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12 novembre 2008
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HANSARD

NOVA SCOTIA HOUSE OF ASSEMBLY

COMMITTEE

ON

PUBLIC ACCOUNTS

Wednesday, November 12, 2008

LEGISLATIVE CHAMBER

Scotia Surgery Pilot Project/Wait Times Reduction Fund

Printed and Published by Nova Scotia Hansard Reporting Services

PUBLIC ACCOUNTS COMMITTEE

Ms. Maureen MacDonald (Chair)

Mr.Chuck Porter (Vice-Chairman)

Mr. Patrick Dunn

Mr. Keith Bain

Mr. Graham Steele

Mr. David Wilson (Sackville-Cobequid)

Mr. Keith Colwell

Mr. Leo Glavine

Ms. Diana Whalen

WITNESSES

Department of Health

Mr. Abram Almeda, Acting Executive Director, Acute Care

Ms. Nancy MacLeod, Chief Executive, Wait Times Improvement

In Attendance:

Ms. Darlene Henry

Legislative Committee Clerk

Ms. Sherri Mitchell

Committees Office

Mr. Jacques Lapointe

Auditor General

Ms. Evangeline Colman-Sadd

Assistant Auditor General

[Page 1]

HALIFAX, WEDNESDAY, NOVEMBER 12, 2008

STANDING COMMITTEE ON PUBLIC ACCOUNTS

9:00 A.M.

CHAIR

Ms. Maureen MacDonald

VICE-CHAIRMAN

Mr. Chuck Porter

MADAM CHAIR: Good morning. I'd like to call the Standing Committee on Public Accounts to order, please. Today we have with us witnesses from the Department of Health regarding Scotia Surgery Pilot Project and Wait Times Reduction Fund. We'll begin in our usual manner with introductions.

I'd like to make mention that the Deputy Minister of Health has sent her regrets - she's sick today - so there is that change in our attendance. However, we have other officials from the department; they'll introduce themselves to you.

I would indicate to our guests from the Department of Health to watch for the red light to come on. I will try and members will try to indicate by name to whom they're directing a question, so that the Legislative Television will be able to get the microphone. Just pay attention to that a bit, before you speak, or we'll lose what you have to say in the Hansard. Thank you. Mr. Wilson.

[The committee members and witnesses introduced themselves.]

MADAM CHAIR: Thank you and good morning. I would now invite Ms. MacLeod to give the opening statement and then we will proceed with the questioning. Thank you.

MS. NANCY MACLEOD: On behalf of Deputy Doiron, I'd like to share a few words with you this morning. She would like to say good morning and thank you for the opportunity to answer your questions today.

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[Page 2]

Timely access to quality health care is important to Nova Scotians. It's a provincial priority and a key focus for her department. Wait times are complex - they demand a comprehensive approach and action on a number of fronts. We have added new equipment, put technology on the ground, streamlined processes, and trained and recruited more health care providers. As a result, we're seeing important wins and we have improved access to health care for all Nova Scotians.

For the first time we're seeing notable declines in some key areas. The provincial wait for long-term care has fallen by 9 per cent, or two weeks. In Capital District we are seeing even more significant reductions as we add new beds; the number of clients waiting for home support is down 33 per cent from highs one year ago. In Annapolis Valley, which historically has had challenges, the wait list has dropped by 78 per cent. Waits for cardiovascular surgery, upper GI tests and bone density scans are likewise falling. We continue to have one of the top breast screening rates in Canada. In many other areas like radiation therapy, hernia repair and cataract surgery, increases in wait times have stopped.

Moving forward, we're laying a solid foundation for future success. When it comes to tackling wait times, there are essentially two critical components that both must be addressed - these are capacity management and demand management. With capacity management, we're talking about the system's ability to help patients.

Through the Scotia Surgery project, we are increasing our capacity to deliver orthopaedic surgeries. At the end of September, 250 patients had seen improvements in the quality of their lives as a result. Federal wait time reduction funding has been wisely invested in key pressure areas including new equipment, recruitment, IT upgrades, home and long-term care and the expansion of chronic pain services.

Now twice as many patients can get bone density scans, MRIs and mammography screens in Nova Scotia. The province's first PET scanner has opened and patients are no longer required to travel out of province for this valuable test. Today, we have the best patient-to-MRI ratio in the country - we have one scanner for every 117,000 residents. Combining this with process improvements, we expect that wait times will soon start to decline.

Under the continuing care strategy, $260 million is being invested to enhance home and long-term care, 1,000 new beds will open and more importantly, services like adult day programs and enhanced respite and palliative care services have already been added. Six additional chronic pain clinics are now open, providing patients with comprehensive care closer to home.

