Assemblée Législative de la Nouvelle-Écosse

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21 septembre 2017

















HALIFAX, FRIDAY, DECEMBER 1, 1995



Fifty-sixth General Assembly



Third Session



8:00 A.M.



SPEAKER



Hon. Paul MacEwan



DEPUTY SPEAKER



Mrs. Francene Cosman



MR. SPEAKER: Order, please. I will call the House to order at this time. Are there any introductions? If not, we will go directly to the daily routine.



PRESENTING AND READING PETITIONS



PRESENTING REPORTS OF COMMITTEES



MR. SPEAKER: The honourable member for Lunenburg.



MRS. LILA O'CONNOR: Mr. Speaker, I would like to present the Annual Report for the Standing Committee on Human Resources. Each one will receive one, there is the box in the back.



MR. SPEAKER: The report is tabled and will now be distributed.



TABLING REPORTS, REGULATIONS AND OTHER PAPERS



STATEMENTS BY MINISTERS



GOVERNMENT NOTICES OF MOTION



MR. SPEAKER: The honourable Minister of Community Services, on behalf of the Minister of Health.



RESOLUTION NO. 747



HON. JAMES SMITH: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



3755

Whereas the World Health Organization has designated December 1st as World AIDS Day to generate awareness of the rights of each person to avoid infection and if infected to receive health care and be treated respectfully and without discrimination; and



Whereas in Nova Scotia alone, close to 400 people have, to date, tested positive for HIV and it is expected that more than 40 million people world-wide will be infected by the end of this decade; and



Whereas organizations such as AIDS Coalition of Nova Scotia, the Advisory Commission on AIDS and the Names Project Canada have organized local activities to raise awareness and promote prevention of this deadly infection;



Therefore be it resolved that this House recognize the importance of World AIDS Day by encouraging the development of AIDS treatment and prevention programs while at the same time promoting understanding and respect for AIDS victims and their families.



Mr. Speaker, I would ask for waiver of notice and passage without debate.



MR. SPEAKER: Is that agreeable?



It is agreed.



Would all those in favour of the motion please say Aye. Contrary minded, Nay.



The motion is carried.



INTRODUCTION OF BILLS



Bill No. 49 - Entitled an Act to Amend Chapter 3 of the Acts of 1987. The Canada-Nova Scotia Offshore Petroleum Resources Accord Implementation (Nova Scotia) Act. (Mr. John Leefe)



Bill No. 50 - Entitled an Act to Amend Chapter 300 of the Revised Statutes of 1989. The Municipal Elections Act. (Mr. George Archibald)



MR. SPEAKER: Ordered that these bills be read a second time on a future day.



NOTICES OF MOTION



MR. SPEAKER: The honourable member for Halifax Atlantic.



RESOLUTION NO. 748



MR. ROBERT CHISHOLM: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas today, December 1, 1995, is being marked around the world as World AIDS Day, dedicated to the shared responsibility with which all must live with this deadly disease; and



Whereas the spread of AIDS has demonstrated too well the tragic results when health protection is neglected and undermined, without political commitment to fearlessly protecting people's health; and



Whereas today, Nova Scotians question how well their governments are safeguarding public health, and fostering community-based non-profit health prevention and advocacy groups;



Therefore be it resolved that this House urges the government to commemorate World AIDS Day in a meaningful way, with action that safeguards health rather than placing intolerable demands upon an overworked health care system and the volunteers who are a key to keep it going.



Mr. Speaker, I would request waiver of notice.



MR. SPEAKER: Is that agreeable to the House?



I hear several Noes.



The notice is tabled.



The honourable member for Kings North.



RESOLUTION NO. 749



MR. GEORGE ARCHIBALD: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas the Human Resources Minister has announced the layoff of over 2,000 health care workers; and



Whereas the Human Resources Minister said yesterday that Christmastime was a poor time to strike; and



Whereas the Human Resources Minister must think Christmas is a good time to lay off workers;



Therefore be it resolved that this government reassess its commitment to health care in Nova Scotia to ensure that Nova Scotians will receive the care they so rightly deserve.



MR. SPEAKER: The notice is tabled.



The honourable member for Sackville-Beaverbank.



RESOLUTION NO. 750



MR. WILLIAM MACDONALD: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas the communities of Lucasville and Upper Hammonds Plains have recently completed the development of a strategic plan; and



Whereas this strategic plan was developed as a result of residents raising issues concerning education, land use, compensation, water quality, recreation and economic development in the communities; and



Whereas the local development office upon hearing these concerns took the initiative to develop the strategic plan;



Therefore be it resolved that this House extend its congratulations to Douglas Sparks and David Norton of the Lucasville Upper Hammonds Plains development office, who along with many volunteers helped to develop this strategic plan designed to meet the objectives of the two communities.



Mr. Speaker, I would request waiver of notice and passage without debate.



MR. SPEAKER: Is that agreeable to the House?



It is agreed.



Would all those in favour of the motion please say Aye. Contrary minded, Nay.



The motion is carried.



The honourable member for Cape Breton West.



RESOLUTION NO. 751



MR. ALFRED MACLEOD: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas the Premier of New Brunswick, in a letter to the Prime Minister, warned that today's unemployment insurance reforms, "will create a political backlash from the Ontario border east, the likes of which has never been seen before in this country"; and



Whereas the Premier of New Brunswick, in his letter, also said the unemployment insurance reforms are "deliberately targeted" at Atlantic Canada and eastern Quebec; and



Whereas the Premier of Nova Scotia has remained silent as these reforms have been undertaken and keeping Nova Scotians in the dark as to whether his government supports or opposes the proposed changes to the unemployment insurance system;



Therefore be it resolved that if the reforms involve the devastation as predicted by Premier McKenna, the Premier of Nova Scotia support Nova Scotians who will be directly impacted by the severe cuts, instead of worrying about the negative political consequences to be faced by the federal Liberal Government in Ottawa.



MR. SPEAKER: Before I allow that notice of motion, it contains one whereas section that I think may be unacceptable, claiming that the Premier has said nothing with respect to this matter. It is my recollection that a government notice of motion on this very subject was presented to the House and carried unanimously. If that is the case - perhaps, the Clerk could assist me.



HON. GUY BROWN: Mr. Speaker, on a point of order. I don't mind playing politics; I am as good as anybody at it in this province. The Premier has stood in this House time and time again, has gone to Ottawa to talk to the Prime Minister, to the appropriate ministers, to the MPs. He has worked his heart out with regard to this whole issue, with his other Cabinet Ministers, the honourable Minister of Education who has worked very hard on a committee, and it was the Premier's initiative that took the Maritime Premiers to Ottawa this week to debate this further. (Applause)



MR. SPEAKER: The House is on record as having . . .



MR. ROBERT CHISHOLM: Mr. Speaker, on the point of order. The Minister of Labour made a wonderful presentation there on behalf of the Premier. But the fact is that no one in this province knows what the Premier has been doing in those meetings. Nobody has heard a word from the Premier of Nova Scotia about what the UI cuts are going to do to this province and what he is doing on behalf of this province to try to defend against those cuts.



MR. SPEAKER: All right, that's enough!



MR. CHISHOLM: We need to hear an accounting from that Premier. (Interruptions)



MR. SPEAKER: That's enough, that's enough!



MR. CHISHOLM: That is why I would suggest that this resolution is clearly in order, Mr. Speaker.



MR. SPEAKER: As Speaker of this House, I simply want to defend what this House, as a collective entity has done. What this House has done is that it passed Resolution No. 716 unanimously, not with the Opposition in dissent, but unanimously as recorded in Hansard on Page 3585. The resolution states (Interruption) Sit down.



The resolution states, "Therefore be it resolved that this House, through our Premier, vigorously represent the concerns and needs of Nova Scotians to the federal government to ensure those needs which are specific to our region are seriously considered as changes to the unemployment insurance program are contemplated.". That was passed unanimously by the House. (Interruptions) So, I have to defend what the House has done and the House has spoken out on this matter through the Premier. (Interruptions) It is the third whereas clause, I am not disputing the motion itself. It is just that whereas.



MR. JOHN HOLM: Mr. Speaker, if I may on that point and on your discussion. The resolution quite clearly called upon the Premier to do something and yes, in fact, this House did unanimously pass a resolution calling for the Premier to stand up and to fight vigorously on behalf of Nova Scotians. Unfortunately, we have absolutely no evidence that, in fact, the Premier did do what this House instructed the Premier to do. (Interruptions)



MR. CHISHOLM: It is another trust-me situation.



MR. HOLM: That is another situation where we are being told to trust him. So, I think the resolution is in order.





MR. SPEAKER: Well, if what the honourable member is saying is true, it would mean that the Premier has failed to carry out a directive of this House. I hesitate to make that conclusion so quickly and I think the third whereas should be struck from the resolution, otherwise the notice is tabled. (Interruptions)



SOME HON. MEMBERS: Let's debate it.



MR. SPEAKER: The honourable Leader of the New Democratic Party.



RESOLUTION NO. 752



MR. JOHN HOLM: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas this Liberal Government and the Municipal Affairs Minister have given their handpicked metro coordinator the responsibility of approving all municipal contracts that extend past April 1996; and



Whereas public concern has been growing about costs and processes used to award waste disposal contracts, some untendered, for metro; and



Whereas these could prove to be the most expensive obligations faced by Halifax area taxpayers and it is alleged that costs significantly exceed those of other modern Maritime waste disposal and recycling systems;



Therefore be it resolved that this House urges the Municipal Affairs Minister to earn some of her salary by using her extraordinary power over metro municipal governments and those of her coordinator to ensure that unjustifiable and untendered obligations are not imposed on the new regional municipality.



[8:15 a.m.]



MR. SPEAKER: The notice is tabled.



The honourable member for Halifax Atlantic.



RESOLUTION NO. 753



MR. ROBERT CHISHOLM: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas the Lung Association of Nova Scotia reports that consumption of tobacco products is rising rapidly and that youth smoking is up at least 5 per cent from 1990; and



Whereas Lighthouse Publishing of Lunenburg County recently surveyed convenience stores throughout the county to see if children are being denied access to this deadly addictive product; and



Whereas the newspapers discovered that 5 of 10 stores sold cigarettes to youth long after federal and provincial legislation designed to prevent such sales;



Therefore be it resolved that this House congratulates Lighthouse Publishing for its enterprising and public-spirited investigation demonstrating how easily cigarette companies can push their deadly product into the hands of Nova Scotian youth and children.



Mr. Speaker, I would like to ask for waiver of notice.



MR. SPEAKER: I hear several Noes.



The notice is tabled.



The honourable Leader of the New Democratic Party.



RESOLUTION NO. 754



MR. JOHN HOLM: Mr. Speaker, I hereby give notice that on a future day I shall move the adoption of the following resolution:



Whereas the Municipal Affairs Minister recently told Colchester County representatives that ". . . she's learned a lot from the mergers in Halifax and Cape Breton."; and



Whereas anything the minister learned has not been put into practice because she has refused to change her disastrous, top-down, high-priced amalgamation formula; and



Whereas the minister, who is spending hundreds of thousands of dollars on dictatorial amalgamation coordinators, claimed that ". . . because of provincial cut-backs her department can't spare any help."; to advise local municipalities about amalgamation;



Therefore be it resolved that this House warns municipalities to avoid the Municipal Affairs Minister and her amalgamation mania and to use vehicles like the Municipal Representation Act for considering amalgamation issues in an objective, cost-effective manner without clumsy Liberal interference.



MR. SPEAKER: The notice is tabled.



Are there further notices of motion? If there are no further notices of motion, that would appear to conclude the daily routine.



ORDERS OF THE DAY



GOVERNMENT BUSINESS



MR. SPEAKER: The honourable Government House Leader.



HON. RICHARD MANN: Mr. Speaker, would you please call the order of business, Public Bills for Second Reading.



PUBLIC BILLS FOR SECOND READING



MR. SPEAKER: The honourable Government House Leader.



HON. RICHARD MANN: Mr. Speaker, would you please call Bill No. 47.



Bill No. 47 - Queen Elizabeth II Health Sciences Centre Act.



MR. SPEAKER: The debate was adjourned by the honourable Leader of the New Democratic Party and I am advised that he has 15 minutes remaining.



MR. JOHN HOLM: Oh, Mr. Speaker, I was hoping you were going to say half an hour.



MR. SPEAKER: No, 15 minutes.



MR. HOLM: Mr. Speaker, I am just opening up my package on my desk here as I am getting organized to conclude my remarks which I began last evening. Now, as I begin my remarks and I am reminded, although I am not going to talk about a resolution that was introduced today, but I was reminded certainly by that of what I heard on the newscast this morning.



This morning on the way in, I listened to a newscast in which the Minister of Human Resources was saying that he didn't understand why anybody would be considering going for a strike at Christmas. Well, Mr. Speaker, I would suggest that maybe this minister doesn't understand it, but that it doesn't matter what time of the year it is, no employee looks favourably on the idea of considering a strike. Whether it is Christmastime or the middle of the summer, strike action is not something that public sector workers or any workers look forward to or relish.



Mr. Speaker, the kinds of provocations that have been placed before those members by this very same minister are, in fact, the kinds of things that are prompting them to consider it, whether that be at the Christmas season or on another occasion. I think that it is time, long past the time, when this government should stop waving the red flag, that they should, in fact, step back, let cooler heads prevail and sit down in a meaningful way to actually listen to what the workers are saying and to be respectful and responsible to them.



The minister also said in that newscast, why would he try to provoke these workers when about one-half of them live in his own constituency. I guess that is implying that that would be a poor political move because many of them are voters in his riding. Again, I think that that misses a fundamental point and it is a sad commentary if the minister is going to be saying that his decisions, what he would or wouldn't be doing, would be based on primarily where the majority of those workers may happen to reside and to vote. Surely, Mr. Speaker, it is the responsibility of all members of this House, not only to ensure that the health care needs in their own constituency are met but that the health care needs of all Nova Scotians are met.



It is also the responsibility, Mr. Speaker, to ensure that not only the workers who live in your own particular riding have their rights respected, but it is a right and the duty of all members of this House to ensure that all workers and especially those workers who are public sector workers, that they are all treated equitably, fairly by their employer and that employer, in this case, being the Province of Nova Scotia, the government.



The bill that is before us fails in so many ways, so, so many ways. I take a look at this bill, I examine it and I ask the questions, like what has this got to do with health care. What does this bill have to do with trying to improve the quality of services that the citizens in this province receive? The bill, Mr Speaker, talks about how hospitals are to be merged. It tries to pretend that it is separating and setting up this totally independent corporation and board, that is going to be at arm's length from the provincial government and, therefore, presumably since it is at arm's length from the provincial government, the province has no responsibility to the workers who were under the Civil Service.



But when you look at the bill, it does not set them up at arm's length. Not only is the province going to control the majority of the purse strings, but the province, the provincial government, the same body that put out the ad in yesterday's paper and there may be one in today's too, I don't know, I didn't have a chance to read today's paper as yet, which is costing the people in the province, costing the taxpayers many thousands of dollars for these ads. Ads which are misleading if not deceptive when they say, No, the facts.



If you were to go out and you turn on the TV and you see an advertisement where it is claiming that a particular automobile has all of these wonderful features and they spell it out and they say that this car can do all of these magical wonderful things or you may be looking at a battery or you may be looking at a box of snap, crackle cereal or whatever you want to look at, they make all kinds of claims. One of the first things that a person will learn, and this is even taught in courses in school as regular parts of particular programs, even in life skills in junior high schools, one of the things you talk to children about is, if you see an advertisement where somebody is trying to sell a product, you look at that advertisement very critically. Some of the things that are being said in that ad may be correct but you also have to examine why that ad is being put in the paper or on the radio or on television. That is, that it is trying to sell a product. The smart consumer, the wise consumer, looks at that ad with a critical eye to say, well, now let's try to verify, let's try to compare it, let's try to find out the other side of the story. When you hear these ads about how wonderful a vehicle is, many people will then go and take a look at consumer magazines and so on to find out how, in reality, that vehicle has stood up in past years and take a look at how satisfied consumers are and what problems exist.



That same kind of critical eye needs to be used when one is looking at the government's ad which claims, "Know the facts.". Mr. Speaker, it is vitally important that people know the facts, the full facts, not the partial facts that are displayed in the advertisements in the paper to the tune of thousands of dollars, which could have been put to better use providing for and ensuring that there is health care in the province. The amounts of monies that are spent might have helped to relieve slightly some of the waits in waiting rooms in emergency departments, could have provided, quite possibly, another home care worker for the province for many months, people who are actually delivering a worthwhile, meaningful service, rather than trying to put forward the government's propaganda, selling their line.



They talk about how long-term disability benefits are being protected, without mentioning at all that this process, this bill, is going to now deny the workers the opportunity to be involved in running the plan. It does not talk about the fact that the pool is going to be made much smaller, the pool of workers, that is, and that the smaller pool is going to be made up more of higher risk of injury persons so the premiums and costs to the workers are likely to go up. It doesn't talk at all about the statutory benefits that this bill is ripping away from the workers at the Victoria General Hospital.



It doesn't talk at all about the fact that the pay equity, Mr. Speaker, is not being extended to the new corporation so that those who have suffered sex discrimination in terms of their pay envelope are going to continue to suffer that discrimination and that those who had had their injustices rectified by receiving increases will be undoubtedly red-circled until other employees, through the collective bargaining process, after wage restraints off, come come up to that level, which will then have the net effect of meaning that everybody is back to the position of being discriminated against.



Mr. Speaker, the list goes on. For the love of me, I don't understand why it is that the Minister of Human Resources is taking such a hard-nosed position and a provocative position on a bill by the Minister of Health. Maybe the Minister of Health has lost control. Maybe the Minister of Health has absolutely no control over what is going on in health reform, that is being run by others. I know it certainly sounded to my ears, from what I heard the minister saying, that he was somewhat less than complimentary to the Minister of Education for the manner in which the Minister of Education tried to resolve the disputes around the Education Act by being willing to table before the Law Amendments Committee process began, amendments that he was going to introduce.



[8:30 a.m.]



So, Mr. Speaker, it is quite obvious that this government and this minister are somewhat out of control and out of touch with reality. I believe Nova Scotians want, deserve and expect more.



As I have said before, those who are involved in the health care system are willing to work, and as they have said on numerous occasions, with this government to reform, to improve the quality of health care for all Nova Scotians, so that the waiting list will go down and that people can receive the care they need and deserve. They have made that commitment.



Mr. Speaker, I know my time is starting to run short, I have two minutes. I would urge the government to be a little less confrontational, to be a little more cooperative and to stop what has become a trend of this government, that is to victimize and to pick on the workers who have served us so well.



So, Mr. Speaker, I want to suggest a reasoned amendment. I would like to suggest the following:



"That the words after `that' be deleted and the following substituted therefor: `this House affirms the legitimacy and the advisability of establishing a decentralized, community-controlled health care system, and rebuke any proposition that large, highly centralized health care facilities can be part of such a system.'".



Mr. Speaker, I have copies of that amendment for yourself, sir, and for all members of the House.



MR. SPEAKER: I would like a copy to be given to the Government House Leader and to the Opposition House Leader. I will entertain submissions on the admissability of the proposed motion, if there are any, after appropriate time is granted for study. I also wish to study the motion myself.



Perhaps a brief recess is in order. The House is recessed until I reconvene it - five minutes we will say.



[8:33 a.m. The House recessed.]



[8:37 a.m. The House reconvened.]





MR. SPEAKER: All right, I think the recess has been long enough. I've read this amendment at some length and it's an interesting amendment. It contains, really, two sections connected by the word "and", and probably the first half of it would have been all right. But the second half, ". . . and rebuke any proposition that large, highly centralized health care facilities can be part of such a system", appears to me to fly in the teeth of Beauchesne's observation of Page 201, Section 671(4), "An amendment which amounts to no more than a direct negation of the principle of the bill is open to objection.".



Now, based on that and on the legal advice of the Clerk, I declare the amendment out of order. I recognize the next speaker in the debate.



MR. ROBERT CHISHOLM: On a point of order, Mr. Speaker, if I may. The section in Beauchesne on reasoned amendments . . .



MR. SPEAKER: I am not prepared to debate my ruling, sir. If that's your point of order, be seated.



MR. CHISHOLM: I would like to have some explanation of how a resolution that speaks directly to the principle and follows very clearly the provisions that are laid out here, under Beauchesne's rules for reasoned amendments can be ruled out of order . . .



MR. SPEAKER: My ruling has been made and is not subject to appeal, except by way of substantive motion.



MR. CHISHOLM: . . . by one section that says, ". . . a direct negation . . ." . . .



MR. SPEAKER: I admonish the honourable member to be seated! Be seated.



MR. CHISHOLM: . . . absolute flagrant . . .



MR. SPEAKER: Please don't challenge me. Be seated!



SOME HON. MEMBER: Oh, oh!



MR. SPEAKER: The honourable member for Queens.



MR. JOHN LEEFE: Thank you, Mr. Speaker. (Interruptions)



MR. SPEAKER: The honourable member has the floor for Queens has the floor.



MR. LEEFE: Mr. Speaker, the legislation which is before us today in second reading is legislation which will have signal impact, not only on the delivery of health care here in the metropolitan area but, indeed, throughout Nova Scotia because, as each and every one of us knows, the hospitals and the health institutions which are being wrapped up by this legislation, constitute singly and in full, the tertiary care institution and institutions which serve the entire Province of Nova Scotia and, once wrapped up in this legislation, will become the single tertiary care institution for all of Nova Scotia.





Men, women and children from Yarmouth through Cape North, from Halifax to the New Brunswick border, will be availing themselves of the services of this new institution as, indeed, they have for decades of those institutions which are being wrapped up in this legislation. So, this bill is, indeed, central to the future direction that health care will be taking in our province.



I think, too, it is a fair observation to make that, as a result of that truth, that there will be an impact on each and every one of our small communities across the province and that, as a result of that, Mr. Speaker, each of us has a role to play with respect to making our own adjudication of the impact of this bill, the adequacy of the bill or, indeed, the inadequacy of the bill, with respect to the provision of health care.



Also, I think the question is moot as to whether or not a health care institution of this size is in the best interest of Nova Scotians and Nova Scotia's health care. We are told in some legitimate studies that there is a critical mass beyond which health care institutions cease to be efficient in the delivery of their services and that that critical mass is somewhere, I think, in the vicinity of 700 beds. I think that is the number, but at any rate, there is a critical mass and I think that that makes it an important factor with respect to adjudicating on this particular bill.



This bill also, very clearly, although I do not think the government intended to present it this way, is a bill which very much involves labour and labour relations and collective bargaining and all of the ramifications that those things have with respect to health care delivery in Nova Scotia. I will be dealing with that at a little later date. Mr. Speaker, one of the members has asked me to yield the floor for an introduction. With your permission, I will do so.



MR. SPEAKER: Certainly. Is there an introduction?



The honourable member for Halifax Atlantic.



MR. ROBERT CHISHOLM: Mr. Speaker, I thank the member for Queens for giving me the opportunity to introduce some employees of the Victoria General Hospital who are here this morning to listen to the debate on Bill No. 47. I would like to introduce Brian Jackson from Nursing, Sally MacLean from Nursing, Lynn Stanton from Nursing, Lori VanderVelden from Nursing, and Dan Burns and Matt Dubois from Clinical Chemistry. I would like to ask these people to please rise and I ask all members to give them a warm welcome. (Applause)



MR. LEEFE: Mr. Speaker, while I was listening to my honourable colleague make the introductions, I realized that I had had a bit of a memory lapse and that when I was speaking to the question of critical mass, the number, in fact, as I recall, is not 700 beds but rather 500. So that is a very important factor and it is one that the Minister of Health has not addressed and I would hope that he would address because he may indeed have information available to him through his department and those who advise him inside and outside government which may put forward a different point of view and I think it behooves him if he has that information to make it available so that we can be assured and all Nova Scotians can be assured that the critical mass will not be overextended such that the impacts on our health care will be negative rather than positive.





All of that said, it behooves any minister who brings a bill to this House to ensure that every effort is taken to get that legislation right the first time. Mr. Speaker, we have seen in this place a number of pieces of legislation come forward which did not get it right the first time and without belabouring the point, I think we could just step back to the Education Act and see a bill which was brought in which, before it came back from the committee, it already has 172 amendments.



We appear, with this legislation, however, to be going down a very different path. I am not convinced that this legislation, with respect to what it will do, is in essence any better and perhaps is just as bad as the Education Act, and yet whereas the Minister of Education collapsed in front of the onslaught of all of those groups who had interest in seeing changes in it, a Minister of the Crown who does not even own this bill, in fact, is saying that there will be no compromise. He has seen the whites of his enemy's eyes and he is ready to shoot and they better understand that. That is one of the peculiarities of this bill, a bill which was brought in purporting to be a health care bill, yet which has been spoken to very little by the Minister of Health but which has been spoken to at length both inside and outside this House by the Minister of Human Resources.



[8:45 a.m.]



It begins to change the complexion of the purpose of this legislation. The purpose ostensibly, I think it is in Clauses 4 and 5, is to improve the quality of and the delivery of health care in the province but, in effect, has the impact of making very significant changes in the way in which labour is managed, employed and represented to its various collective agreements and the relationships of unions to each other. All of that is caught up in this bill.



That was further underscored for me when I read an editorial in the Chronicle-Herald the other day I don't intend to quote from it, excepting to point out that in an 11 paragraph editorial, entitled, "The sky isn't falling", dated November 30, 1995, there is one paragraph on health care and there are 10 paragraphs referencing labour. It is clear that even in the eyes of the Chronicle-Herald editorialist, this is much more a labour bill than it is a health care bill.



Bill No. 47 purports to speak to employment as a labour bill whereas, in fact, we know that it does not speak to employment at all but that it speaks to unemployment. One of the results of this legislation will be the loss of something in the order of 1,000 jobs related to health care within the metropolitan area. That is an important factor that we must consider as we debate this bill and as we determine where we stand with respect to the passage of this bill. That is another reason why this bill is very much about labour and not so much about health care.



We have not had any evidence from the minister that there has been comprehensive forward planning in advance of the introduction of this bill. We have not been given the opportunity by having information tabled here in the House or provided to the media, the unions and other interested parties involved and caught up in this bill, a cost-benefit analysis of the result of this legislation once put in place.



