to go to another union issue, which was the Good Neighbour Protocol. That's referred to in the Auditor General's Report. It was outstanding at the time that he wrote it, and I believe it still is, but could you confirm whether or not you have signed the agreement with the unions that's called the Good Neighbour Protocol?

MR. MCNAMARA: In working with the unions, all the unions except NSNU are on side with the Good Neighbour Protocol, and the issue with the Nova Scotia Nurses' Union - I believe we will solve it very shortly - it's over the being off work for seven days for front-line workers and how they will get paid, and so we believe we're very close to having it signed.

MS. WHALEN: Have you signed with the other groups, or you're waiting for all the groups to sign?

MR. MCNAMARA: We'll be signing at once.

MS. WHALEN: All at once, okay, that's very good. There's also been an article in the paper that referred to physicians who are looking at some sort of insurance plan to cover them for being unable to do their work - for example, surgeons.

MR. CHAIRMAN: I'm afraid your time is up.

The honourable member for Cape Breton North.

[11:11 a.m. Ms. Diana Whalen resumed the Chair.]

MR. CLARKE: I'd like to first start with the Auditor General. Just to get some other context with regard to undertaking what would have seemed, from a public point of view, a non-traditional role of an Auditor General - getting into a topic that otherwise would have been in a, I guess, non-accounting realm with regard to what you would normally look at in terms of due diligence and process within government, management and executive decision making and the accounting of that. For my benefit, coming on the committee, how would you look at the methodology in formulating the audit process? Who would be consulted or what resources would you bring in, in undertaking an audit of this nature which has been responded to very effectively? What do you see as the follow-up to this type of audit?

I know you noted that every two years you would go back and look at that, which probably is a good timeline especially with so much activity current this year and budget lines that will come forward for next year.

MR. LAPOINTE: I would say, to begin with, I wouldn't say that this is a non-traditional area. This would come under the area of value for money audits or performance audits that we perform, in which we look at programs and we look at the program delivery. We look at whether they are efficiently delivered and effectively delivered. We look at governance issues and risks and compliance with law and a lot of other areas and make recommendations on improving the program. So this would be under that area and would be the kind of thing which is about 60 per cent, I guess, of the work we do.

Now what we do in a case like this is we look at the individual program and say well what is the expertise that is required? How do you develop criteria against which to judge the performance of this program? We look for criteria in existence in this case, for instance we use the methodology from the WHO, which is applied worldwide and they simply say here are criteria that you should have in place in this kind of program around the world. So we have an objective outside source against which to judge.

Then we look at the operations of the various players, evaluate it against those kinds of criteria. What we do, of course, is first take a look and say this is the criteria we're going to use and discuss them with the people who are going to be audited and say, do you agree that this makes sense as areas to look at? That's the methodology we followed in this case as well.

MR. CLARKE: And in the formulation of that, was it the SARS outbreak and concern about that that would have triggered this review? As I say, the topic itself would not have been what Nova Scotians would have seen as a normal audit process. What would have triggered your taking on this as a review? Was it the SARS and people's concern about a pandemic and the government's ability to respond to it?

It is true, the government had to respond to emerging issues and formulate a plan. I guess just what would trigger that as a program area to look at in the first place?

MR. LAPOINTE: Well this particular program emerged as a potential audit target in the course of our normal risk assessment of government programs. So we routinely look at the totality of government programs to the extent that it is feasible to do so and try to identify where are the areas of greatest concern, where are the areas of greatest risk and where, in fact, should we focus the efforts of our office.

Out of that emerges a number of prioritized audits of which this has been one and was on the list for a little bit later. What prompted us to move it a little bit forward was that we were also involved in a related program in looking at our response to epidemics, and that at the time of the mumps epidemic. We got concerns at that time that it would appear that the mumps epidemic seemed to stretch a lot of our resources. So we looked at what we had later on, maybe further down the road as something to look at in a pandemic and said well should this be not a more immediate concern. If we have difficulty responding to an epidemic, what if we had a much more serious pandemic situation, would we be stressed out then, too? So we decided to just pull it forward and do it subsequent to the mumps work.

MR. CLARKE: I appreciate that and just because we're sort of a new committee coming at this topic that was done before, in terms of building some contacts that will obviously flow from these discussions. I do appreciate that, for my benefit as a new member to the Public Accounts Committee.

Just building on that, I guess maybe to our other guests who are here from Health Promotion and Protection and the Department of Health, I had taken note and I know my honourable colleague for Halifax Clayton Park, when we're trying to look at the numbers, I mean I sort of did a quick estimation, about $10.8 million that was quickly identified in what has been procured.

