[Page 67]

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

The honourable Government House Leader.

HON. MICHAEL BAKER: Mr. Chairman, would you please call the estimates of the Minister of Health.

MR. CHAIRMAN: Yesterday when we adjourned, the honourable member for Glace Bay was on the floor. He has five minutes remaining this morning. (Interruptions)

We're going to recess for a few minutes, until the staff from the Department of Health arrives.

[9:18 a.m. The committee recessed.]

[9:21 a.m. The committee reconvened.]

MR. CHAIRMAN: Good morning, the Committee on Supply will now be called to order.

[Page 68]

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I know the minister is short of his staff right now due to a delay. I just have a couple of questions to ask the minister, and hopefully he can answer them without the presence of his staff. I promise we won't continue the private health care versus public health care debate or discussion that we had yesterday, because I'm sure that debate will be continued on in other areas, including the media.

Mr. Minister, earlier this year there was a tender that was posted on the public tenders Web site that indicated that the Department of Health, in partnership with the District Health Authorities and the IWK, would be doing a value-for-money audit of the DHAs' delivery system. I'm wondering, at that time, if you recall, we asked a question in Question Period about that very item. We asked you at that time if the company Corpus Sanchez was the bidder selected to do the audit at that time. I wonder now if you could confirm at this time, Mr. Chairman, could the minister confirm whether or not indeed it was Corpus Sanchez selected as the company that would be doing the audit?

MR. CHAIRMAN: The honourable Minister of Health.

HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, to the member opposite, yes, the successful bidder was Corpus Sanchez.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, could the minister tell us then, please, how much Corpus Sanchez is being paid to conduct that audit?

MR. D'ENTREMONT: If you can bear with me, I am going to have to find my own stuff here. Mr. Chairman, I am going to have to get back to the honourable member because I can't - bear with me just one second here, I have a funny feeling that the number is not in this document. I will have to get back to him on that number.

MR. DAVID WILSON (Glace Bay): I understand that the minister is at somewhat of a disadvantage right now, going through some books and that without his staff.

Corpus Sanchez has been hired before and has conducted audits before. If you review the recommendations provided by Corpus Sanchez in the past - I'm sure the minister knows of these, but let me tell everyone - if you review these you will receive what has happened in the past, that the IWK, for instance, when Corpus Sanchez conducted that review, it was recommended that beds for children with cancer should be closed and wait lists for children's mental health services should be allowed to grow, and acute care beds should be closed at the QE II as soon as patients occupying them are moved to nursing homes, and reducing staff hours at the QE II. Those are some of the recommendations in previous Corpus Sanchez audits.

[Page 69]

I'm just wondering again, now that the minister has the luxury of having his staff with him, if he can answer at least one of those questions. How much is this audit going to cost, exactly what is going to be reviewed, and what should be known about this audit that Corpus Sanchez is going to conduct, Mr. Minister?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, apparently the provincial health services operational review, which is what it is called, and the successful bidder again was Corpus Sanchez, I believe will be somewhere close to $1 million worth of work. It's about taking a snapshot of a time of operations for all the districts, so it will give us an idea where our provincial monies are going and basically give us a number of recommendations to mull over on how to make our system much more efficient.

MR. CHAIRMAN: To the honourable member for Glace Bay, the honourable member's time has expired.

The honourable member for Sackville-Cobequid.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman, and welcome back to our second day of Health estimates. I know where I left off yesterday, it was around wait times here in Nova Scotia. I went on for a bit of time there, trying to come to a conclusion of some of the problems seen in the wait times in Nova Scotia and why we have them.

I may get back to that in a little bit, but first I wanted to cover one of the things I stated in my opening remarks yesterday. I went through kind of a list of the subjects I wanted to cover, and one of them that I stated, towards the end, was of great concern to the NDP, of great concern to many Nova Scotians and, for that matter, a great concern for Canadians. It was around the new crop of for-profit health care facilities that we've seen. I know the member for Glace Bay had finished off the day with the minister around a discussion on that, but one of the things that really caught my attention yesterday was a comment from the Minister of Health that had stated, I think during questioning, that everything was on the table when it came to health care and his department's approach on addressing some of the concerns we see in health care.

I want to start off by giving the minister an opportunity to clarify, maybe, or agree or disagree that your government, Mr. Minister, is possibly looking at private health care, and if that is truly on the table for your government.

MR. D'ENTREMONT: Mr. Chairman, to reiterate the discussion of last evening with the honourable member for Glace Bay, the things that we are concerned with in the Department of Health, and one that I hold very important in my list of things I need to be as Minister of Health and the department needs to be, is we have to be concerned

[Page 70]

with, of course, patient safety, making sure that patients are treated with respect and get the services they require, number one.

Number two, we have a publicly funded system. Under the auspices of the Canada Health Act, we need to maintain certain regulations and certain processes in order to meet the auspices of that Act. Number three, we really have to be - not in charge, but at least make sure that we are part of the design of health care in Nova Scotia to ensure that all Nova Scotians receive the correct types of service, funded by the public system.

[9:30 a.m.]

As we get down to how do we maintain our costs, how do we try to find a way that we're not going to eat up more of the budget than we really have to, we have to look at all options. That's where the comment came from yesterday in my debate with the member for Glace Bay. As we look at different delivery models, we really have to keep everything on the table at this point because the things we're doing today are not working to the expectations of Nova Scotians. I think that's probably where we're at right now.

If there are delivery systems - and I don't know what those delivery systems would be - I think it wouldn't be the correct thing to do to say no to them so immediately. We need to have a full review of what our options are in order to deliver services to Nova Scotians. If that means some kind of private delivery, then I think it would be very important to look at those options. That's where the debate went, just to make sure that all delivery models are on the table. If we look at our Emergency Health Services system and our contract with EMC, that is a private company that offers ambulance service to Nova Scotians and making sure that the service is there. It is a publicly funded system and a publicly directed system, for the safety of all Nova Scotians.

I think that comes down to where we're at. We're not throwing anything off the table, because I think Nova Scotians would expect us to make sure that they have the safest and best health system that we possibly can provide for them on taxpayers' dollars.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I guess that was a yes from the minister, that everything is on the table and for-profit health care delivery systems are something that if it crosses his desk, he's seriously going to have a look at it. He mentioned a few different concerns of his. The first one is patient safety. I think that's one of the most important things that we need to do in health care, ensure patient safety. The second one was a public system. I would agree that the public system needs to be protected, needs to get the funds and resources from government to ensure that it continues on providing that service for Nova Scotians.

[Page 71]

I would agree with the minister when he said that we look at the ambulance service in the province. Yes, we have a private company managing the operations, but I have to point out to the minister, with that system in place, there are a lot of rules and regulations and direction from government. They're there to manage it. The trucks, the equipment, the uniforms are all owned by the government. They have control of that system and when we look at what we've seen in the province over the last several years in the private health care clinics and health care facilities, we don't have control. Government does not have control of that. They don't make the rules. They don't tell them what they can do and what they can't do, what equipment they need and what safety measures are in place.

What I'm trying to say is that government is not in control of those facilities opening up in this province and we're seeing them opening up on a daily basis. I have to say, I know the minister is new to the post as Minister of Health, but almost a year ago the former Minister of Health stated publicly that we would see something in the Fall that would help control this, that would hopefully give government more control on what we see in the province, but that didn't come, Mr. Chairman, we never saw that. I know the media has asked the minister again today about this issue and he said we're going to possibly see something coming forward in the Fall.

Well, Mr. Chairman, we've heard that once before from this government. We're hearing it again from this government. I'll give some credit to the minister, being new, but you're still in the same government and it was something that the former Minister of Health said was going to be brought forward in the Fall of 2005 and we haven't seen anything yet. So I'll ask the Minister of Health, through you Mr. Chairman, are we going to see something in the Fall or soon that will give government control of the health care system here in Nova Scotia when it comes to private health care facilities in Nova Scotia?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I do want to remind him of a couple of things. As we talk about a publicly designed and a publicly funded system, there are different delivery models that we should look at. That's what this discussion is and I know we can go on for a really long time talking about this issue, just as this issue has been around for a long time. Every province of Canada has talked about it, some more than others. I've been in this post for four months but, quite honestly, we are not the same government. Quite honestly, it was a John Hamm Government prior, we are now a Rodney MacDonald Government, and I've got to say that we really need to look at things differently. My mandate from my Premier is to come up with some innovative ideas and that's exactly what I want to do to make sure that we protect the health and the safety of all Nova Scotians.

To the member, he talks about these private health care clinics opening up daily. Mr. Chairman, we have three. We have three that are providing different services right

[Page 72]

now that we are monitoring very, very closely. Yes, maybe the correct legislation is not available, but I've got to say, these are doctors who are providing us with non-insured services at this time, things that the publicly funded system does not provide. Also, these are doctors who are managed or overseen by the College of Physicians and Surgeons. These are professionals as well. So I still want to say that even though we don't have that piece of legislation with them, we want to make sure that the safety of Nova Scotians is protected.

When we come forward with a piece of legislation or a piece of regulation for private clinics, I'm sure we'll have a really long debate here in this House. I do commit to try to bring it in as soon as we can, and I'll do it even before that in consultation with the honourable member and also the honourable member for the Liberals, the member for Glace Bay, and we'll talk about private health care to see what kind of pieces of legislation need to be put in. With that, I will continue the discussion with the honourable member.

MR. DAVID WILSON (Sackville-Cobequid): I think that is at the root of why I'm here in the NDP caucus, it's because our caucus believes that a publicly funded health care system not only in our province but across the country, is important to maintain, to fund, and to give resources to. One suggestion that I made to the minister - and I don't know if he has had the opportunity to do this or not - was to go and look at the Romanow Report. This was one of the largest consultations for health care in Canadian history. It went right across this country talking with individuals, talking with professionals, talking with interest groups throughout this province and across the country.

I was fortunate enough to be here in Halifax to take part in some of that. I know that our profession as paramedics made a presentation, a paramedic here in Halifax, Jay Walker, made the presentation to that commission on behalf of the Paramedic Association of Canada. This consultation was large-based, it entailed many thousands, tens of thousands of individuals and I hope the minister has a look at that report and looks at the findings and the recommendations from the Romanow Report. It defines it clearly that Canadians want to keep and value the public system and to ensure that Medicare continues on so that we don't come to the point where what I have in my wallet determines how well my health care is to me. I took pride and cherished the fact that as a paramedic myself I was never asked once when I brought a patient to the hospital what they had in their wallet. I will stand in this House and challenge any government to take that away from Nova Scotians and from Canadians.

I know I could stand at length and debate this and truly provide a lot of information on why we need to continue to protect it. The most important thing is we can't let the erosion of our public system continue and that is truly what is happening

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right now because our governments are not bringing forward stricter guidelines, stricter regulations in Nova Scotia and across the country when it comes to private clinics.

With that I'll move on to something else, I'm sure the Minister of Health will rather talk about other things than this. One last comment which I found interesting that the Minister of Health stated was that it's not the same government - the comment I made about this is the same government - it's not the same government, it's the Rodney MacDonald Government. What that says to me is that Dr. Hamm, who was the Premier of this province for many years, wouldn't allow this to happen but yet he's saying and he's stating in the House today, that the Rodney MacDonald Government, the Progressive Conservative Government of today, will look at private health care in this province. I think that really shows where this province is going and we'll make sure that we stand up to that. Now we definitely will go to something else.

