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October 2, 2017
House Committees
Meeting topics: 
CW on Supply (Health & Wellness) - Legislative Chamber (2181)









4:48 P.M.



Mr. Chuck Porter


            MR. CHAIRMAN: Order, please. We'll now call the Committee of the Whole on Supply back to order. The New Democratic Party has 32 minutes.


            The honourable member for Sackville-Cobequid.


            HON. DAVID WILSON: Mr. Chairman, it's an honour to stand today to ask a few questions. I'll be sharing my time with my colleague and then maybe pick up towards the tail end of Estimates, whenever that happens. I recall in past Estimates, the Department of Health being here for 20-some hours, so we don't know yet if that's where we're going. It might be determined by some of the answers I will try to get from the minister.


            I know I mentioned to the minister earlier, a quick question on LifeFlight. We know there were new regulations, changes to the requirements of landing on helipads in the country and I know it affected LifeFlight here in Halifax with the end of hospital landings, rooftop landings at the IWK and at the QEII.


            I know there was a new agreement made to purchase or to lease a new helicopter - two new helicopters, I believe - so I'm just wondering. I know that was supposed to be up and running by August. I wonder if the minister could give us an update on when those landings will resume. I know it's after the training of the crew, but I wonder, could he give us a bit of a timeline on when we'll see those landings resume at the IWK and at the QEII.


            MR. CHAIRMAN: The honourable Minister of Health and Wellness.


            HON. RANDY DELOREY: Mr. Chairman, through you, I thank the member for the important question about the status of the LifeFlight helicopter. The member is correct that there were circumstances last year that resulted in the opportunity and need to secure new helicopters that meet the federal standards for landing on the helipads at the hospital sites here in Halifax. Originally, they were working to bring those helicopters in for August. At that time, I did speak to the media about the update to the status. They were delayed but the reason for the delay was to have enhancements made to the cabin area to improve the work space environment for the crew and patients. That resulted in about a month and a half, two months, of delay, so we are a little bit behind but the helicopters have arrived in the province just last week, I believe, on Friday. They are physically now in the province.


As the member made brief mention to, but I will restate it because of the relevance,

now that they are here, of course, the crew in the province who will be working and manning these pieces of equipment, these two LifeFlight helicopters, they will be getting some training and so on. So we expect within a month, the next month or so, all of the training in these helicopters should be up for the LifeFlight system to be operational.


            MR. DAVID WILSON: Thank you. It is interesting how quickly social media can help. I think I posed the question on Thursday or Friday and I received a lot of responses that the helicopters were not landing there yet, but yet someone did see them on a flatbed so they were in the province.


            But I appreciate that. I just want to confirm with the minister that landings will resume on the helipads at both hospitals once the crew is fully trained.


            MR. DELOREY: That would be the expectation. These helicopters meeting those standards, in place for the landing sites. Of course, again, for the safety of everyone involved, the training course is the next step. But once that work is all completed, in about the next month or so, we expect that to be taking place.


            MR. DAVID WILSON: I want to continue on. I'm no longer the Health Critic in our caucus - I'm glad to have my colleague taking on that role - but EHS, first response in the province, has definitely been a passion of mine.


            There has been talk over the last little while from some of my former colleagues, those women and men who work as paramedics in the province - and I know that this might bridge not only the minister's department but maybe Labour, or he may indicate where I might have to ask this question - there has been some concern lately with the stance that the government took around negotiations of wages and the fact that we now have a new college set up for paramedics in the province, which comes with a cost to medics. So now we are hearing that not only is there additional cost because they have to fund the college, which was well known before, but also around benefits.


            As we move closer, first responders and paramedics of this province, having a presumptive coverage of WCB, there may be a spike in those benefits. I'm wondering, has the minister or his deputy, his department, had any discussion with paramedics who are concerned with the wage package that is being imposed on them, that their cost for providing care and being registered in the province is going up, that it is a challenge for them?


I'm wondering if the minister give any comments on the challenge of the cost of the new college and other pressures that the paramedics have when, I know that it was not in his - well he was Finance Minister - but when the contract is imposed, as it was, it does have a negative effect when you don't see - the cost of living increases but yet you have these other costs that will come up out of the pockets of paramedics in the province.


            MR. DELOREY: I thank the member for this question. I think all the members in this Legislature recognize the member's continued - I don't think "affinity" is a sufficient word for it - engagement with his former profession.


            This particular question or area, obviously relating to the negotiations that will be taking place between EHS and the employer, with the paramedics. I'm not aware - this is actually the first I would have heard of that specific question coming up. It hasn't through the channels to the extent that - it may have come up at the table, those negotiations, those conversations that take place at the table. But I haven't heard that inquiry.


            I can advise the member, outside of the bargaining process, as he referenced, in the establishment of the college and that framework and the mechanisms, there were discussions at that point. Some sensitivities were raised about the costs of licensing and being members of the college and so on, about the ways that payments might be able to be made either over a period of time or what have you, rather than necessarily being a one-time bulk, set payment for an annualized cost - perhaps monthly payments or things that might make it easier to budget in. Certainly, those conversations had taken place earlier, so there's a recognition of that. But as far as what was taking place or what has been discussed at the table, I don't have an update for the member.


            MR. DAVID WILSON: I might be able to state, hopefully, that I have put the minister on notice. We will hear from those men and women again, I think, on the issues of increased costs on them as they provide care here in the province.


            I want to turn to another area that I have spent a lot of time and energy on over the last number of years. That is, of course, the Collaborative Emergency Centres that we have in the province. A collaborative approach to delivering health care has been talked about and has been moving forward, really for decades, Mr. Chairman, and I know you're well aware of the changes that happened in the 1990s to the point where we're at today, where there is a self-regulating body governing paramedicine in the province.


            But CECs definitely came to light after Dr. John Ross, who was an emergency room physician, worked in every single emergency room in the province. He engaged with staff at the time, hospital administration, and others, to try to see how we could address and how the province at the time could address severe and chronic ER closures. Of course, the document that came out of there, as we refer to often as the Ross report, one of the components in there was the Collaborative Emergency Centres, moving on with that and ensuring that they opened throughout the province.


            I know after the 2013 election, the former minister did a review of those centres. From what I interpreted from that report, they were definitely a positive thing to have in the communities. They were addressing an issue that many governments prior to that found very challenging to try to address. Yes, it did not stop emergency room closures. There are so many components to that, and I understand that fully. But it did have a positive impact in some of those small rural communities, and I have been told that not only to the emergency department aspect, but the access to primary care and a primary health care provider.


            With the 2013 election, the new government doing that evaluation, there haven't been any new Collaborative Emergency Centres opened. I know the government is focused on the amalgamation of the district health authorities. That was their big initial challenge. Then, of course, collaborative clinics is kind of what we've been talking about the last couple of years.


[5:00 p.m.]


            I want to ask the minister, are he and his department and the government committed to ensuring that those Collaborative Emergency Centres that are operating today will continue to operate into the future?


            MR. DELOREY: I thank the member for that question. The member was quite right, a lot of the first mandate, particularly the first couple of years, my predecessor and the government had focused on the restructuring, which was a significant platform in the 2013 campaign, which was the amalgamation of the health authorities.


Within the space and the evolution of concerns being brought forward, of course, in the health care system there are many - in particular, with respect to primary health care access, it would probably be a dominant one that I think, for the member and the members, really highlights and explains why, as a government, the focus for us has been on identifying and trying to work with the people providing health care, front-line health care services, to establish collaborative practice opportunities and collaborative practices to really build the access to primary care.


            One of the examples I cited earlier in these Estimates Debates or Supply, was the example of a collaborative practice in Dartmouth - that was about a week or two ago - which had taken 800 names off the 811 list, and that was after they filled vacancies from a physician who had retired from that location. So not only did they fill the vacancy internally, but also have so far filled over 800 names as of the end of August, off the 811 list, so the practice is working.


When it comes to the emergency room spaces, one of the things that we're certainly paying attention to is - we've heard members when they ask questions, as well with members of the public - the notion of going to the ER, essentially for primary care access, individuals who don't have access to a primary care provider, taking the opportunity, going to the ER for service. We believe that, certainly, by providing enhanced or greater primary care coverage, it will help address some of the pressures in our community ER space.


            As far as the CECs that are currently in place, they continue to operate that work. Again, I think for the services they provide to the communities when people are in need, receiving those services, those medics, along with the nurses working in them, provide excellent service. I can assure the member that Dr. Travers and others within the paramedic community, and with the nursing as well, they have seen developments in their scope of practice over the last number of years. Many of them are very excited to have opportunities to practise to their full scope.


            There are a lot of creative ideas coming forward for opportunities to again contribute to our health care in the province, whether in an emergency context or, again, as I've mentioned, in the primary care collaborative delivery practice.


            MR. DAVID WILSON: Has there been any discussion to reduce the hours or the service that we see now, currently, under that model in the province? Has there been any discussion with the department heads within the province to see a reduction in service? I appreciate the minister's comments around collaborative clinics and that, but these are two different models. I'm wondering, could the minister answer that question?


            MR. DELOREY: I know the member's colleague has asked about facilitating services in their community, which obviously had seen some shifts. To the extent that changes or adjustments have been made, I believe they've been made in consideration of the supply and demand - that is, supply of staff and demands for the communities and the services that were being received at the time.


While I can't say that there have been no adjustments - obviously people in communities would know that has happened from time to time, particularly over summer months or vacations or what have you with staffing, may come into play - but I assure the member and all the members in the Legislature and indeed all of Nova Scotia that the work and the efforts that take place, that go into the planning and staffing efforts, certainly do take into consideration demand on the services. Certainly, the emergency services still exist within our communities. We have one of the best emergency responses, as the member and yourself, Mr. Chairman, would be well aware of, in this province, to provide and respond in an emergency situation for Nova Scotians as well.


MR. DAVID WILSON: I know in my previous comment I said they're two different models. They are, but they're definitely integrated. I think the report showed that it indicated that the purpose of the Collaborative Emergency Centres at the time was to get coverage and health providers working to their scope of practice in the emergency rooms after-hours so that they weren't closed because of a lack of a physician being physically in that facility or in that hospital.


That was the first part, making sure that the doors were open. The second component of that was to do what I think the minister indicated a little bit on in his answer, to drive the demand to the appropriate place, and that was towards the primary care provider so that after-hours, if it wasn't an emergency, that that person would have the ability to see a family physician or a primary care provider the same day or next day.


We know that has had a positive impact on, I believe, the health of the communities and I think as the years go on, hopefully we as a province will look at the model and say, yes, actually driving people towards the appropriate care delivery is needed, hopefully reducing the cost of the overall system in providing care.


When that report was released after the review, there was talk about the usage after-hours in the emergency departments. I would agree that they have been dramatically reduced, but that shouldn't mean that those emergency rooms shouldn't be there and the Collaborative Emergency Centre model shouldn't continue on. That's the concern I have. I hope that the government recognizes that these small communities deserve - many of them, and we've heard it from my colleague, for example, something I didn't know that the miners in Cape Breton paid for the hospital in the past. I didn't know that.


Just because the data is showing that less and less people are using those emergency departments after-hours, that the government should close them down or eliminate the overnight hours that they are there.


I think I heard the minister indicate that the support is there for the Collaborative Emergency Centre. I'm wondering if there has been any discussion - and I know that this has been talked about maybe behind the scenes - is there discussion to change the name of the Collaborative Emergency Centres to come up with a branding? I'm wondering, has that crossed the minister's desk since he's been Minister of Health and Wellness?


            MR. DELOREY: I certainly haven't been involved in any plans or discussions with respect to the naming and the branding of this type of service. Certainly, as I've mentioned I think in my previous response, there is a wide variety of very creative and forward-looking initiatives that do get proposed by various health care providers, Mr. Chairman, but, again, specifically to the question of rebranding or coming up with some other different branding for what are currently in place as CECs, I certainly haven't been engaged nor had those types of conversations since I've been in office.


            MR. DAVID WILSON: Mr. Chairman, I'm wondering, would the minister indicate if there were any plans to opening any further Collaborative Emergency Centres in the future?


            MR. DELOREY: As I think I'd mentioned in one of my earlier responses on this discussion about the Collaborative Emergency Centres, we really have been focusing on the primary care side. As the member referenced, one of the necessary components or valuable components of the CECs is that capacity to direct and provide primary care access, same day, next day, for individuals as I'd mentioned in one of my earlier responses. That's been where we've really been heavily focused, is on our efforts to ensure the primary care supports are in place.


As the member noted in one of his remarks, really so many components of our health care system are tightly intertwined. The primary care, the emergency care, are all intertwined and are interdependent of each other. So, again, right now, we're focused on successfully establishing and rolling out primary care in communities. That's a big focus part to, again, manage some of that demand but also for those communities with CECs or even emergency rooms, that these primary care collaborative practices provide that primary care that, in many cases by volume, shows that the service is being provided in some of our emergency rooms, whether they're CECs or regional emergency rooms, are actually things that could possibly be managed through primary care providers.


Again, there's lots of work and a lot of individual health care professionals proposing opportunities to focus on how they can deliver their services but, as far as CECs at present, I'm not aware of any specific ones in the pipeline, but a couple of collaborative practices.


            MR. DAVID WILSON: Mr. Chairman, I know my time is coming to a close here soon. I know that, especially in the rural communities, one of the benefits to the CEC model was to try to bring a balance to the working conditions of our physicians in the province so that they're not working 10-, 12-hour days, covering 10-, 12-hour nights at the hospital. I've spoken to many physicians over the last number of years and, of course, over the last six months or so, with their concern on working conditions and where they can practise.


            I think it was about two-and-a-half, maybe three years ago, Nova Scotia Health Authority, the Central Zone, changed the policy that would restrict the ability for a family physician to open up a practice in, I'll say, the Central Zone, HRM, Halifax, Sackville. We had a doctor shortage out in my area. We know after the - and I think it was through the election the Premier indicated that he'll work with the physicians of the province to ensure that they can practise where they want to, so I'm wondering, has that policy been changed with the Central Zone on limiting the ability for a family physician to open a practice or work in the Central Zone here in the province?


[5:15 p.m.]


MR. DELOREY: The answer is yes, this was something that not just the Central Zone became aware of. Indeed, last week when we discussed in Estimates about primary care and physician availability and so on, one of the things when we're talking about the 811 list and information that became available, as the member would perhaps be more acutely aware than some of the rural members, was I think, as he said, two and a half or three years ago many Nova Scotians assumed that physician or primary care access was more of a rural Nova Scotia challenge.


            With the introduction of the 811 list for us to get a feel from Nova Scotians, for the first time, as to the needs for primary care coverage, we certainly began to see that in Halifax, the Central Region, or the old Capital under the former model, does have primary care needs as well, which is similar to many rural communities, so that awareness is there.


            We did give the direction, we've made it very clear, I've spoken publicly, including in the media previously, Mr. Chairman, as part of my tour around, certainly communicated with physicians and I've been starting to hear, and not just in the Central Zone but in some of the rural zones as well, that same question has been posed. What I'm starting to hear from physicians and communities that are involved in attempting to recruit physicians to their communities, they are starting to see the changes and the flexibility make its way through the system.


            MR. DAVID WILSON: I'm glad to hear that and get clarity on that. It's something that has been around for many years. I know that other jurisdictions have attempted to restrict the ability of physicians to practise where they want to. From every indication and everything that I've read and some of the research that I've gone through, it doesn't work.