Now the $4.5 million of the 60-40 split, does that mean all of the vaccine has been procured or is paid for, to be procured? What is the status? What do we have?

[11:15 a.m.]

MR. MONTGOMERIE: The company is producing the vaccine now. It will become available to us probably in mid-October, but the regulatory piece will probably not be resolved until November. So actual needles in arms, you're probably looking at November.

MR. CLARKE: Okay, so the $4.5 million, to Dr. Strang, that will give us all the vaccine that we need for the province.

MR. MONTGOMERIE: That will give us enough vaccine to assume 75 per cent uptake for all Nova Scotians with two doses. If there is only one dose required for the majority of the population, every Nova Scotian.

MR. CLARKE: So building on that and that cost, what is the shelf life of the vaccine?

DR. STRANG: The shelf life before it is used - it has to be mixed up, so it comes unmixed. It has a long shelf life.

MR. CLARKE: So I guess, Dr. Strang, if there isn't a big uptake - and that's one of the discussions we had, that you'll actually have a use for - so vaccine is not going to sit or an annual renewal sometimes, as vaccines can have a very short life. If you're getting such large quantities, anticipating a major public uptake of that, that that investment can carry forward.

DR. STRANG: Well, there are discussions going on now that would potentially decrease what provinces get and pay for, simply because we don't need as much as we asked for because we're moving most people with one dose, and the discussions also internationally about whether there are opportunities for Canada to then contribute their H1N1 vaccine to the global effort, because globally there are shortages of H1N1 vaccine.

Lastly, as I said earlier, there's work going on. Likely we would include the H1N1 strain in a seasonal flu vaccine. So it's not that we're going to hold onto any vaccine we don't use over the next few months and use it in subsequent years.

MR. CLARKE: I guess as we go forward, and I know there have been other questions related to this, if we've got $10.8 million, you've indicated - the Deputy Minister of Health indicated that DHAs will have their own supplies, obviously, and through the process here receive the bulk of their funding from the Legislature, and trying to deal with that and the additional supplies - I guess it's on an as-needed basis through the Treasury Board process through the minister and her colleagues, that would bring things forward.

One of the aspects of this is, is there a budget area where you've been tracking total costs to date?

MR. MONTGOMERIE: It's an excellent question because we began, early on in the outbreak, a tracking of actual costs, including additional staff. Russ Stuart and his team have been ensuring that we're tracking overtime. Every impact on the system is being tracked so we'll know the actual cost.

MR. CLARKE: So what has been the actual cost to date, deputy?

MR. MONTGOMERIE: I'm not sure, to be honest. I haven't looked at the update.

MR. CLARKE: Okay, well, I would ask that -

MR. MONTGOMERIE: Let me put context around that. Those are things that normally happen within the department, time and human resource pressures and so on, because the real concern I have, as deputy, is that we have the resources to meet the needs, and that is happening.

MR. CLARKE: Well, one of the things I would ask is if, as the government, through yourself and your associated colleagues, because I know EMO would have a role, as well as Health and all the players, to get that number. The reason I am going down this road is not to make it difficult on what numbers you should have, but the amount is adding up to significant millions. More importantly, as we deal with a new reality in a global environment, we're concerned about whenever the next pandemic may be, whatever the next virus might be - that would be a concern. Right now it's H1N1. As we've known, there have been other issues.

So as we get ready for that, and I guess my point being, is that cost, in addition to if I go back to what Dr. Strang said before, if you are looking at bringing people - I think you mentioned something like 3,000 to 5,000 potential retired nurses who could help with the vaccination process. I guess my question is, has that been budgeted for or estimated, the cost of doing the actual implementation of vaccination?

MR. MONTGOMERIE: That's part of what Dr. Strang and his team are doing now to refer to that specific piece, as they now determine the best way to apply the vaccines -

what is the best method? If the method is to access folks who are retired, what is the anticipated cost?

Once we have that, we put that back in the mix. But I apologize, you are absolutely right. The reason we track the costs plus project, to your point, to the honourable member, is to make sure we have a good sense of what this does cost, to handle this kind of an outbreak.

MR. CLARKE: Well, in terms of the interest, from a Public Accounts perspective, if you add that up, I mean to implement and to have vaccination province-wide could potentially mean millions more in cost at a time when we're seeing - and I'll go another step forward - this year it can be buttressed by a very massive deficit that's been proposed and so those costs can be assumed.

