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MR. CHAIRMAN: Good morning. The Committee of the Whole House on Supply will now be called to order. This morning we will continue with the Minister of Health's estimates. The member for Sackville-Cobequid has 19 minutes left.

The honourable member for Sackville-Cobequid.

MR. DAVID WILSON (Sackville-Cobequid): Here we are, earlier than normal on a Friday morning, but quite interested in pursuing some more questioning around the Health estimates.

I'd like to start this morning around the most important issue, I think, involving health care and health care delivery, and that's the recruitment and retention of health care providers. It's the key component to our whole system here in the province and we know that, in my opinion, and I think in a lot of Nova Scotians' opinions, the government has failed in providing a strategy, a plan to address the needs of Nova Scotians, especially in our rural communities.

We have places like Digby that have been struggling for years to try to ensure their residents have the health care providers in that community to provide services. I attended the rally they had last summer, and it was well attended by all of the members of that community and the surrounding areas. I had the opportunity to speak with the member for that area who was concerned. Unfortunately, government had no representation there or a government member wasn't there.

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I think that sent a strong message; it sent a message of discouragement throughout the residents there to see they were holding such a rally around health care. Usually we see rallies around strikes or issues like that and not around health care. I think the government has to recognize the frustration of rural communities like Digby that have been struggling for years.

I'd like to start - I'll be referring to the Supplementary Detail again. Of course, the minister mentioned the $416,000 that will revolve around the Allied Health - Health Human Resources Strategy. I'd like to ask the minister, will those funds lead to any further training seats or is that money specifically just to create a plan? Will those funds lead to any further training seats in the province?

HON. CHRISTOPHER D'ENTREMONT: The $416,000, I believe, is assistance as far as medical radiology. So basically the allied health professionals, the $416,000 does not refer to dollars for doctor recruitment or added seats to the Medical School.

MR. DAVID WILSON (Sackville-Cobequid): And I assume, to technology seats, is that correct? It's for a strategy and that leads me to, what I talked about yesterday in the couple hours that I had: the relationship of a good health human resources strategy plan, a comprehensive plan; and the importance of retention and recruitment, and how that relates to the workforce, or our workplace satisfaction and the morale of our health care providers in their working environment. We know that with the government's intention with Bill No. 1, I think set out to really put a damper and decrease the morale within that workforce. I have to make mention of the fact that, you know, here we had a piece of legislation that went right at the heart of the democratic process that health care workers have and they were upset.

They rallied, Mr. Chairman. They talked about it and advocated on behalf of their rights as workers and the effects they have. Right now the minister is aware that there are commercials on TV stating that, and the government knows about the opposition by not only our Party, but the Liberal Party as well, to that piece of legislation. What frustrated me the most was the information and the amount of money spent around the media to gain support for that legislation. From what I heard, the NSAHO spent some $350,000 around the media and events, trying to support and bring support for that legislation. So I would like to ask the minister, have there been any health care dollars from your department go toward the media support of Bill No. 1 in that process?

MR. D'ENTREMONT: Mr. Chairman, I can say that no dollars from the Department of Health went to fund any advertising on behalf of NSAHO. I do want to thank NSAHO for their partnership in this issue. You know, as we sit around and talk about the pressures and the issues in health care, for me to sit and watch the work, the anguish, the confusion that is created by a possible strike, puts our system into a lockdown, for lack of any other word to explain.

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Mr. Chairman, I remember speaking with my deputy minister and sitting around a table trying to figure out if we would lose the workers in our health system - I believe that was two Octobers ago when we had the issue of the allied health professionals. I believe it was with the CUPE groups and the NSGEU groups who covered the workers, those kinds of employees within our system. You know, we could not sustain a strike for more than a few hours - for more than a few hours. Every single hospital beyond the ones here in Halifax, I think, because they're covered by a different bargaining unit, would have to have been shut down.

So we sit here quite often talking about the issue of closed ERs, closed ICUs, and the challenges that we have in recruiting professionals. You know, we have to question a bill like Bill No. 1, which I believe is still a very important piece of legislation - one that I believe needs a true debate rather than the closed minds of members of the Opposition today, one that will protect Nova Scotians. Again, Mr. Chairman, I continue to say I need to put the patient number one. It's not about the Department of Health, it's not about the DHAs, and it is not about the unions. It is about the patients and that's what I think about.

MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, the minister talks about the anguish and the stress placed on the system with the possibility of a strike. As I said, and I can't repeat it enough, the key components of our health care system are our workers, are the health care providers. The stress and the anguish and the demands placed on those individuals in this province are great. We're asking so much from our health care workers. I mentioned it early yesterday, around the fact that we have some health care workers working in ORs who work past 1:00 a.m., who have to report back to work within six hours. That's the stress and the burden and the demand placed on those health care workers.

I have statistics and I know we could sit here and debate the positives and negatives around strikes and health care strikes, but we know in provinces across the country that have legislation banning strikes, that they have illegal walkouts. They lose more days in some regions with illegal walkouts, and I think the minister has to realize that.

I wonder what we could have done, what the minister could have done with that $350,000 that they spent on those ads and trying to drum up support. That could have meant nurse practitioners in Digby, or an enhanced package to try to attract nurse practitioners to Digby. So that's the point I wanted to make around that and that's why I wanted to bring that up.

Now, I'd like to move to - and I think I'm going to be in the Nova Scotia Estimates Book now - Page 14.25. We all know the severe crunch that our district health authorities have around capital infrastructure deficits. We know in Capital Health - I know in Capital Health there is, I think, a $90 million deficit in that region, and I know that's throughout the province. So does the minister have on hand, or could he give us the figure of the total capital infrastructure deficit that the DHAs have at this time? Do you have that total number?

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MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Again, just to finish off our discussion around health care strikes and unions and things, of course I have to put in a comment of, I wonder how much money the unions and the coalition of unions spent on advertising against it, of members' dues, members who, I know, did not agree with the stance that the union leadership was taking. So, you know, we can look at this through two different lenses and I know we could spend an awful lot of time speaking about this one as well, so I'll digress as well.

You know, Mr. Chairman, as I believe I had mentioned during my response to the member for Glace Bay - no, I think it was with you as well - we talked about the general issue of capital infrastructure and the deficit that we do have within it. We were talking about the Victoria General Hospital, specifically, during that part of the discussion, but I also mentioned that through the master plan the district health authority here in HRM is putting together - they'll be coming up with a number of what their capital deficiency is. We also have an ongoing project right now with the other district health authorities to give us a better idea of what the capital deficiency is for them and I do hope to report back as soon as I have that all compiled.

[9:15 a.m.]

MR. DAVID WILSON (Sackville-Cobequid): In preparing for estimates, Mr. Chairman, looking through the line items, one thing that really sticks out in my eyes is the figures from last year, the estimates that government put down on the budget or in the books, of what they're going to spend in a certain area. Then we see this year, of course, what they did spend and then of course what they want to spend, or hope to spend, in the coming year.

So under Capital Grants, which the government provides for hospital renovations, construction projects, diagnostic and medical equipment funding, under the line item for Grants and Contributions - Equipment, last year the estimates were approximately $19 million but, in fact, only about $11 million was spent. So I mean we have about $8 million there that was forecast to be spent on equipment, why do we see an $8 million reduction in actually what the government spent last year?

MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and to the honourable member - I just saw something at the side of my head and I know it was the Minister of Environment sort of flicking by there, so nice to see you.

The reduction, of course, would have to do with project starts, the availability of on-time completions of certain projects, the availability of equipment, so we were a little under- spent last year because of it.

I also do want to underline the fact that through approvals and ongoing projects in the acute care system, I believe only - there is $290 million worth of work ongoing, I believe,

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spread over approximately five years, as we continue to build and renovate and change hospitals and other facilities across this province.

MR. DAVID WILSON (Sackville-Cobequid): When I hear that response, and I can understand that some projects may lead into this coming year, but that's for equipment. That's something the government says, okay, here we go, we're going to buy this, we're going to put $19 million aside to buy equipment for capital grants for the district health authorities. Then you buy it, you submit the receipts and then you go on to the following year. So there was a reduction of $8 million last year and I notice this year the equipment grants and contributions are about $7 million.

Why are we not even spending what we didn't spend last year in the upcoming year? I mean, we're going to spend $7 million, but we underspent $8 million last year, so why are we not - we know that medical equipment changes and needs upgrading and the new equipment that comes in is so important to have available to our patients and to the residents. So why are we seeing such a difference between this year's forecast or estimates and last year's estimates and then actually what they spent on equipment?

MR. D'ENTREMONT: This is a bit of a conundrum for us as well. The dollars do represent the requests that we have at the department at this time. Maybe it's because we have replaced a fair amount of equipment, maybe it's because the district health authorities have good maintenance programs, maybe it's because the districts feel certain pieces of equipment do not need to be replaced. I really don't know.

If you do a quick survey, you would probably see we would require maybe $20 million, but over the course of the year we only required $7 million. It's a bit of a conundrum for us to understand why the requests don't come in the way we would expect them to. In my estimation, budgeting really has to do with how many requests you get sitting behind you. I can say the numbers representative in this year's budget are the total requests we have from the district health authorities.

The other thing I do want to say to the member opposite is that we do hold some dollars centrally so that we can react in case of a catastrophic equipment breakdown and that kind of thing. So it is representative of the equipment that's being requested today.

MR. DAVID WILSON (Sackville-Cobequid): I think that's why it's such a concern for me when I see that not only under the equipment, but under Grants and Contributions - Infrastructure. Again, last year, the estimates were $38 million and they only spent $25 million. I know for a fact, with the Capital District Health Authority, the infrastructure deficit is $90 million. That area was underspent by $13 million. I have to get some explanation why Capital Health, for example, if they have a $90 million infrastructure deficit, why didn't they get $13 million, or why didn't the Cape Breton District Health Authority get extra money?

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I need the minister to try to explain this a little better to me, why we have an estimate of $38 million and we only spent $25 million. Maybe he can explain a little better, but I just don't understand and I can't understand what the minister is saying around why there's such a difference when it comes to grants and contributions around equipment and infrastructure for health care.

MR. D'ENTREMONT: To the member opposite, I feel within our department, anyway, we have a bit of an issue when it comes to our capital, especially when it comes to construction. Construction, for a whole bunch of reasons, gets more expensive as we go along. A good example is the ER over at the Infirmary site. Not only was it a little late in getting going, so we did not spend this year's allocation, but we also find that it actually requires about $3 million more in order to complete. So at one side that we are not spending all the money in a year's allotment, we're finding that we need more money in the next year's allotment in order to complete some of these facilities. So we find this happens time and time again with a lot of our construction.

We are, sort of, captive to the market. We are captive to the availability of the contractors starting on time or not starting on time. So, Mr. Chairman, I know we try to best organize the dollars that we do have within it but last year, 2007-08, we were basically underspent in our capital grant.

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

The honourable member for Preston.

MR. KEITH COLWELL: Mr. Chairman, I have a few questions around nurses and I am going to ask some pretty direct questions which probably the minister doesn't have at his fingertips. I would like to know how many nurses graduated from the total nursing programs in the province last year.

MR. D'ENTREMONT: I will get it for you in a second. While he digs, I will stand for a few moments. It is our understanding - and I spoke to this last night as well - there are approximately 296, I believe it was, LPNs graduating this year alone. There are 70 RNs graduating this year. (Interruption) Oh, no, that's added. Sorry, I apologize. I'm mixing up a couple of numbers. I had a little note here. Here we go. I will table this one and you can get a copy for the honourable member.