One of the other areas looking through the estimates and it's on Page 11.14 is around addiction services. Addiction services is very important in our province, we look at alcohol, drugs and VLT addictions. When I went through the estimates I looked under Capital Health Authority, number nine, and if you look at addiction services, there's a reduction of nearly $2 million for addiction services for the Capital Health District. I'm wondering if the minister could provide information on why such a large amount has been reduced for the budget of addiction services for Capital Health?

MR. D'ENTREMONT: Thank you, Mr. Chairman, and thank you to the honourable member for Sackville-Cobequid for the question. The honourable member for Glace Bay asked that same question yesterday. It really revolves around the CHOICES program, which is being offered through Capital Health. We felt that since it was an adolescents' program that it would be better served to be with the IWK. So what you are seeing is a transfer of funds from DHA 9, which is the CDHA, to the IWK. You will see a delete of $1.9 million, but you will see an increase for the CHOICES program of $2.6 million with the IWK.

Mr. Chairman, I want to go to some of the comments that he did make about the Romanow Report, and I think I would be remiss if I didn't touch on it for just a second. With the report and the recommendations that were held within it, Romanow admits, as well, that nothing in his recommendations in that report leads to sustainability of the system. They are good recommendations for safety of the patients and those types of things, yet there is no real sustainability piece in it. That is unfortunate, because I do think it is a very good document, it has some very good recommendations in it.

Two things we are taking from that, and there are other things, but mental health, of course, and the increase in funding and the changes we are trying to do in mental health come directly from the Romanow report. Our focus on primary health care comes from recommendations in the Romanow Report. So it is something that is still a

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document that resides on our desk, rather than a shelf. A lot of the recommendations also hold recommendations that are extremely expensive, and if they don't lead to a sustainability of the system, it makes it difficult to take those recommendations in. Like I said, it is something that is still on our desks and there are still things were are trying to implement from that document.

[9:45 a.m.]

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. I will definitely be looking through those numbers for addiction services, because it is an important area. It has been well brought out in the public, especially around VLT use and the addiction to them, and the problems in Cape Breton with some of the drugs used there, OxyContin, and now, of course, the pending possibility that we have meth coming to our province. From everything I have read over the last little while stating that this is such a highly addictive drug, we need to look at ensuring that we have the services in place for Nova Scotians who find themselves fighting an addiction. I think we need to continue to build on what we have and actually grow those services.

Now I am going to jump around to a few different areas. One of them is important because it deals with the safety of our residents when they enter a health care facility. I am talking around the infection rates we are seeing for things like MRSA, which is an antibiotic-resistant bug or infection, Mr. Chairman. I remember my first encounter with someone who had MRSA, which I think is methicillin-resistant Staphylococcus aureus - I think is the proper name, I haven't said it in a long time - or VRE, vancomycin-resistant Enterococcus. MRSA and VRE are very potent infections that can't be fought with antibiotics. It is very hard to keep that under control. We have many individuals who go into a hospital because of a certain ailment and then all of a sudden they end up catching one of these super bugs, as they call them. The infection rate has climbed steadily in recent years here in Nova Scotia.

Many front-line health care workers whom I have talked to over the last little while have said that one of the reasons behind this is the chronic vacancy of housekeeping services and other positions in our hospitals that are left unfilled, because one of the best ways to combat these infections, MRSA or VRE, is with proper cleaning. So I wonder what the minister can say about such a high rate of increase in these infections we are seeing in our hospitals, and if he knows one of the reasons why this is happening, and if it's true that it's because of some of the vacancies we're seeing in our hospitals in housekeeping and those areas.

MR. D'ENTREMONT: Mr. Chairman, through you to the member opposite, I have to say that in the last year or so we have added personnel to the Capital District Health Authority to address some of the housekeeping issues. We're not aware of any vacant positions as I stand today.

[Page 75]

I do want to tell you we are concerned in the department about infection rates, as we should be and as are most jurisdictions across Canada. Through this year we have hired an infection control coordinator within the department. That coordinator works with each DHA. Each DHA at this point has an infection control committee to look at these items of infection.

The issues of cleanliness and the correct types of cleaners - it just goes on and on of how to try to mitigate this issue in our hospitals- is very important to us. So I can say to the member opposite, I'm very confident that with this process we'll be able to at least mitigate some of the risks. You can't have it perfect, but at least you can mitigate it as best you can.

MR. DAVID WILSON (Sackville-Cobequid): I think it's important to recognize there have been cuts to housekeeping services in the past. I think the government really needs to look at the number of individuals we have in our hospitals, in our clinics throughout the province and ensure we have the proper number of those individuals to get control of these infections that we're seeing in our hospitals. I hope the minister is committing to ensuring these rates will go down. I know he can't definitely say that would be the case, but I hope he realizes he needs to take additional steps. What we're doing right now isn't working well enough and we have to make sure we have the resources there to ensure we can get those rates down.

Once you have been in contact and are a carrier for some of these infections, you're a carrier for life. It can flare up, you can infect other individuals when you're sick - especially in a hospital setting. Other health care providers come in contact with those individuals. I know a personal example myself, when I first learned about these super bugs was after the fact. I picked up an individual, took them to the hospital and later on we got a call stating that we needed to deep clean our vehicle because we were in contact with an individual who had MRSA. I know there are better programs now that hopefully indicate early on to health care providers that you have a high risk patient or someone who was in contact with MRSA or VRE.

Now, I would like to branch off to one of the reasons why we have such a long wait time, especially around MRIs- having to receive an MRI - especially in Capital Health here. I know the government has purchased new ones for many of the rural communities and I understand they will be up and running soon, but we have an aging MRI at the QE II and this is definitely resulting in an increase in wait times here in the Capital Health Region. The business plan calls for a replacement of the machine this year, so I would like to ask the minister when that will be done?

MR. D'ENTREMONT: To the member opposite with regard to the MRI, we have two MRIs in Capital, those are slated for replacement this year. There are four other

[Page 76]

MRIs that are going to various places throughout the province and those will be, I believe, connected throughout the summer, so hopefully they will be in use by Fall.

This process has taken a little bit longer than we had anticipated simply for the reason the manufacturer was changing their models and we opted to wait a few extra months to get the newest software for those pieces of equipment for the same price. So I am very happy to say that within the next few months those MRIs will be connected and hopefully our wait times for MRIs will be substantially cut.

MR. DAVID WILSON (Sackville-Cobequid): I know the minister doesn't like to give a date, I know he states quite often "this year" or "soon", "very soon" or "in the near future". So can I maybe get a closer date of when this will happen? Will we have the replacement for the MRI in Capital Health by the end of September, maybe?

MR. D'ENTREMONT: Mr. Chairman, I can only use Yarmouth as an instance right now. That machine is being delivered, hopefully, within the next few days. Of course that DHA has been diligent and has the room and the facility ready for it. So we hope to see that one up and running by the end of August.

I can commit the ones in Capital Health to the end of the year. I am hoping to have them quicker but when we look at the installation and the time that is going to be required to remove the existing MRIs and reinstall the new ones, plus the training that is going to be required, I will commit to the end of the year.

MR. DAVID WILSON (Sackville-Cobequid): I just want to reassure the minister that if they are not up by the next session, I will continue to remind him that this is something they announced a long time ago, Mr. Chairman, and we should have the technologists up and trained now. This wasn't something that happened overnight. I am encouraged that most of them should be trained by now and hopefully when they come on line they can start working the day the MRIs are put into the facilities and hooked up.

Now I would like to go to another area. Many Nova Scotians are suffering a great deal of pain and spending a great deal of time waiting to get in to see a specialist. Of course I am talking about the Pain Clinic and the wait times we see with that clinic. Mr. Chairman, I don't know if you know any of your constituents or the Minister of Health knows any of his constituents who have chronic pain and are waiting for the services of the Pain Clinic. The wait is up to three years to get into this facility. This isn't for a minor procedure, this is someone trying to cope, someone who is enduring an enormous amount of pain in their daily lives just functioning, just getting up, just walking out of their house. The waits are three years or more.

I know these wait times are getting worse and worse every day. I know last year the DHAs committed money to look at this issue and now I think they have actually

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struck a committee to look at this. So where are the plans and the resources in this budget to lower the wait times for those Nova Scotians who are waiting to get into the Pain Clinic?

MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, the pain issue has been one that we have been working on for the last number of months. We have a committee, I believe it is DHA members, chaired by Mr. John Malcom who is the current acting CEO for the Capital District. They are to come to some recommendations to alleviate the wait time for the Pain Clinic, not only to relieve the wait time for the Pain Clinic here, but to come to recommendations to receive pain services throughout the province.

Even at this point we do also have some services in Cape Breton, in the Cape Breton District as well, so hopefully we can have a more encompassing program so that patients are able to receive that kind of service.

In this budget, to react to the recommendations from the Pain Advisory Committee, that is chaired by Mr. Malcom, we have put in the budget about $700,000 to start addressing those recommendations.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I am a little taken aback by the minister's statement that they have been working on it for months. I mean this problem has been around for years and I would have hoped - and I know he is new to it, so maybe that's how he interpreted the question that since he has been in the post only for months he has been working on it for months, but this is an area we need to look at to see what we can do to relieve some the pressures and some of the anguish that these Nova Scotians have in their daily lives. Three years is a long time.

I know a constituent of mine who just received a letter and the letter wasn't stating here is your appointment, come into the pain clinic. The letter stated are you still willing or do you still want to be seen at the pain clinic? I think it was well over three years, Mr. Chairman.

From what I understand, there was a review done and underway and I thought it was supposed to be finished or completed last fall. Through the Chair, is that true, Mr. Minister?

MR. D'ENTREMONT: Thank you, Mr. Chairman, and through you to the member opposite, the process of the committee was only started last Fall. I also want to inform that we had about $300,000 in the budget last year to work on this issue and to work on recommendations. So, quite honestly, at this point we are at about $1 million in trying to address the pain clinic and the pain services for the province.

[Page 78]

I do also want to say that some of these recommendations will be province-wide, so we aren't just going to have a focus on one pain clinic here in the province.

Some of the problems we have also been exasperated by is the lack of anesthesiologists and other people who can offer these services - it's very much a personnel problem and making sure we have the correct professionals, but there are other doctors who provide similar services, and I think that's what recommendations we will start showing and making sure the people get the service they require.

[10:00 a.m.]

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, we will definitely look forward to reviewing the recommendations and ensuring government acts on them, because far too often we see in this province reviews of programs and departments and recommendations made that go undone and are left to collect dust. So I think this is an area, when you look at wait times in excess of three years at times, that government needs to move on those recommendations to start addressing the concerns of those individuals who are inflicted with chronic pain.

Now, as I said, we will keep moving on to another area that has been something that our caucus has been pushing for to increase and expand, and at one point I think we challenged the government on the steps they were taking to address some of the needs of medical laboratory technologists in the province. We are definitely facing a critical shortage in the province and as technology changes, like the MRIs, the need for upgrading and new technologists increases with that, Mr. Chairman.