It strikes me that if one is going to claim that one is going to save $15 million - we aren't quite sure what we mean by save and I will speak to that a little later. If one is going to claim that one is going to save $15 million, one should be able to demonstrate reasonably clearly where those $15 million are going to come from and how one is going to achieve that saving. We really don't have any more detail, other than the minister's pronouncement that such a saving is possible.



We do not know what the costs are going to be with any degree of specificity, we do not know what the benefits are going to be with any degree of specificity, we do not know if there have been analyses made within the Department of Health, by officials of the Department of Health with respect to this initiative. We do not know if management at the institutions being caught up in this bill have provided information to the Minister of Health respecting cost benefits. We do not know if the government has gone outside to independent and private consultants in order to determine what the costs and benefits are that may be associated with this merger. We do not know any of that. Quite frankly, in the absence of government providing the people of Nova Scotia with that information, I can draw no conclusion other than that the government does not know that itself and that the decision to introduce this legislation was a decision which was based not on knowledge, not on study, not on forward planning but solely on the basis of, it seemed like a good idea at the time.



Mr. Speaker, where is the implementation plan? If the Minister of Health were prepared to lay an implementation plan on the table, provide it to the workers, the men and the women who strive, day to day, to provide health care to Nova Scotians in those institutions, perhaps that would in itself begin to moderate the tremendous concern that they, and we on their behalf, have with respect to this legislation. Is there an implementation plan? We don't know. The Minister of Health has not told us so, let alone provided us with a copy of one if such exists.



What are the job loss numbers, 1,000? We think so, but we are not sure. Is that 1,000 jobs, is it 1,000 full-time equivalent jobs, is it 1,000 person years of work? Does is reference full-time jobs, does it reference full-time part-time jobs, in which case 1,000 FTEs might equate into impacting on many more than 1,000 workers? Does it reference part-time workers? What is caught up in this bill? We do not know because the government has not told us. We do not know because the government has not told those who work in those health care institutions. We do not know because the government has not told Nova Scotians in general and I believe, and I regret to have to say this, that we do not know because, in fact, the government does not know.



Where are these job losses? If one can define, indeed, how many there are in the first place. Are they evenly distributed across the system or are there certain health care sectors which are going to be harder hit than others? Are there some areas which will be little touched if touched at all and other areas where there will be significant job loss? The minister could be helpful in providing that information as well. Perhaps it is true that the only thing worse than knowing the negative consequences of an action is not knowing for if one does not know, one cannot plan and prepare for the future. Certainly that is true of men and women whose employment may well be at stake here. We know that hundreds and hundreds, at least, if not in the thousands, fall into that category.



At one time it was widely viewed in society that many of the people involved with health care were second income earners in the family. Nurses worked to provide supplementary income to the income of their spouse. I don't think that we can say that that prevails today, if that ever was true. Health care workers today are, for the most part, primary income earners. We all know that there has been a significant downturn in employment opportunity, firstly as a result of global recession and, more recently, as a result of global economic restructuring, something over which none of us has any control. That has resulted in fewer jobs so today we find that not only are persons working in health care often the primary wage earners in their families but, indeed, in many cases they are the only wage earners in their families.



As a case in point, I was making a visit to a nursing home last weekend and I spoke with one of the health care workers at that nursing home. Her husband has been unemployed for many months now. Her income working as a health care provider, and she is a registered nurse in that nursing home, is their primary income. I think if we look at all the institutions that are being caught up in this legislation, we would find that that phenomenon is widespread and, indeed, in likelihood, prevalent. We also would find that many of those health care workers whose jobs will be on the line, and, indeed, many whose jobs will disappear, are not only the primary income earners in their families but may, indeed, be single parents and find themselves in the horrendous position of being unemployed with no other source of income and one or more mouths to feed, one or more children to clothe and to keep a roof over the family's head.



We debate this legislation as though it were far removed from those kinds of practical and human considerations. But that really should not be allowed to escape us. The decisions that we take with respect to this legislation, as is the case with so much other legislation this government has brought forward and promises to bring forward, has an immediate and often hard impact on the lives of men and women and children throughout Nova Scotia. That is not an appeal to emotion, that is an appeal to understanding the facts of what this legislation will do if it passes as it is currently written.



Mr. Speaker, the men and women who work in the provision of health care in Nova Scotia and certainly in these institutions, because of the nature of their work, are under tremendous professional stress each and every day they are on the job. I cannot but help believe that many of them take some of that stress home with them. Not everyone is capable of putting their work behind them when they leave their shift or leave their day's work and forgetting it until they come in on the next shift or the next day, to pick up where they left off. That stress stays with them. It may not be consciously with them, it may be subconsciously with them but it is with them nonetheless. Add to that the horrendous stress of not knowing whether your job is going to be there in the next three or four or six or eight months, however long it takes to implement this and, again, we don't know when that will be because no implementation plan has been provided. Add that stress to the stress that these people undergo every day and which they accept as part of the cost of exercising their profession, we place on these men and women a burden that they should not have to carry.



That is a burden which is being placed on those men and those women and, indeed, undoubtedly on their families by the Minister of Health and by the Minister of Human Resources who have brought this bill in without appropriate consultation with the men and women who work in the health professions and without establishing first systems which will assist the men and women who will lose their employment in coping with that loss, and in coping with that loss in a way that they will be able to look forward to the future with hope instead of despair. From neither minister have we heard a single word with respect to the provision of that kind of caring and absolutely necessary process.



[9:00 a.m.]



Mr. Speaker, what about counselling? What about personal counselling for those who will lose their employment? There has been no indication that it will be made available. What about employment counselling for those who will lose their jobs as a result of this legislation? There has been not a mention made with respect to that. What about the provision of financial assistance to help those who want to move forward to new employment, to assist them in moving to agencies which specialize in that kind of activity? We have heard absolutely nothing concerning that.



Mr. Speaker, what about retraining for those who want to move on to another job, perhaps somewhere else in the health care industry for which they are not specifically trained or perhaps who want to move outside the health care industry altogether? There has not been a single word by either minister or by anybody in this government with respect to the provision of funding to assist those men and women in that endeavour. Not a word and that again underscores the total lack of forward planning, the total lack of a strategic plan and the total lack of understanding of the needs of human beings, all displayed by this government in this legislation.



This all must impact on the morale of health care providers in Nova Scotia, particularly with respect to these institutions. How can it help but do otherwise? Yesterday, Mr. Speaker, I noticed a visitor in our gallery, a former student of mine, who is now a health care worker in one of these institutions. She is a nurse, a tremendously intelligent and vibrant person, a person who has given much and wants to have the opportunity to continue giving to her profession. She is not a wide-eyed, wild-eyed, radical person. She is not a Trotskyite. She is not a Marxist-Leninist. In fact, her family falls rather on the other end of the political spectrum which, from time to time, has given me cause for joy. She is, as indeed most Nova Scotians are at least, a small-c conservative.



Yet, this legislation has put such stress on her and raised such concern with respect to her future, that it has begun to push her over the line to the point where she feels so despairing of the future that this bill presents, that she believes she may not have any choice other than to take the ultimate action which is available to workers in distress. That is the kind of impact that this legislation has had on good, solid clear-thinking, clear-minded men and women who work in these health care institutions referenced in this legislation.



Mr. Speaker, when people are under stress, their health is more likely to be negatively affected than when they are not working under stress. I think I have made it abundantly clear that is it my view and I think a view shared by many, that these men and women working at these health care institutions are and will continue to be under stress, particularly those who will lose their employment. Let's remember that when these people lose their employment, they lose their extended benefits and when they lose their extended benefits, that means that they no longer have available to them, as a result of an extended benefit health insurance program, a private plan to access the very kind of services that are designed to help people when they are under stress. So there is a kind of double jeopardy playing out here for these men and these women. I think that is a point well worth considering.



Is the government - and again we don't know the answer to this question, which is why I pose it - prepared, through personal counselling, to provide the dollars necessary for those who are under significant stress and who require extensive professional counselling to be able to gain access to it, or are they simply going to be told you will have to get whatever you can on the basis of whatever dollars you can scrape up out of your, well, I guess unemployment insurance benefits? But it appears that those may be radically changed too so there may be less available to them in that respect than there have been to date. We all will be watching what happens in Parliament today with great interest in that respect.





Mr. Speaker, $15 million in savings. Is it too much for those health care workers and for us in the Opposition and for Nova Scotians in general to say to the government, please quantify where that $15 million is going to be coming from; qualify the impact of the removal of $15 million from the various aspects of the delivery of health care to these institutions and priorize, tell us where, if any money is going to be put back in, the government's priorities lie or does the government have priorities? Is the government simply going to download the responsibility for priorization onto the regional health board for this region or onto the board of that new institution and cop out by saying, don't ask us to set priorities, we are the government. We leave that up to others. I believe the government, because this is their bill, has an obligation to tell all Nova Scotians what its priorities are with respect to this legislation. The people, and most particularly, those who will be most immediately and dramatically affected, the workers, surely have that right to know and the government surely has responsibility to answer.



Mr. Speaker, $15 million in savings. I wonder, will some of that $15 million be provided to the regional health boards because they undoubtedly will be impacted by this amalgamation? Will some of the $15 million be provided to local hospitals which may well be impacted by this legislation, or, will that $15 million simply go into the Department of Finance and the Minister of Finance's bottom line? We do not know; $15 million in savings. What does that mean?



Mr. Speaker, with these changes, and here the Minister of Health has made reference himself so I think it is important that we discuss it in the context of this bill, what about home care? What impact is this bill going to have, once implemented, on home care in Nova Scotia. Will it increase the demands for home care? If it will increase the demands for home care, is the government prepared to take of the $15 million that is going to be saved through this amalgamation and turn it over into the provision of home care? Is the government prepared to move forward rapidly, to ensure that home care is provided evenly and consistently throughout the province, which is not now the case? In fact generally speaking, I would have to say that my experience, as limited as it is, suggests to me that the further one moves away from metro, the less effective home care is because fewer dollars are available to drive it forward. That tells me that the people who live in my part of Nova Scotia, which is small town and rural, may well be affected in the most negative way when this legislation is implemented.



Again, I raise this question not to try to raise fears among the general populace, for none of us who are charged with public responsibility should do that, but simply to underscore the fact that to date no member of this House has had provided in this House, a public forum, nor has the public had provided to them, a detailed, strategic plan which lays out where the money is going to be saved, where the money is going to be spent, how this legislation is going to be implemented, how it will impact on not only this tertiary institution but on the regional health boards and the local hospital delivery system, home care, how it is all going to be tied together. We do not know that because the government has not told us and the only conclusion I can draw is that the government has not told us because the government does not know.



Surely with legislation that is as encompassing as this legislation, there should be some kind of a strategic plan; there should be a well-developed strategic plan with time lines and goals and targets all laid out so that the Minister of Health, or his sidekick, the Minister of Human Resources, can say, look, people of Nova Scotia, here is the plan, and if this bill is only a little part of it, it gets us from over there, where we have been, to over there, where we want to be, and that there are bridges all the way along, from where we were to where we are going to be, to make sure that we achieve what we intend to achieve in an organized manner. So that with some degree of assuredness, the government can say, that is where we want to go, that is where we want to take Nova Scotians and this is how we are going to get Nova Scotians there and this is how we are going to make sure that at the end of the day what we intend is, in fact, going to happen.



Mr. Speaker, one must be concerned, and again it raises a question that should be answered. Will this legislation result in a downloading of responsibilities and roles and costs to the regions and to our local communities? We don't know because we have not been provided with an analysis that would tell us if that is so or not, but it is a question which I believe that the government has a responsibility to answer.



[9:15 a.m.]



This is a bill which, in its early going, speaks to governance. I say that within the context of the regional boards and the local boards having roles to play respecting their areas of governance. But this bill speaks to governance, governance of this new institution.



Now, the minister who introduced the bill has told us that the bill, and the bill is clear on this, will cause the new board not to be an agent of the Crown. Yet, I find it perplexing that, in fact, eight of the board members of this new institution, more than one-half, are going to be appointed by the Crown. Now, my rather simple mind makes it difficult for me to understand how, if it is not going to be an agent of the Crown and yet the Crown is going to appoint over one-half of the board, that there is not a very direct continuing relationship between the new institution and the old institution, which will be part of the new one, which, in effect, was an agent of the Crown. Strange.



There used to be a sailing vessel that was neither exactly one type or another type, it was sort of stuck in between, called a hermaphrodite brig. I was would say that one might use that as a metaphor with respect to this bill, which would appear, at least, with respect to whether it does or does not provide an agency which, in effect, is a Crown agency. The bill itself in that sense I think might be described as being hermaphroditic.



Mr. Speaker, this bill creates a very large provincial institution. It is not called a provincial institution but clearly that is what it is because it is the tertiary care institution for Nova Scotia. It strikes me that the government would do the province in the delivery of health care yeoman service by ensuring that not all eight of those government appointees to the board of the new facility be from metro. If this indeed is going to be the tertiary care provincial-wide institution with respect to the service it provides, then it strikes me that at least three of those members should be from outside the metropolitan area. I think that could be well and neatly defined, such that the public interest would be met and that the influences from Nova Scotia outside metro can be felt and the voices of those us who live outside metro who, from to time, may have to take advantage of the services provided by this provincial tertiary care institution can be heard.



That can be done very simply through an amendment moved by the government, perhaps moved by us, it doesn't matter who moves the amendment, what is important is not who does the deed but that the deed be done. Very simple. Of those eight government appointees, one would come from Cape Breton Island; a second would come from the mainland east of a line drawn from Truro to Halifax, that would be east Highway No. 102, and the third member would come from western Nova Scotia, from west of Highway No. 102. Now doesn't that make sense, that a provincial institution should have membership of its board drawn from across the province? This does not impair the government's capacity to appoint whomsoever they wish. All it does is ensures that this provincial institution will have a province-wide focus with respect to its board and will not, as the case may well be, have a focus which is essentially, if not solely, the focus of the metropolitan area.



The Minister of Human Resources has made it clear that he does not intend to see any amendments made to this bill. Does this government feel so threatened that it would not be prepared to accept what I believe is a sensible and modest amendment which would advantage Nova Scotians and which surely should have the support of all of the members of this House.



Time and time again, over my years in this place, I have heard colleagues representing Cape Breton constituencies say, well I have to go up to the VG Hospital tonight or I have to go over to the Infirmary or up to the Camp Hill Hospital. I have a constituent who is here for treatments. Why wouldn't the Cape Breton members who currently serve in this House support an amendment which would cause Cape Breton to have that kind of representation on that board? That is something that we can talk about perhaps at greater length at another time. If the government were prepared to move an amendment of that nature, I would be quite delighted and I would be prepared to support it and I would encourage my colleagues in our caucus to support it.



I believe, Mr. Speaker, that when the bill was introduced, it was accepted as a health care bill but now I think our view is changing. I think we began to ask ourselves, as we proceeded through second reading, and as more and more frequently the Minister of Human Resources spoke to the bill and less and less frequently the Minister of Health did, that many of us began to ask, whose bill is this? Is it really a bill of the Minister of Health or is it, as it appears now to be, a bill of the Minister of Human Resources, introduced by the Minister of Health? Again, I refer to that editorial in the Halifax Chronicle-Herald which speaks to this bill, which is composed of 11 paragraphs, one of which deals with health, 10 of which deal with labour. It is very clear that the editorialist at the Halifax Chronicle-Herald understands whose bill this really is. This bill is not really a bill of the Minister of Health. This is a bill which is fostered by and supported by and spoken to and defended by, on every occasion available to him, the Minister of Human Resources.



We saw that just the other day when the minister - curious, isn't it? I can never remember a time when a minister introduced a bill and then another colleague had a press conference to speak to that minister's bill. This is my 18th year, you are here 26 years, Mr. Speaker, and I don't think probably you have ever seen that in your 26 years in this place. With this government, things seems, as Alice said, to get curiouser and curiouser.



The Minister of Human Resources, in a press release, which I have right here on my desk, said the other day, and I quote him here, sir, it is his own press release, "The bill respects and preserves collective agreements. Indeed government did not modify existing agreements. All employees come to the new employer with the contracts they have now . . .".



Yet, if you turn to the Chronicle-Herald editorial, you read down on the bottom half, that the bill, in fact, will impact on the rights of many of those now working in the health care institutions caught up in this bill, ". . . to return to one's job after running for political office; pay equity provided to civil servants by provincial statute; and some pension benefits for management employees.". The Chronicle-Herald editorialist seems to think that this is going to impact negatively on those workers.



Or then we could take a look, Mr. Speaker, at a story in the same newspaper dated November 30th. Here what we learn in the paper, if it is true and one can't believe everything one reads, that is for sure, whether it is in the minister's press releases or in the news, or, indeed, I suppose, in any of our speeches, but the bill will also strip the VG employees of bumping rights in the Civil Service, replacing them with the right only to bump someone working at the new Queen Elizabeth II Health Sciences Centre.



This minister, reading in his own press release says, don't worry, smile, be happy, nobody is going to have their working rights abrogated by this bill, is quoted in this news story as saying, yes there will be a difference in bumping rights. He doesn't say in bumping privileges, no, no, he doesn't use that word. He says bumping rights. Now if that is a right, it must be a right which has been acquired through collective bargaining. If that right has been acquired through collective bargaining and the collective bargaining rights of those who work in that health care institution are not going to be abrogated by the legislation that we are debating this morning, then, Mr. Speaker, bumping rights should by conclusion be protected within the new regime.



I would not for a moment say that this minister is duplicitous, speaking out of both sides of his mouth, but I don't think both sides of his mind are functioning at the same time because he has clearly, in his own words, contradicted himself. I think it behooves him, as undoubtedly he will want to do at some time, either to straighten out the contradiction by saying, I was wrong when I said this or I was wrong when I said that, but perhaps by explaining to me why I am wrong in my contention, in my belief in reading the news and press clippings including his own, that the collective agreement is going to be adversely impacted.



We also have a decision rendered by, I think, Peter Darby, respecting workers' rights in collective bargaining with respect to the amalgamation of the metropolitan Cape Breton area into the new regional government. That decision, which is an interesting one, and I would not for a moment purport to be any kind of an expert in labour law, but it strikes me that that decision might well be used as a precedent with respect to any questions which might arise before the same board respecting those units involved in collective bargaining that this legislation catches up. It appeared to me and I only heard the news clip, I was not at the news conference but it appeared to me that the Minister of Human Resources, himself, was pretty unclear about the potential ramifications of Mr. Darby's decision with respect to its implications for the bill which is before us today.



[9:30 a.m.]



Yesterday, this Minister of Human Resources, whose bill this is not we have to remind ourselves, got up here and I heard it on the news this morning again today. He tried to play the emotional fiddle of how close he is to the health care workers of this province through his own family and that was his illustration, not mine. I thought to myself, isn't it interesting that he would get up and saw on that tired old violin in an effort to assuage the fears, the concerns and the deepening anger of the men and the women who work in these health care institutions. After speaking to my friend in the gallery yesterday and having had the opportunity to speak with others of her co-workers, I thought to myself, yes, the Minister of Human Resources may be prepared to try to pluck out a pretty tired old song on his battered violin but these men and women who daily breathe life into the ill at these institutions and who succour the dying, are properly not prepared to play second fiddle to anyone, least of all to him and to the Minister of Health and the legislation they bring forward in this place.



The men and the women who work in these hospitals are afraid. The people across Nova Scotia who are served by this hospital, if they are not concerned, if they are not afraid, should be. This is not just a metro bill, this is a Nova Scotia bill, which once implemented will have impact on each and every one of our communities.



It is the government's responsibility, the government has an obligation, to ensure that any fears which are ill-founded are clearly demonstrated to be ill-founded on the basis of facts that the government can bring forward to support their case. It is entirely insufficient and indeed, cruel but not a cruel joke because there is nothing about this that is a laughing matter. It is cruel for government to talk down to those who are concerned about this legislation and tell them that they simply don't understand, that they just have interpreted it all wrong, that the government really is acting in their best interests. You may be unemployed next week, next month, six months from now but don't worry, everything is going to work out fine. I don't know too many people who are prepared to hang their hat on that peg.



If the government can come forward and lay on the table the strategic plan whereby this legislation was conceived and whereby it will be implemented and support it with all of the financial information that is required to give such a plan life and to answer in a detailed way and in writing to each and every one of those concerns that those workers have, then I will say that the government has done its job well. In the absence of that kind of approach, I can draw no conclusion other than that the government is doing its job badly because it has not moved forward in a planned and thoughtful way.



I noticed a story in the Daily News, dated again, November 30th, "Trust me, Jay Abbass says." Now this is the minister whose bill this isn't, it is not the Minister of Health saying "Trust me,". It says, "Trust me, Jay Abbass says." Well, Mr. Speaker, the truth is naked and in this case it is as naked as a jay bird. The truth is that there is no trust out there, there is no confidence in this legislation, there is no confidence in this government, there is no confidence that this bill is a health bill. There is every belief that this bill is a bill which is very much is focused on labour, that it is a bill that does not deserve the support of this House, which does not have the support of health care workers and I believe in likelihood does not have the support of the men and women throughout Nova Scotia who are coming to realize and who have come to realize that this bill is a bill which will affect every person in this province one way or the other.



Mr. Speaker, in the absence of all the information which the government should put forward, I am given no choice other than to vote against this bill. Thank you, Mr. Speaker.



MR. SPEAKER: The honourable Leader of the Opposition.



DR. JOHN HAMM: Mr. Speaker, I am pleased to have the opportunity to join in debate on Bill No. 47, the bill that will establish the Queen Elizabeth II Health Sciences Centre. The bill now has received a considerable airing, as the members rise one by one and analyze this particular piece of legislation. It is my intention to address this from three aspects; the first is what it will do for the cost of health care delivery in the institutions that are affected by this; second, to discuss what it may do for the delivery of the health services that these institutions provide; and, thirdly, to make comments on what it does for labour relations and morale in health care delivery in this province.



The first two topics, of course, will be in the interest area of the Minister of Health and the third will be in the interest area of the Minister of Human Resources. Other speakers have made comment about the rather peculiar introduction of this bill by the Minister of Health and then very quickly the emphasis went to the Minister of Human Resources, who has become, as the days pass, more and more involved with this bill and the Minister of Health is becoming less and less involved.



Now health reform, and this particular piece of legislation is part of the jigsaw puzzle that is being put together by the Ministry of Health as it reforms health care in the province. One cannot help but be impressed that health care reform didn't begin with this government. The process of rationalizing the delivery of tertiary care in this province didn't begin with this government, it actually began during the days of the previous government. But there is a marked difference in the way that the process was being handled by the previous government. That particular Minister of Health was starting the reform process, in terms of reducing the cost of the delivery of health care service but doing it in a remarkably different way than has been carried out by this government and this particular Minister of Health.



Time and time again we have been looking for cost analysis of the various health care initiatives that have been brought forward. Time and time again the Minister of Health makes reference to what he calls the continuing monitoring of needs. Yet, when challenged, he always fails to produce the documentation that would back up his statement that the continuing monitoring of needs is, in fact, going on, which would assure those that question him that health care reform is being driven by anything other than fiscal restraint.



The Minister of Health has brought forward an estimate of $15 million of saving by amalgamating the Victoria General Hospital, the Halifax Infirmary and the new Camp Hill medical complex, the Nova Scotia Rehabilitation Centre and the Cancer Treatment Centre under one administration. Certainly, if $15 million can be saved by this initiative, then it is certainly worthy of consideration and worthy of implementation, but we cannot accept the $15 million of saving on face value. We must have some documentation, some idea, some indication, some positive proof that we will save $15 million if, in fact, this initiative goes forward and results in lumping these four institutions together.



Now it makes perfectly good sense that the new Camp Hill Medical Centre and the Victoria General Hospital, which provide adult services for Nova Scotians, community health care for the residents of metro and tertiary health care for the residents of the entire province; an integration of the services of these institutions makes perfectly good sense. It becomes less obvious as to the benefit of including the Cancer Treatment Centre and the services provided at the Nova Scotia Rehabilitation Centre under the same umbrella. Whether or not the inclusion of those two institutions within this umbrella makes any financial sense is certainly open to debate and the debate will rage as long as the minister fails to bring forward any positive documentation that will allay the fears that, in fact, this will be nothing more than a cumbersome bureaucracy which will generate new costs based entirely, and generated entirely, on the size of the operation and the fact that it is trying to provide, actually, a very heterogeneous type of service which does not lend itself easily to coming together and being delivered efficiently and at less cost.



All that we are asking is that the minister table any documents that would give us assurance that the $15 million of savings, to which he refers on many occasions, will, in fact, be a reality. Those of us who may be classed as doubting Thomases are really being driven by the fact that so many government initiatives that have been brought forward have not realized, the savings which were predicted initially. We look at the difficulties that are being experienced in the Cape Breton Regional Municipality in which there have been serious cost overruns that were not predicted when the legislation was passed. There were not enough safeguards, obviously, in place to control the transition costs that are occurring up there.



So, it is not that our fears are being raised only by what is presented before us with Bill No. 47, but they are being raised by the track record of the government in terms of its ability to predict the cost of the initiatives that it brings forward, particularly when this government is extremely loath to provide any documentation, when it introduces legislation, to back up the claims that it has of the effectiveness of legislation to provide cost-savings.



You know, health care reform can save money and health care reform can, at the same time, deliver better service. It can only do so if it is well planned and the initiatives are fully studied before they are implemented.



[9:45 a.m.]



All Nova Scotians are extremely concerned about the delivery of tertiary care in the metro area. As has been pointed out by other speakers, the provision of adequate tertiary care is important in every region of this province. It is important to the community hospitals from which patients are transferred here for tertiary care. It is important in our regional hospitals which do not provide a complete menu of services but only provide the level of service that is possible with the population bases which they serve.



Many of the services that are provided and will be provided with the umbrella of this new QE II Health Sciences Centre are of extreme importance to every single Nova Scotian. All Nova Scotians have a vested interest in what is going on here to absolutely determine that, in fact, the tertiary services that we require in our province, will be provided by this new merged institution, this new health sciences centre here in downtown Halifax.



I had an opportunity about a month ago to visit the not yet complete Camp Hill Centre. It is truly a very fine facility, it is a beautiful building and it was obviously well-designed for the services that were initially planned to be provided there. With this particular piece of legislation, the Camp Hill Medical Centre will now be asked to provide services for which it was not originally intended. We have to start looking at what will be the cost of the alterations in this, as yet, unused facility. What will be the cost to make the alterations to allow that facility to dovetail with the services that will be provided at the VG Hospital to provide that complete menu of health care delivery that will be necessary in those two buildings.