But I will go to the next point and that is, as Dr. Strang had talked about, future budget pressures and the importance of tracking this because it is going to become a line item. Whether it is H1N1, I think we've now got into a new reality as having pandemic preparedness and implementation, or program delivery, as a budget item that flows out of what I think has been a very constructive process and I compliment all the players who have been there. I don't think we have any critique of that. But it is in the interest of Nova Scotians to be aware of the true cost of being prepared for and responding to any pandemic and also accounting back what that is and as was indicated, everything from the public information to the communications piece can be very expensive, that's a reality.

So as we go forward, it's one thing to look at where a Cabinet or a Treasury Board may be, this is now going to be potentially in the tens of millions of dollars and a very tight environment and as we go forward for, what has been promised, a balanced budget next year with a massive deficit this year, then it means program choices are going to be made. Now, you don't have to respond to that, but I'm looking at where this fits in the wider mix of priorities and how it gets accounted for in terms of sustainability. Is it just a temporary response to the issue of the day or, I guess the question I would ask, I guess Dr. Strang had mentioned this, has there been a commitment that this is a long-term area that the government is prepared to invest in, or if anyone else wants to respond?

MR. MONTGOMERIE: Early on in the outbreak, Dr. Baikie, our Deputy Chief Medical Officer of Health looked at us and said, this is not a sprint, this is a marathon. We've continued to make the point with the former government and the present government and there's no question everybody understands that.

So to your point, honourable member, you're absolutely correct, for us to be able to track the costs is absolutely critical, but more importantly for us is that we're able to, on a weekly basis and a timely manner, make our points about our needs respecting the government's bigger challenges and how they may tell us to deal with those needs. They may

say you may have to take that out of your budget or we may have to do something over here, but the key thing for us is that we get timely decisions around the pressures that we're facing regarding this outbreak.

MR. CLARKE: Have you or any of the officials been given the budget okay from Treasury Board or Cabinet to do the immunization program that could involve thousands of people in terms of employment?

MR. MONTGOMERIE: Not at this time because when Dr. Strang and his team are ready to come with that specific plan and Kevin will obviously have implications from DOH, then Kevin and I will take that figure to Treasury Board as a specific pressure to do a mass immunization program.

MR. CLARKE: So in the request that we've made in terms of looking at what has been tracked, if we could have that information presented to the committee, Madam Chairman, to your attention through the Committees Office for us to be able to look at because it is a significant area in what I see as the actual function of this committee - to look at the dollars and cents as it relates to an issue of public priority and of that of the government. We don't dispute the merits of this whole process.

It is going to be very important to be clear on the long-term commitment and as referenced, this is a marathon. There is a new reality in our world that we cannot ignore but in an area where there is mounting pressures - and there will be hundreds of millions likely cut to balance a budget or a massive influx of resources - we're going to have to look at where this falls. Again, I'm not asking you to respond but it is where I would put it in perspective of priority.

What I do see is a budget process - and not to get into what the other aspects that the House is dealing with right now, that will come forward - that we're going to be seeing a budget passed that is still going to have other budget pressures added to it, likely in the vicinity of millions of dollars more. It's going to be very important that we track that as a committee, I would think, and look at those cost impacts because it will affect how we'll be looking for the government, i.e. the political members of government, and how they're going to respond to this.

I do want to thank the participants here today for the sharing of the information.

MADAM CHAIRMAN: You have four minutes.

MR. CLARKE: Thank you very much, Madam Chairman. I want to just complete one other aspect because public information is very important. As we know, we've seen the launch of the 811 system. So with that I would assume if people are concerned about their health or potential flu impacts or conditions, that that system will be utilized by Nova

Scotians as another tool in the drawer of dealing with a pandemic. Can you tell me about the costs of the 811 system for delivery and its use to date?

MR. MCNAMARA: I'm sorry, I don't have that at my fingertips but I will get it for the committee.

MR. CLARKE: I would thank you because that is something that I would see as another area with a new program that has been brought in that is going to be key, I would think, to any pandemic. If the public are at home, someone gets sick, it's late at night, this 811 number would be something that would be utilized. To know what the cost of that is as well as what the uptake has been and a further thing, deputy, if you could just note, is really what is the capacity for number of calls, so used, to date and what can it truly handle?

We've seen it before when, and it has got nothing to do with the Department of Health, but when there's a power outage, all of a sudden the phone lines can't handle it because they weren't ready for that. If we had a pandemic and there's a major concern, what is the capacity of the system and how many calls can it take before it can no longer effectively function - hoping that will never occur and that the system gives the support that's needed. So if we can get that information, I think it's another piece to understanding this and I would thank the members for their attendance today and everyone for their time.

MADAM CHAIRMAN: There are actually a couple more minutes left if you would like them. Would you like a couple more minutes? We had extended it because of the procedural question. So we have until 11:30 a.m. Do you want two minutes? Mr. Porter.

