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HALIFAX, MONDAY, MAY 5, 2008

MR. CHAIRMAN: Order, please. We will continue with the estimates of the Department of Health and we have 26 minutes left from Friday.

The honourable member for Hants East.

MR. JOHN MACDONELL: Mr. Chairman, I want to thank the minister and his staff. It's nice to see you again, and I'm glad to have an opportunity to raise just a couple of issues, actually.

The first one I would like to ask about - last December, my sister passed away. Early on in her diagnosis for cancer, it was recommended that she take a prescription chemo and they paid for that, she and her husband. It wasn't cheap. I would like to know why is it that if you go to hospital and receive chemotherapy you don't pay, but if you get a prescription you do pay. This seems to me to be kind of blatantly unfair, so I would like to have some explanation of the government's thinking around why it is that people who require chemo through a prescription can't have that paid for, as anybody else would. That's my first question.

MR. CHAIRMAN: The honourable Minister of Health.

HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, it's a pleasure to be back in the House after rushing all the way from Yarmouth where I did a Rotary Club luncheon, so I apologize for maybe being just a smidgen late.

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My condolences to the member for Hants East and his family on the loss of his sister. I know anyone who had the experience of dealing with cancer with a loved one and, of course, losing them, is an absolute tragic event. From all my family, it is definitely my condolences to you and yours.

The issue of oncology drugs have normally been the issue of IV and being able to administer that IV drug in hospital versus an oral drug in the community. Oral drugs, as far as I understand, across Canada have never necessarily been covered as a treatment, yet there have been a couple of programs that we are looking at at this point. Of course through the Family Pharmacare Program, individuals will have the opportunity to be caught by that kind of program should they fall ill and require some kind of oral oncology drug.

The other thing is that we are going out there right now and looking to see if there is a way to offer oncology drugs in the community beyond this, because we feel that the time has come where some of the treatments are different, some of the things have changed and we really need to get out closer to the community when it comes to oncology drugs.

The other issue with it is sort of the palliative side of oncology, especially when it comes to the palliative care program. That palliative care program would also cover, we hope, and seriously look at the covering of - what do they call it? What kind of oncology is this when you are in a palliative stage? - palliative stage oncology, so it is more of a comfort issue than it is a true treatment issue.

MR. MACDONELL: Thank you, Mr. Minister, for your kind words. I appreciate them and I know my family would.

I guess I would like a little clarification on when you say a couple of programs that you are looking at - I just wonder if you have any notion of how those are defined or if you have them defined at this point. The case of the drugs that I am referring to, they were bought early in the treatment stage, not at the palliative stage, so they were certainly in the anticipation that they would have a more positive effect.

When you say oncology drugs in the community, are you referring to the similar notion to dialysis offered in the community, somewhere where you would get chemo by IV in the community? Is that what I understand you to mean? And I guess that is question enough until I get an explanation of that.

MR. D'ENTREMONT: Mr. Chairman, basically two programs that we are looking at at this point, which is of course the palliative oncology, being able to offer that kind of drug in the community because a lot of these individuals cannot make it back to hospital or it's very difficult for them to travel back and forth. The other program would be the Family Pharmacare Program itself, which would cover oncology drugs if they get into a situation like that as well.

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[5:00 p.m.]

MR. MACDONELL: Thank you. I guess if you're looking at a program through Pharmacare - have you got a price tag on that? Do you have any notion of what people will spend generally, out of their pockets, in the province? I know it's not a static number, from year to year it would vary, but I just wondered if you have any notion of roughly what the cost of that would be.

MR. D'ENTREMONT: From what we understand at this point - we're not too sure of how much drugs are being bought outside the hospital system, just for the virtue of many of these individuals having private insurance and are booking it that way- there was a pilot project, I believe, in the northern region, which was looking at trying to find ways to cover these individuals, and so they might have an idea of what those numbers are, and what I can do is try and get some of those numbers together for you to have available.

MR. MACDONELL: Thank you. I remember the debate around OxyContin in Cape Breton and one of the issues was around a system of tracking, so someone couldn't go get a prescription - it would come up online and you would know they had already gotten a prescription somewhere else. I guess my question would be, if you have a system like that in place, or whether you have a system like that in place, so you actually would have data to know what physicians are prescribing and therefore would have that kind of information at hand - is there a system in place like that?

MR. D'ENTREMONT: There are basically two programs that we're looking at at this point. There is, of course, the Prescription Monitoring Program which would look at mostly painkillers, pain management-type drugs like the OxyContins - even Tylenol 3 would be covered under the Prescription Monitoring Program. So we do have an idea what kind of prescription levels and amounts, and those kinds of things would be available for that kind of drug.

We still don't have, necessarily, an idea of the oncology-type drugs that are administered orally. We could probably get that information fairly quickly, but we don't have that available in our documents right now.

MR. MACDONELL: I want to say thank you. I'd be interested to know, as time moves on, where you are with that and what kind of numbers you get. But it is one that I want to encourage the government on, I think there are, obviously, people who would benefit from that. I just see two different worlds where people are paying and people are not, and it doesn't strike me as being fair.

Just a couple of things around issues in Hants East- the resource centre - I know the Capital Health District does the analysis on dialysis, as to where that service should go, so I want to put a plug in for the resource centre in Elmsdale. I have to say, we have 10,000

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people in the corridor from Enfield to Shubenacadie, Nine Mile River. If I were to look at the dollars spent in my constituency, compared to Tatamagouche area, which is in the same DHA, the populations are not comparable - certainly the northern region doesn't have a similar population. I don't begrudge them getting services and getting money from my DHA - I think if they can, that's a good thing - but it seems to be extremely disproportionate for the number of people in the area compared to my area, and so I certainly think I should be a voice for them.

Dialysis and X-ray are two services that the people on my community health board would like to see in the resource centre - and there may be a couple of others, but definitely those two are the two that keep coming to me. I'm not sure what your role is - well, I guess I found not much in terms of directing the DHA, but I'd like to know around the analysis of dialysis in the Capital District how they determine where dialysis will go and where it won't go, and if you have any comments around X-ray that will be fine - after that I'll hand off to my colleague.

MR. D'ENTREMONT: Mr. Chairman, basically we look at two different things when it comes to the Hants East Clinic, dialysis of course, number one. Dialysis has been a bit of a challenge to make sure that you have the most appropriate service in the right place, trying to project forward the amount of diabetes versus the amount of renal disease. We do have basically three programs in the province, of course the main program here administered by Capital Health which does have remote clinics in places like Antigonish and down in South Shore, at Liverpool, and Yarmouth has its own program and Cape Breton has its own program.

So we need to better appreciate maybe what a smaller unit might be able to bring us, if there's a way to administer that kind of service in a smaller way. The guidelines that go with dialysis: a good clean water source; good sewage so that the water can be treated correctly; and the availability of the correct type of nursing care available at that place. It's not necessarily difficult when you have those three things, but we just need to make sure the demand would keep up with it.

We do have some other outlying areas that are underserved that we need to seriously look at as well. Places like in Richmond County, we have people basically driving from Arichat to Sydney, and that doesn't seem right to me either, so we need to find a little more economical way to do it. Of course Antigonish, and the comment my deputy minister is writing to me is that Antigonish is a full program really. It was a pilot to test the placing of services in other locations and doing it in a different way, and basically having the staff in Halifax oversee it, or provide that kind of oversight for it rather than having them on-site.

I think it's working very well and I think you can probably ask the member for Antigonish about how well that program has worked for his area, and of course all of the surrounding areas too, so it's definitely a consideration.

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What I can probably do is there's a really good presentation that the dialysis group has done looking at the projections in the areas for people, so I wouldn't mind sharing that with you as well.

When it comes to Hants East and other services, you look at the growing populations close to HRM, of course Sackville and in those areas going up to Hants, and there's a little bit in South Shore, but not quite as much - there has been an appreciation for it in this year's budget, there's about a $0.5 million of operating dollars going directly to the operation of the Hants East Clinic.

MR. MACDONELL: Thank you, Mr. Minister, and I'll hand it over to my colleague from Shelburne.

MR. CHAIRMAN: The honourable member for Shelburne.

MR. STERLING BELLIVEAU: Mr. Chairman, through you to the minister. I take the privilege of having the opportunity to ask the minister this particular question - my first question in the House after being elected in 2006 was the question on the construction or the expansion of Bayside Home. I see the minister nodding and I think I just want to refresh the minister's memory that I tabled a design, a blueprint of a building that was scheduled to be built some 30 years ago - and that's growing as we speak - so we know that the plan was in place some 30 years ago and the people of southwestern Nova Scotia or western Shelburne County have been patiently waiting for this to be completed.

Also in 2007, I issued this particular press release, and I'll read a portion of it: "Residents got the impression by the Minister that Bayside was different and could happen faster because it was approved ahead of the current process to build new nursing homes. ... Earlier this year the Minister was interviewed on a radio call-in show in the southwest part of the province. He stated that people of Barrington could expect to see the earth move on Brass Hill in the Fall of 2007."

Well, Mr. Chairman, through you, the earth has not moved, and I know that the members observed in the last week, since this House has been in session, that the government has very frequently tabled a number of pictures. I would love to table a picture of Bayside Homes which I had the pleasure of taking myself over the weekend, and I can assure the minister, if he looks at this particular picture, that the earth still has not moved.

My question, Mr. Chairman, through you, can the minister give us an update and can he clarify, or just recognize the statement of 2007, and can he recognize the picture of this particular weekend - and an update on Bayside Home?

MR. D'ENTREMONT: Mr. Chairman, I would love nothing more than to be able to present a picture of Bayside Homes. Unfortunately, I cannot show you the construction at

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that facility at this point. I will give you an update on where it is in process at this particular time. Of course, just to sort of inform the rest of the House today, basically Bayside was an expansion of an existing residential care facility which would see the addition of thirty nursing home beds and ten in residential care facilities, for a total of forty beds. The occupancy date is still January 2010, as it always has been. The status of it at this point is a "Y", which means a risk at having a material change to scope, budget or timeline, or a little bit at risk - which means that a response sent on step-three functional program, continue to work on the schematic designs at this point, the geotechnical survey has been completed and sent to the design team.

So the issues and the risks, when it comes to the construction, addition of Bayside, is the facility needs to reduce initial capital budget. The first budget came in way above our expectations for that facility, so they've gone back for some further discussions to bring that number down to somewhere that is more on the average of the rest of the replacements and/or new constructions in the province. They do require our final approval on that staffing when it comes to the staffing budget, the number of people who will be serving the residents at Bayside Their final approval for the operational budget is still in discussion with the group. So there's still a fair amount of discussion going on right now in order to give the final go-ahead, but the occupancy itself has not changed - which is January 2010.

MR. BELLIVEAU: Mr. Chairman, at this time I would like to thank the minister for his response and I'll give my time over to the member for Pictou East.

MR. CHAIRMAN: The honourable member for Pictou East.

MR. CLARRIE MACKINNON: I am very, very pleased to have this opportunity to put a question or two to the minister. I hope to have some time a little later on - a little more time. I think I'm probably close to being a filler here, our time is running out.

The number-one concern - I want to address a couple of regional concerns, and certainly the number-one concern in Pictou County is the closure of the intensive care unit there. When there is a closure like that, the concerns are many and they are very justified.

[5:15 p.m.]