I had an opportunity, for example, to visit the out-patient department in that facility which was not originally designed to be the only emergency department in the Halifax area but was designed to complement the service that was to be available at the Victoria General Hospital Emergency Department. Now we find that under the new plan that Bill No. 47 will set up is that all of the emergency services in the greater Halifax area will, in fact, be provided by that one department. It is absolutely certain that that department will have to be extensively renovated before it will be physically possible to provide that volume of service that will be required as it becomes the only area to which people can go for emergency service on this side of the harbour.



It would be very useful, for example, to have some idea of the cost of the renovation of that particular part of the new building, bearing in mind it is yet to be occupied and it is yet to have been used by a single patient requiring emergency service here in Halifax. I had an opportunity as well to visit the recovery room and the new operating rooms upstairs. During the course of the tour when questions were put to the tour conductor as to whether or not the facility could, in fact, cope with its new role, there was considerable concern expressed that, in fact, renovations would have to occur in this part of the new facility as well. If estimates are available as to the cost of these renovations, then they certainly have not been made available to members of our caucus.



These are the kinds of cost analyses that would be very useful to have before us, to absolutely ascertain if the road down which we are travelling is one that will really result in a better service at reduced cost. Or, in fact, are we going down a road that will lead to poorer service at increased cost? There is nothing on the table that gives any of us any idea as to whether or not this is a cost-effective initiative or whether it is just another plan that has been launched with far too little consideration of cost implication and the effectiveness of the delivery of service.



One of the considerations is whether or not the institution that is being created is, in fact, too big. There is some evidence that when an institution in health care delivery gets too big and it reaches a critical mass, then it, in fact, becomes less cost-effective and more cumbersome and less service-oriented. There is some suggestion that at around the 500-bed level, this phenomenon begins to occur and, in fact, we reach the point of diminished return. It would be interesting to see how much consideration has been given to that particular concept, bearing in mind that we will be creating a health care delivery system that will have well in excess of 1,000 beds under its control, delivering a myriad of services - medical, surgical, rehabilitation, cancer treatment - whether or not everything can come under that umbrella and still be delivered effectively.



I still am not convinced that taking the Nova Scotia Rehabilitation Centre and making it part of this greater plan will, in fact, enhance the services that are available at that institution and that we will be able to deliver them at less cost. I still am to be convinced that there is a true saving to be achieved by taking the Cancer Treatment Centre and putting it in this conglomerate that is being created. There has been no suggestion, for example, in this legislation that we should, perhaps, if bigger is better - and that is what this legislation says; it says that bigger is better and bigger is more cost-effective - then why are we going down the road and suggesting that the IWK and the Grace Maternity Hospital should, in fact, perhaps be looking at a separate amalgamation process rather than becoming part of this bigger is better process? If it makes sense that four institutions can, without adequate documentation, be brought together effectively, then why are we stopping and not suggesting that the Grace Maternity Hospital and the Izaak Walton Killam Hospital would not come under the same legislation?



My only reason for bringing that up is that there is not enough evidence to suggest that, in fact, we are going to be producing and providing a better service with this amalgamation of health services in metro under Bill No. 47. There is a great deal of information that we do not have. There are a great number of things that are in doubt. There certainly are a great number of things that are uncertain. The information is not on the table. While the interest on this bill has centered so little on the delivery of the health care at the new institution, it has centered so little on the cost-effectiveness of the process. It has, rather, centered on the labour unrest that this particular piece of legislation is generating among health care workers.



When one starts to look at the state of health care delivery, particularly over the last two and one-half years, one cannot be anything but impressed by the lack of morale in health care workers. The question begs to be asked, what does this particular bill do to improve the morale of health care workers? What does it do to ensure that health care workers become more satisfied with what it is they are doing, allowing them to do a better job in the operating room, a better job in the emergency department, a better job on the wards of the hospital? In reality, Madam Speaker, it does absolutely nothing to improve that situation and, in fact, it is actually tearing down what little remains of morale of health care workers in these institutions.



Unless we can design a health reform system in which health care workers believe and feel that they are an integral part of the decision-making and the planning in the delivery of the new health care system, we will have a health care team which is less than 100 per cent effective. For decades we had health care workers in this province who are absolutely devoted to what it is they were doing and that is providing good health care for Nova Scotians. It is interesting now, when you visit a health care institution in this province, whether it is a home for personal care, whether it is a community hospital, whether it is a regional hospital or whether you wander into the Victoria General Hospital or the old Halifax Infirmary.



What you find then when you meet with health care workers is that they are not talking about what it is they are doing professionally. They are not talking about a difficult case that they are trying to solve. They are not talking about perhaps something that will improve the delivery of service, whether it be in their x-ray department or whether it be in their physiotherapy department or whether it be upstairs in the OR, maybe discussing some new procedure, some new technique, some new technology that excites them and stimulates them professionally. What they are all talking about is how unappreciated they are and how downtrodden they are and how health care reform is going on with absolutely no input by health care providers in this province. This is just another case, this Bill No. 47, of plowing ahead with a government initiative which is poorly understood, poorly researched and which has gone on with little or no consultation.



Now we started out in this process believing that what we were going to be looking at was a health care initiative, but so quickly it degenerated into a direct confrontation with health care workers in the metro area. The health care workers in metro, it is my understanding, are represented by four unions and have some 15 contracts. If this coming together of these four unions or the people represented by four unions and the people whose working arrangement is contained in 15 separate contracts is to be done in an effective way, obviously it can't be a top-down kind of approach.



I can remember, Madam Speaker, and I am sure that you can, in debate in the early days of the new government, when they were saying that this was not going to be a top-down government. I remember also, too well, when the Premier would get up and he would say it is the end of verticality in the delivery of government in this province.



I think time would now suggest that rather than eliminating verticality, that this government has refined it to a point that we have not seen before in the delivery of government in this province. Everything is from the top-down; everything is generated within the confines of the Cabinet Room and no one, but no one, has any input into what is going on.



[10:00 a.m.]



Now you know health care workers, one of the problems they have in terms of morale is that they now perceive themselves as being second-class citizens. One of the points of discussion is the way in which this government handled the Education Act in stark comparison to the way it is handling this particular piece of legislation. I think this is a point because it is impacting on what this legislation is doing to health care workers and they way they perceive it in comparison to the way the teachers were handled when the Education Act was brought into this Legislature.



We all remember so well when the Education Act was brought in, particularly the Nova Scotia Teachers Union objected so violently in terms of what that particular legislation did, or bargaining rights of teachers and what it did to certain contractual privileges that teachers had as the result of negotiations and as a result of their contract with the Department of Education. We all remember so vividly that week of back-pedalling that the Minister of Education did in terms of accommodating the Teachers Union when they pointed out, very correctly, that the minister's interpretation of what that Act did to their rights was in stark contrast to their interpretation of what it did, and finally the minister understood and he came in and we all remember so vividly when he brought in in excess of 170 amendments to the Education Act which addressed many of the concerns of teachers to that particular piece of legislation.



Now let's compare that situation, Madam Speaker, with what is before us today. We again have a piece of legislation brought before the House which does not take into account the contractual rights and the bargaining rights of health care workers, particularly those in the Nova Scotia Government Employees Union. Now they have made representations to the minister through their union that, in fact, they are losing their rights under the Civil Service Act, under the Civil Service Superannuation Act and under the Pay Equity Act. They are losing significant statutorial rights which they have negotiated on previous occasions, negotiated in good faith, and now they are not going to lose those rights at the bargaining table, they are going to lose those rights on the floor of this Legislature if this government insists on passing that particular piece of legislation without amendment.



Now what is the difference between health care workers and teachers? Are health care workers second-class citizens? Should they not expect the same kind of consideration that this government gave to members of the Teachers Union? Should they not go ahead and apply as much pressure to the Minister of Human Resources and to the Minister of Health as the teachers when they showed their displeasure to the legislation which would affect them so profoundly? Should not health care workers have the same right?



Now the Minister of Human Resources has been engaging in media negotiations with the unions, and in fact the other day, during Question Period, arranged for a news conference downstairs in which, rather than to bring forward new information, he used that venue as a medium to conduct his rebuttal to the concerns that unions were bringing to his door about this particular piece of legislation. Is that going to be the way that negotiations between government employees and the government are going to be conducted in the future in this province, or will we revert to the time-honoured tradition of negotiating workers' rights around the negotiation table? Health care workers are incensed about the way this bill was introduced. They are incensed at what it does to their negotiated rights. Madam Speaker, I think they have every right to be incensed, to be angry and to feel betrayed by the government, that chooses now to erode workers' rights on the floor of the Legislature rather than around the bargaining table.



This bill does absolutely nothing to encourage and to improve the morale of health care workers because it does not include them. It merely manipulates them and manipulates them in such a way that it well may be that the minister is absolutely painting them into a corner in which they will have no recourse but to exercise the maximum leverage they have in terms of standing up to government and the way it is approaching this particular piece of legislation. The very last thing, Madam Speaker, that we need in this province is an interruption in the delivery of tertiary care in this province. That is absolutely the last thing. The sooner the Minister of Health and the Minister of Human Resources appreciate that and come to grips with that realization, the better off we will all be.



Madam Speaker, second reading of this legislation is winding down. The process, to this point, has been extremely unsatisfactory. The minister still fails to understand that health care workers in this province and the protection of their hard won employment rights are as important to them as those same rights were to teachers. They expect the same kind of consideration from the Minister of Human Resources as teachers received from the Minister of Education. They have every right to demand the same kind of respect that the members of the teaching profession have and they demand that respect as health care workers. This legislation does not give them that respect.



In concluding, I want to just make a few remarks on the make up of the new Health Sciences Centre Board. When you look at the make up of hospital boards around the province, the one that did stand out, of course, as being different was the Victoria General Hospital Board. The difference was a reflection of the fact that that was, unlike other hospitals in the province, a provincial hospital and the make up of the board, of course, reflected that difference. Other hospital boards around the province have, in fact, one government appointee, who maintains that contact of government with the administration in that hospital through that government appointee. That has been a tradition that has been followed by different administrations in this province and seemed to work very effectively.



As we now go down the road to eliminate as a provincial hospital the Victoria General Hospital, we are creating the new health sciences centre, which is made up of a board including, among others, eight government appointments. The previous speaker, the member for Queens made a very good point, that the services provided in this new institution will be of intense interest to all Nova Scotians who come here for various components of tertiary care. We are talking about certain orthopaedic procedures, cardiac surgery and neurosurgical procedures and so on. These procedures aren't available in the community hospitals and they aren't available in the regional hospitals. It means that a very significant number of Nova Scotians come here every year for these services. So they have an intense interest in what is going on and how this whole process comes about.



The member for Queens made a perfectly good case for including among the eight government appointments, perhaps as many as three appointments from other than the immediate metro area. He made the suggestion that perhaps there be one from southwestern Nova Scotia, one from northern Nova Scotia and one from Cape Breton. I would hope that the Minister of Health, who perhaps would be the one that would determine the make up of the board - it is always very difficult when we now have two ministers intimately involved in the presentation of one bill as to who is going to have the say on which clause - I would guess that the make up of the board might fall under the responsibility of the Minister of Health, so I would suggest to him very strongly that he take up the suggestion from the member for Queens in terms of the make up of the board of the new institution and consider appointments from other than the metro area to give it that provincial flavour that would be very advantageous in respect to the kind of service that is provided in this institution.



With those few remarks, I am going to take my place and allow another to discuss this Bill No. 47. I want to leave the Minister of Human Resources who has been very attentive when this bill has been on the floor, to take very seriously, the criticism that is coming his way generated by health care workers who are absolutely determined that they will receive fair treatment by this minister as this legislation goes forward, legislation which removes some of their contractual rights that they have negotiated over the bargaining table and removes some of their statutorial rights that they are in receipt of as being members of the Civil Service, bearing in mind that this legislation effectively removes them from the Civil Service with all its benefits in this province.



I will take my seat and will anxiously await the remarks of the other speakers to determine if, in fact, their appreciation of this bill is the same as mine. I would be very interested as well if government members who have not had an opportunity to speak to the bill, other than the two ministers concerned, would be very anxious to see what their appreciation is of this particular legislation. I would hope that the minister is taking seriously our request to sit down with the unions and perhaps come up with a plan not unlike that which was included in the transition plan that was negotiated by the previous government with the NSGEU, as it was looking to make drastic alterations in the working arrangements of the civil servants in health care delivery who were employed at the Victoria General Hospital.



I think what that memorandum of agreement proves to us is that there is common ground there that can satisfy the workers and, as well, could achieve what it is the government wishes to do, and that is to put all employees in health care delivery, in the Halifax area, under a common bargaining agent outside of the Civil Service of the province. Thank you very much.



[10:15 a.m.]



MADAM SPEAKER: The honourable member for Cape Breton West.



MR. ALFRED MACLEOD: Madam Speaker, it gives me pleasure to be able to get up today and speak on the Queen Elizabeth II Health Sciences Centre Act, Bill No. 47. I guess the question we all have to ask is, what is the purpose behind this bill? What does this bill do for patient care? What is it going to do for the people who are involved, the ones who receive the services? There have been lots of questions asked over the last number of days and, certainly, over the last couple of years, since this was first mentioned. Our job here is to make sure that the end product for the people is a quality product and we have to wonder if that is what is going to take place with this bill.



The amalgamation of the four units may make a lot of sense, it may be something that can be worked with. But many studies have been done in many parts of the country that say hospitals with over 500 beds are not, indeed, as efficient as the units we have now. So, do we proceed for the sake of saving money, or do we proceed in order to deliver quality health care for the people of our province?



There have been many cuts made right across the board. People understand that we have to tighten our belt, but what people don't understand is, how come there hasn't been more discussion? How come there hasn't been more input from the shareholders, the people who receive the services and the people who need the services? Most people do not realize what is happening to our health care system, Madam Speaker, if they don't have to go to a hospital to receive some. But if the person has to go to a hospital to receive some help, or one of their loved ones has to be taken to a hospital in the middle of the night, then people start identifying with some of the problems that are in our health care system.



We have a good health care system, and the reason it is so good is because of the people who make it up, the workers, the individuals within the hospital, the nurses, the CNAs, the doctors. But then there are many other people who make a hospital work. It could be - and is - the laundry workers, the people who keep the floors clean, the people who provide the meals. All of these people are affected by what is happening with this bill and it is our job to make sure that the effects are minimal, not only on the patient, but on the people working in those industries and the people providing the type of care that the people of Nova Scotia need.



There have been many different types of amalgamations going on, as we know, in different parts of the province. There have been problems in Cape Breton with the amalgamation that has gone on there with the municipal units. Let us hope that we don't have the same kinds of problems with the amalgamation of these four institutions into one here. But there have been other problems.



In the Glace Bay area there have been two hospitals amalgamated into one. As I said before, I spent time with people who worked in that hospital. In one case, in particular, a nurse with 23 years service who is on stress leave. She is on stress leave because of the things happening in the health care system, things she has no control over, but things that she feels and believes are taking apart the very institution she loves and holds so dearly. It is those kinds of situations we want to avoid in all parts of the province, Madam Speaker. We want to make sure that the health care worker, as well as the health care receiver, are looked after in this proposition. I am not certain that that is what is going to happen. We have to remember that there is more to an amalgamation than a building and bricks and stone; there is a lot more to what is going on here. It is the taking of people and meshing them together. I served on a board of directors of a hospital and, at that time, we amalgamated three hospitals into one and it was not a easy process. There were a lot of concerns raised by the employees and there were people who lost their jobs.



Madam Speaker, that does not make it right and that does not mean that this is the right thing to do but if we are going to proceed, we must be sure that we proceed, keeping everything in order and keeping everything in its right place. When I served on that board, I also served as the Chairman of the Human Resources Committee and we dealt with the amalgamation of contracts and we dealt with job losses and we dealt with job reassignments and it was not easy. There were people who got hurt in this situation and it is not something that I want to be part of again. I do not want to see that happen when we do this with this bill because that is what is going to happen. Not only are the people who work there going to get hurt but the people who land there are going to be hurt.



So what are we doing about it? We have the ability, the capability and the resources to make sure that this bill, when it leaves this House, will not hurt anybody but will indeed do what the minister says it is supposed to do and that is to improve the health care but we have to remember that our sole goal should be to look after the people of the Province of Nova Scotia. We have to serve them with compassion and to do that we have to communicate with them. Let us talk to them more so that they understand what is going on.



The unions seem to be quite concerned. They are taking a strike vote. That is not the way to govern. That is not the way that we should be operating. Every time there seems to be a problem with a bill, we have a strike vote and then, as an example, on the Education Bill, we had 170-some-odd amendments come before the Law Amendments Committee, something that I have never heard of before - it may have happened before but I have never heard of that before. That is not the way to govern. We should be bringing legislation into this House and delivering legislation that people understand, that people can read and people know what the effects of it are going to be long before it gets to the point where talk about walking the streets and taking a strike vote.





I was in a restaurant last night, Madam Speaker, and I overheard some health care workers speaking. They said that they thought that they had to vote for a strike because that is the way teachers settled their problem and that would be the only way that they could settle theirs. That is not what we want. That is not the way that we should proceed with this bill.



How many people, Madam Speaker, have to suffer? How many people have to be sent home from the hospital too early? How many people have to wait for long periods of time to get some health care before we actually understand that we are proceeding in the wrong direction? As I have said on several occasions in this House, several weeks ago I attended a rally in Sydney where over 3,000 people were there. They, too, were concerned about their health care. They were worried about what was taking place in health care and I would implore the minister to help solve those type of problems that are there now, before we continue on and build on the other problems that we cannot deal with.



The things that we have to do have to be done sooner than later but when this government came to power, they didn't come to power on a legislative agenda of health care cuts but that is what is happening and it is not the right thing to do. We have to have compassion for the people of Nova Scotia. We have to listen to the people of Nova Scotia. The jobs that are being lost will affect many other people besides just the ones in the hospital system. It will affect people right across this province. This government has said they want to consult but it seems they do not want to consult until there is a strike pending. We have an opportunity to avoid that by making sure that the right types of legislation go forward now.



There are many other things, Madam Speaker, that have been brought to our attention over the course of this debate on second reading but at the same time, we have not decided which route we are going to take. Are we going to cut for the sake of cutting, with no price put on life or do we realize that it is more important to care for the people of Nova Scotia and look after their interests?



Madam Speaker, some of what has gone on has not been easy to fathom or understand and it leaves me no choice but to put forward the following amendment:



"That the words after `that' be deleted and the following be substituted therefor: `this House affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.".



MADAM SPEAKER: Honourable member, is the amendment being circulated?



MR. MACLEOD: Yes.



MADAM SPEAKER: This is in the form of a reasoned amendment and I think it is going to take a few minutes to make a judgment on it.



MR. ROBERT CHISHOLM: Madam Speaker, if I may make an intervention on the validity of the amendment . . .



MADAM SPEAKER: Yes, the honourable member for Halifax Atlantic. If we are going to start entertaining interventions, I will recognize one intervention from each Party.



MR. ROBERT CHISHOLM: Madam Speaker, I just wanted to bring to your attention that a portion of this amendment had been introduced earlier by the Leader of the New Democratic Party. The change was that the words after health care system there was an "and" and some further words. In making a decision to rule that amendment out of order, the Speaker of the House indicated that everything before the `and' appeared to be in order and were it to have ended at that point, then it would be all right with respect to the definitions of Beauchesne under Reasoned Amendments. It appears that what has been done here fits very clearly with the ruling of the Speaker on that earlier resolution.



MADAM SPEAKER: The honourable member for Kings West.



MR. GEORGE MOODY: Madam Speaker, I guess in trying to follow the rules and precedents of this House, this amendment is identical to one that was, I think, made by the present Speaker - not yourself but the present Speaker of the House - in 1991. It was found to be in order according to the rules at that time and I do not think those rules have changed since 1991 in that we are following the same Beauchesne, Erskine May rules that were followed in 1991. So we have put forward an amendment on that basis, on the basis of precedence and following Beauchesne. That is why we are putting it in this form.



MADAM SPEAKER: Honourable member, would you just clarify the reference to which Hansard section you are speaking, when it was approved in that wording?



MR. MOODY: Yes. It is June 20, 1991, Pages 6997 and 6998.



MADAM SPEAKER: The honourable Government House Leader.



HON. RICHARD MANN: Madam Speaker, I would only say that I listened to the Speaker this morning as he ruled and he did not say that this would be in order. He said that, in fact, it may be able to be considered by itself, but he did not make the ruling that it was in order. He did rule the amendment this morning out of order.



I would suggest, also, that the reference made by the honourable member for Hants West certainly would have been an amendment made in 1991 but certainly to a bill much different than the bill before us today.



MADAM SPEAKER: It will just take a few moments to deal with this amendment before I make a ruling on it.



The honourable Government House Leader.



HON. RICHARD MANN: Just a point of clarification. It was the member for Kings West, not Hants West.



MADAM SPEAKER: Thank you. I am going to recess for three to four minutes while we seek out the Hansard edition for a referral.



[10:30 a.m. The House recessed.]



[10:38 a.m. The House reconvened.]



MADAM SPEAKER: Order, please. I will call us back to order. I have had the opportunity to look at Hansard from the debates of Volume 9, 1991. There were no reasons cited in Hansard for the previous ruling so it was not particularly helpful. Given that this amendment seems to fit in with Beauchesne's rulings on acceptable amendments for reasoned amendments, I am going to rule it in order.



The honourable member for Kings West.



MR. GEORGE MOODY: Madam Speaker, I would like to speak to the amendment of Bill No. 47. When we talk about decentralizing and allowing community control - one of the things that Bill No. 47 does very clearly - the idea with the previous government when we had the interim agreement that we had agreed to, was that the VG would be run by the community. In order words, it wouldn't be like Bill No. 47, to set up a corporation that is really not a Crown Corporation, but, yet, practically all the people appointed to the board are appointed by Order in Council. In other words, were not getting an institution that in any way is community controlled.



I think, Madam Speaker, the Minister of Health has continually stood up in this House and whether it is the Blueprint Committee or whether it is a Royal Commission or any report that you read, you will find that what is being said, is that more and more we should become community-based. In other words, very clearly communities should have a say in our health care system and what the community needs are.



What the government is doing in this legislation is ignoring the community. On one hand they say, well, we want to take the people out of the Civil Servants but we are going to have a corporation that isn't a Crown Corporation but yet it is controlled by government. Very clearly, if you are going to be a community-based institution, very clearly that institution has to be controlled by the community.



Now how does the community have a say in that? How is it controlled by the community? Obviously it is not by government appointments. By government appointments be get known Party supporters, we get people answering to the government on decisions they make. I have watched what happens at the IWK and the Grace Maternity Hospital that was going to merge into one. But that is not government controlled, that is not controlled by Order in Council appointments. As a matter of fact, I have been to the annual meetings of the IWK, where they have a lot of community involvement. They have people from the community voted on the board and have the board actually be part of that institution.



What we are doing when the minister says, for instance, in the Valley we are going to close two hospitals, the community had no control or any say about the needs and the direction health care is going in. Time and time again this government stands up and time and time again it says, we are going to allow the communities to have more involvement, we are going to allow, even though the Blueprint Committee recommended that community health councils be established first, the government said no, we are going to establish regional health boards. Who makes up the regional health boards? Government appointees, not community representatives chosen by the community.



We do not have, in this province, community health councils so that communities can have control. I understand, Madam Speaker, that the budgets are decided by the government, I understand that. We have always had that but we have had community health centres, we have had community hospitals, we have had all those things in the past, where communities themselves made local decisions, obviously based on the amount of money that government provided for them to use.



What are the advantages of having a community controlled health care system? Madam Speaker, as you talk to people in various communities who are upset about what is happening to the health care system, and part of the reason that they are upset is because they are not part of it, they are not part of the decision-making process as a community, to decide if they have so much money to be allotted in a particular area how that money is spent.



I know that the people are very angry in my area. I just heard this morning that the community health centre now, part of it, is going to be rented out possibly for the amalgamated school board, not for health care, long-term care, as they were led to believe by the government. Now the regional health board is saying no, we don't have to keep any commitments that this government made, we don't have to keep the commitment this government made that this facility would be used for long-term care. We are now the regional health board, we now decide how the money is spent.



My question is, Madam Speaker, where does the community play any part in that decision-making process? Thus far they have been shut out. Yes, communities have had meetings and this government will say over and over again that we want communities to have more input but we can't find, in any way, as you look at what is happening across the province and we have meetings in various communities, as in Cape Breton where 3,000 people turned out. They are still trying to figure out how in the world they, as a community, can have some input into what is happening in health care.



[10:45 a.m.]



We talk about decentralizing so we can have community control. The government says it is committed to that but here we have a bill that does just the opposite. How can I believe this government when it says, we want the community to be part of the decisions that are going to have to be made in the direction of health care? First of all the minister said, this board with the merger isn't going to come under the regional health boards, it is going to be separate. Now the minister said that regional health boards were the start of allowing the communities some control. I assume that eventually, regional health boards members will be chosen from the community and not appointed downstairs in the Cabinet Room. Then, I assume that the government will allow community health boards to spring up and that the community health boards will have representation on those regional health boards.



What the government has done in this merger is shut out the community completely. This board doesn't report to, or is not under the control of, the regional health board. What this government has done here, as we move along, has said this is going to be controlled by government.



As we make changes that affect health care and we know that changes affect the community, we all know that communities around this province, even though we are a small province, are pretty diverse. We also know that the needs in various communities are very different. If we believe that to be true then this government will move in that direction. I think the government has been trying to deflect any criticism of decisions they make by allowing regional health boards to partly control the funding. What the government has done is say, we are going to give an envelope to each regional health board.



Already I hear it starting as the cuts are made, be it in the Valley or be it on the South Shore because it will happen. When that envelope says that the regional hospital on the South Shore gets x number of dollars which is less than it is getting now, the Minister of Health is going to say, oh no, excuse me, it is not my fault, it is the regional health board's fault. They have made the decision to put the money somewhere else, even though the envelope didn't have enough money in it to adequately fund health care in that region. Also, what you have is one community pitted against another in each region. What you also have are services competing against other services for part of that envelope. If we truly mean that communities are going to have some say, then they not only have to have a say in the services they need, there has to be a way that those services are funded because you can't have one without the other.