We've made the first federal wait time guarantee in the country and will soon have increased capacity to treat cancer patients requiring radiation therapy. We're increasing our

[Page 3]

capacity to deliver emergency care, work on the new emergency department for Capital Health and the new hospital in Truro has begun.

Today, Nova Scotia has some very positive health human resource numbers. We have the highest number of physicians per population in Canada and we also have the lowest percentage of people without regular family doctors in Canada.

The second part of the equation is demand management - it speaks to the number of people that require assistance from the system. Our goal here is to ensure that everyone receives the right kind of care. One of the key ways we are working toward this is by implementing primary health care initiatives. Nova Scotia has 39 collaborative care teams and a new TeleCare system will spread demand across the system, reducing waits and delivering the best possible care in the most appropriate manner for patients.

Technology is a key enabler of reductions. Through it, we're creating efficiencies and managing demand. As part of the diagnostic imagining pilot project, for instance, we are providing family doctors with software to support them as they make decisions about what tests are most beneficial for their patients. Patients receive the best possible care and waits for tests are decreased.

Finally, with our partners, we have also launched initiatives like the orthopaedic assessment clinic at Capital District Health Authority. To reduce the wait for surgery, orthopaedic patients requiring arthroplasty surgery are assessed through the clinic to determine the most appropriate care path for individual patients.

I hope these examples have given you a sense of the scope of initiatives underway in branches across the Department of Health. While we are making important progress, we also know there is more to do and we are committed to staying the course. Now, we're very pleased to answer any of your questions.

MADAM CHAIR: Thank you very much. The opening round will be 20 minutes per caucus. I recognize Mr. Wilson for the NDP caucus.

MR. DAVID WILSON (Sackville-Cobequid): Thank you for coming before us today. This committee often has the Department of Health in front of us, trying to sift through some of the problems we've seen over the last number of years. Of course, with today's topic of Scotia Surgery, there's no secret that myself and our Party have been very critical over the last number of years about entering into these private clinics and seeing private clinics come to our province and the government's decision to do that. So I'll hopefully ask some questions around that, hopefully you'll be able to answer as much as you can - I know the deputy is not here today. Then, of course, there will be some other questions around health care that are important and that we've brought up over the last number of months.

[Page 4]

First of all with Scotia Surgery itself, with the private clinic - how much of taxpayer money is going toward the contract with Scotia Surgery and I'm not sure who would be best to answer that question?

MADAM CHAIR: Mr. Almeda.

MR. ABRAM ALMEDA: The total cost of that project will be under $1 million, but you have to understand that a significant portion of that, around $300,000 is the payment for physicians - that is the surgeons and the anesthesiologists - which we would have anyway regardless of where the surgery was done. The total cost of going to Scotia Surgery - that's outside of what the surgery itself would cost - is $500 an hour and that $500 an hour is for the rental of the facility which includes the nursing component and the equipment required to fund those surgeries. So the total cost will be under $1 million - about $670,000 for the surgery cost at Scotia Surgery. That is the consumable cost for each surgery, and the facility cost and the surgeon and anesthesia cost.

MR. DAVID WILSON (Sackville-Cobequid): With that $500 an hour, the private clinic is responsible for the nursing staff, correct?

MR. ALMEDA: They are responsible for everyone except the surgeons and the patients.

MR. DAVID WILSON (Sackville-Cobequid): So I would take it they charge the province per procedure, is that correct?

MR. ALMEDA: I'm sorry, I missed your question when the gentleman was coughing.

MR. DAVID WILSON (Sackville-Cobequid): It echoes a lot in here. Do they charge the province per procedure? Is there a list of what each procedure costs and is it on a monthly, quarterly, yearly basis that the province will cover the cost of those surgeries?

MR. ALMEDA: It's on a daily basis. Daily, on average, there are six patients done, six surgeries completed. The cost includes, again, the consumable cost for each case - that is the instruments and the activities that are used in doing the actual surgery, the physician cost and the cost for the facility. The average cost right now is about $1,400 a case.

MR. DAVID WILSON (Sackville-Cobequid): How do they get reimbursed for that? Every day they send a bill to the province, is that how it works, or is it at the end of the month?

MR. ALMEDA: On a monthly basis, they send the bill to the Capital District Health Authority. The contract is not with the province, the contract is with the Capital District Health Authority and the surgery centre.

[Page 5]

MR. DAVID WILSON (Sackville-Cobequid): But ultimately it is with the province because the taxpayers are footing the bill and it just flows through Capital Health.

MR. ALMEDA: Absolutely.

MR. DAVID WILSON (Sackville-Cobequid): Is there a possibility for us to have a copy of what each procedure costs? Do you have a list that you could provide the committee that states for a knee scope, this is how much they would charge?