Now, I know that in the short term we are looking at some solutions and things are looking a little better there. So having said that, it's the long term that I'm addressing here at the moment. I would like to ask the minister, in relation to the new residencies announced in the budget, is there any way that we can look at those with a health authority being able to designate the subspecialty, or whatever, that those physicians could in fact- in the Aberdeen's case, internal medicine is very important and we don't know how may of those new residencies will result in internal medicine, so the question is, then, is there any way that a health authority has some kind of say in the direction of a residency?

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MR. D'ENTREMONT: Mr. Chairman, I wish all questions would be that easy - and it's yes. Basically what happens is there's a bit of a survey that goes on from the department in Halifax out to the district health authorities asking them what their requirements are. We, of course, always know what open positions are available in each district and we would, through negotiations, direct Dal on what kind of physicians we need. The unfortunate part that we've had in the last couple of years is that there has only been the availability of one internal medicine specialist at Dalhousie, and it concerns me that we do need to have probably three more, in my mind, for a total of four, for training across this province.

I do want to tell the member opposite some very, very good news that I learned on the way in from my meeting in Yarmouth. We are going to be opening the ICU a week earlier than we had originally anticipated. It will be opening on May 8^th. There is a long-term locum program in place, which is something happening sooner. I believe there are about three physicians who will be participating in that local program, so May 8^th - it will be actually a full week earlier than we had originally anticipated, and apparently the original mid-month date wasn't firm, that was what they were hoping for, so I can confirm to the House today that on May 8^th a long-term locum program will be opening.

MR. MACKINNON: Thank you very much, Mr. Minister, certainly the member for Pictou West and I were aware of that, but we of course weren't going to make the announcement, it was up to you to do that. So thank you very much, we are happy that Pat Lee and others at that hospital are doing an exceptional job in trying to address the problems that are there.

I have a concern about the sustainability of the orthopaedic program at the Aberdeen. There is a concern in the community about that. So my question: Is that concern justified, and is there adequate funding for the orthopaedic program at the Aberdeen?

MR. D'ENTREMONT: Mr. Chairman, I can assure the member for Pictou East that the dollars are there, available to that program to continue. The challenge that we've been having at that site, of course, has been the lack of staying power for the orthopaedic surgeons who are there. We are a tad short, I believe, on the complement there. I know the district is doing its best to try to recruit for that program and I'm sure, knowing their successes in the past, they will be successful in recruiting another orthopaedic surgeon there.

MR. CHAIRMAN: Honourable member for Pictou East, you have approximately two minutes.

MR. MACKINNON: One additional question, I have a couple others, but I probably only have time to get one additional question in. Two years ago, there were between 16 and 18 seniors in the Aberdeen Hospital awaiting a long-term care facility. Right now, as of this morning, we are looking at 28, and the number peaked a couple of weeks ago at 32. So 30 per cent of the beds at the Aberdeen Hospital are being taken up by seniors, and that's

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through no fault of their own, certainly. My fundamental concern is that we are dealing with 89 units at the Shiretown, which are going to be replaced with 89 units in two facilities - for a net gain of zero - and I believe that that is fundamentally wrong.

We need more units in Pictou County. The population is aging. Some of the patients who are in the Aberdeen Hospital awaiting the long-term care facilities are, in fact, people who have been there for eight months or more. In one case we're dealing with a person who has been there for two years - now that is a special circumstance and that person actually needs security at the door of that unit.

I feel that this is fundamentally wrong to replace 89 units . . .

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

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. Good afternoon, Mr. Minister and staff. I will just sort of forewarn you right now that I'll be jumping all over the place. I don't mean to have you leafing through your booklets, but that's just the way it's going to go, everything from wait times to midwifery to long-term care. We're going to bounce around for the next hour.

Let me start by asking this, Mr. Minister. Mr. Chairman, concerning the issue of midwifery regulation, the Midwifery Regulatory Council specifically. I note in the Budget Address there is $200,000 set aside for that council. I was wondering whether the minister could please confirm as to whether or not that expenditure is included under Primary Care Initiatives, Page 14.7 of the Supplementary Detail.

MR. D'ENTREMONT: As Allan searches for that, I will take on the member for Pictou East on his comments for the area. Throughout the province there are a number of individuals, of course, staying in the homes close to Pictou, close to New Glasgow, who deserve to be in places closer to their homes, which are Truro, Colchester, the Amherst area and Cumberland, et cetera. Once those homes are built, by 2010, those individuals will be moving off and opening up a fair amount of beds in the Pictou area. So there is a balancing effect in the first round of beds.

The issue of midwifery - I thank the member for his question - is one that we're getting dollars ready to basically start, I believe it is three pilots across the province in order to hire, full time, the approximately six trained midwives that we have in the province.

I know Allan is still searching away here to find out where the dollar amounts are put. We know the hiring is under Primary Health Care so we'll just dig a little further to see exactly where they fit in the budget. Again, we'll be hiring as a pilot, the six midwives to

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basically work within those districts, to make them aware of what a midwife is, how that person would integrate into the health care system, especially when it comes to child and mother care, when it comes to pregnancy.

MR. DAVID WILSON (Glace Bay): I'm not sure, Mr. Chairman, I think the minister is saying you are going to answer that at another time?

While you continue to dig, then, let me give you an indication of what I'm looking for. I'm looking for you to elaborate whether those funds are going to be used actually for the transition of midwives into the health care system, or is that money going to be used solely to establish the regulation council for midwives in the province.

MR. D'ENTREMONT: Basically there are two amounts in here somewhere - the $200,000 is to help establish the College of Midwives, which will receive the regulation and the disciplinary issues when it pertains to midwives. There are some extra dollars in there and I believe they would be fitting under the Districts and Primary Health Care on the hiring of those individuals into the health system in those areas.

MR. DAVID WILSON ( Glace Bay): What I'm looking for, Mr. Minister, then, is how much of that $200,00 is going only for the council, how much money has been set aside to introduce midwives into our health care system? You said the six midwives? How much is that going to cost to introduce those six midwives into the health care system?

MR. D'ENTREMONT: Mr. Chairman, as I said, we'll be setting up three pilot projects. The districts are bidding on those three pilot projects. We figure it will be an extra $0.5 million in order to integrate those midwives, as they stand, into the system today.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, that $0.5 million then, that will be used specifically, and only once, for the introduction of those six midwives? Does that mean that we will see midwives practising in this province this year?

MR. D'ENTREMONT: Mr. Chairman, if everything goes the way it is supposed to go, and when it comes to the final approval of those regulations, the final proclamation of the Act, we think that's happening at the end of November or December. At that point there should be six midwives working full time in the system in Nova Scotia.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, this is May - could I ask the minister why it is going to take until the end of the year to make that a realization?

MR. D'ENTREMONT: Mr. Chairman, of course, through the advisory committee, which is the set-up committee for the college, which of course is made up of a number of different professionals, including midwives, want to make sure that the regulations are complete. We don't foresee the regulations, and this is between the college lawyer and, of

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course, our lawyers, to make sure that all the regulations are in place, so that when the midwives start, they will be covered by those new regulations and by the Act.

We feel - and I'm maybe giving too much time to this- but we don't think that's going to be available until December.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, let me change the topic a bit, then. Again, on Page 14.7 of the Supplementary Estimates, I note that there is no money that is set aside this year for pandemic planning. I'm wondering, has that money been rolled into another budget item?

MR. D'ENTREMONT: Mr. Chairman, the dollars would basically be in administration. Of course, as I probably said, if it was on Thursday or on Friday, we talked about the new emergency planning unit that we've set up in conjunction with the Department of Health, the Department of HPP, and the Department of Community Services, which is being headed up by Commander Russell Stuart, Retired, and I believe those dollars are under our administration headlines.

MR. DAVID WILSON (Glace Bay): Mr. Minister, how much has actually been set aside, in total, for pandemic planning? Let me give you a couple of questions here. If, whatever that amount is - how much, if you're indicating that you're allocating money for pandemic planning to district health authorities, then how much for each district health authority and, if that money is going to the DHAs, is that money portable; in other words, can that money be used for things other than pandemic planning?

[5:30 p.m.]

MR. D'ENTREMONT: Mr. Chairman, simply put, there are a couple of places you would find pandemic planning. One, of course, through HPP, the vaccine side of pandemic planning, and of course the rest of it would be - well, three places: one place under the emergency planning unit through Community Services; and Health; and the districts themselves, through their business plans, have dollars attached to it. I don't have those dollars available to me right now, but I could have them available to us in the next number of days.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Minister, that would be much appreciated. I would hope, anyway, that there would be a fair amount that is allocated for this, given what happened with the outbreak of mumps in the province and so on. We know that we have to be a little bit better prepared and, in order to do that, of course you have to provide the funding that should be there.

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Let me switch to another topic, the one of wait times, Mr. Minister. According to the Budget Speech, there was mention of a chief executive of wait times improvement. How much is going to be spent on that position?

MR. D'ENTREMONT: Our executive director of wait times improvement, there is so much going on in that realm and, of course, the importance that this government has put upon it - it is basically a contract with an individual for $120,000, plus benefits, plus office space and all those things that would go along within the department. So those are the dollars that are attached to it at this point.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, specifically with that position, number one, where is it in the budget - where is the money in the budget for that position? Let me add a few more questions: Has that person been hired; how long is the contract; what were the qualifications for that person; and what exactly is it that person is expected to do?

MR. D'ENTREMONT: Mr. Chairman, I apologize for taking a little time to make sure I get all my facts straight here. It is a five-year contract; this individual comes with a nursing background; and she was also VP of an international consulting company. The individual's name is Nancy MacLeod, and I believe she has started in the department within the last number of weeks in order to try to organize the whole issue of wait times in the province.

MR. DAVID WILSON (Glace Bay): Mr. Minister, one could, I guess, if one looked at it in a particular way, spending that much money on an administrative position to try to improve wait times might lead one to ask some of the following questions: How can we be assured that that position, that person is actually going to do something to improve wait times in this province? I am left to kind of wonder, wouldn't it be more efficient to work with the physicians, the specialists and other health care providers to ensure that improvements are there in wait times, rather than simply adding what is going to turn out to be another very expensive administrative position?

MR. D'ENTREMONT: Mr. Chairman, as the member opposite is aware, we have been spending a lot of time and there are a number of dollars allocated, some federal dollars allocated to wait time improvement in this province. There are a lot of complexities when it comes to wait times and therefore requires the dedication of an individual and of our project office.

Mr. Chairman, I can say that my deputy minister, the executive director of acute and tertiary care, my CFO, are incredibly able and talented individuals, but they cannot organize the whole wait times issue because of the complexity within it. I think the dedication of an individual who can work across the system, work with physicians, work with district health authorities, work with everything that's involved in order to make wait time better, I think it's very important to have a true leader in that capacity.

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MR. DAVID WILSON (Glace Bay): To a certain extent I agree with the minister. I understand where he and his staff are coming from, but to the ordinary Nova Scotian who is walking into an emergency department and waiting or whatever, if I were to tell them that we've just hired another administrative person to be the chief executive of wait times improvement and we're paying them $120,000 a year, that wait times are going to get better, don't you worry about it - I would think that I probably wouldn't be able to convince them that's going to do anything to really improve wait times. It has nothing to do with the individual you've hired, her qualifications or anything else, it's just that it would appear, on the surface anyway, that another administrative position is going to be the be-all and end-all of curing wait times in this province. We've learned in the past that is not the case.

I do have a lot more questions for the minister, but I did want to accommodate my colleague for Preston who has some more questions that he would like to get in at this time, so if I may, Mr. Chairman, turn it over for the next whatever amount of time to my colleague from Preston.

