NOVA SCOTIA HOUSE OF ASSEMBLY
Wednesday, April 4, 2012
Department of Health and Wellness
Better Care Sooner
Printed and Published by Nova Scotia Hansard Reporting Services
Public Accounts Committee
Hon. Keith Colwell, Chairman
Mr. Howard Epstein, Vice-Chairman
Mr. Clarrie MacKinnon
Mr. Gary Ramey
Mr. Mat Whynott
Mr. Brian Skabar
Hon. Manning MacDonald
Mr. Chuck Porter
Mr. Allan MacMaster
[Mr. Andrew Younger replaced Hon. Manning MacDonald]
Mrs. Darlene Henry
Legislative Committee Clerk
Mr. Jacques Lapointe
Mr. Gordon Hebb
Chief Legislative Counsel Office
Department of Health and Wellness
Mr. Kevin McNamara, Deputy Minister
Mr. Ian Bower, Executive Director, Primary Health Care/EHS
Ms. Emily Somers, Provincial Lead, Better Care Sooner
Ms. Linda Penny, Chief Financial Officer
HALIFAX, WEDNESDAY, APRIL 4, 2012
STANDING COMMITTEE ON PUBLIC ACCOUNTS
Hon. Keith Colwell
Mr. Howard Epstein
MR. CHAIRMAN: Good morning. I'd like to call the meeting to order, and I'd like to start by having everyone introduce themselves.
[The committee members and witnesses introduced themselves.]
MR. CHAIRMAN: I'd like to welcome the Department of Health and Wellness here this morning and I would ask you to proceed with your opening remarks.
MR. KEVIN MCNAMARA: Thank you very much, Mr. Chairman. I have with me Emily Somers, who is our provincial lead on the Better Care Sooner initiative at her department; Linda Penny, Chief Financial Officer; and Ian Bower, who is the Executive Director from Primary Health Care in Emergency Health Systems.
We are pleased to be here today to discuss the advantages and the changes in our health care system. As you know, these changes have been driven by Better Care Sooner, government's plan to improve health care in Nova Scotia.
Our work to improve the health care system began with the appointment of Dr. John Ross as provincial advisor on emergency care in Nova Scotia. Dr. Ross is a highly respected emergency room doctor with years of experience. His research on the Nova Scotia system and his report entitled The Patient Journey Through Emergency Care in Nova Scotia has provided us with a road map in our plan to improve emergency and primary care.
The Better Care Sooner plan was introduced in December of 2010; it is government's response to the Ross report. Ultimately, our Better Care Sooner plan is focused on the patient experience and how we can enhance the patient journey through the health care system. Better Care Sooner contains 32 action items and is designed to provide and enhance access to physicians, nurses and other health care professionals, streamline the patient-centered emergency care, care for seniors, people with mental illness and others with complex needs, appropriate use of paramedics, and the 811 nurse line.
Using Better Care Sooner as our road map, the Department of Health and Wellness has undertaken innovative approaches in a number of different areas. For example, we have opened Nova Scotia's first two collaborative emergency centres, one in Parrsboro and the second in Springhill. Collaborative emergency centres provide Nova Scotians living in smaller communities extended primary care hours, same-day or next-day access to appointments with family physicians or other health care professionals, and 24/7 access to emergency care.
Overnight CECs will be staffed by nurses and/or paramedics working with the HS physician oversight. Other CECs are targeted this year in the communities of Tatamagouche and Annapolis Royal, and others to be announced in the near future by the minister. Since the CEC was launched in Parrsboro in July, over 4,800 patients have been seen during the daytime hours, and nighttime visits have been cut in half because individuals are getting access during the day.
We started the Extended Care Paramedic program in 17 nursing homes in the Capital District Health Authority. Under this program, skilled EHS paramedics assess and treat nursing home residents in the facility. These patients get the care they need at home so they do not need to visit the hospital in non-emergency situations. Seniors receive a plan for follow-up care in their facility, or transport to hospital at a later time if this is necessary.
As part of the Emergency Health Services LifeFlight, the Department of Health and Wellness has added an aircraft which is dedicated solely to emergency health care. This aircraft is used to transfer critical care patients in Nova Scotia and throughout the Maritime Provinces.
We invested in a two-stretcher ambulance. This ambulance is situated in Glace Bay and will transfer non-emergency patients between the facilities in the Cape Breton Regional Municipality and Halifax. It is increasing efficiency in our health care system and better protects the health and safety of Nova Scotians by freeing up the availability of other ambulances for emergency responses in their own community.
We opened the Rapid Assessment Unit at the Halifax Infirmary. In its first year, this year, it provided care to almost 2,900 patients at the QE II - diverting the majority of them away from the busy Charles V. Keating Emergency and Trauma Centre. This has created more space in the emergency and trauma centre for patients who need emergency care, and it also resulted in fewer patients waiting on stretchers, allowing EHS paramedics to get back in the community sooner. Without this unit, overall wait times in the emergency and trauma centre would have been higher over the past year.
We opened eight new hospital beds at the Halifax Infirmary. These beds are helping to reduce overcrowding and bottlenecks at the province’s largest emergency centre. Right now, in Nova Scotia, we have trained advanced care paramedics who can immediately give lifesaving drugs to Nova Scotians having heart attacks rather than having them wait until they arrive at a hospital. Across our province you can now call 911 and receive care sooner at your door if you’re experiencing a heart attack, rather than delay treating by driving to an emergency room - by the way, we’re the only province in Canada that has this fully province-wide.
We have hired nurse practitioners to work in certain nursing homes across Nova Scotia. Nurse practitioners contribute to more effective and efficient patient care for residents, help reduce wait times in emergency rooms and, most importantly, give seniors the care they need at home. We have rerouted stroke patients to specialized units across the province. Starting in November of 2010 stroke units were opened across the province in regional hospitals, and ambulances now take stroke patients directly to these hospitals to receive care - these units are located at South Shore Regional Hospital, the Yarmouth Regional Hospital, Valley Regional Hospital, Colchester Regional Hospital, St. Martha’s Regional, as well as Cape Breton Regional and the QE II.
We have released two emergency department accountability reports. Since 2010 the government has been releasing annual ED accountability reports, and these reports provide accurate reliable data to better understand the challenges facing the province’s emergency care system. We’ve launched a public awareness program to increase the understanding of 811 and 911. We’re also helping Nova Scotians make informed decisions about their health care needs through the 811 nurse line. Currently, an average of 500 Nova Scotians call 811 daily - since it has become operational two years ago, over 100,000 Nova Scotians have received health care advice through this service. Another big investment we have made is the new or replacement nursing home beds to make life better for seniors and their families.
Seniors are also benefiting from concrete steps we took to reduce drug costs. Our Fair Drug Plan means seniors and families enrolled in Pharmacare are paying less for generic drugs, and we have saved $6 million so that we can invest in other drugs and programs Nova Scotians need and want. For example, patients receiving palliative care at home are eligible for full drug coverage at no cost with the launch of a new expanded Palliative Home Care Drug Coverage which was started in February of this year. We are making it easier for those who want to remain in their homes as long as possible. We have brought in improvements for seniors such as the Home Adaptation Fund, the Caregiver Allowance, and we ended security deposits for seniors in long-term care facilities.
Here in Nova Scotia Our Better Care Sooner plan also places a priority on disease prevention in an effort to keep people well and to decrease stress on our health care system. For the past two years we’ve been providing free flu shots to all Nova Scotians and, as part of a commitment to deliver better care sooner, government is developing our province’s first-ever Mental Health and Addictions Strategy that will improve these services for Nova Scotians who need them. The Minister of Health and Wellness will release this strategy later this Spring.
While much has been accomplished, there is still some work to be done on the Better Care Sooner plan. Next year, working with the district health authorities, Nova Scotia will be the first province in Canada to begin implementation of standards for emergency departments. Under Better Care Sooner, the Department of Health and Wellness will also focus on improving patient access and flows in our ERs and creating senior-friendly emergency care.
I want to thank you for the opportunity to share this with you, and we look forward to answering your questions.
MR. CHAIRMAN: Thank you very much for your presentation. Our first questioner will be Mr. Younger - 20 minutes.
MR. ANDREW YOUNGER: Thank you for your remarks. I want to start by asking about something you referred to, the collaborative emergency centres. It’s interesting that the Minister of Health and Wellness keeps talking about five, five, five, and we obviously know where those are. As you just said, only two of them are open and nobody seems to know when the others will open. I would actually like to ask you about the two that you said are open - Parrsboro and Springhill. Can you tell me when Springhill opened? Because just the other day they said it wasn’t - in fact, it’s still on their Web site from a couple of days ago.
MS. EMILY SOMERS: The CEC in Springhill opened March 28th.
MR. YOUNGER: Oh, that explains it, because I’m looking at March 26th and it’s saying it’s not open. I appreciate that clarity, thank you.
When can we expect - the Minister of Health and Wellness keeps going around and saying there are five collaborative emergency centres and we know that those would be Springhill, Tatamagouche, Pugwash, Annapolis Royal, and Parrsboro. We know where they are, but when are the other three going to open?
MS. SOMERS: Each of the districts has submitted proposals for those that were identified by John Ross. Each of them are identifying when and if they are ready to open a CEC. We have received proposals from Tatamagouche, Annapolis, and Musquodoboit Harbour, and we are in the process of reviewing those and providing them the green light to proceed. We expect three more to be opened this Spring.
MR. YOUNGER: I’m sure you can understand the concern of some of these communities, that in the big announcements in the Fall that these were happening - and in fairness maybe they didn’t understand the process that would be involved in that - they’ve sort of been sitting around waiting and suffering through ER closures ever since thinking that was coming to an end.
I wanted to ask about something else that I find amusing, that gets listed in the Better Care Sooner plan, which is the Dartmouth General Hospital. It actually lists it on the Web site and so forth as a renovation. I was at the press conference - and I’ll even table the remarks by both the minister and the others that actually say it’s not, that this is just a plan to look at a possible, potential, future renovation and there is no government commitment for funding that renovation at the moment. I wonder if you could clarify that - and I’ll certainly table those comments.
MR. MCNAMARA: I’ll be happy to answer that. Yes, it is a phase which is a planning process, but there is a commitment to honour that planning and to make that a reality. So, it will occur, but I can’t give you the exact date.
MR. YOUNGER: Well, the minister says it isn’t.
MR. MCNAMARA: Pardon me?
MR. YOUNGER: The minister and Chris Powers say it isn’t. They say this is just a commitment to this phase and in fact there is no commitment to the actual construction. Can you explain the discrepancy between what you’re saying and what the minister is saying?
MR. MCNAMARA: What I’m saying - it will be built into the future budgets of when the construction dollars will be spent. I think that’s what the difference is. We’re not going through a planning exercise just to plan.
MR. YOUNGER: I’m not sure I agree with you because we’ve been through this planning exercise before for the fifth floor of the Dartmouth General.
MR. MCNAMARA: My understanding is that it will be a commitment to build and to fix.
MR. YOUNGER: All right. Has the RFP gone out for that? As far as I can tell, on the government Web site . . .
MR. MCNAMARA: I don’t think the RFP has gone out yet; I think they’re in the works of doing that at the present time.
MR. YOUNGER: I guess you can understand my concern. This was announced in December - that an RFP “was imminent” were the words used at the time, and we’re now into April and the results of that RFP and study are supposed to be back, according to the minister, by the end of the summer.