MR. ALMEDA: I absolutely can provide that, I don't have it in that level of detail today. I have the average case cost and I'd like to say, if you don't mind, that the average case cost increased from the time we started. When we started, we used a knee scope as the basis for forming our budget.

[9:15 a.m.]

What happened over a period of time, everything was working so well over there that the surgeons approached us and asked if they could do shoulders. Shoulders are an ASA 2, where the knees are an ASA 1, so there's an increased cost because there are some prosthetics, some pins that have to go into a shoulder to hold it in place when they do the repair. Those things have an additional cost to them, so that drove the cost up by approximately $200 a case.

MR. DAVID WILSON (Sackville-Cobequid): So if you could provide the committee in the near future a copy of that list, we would appreciate that.

MR. ALMEDA: I absolutely will, sir.

MR. DAVID WILSON (Sackville-Cobequid): So this contract with CDHA, how long is the contract for? When does it expire?

MR. ALMEDA: The contract is for a one-year period, it expires on April 1st and it's for a period of work of 44 weeks based on 12 cases a week, approximately 528 cases is what we hope to put through there with the budget that we have.

MR. DAVID WILSON (Sackville-Cobequid): After that year, what mechanism is in place to review if this was a positive thing, if it's worth the money? Has the Minister of Health indicated to the deputy or his staff any feasibility study that has been done to ensure that we're getting the best bang for our dollar? Is there something that is going to be a trigger, at a certain time within the contract, to evaluate that?

MR. ALMEDA: Yes, absolutely. Every month we get an evaluation from the orthopaedic manager from Capital District who provides us with the number of procedures

[Page 6]

done, the time it took per procedure, how much it cost per procedure, what the satisfaction rate of the citizens who received the surgery was. In the month of December there will be a full evaluation done, that's pretty much at the three-quarters mark of the project, and recommendations will be made to the minister at that time as to whether it's a good thing to continue or whether it's simply going to be a one-year project.

MR. DAVID WILSON (Sackville-Cobequid): Are you aware of recent developments in British Columbia? In British Columbia the government had a similar agreement with a private surgery clinic, where after their contract, or during negotiation of a new contract, there was going to be an increase of about 20 per cent. Hence, the provincial government decided it was too expensive for them. They cancelled the contract with the private clinic and, of course, wait times increased.

What guarantees can you give us, or assurances can you give us, that we won't see that here in this province or is that just left up to - hopefully that won't happen or we're going to wait and see?

MR. ALMEDA: Whether I could say it's a guarantee or not, sir, wouldn't be possible at this time. However, the owner of the clinic is Dr. Philip Cyr who is an oral surgeon, a dentist. That's what that facility originally opened for.

I've been involved with Dr. Cyr for some 10 years in negotiating dental services for the province. He said to me that the facility fee, if we were to continue, would not increase. The only increase to the government would be if we decided to do more cases there. We're using, based on his availability, two days of surgery time per week. He has the ability to allow us to use up to six days per week, if we so desired. Of course the increase in cost would be based on what it is today. There would be no increase in the hourly cost.

MR. DAVID WILSON (Sackville-Cobequid): So has the Minister of Health indicated to the deputy, or you guys, what a ceiling would be? Have you had a discussion reflecting on what happened in British Columbia, saying we're not going to continue this if we see a 10 per cent increase or a 5 per cent increase? Have you had discussions like that, or is that something that the deputy minister might have had a discussion with the minister about?

MR. ALMEDA: The minister and I have discussed this contract several times, as well as with the deputy minister, but we haven't talked about any increase in the actual cost. I think I can safely say that we wouldn't be interested if there was an increase in the actual cost.

MR. DAVID WILSON (Sackville-Cobequid): Okay, thank you. Are all of the ORs here in Capital Health - I know some of them are closed down or are warehouses - how many ORs are operational here in the Capital District region, roughly? Maybe the simpler question

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is, how many of them are not being utilized? How many do you know that are sitting idle here in Capital Health.

MR. ALMEDA: There are none sitting idle. In fact, the last one that wasn't in use was opened several weeks ago.

MR. DAVID WILSON (Sackville-Cobequid): There was a recent report that because of an increase in surgeries from Capital Health District, they're about $7 million over budget. Did they have to close down some ORs recently to try to come within budget? Of course the minister is very adamant that the district health authorities throughout the province can't run a deficit, so are you aware of ORs closing down for some period of time to try to maybe absorb the cost that has incurred because of the increase in surgeries we've done here in the last year?

MR. ALMEDA: I'm aware of what you're speaking of sir, but what I can assure you of is that the President and CEO, Miss Chris Power, in her statement last week, made it clear that any reduction in their budget to mitigate their deficit would not include any reduction in surgeries whatsoever.