            I know there's always that pressure, being minister and trying to find ways of trying to get physicians to go to under-serviced areas, but restricting the licences and restricting the ability for somebody to set up a practice just doesn't work. I hope the minister stands firm if anybody on either side of him comes to him with a recommendation to change that, because it just doesn't work.


            There are other areas and opportunities and ways to try to, hopefully, get physicians to go to under-serviced areas. One, I believe, is to make sure that that balance of work and home life is achievable if you are a physician and you work in the system here in Nova Scotia, especially in rural communities because often the rural communities placed an even greater pressure on those men and women who practise medicine. I think if you were to look at the model that was implemented around the Collaborative Emergency Centre, and that is just one example, you can achieve that work and life balance. Hopefully that can lead to maybe the recruitment and, more important, the retention of physicians because you can pay someone a little extra to go somewhere, but you need to make sure that that balance is there.


            I know I have only about a minute and a half. One of the things I think I asked or I might have said it in a statement or a debate over the last while, since the Throne Speech and the budget, the one area that I didn't hear a lot from or I didn't hear at all - not to say that we didn't hear about mental health - but the Mental Health and Addictions Strategy that was implemented a number of years ago was about a five-year strategy.


            I wonder, would the minister indicate if we're going to see an update or a continuation of Phase II of the Mental Health and Addictions Strategy?


            MR. CHAIRMAN: The honourable Minister of Health and Wellness with about 35 seconds.


            MR. DELOREY: I believe one of the member's colleagues, I think perhaps the Leader might have asked a similar question, talked about the dollar amount that is actually targeted towards the framework. I believe for this fiscal year, in 2017-18, it's about $6 million going towards the mental health strategy, the Together We Can initiative. That work is ongoing, as well as the other initiatives we have highlighted in our budget.


            MR. CHAIRMAN: Order, please. The time for the NDP caucus has expired. I will now recognize the PC caucus.


The honourable member for Pictou East.


            MR. TIM HOUSTON: I will start off with following up on that, the Mental Health and Addictions Strategy, Phase II document. You mentioned the money that is available. I wonder, do you have a timeline for when that Phase II would start?


            MR. DELOREY: I am not framing it in terms of Phase I or Phase II. The investments are investments in priority areas that were identified in that program - again, I give credit where credit is due - that was under the previous government, of which the previous member who was asking questions, was part of. That work is continuing.


            In addition to that, there have been a number of initiatives we have already started. Indeed, my predecessor, the current Minister of Communities, Culture and Heritage did strike a panel on mental health, received some recommendations there. We have recommendations that have come from a recent visit to Cape Breton. We have a number of initiatives and activities that have been flagged by mental health professionals, that complement and go in line with what has been going on here.


            The efforts are continuing, but I haven't viewed it or phrased it or framed it as a Phase I/Phase II continuation, something new. It is really part of our work that we have to provide to Nova Scotians, to continue our focus and continue our investments and continue identifying where we can make a difference in the lives of those Nova Scotians who are either suffering from, or potentially susceptible to, mental health challenges. Again, that work is ongoing and will continue, but it just hasn't been framed or phrased in a context of Phase II or something in that sense.


            MR. HOUSTON: It has been about two and a half years, I think, since the Nova Scotia Health Authority started to reorganize and restructure Mental Health and Addictions. After a couple of years, we should start to see some fruits of that labour. We should start to see some payoff on the reorganization. But that is not what the media is reporting. The media is reporting hot spots like Cape Breton with ever-increasing suicide rates. I do take that the media is not the only gauge on these types of things.


            I wonder if the minister can provide any metrics that the department is looking at, to see whether the reorganization is producing positive results, any metrics the department is looking at to see if the reorganization is effective. I am wondering, could the minister shed some light on what the metrics might be and whether the department's read of the metrics is telling them that these major changes that have been made are producing positive results?


            MR. DELOREY: Mental health is an area of the health care system that is perhaps more challenging than some others for boiling it down to metrics and measurements. From my experience, and I will be the first to admit I am not a clinician, so this is information gleaned over studies and information I have read and, of course, information I would have gleaned in my short period of time as Minister of Health and Wellness.


            The reality of mental health is that when an individual is struck with mental illness, in particular, there is no mechanism or means by which one can predict or really anticipate, nor when one is to become ill and, likewise, the path to recovery. The impacts are so diverse and personalized in some instances, the psychological sums are physiological and chemical relations so that it becomes very difficult, I think, to simply boil down to metrics for improvements, particularly in the mental health space.


The member made reference to some data from media referencing suicide. There are metrics but the challenge particularly with simply relying on raw data - and this is in conversations with some individuals who are experts in this field - if you actually do boil down the metrics for suicide, really the numbers are so small that - we want them to be zero as a society, but that's not the reality - generally speaking, the numbers are collectively so small that a few additional incidents where tragedy strikes can lead to significant variance in what's boiled down to as ratios and data.


In addition to that, many times the underlining data that contributes to, in the example used of suicide, economic impacts, in particular with men, I believe. As stereotypical as it may be, the data does show that when they become unemployed, lose their job, the pressures, societal pressures - again, as stereotypical as it may be - certainly build up and you do see an increase in that population during times of economic downturn, as we would have seen in the last couple of years, particularly with the changes in the oil industry and a lot of our own neighbours and family members who would have been working out there and may have lost employment or seen reductions in their employment, have become more susceptible.


            Again, I guess all that is to say of all the areas in the health care system, to attempt to simply drop it down to two metrics and identify, particularly in light of the broader social context of what's been going on lately, it's extremely challenging to try to do that and simply point at the reorganization as being successful or not.


What I can assure you, Mr. Chairman and the member opposite, is when I did my tour and I met with the mental health and addictions groups in the various communities that I met with across the province, we talked about the amalgamation of the mental health and addictions groups within the Health Authority and the work that they were doing. I explicitly asked the question about how they felt that process was going, whether they felt it was positive. Resounding in each of those groups, it was a positive response, that individuals on the addictions side making reference that, you know, their clinical skills and certainly a lot of comorbidity - that is, individuals with addictions and with mental health, we often see coexisting - so, the supports and the services are being provided in both of those groups, and working more closely together now than they would have in the past so, certainly, there have been some positive moves in that regard. Thank you.


            MR. HOUSTON: Thank you, minister, for that response. It is a massive reorganization, and when somebody undertakes a massive reorganization, they should have an end goal and my only curiosity was whether the department is looking back to see, did we fulfill the goals? I didn't hear that, other than on the minister's tour, that people are saying that things are great.


[5:30 p.m.]


I just caution the minister, I don't think that things are great in mental health and addictions. If people are telling him that everything is running great, maybe they are just saying what they think he might want to hear. I do have a lot of concerns in the way that the addictions treatment is being provided or not provided. The only metric we should be using is, are people getting the services they need when they need them? That's the metric that I would ask the minister to keep in mind, as tricky as metrics can be.


We know in Pictou County the short-stay unit closed. We all know the history on that. It was a temporary close, then it wasn't a temporary close. I'm just wondering, can the minister can give me any sense as to whether there are any plans to reinstate a short-stay unit or some bed coverage at the Aberdeen Hospital for people in need in the case of mental health and addictions?


            MR. DELOREY: May the record show, I think this is one of the few times the member and I can come to agreement, at least in the last few years. The notion of access as a metric, as an access point, the availability of services to individuals. That is not a judgment case on - I thought when he was asking about metrics he was looking for more clinical-specific types of metrics in the individuals, but certainly from a system perspective, the access points as the member would know, we are certainly investing to improve access in a variety of ways, whether they be through our crisis support lines, putting additional resources there.


With our Telehealth Network, indeed I believe Doctors Nova Scotia have recently put out a report on a mental health lead who is located in the city, provides a number of services, does some teaching and other things, and also provides services through Telehealth, so they are able to provide their clinical expertise from here in Halifax to community centres, through secure video conferencing, in other communities. There are moves to build and secure that kind of access, crisis response teams and so on.


            Putting access in our communities and a major focus on our youth, investments we do know from research that, in many cases, individuals who may be susceptible or suffer from mental illness throughout their life, often that illness begins to manifest itself in adolescence and in youth. So that is the reason why that's where a lot of our resources are being directed because we both first work where we can identify the individual who may be prone to mental illness, but also by identifying we also have the opportunity to work with them to bring and enhance their treatment options, their coping mechanism, to support the wellness of the individual. Having those supports, building that capacity at a younger age provides value throughout the system as it reduces or has the potential to reduce demand on the more acute services as those individuals get older.


Again, the success of serving and providing those services, particularly in our youth, actually provides value to all individuals and ensures that there's more distribution of our more acute services to those who need it most, going back to that metric and ensuring that the access points are there for those individuals when they need it.


            MR. HOUSTON: If I may summarize and re-ask, no access point at the Aberdeen is what people should expect?


            MR. DELOREY: We are continuing to assess throughout our communities what level of services are necessary. Of course, in-patient bed access is the most acute service being offered or being made available to communities. That work, I believe, at the NSHA is still ongoing. As I said in my first response, most of the significant portion of efforts and investments are going to providing supports and services through our Department of Health and Wellness, the NSHA, the IWK, and also through our education system.


            I mentioned that focus on youth. Where are they located? They are located in large part in our school system, providing SchoolsPlus, providing clinicians, investing to ensure that we have additional mental health clinicians across the province to provide those supports and services in our communities where and when people need them, again recognizing that in-patient beds are really reserved for the most acute, most severe incidents that manifest. Where and when additional expansion in those types of beds will be required is something, again, that is part of the NSHA's ongoing work to assess.


            MR. HOUSTON: I wonder if the minister can provide any statistics on the number of Pictou County residents who have required in-patient beds or acute care at another facility, in another hospital, whether it's Truro, Antigonish, or further abroad. How many people from Pictou County are actually requiring services offered at another hospital?


            MR. DELOREY: That level of detail of specific patient data I don't have available here with me this evening. I'm going to put a caveat, depending on how big or small those numbers are - if they're too small for privacy reasons, I just put the caution out that we may not be able to release. If numbers are too small, it may be possible to identify individuals. But what I will promise the member is that we will take a look to see if we can ascertain that level of data. I know he wouldn't be the only one - I think there are two other members of his caucus who would share an interest in that data. We'll see what we can pull together, and if it's available, we'll make it available through the process.


            MR. HOUSTON: I wonder if the minister can provide the House with a date as to when the new emergency room facilities at the Aberdeen would open. They look like they're pretty much ready. I wonder, how close are they actually to opening?


            MR. DELOREY: The current status is it is, as the member would know, very near completion. I don't have an exact date, but it is in the final stages of work on the internal system's final stages, but again, I don't have the exact date. I can reach out to the NSHA and see if they have an exact date with expected opening for access. Generally speaking, I would say it would be imminent, barring any issues with the final occupancy reviews and so on, but as far as work, I think it has progressed very well and it's in those final stages.


            MR. HOUSTON: Mr. Chairman, I will read an excerpt from the budget: $6.4 million more to hire more specialists, perform additional orthopaedic surgeries and offer pre-habilitation services, reducing surgical wait times, and moving us closer to the national wait-time benchmark. The minister probably knows as I do that the barrier to care is not always the availability of specialists. A big barrier to care, especially around orthopaedics, is access to OR time and recovery bed time, and there are a number of inefficiencies within the OR time-allocation system that often frustrate specialists. I would like to ask the minister, how will the government address access to OR time to help the wait-list for orthopaedics which is really the main issue in my mind?


            MR. DELOREY: Mr. Chairman, I thank the member for highlighting the government's commitment and investment to move forward on continued increased investments in orthopaedic surgery, with the investment covering both the pre-habilitation work to ensure that the surgeries that do take place have the highest probability of success for both the patients and also our system - you know, anyone who does this type of work, I think seeing it carried through successfully and that is that the work takes hold and that the individuals recover in a timely fashion.


The member's question really was, specifically, more focused on OR time and how we manage that. Some of those initiatives that would take place include things like expanding access on weekends, so that there will be some Saturday access, so we're getting access to ORs at, perhaps we'll call it non-traditional times, so we're tapping in to make sure we make the best use of the space and the infrastructure that we have. Over time, certainly, we know that we have expansion in OR capacity in Dartmouth General Hospital, the work that is ongoing with the expansion over there. We know that we're committing space there to focus on ortho work. Perhaps the member, again, recognizing that the hospital in his community does provide ortho services - I know my community in Antigonish, many often go to Aberdeen Hospital for those services.


As far as the OR time, we are looking at non-traditional OR access points so that we can - we already have the systems, we can't necessarily just bump other surgeries and work that needs to be done, but there are times where like Saturdays the ORs may have been underutilized and we're tapping into that time to move forward on delivering this much-needed service to Nova Scotians.


MR. HOUSTON: I'm also curious as to why orthopaedic surgeries were specifically singled out in the budget. Obviously, hip and knee replacements, they make a huge difference in a patient's life, but there are many surgical specialties that have unreasonably long wait-lists, and thyroid cancer is one that comes to mind for me. I'm wondering, will the department work on bringing us closer to the national wait time benchmarks for all surgical specialties or is this money specifically dedicated to ortho?


            MR. DELOREY: As the member would note, in this budget for 2016-17, it is an explicit and direct focus on the ortho surgeries. This is an area that has been a challenge not just in Nova Scotia, but many parts of the country. I don't believe any jurisdiction is meeting the national benchmarks. This is an effort to ensure that we continue moving in the right direction. Of course, I think all of the efforts that we are undertaking as a province with all surgical, or services that we provide, is to do the best we can with the resources we have.


[5:45 p.m.]


            I think the opportunity that presents itself though is, again, the concerted effort folks did, in this instance on this particular service, denoted some creativity that goes into this design, identifying opportunities to make the best use of the investments that may already exist, in response to the last question. Looking at means to optimize the utilization of expensive infrastructure that we have in place - that would be ORs - going through initiatives like that, the learning that we get out of this investment and this targeted focused investment, I think there will be lessons that we will learn - other things like centralized booking that allow us to identify where the opportunities and the waits are best managed. These are all things that really help all surgeries and help us perform more efficiently and effectively. Again, as I said, there will be some things that we can learn out of these targeted investments that I think will help us optimize the services we're providing in all of our surgical areas as well.


            MR. HOUSTON: The $6.4 million line item, it says $6.4 million to hire more specialists, perform additional orthopaedic surgeries, and on and on. I wonder if we can maybe get a breakdown as to how much is for hiring more specialists versus how much is for just getting more surgeries done. I do think that that is an area where we do have the specialists, but they need the time and the parts to do it.


            MR. DELOREY: The breakdown - the hirings that will take place, which again is a big part of the costs necessary for the delivery - that's four ortho surgeons, four anesthetists to provide the actual surgical procedures, but that also includes around 40 additional staff members and service providers, which may include physio and nursing staff and so on. Those are all part of the significant parts of the costs associated with performing these services. As noted, that includes what was highlighted - pre-habilitation services. I believe there were some questions last week about - you explicitly referenced pre-habilitation, what about post - but as I noted with the support groups, post wasn't flagged or highlighted because that was a given. We highlighted and stressed the pre-habilitation services, mostly because it's a lesser-known service - more a newer service that has been shown to have positive outcomes on the surgeries themselves.


            MR. HOUSTON: Just a final thought on the orthopaedic situation - is there any thought to funding any additional ortho clinics around the province to help reduce wait times, or is it just the clinics that we have, we're going to try to get more resources to them?