MR. CHAIRMAN: The honourable member for Preston.

MR. KEITH COLWELL: I thank my colleague from Glace Bay for allowing me this time. It's very appropriate you're talking about administrative staff for wait times. It just so happens I had a lady in my office this morning who has been waiting for an operation at the Dickson Centre for a year. She's number seven on a list and has been number seven on a list for a year, and a specialist told her that they cut back the operating time in the operating rooms - and actually to come forward and see her MLA to see if anything could be done.

This particular lady is a 25-year survivor of cancer and she has called the specialist, she's asked for a cancellation, anything that she could possibly do to get this done. Now the growth she has is growing and they figure it's going to turn cancerous. This sort of wait time just isn't acceptable. It would be interesting to see - like my colleague says here putting more money into administration, maybe we should put some more money in the operating rooms and see if we can get these opened longer and get this forward.

MR. D'ENTREMONT: Mr. Chairman, before I go to answer that issue, I know the member opposite had been talking about cleanliness in hospitals, and I just wanted to table some of the information on the training that goes into the cleaners in each department in the hospital. It talks about how they clean, the frequencies, and days per week, et cetera. I just want to table that and maybe get a copy for the member for Preston.

When it comes to operating rooms, and this has happened within the last year, we were running in Capital District at approximately twenty operating rooms working on a full-time basis - there were approximately twelve that were not being utilized because the lack of anaesthesiology. Due to the hard work of people like Jaap Bonjer, Dr. Mike Murphy, we are at full complement when it comes to anaesthesia; we are utilizing all operating rooms in

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the district, which I believe is 32, on a full-time basis. I know that through the district they are catching up on an awful lot of that backlog and, hopefully, the member's constituent will be seen in a timely manner.

MR. COLWELL: According to my constituent today - and she's not an individual who comes forward and complains about everything, it's the first time I've actually ever met her in my office - she's very upset, and you can imagine anyone who has gone through cancer once and survived has a different perspective on life and what it means if you don't get timely medical care. She went through the whole process, has seen her family doctor, the specialist, everything is all set to go and there's no operating room time. From what the doctor's been saying it may be several months before it can be operated on, and the growth is now becoming very obvious and it's becoming a very difficult thing.

How many more people are in this situation? This is a very, very serious situation. It's one thing if you're going to get a knee replaced or hip replaced - you can live with that even though it's very painful. You can live with that, but if you are talking with someone who has had cancer in the past, possibly this will turn into cancer again, how can you explain to somebody like that that they can't get the treatment they need when they need the treatment?

MR. D'ENTREMONT: Mr. Chairman, I'm just conversing a little bit with my deputy about this one. As far as we understand, and working with our oncologists, we are within national standards - this one seems way off the national standard on wait times when it comes to some kind of oncological type of operation.

I wonder if the member could provide me with some information on that, then I can go and maybe look a little closer at that. There might be some situation or circumstance, that what that constituent needs is special, I don't know. It is not the norm that I've been hearing from the department when we track this information. So if the member could provide me with some of that information, I'd appreciate that.

MR. COLWELL: Yes, I'd be pleased to do that, out of this environment, of course, because I don't want to identify the individual we're talking about - as I know you don't want to either.

I want to thank you for the information on this cleanliness housekeeping service. It's interesting information, but in some hospitals I would suggest this is not happening. I would like to know, since I asked you the question on Friday, if the department has had an opportunity to further inspect some of the hospitals - this is a very timely thing - and if there has been anything done, or if staff has had any opportunity to, indeed, look at this and see what can be done to resolve this problem.

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MR. D'ENTREMONT: Mr. Chairman, I know over the last couple of days, as we've been in estimates discussing our budget, there have been a number of phone calls to the CEOs of each district, so they're very well aware of the discussion and I would hope that they are following up on some of the issues, as the issue the member brought up on Friday, I believe.

I also had the opportunity to check out, again, my hospital in Yarmouth. Of course we had a quick meeting with them this morning, talking about some of our broader transformative change issues, but I was also there for an EKG and because the member brought it up on Friday, I was sort of snooping around and looking around as well. So I know that our hospital is very well served, Mr. Chairman, but I know that the comments have been shared with the CEOs for them to followup on that.

MR. COLWELL: What exact plans does the minister have, or the deputy minister or the senior officials of the department have, to ensure that this is being done? It's fine to say that it has been followed up on - and I do appreciate that effort and I know you take this very seriously - what exact plans are going to be in place to ensure this happens and continues to happen properly and, indeed, when the patient goes in there the place is clean and properly cleaned.

Again, I stress, as I stressed on Friday, I don't believe it is the staff that is the problem here, it's the resources and the ability to get into the rooms to do the work. So if people can't get in there to do the work because they're overcrowded, or whatever the case may be - which appears to be with the wait times and everything, they're scrambling to try and get everyone looked after - what exact action plan do you have to make sure this is going to happen?

MR. D'ENTREMONT: Mr. Chairman, again, two things are happening in that respect. Of course it is, again, sharing that information with our CEOs to follow up and come back with a report to us on how their cleanliness is, maybe, and the other issue is providing it for checking from the Infection Control Committee - the Infection Control Committee in each district will be following up on the cleanliness of those hospitals. Also, the accreditation of a hospital depends on a lot of factors, including cleanliness, so we'll go and check up on that issue as well. So there are three ways that we can go at this one, and I can assure the member opposite that we will be addressing this one as quickly as we can.

[5:45 p.m.]

The issue of having people in - I mean we have two- person wards and we have three-person wards in most of our hospitals, and a lot of them in the new hospitals, of course, are single rooms. I know there are mechanisms in which to clean rooms even when there is a person in them - there are even ways to, of course, change linens while a person is in bed. I've actually seen it done and it's quite a task, but definitely something that is very needed

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in some cases, depending on how long an individual has lain in bed but, anyway, we will be taking that on very aggressively.

MR. COLWELL: Mr. Chairman, I'm going to turn my time back over to the honourable member for Glace Bay.

MR. CHAIRMAN: The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. Mr. Minister, on Page 24 of the Budget Speech, it indicates that your government is well underway to meeting the goal ". . . of a wait-time guarantee of eight weeks for patients needing radiation therapy with the help of Health Canada's $33 million." Could the minister then indicate whether that $33 million is for this year alone, whether it's spread over a number of years, and if this money is spread over a number of years, then which fiscal years and how much for each year?

MR. D'ENTREMONT: Mr. Chairman, again I was very happy to be part of the first province to sign on to a wait-time guarantee with the federal government. Just to give you an idea where the $32 million is going, basically $24 million goes to equipment and upgrading of the two existing oncology sites. Basically, when it comes to the construction of bunker design: the bunkers; the LINACs, or the linear accelerators; CT simulators, which is for Cape Breton, which I think is a cost over the next - well, 2007-08 there was a - okay, I'll list it off here. Over 2007-08, $156,000 was spent; 2008-09 there will be $1.9 million spent; and then in 2009-10 there'll be $2.2 million spent - for a total of $4,256,267 for the site in Cape Breton.

In Halifax, there will be bunkers; the CT simulator; the tomos - I have no idea what a tomo is; two LINACs; and other costs - bringing us to a cost of $16,453,014. This year is the first year that we'll be spending dollars on that, which is $4.2 million this year and $12.2 million next year. What we're also seeing is $8 million, of course, which is two pilot projects not particularly attached to the issue of oncology. One was $4 million for orthopaedics and the other was $4 million for radiology.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I'm wondering, could the minister indicate what the current wait time for radiation therapy is in this province?

MR. D'ENTREMONT: No, I don't have the particular numbers with me today of what today's wait time is. We know that we're within days of that guarantee, but we know that over the next three years, the incidence of cancer will increase. So, therefore, we need to meet the increase, not the list of today, but we need to meet the increase of 2010. So we know we're pretty close to that eight weeks right now and, you know, even with the extra added on, we will still maintain that six weeks.

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MR. DAVID WILSON (Glace Bay): Mr. Chairman, the Budget Speech went on to mention that there's a pilot project underway for diagnostic imaging. Could the minister elaborate on that pilot project? Where is it, how much is being spent and how long has that pilot been underway?

MR. D'ENTREMONT: Mr. Chairman, there are two projects in that, again, $4 million for diagnostic imaging and $4 million for orthopaedics. The diagnostic imaging is basically pertaining to a computerized program that primary physicians would be using to order radiological tests, basically inputting information on the patient, and the program would kick out the type of test that the individual should be taking, whether it be the difference between taking a simple X-ray versus a more expensive MRI, so it would be more appropriate in the tests that are actually happening. It is a program and a system that is approved by the Canadian Radiological Society.

Basically put - I'm just trying to look at the cash flow here - this year there was $465,000 spent. There will be $1.57 million spent next year, so that's 2008-09, and in 2009-10 there will be another $1.4 million spent for a total of $3.4 million.

MR. DAVID WILSON (Glace Bay): I note on Page 14.17, under Capital Grants, the monies allocated for Diagnostic and Medical Equipment have decreased by $12 million, estimate over estimate, and by $4 million, the estimate over last year's forecast, so I'm wondering if the minister could please explain that reduction.

MR. D'ENTREMONT: That is the leftover money from the FME or the Federal Medical Equipment fund. It is dollars that are fully committed, but the districts in the system have not been able to purchase or get that equipment on-site, so that's representative of the dollars that have come, three years ago, from the federal government.

MR. DAVID WILSON (Glace Bay): Did the minister say it was like a trust fund? Okay. I'm wondering if the minister has any idea of capital requests that are there from the district health authorities for diagnostic and medical equipment, and how does the budget align with those requests from the DHAs?

MR. D'ENTREMONT: We went out to the districts to find out the age and quality of the equipment that they have. We know there are some gaps, a lot of districts are making do with the equipment that they have. To be quite candid with the member opposite, the dollars in this budget are low when it comes to equipment replacement in the districts.

MR. DAVID WILSON (Glace Bay): If the minister is admitting the dollars are, as he put it, low, is he saying there's an actual reduction in the amount of dollars that are being spent on diagnostic and medical equipment? If that's the case, if the actual dollars are less, if the amount is low, then how, in the name of heaven, would you expect to reduce wait times

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if you're reducing the budget on diagnostic and medical equipment? How could you possibly accomplish any type of goal that you would set to reduce wait times in this province?

MR. D'ENTREMONT: The deputy is saying to me that a majority of the really heavy capital equipment has been replaced over the last number of years, so that leaves a lot of the smaller stuff, but they do need to be replaced. But the MRIs and the CTs have all been replaced in this province.

To the member opposite, I am given a grant of a certain tens of millions of dollars, in this case, in this year, it's $51.7 million, which takes in all capital requirements for the province. This year, we had to contend with some rising costs for construction, which included the extra dollars we had to put into the Colchester Regional Hospital, some of the extra dollars that we have to put into the emergency room here at the Infirmary site, and the rest of the construction is going on. Some of that construction and renovation doesn't include replacement of equipment, but they are held within the design and the plans for those areas.

MR. DAVID WILSON (Glace Bay): I want to stay on that topic just for a minute, because I asked the minister specifically for his opinion on how you would expect to reduce wait times in this province. If you're talking about some diagnostic equipment, whether it be the big stuff or the little stuff, it all fits into the area of diagnosing illness. If it's not there, if it hasn't been replaced and even if you are using some of that money that's there for capital projects and so on, you know you can have the bricks and mortar but if you don't have something inside of it, then there's not much sense in having the bricks and mortar, and you need that equipment.