RNs, there are existing 330 training seats in the province. We are expanding that by 70 seats to bring our total of RN training seats to 400. This also has a breakout - as was requested last night - by site: St. F.X. has 125 seats; Dalhousie has 135, they will be expanding by 25, Dalhousie has some additional seats, I believe that's probably some spare stuff that they are going to be moving around a little bit, which is 24; Cape Breton University

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has 50, they are expanding it by 16 to a total of 66; Yarmouth has 20 seats and they are expanding by five to a total of 25. So, again, that's 400.

In the LPN list, there are currently 90 training seats at the two sites, which is the Dartmouth Waterfront Campus and Cape Breton. There is a bit of a program at Yarmouth that's on a rotating - but anyway, there are some new seats for them in this year. So there's an expansion of 223 seats for LPNs that are going to the NSCC and they will be going to pretty much all the sites. So Strait-Richmond, Dartmouth, Cape Breton, will be getting some added ones, 30 to Pictou, 30 to Annapolis Valley, 30 more to Yarmouth, 30 to Cumberland, 30 to Lunenburg, and I think there are a spare 13 that will be used as maybe depending on what kind of programs the NSCC wants to set up - for a total of 313 training seats for LPNs. I will table this, if I can get a copy of it.

MR. COLWELL: How many graduates in 2007?

MR. D'ENTREMONT: Mr. Chairman, there was very little expansion last year, so if we take the numbers of this year's graduating, there are 296 registered nurses graduating at the end of this year and there are 153 LPNs graduating at the end of this year as well. So it will probably be pretty similar to what it was last year.

MR. COLWELL: The number for 2006?

MR. D'ENTREMONT: About the same. I don't have that number but I can provide it to him in a table form with previous years on it, if he so wishes.

MR. COLWELL: Yes, I would request that and also one for 2005. Is that a yes?

MR. D'ENTREMONT: Agreed.

MR. COLWELL: And let's include 2004 in that as well and 2003 - the number of graduates in each year.

Now, the real question is, with the number of graduates, we have a large number of graduates here, in 2003, of the RNs that graduated and the LPNs that have yet to be supplied that information. How many were hired by the province?

MR. D'ENTREMONT: Mr. Chairman, I know that we hire and retain over 80 per cent. Last year I think we retained 86 per cent of those new graduates. Also, for the member opposite, I will endeavour to have well over 10 years' worth of graduating nurses seats. As a matter of fact, I will probably go back to 1995 when you see that there was basically the shutdown of the two-year programs when we basically had no nurses graduating for a certain period of time. So I will have that available for you too. Again, we hire about 86 per cent through the program.

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MR. COLWELL: Yes, with that information, I would appreciate receiving not only the number of graduates over that 10-year period, but also the number of nurses who were hired in the province by the province to work in the hospitals in Nova Scotia. I think it's a very important statistic. I can recall one year, I have a nephew who graduated from Dalhousie and there were - I can't remember the exact number - 100-some graduates from the RN program and like only 35 of them were hired out of the whole program. The rest couldn't get jobs in Nova Scotia. That was within - I can't remember the year, but it must be four or five years ago.

So when you look at the nurse shortages and the number of RNs who have been hired and LPNs in the area, it comes to mind when you go through this process - and I ran a business for a long time - you see so many nurses in the hospital working extra shifts, overtime. I can tell you, from running a business, after someone works 54 hours a week, that's the limit; if you work over 54 hours a week, you are basically dysfunctional. I know some of these nurses work over that. I don't know how they do what they do. I have the greatest respect for them.

[9:30 a.m.]

My wife was in the hospital three times now in the last three years and the care that she received in the hospital was - I can't say enough good about it. The people were excellent. They are working under adverse conditions lots of times and I can't say enough good about the people who were there. You can tell, when you talk to the nurses, they were tired, they were stressed, because of the hours they have been working. Some of the patients weren't very good to deal with, which was very unfortunate, because the nurses and the staff there are there for one reason, to help people get well.

I really want to see what those numbers are because if we aren't hiring enough nurses here, that means it puts a stress on the nurses who are here. It costs us more money to pay nurses overtime than it does to pay an entry-level nurse who comes into the system who isn't burned out, who really can use the income to pay off their student loans and to build their life. Whereas a nurse who is older really needs more time off and indeed should be spending more time with their family if they so wish. Again, it is up to them to decide that.

I would also like to know, I would like to get a report, for the last 10 years, since you're going to supply me with 10 years, how much overtime you paid to nurses in the system. I think that's going to be a staggering number from what I've seen, the little bit of experience I've had in the hospitals and the working Also, the number of sick days taken by nurses in the hospitals because of the stress they deal with every day and the ongoing long hours that they have to endure. Could you commit to providing both sets of information on that?

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MR. D'ENTREMONT: Mr. Chairman, back in 2000 when this government was new and trying to take hold of a system that was in shambles for the most part, we were hiring approximately 50 per cent of the graduating nurses. I can say that the number of graduating nurses and the number of seats was probably half of what it was in this year's number. Today we are hiring over 86 per cent of those graduating nurses with more and more seats available.

Mr. Chairman, also, you know, in the last year or couple of years, we've been able to repatriate over 100 nurses coming back from the United States, Alberta, and all those places where they went away to, they're coming back to work within our system, to come home. We're also doing a number of retraining for our nurses to give them other opportunities within the system so that they don't get necessarily as burned out as we think they do.

Mr. Chairman, I was asked last evening to provide the dollars and cents spent on overtime for our nurses, and what I'm going to table here, and I think the member opposite would be interested in seeing, is broken out by district health authorities. This is from September 2006 to September 2007, broken out by just the health authority. This is nursing on the yellow sheet. In the front we can see the overtime listed by DHAs for different jobs within the system, the clericals, the health care services, nurses, Addictions and Public Health, management, non-union, and all other disciplines, and you will see the large number on overtime that we do spend to keep the system going.

MR. COLWELL: I appreciate receiving that information, that's greatly appreciated. When you look at overtime costs, overtime costs have a lot more costs than the dollars and cents shown on your sheet. It typically means people can be off sick longer, it means that their ability to function is diminished somewhat, although I've never seen that ever happen in the hospital, but the ability to do that just because you're tired does take a toll on an individual and then the stress of someone. I know the nurses and the doctors in our health care system take what they do very seriously, they're extremely good professionals and if there's something that they can't manage to get done on a shift because they're tired, it must put a tremendous amount of stress on them when they go home and think why couldn't I have gotten this done, when it was physically impossible to do.

The one thing I did notice in the hospitals though, and I would like to know how this is structured now, and I've heard this complaint over and over again, as the minister knows - and I'm not talking about the floor that was in the media a while ago with one of my constituents - the hospitals aren't clean, not as clean as they should be. Is that contracted work now or is that civil servants doing the work?

MR. D'ENTREMONT: Mr. Chairman, I'll answer the last question first and maybe make a comment on his last comment there. No, the hospital cleaning depends from site to site, in district health authority to district health authority. I know in Yarmouth it's civil servants or staff of the DHA that do the cleaning. I believe here in the Capital District, I think that's a contracted service.

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At the same time, I know going back to the nursing staff and other allied health professionals within our system, we are looking at the model of care change and one of the recommendations of the transformation document of the facilities review was to look at model of care. Model of care means allowing the practitioners within our system to work their full scopes of practice, you know, let clerical do the paperwork, let the cleaning staff do the cleaning on the floor. What we were finding, nurses are trying to do everything for lack of having clerical and those other staff available to them. So we need to invest a little money in some of these other positions so that the nurses can actually work to their full scopes and work within their time allotments rather than working all this overtime.

If you ask a nurse, you know, what is the majority of their time doing, well, the majority would be patient care, but a lot of the time they spend filling out paperwork, getting reports and charts and all that stuff done, you know; in a lot of cases, because there might not be cleaning on the floor, they find themselves doing a bit of cleaning, light housekeeping. They find themselves doing some other things that they really shouldn't be doing and we end up paying as a province for that overtime that they're garnishing because of it.

So, anyway, again the cleaning standards, we're also trying to have the cleaning standards, going back to the cleaning issue again, some are contracted and some work for the DHAs, but we're looking at some cleaning standards that should be monitored by the DHAs. So if there's a specific issue that the member opposite wants to provide me with, I would be more than happy to go back and have a look at that more closely.

MR. COLWELL: The areas that I can talk about from personal experience are the Victoria General Hospital and the Dartmouth General Hospital, both very good hospitals and both have excellent staff, but the cleaning in those two facilities, if you walk into a ward and look on the floor, there are dust bunnies in the corners. The floors have got stains on them that could have been easily wiped up and the list goes on and on. Those are the only ones I personally have seen and I was recently talking to a gentleman who was in the hospital and he said that there was a bloody bandage left in his room for a week - a week. Now, that probably had some infection possibilities, who knows, I'm not a doctor, I wouldn't know that, but it's the sort of thing that standards that should have been in place years ago for cleaning evidently aren't in place and I'm pleased to hear that the department is moving in that direction.

I worked in military contracting for a long part of my life and standards save lives. In my case, if you pushed the button and the thing didn't work, someone's dead, and usually it was the person who pushed the button because someone else is pushing the button and shooting something at them. I can tell you once you put standards in place - it's a long, hard, difficult thing to do, but once you get them in place - they actually save you a fortune, an absolute fortune. Number one, people aren't discouraged because their workplace isn't as clean as it should be. In this case we're talking about cleanliness in a hospital. You have less likelihood of infections and these superbugs that the hospitals are talking about if the cleaning

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is done properly, and just a general atmosphere of an employee coming to work in the day. If they leave their home and their home is spotless and they come into an environment that's not as clean as it should be, they say, why do I have to put up with this?

In a nurse's case or a doctor's case, or even a technician's case, it's not their responsibility to clean the hospital but if these contracts aren't done properly, well, the people who have the contracts should be directed to do it properly and there should be standards put in place. It's all part of our health care system keeping the facilities clean and working well so that they do a proper job. What kind of standards are you talking about putting in place? Are they going to be comprehensive or are they just going to say, well, you've got to clean the floor once a week, or what? What kind of standards are you looking at?

MR. D'ENTREMONT: I know there is a set of policies and guidelines that are done in concert with the district health authorities in their bylaws - I don't know if it's bylaws, but anyway, within their policy manuals on what the cleanliness needs to be in concert with infection control. So what I can try to do, I don't know how available that document might be, I don't know if we can have that today, it will probably be next week sometime before I can get that out of the district health authorities, but there is a set of standards that are nationally accepted that I do believe have a lot to do with the accreditation of those hospitals that they have to meet. So I'll see if I can endeavour to get some of that information for you as well, but I know there is a rigorous set of standards that they have to meet.

MR. COLWELL: Just so I can understand it properly, I understand there are standards nationwide for cleanliness when it comes to sterilizing equipment that's used in the hospital. I'm pleased to see that, as everyone should be. The general cleanliness of the rooms, or the hallways, or the building in general, is that included in that system as well, or is that a separate standard that's used for that? If it's the same standard, I'm very concerned about the sterilizing of equipment, because when you walk in a place and you see it, and it's obvious that the place isn't clean - it doesn't mean that the instrument they're going to operate on you with isn't sterilized properly, I doubt it, I imagine it is.

It really begs to the point if you have someone coming for an interview to work in an office job and they appear in a pair of greasy old trousers, you're not going to hire them. They could be the best person who ever walked into your facility, but if they don't present themselves properly, it sets a bad example. Is the standard for cleanliness in the hospital the same as it is for sterilization - well, what I want to say is, is the same sort of process used or is it two separate things?