MR. MCNAMARA: The thing that is happening is this is done through Capital Health, so they’re doing their planning with their staff and once that is completed the RFP will be let.
MR. YOUNGER: I do understand that it’s done through Capital Health, but we’re talking about Better Care Sooner and the Better Care Sooner plan is claiming that the renovation is going ahead.
And I think you can probably understand where my concern is - I have a minister and the CEO of Capital Health saying there is no commitment, very firmly that there is no commitment to do the construction, that they’re going to look at it. Also saying in December that that RFP was imminently going out and there is no RFP out at the moment and that the results will be back in the summer. Well, when the media asked about this at the press conference in December, they said the reason it had to go out imminently is because it would probably take eight months to do - which makes sense, I don’t dispute that six to eight month time frame to look at the cost and design. But if that’s the case and the RFP hasn’t gone out yet, and say it goes out tomorrow and it takes 30 days to review an RFP - just for the sake of argument, which is probably pretty quick - that puts it in May and puts six to eight months not at the end of the summer, but into next year.
MR. MCNAMARA: I have just been advised the RFP is in the final draft and should go out within two weeks.
MR. YOUNGER: Okay. Do you know - will the results of the study still be back at the end of the summer, as the minister promised?
MR. MCNAMARA: This is my belief.
MR. YOUNGER: Right. So they’re going to do a shortened timeline then . . .
MR. MCNAMARA: They’re going to do the work and then we will be able to go forward, but my belief is that the Dartmouth General Hospital renovations will go forward.
MR. YOUNGER: I hope they will; I really do. The reason I’m asking about this is because I was there at the press conference and I was quite open. I said I hope that this does go ahead. However, we’ve been through this before. A previous Tory Government did the exact same study and had the plan - we can drag the plan out here and look at the plan for the fifth floor that never got funded because of other priorities and budget pressures.
I personally sat in the ER waiting to see a doctor, two or three weeks ago, for four hours because they were overcrowded. And that’s fine, I understand that happens. But there were a lot of people there - and a lot of people waiting with much more serious injuries than I had, and the planning does nothing to solve the overcrowding at that hospital. And you can understand when there are a lot of people serviced by that hospital, who have heard that there would be a study before.
MR. MCNAMARA: Again, going back, things have changed since the original plan was done for Dartmouth General . . .
MR. YOUNGER: Oh, I know that . . .
MR. MACNAMARA: . . .the replan has to occur. In talking to the Dartmouth General Hospital Foundation, we have asked them to raise their 25 per cent of the capital cost - I would not be, and the government would not be, asking them to raise 25 per cent if there was not a commitment to move it forward.
MR. YOUNGER: Okay, then that brings up the next question. If you’re asking them to raise 25 per cent of the capital cost, at that announcement the minister wouldn’t actually put a dollar figure on - in fact, what I just tabled there actually has Chris Power saying, well, obviously we can’t because we haven’t had the study. I appreciate that you’ve asked the foundation for 25 per cent, so if you asked them for 25 per cent you must know what 100 per cent is going to cost, or a ball park - they can’t raise 25 per cent of an ethereal number.
MR. MCNAMARA: As you know, the Dartmouth General Hospital has been raising money for a number of years towards this renovation, so they’ve had a head start. In fact, in meeting with the chairman of the foundation last week, we discussed the commitment of 25 per cent. We don’t know the exact amount until the RFP is completed, but they are putting their team together to go out and complete the fundraising once they have a final target.
MR. YOUNGER: I’m sure Mr. Conrad told you - just as he has told me - that it’s pretty hard to approach businesses or individuals and say well, listen, we’re raising money for this and we have to do 25 per cent. I know they’re very eager to help, but it’s hard when they don’t know what that total dollar figure is. I appreciate that you’ve asked them to raise 25 per cent, and I have every confidence that they will do that - but there’s a big difference if it’s 25 per cent of a million or 25 per cent of $20 million, right?
MR. MCNAMARA: I agree, and I think we’ve learned from the past, in what governments have done in the past, announcing a target and then not being able to meet it. We want to make sure that the full evaluation is done so we don’t end up like we did in Colchester.
MR. YOUNGER: I agree. I completely agree with that, but I think that gets right back to my original concern, which is I think the minister was quite honest, to be frank, and Chris Power was quite honest at that press conference when both of them said we’re not going to commit to this construction until we actually get that RFP back and know what it’s going to cost, which sort of fits with that whole Colchester thing that, my goodness, if it comes back and it’s outrageously expensive then we have to scale down or we have to figure out what we’re going to do. It has to be affordable; I think we all agree to that, but you’re telling me that - if I understand you correctly - the construction is going to go ahead.
MR. MCNAMARA: That is my belief. We know they’re aiming towards two operating rooms that have to be added to that area, plus a number of beds - I think approximately 50 - that’s to infill the floor that is already there.
MR. YOUNGER: Oh, I know. I’ve been on the floor. It’s a nice, big, empty floor.
MR. MCNAMARA: So my belief is that we would not be going this route if it wasn’t to come to a completion. I think one of the things we’ve been trying to do, that this government and our department are trying to do, is to not commit to things we won’t do. So we’re trying to make sure that we have a game plan in place. Yes, we’ll be going to government for the actual amount of construction cost once we know what it is, as we go to the foundation.
MR. YOUNGER: I guess all I’ll say to that is what I said before - the study has been done before. And I appreciate your commitment - listen, I absolutely hope that you’re right; I very honestly do hope you’re right. But I think you can understand - as someone who has spent their whole life living in Dartmouth and has seen plans for the fifth floor been funded and done by government and then the construction not followed through - this really isn’t much different than promising to lower the HST, that it comes after a future election, it isn’t within the mandate of the current government and it relies on future commitments. That’s where it gets troubling.
The other question I have about that - and I’d like to know whether this has changed - is Ms. Power said at the time that this would not actually be additional beds that would be created by this, but would be a shifting of beds, or would most likely be a shifting of beds from other Capital Health sites. There would be two new operating rooms - that’s what they’re looking at - but the beds that would be created on the fifth floor of the Dartmouth General would actually just be a transfer of beds from other sites.
MR. MCNAMARA: I think what Ms. Power said was that there would a shifting on an interim basis while there is work done to replace work around the VG. So you have to look at Capital Health as a full entity, and then over time you would do the second part.
MR. YOUNGER: So will there be a net increase in beds in the Capital District system after this is all done?
MR. MCNAMARA: Eventually there will, yes.
MR. YOUNGER: Okay, eventually. I appreciate that there are different construction projects going on, but when you say “eventually,” what kind of timeline are you talking about?
MR. MCNAMARA: I can’t give you that exactly. We also know . . .
MR. YOUNGER: Even a ballpark is fine. I’m not going to hold you to - if you say four years and it ends up being five, that’s fine.
MR. MCNAMARA: I can’t even do that. But I can also tell you other things that are taking place, as over the next five years the federal government is pulling out of covering veterans’ beds. We know that the veterans’ unit will be coming available to us as well, as another opportunity, so we have to work that into the plans that are being developed.
MR. YOUNGER: When you call that an opportunity, what would you - maybe I should ask it in a different way - with the federal government’s change in involvement in veterans’ beds, how is that going to impact?
MR. MCNAMARA: It means that the veterans - there will be no veterans in the Veterans Building, so that facility will be available as well.
MR. YOUNGER: It will be available, but it will mean an additional cost to the Department of Health and Wellness, I assume.
MR. MCNAMARA: No question. And you have to do the appropriate renovations, and how we would utilize that space is what we will have to work our way through - that’s part of the planning.
MR. YOUNGER: But of course those veterans will still need beds, whether they’re provided by the federal government or provided by the provincial government, right?
MR. MCNAMARA: My understanding from Veterans Affairs Canada is that there will no longer be those veterans around, because if you look at the age of them now - the ones that they provide coverage for – there are newer ones coming up, and we have to work and figure out how we’ll provide that care as well, but my understanding from Veterans Affairs Canada is that they intend to spend more on home care and less on institutional care. And this is not just in Halifax, it’s across our province.
MR. YOUNGER: Oh, I suspect it’s across the county, too.
MR. MCNAMARA: Yes.
MR. YOUNGER: Listen, I recognize that it’s not your decision, and I also appreciate the fact that you recognize that veterans are not just people who served in World War II or Korea, or wherever else, that we have veterans today - there are some people coming back from Afghanistan and some of our peacekeeping missions who are seriously injured and need care as well. I think that that will be a potentially significant additional cost pressure in terms of - because somebody’s going to have to, and hopefully the home care will work, but home care doesn’t work for everybody.
MR. MCNAMARA: Again, the veterans’ care is a responsibility of the federal government, and I think we all collectively have to hold them accountable for that and make sure that . . .
MR. YOUNGER: I agree, but there are a lot of things that the federal government is responsible for that they abdicate from so, unfortunately, to some extent it’s not much different than the OAS situation - it will fall to the provincial government to deal with. The gap between 65 and 67, which is a whole other department - it would be Community Services, and I recognize that - but I agree with you that it is a federal responsibility and all of us will have to advocate on that. However, some of these things seem to still fall to the provincial government, whether we like it or not, when the federal government abdicates its responsibility.
So here we have a situation with the Dartmouth General Hospital where eventually there will be new beds created, and that's fine, but the Dartmouth General Hospital is routinely in a code census. I'm going to do this by memory so I might be slightly off, but it was something like 140 days last year that it was in a code census situation. It might be a little bit more or a little bit less, but there is a serious overcrowding issue at the Dartmouth General Hospital - as there is at other hospitals.
There are many points to it, but one of the points of addressing the fifth floor issue was to try and alleviate that to some extent by creating additional bed capacity. Anybody who has been there knows that one of the issues is finding in-patient beds; in fact the day that I was there, that was exactly the issue - there were a number of people waiting for in-patient assignments and they couldn't take other people in. Unfortunately a young person had a very serious accident and died, and that had taken up another part. So with the word “eventually”, that fifth floor issue is not going to address the overcrowding in the near-term, maybe not in the medium-term - so what is the plan to address that?
MR. MCNAMARA: On an interim basis, in fact a couple of months ago I met with George McLellan from EHS and Chris Power from Capital Health and talked about how would we first work on the ambulance off-loading, because that is important as well. So a transition team has been put in place, including an RN and one of the paramedics, to look at that.
So how do we improve that system? There have been major improvements in Dartmouth on that; there have been some improvements in Halifax - not as much as in Dartmouth. We are also looking at what we can we do to keep people out of the ERs. For example, the issue of adding paramedics to go to nursing homes is one thing. We have to look at other avenues of how we can provide access for individuals to go see a physician because, as you know, often people who end up in ERs are there because they don’t have access to a health professional. So part of the Better Care Sooner is part of that plan as well.
We are also working our way through a physician manpower plan for the future so we can identify where we need physicians or other health care professionals and how best we do it. We are looking at how we can add other additional health care professionals, particularly in rural communities - looking at nurse practitioners. Even when we open our CECs as we look at the Musquodoboits, for example, it starts to relieve pressure off the Dartmouth General’s ER. So it is a bunch of stages to get there. We are trying to fix a lot of things in a short time and, unfortunately, it doesn't happen overnight.
MR. YOUNGER: I realize that and I appreciate that there has to be a long-term and a short-term plan.