MR. PORTER: I just had two very quick questions and I'll start with Dr. Strang, just one quick question on the vaccination again. I know we talked about some getting and some not. If a person, say I had Pneumovax this year, does that matter whether or not I get the H1N1?

DR. STRANG: Well, presumably if you had Pneumovax for a reason, you would be in a high risk group so you would be one of the groups then that I would say absolutely should be up front getting an H1N1 vaccine.

MR. PORTER: Thank you for that and a quick question to our guest, Dr. Buchholz, you're a part of the advisory. What is your role exactly in all of this?

DR. KEN BUCHHOLZ: A couple of different roles. Initially when the pandemic co-leads were set up, I sat in as one of the initial co-leads with Dr. Strang before we restructured. My role is to provide basic medical advice for some of the issues that come up and also to provide the physician liaison with Health Promotion and Protection and with other branches; also to vet any medical concerns that are there. I work hand-in-glove with Dr. Strang and Dr. Baikie and Health Promotion and Protection in general, part of their

expert panel. We have a group of experts, epidemiologists, infectious disease specialists, other medical specialties. Part of the role that I play, as a primary care family physician by training with experience in emergency in the rural area, is bring that context to the discussion. The other major role that I play is the engagement with practitioners in the field, with family practitioners through Doctors Nova Scotia, and the liaison with vice-presidents of medicine and chiefs of staff at the district level.

MR. PORTER: Thank you very much and my two minutes goes by very quickly.

[11:30 a.m.]

MADAM CHAIRMAN: It does indeed. Yes, with that, we'll turn for the final 20 minutes of questioning to the NDP caucus. I would like to call on Ms. Kent.

MS. BECKY KENT: I'll start my time out with just a few comments. I want to first of all thank the presenters today through you, Madam Chairman. I can tell you that as a mother of three boys who are still in the high risk section of the issue that we're facing, it gives me a tremendous amount of comfort to come here, have this opportunity to come here, and hear directly from you all. I have not had the pleasure of meeting a number of you and, in particular, Dr. Strang, you know, many people, the average citizen, the mums, the dads, the seniors, the teachers in our communities, hear your name and I'll be honest, you're held in very high regard and it's particularly comforting. I have tremendous respect for the whole team that we have here in Nova Scotia who are working on this.

I think that Nova Scotians, on behalf of all Nova Scotians, we have much to be thankful for and so I just want to offer that to you now and I think that's probably a message from many of my colleagues, if not all of them.

Nova Scotia certainly has been a leader in many ways and although this would not necessarily have been the one we would have chosen to have had the first opportunity to, I have no doubt in my mind that what we are doing here in Nova Scotia, and what we will continue to do, will make a difference not only to our province but all of Canada. I'm very proud to be able to sit here and to understand that.

Mr. Montgomerie and Mr. McNamara, your explanation, your ability and what you've articulated to us today has been tremendously helpful to know where we have been, how we got to today, that's really helpful. That's a message that I think we, as well, need to convey to Nova Scotians. Not everyone out there - we all know that the families and citizens that we represent and those that you're working for, we are all dealing with issues well beyond the scope of this H1N1 every day and it's not on their minds all the time. So it's really important that our government and our Nova Scotia leaders and decision makers, and particularly you and your departments, have this well in hand and that's the message I'm

hearing. I'm just thrilled to be here to hear that and if we can somehow get that message out through us and through your communications, that's important.

On a couple of questions though, I do want to ask Dr. Strang that since the first case of H1N1, we clearly have had a lot of effort, a lot of energy, a lot of resources attached to the process, the strategy to get to a certain stage and then when we had our case - are you confident, are you comfortable with the amount of - or have you been properly resourced with what you need to deal with the onset of where we're now going? I know this is a moving target, but to date have you felt that you've been properly resourced?

DR. STRANG: Yes, with the previous government and with the current government, through both deputy ministers, every time I've needed to go and identify an issue that needs resource attention, the consistent answer has been that whatever resources are needed so Nova Scotians are kept safe and healthy during this will be made available.

MS. KENT: That was my question, is that the message that's coming from the current government - we have more indication of some of what is on record from the previous government, the transition from the former government to the new government, that message is that - I guess most specifically, what is that message, and I think you've pretty much answered that. Knowing that it's a moving target, can you comment on that, their understanding of the fact that we just don't know that change, as Mr. Montgomerie has noted.