            MR. DELOREY: I believe right at present, from explicitly an expansion side, for work being done, I think, would fall in mostly with respect to what's going on at Dartmouth General at present, for where specifically the ortho surgeries are being done.


            MR. HOUSTON: I think I'll finish up my time with a couple of questions on the federal taxes. I did see a line item - $9.6 million to advance new collaborative care teams across the province, increasing access to family doctors, nurses and other primary health care providers. We know the situation in Nova Scotia. This seems like a drop in the bucket when you have, I think, 30,000 people on the wait-list for a family doctor, but closer to over 100,000 depending on who you listen to - actual people looking for a family doctor.


            My concern is that this whole situation will be made worse by the federal tax reforms. I was at the meeting where the doctors showed up, and Doctors Nova Scotia produced some statistics that suggested that over 400 doctors would leave the province or scale back their things. I'm wondering, does the department have any kind of contingency plan to offset the detrimental effects that these tax changes might have?


            We know that there won't be time to salvage it. Doctors are people. When they make up their mind that they have to do what's right to protect their family and their own situation, they're not going to sit around and wait for committees to debate and see what happens. They're going to move.


            I'm wondering if the Department of Health and Wellness is, (a) concerned about the federal tax changes. They might not be to the degree that I am, but I'm very concerned. I wonder if (a) the department is concerned and (b) if there's any plan B.


            MR. DELOREY: I think the member would be aware I have met with physicians, including Doctors Nova Scotia and others, and this topic has come up. As I've indicated, I have spoken to my counterpart. The Premier has been very clear that he has also raised this with the federal government in terms of the concerns, particularly in the Nova Scotia context. We're certainly on the ground doing our part to ensure consideration.


            If the member was to look at more recent comments from the federal government, the commitment to ensure opening the door for changes, as part of the tour that the federal Minister of Finance has been undergoing, listening to Canadians - indeed, I believe that included a stop here in Nova Scotia last week or the week before - to hear first-hand and to consider making changes as they go through. Again, those efforts continue to be ongoing.


            The investments that the member referenced going towards collaborative initiatives both for collaborative practices with physicians but also with nurse practitioners, family practice nurses, social workers, and dietitians - really the scope of skill sets that are needed in each of those practices can be identified by those coming together to provide primary care services. It's not a drop in the bucket, as was indicated.


            I had previously mentioned one collaborative practice in Dartmouth. Not only did they take all of their internal wait-list from a retirement that took place in the facility that they were operating in, but in just a couple of short months, they have also taken 800 names off of the 811 wait-list. They continue to have capacity, they're continuing to get names from the 811 list, and they're continuing to fill more spots.


            That's just one practice, picking up in just a couple of months 800 just off the 811 list after resolving internally. This is an approach that is showing results. We just need to continue our efforts and get these established throughout the province.


            MR. HOUSTON: Just a follow-up - I guess 800 people coming off a list is a good thing, particularly for those families, but when you have 100,000 people on the list, I guess we could get into the semantics of what is a drop in the bucket and what is not a drop in the bucket.


            If there are 100,000 Nova Scotians looking for a family doctor - I don't know if that's a number that the minister would agree to or not, and maybe he could give his own number if he doesn't. If tens of thousands of Nova Scotians are looking for a family doctor, would it be the minister's position that $9.6 million invested in new collaborative care teams is going to address all the people that the government accepts are currently looking for a family doctor, or is it going to address a portion of the people looking for a family doctor?


            MR. DELOREY: You know, it's interesting the member is taking about 100. His caucus Party social media report referenced 120 and was promptly corrected by the head of the organization that put out the report, so the number that we would have of individuals looking for a physician would be about 33,000 as of the end of August. That would be the most recent data. We'd be expecting to get an update some time in probably the second week or so of October, which would give us the end of September data. We're looking at somewhere around 30,000 or 33,000 people who are registered looking for primary care services.


As I said, the 800 is just within a couple of months of one individual. Will this investment on its own solve the problem? No. Nobody suggested that it would. This situation with Nova Scotians looking for primary care services didn't happen overnight. People didn't wake up in 2013 or on April 1, 2015, and say, wow, I no longer have a primary caregiver. Indeed, this is a situation that has existed over time. This is one initiative that was cited for investment.


We have other initiatives including our investment in establishing a clerkship program for third-year medical students from Dalhousie University to have the opportunity in the first iteration to go and continue their third-year studies with a practical component of over 40 weeks in Cape Breton communities. What we know then is, in addition to expanding our positions available for residents, that when a physician does train or have exposure to work in a community, there's a higher probability of them settling down in that community. That's why you only see in a family or general practitioner-residence program, a two-year program, that individuals have a desire to stay in or around those communities or similar communities to those where they served their residency training.


            That's why we think the clerkship, the expanded residence programs, these all interplay with things, and our investments in collaborative practice. We also have other programs, tuition relief. We provide family medicine bursaries to help encourage physicians offset their study costs but also encourage them to practise in an area, so we have a variety of initiatives and incentives. Some are attracted to some. Some aren't. That's why you have to have a suite of options. We continue to look for those options. I had the opportunity to speak to residents. They are excited at the prospect of working with us to identify what will work for their membership and for the residents of Nova Scotia, to help them make the decision to stay and practise here in the province.


            MR. HOUSTON: Denial is rarely a solution and there are a number of statistics out there that talk about the number of Nova Scotians who don't have a family doctor and, it's interesting, I've heard the member refer twice to our Party being corrected on a number, which is absolutely false. Don Mills did an insight release. He said that 18 per cent of Nova Scotians, 13 per cent of residents, don't have a family doctor. The minister can correct us tonight if he wants but there are 924,000 Nova Scotians and 13 per cent of 924,000 is the number that we had initially put out, which was 120,000-some-odd, and we put that out there and apparently that must have made the pollster a little uncomfortable to have a real number attached to it, because he said it's factually incorrect.


[6:00 p.m.]


I challenged him to correct us, which was then met by radio silence. I would welcome the minister to correct us today as to what 13 per cent of 924,000 is. The minister says there are 33,000 Nova Scotians without a family doctor. I believe that's probably the number of people who have registered on a list.


            Perhaps what is lost on the minister is people get tired of registering on lists. And no, people didn't wake up in the morning in 2013 and realize they didn't have a family doctor, but I can tell the minister that he should not be patting himself on the back for that because since 2013, there are many, many thousands more people who don't have a family doctor.


            The minister can talk about the programs that are going and even the clerkship program, the issue that I have is that that may yield a family doctor in four years, after that person has finished two more years of medical school, two more years of residency, so maybe four years down the road one of those people may stay and practise family medicine here, maybe, because there's nothing in what was put forward in this budget that obligates them to. There's nothing that was put forth that encourages them to.


            It's a little disheartening for people like myself and it's a little disheartening for the many thousands of people who don't have access to primary health care, to hear the minister stand there and say, well it's not 100,000 - he said it was 121,000 it's not even 121,000, it's 33,000. Who cares? Maybe the minister can provide a number tonight - is 33,000 the number the minister wants to stick to - 33,000 Nova Scotians who don't have access to a family doctor? Is that the minister's official number?


            MR. DELOREY: I thank the member for the question. As was referenced earlier, that it is, as of the end of August, 33,000 that we're aware of who are looking for primary care services in the province. As the work goes on, again we are continuing our endeavour to ensure that all Nova Scotians who are looking for primary care services, we have those services available to them. That's why, as I said, the investments - we know that changes in how physicians practise, both their training and their preference for - their approach to their practice has changed over the years.


            It's my understanding that this contributes to some of the pressures being seen not just across Nova Scotia, but across the country for recruiting and maintaining coverage in the primary care space.


            The fact is, we do have incentive programs. As I said in my last remarks, those programs are yielding results. Some are more effective than others. Again, they are designed to have a suite of options so that individuals, depending on their circumstances, can choose the incentives that they are most attracted to and they continue to provide the services.


            The references to when will we see value, when will Nova Scotians see value in things like the residency program, while it may be true that the individuals won't be able to get out and practise on their own until they complete their residence program, let there be no mistake that when a student is a resident they have completed their medical studies - that is, the classroom portions - they've had initial training opportunities and they do provide care services to Nova Scotians, even as a resident in a community.


            If the member wants to get into a debate about semantics or numbers and what have you, I hope the member is not suggesting that residents don't provide service or value to Nova Scotians or the patients that they see. I'm sure that's not what he and his caucus are trying to suggest, that only once a resident completes their residency that they provide a valuable primary care service to patients. I suspect that having that conversation with a resident in the Province of Nova Scotia, he might be corrected on that assertion.


            Again, these investments and these expansions in these areas are going to yield results and increased and improved primary care access for Nova Scotians, even while residents are serving.


            What I was getting at was that we do have data that does show that residents who practise in an area have a higher probability, I believe - and I will stand to be corrected on this point - but I believe, if memory serves, about 70 per cent of residents do stay in the province where they've practised. So again, that is a good investment. That means as you're getting the primary care service for the two years that they're in residence, that 70 per cent of them will actually stay in the province to continue to practise after that fact.


            Again, this is a program that is designed, that past data and metrics suggest will yield positive results, both in the short term as residents practise and complete that portion of their training, and also because there's a higher probability that once they complete their residency that they're more likely to stay here in the province where they've completed that work.


            MR. CHAIRMAN: The honourable member for Dartmouth East.


            MR. TIM HALMAN: We all know that there is an enormous sense of frustration in our province towards the health care system. In my community of Dartmouth East, I've had an opportunity, like most MLAs, to have some really frank, open conversations with doctors and nurses and nurse practitioners, and there is a frustration. I think a lot of it has to do with a lack of communication on the part of the Health Authority and, to some degree, a certain lack of professionalism, professional treatment of our doctors.


            Many of the questions I'm about to ask emanate from my conversations with doctors. Sticking to the theme of a lack of communication, in Dartmouth, we need some clarity as to what the plan is to enhance the primary care in Dartmouth. Certainly, being on the doorstep, listening to members of my community, it all comes down to primary care. If you could, what is the plan to enhance primary care in Dartmouth?


            MR. DELOREY: The efforts for Dartmouth are consistent with our efforts across the province. We are investing and we recognize a shifting interest in how physicians want to practise - not universally, not necessarily every service provider, but certainly a growing trend particularly amongst young physicians who are graduating, that they are being trained and taught in a much more collaborative, team-based environment, working with other health care professionals as a team - whether they be nurse practitioners or making use of family practice nurses and others who can provide support at the primary care level. Indeed, that is becoming the trend.


            Certainly, our focus in our health care system is to adapt to that changing foundation, and it is relatively early stages in that transition, to be a more attractive place for young physicians, in particular, to come to Nova Scotia and practise. For those who complete their residency and their training here, that they be more likely to stay because those opportunities exist.


            At the same time, I would hope that, perhaps, the individuals that the member has spoken to and others, recognize and see that things are changing - that they are moving in a better direction. They may not be perfect, but again, the recognition of the collaborative framework was identified a while ago. That became a priority and the initial way that it was going to be rolled out was, this is the box, this is what it will look like. It's in this kind of infrastructure with these primary care practitioners, X number of physicians, X number of nurse practitioners and so on. That is what a collaborative practice looks like, and anyone who wants to open a collaborative practice, it must look the same and it's a cookie cutter.


            It didn't take long to receive feedback and indications that that won't work. I think that ties into what the member was referencing about - that physicians, their professionalism, their economy as practitioners, and recognizing the profession in itself and their ability to identify what is needed in the delivery of the primary care that they were providing.


            I think a question was asked earlier today by the NDP caucus about the flexibility of physicians to practise in other areas in primary care if there is a need, that that barrier at one point was put in place. I want to assure the members, the intent was not to frustrate primary care providers, but rather it was an effort to see where the most acute needs were in our communities. I think this was an approach that was being taken by the NSHA to meet those most acute needs and so they were trying to say, this is where the need is highest, we want to start knocking those highest need communities off first so when we're recruiting, find someone who is interested in working in Nova Scotia and move them to that area.


Clearly it didn't work. It wasn't the approach. It wasn't well received by the physicians and it ignored the needs in some other communities. Although there are communities that may be identified as being in more acute need, we have needs across the province. If we're able to meet the needs, that's the model we're shifting to.


Similarly, with the collaborative care practices, providing the flexibility so every collaborative practice doesn't have to look the same necessarily. One of the things that I learned in the half-dozen or so practices that I visited, every single one of them worked a little differently. They had slightly different configurations and varying degrees of collaboration between the practitioners. Some had family practice nurses and nurse practitioners; some only had one or the other. They were all a little bit different, but they all provided good primary care and the satisfaction of the employees. All of the individuals in the groups seemed - again, in the conversations with me - quite high.


The member for Pictou East suggested that perhaps when I was meeting people, they just told me what I wanted to hear. I guess that's a possibility, but being in the room, reading the body language, certainly the feedback I received seemed genuine. Again, this is the path that we're on.


When I talk about the collaborative practice, the one that I recall, the number that they - only about four months old, that this particular group started up and they've already completed the internal wait-list and they've already, in the last two months or so, taken 800 names off the 811 wait-list and they're continuing to take names off the wait-list. So they're very excited about the progress they've been making. I think it's been very successful and we want to replicate that success, not just in Dartmouth, but right across the province.


MR. HALMAN: You mentioned the importance of making our province a more attractive place for doctors. In another term, I suppose you could call that "pull factors." We need to strengthen and enhance pull factors to bring doctors to our province. What are we doing? What is the plan to create more pull factors to bring doctors here to Nova Scotia? I ask this because it's a common question, I believe, that's asked throughout our province. This is in the spirit of communication - the spirit of clarity. What's the plan to bring more doctors?


[6:15 p.m.]


MR. DELOREY: I think there are a multitude of factors that make a place more attractive, whether it is to a physician, nurse practitioner, any health care provider, or indeed anybody who is looking to set up, be they entrepreneur, teacher, or any profession or individual who would want to move to Nova Scotia to make it their home, to provide whatever craft or skill or service or profession they may have. Some of the factors are, I think, as a Nova Scotian, having been born and raised - I am a bit biased towards, and of course those are the natural attributes of the province that we have, not easily replicated. But in specific context of our health care system, I have already mentioned our efforts to invest and recognize the changing patterns of how physicians want to practise, of being flexible to work with those who have different approaches.


            One interesting thing is, you look at the opportunities or options for how physicians are remunerated. You know that there are different models, fee for service, APP which is more in line with a salary-based compensation model. Indeed, I believe Nova Scotia is the jurisdiction with the highest ratio of APPs. There will be more on that salary approach. That may explain why Nova Scotia is one of the leading provinces for individuals - I know the attention tends to be on the number of people without primary care providers but we do get a high ratio, on a per capita basis, of people having access to primary care providers.


I know people talk about the per capita number that came out in the CIHI report and say, yes, but you have a medical school. Well that's right, we have a medical school and that attracts physicians. It makes it more attractive because there is great research taking place here and there are opportunities to work with specialists to support your patients. We have great tertiary and quaternary services here in the province. We have a phenomenal regional children's hospital here in the province, and that ensures we have more specialists. But it also ensures we have more family practices, because I think physicians want to have the support services to ensure that the services available to their patients are available.


            We have those initiatives. As was mentioned a little bit earlier, we are investing in the collaborative practices, again, shifting practice methodology. We are investing in that to help encourage particularly new physicians or those who may wish - and nurse practitioners and other health care providers who may want to move and relocate here because it's an environment that is conducive to the way they want to practise.