MR. D'ENTREMONT: Thank you very much. No, there would be a set of guidelines that would be required, through their accreditation, but also through their infection control divisions or groups within the district health authorities within our groups that would set the kind of cleaning solutions they would have to use, the frequency, the use of those cleaning solutions, the kind of equipment they should be using to clean the hospital, clean the rooms,

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clean different areas of the hospital. So there are a set of standards that they need to meet, that are done in concert with infection control.

I know we've spent a fair amount of time in updating and changing our infection control policies in this province to stop the spread of things like MRSA, VRE and those kinds of hospital-borne diseases. So, Mr. Chairman, I can say to the member opposite, I know there is a real rigorous set of guidelines and if a hospital is not meeting them, I'd really like to know about it to make sure that I can work on it quite quickly to make that change.

MR. CHAIRMAN: The honourable member for Halifax Needham on an introduction.

MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I'd like to thank the member for Preston for yielding the floor so that I can do this introduction. I'm doing this introduction on behalf of my colleague, the MLA for Halifax Chebucto.

Today, in our gallery, we have students who are with the Halifax Regional School Board, Adult Education English as Second Language School. They are accompanied by their instructor, Vicky Cullen. These students hail from Korea, Iran, Yemen, Afghanistan, China, Turkey, Uzbekistan and Ethiopia. I would ask them to rise and receive the warm welcome of the Legislature. (Applause)

[9:45 a.m.]

MR. CHAIRMAN: The honourable member for Preston.

MR. COLWELL: Thank you very much and welcome to our gallery today. It's always wonderful to see guests here - enjoy the proceedings.

You addressed part of my question. My question was, when it comes to cleanliness of the rooms - let's make it more specific, I don't really have a concern with the sterilization and the other things, although there are problems and there always will be problems, no matter how careful you are and what you do, because the bugs are so persistent. It's actually in the rooms, I mean if you find things in the garbage that shouldn't be there for extended periods of time, if the floors aren't clean, if the walls aren't clean, if the bed sheets aren't clean, those are issues that really don't give you very much confidence in the hospital, although it may be the best staff, which we do have, doing the best job they possibly can.

It's not an environment that you want to be in, as a patient. You sure don't want to be there as an employee who goes there every day and tries to work and do your job with all the stresses you have with the work. That's really what I'm trying to get at. Could you tell me, what steps are being taken to clean the hospitals up?

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MR. D'ENTREMONT: Mr. Chairman, again to the member opposite, it must truly vary across this province, the cleanliness of our hospitals, because I know during my stay no more than three weeks ago in the hospital, in the ICU unit in Yarmouth, I can tell you that place was absolutely immaculate. You could probably eat off the floor, even though they would advise against it.

Mr. Chairman, I can say that when a patient is moved, the rooms need to be cleaned, the linens need to be changed, the garbages need to be emptied, et cetera. I'm sure there are set guidelines on getting a room ready for the next patient. I don't necessarily know of the procedures or the requirements during the hospital stay, but I know that the linens need to be changed on a certain frequency, that the room needs to be cleaned. There's a very specific use of different disinfectants that would be prescribed in that standard on the cleaning of those rooms.

I can say to the member opposite, as well, that in this budget there are some dollars available for the set-up of an infection control unit. There is another $218,200 in this year's budget alone to set up an infection control unit. That will advise the district health authorities, the hospitals, on infection control, which would really get down to the cleanliness and cleaning and the methods of cleaning the equipment used, the liquids used, et cetera, in those hospitals.

I can say that there's an appreciation for the importance of clean hospitals in this year's budget. I can say I know my home hospital in Yarmouth, and I know the member for Clare, Mr. Chairman, that you can say it is a very clean hospital. But if I compare it to my visit just the other day to the Infirmary site, well, there's a difference in cleanliness, to say the least. So it's an issue I will take under advisement on behalf of the member for Preston and will look closely at that one on his behalf, as well.

MR. COLWELL: I would suggest, and I'm only suggesting this, that there's so much need for beds in the Halifax area that when a new patient is moved in, the cleaning protocol isn't done because there simply isn't enough staff or time to do it, quite frankly.

When you have a ward with two or more beds in it, you'd have to move the - from what I understand talking to cleaning staff, who are very frustrated about this as well, that you have to move the people out. To actually clean the whole room properly it takes two or three hours to do it, and then put them back in. The problem is, there is nowhere to move them, so you can't get the rooms cleaned up and they're behind the eight ball all the time.

I don't know what the solution to this is but if you don't soon find a solution, you're going to have, again, people sick because the staff can't do their work, don't have the resources to do it. It costs our health care system more in the long run, makes longer delays and really makes it more difficult. What can we do to fix this? I mean this has to be fixed right away.

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MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Again, going back to some personal experiences not so long ago, when my mum was in for surgery. I can tell you that what I observed, and it might not be the complete practice across our system, but what I observed at the VG site is that mum came in on her own bed, a bed that had been disinfected and ready and brought in, and then when she was ready to be discharged, that bed actually left that room and the new person came in with their own bed or a new bed. So there's a method in which they take the beds out, clean them, clean the floors, clean the side stands with disinfectants, before they do move patients in.

There is an appreciation for that kind of method. It really doesn't have to do with rooms, it has to do with the availability of equipment. As a new patient is ready to move into their own room or into a shared room, new stuff actually comes in that has been centrally cleaned by the staff. Maybe it could be on the floor of that unit or it could be in a more central location in the hospital. So a lot of that equipment is cleaned and disinfected before they even hit the room.

MR. COLWELL: Well, fortunately I haven't spent a lot of time in hospitals and I hope that nobody has to, but I've never seen that happen, ever. Usually they come in on a gurney, transfer to the bed that is in the room and away you go again. So maybe because you're the Minister of Health, there's a little bit of extra care, not because you insisted on it, because I know you wouldn't do that, but perhaps the staff was trying to impress the minister at that time.

I've never seen that happen and unfortunately, my wife has spent quite a bit of time in hospital and again, with the best care that you could ever imagine. Indeed, they've saved her life on two occasions, in the last three years.

Again, I'm stressing that I think we've got excellent staff but they need the resources. When I say resources, they need the time, they need the space and they need the guidelines to work with, that says this is what we should be doing to ensure that the facility is as clean as we can possibly get it. If you want to go for a walk someday, you and I will go for a walk in a hospital anywhere here in HRM, and I bet you the second or third room we hit, you wouldn't want to have your house look like that. The hospital should be as clean as, or cleaner than, anyone's home.

That's an issue and the more I talk to people who have been in the hospital, they say exactly what I'm saying, the care is incredible, the people they deal with in the hospital are incredible, but the places aren't as clean as they should be. So that's really the issue.

I'd like to know - maybe we can get documents from the health authority to see if they really do change all these beds, because I can tell you, quite frankly, when my wife was in there, on three occasions, that did not happen.

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MR. D'ENTREMONT: Thank you, Mr. Chairman. With all due respect to the member opposite, I do take a fair amount of insult that the member would suggest that a hospital treated my family any better than his family, because of my position. Shame on him for mentioning that during this debate. With all due respect to the member opposite, I would appreciate if he would retract that, because I can't believe he would suggest that.

MR. COLWELL: You didn't listen very carefully to what I was saying. I said at no time would I assume that you, as minister, knowing your reputation, that you would ever request or expect any different treatment than any of the rest of us, and that's what I said, if you check the record, and I stand by that.

Let's talk about the fourth floor in the VG. There was an issue with one of my constituents who was in there, the place is full of flies. I wasn't going to bring this up, but since the minister insisted on talking about issues, I think probably it's a good time to bring this up. That's a place that is not clean, I've seen it first-hand, even the staff who work there say it isn't clean and it's not appropriate for anyone to stay in. I'd just like the minister's views on that before I have any more comments.

MR. D'ENTREMONT: Mr. Chairman, again, I didn't hear a retraction because I heard that these things were done because I was Minister of Health and my mother happened to be on the third floor of the Victoria General Hospital. If that's not what the member said, I apologize for that, but I do take offence to some of the comments that he did make there.

Mr. Chairman, I'm sure that nobody on that floor knew who I was or knew who my mother was until four days later when I went to pick her up in my suit. So I can say that I watched closely, but they did treat us very well, as they treated everybody else well within that unit. I paid attention to the cleanliness of that floor, I paid attention to the cleanliness in the rest of that hospital.

Mr. Chairman, it is an older hospital that was built - in that particular wing, it was the Centennial Building - in 1967. It is an aging building and you know what? I think they're doing the best they can in keeping it as clean as they possibly can.

With respect to the fourth floor, it is an age issue. It really has very little to do with the cleanliness, because I think they're trying to do the best they possibly can with an older building. The member opposite knows, from our discussion last night, that we had a fulsome discussion around the VG sites, with the member for Sackville-Cobequid, on the possible replacement of that facility, of the kinds of services that we're going to be needing for that facility.

Mr. Chairman, I can assure the member opposite that through discussions with the district health authority, with I believe Shannex and the availability of the Sisters of Charity building in Bedford, that there's an opportunity for us to maybe renovate. The Sisters of

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Charity, I believe - they are building their own site and moving out of it. Anyway, there's an availability to maybe finally close the fourth floor of the Centennial Building. In my mind, that's what we need to do, rather than trying to fix it up any more.

I know the member opposite has had the opportunity to visit that floor, I'm taking from his discussion but, Mr. Chairman, I also visited that site unannounced on a couple of occasions. I can see the concern that families would have about that site but the other option, rather than going there, is sending these individuals home. I don't think the member opposite is suggesting that we should be sending people who need this extra care, that we should be sending them home. They need nursing care, they need extra services. The only other option that we would have than utilizing the fourth floor would be to send them home. I really don't think the member opposite is suggesting that.

At the same time, Mr. Chairman, I know, through my discussions with the district health authority, that they are spending time and dollars to ensure that the place is as clean as that building allows it to be.

MR. COLWELL: Well, thank you, I'm very pleased to hear that you're looking at another site for this operation. I'm positive that when you move patients to another site that you'll have it in the best possible condition that you can have before you move anyone in. Because once you get people in, it's a problem you're having with the fourth floor, which I totally agree with. It's very difficult to do anything once you have patients there because you can't have paint and odours that would upset the patients, and probably a lot of them with sensitivities that most of us won't have.

When do you anticipate that you might be able to have this new facility up and going, and how many people will it be able to accommodate?

MR. D'ENTREMONT: If everything goes well, and my fingers are crossed as well, we should be able to have something happen by the Fall. So there are still a few months to go but if we can get something available by the Fall, I think it would be a great day to be there, moving the last patient out of that fourth floor, and get them into a facility that of course would be cleaner and a little newer and renovated. To be able to offer them not only - I mean my issue with the fourth floor, even though it's the age of the building, it's the lack of services that are available to the residents. I know that when a patient goes on to a long-term care facility, not only do they get a room but they get all the services that are available to them - the recreation, the meals and management and those kinds of things, which are very important to the well-being of the patient as well.

That's the reason why I want to see some changes when it comes to that fourth floor and a transitional unit.

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[10:00 a.m.]

To a previous issue, and I apologize that I'm reading from a Blackberry on this one but I will read it into the record. This is a note on hospital cleaning: in CDHA the VG and the IWK are cleaned by an outside contractor, which is Crothall Services. All other sites are cleaned by Capital Health employees, so Dartmouth would be cleaned by Capital Health employees. There is a seven-day cleaning course that employees must take to be employed. Beds are changed each day and all floors are cleaned daily.