MR. DAVID WILSON (Sackville-Cobequid): So in your previous answer you said that you think, or you believe, all the ORs in our area, in our district, and for that matter maybe across the province, are being utilized 100 per cent of the time?

MR. ALMEDA: I didn't say 100 per cent of the time and I'm not exactly sure what 100 per cent of the time means. Usually a very efficient OR would run at 85 per cent capacity because there are requirements for time to change between procedures. Rooms have to be cleaned, different staff might be coming to that room, so there's always down time in an OR.

MR. DAVID WILSON (Sackville-Cobequid): And with the private surgery clinic opening up, has the minister asked staff, or the deputy, to look into where the personnel for that facility is going to come from before we signed a contract, or before Capital Health signed a contract. Did he ask to try to find out where the personnel will come from? We all know that retention and recruitment is a huge issue. So was that question asked and did you guys look into where this private facility is going to get the personnel to staff that facility?

MR. ALMEDA: Yes, absolutely. There was an all-Party meeting, in fact there were several all-Party meetings, that took place at the VG site with folks from the Capital District Health Authority, the department, and the owners of Scotia Surgery. We did, in fact, ensure that - I'm sorry, I forgot the question there. I'm sorry, I lost track of the question.

MR. DAVID WILSON (Sackville-Cobequid): What I'm trying to get at is where these personnel . . .

[Page 8]

MR. ALMEDA: Yes, the nursing staff, yes. I know Dr. Cyr well, as I said, and he had several nurses on staff. The majority of them are retired folks and they were only working part-time. He was able to put two more days of service in place without hiring any additional staff.

MR. DAVID WILSON (Sackville-Cobequid): Do we have a shortage of OR nurses and other professionals who work in our ORs currently in Nova Scotia? Is there a need for personnel to work in our ORs?

MR. ALMEDA: Yes, absolutely, there is a need for more trained OR nurses. In fact, when we went into this process with Scotia Surgery, there was an empty room, an unused room I should say, at Capital District, and when the question was asked, why aren't we using that, the CEO was pretty quick to respond with the fact that they simply didn't have the staff to run it at that time. I think that situation has changed.

MADAM CHAIR: Ms. MacLeod.

MS. NANCY MACLEOD: I think it's also important to note here though that it isn't only Capital District, it's North America, that there are challenges with health human resources. The Department of Health has a strategy in place for recruitment, retention, training, for making sure that the resources in our health care system are working to licensure and we have the right support personnel in place. So this is not unique to Capital District, it is actually a worldwide phenomenon right now.

MR. DAVID WILSON (Sackville-Cobequid): And I would agree, and that has been one of the criticisms we've had over the last number of years that I've made as the Health Critic for our caucus is, we have our public system that needs nurses, needs health care providers, and then we allow a private facility to come in, and they need health care providers, they're able to obtain them. I don't understand how that's beneficial to our public system when a private clinic can come in, and we all know that they're going to - I use the terminology quite often - they're going to poach health care workers from the public system, no question.

I don't begrudge any health care provider who works in both because it's an opportunity and every Nova Scotian wants an opportunity to work and make money and raise their family. But when the government allows a facility like a private clinic to come in, I just don't understand how, when we have a shortage of personnel in the public system, allowing a private system to come in is going to benefit the public system. Do you understand where the concern is and why we feel that if that facility can obtain those workers, why can't we do that for the public system and just take away that opportunity so that they have more opportunity in the public system than they do in a private system?

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MR. ALMEDA: Your point is a very good one, sir, but the clinic that we're referring to, Scotia Surgery, it isn't something that we allowed to open, they have every right to open. It was opened as an oral surgery clinic, that is it's a dental clinic that does surgeries. It was opened to do surgeries on people who are not covered by MSI. Most dental services, as you're probably aware, are not covered by MSI. In fact, it's very limited. So a lot of oral surgeons in this province run clinics, they just don't run clinics of this size.

When Dr. Cyr opened this clinic, he opened it with the hope that he was going to be able to attract activities from the public system that are not - I should say not from the public system but from folks like WCB, the RCMP, DND, et cetera, who are not covered by MSI or by Health Canada.

The folks he hired were retired folks who wanted to work there and, as you say, people do have a right to work where they want and there are people who have decided they don't want to work in the public system, not just nurses. There are anesthesiologists, there are others who say I don't want to be in the public system any more and those are the folks who provide coverage to his private patients. All of the patients who go to Scotia Surgery come directly from the wait list of the Capital District Health Authority. There's no queue jumping. The surgeons who provide the service are the same surgeons who provide the service in the Capital District Health Authority facilities. The anesthetic people are the same. In fact, we've brought in R and R through the House to declare that facility a hospital, in accordance with the Hospitals Act, for the purpose of the time when they are providing those public services there, so that the physicians and anesthesiologists would be covered by the by-laws of the Capital District hospital exactly the same as if they were doing the operation in the Halifax Infirmary or the Centennial Building. That room is merely an adjunct of the Capital District Health Authority when those activities are being carried on.