I know that the new generation of technologists is being trained in New Brunswick; we have seats allocated for Nova Scotians there and that is ongoing until 2008, I believe, that agreement. The first graduates in Nova Scotia from this program won't have completed their studies until 2009. Hopefully, finally that program will be moved back to our province where we should have it, where it should be in-house so that we can ensure that those individuals who are being trained have a better opportunity to stay and remain in Nova Scotia.

Mr. Chairman, when you go away to school and leave the province and get your training in another province, even though you are from Nova Scotia, right there the likelihood of them returning to our province has gone down dramatically. I think we need to ensure that we train Nova Scotians here in the province. We have a great opportunity to do that here with the many technical schools and colleges that we have here in the province - there is no reason why we should be sending this out of the province. Even with the numbers in the class, I believe there's a total of around 24 techs a year that can be graduated through these laboratory technologist programs, we're still going to need more when this new crop of graduates graduate. I'm wondering why the government

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hasn't looked at more seats, and maybe this could tie into economic development and rural economic development. I know the minister is the Minister of Health but maybe this could tie into offering satellite programs in some of our rural communities so that not only are we keeping our students here in the province, but where we need these individuals mostly is in some of these rural communities.

If we can take an individual resident from a rural community and set up a satellite program so they could get trained in their community, who knows what will happen. I think the likelihood of them staying in those rural communities grows because as you get older you start to put ties down and roots into communities that you get trained in and hopefully remain. My question to the minister is, will your government look at possibly increasing the number of seats and the possibility of these satellite schools so that some of our rural communities could take advantage of having economic growth go to their communities by providing a school? You don't even have to build a school, you could utilize what's there now, but maybe even a professor or even what they've talked a lot about is telehealth and tele-education is popular.

I wonder, has the minister thought about those two issues and if we can see some movement on that over the next little while to ensure that we have the proper number of technologists here in the province in the coming years to hopefully sustain the growing changes in technology that we see in health care equipment?

MR. D'ENTREMONT: I'm very happy to stand and talk about our success here. As the member opposite referred to there is an agreement that we have right now on seats in New Brunswick. At this current time we are providing bursaries to 22 of these students, this is a type of bursary that they have to come back and work for us for a set amount of time. I'm very happy to say that the first class graduated this year and 22 of them, I believe, are being employed in Nova Scotia. We're very happy to say that this interim step is working to increase the number of medical lab technologists across the province.

I also want to say that in the design right now, until we have our community college across the harbour complete, that's where our new program will reside where we will have approximately 25 students going through that program every year. It bodes well to making sure we have the medical technologists that we require in our system. The other thing that we are looking at to increase the number and the service in our labs across the province is also looking at the possibility of a medical lab assistant program, which could be offered across the province. It's something that could be done in a satellite method in conjunction with the medical lab technologists program. It would not exactly be a full lab technologist but an assistant that could work within that to take a lot of those tasks and make our labs much more efficient. So there are a number of things we are doing and we're very happy and I congratulate the 24 students who graduated this year who have received placement in our medical system.

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MR. DAVID WILSON (Sackville-Cobequid): I'm encouraged by the numbers that are coming back but it's nowhere near the number that we need to sustain the development and the ongoing issue of the number of technologists we need here in the province, especially now and the next few years. I didn't hear the minister stating anything about looking at the possibility of satellite training for technologists, I did hear about assistant technologists which is a first step but I have to remind the minister that it's not that easy for rural residents who are deciding to go to school, to pack up and come to Halifax, or Dartmouth across the way, to go to school. It's very difficult and that's why I stated the benefit of having these satellite schools is that what we're doing - what I said about taking Nova Scotians out of Nova Scotia to be trained in another province, the same thing can be said about individuals wanting to be trained or educated and taking them out of those rural communities. Once they leave those rural communities and come to the city, come to HRM, I would say, and I don't know if the minister would agree with me, they're most likely to want to stay here in the city. We've seen the out-migration (Interruption)

He said no from across the way, but I don't think he truly believes that because if you just look at the out-migration of our rural communities, which he represents and you, Mr. Chairman, represent, those numbers are stating that is what is happening. I think if we could take steps to ensure that individuals, residents, students, young Nova Scotians who want to be trained, who might not have the funds for one to come to the city - HRM is becoming more and more expensive to live, to rent an apartment, everything is increasing - so whatever the government can do to ensure that we get the services that you can get here around HRM out to the rural communities, will help in rejuvenating, and hopefully increasing the number of young Nova Scotians staying in rural communities. So hopefully he understands my point and that's something, as minister, he'll take back to staff and look at the possibilities we could look at down the road.

The other question that someone had brought up to me actually was around physicians and the seats we have at Dalhousie. I know I've talked to many medical students, introducing a bill on their behalf to help, hopefully ensuring that some of those medical residencies stay here in the province. One of the things that I heard was, again, how difficult it is and how expensive it is for rural students to come to Halifax and to get accepted to medical school. They're competing not only with other Nova Scotians, they're competing with other Canadians and people from other countries.

So one of the questions someone brought up to me, which I said I would mention to the Minister of Health, was, has your government ever looked at designating any seats in medical school for medical doctors for rural communities, for individuals who might come from a rural community, to hopefully give them that extra assistance that they may need to take that step into becoming a doctor in this province? I know one medical student I talked to, who comes from a rural riding, states he's staying here and he's

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actually going back to a rural riding. So I think there's another avenue for government to look at to hopefully ensure that we get those professionals, get those physicians here in the province, trained for one, and get them to remain in the province and remain in rural communities.

So is that something the minister has ever thought about or would be willing to take back to his department to have a look at to see if that's something that might help rural communities obtain the physicians that they need?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, thank you for bringing up that very important issue of the Dalhousie Medical School. Over the last number of years we've increased the seats there from 82 positions to 90. I know it's not a big jump, but it is an increase nonetheless. I think as we do it, we're looking at adding some more residency positions across the province as well as making sure that as that class graduates and moves on, they get their residencies here in Nova Scotia and we have a better chance of retaining those.

At this point in our discussions with Dalhousie and the medical school there, there is no, what I would call, preference for Nova Scotia students or things of that sort yet. I know there are a number of communities across this province now that are providing help to some of our medical graduates and to our students to try to get them to come back to our areas. It's something that I've thought about a lot in the last number of months.

We have a much better chance of retaining our students - if we have a kid from Clare who wants to go and, as a matter of fact, I think there are two or three students right now from Clare who are attending medical school in Sherbrooke. I didn't pull any strings for that. Right now those students are expressing interest in maybe coming back to the province, but we have to provide them maybe with a different way of practice, collaborative practice- types of clinics and those types of things. That has been a very successful program that we have been able to do, having those three seats through Sherbrooke.

New Brunswick just recently announced that they will be doing some medical school through Université de Moncton, in conjunction with Sherbrooke. As well, Dalhousie, I think, is going to be in conjunction with Saint John, or the University of New Brunswick in Saint John, and with 20 to 24 seats. So there are a lot of changes happening in the way that physicians are to be trained, and the seats available to Atlantic Canadians. Like I said, I have thought this on a lot of occasions, but we have a much better chance of having physicians in our rural areas if they originally come from those rural areas. So we need to do a lot more to provide them with the opportunity to attend medical school.

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MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I will shift gears again and kind of incorporate definitely something that I have brought up many times over the last three years in this House, in this Chamber, around health care, especially around the Cobequid health region and what we have been promised, and what we see, and what we have, and what we need. I'm definitely proud to represent an area that I believe is the only area that has seen construction of a new health care facility or centre. I don't believe there has been any in recent years. The residents appreciate the new facility and look forward to using that facility, and hopefully using the services that are going to be there.

I know the government announced several services that will be offered at the new Cobequid Health Centre. One is cancer care, the ability to receive some of your cancer treatment at the facility. To my knowledge, as of today, that unit hasn't been opened yet. So I would to ask the minister, when does he foresee that service being provided at the new Cobequid Health Centre?

[10:15 a.m.]

MR. D'ENTREMONT: Mr. Chairman, as you know, most services that are held within districts are basically under the purview of the DHA, so we have to sort of work in conjunction with them when it comes to services. I'm very happy that the Bedford-Sackville area has been in receipt of a $34 million facility, and it is quite a facility to behold. I'm very happy that our government was able to provide that to those residents.

Insofar as the oncology piece and a cancer centre, Capital Health has been in the process of hiring three new oncologists. I think two of them have been offered and hired, and there is one offer still outstanding, to try to have that. I do believe, at this point, they are looking at providing those services, once that full complement is up, to offer those services at the Cobequid Health Centre.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I think it's important that government follows through on the announcements. They take great pride in announcing things very early. The new Cobequid Health Centre is a prime example. I don't know how many years it has gone back, how many times they have announced the opening and re-announced it, and now the services that they announced at the time still have not been up and running. I think it's important they realize they have to live up to those commitments to get them out, because it's an important issue.

Cancer care and treatment of cancer is important to all Nova Scotians. As a paramedic, I know what it takes out of an individual coming from outside the city into Halifax to receive the treatment and care of chemotherapy or radiation, and all they want to do is get back home. So I hope that service and the ambulatory care clinic comes on-line very soon so that the residents in the Cobequid health region - as I said many times

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in this House, it services well over 100,000 residents, or can potentially service 100,000 residents.

I know the minister has stated several times, especially when I bring it up in Question Period, Capital Health, and that they are in control of what services, and their budget. I understand that, but ultimately the Minister of Health is put in the position to ensure that the services get delivered to Nova Scotians so hopefully, he might be able to give me a little more of an answer on the next question around the use of nurse practitioners, especially in the emergency room.

Mr. Chairman, we are so underutilizing our nurse practitioners now. I have read studies that stated nurse practitioners can dramatically drop the number of patients needing to see a doctor. I think one report I read said that a nurse practitioner was able to divert 80 per cent of the patients that came into a clinic from having to see a physician.

I'd like to ask the minister - I know he has talked about nurse practitioners and the use - when can we see, or are you working at, getting nurse practitioners utilized, especially in our emergency rooms? It could benefit not only the Cobequid Health Centre but areas in the rural communities that see closures of emergency rooms. I'm wondering if that's an area you've looked at, talked about and are pushing to have that accomplished?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I very much appreciate his interest in nurse practitioners and the benefit they can give the current health care system. I believe it's very important. I've seen some of these professionals at work and the service they provide is, of course, second to none, which is why I was very happy to introduce a bill to this House in the last sitting and again this sitting, which again expands the scope of the nurse practitioner and what kind of services they can offer.

As it stands today, there are 19 nurse practitioner positions in the province. Unfortunately we have a couple of vacancies we are still trying to fill to make sure we have the full complement. At this point, each DHA holds it within their business plan to request nurse practitioners. I can say there are a number of requests to us right now, but, of course, due to funding, we have to make sure they're in the right place and we're better using our funding.

We also have to pre-define the use of the nurse practitioner in an emergency setting. We want to make sure they work as collaboratively as possible and that their roles are very well defined within that emergency setting as to who sees what, when, what kinds of levels and what they are allowed to do, which has been a bit of a challenge.