MR. COLWELL: I didn't see that happen, quite frankly. The beds weren't changed daily and the rooms weren't cleaned daily. I would say it's more likely probably the people working on that floor, or the inability to get in to do the work. I would think that's probably what has happened and I will discuss that afterwards.

There's one question that maybe you can't answer yet, how many beds are you going to put in the new facility for long-term care?

MR. D'ENTREMONT: Thank you. Parkstone, I think, is the one that we're looking at, would be able to accommodate approximately fifty patients, so that would well take care of the patients who are in the transitional unit today, which I think is thirty or so, and of course be able to take on some other people who are probably here and there within the hospital system here in HRM.

MR. COLWELL: After the people are moved out, are you going to renovate, as much as you can with the age of the building, the fourth floor and use that for general hospital beds again?

MR. D'ENTREMONT: No, I think we probably would just close that off until we have a better idea of what we're doing with the building as a whole. I think the availability right now - that was a closed floor to begin with, and was reopened in order to take on this transitional role. I think we'll probably close it up again for the interim, until we have the master plan from the Capital District on what the future is going to be for the VG site as a whole.

MR. COLWELL: Mr. Chairman, I'm going to turn over some of my time to the Leader of our Party for some questions, and I'll resume if he doesn't take all the time.

MR. CHAIRMAN: Thank you. The honourable Leader of the Liberal Party.

MR. STEPHEN MCNEIL: Thank you, Mr. Chairman. I'm pleased to join the discussion today. I want to thank the minister beforehand for his co-operation over the past year, from my constituents' perspective, in terms of maybe not always getting the answer I

[Page 70]

want or the answer that they want to hear, but for his co-operation in trying to at least provide them with an answer.

I was very pleased listening to the Budget Speech when we talked about the coverage of the drug Avastin, as well as the colorectal screening. My first thought, of course, went to the Connors family and the tremendous work that they had been doing, and that Jim Connors had done, on behalf of Nova Scotians fighting for this drug coverage. As everyone in this House knows, Mr. Connors himself had coverage, but he was fighting for Nova Scotians who did not, and this really was I hope - I am sure it was - a proud day for his family when they heard that this drug was being covered, for the tremendous work that he had done.

As I was looking through the budget, I'm looking, trying to find out - where in the budget have you put in the costs for the colorectal screening program that's going to be implemented?

MR. D'ENTREMONT: I'll go to the screening program first and then I'll talk about Avastin. There is approximately $2.7 million in this year's budget to basically turn on the colorectal screening program, to get it incorporated into the districts across the province - so it will be a stepped approach, available in different parts at different times. Also, there will be some training going on for the health care providers who will be working on the colorectal screening program, as well as maybe some more general training for the public so they understand what the program is and how it's going to work.

Mr. Chairman, within the budget documents, the cost of pharmaceuticals is probably held within a bunch of different places. With the district health authorities, they would have their own pharmaceutical listing - and I'll probably grab some of those pieces for you as soon as we can find them - as well as there's a general pharmaceutical number that we pay for, the other cancer drugs that are in.

Approximately - depending on what the guidelines are going to be, and we don't necessarily have a clear set of guidelines on usage of Avastin at this point, which will have to be done in concert with our oncologists, with Roche, the company that provides Avastin, hopefully we'll have it available as soon as we possibly can.

The estimate this year in exception drugs - these are the things that we don't either see coming up as a new drug or some things that maybe we approved at the last minute and we couldn't necessarily get a line item for it within the budget - exception drugs are $29,439,100 that we are going to be estimating to be paying for this year. There is an increase in that budget line from last year of about $449,000, so it waxes and wanes on the usage of drugs and the kinds of drugs that are covered by that list.

MR. MCNEIL: Today it was reported, and you were quoted in the paper telling Nova Scotians that your best guess is that the cost of Avastin will about $3.6 million. When we go

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through the Budget Estimates there is a special drug budget program that has increased by about $1.6 million. We are still short - if you look in the Cancer Care Nova Scotia budget, there has been an increase, but I assume that is where part of the $2.7 million that is for the colorectal screening program is located, so there seems to be some discrepancy between the number that you are quoting, being attributed today in the paper, and what is actually budgeted in the estimates here.

I am wondering - this program, will this be available to all Nova Scotians? Are you capping it? Who will determine which Nova Scotian, who requires the drug, will get it? What are the parameters that your department is putting around this program?

MR. D'ENTREMONT: The colorectal screening program is listed under Cancer Care Nova Scotia, which is a total estimate of $7.6 million and there is a line item for the $2.7 million that the colorectal screening program will be costing us. In reference to Avastin, it is approximately $3,500 per month, so therefore about $35,000 per patient per year, and we guess there would be somewhere around 100 patients who would require it. The nature of Avastin is that it is a late treatment drug, so it is probably a third run, and it would require that the oncologist would have tried to treat the cancer with one and two before you go to three, which is how this is being used in other provinces. So it would be a guideline, I think, that we set up through Cancer Care Nova Scotia on the usage of any of these drugs and how they are used in the treatment.

So hopefully we will have some of that done as quickly as we can to have basically both things roll out at the same time, because my concern was, as we roll out the colorectal screening program that we will be finding more incidents of colorectal cancer. Some of them would be early stage - not thankfully, but at least treatable by a certain number of methods - in some cases we would have late- level cancer and we would have to treat it with a drug like Avastin. So we want to make sure we have the full slate of drugs available.

MR. MCNEIL: Mr. Chairman, I hope, as we roll out the colorectal screening program that we do discover the cancer at a much earlier stage. That's the purpose of rolling out the program - it's to identify that cancer early on, treat it, and make sure that Nova Scotians have an opportunity to recover and live a full and healthy life.

You mentioned the increase in your budget for Cancer Care Nova Scotia. When you take away the $2.7 million that it is going to cost to implement colorectal screening, that nowhere near leaves enough money to cover the drug Avastin, so I am wondering where else in this budget - so Nova Scotians can feel comfortable that this program will be there and available, and I think it's important to tell Nova Scotians whether or not it is the intention of government to cap this program, whether this program will be based on the ability of one to pay, whether it is an income-based program, what are the parameters around this drug coverage that Nova Scotians are going to have to adhere to?

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It's important that we lay this out, because when this was introduced on Budget Day, Nova Scotians believed that the drug Avastin would be available to them without any parameters - as long as their medical professional believed that they required that drug, it would be available for them and it would be covered by the Province of Nova Scotia. So I think it's important that we identify where in this budget that money is located.

MR. D'ENTREMONT: Mr. Chairman, I can again say to the member opposite that this was a late addition, therefore you will not see a line item that specifically says "funding Avastin." What I can say to the member opposite, if he wants to refer to the Supplementary Detail, Section 14.5, exception drugs, there is an estimate of $29,439,100 - we will be funding Avastin through that fund and, of course, through some of the funding with Cancer Care Nova Scotia. So the dollars are available there.

The other issue is that by funding Avastin and the utilization of Avastin, there are other drugs that will not be used. A lot of times the third- run cancer treatment was covered by another drug, so you can take the cost of what that drug would have cost you, you can delete that and sort of plug in Avastin. So even though I don't necessarily have that line, because it was a late addition, I can say that the dollars and cents are there, within our Pharmacare Program, to cover the cost of Avastin.

The clinical guidelines will be set on the usage of Avastin by clinicians, by oncologists and again I can say to the member opposite that in all other jurisdictions this is a late- run cancer drug, a third run, so it is available at that time.

Mr. Chairman, those people who has come to us as MLAs, who have come to us as government members or Opposition members, are in third-stage cancer for the most part, which is not a great place to be. Again, we're talking about Avastin that does not cure cancer, but it does extend life, and I'm sure for those who are suffering from cancer, every month that we can add to their lives is a precious month.

MR. MCNEIL: Mr. Chairman, I appreciate the openness of the minister around the addition of the drug Avastin to the budget, but regardless of the fact that it was a late addition, it still has to be budgeted - we have to have confidence, Nova Scotians have to have confidence that the government has put in place enough dollars to cover this.

Today you were quoted as saying you believe it is going to cost about - your best guess is $3.6 million. The line item that you refer to in that budget is increased by $400,000. Each line item in this has increased by $300,000 or $400,000 - that's a far cry from that $3.6 million that is required.

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[10:15 a.m.]

Nova Scotians need to know whether or not this drug will be funded completely. If their medical professional believes they require that drug, where in this budget have you funded for it? It's one thing for us in this House to say that we're going to cover this medication, but Nova Scotians have to have confidence that the money is in the budget to make sure we can do that.

So we need to have some clarification. Where in this budget is that $3.6 million located for this coming fiscal year, to make sure that those Nova Scotians who have been fighting for this coverage and Nova Scotians who require this drug, are going to be able to receive it and have all the confidence that they're not going to be forced into financial ruin because we haven't taken the due diligence to make sure that the funding is in our budget?

MR. D'ENTREMONT: Again, I explained that this was a late addition and therefore it does not have a line item. I can also say that there are a number of places within this budget that underline the cost of drugs. Mr. Chairman, this is a budget that guesses - these line items guess the cost and utilization of cancer drugs throughout the course of a year and if you take a new drug, which supplants another drug, the costs tend to even themselves out.

Mr. Chairman, I can say that the dollars we have available for pharmaceutical services, the dollars that we have available for Cancer Care Nova Scotia, the dollars that we have in other parts of the budget, I can assure the member opposite and I can assure all Nova Scotians that the dollars are here in place to fund the drug Avastin for this year, and we will have a true line item for this drug in next year's budget.

MR. MCNEIL: Mr. Chairman, let me first of all say that we, as a Party, are pleased to see this drug coverage; we're pleased to see the colorectal screening program - as you know, our Health Critic has been talking about, speaking to you and your predecessor about a colorectal screening program in this province, and we are pleased to see it being mentioned.

It is not good enough to say that the money is there and this drug will be replaced and we will find the money here or there. Nova Scotians have to look at this and we, as legislators, have to see in this budget - there has to be some level of confidence that we can meet that commitment. It's one thing for all of us to say we're going to do it, and then when it comes time to pay, it's not there.

You've been quoted in the paper putting out this figure of $3.6 million. You mentioned earlier that it's approximately $35,000 that it will cost per year per Nova Scotian, roughly 100 of them. So you have that figure already somewhere cemented in the logic that you used when this was put into the budget. You have a great idea of what your estimate should be, but nowhere in the budget do we see that estimate being reflected in the numbers.

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There are a lot of assumptions happening here - you're assuming that when this drug is prescribed to someone else, another drug will be removed, this will take the place of it, the cost of it. We should not be assuming all of this. You identified yesterday to a reporter that it was $3.6 million it was going to cost. When you added that to the budget at the late stages, we should have been able to identify quite readily somewhere in the line, and it doesn't have to be a line item that specifically says for the drug Avastin, you could have added the money to the special drug program or you could have added to the cancer care budget item, but those budgets have only minimally increased - they probably reflect inflation in some cases.

So I think it's important over the next number of days that as a department we can identify where that money is and be able to tell Nova Scotians with some confidence that it's there - I would encourage you and your deputy and your department to be able to say here's where that money is.

I also want to talk for a minute, if I can, Mr. Chairman, about an idea that we brought to the floor of this House around making sure that we were covering - making sure that medical students had an opportunity to practice here in Nova Scotia. We had said to you, Mr. Minister, that when those twenty seats that were coming available because New Brunswick students were going back to Fredericton, that we wanted you to enter into an arrangement with Nova Scotian students that you would pay for their full tuition at medical school providing they signed a contract with you that they would work in the Province of Nova Scotia in under-serviced areas.