MR. DAVID WILSON (Glace Bay): So with the recent announcement that Capital District Health Authority has run a deficit because of the number of surgeries that they have done last year, are we going to see their surgery numbers drop next year and more patients being funneled towards the private clinic than the public system, where I feel that it should have been done in the first place?

MR. ALMEDA: We're not. In fact, when Ms. MacLeod spoke to some of the activities that are happening here outside of the Scotia Surgery, like the Orthopaedic Assessment Clinic that we've set up at the Halifax Infirmary to enhance flow-through, we will, in fact, see more people come through there and a quicker determination of who needs surgery and who doesn't.

We would also, I would say on behalf of Dr. Jaap Bonjer, who is the Chief of Surgery, he would argue for another year or two at Scotia Surgery, in fact, to increase the numbers, because what we have at Capital District is we have a tertiary care facility where a lot of secondary care, and even some primary care type of activities, are being done. It's not

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inappropriate to do those things outside of a facility like the Capital District and the Scotia Surgery, from my perspective, provides a good bang for the buck, if you'll pardon the expression.

MR. DAVID WILSON (Glace Bay): So I know, though, that especially with Dr. Bonjer, he has talked quite frequently about the need to take down the pillars of health care where my section of health care is my section or health care or surgery or all that. So how are we with - you mentioned that hopefully we can utilize that facility more, but what about the other ORs? I know for a fact that in some district health authorities there are a lower number of hours being utilized in the ORs. Why are we not seeing our patients have more opportunity? I know they are providing some surgeries outside, if you're from Halifax. Why are we not seeing more of an attempt to funnel those individuals, attack the wait list and get them into the public system in Colchester, or wherever in the province? Why haven't we seen more emphasis on that?

In my opinion, I think it's an easier copout for the government to say, well let's use Scotia Surgery because they're here, let's utilize them. Why don't we see more of an emphasis on utilizing those beds and ORs outside the Capital District, to increase their volume in those districts?

MR. ALMEDA: Sir, it's basically because the facilities you're referring to are not equipped to do orthopaedic surgeries. They don't have the trained staff to do orthopaedic surgeries, that is the nursing component. We are doing surgeries in other hospitals. We're doing them in Hants, we're doing hernias, we're doing hernias in Amherst. We've now got an agreement with the Stadacona hospital to do some of those types of surgeries, plus scopes there.

There is one other orthopaedic centre that is doing some surgeries outside of the Canada Health Act, on Saturdays, and it isn't what we'd be interested in. The problem is - I can assure you and it's easy to identify - the difficulty with what you're suggesting is to get the surgeons, the anesthesiologists, to travel. They are independent entrepreneurs, and while your government pays for their services, they decide where they're going to work. If they don't want to travel out of Halifax to do surgeries, we have no method to force them to do it.

[9:30 a.m.]

We have only four orthopaedic sites in the province - Kentville, and I think I'm clear in saying that it's maxed out at present. In Pictou County, where we've been trying in New Glasgow to build an orthopaedic program there, we've had great difficulty in doing that. We need four people to run a proper program, not just for lifestyle for the physicians, but also for coverage for the patients. The program in Cape Breton seems to be well-run. They don't have any great difficulties with their wait list there or in attracting the surgeons.

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The real answer to your question is the fact that they don't have trained people in these other places that you referred to and the surgeons don't necessarily have to travel if they don't want to and, if they do, there would be an extra cost.

MADAM CHAIR: Order, the time has now expired for the NDP caucus. I recognize Mr. Glavine for the Liberal caucus. You have 20 minutes.

MR. LEO GLAVINE: Thank you very much, Madam Chair, and thank you very much for being here and pass on our regards to Ms. Doiron, we do miss her at these events.

We note with interest that the Government of Newfoundland and Labrador regularly reports progress with regard to wait times for the five key pan-Canadian benchmarks that were established December 2005 - New Brunswick actually goes even a step further in that they not only measure in percentage, but you can actually use their Web site to find the number of people waiting for a surgical procedure, both overall and in an actual facility, which is a tremendous step forward. When was the last time the Department of Health provided an update to Nova Scotians as to where we are when it comes to meeting the pan-Canadian standards announced in December 2005?

MADAM CHAIR: Ms. MacLeod.