When we are moving to prevention and away from institutional care - there is no question in the past that the majority of our emphasis was on acute care - we recognize that there is a balance between prevention and acute care. We will never do away with hospitalization because it is always a necessary part of the system. We also recognize that prevention can be very helpful and if you allowed communities - because I have seen it - you know, when government controls something, people take a whole different attitude to when the community controls it and the community feels it is their project and part of their community. They will rally around, whether it is raising money for that project or whether it is seeing that people participate in that project.



We have had, on the Hants shore, a community centre - and I remember this as Minister of Health - and they had no funding from government. They were struggling with the community health centre. But it was totally community organized. We did put in some funding at that time - and I think the funding is still there, to my knowledge - so that they could hire a coordinator and they could work on preventive measures. Seniors came; not only did they come to check their blood pressure and those kinds of things, but it was an opportunity for them to learn and promote healthier living. They had courses on diets, cooking, all of those things that contribute to a healthier lifestyle, all of those kinds of things that are so important.



Madam Speaker, do you know what made it so successful? It wasn't the amount of money, because it was $100,000 or $150,000, or something, for the whole budget. It wasn't that. It was that they had probably 80 per cent of the community involved in those health projects. Why? Because the community supported it and many people in that community were on committees, they knew what was going on, they promoted it within their families. If we can do that, if we could make sure that even if we get to a large institution that the community could have some ownership, the community could say, hey.



One of the things I have found that I think is going to hurt this government, and, Madam Speaker, it doesn't matter what hospital institution in this province, over the years there has been campaign after campaign, we talk about the dollars that government puts into health care, there are so many volunteers and so many fund raising projects, there wasn't an institution in this province that was built totally by government. Not one. How was it built? Every hospital that started in this province was started because the community felt there was a need. Then the community went out and raised funds and, in some cases, yes, the province did contribute. But the community felt part ownership.



Do you know how many of those rooms were furnished? They were furnished by legions, furnished by Lions clubs, furnished by various groups in the province, because they felt that the community had ownership. They don't feel that anymore that the community has any ownership or that the community has any opportunity to participate. That is taking away something very fundamental in this province, fundamental because we, as Nova Scotians, have always taken a great deal of pride in our community, taken a great deal of pride in helping others, taken a great deal of pride in volunteering and working for a worthy cause. What this government has done is taken that all away.





I had a friend who was on a foundation board at the Rehab Centre here in Halifax, one of the institutions being mergered. They went out and raised hundreds of thousands of dollars for things that the government couldn't afford to buy and for programs that couldn't be afforded at the Rehab. Do you know what the government told them, after this merger go away. Go away; there is going to be just one foundation for all of them. Every one of those people, including this friend of mind, said, look government, we are not going to have any say anymore. We were part of the community; we gave up nights, weekends, so that we could raise funds for that corporation. Now you don't need us anymore and you don't want us anymore. That is what they feel. They have all given up. They have hired a lawyer to make sure that the funds they have raised aren't taken by this government, that they are spent on the Rehab. Now it may be tied up for years in courts, but they hope that they have protected themselves. But isn't that a strange way to deal with a volunteer group that is out there raising hundreds of thousands of dollars for an institution? I can name institution after institution where that is now going by the wayside because of this government's policies, because communities and people like my friend and others on that board, they feel that they no longer can contribute in a meaningful way.



That foundation board had such great ideas. They had very talented people on that foundation board, raising money, hundreds of thousands of dollars, and now the government has said, uh, uh, we don't need you any more; you are not part of this because this is the corporation by the government; you can't be part of this; we appoint people from the Cabinet now. So the community is gone; the community feeling is gone and that is where this legislation is leading us. There is absolutely no question in my mind, as I watch the minister unfold, because if he had unfolded the Blueprint Committee like he was supposed to, we would have had community health boards first.



Every community, including the metro community, would have elected people in a democratic way to form that community council. There would have been no envelopes at first but, as I understand it, in my area they are trying to form a community health council with no funding from the province. There is no money. The regional health board has said to the community health boards that you might get up and going, but you are totally on your own. Do you know what they have also said? We have no role for you. You can't have any input because the legislation doesn't allow for it. You can't have members on the regional health board. Legislation doesn't allow for it.



I know a lot of people who were on that Blueprint Committee, a lot of excellent people. I don't think the minister or anybody in this House would stand up and say that those people on that Blueprint Committee weren't top calibre. Every one of them, top calibre. They built a consensus - can you imagine - labour, management, everybody, right straight down. Every group was represented: community groups, seniors groups; all of them were represented on that committee. They said, we think reform will work. Oh, they worked hard. They worked day and night because they had a deadline and they thought that this government was serious when they said that if you develop a plan to reform health care, then we will use it and these are the parameters that you have to work within. They knew that. There were restrictions that were given to them.



When the government said that this is going to be community-based, they believed them. They went to work, Madam Speaker, to develop this Blueprint Report.





[11:00 a.m.]



Very clearly the first recommendation, you start with the communities and community councils and you allow them to build. Then you go to regional health boards. Very clearly it said that this merger was not to go ahead until the proper studies were done, very clearly, until the community felt that it was in the best interest of health care in their community, then this wouldn't happen.



Now the government chose to ignore the very basic recommendation that it set the committee out to do. It set up regional health boards, and they are not even representatives of the communities because they are chosen by the government. We believe and the government believes that communities either have a right to have input into what programs are offered in their communities or they don't. The government has to make that decision, I understand that. But since we are told that we are decentralizing, and I have to tell you at least before we had local hospital boards, local people, farmers, teachers, clerks, secretaries, all of those kinds of people, business people, were on the board of the little hospital in our community.



That board is not going to count any more, it is going to disappear. So we don't even have any control any more of what hospitals are left because the regional health board controls them all except this one. You know, the community now has no say, they have a director for the South Shore Regional Board, and he says this is what is going to happen; this is the money, we don't even need an administrator any more for a particular board, locally, because you are going to have a department head and then this chief honcho from the whole region is going to run the show.



You know, Madam Speaker, if you look at the four regions of the province, I don't know how little communities are even going to get to attend the regional health board meetings because in some cases, in the Valley, it would take five or six hours to get to the meeting. When we talk about communities we talk about health care workers, too, because hospital workers live in the communities that they serve. So they are friends and neighbours of the people we used to have that have some input on the kind of services that were provided.



It used to be that there were no questions, that the budget came from government. But the local community, on its little board, could decide; do we spend the money on the out-patient side? Do we spend the money on the x-ray side? Do we spend the money on the dietitian side? Do we spend the money on opening more beds? Do we spend the money in the OR? How do we spend our money? At least the government controlled the money, I acknowledge that, but the local communities had a say.



I can tell you, Madam Speaker, whether you are in Springhill, where my good friend lives who has a community hospital, he understands it well, knows they have had good local hospital boards. Those local boards in his area cared about that facility and the community cared about that facility. That board is going to be gone in April. (Interruption) Well, according to the minister they are going to be gone and it is going to be controlled by the regional health board. (Interruption) I understand and I promote the community boards but thus far, we were starting that in our area but the government said there is no funding to help you. They said not only is there no funding, there is no role for you to play yet with regard to the regional board. I believe that members do support and I support the community boards but if there is no funding and there is no role, why in the world would volunteers spend all of their time on a board that has no role to play or no real voice or have no funding, not that these people expect to be paid but there are costs if you are going to be effective.



There are so many reasons why all of the many problems that we have in health care could be, I think, worked through by the community. If the community understands what it is the project or institution is trying to do, they will get behind that project or institution and they feel very proud about that. I have had so many people say that they are still in shock in Kings West because they lost their hospital. Some of them have said, my father fought in the war so we could have freedom and we, as a community, could have a hospital. Then someone comes along and says, you can't have a hospital.



If someone came along and we had a community group and they said, your community only gets this much money, what are you going to do? Maybe the community would decide it wouldn't need a hospital. Maybe the community would decide there were other services. At least the community could make that decision and have some say in how the structure was set up and that is so important. We all acknowledge that times are tough, it is tough for people at home on salaries, it is tough for every government in the western world, it is tough for everybody. We understand that, people have gotten through tough times but do you know they get through it much better if they work as a team, together we can achieve more, team. Together, obviously, a whole lot more can be achieved. Together we can build.



I don't understand for one minute why this government, in the legislation to amalgamate this large institution, hasn't thought about the community at all, it has left the community out. I can't, for the life of me, understand that if this government means what it says, this legislation would have allowed the community to have some say in what services are provided in this new facility, some say in the whole process. What we found in this bill like other bills, the government hasn't allowed community input. It has ignored workers and it has ignored people in the community.



Health care is so important. I don't think there is another issue or topic that affects families, lives, the quality of life, there is absolutely nothing. You know, the old saying and we have all said it, I am sure. Money cannot buy you good health. It cannot, although I have to admit that putting money into a health care system can help achieve good health. I have to admit that. As individuals we can be wealthy or poor, and one of the things I have always been proud of, to have lived in Canada, in Nova Scotia - and I think you are probably proud of it, too, Madam Speaker, and we all are - is that we have a system that is available to everyone, a system that is available to every one of us. Whether we are poor, whether we have a lot of money, it is available to us. That is why it is so important, with the limited resources that we have, that we make this work. I cannot think of a better way to make this work than allowing communities, allowing health care workers to work together to make the kinds of changes that will ensure that every one of us still have that opportunity in the future, regardless of how much money we have.



This government and myself and, I think, the other Party have said that we do not want a two-tiered health care system. We are all opposed to that, Madam Speaker, every one of us. If we are going to achieve that, then we have to allow the community to be part of the process, we have to allow the workers to be part of the process. Each time government makes decisions in isolation of workers and communities, government seems to get into trouble. Then they wonder, oh, what happened in the process? Why is it that things are not going smoothly?





Madam Speaker, whether it is a health centre, whether it is a local hospital or whether it is some other small project that we have had up and running by health coordinators in this province, whether it is a clinic, it does not matter; if the community feels that it is in their best interest to support it, they will come out in droves.



When they announced the closure of the hospital in my area, they had a meeting. People were not militant but there was standing room only, with a couple of thousand people. Why was the community there? The community was there because they thought they were losing something and they had no say. They were right, they had no say because big government decided, we know what is best for you. If someone had had the decency to go to that community and say, look, we have to make changes, there are going to be fundamental changes in the health care system; if they had had the decency to go to the community and say, we have got to make changes, will you sit down with us and work through those changes? But the government came and said that there is going to be no hospital; no matter what you say or what you decide is best for you, there is going to be no hospital.



[11:15 a.m.]



The government did not even say, we will provide $1 million for health services in the area. It did not say, we will provide $2 million for health services in the area. It did not say any of that. The people felt betrayed by government deciding for them. Only if there had been an opportunity for the community to be part of the process of deciding what is best for their community with the monies that are available from government. Madam Speaker, I have heard many people say, can we contribute? If we had control, like we used to have, we would contribute to the project. We would fund. I don't think there is a community in this province, prior to this government destroying that approach, that hasn't raised funds for a health care project or a health care facility in this province. Not one. What people are saying to me is that we did all of that thinking that we were doing right for the community and that we had some say. But now they are finding out that they really don't have any input, they don't have any say, so they are giving up doing the kind of fund raising that they have had in the past.



Madam Speaker, you and I both know that we have in our communities a lot of very resourceful people. We have people in our communities with many talents. If this government believes in decentralizing and allowing community control, they would allow these people with many talents to be part of a decision-making process on the kinds of health care that would be provided in their community, not only would they be part of a group that could decide the community needs, you would find that there would be many volunteers who would come out in support.



You can look at what happened in Cheticamp, Madam Speaker, where the community got involved around that hospital, when a number of beds were closed. People volunteered for just Meals on Wheels, a program that we once had in our area before the hospital closed. Did it cost the government a lot of money? No. I admit the meals were prepared at the hospital but delivered by many volunteers in that community, dedicated volunteers. Did that contribute to healthy living for some seniors who had those hot meals? Certainly it did. Can you evaluate that and say, these seniors had a healthier outcome because they had these hot meals? Well, when the minister talks about evaluating outcomes and about a data system that he is setting up for waiting lists, where is the community? The people who are calling or having difficulty, where is the community, where do they turn?





Madam Speaker, I am worried where we are going in health care reform, very worried. Yes, we had a Royal Commission and it recommended community health councils. Yes, we had a Blueprint Committee and it recommended community health councils. I don't know of any group across this country that hasn't said, we need more community control and more community input. I don't think you can show me a report that doesn't say that works best. I can tell you, whether it is the Cobequid Multi-Service Centre out there or whatever, was it government that started it? No, government didn't start it. Government didn't start any of these. Who started it? It was started by the community because they had an idea after they identified a need. It was started by the community.



Yes, they may have gone to government for some help, but I can't think of a case that when they went to government for help, it wasn't a worthy project. In many cases, it was for very small amounts of money. If we believe in our communities and we believe that we do have people out there, other than government appointments, because I will have to tell you -when you have government-appointed boards, the community does not feel that they are part of that group. Because who is that group responsible to? Not the community, not the community at all. They are responsible to the government because the government appoints them. If they don't act in the best interests of the government and not of the community, they won't be reappointed to the board.

I know of cases where that has happened. People say I may have not supported the government because I totally and honestly felt that the government position was wrong. But if I speak out, I am gone. I think having a difference of opinion is healthy sometimes. Nobody is always right. We like to think we are, we're not. History has proven that we are not. So, the problem being with appointing these people, there is no community identity.



I have to tell you, in the regional board in our area, there is no community identity. As a matter of fact, there isn't even anybody from Kings West on the regional health board so I don't even know how at first they would have any community identity. But, if they were, they would not have that community identity as if they were chosen by the community, reported to the community and the community felt part of it.



We are coming at an age, Madam Speaker, where populations of seniors are growing immensely. I am reaching that myself. Many of us in here, some of us have reached it, some of us are getting close. The numbers are going to grow. We all know that when seniors retire, some of them work, still come to the Legislature. Some of them are volunteers because they want to keep active and they have a lot to contribute. I have to tell you that I talk to a number of those people and they don't know how to be helpful any more in the health care system like they did in the past because they don't know. The community is not running the show any more and so they aren't going to be able to get involved.



The other aspect that is going to happen, Madam Speaker, is that as the population gets older, we are going to use the system more. Is the system going to be there? As people get older, and we talk about decentralizing, people who have to come to Halifax for things that used to be in the Valley at the regional hospital are not there any more and they have to come to Halifax because of the lack of specialists. Some of them don't like to drive in the city, some of them can't drive in the city. I don't think we understand the cost to some of these seniors of having to be in here for a 9:00 o'clock appointment, go home because there is no bed, come back the next day, have the procedure and in some cases, they say, you had better stay close by in a hotel or motel so you can come back the next day. Maybe we don't need a hospital bed but we need a system that decentralizes and allows, in many cases, for those people to be provided for, in their community.



We have people coming all the way from Cape Breton for cancer treatment because it is not up and running in the new regional hospital. Part of all of decentralizing and community control, because the people in Cape Breton went out and raised all the money for the equipment at the cancer treatment facility that is going to be and hope to be in place in Cape Breton - the community raised the money, not the government - that was part of having the community involved in the planning of the new regional hospital. Now the people are wondering, we raised the money, we don't have the facility. When you go back to those people, Madam Speaker, to say, you know, we need you again for a community project, how are you going to get these people to agree? They are demoralized, they are worried about the system but they feel that they don't have any say anymore about what is there for them, not only them but their families in the future. That is an awful feeling.



So we have to rethink the direction the government is going in in this legislation. We have to rethink about how important communities are. How important are the people in those communities? Are they worthy to be part of this process? Of course they are worthy to be part of this process. Do we believe that they have the ability to be part of this process? Of course we do. Do we believe that they can have meaningful input? Of course we do. Do we believe that we can trust them? Of course we do.



Well, if we believe all those things, why is it that the Cabinet is going to decide all this for the communities and not the communities themselves? I hear this constantly. I know I hear it in my area and I hear it in other parts of the province. I will tell you, Madam Speaker, there is no issue that is going to be more front and centre, whenever this government decides we go to the polls, because communities are crying out there for some way to say, wait a minute, we recognize the fact that there may be changes. But they are crying out there for an opportunity to be part of those changes.



I don't know how much time I have, Madam Speaker, and I don't want to . . .



MADAM SPEAKER: You are almost there, you started at 10:39 a.m.



MR. MOODY: Oh yes, I have only about 10 minutes left. Thank you very much, I didn't know when I started.



So, Madam Speaker, as we move on this amendment, I can't see why the government wouldn't support this amendment. First of all, the government has continually said, the Minister of Health has said, and if they all believe that the Minister of Health is correct, the way we have to go is to involve the communities. But do you know what this government is doing to a group that did involve the communities, and that was the Health Council? The Health Council was a group that was a watchdog of any government. When I was Minister of Health they did criticize me but I didn't try to change the members or try to dissolve the Health Council. The Health Council went around this province to many communities. Part of their role was to go to Shelburne, to go to Kings County, to go to Lunenburg, to go to Cape Breton and hold public meetings, which they did in all those communities. The communities felt, hey, somebody does care about us; somebody wants to hear what we, as a community, have to say about the direction of health care in this province.



[11:30 a.m.]



Madam Speaker, the sad part is, a very sad part of all this, that the Health Council is disappearing, it will be all done. The minister has said, well no, we are going to have a research component. My question is, and I know what researchers do, in a sense, they are not going to be going out to the community, they are not going to be a watchdog on the changes that take place for the communities. The communities thought they had a friend because you know it doesn't matter who is in government, it is big government. We all know that a lot of communities feel, rightly or wrongly, in some cases maybe not always rightly but in some cases rightly, that governments don't always listen to them. That is probably a natural reaction. It doesn't matter what government is in but sometimes they feel that way, that government is big and they are small.



Just knowing that talking to people who might come before Law Amendments Committee on this bill, hospital workers have said well, can we go in there and speak to government, little old me? I am only a little worker and I have never done that before. I tell them, look, anything you have said to me has been very intelligent and I know that you could contribute and we want people to contribute, we want you to feel that you can contribute.



You know the Health Council went to these various communities and people spoke to them about the kinds of changes they would like to see for their communities. They also spoke to the Health Council about how the changes were affecting their communities and how they saw it affecting it not only now but in the future. They also said they would like to see it affect them in the future.



The Health Council, yes, brought that back to Halifax. And if it didn't agree with the government of the day they spoke out. I was there and I took some criticism, and rightly so. I understand that part of being in a position where you make decisions, you can be criticized. This Minister of Health was criticized once and he said, no, no, we have to change the Health Council, that is not the role of the Health Council to bring back the communities' concerns and then criticize me for the way that I am changing health care in this province. To me, Madam Speaker, and everyone of those Health Council people, and they were of all political faiths, believe me, the initial group I supported, I know some people supported the Party to the left and I know some people supported the Party across the way. There are some very strong people who supported the Party across the way, I remember having some discussion with some council members on politics, not at a function of the council but at another function. I knew that but I respected that person because that person had a great knowledge about the health care system and the reform that needed to take place. I would have been happy if the government had appointed five Liberals with the qualifications. I would be more happy than seeing it die.



So who is going to go out into the communities now? Who is going to bring the message back to government? It is not going to be the regional boards because they are appointed by the government. Who is going to bring back the message to government about the changes that affect each community in this province? There is no mechanism, there is no vehicle to have that happen.



I think, Madam Speaker, that if members of this House truly believe that we want to decentralize and truly believe that the community is important and part of shaping health care not only now but in the future, they would have to support this amendment. Otherwise, they are destroying the very basic principle that this government has said it wants to do. They are also acknowledging, if they vote against this, that the community should have no control, absolutely none, or no say in the changes that will come about that affect them.



I hope that each member of this Legislature will give serious consideration as they think back to the communities they represent in this House, and think back to the kind of people they have in those communities, be they health care workers, be they business people, professional people, housewives. How would you like to have some of those people have some say? I think you would, I know I would. I would be so happy whichever side of the House I was on to allow my communities a real voice on the kind of health care changes and system that this province is going to have, I would be so happy and I know they would be too. I am pleading with each one of you to allow that process to happen, if you truly mean it.



Here we have a great opportunity in this province to use the many talents we have in developing a community health care system that probably will then be second to none. The minister talks about a system that is second to none, but when you isolate communities, it is not second to none, it is far from it and people are very upset.



I know my time it up and I want to say that I will be supporting this amendment. My friend who moved the amendment made a very good amendment, it is one that I hope will pass and I look forward to listening to what others say about the debate. Thank you.



MADAM SPEAKER: The honourable member for Cape Breton South.



MR. MANNING MACDONALD: Madam Speaker, to you and to the members of the House I would like to take this opportunity to introduce a gentleman visiting in the gallery today, a distinguished former alderman of the City of Sydney who is in Halifax on business, Mr. Edward Paris. I would ask the House to accord him the usual welcome. (Applause)



MADAM SPEAKER: The honourable member for Queens.



MR. JOHN LEEFE: Madam Speaker, I didn't realize I was going to have a double opportunity this morning to address this legislation. I am very pleased with the amendment that my colleague, the member for Cape Breton West, has brought forward. It is clean, it is clear, it is concise and I think all of us can understand the intent of the amendment and I would hope that all of us would be in agreement with that amendment.



The amendment really speaks to size. It speaks to centralization; it speaks to the preponderance by some to developing larger and larger institutions to serve wider and wider segments of our community; it speaks to that as being bad public policy in contrast to good public policy; it speaks to the phenomenon which has been addressed by others in debates on other amendments and on the main motion in second reading, to the question of critical mass. When does big become too big and when is smaller better than bigger?



We now understand clearly that there is a critical mass of about 500 beds beyond which there is a greater chance of problem than there is with 500 or fewer beds respecting that question of critical mass. It also speaks to the law of unintended consequences whereby action may be taken which results in all kinds of things happening which were never intended. That, very clearly, becomes a greater danger as we approach, then exceed that critical mass of 500 and run the danger of being mired down in a hopeless bureaucracy and a system which is so caught up in itself that it ceases to serve the community that it was intended it should serve.



This amendment really says to us that services in our communities, in fact, equate to our communities, that if our communities cannot provide the central services, then our communities will, at first, whither and then will die. This certainly is true of health care. We know that if we do not have health care available to us in forms and services and delivery systems which complement our communities, then our communities are going to be adversely affected. Certainly health care must be one of the most basic services, if not the most basic service that anyone looks to within their community, for sustaining themselves and their families. I would say, perhaps, a brother or sister service - not even as far distant removed as a cousin service, but a brother or sister service - would have to be education. These really are the two pillars upon which our local communities are based. Without schools, without health facilities, our communities are tremendously weakened, perhaps even weakened to the point where they may be bled white.



So it is, Madam Speaker, that whether an intended result or an unintended result, the greater centralization of health care facilities, health care systems, the provision of health care itself, lends itself to the denuding of our communities of one of the most basic, one of the most important, one of the most vital services that our communities require in order to exist.



This government - and we see it in many policy areas - seems to be driven by a conclusion, which I do not know how they reached, that bigger is not only better, but that bigger is best. This is a government which has talked at length about regional control, local control, regional health boards, community health councils, but while all of the talk has been outward to the regions and the communities, all of the walk has been inward to the centre. The bill we are debating today, the bill which is proposed to be amended by this amendment, is further evidence of that drive towards centralization, centralization of services, centralization of decision-making powers, centralization of decisions regarding funding.



Madam Speaker, if we wonder how our communities are affected as our health care institutions change, their roles change, their functions change and, in some cases, they cease to exist altogether - or they exist in a new clothing which completely changes not only their appearance, but the way in which they function within our communities - if we want to see communities where those kinds of changes have been effected, I would hope in such a way that the results were unintended, but nonetheless, however unintended, are still damaging.



[11:45 a.m.]



We need only look at what has happened to hospitals in places like Berwick and Wolfville, Roseway in Shelburne, the hospital in Digby, the potential impact on my community hospital in Liverpool, Queens General, and this is true throughout the province. We look at our communities that have had the roles of those hospitals change and we must ask ourselves, are our communities stronger for those changes? Are our communities better served with those changes? Is health care delivery better provided for those changes?



I think it would be very difficult for us to find more than a handful of people in any of those communities that I have cited or, indeed, in any other community where their health care institution has been changed or perhaps closed, who would say that they are better for that decision having been taken.



Madam Speaker, I believe that it is true to say that we are moving further and further away from community-based health care, towards a centralized system of health care. We have heard talk about community health boards yet these community health boards of which there is talk do not have roles defined. We do not know how they will be elected or when they will be elected. We do not know precisely what the interface will be between them and the regional health boards, let alone them and those who stand at the levers of power in Halifax, and I very much include the Minister of Health in that. We do not know and it is the not knowing which causes us to be fearful of the future.





So, Madam Speaker, we may talk of community-based health care provision, we may talk about decentralization and we may talk about strengthening our communities. But the ugly fact is that this bill is a further example of this government's policies which are, whether advertently or inadvertently, causing our communities to play smaller and smaller roles in decisions concerning health care, and for those decisions to be made closer and closer to the vortex here in Halifax.



If we want to destroy local participation and local interest and local pride in health care delivery to our local institutions, then I believe we could not do better than to support the initiatives by government which, in fact, however much the government may not have intended it, are only further alienating our communities and alienating the people of this province from the decision makers.



What we see is our communities deteriorating. We see them deteriorating because, firstly, they do not have a sense that they are participating in decision-making and secondly, because they see health care institutions which they have strived so long and so diligently to build up being dismantled, purportedly on their behalf. But they know better than to believe that this is in their interest.



This phenomenon strikes very much at the heart of the whole matter of community economic development. That is why I would think, for example, the Minister for the Economic Renewal Agency would see that he has a vital interest in what happens as a result of this legislation.



You and I know, Madam Speaker, as does every member of this House who serves any kind of a rural community, that if health care, like education, is not provided through the community in a way which not only is adequate but which is seen to be adequate, then it is very difficult for us to attract people into our communities and so our communities cease to grow.



That is not only true of individuals who may be looking at our rural and our small-town communities with respect to good places to live, it is also true of corporate citizens who may be looking for places in which to invest across Nova Scotia. The great likelihood is that an investor, who looks at a community and sees that that community does not have the pillars of human services encompassed within it, will say that that is not a good community in which to invest, the reason being that the community without adequate health services, as with the community without adequate education services, is not the kind of community that people will flock to to live in.