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Nurse practitioners had a bit of a shaky start when the idea was first brought to this province. Nurse practitioners have been around for 20, 30, 40 years or more - the old outports used to have nurse practitioners. It's not new, but we have to bring the physicians on line. More and more as we go along here, the physicians are very happy to work with nurse practitioners. It's kind of funny now that in a lot of places as we set up new clinics, it is definitely the physicians that ask to have those nurse practitioners in their practice.

So, hopefully in the next number of months as we go along through this budget process, I'll be very happy to announce some more nurse practitioners throughout this province.

MR. DAVID WILSON (Sackville-Cobequid): I appreciate those comments, but I just want to give one example of how we're not utilizing them to their full potential. At the Cobequid Health Centre, for example, we have a nurse who was trained, took the program, trained as a nurse practitioner and was unable to work to that level of training. In my mind, that's just such an underutilization of such an important health professional.

I also request that we need another physician at the Cobequid Health Centre, which is probably about a $200,000 cost for just one a year, but in the meantime, I think the use of nurse practitioners is a very feasible way to address some of those concerns. A nurse practitioner's cost for one year may be $20,000, so, yes, we need another physician at the Cobequid Health Centre but I think we need to seriously look - I know the minister has stated he takes directions from the health authorities, but maybe the minister should jump in first and maybe save some money by saying, well let's get the nurse practitioners there quickly. I know that many of them have done their training through the Cobequid Health Centre and I would think they would be well received there and throughout the province when it comes to their ability to work in that setting.

To the story of the nurse practitioner at the Cobequid Centre, unfortunately we are losing her. I know she has taken a job outside the province and probably is gone now and that is a great loss to the province. I think the minister should really look at speeding that up and ensuring that Capital Health and other health authorities have a serious look at that because I think nurse practitioners could be a good way to start addressing some of the wait times that we see in the province.

I know I have only a couple more minutes. The last issue in health that I want to talk about in my area is, of course, the long-term care facility. I have talked to the minister several times inside this House, outside this House. I know other ministers have concerns on long-term care facilities for the Cobequid Health Region. That area has been recognized as in need for, I think, well over 15 years, if not more. We are on the verge of having a facility built through Northwood, gaining the contract to build and put in place and, all of a sudden, we hear the rumours of a different site selection. I must say,

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the former Minister of Finance from your own government was promoting the area around Rocky Lake. Your past member from Waverley-Fall River-Beaver Bank was promoting Rocky Lake and, all of a sudden, now we are hearing of this alternate site.

I have to emphasize the fact that many of the resources that seniors who will reside in the long-term care facility will need and utilize will be available at the Cobequid Health Centre. With the Rocky Lake site - I believe the Cobequid Health Centre is less than a kilometre away. Also, that is where the advanced care paramedic ambulance is, so that is less than a kilometre away, within minutes of responding.

So I encourage the Minister of Health to do what he can and do the right thing for the people, not only of Sackville, but of Bedford, of Fall River-Waverley-Beaver Bank. I mean, this long-term care facility is supposed to help the whole region. If you look at where that proposed site on Rocky Lake is, it is right next to Highway No. 102 where it is quick access to Fall River. It is in the community of Bedford which is on a road linking Bedford and Sackville. So I hope the minister recognizes the importance.

We have seniors sitting in malls getting petitions now - 4000 signatures - to ensure that that's the site where this new facility should go. So with that, I know I have only about 30 seconds but I think I am more or less just leaving that to the minister. He knows my feelings on this issue and I hope (Interruption) You can commit on the other time, no problem, but I hope that is resolved in the near future. Thank you, Mr. Chairman.

MR. D'ENTREMONT: Mr. Chairman, the Northwood site for the Cobequid Health Centre area has concerned me over the last number of months. The recommendation that is now currently on my desk - and I have to say I was still uncomfortable with it because of the communities' requests and interest in the issue. I just want to make sure of that before the final selection comes out.

As the member opposite knows, there were nine different sites reviewed during this process. It has been brought down, of course, to one and I just want to make sure that that is the right one for the community, as well as the right place to build this facility for Northwood.

I am going to commit to something today, so you write it down; I will have this announced by August 4th. I am going to look at the staff, they are probably going to freak out. So there you go, by August 4^th we will know where it is going.

MR. CHAIRMAN: The honourable member for Sackville-Cobequid's time has expired.

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The honourable member for Kings West.

MR. LEO GLAVINE: Thank you very much, Mr. Chairman. I am certainly pleased today to rise and ask a few questions and make a little bit of inquiry from the minister and his staff. This is an area, of course, health, that is a top priority, I think, for all MLAs here in the House and certainly Nova Scotians.

Having had the opportunity two years ago to do a wait times round table across Nova Scotia, it certainly provided me with a number of insights and certainly a good factual base to be able to speak about a number of the topics that have already been referenced here in the House. I do apologize for not having been able to be in the Chamber for all of the discussion. So there may be a little bit of redundancy on some of the questions that I do ask as I also had to sit in on Agriculture.

The first and primary area that came to my attention as a candidate back in the year 2003, and it's one that certainly has not diminished in this province. Maybe one that's not as hot-button a topic as it was perhaps in 2003, but certainly one that is ever relevant and ever critical in the delivery of good health and having timely health delivery in Nova Scotia and that's, of course, around the area of wait times. So I'll have two questions here, one in reference to the QE II because as the major provincial hospital in our province, what is happening there certainly has that ripple effect right across Nova Scotia.

On the day when I had a tour of the QE II, about 15 or 16 months ago, perhaps there was no more striking piece of information that came up than the fact that there were about 150 patients who had been in hospital for three months or more waiting for placement. We know the kind of impact that that has when those patients cannot be moved out to either the regional hospitals or smaller community hospitals, or obviously to long-term care beds. I'm just wondering, what is that statistic today in terms of the number of patients and a baseline for around the three-month period and beyond for patients waiting at the QE II for placement?

[10:30 a.m.]

MR. D'ENTREMONT: Mr. Chairman, the member opposite, thank you for taking some time to question the estimates of the Department of Health, I thank you for your interest in it, and I kind of missed your questioning on Agriculture because, of course, we had some good conversations over there. You are referencing Unit 4B which is, of course, over at the CDHA. Currently it ranges between 150 and 180 residents, in that area. This year the new funding, in order to do more work to continue the operation of that facility, we are looking at another $745,000.

[Page 87]

MR. GLAVINE: Thank you very much, Mr. Minister, for that little synopsis. Certainly it still remains a startling statistic and one that certainly impacts again on the delivery, I think, of timely health right across Nova Scotia that we haven't seemed to be able to make strong headway. The same picture is much in evidence in the Annapolis Valley, in the Annapolis Valley Health Authority, where we have anywhere from 15 to 20 at any given time who are awaiting placement at the Valley Regional. Once again, I'll just ask that basic question, in terms of the planning that is currently going on to make more acute care beds available at the Valley Regional, I'm wondering, what is the timeline for an increase in beds at Valley Regional and what are the expectations when those beds become available for actually reducing some of the wait times in our area?

MR. D'ENTREMONT: Just to the previous question from the member in reference to the LTC facility, or wing, at Capital Health. As we talk about the Sackville-Cobequid site for Northwood, that's 150 seats, we're also talking about a joint facility between Community Services and Health which will be another 150 beds, and of course there are even more challenging behaviours as well. There are some initiatives that are going on that hopefully within the short term will alleviate some of the problems that we're having on sending people there. Ultimately, once we're done this construction of beds and continuing along with the continuing care strategy, we will no longer need those kinds of facilities at all.

In regard to the acute care beds that are being constructed at the Valley Regional, of course there was about another $3.9 million in this year's budget for the completion of those beds. My deputy tells me that we should be somewhere in the next three months or so before those beds can be occupied, so hopefully sometime in the early Fall we can see the usage of those beds. Of course that opens up a whole bunch of options for Valley Regional when it comes to their orthopaedic program and those types of things in order to provide more services to Valley residents.

MR. GLAVINE: In regard to the planning for the Valley Regional, which is the centrepiece of health care delivery in the Annapolis Valley, it brings me to a more underlying kind of question, and I'd like to hear from the minister in terms of what is the construct, the basis of providing the current amount of funding to the Valley District Health Authority, because I'll come around to another question which I think is perhaps critically relevant to the delivery of health in our region - I'm just wondering, is it based on the total population it serves, is it based on the size of Valley Regional, the other facilities we do have, the number of professionals delivering; what are some of those bases on which the Valley District Health Authority receive their funding for a fiscal year? I think the kind of service, the timeliness of the service and the very nature itself is tied into that, and I'm just wondering about a little general framework for that please.

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MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, I'm getting the hang of listening to two conversations at the same time, making sure that we have the correct information as we stand up and answer these questions.

When it comes to the funding of our DHAs, in particular the Valley Regional, it is most definitely service-based, the type of services that are being offered in each facility and each area. The business plan and the programs that are proposed and continued within those business plans, as well as historical pieces of how the funding has happened over the last number of years, Mr. Speaker, we have committed and continue to commit an increase of 7 per cent to the DHAs for the near term so they can have the best planning possible. The challenge has been in the past, for every DHA, is to make sure they can plan on a yearly basis, because a lot of these programs are over three or four years and they continue. So it's very difficult when you don't know your budget from one year to the other, so we have committed that their budgets would be the same, plus 7 per cent, in order for the continuation of the expansion of some of those programs.

Also as the member for Glace Bay had mentioned during his questioning, he had asked about the facilities review and basically working in each DHA to do a snapshot in time of operations of a DHA so that we have a clearer picture of where Nova Scotia taxpayers' money is going and how it's being transferred into services so that we can make better assessment of those business plans and give more evidence, of course, to the DHAs when they come and ask for funding from us.

I've got to say as well, from my visits with the DHA in the Valley, they do a phenomenal job and again to the point, I congratulate all DHAs for coming so close to their budget target, being within one-twentieth of 1 per cent of their target for this year. So I think things bode well on having even ground and I look forward to some of the new services and expansion at Valley Regional Hospital.

MR. GLAVINE: Thank you, Mr. Minister, and certainly I'm pleased to hear that there are now annual increases because it's one of the areas that I'm not sure is being taken account of to the extent that it should. I feel the Annapolis Valley Health Authority in our area is certainly already at the very beginning stage of what we're going to see across Nova Scotia when we talk about an aging population.

Within the Annapolis Valley Health Authority, we include of course Digby, we have three communities now that have a population where 25 per cent is 65 years of age and over. We have eight communities in Nova Scotia where 20 per cent of their population is 65 and over, and in the Annapolis Valley we have five of those communities. So the aging strategy piece has pointed out some directions that we need to be going. I'm wondering if the Department of Health now has that kind of long-term planning that is going to allow for the other critical pieces - the long-term care beds, continuing care, home care - which are some of the pieces of the plan that will enable the

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district health authority, the Annapolis Valley District Health Authority, to deal with what I see as the beginnings of a very significant, very large senior population?