In addition, specifically to physicians in the primary care setting, those residency spaces and expansion as I mentioned, that increases the probability that these individuals (1) will provide services while they are going through the residency, and (2) there is high probability, based on past historical data, that an individual who completes their residency has a higher probability of staying in that province, even in those communities where they complete their residency.


These are things, when you look at the residency program, something I have learned since I became Minister of Health and Wellness, is exactly how the residency program operates, and it is not a situation - I will tell you what my assumption was. My assumption was Dalhousie was the medical school. It has a certain number of resident seats that they allocate to their students. But that is not how it works. Indeed, the residency is a unified national program, so all the jurisdictions, they have a certain number of seats. They register those seats with a national program and that program then allocates the resident spaces out. It's almost like a matching service, a digitized matching service to align medical student resident candidates with available residency seats across the country.


            It explains why when I was in Dartmouth where they have 10 residents, five in each first and second year, only one of those residents who were at the meeting was actually from Nova Scotia. The rest were from outside of Nova Scotia and that was just because they got aligned with Nova Scotia, in this case the Yarmouth seat, so they had a high propensity, desire, to stay here in Nova Scotia based upon their positive experience of working in the southwest portion of the province - again, I think the steps that we're taking do increase that pull factor the member was referencing.


            MR. CHAIRMAN: Order, please. The time for the Progressive Conservative caucus has expired. I will now recognize the New Democratic Party caucus.


The honourable member for Dartmouth South.


            MS. CLAUDIA CHENDER: Mr. Chairman, I have a hunch that my colleague, the member for Dartmouth East didn't get all of his questions in, so I'll take the opportunity to just ask a couple more questions more specific to Dartmouth, and then I'll yield to and share the time with my colleague, our Health Critic, the member for Cape Breton Centre.


            I mentioned the other day that we do believe that we are facing a primary health care crisis in Dartmouth, in particular. I think I used the statistic that 35 per cent of our physicians will be retiring within the next five years. It came to my attention today that four of those physicians will, in fact, be retiring before December. Based on some of the physicians that I've spoken to at the Dartmouth General Hospital who are very concerned about that, that's going to mean relatively immediately we will have somewhere in the order of 10,000 people, on the back of the envelope something like 15 per cent of the population of Dartmouth that currently has a physician, without a physician, by the first of the new year.


As you can imagine, that's deeply concerning in any number of ways, so I guess my first question is - and we've heard it a couple of times, how we tried to target physicians. It didn't work. Nonetheless, I do believe we are facing a crisis in Dartmouth. I think we are going to see huge problems. I think first it's going to hit the hospital lists, and then it's going to hit the rest of us, so I'd like to know, what are the department and the minister and the Health Authority doing to remedy that immediate situation?


            MR. DELOREY: Mr. Chairman, I thank the member for the question. Indeed, as I mentioned, all of the steps that are being taken across the province would apply to Dartmouth, but I can assure the member and her colleagues - four colleagues that represent Dartmouth, north, east, south, and west - three colleagues and herself and for each of the representatives of Dartmouth for the constituents, that the NSHA does recognize - I think I mentioned earlier, it was one of the things about having a single health authority, but also, establishing the 811 list has actually benefited the province. It gives us a lens and a view that we didn't necessarily have previously.


I think many Nova Scotians, including the media, assumed that access to primary care was strictly or almost uniquely a rural challenge or phenomenon and the data shows that there are urban challenges as well. Those efforts - I know the NSHA is engaged in conversations with physicians in and around the Dartmouth area about establishing more collaborative practices. The one that I've referenced previously was a new practice, not necessarily with all new physicians, but people who've gotten established in that practice.


You made reference to hospital lists. There's work, ongoing discussions with Doctors Nova Scotia about a program to support that service across the province. Again, it would help address some of those concerns there as well. So, there are steps being taken, and certainly an awareness is the first step. So, that's awareness and then focused efforts and work there.


Again, in the absence of being able to force anyone to perform work in a particular location, our efforts are to show people the opportunity and the success and the positive response, and like I said, the Woodlawn facility was such a positive experience. Those individuals that I was meeting with were very pleased with the environment they were practising in with the collaboration and the supports for some individuals. It was the first time, I think, working with a nurse practitioner and family practice nurses and seeing how together they are able to actually, really efficiently provide primary care services to a wide range of people in the population.


            MS. CHENDER: I look forward to, at some point, hearing about some concrete measures, hopefully, that are being taken, particularly around recruitment. I followed that line of questioning the other day. I understand there are efforts. I am told that those efforts are not particularly successful or not successful quickly enough.


            Turning from there, I would like to ask about, more specifically, the Dartmouth General. I think as I mentioned earlier, from what I am hearing, the hospital is sort of the second wave that is absorbing this challenge, a lack of primary care. I am told that this looks like it might be the worst flu season in several years, so what I am told by some folks at the Dartmouth General is that as a regional hospital, they are deeply concerned about this because there is a lack of family physicians, there isn't that first line. Those folks will show up in hospitals sick. There won't be a release plan.


            I'm wondering, is there specific money budgeted or plans contemplated to deal with this upcoming flu season and to help the staff at the Dartmouth General and, indeed, all our regional hospitals? I understand that all your answers will be somewhat generalized across the province, to deal with these issues that are coming forward.


            MR. DELOREY: The member raises a good point with flu season approaching. I think the anticipation is predicated on experiences in other jurisdictions that have already entered the flu season themselves. I think one of the potential factors there, and really it spans much of our health care system in terms of our first response, and that is prevention, so when it comes to flu, certainly we're nearing the point of flu vaccine. That would be step one, encouraging - and I would encourage the member and indeed all of us, as we put out newsletters to our communities, to encourage our constituents to get their flu shot this flu season, especially if we are anticipating a potentially difficult strain of the flu.


            As the member may be concerned or some members, Mr. Chairman, may beg the question, well if you are sending people out to get the flu shot, wouldn't that be more pressure and what about those who don't have a family physician? Well I'm pleased to advise you and the member opposite, if they're not aware, and indeed all Nova Scotians, that indeed our pharmacists are able to provide flu shots as well. So, members of the public, our constituents, you may want to take the opportunity to let them know that they can get a flu shot and they can get it from their local community pharmacy. That would be a proactive, preventative step we could take. We'll certainly be encouraging all Nova Scotians to take that step and do what we can to mitigate or minimize those impacts.


            As far as what steps would be taken, when any type of - if you end up with a pandemic type of situation, certainly there would be emergency protocols and responses that would kick in and respond then. But again, it's too early to say whether that would materialize or not at this point in time, but again, prevention would be step one, so encouraging your constituents and all Nova Scotians to get that flu shot would be step one.


            MS. CHENDER: Mr. Chairman, I am happy to be able to have afforded the minister the opportunity for that PSA to remind us all to get our flu shots and that pharmacists can give them and that's great. It's not specifically germane to my question but I appreciate the answer, such as it was.


            My last question is, it's more of a general nature, but I've heard now from several people in Dartmouth, particularly folks who have been through this merger which has been difficult in any number of ways, that they take particular umbrage at the slogan of the NSHA. I should preface this by saying, people in Dartmouth are from Dartmouth and they're not from anywhere else. There are a lot of different constituencies that will claim the same, but the idea that they are being told that they are more the same than different, they take particular umbrage at that.


[6:30 p.m.]


Part of that is just a personality quirk, Mr. Chairman, but part of it points to a bigger issue, which is that many of our regional hospitals are not more the same than different, in fact. They treat very different populations who have very different issues. They have different complements of staff. They have different ways of dealing with things. They have different amounts of administrative support.


            One of the challenges that comes out of that, particularly in light of now having a single health authority is that, I have spoken to many folks who feel incredibly stymied in any effort to innovate within the very limited resources that they have. That's very disheartening in a number of ways. It's disheartening because, as we are continually reminded by you and your colleagues, we are working with a very limited fiscal envelope. It seems like it would be incumbent upon us to encourage innovation at every level of the health care system so that people can, in fact, be as efficient as they can be, within their means, within their circumstances. But from what I'm hearing, because of the centralization of bureaucracy, because of the lack of physicians present in many decision-making roles, where they were present in the past, folks are feeling stymied in their efforts to innovate.


            I want to know specifically, through you, Mr. Chairman, to the minister, if there are line items in this budget that I could see that are focused on helping regional hospitals to innovate, to instill best practices, to do that kind of work. What I'm hearing is, those folks are at their max, they have extremely limited administrative support, and they don't have the money, the ability, or particularly the permission to move forward in being more efficient and in using their funds more efficiently.


            MR. DELOREY: I thank the member for the information. I can assure her that the concern with the model or the approach of more the same than different, is news to me. Certainly, on some of the other aspects underlying, we would have heard similar comments, but not that specific one.


            Just on that point, I think that really stems from the One Nova Scotia report. I think that was stemming from a desire and efforts, in an organization, to bring people together to encourage people to think and recognize our similarities and that which brings us together rather than our differences and that which may separate us. That theme, that approach, was also stressed and highlighted in the One Nova Scotia report. In a province this size, for us to be successful - for what it's worth, I think what the Health Authority was trying to accomplish or the message it's trying to convey is that we are a province of just under a million people. We need to work together. We need to focus on our common mission and objectives, more so than that which divides us.


            That in no way for your constituents in Dartmouth - I have come to recognize in some of my visits and interactions with individuals, including one member of the media if you follow this individual's Twitter feed, who is quite a proud resident of Dartmouth, who makes the point very clear, of their unique culture and character. For what it's worth, the intention is not in a divisive context but rather in a desire and effort to show where we can unite and get behind a common purpose and objective.


            More to the point of the question around what steps or what interests in terms of opportunities for improvement in our health care system and work, I'm not aware of a specific line item at the regional hospital by hospital perspective, in part because that's part of the NSHA budgeting side of things for each of those hospital facilities. Something at that level of detail would be stemming out of their budgeting process, but broadly when you're talking about our government and our interest and our efforts. Certainly, our work with Dalhousie in particular, not just their medical school but their broader health services program there - we have the former Dean of Medicine, who is now VP of research with the NSHA - really recognizes the importance of that research contributing to the best practices within our health care system, that there are efforts ongoing.


I go back to those early stages of a big reorganization like this, that a lot of that central control was a necessary part to even understand what types of innovative practices and activities may have been taking place in different regions of the province, some perhaps better, some just different. It did take some time and it did require that strong central component to pull all of that in together, to get that assessment. Now that they've been in place for just over two years now, about two-and-a-half years, that opportunity to engage in a little more engagement, I think we'll start to see that as well as part of the process. I think that's a natural evolution with major organizational change like this.


            Again, it's not to in any way diminish or downplay the legitimacy of the concerns and the experiences of those health care professionals on the front line who have the lived experience of going through this transformative restructuring. Suffice to say again that, you know, that's a big part of the early stages of any reorganization of this magnitude, that the next phases are more of that opportunity then to get back out and engage, because you know then how the systems are operating. Where are the innovative centres? What areas have really been contributing and really pushing the envelope and where do you tap into? I think those opportunities then present themselves. It is a transitionary period but at a broad level, as I said, really investing in Research Nova Scotia.


We have the former dean in a research role as a VP of research, with the NSHA, so those relationships are very strong. The evolution of the health services in our university sector, not just at Dalhousie University but our other universities as well, whether they're through their nursing programs, their nutrition programs and other programs, doing great research that contributes back into our system and for our communities and, again, for those front-line health care professionals. Oftentimes, that research is collaborative between the researchers in an academic setting and those on the front lines. Really, in many cases, you can't do one without the other. So, again, that work is ongoing.


            MS. CHENDER: Thank you. I guess just to clarify, I would say sometimes you can't do one without the other but sometimes, I would suggest, that you can and that there are lots of ways in which small regional hospitals can and are forced to innovate and adapt to their unique circumstances. I would love to see, at some point during this process or afterwards, some evidence that beyond high-level VP research stuff, that there was actually some support, even in the form of administrative support or money or specifically targeted information towards those folks on the front lines.


Before I yield my time to my colleague here, I also just want to clarify that the Dartmouth that we're talking about would also include our members from Cole Harbour, so it isn't quite - I think you were clarifying like how many members we're including. I mean, we're talking about a big part of the metropolitan area, but I want to thank the minister for his time and I'll yield my time now.


            MR. CHAIRMAN: The honourable member for Cape Breton Centre.


MS. TAMMY MARTIN: It is surprisingly a really appropriate time for me to have some follow-up questions after my meeting yesterday with the community, with the residents in New Waterford. I don't know if you followed any of the press that has come out of that meeting, but Dr. Peter Littlejohn was in attendance and spoke quite freely and I understand that he is the vice-chairman of this new collaborative care centre that is coming to New Waterford.

            Last week, we spoke endlessly about collaborative centers and/or what is happening with them or not, in relationship to Cape Breton Centre. I was very disappointed to hear completely different information yesterday from the vice-chairman of this program or plan than what I heard last week from the government.


            We held a town hall or question-and-answer meeting yesterday with the residents of New Waterford and surrounding area, who have concerns about our emergency room, about the mobile care team, just to name a few. When I asked the minister last week what is the address of the new centre, albeit he didn't know the numbers, but he couldn't even give me a general location.


            I received that information yesterday from the vice-chairman of the centre. When I asked the minister last week, what would be the timeline on this centre, the Minister of Health and Wellness assured me that it was preliminary stages of discussion. Yesterday I was assured from the vice-chairman or the co-chairman of this project that the sod was turning as early as the Spring of 2018, and it will be completed probably within that year. As the representative for Cape Breton Centre, and Health Critic, to say I am disappointed that I don't know any of this information is an understatement. To say that somebody is not being forthright with me in this House and the members of my constituency, is extremely disappointing.


            I ask the minister, was it Dr. Littlejohn who was not being forthright with me? Or was it the minister? Could you please provide some clear clarification?


            MR. DELOREY: I stand by the information I provided last week in our comments that no formal decisions as to the final location zone have been completed. You know, the review and approval process that would have to follow before those things are in place. While what may have been presented to the community represents the current status and preferences of those involved, certainly to my knowledge those processes have not gone through and been received and vetted and finalized. Again, I stand by the comments and the information that I provided last week.


            MS. MARTIN: Thank you to the minister for that response. Again, I'm not saying what is right and what is wrong. But when I was asked in questions yesterday why I can't provide this information, I said, one, I have not been included. They said, why don't you come to the meeting? Two, I have not been invited to any meeting, which I think is quite disrespectful of the position I hold and for the residents that I represent.


            I ask if it's the minister or whomever it is in your department who is spearheading this, that I be included in any correspondence and/or meetings going forward. I can quote Dr. Littlejohn as saying that the demolition of Mount Carmel School is taking place in the very near future to begin the process to build the new collaborative health centre.


[6:45 p.m.]


            I'm not accusing the minister of not being forthright with me, but I am getting completely different information from the Minister of Health and Wellness, as well as from the vice-chairman or co-chairman or whatever position it is that Dr. Littlejohn holds. He was very clear yesterday that the plans he has received have been from government - because I was asked again by a community member if I had been included. I said, when I asked the Minister of Health and Wellness last week if those plans have been sent out, the minister told me no. Dr. Littlejohn looked at me in the meeting and mouthed to me, well, I have them, so I'm being told that there are plans out there with a plan in place to begin and the minister is saying something completely different.