To be quite honest, I was disappointed not to see that in the budget. It was one of the things that I believed we would see in this budget, but it wasn't there. I would like to know - either you've dismissed that idea out of hand as a government, or are we moving forward and Nova Scotians can see a program similar to that, a program that is like that in the near future? Let me tell you, Mr. Minister, as you're well aware and your department is well aware, there are many Nova Scotians who do not have access to a family physician.

We can talk about the ratio per capita and where we fit nationally, but there are many Nova Scotians, the only number they know is that they don't have a family physician, they don't have a number to call. So I'm wondering if you could talk about whether or not your department actually seriously looked at that option and where we are with that.

MR. D'ENTREMONT: Mr. Chairman, I will go back just to finish off the Avastin issue and then we'll talk about medical seats there for a quick second. The dollars - again I can assure the member opposite - are available; they are in three or four different spots within our budget. I can talk about other programs - the high-end drugs approved by the provincial committee; claims-based funding to districts, which is another $6.9 million that is available. Again, the coverage and the utilization waxes and wanes, so sometimes there's a high use of one drug and no use of another drug, and I can say that there is up to $3.6 million available within those three different funds to cover a drug like Avastin.

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The other thing that I can say, Mr. Chairman, is that $3.6 million represents the maximum use of this drug per year, if that patient would be receiving the drug for the full year. Our experience and the information that we have, the patients do not receive the drug for the full year. Mr. Chairman, again as I've said before, the average extension of life that this drug offers is approximately five months - 4.7 months. So most patients do not receive it for the full year.

So, again, I know the member opposite is looking for a specific area and to see a true addition of $3.6 million. But I can say within the budgeting process, within the space that we leave ourselves because of the other drugs that would have been coming down the pipe during the year anyway, we make budgetary decisions to include certain extra dollars within that funding envelope to fund drugs as they come down. Oxyliplatin, for example, that was approved last year - it did not have a number in there and if you look at it, we're funding ten new drugs and there has been no change to our item. So it is funded within that envelope because utilization changes, drugs change, and we really have to sort of roll with the requirements of those funds.

The medical training seats - and I thank the member opposite for his interest in this, for his leadership in this. I want to talk a little bit about the difficulty that I have been having when it comes to the medical school in trying to negotiate - and again this negotiation is not only through our department but it's in concert with the Department of Education as well, who has the responsibility for universities. When I first came to the Department of Health and had my tour of Dal Med, there was basically a sales pitch at that time to increase the number of seats to its maximum, without infrastructure change. The maximum that I think that school can take at the time - if I remember in my conversation with the Dean of Medicine, Dr. Harold Cook - is about ninety-six. So we can put approximately another six students into that facility, we understand. I mean it could be up to 10, we're aiming for 10 but they're saying they could do about six because we've got ninety undergraduate students, I believe, going through there now - in order to train more.

It always has been my intention on this one to have those to be designated seats for Nova Scotians, more specifically students who have an interest in family medicine, and more specifically to have a return for service built into those seats. There has been agreement in our conversations with Dalhousie University to allow this to happen, but I don't have a number that has come back from them that can tell us how much this is going to cost us. It's about $56,000 per student per year, so if we're going to add ten, you can do the math on that. It's still my intention to go forward with this for September and I feel that within our training envelopes that we have the dollars available to do that on behalf of Nova Scotians and on behalf of your leadership on this one as well.

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

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MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I want to pick up where I left off because I don't think I received the clarification around an issue where I'm trying to get some clarification. I'm not an accountant and a lot of Nova Scotians are not accountants, but when I read through the budget estimates, which I've done for several years now, I still can't grasp the idea that if government is estimated to spend $19 million and they only spend $11 million, where does that $8 million go? I would like to ask the minister again - and that figure I mentioned was on the grants and contribution for equipment within health.

That $8 million that we did not spend last year, and we know this year we are going to spend $7 million so my trying to figure that out in my mind - we are actually underspending about $1 million. So really, in my mind, there is a cut to the money available for equipment within Health of $1 million, so again maybe I will give the minister one more chance to try to clarify - if the government was going to spend $19 million and they only spent $11 million, where does that $8 million go and why are we only spending $7 million this year?

MR. D'ENTREMONT: Mr. Chairman, neither am I an accountant. I really just don't have that ability. I do have a lot of respect for those who are CAs, my CFO here, for the work he does for our department because he does spend an awful lot of time with numbers. Of course, my brother-in-law is one as well, so I do get to hear a lot about accounting on a regular basis and I really have no details to fight with my brother-in-law when it comes to some of these issues.

But anyway, basically what happens here - due to late starts, whatever - the cash flow cannot happen, so if we budget $19 million for the construction of X building and we had envisioned it to spend $19 million from September to March and the cash flow is available so we can write the cheques out for that $19 million, but the project itself really only starts in December, let's say, so it only runs for the four months remaining, we can only kick out $11 million in paying that directly. So what happens is that I can't take that extra $8 million and pay it forward; that $8 million, due to the accounting rules of the province, has to be sent back centrally. So as much as we try, within our department, to find other homes for those dollars, dollars do end up going back to the Department of Finance to be used centrally for other issues of government.

[10:30 a.m.]

MR. DAVID WILSON (Sackville-Cobequid): Which leads me to believe that the spending spree that the government had toward the end of the year, the $220-some million, plus $75 million to the fund, that is where that money is coming from - that is my understanding. So the money you spent at the end of the year, the spending spree you spent just at the end of the year without approval from this House, part of it ultimately came from grants and contributions that were supposed to be or were meant to be spent on equipment in health care.

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Anyway, I am going to go on to another area - Program Expenses for Capital District Health Authority. We look at the line items and the forecast of last year, what we spent for Capital Health - in the Estimates Book, Page 14.2 - was $620 million. So this year, under the estimates, it's recorded at $605 million. So that is a difference of $15 million. I wonder, could the minister explain why their budget for Program Expenses for Capital Health is $15 million less than what we spent last year?

MR. D'ENTREMONT: As Allan is trying to find those numbers, I will sort of rebut the issue of the dollars going centrally and maybe ask the member opposite to tell me whether he doesn't think that student relief was important, that he didn't think that the MOU with the universities was important, which all have to do with making it more economical for nurses to go through the system, that makes it more . . .

HON. MARK PARENT: Protected areas.

MR. D'ENTREMONT: Protected areas. Well, I'm talking about health care, with all due respect to the Minister of Environment. I know he's very passionate about environment.

Mr. Chairman, I can say that you know there were some direct benefits to health care, and especially from the other line of questioning that we've gone through over the last number of hours on the recruitment and the retention of nurses and other HHR staff, that it's very important to have competitive tuitions, competitive bursaries, and competitive pieces that are available to the university system. So, you know, there is a direct correlation between those two. (Interruption) Thank you very much, Mr. Premier, at least I don't feel so alone answering all these questions.

I need to get the explanation here of those dollars, so if you want to wait a second or you can go on and ask another question and we'll only be one-off for now.

MR. DAVID WILSON (Sackville-Cobequid): Actually it's first a comment - no question those expenditures are important, but what's most important is the fact that I supported a budget last year that was supposed to spend $19 million on equipment in health care and only $11 million was spent. That's the most important thing, Mr. Chairman. I didn't support any budget that spent $300 million just leading into the end of the year. I supported a budget last year that was supposed to spend $19 million on equipment in health care. That's the important thing and that's why we have such an issue when we see $8 million where I don't know where it went. It went in, I guess, to the spending spree of the government - that's my issue and that's what's important.

So I would like to go to now around some more questions and I know the minister will get the question around the $15 million reduction that I see in Program Expenses for Capital Health. One of the things I noticed here in the line item - and maybe he can get his support to get it - it's on Page 14.16 of the Supplementary Detail, and it's the line item that states

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under Program Expenses for Long-Term Care programs and it was Strategic Framework. Last year it was $1.1 million, this year it's $8.5 million. I just want some clarification on what that line item entails, why is that expense there, and I believe it's up maybe $7.4 million, in Strategic Framework, it's the last line item under Long-Term Care, Program Expenses.

MR. D'ENTREMONT: Mr. Chairman, let's talk about the strategic framework. Basically it has to do with the HHR strategy and other strategic frameworks when it comes to, of course, the training and the recruitment of CCAs and other health professionals in the long-term care sector. So those are the dollars directly to the additions of CCAs and those types of people within our long-term care system. So that's what that line item is.

The Capital Health issue, the $15 million issue, has to do with the reallocation of wage settlements. Last year what we ended up having to do because we didn't have the true allocations of all the dollars and cents due to - I forget which wage settlement it was - that we just sort of lumped it into Capital Health. What we see this year is we actually had time to place it into the correct district health authorities, so that's why you see the difference of $15 million. The $15 million would actually be shown in other parts of our budget in the other district health authorities.

MR. DAVID WILSON (Sackville-Cobequid): So under that Strategic Framework, that $7.5 million - I think the minister mentioned that part of that's the recruitment and retention aspect, or some has been involved in that. So I wonder if the minister or his department keeps track of the spending amounts for each discipline - say physicians, nurses, technologists, on what you're spending in recruitment, in trying to recruit and retain those health care providers. Do you actually keep records of how much you're spending to attract those health care providers to our system and hopefully retain them also?

MR. D'ENTREMONT: I don't specifically have it maybe for physicians and maybe some of the other pieces, but I can quickly list some of the issues that are within the nursing strategy and the additions to the nursing strategy this year, as I spoke to last evening. In recruitment and retention, advertising and promotion, there is about $500,000 that is listed there; RN recruitment incentives, strategies, is still to be determined - there is still some work to be done around that one but we were allocating about $250,000 to that; the third year co-operative experience, which we were finding some very good benefits to that and apparently the students are enjoying that quite a bit, that is $240,000 and we are trying to expand that to 40 students, I think, this year at about $6,000 a pop. So that brings it to 100 per cent of the students. So that forty brings it to 100 per cent of the students who will receive that third year co-op experience.

Facility-based recruitment and retention initiatives fund which is about $239,000; facilities-based placement premium, which is an incentive, $84,000; and upgrade for food handlers and medication management modules and those kinds of learning initiatives is $80,000; prior learning assessments, assessors, RNs provide on-site assessment to transfer

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credits for outside students to do work with those students who have been trained in other jurisdictions that have come to Nova Scotia, and we will put some dollars in place for a coordinator to coordinate the transfer of credits program. We are finding some nurses are going off for some of the training and want to come back to Nova Scotia or are taking their master's degree and we are trying to find ways to incorporate that outside learning into the programs - again, this is all in addition to the $5 million that we have in the nursing strategy, that we have had in our budget for the past number of years.

MR. DAVID WILSON (Sackville-Cobequid): I wrote most of them down. Hopefully I have some support from the gallery to keep track of some of those numbers. I would appreciate it if that is something you could share with me, a list of that. I would appreciate that. I think it's important to have that information and have that with us.

So now I want to move on to - I'm going to use the Supplementary Detail book, Page 14.4. I want to talk about, again, what we approved last year through the budgetary process, a budget that was supported by this House and what was actually spent again. I know I'm concentrating a lot of time on this, but I think it is an important issue that we need to try to get some answers of why certain areas and certain line items and certain departments and certain programs you didn't spend as much money as the budget had indicated last year.

So under the Pharmacare Program and the Pharmacare Payments, first question, what does that line item entail? What exactly or what is covered under that $178 million for Pharmacare Payments?