I certainly see signs in my community and in my riding where some of the seniors' issues are not getting the kind of attention in their health care system that we need to be delivering. While we do have one outstanding facility in the Grand View Manor, there are still many other services that our seniors can be receiving in terms of health care. So I would just like a little bit of an overview of where the plan is going to be looking after the geriatric patient and certainly the long-term care requirements that we do have.

MR. D'ENTREMONT: Mr. Chairman, through you to the member opposite, when it comes to the Annapolis Valley, I think we've been very cognizant that is an under-serviced area when it comes to the availability of long-term care beds. As a matter of fact, when we did our review, we looked at trend analyses, looked at the demographics of the area, and basically made the calculation of 10 beds for people over 75 who must access a bed because of varying reasons.

As we looked across the province, in order to come up to our calculation of the 826 beds or so because, of course, as needs are presented to us, as proposals are brought to us, that number may fluctuate a little bit, but ultimately the Annapolis Valley would be receiving well in excess of 150 beds throughout that calculation. I know the member for Annapolis has been asking quite honestly for services in his riding and for Middleton. I know that would be about 40. So as we make those calculations of a true distribution across the Valley, I think we're looking at 150 or more beds for the area.

I look forward to getting some requests for proposals out there and seeing which communities would be willing to have that kind of facility. Ultimately, at this point, we haven't had a true discussion on what kind of facilities we're looking for, whether it's expansion or new facilities, and that information and that kind of consult can come from members just like you.

MR. GLAVINE: Many of the topics that I'll cover this morning are definitely integrated into the whole medical delivery. One of the areas that I still hear some local concerns about - I just heard recently that at the health centre in Berwick, which has blood collection services, they went to a new electronic means of gathering information and putting it into a system that would be available long term. It brings up the whole area that I certainly have had some wonderment about. It was raised a number of times when we went around the province a couple of years ago, and perhaps you already may have had some address of this particular issue in the earlier part of the estimates, it's around our electronic medical record system.

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The larger kind of global question here is that at the end of the day are we going to end up with a fully integrated system? I know it has been very costly. I know there have certainly been a number of delays. I know there is still duplication that is going on. Again, I would just like to have an update as to where we are with the implementation, and what is the timeline? And since we are doing budget estimates, what has it cost Nova Scotians to date to put this system into place?

[10:45 a.m.]

MR. D'ENTREMONT: Mr. Chairman, I thank the member for Kings West for those questions. Basically they revolve around the program called the NSHIS, Nova Scotia Health Information System, and what we're trying to do is to make sure that all parts of the province are connected with the same type of programming so that there can be sharing of information from one district health authority to the other, from one clinic to another, from one hospital to another.

I can say we are currently working on completing the client registry component of it. We're still expanding the primary health care component of it, which is the interconnection of clinics and doctors' offices. We are currently only at about 30 per cent there, so we're still trying to expand that to a place where all doctors' offices and those types of facilities have access to it. We continue to work on the financial reporting systems for DHAs to make sure they have the correct payroll systems and HR systems and those types of things within their accounting, things so that they can share information back and forth with the Department of Health as well.

We also want to expand to a Pharmacare Program, which is a component of this. As well, we could talk about PACS and the information sharing of diagnostics, X-rays, MRIs, CT scans, and those types of products. That is complete to about 91 per cent of the whole province, there are only two or three machines that can't be connected, apparently. So we've made some strides largely in part to the sharing and the contribution of Canada Health Infoway, which has been a funding partner with us through the auspices of the federal government. Many of these programs and systems are extremely expensive, due to our connectability and the wiring and technology that is required for them.

Things that I do want to see in the near future are, of course, the expansion of that primary health care capacity, making sure that our clinics and areas are duly served by it, and also to make sure that the patient health record is clearly available to all sections of the province. So if you have a person from Yarmouth who gets sick in Kentville, that patient's information is available to the doctors for treatment.

We also have the health surveillance system that is under design which is a great component of the system. We also have a couple of things like the OR scheduling

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program which would help us out with our wait times. The unfortunate part there is that it's a complicated piece that all district health authorities must sign on and ultimately another expensive program, but we continue to work with it. But all districts at this point are all inter-operable, they are all able to share their information from one district to another and we'll continue to expand that system in the near term.

MR. GLAVINE: Kind of brings me back again to the round table on wait times. Again, I'm familiar with a couple of the doctors at the Annapolis Valley Regional Hospital where they have seen very little change over the past two years, for example, in orthopaedics. It is still a nine- or 10-month wait. We also have patients that come from the South Shore up to Annapolis Valley Regional Hospital for their surgeries, for joint replacement.

In terms of the availability in other parts of the province, and that being on-line, is it up to doctors to post their list when you say it's probably not as up to speed as you would like? Perhaps there can be more movement of patients from one part of the province to the other - Valley Regional and the doctors performing surgeries, they certainly have a lot of pressure on them to try to reduce that nine- or 10-month wait time for a hip or a knee or other joint replacement. If that list is available to a patient in the Valley, on the South Shore, in Truro, or New Glasgow where similar surgeries are done, if it's posted and available, then the family doctor can help them in terms of making a decision about another location where they could go.

I know that may not always be preferable for a family, but we know it's a much shorter time in hospital now before these patients do get back home, so long hospital stays and having family around is not as critical a piece. I'm just wondering where that list is, its availability, its on-the-ground significance for patients making those kinds of decisions - where is this at this particular stage?

I remember the day of the announcement. I was at the Annapolis Valley Regional Hospital, there was a lot of fanfare around this particular announcement. I'm just wondering in reality, how is it working? Is it making a difference to patients in Nova Scotia?

MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Kings West, the information he refers to is our wait time Web site. It is available to all Nova Scotians off our main Web site where people can go and look at different regions. I believe it's broken down by regions, by hospital, also by the type of surgery and the type of service they are requiring. On there we can find a whole list of different services that can be done from orthopaedics to diagnostic testing to cancer - I believe there are probably 10 or 20 different lists you can pull down. So a patient, in conjunction with their family physician, can make a decision on where to put their name in for any type of surgery.

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Going back to the primary health care service, we were talking about the inter-operability, or the connection of doctors' offices to this main health system. Of course, not all doctors' offices are connected yet. As we are setting up new primary care clinics, we're making sure that information is there. For instance, the one we have in Yarmouth, the new IMG clinic we have there, they have the newest technology, wireless tablet PCs; it's quite interesting that when they do their diagnosis and do a request for pharmaceutical, they can bring down and have the best information available to them right there on the machine of what kind of dosages and the kinds of pharmaceuticals that should be prescribed for those patients.

Also, that information can be sent quickly to the pharmacy. I was actually speaking with one of the pharmacists, a friend of mine, and she said she was more than excited when she got the first print-out from the system that she could actually read it. So as we are talking about safety in pharmaceuticals and the correct dosages, I think this is a leap ahead.

The main piece you are referring to is the wait times Web site that is held, just click off on the right-hand side of the Department of Health Web site.

MR. GLAVINE: Before I leave the area of electronic medical records and so on, the important piece here is the provincial system that in time will be in place. I was wondering if we could have at least a ballpark figure on what it has cost to date to put this into place. I know that we roared ahead at first and then we had some problems with the system. I'm just wondering, what is it costing and has cost Nova Scotians to put this system in place?

MR. D'ENTREMONT: Mr. Chairman, I don't have that number with me but I will endeavour to have that listing to the member and I will try to have a bit of listing with the program or what IT solution it is and maybe what kind of costing went along with it. This has been happening over the last number of years as we go on, so it will be over a number of budget years and, of course, we will show this year what kind of funding is available to implement these kinds of systems.

MR. GLAVINE: In my remaining time, just to get to look a little bit more at some of the local questions, or maybe I still have quite a bit of time, I'm not sure. Anyway, currently in my riding we certainly have, as in other parts of the province, doctor shortages. The community of Berwick, of course, lost two doctors as we know by now, in just a very short time, in a one-month span. They had almost recruited one doctor who was certainly going to be sponsored, had a local doctor to act as a mentor, had passed their clinical assessment program, but for some reason the district health authority lost this doctor from coming to the area. I'm just wondering again, where is the department with assisting small communities like Berwick, to get their complement of doctors up to speed?

[Page 93]

MR. D'ENTREMONT: Mr. Chairman, recruitment, of course, has been a challenge over the last number of years, to make sure that we have the physicians in the areas where we needed them. The ironic part in the province is that we have probably the second highest physician-to-population ratio in Canada, yet they are mostly focused here in HRM and in some other centres. So we talk about Berwick and other rural areas where we're having a little more of a challenge to get the physicians to locate there.

Of course we have a recruitment officer in the Department of Health whose sole purpose is to continue to work with areas that are looking for physicians, to make sure they are aware of the availability. We are also working with Physician and Pharmaceutical Services within the department to make sure that the correct remuneration packages are available to them, depending on whether they want to collaborate or work alone, fee-for-service, those types of things. We also try to treat every part of the province fairly and as equitably as possible so there is no one area over another.

We also find that within each district at this point each council, through the municipalities, through the district health authorities, through different organizations have different types of incentive packages, as well, that we try to work with and deal with when physicians are interested in coming to this province.

It is still a challenge to make sure that we have physicians coming to our province, yet I think the trick here will be to continue to work with the School of Medicine at Dalhousie to make sure that we can take students who are interested in medicine from our areas, provide them with the mechanisms to go through school, and hopefully entice them to come back to their home communities. I know a lot of us through this Chamber had the opportunity to attend university, in a lot of cases we had to go away to university, yet something brought us back home. We hope that kind of rural feeling will bring a lot of our students back to our area. So we need to have better mechanisms and continue to work on that to make sure that we have physicians in our rural areas.

MR. GLAVINE: Mr. Chairman, I thank the minister for that response. Also, reiterating for the second time not just the importance of getting doctors into rural areas of Nova Scotia but certainly pointing to one of the more successful areas of recruitment, and that is actually having students from rural areas who are in med school and who would go back to rural areas. He's absolutely correct on that.

In fact, just recently, I was handed a research paper done by a medical student at Dalhousie. He looked at other provinces and what they deem to be the most successful means to get people to come to rural areas. One of the most successful areas that he had documented, in fact, was northern Ontario. If we think of northern Ontario, with its isolated communities, its distant communities, and certainly remoteness in the Canadian

[Page 94]

Shield does exemplify great distances and small communities. What they did was look at students who had applied to med school from some of these small mining and logging communities and actually assisted with their education and put in place a five-year plan for them to come back to their communities.

[11:00 a.m.]

I think it's great for us to talk about this. I know we're going to see in rural communities - we have Berwick that just lost two doctors. Next year, at this time of the year, in June, two doctors in Middleton have announced their retirement, a year ahead of time, obviously, to give their patients an opportunity to look elsewhere. Looking at the age of the doctors in some of the small communities of the Valley, and I'm sure it's similar along our coastal communities, I'm just wondering, what are some of the concrete pieces that the department is looking at in getting doctors to come in and be the next generation of primary health care deliverers, our family doctor?