MR. MCNAMARA: That's correct.
MR. YOUNGER: I realize there is no silver bullet to that. I think where the disappointment comes for many people is they looked and said for many years, and many people, including myself, fought to have that fifth floor moved ahead. We will be cautiously optimistic that maybe this time it will, then we hear well, yeah, it will be years before we actually see that trickle-down effect from that - so we need to find another source.
All of those things you talk about are great, and metro is a bit of a different situation than some of the rural communities, in some respects - there are similarities, of course. If you have a family doctor and you can't get an appointment, or you don't have a family doctor, there are a whole pile of walk-in clinics around metro and you can usually get in fairly easily. The problem is, just like everything else, they close at whatever time - some of them close at 8:00 p.m., some of them close at 6:00 p.m., some of them are open on weekends and some of them aren't.
I know that those take pressure off the ERs and they would take pressure off the QEII - probably Cobequid, too, I assume - but they close. So the physician problem isn't the only key to this, on a metro, basis because if you have something serious enough that can't wait until the next day and the walk-in clinic is closed, Saturday night at 10:00 o’clock you have no choice but to go to an ER. That doesn't matter if it is a senior, obviously some of that is taken by the paramedics.
That's the short-term problem, as I see it, in terms of the urban areas. Creating a physician database and all that is not going to solve that problem because they’re still going home at 9:00 p.m. or 8:00 p.m. or 6:00 p.m., depending on whether they offer after-hours. That's where your code censuses are primarily happening, in the overnight hours. So what is the short-term plan to address that?
The long-term plan is fine. Let's assume that this all works out, you get additional capacity five years down the road after all the other stuff is done, or six years, whatever that eventual time ends up being - what is the short-term plan to address that? - because it’s not just here you’re having a trickle-down effect, the QEII and Cobequid and everywhere else.
MR. MCNAMARA: As I mentioned earlier, it is steps, and one of the steps was just, for example, having paramedics go to nursing homes to prevent those individuals from ending up in emergency centres. Our CECs that we’re looking at, we’re looking at same day/next day access as part of it. So as we develop those facilities, the Musquodoboits, for example, will have an impact on the Dartmouth General because individuals can be seen - like it is happening in Parrsboro. One of the things we’ve learned from Parrsboro is that we now have individuals from neighbouring communities going to Parrsboro for care because they know they can get an appointment either the same day or the next day. It’s an improvement from the past, of having to wait two weeks to see a doctor, which is why many individuals end up going to ERs.
MR. CHAIRMAN: Order, please. Mr. Younger’s time has expired.
MR. CHUCK PORTER: Thank you, Mr. Chairman, and thanks to the committee today for being with us. I have a few questions, and I want to start with the EHS deputy, if I may.
You had a comment in there about an addition - am I to understand from this that you have two aircraft now working out there, as needed?
MR. MCNAMARA: I would ask Ian to respond.
MR. PORTER: Sure, whomever is fine, yes.
MR. IAN BOWER: Yes.
MR. MCNAMARA: So we have the helicopter - what else is there for an aircraft?
MR. BOWER: There’s a fixed-wing airplane there as well now. It’s actually in the process right now of being fully reconfigured to be a dedicated medevac airplane.
MR. PORTER: Is that in place and running now?
MR. BOWER: It is in place and running now. As I say, right now that plane is actually out being fully reconfigured to meet all of our medevac needs for now and in the future, and we have a temporary plane doing that right now for us. So they’re both in service.
MR. PORTER: Great. I’ve been away from the business for a little while so I wasn’t sure. How long has that been in place?
MR. BOWER: Since November of 2010. Now, we’ve always had a plane as part of the configuration to back up the helicopter, but it was on an as-needed kind of basis. We decided in 2011, late in 2011, under the Better Care Sooner plan, to dedicate the fixed-wing to that capacity.
MR. PORTER: I was very familiar with the on-call availability of a fixed-wing aircraft.
What was the additional cost brought in now - the budget would have obviously gone up from that resource that we’ve been providing for some number of years, a long time now - what’s the addition there to the spending?
MR. BOWER: We actually have always had a budget to accommodate excess capacity, usually excess minutes for the helicopter. So actually what we did was rededicate some of our own existing budget to support the dedication of the fixed-wing. So there was no incremental cost over our existing budgets.
MR. PORTER: Very good, thank you.
I want to jump to a number of things, and my 20 minutes will go by rather quickly - as it always does here. Deputy, I’ll ask you and you can assign it to whomever you think is appropriate - I want to talk about dialysis for a few minutes.
This time last year we were in the estimates and the budget stated there would be $998,000 - if my math is correct – allotted to dialysis in some way, shape, or form. I did question the minister throughout the estimates on that and was given - we’re looking into that, we don’t know where it’s going yet, and so on and so forth. About two hours after the estimates ended I had a call saying – because part of my questioning was: Are we going to see money extended to the Hants Community Hospital in Windsor? – and the answer was basically, well, she couldn’t commit to that, or wouldn’t commit to that, but obviously the answer was no, which I did find out only a couple of hours after the minister’s estimates ended which was, of course, discouraging.
As you know, we’ve had a long-term effort going on there now in raising funds for dialysis. We have a number of patients who do come both this way and to Berwick and they would certainly like to have something closer to home, especially with a facility there that’s willing to offer it and a community that is willing to support it.
Now, I’ll start with of the $998,000 - can you tell us where that money was spent?
MR. MCNAMARA: Perhaps I’m going to have to get back to you where it actually was spent, because we don’t have that information with us - but we’ll get that for you. What I can say is a couple of things. One, on dialysis - we are doing construction at the Victoria General Hospital so that we can expand our Home Dialysis Program, which is the way that we want to move in the immediate future. We think that that is better care for patients. We also think that it allows individuals to have dialysis in their own home, and it also provides that we can do more people at a lesser cost per individual. So it is a better way.
Our experience from individuals who have gone through it is that it is extremely popular for those individuals once they get into it, and as a matter of fact we had a conference in Halifax of the physicians involved in dialysis, as well as a couple of speakers
from Upper Canada who were talking about the benefits of home dialysis, and the physicians have really bought into this and see this as the way of the future.
It wasn’t where their mindset was previous to this, and so they believe it’s a way to move in order to be able to - particularly with the increasing number of diabetics and those leading to diabetes - afford and have an affordable program.
MR. PORTER: It’s interesting, I have, locally, heard from over 40, 45 people who travel one way or the other, some who have been on home dialysis, some of whom would say home dialysis does not work, obviously, for everybody. There’s a fair bit of work to that, the training, supplies, and there are some circumstances - as a matter of fact, from what I understand, quite a few circumstances - where it doesn’t work, or work well. And families are sometimes not comfortable with doing that.
The other problem is that they lose even more ability to live a normal life because they’re hooked up on this machine every three or four hours for a period of time every day. It changes their life considerably - not that travelling three days a week to hospital doesn’t - one way or the other, it still takes a lot out of these people.
Is there a percentage that you’re hoping to get to? I would think it wouldn’t be 100 per cent, but I may be wrong on that - I’ll let you answer that. With regard to home dialysis, is there a goal that you have set, or that organization has set for - as you spoke to, deputy - the percentage of diabetes and the growing . . .
MR. MCNAMARA: What the percentage is working to those who are appropriate to have home dialysis - and, as you mentioned, it is very inconvenient if anybody has to have dialysis - with the home dialysis, many of them can do it overnight as well. So it does give them the opportunity to live a normal life during daylight hours, or during our normal awake hours - I will use that.
So the belief that we have been working with, with those physicians, is that it will work for a lot of individuals, but not everyone, as you indicated. Some of our existing facilities can take up those who cannot do home dialysis.
MR. PORTER: There are people whom I’ve spoken to locally who are hooked up every four hours, all day, around the clock, who are not living any kind of lifestyle anywhere near what we would.
MR. MCNAMARA: I’m not the expert in dialysis here, so I’m not going to go . . .
MR. PORTER: That’s fine.
MR. MACNAMARA: But I do know, in talking to individuals that they talk about home dialysis being preferable - for individuals for whom it works. And you’re right, there are some it doesn’t, but again I’m not the expert on it.
MR. PORTER: So the $998,000, if I heard you correctly, you can’t tell me where that was spent, but I do know - I believe some of that was allotted for Dartmouth General perhaps and some at the QEII here in Halifax. In saying that, there’s a gentleman by the name of Wayne Redden who comes from my area. Wayne was part of a get-together, I guess we’ll call it, in Windsor one day back last Fall at a local - Dr. Jane Haliburton had hosted this event with regard to diabetes and awareness and dialysis and so on.
Wayne got up and spoke in front of the cameras about travelling in and out of Halifax three days a week and what that meant for him - and he spoke about the money that it was costing and he spoke about the money that was being spent in the dialysis unit that he travelled to. He said we had perfectly good chairs here, but yet we spent money on new chairs. How can we justify spending money on chairs when we have – and that’s only one example, I don’t know what else was spent on, deputy, but how can we justify ever spending money to replace chairs that patients themselves are saying there was nothing wrong with the chairs we had? Why are we not investing that in other areas like Hants Community, where we have a community that has come together to say we want to be part of this, in providing this?
MR. MCNAMARA: I can’t speak to the specific incident of those chairs, but I’ll give you what my understanding is - individuals who are on dialysis are very susceptible to infection, and sometimes the chairs wear to the point that they can carry germs from one to another, so the appropriate process is to replace those chairs.
MR. PORTER: Okay, thanks for that. I would think that with all of our sterile techniques - and I know that things do wear, don’t get me wrong, especially when you have people coming and going at the rate they’re coming and going, and the numbers, and everybody does have a bit of a different circumstance, I don’t doubt any of that or take anything away from that, but seeing it from the patients’ perspectives, you can appreciate where those comments come from and why the questions are asked.
As you may or may not know, we have raised in the vicinity of well over $100,000 in the Hants community area. We have a commitment from people there who are interested in being part of that. I know that the long-term and the operational costs are always a piece that you as a government have to look at, and it’s not as simple as purchasing the machines. I know that there is money to be spent in renovating an area of the hospital - and that would be probably quite a few dollars, making that what it needs to be - but at the same time, that commitment is there from an organization that has been working hard to raise money and does believe at some point that will happen, and wants it to happen.
I will ask you this: from the government’s perspective, will you ever see a time when this government would consider investing the dollars needed to make dialysis happen at the Hants Community Hospital in Windsor?
MR. MCNAMARA: I do not see it in the foreseeable future.
MR. PORTER: “In the foreseeable future.” I’ll take that as a direct no from the government that is here today, that are not interested in investing in the people in the Hants community. I’ll ask this question on top of that as well: the justification behind that is that - I don’t want to put words in your mouth, and you can correct it - we’re close enough to the HRM and to the other facilities that offer it? Is that the assumption of government today?
MR. MCNAMARA: That’s correct. I think you have to go back and say, for example, in our community we raise money for dialysis so we want this service. Another hospital can say, the community raised money for an MRI, we want one. We have to look at a provincial plan, so when we do, our actions are based on a provincial plan, not based on somebody raising money - I can recognize that for some of those individuals it would be preferable for them, but we have to look at the bigger picture.