So, we do grievous harm to the Digbys, the Liverpools, the Caledonias and the Tuskets, and so on and so forth, right across this province by pulling those kinds of services back out of the community and concentrating them either in regional centres or here, as in this bill, in the capital region of this province. Not only do we accomplish that - an unintended result, I am sure - but we also raise questions in the minds of the citizens within our rural and small-town communities, who have the capacity to be mobile, as to whether that is a good place in which to continue to live, a good place in which to bring up their children, a good place in which to be retired for, indeed, health services are so essential to us as our communities grow older and as the demographic studies demonstrate, as the age profile of Nova Scotians skews more towards those retired than to younger Nova Scotians.





So we run the very real risk of not only being able to attract people into our communities because we no longer have a decentralized community-controlled health care system, we also run the very real danger of driving out of our communities people who live there now, people who provide leadership there now, people who breath life into our communities now. No small town and no rural community in Nova Scotia can afford to lose that kind of leadership.



Mr. Speaker, decentralization of our system, I believe, serves the health needs of Nova Scotians. Decentralization of the system serves our communities. Decentralization of our systems, and causing people in our communities to believe that they have real ownership in our institutions, is in the public interest.



Now I give you a case in point, sir. Every September, in Queens County, we have an event which is called the Hospital Hustle; it is usually the second Saturday in September. The purpose of that event is to raise funds for Queens General Hospital to buy special equipment. I think this past Hospital Hustle was, I believe, about the 20th. Over those 20 or so years, almost $0.5 million has been raised in our little community of 13,500 people, all of which has gone into buying equipment for Queens General Hospital to serve the people of our community. That is money that did not have to be raised out of general taxation revenues. That is money that government did not have to dig into its pockets to raise. That is money that was raised in our communities and invested in our communities, to serve the people who live there, to serve the old and the middle aged and the young. That is money that was raised to provide health care for visitors to our community who from time to time need to call upon it.



All one need do, also, is to walk into Queens General Hospital and look at the wall of honour, which names literally hundreds of persons who have donated thousands, tens of thousands of dollars, indeed, hundreds of thousands of dollars to renovate our hospital, to add to our hospital, to make it a better place for health care, to make it the kind of place that not only will serve our community at large but also will attract and retain the same quality and numbers of medical practitioners to our community in the future as we have enjoyed in the past.



If we move towards a highly centralized system, as this legislation will do and as this government is bent upon doing, then we jeopardize, if not outright destroy, the will and the ability and the capacity of all of those people who have dug deeply into their pockets, at no cost to the taxpayer, to provide a better hospital, to provide a better facility, to provide better equipment, to provide better health care for our communities.



How can anyone in our communities have a sense of ownership with respect to this new, huge institution which will be created by this legislation? How can we possibly identify with it? No one can put forward the argument that, oh, well, those dollars simply won't have to be spent there in your local community, Liverpool or Digby or Yarmouth or wherever; they can come in to help pay for the larger tertiary care provincial hospital here in Halifax. You know, Mr. Speaker, and I know and every member of this House knows that that will not happen, that those millions of dollars, if one looks at them province-wide, which are raised within our communities for our community health care institutions, most particularly our hospitals, will evaporate like that. They will be gone. If government is going to be called upon to provide the same kinds of services through a centralized system as is provided through a decentralized system where the communities know that they own much of what is happening in those communities, then the government is going to have to dig into its pockets to make up for those lost millions of dollars. Let us never forget that there is a hole in the bottom of that pocket and the hole in the bottom of that pocket leads right into the pocket of the taxpayer.



MR. SPEAKER: The honourable member for Inverness, on an introduction.



MR. CHARLES MACARTHUR: Mr. Speaker, through you to all members of the House, I want to introduce a councillor from the great County of Inverness, Mr. Duart MacAulay. I ask him to stand and receive the warm welcome of the House. (Applause)



MR. SPEAKER: I want to thank the honourable member for Queens for allowing the introduction.



MR. LEEFE: Mr. Speaker, pride of community and pride of ownership are catalysts to building our communities and they are catalysts to economic development within our communities. If we lose control and lose the bricks, the mortar and the men and women associated with the provision of health care, then our communities lose and ultimately Nova Scotia loses.



[12:00 p.m.]



It has always been one of the great assets that Nova Scotia has had available to it in contrast to some of the other provinces close by, there has always been a sense that no matter where we lived in Nova Scotia, we were served with equity. That sense is being lost and sacrificed on the altar of centralization of facilities and centralization of decision-making.



If we remove local control, we lose local pride, independence and local money. If the government cares about nothing else, it should at least be concerned about that. What will this local pride, this local sense of ownership, this local volunteerism and this local funding be replaced by? Well, my great fear and my sole observation is that it will be replaced with a vainglorious pride born out of the centralizing tendencies of a patronizing government which was elected by the people but I think in the view of many people today is not governing for the people and certainly, is not governing by the consent of the people.



It is government from the centre and I don't mean the political centre, I mean the powered centre. It is government by control and command. It is government by centralization of the real levers of power, all at tremendous cost, insurmountable damage to the social and community fabric of Nova Scotia.



Any of us in this place who have been sent there to represent the small communities, our towns and our rural areas, have an obligation to support the amendment which is before this House this morning. Thank you.



MR. SPEAKER: The honourable member for Halifax Atlantic.



MR. ROBERT CHISHOLM: Mr. Speaker, I am pleased to rise and participate for a short time at least on the amendment that has been introduced. The amendment says that, "this House affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.".





I rise in support of the amendment to Bill No. 47 because I believe that with this bill to amalgamate the four major tertiary care institutions in Halifax in the Province of Nova Scotia, that what we are doing in many ways is turning our backs on many of the recommendations that have been put together by the Blueprint on Health System Reform. We are doing it without any consideration for a process that includes decisions based on trying to achieve some attainable, definable objective.



I think that the decision that is presented here in this legislation is one that has been made without any regard to the considerations that have been suggested by the Blueprint Committee. By such considerations I am referring to things like being able to identify what the needs are in the community. What is the health impact assessment of any decisions to change how we deliver health care in this province.



The Blueprint Committee called for, right off the top, that before any major transformation was made, any major decision was made in terms of how the system was going to be changed or in terms of how health care was going to be delivered, they recommended to the minister and to this government that there be a complete assessment done of the health care needs from one end of this province to the other. Not only with respect to the community and to individual community needs and how if there is a hospital in that community, how those needs are now being met by that hospital and how they will be changed by reorienting the system from one based on acute care to one based on primary care, in other words, one based more clearly on the community and one that is actually controlled by the community, Mr. Speaker. That has not been done.



Assessing the needs of the province as to the specialized and technical nature of the tertiary care system and how best to deliver that form of health care to residents of the province, that has not been done. There has not been an adequate or there has not been any study, Mr. Speaker, that I am aware of in any of the requests that I have made of the minister or his department, either verbally, in writing or through freedom of information requests, that there was any assessment of the health care needs of the community or the province before this decision was made.



Also, Mr. Speaker, and we have raised this before in this House, there was no cost-benefit analysis made by the minister or his department or this government on whether, in fact, it was a good idea for the purposes of cost-efficiency to pull these four institutions together into one.



So I have some considerable concern that we seem to be flying down this road of amalgamation, whether it is in municipal governments, whether it is in school boards, whether it is in community colleges and now in hospitals, in tertiary care hospitals, Mr. Speaker, and in regional hospitals, without any real hard evidence that that is going to do anything other than cause chaos and confusion, because that we can clearly see is a by-product of these kinds of decisions.



Any evidence that we have looked for has indicated, for example with respect to health care, and I refer again to a report, a Review of the Multi-Hospital Arrangements Literature Benefits, Disadvantages and Lessons for Implementation, that was put together, dated September 1995 by McMaster University in Hamilton, Ontario. The conclusions of this study, Mr. Speaker, of the literature were that any decisions that had been made up to that point to merge or to participate in multi-hospital arrangements of some kind or other had generally been made without any hard evidence that there was going to be anything gained in a positive way either in terms of costs or in terms of quality of health care and that if it was made on that basis, it was simply made on anecdotal evidence.



That is the same kind of anecdotal evidence that I think this government is proceeding with on this decision. The Minister of Health has stood up in this House and outside the House and wherever anyone will listen and he said that we have four world-renowned world-class health care institutions that are now going to be pulled together into one world-renowned world-class health care institution. What does he base that conclusion on? Well, he doesn't say. One might conclude that if you have four good things and you put them all together, you might get one better thing.



Mr. Speaker, I think that is an extremely simplistic analysis and it doesn't bear out under close examination, because as we are seeing, for example, in the Cape Breton Regional Municipality, they pulled together eight units to be able to provide more effective and more efficient delivery of service for cheaper money, and we are already seeing that that process is running up bills that are going to cost the taxpayers big time down the road, in complete contrast to the promises and commitments made by this government who undertook that strategy.



Perhaps more importantly, Mr. Speaker, the fact that we have those four world-class institutions is not a debatable item. But the question should be, how can we better make those institutions representative of the needs of the community? How can we better bring them under the control of the community in order that they better respond to the health care needs of the community? How can we ensure that we coordinate the services they deliver with other services that are provided in the community and other services that are required in the community? I think those are some important questions that have to be answered, that stick more closely to the whole process of health care reform that was recommended by a succession of task forces and Royal Commissions and, finally, the minister's own Blueprint for Health System Reform.



What we want to do is we want to shift the resources that we spend on health care in this province from being focused on acute care, primarily on health care delivered in institutions, we want to shift those resources into a primary care system - which doesn't include institutions, by the way - which follows a philosophy and a model that has been shown to be more effective, that if you make the community more responsible and give them an opportunity to participate more directly in determining the systems that will meet their health care needs and if you provide the resources in the community, that is a better way to deliver health care and to meet the needs of health care of the people of this province, and anywhere else, more effectively and more efficiently.



While the government is going full speed ahead with the merger and amalgamation, with the combining of bricks and mortars and systems, Mr. Speaker, we are not seeing a further devolving of services in the community. We don't see the kind of community-based clinics that we have been looking, that the minister has been promising we are going to begin to see in the community. In fact, we have not seen the minister come forward to establish community health boards, which are supposed to be an integral part of this whole reform process and an integral part which will play in important role on how, in fact, the systems, whether they be community-based or province-wide, are going to be delivered. That is a problem and I think is an indication of why and how these decisions are going awry, decisions that are being made by this government.



Mr. Speaker, the Blueprint for Health System Reform spoke about tertiary care and how better to provide it. They talked about the need, before any changes were made in the establishment or the current framework of tertiary care institutions in this province, about how a provincial programs advisory committee needed to be established in order to coordinate and evaluate provincial and tertiary programs.



As we know from having corresponded with the minister's department, that recommendation has yet to be fulfilled. In fact, there is some suggestion that it has been partly vetoed. We know that the provincial programs and services board will only be established by 1996. It will then spend a year developing a plan focusing on coordination and planning, but no mention of the funding authority that deals with how the tertiary care institutions are, in fact, going to be governed, Mr. Speaker. The concern there is that that particular provincial program will not be dealing with - as we understand at this point - the regionally delivered provincial programs such as breast cancer screening, which is a program that this government made some commitments on and is very slow ensuring it is developed from one end of this province to the other.



[12:15 p.m.]



Mr. Speaker, the point being, that significant decisions here are being made in terms of the delivery of tertiary care in this province without this provincial program advisory committee even being in place yet. It is not going to be in place until 1996 and it will then take a year to study and to plan. By that time, I would suggest to you, the QE II, including that new hospital down there that the provincial taxpayers paid $150 million on, which hasn't even opened its doors before it was being redesigned and renovated, with estimates beginning at $12 million, an additional $12 million at a minimum, we would suggest that many people are beginning to realize that that is a mere spit in the bucket when you figure the kinds of changes that have to be made in order to make this facility fit in with a plan that they are only now trying to pull together.



These decisions are being made without any consideration for the recommendations of the Blueprint Committee which tried to suggest that these kinds of decisions and the role of the tertiary care facilities and the provincial programs needed to be integrated with what is happening across the province in each and every one of our communities, including the communities here in Halifax. Mr. Speaker, not only are the four institutions being physically linked together under one governance structure, but also all of the people that deliver health care in each one of those institutions are going to be shifted and shuffled. We know, through an earlier announcement by the minister, that another 800 to 1,000 of those people are expected to lose their jobs.



One has to ask the question, has anybody stopped to consider what impact that is going to have on the ability of those world-class institutions to deliver health care in the Province of Nova Scotia? What about the people in Glace Bay who need a transplant? Is this going to enhance their access to tertiary care here in metro, Mr. Speaker? People are already now talking about the problems in getting treatment, whether that be for cancer or whether that be for other illnesses that require highly technical and specialized services. Those kinds of services now are under such pressure, under such stress as a result of the cutting out, the slashing and the hacking of millions of dollars and of tens of thousands of worker hours, and thousands of health care professionals and support personnel.





What effect is it going to have on the ability of those institutions to continue to provide primary care to people in metro, Mr. Speaker, because those institutions also are mandated to provide for the needs of residents of metro as well as residents across the province. We now see, already, institutions in metro that are under extreme stress because of the demands that are being placed on them, not only by people locally but by people across the province and people in the Atlantic region who require those kinds of health services. Was there any consideration of that? Was there any consideration of whether those services can be better provided? We certainly have not seen any evidence of that and I think that is reason for all of us to be extremely concerned.



I go back to the point I made earlier. All of the studies, all of the recommendations for health system reform have talked about us ensuring that the changes that we make respond to the needs of the community and to the needs of the people of Nova Scotia, Mr. Speaker. Impact assessments need to be done before decisions as significant as this are made. Things like health/human resource data need to be collected in order that we line up what we have determined are the health care needs of people in our communities with the human resources that we already have, those dedicated, committed, highly skilled individuals who are now providing health care here in metro and across the province.



We need to make some decisions in terms of how to utilize our services, those services that we have that are now in operation and that have been in operation and that may be in operation, in order that we can answer the question of why and where consumers' health services are best delivered, more effectively and more efficiently for those people.



None of those questions have been answered. I don't even know if any of those questions have been asked, Mr. Speaker, other than what appears to be happening, as is what is happening with almost every decision by this government, is that because of the fiscal pressures, because of the economic decline in this province, because of the fiscal crunch that this province feels itself under, they are making decisions to reform the health care system. They are making those decisions because they think it is going to save money. The problem is, and this has again been shown in study after study, if you don't care for people's health care needs, if you don't ensure that there is a healthy, well-educated population, then you are going to end up paying big time down the road. In other words, decisions that are being made to meet the short-term fiscal needs of the Minister of Finance and other members of the Treasury benches are going to end up affecting the population, affecting the health profile of this population and end up costing us much greater down the road in terms of people being further or perhaps more reliant on the health care system.



How are we to imagine that this government has anything else in consideration when they try to tell us that taking 2,500 health care workers out of the system has not affected the quality of health care delivery in this province, that taking a further 2,500 people, bodies, individuals who deliver health care in the Province of Nova Scotia, is not going to affect the quality of health care in the province, that the shutting down of hospitals, that the reduction of the number of beds by up to 25 per cent and greater is not going to have an impact. At the same time, they are failing to put into place the services in the community that are required to replace the capacity that has been reduced in our health care institutions. Nova Scotians don't believe that. Nova Scotians do not believe this government when they say the quality of health care in this province is not being negatively affected by decisions they are making. They don't believe that and I would suggest to you that this government is going to learn that fact very quickly.



At a rally that I attended a couple of weeks ago in Sydney, a point was made by a physician in Glace Bay who was concerned about the decisions being made by this government to reduce the capacities of community hospitals, of hospitals in the community, to meet the health care needs of their community. This physician said that these are hospitals - the hospitals that exist today - that exist because communities have decided, at some point or other, that they required them in order to meet the health care needs of that community. Now what is happening is that the province is coming along and saying to these communities, well, we don't think you need these hospitals any longer, or we don't think that you need to be able to utilize those hospitals to the extent you think is necessary.



In a very arbitrary manner this government, through the Department of Health, goes along and shuts down hospitals, it shuts down portions of hospitals, if not directly by actually saying that the doors will be closed, they do it clearly by cutting off funds and funding to these facilities, without even having any discussion with the community about what their health care needs are, whether they are being met by the hospitals or whether they can be better met some other way. It is the government that decided that the hospitals aren't meeting the needs of the community, and they go about unilaterally making decisions and making changes without ever consulting members of the community. That completely goes against the principle of health system reform advocated by the Blueprint Committee, by the minister's own action committee on health system reform.



Our caucus has stood up for years now and advocated the shift from a system focused on acute care to a system focused on primary care, because of the fact that we believe - and we still believe, Mr. Speaker - that the best way to provide and meet the needs of the citizens of this province, or anywhere else, to meet the health care needs of people, is to do it with programs and services that people have control over, that people have input in developing and that are accessible within people's communities, and a major component of that also includes education, information to ensure that we combine things like job creation, lifestyle choices, that we combine those items into the whole question of curing illness. That is what we have said and I think that is what the Blueprint Committee said when it delivered its report in April 1994, to lay out the principles and to lay out some specific recommendations on how the system should be reformed.



[12:30 p.m.]



The problem though is that the government, that the Minister of Health, has missed it. The Minister of Health on numerous occasions, when our caucus and others raised questions about what is happening with health care reform in this province, say well, we are not truly committed to health care reform. He tries to suggest that we are defenders of the status quo and that if we continue to deal with those concerns that we will jeopardize his attempts at reform.



Mr. Speaker, this bill is evidence of the fact that the minister and his colleagues are not following the kind of health care system reform that we have advocated, that the Blueprint Committee has advocated, that the Royal Commission on Health Care advocated, that every task force since 1974 has advocated. This government is not following that because every single recommendation with respect to health system reform talks about involving the community, identifying the needs of the community and changing the system in response to that, in order to meet those needs.





It is not about deficit reduction, although unquestionably we believe that by delivering health care, by having a health care system focused on the primary health care model, that we will spend less money on health care in this province. But each and every recommendation has said that we cannot make these decisions on the basis of finances alone, that we need to ensure that we maintain our focus on the community and on the needs of the community. Those are the decisions, that is the basis for the decisions to make changes to the health care system in this province. Mr. Speaker, I believe that this government has strayed some considerable distance from that model.



You know one of the whole questions here is that health care - and we have said this and the government has said this, the Minister of Health has said this - is not beds, health care is not bricks and mortar, health care is not systems and equipment and so on, health care has to do with people helping people, Mr. Speaker, meeting the needs, dealing with sickness, dealing with attitudes towards healthy lifestyles, it deals with the whole process of wellness.



That is not what this bill does. All this bill is is a decision to change the governance of four institutions into one, to completely change the systems approach of those institutions and to jam all the health care workers from those systems together. It is being done because for some reason that we can't fathom and the people of Nova Scotia can't fathom, this government seems to think it is going to cost less, whether that is because of the 1,000 health care workers that are going to be laid off or whether that is because of one set of administrators, I don't know. There is no evidence at all that that is the case, that that is what is going to happen.



What they are doing is shoving together the physical aspects here, in terms of the bricks and mortar, in terms of the systems, but they have forgotten about the people who deliver health care. They have forgotten about the people who receive health care. They have forgotten, I think, about the most important component of the health care system and that is the people who are involved, Mr. Speaker.



I think that is the only reason why you would get a bill in this Legislature that would not only try to jam those four institutions together, but would do it in a way that is so disruptive and discouraging to the people who actually deliver health care, that shows them no respect, Mr. Speaker, many of them, in terms of the years of valiant contribution that they have made to people in this province, that by not recognizing the rights that the VG employees, for example, are going to lose because of the transference out of being covered under the Civil Service Bargaining Act, its regulations and Statutes, by not recognizing that, is doing a disservice to these people. It is causing them great anguish and to ignore that, I think, is simply disrespectful. More importantly, perhaps, to ignore the fact that these are the people that are delivering health care, and if you send these people into turmoil, then these people are going to have difficulty continuing to deliver the same quality level of health care that they have been delivering for so many years.



That is clearly an indication that there has been very little thought go into this bill and there is very little consideration here about the whole issue of the tertiary care institutions meeting the health care needs of not only people in this community, but people across the province, and that is something that I think we should all pay some considerable attention to, Mr. Speaker.



The Blueprint Committee, it was indicated earlier by a previous speaker, was representative of and had participants on it from all the organizations, I think, involved in the delivery of health care in the Province of Nova Scotia. It had consumers as well as representatives of health care professionals, doctors, nurses, and CNAs; unions, seniors, the mental health association in the community and numerous other constituency groups in the health care system were represented on that committee. These people worked day and night because, if I recall correctly, they were given approximately two months to come up with the report that they did. They engaged in meetings that lasted literally days, trying to wrestle with the complex decisions that had to be made in determining how the system was going to be reformed.



They talked about things like labour adjustment in recognition of the fact that you can't just simply turn out all the people who are now delivering health care onto the streets and then leave them here and then try to set up a new system over there. Not only was it morally wrong, but it didn't make sense in terms of ensuring that there was some continuity in the integrity of health care delivery in the Province of Nova Scotia.



Recommendation after recommendation on human resource strategy recommended that time, money and considerable energy be put into developing a strategy, province-wide, that provided for how employees who were affected by the changes were going to transfer from one system to the other. If people were going to be laid off because it was determined through a clear assessment of health care needs and utilization that services that were now provided in a hospital would best be provided in a clinic in the community or through a home care system, then those people displaced would have an opportunity to transfer into the community. Those people would receive the appropriate training, if any was required, and any other adjustments that would be required for those people to make an easy transition into the community, into delivering a different level of service.



This is not something new, this province is not breaking new ground here. This whole process of health care system reform has been initiated in other provinces before this province, and they have dealt with those difficult questions about human resources and labour adjustment. There have been a couple of different forms of agreements reached, between health care providers and governments and authorities that are making the decision, that have provided, in one way or another, security for those people now in the system to move into the new system, if that is the determination.



The organizations representing employees, including managers and administrators, were involved in the process and have been involved in the process and continue to be involved in the process at every step along the line, to ensure that there aren't the kind of disruptions, the kind of dislocations, the kind of confrontations that we are seeing here in this province, and to ensure that things are planned out, to determine and to ensure that things are strategically considered, to ensure that there are no surprises, to ensure, above all, that there is a commitment to the process developed out of a shared responsibility and out of trust that grows from the recognition that everyone has a place in the system, that everyone deserves, because of that place in the system, to be treated fairly, to be treated equitably and that their skills, their experiences and their contributions will be taken into consideration before decisions are made.



So, it has happened in other jurisdictions. (Interruption) No, it has not always been smooth. It is a very difficult process, but simply because it is difficult doesn't mean that you can turn your back on it; it doesn't mean that you ignore the integration of all of those people into the process. To ignore those concerns, Mr. Speaker, I think is to simply set up opportunities for confrontation and disruption and problems in the system because as is the case with any other operation, any other process of developing a product, delivering a service, meeting needs of others, if the people who are delivering the service are not happy, are not satisfied, are not committed, do not feel that their commitment is being recognized, if they feel that they are being poorly treated, badly treated and worst of all, treated with disrespect, then that will have an impact on their ability to do their job and in the long run, I believe, it will end up having a disastrous impact on the system.



[12:45 p.m.]



Again, I go back to the blueprint. The Blueprint Committee, Mr. Speaker, said that the Government of Nova Scotia should establish a Human Resources Advisory Committee to report on a comprehensive health human resource strategy based on population health needs. Has that been done? No. Was that done before 25 per cent of the beds in this province were reduced? Was that done before 2,500 health care workers were cut out and a further 2,500 planned? No, it was not. Was that done before the decision was made to amalgamate the four major tertiary care institutions in this province? No, it was not. Another example of where recommendations of the Blueprint Committee have been completely ignored.



What about the whole question of, one of the issues with this bill is what is happening to a group of employees that are being transferred from one employment situation to another and that are, as a result, losing many rights, Mr. Speaker, that they had under their former circumstance. In the Blueprint Committee, it even talks about that no transfer of Civil Service employees be done until there is a proper legislative framework which protects employee rights. That is done in recognition of the fact that you cannot simply downsize, shut down beds, shut down hospitals, merge other hospitals, combine collective agreements under different legislation, without having some kind of a framework to ensure that that happens in a way that is responsible, to ensure that that happens in a way that is constructive and that recognizes not only the needs and the rights of those employees affected but recognizes the needs of the system to have those qualified, competent, committed, dedicated health care professionals continuing to do what they have been doing for so many years.



That has been missed in this legislation. That has been missed in every decision this government has made with respect to the delivery of health care and with respect to health care system reform in the Province of Nova Scotia. We are beginning, I think, more and more every day to see the results of that, Mr. Speaker, and it is not a pretty sight.



I have talked to some physicians recently about the problems in dealing with waiting lists and what they mean and so on because in many cases they are growing. In some cases they are not and in some cases they are getting smaller. For example, in the area of elective surgery, it was explained to me that this includes someone who requires a coronary bypass. The system, the way it exists now, can't respond quickly enough in order for specialists to assess the difficulties and to be able to treat the difficulties, that people are on waiting lists to not only get tests, to not only get treatment, but also to deal with the realities of the problems their illness is creating.



The system, as it stands now, is backing up to the point - because of the reduction in beds, because of the reduction in personnel, because of the cutting out of money - where people's health is in peril. Not only their direct health related to the illness, but if you or I were to have heart problems, that we required those kinds of tests, some kind of procedure, some kind of treatment, that when it was determined early on that in order to ensure we don't run into real serious life-threatening problems, that we need to curtail our activities, that we couldn't work any more, that we couldn't come to this wonderful, stressless work place that we have here and participate in this stimulating debate, that we had to stay home and put our feet up. If we weren't able to earn an income, if I wasn't able to earn an income, that would have a considerable impact on my family, and I think that is the case with a lot of people in this province. The longer it takes to identify and treat an illness, an illness that impairs your ability to earn an income, the greater negative impact that is having on not only you and your health, through the stress, but I would suggest it is also having a terribly debilitating impact on your family and on those people who depend on you and depend on your income in order to pay the bills.



It has been suggested to me that the tertiary care system now isn't meeting the needs and if it is blocking up to the point where people locally and people provincially are not being cared for as quickly and as appropriately as they should be, then I would like to know what difference it is going to make to put those institutions under one umbrella, to take more people out of the system and, inevitably, to take more money out of that system.



It has been described to me, Mr. Speaker, that the tertiary care hospitals in this province, the ones here in metro, the ones that deliver programs provincially and regionally, are more greatly underfunded than any other tertiary care hospitals of their kind in the country. The staff and the administrators of these facilities are facing an impossible task, and that is not going to change simply by changing the system.