MR. D'ENTREMONT: Of course each district, Mr. Chairman, has a physician recruitment plan, and basically a family practice physician practice plan to make sure that we have the types of professionals, such as a family practitioner, in each area. You reference a challenge that we're facing in health care, especially when it comes to physician recruitment, and that is as some of our older doctors are retiring we're finding that it requires more doctors to replace a single doctor. Their patient loads are different. The new breed of doctor wants to have a certain lifestyle, wants to have a family, wants to have time to do things correctly. So we are finding it more of a challenge to find these family practitioners to come to our area.

I do want to say that in the last year, 2005-06, in our communities the DHA 3 has received some recruited doctors: Middleton received one, Annapolis Royal received one, Kentville saw an increase of at least four doctors recruited, Wolfville had two and New Minas was able to recruit one. So I think by looking at the other districts, the Valley district is doing quite well on recruitment compared to other regions in the province. As the plan continues, we continue to look at the remuneration of doctors and making sure they have the correct fee-for-service plans, making sure they have due remuneration and are comfortable in those communities.

It's also important for our communities to make our new doctors comfortable, to make them a part of our communities and I think this has been a challenge for a time and I think it's very important for our municipalities and towns to do their best to help us keep those doctors as they come in, because retention, in my estimation, has been just as much a challenge as recruitment has been.

MR. GLAVINE: I thank the minister for that overview. There's no question that when I do meet with the CEO of District 3, the Annapolis Valley Regional Health

[Page 95]

Authority - one of the references that is often given for a model that is working extremely well is what we currently see in Annapolis Royal. There's no question that we're seeing it from the point of view of the doctors, the other medical practitioners, the patients and from the community - we see a very, very strong approval of that model.

Looking at two little offshoots here, first of all I know that I live close to an area that's such a collaborative practice and I don't mind using estimates to both promote and to ask the minister, are there other areas of the province being looked at? When I take a look at the Kingston-Greenwood area, in my view it's one of the population growth centres of the Annapolis Valley, it also has a transient population. When I went door to door - and it is now less than four weeks since we've gone door to door - in the Greenwood-Kingston area I had a lot of questions and a lot of asks about what is government doing, what are you prepared to do to support more doctors in our area?

I certainly think that the Kingston-Greenwood area, possibly in collaboration with some of the doctors that provide the service personnel on the base with their service, may in fact be able to be incorporated into a collaborative practice for that area. I'm just wondering, is that the model that's going to be expanded if we're taking a look at - there are five counties now of the 18 in the province that still have some population growth going on and I certainly think that Kings County in general and District Health Authority 3 has to look at the provision of expanded medical services and I'm just wondering if this is one of the models that can be applied to an area that is under extreme pressure for family doctors.

Certainly, in my view, having a family doctor is still one of the great and important pieces that we all need in terms of our health and I think in promoting good health and having that history of the patient is a critical piece for good care. I was just wondering, could the minister provide some insight on that area and if in fact there are budgeted dollars to start to look at that kind of model?

MR. D'ENTREMONT: To the member opposite, we're talking about primary health care collaborative practices which is not much of an acronym but a good explanation of what we're talking about as we talk about doctors and other practitioners in the same setting.

Annapolis Royal, of course, is a very good example of what can work, and how we can alleviate some of the problems that we've had in other areas. Other areas that we've seen some of the same type of set-up, of course, in Tatamagouche, we're looking at the North End Clinic, the Duffus Street clinic, and then a couple of other places in Advocate where they basically have a central node for the physicians. The physicians will travel to some of the other communities held within it. I think more and more, especially as the new doctors are graduating and coming into our system they're finding, that these

[Page 96]

collaborative practices work much better for them because they are trained in more team settings and require a little bit of work together.

I think what we're also seeing within these collaborative practices, we're also seeing that they have a little bit better quality of life, that they're able to depend on one another to fill shifts when someone is not feeling so well or has other responsibilities in the community or at home.

So we will continue to try to expand these as different communities come forward and propose these to us. I think that's the key right now to rural family medicine, is definitely to try to incent and make sure that we have more of these collaborative practices across the province.

MR. GLAVINE: I'm not sure, Mr. Minister, if that was a yes to the Kingston-Greenwood area, but the overall tenor of your direction is appreciated, and certainly hope to work with you in this area of shortage.

One of the areas I do happen to be critical of government on is the implementation of nurse practitioners in the system. I know we do have a few who are working, but when I take a look today and I talk - and I have talked to a couple of the doctors in the Berwick area where they have just recently lost two doctors, they feel that a nurse practitioner in their system where they have, in fact, at least a couple of the doctors who have their offices right in the medical centre, if we had a little bit more flexibility in that program, I think it's one that could certainly alleviate a lot of pressure on the doctors in an area where we are feeling the pinch of shortages.

Again, I'm wondering what the plan is. Are we going to be able to get nurse practitioners in that clinic-type setting where you already have an array of services being offered? I feel diverting 20 per cent - I'm not sure what the goal is with a nurse practitioner, but if we could divert 20 per cent of patients coming into the medical centre in Berwick or outpatients at Soldiers Memorial or any of the health centres, I think it's one of the real saving areas that we can approach. Again, probably like you, Mr. Minister, perhaps you know one, two or three of these people who are trained as nurse practitioners. Certainly when I look at the background and I look at two or three in our area - in fact, we have one from our area who is actually doing some practicum here in the city now in the nurse practitioner role - I absolutely think it's a piece that is worth the initial investment for the enormous long-term savings that we can start to generate in our health care system. I would just like your comment there. Is there a one-, two-, three-step kind of program that will see more nurse practitioners on the ground in Nova Scotia?

MR. D'ENTREMONT: Mr. Chairman, I can commit to the member opposite that we will continue to expand the nurse practitioner services across this province. We do

[Page 97]

talk about the 19 that we do have in the province. We still have a couple of vacancies to fill at this point. We do want to continue to expand those.

Mr. Chairman, also within the district health authorities they do have a lot of leeway on the kind of professionals that they hire within their systems as well, and we do urge the DHAs to use a nurse practitioner in their complement of professionals at the clinic level, at the hospital level, and whatever they feel they can use the services of a nurse practitioner for.

I can say to the member opposite that we will continue to expand the positions for nurse practitioners. The challenge really is how they collaborate with a physician, where the medical oversight comes up and also the billing piece, where is where we had to make a decision to flow the funding from the department and through the DHAs for the time being on the payment of nurse practitioners, but I will continue to commit on the expansion of nurse practitioners in this province.

MR. GLAVINE: Mr. Chairman, I thank the minister for that certainly positive response. It's one that I think whose time has come.

Just a couple of other areas. Recently on a visit to Valley Regional and speaking with the chief of staff there, one of the concerns raised was the pay differential for anesthesiologists - and I know that the cases you would find in Capital Health or at the QE II certainly are ones that are more complex, perhaps much longer operations than some that are performed at Valley Regional. Again, that could be one of the deterrents from attracting and maintaining the appropriate level of anesthesiologists at Valley Regional. It is one that, again, I'm wondering if the Department of Health and the minister is aware of and again I'm wondering how that will be addressed, if it has not already been addressed.

[11:15 a.m.]

We know that for Valley Regional and our regional hospitals to perform their functions, if not tertiary level care but certainly secondary level care, they have to be able to have anesthesiologists, so I was wondering, could the minister make some comments in that regard?

MR. D'ENTREMONT: Mr. Chairman, the anesthesiologist issue has been one that those professionals had been underpaid for some time, which we started a couple of years ago to bring their levels of pay back to a Canadian standard. Basically they have been stabilized and competitive and the chief of anesthesiologists at Capital Health, who at the current time is trying to recruit some, feels that he will be successful in doing that with the current pay scale for those professionals.

[Page 98]

We also have been able, through Physician Services, to be able to come up with an alternate funding plan for anesthesiologists, which is now available in Capital Health, Dartmouth General, those areas. I do believe those will be rolled out across the province, so that all our anesthesiologists will receive their due remuneration, depending on where they are in the province. I think with those changes and stabilization and making sure they are competitive, it will bode well. The "also" part that we have talked about, leading a development of anesthesia assistants, as well, to make sure we have some supports for these anesthesiologists, that they have an assistant or those types of people who can do some extra monitoring, and hopefully expand the service we are offering for surgery and other uses at this point in time.

MR. GLAVINE: Mr. Chairman, I thank the minister again for that direction in which there can certainly be some measure of assurance to the anesthesiologists working at Valley Regional, perhaps at other regional hospitals, that fairness in compensation certainly will be the order of the day.

One of the other areas that I certainly keep hearing about in my riding office and as I talk to health professionals. We know that home care is certainly a critical piece in the delivery of good health and in allowing patients to come out of hospital much quicker than in the past.

However, once again, there are difficulties that are often there. We hear, for example, my most recent case was a stroke victim who is now home and had no help for five weeks. It was in those first five weeks that her family was trying to help her cope without any kind of support. What they were looking for, as much as anything, was to have home care come in and help them deal with basic cleaning and hygiene and so forth for their parent.

One of the things that keeps getting suggested to me - and I'm not sure if in fact there is strong documentation and good research and so on to support it in Nova Scotia, but while we do adapt and take from other jurisdictions, I like made-in-Nova Scotia solutions. I'm wondering if, in fact, downloading the home care to the DHAs and allowing for more localized versus centralized administration for something like home care, may be a good way to go. I'm just wondering if District 3, or one of our districts, would be willing to pilot and take a look to see if there can be greater efficiencies, a more timely delivery of services. Certainly in regard to the efficiency piece, the geography of areas sometimes is not always accounted for in the delivery of home care.

I'm just wondering, again, if the minister and deputy are looking at this piece and are able to offer Nova Scotians some small tangible improvement. We know there are some great strengths in this program. I know some of the people in our area who work in home care, and I know that it's a matter of some fine-tuning, some extra resources, and I would just like to know where the department is going in this critical area.

[Page 99]

MR. D'ENTREMONT: Mr. Chairman, through the continuing care strategy, we talk a lot about home care and different programs that we can bring forward to help the care of our seniors in their communities. It has been exceptionally tough for the Valley. It seems that we definitely have a personnel problem, we just cannot get the continuing care assistants and the home care workers we require to provide the service. Many of the people offering the service tend to be married to some of the personnel at the base in Greenwood, and of course those tend to be transients. They come in to do services and their spouses end up getting transferred to other bases.

It has created quite a bit of a challenge for us in the Valley region, to the point where we're continuing to work with the Nova Scotia Community College in the training of continuing care assistants and people who should be able to offer those services in their area. We're currently investing about $900,000 in the recruitment of continuing care assistants, we are working on a marketing campaign to offer this as a profession to Nova Scotia students and other people looking at changes in their professions. We're also offering bursaries to those types of professionals. I think we're doing a fair amount to try to bring up that pool of workers to alleviate the problem that we're having in the Annapolis Valley.

I also want to underline a couple of other programs and expansions that we're talking about that we do have some funding for. Of course, there's the self-managed care program, which is one that has had good uptake and allows patients with some complicated illnesses to get the professionals that they need for home care and other pieces; increased home support that we are investing another $2 million to try to expand programs in areas and, of course, community initiatives that we're trying to do to alleviate some of those ALC pressures of the $3.6 million. So we are trying our best to keep that system alive, but we do have the longest wait time for home care services in the Valley at this time.