MR. PORTER: Yet we raise money and have forever in the foundation in Hants Community, as do other hospitals around the province and probably throughout the country. I don’t know, but I know that we’ve raised money to put crash carts on the floor, because government obviously says, we can’t afford to supply everything that you’d like to have. It does cost a lot of money; they do wear. There are all of these circumstances surrounding that. People are obviously of the belief that we want to work hard, we want it to happen. It is something that they think they’re being treated as second-class citizens because of the need, the desire to have it locally, especially when you have an organization in the community that is raising money to try to help them and make that happen.
There are people that I have out there right now who have been travelling for 15 years for dialysis, if you can imagine. There are people out there who are no longer there because they get weary and tired after travelling for many years, who just said, I can’t do it anymore, and have now since died and are gone because they just couldn’t take the stress and the strain and all of the things that go along with that disease after you’ve done it for many years. That’s very unfortunate.
MR. MCNAMARA: Could I just interject? I think it’s unfair to say “second-class citizens.” We have individuals in Digby who have to travel farther. We have individuals in other communities who have to travel just as far or farther as well. As I said, we’re trying to deal with a provincial program and, as I indicated when I was here before, talking about diabetes, if we had the money to move a dialysis centre, we would go to Digby first because of the greater distance they have to travel than any other individual in this province.
MR. PORTER: That’s great, and I want to be very clear on this point: that’s not me saying it. The people saying it are those who are affected by it and those people out there who are raising the funds who are affected by it. Those are family members who have seen their loved ones go, who are affected by it, who are saying that. I want that to be very clear for the record today, where that comes from when it comes to the urban/rural divide. That is how they see it, unfortunately - or fortunately, however you want to look at it. I also take your point as well - there are people who travel farther. I understand that.
The dialysis centre in Berwick is moving to Kentville, yes or no?
MR. MCNAMARA: I don’t know right now.
MR. PORTER: Was that not what was put out sometime back?
MR. MCNAMARA: I’m getting older, so my memory isn’t as good as it used to be, but I can find out for you.
MR. PORTER: Thank you, and if you could, just on that, maybe in finding out the time frame for that to happen, if that is going to happen, because what that does is shorten up the drive - not by much, but probably by 10 or 12 minutes for those travelling from my area. They will be interested in seeing what is going to transpire there, so that would be fine.
I want to move to home care: the $400 that families apply for, for assistance in looking after the folks at home. I had a call yesterday on the way in, and I’ve asked for this to actually be sent to me in writing from the Department of Health and Wellness, whoever they spoke to. This is a patient who has been, I think, 15 years now on dialysis, who has family. Of course the cost of going along with that is phenomenal, et cetera, as I just spoke to. They have applied for this $400 caregiver allowance, in buying into Better Care Sooner, all the things that government is trying to promote.
They meet all of the requirements, the wage, all of those things, the income. They get a call and the question is, does your husband put toothpaste on his hairbrush or his comb? Of course the answer is no, he does not. He puts it on his toothbrush. Well, I’m sorry then, Mrs. Frances LaPierre, you do not qualify because your husband is not confused enough.
Now, I’ve got to be honest with you, when I get this call - and I’ve asked for it because I can’t believe this, I’ve asked for this in writing - and I’d just like to have your comments on this, how could you possibly be disqualified, looking after a loved one, whether they are confused or not confused, if they have a physical need whereby they are disabled at home, and meet every other requirement? I’m just amazed that I would even get this call, number one, but knowing that we were here today, I couldn’t let this go and not ask you for your thoughts on this, deputy. How could this be?
MR. MCNAMARA: I honestly can’t answer that because I don’t know the circumstances. I don’t have a clue as to what you are referring to. If you get me the details, I’ll look into it. That’s the best I can do.
MR. PORTER: I’ll get them, there’s no doubt about that. That’s why I’ve asked for them because I’m having a hard time understanding how it could happen. But even just the whole piece here now, I’m hoping - and we’ve heard all kinds of different stories on how people are disqualified on this $400 allotment over trivial things or what they deem to be trivial - now in this case they were told they met all those requirements. Why would somebody from the Department of Health and Wellness, though, call up to ask about the status of somebody’s cognitive ability? I mean there must be an answer here somewhere. What is the process? I’ll ask you this, deputy. You fill out the paperwork, you apply. Can you tell me what the process is, or one of the folks with you, as to what happens after the application comes in the door?
MR. MCNAMARA: No, I cannot, but I can find out for you. I mean, again, as a deputy I don’t get down into the details of everything that takes place in the department, but I will find out the process for you.
MR. PORTER: Okay, because that is vitally important to these folks, as you can well appreciate. To say that they are frustrated would be putting it mildly.
MR. MCNAMARA: But talking about home care, and I do know from my national work, Nova Scotia is leading the country in what we provide in terms of allowances for individuals. Having said that doesn’t mean that we aren’t trying to do better. As you will note, there’s money in the new budget to go for increased utilization and ways to look at home care as well.
MR. PORTER: And look, I think that’s great. Having been a paramedic for a lot of years, going to these homes, I think that the programs whereby you are using these advanced care paramedics are all great. Anything you can do to prevent transfer, there’s a huge cost, believe me. I know it well and I appreciate it. I know what it does to tying up resources. Those are all good things. I would never take that away.
I think for the most part people believe any time, regardless of who is in government, that there are things that will help everyday people who are in those circumstances. They would look at those as probably being reasonable and being good things but those examples of yesterday are very frustrating when government stands up in the Spring, announces a budget and is preparing to go into an election, sometime soon - maybe it is not this year but we do know we are going - and saying all about how we’re doing such a great job. That’s typical, that’s not new. We all know that.
But in talking and in using the philosophy and the words Better Care Sooner - you know every night on a hockey game on TV, if you get time to watch it, prime-time ads about Better Care Sooner; the news, Better Care Sooner and we’re spending - and that’s my next question, I know I’m running out of time here - can you tell me what we’re spending on all of these wonderful advertisements that you are doing?
I know that I did some research last year. It was well over $100,000 for just a very short period of time. What have we spent in the last year on TV advertisements for this campaign?
MR. MCNAMARA: I’ll ask Linda to give you the amount but before she does, one of the things we have learned is that if we don’t advertise, individuals do not utilize those services. It would be a waste of money to pay folks to operate an 811 line if nobody called it.
The only way you become familiar is to go to the means that you can to get to individuals so they will access the service. When individuals call 811, it means that they don’t show up at an ER at times. It means that they can get good advice on how to deal with their child. There are a lot of positives from this, but yes, there is a cost to doing that. But if we don’t advertise, the matter of fact is that we won’t have anybody calling. Linda, do you have the amount?
MS. LINDA PENNY: We’ve spent in total, in the last fiscal year, $388,400 on TV.
MR. PORTER: So just shy of $700,000, say $680,000?
MS. PENNY: No, $380,000.
MR. PORTER: Oh, $380,000. That’s just TV, or is that paper and radio?
MS. PENNY: That’s just TV spots and promotion in March.
MR. PORTER: TV spots and promotion?
MS. PENNY: TV spots throughout the year, and there was a specific item for promotion of 811 in March.
MR. PORTER: Okay, what are the add-ons besides that? I’m going to assume that you’re doing radio or you’re doing TV.
MS. PENNY: So the total amount is $631,000, and I can break it down a little more for you. We’ve got $900 for CEC advertising. I mentioned the $388,400 for TV. We’ve got $119,100 for print and mail. We’ve also included a flu shot awareness campaign of $119,000.
MR. CHAIRMAN: Order, please. Unfortunately, Mr. Porter’s time has expired.
MS. PENNY: I’m done.
MR. CHAIRMAN: And you can continue that in the next round, Mr. Porter, if you like. Mr. Whynott.
MR. MAT WHYNOTT: Thank you very much, Mr. Chairman, and hopefully we’ll be able to go on to some of the positive things in this whole Better Care Sooner plan. Just a few things to comment from my Opposition colleagues. It wouldn’t be a surprise to them that in the Better Care Sooner plan that was laid out on the checklist on the back of the report, it actually says, “launch a public awareness campaign.” So unlike the Opposition when they were in government - they did things off the cuff with no plan, and this is exactly what we have put forward in the Better Care Sooner plan.
The other thing, Mr. Chairman, if you don’t mind, I know in the Rules of the House we have to ask permission of constituents being named and their issues brought forward. Is that the same thing with the rules here?
MR. CHAIRMAN: Just one second. Before we do, I’ll ask Mr. Porter if he did have permission from the individual. If he did, it’s appropriate. Mr. Porter?
MR. PORTER: Yes, indeed, that was asked in my conversation yesterday, I’m very familiar with the Rules of this House and this committee, having sat on it for a number of years, Mr. Chairman, and that permission was granted, just so you know, for the committee to know.
MR. CHAIRMAN: So it is in order. Mr. Whynott.
MR. WHYNOTT: Thank you very much. Also, just to set the record straight, I think, in regard to my honourable colleague, the member for Dartmouth East - he talked about the fifth floor at the Dartmouth General. I know that the current Minister of Labour and Advanced Education, as well as many of our colleagues on the Dartmouth side - MLAs - have been fighting even in Opposition when in regard to the fifth floor, and I’m glad to see that our government is moving forward on plans to use that space. Again, we don’t put things on the back of a napkin, and just say - unlike the previous government did with the Colchester hospital, I’m glad to see that now we have in place a mechanism that the Auditor General actually pointed out in that regard. So now we’re moving forward with an RFP process - I assume, Mr. McNamara, that new process that has been identified is now being used for the Dartmouth General upgrades. Is that correct?
MR. MCNAMARA: That is correct, and that includes individuals from TIR to be involved with us, to give us the appropriate expertise to make sure we’re doing the right things.
MR. WHYNOTT: Doing the right things and ensuring that we get the cost correct, is that it?
MR. MCNAMARA: Yes, that is correct.
MR. WHYNOTT: Okay, thank you. I just wanted to clarify that before my blood pressure got any higher.
I want to talk a little bit about my own personal experience with 811. I think this is a phenomenal service. It’s interesting - one of the ads talks about new situations that you may come into in your own personal life, and that certainly has happened for me over the last year with a new little one in my life. Within the first week of her being born, we had a situation where she wasn’t breast-feeding. Obviously that’s a new thing for families. She didn’t eat for over 20 hours, so we had a concern there, obviously.
We called 811 and they worked us through the system. They said, well, we think you should go to the IWK. Sure enough, when we arrived at the IWK, they knew we were coming. They had all of our information, so we didn’t have to go through registration - the long registration process that we usually have - and we were in to see a doctor within half an hour. These are the types of things that I think are such an important investment, that this whole mentality of - I guess one of my questions is around this whole mentality of people, that we need to get into the idea of thinking that we have other health care professionals who are out there who need to be utilized, such as advanced care paramedics, paramedics themselves, RNs, LPNs, nurse practitioners and, of course, our doctors.
Do you see that changing? Is this something that, especially with the idea of a CEC - are we seeing that change in Nova Scotia that we need to?
MR. MCNAMARA: We are seeing a change. There is still a lot of work before it comes to full fruition. For example, even on a national basis - I'm doing a teleconference this afternoon with a number of my peer deputies talking about medical training and how we get physicians to work in teams. Physicians are not trained to work in teams, they are trained as individuals and then we expect them to automatically do it. So part of the new medical education we're looking for is getting that to take place, so they will take full advantage of other health professionals.