So, again, to be realistic - and what I'm looking for from the minister is a realistic attitude or a realistic forecast of how much we can expect to see wait times actually reduced in this province. If you're dealing with a problem of a budgetary problem for wait times for diagnostic equipment and medical equipment, then you know, big or little equipment, that's going to affect the actual effect that you can have on the reduction of wait times. So realistic is what I'm looking for - whether it's a short answer or a long answer, a realistic answer of how much the minister expects his department is going to be able to do, for instance, for the rest of this year in actually reducing wait times in this province.

MR. D'ENTREMONT: Mr. Chairman, I'm trying to be as realistic as I possibly can be and as candid as I can be when it comes to wait times. Wait times is a very important issue for me. I do not want to see people waiting longer than any acceptable norm. We know immediately it cannot happen but within accepted norms, within reasonable times, people should be getting their treatments as soon as possible.

Mr. Chairman, I can say that under the $290.8 million worth of projects ongoing in this province today, which includes bricks and mortar, which includes new equipment, I can say that with the dollars that are expended to the district health authorities, which do have

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line items on some of the smaller equipment, that we will be well served this year in replacing equipment - making sure that also should a major piece of equipment go down, we will be replacing it. So there are dollars and pieces of money within our budget that are going toward equipment replacement. As I said, if anything major happens, we are going to be covering those costs as well.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I realize, I really do, that the minister is trying to be as candid as he possibly can. I realize the difficulty of the situation and the enormity of the situation as well. I realize that. But again, when we get to the basics of it all - and I'm sure the minister, as any other MLA in this Chamber, is quite used to hearing complaints about waiting for various aspects of health care in this province. When we talk about realistic goals, for instance, the minister has set a realistic goal that we should have a wait-time guarantee of eight weeks for those needing radiation therapy in this province.

We also know, at the same time, that if you're looking for such things as - there are some orthopaedic surgeries, for instance, that are requiring wait times that are not in the number of weeks anymore, they are over a year, whatever the case may be. We know that the minister has made some attempts to reduce wait times in some areas because we have recently had the introduction of the use of surgical suites at Scotia Surgery.

So, again, to be realistic and to set those goals, I'm wondering, if the minister has those plans, what are his goals specifically in this province to reduce whatever the area may be of wait times? Again, I know that area is huge, it's big, when we talk about wait times. To the average Nova Scotian, wait time can be whether or not they're waiting to get their hip replaced, how long they waited in an emergency room or how long they waited to get a doctor in their area. I don't know, actually, if that's a category, but I would place that in that category as well.

[6:00 p.m.]

What I guess I'm looking for is the minister to give us - not that he hasn't been candid and has been realistic - an overall picture of where he hopes, in the next year, the next two years, the next five years, that this province is going to be in terms of wait times, and how we can really take a good kick at those wait times that are out there and knock some of them down to a reasonable level. Ideally, to get rid of them so that we would no longer have wait times in this province, that would be the ideal situation but, realistically, to take a look at it and say, where are we going to be five years from now? Are we still going to be waiting a year and a half for some orthopaedic surgery? What sort of wait times are we going to have? I invite the minister in this case, again, to be candid, but at the same time let's hear those plans that you have, Mr. Minister, to reduce wait times in Nova Scotia.

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MR. D'ENTREMONT: Mr. Chairman, I appreciate the member's interest in this aspect of health. Wait times has been extremely complicated because you don't want to focus on one area at the expense of another area. So you have to do these things in a very coordinated fashion, which is why I think it's very important to have one person who is organizing, not 10. Really, in the department right now, I can count six people who are dealing with wait times in the province all on extra time over and above their existing job. So by coordinating this, I think it's going to make a big difference on us understanding where some of those bottlenecks are.

To the member opposite, you know personally, this is where I think we're going to be focusing our time. This is where I want to be focusing our time. Number one is orthopaedics, trying to find mechanisms in which to see individuals more quickly. I think, with the dollars available to us from the federal government, which is $4 million on the orthopaedics Web site, the orthopaedics patient portal, it will make a difference for patients so that they are more informed about that wait time.

The addition of an assessment clinic, I believe, will make a humongous change to the wait times in this province. As I said before in this House, we have been approached by a group basically out of Calgary that set up an assessment clinic in Calgary a couple of years ago. Basically all orthopaedic referrals go through that assessment clinic and are triaged accordingly, whether you need physiotherapy at the early stages of some kind of orthopaedic issue, whether you need major surgery or minor surgery, would be referred off to it.

What they found in Alberta is over half, somewhere close to half, of the people who were on this fictitious, unknown, wait list - because right there, there are probably five different orthopaedic wait lists in this province that become one - about half of those patients did not need surgical intervention. They needed extra pharmaceuticals, they needed some physiotherapy, et cetera. So I think by focusing on an assessment clinic and by merging those five or six wait lists into one, I think we could make decisions more quickly.

So that's where my plan is for orthopaedics, and also utilizing the surgery, the ORs as we have them today, again to the dedication of the individuals at Capital Health, of opening all those surgical suites and also the use of Scotia Surgery for some of those minor procedures. What we are seeing, if we can take 500 of those smaller procedures, those knee scopes, those little day surgeries, there are at least 500 persons-worth of more work that can happen during the allotted times in the bigger OR suites here at Capital Health. I couldn't wager what a guess would be in what kind of change it would mean to a constituent of mine or a constituent of the member for Glace Bay, but I know there will be some substantial changes beginning this year and hopefully getting better over the next couple of years.

If you take a wait list, I think they were saying somewhere around 4,000 people sitting on the wait list here at Capital Health. So that's just this service, and if you can take

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2,000 people out of that list and serve them more correctly and more appropriately without surgical intervention, I think we're going to go a long way.

The other place where I want to see some focus happen is, of course, our ERs. The waits that people are having at ERs, I know, Mr. Chairman, you have heard it quite often for the hospital in Yarmouth and I do normally use Yarmouth as a good example for things, but in this case I'm going to use it as a bad example. Waits, a lot of times, if somebody is sitting in the ER waiting for whatever it may be, if they are waiting more than a couple of hours, I don't think it's right. I do hear of constituents who are waiting eight hours, 10 hours or more in some cases, to be seen for minor issues - colds, flus, prescription renewals and those kinds of things. What we need to do is go back to our basics, as I've said before.

A lot of these emergency rooms began as out-patients. Out-patients were designed to treat the population of people who didn't have a physician, didn't have time to go to their physician, or what have you, and could be seen in a more structured fashion. You had another smaller group of people who needed the ER, so the ones and twos, if I can use the listing - I forget what the listing's called . . .

MR. DAVID WILSON (Glace Bay): The triage.

MR. D'ENTREMONT: Yes, the triage list, thank you to the member for Glace Bay. So we need to have two separate clinics and I think they need to be stacked in different ways to make those ER changes. I know in Yarmouth, there are a couple of proposals that are coming to us that would reinvigorate that, going back to the basics of providing a primary clinic of some kind to see the 70 per cent of people who are sitting there waiting for 10 or 12 hours.

Again, I know that's a longer answer probably than the member really wanted me to do, but my two focuses will be orthopaedics and ERs.

MR. DAVID WILSON (Glace Bay): If I may ask, Mr. Chairman, just how much time is remaining?

MR. CHAIRMAN: The honourable member's time will expire at 6:21 p.m.

MR. DAVID WILSON (Glace Bay): In closing on that subject - I know another one of my colleagues would like to ask you a few questions - on the subject of wait times and the minister was talking about ERs and so on. Unfortunately, in this province, one of the problems we face in wait times is that sometimes we're just on the edge of peril in health care. All it takes - my community is a perfect example - is one doctor to pull up roots and leave and you have a crisis on your hand of thousands of people who are left without a doctor. Those are thousands of people who are probably not going to find another doctor and thousands of people who are going to work their way into the emergency departments, in my

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area anyway, because there are no community clinics that are available to go to at various hours.

You have that instance and it can apply to a major piece of equipment breaking down as well. If that happens, then you have problems with wait times and so on. I understand the minister's - I don't like to call it a predicament, but I can understand why the minister might have some stressful moments in his career, as other ministers have had in the past.

I'd like now to share my remaining time with my colleague, the member for Kings West.

MR. CHAIRMAN: The honourable member for Kings West.

MR. LEO GLAVINE: Thank you. An area that the minister is familiar with, and perhaps all of us here in the House - I think the member for Antigonish was the Minister of Health when autism was a very, very major topic and concern for Nova Scotians and was brought to the floor here in the Legislature. Through committee work, it has become a line item in the budget.

One of the major pieces in that program over the last couple of years that has been rolled out - we all know there is still a tremendous need for the EIVI therapy. If we can intervene with children in the early years, then we know the results are much, much stronger. Inside of the mental health budget for this year, I'm wondering, Mr. Minister, are there some increases for that particular program? We know it's stronger in some areas of the province than in others, but budgeted amounts are going to be a critical part for the expansion of that service.

Currently, there is a lottery that is used to select children for this critical therapy which is proving, in most cases, to make immense improvements, immense gains, help children be much better prepared for school. So I'm wondering, Mr. Minister, is there some additional support for that program in this year's budget, inside the mental health allotment?

MR. D'ENTREMONT: Thank you very much. Mr. Chairman, I can say that this government was very happy to be in the front of the autism issue, the issue of getting the correct type of programming for these children. Approximately $4 million goes into this treatment of young children who are not yet in school, who have been diagnosed with autism spectrum disorder. The treatment program is now up and running in eight DHAs and, of course, at the IWK.

Just some stats here: to date some 116 children have completed or are currently involved in the program; there are approximately 75 children eligible for the program; and the children are randomly selected, alternately between two age groups, up to age four and five years old. This ensures that the eligible children have equitable access to this treatment

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program, as we currently do not have the capacity to see all of the children who would benefit from the program. What we are seeing is that as the program has evolved over the last three years, I believe, or four years, we're getting closer to being able to see all the children.

The dollars that are attached to it, and this is overall mental health, this is not showing the autism, so the autism program has not been increased, it still maintains its $4 million. The increase in mental health services for the districts, in this particular case, is up by $10.1 million.

MR. GLAVINE: Thank you, Mr. Minister. I asked that question because we know there are many more cases across the province than treatment is able to be provided for. I got quite an insight to this just as late as Friday, in meeting with the Superintendent of Schools for HRSB. They have 50 children identified on the autism spectrum disorder who will come into their school system this September. So I raised the issue for that reason and that just really highlights, now, how extensive the children are on some part of the autism spectrum scale, I guess measuring from one to 12, in terms of its severity.

One of the issues that has come to my office and in dealing with VAS, the Valley Autism Society group, is again, general practitioners who don't have the expertise and the background for the earliest identification. I know that it's a professional requirement on physicians to do so many professional development modules through the year.

I'm wondering if the department has, or is looking at, any professional development for the physicians, in conjunction with Doctors Nova Scotia.

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. We haven't necessarily gone down that road, even though I think we might be able to do it now because there are a number of trainers out there who can inform physicians on what to look for, what to deal with, and those kinds of things. So I think this is maybe something that we can take under advisement, to see if we can enrol something like that, some kind of continuing education program for physicians to make them aware of the issues surrounding the program and, of course, children suffering from autism.

[6:15 p.m.]