DR. STRANG: There are things we can predict, like how much the vaccine is going to cost, but what we can't predict is ultimately how many people are going to get vaccinated, so we cannot give you a final dollar figure of what vaccination will cost. We can't predict ultimately how many people are going to get sick and seek care and what the demand and utilization is going to be. Those are the only things that we have to be prepared to meet those surge utilization needs on the health care system and the costs that are associated with them. It'll only be after the fact that we can total it all up.

MS. KENT: Again, I think you noted it but if you could tell me - give me a little insight - when you describe you're getting timely responses to your requests, can you give us a better understanding of that so that we can share that with Nova Scotia?

DR. STRANG: I will use the example of the epidemiologist. That's a long-term capacity issue which the Auditor General identified but when we brought it forward, my director of surveillance had put together a plan that would move the recruitment issues and some of the compensation issues associated with that so we were competitive, brought forward that plan, and we were given the capacity through our department, the Treasury and Policy Board, as well as the Public Service Commission, to move that forward very quickly. So now today, as I said earlier, we're at a place where we're ready to almost close off, sign some agreements with people.

MS. KENT: Clearly, responding to a pandemic is a huge, huge task. Who would have thought Nova Scotia would have been the first ones to have that privilege, if we can call it that.

I want to bring us back again to the average citizen - we're all average, we all have different things that we face - our families at home who are making decisions on a daily basis when they wake up in the morning and their child has a sniffle or if they've gone to school and they get wind of something going on. I think of a recent experience that I had as a member of a Scouting movement in Cape Breton. I had the privilege of being part of a big provincial Scouting jamboree. I was on a team taking care of around 3,000 campers. When you get 3,000 campers amongst each other, there are various levels of hygiene and contact and things like that. One of the things that quickly became apparent to us as the organizers behind the scenes is that we had the potential for some kids who may have had to go home related to H1N1.

Where I'm going on that is I was very impressed with the role that organization had, the access to resources to make good decisions, handle it, contain it without the fears that are associated with that because they're out there, the misunderstandings that can happen when information starts to go around. I know that organization was very quick to get the insight into what they were dealing with so they could then roll out the next stage, which it ended up sending some of the youth home.

What I didn't understand entirely, and I wonder if you could share, what would the roles have been from Public Health, for instance, or the district health authorities and other levels of government, to help assist the on-the-ground organizations like the church groups, the local organizations that are out there? What is their role that Nova Scotians can understand and have comfort in what information is coming out when they're sending their kids to these events and activities?

DR. STRANG: Well, part of the planning response - like I talked earlier about the school boards - is to get good, basic information out broadly. I think we've done a very good job of that as your story attests to. We anticipated in June that we'd have summer camps, so we made sure we got information and got that out to summer camp providers and organizations. We've done the same with schools.

In the response mode, there is always local Public Health available to receive a call from a school, a university or a church camp, if we think we have an outbreak of some infectious disease going on. We deal with those all the time. There are Public Health professionals to support that and then there's always the EHS and then our hospital system if necessary.

MS. KENT: One of the things that I recall - I've had experience with child care, early childhood education scenarios and lots of youth organizations - is that often the first line of

information which is spread among the mothers, the parents and the caregivers, is to contact Public Health. So when you have a question around what to do, around all of this, where is the first line of information for a person who might be at home and they might go on the Internet or they might want to make a phone call? What is the best first step for a parent who may not have had the contact from the school, for instance, in getting that information? Not all kids get their bookbags emptied with the message.

DR. STRANG: On our Department of Health Promotion and Protection Web site, we have a lot of information there specific to groups or just general information and it links to the Public Health Agency of Canada Web site. We have good information that we've linked through the providers of the 811 line. So while their basic purpose is to deal with people who have symptoms, often you can be waiting for a few minutes there and we've worked with them to get kind of prevention messages, as well as the staff understand our prevention messages and are equipped to deal with that.

Again, we come by Public Health as much as we can. One of the major things we do, not just on H1N1 but on a number of infectious diseases, is anticipate what the basic information is that the public needs to have and what are the many community organizations, and other things, that we can give that information ahead of time so they're armed with it.

MS. KENT: Thank you. What about the doctors? I mean at the end of the day if a decision is made to take a child or a family member to a doctor and your message is getting through to the doctors, what has been the working relationship with that, with the doctors' offices and the uptake on it? Clearly they need to buy into it, they need to be part of this. Our families are going to our doctors, understanding that it is just a given that they're going to take the best care that they can of their family, so can you give me a little insight into that?

DR. STRANG: Absolutely, that's critical. As I said earlier, one of the learnings from mumps is that it strengthened that relationship. So when we had our first live, confirmed case at midnight on a Sunday and worked through that, by Tuesday we had our first tool kit for front-line care providers about what is H1N1, what do I do, who do I test, who do I treat, all that kind of stuff. That was out, so within 48 hours we had that out.