We know that many other health professionals can take time away from physicians and allow them to spend more in-depth time with patients. We know that nurse practitioners, RNs, physiotherapists, OT, can do a lot of work that in the past was done by the higher-paid individuals. So this is a change and we are seeing it. We are on the cusp, there's still a lot of work to go.
MR. WHYNOTT: Yes, because I know that at my wife's family doctor they are starting to move in the direction of having patient-centred care so that you can actually tap into the knowledge of all those other professionals. I know from my family doctor, the one I have had since I was much younger than I am now, would always have 9:00 a.m. to 5:00 p.m. hours, five days a week. She is moving forward with maybe not being open on a Thursday but she would then have 3:00 p.m. to 10:00 p.m. or have a weekend.
Is there any incentive there for doctors? I know that part of the huge list of action plan in the Better Care Sooner plan is to ensure that we have after-hours, or what used to be considered after-hours care. Do we see that incentive there for doctors to move that way?
MR. MCNAMARA: With the CECs we're trying to get physician coverage from 8:00 a.m. to 8:00 p.m., seven days a week. So that changes from closing their offices at 4:00 p.m. or 5:00 p.m., which they did in the past and went to the ER. So we have seen that change and that is working in those communities where we've started it and we'll be expanding it over time.
We also need to work with physicians for those who are not part of CECs, how we can expand things in a different way.
The other thing - as a matter of fact, I asked our staff to look at, even for physician coverage - is there a way that we can develop a fee so that physicians can get paid if they do e-mails or do phone calls, for which in the past they haven't been? For example, sometimes an e-mail to your doctor can solve a problem, rather than having to come in and see someone because our existing system says if you don't have a face-to-face meeting, the physician can't get paid. We're looking at how we can deal with things like refilling prescriptions, other things that can be dealt with quite simply. So if we start changing more on that, it means that the doctor will provide extra hours in a different way.
MR. WHYNOTT: I saw a news release, I think it was yesterday or maybe Monday, about the e-filing system.
MR. MCNAMARA: Oh, you're talking about the release and talking about Nightingale?
MR. WHYNOTT: Yes, yes. My understanding was that there were two systems in Nova Scotia, right?
MR. MCNAMARA: Well, there are two main ones. There are a number of them.
MR. WHYNOTT: But two main ones, so are we moving to one?
MR. MCNAMARA: The premise that Nova Scotia was working, Nightingale was to be the system provided, the main one that we were endorsing and asking physicians to buy in on. There's another smaller one, Practimax, that many physicians have been using. It's a locally-grown, small operation. Some of the concerns we have, even though it's good in many ways, is what happens if we lose one or two of those individuals running that company, what happens to it?
The other thing that we're trying to work on is how we have a system that is inter-operable. It means that the physician can communicate with the hospital, can communicate with the pharmacy. So the more systems you have, you have to spend a lot of money to make the systems talk to one another.
One of the systems we have right now, even in our existing hospitals, doesn't talk to one another and that's what we're trying to improve. We need to get to a system so that a physician can get the information they need, appropriately and accurately. It will help us in many ways, from being able to do prescribing, being able to control issues around narcotics, and as was mentioned in that press release, Nightingale is the only system that has been certified by Canada Infoway nationally and which we’re very proud to be participating in.
MR. WHYNOTT: I didn’t realize that - even within my own family doctor’s office, let’s say, they don’t talk to the hospital if I need to go get a test done.
MR. MCNAMARA: Not in everything, no.
MR. WHYNOTT: Is that right?
MR. MCNAMARA: Where we have good interconnectivity is in our ways around X-rays. So the system allows the hospital, a radiologist, a lot of physicians, they can connect. That’s probably our best system province-wide. We have to do some more work as we’re continuing to do this. There are some opportunities, but it isn’t as good as we’d like it to be.
MR. WHYNOTT: There was funding from the federal government for this sort of upgrade, was there not?
MR. MCNAMARA: Through Canada Infoway. It’s usually 50 cent dollars, so we have to do matching dollars and, for example, we’re working right now on a number of things - one being a provincial pharmaceutical information system, so that physicians, pharmacies and hospitals can communicate on prescriptions and so we’re going to that exercise at the present time.
MR. WHYNOTT: You mentioned pharmacists. I know oftentimes we talk about nurse practitioners, LPNs, RNs and doctors - where do pharmacists play in this? I know that we changed - if I remember correctly - how pharmacists play a role in the whole health care system. Are we seeing a positive outcome in that regard?
MR. MCNAMARA: We still have more work to do. We still have negotiations with the Pharmacy Association of Nova Scotia to get that finalized, but pharmacists on their own have also - the majority of them are pretty good and try to help their patients as best they can. What we’re trying to do is give them more opportunities to relate to patients and not require a physician oversight when doing certain work.
MR. WHYNOTT: I’ll switch gears here for a little bit. I was up in Cumberland County recently and I was speaking with someone who said to me that prior to having access to a CEC, she couldn’t get a doctor. She couldn’t see a health care professional for like a week to 10 days. I know that this whole idea of a CEC sometimes makes communities a little anxious because they don’t know what to expect. She said to me that now that we have a CEC, I can go in and get an appointment today or tomorrow. When a community has been announced that they’re going to have a CEC, are we still seeing that anxiety from the communities or are they opening up to the idea, seeing that they are successful in some areas - or are successful in all areas - and is that anxiety still there for those?
MR. MCNAMARA: Quite honestly, the anxiety comes more frequently from staff than it does from the residents of the community and they do create some anxiety with individuals by reciting their fears. Residents, in many cases, are looking forward to it to come; they want access; they want to be able to go see someone. The great thing about having a facility open 24/7, regardless who it is staffed by, means at least there is somebody you can go to if you need it. If you go to a facility and it’s closed, you can be in real trouble. The other thing is, with having a CEC they can call an EHS and have an ambulance there very shortly and transport someone to a facility that can provide the necessary care. That’s no different than what happens in many of our community hospitals at the present time. Even if you get a GP and a nurse, you still have to call and transfer if the individual requires a higher level of care than that team can provide.
MR. WHYNOTT: I know our province has been recognized nationally for our innovative program where paramedics provide care in the nursing homes. That’s a newer program - I guess newer being in the last couple of months, right? Have we started to see benefits in the system? I mean, I guess it’s more of a shorter period of time, but I guess over time we’ll be able to see those benefits. Have we seen short-term benefits, for instance, if there is a paramedic, say, at Northwood here, which I think there is. Is that correct?
MR. MCNAMARA: I’m going to ask Ian to answer your question.
MR. WHYNOTT: So are we starting to see benefits so that we’re not seeing seniors being transported to the QEII or the Rapid Assessment Unit, that sort of thing?
MR. BOWER: Thank you for the question. We are in a long-term evaluation of the program. It did start a year ago, basically from now, from where we are today. The benefit though, that has been clearly seen, is the transfer right out of the nursing homes. So, around 75 per cent of those residents, when they called 911 in the past, about 75 per cent of those folks would all have gone to the emergency department, but 75 per cent of those callers are not going to the emergency department at all, or to the hospital at all, and are being treated in their home place of residence.
Twenty-three per cent or thereabouts are actually having a coordinated transfer, so if they need some kind of tests, that’s being arranged with the hospital. An ambulance will come and get them eventually but it won’t be coming to wait in the emergency department, it will take them directly to where they need to go in the hospital, it gets done and they go home. A very small percentage, I think it’s 3 per cent, are immediate ambulance transfers. So in that respect, from a benefit, we can see that immediately and residents have been very favourable, as have the nursing homes, that people are staying in their homes.
MR. WHYNOTT: Are we going to see an expansion of this? Are we going to start putting more paramedics in nursing homes?
MR. BOWER: The model will be unique across the province. We’re going to evaluate this one to see how it is portable across the province and how it may not be. I mean Capital District does have uniqueness in the sense that there are a lot of nursing homes in a close geography and it allows it to take place. There are different models, though, to achieve the same kind of results that we’re going to evaluate and those are some other things that we’re looking at in this province now, through the ACP, and through home visits and things like that, that we can effect the same kind of benefit but maybe through a different way. So it may not look the same and it may not be called the ACP initiative but I think we can achieve similar ends in other communities throughout the province.
MR. WHYNOTT: Now, just in that regard, like I said, I know we’ve been recognized nationally for this. I think we’ve won an award. Can you explain that award?
MR. BOWER: The Public Administration of Canada partners with Deloitte & Touche and they have innovation awards every year in a number of categories. We really feel that Nova Scotia has been positioned for some time within the EHS system to start to do different things other than EHS and EMS systems in the country. We took that opportunity that presented itself in Capital Health and we’ve worked with it, we’ve evaluated it. We’ve done research on it and we continue to do research on it and publish on it. It’s gaining a lot of interest and attention internationally. It has broken down traditional silos in the health care system where you’re actually seeing partnerships between family physicians and primary care providers, and nurses in the nursing homes with paramedics and emergency physicians, to do the best to keep residents in a place. So it is collaborative team work that’s happening in real time.
So we felt that it was warranted to apply and get noticed within the health care industry for this and we were successful as a gold award winner at those national awards in Toronto back in January, amongst I will say, a lot of very interesting innovations going on in the country, but this was one of those. So we were very pleased with that recognition for the program.
MR. WHYNOTT: That’s good to see because I think we’ve always seen, on many different subject areas and different topics, Nova Scotia has been last and I think we’re starting to finally see Nova Scotia coming first in a lot of different areas in health care and other economic development and the rest of it. Are other provinces calling Nova Scotia and looking at some of the things that we’re doing now that we - I mean I would consider ourselves as a leader. Are other provinces calling us and saying, hey, what are you folks doing in this area and what’s your best advice on how we can incorporate some of the things that you’re doing in our province?
MR. CHAIRMAN: Mr. McNamara.
MR. MCNAMARA: Yes, we are getting calls and even when I have meetings with my deputy peers, one thing they’ll ask about is how we’re making some of the achievements we have made, particularly when we’ve been going through an exercise of reducing our budgets, particularly in DHAs, and yet still being able to put in new services that are innovative and new.
The CECs is definitely of interest. It’s one of the programs that may even be reviewed by the Council of the Federation as they’re looking at, as the Premier had indicated, we look at some innovative ways to provide health care. We’re getting the same with some of our other programs around paramedics and how we’re doing other work. So it is something that’s of great interest but it’s also fair to say that we try to explore ideas in other provinces, as well, if we can see some good ideas to copycat. I’m a real believer we shouldn’t be doing things 13 times like has been the history of the past in this country.
MR. WHYNOTT: Yes, for sure. No, and I appreciate all the work. I think the minister has done a phenomenal job in promoting this initiative. We are seeing benefits to all Nova Scotians, no matter where you come from or what age group you’re in for this plan. I go through the list here on the back of the document, and we have accomplished a lot here.
Some of the things may not have happened in the year they said they would, but I think we’re getting there. The department, all of the partners from the top down, from the bottom up - health care professionals are the lifeblood of our system, and I want to thank them personally for everything they have done to ensure this plan follows through on what the government has said we would do. With that, thank you.
MR. CHAIRMAN: Mr. Younger.
MR. YOUNGER: Do I have 10 or 15 minutes?
MR. CHAIRMAN: You have 14 minutes.