Some of the other things we're trying is to add portable home oxygen, more respite care, more palliative care, to help out the families to take care of their loved ones because I think it is very important that there are a lot of people out there who would really want to take care of their parents, yet sometimes don't have the financial means. I think it is very important that as part of the continuing care strategy, we move into what we call the caregiver strategy to make sure that we have the points available to families to take care of their own as well. So I think we're well on our way, but the concern for Annapolis Valley will continue to be one of personnel, to make sure that we have people available to fill those positions.

MR. CHAIRMAN: The honourable member for Kings West has approximately two minutes.

[Page 100]

MR. GLAVINE: Thank you. With just two minutes left, I guess I'll depart from that area of home care which the minister has outlined and he recognized some of the unique problems that we do have in District 3. He didn't commit to a pilot program of decentralization, but maybe that's one that in time we will be taking a look at. Just very quickly, I'm wondering with the EHS service, does that come under his ministry directly and, if so, is there a need to look at fine-tuning and so on in an area? I'm just wondering if that's his area of responsibility.

MR. D'ENTREMONT: Mr. Chairman, the answer is yes, EHS is a part of our department, as is the ground ambulance system, the LifeFlight system, and all the components that go with that. We're very happy with the system as it stands today. We are very happy with response times and the service that they provide to Nova Scotians. This system, in my estimation, is the best emergency health system in Canada, if not in North America, and we will continue to monitor to make sure that the service is available to all Nova Scotians at all times.

MR. GLAVINE: With perhaps not enough time to do a follow-up on that question, I will see the minister about a specific question. I want to thank him and his staff for providing me with some of the background and solid pieces of information to continue to work with the department. Thank you.

MR. CHAIRMAN: Before the Chair recognizes the next speaker, we will take a comfort break for the minister, his staff and others. So the committee stands recessed for a few minutes.

[11:26 a.m. The committee recessed.]

[11:41 a.m. The committee reconvened.]

MR. CHAIRMAN: Order, please.

The Committee on Supply will now reconvene.

The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I welcome the opportunity to ask a few questions to the minister and his staff. I want to focus in the beginning on mental health services.

Mental health services often don't get their due. They have some pretty heavy hitters to be in competition with when it comes to health care services, things like cardiac and cancer. Often, because there is so much stigma associated with having a mental health disorder, I think that maybe sometimes the public will, to make this a high priority

[Page 101]

and see the kinds of services and resources that are required isn't always as strong as it is in terms of some of these other, also very serious areas of need in terms of health care.

Here in the Province of Nova Scotia, we have seen on the front pages of our paper the concerns around various individuals who are stuck in forensic units, who are inappropriately in front of the courts. I want to ask the minister - specifically around seniors with mental health disorders who are in need of 24-hour care but who are aggressive and known to have the occasion to have violent outbursts, it would be inappropriate to place them in a general population of seniors - what does the Government of Nova Scotia have available, right now, for these seniors? How will this government address the gaps in the services that are available for these seniors in the short term, in the very immediate term?

MR. D'ENTREMONT: I thank the member opposite for taking her time here at estimates and asking questions about a very important issue of mental health and more specifically regarding the safe keeping, the care of some of our seniors with challenging behaviour.

I will admit right now that the current system is a little lax and not quite available to these types of individuals, quite sadly. As we talk about expanding in the near term and short term, there has already been a commitment from the Minister of Community Services for a five-bed unit as an interim step to try to take care of some people with challenging behaviour; also, a joint facility, as we have been discussing over the last number of months between the Department of Health and the Department of Community Services, to take on the role for those folks who don't belong in a forensics hospital or another type of facility. We still have a lot of work to do insofar as that, but at the time being we are trying to place these folks in the best facility possible, some of these being long-term care facilities with challenged behaviour units and other types of facilities across Nova Scotia.

[11:45 a.m.]

MS. MAUREEN MACDONALD: I want to thank the minister. I can't begin to tell you how frustrated I am with this government's response to a problem that we have known about for probably one and a half to two years. It doesn't seem to be improving, it seems to be getting worse while these discussions are going on.

I don't know what the problem is in terms of the ability to act, but there is no action. With all due respect to the Minister of Community Services, a five bed transitional unit will not even begin to address the problem. I'm talking specifically about seniors, a growing senior population to begin with, but in that population, people who have mental health disorders and who, as a feature of those mental health disorders, will be aggressive, agitated and will expose staff in situations to violence in the workplace

[Page 102]

which is, in itself, a problem. Also other frail seniors can't be placed in a long-term care facility with other seniors who are frail and vulnerable, and the patient-staff ratio such that there isn't that constant supervision standing over those people.

I want to come back to that specific question about that specific population and the question is where now in the Province of Nova Scotia are there beds for seniors who have mental health disorders, who are aggressive and, if there are none, when will we see some in the short term to deal with a very serious and growing problem? That is my question.

MR. D'ENTREMONT: To the member opposite, there are a number of facilities now - and I'm assuming that she's talking about people who have been assessed that require long-term care, so these are the ones that are moving into long-term care facilities. There are a number of facilities across this province that have challenging behaviour units - Alzheimer's units as some people identify them to be - and they are in various places around the province, which is a concern. As these folks move into populations, the busier it is, the more agitated they are in most cases. They do require a different type of care and it's one that we will continue to expand upon.

I have to say that in this budget there is an extra $670,000 for challenging behaviour, so the expansion of some of these facilities, extra care by professionals, as well as another $225,000 in the continuing care strategy, so this year alone we're focusing about $895,000 towards challenging behaviours and making sure that these seniors are protected and taken care of in the proper manner.

MS. MAUREEN MACDONALD: I want to thank the minister. Mr. Chairman, I want to ask the minister about a specific proposal that was in front of his department, as well as the Department of Community Services, from an organization that's based here in metro, that's well known to me for the very excellent work they do with homeless people and hard- to-house people. This is an organization called the Metro Non-Profit Housing Association and they had a proposal in front of your government regarding supportive housing for people who have both addictions and mental health disorders, who are very hard to house, who are overrepresented in the homeless population on the streets, overrepresented in the emergency shelters throughout HRM and who are often exploited, I guess you would have to say, by a class of landlord that offers less than desirable living conditions for people who have serious health problems.

This organization has been trying desperately to get the government to recognize the need for supportive housing. This is housing that will have staff available to ensure that people are eating properly, getting medications - and it's precisely as it says: it's supportive housing, which means that there's a staff component, which means there's a cost component, and it's not just throwing these people into the community and having

[Page 103]

a friendly visitor drop in once in awhile, it's having people right there who can really monitor and support people on a very regular basis.

It's a model that has worked in other areas - there was an excellent presentation from a group from Toronto that the Canadian Mental Health Association brought in for one of their annual working educational public conferences, and they did this phenomenal presentation on what that has been able to achieve in the City of Toronto. I want to ask the minister whether or not his government, his department, will be providing financial support to Metro Non-Profit Housing Association for the supportive housing initiative and, if support is forthcoming, when will we see that?

MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I am unaware of a proposal from the Metro Non-Profit Housing Association, nor is my deputy minister aware of it. What we are aware of is that there are discussions ongoing right now with Capital Health with that group. I can commit to the member opposite that we will continue to have those discussions and look at the proposal that is being brought forward, and I'm sure with other partners that would be required on this, namely Community Services. I do believe at this point that there are just discussions ongoing with Capital Health, that we are aware of at this point.

MS. MAUREEN MACDONALD: Mr. Chairman, I'm confused that the minister and the deputy minister are unaware of the proposal. I had this proposal probably a year and a half, two years ago. I know - is it Mr. Campbell? - Mr. Jim Campbell, perhaps, in your office, has been in regular contact and involved in discussions with Metro Non-Profit Housing Association, as well as representatives from the Department of Community Services. I've seen some correspondence with staff from the minister's department. So it's not solely in the purview of the Capital District Health Authority where this is happening, although it may have been kicked back to Capital District. The point remains, this is a population that is crying out for the appropriate living conditions in the community and just not receiving the kind of support and attention that's required to make what would be a very important service a reality.

I want to ask the minister at what stage is the department in providing patient advisers to people with mental health disorders who are now in hospital under the Involuntary Psychiatric Treatment Act? I don't know that the regulations have all been finished around the Involuntary Psychiatric Treatment Act, perhaps they aren't, but I would like to know, what stage are we at of implementing the Involuntary Psychiatric Treatment Act and putting in place patient advisers?

MR. D'ENTREMONT: Mr. Chairman, the funding is before you within this budget for the funding for the patient rights advisers. It is our understanding of the process, from my understanding of the process, that as soon as we get approval for the funding here, we will complete the selection process as it has been undergoing at this

[Page 104]

point. Once the patient rights advisers are in service, then we can complete the regulations for the Involuntary Psychiatric Treatment Act. So I think that's the process. So as soon as we can get approval - hiring, Act.

MS. MAUREEN MACDONALD: Mr. Chairman, there are so many things I could ask and I have to limit my time and share it with my colleagues. I'm going to move from mental health and ask the minister about a concern that we've had here in the NDP caucus for quite some time, and that's a concern around ambulance fees. I want to tell the minister of a situation that I had in my constituency with a constituent who's over 80 years old, who has a life-threatening blood disorder, who lives in a senior citizens' manor independently, not in a nursing home, who loses consciousness because the oxygen count in her system, her blood, is such that she doesn't get oxygen and she passes out.

She had to be taken to the Queen Elizabeth II Health Sciences Centre because of one of these fainting spells. She was admitted, she was in hospital for a number of days. She subsequently received an ambulance bill in the vicinity of $500 or so and eventually that account was placed with a collection agency in Newfoundland and Labrador. This is a woman who lives in a low income seniors' residence and has very limited income. She was called and harassed, I think is the only way to put it, to pay these ambulance fees to this collection agency in Newfoundland and Labrador.

In the course of that attempt to collect on these outstanding fees, the collection agency in Newfoundland and Labrador was under the impression that she was a person who was gainfully employed and had absolutely no good reason not to be paying those fees. I can't tell you how upset and agitated this lady was when she called me. She is 81 years old, she is very frail, she is not in good health, her use of the ambulance was not frivolous, it was because of a life-threatening situation.

I use this as - perhaps it may be one of the more extreme examples of what we see, but the former Minister of Health made a commitment to the members of this caucus that there would be a review of ambulance fees. I'm wondering, where is that review at? Has the review been conducted? Is there a report? What is the department's position with respect to the outsourcing of the collection of ambulance fees to collection agencies in another province and these kinds of incidents? I'm sure the one I had with my constituent isn't unique.

[12:00 noon]

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and through you to the member opposite, of course I can talk at length to our EHS system and the program and the service that it has provided to all Nova Scotians. It is unfortunate that your constituent had to go through such harassment from the Newfoundland and Labrador company in trying to get that fee back. I can commit to the member opposite that if it has

[Page 105]

not been resolved, to make sure that she does get that information to me so that can be resolved. I'm sure that we do pay for almost 92 per cent for all transfers and fees in the province to date.