We've continued to adapt that as the information evolves and becomes more sophisticated. We've developed a stronger relationship with Doctors Nova Scotia. All the clinical information that we produce now goes through their section of general practice and they've volunteered, a handful of them, to review the information to make sure it is appropriate and relevant. So that is working very well, in terms of that link to primary care providers and making sure that they have input into what we're saying so that it makes sense for them.

MS. KENT: Thank you very much. I have just one further question before I'm going to pass it along to one of my colleagues here. Again, we have had the experience of having the first case here. Whether we want to or not, we're going to be leading this.

You've referenced our ties to our federal-provincial-territorial levels of decision-makers. I know that we do have the benefit of resources here within our community and other doctors. I wonder if you can give me a little insight into what are we taking to that national table and national strategy that when we take it there, what happens with that information and how then are you able to turn what you're getting there back to Nova Scotia to benefit us, here in Nova Scotia? Do you understand my question?

DR. STRANG: Let me try, I think so. There is at the national level the same issue groups that are working at those many levels, there are experts sitting on those. So we're fortunate that we have a number of experts from Dalhousie - vaccine experts, infectious disease and infection control experts. They are also part of our provincial expert group. So the way the process works is that those work groups work up specific issues, say around vaccine. It comes to a central coordinating group that my deputy, Dr. Baikie sits at. It then comes to our overall decision-making group that I sit at and we're fortunate that Deputy Montgomerie sits there because he's a liaison deputy.

So there is a lot of scientific analysis that goes in first on specific issues. It then comes to higher level tables that maybe then look at what are the policy implications. Certainly provinces, we put forward issues, run conference calls twice a week. We put forward issues that then are directed to specific work groups. They then come back to the various tables where there's FPT representation and ultimately that at my level we sit and we make sense of it and say what are we going to do, knowing that as was referenced earlier, we strive for national consistency but each province has to ultimately make decisions based on what makes sense in their jurisdiction.

MS. KENT: Thank you very much.

MADAM CHAIRMAN: I'd like to call on Mr. MacKinnon. You have about five minutes left.

MR. CLARRIE MACKINNON: Thank you very much, Madam Chair. I have to be very careful how I frame this because I had the pleasure, the privilege of attending the Council of State Governments in Vermont recently. There were medical people there in some of the forums. One leading person was, in fact, saying, and this is not my opinion, that there have been stronger strains of flu, that there have been greater losses of life and almost a feeling that there was too much hype in relation to this. What do we say to Nova Scotians who do, in fact, think that?

[11:45 a.m.]

DR. STRANG: I'll say, first of all, yes, I mean we're fortunate, in fact, we've been hit with a pandemic which is not nearly the level of severity that it could be so we're fortunate in that way. It is serious, it does create, in a small proportion of people, it does create a very serious illness and there have been deaths. Even large numbers of people becoming sick with influenza creates lot of challenges in our school systems and workforces, et cetera.

So yes, we do need to take this seriously but we have to put it in the right context. A lot of what I strive to do is to try to find that right balance between giving people the right information, so they can have what I call a common-sense appropriate response, and not overreacting.

For instance, it's safe to send your child to school - follow some basic prevention messages - but if they're sick, keep them home. You don't have to be alarmed and take your kid out of school for the next three months. It's finding that balance. We do take it seriously and from a planning perspective, we have to anticipate the worst case events and be as prepared as we can for those and hope that we get something less than that because that makes our job easier.

At the end of the day, we need to pay attention to this. I think we're paying the right level of attention to it and I'd much rather be criticized, I guess, for overreacting a little bit now than being criticized after the fact for underacting.

MR. MACKINNON: So what kind of balances were found in New Zealand and Australia, Chile and Argentina and so on? Were balances found there?

DR. STRANG: What they found is, and we're learning from this, back two or three years ago our pandemic preparedness that we were based on and are still based on - it could be the worst case scenario, kind of 1918, 1919 where it's hugely problematic, high rates of illness and death and significant social disruption.

Very early on, as we started to understand H1N1, we realized we're not actually in that situation so we can scale back some of our response and I always use the word reasonable - what's reasonable? What is reasonable changes depending on what we're faced with. What was reasonable back in the first week became by the third or fourth week a little bit unreasonable and we could scale back a little bit.

What they saw in the Southern Hemisphere and the key pressure points are around large numbers of people getting sick with normal flu-like illness, creating lots of pressures on primary care and emergency rooms and then this very small proportion of people becoming severely ill creating pressures in intensive care units.