MR. YOUNGER: I would like to start by following up on something the member for Hammonds Plains-Upper Sackville asked about, which was the pharmacist issue. In speaking with a number of pharmacists and so forth, one of the commitments when this new tariff model was put in place was all these great things that they’ll be able to do once the policy is implemented and passed, and they were promised that would happen relatively quickly. My understanding is that still hasn’t happened. Can you give an idea of the status of that?
MR. MCNAMARA: As I had indicated, part of it is negotiating fees. Any time you get into negotiations, they never happen fast - whether it’s with pharmacists, doctors, unions, or other governments. Part of that is getting that in place. As I had indicated, most pharmacists are professionals, and they’re still providing service as best they can, but pharmacists are also employed by large companies that are interested in profits, so that also dictates how fast things happen.
MR. YOUNGER: I don’t speak to that. I think the issue isn’t so much the fact that negotiations take a long time as the fact that the government trumpeted that this was going to happen and made people feel it was going to happen imminently, right away. They should have known the negotiations would take some amount of time. The public was promised by the Minister of Health and Wellness things like renewals of routine prescriptions and all kinds of things - some of which may happen, some of which may not, I assume, depending on your negotiations. In fact, when you talk to a lot of pharmacists now they say that even when that’s negotiated, it may or may not happen because it’s unclear who’s going to pay for that.
Also, apparently in some of these negotiations there are now some discussions around the need for some renovations at pharmacies to meet requirements around privacy - which actually may make sense in some of them, but it’s still a cost - for example, to do prescription renewal consultations and so forth. Do you have an idea of when you can expect that policy to be in place?
MR. MCNAMARA: No, I can’t give - as I’ve said, we’re in negotiations. One thing I can tell you is that I am not, as a department, prepared to pay the same to a pharmacist to fill a prescription as I would to a physician who’s going to go through a different regime. You start at that level and you have to work your way through it.
MR. YOUNGER: I appreciate that, and to me the issue is - and I don’t disagree with the member for Hammonds Plains-Upper Sackville that those are potentially good things, but the fact is that they haven’t happened and we don’t have a timeline for them happening. The minister and the government made it seem as though those were going to happen imminently, and I know from speaking to a number of pharmacists in my constituency that they frequently get people coming in and assuming those things have already happened and that the pharmacist can do it. They get upset with pharmacists because they say the government said you can renew a basic prescription or you can do this, when in fact they can’t do that at the moment, because the government hasn’t finished negotiations and hasn’t implemented policy.
MR. MCNAMARA: There’s a difference between can’t and won’t.
MR. YOUNGER: Well, they can’t, though. Are you telling me that the pharmacists . . .
MR. MCNAMARA: Pharmacists for years have been able to do some refills on certain prescriptions, and the mechanisms are there on some of the things, but it comes down to being paid for it. That’s where we’re working our way through.
MR. YOUNGER: Of course it comes down to being paid for it, because the government reduced the amount they get on other things on the promise they would get paid for these things through a tariff, which is why you’re having the negotiation at the moment.
MR. MCNAMARA: Correct.
MR. YOUNGER: So they might have done it for free before, had they not been reduced on the other end. It was a negotiation. The Minister of Health and Wellness stood up in this House and said that, said it was going to be a trade-off.
MR. MCNAMARA: Yes, so we are in negotiations, but again, when you’ve worked hard to save money for individuals for government, the government’s not going to turn around and pass it all back in a different mechanism otherwise there would be no savings to anybody. We may as well let the companies give the marketing money to pharmacies.
MR. YOUNGER: And that’s fine, that’s not really my point, my point is that it is misleading for the minister to stand up last year and say this was all going to happen at once and make people feel like they would be able to do this when in fact that wasn’t the case. At no time - in fact it was the minister who led the media and the public to believe that it was just a matter of Cabinet signing off on a policy and it would happen and, of course, that’s not the case, as you just said. There’s a need to negotiate those, and I agree, you’ve got to save money, my point is that it’s important for the minister to be honest about what the timeline was and not mislead.
MR. MCNAMARA: I think the minister was honest. I think that we’re working hard to make it happen. I think that to infer the minister was dishonest is not correct.
MR. YOUNGER: I think it was misleading.
MR. MCNAMARA: I disagree with that as well.
MR. YOUNGER: I think a lot of pharmacists would suggest it is because they’re hearing from the public on that.
Moving on to some of the other items. In the Ross report, which a lot of this comes out of, on Page 29 of that report Dr. Ross says, “We continue to try to pay for everything within a budget that is unrelated, and unresponsive to the pressures from within. This leads to unacceptable wait times and one crisis after another.” And you kind of alluded to a similar thing. What I’m wondering is, he talked about the idea that block funding is a problem and actually increases wait times, so I’m wondering if the department has begun to look at performance-based funding, which he alluded to.
MR. MCNAMARA: We are working with physicians on a number of things. One is we are going through a new process on the EAP funding, which deals with how we get accountability built into our system and what do we get for what we are paying, so we are working through that process. It does involve not just the Department of Health, it involves the physician groups, and it involves Doctors Nova Scotia. Same as when we were looking at the fee schedule, we were looking at the appropriateness of fees. Some of the fees haven’t been reviewed for years so we are going to through a process and we have to start, for example, if you look at what we pay for cataract surgery, is it out of whack for the amount of time that individuals do that operation at the present time. It was initially established when you did one per hour, now they do six per hour, so we’ve got to look at that. On the other hand there are some other procedures where we’re not paying as much as we should but it is a tremendous amount of work. We do have a team on it and we will get it in place. Again, it’s not an overnight process.
One of the difficulties we’re having with all of these things is we’re starting from scratch on many things and starting to build a new system and trying to - unfortunately, we’ve been trying to fix things for years and it’s not easy.
MR. YOUNGER: I agree, but on the specific issue of performance-based funding, is that something that, in these discussions, you’re looking at?
MR. MCNAMARA: Obviously people are going to be held accountable for what they are paid for.
MR. YOUNGER: Is that a yes?
MR. MCNAMARA: That’s a yes in a way. It’s probably a different wording but it means the same thing.
MR. YOUNGER: No and that’s fine I’m just trying to get at whether - and I understand, I mean you were clear that it is in negotiations and in discussion I’m just wondering is it . . .
MR. MCNAMARA: But no. people are going to be held accountable for dollars and that’s what we have to work our way through. It’s, again, system by system. We have to do that and it’s not easy. Physicians are individual businesses, whether we like to admit it or not, so even though they are represented by Doctors Nova Scotia they all have independence, so it’s a convoluted process. Getting a negotiated agreement with, for example, a union, is convoluted enough, add doctors with their independence, it is a lot harder but we will get there. There is a commitment from Doctors Nova Scotia to work with us so I don’t want to malign physicians when I say that. I’m just saying there are so many parties to it, it makes that more interesting and challenging.
MR. YOUNGER: Okay, and I didn’t have the impression you were maligning doctors in that at all, it was more a question of is that something that is on the table.
On Page 13 of the Better Care Sooner plan it talks about spending $2.5 million to directly help hospitals find doctors for hard-to-fill shifts. How much of that has been spent on actually helping hospitals find doctors?
MR. MCNAMARA: Was it hospitals or communities?
MR. YOUNGER: I believe it says hospitals.
MR. MCNAMARA: Okay. Well we have spent money, I can’t give you the dollars right off the top of my head and Linda’s trying to look there. What we have spent, we have spent money, for example, to support some extra physicians in the Tatamagouche area, some of the other communities. We are also looking at a process to do a locum emergency program in the next year but that’s not part of the past so I can’t speak to that, which is what we’re here to talk to. They’re trying to find the figure as I’m trying to drag out the time here. (Laughter)
MS. PENNY: In 2011-12 we’ve spent about $544,000 to help ER coverage. In the previous year it was about $1 million - I’m just rounding it to about $1 million.
MR. YOUNGER: All right. In that previous year . . .
MS. PENNY: In 2010-11.
MR. YOUNGER: . . . yes, where you’re talking about $1 million that was spent, that was on hospitals finding doctors? I’ll tell you why I ask, because last year in Question Period the minister said that not a dime had been spent on that and now you’re saying that $1 million had been.
MS. PENNY: Yes, this is actually for physicians to provide ER coverage, to keep the coverage in the ERs.
MR. YOUNGER: That’s good, that’s just the complete opposite of what the minister said in Question Period last year, that’s why.
MS. PENNY: There are a lot of numbers around this and it’s very broad, so that’s just the first one that we pulled out.
MR. YOUNGER: I realize that. No, no that’s fine, that’s why I’m asking is because it said this was a specific commitment on a specific amount.
MR. MCNAMARA: Can I clarify? I think the question you were talking about was the ER Protection Fund; they had money come from it. The answer last year was no, it did not because we had the money within our own budget, we didn’t have to go to that extra fund and ask for it. So that’s why it’s different, even though it’s the same - we did spend the dollars, we just didn’t go to that particular fund and ask central government to give us . . .
MR. YOUNGER: Okay, so you spent the money but you spent it from the existing budget . . .
MR. MCNAMARA: Within our own budget.
MR. YOUNGER: . . . and so that $2.5 million is still there.
MR. MCNAMARA: Well, each year it’s there to work towards and we definitely have plans for this year, with the expansion of our . . .
MR. YOUNGER: Okay, then, the next question with that is, if it’s every year, is that - if none was spent in one year, does that make it $5 million the next or is it just the $2.5 million fund?
MR. MCNAMARA: Well, it’s - Linda can answer that.
MS. PENNY: I can answer that. It’s actually a $3 million fund. In 2010-11 we spent out of the department’s budget, $3.179 million of items that would have qualified for the fund but we were able to cover it because we had a surplus, so that’s why you didn’t see 2010-11.
In 2011-12 we are forecasting to spend over $2.8 million of the $3 million.
MR. YOUNGER: Okay, that makes sense. Thank you, I appreciate that.
With the CECs - and I apologize, I’m just back and forth all over the place, I obviously only have a few minutes left. What I’m wondering - and I know you probably don’t have this at the moment but I’m wondering if you could table it with the committee - are the annual operational costs for the CEC model in Parrsboro, and I guess Springhill is open now which is good. What I’m interested in, the annual operating costs as well as to provide some documentation which would show the annual operating cost in the same facility before it was a CEC.
I realize it’s not just about money because I think you’re probably going to say it’s not just about money and I do understand that but I am interested in comparing the two.
MR. MCNAMARA: Yes, we’ll get that for you.
MR. YOUNGER: Okay, I appreciate that. How is it captured with the CECs when - obviously there’s a referral process, if I refer somebody off-site to another facility, does that cost then get transferred into the facility to which they’re transferred, or does it remain in the CEC?
MR. MCNAMARA: It remains. The way we fund facilities is facility by facility. The funding doesn’t follow the patient, it’s with the facility. I think I’m answering your question.
MR. YOUNGER: Yes, you are, but it actually raises another question that I’ve heard come up lately, which is, are you looking at money that follows the patient?
MR. MCNAMARA: Not at this point in time. To get there takes a lot of work to get to the case costing, all the things that go with it. So we are a long way from that.
MR. YOUNGER: All right. In terms of the QEII and the emergency facility there, I know some additional money was put in there. They are still obviously another site that’s dealing with routine overcrowding. I would say it’s probably a little bit better. What is the plan there to continue dealing with that issue?