I think we have to go back to the recommendations of the Blueprint Committee. We have to refocus, as this amendment suggests, in the whole question of the community and the community being involved, decentralizing services, identifying the needs in the community, the needs across the province, and adjusting our systems in a decentralized manner to meet those needs, Mr. Speaker.



I would suggest to you that that is, in fact, what is happening here, that the government is missing the boat on this and as a result, you and I, as consumers of health care in the Province of Nova Scotia, will pay the price for the people who are employed, the people who deliver health care in those institutions will pay the price.



Madam Speaker, I wonder if you would give me an indication of how much time I have left?



MADAM SPEAKER: Yes, you have until 1:03 p.m.



MR. MANNING MACDONALD: You are only going to take five minutes . . .



MR. CHISHOLM: Thank you, Madam Speaker. Well the member for Cape Breton South was under the misapprehension that I was going to take five minutes but . . .



MR. MANNING MACDONALD: I was only going by what you were saying.



MR. CHISHOLM: Well, I didn't say five minutes, I said a few minutes. To me an hour is a few minutes. (Interruptions) This is an issue that I take very seriously. The health care system and how it is reformed and how it meets the health care needs of the people of this province I think is very serious, I think it is something that deserves debate and I would appreciate hearing from the member for Cape Breton South, for example, to represent the concerns that I heard from 3,000-odd people in Sydney who are concerned, from Glace Bay, from North Sydney, from New Waterford, from Sydney, from the communities in that area people were saying that what the Minister of Health is doing in his decisions to cut and slash money and people out of the system is harming their system. It is harming, and they say their system, Madam Speaker, not the system of the Minister of Health or of the member for Cape Breton South, but their system is deteriorating because of decisions by this government, the government that the member for Cape Breton South is part of.



Madam Speaker, let's not forget that health care is all about the community and the system is all about meeting the health care needs of those people. These kinds of decisions fly in the face of that principle, Madam Speaker. I believe that deeply. I think this government has an obligation to Nova Scotians, not simply to try to manage the deficit problems that we have. That is not the only problem and let's not forget that is not why they were elected in 1993; they were elected to create jobs, they were elected to reform the health care system, in line with the recommendations of the Royal Commission on Health Care in this province. They were elected on the basis of making health, education, community services, job creation, economic development, decisions with the community, with the people who are participating in those systems, not behind some veiled curtain, not in some reclusive position without consideration for the concerns and wishes of the people of this province.



This government is doing the same thing that ended the previous administration's reign, Madam Speaker, they are making decisions on their own, without consideration for what it is that the citizens want or believe. That is the problem and that is why this amendment is so appropriate, because it talks about decentralization, it talks about the community being the people who are supposed to control the health care system, who are supposed to ensure that the health care system meets their needs.



This bill breaks that principle and this bill, I believe, needs to be drastically changed, needs to be altered not only because of what it does to the system of tertiary care delivery in this province but also, and perhaps just as importantly, because of the way it treats many of the employees, Madam Speaker, that deliver health care, right now, and have delivered health care for 30 years many of them, here in these institutions on behalf of the people in metro, on behalf of the people in Nova Scotia and they don't deserve to be treated with this cavalier attitude. We have an obligation here in this House to ensure that this legislation is changed before it comes back and before, in fact, it ends up being passed into law.



[1:00 p.m.]



Madam Speaker, I realize that my time is drawing near, I hope that I have made good use of my time by trying to express as best I can the problems that I have with this bill in relation to the amendment that has been introduced by my colleague. I will indicate, as I take my seat, and listen to other participants in this debate that I believe very much that this is an appropriate amendment and that it is one that we should all support. More importantly, I want to say before I take my seat, that I urge this government to avoid the confrontation that is before us, to ensure that we avoid the disruption in service that is pending and that we make some commitments to make real, serious alterations to Bill No. 47. Thank you.



MADAM SPEAKER: The honourable member for Colchester-Musquodoboit Valley, on the amendment.



MR. BROOKE TAYLOR: Madam Speaker, I am very pleased to rise this afternoon in support of the amendment. This amendment was put forward by my colleague, who happens to be the newest member to the Assembly. The member for Cape Breton West put a lot of thought and a lot of consideration into this amendment. He examined the legislation, Bill No. 47, the Queen Elizabeth II Health Sciences Centre Act. In concert with his caucus colleagues, he helped work up the amendment that we have before us today. The amendment is essentially saying that this House affirm or ratify, so to speak, the legitimacy and advisability of establishing a decentralized community-controlled health care system.



Now, there are many reasons as to why I support this amendment, Madam Speaker. I have, on different occasions, made contribution in second reading and to the other various amendments that have been before the House. But the health care providers in this province, at the present time, are under a lot of stress and they are under a lot of anxiety. I don't think too many of them are relaxing as we are speaking here today. They are very concerned about their jobs. The Minister of Health has suggested that as many as 2,500 health care providers, health care workers, health care employees will lose their jobs as a result of this government reforming the health system. I can't emphasize enough how burdened those employees are as we are speaking. The oppression that those people are under is immense.



Madam Speaker, I don't think there are too many members in this Legislature that don't support community-based decisions, whether they are relative to health care or fire services or church matters or what have you; most people, I think, in good conscience, would support community-based decisions. But the present system, the way the regional health boards have been set up and right now, I have to tell you, to be honest, it is hard to ascertain whether the regional health boards are still interim regional health boards or rather they are permanent health boards. But I can tell you in the central region that many of us are extremely concerned that the rural parts of Halifax County are not represented as well as they could be on the Central Regional Health Board, at least. So we have concerns that the regional health board and the community health boards will be people who actually are appointed.



They are going to be appointed by the Governor in Council or Cabinet, Madam Speaker, and we have to ask the question, will those appointees really reflect the health needs of the community? What about the pharmacists out in the community, the entrepreneurs, the proprietors of restaurants and service stations, farmers, foresters, and perhaps even the politicians that have worked, represented and volunteered on the local hospital boards. The local hospital boards ensured that the local and the community voice was represented well. There is a certain pride, a certain gratification, honour and, in fact, there is real joy in representing your community and volunteering.



Now if we are supporting this amendment, and I trust the government in good conscience will support this amendment, because what we are doing is we are asking this government and this House, Madam Speaker, the Nova Scotia Legislature, this Assembly, to affirm the advisability of establishing a decentralized community-controlled health care system. When you talk about a community-controlled health care system, you can't omit the people. It is extremely important that people are involved.



Now when the Minister of Health preluded moving the bill to second reading, before he made his motion, he made a lot of comments.



MR. MANNING MACDONALD: On a point of order, Madam Speaker, the honourable member opposite when he opened his remarks on the amendment, stated that the amendment was carefully crafted by the member for Cape Breton West. I would like to offer a correction. It took me a little while to find the two amendments, but the NDP amendment earlier in the morning, states, "That the words after `that' be deleted and the following be substituted therefor: `this House affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.'". Now that amendment was ruled out of order, earlier.



The second amendment that was introduced by the Tories, by the member for Cape Breton West, "That the words after `that' be deleted and the following be substituted therefor: `this House affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.'". Exactly identical resolution that the member states was carefully crafted by the member for Cape Breton West and I would like to read that into the record as a correction. The member for Cape Breton West simply copied the resolution from the NDP and introduced it as his own. I think let's get the record straight on that. (Applause)



MADAM SPEAKER: Well, I would rule that that is a record-straightening clarification and not a point of order.



MR. TAYLOR: Madam Speaker, the member for Cape Breton South is getting very picky here this afternoon. (Interruptions)



MADAM SPEAKER: Honourable member, I can understand where you are leading to, but I would prefer you stick to the amendment. (Interruption)



Order, please.



MR. TAYLOR: Madam Speaker, the honourable member for Cape Breton West introduced an amendment. Now, I know that the honourable member for Cape Breton West introduced this amendment and he did sit down with our caucus and we discussed this bill in its entirety, clause by clause. Believe me, when it ever gets to this House in clause by clause, there is going to be some much needed amendments come forward. We are not sure what is going to happen in the Law Amendments Committee, and I don't want to get off on that track right now, but I can tell you, and I would like to tell the member for Cape Breton South and all members in the House that this amendment is supported by more than just the Opposition. This amendment is supported by the Nova Scotian taxpayer and the Nova Scotian public as patient. Why wouldn't they support this? We are talking about putting the control of the health care services in our province in the hands of the people.



When the Minister of Health formed the regional health boards, he formed a central, northern, eastern and western health boards. I sent some correspondence to the Minister of Health indicating that we would like to see some further representation from the rural parts of Halifax County. We don't feel that we are receiving adequate representation. The Minister of Health told me that we were, in fact and at that time I didn't realize that the Health Minister didn't take the time to look to see how many miles Musquodoboit Harbour is from Middle Musquodoboit and Upper Musquodoboit and so on.



We had another example where the Minister of Health didn't know where Musquodoboit Harbour and Middle Musquodoboit were because I asked the Minister of Health, relative to a concern we had . . .



MADAM SPEAKER: I am not certain that this line of reasoning is consistent with the amendment that you are attempting to debate.



MR. TAYLOR: Madam Speaker, what I am trying to do is draw a similarity here. We are talking about health services being in the community. If somebody in Musquodoboit Harbour, where we have very fine people, is representing the needs of the entire Musquodoboit Valley, it is going to put an incredible load on their shoulders. What I am trying to point out is if you are going to have community-based hospital services, you have to have community representation.



As a result of some of the legislation that is before us, the volunteer from the community is going to lose that sense of pride, that sense of dignity and joy that they take so much pride in when they serve on community health boards. We hear that there is just not enough money to fund the community health boards, this is the information that we are receiving.



The minister came forward with a plan about regional health boards and certainly, talked about community health boards but the fact of the matter is, the community health board concept, while it may be laudable, just hasn't gotten off the ground. So what we have now is a case where the regional health boards, which may be interim or could be permanent, are making all of the decisions relative to the health care services in this province. That is unacceptable because those folks on the regional health boards, although they are very fine people, I am sure, in their own right and are very qualified, I would never question the qualifications of the individuals on the regional health boards but my concern is this, if you don't come from a community it is extremely hard to speak for a community.



We can look at all of our different volunteer organizations and I think the principle remains the same in many of our communities. In some, perhaps, there aren't volunteer fire departments but all of our volunteer organizations are made up of people from all different walks of life. If you have people who are representing a community organization that do come from a very broad background and all areas of employ are represented, then you have a very diverse group who are coming together on behalf of a community. When they intertwine and interact with each other, the result and the product is something to be proud of. Now what we have here is absolutely the complete opposite. It is important that this governing body, this Diet, it is important that the House of Assembly recognizes that the communities do want a say in how their health care is provided.



There has been a lot of talk as to whether or not employees of the present four world- class facilities will have employee protection. What we have learned from the Minister of Health is that 800 to 1,000 employees will lose their jobs. The Minister of Health tells us that the patient load on an annual basis is somewhere around 35,000. Now, 35,000 by anybody's imagination is a very substantial amount of people, so that basically means that for each and every one of us here in the province, most likely, we will know some people who will have to go into that facility. This is going to be the largest adult referral centre in the Maritimes, in Eastern Canada, so it is important that the bill and that the amendments that we are putting forward here today are certainly well prepared and given the very serious deliberation they deserve. In Opposition, we do have a responsibility and accountability to come forward with amendments to make bills much more doable and, in this case, the 26 clauses in the legislation all need amendments. That is what we are hearing; people have some concerns with this legislation.



[1:15 p.m.]



If we are really going to better serve the health needs of our community, then I would encourage and elicit any member, whether they are in government or in Opposition, to get up and speak on the amendment. If you want to speak against the amendment and sit on the back benches and cackle and heckle, well, that is fine. But if you really want to speak on the amendment, you should get up and say something, be publicly recorded. I don't think there is any problem in having somebody stand up and speak in support or, if you have some problems with the bill, speak against the bill . . .



MADAM SPEAKER: Honourable member, I think every member in this Chamber knows that it is their right to get up to speak. They don't have to be asked to speak or reminded to speak or teased to speak or told they are cackling and should speak. Each member in this Chamber knows they have that privilege.



MR. TAYLOR: Thank you, Madam Speaker. I always appreciate and respect your rulings, but I thought from time to time - perhaps I was wrong - that it would be appropriate to just jog the memory of some of the government members, because it isn't too often we see the backbencher get up and really speak on amendments or bills or what have you.



Madam Speaker, we are not talking about herding a bunch of cattle out of an old barn into a much newer, more modern barn here, we are talking about people and we are talking about health care. We are talking about clerical workers, we are talking about support staff, we are talking about health care providers, we are talking about RNs, CNAs, PCWs, orderlies, surgeons, neurosurgeons, neurologists, general practitioners; all of those people will have some concerns about this legislation. If this government has the wherewithal to support this amendment, it will enable members from the different parts of the province to go back to their constituency - and I have advised this on different pieces of legislation that we find needs further fine-tuning - to go back to Cape Breton South, Yarmouth, down to the Eastern Shore or to Cole Harbour and talk to your people. Go talk to your constituents and find out what they are saying about very important public policy. That is what we have before us; public policy.



People in the health profession are under a lot of pressure, even those who are lucky and fortunate enough to have a job. The general practitioners are under a lot of pressure and they are under a lot of wait and worry. It is small wonder that from time to time we see some of our doctors move to other provinces. I think part of the problem is that we don't have an amendment like this in our current legislation.



What board, in fact, is going to look after the Queen Elizabeth II Health Sciences Centre? Nobody has told us whether it will be the Central Regional Health Board, nobody has told us whether it will be a different entity altogether. It is important that whoever looks after that facility has a keen sense into just what they are managing. They are going to be responsible for delivering health care to 35,000 or 40,000 people, and the government could quite easily walk away and wipe their hands and make the board look like the bad person relative to this piece of legislation and how it is enforced. I ask you, and I ask all members of the House, is that being open? Is that being transparent? Is that being accountable? No, I suggest it is not.



You know the Minister of Health has asked us to have a lot of confidence in his ability. The Minister of Health is obviously a very busy man. He told us to have confidence but I have to tell you that talk is pretty inexpensive and low-priced. Talk can be cheap. Madam Speaker, that is not being unparliamentary, I say it with all due respect; if you haven't got something to back up what you are saying, you have absolutely nothing.



The Nova Scotia Government Employees Union, for example, have told us that they are calling on the government to make major substantive amendments to this piece of legislation. When we are talking about an amendment, and you know, Madam Speaker, everybody is being quite helpful here today and there are a lot of facilitators here and we appreciate that but I guess the point we are trying to make is if they would just take the time, and I would encourage all members, I don't think I am being out of order, I think I am being very on topic to ask members to take a look at the amendment and read the amendment. It seems like a very reasonable request.



Communities must not lose control of their hospitals, they must not lose control of their volunteer organizations because this legislation provides a way, through its very framework and through the terminology included in the bill, it provides the way for destroying many of our community health boards. Many of our hospitals that have boards in place now may find they are redundant, as a result of the legislation. So the amendment which was introduced by the newest member to this House who, after much careful consideration and, of course, in concert and in cooperation with the Third Party that introduced the amendment a little earlier in the day, the minister for Cape Breton West fine-tuned it a little bit and the Speaker made a ruling, and of course it is a very good amendment.



MADAM SPEAKER: I think it is the member for Cape Breton West, not the minister.



MR. TAYLOR: Yes, absolutely, I apologize, but it is a very good amendment and I commend the Speaker for recognizing that and allowing the amendment to be before us as it is at the present time.



We have an infrastructure in place and human resources in place at the four facilities that are going to be merged that I submit is second to none. We have an infrastructure, and I can only speak of a personal incident, if I may, Madam Speaker, where not too long ago one of my friends was called on to go down to the Queen Elizabeth II and get stitched up, and although the wait was a little bit excessive, the individual . . .



AN HON. MEMBER: Was it a hockey accident?



MR. TAYLOR: Yes, it was a hockey accident, but the individual was looked after very well at the hospital.



We are going to shift gears a little bit but still on the amendment, Madam Speaker, the Minister of Health told us that as a result, subsequent to this merger, we will see a saving of some $15 million. Now I suggested during my contributions to the different amendments in second reading of this bill that $15 million is a vast amount of cash, a vast amount of money. It surely seems incumbent that the Minister of Health could produce some cost-benefit analysis that recognizes, clearly outlines and determines where those savings will come from. I think in Opposition we have asked for that detailed study and the minister told us that he had a study but it has never been tabled. Now again I point out how important it is that we have a copy of that study because in Opposition we have a responsibility to get a copy of that study, look at it, and then we can say well yes, here the minister made a notation where duplication will be eliminated at the Cancer Treatment Centre, over here at the Rehab Centre we will save another $4 million and at Camp Hill Hospital we could save another $2 million. If you have some figures to represent what the minister is talking about, then it is very easy to support the legislation.



Now the amendment that is before us is before us, I believe, because studies like that were not detailed and tabled. So if we are really going to have a controlled health care service, we have to know, we have to have from the different facilities in the province an audited statement. An audited statement I do not believe is something that is unusual. It is not a request that is unreasonable, because audited statements give different members and certainly give the Opposition an opportunity to examine and scrutinize exactly where a minister may be coming from.



A lot of times we find that the health care in this province and the health care reform that we are going through, a lot of the decisions are being made because this government is committed to deficit reduction. When we are taking austerity measures and, certainly, being financially responsible, there are going to be times when people are upset and annoyed. But they are not just upset and annoyed for some frivolous reason; in this case, the employees of the health care profession are upset because they see that perhaps they could lose their jobs.



Health care reform is very deep, it is very critical and, in this case, it is going to be most far-reaching. The stress, the anxiety and the burden that the health care worker is going through must be immense, Madam Speaker. As you know, we have 18 counties in this province and all of those counties will have a hospital of some sort or another. I would suggest to all members of the House that the communities where the hospitals are located, and the counties where the hospitals are located, and the constituencies where those hospitals are located would want to continue having a voice as to how health care is delivered in those different hospitals. It seems like a reasonable request.



I know that the citizens in Colchester and I think I can safely say in Cumberland County and Guysborough, in Halifax and Hants, they would like to have a say in how their health care is delivered, but the government is not giving them that opportunity. The opportunity has long since been taken away. If this amendment is endorsed and ratified by all members of the House, it will put the much-needed community voice back into the delivery of the health care service in the different communities across the province.



I outlined another concern to the Minister of Health that I had relative to neurosurgeons in the province. That is another concern that could be addressed by a controlled health care system. If we are going to decentralize, it is important that the decentralization is community controlled. The Minister of Health told me that there were six or seven neurosurgeons in the province. Again, that is another list that I am waiting for. All these are very legitimate and well-founded concerns. The minister told us to have confidence in the legislation and we would like to have confidence in the legislation but, based on the language and the terminology in the bill, we have to come forward with amendments such as this; it is absolutely fundamental that amendments like this be carried forward and be inserted into the legislation.



None of us doubt that many of the decisions that this government is making are based on the almighty dollar. I believe that all members and all ministers representing the different government departments have received a directive from the Minister of Finance. They have been given figures that are very firm and they must fall within the numbers that have been dictated to them by the Minister of Finance. That is all fine and well, but you cannot cut and cut and not affect the everyday Nova Scotian. That is what this government seems to be doing, Madam Speaker. That is another reason why we have come forward with this amendment; an amendment that is very supportable.



If you recall, it is not too long ago, perhaps two and one-half years ago, the government came to power, talking a lot about 30-60-90 and jobs, jobs, jobs. 30-60-90, when it started off, was a very good initiative. It meant consultation, Madam Speaker.



[1:30 p.m.]



MADAM SPEAKER: Honourable member, I fail to see that 30-60-90 is related to the amendment in terms of . . .



MR. TAYLOR: Oh, I could explain that.



MADAM SPEAKER: . . . establishing a decentralized community controlled health care system. I have given you quite a bit of latitude. Many of your comments would have been well suited to second reading on the bill but we are on an amendment.



MR. TAYLOR: Well, in conclusion, Madam Speaker, I just want to say that most of the health care workers have partners, they have dependents, they are extremely concerned, they have groceries to put on the table, financial obligations, commitments. The similarities that I have tried and, in some cases, been unsuccessful with are very important. This legislation needs an amendment such as this. I will take my place now and await the next speaker. Thank you.



MADAM SPEAKER: The honourable member for Kings North.



MR. GEORGE ARCHIBALD: Madam Speaker, it is a real pleasure for me to speak on this amendment that tries to put the people back into health care. About two and one-half years or almost three years ago, now, the people in Nova Scotia got an adventure, there was an election, they were promised openness, partnerships and all that sort of thing, and the electorate for the most part, as we can see from the numbers that got elected, said we want to be part of a government that delivers to the people partnerships, sharing and the community. We want to get back to basics. So they voted for the Party that said, we are going to give you exactly what you want. I mean they did the polls, they knew what the people wanted, they said community is important. I knew that. This government really and truly got elected on the basis of representation of what the people really wanted. They said, you have had 15 years of a government that didn't give people what they wanted, so now, let's try it this way.



So, health care was a big item. The Minister of Health, presently, was a candidate and he talked a great deal about communities and the importance of community health care. I don't know of a health care worker in the province that wasn't excited about taking part, I don't know of a community that wasn't excited about saying, look, we are really going to have a say. We are going to run the show. That was before but this is now. The old saying, the proof of the pudding is in the eating and that sort of thing. You know why they say those things, because sometimes politicians, we hurt ourselves when we do it, but sometimes politicians make promises.



Now, this government has a real problem working with the employees in health care. I want to help them. For the life of me, I don't understand what is going on. I am trying to figure it out. The Minister of Health two weeks ago announced that we are going to have 2,500 jobs gone out of the health care system. Yesterday in the House, the Minister of Human Resources said that this was a terrible time of year to talk about going on strike. For the life of me, I can't figure out how the Minister of Human Resources can say you shouldn't go on strike but he can tell the Minister of Health, fire them, lay them off, let them go. Who are the people who will be receiving layoffs? How many people in the community that I come from and I represent are part of the 2,500? How many are going to be in Sydney, how many are going to be in Pictou, how many are going to be in metro? We are not sure but if it is such a bad time to talk strike, why is it such a good time to do layoffs?



Is the government listening to what the people are saying? Community-controlled Valley Health, where I live, used to control its own destiny. The Blanchard Fraser Memorial Hospital, through the community-based board of directors, and that board was all encompassing, we had representatives from the service clubs, from the ladies auxiliary of the hospital, from the medical staff, from the professions downtown, there wasn't an area of the community that was not represented on that board.



During the last 25 years at the Valley Regional Hospital, they said, look, we are going to build a centre of excellence and at the Blanchard Fraser Memorial Hospital, 25 years ago, the anaesthetist was a GP, a general practitioner, who had taken some courses in anaesthesiology. The surgery was done by GPs who had taken some course work. The community decided this isn't good enough. We want specialists involved in the health care in our area. So they made a conscious effort to attract specialists to come to Nova Scotia for surgery, for anaesthesiology, for all the specialties. If you had a broken bone, if you had chest surgery, they had the specialists operating out of the Blanchard Fraser Memorial Hospital. Their area of reach went far beyond the town limits of Kentville and surrounding area.



Word was getting around that the community in the Valley was doing a pretty good job at caring for the sick, the injured. People from Bridgewater, from Yarmouth, started to come to Kentville for major surgery. For many years we had the Nova Scotia Sanatorium at Kentville. So a lot of people were used to going to the Valley for treatment but even more people started coming from Windsor, Digby, Annapolis, Bridgewater, all over Lunenburg County because the community decided we were going to have the specialists operating out of that hospital.



The hospital then evolved into being a regional hospital, providing needed service. This didn't happen because the Minister of Health in Halifax said I want you to do it. The community in the Annapolis Valley decided this is what we wanted to do and that is what they did. After the hospital became so busy and the equipment started moving in, the building wasn't really that old. Part of it was built in the 1930's and part of it in the late 1950's, early 1960's. So, it wasn't that old but the problem was it didn't have air conditioning. As the lab worked increased, they had motors to run all this lab equipment so they could do their blood work. They had equipment that would run x-ray machines, the MRI machines. All of that delicate, sensitive machinery, has to run at a constant temperature. In the summertime, the machines would shut down. In the winter they would shut down because of the heat generated from the motors.



In ICU they had installed some portable air conditioners to try but even with that the equipment couldn't keep up. The halls were used for storage space. The rooms were altered, the entrance was altered, the BFM was a very tired building because it wasn't built with the 1990's in mind. There were two other hospitals connected with the regional one in the Valley. They combined the three and built the new Valley Regional Hospital which was opened in April 1992.



So far, I think we have to say, the community had a good idea. They brought in the special technical services that are required in the medical, technical and nursing field. They brought all that to the central hospital and it was working very well. The community decided that was the way it was going to operate. But the Valley Regional Hospital that is there now is more efficient and, in fact, the administrator told me that their cost-savings on overhead and operation have been so great that the hospital will have paid for itself in cost-savings in less than seven years. Now that is hard to believe, because it was a $42 million hospital, including the equipment, but it was such a good idea from the community, they have saved enough to pay for it.



To get the hospital constructed - and I heard my colleague for Kings South shout one day, he said that should never have been built, it was just a political thing to help you get elected - the community, the board of directors decided that they needed that hospital. It wasn't a decision made by the Department of Health in Halifax that said we have to go to Kentville and build a hospital to try to get that guy elected again. The people in Kentville needed the hospital and the people in Wolfville, Berwick, and Annapolis.



The member for Annapolis was on the first foundation to establish the regional hospital in Kentville. He wasn't going to do anything to help me get elected. He worked rigorously. The current member, he was on the original board to raise the funds. They had to raise 20 per cent of the money. Do you know the volunteers in the community went out and raised that 20 per cent in record time? They didn't raise it in Kentville, in Berwick; they raised it from Windsor through to Annapolis. Even people from Bridgewater who had received good treatment there, contributed. Many of the national companies did as well.



But it was a community effort. The service clubs made commitments. I am a member of the Rotary Club. We pledged $120,000 and we fulfilled that pledge. The Ladies Auxiliary have not stopped working and planning. In fact, they had a bake sale, that if you blinked, you missed it because it was so successful, the people were lined up three-quarters of an hour before it started and they were standing with their hands on their first purchase they wanted, and I don't blame them because it was that good. But these are the volunteers in the community.