MR. D'ENTREMONT: Mr. Chairman, to the member, again - as I was sort of answering questions from the Leader of the Liberal Party - the medication, pharmaceutical side waxes and wanes and changes every year. Quite to our surprise this year, there is basically a decrease in the cost of our pharmaceuticals due to the availability of generics in this year's round, a change, the decrease in tariffs, in the tariff agreement. Even when that happens, that gave us a considerable savings but utilization has gone up 8 per cent. As I said, things change within that module, so this year is representative of the new generics that are on and the tariff agreements that have been signed.

MR. DAVID WILSON (Sackville-Cobequid): So what we could take from that, then, is the saving of last year, which was about $7 million, ultimately the Avastin portion of pharmaceuticals which I think the tentative number on that is around $3.7 million, maybe even $4 million. So really the savings from last year will cover the cost of Avastin this year - and we noted here in the budget that we are actually budgeting less for Pharmacare than we actually budgeted last year by some $1.5 million, maybe even $2 million. So at least there I can see that if we didn't spend $7 million, or we saved $7 million, why shouldn't you spend that on a pharmaceutical like the drug Avastin. I'll get into that a little later with some comments about that issue.

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Now, I'd like to move down to, again, kind of on the same theme around what we passed in the budget last year and what we spent and maybe some clarification on some programs that I think are so important here in the province. They're used by Nova Scotians who are vulnerable, who need the help of government and apply for these programs.

The first one is the low-income residents with diabetes, or the low-income diabetes program. It was budgeted last year at $2.6 million, we only spent $1.4 million. I'm wondering why such a difference again in that program? We're looking at over $1 million saved in the low-income diabetic program and I'm wondering why. Is it because the uptake - people weren't applying for the program? If that's the case, maybe we should spend some of that $1 million in ensuring those people are aware of this program, or expand what is covered in that program. Why such a discrepancy from last year in that low-income diabetes program?

MR. D'ENTREMONT: Just a general comment - this has to be maybe one of the first times we've had a discussion around decreases in health care costs on the floor of this Legislature. We do have some programs, as they've started rolling up, they're not spending the dollars we had thought they might. In this particular case, it really has to do with take up. Maybe we need to do a little better job in advertising and working with physicians and pharmacists to make sure that diabetics know this program is available to them.

We do know that in the course of setting up a program that it really takes about five years for a program to become fully subscribed. I think this is just representative of that. Again, we would hope more Nova Scotians would take part in the diabetic program, because it does provide such a good help on the cost of insulin and other components of treating and caring for diabetes. So, Mr. Chairman, again, it is a strictly utilization on this one as well.

MR. DAVID WILSON (Sackville-Cobequid): So if that's the case with this program, a program that we supported and advocated for for many years, the minister stated that maybe we should look at the advertising of this. So have you had the discussion with the staff of the department to say, are there people we're missing with this program who we could help? Have you had those discussions, and when will we see an increase in awareness around this important program?

[10:45 a.m.]

MR. D'ENTREMONT: Mr. Chairman, yes, I've had that discussion. I have regular discussions with my pharmaceutical staff on the usage of these programs - this one and the Family Pharmacare Program, as well - to make sure we're meeting the needs. As far as we understand, the take-up on the diabetic assistance program is good - it is not fully subscribed and we would hope it would be fully subscribed within the time frame that we set. We really don't know exactly the reason they're not picking it up as much as they should. Again, I think we have to do a better job in advertising and making it available in doctors' offices and

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pharmacies so that Nova Scotians are aware this program is available for the treatment of their diabetes.

MR. DAVID WILSON (Sackville-Cobequid): I look forward to seeing an increase in the awareness campaign around this program.

The line item right beneath that one is also an important one here in the province, one that many of our children here in the province take advantage of - the children's dental program. That too has seen a reduction in what the actual cost was at the end of the year, a difference of just over a half million dollars.

Recently I had a call from a constituent who was in the situation where I believe the cut off time for this program, or for children, is the age of 12. This individual started the process with her family to have some oral health care problems addressed and found themselves with a huge bill at the end of it. When they asked and applied to have that covered under the government's program, they were denied. On appeal, they told us and told me in a letter that I believe the minister or a member of his staff sent me that, well, no, we're not covering her because she's over the age, but those procedures weren't going to be covered anyway even if she was six months younger at the start of that process. So with $0.5 million savings, why would we see, you know, a child in Nova Scotia who is on that borderline of the cutoff, why wouldn't we see maybe exceptions in maybe expanding what they do cover for procedures under the dental program for kids in the province?

MR. D'ENTREMONT: Mr. Chairman, the children's dental program is one that I think is important for the dental care of children, to make them aware and treat them through their infancy so that they can continue on in adulthood taking care of their teeth. Of course, you know, dental care is very important to the overall well-being in health of a person - again something that's very important to us.

Just to speak of the program quickly, it's a two-component program providing diagnostic and treatment services, prevention activities, through the application of a Public Health initiative to eligible residents of Nova Scotia up to their 10^th birthday. The program has two components - the insured services treatment component and the Public Health services component. I just wanted to - I'm just trying to read the rest of this here so it's not so much, OICs and numbers like that provide that in most cases where private insurance coverage has left an outstanding amount due, the government will accept responsibility for those costs - so either to pay for the full costs or whatever the private insurance does not cover.

What we find this year is that there was a tariff increase this year of about 5 per cent. That's an increase of approximately $211,800 but there was a huge utilization decrease within that age group of about $345,700 so it does show that total decrease of $133,900. So to the member opposite, you know, we're unsure of why the decrease went down because it does cover an awful lot, but maybe it is representative of the availability of private insurance for

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families with children now, either through this program or maybe through private programs. So we are going to watch that one a little closely because I remember when I was in that age group, I believe it almost covered us to 14, I think, at a time. So, you know, we need to monitor that one and if we do have some extra dollars left over next year, maybe we should be increasing the age on it.

MR. DAVID WILSON (Sackville-Cobequid): And that's why earlier this week or maybe it was last week - today is Friday - earlier this week the member for Halifax Atlantic talked about a piece of legislation that she introduced and it was about that portability of a private health care program. I mean that piece of legislation if it was seriously looked at by the government - hopefully it will be - I would think could help reduce that cost, maybe even eliminate that line item there, or at least reduce it because of additional third party coverage. So I know we're not supposed to talk about other bills but I thought I would put a plug in for that piece of legislation.

So now I want to go to the couple pages past that one, Page 14.7, and the line item is Cancer Care Nova Scotia. We had $4.5 million last year and there's a definite increase to $7.6 million. So is that the money allocated towards the colorectal screening program or could you advise me why that increase is there?

MR. D'ENTREMONT: Mr. Chairman, Cancer Care Nova Scotia, of course being a very important program for us.I do also want, I don't know if I, I did announce it at a statistics briefing that we had over at the Holiday Inn not so long ago, that we do have a new chairman for the Cancer Care Nova Scotia. I do want to thank and wish well Réal Samson who will be taking over the chair of Cancer Care Nova Scotia and wish him well.

Yes, quickly put, the biggest increase is the colorectal screening program - $2.7 million. Some other pieces are pretty much just wage increases, staff increments, funding for staff increments, clerical support for cancer drugs, health record technician, adjustment prior years, internal wage transfers and those kinds of things, to bring us to the total of $2,908,100.

MR. DAVID WILSON (Sackville-Cobequid): So the $2.7 million is in that figure? Okay, just for my record. One of the things that I read - and I read pretty much all my mail - back at the end of last year was the media piece that the government was criticized on that they sent out, promoting what the government is doing. In that, from my recollections, there was a piece on colorectal screening. I believe, and maybe the minister can correct me, but I believe they said they are going to spend in the upcoming year, $3 million on a colorectal screening program. So why are we at $2.7 million when not even a year ago, in the media release and in the newsletters that you sent out to all Nova Scotians, you said you would spend $3 million. There is $300,000, so why the difference between $3 million to what we see today in this budget of $2.7 million.

[Page 83]

MR. D'ENTREMONT: Mr. Chairman, the $3 million number is really representative of some of the other dollars that would be spent on treatment and some diagnostic pieces that are happening within the districts. As much as we try to budget centrally for this program, there are some other expenses that the district health authorities would be spending so we basically rounded the number to an even $3 million for that document.

MR. DAVID WILSON ( Sackville-Cobequid): As I said, Mr. Chairman, that is not what the mail out said to Nova Scotians. It said $3 million. It's just another example, I think, of here the government is saying we are going to spend some money, we are going to spend $3 million but really we are going to spend $2.7 million. Or we are going to spend $19 million on equipment but no, we are only going to spend $11 million. So I hope the minister understands our frustration when we try to go through the line items here and we see what the government says they are going to do and what the government does.

Maybe the minister will comment on that later but I want to move on to another line item. We all know, I know and I think the Chairman knows the importance of health research in our country and in our province. In order for us to ensure that we can best service our residents with new initiatives in health care, with drugs, in any aspect of health care delivery, health research is needed. We need to make sure that if there is an investment made by government, that the research is there to back it up. We've seen cuts on the federal level to health research throughout this country, which is a shame.

I know Prime Minister Harper is not, in my opinion, very favourable toward the health research programs throughout this country. That is why I am bit concerned here when in this line item underneath Cancer Care, we have Health Research Foundation Grant where they received $6.4 million last year and now we see that in the upcoming year they will receive $4.9 million - a difference of $1.6 million, Mr. Chairman. So with that reduction of money going toward health research which is so important in this province, why has that reduced? Is it because they asked for less money? I don't think that is probably what happened. Why is there a reduction of $1.6 million toward the Health Research Foundation Grant this year.

MR. D'ENTREMONT: Mr. Chairman, if you look at estimate to estimate, there is only a $13,000 increase in that budget. What we saw last year, there were a couple of one-time funding initiatives that were given to the health research foundation. There was $1 million in grants and projects that it was increased by. During the year, there were a health policy research centre dollars that were available to them at $500,000 and there were some office renovations that we undertook during the year of $17,000, I believe, for a total of $1.5 million or so, over and above the existing budget of $4.9 million. So that's sort of why we see some extra dollars in last year's but if you probably went back a year beyond that, you would see a pretty similar number from our grant to help research.

MR. DAVID WILSON (Sackville-Cobequid): And I do note that but what I'm trying to emphasize is that we have a federal government that is backing away from health research.

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I know last year they've gotten a bump on money towards their program and their initiatives. I just want to lastly emphasize the fact that they received additional money last year. It would be just as beneficial to Nova Scotians and to the government to ensure that they have available additional funds like they had last year, if not matching last year's.

So I would like to move down the page a little bit. Last year under the line item on pandemic planning, last year we spent $610,000 on that line item but this year there is no money allocated. I wonder why maybe that line item has no funds allocated towards pandemic planning in the upcoming budget?

MR. D'ENTREMONT: Mr. Chairman, just to go back to the health and research issue - I mean health and research is very important to me. You know, I thoroughly enjoyed meeting the researchers, very interested in the projects that they undertake and the benefits that it gives to Nova Scotians. I find clinicians and researchers, you know - they're one and the same. If we can have a physician or a specialist come into the province who can see patients on one side and do research on the other side and have a more wholesome life, why not offer that here in Nova Scotia.

What I can also say to the member opposite, even though the dollars for the Health and Research Foundation have seemed to be pretty steady over the last number of years, there are a number of other funds that directly fund health research in this province. The Premier's Innovation Fund; brain research; the Brain Repair Centre, which is really a research organization, it's funded directly or funded through the Department of Economic Development. Of course, each DHA has its own research fund that they use more locally for research that's happening with their staffing.