That's where we're focusing a lot of our attention around primary care. How could we deliver primary care in different models if we needed to, investment in the intensive care piece and then the third pressure point of course then is the immunization.

MR. MACKINNON: I have a habit of trying to bring focus on rural areas, as a rural MLA. We talked about looking after First Nations and so on, but when we look at rather remote communities - like Bay St. Lawrence, Capstick, Meat Cove and so on - how are we going to get the proper services to those communities?

DR. STRANG: I'll speak on the public health and the vaccine side and clearly my direction to the public health system, my staff and Public Health and the district health authorities is, access needs to be one of our key principles. We need to make sure all Nova Scotians have adequate access, but that needs to be balanced out with safety as well and making sure that we have people with the right competencies and the vaccine can be assured to be delivered safely. It's finding that balance, but we are committed to making, as best we can, adequate access in as timely a manner as possible.

MADAM CHAIRMAN: The time really has elapsed for your questioning, Mr. MacKinnon. Thank you. That does end our round of questioning this morning. I thank our guests for being here.

I wanted to recap, there were three items of information that were requested from different guests. One would be the cost of a social marketing consultant. The other was the actual tracked cost to date on all of the H1N1 up to this point in time. The final one was the cost of the 811 system and its use to date, including the capacity of the system - in other words, how many calls can it take in terms of knowing that resource is in place for expanded need during any pandemic.

So, if we could leave that and I have allowed a short time for closing remarks. We do have committee business as well so you don't need to fill the entire 10 minutes.

MR. MONTGOMERIE: The Auditor General, in his opening remarks, said leadership, coordination, supply. I affirm to the honourable members today and the people of Nova Scotia, on September 30^th, your health system is in good shape.

MADAM CHAIRMAN: Thank you. Did you want to say any remarks, Mr. McNamara?

MR. MCNAMARA: Just to thank the committee and the Auditor General for helping us to bring this to the attention of Nova Scotians. I think the more we can do of that the more we can convince people to accept the vaccine when it comes forward and to help us help them look after themselves. Thank you.

MADAM CHAIRMAN: Thank you very much. I certainly want to thank you for taking the time today, it was a longer meeting than usual. I know it's difficult for everyone to be here for three hours, but I really appreciate your coming together and we may call you again as this unfolds. I'm sure that you will be there to help get the word out.

We will now go to some committee business, you're welcome to prepare to leave if you'd like and we'll just go to our committee business which hopefully we can take care of in the next 10 minutes that are left for us.

One point is there was a question coming from the floor about what would be an appropriate question or not - the ruling from the Chair. Our Legislative Counsel is here today and could give us a quick answer to that. He has had a chance to look at that, so if Mr. Hebb could just address that briefly.

MR. HEBB: Yes, I had a chance to look into the matter and the restriction on questioning that the vice-chairman referred to is only applicable to Question Period and has no application here in the committee.

MADAM CHAIRMAN: I think that's important - we are a new committee with many new members, so it is important that we know that distinction. That will be just for going forward in other questions. Mr. Preyra.

MR. PREYRA: I was just coming back from a Public Accounts Committee meeting in Edmonton and a number of us were there. One of the issues that was raised, and there seemed to be consensus at the end, was that Public Account Committees serve in large part to look at money that has already been approved by the Legislature, programs that have already been approved by the Legislature, and to assure ourselves that the money that has been approved and that the programs that were approved were being carried out in accordance with the terms that were set out by the Legislature. My concern with that was that if you have something in the budget that is subject to debate in the Legislature that has not yet been approved, that it's not within the purview of the Public Accounts Committee to question whether or not the ministerial allocation is correct or whether or not those funds were properly approved by the Legislature. It's particularly important, given that we are in estimates at the moment and the Committee of the Whole House on Supply is looking at that very question, that it is an appropriate question to be raised there. The Department of Health staff - the Minister of Health, in fact, is there in the House to answer precisely those types of questions. It seemed to me inappropriate to be addressing those questions to the deputy and the bureaucrats when, in fact, it's a question that should be addressed to the minister in the House.

MADAM CHAIRMAN: Thank you. Mr. Porter.

MR. PORTER: I just want to speak to that. I think that we do follow those guidelines for the most part and have since I've been on this committee for over three years - Madam Chairman, you've been around here for awhile as well. I would say to the honourable member's comment with regard to questioning, that money is being approved almost weekly, as they alluded to this morning. They go to Treasury to talk about the excessive needs they might have, the pressures, I think, were the words used. We are also aware in this House that the departments can spend up to 50 per cent of the budget before the final approval, so that money has been allotted for all intents and purposes.