            Somebody needs to come forward and tell New Waterford-Cape Breton Centre and myself what exactly is going on.


            MR. DELOREY: I'll reiterate, I stand by the comments and the information that I provided last week and in the first part of the question this evening, that there have been no formal decisions on these points. While an individual - and there may be proponents who are advocating for certain positions - the actual decisions have not been made. I've not received nor seen the final or any finalized or near-finalized proposals across my desk. That's my point. An individual may have very strong positioning, but again, I can't disclose information that hasn't been finalized. If a decision hasn't been made - final decisions haven't been made. That remains the case.


            With respect to the member's interest in participating and sitting in on government meetings, I'd just like to clarify that the role that the member plays is not as a member of government. Those aren't necessarily likely to happen. For that reason - there are things that do take place. Certainly, if there are public-based meetings and so on, we'll endeavour to ensure the member is notified in advance and aware of what is taking place in her community. Again, I think the scope of the desire of the comment or the request earlier, is a bit broader than what I think would be possible.


            MS. MARTIN: My apologies to the minister - no, that isn't what I meant specifically, but maybe I could be a little more direct. My understanding is there is a committee in place with Dr. Littlejohn as a co-chairman or a vice-chairman, who are meeting to ensure that this process and this plan goes forward. I guess that's what I'm asking to be included in, if that is coming from your department, because it's not only government officials who are included in it.


            Just to clarify, the information that we were told yesterday in a community meeting at the Army and Navy in New Waterford, that the sod turning would be in the Spring and that the facility would be up and running within probably a year - that is not the case as you know it?


            MR. DELOREY: As I'd indicated, the decisions necessary to make those statements have not been finalized at a level that one would be in a position to make those statements, so no, we're not in a position to say that's the case at this point in time.


            MS. MARTIN: The other report that is out there and that has been publicized, is that my predecessor, Dave Wilton, is the government's representative on that coalition team. Can the member speak to that?


            MR. DELOREY: I believe the committee or coalition that the member is referencing - and again, I'll have to double-check to verify - I'm not aware of that being in existence as a government-led or run committee, as we've mentioned before, the notion of having communication and engagement with the community. Again, I'm not aware certainly in terms of a government-led initiative that would be formed or structured in that level of formality.


            It may be the case that community proponents have established a committee and government attends, as invited by that group. I'll double-check to see whether the NSHA has, but we've been checking and I'm not aware that that's a formal group that either government or the NSHA has established. If it were, it was established before my time and I wasn't aware of it. I'll keep digging and see if I can track that down.


            It may be the case that it existed as a community group or group of stakeholders who came together as a result of some of the initial outreach that was done by the NSHA as part of, as I've said, an outreach to engage with the community, and perhaps it may have taken a more formalized structure with some community members and representatives. But again, I'll double-check with the NSHA just to verify that it wasn't anything more formalized on their end, but not that I'm aware of.


            MS. MARTIN: Just to be clear, the Minister of Health and Wellness is not aware of any government-appointed representative on this committee or task force or concerned community group? Just to be clear, the government has not appointed somebody to sit in on this, as a representative of the government?


            MR. DELOREY: Mr. Chairman, again, this is the deputy who predates myself in the department, and neither of us is aware of such an appointment to a committee on that side. I can understand why the member would be frustrated, feeling not being part of some initiative and so on. But again, I think that may have transpired to be something that perhaps was developed within the community.


            As the member knows and as I learned in my visit to her community in New Waterford, that is a community with very engaged citizenry. It wouldn't be surprising that taking an initiative on such an important topic would be taking place in the community and engaging with the right individuals within the NSHA, that could give the impression of a larger and more formalized structure that may, again, the origins of which may look like - because there has possibly been some participation from NSHA or government officials, that doesn't mean that's where the entity actually originated from.


            Government does from time to time, when communities reach out, make itself available to help provide information and oversight and support the work that is being done in their communities.


            MS. MARTIN: I thank the minister, I really appreciate your information and it absolutely does relieve some stressors and concerns that my community has, for sure.


            Moving forward, I want to ask you about some budget line items that I know, previously there have been cuts to some of these groups, to some of this funding. Specifically, we're looking for the budget line that provides funding to community health organizations. We're looking to find out how much has been allocated and how much is allocated, because we do know that there have been cuts with Eating Disorders Nova Scotia, the hearing impaired, those types of groups.


            I have a list of groups: AIDS Coalition of Cape Breton, Kids First, St. George's YouthNet, Chebucto Connections, Antigonish Women's Resource Centre, Free Spirit Therapeutic Riding, Split Rock Learning Centre, Eating Disorders Nova Scotia, Schizophrenia Society of Nova Scotia, and the Alzheimer Society. I'm sure the minister understands where we're going with this.


            As I said, there have been some changes to the budget, some cuts over the last - so we'd like to know where we can find line items, to know where we have been and where we're going, to ensure that we're going in the right direction.


            MR. DELOREY: I appreciate the member's concern, and I'd actually like to thank the member for raising the Antigonish Women's Resource Centre. I think that's an organization I've worked with, as the local MLA, quite diligently for some of their programs and services. In particular, the work they do around sexual assault and awareness, and mental health programs and initiatives which - if you'll afford me this slight public service announcement - that they've actually even expanded their services beyond the Antigonish region to provide supports in both Pictou County and Guysborough County. Despite their name of Antigonish, they certainly do have a broader range of services because they do phenomenal work there, so a shout-out to that organization and those who work and support it.


            I had a similar question to this from the Progressive Conservative caucus last week, the background of which, because of the interrelation and complexities of various NGOs that are supported and fall around the health umbrella, and that level of detail in the line items, but also because of the varying nature of the types of funding that are out there. Some are grant project-based funding. Some are operational. Some overlap with DCS, so even if we just used the Antigonish Women's Resource Centre, I know they get funding from DCS. They do fundraising. They get some from Health and Wellness, so I think it's challenging unless I put the context around the specifics of what the member is looking for.


            I think what we ended up coming to was, if the member could submit the list of organizations that she would like to have, we can look to see which allocations have been made with the asterisk, of course, acknowledging that there are other grant programs and program funding that are application-based throughout the fiscal year. Until applications are received and so on, the funding decisions wouldn't be there. Organizations may have had funding for a program that was a new program or project in a previous year and have something new coming up the following year, which may be approved or not approved depending on all of the projects that come in.


Because there are so many different ways in which some of these organizations are funded, it doesn't always line up in a year-over-year program, but certainly to the extent that there are operational funds going into the organizations and if any grants have been already approved. If the member will table the list, it might be the easiest way. We can try to track that information down and get back to her.


            MS. MARTIN: Mr. Chairman, we'll provide that to the minister and look forward to his response.


            Although we may agree to disagree, I'll have to echo the statement of my colleague from the Progressive Conservative Party about the discrepancy in doctor shortages. I believe, as well, that the doctor-shortage numbers are somewhat underestimated from the government side because I do know that people are frustrated and they're tired of putting their name on the list.


There's one new doctor who came to Sydney, and when I called to see where some of my constituents were on that list, they had over 3,000 applications to get in to see that doctor. First of all, the words "application to see a doctor" sound ridiculous to me. Secondly, they said we have no idea where anybody is because there is just too much paperwork, so I think people are just frustrated. Just to give you that little piece of what's going on with the people who are home and say they can't be bothered to do that, you know, I can't be 3,005 on that list anymore, they go to the emergency room looking for primary care.


However, it was the government's promise in 2013 that every Nova Scotian would have a doctor. Whether it be 35,000 or 350,000, regardless, we still need docs and, in your words, the government needs to focus their efforts. I think the government needs to do more than that. We're at a crisis.


[7:00 p.m.]


I think the government needs to do more than that. We're at a crisis, and I'll say we're at a crisis until the day that I'm either finished my term or whatever may happen, but we're in a crisis and I think the government needs to recognize that. I think there are situations where there have been job losses or job cuts or layoffs, getting to my point that I hope that sometimes we recognize the error of our ways.


            The extra support for parents at the IWK, that was eliminated in June. There were three people who coordinated the services who were laid off - where do those parents go now?


            MR. DELOREY: I believe the specific situation that's being referenced - again, if I'm mistaken of the specifics and I don't recall the name of the program off hand, it was a specific volunteer program, I believe, for holding newborns or something to that effect. It is my understanding - and I believe representatives from the IWK have responded to this publicly, and I think there has been some media coverage of this situation - what transpired there was efforts within the organization to consolidate their volunteer services so that all volunteers, supports, and services within the organization go through a central department or division team.


            I think, again, some of the rationale of that - when people want to volunteer, to know that they just have to go to one location, in whatever capacity they want to volunteer, there are many benefits. I think that's the rationale and the thought process by which that approach and decision manifested itself. So, volunteers throughout our communities will, most likely in the Halifax-Dartmouth area be more closely geographically located to the IWK, but I believe they have a centralized - I don't have the contact information for that central volunteer coordinating group, but certainly if the member would like we could track it down to let the member know and pass it along.


            MS. MARTIN: Switching gears a little bit. Obviously, we all know where bargaining is for health care workers right now - or where it isn't, for lack of a better term. We know where the funding isn't going to be or where the focus of bargaining is, so that puts us in a different position - not me anymore, but it puts them in a different position.


            There are lots of discussions going on out there about P3s, the refurbishing, the refinishing, the building of a new Victoria General Hospital. I've had complaints and concerns from doctors and staff at the QEII about legionnaires' disease in the water. They've had to shut off the fountains - and there are mice within the facility, in the locker rooms. One surgeon said to me she hopes she doesn't see any in the O.R., but if they're in the locker room, they're probably in the O.R. too - they just haven't seen them.


            My concern, our concern, the public's concern, is that a P3 would be jumped into and the state of the facility would suffer. My other concern, and our other concern, is when those services have been diminished - housekeeping, laundry, food services, for example - when you're getting into bargaining and there's nothing on the table, I guess I'm looking to this government to ensure that because their collective bargaining rights have already been stripped away financially and for strike action, I guess I'm looking for some reassurance from this government that you have no intention of contracting out food service, dietary, and laundry.


Those people, as I have said time and time again, are all part of the process. When you diminish the services that they provide, that only leads to increases in numbers of infections and infectious disease and things of that nature. With bargaining going on or trying to go on right now, and there's not a lot on the table and there's probably not going to be a lot on the table, can this government guarantee that you are not looking to contract out those workers?


            MR. CHAIRMAN: I want to remind members here in the Chamber that electronic devices are to be turned to silent or to off. That would also apply to folks in the gallery, our visitors. Thank you very much.


            MR. DELOREY: Mr. Chairman, I thank the member for the question. I think the specifics of what the member is asking is whether government has intentions to outsource those services. Nothing has ever been proposed or brought around my desk or table to suggest that anyone is even looking at those services in that regard. I have seen or heard nothing to suggest that that would be something on the table at any point since I have been in this role.


            MS. MARTIN: The request hasn't been made to you to allow any of those services, in this round of negotiations, to be contracted out?


            MR. DELOREY: I have not had or seen any requests of that nature, no.


            MS. MARTIN: Should this round of negotiations go on - because it's going to be a difficult round - for two or three years, do you foresee that the government will have the same opinion as you do today - can we have some sort of guarantee that this is not going to be something that could change in the next couple of years?


            MR. DELOREY: I think the challenging part of the member's question is foresight into a few years. You get into three years' time frame - our last government was three and a half years, so when you start getting into time frames like that, I would be loath to attempt to make a prediction as to what position the government of that point in time would be taking a position on something. Whether I would be in that position - I can just say, as I did in the last question, I have certainly had no one ask or bring anything of that nature to me; I have certainly not attempted to initiate anything of that sort myself. Bargaining, as far as I know, is taking place at the tables between the employer and the various bargaining associations.


            MS. MARTIN: I have a question to the minister about patients rooming together. I have had concerns and questions from families, and from doctors specifically, saying that Nova Scotia is one of the few provinces where men and women are housed together in the same room. I have specific questions from family members who have a feeble old nanny in a room, and there might be two other men in there who are whatever age. Just because of the history, that's not something that normally took place. People are concerned. People are questioning: are we that desperate for beds that we cannot ensure that Granny Jane is in her own place when the gentlemen are in their own place?


            The doctors say that it is causing issues with privacy, so I'm wondering what the minister's position is on this.


            MR. DELOREY: I thank the member for bringing that concern forward. It's not one that I've heard in my own constituency so I guess it's not one that has percolated up to me in the past in my visits and conversations. I guess my read on that, from what the member has brought forward, is likely more of an exception-based scenario of services, as opposed to - in other words, if the opportunity is to have a similar sex or gendered rooming, I think that would be more likely the case than not but that in some exceptional situations that, again, to ensure that the people with the highest needs are getting the services, in some facilities that may be something that has to transpire, or does transpire, to ensure those people in need of health care services are getting those services.


            I certainly think it's a better approach than not providing services. That's number one I think for health care providers in those facilities, making sure that the people of Nova Scotia who are in need of care are provided that opportunity. If the distribution of the available beds doesn't lend itself, again my understanding or expectation would be that they make efforts to accommodate, but again recognize in some cases it may not be possible.


            MS. MARTIN: Another concern of doctors and again I've never - and I've worked in the Health Authority for a long time - I've never heard doctors be so vocal as I have now. Maybe it's just that I'm an elected official or that things are really just that bad. Doctors are even coming forward to talk about MRSA and C.difficile and the VRE - and these are all superbugs, for lack of a better term, that are rampant in a lot of hospitals. I'm sure you know, in Cape Breton, I think at one time we had eight cases of C.diff. You weren't the Health and Wellness Minister at the time but I think we had eight cases of C.diff. It was almost an epidemic.


            There are lots of circumstances that add to that or lots of factors that add to those circumstances. However, doctors are now raising concerns because of the lack of beds, because of the shortage of space, because of the overflow, because of "hallway medicine" as some professionals are calling it, some facilities are forced to use a curtain as the barricade, if you will, for contact precautions. So, if you have a loved one in there, typically they would be in a private room and there would be a sign - Stop. Visit the Nurses' Station - and you would gown up or whatever before you go in.


            Now there are instances, and again, specifically in Halifax that I'm getting most of these concerns from doctors, that these "Stop" signs are now on the curtain that goes around bed one or four. Does the government have any intention of working together closer with the Department of Health and Wellness, with NSHA, with infectious control, the CDC, all of those players, to try to control and/or help and prevent the way too many infectious diseases that are going on, and being picked up sometimes when you go into the hospital for just a broken leg?


[7:15 p.m.]


MR. DELOREY: Mr. Chairman, I thank the member for raising this concern. First, I think it's important and imperative to recognize that the work of all our health care professionals, from the top of the organization down, really do concern themselves with the care being provided and, certainly, their commitment to look for opportunities for quality improvement. In this case, we're talking about quality improvement for infectious disease control that they do take the steps in their work, again, whether that's front-line employees or the organization more broadly.


Certainly, the references to some of the concerns in some of the aging infrastructure, in the Halifax area in particular, that were raised, that's one of the reasons we're moving forward on the broader QEII redevelopment ensuring that we can establish the infrastructure that's needed not just for yesterday's needs but, indeed, looking to the future and doing so in a way that's least disruptive to the existing environment. That's why we've taken steps as part of the programming initiative to look at the existing infrastructure we have. That's why Dartmouth is seeing the investments that they've been seeing in their expansion - just not that long ago, I think just recently they completed the work on the fourth floor, and I believe if it's not open it's very, very near to having patients in.