The pandemic issue, there was an amount of money last year that was one time spent for, I believe it was either antivirals and equipment. I'm just looking here, right, and there was intensive work last year on the pandemic plan, the document that people will refer to if we do find ourselves in a situation. So there were some dollars spent last year on antivirals and those items that are, of course, still good this year that we didn't have to spend money on again. Of course, all those costs are shared with HPP. So there are some dollars over in the honourable Minister of HPP's budget that talks to pandemic as well.

[11:00 a.m.]

MR. DAVID WILSON (Sackville-Cobequid): And I would hope, and I know the minister can't comment on line items under Health Promotion and Protection, but I hope that there are funds there to start the work around a comprehensive strategic plan, especially around the accountability and the management structure of pandemic planning. It was criticized in the Auditor General's Report most recent report, around the fact that there are no clear lines of communications because of the crossover between the Health Department and Health Promotion and Protection Department. We have, for example, our nurses who

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work under Public Health, work for the Capital Health region or the District Health Authorities' which falls under your mandate. Yet their goals and policies and regulations come from another department and that was a criticism from the Auditor General. So maybe a quick comment from the minister on where we are and is there money allocated to ensure that there's a plan that overlaps departments like the Department of Health, and Health Promotion and Protection? To ensure that the government doesn't have another audit finding like we had in the last Auditor General's Report and that we can ensure that the safety of the public here in Nova Scotia is best served by departments working together.

MR. D'ENTREMONT: Mr. Chairman, our pandemic plan had been developed over a number of - a couple of years to put it together, which was done in concert with our department, with the Department of Health Promotion and Protection, with all DHAs, with the federal government and, of course, with EMO, to organize that. It is a document that will continue to be groomed, one that will have to change and react depending on the possible threats that are out there, the difference in technologies that will be available to protect our citizens, et cetera, et cetera.

Mr. Chairman, I can also say that even though I do relish my time here in the House, I was scheduled to be at the Exercise Staunch Maple, which is going on today over in Shearwater. Exercise Staunch Maple is a combined initiative of, I believe, EMO, HPP, ourselves and the federal government on really exercising what happens if a cruise ship, for example, comes into our harbour with injured patients, with injured individuals on board, or with some kind of illness that we cannot identify.

Mr. Chairman, over on the waterfront today - and I hope that the media will be reporting on it tomorrow, on the success, or the experience of Exercise Staunch Maple. Again, I know the Armed Forces I think is - I can't remember which ship we have over there, but I know DND is participating with this as well, the cruise ship, they're pretending they're a cruise ship, but ultimately we'll be setting up a field hospital to treat these patients or these ship-goers in an appropriate manner.

So it's basically a very good learning exercise to see how our procedures are working, to see how our policies are working, and to see how our workers, our specialists, are working to contain and treat the patients who are sick over there.

So even though, again, I'm glad to be here to be discussing the estimates, I was really looking forward to seeing the progress at Exercise Staunch Maple. Had I known, I would have invited you over.

MR. DAVID WILSON (Sackville-Cobequid): I would have taken a break from all this if you wanted to go. There are a lot of criticisms around the lack of plans and are we really ready for emergencies, but I know the good people who work in emergency services, like the paramedics, firefighters and police, will do the best job even without maybe the government

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doing its best job to have the plans and policies in place. So I wish them well today in their exercise.

The reason I talked about the public health aspect of it, because during the next few pages in all the district health authorities under their program expenses, last year there were line items under Public Health Services for each of those DHAs. So, for example, district one, the South Shore District had $1.1 million; Southwest District had $1.7 million; Annapolis Valley, $1.7 million; Colchester, $1.7 million; and so on. Roughly $12 million last year, that I can point out, was spent or was under the umbrella of the Department of Health. This year those are all zero. Why the change from last year to this year?

MR. D'ENTREMONT: Mr. Chairman, to that, there were $22 million worth of programs and dollars transferred from the Department of Health to the Department of HPP, and those line items represent those transferred programs that are now over under the bailiwick of HPP.

Also back to the issue of pandemic planning, emergency preparedness, there has been a health emergency management centre established by DOH and HPP. It was set up last year. We have a retired navy commander, Russell Stewart, heading up the unit to better organize the operations of our departments if we would ever find ourselves in a medical emergency such as a pandemic.

MR. DAVID WILSON(Sackville-Cobequid): Did you say Dr. Stewart? Is that who (Interruption) I thought he was mentioning Dr. Stewart who was instrumental in changes to the paramedic service throughout the province.

You said that there's a transfer of $22 million and I know you can't answer this question and hopefully our Critic for Health Promotion and Protection - I know the government often states that the Office of Health Promotion and Protection were increasing the funds to promote healthy living, that whatever increase they have this year, $22 million of that was under your umbrella. I'm sure our critic will keep an eye on that and I'm not sure if that's how much that department's budget had risen this year or not, we'll have to look at that.

So now under addiction services of course in all of those district health authorities, they have line items for that and I've highlighted them all. But there's only one, Colchester East Hants District Health Authority, that had seen a reduction - maybe a small one but still a reduction of nearly close to $70,000. In addiction services I think every penny counts, every dollar counts, so $70,000 would go a long way in helping those Nova Scotians who find themselves fighting an addiction and needing the help of their health authority and those professionals in it. Even though it's a relatively small number of a reduction when we look at the overall budget in health, I think for that important service - which I think in my own opinion is underfunded - why is there a reduction of close to $70,000 or maybe $68,000?

[Page 87]

MR. D'ENTREMONT: I don't have the necessary details on that one so I'll have that available to you hopefully early next week maybe even by the end of this one, but I doubt I'll have that line item available to us.

MR. DAVID WILSON (Sackville-Cobequid): We'll make sure we look at that and hopefully receive that. Now I have kinds of questions on a few things. I know I have about 20 or not even 20 minutes. I'm going to look into the Assumptions and Schedules book that we have that we were given. Under it, on Page 1.15, is listed money that we've received on the federal sources and that would be revenue coming into the province. It goes back to 2004-2005 and then the years leading up to 2008-09. So in 2004-2005, we received $44 million under Health Reform Fund. Could the minister maybe say how much of that money is left, if any, and maybe quickly where did that money go?

MR. D'ENTREMONT: I believe that number is representative of the primary care fund. Pretty much we were getting dollars directly from the Federal Government to fund our primary health care initiatives in the province. As far as I understand, at this point, all dollars from that fund have been spent or pretty much all spent up last year so there are no more dollars in that fund.

MR. DAVID WILSON (Sackvile-Cobequid): So all spent up to last year, so this year that money is gone. That $44 million, I know there's no new money in there, but that $44 million would have been spent up to this date? Just for clarification maybe.

MR. D'ENTREMONT: About 25 per cent of physicians have EMRs, and EMRs were paid for through that - the electronic medical records, or the computerized programs for them were paid under that fund; the district health authorities set up primary health care plans, and that was funded out of that fund; there were primary care coordinators in each district that were paid for from that fund - so there were a number of initiatives that basically we continued to pick up after the expiry of that fund.

MR. DAVID WILSON (Sackville-Cobequid): I know the minister might not have all those details, but is it possible to get a breakdown of that money? The biggest criticism we have and Nova Scotians have, and that I have, is that we receive $44 million from the federal government, it goes into the bank account of the Government of Nova Scotia and then you bring out your estimates, you bring out your budget every year saying we are going to increase spending in this area in health care but, yet, $44 million of that spending over the last four or five years came from a fund that the federal government gave us.

I hope the minister can provide me with a breakdown and maybe it will keep me quiet over the next six months - if I get that breakdown of where exactly that money went. I mean, if you spent it you must know where you spent it, and if you can give that to me I would appreciate it.

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I don't have much time and I'll be close to wrapping up my portion - I know in the next time allotted for this, the member for Halifax Needham will speak so I am going to talk about a few quick things and hopefully get some clarification. One is the recent changes to the Pharmacare Program, and I asked the minister in Question Period this week about it. The minister mentioned that there may have been an error about sending an invoice out to seniors, and that's really a lot of the confusion that I have received calls on. Here we have changes to the program, so seniors who have been in the Pharmacare Program for whatever length of time, some of them for years, receive a package from the government saying we are changing the way the payment plans are and how you are going to pay for this - so they had questions.

The government set up a 1-800 number and, of course, they were inundated with calls, and I think that number crashed, and since many of them had concerns they turned to their MLAs to try to find out - well, I was unaware of those changes pretty much right up until the time I started to receive calls. So those seniors actually filled out their information, sent it in, saying here is how I am going to pay the premium. Some of them paid it upfront, some of them went on monthly billing, like they always have been, and then within days, some of them received an invoice saying they owed the premiums in full.

[11:15 a.m.]

With that confusion, with the crash of the phone line, can the minister say today that no senior who might have missed the deadline for the Seniors' Pharmacare Program will incur a penalty - because you have some severe penalties placed on you if you don't enter that Pharmacare Program by that date and you're stuck with those penalties for, I believe, five years - so can the minister state that no senior will be penalized because of that confusion, because of the inability for them, at that time, to get the question that they had answered?

MR. D'ENTREMONT: Mr. Chairman, I think if we had a chance to go back and do it differently we would. There was some added confusion with two programs at the same time, of course, the new Family Pharmacare Program and the Seniors' Pharmacare Program and how those two programs interact.

Of course, there were a number of changes, the major one being the opportunity for seniors to pay their deductible, co-pay, over a more spread-out way, through a payment plan, which was asked for, again, by the Group of Nine. Anyway, there were a number of changes that were there that may have been a little more confusing than they should have been, but there was a bill that was sent out in error to individuals that caused the majority of that confusion. There were immediate steps taken to address that situation and to provide that solution to ensure that seniors could leave a message and have their calls returned.

There was just no way that we could take the volume of calls that were coming in, so we did set up an answer system, which I know was difficult because, in my experience anyway, it's very difficult for a senior to leave a message. They want to talk to a real person

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and I do not blame them. So, anyway, we did set up that program, we were able to take those messages and get back to those seniors as soon as possible. I can say that no seniors were penalized as a consequence of the delay in contacting the program - and even if we heard of one today they will not be penalized because of the glitches that were in that system.

MR. DAVID WILSON (Sackville-Cobequid): I have to wonder why you didn't just say that in Question Period. I know this is a different atmosphere than Question Period - as everybody says, it's not answer period. So I'm glad for that answer and I hope you've learned a lesson - don't mess with our elders, they get upset, and they don't like changes. They want to know exactly where their money is going and how they're going to pay for it - and those changes affect them in a negative way.

One of the things about the Pharmacare Program that I did notice - there was a big change - was the fact that if they do pay their premium fully, they're not going to get any refund if for some reason they don't meet those requirements, right? So I believe that's different from the program last year. Is that a change that took place - even though they've paid in full, there won't be any refunds if they don't use their premium and their total co-pay that is required by them?

MR. D'ENTREMONT: Mr. Chairman, you know, this is a quasi-insurance program, so the dollars that do go into it do get used in paying for drugs maybe for other people if certain individuals don't use their total amounts. This was a bit different when it came to having to decide at the beginning of the year, you know, looking at your drug utilization over the last year, and if you spent over that amount, your total co-pay, which of course it was capped at $300-odd, $390 or $380, whatever that number was, you could make a decision and say I want to pay that monthly as well - but you had to guess, and if it turned out you made that decision and you didn't use up to that co-pay amount, those dollars would not be refunded to you and they would go into the larger pot for that program.