The other issue that has been becoming more the voice of the advocacy groups really has to do with transitioning youth out of school into appropriate support and services in the community. So we're sort of - I think we've sort of got the right program going on for the younger children and making them more available and more appropriate for the school system. What we need to work on now, as those children age and get through the system, is to be able to find mechanisms to get them into the community and be citizens who have something to offer to our communities. So that's where I think the advocacy groups are going.

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The other issue that I think is very good and is the result of recent changes with the diagnostic process at the IWK is that the wait time for diagnosis has decreased considerably. So you know sort of one of those things that as you start going down a road, you learn a lot more and you can do more good. So to the member opposite, I think there are many more things that we can do, but I think we're on the right track when it comes to this program.

MR. GLAVINE: Thank you very much, Mr. Chairman. During the committee meetings of Community Services in November 2007, all members of the committee supported the concept of a working group. If I take just a couple of the areas talked about here today and we talk about the need for an expanded EIBI program for speech pathologists, occupational therapists and so on, to work with these children, even when they're attending school, there are a whole number of issues that are not addressed.

We're now hearing more and more about the needs over the life cycle of these children and needs for those who did not get any help when they were young, through intensive behavioural therapy. So those children are now going through school or post-school and a working group would help to identify even just an actual number of children to adults who do have the autistic spectrum.

So working groups in the past are in no way to diminish or to say there are some neglect or deficiencies with the department. I know the kind of work and the leadership that Patricia Murray has brought to Autism Nova Scotia. But by having a working group that spans out across the province, there is indeed real value in what they can bring to Autism Nova Scotia, for pointing out areas that still would need considerable work.

So I'm wondering at this time, is the minister doing some reflection on the value and the need for that program in the coming months and years?

MR. D'ENTREMONT: Thank you very much and to the member for Kings West, I think we continue to reflect on all our programs, to make sure that patients are getting the best services they possibly can.

I think within this one, I think the challenge of a standing committee or a working group is sort of the size of it. Right now the committee is made up of professionals and psychologists, et cetera, from the districts who work together. I just want to read through - the working groups include working groups from DCS and DOE. There's a physician group, there's a families group, there's an advisory team and an EIBI implementation management team. So there are already a number of people in groups working on autism disorder in this province.

In my mind I don't want it to get to be too big and cumbersome. I think they're being reactive and working very well. But as needed, we can pull the expertise of each group together and sort of do the same thing that a broader, larger group would be able to do. So

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I just don't want to - governments tend to over-study things and over-analyze things when it comes to a disorder like this one. So I want to keep this group as reactive as we possibly can.

MR. CHAIRMAN: The honourable member for Kings West has one minute left.

MR. GLAVINE: Thank you, Mr. Chairman. One last question and I'll just give the minister 25 to 30 seconds for a comment here. In the community health boards there are wonderful initiatives, but isn't it the Department of Health that gives them some of the directions or are they fairly autonomous to the communities in which they exist?

MR. D'ENTREMONT: The member opposite underlines a very important piece to our system, which is those community health boards. Those community health boards work in concert with the districts, which is where their responsibility lays. We're pretty much hands-off when it comes to what the districts, or what those community health boards, will be working on, what they won't be working on. So they have a pretty free hand there but, of course, they still have to do things within reason on the needs and the requirements of their communities and their districts.

MR. CHAIRMAN: The honourable member for Queens.

MS. VICKI CONRAD: Mr. Chairman, I want to focus my questions around the need for a palliative care strategy in the province. I recognize that some good news came out of the Minister of Finance's budget the other day when there was recognition for a palliative care coordinator, for the province, to look at all aspects of the current system and to help ensure that families do receive compassionate care for their family members who are facing their end-of-life care. But I'm more concerned about the fact that there really is no provincial strategy that enables all Nova Scotians to effectively have end-of-life care for their loved ones and certainly the care that's needed for families as they sit with loved ones through those very difficult moments.

We certainly do have palliative care initiatives, across the province, that many groups and organizations have taken upon themselves to deliver that much-needed service in communities. Certainly some of the DHAs and hospitals are recognizing, and have recognized, the need for more access to palliative care and that's a good thing. Certainly we see some nursing homes that have taken up the challenge of offering palliative care services to members of the community and, of course, the VON and home care also work diligently at ensuring that those services are in place in the communities but, unfortunately, what has happened is it has become a patchwork of care across this province.

For many Nova Scotians, it has become very difficult to accept a patchwork system that may or may not be in place for them, for their loved ones, as they're struggling with their end-of-life care. Sometimes Nova Scotians are looking at palliative care in a hospital

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environment and perhaps their wish has been to have palliative care at home but, unfortunately, the palliative care service at home is not available to that particular person in need and so, therefore, their wishes, their last wishes, are not being met. What happens is not only does that place a lot of stress on the person in their last days, but it's also a huge stress load for the families sitting with loved ones and working through all of the issues that are facing someone in their last days.

So my question for the minister is, with this palliative care coordinator looking at all aspects of palliative care across the province, will this coordinator be piecing together the missing components to that strategy; will that coordinator be working with the DHAs, the VONs, the home care folks, the private agencies out there that are delivering much-needed palliative care; and most importantly, will the minister be looking at furthering not only the scope of practice for this coordinator but also putting much-needed financial resources into a full, provincial palliative care strategy for the province so that all Nova Scotians are getting the care they need in their end-of-days life, and also a comparable care across the province so that, you know, someone from my community can receive the same care as someone in a neighbouring community and so on? I think that's what's important, Nova Scotians looking for the same type of care opportunities and the same sort of access to that care.

As we all know, people who are living out their last days need to have that care, that compassionate care. They need to be facing their last days with dignity. Their families need to also have the comfort and security of knowing that their loved ones are certainly receiving the care that they need. So I'm hoping that the minister is able to tell me, first, the scope of that coordinator's position in the province; who that person will be working with, closely enough; what is their specific mandate and what funding is going to come, either with that position, or in behind that position, to have a strategy across the province?

MR. D'ENTREMONT: Thank you to the member for Queens for her interest in palliative care services. You know palliative care services is one of those issues that brought me to public life and I was very happy to support a move from southwest on expanding their services. They were one of the areas that had no palliative care services whatsoever. So I was very happy to be part of a government that started to equalize some of the things that were happening in this province.

So let me talk about the position first and then I'll talk about some of those expanded services as well. Simply put, the role of the provincial palliative care coordinator was initiated in 2007. Sheila Scaravelli is the acting director of acute and tertiary care. She's going to be acting in the palliative care coordinator role. Sheila has had tremendous contact with palliative care organizations throughout her career and as a matter of fact, at the Nova Scotia Hospice Palliative Association meeting in Truro, I believe, and here in Halifax - and I know that the member for Truro-Bible Hill did attend - there was definitely a cheer that went up when they were informed that Sheila will be taking up that role.

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So the position is currently in the process of being classified and posted. Well, I think most of that has been done. The position will be supervised by acute and tertiary portfolio. That has been my, you know - if ever I get discouraged as a minister, that's probably one of the issues that has discouraged me the most, when we talk about different divisions wanting different things of the same people. There's a tremendous challenge on whether this should be a position for acute care or whether this should be a position for long-term care or continuing care.

Finally, after months of haranguing, I put my foot down and said, no, acute care will be getting this position because we need to get the person into the position and get it going because if we don't get it going, then we continue to be that far behind our process. So the coordinator will develop an integrated model of palliative care, including researching and analyzing current issues, the best approaches to serve palliative care clients, and will develop a consistent approach to palliative care across Nova Scotia. Too much time has gone by now where, you know, each area has such a different one.

I think the original strategy was really - here are the palliative care recommendations that were developed in, I believe, 2002, when that project was initiated to develop that framework for expanding palliative care services in Nova Scotia, but we sort of left it for the district health authorities to set up a provincial program and the very thing happened that you mentioned was, you know, there's a patchwork of things across the province. I mean, if you go to Pictou, of course, they have a wonderful palliative care unit and palliative care services. The northern region tends to do better than the western or southern regions of Nova Scotia.

I had the opportunity just the other day to visit the new hospice at the Cape Breton Regional Hospital, I think it was on the fifth floor of that hospital, basically a converted wing or a converted unit in that facility - absolutely phenomenal. When you walk in there, it's a very dignified place, it is very quiet, lots of room for families to come in. Basically their mantra, their reason for being, is to have people in there for short stays, you know, getting them ready and sending them home. The unit is also a place where the community can call in if they've got a question about the care for their loved one. So it's a fully integrated service with the home palliative care services and that inpatient hospice care.

[6:30 p.m.]

We are expanding palliative care options, which is entitlements, which is mostly to the nursing ones, there's an extra $652,500 that's going into palliative care this year. I think that's more visits, expanding the home care, so more visits by RNs or VON members. I think home oxygen, I believe, and I think there was another issue - I can't remember - that continues to expand within that envelope of $652,000.

MS. CONRAD: Did you say $652,000? That $652,000 then gets divvied up throughout the province to all home care agencies?

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MR. D'ENTREMONT: Those would be divvied up amongst the patients. Basically the dollars will go to expanded hours for those individuals at home. Finally I can say something goes directly to the patient in this case.

MS. CONRAD: So, of course, we never know from day to day who is going to be in need of palliative care services, so that money could kind of be a moving target in terms of - I guess the question is, how did you come up with this particular figure? Is it based on stats in the previous year of how many individuals are looking at receiving palliative care services? I just would like to know how you came up with that dollar figure.

MR. D'ENTREMONT: To the member opposite, year over year we have an idea of the population requirement and that kind of service so we can project that pretty accurately. I apologize again for using a Blackberry, but it seems to be our raison d'être, or our method these days. Palliative care patients can now access about 200 hours of home care services per month for a total of 600 hours in the last three months of life. That's an increase of about 50 hours per month or over 150 hours over the three months. That's what our calculation is based upon for that population that we project and the added number of hours.

MS. CONRAD: Of course, I'm understanding that to be extended hours over and above whatever services at home they need. Thank you for that answer.

If I can just move to another question before I turn the floor over to one of my colleagues. I want to ask about the use of respite beds in long-term facilities. Again, this is something that a lot of long-term facilities have worked very hard at making sure they have a respite program in place for the communities to serve the community needs. Of course, we all know that for the prime family caregiver, at home with a loved one, seven days a week, 30 or 31 days a month, 365 days a year, can be a huge task for a family caregiver. So respite beds become very important, especially if they're combining respite service with respite through home care, or other services that are delivered in the home.

For a lot of families, just knowing that bed exists so that they can get away for maybe two or three days, or in some cases a week, just to get the care they need for themselves. What I'm hearing from some of the long-term facilities that have been working hard at ensuring these programs work for communities is that it's a little bit difficult for residents of the community to actually access the beds at any given time. There is a structure, there is a process in place for a person to be able to get into a respite bed. That becomes very frustrating, not only for the family caregiver who is making plans and perhaps only has a certain amount of time that they can work with in order to get the rest they need in order to deliver care to their loved one.

With that process they have to go through, sometimes they end up putting their plans on hold because a respite bed may not be available or may not be open for several consecutive days in a row because sometimes the beds are not open, say, Monday to Saturday

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or three weeks consecutively. So if you could explain to me, what role is your department playing in terms of assisting long-term care facilities to ensure that the respite bed programs that they have in place will grow stronger and will continue - also, not only continue, but get rid of some of the red tape that families are struggling with?