Do you know something that is absolutely, totally, completely disgraceful? Those people form the auxiliary who worked so hard will have no place, absolutely no place, in the decisions in running this hospital. They always have in the past. But this government and the minister have taken that away. He says, I have the answers and if I don't, the people I am going to appoint do. The people he has appointed to run, oversee and decide what happens at the Valley Regional Hospital, don't even live in Kings County. There are two people on the regional board from Kings County; seven from Lunenburg, three from Annapolis, three from Digby, another handful from Yarmouth. The hospital is in Kings County and we only have two.



[1:45 p.m.]



I was at the Federation of Agriculture meeting this morning and I expected to be talking to farmers about agriculture. But do you want me to tell you what they talked about? Health care.



MADAM SPEAKER: What I would like you to talk about is the amendment.



MR. ARCHIBALD: I haven't said one thing that didn't talk about community health care. Every single word I have said has been about community. I will read you the amendment if you haven't read it. It says, ". . . `this House affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.'". (Interruptions)



MADAM SPEAKER: Honourable member, I am just suggesting to you that you might want to bring yourself back to the focused debate on the amendment and not on the agricultural meeting that you attended this morning.





MR. ARCHIBALD: I want to give you a little information, and perhaps if more members of this House would do what I did and talk to the people, they would find what the concern was. The concern was not on agriculture to those three people, the three people I spoke with first thing this morning, they were concerned about health care. They told me that the community is being excluded. They had firsthand information from an experience in the hospital that was unfortunate. Now, if you are telling me that I am out of order, tell me again, because when . . .



MADAM SPEAKER: Honourable member, I didn't use those words, they are your words.



MR. ARCHIBALD: Community hospitals and community care and putting the hospitals and health care back where it has been, we absolutely need it. When people are telling me they go to the hospital and they took his wife and there wasn't a bed . . .



AN HON. MEMBER: Now, that has nothing to do with the amendment. (Interruptions)



MR. ARCHIBALD: He said it didn't used to be that way when the community had some say. He said, what can I do? Now you may laugh at it, but it is a serious situation when you get to a hospital and there is no bed. This isn't the first time we have heard that. If you would like, if you think I am making it up, I will have him write you a letter. Working together, we built a health care system, by working within the communities.



The Minister of Human Resources has taken part in this debate 100 per cent. Nobody is going to criticize him, because he was answering our questions. But I would like to know why the Minister of Health won't stand in his place and answer our questions; tell us where we are wrong? This is a critical bill and a very important amendment and we deserve to hear from the Minister of Health.



Local involvement by service clubs and local people, the auxiliaries, the citizens working together and the volunteers - I would like you to go to the Kentville hospital and see the volunteers with their red jackets. They are in administration, they are in the gift shop, they are running an artist studio so that they can raise more money for the hospital, they are running visiting; there isn't a facet of this hospital that they are not involved in. But, you know, all those volunteers weren't consulted.



This Minister of Health, without the benefit of any community involvement, closed the Wolfville hospital and he closed the Berwick hospital; no consultation. Some people are saying he didn't even have the right because he didn't own the Wolfville hospital. It was paid for by the local community. If we had a community board, would they have closed Wolfville? Would they have closed Berwick? Probably not. There was a cost-efficient function developed by the community in Wolfville. Day surgery was taking place at Wolfville at about one-third the cost of the hospital in Kentville; it was working without interruption. At the present time, day surgery is postponed frequently when there is an emergency from a traffic accident or an illness and something has to be done in the operating rooms; then the emergency takes precedence.



When they operated out of the East Kings Memorial on day surgery, it was scheduled, there were no interruptions. It was better for the community, it was better for the patients, but the minister told us in the House that he had closed it because it was only a five minute drive to Kentville. Well, I do not know how he did it. Would the community have made that same decision? Now EKM is open, without any community involvement from the regional board that the minister set up. Nobody is certain what is happening. I can tell you that because I know for a fact because I asked the minister in Question Period. He did not know what the budget was going to be this year. Last year the budget for EKM was zero dollars. On instructions from the minister, money was funnelled from the Valley Regional to keep the EKM going. Where is the community involvement?



The workload is going up at the Valley Regional - lab work, emergency, the OR - and the staff is down by over 20 per cent. They are using the beds in ICU for a recovery room and they are using the recovery room beds sometimes for ICU. Occasionally, the recovery rooms are even spilling out into the wards. It is very stressful for staff because they are at a minimum level and they have to be called back. This is the reality that we are living in. The staff that we have are working to their absolute fullest.



You know, we do need the community involvement because, from time to time, the minister's decisions, made by his central office, are not the ones that the community finds helpful, useful or, in some cases, even sensible. Really and truly, what else could it be? The minister said, I am closing the EKM in Wolfville, but now he is trying to figure a way to open it again. Is it reasonable? It certainly is not. No local thought, no local community, nobody except himself because he said that it is only a five minute drive.



The people in the western region of Nova Scotia showed their commitment to community health care. They raised 20 per cent of the money to build the new hospital. The volunteers went out and raised it. Earle Rayfuse, the member for Annapolis, was one of those volunteers who went out and raised money for that hospital.



The Candy Stripers, these youngsters from high school are constantly calling and wanting shifts to work in the hospital so they can take part, they can learn and they can help. Each and every one of them learns from their experience of working with people who are sick and injured. They are learning things that will never ever leave them. How is it that we happen to have Candy Stripers? Because there are volunteers that organize, community volunteers that give their time to train and to speak and to coordinate the Candy Stripers. Does the minister even appreciate the assistance of the community volunteers? In spite of all the things that this minister and this government have done to health care, the volunteers are still in there, working harder now than they ever did.



We don't have adequate representation from our communities on the regional board. We have asked the minister several times to make it more equitable for the Valley region. We have asked him, we have written him, I have written him, the Mayor of Kentville has written him. Rev. Dr. Sid Davies in Kentville has called him. He chaired a committee that met with communities from White Rock to Black Rock and everywhere in between asking, what do you want to do with health care in the future? At one of the meetings they passed a motion to ask for additional representation. Their response wasn't any better than mine; it was just, I know best. That is what the minister said, two is plenty from Kings.



It is not even reasonable, it is not sensible. Now that the Valley Regional Hospital, which is a big hospital, the administration for the hospital will be taken care of from the former naval training base at Cornwallis because that is where the regional manager's office is going to be. After June 1st there will no longer be an administrator of that hospital. Was the community consulted? What does the community in the Annapolis Valley feel about that? Truly, does it make any difference? Sometimes I think this government is like a wooden dog that wouldn't listen, because we have been asking, people have been begging but nothing makes any difference, nothing is getting through.



Is it fair that we have such terrible representation, such inadequate representation on the regional health board? It isn't fair but politically perhaps it is okay. You know, the minister should look further than people who he knows and he should contact people in the community, people who have served on the board of the hospital for so long. They must be doing something right because that hospital had an excellent record and it is still doing the best it possibly can in difficult times. Maybe some of the people who are on the hospital board should be on the regional board, but all the people who were on the hospital board, the Valley Regional, didn't quality. That is sad.



Our communities feel alienated; Berwick and Wolfville both feel alienated because of the lack of community involvement, no input. The community has a role to play. Centralized authority is not working for the benefit of the sick and the needy and in Nova Scotia. I started to tell you of some occasions this morning that caused concern so I won't tell you any more. Perhaps some of you have experienced the same thing, perhaps someone from your community has called trying to get an appointment with a physician or trying to get a bed in a hospital.



In Cape Breton there was an announcement to cut $11 million. None of the community was involved in that decision, that was a central office decision. It is getting scary what is happening in health care. It is so scary that the Minister of Health had to hire a doctor finder so that the physicians that are leaving can be replaced. Let me talk to you about the community of New Germany. They built a health care centre and the honourable member sitting right over there, the member for Lunenburg, she cut the ribbon to open it.



AN HON. MEMBER: No, she didn't.



MR. ARCHIBALD: You didn't? Well you were certainly front and centre the day they opened it because I saw a picture of you being there. The New Germany health facility is an example of what the community can do. The community feels somewhat let down when they contrast the community involvement from what it should be from the Department of Health.



[2:00 p.m.]



The Noel Shore community built a health centre on their own and the Department of Health helped with programs that were necessary for that community. There are different communities in the province that have different needs, that is community health. We have different needs in the Valley perhaps than they do in Cape Breton and I think the people in the Valley are best able to tell you that rather than the minister in his office in Halifax. People fought to build our community hospitals; the people should have a say in how they are operated.



You know, this bill that we are trying to amend, we don't even know what the make up is going to be for the board for the QE II in the long term. Is it the community hospital for metro? Is the community going to be involved in any decisions at all? How can they feel a part of it when all appointees are politically appointed by the government through the minister?



If you want to destroy a community, the quickest way to do it is for the government to say, we have got all of the answers, just do what you are told. The community can show you time after time that they have the answers and they can solve problems and they can help. Believe me, the communities want to help in health care. The staff want to be part of health care reform, but this government has ruled everybody out. There is only one area that seems to really know what is going on, in the minds of the government, and that is the central office. Put the decisions in the hands of the minister; take it out of the community.



The community has gotten along pretty well for a long, long time, developing and building on the health care system. Now, it is different. Volunteers are wondering, are we appreciated? Should we keep putting all of our time in here? They know the sick, the injured, they know they need them, but does the government? We have to let the communities make the decisions about health care. We cannot exclude them any longer. We have people with expertise, ideas and abilities, they want to help. A decentralized, community controlled health care system won't cost the government more money, it will save the government money. We are all in this together and there is only one taxpayer. The government has to learn not to fear the decisions of the people and not to fear the advice they get from people because there is no area of the province, there is no group that has indicated to the minister or this government that health care should be tightly centralized within the grasp of him or his department.



When are we going to hear from the Minister of Health? The most important bill that man has ever put before this House and when is he going to stand in his place and defend it? That is a legitimate question.



Regional health care, regional health boards may sound new and sound exciting but they are not delivering to the people of this province. How is the community going to get involved in these regional health boards? We heard that the boards were going to be appointed later on. It is sort of putting the cart before the horse. He appointed, I suppose his friends or relatives or people he knew, I don't know how he picked the people he picked. I know he didn't pick very many in Kings County. (Interruption) That is true, the community had nothing to do with it.



Now I must admit that Dr. Perkin, who is Chairman of our regional board, is a fine, upstanding gentleman and he is a good chairman and that was a good appointment. I am not arguing about Dr. Perkin at all. I have the greatest respect and admiration for that man. He ran probably one of the finest universities in all of Canada but he is there by himself. Where is the community? We keep waiting.



AN HON. MEMBER: How does the community have access?



MR. ARCHIBALD: Well, who knows how the community has access because the communities don't know. The boards that are sitting at the hospital, the people, this is sad, Mr. Speaker, it is really sad. The people who put money, their hard-earned money, some put $20, some put $200 and some put several thousand dollars, individuals put their hard-earned money into building these hospitals, helping to build our health care system and then we have a gentleman, who happens to be minister, who totally, completely disregards every single person who has made a contribution to the Valley regional health care. He has never consulted with anybody. He is on his own.



AN HON. MEMBER: Did he meet with them?



MR. ARCHIBALD: No, he didn't meet with them. He said in the House, he closed Wolfville because it was five minutes away from Kentville and I know that everybody in the House realizes that is not a valid reason because Kentville and Wolfville are a lot further than five minutes apart. You see, if that is an example of the thought process, it is pretty scary.



I know for a fact that when the deputy went to close the Annapolis hospital, between Halifax and Annapolis the decision was changed and a different fax arrived. Don't close it. Was the community consulted when the minister said we are going to have fancy new California ambulances? Nobody in my community was consulted because if they had been they would have said listen, you tell us what kind of an ambulance you want and we will deliver that kind of an ambulance and that is the service we will provide.



We arrived in the House one morning and we had an ambulance bill put before us.



MR. SPEAKER: But the member realizes we are not talking about the ambulance bill today. Today we are talking about Bill No. 47.



MR. ARCHIBALD: No, we are talking about regional and community health care. I am so well aware of community health care because I worked hard to help our community build the Valley Regional Hospital.



AN HON. MEMBER: You probably even raised money and made a contribution.



MR. ARCHIBALD: I certainly did. I am part of community health. I used to be. My family is involved. My wife works hard as a volunteer at the hospital. She puts in several days every month, along with hundreds of other people in the province. When are they going to be heard and listened to? When is the minister going to talk to the volunteers that are making health care happen in this province? When is he going to meet and talk with the workers? We are laying off 2,500 people and they got the announcement two weeks before Christmas. It is not a fit time to talk about strikes, but it is all right to start talking about layoffs. I guess a layoff is better than a strike. Who is in charge of health care in this province? I am telling you, if we don't get input from the communities pretty soon, the devastation that is being caused and will continue to be caused, will not be repaired easily. We have already seen (Interruption)



Well, the Provincial Health Council, we have a letter demanding the minister's resignation because there are only five people operating on the health council now. It goes on and on. Where are the communities? When are the people who are paying the bills going to be consulted and listened to?



I was at a meeting in Truro. There was a community meeting in Truro. The minister really would have learned a lot. We had dozens of them in Kings County because people are worried about health care. I don't think there is anything that is of greater concern to Nova Scotians right now, right today, than health care. What in the name of time is happening? We cannot find out. We have a bill before us - that we are trying to put an amendment - that the Minister of Health introduced and all we have been hearing from is the Minister of Human Resources ever since.



I am beginning to feel that the Minister of Human Resources should be the Minister of Health. He is the man speaking for health. When do we hear from the Minister of Health? Mr. Speaker, this is the most serious issue that Nova Scotians and your government have faced and so far, you are not handling it well. This government is not handling the needs of the communities. They are not handling the needs of the sick, the ill, nor are they working anywhere close to a harmonious relationship with the staff and the employees who are putting in hours, many of them working beyond any contract that this government may have signed with them. They are doing more and getting paid less and is there anyone in this government who is interested in paying attention to the workers and the communities and health care? It is a serious matter and I hope that at some point the Minister of Health will stand in his place and give us some answers because we deserve them and we demand them. Thank you.



MR. SPEAKER: The honourable Leader of the Opposition.



DR. JOHN HAMM: Mr. Speaker, I am pleased to rise to speak to the amendment to Bill No. 47. The essence of the amendment is to, ". . . affirm the legitimacy and the advisability of establishing a decentralized, community-controlled health care system.". I think this is a legitimate amendment, as did the Speaker, in ruling that this amendment was in order because what has been happening as we debate, we suddenly realize that the Blueprint on Health System Reform clearly indicates that the delivery of community health care should in fact have a strong input from the community. So the essence of this amendment really comes from what was recommended in the Blueprint Committee.



The traditional way that health care was delivered, and very effectively over the years, was in fact a community-based system. We look back at how hospitals were built and, of course, originally hospitals were built and entirely funded by the communities. It was community-based and there was a great deal of community input. It worked very well. Bearing in mind that hospital health care before 1950's was, in fact, a responsibility of the patient. So when you went into hospital, of course, you paid the entire bill yourself, before the introduction of the hospital insurance plan. This was made possible by the fact that there was a tremendous amount of community involvement in the delivery of health care in those pre-hospital-insurance days.



[2:15 p.m.]



I remember looking at a report of our particular hospital which was written, a report from pre-hospital-insurance days, and it absolutely outlined with clarity the amount of community involvement in the delivery of health care. In the course of the report, it was given that a certain amount of food was brought in by a certain individual for the hospital, a certain number of bottles of preserves were brought in for the hospital and so on. The point of this little story is to clearly point out that traditionally in this province, hospital care and health delivery was a community-based effort and everybody chipped in and tried to help out, and that the hospital itself would be built with community funds.



Over the years as the government became more and more involved in the delivery of health care at the community level and as things became, perhaps, more centralized, a little less decentralized, then the amount of community involvement decreased but nevertheless it did not cease. Even today when hospitals are built in the communities, it is not 100 per cent of government provincial funding. Certainly with our hospital which has undergone its second of our so-called two renovations, 20 per cent of the capital expenditure actually comes from the community. So communities continue to contribute to their own hospital care from their own resources.



There is a very great concern, as we are moving towards less and less community control of health care, that the willingness of the community members to contribute in a real meaningful way to the funding and the support of local health care delivery will certainly diminish as they become more and more disenfranchised as this process goes on.



In our own hospital board, there is one member appointed by the government to sit on the hospital board. That hospital board is made up, otherwise, entirely of local people, who are appointed through the local process. Now, the government appointee as well is a local person but they are appointed by the government and they are to represent the government's interests in that board. We see in Bill No. 47, and I think this gives legitimacy to the amendment, that the new hospital board will not be appointed by members of the community but, in fact, the eight directors will be appointed by the government. Will this lead to a sense of increased community involvement or in fact will it lead to that sense that this is just another government agency and that there will be no room for community input?



The document from Blueprint to Building, Renovating Nova Scotia's Health System, makes some very key observations in terms of what we are talking about in this amendment. I will just quote a couple of short sentences from this report. "Community members will play a key role in making decisions about health and health care resources in the future." Bearing in mind this document comes with the stamp of the Nova Scotia Department of Health. "This is in keeping with government health policy and the Blueprint's recommendations . . . Our goal was to create a system that would give regions and communities the ability to define and deliver services and programs to meet the specific needs of the residents. At the same time we need it to ensure that every Nova Scotian can receive a consistent level of necessary health care services of the highest quality.".



The documents that relate to the reforming of our health care system certainly paraphrase what this amendment is all about. It absolutely confirms the desirability of the communities having a real say in what goes on in health care delivery.



One of the issues that comes forward is to the relationship of the new QE II Health Sciences Centre Board of Directors and what that relationship will have with the regional health boards. That has been the subject of a number of questions in the House and to this point, the minister has not given clarification as to what that relationship will be. It would appear to be the direction of government that eventually the regional health boards will take over in the communities the administration of the community and regional hospitals in the province. When that is going to occur, of course, is open to some doubt because it was supposed to have happened in September and it is now December and it still hasn't happened.



I have some reservations as to how effective that particular administrative structure will be and I am anxiously awaiting the details of how it is this politically appointed board plans to run our hospitals at the local level. That leads, of course, to the speculation as to what will be the relationship of the metro regional health board to the Queen Elizabeth II Health Sciences Centre board, bearing in mind that in addition to tertiary care, this particular organization delivers community care for the residents of Halifax, Halifax County, Bedford and in conjunction with the Dartmouth General, to the people of Dartmouth. The community service function of this organization, if it is to have some relationship to the community, will have to be in some way tied into the regional health board.



The regional health boards, to this point, are political appointments. They have gone well beyond what was their indicated lifetime, indicated by the Blueprint Committee and still, nevertheless, they are operational. I am not aware of any plan that the minister has before him that in the immediate future that elected boards will, in fact, replace these politically appointed regional health boards. One cannot help but be critical of the failure to meet the time lines that were originally established in setting up these boards, in perhaps concluding that somehow the process has gotten off the rails. It hasn't been able to meet the time lines that were originally provided by the minister and provided in the Blueprint.





The whole purpose of this, I think, is to try to point out to the government and to the Minister of Health in particular, that rather than decentralizing, as indicated as being the objective to be sought after in the Blueprint Committee but that rather than decentralizing, actually, he is centralizing health care. This may well result in a disenfranchisement within the communities of health care delivery and a failure of communities then to respond and to provide the assistance that they do to health care delivery in our province.



I know that there is a Victoria General Hospital Foundation. That foundation, as well, is made up of volunteers and people who are anxious to assist in the financing and provision of certain equipment, therefore the Victoria General Hospital. We have a similar organization in our hospital, the Aberdeen Hospital Foundation. That foundation has been very successful in raising a number of millions of dollars. Actually, at present over $5 million and, before it is through, it will be over $6 million of community money which will be used to augment the money available from the province in the provision of equipment in the hospital.



You know if the community loses that sense of ownership that it has for the Aberdeen Hospital and if it loses that sense of being part of the decision-making process and part of the process of the delivery of health care, then that kind of community support will, in fact, disappear.



Now From Blueprint to Building - again renovating Nova Scotia's health care system - absolutely confirms that what I am saying, and just a short quotation, Mr. Speaker, I think to add weight to my words. "Community involvement will occur through a network of Community Health Boards (CHBs), four Regional Health Boards (RHBs), and a Provincial Programs and Services Board (PPSB). By building up from the community, to the regional, and then to the provincial level, each aspect of planning will become part of a well-integrated whole.". So it would seem that the documents the government provides, in terms of the reforming of our health care system, absolutely confirm that they want to decentralize the system. Yet, when we come to the Legislature and we start looking at the documents that will effect the real change, we are, in fact, centralizing the system. Again I point back to the fact that the board of directors, the eight directors of the board for the hospital, will, in fact, be appointed by the government.



It would seem to me that if we are to take the provincial hospital, the Victoria General Hospital, and isolate it and make it less of a provincial hospital, then one of the ways to do that would be to have more involvement at the board level by the community and rather, again, as we did with the regional health boards, simply have a number of people appointed by OICs as representatives of the government who are, in fact, running the hospital. So there is a great deal to be considered in this amendment. I think it is a positive amendment and I think by accepting this amendment here we would give the government some food for thought. I think it would give them an opportunity to perhaps put health care reform back on the rails, back and follow perhaps more closely the recommendations of the Blueprint Committee, perhaps follow more closely the recommendations in their own document, Renovating Nova Scotia's Health System.



You know it is one thing to put out a glossy brochure for widespread distribution, which is really perhaps nothing more than a PR exercise, and it is another thing to come into the Legislature with legislation that absolutely follows the directions that the glossy brochures indicate is the direction the government wants to take. So let's get back to the glossy brochure, Mr. Speaker, and let's pass this amendment. Thank you very much.





MR. SPEAKER: The honourable member for Halifax Citadel.



MR. TERENCE DONAHOE: Mr. Speaker, I am pleased to have an opportunity to address a few words to the amendment now before your House, that, "`this House affirm the legitimacy and the advisability of establishing a decentralized community controlled health care system.'".



It is clear that the thrust of Bill No. 47 runs absolutely counter to doing that. I guess what strikes me so much, Mr. Speaker, is that as my Leader has just said, the hallmark, according to the Minister of Health from his earliest days as Minister of Health, the hallmark of his vision, if I may use that word, of the reform of health care delivery service in the Province of Nova Scotia, has been community based and decentralized.



My Leader, just moments ago, made mention of this glossy document, From Blueprint to Building. I would like, as I begin my remarks, if I may, to go to the document, Mr. Speaker, which the Minister of Health refers to frequently, some might say, ad nauseam, as his Bible. That, of course, is this document entitled, Nova Scotia's Blueprint for Health System Reform. It is dated April 1994 and it is a set and series of recommendations by the Minister's Action Committee on Health System Reform, the so-called Blueprint Committee. I don't know if I have a particular paper reference to it, but I can tell you without fear of contradiction that the occasions on which our Minister of Health, the Honourable Ronald Stewart has said here in this place and publicly outside this place, that he endorses to the full the recommendations of the Blueprint Committee, those references and those statements from the Minister of Health, are legion.



[2:30 p.m.]



He has made that comment so frequently, it would take a super computer to add the number of occasions on which he made remarks to that effect. I would like, with your indulgence, Mr. Speaker, to go to the Minister of Health's Bible, to go to the blueprint and I would like to make a few references to it through the course of my remarks relative to this particular amendment.



The document which the Minister of Health says is his Bible, says among other things, the following. Under a section entitled, What Nova Scotians Are Saying, you will read, as I know you have read this document some time ago, Mr. Speaker, "In reviewing these reports and the recommendations . . .", and presentations made to the committee, ". . . made during numerous public consultations, it is clear that people are worried about the future of Nova Scotia's health care system.". Indeed, if they had known that Bill No. 47 was coming, the language would have been stronger than worried about the future. This document goes on to say, "Many Nova Scotians have said: . . .", and they have said quite a few things and I will just make reference to a couple, "they want to have more say in decisions affecting their health; they want to be informed consumers; they expect services to be organized in such a way where people won't fall between the cracks; they want a health care system that is efficient, accountable and responsive; they expect organizational and departmental barriers that prevent people from accessing services to be removed.". And, on and on and many more things said in this blueprint document.



Well this is the document and those are the statements upon which the Minister of Health says he has been predicating his and this government's health care reform initiative. As I say, in the face of all of that, we see Bill No. 47. The amendment says, "`. . . affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.'". Well, our Minister of Health says that there are certain principles which he employs as Minister of Health, as he undertakes what he calls his health care reform initiative. I would like to refer to a couple of those. He says, and the reason I say he says, as I make reference to the blueprint document as I have said a moment ago, Mr. Speaker, the Minister of Health says that he stands by and behind and in full support of every word of this document.



This document says, "Health care must be consumer, family and community-focused, not facility and provider-driven. Health care providers will respect the whole person and strive to integrate body, mind and spirit. Integrated, seamless systems will be designed to accommodate the needs of individuals and communities. As Nova Scotians have a right to appropriate care, there will be a shift in emphasis from institutional care to community-based service.". I ask you to assess the language of Bill No. 47 against the words "there will be a shift in emphasis from institutional care to community-based services.



Dr. Stewart's Bible says further, Mr. Speaker, "Health is a community responsibility. Local and regional structures will be established to give individuals decision-making authority. These structures will be accountable to the communities they serve. Appropriate supports must be put in place to allow Nova Scotians to actively participate in this decentralized locally-controlled health system that meets provincially-prescribed standards for programs and services.".



The Minister of Health's document, his Bible, further goes on to say that, "The reformed system will optimize and integrate the capabilities and skills of providers, patients, families and volunteers. Health care services will be delivered by persons and multidisciplinary teams who can offer the highest quality care with the greatest efficiency and effectiveness. The system will work to develop effective partnerships between and amongst consumers and providers.".



Further, the document says, "access to information about health and the health system is essential for effective decision-making to occur at all levels. Informed consumers and providers will know how to achieve good health, how to make best use of the health system and how to participate in managing it. Providers have a responsibility to give consumers the information they need to make informed decisions, including providing easy access to their health records. At another level, data collection and analysis is essential to the evaluation process of the health system.".



So it is clear as we read those words and we read the principles enunciated in the Minister of Health's Bible, the blueprint, that there is a great emphasis, Mr. Speaker, as you see, on community-based health administration and community-based health delivery.



Mr. Speaker, the Minister of Health will tell Nova Scotians and has told Nova Scotians repeatedly that based on his Bible, the blueprint document, we would be moving away from what he described. Frankly, I share his view and the description that we would move away from too heavy a dependence on institution-based health care and move to a decentralized, community-based health care delivery system, and I share that view. I believe that is right, I believe that to too great an extent we have in the past, and even as of the present, we are too greatly dependent upon an institution-based health care delivery system.