MS. NANCY MACLEOD: Thank you for that great question. Actually, the Department of Health Web site wait times component is regularly updated with current information about the benchmark targets, as well as other surgical procedures and diagnostic tests. I can share that information with you today, if you'd like, on the radiation therapy component. We are within the national target of four weeks for all but the lowest urgency patients for radiation therapy. For joint replacements, hips and knees, we are not meeting the target of six months, we have about 30 per cent of our patients who are having the surgery within that time.

MR. GLAVINE: So then there are some of the procedures that we're not meeting the benchmarks, and we really don't want to show Nova Scotians how bad they are. You can't even compare one month with the previous month - one month comes up and then it's gone. We don't even want to show Nova Scotians that October may actually be worse than September or August - is that good accountability for government and the Department of Health in this matter?

MS. NANCY MACLEOD: I really appreciate that question because it leads into a couple of initiatives that are underway at the Department of Health. One is the implementation of a patient access registry for Nova Scotia. This is a surgery project, being funded by Health Canada, that will enable us to have full information about all patients in Nova Scotia waiting for surgery so that we can share that information with Nova Scotians. The information that you see on the New Brunswick Department of Health Web site comes

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directly from their surgical patient registry. Nova Scotia will be implementing a very similar piece of technology, a database here, so that we are striving to be able to report in a timely manner and current information.

Another initiative that we're working on is a revamping and revitalization of the wait times Web site. We are looking at all of the information that's available and that will be available with new projects that are in process, and making sure that what we put on the Web site is meaningful and timely for Nova Scotians. So yes, but there are two significant initiatives underway to address the question that you have.

MR. GLAVINE: So that will be a change then from currently, where the DHAs don't seem to be reporting in a timely way where they are in terms of wait times, I guess, when did the department last ask DHAs, especially in relation to the five pan-Canadian benchmarks?

MS. NANCY MACLEOD: We receive information from the districts on a monthly basis. The biggest challenge right now with that information is that there are numerous different computer systems out there, and the way we get that information is different in every district. With implementation of a standardized model and database for information it will be an automatic retrieval pulling of information from the district's information systems which we can automatically feed to the Web site. So it will be a very streamlined process with a standardized way of recording and collecting the information.

MR. GLAVINE: In conversation with a few of the orthopaedic surgeons in Kentville, I got quite an education in that my view was pretty well skewed that this is a 65-plus kind of procedure, it's a procedure for elderly, the hip replacement and knee surgery, but I discovered in fact that that's not the case at all. There are many people who are out of the workforce for long periods of time because they do need a hip or knee. How many people would be waiting in the province today for a hip replacement?

MS. NANCY MACLEOD: Unfortunately, I can't give you that information because a lot of that information is in the surgeons' offices, the surgeons have information about the patients that they are consulting with and planning to perform surgery on. Implementation of the patient access registry though will give us that information because it will be a repository of information of all patients waiting for surgery. So once we have that technology in place, we will be able to report those numbers.

MR. GLAVINE: In April 2008, the Wait Time Alliance issued a report card charting the progress of all provinces. Here in Nova Scotia, when it came to hip and knee replacement, we received an F, and a B for cataract surgery; however there was not sufficient data available when it comes to grading cancer procedures or cardiac bypass surgery. Why was there insufficient data made available for these two procedures which were established by this government and the federal government as priorities in 2005?

[Page 13]

MS. NANCY MACLEOD: I think the issue with cancer is that radiation therapy is where Nova Scotia was the first province to enter into an agreement with and that's the project that we're working on, but the Wait Time Alliance, I believe, is looking at other types of cancer treatments that we currently don't have the capability of collecting province-wide information on. So it isn't the radiation therapy component, that's my understanding, it's chemotherapy and others.

For cardiac care, we do report the differences. A national reporting is in three categories and Capital District reports in four different categories. But what I can report to you is that for the vast majority of patients requiring cardiac surgery in Nova Scotia, we are well under the national target. The highest-level priority patients, other than emergency, Level I, they want to have the surgery within two weeks - we're currently at three days for those patients. Level III patients, where it's 26 weeks, we're currently at 10 weeks to provide cardiac surgery for those patients.

MR. GLAVINE: Those are the good news stories, but we still have an F on the hip and knee replacement . . .

MS. NANCY MACLEOD: Yes, we do.

MR. GLAVINE: . . . and people out of work for long periods of time. Recently, in the Kentville Advertiser and the Berwick Register, Dr. Beveridge came down - he was one of the most vocal and outspoken doctors that we have seen in the province in some time - and talked about the desperate state in western Nova Scotia for hip replacement and knee surgeries. Are we going to be able to address this? Are we going to have a central registry where people can make choices about where they go? I'm wondering how the department is planning the strategy when we haven't seen any progress at this facility in five years? I was on a round table five years ago, heard many of the same surgeons speak and here we are five years later and they're talking about two years that they have to tell a patient.