MR. MCNAMARA: Well, as I mentioned, we’ve been meeting with Capital Health on things that we can do to try to alleviate the situation. Unfortunately, in the immediate . . .
MR. CHAIRMAN: Order, please. Unfortunately Mr. Younger’s time has expired.
MR. ALLAN MACMASTER: Mr. Chairman, my first question is about - one of the things I’ve heard in my travels is that there are people out there who are not calling the 911 line to get an ambulance to take them to the hospital because they’re afraid of the bill. So they’re choosing, in some cases, to drive themselves and that could be very risky if they could be taking a heart attack or a stroke. Is there a way that - I guess one of my ultimate questions here is going to be what would the cost be just to pay for that service so that if somebody calls looking for an ambulance, it’s paid for by the government - but even before I ask that question, is there any way that the system can analyze a call to make sure it is worthy of an ambulance response in an emergency case?
MR. MCNAMARA: Yes, I’ll start. I think one of the things we’ve been struggling with is on that. For example, if somebody calls an ambulance, the paramedic - particularly even if the individual wants to - has to transport them. They don’t have the right to say no and so that’s one of the things that we’ve been looking at - are there other possibilities? But, yes, EHS can assess, for example, and with the individual, decide that it’s not appropriate to transport. We also know that if you show up at an individual’s residence and do that assessment, there’s no cost. It’s only when there is an actual transport.
The second thing, we also recognize that there are individuals who are hardship cases but there are ways around that. For example, it can be - is $10 a month the minimum or $5? - a $5 a month payment if that was necessary. There are cases where we have written it off, when there are particularly real hardships. So we do try to look at - but, again, for all of us, I think we have to encourage people to call 911. Even if you end up paying for it, it’s worth our life to do that and it’s infrequent that people are having multiple calls. We’re looking at other ways to try to help individuals. One of the things on a go-forward basis is even looking at individuals for transfers between long-term care facilities, how can we reduce that cost because it comes out of individual’s comfort allowance?
MR. MACMASTER: What would the cost be if the government chose to cover the cost? Can you give a rough estimate?
MR. MCNAMARA: I think we’ve got a note on the amount, I can get you the actual amount; I don’t have it right in front of me.
MR. MACMASTER: If you could.
MR. MCNAMARA: But I will say one thing we have to be concerned about, too, is that it doesn’t become what I will call a taxi service because that can happen as well. The experience in other provinces that have done away with fees is that it has become the opposite problem, people use it for everything. It’s a balance and we have to work our way through, recognizing that Nova Scotia has the most sophisticated EHS system in the country. I mean even when we do a comparison on prices, we are in about the middle of the pack, but some of the ones that are charging higher don’t have the level of sophistication our system does.
MR. MACMASTER: My next question is around collaborative emergency centres. Would you consider something like this? Is something like this being considered for say the hospital in Inverness?
MR. MCNAMARA: It’s not on the initial list at this time but it doesn’t mean it’s out of the question for the future. I mean I think what we have to do is as we’re gaining experience and seeing the acceptability, I’m saying there may be more facilities we can add to it. I think what we wanted to do is ensure that the facility is there 24/7 for individuals.
MR. MACMASTER: Is there recognition of the need to get buy-in from the communities where you’re implementing these CECs?
MR. MCNAMARA: There is and we’ve been going through meeting with community groups. In fact, in Tatamagouche, for example, we were having some challenges with the staff, not in a bad way because they just didn’t understand the system. So myself, the CEO of the area, Emily, the College of Registered Nurses, Dr. Ross by Telehealth, the physician, we all went and met the whole group there and talked about what the challenges were, how we could help and support them, what is there. So, no, we’re prepared to do whatever is necessary.
The other thing we also recognize is that when a CEC is opened, we have to put out communications to that particular area so they understand the expectation of what you can expect when you arrive at a CEC and what you cannot expect. We haven’t even really done a good job in the past of saying what you can expect when you show up at an ER. So this is an improvement in that way even.
MR. MACMASTER: Well, if I can say as a member of the Legislature, I don’t mind seeing changes in things like the health care system, but I think it’s very important that people understand what the changes are because they’re very defensive of protecting what they have.
MR. MCNAMARA: Sure.
MR. MACMASTER: And I can think right now, in Inverness, which is covering the western side of Cape Breton Island, the discussion around emergency surgery, which I’m sure you’re familiar with, that’s an issue, the way it came out. People got very upset about it and were very concerned about it. I learned a lot more about emergency surgery myself. I realize that if it is cardio-surgery or ortho-surgery, well that’s really specialized. It is in people’s best interests to have somebody who is doing that kind of work every day, it is very specialized work and we all want to be put in the best hands of care.
I guess I just want to make that point of the importance and if you want to make any comment on that, I guess the importance of making sure the people understand what is going to happen before it just happens.
MR. MCNAMARA: I will tell you this, if I get my knuckles rapped by the minister, it is usually for not doing the consultation and that has happened a few times. So sometimes we haven’t been as diligent as we should have been, as a department.
MR. MACMASTER: Okay. Do you have a thought on - like what seemed to happen there, there appears to have been some surgeries happening that were not necessary to happen after-hours. But that said, there are a number of surgeries that have been performed there over the years. We had a young girl here yesterday who had started a petition. Her sister was born by way of emergency surgery in Inverness years ago and it was on a Saturday evening. So there are times - they may be very rare, maybe it is five or 10 times a year - when I think emergency surgery would be needed in an area like that because it is two-plus hours away from Antigonish or Sydney. Do you have any thoughts on trying to maintain that service in a place like Inverness?
MR. MCNAMARA: Well, as you know, at the present time, looking at the evening and weekend hours is where the reduction is and we look at the numbers. So it’s how you justify, I guess, and the safety of doing this. I think one of the things we have to look at is - and not just there but across this province - how do we provide safe surgery? We’re looking at how do we have a surgery program and maybe as we can get our technical expertise and some other things in place, eventually we can do more.
Then we also recognize there is a glitch, or can be a glitch at times, if you’ve got a major storm or if the causeway is closed, for example, which does create, so we recognize that’s there. At the same time, we also know we have the best EHS system in place. We do have LifeFlight. We do have ways of working around weather. We do have those glitches that occasionally occur but they occur, unfortunately, even in places where we do have good facilities and we have to transfer patients.
We have to work on making sure we have the best standards that we’re providing care and that’s always the hardest part of working through the quality at the same time of trying to provide a good service and making sure that people know the expectation of what they can get is correct. There’s an assumption sometimes that surgery means any kind of surgery and it is an issue, as you’ve learned in doing your homework.
MR. MACMASTER: I know that surgeons used to do every kind of surgery, no matter what it was. I know that things are becoming more specialized now. I guess in rural areas one of the concerns is that while we appreciate the quality of care and the need to have very high standards, we also realize that if you completely remove a service, it doesn't matter how high the standard is, if the service is gone, it is gone. That’s an issue of quality care, too, because if you had internal bleeding after an operation that day, and it was in January, and you were going to get an ambulance and drive, not across the Trans-Canada but over a mountain, through snow-covered roads to get to another hospital, you might want to take your chances with somebody who has been a surgeon for 25 years in Inverness. Do you have any comment on that?
MR. MCNAMARA: Well, taking your chances is a word I don’t like. But anyway, I think we still have to make sure that we can provide good services, though sometimes physicians can still do something in true emergencies when there’s no other choice. I mean it’s no different than a physician who runs across a car accident on the side of the road. What you expected or what you would do in that case is much different than in a sterile hospital room. Sometimes you have to act with what you have and do your best.
I mean that would be no different than if you lived on - well, we have individuals living on Tancook Island, for example, who are even further away from having a service than you would in Inverness. But Inverness does have some good services and they can support most individuals at most times.
MR. MACMASTER: I think maybe we’re closer on the same page there. The reason I used “taking a chance” I guess is because a lot of people see getting in the ambulance to go to the regional hospital is taking an even greater chance with their life.
The next question I’d like to ask is, have you considered recognizing that in rural areas - Inverness serves, of course, more rural communities beyond Inverness because it’s sort of the hospital for the western side of the island. When you look at surgery and if you have a surgeon in Inverness, we have some who are probably going to retire in the next few years. Have you ever considered trying to keep capacity in an area like Inverness for, say, something like surgery, for daytime surgery, by means of maybe farming some surgeries out of the regional centres into a rural area? That way you have a surgeon in the rural area, there can be a case to keep them there. Also, that bolsters the quality of care in that area.
MR. MCNAMARA: What we’re going through right now, I have Dr. Carman Giacomantonio, who’s with Cancer Care Nova Scotia, looking at surgery for me province-wide: what are the things that we should do, how should we do it?
We also have to set up surgical standards. We started, as has been mentioned in this program, having standards-free ERs; surgeries, as in pathology and diagnostic imaging, have to follow, and so we go straight down that path as well. That would guide us on what is the right thing to do in order to provide appropriate and safe care for Nova Scotians.
MR. MACMASTER: Okay. It’s good that that work is happening and I would ask that when something comes of that work, that the communication of it to the people, so they understand, is very important. There are decisions that are going to be made to change things. If people don’t buy into it locally, it’s very hard for anybody to be supportive of that.
MR. MCNAMARA: I understand that. You talk about surgery, I was just thinking that as a young child I lived in rural Cape Breton and I had surgery done in the doctor’s office on my neck. It has changed a lot from those days. I wouldn’t want to go back and do that again.
MR. MACMASTER: I know. I guess what people see though is, they don’t have the same knowledge that you have, obviously.
MR. MCNAMARA: I understand that. I think one of the things we fail to talk about is quality and safety as much as we should.
MR. MACMASTER: Okay. I’m almost out of time here. There is one item I would like to ask. There were some numbers on the advertising, if those could perhaps be e-mailed to the committee chairman, it would be appreciated.
MR. CHAIRMAN: Ms. Penny, would you give us a commitment to do that, please?
MS. PENNY: Yes.
MR. MACMASTER: I think I just have time for a couple. Have you ever considered showing people the bill for the services they’ve received? Not to make them feel guilty or bad but just to give them an appreciation for the support we have in the province to help people when they need our health care system.
MR. MCNAMARA: I think we have to be innovative and think of how we do that. Even doctors do not know the cost of the services they provide, quite honestly, and we have to start even there. It was tried many years ago, it was during a Progressive Conservative Government that sent individuals out and said here’s what it cost. It created a major uproar because a lot of people thought it was a bill. That’s what I’m talking about, we have to be very careful.
I think we have to start thinking, as we cost things out, to let people know but not in a way so they don’t use services, so they use them appropriately.
MR. MACMASTER: Exactly. One last quick one. Inverness CT scan, why delay the purchase of a CT scan if it’s going to save travel dollars and pay for itself within a year or two?
MR. MCNAMARA: I don’t even think I have a process from the district for approval of a CT scan.
MR. CHAIRMAN: Order, please. Mr. MacMaster’s time has expired. Mr. MacKinnon.
MR. CLARRIE MACKINNON: I’m going to be sharing time with Mr. Skabar and Mr. Smith. I’ll try to keep the questions short, but if the answers could even be shorter perhaps it would be better.
The situation is that, on occasion, Opposition Parties take shots at public education campaigns. As a former media person and a PR person, I believe that public education campaigns are very, very important. I’ve never heard one negative word from a constituent in relation to the public education campaigns, particularly in relationship to the 811 system.