This blueprint document, the minister's Bible, goes even further when it talks about regionalization and decentralization. This minister says that he supports a document which speaks to regionalization and decentralization. I, this moment, and all members who are so inclined, have the opportunity to speak to an amendment before this Legislature which asks this House to affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system. Amazing, isn't it, that in the minister's Bible there is a section entitled Regionalization and Decentralization?



The document is illustrative because it points out what direction this very minister gave to the people who were designing the blueprint document. The document says this, "The specifications given to the Blueprint Committee by the Minister of Health . . .", by Minister Stewart, the Minister of Health for the Province of Nova Scotia, he actually gave certain specifications to the Blueprint Committee, completely appropriate and he did it. The document says this, "The specifications given to the Blueprint Committee by the Minister of Health called for a reformed health system that would be regionalized (resources are organized and shared among communities in an area) and decentralized (spending decisions are made locally rather than centrally).".



The document goes on in describing the minister's direction to the Blueprint Committee to say that, "There are several important reasons why the health care system should be regionalized and decentralized: to allow for effective community input into decision-making about health care resource allocation; to improve the coordination and integration of health services at the community and regional levels; to minimize administrative and overhead costs in order to put more money towards services and programs; to reduce disparities among regions in the access, availability, cost and quality of health care; to reduce disparities in health status within and among regions, to develop a funding formula that responds to the health needs of the region.".



I find it very interesting and very curious, Mr. Speaker, that we have a Minister of Health who tells the Province of Nova Scotia that his vision of health care, health reform and redesigned health care delivery is based on this blueprint document. He refers to it, or he has on many occasions, as his Bible. It has a section in it talking about the fundamental need for regionalization and decentralization. It outlines in the document, itself, the very specifications provided to the Blueprint Committee by this same minister.



Believe me, I will not re-read what I just read but all of the specifications that the minister outlined to the Blueprint Committee, Mr. Speaker, each and every one of those so-called important reasons why the health care system should be regionalized and decentralized are fundamental to making it possible for the community to have a role and function, a greater say, a greater play and a greater authority in the delivery of health care. Then, curiously, it is that same minister who purports to believe all of these things, and he says out of his own mouth that he believes all of these things, that he supports the document, this same minister then produces a bill, Bill No. 47, to establish an absolutely humongous centralized health care science centre.



Reference has been made to other speakers, Mr. Speaker, in the course of debate, perhaps even relative to this particular amendment but, certainly, in earlier stages of the debate relative to Bill No. 47, about studies which have been done that address the question of the critical mass of the size of health care delivery institutions.



We have been told, and I don't have them with me but I have had access to, documentation which indicates that in a great number of other jurisdictions there is increasing concern whether health care delivery institutions, which are very much in excess of 500 or 600 beds are, in fact, going to be effective, cost-efficient, administratively easy to run and provide quality service.



There is more to the minister's Bible, as I know you know, Mr. Speaker. In addition to some of the things to which I have already made reference, you will be aware, Mr. Speaker, that this Bible provides for the establishment of regional health boards and community health boards.



What I find interesting is that we do not know, despite repeated questioning, whether or not this minister who purports - the Minister of Health is the minister to whom I refer - to support the regional health board, community health board concept, we don't know whether or not this new health sciences centre which is contemplated by Bill No. 47 is going to report in any way, shape or form to the regional health board. Well, you cannot have it both ways, the Minister of Health cannot have it both ways.



If there is a regional health board and there is in the central region, when are we going to learn? Are we going to learn after we are asked by a 41 seat, 40 seat, whatever number seat majority, Liberal Government, after we are asked to pass a piece of legislation that pulls all these institutions together. Are we then going to be told by the Minister of Health that, yes, it does, or no, it does not have any relationship to the regional health board and the regional health board here is not going to have anything to do with the QE II Health Sciences Centre?



I don't think that is fair to anybody here. I don't think that is fair to the people of the central region of the Province of Nova Scotia. Since these institutions affected by Bill No. 47 are vital and crucial to every community and every resident of the Province of Nova Scotia, I don't think it is fair to anybody in Nova Scotia and indeed, it has implications right across Atlantic Canada because the QE II Health Sciences Centre is of vital importance and a fundamental and central element in the health care delivery system right across all of Atlantic Canada.



So when are we going to get an answer from the Minister of Health who says his Bible is this blueprint, and the Bible talks about regional health boards, the Bible talks about the community health boards and the Bible talks about home care, and when are we going to be told, relative to us being asked to pass judgment one way or another on Bill No. 47, as to where the regional health board fits in relation to this Health Sciences complex?



[2:45 p.m.]



Back in February 1994 - this is now December 1995 - there was a release and the release is entitled, Health - Blueprint Committee Releases Decentralization Plan, that is what we are talking about, the decentralization and the regionalization of health care delivery. Back in February 1994, the Blueprint Committee released its decentralization plan. If you wanted to have further detail you were to contact Dr. David MacLean, Blueprint Committee Chairman. Just a couple of references from this document, if I may.



This is dated February 1994, almost two full years ago. "Steps to give communities more power to make decisions relating to health are outlined in recommendations released today by the Blueprint Committee on Health Care Reform. The Committee, appointed in November" -so two years ago the Minister of Health appointed this group - "by Health Minister Ron Stewart to develop a broad policy framework for reforming Nova Scotia's health care system, will submit a final report in mid-April.".



A little later on in the element that relates, I suggest, to the amendment that is before your House is as follows, "In order that the reform process moves ahead without delay" - without delay, now this is February 15, 1994 and we were going to move without delay and we are getting close to two years later - "the committee recommends that it proceed in two phases. In Phase I, interim regional boards will be established for a period not to exceed December 31, 1995. They will also establish community health boards and work with the province to identify regional funding arrangements, core programs, standards for service delivery and methods for evaluating programs and services. As well, they will develop and implement regional plans and will include rationalizing institutional programs within their region. That is why it is so important that two thirds of the regional health boards be comprised of representatives chosen by . . .", would you believe it, " . . . community health boards.". The Blueprint Committee also recommends that health care consumers make up half of the community health boards, "If we want consumers to fully participate in the process, they must be represented at the table when decisions are being made", Dr. MacLean said.



I may be wrong but I don't know, I am quite certain I am correct in believing that they don't. I don't believe that the regional health boards are comprised of representatives, two-thirds of whom are chosen by community health boards. I come to that conclusion by this very complex piece of deductive reasoning because we don't have the community health boards, the community health boards who are, according to our Minister of Health's Bible and those who were helping him write his Bible, they were suggesting that these regional health boards, it was so important that two-thirds of the regional health boards be comprised of representatives chosen by community health boards and the community health boards aren't there, so how can we have regional health boards, two-thirds of the members of which are representative of and recommended by community health boards?



Well, we don't. What we have is regional health boards which are comprised of political appointments made by this government under the guise and through the cleansing process of the Human Resources Committee, of which I happen to be a member and every couple of weeks I have the pleasure of going to the Human Resources Committee and watch a wave of Liberal names go by me and the committee and they are appointed to agencies and boards and commissions across the province. (Interruption) Oh, I had to finally get it in. Well, I would imagine there are other members of this House who would agree with me that I am not far off the mark when I suggest that that is the way in which the Human Resources Committee has functioned and the results that have been reached.



So we get all kinds of documents, Mr. Speaker, from the Minister of Health talking about his new health care reform process and that it is community-based and it is going to be done in accordance with what he calls his Bible and, again, it is the blueprint.



There is another in the Minister of Health's Bible and it relates to the amendment. This is the document which the Minister of Health says to the people of Nova Scotia he supports. He stands by all of the words and the recommendations made in this document and there is a section in it entitled, "Community Development . . . The Foundation. Community development is essential in a decentralized health system in which communities will have much greater authority and control over their own health. Community development means: assessing a community's needs and identifying its strengths; building partnerships between and among community members and health professionals to respond to identified needs; managing and sustaining change by providing information and organizational assistance; working with various sectors within the community including government agencies, educational institutions, service agencies, private organizations and volunteers.".



Well, I have spoken to a lot of people in the metropolitan region, Halifax-Dartmouth-Bedford-Halifax County region, the central region of the province and the area in which my constituency sits. The area, as it happens, in which my constituency resides within the boundaries of which all of the institutions which are intended to be brought together by Bill No. 47 happen to be located. I am not so sure at all, Mr. Speaker, that the effect of Bill No. 47 is to, ". . . affirm the legitimacy and advisability of establishing a decentralized, community-controlled health care system.". On the contrary, it in very large measure runs counter to that.



Now there is another organization that is extremely knowledgeable about matters relative to the public health delivery system in this province, Mr. Speaker, and that is the Provincial Health Council. You may be aware from discussion here in this place, and I certainly am from discussion here and with the minister and with representatives of the Provincial Health Council, the Provincial Health Council, as far as I am concerned, is one of the most important organizations relative to the delivery of public health care in all of the Province of Nova Scotia. It happens to be an organization which, as I assess it, I believe this Minister of Health wants to completely emasculate what we have come to know in this province as a most important and effective Provincial Health Council, which has as one of its fundamental mandates the very kind of thing which the minister pays lip-service to.



The minister constantly talks about the need for community-based knowledge and input into the design and delivery of health care in the Province of Nova Scotia. If he would, in my opinion at least, be fair-minded in his analysis and assessment of the way in which the Provincial Health Council has functioned over all of its existence, this minister would find - if he would open his mind to what that council has really done and been able to do over the years - that regardless of the colour or stripe of the government of the day, the Provincial Health Council has historically been volunteer men and women who have done exactly what the Minister of Health says we should have happen. It is and has been the community, through the Provincial Health Council, come to an understanding, as I say, almost entirely based - with the exception of a couple of staff people - on volunteer effort, that they would be making recommendations to the minister of the day, the government of the day, as to how best to go about certain elements of health care design and health care delivery.



The Provincial Health Council had an opportunity, Mr. Speaker, to communicate with the Minister of Health and they had an opportunity to make some observations to this Minister of Health, the sponsor of Bill No. 47, relative to this document, entitled From Blueprint to Building. I might say it is very interesting reading and I would recommend it to the attention and for the edification of each and every member of this place, because it is worth reading. But just a quick reference or two to it, if I may.



The Provincial Health Council wrote, as I said, to the Minister of Health on October 20, 1995. In their critique, they were saying to the Minister of Health: Thank you for your - meaning the minister's - letter of September 12th responding to the council's comments on the report, From Blueprint to Building, Renovating Nova Scotia's Health System. They made many comments and I will make a couple of brief references to it, if I may, Mr. Speaker.



They made this comment: Community development, this ongoing process, the foundation and very essence - I should say, let me get this correct. The first item I will read to you is under a column entitled, the council's advice, the advice which the council gave to the minister and to the blueprint people.



Community development, this ongoing process, the foundation and very essence of health system reform is not even mentioned in this report. They were concerned that having learned that the Minister of Health had based his recommendations and specifications to the Blueprint Committee on a need to be mindful of community-based delivery and community involvement and volunteer input, the Provincial Health Council takes a look at the document and said to the minister, under Community Development: This ongoing process, under community development, the foundation and very essence of the health system reform is not even mentioned in this report. How can there be a truly bottom-up, decision-making process without community development? The role, responsibility, centre and resource for community development must be clarified.



Under a column entitled minister's reply, on September 12, 1995, the minister said: The health system reform branch was created to foster and support community development as a foundation of health reform . . .



MR. SPEAKER: I think the member should realize that on an amendment, you can reference documents, but not to read extensively from them. I would just ask the member to keep that in mind.



MR. DONAHOE: Okay, thank you, Mr. Speaker, yes.



The minister responded back to the observations made to the minister and the minister said that the Provincial Health Council, Madam Speaker, could be assured that progress in this area of community development and mobilization will form the basis of future progress reports. Well, as we have seen things unfold, there has been little or no progress as I see it, of community development and mobilization forming the basis of health care delivery in and across this province.



[3:00 p.m.]



This document, and I am mindful, Madam Speaker, of the Speaker's admonition that I not quote too extensively and I understand that but I think it is important for us to understand in this debate that the Provincial Health Council made it known to the Minister of Health that they were of a view that a priority should be placed on establishing community health boards so that they could play a key role in health planning and the development of regional plans. That is what the blueprint document says is supposed to happen, that the community health boards would be players in the development of a regional health strategy.



So, rightly, I think, the Provincial Health Council says that to Minister Stewart, the Minister of Health. The Minister of Health responds by saying that a priority is being placed on the establishment of those community health boards. In response further back to the minister, the Provincial Health Council says that they are concerned, that where regional health boards begin to assume responsibility for hospital governance in September 1995 and emphasized the development of regional health plans, the efforts to establish community health boards will be minimized.



Well, do you know what? Madam Speaker, it is my opinion that the Provincial Health Council is right on the money because that is exactly what is happening. We have not seen evidence of the development of community health boards across the province. I don't know of colleagues who are aware of the development of community health boards in their constituencies. I know of community health boards in their constituencies, I know that there is some regional health board activity.





The very point that the Provincial Health Council makes, which the minister wants to do away with, maybe now we start to understand why the minister wants to do away with it because they speak the truth, they say, in essence, Minister Stewart, Minister of Health, you say that this blueprint document is your Bible, it is predicated on an understanding and on a philosophy and on an attitude that health care delivery in the Province of Nova Scotia will be community-based. You even, Mr. Minister, set out specifications to the Blueprint Committee and you called yourself for a reformed health system that would be regionalized and decentralized. A whole blueprint document and a province-wide travelling commission was established and went from one end of the province to the other, came up with the document, with the blueprint. Minister Stewart, the Minister of Health by the day, practically, tells Nova Scotians that is his document, that is his Bible, that is the basis on which he is doing what he is doing.



Here, now, we see the Provincial Health Council indicating to him and raising with him very legitimate concerns about the fact that the establishment of the community health boards which will be the closest link for all of us as residents of our respective communities in the Province of Nova Scotia and our health care delivery system are not yet being acted upon.



I don't know, Madam Speaker, you read this stuff and you listen to the minister constantly say, trust me. Every time we ask him questions in Question Period we hear, and we make suggestions to him, that he is not following the blueprint document, the document he likes to call his Bible. He stands up and takes great umbrage and with great indignation says, with some real vigour, yes, I am following the blueprint document. Well, I think it is clear, Madam Speaker, from community after community that the minister is not at all following the blueprint document. I keep making reference back and back to the blueprint document because that is the document, Madam Speaker, which says that we have to move away from an institutionalized health care delivery system and move to a community-based health care delivery system, and it just simply is not happening.



This minister has been minister since May or early June 1993, we are now in December 1995. We do not have community health boards established. The timeframe is now upon us at which they were to be. We have regional health boards established but we don't have them established in the way that the blueprint document recommended that they would because the blueprint document suggested that as much as two-thirds of the representation of regional health boards should be representative of community health boards. So the only conclusion that many of us, and certainly I can come to, Madam Speaker, is that the poor minister has it backwards. He just simply is not following that blueprint document.



Madam Speaker, I would defy any member in this Legislature to vote against a proposition that we should, as legislators, ". . . affirm the legitimacy and the advisability of establishing a decentralized, community-controlled health care system.". Where better to have the significant decisions about the delivery of health care in our respective communities made than in our respective communities? Do you want all of the significant decisions about your health care delivery made in the minister's office? That is, in fact, the risk we run in the field of education if we should happen to pass the education legislation that is before this House, and I don't think we want to do it in education and I certainly don't think we want to do it here in health.



The problem that I think we have is that we have the Minister of Health, Madam Speaker, with just simply absolutely too many balloons in the air. We have a situation going (Interruption), and yes I can. I am getting a note from the Government House Leader that there might be a few other bits of business that he would like to get out of the way and he has suggested that my tedious contribution to this debate might be adjourned at this point and I would be pleased to adjourn the debate at this stage.



MADAM SPEAKER: The motion is that the debate be adjourned.



The motion is carried.



The honourable Government House Leader.



HON. RICHARD MANN: Thank you very much, Madam Speaker, and I thank the honourable member for Halifax Citadel for his cooperation. I would ask that we revert to the order of business, Introduction of Bills.



INTRODUCTION OF BILLS



Bill No. 51 - Entitled an Act Respecting the Width of Certain Streets in the Town of Truro. (Hon. Eleanor Norrie as a private member.)



MADAM SPEAKER: Ordered that this bill be read a second time on a future day.



The honourable Government House Leader.



HON. RICHARD MANN: Madam Speaker, would you please call the order of business, Statements by Ministers.



STATEMENTS BY MINISTERS



MADAM SPEAKER: The honourable Minister for the Economic Renewal Agency.



HON. ROBERT HARRISON: Thank you, Madam Speaker. It gives me great pleasure to rise and make a ministerial statement today. Nova Scotia is on a job creation roll. The monthly employment figures just released today, I am happy to report there are 9,000 more jobs in November as compared with the same time last year and on a month to month basis, there were 1,000 more jobs in November than in October. Clearly we are gaining ground. Only British Columbia is reporting stronger job growth than Nova Scotia and I think all members would agree, this is great news for Nova Scotia. (Applause)



However, this does not mean that we are satisfied. We are continuing to press for gains in the information technology sector, particularly, with tele-service centres. For example, SHL Systemhouse in Sydney has created close to 100 jobs. Last week we had the good news from Canso where 100 new jobs were created at the Seafreez plant. In fact, 5,000 new jobs were created in Cape Breton alone this year. This demonstrates well placed confidence in our fiscal program, confidence that is shared by the private sector. Those businesses that want to make new investment in Nova Scotia and those entrepreneurs who wish to start new businesses, helping to create jobs not only for themselves but for other Nova Scotians as well.



While we fully expect this trend to continue, there are some areas of Nova Scotia that are not doing as well as others. I am therefore pleased to announce that the Nova Scotia Government will help to put 625 people to work beginning in January 1996.





The Nova Scotia Works Program will put 325 people to work in six counties with the highest unemployment rates, namely Digby, Guysborough, Victoria, Richmond, Inverness and Cape Breton Counties. The Nova Scotia Department of Housing and Consumer Affairs will add 300 jobs to the program, distributing the jobs province-wide but giving priority to those six counties with the highest unemployment rates.



As an incentive program, Nova Scotia Works encourages employers to hire unemployed Nova Scotians for a specified period but with a longer term view to full-time work. The person hired benefits from on the job training, while the employer gets an enthusiastic worker who might not have been able to afford to work without government support. Maintaining local economies is a priority of this government. Our government recognizes that certain areas of the province need and deserve special attention. We are giving the private sector in rural Nova Scotia the ability to create badly needed jobs wherever long-term prospects for success appear the best.



The Nova Scotia Works Program is a partnership program with business and local governments and non-profit organizations and it is also a partnership among three departments within our own government. The Nova Scotia Economic Renewal Agency will provide a 50 per cent wage subsidy to private sector and municipal employers creating employment opportunities between January 15th and May 4th, 1996. For each person hired, non-profit organizations will receive a $5.00 per hour subsidy toward their salary. The Economic Renewal Agency will contribute $1 million to help create all 625 jobs and the ERA funding will help to lever $1.6 million from our other partners.



Under the Nova Scotia Works Program, jobs will be allocated based on the unemployment rate and the population of each county. The unemployment rate around the province ranges from 24.6 per cent in Victoria County to 7.9 per cent in Halifax County. The six counties participating in the Nova Scotia Works Program all have unemployment rates of over 15 per cent. Through local employment resource centres, the Nova Scotia Department of Community Services, will help employers identify potential employees in the target group which includes, Social Assistance Recipients, unemployed workers who are not eligible for either insurance or do not qualify for TAGS.



I would like to thank two of my colleagues, whose departments are also partners in Nova Scotia Works, the Minister of Community Services, Hon. James Smith for his help and cooperation in developing this program and I might add that the Compass Program which will be a partner here is now being nationally recognized for its achievements with workers in Nova Scotia. Also, I would like to thank the Minister of Housing and Consumer Affairs, Hon. Eleanor Norrie, for assigning 300 jobs in needed renovation and work in housing across the province for this winter employment program. (Applause)



Nova Scotia Works can inject activity into these special areas giving local businesses a nudge toward economic prosperity, while giving men and women the opportunity to become part of Nova Scotia's proud work force. I sincerely hope that all members will agree with me in believing that this program will make the upcoming holiday season a little brighter for many Nova Scotians. Thank you. (Applause)



MADAM SPEAKER: The honourable Leader of the Opposition.





DR. JOHN HAMM: Madam Speaker, I thank the minister for providing a text of his remarks, it is most helpful. Certainly, on behalf of the 625 Nova Scotia workers who will be able to be employed this winter as a result of this program, I certainly thank the minister for his announcement.



However, there are some items that I think bear some scrutiny, in terms of the minister's remarks. The minister made reference to the fact of new jobs that are present in Nova Scotia. The minister cannot help but be aware that there are thousands of Nova Scotians who have now given up on the prospects of work and are simply out of the system and are no longer forming part of the statistics that we rely on in determining the health of our economy here in the province.



I also welcomed the remarks of the minister when he made reference to SHL Systemhouse Inc. That has proven to be a very successful industry here in Nova Scotia and I am sure the minister remembers very clearly that SHL Systemhouse Inc. was brought here by the previous government as one of their economic development initiatives and it is one of those that has been very successful. So certainly effective economic development and a proper approach in bringing the proper employees here to Nova Scotia can have a lasting effect.



The minister gave the details of the wage subsidy for municipalities and so on and a $5.00 wage subsidy to non-profit organizations. These jobs will largely be distributed to six counties with the highest unemployment rate in the province. However, by inference the minister indicates that some jobs will be made available in the other counties of the province and I would be most interested in receiving a list of the numbers of jobs that will be available in the other counties of the province sometime over the next couple of days. I am sure the minister will be making that available in due course because certainly in the county in which I live, while we don't qualify as being one of the six worst counties, those few jobs that will be assigned to Pictou County will be very important this winter and I look forward to receiving that number.



This is a good news announcement from the minister and I certainly accept it that way. I think it is unfortunate, however, that we are looking at, in one case, a Winter Works Program in which 625 jobs are going to be created and then we are looking at another piece of government business which announces that we are going to lose 2,500 health care jobs in the province and we don't have any indication as to the effect that will have; 2,500 health care jobs are going to be lost and we don't have the foggiest notion as to what will be the effect on health care delivery in the province.



However, I thank the minister for his announcement and I think it is appropriate, in view of the times in which we live, that we do have a Winter Works Program. I think it is appropriate as well that the weight of that initiative is directed towards those counties that have the highest unemployment rates. I will look with interest at how many jobs would be assigned to other counties as well.



MADAM SPEAKER: The honourable member for Halifax Atlantic.



MR. ROBERT CHISHOLM: Madam Speaker, let me say at the outset that any jobs that can be created in the Province of Nova Scotia is good for the province, good for the people who are able to receive those jobs. But I find it somewhat ironic that the government is making contributions to private enterprise and local governments and non-profit organizations to supplement wages and help create local jobs, when on the other hand, through the Agreement on Internal Trade and through procurement policies, they are taking away their ability to show preference to local companies and to help generate jobs in the regional areas of the Province of Nova Scotia, which is somewhat discouraging, I think, and shows policies working at cross purposes.



As the previous speaker indicated, this has to be set up next to the spectre of 2,000 or 2,500 jobs being lost in the health care sector, over 100 jobs being lost as community colleges are closed, the devastating impact that the UI changes are going to have to seasonal workers and others in Nova Scotia. Anyway, I think it is important to put this small glimmer of good news into context.



The other point, Madam Speaker, is that if the trend of the slow increase in jobs, which is really a few jobs increasing and the size of the labour force remaining constant, if this trend continues the number of jobs in Nova Scotia in 1996 may, actually, be higher than the number for 1990. We will be the last province in Canada that will have reached that mark.



The other trend that is extremely disconcerting, Madam Speaker, as the minister talks about trends, is that it now appears clear that starting in July, of the job growth that has occurred, it has been primarily due to more part-time jobs (Interruptions) I repeat that, it is primarily due to more part-time jobs and fewer full-time jobs. That was pointed out; it was emphasized by the Finance Department's monthly bulletin that said the number of full-time jobs is going down in Nova Scotia. If you think about that and the number of part-time jobs that are being created in relation to full-time jobs, you think about that in relation to the recent announcement of UI changes and the pounding that that is going to mean for those workers who are working part-time now and people who, through no fault of their own, are going to be forced to take longer to try to qualify for UI, are going to receive less benefits and for a shorter period of time. I would say that in Nova Scotia, workers are being hit very hard as a result of policies of this government and of their cousins in Ottawa.



Madam Speaker, I think it is important to put this announcement in some context, as I have tried to do. Prospects in Nova Scotia do not look good. There is an apparent evidence of the policies of this government working at cross-purposes. We are, on the one hand, laying off people and conducting policies that will end up with people being laid off, and on the other we are spending money out in the regions to try to generate some other jobs. It is better than nothing, but I wish this government would try to coordinate its decisions and activities in order that we begin to see some real action on the whole question of full-time jobs and the real development of economic activity in Nova Scotia that will help us try to overcome those kinds of policies that came down today from the federal government. Thank you.



MADAM SPEAKER: The honourable Government House Leader.



HON. RICHARD MANN: Madam Speaker, would you please call the order of business, Tabling Reports, Regulations and Other Papers.



TABLING REPORTS, REGULATIONS AND OTHER PAPERS



MADAM SPEAKER: The honourable Minister of the Environment.



HON. WAYNE ADAMS: Madam Speaker, I had a request yesterday in Question Period by the member for Queens to table today all relevant background material and reports which led my department to the development of the beverage container deposit-refund system. I am pleased at this time, Madam Speaker, to table in the House the documents that give the background. (Applause)



MADAM SPEAKER: The documents are tabled.



The honourable Government House Leader.



HON. RICHARD MANN: Madam Speaker, that concludes government business for this week. I would advise members of the House that we will sit on Monday from the hours of 2:00 p.m. until 10:00 p.m. The order of business will probably start with Public Bills for Second Reading. I would also anticipate, perhaps, doing a bit of Committee of the Whole House on Bills, as well as potentially some third readings. I would therefore move that we adjourn until 2:00 p.m. on Monday.



MR. RONALD RUSSELL: Madam Speaker, in what order?



MR. MANN: As they appear.



MADAM SPEAKER: The motion is carried.



[The House rose at 3:26 p.m.]