I think it rightfully is the place for this committee and members to ask those questions. As counsel has already alluded to, we are well within our rights to do so, that the rule only does apply during Question Period. This committee is examining very closely - and always has in my opinion - the past expenditures and also plans for the future on a rare occasion. Mostly it is the looking back - has the money been spent appropriately - and I would suggest that we continue to follow that line. Thank you.

MADAM CHAIRMAN: Mr. Colwell.

MR. COLWELL: Yes, I agree with Mr. Porter. Today the questioning was along the lines that the committee normally would take. The expenditures are in place and I don't think anything was out of order. Counsel for the committee has very clearly indicated straightforward that they are questions we can ask and these rules only apply to the estimates of the House. I'm very satisfied with that. Personally, I didn't see anything today that transpired that would contravene what the legal counsel has said.

MADAM CHAIRMAN: Thank you. Mr. Preyra, did you have something further?

MR. PREYRA: Just to follow-up - no, I agree completely with what is being said here about questions that were asked in general - in fact, all but one question - and I still have reservations about those questions and I think I will raise them again. Thank you.

MADAM CHAIRMAN: I appreciate that and I would just like to go to some of the other business before us. We'll see that next week the committee meeting is to be set not here in the Legislature but across the street in the committees room. The reason for that is we have the Order of Nova Scotia ceremony on Wednesday next week. So we will be meeting across the street rather than in here. Also the same package of material that we received for this, which was electronically given to the three caucuses, it will be the same material we will be looking at because the subject for us will again be pandemic planning but our witnesses will be from the Emergency Management Office. So that will be one thing.

As well, at the end of that two hour meeting next week we'll have a meeting of our Subcommittee on Agenda and Procedures. That committee does meet in camera but we would ask that each of the caucuses come forward with more suggestions on items for the

agenda. When we go forward to the future dates, there are a couple of things I had neglected in our meeting earlier in September, to confirm the Auditor General's dates, and you'll see them on our agenda that December 9^th is the expected in camera date for the next Auditor General's Report followed by the week after when we review the report in public. So I'm just looking for confirmation from the committee that date is fine with everybody and we just want to make sure that that can be planned. So, good, I hear no objection to that - we'll consider that done.

When we set the agenda, as well, we wanted to discuss further calling the Deloitte officials. That was for the state of the province's books. Essentially we had only an earlier preliminary report so we'll just look and see what the time frame might be for that. We also have a conflict with the emergency room closures. It's set for October 14^th on our agenda here but we've heard from the Deputy Minister of Health that he's not available that date and he had actually been moved around because Transportation and Infrastructure Renewal couldn't come on the 14^th. So we may have to move emergency room closures back to a later date but we can look at that next week in the agenda setting committee, if that's fine.

The only other point I have for today is a note from Legislative TV, that is that all Public Accounts Committee meetings are intended for broadcast and will also be available as podcasts. They wanted the committee members and others to know that means the audio proceedings of the committee meetings will now be available on the Legislature Web site. So that was another important point for them.

I think that concludes all of the business. Oh, yes, sorry, Mr. Preyra.

MR. PREYRA: I have a question. During the course of our questioning we asked the Auditor General about the state of readiness of Capital District Health Authority and Pictou County Health Authority. In questions directed at the Department of Health and Health Promotion and Protection, I got the impression that it's something that we need to know more about, and in your questions as well, about the readiness of school boards and local groups. I'm wondering if we should give particularly, you know, a rural community and an urban community a chance to see exactly how this is working at the grassroots level. So I would like to move that we invite the officials from the Capital District Health Authority, the IWK and the Pictou County Health Authority to address issues raised in the Auditor General's Report on Pandemic Preparedness.

MADAM CHAIRMAN: I had certainly noted the suggestion.

MR. PREYRA: I didn't know if you were going to raise it yourself, Madam Chairman.

MADAM CHAIRMAN: Well, my thought had been to capture that and to bring it forward to the agenda setting and procedures because we do determine all of our witnesses

at the agenda setting committee and we're in fact, I think, the only committee of the Legislature that in our mandate has an agenda-setting committee that is required to do that. So if that's fine with you, Mr. Preyra, I would like to put that on as an item for next week, if that's fine.

MR. PREYRA: Okay.

MADAM CHAIRMAN: But we will have captured it and certainly our clerk has made note of that as well. So thank you very much, I think it has merit. With that, I have a motion to adjourn, that's great.

We stand adjourned. Thank you very much and thank you for the long hours you spent today.

[The committee adjourned at 12:00 noon.]