            You know, a lot of work that was done even through that construction phase - I went up and toured it when it was just studded in basically and then, more recently, as it was nearing completion stage and the difference is obviously noticeable, but when I was there during the construction phase, the degree to which they take to ensure they maintain the integrity of the operational portion of the hospital while they're doing that construction  - obviously doing construction in an active hospital setting has the potential to cause risks, so they take a lot of precautions there maintaining the pressure, the negative pressure in the environment and so on, to keep anything in the construction area dust or what have you contained in that space.


They do take it seriously. They take those steps and have been and, again, as I said, the expansion that's going on at Dartmouth as well, additional beds as well as O.R.s to allow an easing burden out of the existing VG/QEII site, those are some of the initiatives we're taking to help move these and address some of those concerns, as you noted, more acutely concern raised in the central region.


            MS. MARTIN: Mr. Chairman, thank you to the minister for those responses. Just to clarify - we talked briefly about the IWK. I would like to know though if the minister can tell me when his office, himself, and/or the Deputy Minister of Health and Wellness found out about the state of affairs, so to speak, or what was going on at the IWK - can you tell me when?


            MR. DELOREY: Mr. Chairman, I thank the member for the question but, just for clarity, is the member talking about the volunteer situation which she'd asked about before or something else?


            MS. MARTIN: Sorry. Mr. Chairman, no, the state of affairs, the scandal, the spending scandal - when did you and/or the deputy find out?


            MR. DELOREY: Mr. Chairman, I thank the member for the question. I would have to go back to correspondence records. If the member is looking for an exact date or time that either myself or the deputy would have been made aware of the circumstances with respect to the CEO expense situation, I would have to go back to those notes but I believe I was minister of - yes, I would have to go back to my notes to find out the exact timing of when that was raised as an issue with us. Sorry.


            MR. CHAIRMAN: The honourable member for Cape Breton Centre, with a dozen seconds.


            MS. MARTIN: Mr. Chairman, I would request that you send us the information of the date when you and/or your deputy found out about the scandal. Thanks so much, and thank you to the minister.


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


            Just before I move on, minister, would you or your staff require a break at this time? Staff are good? Very well, we'll carry on.


            For the PC caucus, the honourable member for Pictou Centre.


            HON. PAT DUNN: Mr. Chairman, I have perhaps two or three questions for the minister, and then I will pass it on to one of my colleagues.


            Earlier in the evening, I was listening to my colleague, the member for Pictou East asking questions concerning mental health and addictions. It's certainly a major undertaking; we all realize that.


            On the weekend, I received a call from someone who had considerable experience with these two fields over several years, and I took the opportunity to talk to a couple more people who have had some experience dealing with mental health issues, addictions issues, and so on. The three in particular I talked to were opposing the merger that occurred. They felt that they should stay not exactly isolated, but they shouldn't have been merged together. Again, that was their opinion.


            They also made comment that some employees who are working with people in addictions do not have the background for that, lack that experience to assist people suffering from addictions. They also mentioned that some employees are very hesitant about speaking out about things like this due to perceived repercussions.


            I guess my question is - and I assume this will happen, going forward - will the department examine closely the educational component in particular that is in place with addictions? There has been a change in philosophy and so on. I just wonder, going forward, what will happen?


            MR. DELOREY: I thank the member for the question. I guess one of the most concerning things that the member brought up was an insinuation or suggestion that some employees have a fear of repercussions for bringing forward their concerns. I hope that's not the case.


            If that's something that the member has heard, I hope they go back - certainly from my perspective that shouldn't be a concern for the employees, particularly in this area of mental health and addictions. Again, the work that those employees do on behalf of Nova Scotians - indeed not just Nova Scotians but some of the most vulnerable Nova Scotians who require supports with mental health and/or addiction challenges that they're facing. I hope the member, if he wants to talk off-line at some point, we can pick that conversation up if the individual is someone who would be comfortable sharing with me directly.


            I can reiterate, however, that on my tour, the meetings that I had - again, being cognizant of that restructuring, that change with the amalgamation, I went out of my way, number one, to make sure that I visited those sites within our system and went out of my way to ask those questions, the very question of how has it been going, and the information I received was positive; in fact, as the member's specific question touched explicitly on education and the training aspects of it, indeed that was one of the things that individuals spoke to me about, that they did get training, they've had training sessions to help facilitate and bridge the gaps.


            I didn't gather at that time explicitly what the nature of those training programs were, but these were employees within those groups providing information as I was touring their facilities.


            What was made obvious though was, again recognizing that change and restructuring is challenging in any organization and even within a team or a group of people, both the provision of mental health services and addiction services are challenging and extremely important and often overlooked services being provided in our health care system.


            I could appreciate perhaps if individuals may have concerns that one side of that coin may get more or consume more resources than another, if that is the nature of the concerns being raised, but I assure you again, as I think I mentioned earlier this evening, in many, many instances there is a coexistence, a comorbidity when it comes to individuals suffering from mental health and/or addictions. What I mean by that is individuals who may have an addiction, whatever that addiction may be, often either may lead to other mental health challenges or the addiction may have manifested itself as an individual's coping mechanism for a pre-existing mental health issue - and that's what I mean by the comorbidity that both the addiction and the mental health challenges coexist, so the treatments really being done in parallel.


I think, again, the rationale of that amalgamation had to do a lot as well with the fact that individuals were being moved between two distinct teams for support services and recognizing that perhaps being more tightly - through no fault of their own, having two different conditions being treated by two different groups, mental health and addictions, that by amalgamating and bringing those two groups together to represent mental health and addictions as one operational unit, that individuals were able to come in and whether they come in and are stepping forward and whether they are stepping forward for treatment of an addiction or they are stepping forward for treatment of a mental health issue, both are so heavily stigmatized in our society that it is such a challenging step for an individual and yet a critical step is to seek treatment for either of those two.


            As I've mentioned, when the two are often coexistent it shouldn't matter which door they walk into first. Their services and the treatments - and again that is the design and the objective I believe of that bringing of the mental health and addictions groups together so the work is to treat the person and to treat the challenges they are facing, to provide the supports and the mechanisms and the training and the tools that they need to address all the challenges they face, whether on the mental health or addictions or both.


That's the purpose, and again back to the very specific part about the training, in my tour individuals had indicated that as part of their professional development workshops, training was under way and they had gone through some. So, what the continued ongoing professional development and the extent to which further training is needed, I'm not sure, but I am aware that some has taken place.


            MR. DUNN: Mr. Chairman, perhaps just to follow that up, my understanding that the prior practice with addictions with the educational component, once they had the patient at a detox centre they would - the expression, "dry out" the patient - and after that, immediately, there would be five or six days of educational component, as you mentioned, mechanisms, strategies, and so on - has the practice now changed to where it's over a 14-day period or a 14-week period where there's an hour a day per week going forward?


[7:30 p.m.]


            The reason why I'm asking that is a couple of former employees, retired, said if we release a patient after drying them out after four or five days and send them packing, expecting them to follow that route, the first place they will stop is an NSLC outlet before they get home - I just want you to comment on that.


            MR. DELOREY: Mr. Chairman, I apologize to the member if that was the training component that he was referring to in his first question. I thought he was talking about the staff training, not the patients. I apologize. (Interruption) Both, okay.


            With respect to the programming, again one of the things I became aware of through the tours is the efforts are ongoing still to establish the consistency. One of the natures of the multiple health authorities that pre-existed the current structure was that each district in the old model may have adopted different approaches to these treatments, so they vary a little bit.


            Given a personal interest in the area of mental health and addictions, given the very real importance of the need to do better, as I toured facilities I spent perhaps a disproportionate amount of time in these sections of the facilities across the province.


            I'm going to base this response on the information that was provided at a particular facility, because we actually spent quite a bit of time talking about the clinical research around addiction services in particular. I was at a facility which had adopted what was seen as perhaps a non-traditional approach to addiction treatment. I say "non-traditional" because in the last few years they have shifted from primarily treating it as kind of a detox in-patient approach. They still have in-patient beds available, but what they have seen as they have shifted their approach to treatment where the focus is on having the counsellors and supports available, not just available to the patient suffering from an addiction but to family members as well, and to those supports that the individual may have in the community, that they too are available for supports to learn coping mechanisms, support mechanisms, that they have access to these services.


By having them available to the citizens, they have actually seen quite dramatic improvements in some metrics associated with - if you look at relapse, if they compared their data on relapse for individuals who had previously been admitted for addictions and gone through the traditional treatment program, yes, they would dry out or sober up through the process, and they would have some coping mechanisms and be sent out, but they would have a high propensity for relapse. Now, whether it was the next day or down the road a little bit, the relapse rate was quite high. But there were some employees within this particular site, through professional development research they became aware of a new approach.


            As I have mentioned, that approach being more focused on the availability of support when people need it, so when they feel like they are going to relapse they know immediately where they can go to get that counselling support, get the people available - and recognizing that the support is not always just the individual patient who needs those types of supports, sometimes their support network needs those supports as well.


They can see the warning signs and when an individual may be on the verge of a relapse. So, again, I can say that they are likely in communities seeing some possible shifts, but to the best of my knowledge the information that has been provided to me thus far is these are based on clinical experiences as well as seeing hard data on the success of some of these approaches to provide longer-term access and supports to individuals, so that it is not this continuous cycle of come in, dry out or sober up in a detox in-patient, and then out into the community to fend for yourself.


They are really looking at the longer-term treatment and support and recognizing that individuals are fallible, that it is not a failure if you relapse. It is an opportunity to do better the next time and that individual is not being judged and is being serviced as a whole person, and that includes recognition of their mental well-being and not just their physical as they are going through this. That is my understanding of changes taking place in that regard.


            MR. DUNN: Thanks to the minister for that answer. I am going to finish; I'm going to try to put two questions into one, dealing with dialysis again. We had a brief encounter with that last week and I talked with the former minister a few times over the four years. Of course, we are all aware that there are four seats in the Sutherland Harris Memorial Hospital and there is a waiting list.


            There are people going to Antigonish and Truro and it's no comfort to them regardless if you are going 20 kilometres or if it's 100 or 130 or 30 kilometres. However, you had a discussion with the member for Pictou East earlier in the evening when you were talking about the ER, the new ER which will be opening up very, very soon at the Aberdeen Hospital in New Glasgow. Following that they will be renovating the old ER and I keep thinking what a wonderful opportunity for them to put a few more dialysis chairs in the county, at that particular hospital prior to renovating the old section.


            Also at the Sutherland Harris unit, the unit there, minister, as you are probably aware the provincial office recently visited that particular site and had a look at it and so on. It is my understanding that the Sutherland Harris Foundation is willing to put the dollars forth to provide the infrastructure for more chairs, or additional chairs, and at this point, I'm not sure, if they are willing to put even more dollars beyond that as far as the chairs themselves, whatever, but looking at those two sites going into the future the renovation of the old ER, I'm wondering, what is the opportunity sometime very soon - I had a gentleman in my office early this morning who knows he will be needing that service soon, and I am sure because of our aging population we will have a longer waiting list.


            MR. DELOREY: I thank the member for the question. As he noted, this is something we have chatted about across the aisles through Question Period and in estimates as well.


            Dialysis - again, the nature of the service or the nature of the treatment for patients - is definitely life-saving; it's a necessary treatment. For those members of the House here, Mr. Chairman, and for yourself if you are not aware of what the treatment consists of, when the member references "chair" it is literally a chair that the patient has to sit in for upwards of - it could be four to seven hours sitting in that chair connected to a machine that allows your blood to be processed and cleansed and processed back into your body to keep your organs and your body functioning.


It is life-saving; it is a necessary treatment. We do recognize there are individuals in many parts of the province who have to travel to receive these treatments. Efforts are under way in the province to improve the situation for Nova Scotians who require dialysis treatment.


            Those efforts mean that we have, I think, four or five locations across the province that we are working to enhance or expand or bring dialysis, so that is a combination of expansion of existing dialysis sites and/or new dialysis sites. The work is under way, those efforts again targeted to try to either address wait times and/or travel times that are greatest for patients.


            It's part of our efforts to improve the situation for dialysis patients across the province. It is the first step and again, as I said, we have about five locations under way. Right now, we are working and focusing on getting those projects moving forward and implemented as successfully and efficiently as possible.


            We will see those services and enhanced services for dialysis then as the travel patterns of Nova Scotians shift. As these new beds come on line we will have the opportunity to see how the demands and the needs are in the potentially additional communities to address the demand in the communities, but also potential travel challenges for people in surrounding communities.


            MR. DUNN. Thank you, minister, for that answer, I think of a couple of constituents I have, both work, and as a result they are travelling for three days a week and missing a tremendous amount of work. Where they happen to be employed, it is causing a lot of problems at their place of work. But hopefully the next location will be in the Pictou County area where we can see some more dialysis chairs going in.


            At this point, Mr. Chairman, I am going to turn it over to the member for Dartmouth East.


            MR. CHAIRMAN: The honourable member for Dartmouth East.


            MR. TIM HALMAN: I would like to thank my colleague, the member for Pictou Centre for his insightful questions on the health care system.


            Switching gears a little bit, Mr. Minister, let's delve a bit into the budget. It is indicated that there are 10 new spaces for international-trained doctors. I know, certainly speaking to constituents in Dartmouth East, a lot of people look at this as a real potential solution to some of the shortage that we are seeing.


            I know a constituent who was educated overseas and can certainly benefit from this, so two questions: why not more spaces, why 10 - and I recognize that it was in the platform, but can you explain the rational for that - and then also, the timeline for the implementation of those new spaces?


[7:45 p.m.]


MR. DELOREY: I thank the member for the question. I am pleased to hear that his constituents and community are responding to the initiative that has the capacity and potential to help as one of many initiatives to help improve access to primary care for Nova Scotians, including those in Dartmouth East.


            There are multiple variables that go into play when establishing things like this, especially a new initiative like this. Some of those variables relate to getting up and running and establishing and building the capacity for the supervision that needs to take place with those seats. We do not have as much as we might like. I have highlighted how great the potential is that these residency seats and the data shows that individuals who complete the residency are likely to stay in the province or the area where they have completed a residency.


            One may question why don't you just work out the number of physicians you need, open up that many residency seats, but again the supports, the services, the front-line physicians who are going to supervise, so those residents are being supervised and so there is a capacity limiting factor in that regard, getting the people who are willing and able and interested in bringing and managing those residents through that stage of their training program.


            We are working with 10 to get this program up and running. I know I have had conversations with the Minister of Immigration recently and she is very excited about this program and her role. I think our Minister of Immigration and her team and the support organizations have demonstrated how successful their efforts have been at recruiting and putting a focus and an awareness of the needs and opportunities for internationally trained and potentially immigrants or perhaps people from Nova Scotia who have trained elsewhere.


            There are lots of opportunities here, I think, that will be good for Nova Scotia. But again, we are starting with 10 because it is manageable and doable, but it's early stages with working with Dalhousie as well as the physician community to ensure we get the right supervision in place to ensure that these positions can be filled and successfully completed.


            MR. HALMAN: Can you give a more specific timeline as to when we can start to see these positions opened up - is it realistic within the next eight months, 10 months, 18 months?


            MR. DELOREY: As I mentioned previously, the work with the Dalhousie Medical School and the physician community to establish these seats is still ongoing. I will double-check what the status is within the groups and get back to you with a more specific timeline as to where they think that is at the present time.