In fact, they tell people, you're 100-something in the queue to actually be seen. It's a major retirement area, for another factor. Things are pretty desperate there and when a medical doctor - which we don't see a lot of - speaks out in this province about how sad the state is and the kind of information he has to give patients, where are we going to go?

MS. NANCY MACLEOD: We are taking a systematic approach to addressing concerns with wait times in surgery, and that includes orthopaedic surgery, things like the registry that will be implemented so that we're aware of where patients are in the province who require surgery and, as you said, are there options for them. Are they willing and able to travel to other places of the province to have their surgery, recognizing though that with arthroplasty surgery, this is not a day surgery procedure? There are post-operative care concerns that have to be addressed - it's not the same as going to Amherst to have a day surgery, hernia surgery, and then you can go home. You're in hospital post-operatively - so

[Page 14]

where the surgery is done the support resources have to be there and the physician care has to be there for the patient post-operatively.

In partnership with the Capital District, an Orthopaedic Assessment Clinic has been put into place - it's recently up and running - and what this clinic does is it's a centralized referral point for patients requiring arthroplasty surgery. So, a case manager reviews the consults that come in to help determine and work with the surgeons to make the best use of the surgeons' time in their consult appointments because not all consults that come in are patients who actually require plastic surgery. So streamlining the process to make sure that the patient gets the right medical or surgical care that's required is really helping to reduce the time to consult.

With regard to patient choice, consults are coming in to a surgeon but as the patients are being contacted, they're being asked would you like to see the next available surgeon or would you like to see the surgeon you've been consulted with, giving the patient choice. If they choose to stay with a surgeon who has a longer queue than another, it is the patient's choice but the option is being given for them to see the first available surgeon.

What we are also doing in Nova Scotia is implementing the Nova Scotia Surgical Care Network. This is a group of providers, administrators, clinicians, from around the province who will be getting together on a regular basis to look at surgery from a provincial perspective.

MR. GLAVINE: But, Ms. MacLeod, we've been working on this now for quite some time. Shouldn't we be there now and shouldn't patients anywhere in Nova Scotia have a sense that I could go to New Glasgow, I have family in Cape Breton, and I'm prepared to do this? I mean, why don't we know this at the end of 2008 when we've been addressing it since at least 2003?

MADAM CHAIR: Mr. Almeda.

MR. ALMEDA: Actually, sir, we've been telling people that for at least a couple of years since, we got two surgeons up and running and for awhile had three in New Glasgow. As you're probably aware, your constituents do call us directly and speak to us sometimes about their suffering on the wait list and we do suggest to them they go to these places and they have gone to those places.

I would like to speak to your question about Kentville but, first of all, I'll go to Halifax. There is a long waiting list for arthroplastic surgery, there's no question, but based on a review done by Dr. Jaap Bonjer one year recently, very recently, his report to me stated that if we could run the minor surgeries through Scotia Surgery until the year 2010, he would have the arthroplasty procedures here in Capital District running in accordance with the nationally accepted wait time - that is less than six months for any of those arthroplasties.

[Page 15]

That would mean an additional cost to us of about $1 million a year to continue to do surgeries over at Scotia Surgery.

Nancy and I just recently met with other members of our department with the folks from District 3 to talk about what's going on in District 3 and they have a lot of problems like every other health district. In terms of the orthopaedic surgery, the problem isn't around rooms for the procedures to be done - it's around beds. That facility, like a lot of facilities, still has ALC patients where processes are being worked through to free up those beds. When that happens, that will have a large impact on their orthopaedic surgery plus the successes that we know we're going to get from this orthopaedic assessment clinic to streamline the process. We do have these people from the other three areas who are corresponding members of our committees and those processes will be rolled out to those other three locations.

MR. GLAVINE: If I could move on to the CBC story this past weekend about the cost overrun of $7 million, our deficit in Capital District, how much of the $7 million deficit would be attributed to the 1,000 additional surgeries - not that they weren't needed and absolutely is a good story - but how much would be attributed to the actual additional 1,000 surgeries?

[9:45 a.m.]

MR. ALMEDA: A very good question, thank you. From my perspective, and I may be proven wrong, but I don't believe it is to do with the surgeries; I believe it's other costs. The number of additional surgeries they did really brought them back to a base line of a couple of years ago. When there was a period of time when we didn't have any anesthesiologists, as you're aware - I'm sure you heard it from your constituents - the wait list even for consultation was growing up to two and a half to three years sometimes. It was because we couldn't attract anesthesiologists. Once we attracted those anesthesiologists and started the rooms working again - you know, at their capacity - they started doing more surgeries that hadn't been done for a couple of years. So the 1,000 that they did last year actually brought them back to a level that they should have been at the prior year but couldn't get there because of the lack of anesthesiologists.