MR. D'ENTREMONT: Mr. Chairman, this is one area that we've spent a fair amount of time on in the last number of months. We were finding that the current respite beds in the province were being utilized somewhere near 40 per cent of the time. So 60 per cent of the time these beds were remaining empty that could be utilized in either a different fashion or be used by families that need respite care. So we're changing the entitlement. I mean right now it had to do with entitlements of using up those full 28 days, or each patient was available to 28 days in a respite bed per year, or something along that line. We're expanding that to 60 days within a year. So we're giving basically, you know, an open-ended amount of time so if you need to put your loved one in a long-term care facility for a week, you know, and then they get really sick down the road, there's still plenty of weeks available to them to spend a month if need be. So that was one of the barriers that we were seeing.

We are developing a respite in the home program, a true program. I mean through home care we were trying to provide some time and do it that way, but it wasn't a true respite program. So I think it's more effective in some cases, especially for those individuals who are suffering from some kind of dementia, you know, to be able to keep them in their home more appropriately. Also, you know, if the beds are only being used 40 per cent of the time, over the first blush we should be able to increase that to another number, and hopefully to 60 per cent, or at least double it to 80 per cent.

There's still a number of days left in those beds that we could utilize for adult protection cases. We could utilize it for rapid reaction, some issues that we've been having that we need to be more reactive to. So there has been some tremendous work being done around respite and I'm hoping to announce that in the next number of months on what we're going to be doing with those, because it's not only good for the patients but it's better planning for the long-term care facilities themselves.

MS. CONRAD: I would like to turn my time over to my colleague.

MR. CHAIRMAN: The honourable member for Pictou West.

MR. CHARLES PARKER: Mr. Chairman, I appreciate the opportunity to ask the minister and his staff a few questions here. I had the opportunity on the weekend to attend the Passport to Health Fair in New Glasgow. It was well attended. It was very, very good and lots of great ideas on how to stay healthy in our lifestyles at this time. The question that kept coming up to me over and over was, what's going on with our ICU, you know, what's going on with the Aberdeen Hospital? I know my colleague here asked an hour or so ago about

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some of that, but I just want to return to it for a couple of minutes because it has created a lot of anxiety in the community, a lot of stress.

While it's good news that there's progress being made here, that come Thursday, I guess, the hospital will again be receiving patients in the ICU but, as I said, it has been a real concern in the community. That's what was being asked of me on Saturday over and over at this health fair, when is our ICU going to be reinstituted and how did it ever happen in the first place? Are we not a regional hospital, is it not inconceivable that this happened, that we don't have an ICU in the greater Pictou County area?

So I wanted to ask the minister first of all, how did we come to that situation where we had no doctors to cover ICU care and what was the Department of Health's role? What was the department's responsibility here in ensuring that we had a continuous number of internal specialists on call at all times, and is it entirely left up to the DHA or does the department have a responsibility here? So I would just like to know how we got to the situation, what was the department's role, and what assistance was given to our local health authority to try to prevent it and, perhaps even more important, to prevent it in the future?

MR. D'ENTREMONT: Mr. Chairman, that's been a constant challenge, and I know the member has brought this to my attention over the last number of months as I've been Minister of Health. There are sort of two things happening here. There are a number of internists in that area - as a matter of fact, one of the highest-grossing internists in the province is from that area - and I think there has been a challenge to keep physicians there, or new internists there, because they cannot compete with the existing pool of physicians. Since they are basically billed on a fee-for-service method, there hasn't been a whole lot of sharing going on of that patient pool, on their other job of being an internist.

We take from those internists - they provide us with on-call in order to staff the ICU on a one-in-three or one-in-four basis, or whatever it has been. So by not being able to make a go of being some kind of internist in the area and providing that backfill or that time in the ICU, we've lost them to other areas of the province and to other parts of Canada.

So there are two things going on here today. Of course my answer to the member for Pictou East is they have a locum program that is going to be working for them in the long term. We will be seeing doctors there, utilized within that program as of May 8^th - that's actually a full week sooner than the district had anticipated, so it will be getting people in there.

I hope this new master agreement - the master agreement that has now been shared with doctors - will allow more sharing of patient loads and the dollars that are associated with it, to allow more collaborative approaches and allow those physicians to participate in the ICU program.

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MR. PARKER: Mr. Chairman, I know it's an ongoing challenge and I guess it was a shock to the community when it was announced a couple of weeks ago that there wasn't going to be enough on-call doctors to cover the ICU unit, and then I guess other hospitals in the area, whether it was Antigonish or Truro or Bridgewater or Halifax, or wherever, were being asked to pick up some of the slack, and I know there were seven patients that were transferred to some of these other hospitals, although they said that they, too, were bursting at the seams and they may or may not be able to handle patients on any given day, depending on their own circumstances - and not only the ICU but even the emergency department, there could be backups or difficulties occurring there because, again, these are the heart of the hospital system, and without internists there's no guarantee the other departments within the hospital can function.

I guess my next question, then, is in relation to the recruitment of our internists and what responsibility, or what is the department doing to try to attract more internists to the province and especially at the Dalhousie Medical School - I understand there's only one graduate there this year who is an internist. There has been some suggestion that we have good quality graduates from our high schools who are going on to study medicine, but because they have a large student debt, away they go to Calgary or the U.S. or somewhere that's offering more money.

So in the recruitment side, is there any consideration being given to keeping our own high school graduates here and some financial incentive to get them to come back to their home communities?

MR. D'ENTREMONT: Mr. Chairman, to the residents of New Glasgow and all of surrounding Pictou County, we're pretty happy that the district health authority has found a solution to their ICU issue.

[6:45 p.m.]

Specifically to ICU closures across the province, just to give you an idea of how we track this - DHA 1 has had no closures; DHA 4, which would be Colchester, has been closed for about 375 hours over the last year; there have been no hours closure in District 5, up to today; no closures in District 9; no closures at the IWK. So from the data that we've been able to compile - there are some districts that have not provided us with that information - total ICU closures have been about 375 hours from April 1, 2007, to March 31, 2008. So ICUs have only been closed about 0.3 per cent of the time and there have been other ICUs and capacity within those ICUs to cover those individuals.

More specifically, to recruitment or retention, of course the department provides dollars through the College of Physicians and Surgeons for their CAPP program, which is the assessment tool they use to look at international medical graduates. There has been some relative success in getting those individuals through the system and the extra training that

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they require in order to practice in Nova Scotia. I forget the total number of doctors we've been able to run through that system - and, of course, there is the appreciation for training our own.

There have been some negotiations, some discussions going on, and Dalhousie seems relatively happy with proceeding now with our need. We need more internists, there has only been one per year that has been trained. This year there was a tremendous wait list for more internists, so we want to expand that number. The nine that are being expanded this year, I think there's an appreciation within those nine, some of those will be new internists.

Beyond that, of course, is trying to have a central role in government within our department for recruiting in general, to make sure that all districts have the same types of tools and access to the pools of physicians across the country.

MR. PARKER: Thank you, Mr. Chairman. Again, I didn't hear an answer on the high school recruitment issue, but perhaps you could come back to that.

I do want to change channels here a little bit and come back again to an issue my colleague raised earlier, on long-term care. Certainly for seniors and their families, I can't think of anything that's more stressful on their lives when, all of a sudden, an elderly parent becomes ill and they are faced with the need to go into hospital, and then quite often the need to go to a long-term care facility from there. All of a sudden a daughter or a son is being faced with personal care issues in the home or perhaps sometimes there's just no option and they end up staying in the hospital.

Right now we have 28 residents in the Aberdeen Hospital, I think there are something like 1,400 or more across the whole province, and waiting in limbo between home, where they used to live, and a nursing home bed that is not yet available.

I realize that by the end of 2010 there is to be a number of beds that will be available to long-term care residents. I want to specifically come back to the Shiretown Nursing Home in Pictou and certainly while we're glad to see new facilities being built, in actuality there is no net gain of new beds for beds in the Pictou County area. Actually some of those beds are going to be moved out of the Town of Pictou to other areas of the county, but 89 new beds replacing 89 old beds.

So the question that some people are asking is, what's wrong with the beds that are there now? We're in such a dire shortage of long-term care beds, is it possible to help relieve some of the short-term difficulty that at least some of those beds could still be utilized, if only in the short term, to help alleviate the overcrowding or the long, long wait list? If they're good enough in 2008 and in 2009 and in 2010, could they not be extended, in addition to the new beds that are being built, to keep them on for a bit longer, to help relieve some of that wait time?

[Page 146]

MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I can say to the member opposite that the methodology that was used to place beds across the province was one that was robust, one that was based on trends, one that was based on a population basis. I think I'm still very comfortable in the allocation of beds around this province.

The issue for Pictou County was really based around the number of beds that are available there today, which there are a number of beds available in Pictou County. There were a lot of areas that had no beds. As I said to the member for Pictou East, there are a number of people sitting in the Shiretown, sitting in the Odd Fellow's Home, sitting in the other facilities in that area, who need to go home to Cumberland County, who need to go home to Colchester County, therefore, freeing up beds for the residents of New Glasgow, Pictou and surrounding areas.

So I'm still very comfortable in saying that our methodology is one that will create an equal footing right across the province.

At the same time, the member did refer to a number of people waiting - I think you said "waiting in hospital." The number today is about 1,200 individuals waiting for placement in long-term care, which includes community and hospital. I figure the number is probably - let me see, as of March 5, 2008, let me list these ones off and somebody can add them up for me, if you want.

There were 57 people waiting for placement in South Shore; 66 people waiting in South West Health; 72 people waiting in Annapolis; 122 people waiting in Colchester East Hants, therefore, why we are concentrating on that area; the Cumberland Health Authority was 39; Pictou was 97; Guysborough Antigonish Strait was 95; Cape Breton, there were 350 waiting for placement; and Capital Health is 445 - for a total of 1,343 people. So there is my number as of March 5, 2008. I would probably suggest that there are less than 200, at this point, waiting in hospitals across the province for long-term care.

MR. PARKER: Mr. Chairman, the reality is we still have a lot of people waiting in beds - 1,200 or 1,400, whatever - at home or in hospital. It's still too many. I don't think the minister will disagree with me on that. Even at the end of 2010, when there are going to be a number of new beds, there's still also an aging population that's going to add more people to the wait list. There are going to be more seniors looking for a long-term care bed. I don't know what the projections are at that point in time when those new beds come on stream but, regardless, there will be some number of - a few hundred, I'm sure - people waiting for long-term care beds. So in light of that, with a home that's only 35 years old, new beds coming on, why wouldn't it make sense to keep those beds open also, in addition to the new beds that are there, just to help alleviate some of the increase in the aging population and the numbers that are not going to find a bed at that time?

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MR. D'ENTREMONT: Mr. Chairman, I know through the process of the replacement beds at this point, where there are nine facilities being replaced, there has been some discussion going on as to what to do with the existing facilities. None of those facilities, in our estimation, can sustain long-term care patients in them as they are constructed. The care is too difficult for the employees working there; the care is too difficult on the day-to-day living for those residents, which is why we moved to replace them. The mechanicals are too old and the cost for the replacing of those mechanicals is far too much money for the availability of those buildings.

Now, that being said, I think there is a move afoot to look at what else we can do with those facilities - with some renovation, in some cases, major renovation, can we provide another level of care that's needed in those communities? Is there a way to use those buildings for assisted living? Are there ways to use them for some kind of housing method? We don't know at this point because we have been very focused on making sure that we have the long-term care replacement beds available by 2010. We will look again at that, I think, once we get closer to those dates.