            MR. HALMAN: Let us talk a bit about the Dartmouth General Hospital. As you know, minister, we have opened a new acute care ward and I understand you have toured the Dartmouth General. Renovations are done - when will the funding and staffing be in place to support the added acute care ward?


            MR. DELOREY: I appreciate the member's question. As I mentioned earlier and as the member noted the renovations on the floor are essentially completed. I am not aware of the NSHA looking for additional resources to complete that operationalization of that unit so obviously that present move to their operational was with the funding that they have in place. As I mentioned to some former questions, the specific breakdown of the allocation of their budget comes when the NSHA completes their budgeting process.


            Again, based upon the funding we provide to them as the bundle, and as we prepared there wasn't a specific ask for additional for those specific floors, which just means their ability to reallocate within their own system across a billion-dollar organization that is where they find the resources to ensure that they get the staff they need on that floor.


            MR. HALMAN: Just a few more questions of a local nature, Mr. Minister. I want to ask you a little bit about a residential care facility in my community. It is called the Clamar and it is on Main Street in Dartmouth East, and it has faced chronic vacancies for the last four years. Employees at the facility have indicated to me that the there is an interest in people being placed there, but they haven't heard from the Department of Health and Wellness in terms of whether or not they can get people into the Clamar. Now, according to the government website, the average wait time for residential care facilities is 135 days.


My question to the minister is, why is there a facility that they have indicated to me that there are seven empty beds - why aren't those spaces filled?


            MR. DELOREY: I suspect, but I can't say for certain, as I am not familiar with the specific site that the member is inquiring about, but based upon the description that has been provided - and I am loath to do this on the floor of the Legislature - start with the assumption being that is a private facility and not a provincially run facility. So that would be a facility that established itself based on market condition and the capacity to provide services for people with private rates and so on.


            If they have vacancies it would be open on the private market for providing those services. To my knowledge, I wouldn't suspect that is a provincial set of beds that would be vacant and not receiving utilization.


            MR. HALMAN: I am hoping, minister, that we can chat about that a little further, thank you. Just one final question of a local nature in my community. A constituent in Dartmouth East has been waiting for a ministerial review for five months regarding the expense of keeping his wife at home. My constituency office has been in contact with the Department of Health and Wellness, with your office. We have been told that the new review would be signed and mailed out the week the House was back, but there is still no word. I was hoping if we could, minister, expedite that and get your attention on that matter. Thank you, Mr. Chairman.


            MR. DELOREY: When you get to specific constituent levels, I think all members would appreciate not delving into too much detail, so I will certainly pick that one back up and follow up with the member directly outside of this venue. We'll take a look at that status and give him an update.


            MR. HALMAN: Minister, I appreciate that. I now pass the floor to the member for Sackville-Beaver Bank.


            MR. CHAIRMAN: The honourable member for Sackville-Beaver Bank.


            MR. BRAD JOHNS: Thank you, Mr. Chairman. My questions are somewhat local in nature, very specific to the Cobequid Health Centre in Sackville.


In the summer, there used to be group therapy sessions that were held there for mental health issues, basically anxiety and depression. That program was cancelled, I believe, in the summer. They said at the time that the attendance was too low; there were only about 11 people there. There was also a discussion about reviewing the same program at other locations across the province, and I'm just curious to know if locations across the province are continuing, and if it was just the one at Cobequid that was cancelled.


            MR. DELOREY: Thank you for the question, obviously it was very specific. I will double-check and we'll bring that information back to the member on the details and the specifics of that. We don't have it right here with us, so we'll dig in and get back to you on that specific.


            MR. JOHNS: Thank you, Mr. Minister, I do appreciate that. I find it confusing because I know that typically one size doesn't fit all. It might have been a very small group, but I think that it was working very well for those 11 people, and I just can't see how it's more cost efficient to provide individual therapy sessions for 11 people than it is - even if it's 11 when it's typically 25.


            I had other questions continuing on around there. I know there has been a lot of discussion in regard to mental health crisis centres around the province and establishing those. I'm wondering whether or not Cobequid is being looked at to have a crisis centre like that, particularly given that within I think the last year or two years we have had probably five or six adolescent suicides in Sackville. I'm wondering, what is the long-term plan, and will a crisis centre be established at Cobequid?


            MR. DELOREY: I thank the member, along with the many members who have been delving into questions relating to mental health and/or addictions. Again, a lot of the focus of our efforts in the mental health space have been targeted more so to community- based programming, getting the supports out to the community reach, with a particular focus and emphasis, although not solely, on the youth. But certainly this year we're quite focused a lot on youth. That means the additional clinicians out for communities that we have invested in in the Department of Health and Wellness and also the investments being made in our education budgets to provide the broader support, additional SchoolsPlus and clinicians available to support particularly youth. I have mentioned previously the value of getting the diagnosis - the recognition of individuals who may be showing signs of a mental illness or challenges.


            We do know that often they first manifest themselves in adolescence while people are still developing. Having clinicians closer to those students will be a good thing because in many cases individuals don't have the training or the expertise - how do you know if it's teenage angst versus a more serious mental health condition?


[8:00 p.m.]


That's why we try to focus there and get the training and the skills set. That has been a major focus, and then focuses on broader community supports and initiatives to connect groups. I'm not aware at this point of specific efforts or plans to expand a crisis centre at the Cobequid, which is the specific question.


But again, the supports and the efforts that we're making to expand services to - again I think just over the weekend I saw a release by Doctors Nova Scotia talking about a mental health provider, physician, provide support in a number and roles in a number of different areas and some of the work that this physician is providing services through Telehealth, through a secure health system for video conferencing so that although located up here and providing the services out of metro, is providing the support services to people outside of metro even, so there are initiatives like that where we're providing access to very specialized expertise through Telehealth options that would be a secure video conference link through our health care system. There are opportunities and initiatives like that as well.


            Again, nothing to the specific question on the radar that I'm aware of right now, but there is a lot going on broadly in mental health to support all Nova Scotians, including those in the member's community.


            MR. JOHNS: Thank you, Mr. Minister, for that and thank you for directly answering my question, I do appreciate that. I would like to potentially see that perhaps there's an opportunity to put Cobequid on the radar. We know that the catchment area for Cobequid is between 15,000 and 75,000 people. It takes in Clayton Park, Bedford, Hammonds Plains, Lucasville, Sackville, Fall River, and Waverley, so it is a huge catchment area and I think it is really an underutilized resource.


            Further on that we come to my next question, which is regarding the expansion in Bayers Lake. I was in and out, so I apologize if this is something that you've answered.


I was somewhat dismayed when I heard about the announcement, not because I didn't recognize that there needed to be something here in metro to address the issue that is currently going on with the hospitals now, but I was disappointed to see that and I don't know, perhaps the government did and you can answer this, but that there wasn't a review of the existing infrastructure that's in place, i.e., the Cobequid Centre. I know that when Cobequid was built that it was built in such a way to be able to be expanded on. The footprint was adequate, as well as the infill that was put in place was built to be - it was constructed to be built on and built up.


            I would have thought that it would have been a very good location to look at doing an expansion to Cobequid, to create something very similar to Dartmouth General, which wasn't necessarily, I would have thought it met the needs of the government, it wouldn't have been directly downtown but yet it still would have been within that catchment area of 75,000 people, that the location the government decided to choose in Bayers Lake was.


            I'm curious to know, twofold, why was Bayers Lake at the end of the day, why was Bayers Lake chosen, and was Cobequid considered as an expansion at the time of that decision?


            MR. DELOREY: As the member would know, and I believe there were several questions even in the short-lived Spring session of the Legislature about the decision around the Bayers Lake location and the work that was done there - I believe they might have looked at 14 sites, I think, if I recall correctly. At that time, multiple sites were looked at, and I don't recall if Cobequid was on that list of sites that were considered, but one thing I can assure - the member made reference to the potential of building up and so on would be kind of like a Dartmouth General. That wasn't the purpose and the objective to create kind of another Dartmouth General, another large single hospital location.


I think part of it is also looking at the services for community members not having everyone going in to the same spot, so as the member noted, the location that was ultimately decided on is a location that does have a number of entry points - that is, highway entry points - so individuals coming from a variety of parts of the province who would be coming in for services, it provides ready access without having to go all the way through, as the member noted.


The Cobequid site doesn't require going down to the peninsula either but, again, this site and the service area and the population that it serves ultimately is providing those resources, yes, in a different site, but really designed to meet the needs of the population that is there today and expected to be there tomorrow as well.


            MR. JOHNS: Yes, thank you, again, Mr. Minister, and I guess we'd have some debates on how accessible Bayers Lake is. I've waited quite a bit - 15, 20, a half-hour sometimes getting out of Bayers Lake, especially Christmastime but, you know, I guess just a comment would be, I'm hoping that the site that is constructed in Bayers Lake will meet 100 per cent of the needs of people then, because Cobequid is not quite there and I think there would have been that opportunity - and additionally to that, as I spoke during my Reply to the Speech from the Throne, for numerous years through numerous governments and numerous politicians since the new Cobequid facility was built, politicians have asked to try to get that facility open 24/7 and I think it was 2014, the hours were extended to 11:00 p.m., 12:00 midnight, but it's still a want from the community.


I'm wondering if anybody ever actually reviewed whether or not it would be feasible to have the facility open 24 hours on weekends, perhaps like opening on a Friday night and a Saturday night, 24 hours a day - whether or not that was ever looked at and, if not, whether or not it's something that could be considered in subsequent budgets down the road perhaps.


            MR. DELOREY: Mr. Chairman, I thank the member for the question. I'm not aware of an analysis specifically on Cobequid for expanding to a 24-hour service. Certainly, again, a major focus that we've been targeting on has been the primary care services throughout the province. We've been working very hard on those collaborative centres recognizing that much, by volume of into what would be our after-hours supports are visits to the ER even in many cases that would fall into things that could be perhaps supported by primary care providers as opposed to what we would classify as truly emergency type services in those after hours.


Again, our focus being on improving our primary care access, getting those volumes of supports for the population in place so that that reduces the pressure on our emergency departments throughout the province and, as we see, those improvements I think we'll see, again, as a result of the investments in our collaborative practices recruitment incentives, residency programs, and others to improve that primary care access we'll see those benefits percolate throughout the system but, again, back to the specific of the question about that specific site, I haven't seen any specifics on that.


            MR. JOHNS: I am going to wrap up, so I would like to say I do appreciate your straightforwardness on my questions and answering those. I do recognize that we are at the 11:30 hour according to the budget and so I recognize a lot of the things that are brought up are things that I have brought up here today, I hope would be consideration in the next year's budget. As well, I realize everything can't happen all at once but if they are brought to the attention and people have adequate time to start planning, hopefully we can see some of these things come forward in next year's budget.


I know that we still have nine minutes so I would like - I don't have any further questions but I do believe we will continue if that's okay.


            MR. DELOREY: Just as we continue, I actually did get some updated information to the member for Dartmouth East. That facility, I did get information that indicates we do fund - I don't know the size of the facility but we do fund some beds at that location.


            I will double-check to see if any of those vacant beds are actually private beds, and if so, we will certainly take steps to ensure that they get placed appropriately, but again I do have that additional information and I do want to make sure as I got it I share with the House and indeed with the member for Dartmouth East.


            MR. CHAIRMAN: The honourable member for Northside-Westmount.


            MR. EDDIE ORRELL: I guess I want to start off with a few simple little questions. Hopefully it will lead into some more challenging and difficult questions after that.


It has been brought to my attention that diabetics who were getting eye exams yearly are now told that they are not going to be funded to get their eye exams yearly; they are going to get them every second year. I wonder if the minister can confirm that and I wonder why that would be brought up - if it is important to do yearly up to now, why would they push that back two years if it is not a cost-saving measure?


MR. DELOREY: Contrary to the suggestion the member made I don't share his hope that we move to more difficult questions. I would be happy to stick with the simple questions. Notwithstanding the seriousness of the question on the floor, I think where some of the suggestions come from I believe the society has adopted or came up with additional recommendations that there are certain circumstances where the recommendation is one or two years or one to two years for eye exams.


The intention is not to restrict solely to single year - sorry - not to restrict to two years of eye exams but follow the clinical advice and recommendation. There would be an effort to look at making sure the policies in place adhere to the clinical recommendations that are out there. Which again, there were recent changes there made reference to one to two years as opposed to a firm every year, because there are some clinical circumstances where they don't recommend necessarily every year, but in some cases two years, but in other clinical circumstances where every year is still appropriate.


It is ensuring that the program adheres to the recommendations coming from the clinical studies surrounding diabetes and the optometry needs therein.


MR. ORRELL: It is going to depend on case-to-case, patient-to-patient - there is not going to be anything set that a person who needs them every year will still get them every year, and for someone who doesn't need them every year that the studies are showing some people can get away with two years, so it is going to be a case-to-case thing. That is okay but the concern is the person who needs it every year may fall into the cracks, they are saying, you know, every two years now so you are going another year, and if they have a problem after that - it is missed because it a two-year thing, will the government cover the cost of the problems to be fixed if that is the case?


[8:15 p.m.]


            MR. DELOREY: That's a very important topic of discussion. What I was saying and what I want to leave with the members is that these decisions would be clinical decisions, as I mentioned in the first response, you know, the practice approaches, adopting the clinical recommendations. In patient-by-patient circumstances, that would be clinical advice. That's what we would expect people to adhere to so, again, respecting the equities of those clinicians providing the services through the programming, that again is built around the guidelines that were established by the clinical experts. That's not a political decision to be made.


            MR. ORRELL: Thank you for that answer. I just wanted to make sure that someone who needs it is going to get the care they need. Eye care and vision are probably one of the most important things, especially in a diabetic's life. They're approaching me with a concern thinking it was a cost-cutting measure and not clinical. It wasn't explained to them, so I will explain that to them. Thank you.


            Another question I have - Harbour View Hospital in Sydney Mines is a regional rehabilitation centre, and since Dr. Watt retired back a year and a half ago, it's my understanding, and correct me if I'm wrong, that they haven't had a physiatrist there on a full-time basis since he retired. There are some people filling in, filling out, filling in, filling out. It's difficult to run a proper rehab centre that way. The staff there are amazing. I worked with them, and the people who do rehab in that hospital are absolutely amazing. They would be picking up the slack I'm sure, and doing their thing.


            Can the minister indicate to me if there's an active search going on for a physiatrist, where that might stand and if that would be in the near future, so that those people who are concentrating on the rehab could actually concentrate on that instead of trying to do two or three other jobs at the same time?


            MR. DELOREY: I want to acknowledge the member's acknowledgement and recognition of the work that gets done at that facility and facilities like it across the province. Again, it's the people within these facilities who actually provide the service to the people of Nova Scotia. For the specific site or site-specific requests, I will have to double-check with the NSHA on what their specific recruitment efforts are, but we will get back to you on the specific status.


            MR. ORRELL: We're getting some money in this budget for extra orthopaedics, extra orthopaedic surgeries. I think it's something to the tune of $6.4 million, which is going to allow us to provide more services, more surgeries. I see that prehabilitation is offered in that program. It's a great program for people who can handle it, but for people who are too far gone, it's probably not the greatest thing because it makes them worse. Are there going to be more spaces available to the physios, the OTs, the social workers who are doing this prehabilitation?