But, Mr. Chairman, I can also assure the member opposite that those changes were not done without a lot of consultation with organizations, seniors' organizations - the Group of Nine to be more specific - and I can say that I took a lot of heat when I came into this department two years ago, when we didn't put the co-payment option in. I thought the Group of Nine were going to come after me and beat me to a pulp, but anyway it took a year, you know, it was a missed opportunity but ultimately it took us a year and some major planning and some discussions with our service provider to make that monthly co-payment option available. So I know it was difficult during that time, but I can assure, again, that no seniors were penalized because of that technicality or that glitch.

MR. DAVID WILSON (Sackville-Cobequid): I'm glad to hear that, Mr. Chairman, and Mr. Minister. Now, quickly, to an issue across the harbour here - Dartmouth General, fifth floor, vacant. How is this? I think they have boxes in there and stuff, and one of the suggestions I've heard, and I hope the minister heard, was why not use that as a day surgery

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clinic where we could utilize an OR that's not being used over there, I believe - have a day surgery unit there and invest funds into a public system instead of, I think, taking the easy way out and signing a contract with a private clinic. Is that an option you're going to look at, Mr. Minister, in the near future, and hopefully we might see that?

MR. D'ENTREMONT: Mr. Chairman, I can say to the member opposite that it is hard to believe, it is hard to believe that we had a piece of infrastructure like that sit there since 1986 - I don't know, where's Darrell? Darrell was on the original board of directors, or the member for Cole Harbour was on the original board of directors that built that hospital - how a piece of infrastructure like that went unused for such a long period of time is absolutely incredible to me.

Anyway, what that really says is that - again we're talking about the master plan the Capital District will be providing to us, I'm hoping towards the end of summer, will incorporate what we want to do with that. The ideas that I'm hearing for that site would be - I think there are three options that are before us, and I like the surgical idea better, having patient rooms for maybe orthopaedic surgery, or what have you, available on that fifth floor.

But there have been some other discussions of just a basic in-patient wing to maybe even another addition of transitional care, or something like that, that you could utilize that floor for - and none of those options are cheap. The renovation or the set-up - I can't say renovation because there's really nothing there, but the set-up of that floor, I've heard numbers of about $4 million to $5 million in order to do that. So that would have to be addressed in the broader capital infrastructure requirement of Capital Health.

MR. DAVID WILSON (Sackville-Cobequid): I think we need to definitely move on that. It's such a waste of an opportunity to have a facility like the Dartmouth General where we can expand and provide more services, and provide services that we need to look at changing and moving from the old VG building.

I know I only have a few minutes, so I want to end my time here today - and, as I said, the member for Halifax Needham will pick up in our next allotment - around an issue that I have mixed feelings about, and that's the decision of the government to fund Avastin. The reason I have mixed feelings about it is I think it's great for the people who have been struggling with cancer here in this province, who have been prescribed Avastin and had to make that difficult choice to either pay out of their own pocket or go without, and the reason I want to bring this up at the end is because we had people come forward who are in those difficult situations. Blair George and his wife, Marlene, who is fighting cancer, and they have spent a large portion of their life savings to fund that drug, came forward after, I think, they realized a couple of other advocates, who put a face on this issue, passed away in the last couple of months.

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One, of course, is Jim Connors, who passed away last month, who was a strong advocate, not only for Avastin, but for cancer care, sitting on the board for the Canadian Cancer Society. Here's a gentleman who didn't need to worry about the choice of paying for Avastin, he had the means. He said that: "I can afford it." He paid for it. It extended his life, I have no doubt, talking with him over the last while, and I know our Leader had talked to him so much over the last year, two years, about this issue. He was able to pay for that, but he advocated on behalf of those Nova Scotians who couldn't pay. People like Judee Young who was a nurse here in our province, was a health care provider and she made the difficult choice not to bankrupt her family to pay for Avastin. She lost her life just over two months ago.

And that's why I have mixed feelings about this. I think it's so important we recognize people like Judee Young and Jim Connors and Marlene Blair who were fighting every day. All we got from this government for the last two years was that we can't do it, we won't do it, we're not going to do it. Now, today, we see that this budget has that in it and I'm glad to see that. We will never know if Judee Young had received that drug, if she would still be here today for her family, especially her nine-year-old son. (Applause)

MR. D'ENTREMONT: You know, this issue has not been easy for me either. It's one that - we try to make the right decision on behalf of everyone. We talked earlier today of the complexities of health care. There are a whole bunch of different treatments that come before us on a regular basis that have hope, that have some kind of benefit to patients, and it is really hard for a minister, for a department, to try to look at some of these things objectively when we know that we are trying to do the best that we can with the dollars we have and the services and information that we have.

I would have liked nothing better than to have said yes to Avastin two years ago, but the expert panel that I have to trust, that provides the information to us - which was made up of public members, it was made up of oncologists, it was made up of a specialist - had said that this drug does not provide the benefit that people are saying it did. One of the toughest decisions I think I have ever had to make as a member of government, as a human being, was to say no to that drug. My heart breaks every day when somebody brings up the name Judee Young or brings up the name of Jim Connors. I hope today that at least this fixes that issue - it doesn't fix it for them, but it will fix it for generations of people to come. I hope that we do have a better appreciation for trying to get some of these drugs through.

I thank the committee, because they had to make a tough decision as well. They knew what the public pressure was, they saw the human face that was on this one and I just want to say that I'm glad we were able to bring it forward here. I would have been much gladder, much happier, and much more able to mend that broken heart that I had by saying no to it, to be able to provide that a couple of years ago. I want to thank the member opposite for his intervention on that one.

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MR. CHAIRMAN: Order, please. The time has expired for the NDP caucus. We will take a short recess for two or three minutes.

[11:29 a.m. The committee recessed.]

[11:32 a.m. The committee reconvened.]

MR. CHAIRMAN: Order, please.

The honourable member for Preston.

MR. KEITH COLWELL: Mr. Chairman, I am going to share my time with my colleague, so I will just be quite brief on my questioning.

I have a couple of questions about doctor recruitment. I know it has been a real big issue in the rural areas for some time and I know that the minister has been working to try to alleviate that problem and it is very complex. Unfortunately, the problem is starting to spread to HRM. We have a medical clinic in Mineville that now has experienced difficulty getting a doctor. Now this was unheard of until just now. The patient load is increasing every day as the population increases in the area and we are having a real big problem getting doctors in the area. What programs are in place to assist someone in the area here, where there hasn't been a problem before for doctors recruitment?

MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his question. What we are finding is that we don't necessarily have that doctor recruitment issue in the urban cores. Mineville, even though it is not so far away, would still be qualified by those in the urban core as being rural, you know, kind of. I know it is only five miles away but it is not in the core. What we are finding is that because of the availability and the proximity of a trained hospital, the availability of the university nearby, that some of the new physicians don't want to wander so far away from that kind of expertise to help them in their clinical decisions.

I think it really, in some respects, has a direct relation to the way doctors are being trained today. They need to have everything fancy around them. They work in a team, they work in a group. The thought of going to work as a private practitioner, a family practitioner, in a rural-ish area - we will call Mineville rural-ish - so we need to really focus on doctor recruitment as a whole. That's why I think we have this challenge in the more rural areas that we continue to talk about, why don't you spend more time and more effort on recruiting for places like Digby or spend more time on recruiting for places like Tatamagouche. What we are trying to say is, we are trying to be fair and even across the board in our recruitment strategies.

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Just to give you an idea on our physician recruitment lately, DHA, and we will talk about CDHA, there were eight family practitioners recruited in 2007-08, so you would hope that maybe one of those eight would end up in a community like Mineville. You can't necessarily force them to go there but maybe we need to find some kind of incentive locally for that area. There were 25 specialists recruited to the CDHA for a total of 33 physicians in last year alone. Out of those, there was one CAP physician, so one international medical graduate who came to the area.

So, again, it is just trying to be general for us and then you will have the district health authorities themselves trying to make that decision on where they would like to place those physicians. Maybe we should have a discussion with Capital District to see what their plans are for a community like Mineville.

MR. COLWELL: Yes, and I appreciate the answer on that. It's a serious issue and it's to the point that the community may be in trouble with not having enough doctors in that clinic down the road - hopefully that isn't the case - and the recruitment has been quite a problem. Fortunately for the area, the area is an incredible place to live and you're only a few minutes from the hospital so that is a bonus, but if we're having that kind of trouble in that community, we're going to have a huge problem in the really rural areas where it's not so close to things because a doctor today wants to not only be tied in close to the hospital, which is important, but also when they're not working, it's nice to be able to go to the theatre or do whatever else you want to do in your recreational time, and have everything available in a community like Mineville.

So it's a real and serious concern and one that hopefully doesn't become a long-term concern but just a short-term thing. So anything that we can do to help resolve that, I would appreciate it and I wouldn't mind talking to the minister about that at a future time when we're done this to see what we can do to help in that community. I can give you more details which I don't want to really discuss here.

MR. D'ENTREMONT: Again, thank you very much for that intervention and, as well, the other thing that we are seeing is that a lot of physicians who are coming to Nova Scotia to practice, of course, come with a family or come with a spouse and that spouse tends to be a professional as well, whether it be an accountant, whether it be an engineer, and sometimes it's very difficult for that spouse to find employment in a rural area. So maybe, you know, not necessarily specific to your instance, but maybe it's an opportunity in your instance as well that there are other options for that spouse as they come to practice here in Nova Scotia. So, thank you, and I look forward to that information and that chat.

MR. CHAIRMAN: The honourable member for Kings West.

MR. LEO GLAVINE: Mr. Chairman, I know we're moving along through estimates and I was in the Red Chamber when my colleague, the Health Critic for our Party was asking

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his questions. So I hope I don't engage in too much redundancy but there are some questions that I would like to put to the minister. First of all, I want to thank the deputy minister for the occasions through the past year, both at the Public Accounts Committee and also in correspondence and calls, for her promptness and frankness in the issues that I've raised with her and, as well, I welcome staff here today.

To start off with, probably the issue that is most pronounced in my own community of Kingston-Greenwood-Middleton and surrounding area, we know that the beds at Valley Regional and those that support them at Middleton and Annapolis have really experienced an enormous period of 100 per cent occupancy for some time. So in the last few weeks, to lose four beds on the medical ward at Soldiers Memorial has definitely caused some alarm in the community and among the staff at the hospitals, particularly the nurses whom I've spoken with. At this point in time, it definitely looks like a shortage of nurses, nurse fatigue and so on, that brought these beds to a closure. So I'm wondering if the minister could speak to that in the hope of returning those beds to active service.

MR. D'ENTREMONT: Mr. Chairman, welcome to the discussion on the estimates of the Department of Health to the member for Kings West. There are a couple of things going on in the Valley, of course, the redevelopment project at the Valley Regional I think will help with some of the pressures that we have been seeing across the Valley with the hospitals that we do have in there. More specifically, I'm trying to find, do I have it over here, I'm just trying to find the initiatives that we have in nursing that we talked about in the province.

We are adding new seats to our specific programs across the province so one issue, of course, is the availability of nurses to begin with, to staff the different hospitals and wards around our province. So we are working on an expansion of hospital seats specifically within this budget and I can't remember, I know we had a document with some numbers here, but anyway (Interruption) Yes, the nursing seats again. (Interruption) Okay, 70, there are 70 new nursing seats in the province. Oh, yes, right there, you should always look down below your nose, 70 new seats.

So just to give you a quick rundown of the schools and the nursing program that they have and the number of seats that they have, St. F.X., of course, has 125 existing seats. They will not be getting an increase this year. Dalhousie has 135 seats and they'll be getting 25 new ones, to be training 25 new nurses, for a total of 160. Additional negotiations- apparently we're just ho