MR. PARKER: Mr. Chairman, I guess I was just asking, is it possible, considered on a temporary basis - like it's 35 years old now and two years from now, in 2010, it will be 37 - could its lifespan be 39 just as a temporary measure to help out maybe two or three years to get over the hump? They have been serving the community for 35 years, can they serve for two or three more? I guess that, just simply, is the suggestion.

My time is limited and I have one final question I want to ask you. In a letter where you replied to my letter, it's about the drug Lucentis, which is an eye drug for those who have macular degeneration, asking if this drug can be listed under the Pharmacare Program for seniors, and you've mentioned in your letter that it's going to be listed with restrictive criteria, or it's currently going through the process and it's a possibility that in the near future it will be listed as a drug that will be covered under the Pharmacare Program - that letter of April 24^th of this year. Can you just give us an update, Mr. Minister, on the status of Lucentis - do you anticipate that it will be added to the formulary for drug coverage in this province?

MR. D'ENTREMONT: Mr. Chairman, I believe, if I remember correctly, the issue is that the drug has been looked at favourably and the drug will have certain restrictions built in around it so that it's used correctly for the right type of patient. I'm waiting basically for those requirements to come to me for final approval, so as soon as the committee does its work we should have that information available to patients.

MR. PARKER: I thank the minister and his staff for those answers, and I'm now going to share my time with the member for Halifax Atlantic.

MR. CHAIRMAN: The honourable member for Halifax Atlantic.

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MS. MICHELE RAYMOND: Mr. Chairman, I welcome the opportunity to ask a couple of quick questions of the minister. I think these are both things that we have - one is something that we have discussed before. I just had a question about the listing, the way in which things make their way onto the provincial formulary. I think the minister will remember we had some dialogue around a constituent of mine who had suffered from various degenerative diseases and so on and was in need of pain relief.

What had proven very effective for her - she was responsive to morphine but had some difficulties with it, allergic difficulties, and she was also responsive to Tramacet and Tramacet was not covered in the formulary, and the reasoning was that it was considered to have a strong addictive potential after more than five days of use. But what had surprised me was that the World Health Organization, and in the United States as well, the FDA, had both listed it as having a lower addictive potential, in fact, than morphine, and I was wondering how it was that Nova Scotia had come up with a different conclusion about this and what it would take to see this argued in its way to the formulary, because in the meantime - I mean this woman had been told that she was going to have to use a medication which was (a) bad for her personally, but (b) something which we are dealing with as a systematic problem from abuse of these drugs.

MR. D'ENTREMONT: Mr. Chairman, I do remember some of the discussion that we were having around it, and I thought maybe it had been resolved at this point, but I guess not. Basically we work from the Canadian Drug Review which has the responsibility of overseeing and looking at the studies and studying the drug for listing. We then look at those drugs that have been positively identified by CDR, by our provincial formulary committee - I forget exactly the name of the committee - and basically they do a test on cost-effectiveness and either list or do not list. So, you know, I'm not too sure whether CDR has sort of made the decision on whether or not it's more addictive or less addictive than morphine or whether it was our committee because it's not really the role of our committee to make that kind of decision.

MS. RAYMOND: Yes, I had the impression it probably was ultimately a decision made rather on the basis of cost-effectiveness than on addictive potential - that's fine.

The other question that I had - actually I was just bounced over here from a discussion with the Minister of Justice who said talk to the Minister of Health, so here I am - it's another constituent case.

[7:00 p.m.]

We had discussions last year about a young woman who had been identified as bipolar in her youth, while she was a minor and so on. She had proceeded to various addictions and so on to a life as a part of a methadone clinic, living on the streets, sort of incarcerated on and off, on and off. Most recently I was talking to family members. The

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methadone clinic had said she wasn't appropriate for psychiatric assessment because she was using cocaine at the time. Mobile Crisis Intervention Service had said it wasn't appropriate to assess her because she was using cocaine at the time. She was then incarcerated for six days.

We knew it would be six days and during that time, one would assume that she was not - I mean one would hope that during her incarceration she was not continuing to use cocaine, so it would seem reasonable that an assessment could be done at that time. We just watched that window of time close without it being possible to invoke mental health services. I'm just wondering, at this stage, what protocol is there, in the absence of the mental health courts and so on, to be sure that mental health assessments can, in fact, be done when somebody is in safe care and presumably, as they say, clean? (Interruption)

MR. D'ENTREMONT: Mr. Chairman, I thank the Minister of Tourism, Culture and Heritage for his comments as we roll around. It's good to have some support behind me here. Sometimes I feel pretty alone here with my staff. (Interruptions)

I can say that there has been, in this year's budget, a tremendous concentration on increasing addiction services, as well as mental health services, for the DHA specifically and, of course, more centrally. The wait list right now for assessments is still far too long to get the services that are very much required by individuals. It sort of saddens me a bit that someone who was basically captive could not get an assessment when it's going to be much more difficult when that individual goes back into the same type of situation and probably starts using again.

Far too often I think we sort of put mental health on the side burner because acute care seems to be such a monster in how much dollars it really requires. So I'm very happy that there are some added dollars this year. There are some added dollars, as well, I'm saying about a $10.1 million increase in mental health services for the districts which I think, hopefully, will help out with those assessment tools, as well as $2.9 million for addiction services in the district. So hopefully there will be some more dollars and therefore some more tools in order to do assessments in this province.

MS. RAYMOND: I certainly hope that with additional money there will also be pointed attention to the need for emergency assessments under certain circumstances.

With that, I would like to hand over the rest of my time to the member for Halifax Citadel.

MR. CHAIRMAN: The honourable member for Halifax Citadel.

MR. LEONARD PREYRA: Mr. Chairman, I have a few very quick constituency- related questions but I will start with just a larger question about Bill No. 1. As you know,

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my constituency, Halifax Citadel, includes a significant chunk of the health care services and many of the health care professionals work and live in my constituency and it has caused a great deal of concern and upset. I guess my question for the minister is, with so much of an emphasis on recruitment and retention, and given the experience that we have in Bill No. 68, why persist with Bill No. 1 and why do something that's so provocative and has so little to offer at the end of the day?

MR. D'ENTREMONT: Mr. Chairman, you know I don't know how far I can go here because this is a bill that is, of course, still before the House, one that we feel has been asked for by our constituents, one that we feel that our system - we have talked for the last nine hours now on the estimates and issues for health care and we talked about the shortages of professionals within our respective jurisdictions, within our respective divisions within those hospitals. It was our feeling that any strike, even the threat of a strike, puts our system into turmoil and we can't continue to do that to the patients of Nova Scotia, which is sort of the impetus of having a bill such as Bill No. 1.

It is my feeling that this does, in no way, limit the recruiting capabilities of the system as most jurisdictions in Canada have some kind of essential services legislation that governs strikes and/or lack of strikes in those particular jurisdictions. Those are my overarching feelings and views on it. Of course, if you want some more detailed views on that one, you would have to ask the Minister of Labour who did introduce that bill.

MR. PREYRA: Mr. Chairman, I have smaller questions relating to my constituency. I had asked the Capital District Health Authority about the move of the blood collection clinic from downtown, from the central Halifax Infirmary site, to Bayers Road. We have no disagreement with the move to Bayers Road, given that that's where a good chunk of our population is and would find it more accessible but, that being said, a number of people who live around the hospitals, particularly seniors and other people with special connections to the hospital and need services, have moved there principally for that reason, and I've received a lot of complaints about the fact that the clinic has effectively been moved.

Now, in the response that I received on April 17^th - I could table it if the minister would like, but I don't think this is something he doesn't already know - it says that the existing Infirmary clinic site will serve ambulatory clinic patients who have multiple tests at the same site on the same day. That essentially means that you're limiting it to people who are already in the clinic itself, and I'm wondering if perhaps, apart from the necessity that some people have, especially seniors, if you would reconsider that decision being that restrictive, and also if you could communicate with the communities around as to what the new clinic will do.

MR. CHAIRMAN: We'll ask the honourable member to table the document, please, just in case it's not available.

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MR. D'ENTREMONT: Mr. Chairman, even though we do let decisions like that be the responsibility of the district health authorities, it was one that was done with a bit of consultation with us as well. It was the feeling that with the other services that are now available at the Bayers Road site, that blood collection did seem to be a good fit to what goes on there. I understand the member's concern for individuals who would be living closer to the Infirmary site, yet at the same time we need to find a spot that best represents the largest piece of that population, which is in that Bayers Road area.

It is something we'll watch closely to see if it's actually addressing the needs. It is pretty much a new service that has been going on there - I don't know, I know in the rural areas there's blood collection that happens at some pharmacies and things as well. I don't know if that happens here on the peninsula or not. So maybe its's something that we can look at, maybe a temporary clinic or something to the future, if it's not meeting the needs of the residents.

MR. PREYRA: Just to be clear, I'm not asking for those services to be privatized in pharmacies and things like that, I'm just saying that the change in the service has either been a great inconvenience because the people around, the seniors in particular, are being told that they'll have to get their blood collected elsewhere, or in fact they're getting misinformation from the staff there and they could do it. So at the very least there has to be a clear way of communicating with people to know exactly what the new clinic will do.

I have another question, Mr. Chairman, and that relates to the Gabrielle Horne case. Now, about a year ago, I asked the minister about this case and previous critics have asked this question, and in each case the minister has promised to provide this information right away, in fact the next day.

The last time I asked this question, the minister, and I was asking at that point about all the legal costs that had been incurred in this case, it really is a huge miscarriage of justice - a number of independent adjudicative bodies have found that it is a great waste of the taxpayers' money and we're running into millions of dollars now - and I had asked if the minister would provide us with a detailed breakdown of the expenditures, both within the Capital District Health Authority and with outside consultants that had been used for that, and the minister promised to give them to me the next day in fact. I haven't received anything to date, and I wonder (a) when are we going to deal with this case and (b) when am I going to get that information?

MR. D'ENTREMONT: Mr. Chairman, if I had promised something, I apologize for not getting that information to you, and I will endeavour to see if I can get that information from Capital Health. Again, the member opposite could also ask Capital Health for that information, but I'll do that on your behalf, to see if I can get it from them.

[Page 152]

I know the case has been settled; I know they are in another disciplinary hearing right now for another individual, that they're basically using the new bylaws that had been approved for them, in concert with, or as a result of, the Gabrielle Horn case.

Ultimately, we don't want to see these disciplinary or any kind of internal hearings to be taking more than a number of weeks or months, rather than the years and years that it seems like these things have been going on. I will endeavour to have that information for the member opposite. I apologize if I did not provide it last time.

MR. PREYRA: Mr. Chairman, the last time I asked this question, the minister said he could get that information directly, and would, and I appreciated that response and I would like to see it.

I have a question that maybe is not an appropriate question to ask the minister but, I'll ask anyway, since we are in committee. The Friends of the Halifax Common have talked about the extent to which health care facilities have taken over what used to be a large green space. Now, we have no objections to the Common being used for purely medical things that promote the health and welfare of the community, but their concern - and certainly as the MLA for Halifax Citadel, I notice that every day the hospitals have tremendously large, over-sized parking lots and they have replaced that green space and we seem to have more and more and, as I understand it, there is something happening at the Queen Elizabeth High School as well that has caused concern with the Friends of the Halifax Common, that a lot of green space is being taken up, not by purely health care facilities, but by parking lots. I'm wondering, what authority, if any, has the minister, and whether he can use his good offices to make sure that some of this green space is reclaimed or that the parking lots don't take over more and more of the Common's green space?