As far as the independent review has been taken, the review has been provided to the department at this point and it is currently being reviewed by staff, so I'm hoping to have some of those recommendations brought forward for public dissemination and see what their thoughts are on it. It does show some very interesting things, but it does put us very much in line with other Canadian provinces in how the fee service is being charged to Nova Scotians and to patients in Nova Scotia.

MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I want to thank the minister. I very much look forward to seeing the result of the independent review. This caucus has some concerns about the growing amount of public-private partnerships in the health care delivery. It's not all a rosy picture - the kinds of things that result for the citizens of Nova Scotia when they need health care. Certainly the positive part of EHS is the outstanding service that people receive, which I have witnessed first-hand and have heard so many positive stories from one end of this province to another. The staff are professional, they are efficient, they are caring and they do an outstanding job.

But when you look at the placing of accounts with collection agencies that first of all aren't in the province, secondly have no idea who they're dealing with and the kinds of fairly strong-arm tactics that get used in the field of collections generally, that's what it's all about, it's collecting money. The fact that you're dealing with people who are frail, elderly, sick, poor, all of those kinds of things, really don't make a hill of beans of difference to the person, that faceless person, who is on the other end of the phone. It's one of the really negative downsizes of public-private partnership and it's the people of the Province of Nova Scotia who pay for that in more ways than one.

I recently had a situation where a constituent contacted me to talk about a serious health care problem. It was a situation where somebody needed to get to the emergency department and because they were so concerned about the fee that they would face if they were taken there with EHS, they weren't prepared to call EHS. This was a cardiac situation and you have to ask yourself - this is exactly what the studies have shown around letting fee-for-service come into our health care system.

The impact is that people who don't think they can pay will in fact not use health care services when they most need them either for the kinds of preliminary intervention that can actually save us money down the road because the more critical levels of care won't be required when things hit a crisis. I look forward to reading the review and seeing how ambulance fees have been assessed and their impact and what have you. I

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assure the minister that if we don't see that review soon we will be coming after it over and over again until we do.

I have two more things I want to ask. I want to ask why on earth the government of Nova Scotia hasn't done anything to intervene in the disgraceful situation of Dr. Michael Goodyear and Gabrielle Horne. This has gone on now for three years and I understand all of the stuff around litigation, you don't want to get involved when there's litigation going on, but you know, this is not acceptable. It's not acceptable to me, as an individual in this House, to see that an organization like Dalhousie University has to play a leadership role in asking the Government of Nova Scotia and urging Capital Health to deal with this. If government has any power at all, then they certainly have the power to do something in this case.

It's unacceptable that anybody, any individual, and particularly our health care experts and providers who we desperately need - we want to create a positive business community and we should also want to create a health care environment that is a really strong health care environment for our professionals and for people who do research, oncologists like Dr. Goodyear, for heaven's sake. I want to ask the minister, are you prepared to allow this to go on or do you have any intention of trying to facilitate a settlement and bring this disgraceful situation to an end?

MR. D'ENTREMONT: There is no real legal framework for us to interject, yet we can be the sober second thought and urge certain parties to sit down and discuss this situation that is unacceptable and has been going on for far too long.

We have already had Capital Health sit down and come up with a number of recommendations that are being reviewed currently by the board of Capital Health. We're also urging Doctors Nova Scotia to change some of their guidelines that would allow these two physicians to practise. We've been very active in the last number of months to make sure that we have the parties talking and making sure that these two physicians continue to offer service to Nova Scotia. We definitely have not been sitting idle on this issue.

Just to a previous question, to the member opposite, the proposal from the Metro Non-Profit Housing Association, the proposal did go to Community Services. So while it's not necessarily with our office, it is with Community Services.

MS. MAUREEN MACDONALD: Mr. Chairman, I thank the minister for his clarification.

Mr. Minister, on the Horne/Goodyear situation, I recognize you don't have the legislative framework, but this Legislature has the ability, the government has the power to put in place a legislative framework to deal with this situation. That's my point. We

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cannot allow this to go on and on and on and on and on without - I mean, frankly, we've got the hammer and we're not prepared to use it. That's what I'm saying to the minister. Ten years? How long are we going to let this go on? How long are we going to allow two highly-trained, highly-skilled medical professionals who deserve a little bit of justice as the people of Nova Scotia deserve to have them working at their capacity in our health care system? Frankly, it leaves me speechless that we allow this to continue. I'm not going to really ask the minister to stand up and respond to that, that's my point to you.

Perhaps you can answer in this next question. I want to ask about the assessment, if there has been any assessment done of the low-income Diabetic Assistance Program that was introduced. It is a program we were all really looking forward to, we were really glad when it was introduced, but there have been some criticisms of the program and the fact that people have to have the money in their pocket to get the supplies and the things they need up front, and then they recover it. That's the whole point of a having a low-income Diabetic Assistance Program, is to help people who don't have the money get these things. Has it been reviewed? Is there a report? Is there a plan to do a review? Is there a plan to address, specifically, that problem?

MR. D'ENTREMONT: Mr. Chairman, just to finalize the discussion in regard to the two doctors who are currently under review at Capital District. We've asked the DHA to come back with changes to their bylaws. I have approved those revisions to their bylaws to allow this dispute to finally be finalized, hopefully in the very near term, so we will not prolong any longer. We didn't have to bring down the big hammer of legislation, but it would have been next should this not have been resolved.

When it comes to the low-income Diabetic Assistance Program, which is a program that I think has been phenomenal and is going to be helping lots of Nova Scotians, the conundrum we were sort of in on the rollout of the program, because we did not have the IT solution to administer a Pharmacare Program in contact with the pharmacies, we felt it was probably just as important to roll the program out, get the medications to the diabetics who required them. I'm very happy to announce, or to re-announce that the recipients/patients can now get their medications with only the co-pay, except for one retailer that is still having problems with the IT solution and making the connection. So low-income diabetics can now go into pharmacies and get their supplies, as anyone would with any Pharmacare Program.

MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I want to thank the minister and the minister's staff. I would like to pass the remainder of the time to the honourable member for Shelburne.

MR. CHAIRMAN: The honourable member for Shelburne.

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MR. STERLING BELLIVEAU: Thank you very much, Mr. Chairman. I do appreciate the time to talk on this important topic, especially from Shelburne County, and I know that my colleagues from across this beautiful province share this valuable time.

I think we can talk for a number of hours, and we will on this particular issue, about all the improvements we can do, or suggest to do, under the health care system. It comes down to one basic, simple solution. I suggest that it is all about finding money to do this.

My question to the minister and his staff is, will his government and the minister fight for an amendment under the Canada Health Act? My understanding is that the funding now is based on per capita to each province. I suggest to you that we have an aging population, that this giant iceberg is moving through our system and that I encourage the minister and his staff to follow this approach to get more federal dollars so we can address these issues, especially dealing with health care. We have an aging population that is different compared to other provinces. So that is my first question, Mr. Chairman.

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. The solution to all problems apparently is, of course, finding more money. Unfortunately it is not always the case, we can't grow a bigger budget than we have. The honourable member does talk about working with the federal government and this was something that we would continue to do and continue to have discussions around CHST, the Canadian health services tax, and how that number is distributed across Canada.

In the news, the Premiers have been talking about the equalization gap of Canada, where we have provinces that are doing extremely well and other provinces are not doing quite as well. So we do have to have a better distribution of funds for all programs within our province, within Canada. It's one that I'm very proud that our Premier as well as our Minister of Finance, and all ministers who sit at federal-provincial tables, that we continue to make sure we have our fair share of funding from the federal government.

[12:15 p.m.]

I can commit to the member opposite that I will continue working with the federal minister, Tony Clement, on programs to make sure that we have money for wait time guarantees or wait time benchmarks, that we continue to have money for the expansion and replacement of medical equipment, that we have extra funding for other programs that come along that should be shared.

I also have to say to the member opposite that the purview of health, as laid out within the Canada Health Act, that it is the purview of the provinces. So that has been

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our challenge up to now, but we will continue to do our best to make sure that we have our fair share from the Canadian Government towards health care.

MR. BELLIVEAU: Mr. Chairman, again, if you are familiar with Shelburne County, our incentive packages to attract professional doctors to our community has been addressed, I believe through a Private Member's Bill a few years back. Our community and county have struggled for a number of years to attract these professionals to our community.

If you look at the long term, and it's interesting - I note a personal story within Shelburne County of parents who cannot get their child in medical school. It's interesting to note their story because to me here is a good example of that individual getting their education and eventually coming back to our community.

My question to the minister and his staff again is that these rural communities across Nova Scotia are struggling to find long-term approaches to their professional health care needs. To me there is a simple, logical explanation to this. The Minister of Health and his staff should be suggesting to the medical schools in our province that they should be designating seats for rural students to educate themselves and, hopefully, our community will support these students and these students will commit to coming back to these communities. Again, my question is that these seats have to be designated because these students who are coming from our communities are competing with international students and again I ask you, this is a common sense approach of trying to address an issue that is going to help us down the road.

MR. D'ENTREMONT: Mr. Chairman, through you to the member for Shelburne, I just want to commend that community. It has done fairly well over the last number of years in recruiting different positions but it, like other parts of the province, has had some difficulties in retention. I think that's sort of our trick, and why the member opposite brings up the issue of taking students from our communities, helping them get through medical school, because we have a much better of chance of getting them to resettle back at home.

Dalhousie School of Medicine does sit with our recruitment committee and does play a large part in the recruitment of doctors in Nova Scotia. There are discussions ongoing of how to better that situation and I, too, agree with the member opposite that it would probably roll down to the designation of a few seats to try, maybe even as a pilot to try this out, just to prove it, because I know and you know that this probably should work. So I look forward to the discussions with Dalhousie, but we also have an opportunity here, it's not just with the Dalhousie School of Medicine, but we also have to look at the availability of doctors doing their residencies in our local communities as well because we only have a certain amount of good residency seats that are sprinkled around Nova Scotia, the Capital Health District and a few other facilities across the

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province. It would be nice to see them in places like Yarmouth or Shelburne where we could be able to do some residencies there because as they get comfortable in a community, hopefully, they can stay in those communities.

MR. BELLIVEAU: Mr. Chairman, I'm going to ask the minister, after I sit down, for clarification on what I thought I heard. I thought there may be an opportunity for a pilot project on this. I will ask him for his clarification on that but, anyway, I think that the questions I brought forward here are a common sense approach to addressing a major issue in our province. I suggest again that we have this major iceberg of aging population, which I'm part of, the baby boomers' generation. If these issues aren't addressed, we're going to continue to hear stories and I'll tell you a few from my community, of residents in my community, their wife is in an establishment 50 kilometres away in one direction and their sister is 50 kilometres away in the other direction. I ask the chairperson to make that decision for that individual, what direction do you go each day to accommodate your loved one. We have veterans who are going to our hospitals now and there is simply not a bed for them. These veterans did not turn away from us when it was his or her duty, but our health care is turning away from our seniors and our ill.

We have personal stories. I can tell you personal stories of people who are patiently waiting for heart transplants. They are patiently waiting to go in to have a bed to do the preliminary tests so they can be in line for these operations. We have people who are waiting for knee and hip oper