I’m wondering about the impact on the usage of 811 with the public education campaign on it. Without that education campaign people would not be fully aware of that program.
MR. MCNAMARA: What happens when we have the high level communication, I said we get a higher call volume and then the problem on the other side is trying to respond as quickly as we’d like to. So, yes, there is a much higher usage every time we have and I think as Mr. MacMaster was saying, we have to do a better job communicating in communities on all of those things we’re doing and I think that that is important.
MR. MACKINNON: The Pictou County Health Authority has been looking at an expanded ER and pharmacy. These are major structural changes that would be taking place there, multi-million dollar changes, in fact. The budget just presented yesterday does, in fact, have money allocated for that, is that correct?
MR. MCNAMARA: That is correct.
MR. MACKINNON: And a significant amount?
MR. MCNAMARA: I don’t have the amount.
MR. CHAIRMAN: Ms. Penny.
MS. PENNY: As we’re still in the planning and design phase we didn’t really want to put the amounts out there because then the contractors know ahead of time what’s available. There is funding in the budget, definitely.
MR. MACKINNON: I was only going to ask two quick questions and I already have, but Mr. Younger has, in fact, encouraged me to ask another one because he was talking about the expanded role of pharmacists and the negotiations that were taking place and so on. He talked about the generic drug situation as well. Now my only sibling, my brother, a pharmacist, owned his own pharmacy for several decades and informed me that he used to get well in excess of $100,000 a year in rebates. We didn’t do what Ontario did in moving very quickly on those, we came in with a gradual reduction in the rebates and not wiping them out totally. Have we seen savings to seniors and others already in relationship to that because I think that’s a very important step taken by this province?
MR. MCNAMARA: Yes, we have seen savings as a government. In addition to savings by the government there are individuals who go and purchase their own drugs, have also had the same savings. The pharmacists have applied it equally across the board and I would give them credit because they didn’t have to, so I think they deserve credit for having done that.
MR. CHAIRMAN: Mr. Skabar.
MR. BRIAN SKABAR: Thank you very much. I am glad to hear that the pharmacists have taken up the mantle and shared those savings with individual consumers. I want to get back to the CECs for a moment. Cumberland County is the home of the first CEC in Parrsboro and the one opened up in Pugwash. Earlier in your statement you mentioned that the Parrsboro CEC had seen 4,800 patients and that the night time patients were reduced by 50 per cent. I thought that would have been a little bit more. If I recall correctly, when Dr. Ross did his assessment of emergency rooms in rural communities, that the vast majority, something like upwards of 90 per cent of the patients he saw when he took a couple of shifts there, were non-emergency cases, that the reason they were there is because they didn’t have access to primary health care. I thought the number of night time patients would have been reduced by more than 50 per cent?
MR. MCNAMARA: I think some individuals know that they can get quick access at night and some people work different shift work, they work different times, so this is a way to get some of it. I can’t explain it all, but overall, it has been positive. I think one thing just to talk about Parrsboro and I’ll get in maybe a couple of better facts that I can give you, is that with changing that and the physicians not having to be called at night, in effect it has really provided one more physician during the day because you take that 40 hours at night, it becomes more hours that are available, so it’s almost like recruiting one new doctor during the day.
MR. CHAIRMAN: Ms. Somers.
MS. SOMERS: There may continue to be opportunities to reduce the number that are visiting by night. If you look at the statistics right now, 33 per cent of the patients who are going there at night are treated and sent home; 44 per cent are treated and sent to the primary care unit the next day for follow up. Potentially, there are patients who continue to go there for whatever reason that continue to seek primary care. As we continue to work with the community and as they become more comfortable with the services, we may, in fact, continue to see that switch, but we’re pretty pleased right now with the fact that there has been a 50 per cent reduction to do the increase in access in primary care during the day.
MR. SKABAR: So it sounds like the culture of going to the emergency just hasn’t been - well, it’s still there, that people go after hours because that’s what they’ve always done.
MS. SOMERS: It is certainly changing, so we’re now seeing 50 per cent less. Probably over the next six months we’ll continue to see a drop in that number, but you’re right, it is a change in culture. It’s a change in a routine that has been there for many years when you would go for primary care to your emergency room. That is changing and we have seen this change happen over the last eight months since Parrsboro has been open.
MR. SKABAR: Even though it has only been eight months - I live in Amherst and Amherst is kind of the centre for shopping and a lot of people go to Amherst on a regular basis. People have been coming to my office and saying, why can’t we have a CEC? Because they do have access to primary health care from eight until eight, seven days per week and that’s still something that many people have a difficult time with in places where the ER doesn’t close.
One of my colleagues asked about the operating cost of CECs. I’m interested in finding that out as well. My understanding was that it would be probably about the same break-even point from what it was before, considering how much we were paying emergency room physicians to stay there all night. That is my guesstimate. Are we somewhere in that neighbourhood, do you think?
MR. MCNAMARA: There is some additional cost. If you say the physician was paid at night, but now we’re paying him to do more during the day, so the money is being utilized. We have added paramedics, for example, or a nurse, in some cases. We’ve had some construction costs in some areas. So the CECs are not a money-saving venture. It is a venture to provide 24/7 emergency care to individuals in the community.
MR. SKABAR: That would be better care sooner then.
MR. MCNAMARA: That is correct.
MR. SKABAR: One last thing. You mentioned that when a CEC was to be implemented in a community, there was more anxiety from the staff than from the patients or the community. What is the nature of the anxiety from that?
MR. MCNAMARA: It comes from a number of things. One is that people are wondering, what happens to my job? That is obviously the first one and that’s normal. That’s a natural phenomenon with individuals when you go through change. Secondly is, how am I going to cope not having a doctor with me because I’ve been used to being able to call the doctor at home who can come in, but there is, with the medical oversight, they still have that. It’s just going through a new process and anytime any of us change and if you lose what you feel is your life vest, it’s just - what is a new way of doing it? So it takes a little bit of time for people to get used to it. We are finding that those who have been in it and find that it does work, they feel comfortable. It’s just going through the process of change.
MR. SKABAR: One more little comment before I pass the floor on to my colleague. Years ago I started my career up in northern Manitoba where, long before satellite phones and radio phones and before, I think, the term “nurse practitioner” was developed, I’d seen a team of young nurses there in the course of an evening deal with a gunshot wound and deliver a baby before supper. The patients were medevaced when they could be, but that didn’t always happen. I’m glad we’re finally catching up to the whole concept and formalizing the way that should be done.
MR. MCNAMARA: I just hope they don’t deal with gunshot wounds.
MR. SKABAR: The gunshot wasn’t the baby, no - it was different ones.
MR. CHAIRMAN: Mr. Smith.
MR. MAURICE SMITH: I guess I want to start by putting a plug in for 811. Last evening, I had a call from home and my wife was telling me that her brother was having chest pains. They live about 15 miles away from the hospital and he was reluctant to get 911 involved. His wife remembered about 811 and called, and on the advice that they got there, they got him to the hospital, so it’s working.
The other thing that gives rise to a question from that is, do you find that because of 811, people are not using 911 as much?
MR. BOWER: We absolutely would not want 811 to discourage people from using 911, I think to a point that was made earlier that we want emergencies to go to 911 and call 911. However, if you do call 811 and it is deemed an emergency, you are moved right through to the 911 system with little delay - no calling back, that kind of thing. We are hoping that 811 is not creating a negative impact on the 911 calls, for the appropriate calls, but 811’s intention and design is to appropriately direct people to the appropriate part of the heath care system - which, for the service, over 30 per cent of that is not going anywhere but providing good advice and good self-care. Some of it may be seeing a family doctor and some of it may be going to the IWK or to another emergency department.
MR. SMITH: Thank you. In your opening address you talked about the new fixed-wing aircraft. I’m just wondering about - and you mentioned that it’s something that is used in the Maritime Provinces, not just in Nova Scotia. Is there a cost sharing of that?
MR. MCNAMARA: We have an agreement with those provinces to get repaid when it is used, and it also applies to the helicopter services. We recently renegotiated.
MR. SMITH: Just wanted to know how generous we were on that one.
MR. MCNAMARA: We used to be generous, but no longer.
MR. SMITH: On the issue of palliative care, this is a particular concern in my community. Can you tell us if there are any plans for expansion, or where we’re going with that issue?
MR. MCNAMARA: As the minister announced in February, we started providing free drugs for individuals at home . . .
MR. SMITH: Yes, I knew that.
MR. MCNAMARA: . . . during the last six months or what is expected to be the six months of life. We do have somebody in the department who was leading palliative care but moved on to another position, but we are now bringing somebody else in to look at what we can do. That is an interest of the minister, and she has asked us look at how we can provide better palliative care in our communities. There’s also a lot of interest from communities in trying to do their own things around palliative care, respite beds, et cetera.
MR. SMITH: Just quickly, before I run out of time, we recently had the stroke unit come to Antigonish. Can you just tell us about the effect of that?
MR. MCNAMARA: The great thing about the one in Antigonish is it’s an agreement between two district health authorities in order to bring enough expertise together to look after stroke patients in one place. It started in Yarmouth as a project and had great results. What we’re finding is that it does provide better care to stroke victims and it does allow more of them to go home and to be rehabilitated - a very positive program.
MR. SMITH: Thank you. We’re lucky to have it. That’s it for me.
MR. CHAIRMAN: As for time, we only have 10 seconds left, so I guess we’re finished. With that, Mr. McNamara, are there are any closing comments you or your staff would like to make?
MR. MCNAMARA: Sure. First, to thank the committee for the opportunity to come and talk about better health care. It’s something the minister is extremely interested in, and keeps challenging us to do more. One of the things that was not in my talk, or else that I should mention, is that the minister did change the policy of last year, that we could provide some capital funds to community health centres to be able to renovate or rebuild.
For example, there have been funds provided in Arichat, Shelburne, and - Digby, I think was the third one. So this is a new policy. In the past, if they were not part of a district health authority it couldn’t happen. I think this is very positive. It’s something we can look on in the future that will help, particularly, a number of our small rural communities. Thank you very much.
MR. CHAIRMAN: Thank you. Does the Auditor General have any comments today?
MR. JACQUES LAPOINTE: Thank you, Mr. Chairman. I don’t have anything further to add today.
MR. CHAIRMAN: Great, thank you. There were three items that I noted and the clerk might have noticed some other ones. Mr. Porter asked for some information about dialysis, different locations that some people may be able to go to. There was also a request from Mr. Porter for information on how you access, I believe the words were - and we’ll double check that with the clerk - the $400-a-month program for palliative care at home. Ms. Penny committed to providing the breakdown of the advertising costs of the Better Care Sooner promotion campaign.
With that I would like to thank the Department of Health and Wellness very much for coming again. It’s always a pleasure having you here; it seems we see you quite often. Again, thank you very much for all the information you provided today.
We have very little committee business today. The subcommittee today will be cancelled at the request of the co-chair. Evidently he had to go someplace on other business today. The requested information from the Nova Scotia Office of Immigration was provided to everybody when you came today.
Our next meeting is April 11th, next Wednesday, with Efficiency Nova Scotia on efficiency and demand-side management fees.
Without anything else that anyone has, a motion to adjourn would be in order.
MR. YOUNGER: So moved.
MR. CHAIRMAN: We stand adjourned.
[The committee adjourned at 10:55 a.m.]