MR. D'ENTREMONT: Mr. Chairman, as the member opposite would be aware, we would have to adhere to the municipal planning bylaws on the requirement of parking spaces for the usage of the hospital. I know that it's kind of funny that you would ask me that question - it really was the impetus of moving the blood collection to Bayers Road, the lack of parking at the Queen Elizabeth site. So it was a tremendous concern. And I know, from spending some time there the other day, that it is an expensive endeavour as well to have your car in there for more than a few hours.

Ultimately, what we've been trying to do, even across the province, is provide parking garages of some kind rather than having these big, spread-out parking lots. The challenge we have, of course, here on the peninsula, especially close to the Common, is making sure that we can green up the space we've got. I think there has been some tremendous appreciation of what that is all going to look like once the new ER is constructed, once that is built, what's going to be available there. Of course, the ongoing discussion and issue of what's going to happen with the Queen Elizabeth High School in the future - is that going to be something that can be greened up and used as a green space, is it

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something that we're going to require for future expansion of the hospital system there or not - I know is part of the planning when it comes to Capital Health's master plan.

MR. PREYRA: Mr. Chairman, through you I'll thank the minister and hand over whatever time is left to the member for Pictou East.

MR. CHAIRMAN: Thank you. The honourable member for Pictou East.

[7:15 p.m.]

MR. CLARRIE MACKINNON: Thank you very much, Mr. Chairman. I appreciate having a second round and I just have two quick questions remaining. One is - and the minister well knows my concern about this because I have written to him and this is one that he can answer very, very quickly with just giving me a date, if he would - the situation is that patients at Glen Haven Manor, in New Glasgow, have to alert staff by ringing a dinner bell, or something even bigger than a dinner bell, to get assistance. Lots of times the ringing in such a facility, with so many patients, is something that is certainly hard to get attention at times. So it costs $150,000, in an estimate, to do a replacement, or to install I should say, to replace the bells. So I'm wondering if that $150,000 is forthcoming?

MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his question in regard to Glen Haven's call bell system. I know that there has been a proposal that had been developed, one that is before the department for its consideration at this point. Of course we're holding off until we see approval of the budget.

Mr. Chairman, I would say that soon after approval, the dollars would be flowing, as far as I understand, to Glen Haven for its new call bell system.

MR. MACKINNON: Another question that I have is when you look at the health authorities in the province, often it seems that they are competing in relationship to attracting doctors. We have a health authority that I'm familiar with that was offering a signing bonus of $50,000 and free secretarial service and some free office space and so on - then there is a one-upmanship where $150,000 is being offered as a signing bonus. Would it not be better, Mr. Minister, if there was some kind of uniformity or some kind of co-operation, and even collectively trying to attract doctors to Nova Scotia and sharing some of the ones who we are able to attract - is that too Utopian to talk about?

MR. D'ENTREMONT: I do think it is a little too Utopian, yet I think there are still some services that we can provide to the districts in order to try to even out the recruitment efforts of each district. To tell the member opposite that there's approximately - there is a ceiling that is prescribed that no district can go above that ceiling when it comes to extra benefits, and the extra benefits can be no more than 20 per cent over the approved rates, or the rates that we would have already approved through the master agreement contract.

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So I mean in some cases, depending on what the rate is approved for that position, it could be up to $100,000 in some kind of payment, which I do think is a little bit much, but at the same time it has been very positive, in some areas, to attract.

We do need to find a way, centrally, if we can hold on to those doctors we share them with the districts, and then it is up to the districts to hold onto them or not.

MR. MACKINNON: I'm going to turn the remaining time over to our heavy hitter. Thank you.

MR. CHAIRMAN: The honourable member for Sackville-Cobequid, with about two minutes.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. I just want to take another moment here to wrap up our time. I understand that the Liberal caucus will have the next hour with the minister.

It's interesting, the minister mentioned a few minutes ago on "approval of this budget." What really stuck with me this year, reviewing the estimates and going through the numbers- and I asked the minister several questions on this point earlier last week- what really drew my attention was the fact that here we are struggling in the Province of Nova Scotia to ensure that people in our province receive the care they need, when they need it, but

time and time again, going through the budget estimates, we realize and look at the fact that from last year's budget that was approved by this House, that several lines - and I'll just mention four of them - in the budget, Mr. Chairman, were underspent. I just can't fathom why, today, when there's such a demand and need in health care, we underspend the budget estimates and we underspend in those areas.

One which I didn't mention, which I don't have time to ask the minister, but I understand was underspent, was in home care, roughly $6 million. So with that program being underspent by $6 million, the Pharmacare Program, the grants and contributions being underspent by $7 million, the capital grants for medical equipment, $8 million, and under capital grants for infrastructure, $13 million - that's $34 million in just four line items that we underspent last year, or the government underspent, in health care. I don't understand why this government would continue to allow that to happen, and I hope that they learn from that and that we won't see that, and the people of this province can get the health care they need when they need it.

MR. CHAIRMAN: Order, please. The time for the NDP caucus has expired.

The honourable member for Preston.

[Page 155]

MR. KEITH COLWELL: Mr. Chairman, first of all, I want to thank the minister for giving me the information on how the hospitals are supposed to be cleaned and it just raises more questions unfortunately - and you figured that would happen, I know that.

I'm just going to Section 9.0 Appendix B Housekeeping Service Requirements. Housekeeping Services Requirements - Critical Care, and it says right here: "When the Critical Care Unit area is vacated, but not less than every three months:" - and this is the exact procedure - "Wash all walls, ceilings, doors, and ledges. Wash all light fixtures. Wash all internal glass. Wash all ventilator ducts thoroughly. Machine scrub and/or strip old finish from hard-surfaced floors and reapply suitable non-slip finish. Change Cubicle Curtains As Required."

Do you see anything wrong with that?

MR. D'ENTREMONT: Since I gave my copies away, I just need a copy back to have a look at what he's referring to there. I apologize, I should have gotten three copies of that one.

So when critical areas are vacated, but not less than every three months, " . . . not less than every three months: Wash all walls, ceilings, doors, and ledges. Wash all light fixtures. Wash all internal glass. Wash all ventilator ducts thoroughly. Machine scrub and/or strip old finish from hard-surfaced floors and reapply suitable non-slip finish. Change Cubicle Curtains As Required."

No, but I'm sure you're going to tell me what's wrong with it.

MR. COLWELL: I don't think that the process of what has been identified in this, this is out of order, I think that that's probably appropriate for what has to be done. The unfortunate thing is you wash the walls, ceilings and doors and ledges with what? Is it disinfectant? It doesn't say that. Is there a regimen of different disinfectants you have to use, or sterilizing materials you have to use?

This is a critical care unit and you can't expect an individual who's doing this work to carry out the work if they don't have the tools to do it with or the proper training to do it - which should be provided by the hospital or the employer, whichever the case may be if it's a contractor - or if they don't have the instructions. So basically I can go in there with a dirty old rag, a bucket of water, and to this standard I meet everything on the standard, absolutely everything on the standard. I don't have to change my water; I don't have to use any chemicals of any kind or anything. And that's a critical care unit, a critical care unit where somebody is going to get, you know, probably some other illness because the place wasn't cleaned properly - and, again, it's not the person who's doing the work, because they weren't given the tools or the instructions or the ability to do the work that they should be doing.

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MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for underlining that deficiency within that document. I don't know, in the rest of that document there might have been an underlining of the kind of tools that need to be used, I'm not sure, but I'm going to bet that there is an approved list of cleaning agents that is set forth by the infection control committee in each hospital. So if there's another document to be had, I will be getting it for the member's perusal.

MR. COLWELL: I appreciate that answer, but the problem is this document doesn't refer to any other document, so therefore I can do exactly what I said. I can take an old bucket that I got out on the street someplace, fill it up with water from dear knows where, get some kind of soap if I need - you don't even say you need to use soap here - and I can wash the place down and I've done my job, if I am working there, exactly the way it is instructed here. So that is a serious problem - that's the critical care unit.

Now, there is a whole bunch of other things. Quite frankly, when I look at this, if I was going to clean Maritime Centre, this building or any other building, there are only a couple of references in this whole thing that would be different. That would be just a commercial building someone travels in every day and goes through any other building - I would have a hard job finding anything in this that would indicate to me that it is a hospital where infections are a problem and where the lack of cleanliness can cause very serious illness of people who are already ill.

Here is a neat one right here, and I can give it to the minister again to have a look at this, but I will just read what it says: "Mop Up Spills" - that sounds simple enough, you spilled some water on the floor, you mop it up - it says: "Mop up major spills on request 24 hours per day." No problem. So I move in with my mop and I mop it all up, but what happens if it is blood? What happens if it is something else that has been spilled, some kind of chemical? No instructions here how to handle it - absolutely nothing. I will let the minister have a look at that.

So what I am saying - and I really appreciate the comments that you've made about the Yarmouth Hospital and I am very pleased to hear that there is at least one hospital that does an excellent job of cleaning up, and I am sure there are more than that, but if this is the standard that people are using - the people who are doing the work, I think, are doing an exceptional job because they are going well beyond what the standard is, and I want to give them a lot of credit for doing that.

Here is another one; here is another spot right here. This is Housekeeping Services Requirements, in-patient units, the place people are staying in, and that means a lot of people are visiting. "Water Fountains" - I'm going to clean the water fountains, and it says: "Clean and polish. Once daily." All the instructions, that's it. So what do you clean it with? How do you clean it? How do you ensure that somebody who is coming in doesn't have an infectious

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disease, has a drink of water, maybe some fluid gets on a spot on the water cooler that can infect somebody else and it is not cleaned?

So I will say this is one requirement here I've seen - the only one I've seen in this so far - "Isolation Cleaning." It has a standard; one standard here. "Perform daily cleaning and terminal cleaning in isolation rooms as described in Isolation Rooms and/or as amended by CDHA/ VGC's Infection Control Committee." Now you cannot clean these rooms daily; it's impossible. My wife was in isolation for a week, and they didn't clean it for a week. They just can't do it; they can't get in there, they physically can't go in the room and do it. So you can't do it daily. Now when you change patients, I am sure this standard is a very thorough standard and, as you go through that process, I am sure that it works very, very well.

Then, when you go through all this stuff, through this whole document, there is no quality check to see if the work was done. None. There is no place in here that requires a quality check on what has happened. Even if the individual doing the work does it right by the standard here, there is no way of going back and seeing if indeed these things have been done. You need quality assurance on this to make sure that things are done and it is a pretty simple, easy process. It could be just as simple as a nurse filling out a report at the end of the shift that yes, I am satisfied with the cleaning and these are the things that were done - or the head nurse. I don't want to put any more work on the nurses, don't get me wrong, or the supervisor who has to fill a report out that says, yes, this was done every day, and then if they get a complaint it is handled properly.

[7:30 p.m.]

You know the more you look at this - here is another one, "Clean Bathroom Fittings" - again, in an area where there is a ward with two or more people in it, maybe with little bit different illnesses, could infect each other - "Thoroughly clean and disinfect hand basins, baths . . ." So they are talking about disinfectant, but there is no procedure, there is no standard written down here how you do this.

Now the minister will be very familiar with this, coming from a fishing community - in a fish plant you have to change the disinfected material daily, because if you don't change that chemical cocktail daily the bacteria gets ahead of you so bad you can't get rid of them, and you know that for a fact from the industry. The kind of bacteria we're picking