Right now, space in the hospital is limited. Numbers are good. They're not short anywhere that I know of in Cape Breton as far as physio and OT goes. I could be wrong. Like I say, I haven't checked in the last little while. But space is limited, and if you're going to add those programs in, they're going to need more physical space and possibly more people - is that included in the $6.4 million as well as the surgeons, anaesthetists, recovery rooms, and so on?


            MR. DELOREY: I thank the member for the question. Again, it's a very important program that we're investing in in this budget, which is really a continuation of decisions we have made since forming government, continuously increasing our investments to ensure we get more progress on addressing the wait-list in orthopaedics. With respect to the investments, certainly the investment covers the operational side of the delivery. That included four orthos; four anaesthetists who would be performing the surgery; around 40 additional staff members, I believe, throughout the system, which would be - again, I think some of those people you would be talking about in the prehabilitation and rehabilitation side of delivering the programs.


            As far as infrastructure needs, I'm not aware that there are going to be any challenges with achieving that, based upon the planning that's in place. The efforts are going to ensure that we achieve these results, making better use in planning the space utilization that we do have - mentioned about the ORs, for example, using Saturdays, non-standard times. We think that there are opportunities to deal with it those ways rather than through infrastructure investments.




            For the New Democratic Party, the honourable member for Halifax Needham.


            MS. LISA ROBERTS: Thank you very much, Mr. Chairman. I wonder if the minister could explain to me the link - if the link exists - mandated by the department between continuing care eligibility and use and long-term care eligibility?


            MR. DELOREY: Mr. Chairman, I think, just to make sure we're on the same page here with the definition, when we're talking about and highlighting continuing care, we're really talking about the broadest context and umbrella of services. Under that would come home care services, for example, and our long-term care services.


            I'm not sure if - perhaps that clarification of the definition when we're talking about continuing care - it's a continuum of care that can go from home care services, where people are receiving services, and all of the various home care service scenarios that may exist, as well as a program that came up last week in reference, one that's not well noted.


            It's kind of a self-directed program for individuals, where they don't necessarily have to fit under the traditional home care model but can work with some professionals and develop their own care plan and find their own care providers. It gives them some flexibility, particularly helpful for students who would be at the university level, so where parents can work with their youth. Their needs, you may imagine, may evolve as they're growing and aging, and then when they get to that point where they're going to university or college perhaps, having that flexibility to continue with their care providers as they move on.


            That would be the continuum under the home care side, and then of course the long-term care side would be what we would classify or consider more commonly as our nursing home services and so on.


            MS. ROBERTS: Thank you for that. I am just coming to understand these various streams myself.


            I guess really the intent of my question was to ask about whether there's a progression, that an individual must go through home care in order to become eligible for a nursing home bed. What's the policy on that?


            MR. DELOREY: I appreciate the member's clarification. There are care coordinators within the continuing care system. Citizens who may need these types of services, continuing care services, would be assigned a care coordinator. That would be someone to help assess, and the assessment process, again, would be based upon clinical assessments. They would follow standards that exist for those needs that are identified and they try to align those services, be they home care or long-term care, to meet the needs of the individuals. Those assessments include both the assessment of the individual and the individual's living environment that they may be in.


            Again, in certain circumstances, an individual may - if they had a different home environment, you know, if you think things like if they had a different home environment, their condition might afford them a little more capacity to stay at home than someone in a less-demanding home environment. But that's where through home care services you try to mitigate and see, but if you can't get sufficient services in that actual environment, again, the individual's, collective well-being may be best suited in a long-term facility but, again, it varies on a citizen-by-citizen basis given the totality of their physical health conditions, but also their environmental conditions as well.


            MS. ROBERTS: Thank you very much for that answer. And just a last question on that, what role, if any, do family doctors have in that clinical assessment for eligibility for wherever, whatever service or level of care is recommended by the care coordinators?


            MR. DELOREY: Mr. Chairman, I thank the member for the question. I would have to double-check the logistical specifics if it's firmly mandated or simply a possible injection. I don't know if it's a mandated thing that a physician assessment is necessary as well or if it is simply - there are instances, I know, as an MLA where individuals do approach their care provider, their family physician to provide a letter of assessment to be submitted to the care coordinator for consideration as part of the process. What I can't say with certainty, and I'll double-check, is whether or not the physician level of assessment is a mandatory part of that process. What I can say is within the hospital context, so I believe physicians do an assessment before discharge for patients.


That would be another place where a physician's feedback or input would go into the care for consideration, but I'd have to double-check to see if it's a mandatory piece or simply just one of the pieces of data that is considered. If you can just give me two seconds, I'll just - there's breaking information that might have further clarification, so if you could just bear with me for two seconds, it might be helpful.


            Mr. Chairman, I was just confirming that, indeed, I believe physicians do complete an assessment if it's for a long-term care facility, but that physician assessment is not a necessary requirement for home care services and supports although, as I said before, you may have physicians who provide some of that information. Thank you.


            MS. ROBERTS: Thank you; thanks for those answers.


I wanted to ask about Thrive! which its website hasn't been updated since 2015 - is that a current strategy or a current program of the Department of Health and Wellness?


MR. DELOREY: Mr. Chairman, I was hoping you would call on the former Minister of Health - yes, I guess there's one, two, three - I'm counting at least four or three former Ministers of Health in the Chamber right now, but in seriousness (Interruption) Oh, I'm being advised that indeed the minister who initiated this program unfortunately, or fortunately, I believe, the program is still existing but it's actually shifted out from Health and Wellness over to the former Health and Wellness Minister in his role at Community, Culture and Heritage because he also has sport under his mandate and, indeed, it is a more recent transition, but that relates to the former minister's deep appreciation of the program and the role that sport and active living and engagement play, so it was something that we felt fits well within that mandate under sport. I don't have that information in my department any longer for the current, but it is still active, the minister assures me.


[8:30 p.m.]


MS. ROBERTS: Thank you for the answer. That's interesting because one of the things I heard when the Bayers Road outpatient clinic was announced was how contradictory it was to Thrive! and to the direction given under Thrive!, where one of the four pillars was about planning and building for health communities that allowed for active transportation, because of course it's one thing for an individual coming from rural Nova Scotia to arrive at a location by car without having to navigate the city but then of course there are employees who are going to be going to that facility every day who will also effectively at this point have to drive every day because it's the only way to get there.

            I guess I was wondering and interested to know, how many employees do you expect to have at that outpatient clinic?


            MR. DELOREY: I thank the member for that question. At this point the staffing levels and needs of the facility aren't yet finalized or determined so I don't have that information. Again, it's still really in the early stages with the facility and the site. I believe the work is under way by the original owner on getting the site ready, that is what is known as being "pad ready," that they have to get that work done before we take full ownership and the site is ready for development. So, we're still in kind of the early stages of that side of the facility - this will all come out in due course.


            MS. ROBERTS: Thank you for that answer. I believe that the language shifted a bit in the Throne Speech this time where it was said very explicitly that whatever programs and services are provided there will not replace services available for I guess - I don't know if the term was actually "downtown" but I'm wondering, what does that mean in terms of workforce planning and recruitment - are we going to be looking at requiring additional human resources to staff to two different locations or how is the department thinking about that?


            MR. DELOREY: Yes, the Throne Speech was quite clear there in terms of replacing, and I think the context of replacement was there had been some concerns expressed that the facility was designed to pick up services that existed on the peninsula and move them - so stop providing any services on the peninsula and provide them out at the Bayers Lake site. So that is the reference.


            The member hits on a very important question around the workforce planning concept because, while the services would still be there, currently the services that are provided at the current location on the peninsula receive some demand from off-peninsula, which of course may replace, so how that plays out on the workforce planning and so on, based upon the demands of those services.


The services would still be available is what we're trying to make sure people were aware for those and again back to the notion of the Thrive! and the active transportation for those on the peninsula able to partake and access the services there in that regard, but again as those things evolve, this is designed, we've got services that are needed, the demand is there, that we're looking at expanding capacity. That's really what this clinic is about. But again, where the shifting demand patterns come out to play when a new facility comes online like this, that's part of the planning as it gets closer and we get a feel for how those patients will move through the system in that way.


            MS. ROBERTS: Thank you for that answer. The last question from me, and this may not be something that you have right at your fingertips, but I would be interested in knowing the average age of new MSI cardholders or new MSI number-holders - is that something that the department would be able to provide, or is that something that you do have at the top of your mind?


            MR. DELOREY: The member is correct, that's not information I have top of mind. Again, I'd just have to cross-reference and double-check if there are any privacy restrictions with accessing that type of information. If it's not an issue, we'll certainly endeavour to provide it, but if it is I'll certainly advise that it's due to privacy constraints, that that might restrict it. I put the caution there just in case it does come out but, again, aggregate data, I'm not expecting but, just in case, I wanted to put that caveat.


            MS. ROBERTS: Thank you very much and yes, if your department could provide that information to our caucus, I'd be interested to see that.


I'm going to be passing over questions to the member for Sackville-Cobequid.


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


            HON. DAVID WILSON: I just want to start off on a few different areas. Hopefully, we'll get through them in the next few minutes. I know it will then be handed off to the Progressive Conservative caucus. One concerning area of change that we've seen across the country and I know I've brought this up on the floor of the House a number of times to the former minister without success on getting a definite answer on where the government's direction is going to be, and that's involving the voluntary blood donation process that we have here in Nova Scotia.


            We know that across the country jurisdictions have been looking at allowing for-profit blood collection companies to set up shop. I know I speak on behalf of our caucus that that's not a direction we would like to see, but we're not alone in that, Mr. Chairman. I want to give the minister an opportunity today to indicate - is his government going to allow for-profit plasma or blood collection companies to open up in Nova Scotia?


            MR. DELOREY: I thank the member for the question. Blood services and blood collection, I think all members would be aware of the importance that those donations and the access to blood plays. What many people may not be aware of though is, as the member made reference to, not just blood but blood plasma is the role - I think I may have mentioned this once before, but in my donations of blood I'll say in my ignorance before coming into this role was that if I donate blood I see the bag filled up, I just assumed that that goes into a fridge until someone needs it in an operating room or some other medical procedure - and blood in, blood out, blood in.


            I've since become aware that indeed people take the whole blood that gets donated and extrapolate plasma and are able to develop many other products for various treatments for patients, which has increased the demand dramatically. But all of that said about the demand and the products that our blood provides, in a Nova Scotia context my understanding is that indeed we donate still as a community very well - people in Nova Scotia obviously recognize the importance and have a long-standing tradition of donating and I don't see that changing any time soon.


            MR. DAVID WILSON: I'd like to ask the minister if he has had any meetings or has met with the CEOs of any of the private companies that are operating in Canada - I wonder, has he had any meetings since he took office after the last election?


            MR. DELOREY: Mr. Chairman, I have not. The information that I've learned about blood services was part of my overall, I'll say, onboarding experience, the learning of the department. So, in terms of broadly discussing, you know, and getting a deeper understanding of how Canadian Blood Services and Nova Scotia's role and how Nova Scotia contributes and that's where that, again, information that I think we should be very proud of as a province that our donations are actually on a per capita basis and demand basis quite strong, so, again, not seeing that there's really a presentation and I'm not even aware that any private organizations have ever been reached out, so I've not seen or - not to me, not since I've been in office.


            MR. DAVID WILSON: Mr. Chairman, the reason I ask is I know that they have in the past with the former minister - and I hope the minister, the current minister, stays true to his comments. I just remind him that it is the job of the Canadian Blood Services to make sure that we have the stock not only of whole blood but plasma in this country for the Province of Nova Scotia. I know for some time they were kind of silent on what direction the Canadian Blood Services would take, but I'm encouraged with recent statements and I believe we have a seat or we - you know, they're accountable to the ministers and to the provinces in Canada, so I hope that the minister continues on with that sense of pride of the voluntary donation that we have here in Nova Scotia.


I know I'm running close to my time, so maybe I'll ask the minister, would the government entertain enshrining that in legislation? I've introduced that legislation on a number of occasions over the last number of years - has there been any talk to enshrine that commitment to the voluntary blood donation process here in Nova Scotia and, if not, will the minister consider legislating that in our province?


            MR. DELOREY: Mr. Chairman, I thank the member for the question. I can answer, again, with the many, many things on the plate and the many competing priorities within the Department of Health and Wellness, this wasn't one that has been front and centre or at the forefront of my efforts, again in part because of the information I provided that the information I've received thus far on how the people of Nova Scotia and, I guess, the rates and the success of our donation services which I think speaks volumes to the people of Nova Scotia who go out and continue to donate. I'll take this opportunity, if the member doesn't mind, to use a public service announcement and remind not just the people of Nova Scotia but the members of this Legislature that they have the opportunity to donate blood.


            Growing up in a rural part of the province, I only had the opportunity when the mobile clinic would come to Antigonish to do those donations conveniently at the university, but since I spend more time up here in the city, I'm actually able to donate on a more regular basis now. In fact, there's a clinic - I don't even know where the name of it is in the city - Google gets me there and it's a crazy road structure but the people are fantastic and you're able to donate, basically, every couple of months. So, again, I would encourage all members to do that.


As I said to the member, legislating hasn't been top of mind. We have a lot of critical issues, not that this issue isn't of concern but I haven't really seen that there's any indication of people wanting to move towards privatization in Nova Scotia because of the success we've had with donations.


            MR. DAVID WILSON: Mr. Chairman, I appreciate those comments and I'm sure those who have been organizing across the country for decades now will be somewhat encouraged, but I didn't really hear the answer of, yes, you were going to pass legislation - but we're going to keep chipping away at that.


[8:45 p.m.]


The next area is an area that is of concern too. It's not in the forefront or on the front pages of the paper when it comes to health care services - it's dental coverage for children. For many years, the cut-off was 12 years old. I was proud to be part of a government that moved that. Each year, we were going to add a year so that kids up to 17 could have dental coverage.


            Currently, the children's dental program is cut off at 14 years of age and under, who are eligible for the dental coverage. I would like to remind the minister that his Party and his Premier had committed to maintain adding the years up to the age of 17 but made the choice a number of years ago to stop the expansion of that program.


            I'm wondering if there has been any discussion in the preparation of this budget - I know it wasn't in the Throne Speech, and I don't find it in the budget - was there any discussion of moving that age limit for older kids to ensure that our children get the dental coverage they deserve? (Interruptions)


            MR. DELOREY: Mr. Chairman, I'm only grinning because of some commentary from the peanut gallery, not because of the topic on the floor. It is indeed an important question and a serious one.


            Of course, the health, including the dental health, of our youth population is an important topic for the government. I think all Nova Scotians would share that concern. To the member, I had meetings a few weeks back with representatives of the dental association. Actually, their feedback and comments they provided me align very much with some comments that I heard on the campaign trail from dentists, including retired dentists, in my community.


            What I committed to was giving due consideration to the recommendations of the dental association. Their concern is more interest in expanding the scope of services being offered to young Nova Scotians. They believe and have advocated to say that using our resources in that regard is more important and will have better outcomes than simply extending the age for the very generic basic services that are currently being offered for children up to the age of 14.


            MR. CHAIRMAN: Order, please. The time for the Committee of the Whole on Supply has expired for today.


            The honourable Government House Leader.


            HON. GEOFF MACLELLAN: I move that the committee do now rise and report progress and beg leave to sit again.


            MR. CHAIRMAN: The motion is carried.


            [The committee adjourned at 8:48 p.m.]