The detail on what their cost overruns are about, I really don't know. We've just started having discussions at the department about it but it's an internal activity for the Capital District Health Authority's senior team and I know that they're addressing it with an internal plan on how they're going to reduce that debt. It won't be in reducing surgeries.

MR. GLAVINE: Okay, so that tells us then that it's not surgeries but, at the same time, government is sitting with about $17 million currently in the wait time reduction fund. So could you please tell us what this money is being used for in the fund if it is not being used to increase the number of surgeries and reduce wait times, which can only be

[Page 16]

accomplished when more surgeries are performed? I'm just wondering if you could give us a sense of where this $17 million would be going?

MADAM CHAIR: Ms. MacLeod.

MS. NANCY MACLEOD: Thank you. Yes, the wait time reduction fund has been in place for a number of years and the allocation for this fiscal year is spread over numerous areas related to access to the system. Those include the telecare line that will be coming, part of the continuing care strategy, home care services expansion, nursing seats in the province for both LPN and RN seats, the stroke strategy, colorectal cancer screening, improvements in the primary health care with the collaborative teams and support programs and mental health and addiction services. So the money is spread across the system to help address numerous areas of access.

MR. GLAVINE: But possibly, we could look at it from the point of view that we may not have gotten ourselves quite into the trouble that we did. I know recruitment has always been a challenge in retention.

If you go to Volume One of the financial statements, Public Accounts document - between 2007 and 2008, the province drew down about $34 million, but why was there as much as $51 million sitting in the wait times reduction fund in 2007?

MS. NANCY MACLEOD: I'm sorry, I can't answer that question. I'd have to defer to my finance colleague but we'd be happy to get that information and provide it.

MR. GLAVINE: My understanding is that we get these incremental improvements in the system, yet in 2007 we're sitting with $51 million in a wait reduction fund. Then, all of a sudden, we get this big draw down of $34 million. Did it go to bail out some of the DHAs, for example? I know some of them were over budget.

MS. NANCY MACLEOD: That's not my understanding of how the money is being used. Finance at the Department of Health has meticulous records of where the money goes; I just can't provide that for you. I can tell you the areas where the money is going but, sorry, I can't provide that detail today.

MR. GLAVINE: As far as you know, does the federal government require an accountability as to where you spend the money? If so, could you table before the end of Public Accounts Committee, a copy of that report, or provide it at a future point, please?

MS. NANCY MACLEOD: I would have to, again, go back to our finance colleagues and ask for that detail.

MR. GLAVINE: Okay, and just before I finish up - I don't think I have much time?

[Page 17]

MADAM CHAIR: You have two minutes.

MR. GLAVINE: In your opinion, what is the largest unaddressed issue the province faces in dealing with wait times?

MS. NANCY MACLEOD: My opinion is, it's a system approach. We have to look at all aspects of the health care system and address each component together and in turn. There isn't, in my opinion, a single thing or area that you can address without having a ripple effect in other areas. We need to look at the system overall and address all of it together.

MR. GLAVINE: I live in a part of the province where the population time bomb is probably coming at us a little bit quicker. In the Valley, there are five communities where at least 20 per cent of the population is 65 years old and over, and that doesn't even account for the cohort 46 to 61, which is the baby boomers. So I'm seeing that, if we don't have capacity and if we don't have the ability in this area of the province, that's only going to get worse, and then of course we will have the remainder of the province. So I see a big, unaddressed problem. That's why I asked you how you see it needs to be addressed.

MS. NANCY MACLEOD: And I'll reiterate, it's the whole system. It's looking at, in areas where the population is aging more than others, it's making sure that we have a system in place to enable people to stay in their homes longer, people who want to stay in their homes. It's by having respite programs and home support and the right resources in the communities to meet the needs of the people in those communities, whether it's through collaborative care teams or through home care programs, but it's a system approach to looking at the needs.

MADAM CHAIR: Thank you. Order. The time has expired for the Liberal caucus.

I recognize Mr. Dunn for the PC caucus, you have 20 minutes.

MR. PATRICK DUNN: Thank you, Madam Chair, and thank you for being here this morning. You can send our get-well wishes to the deputy, also.

The timely access to quality health care is certainly a priority for all Nova Scotians and the government. I know the department is certainly looking for many innovative ways to reduce the wait list that we have in our province, for example, in orthopaedic surgery, and it's certainly the right thing to do for patients living in the province. You mentioned in your opening comments that as of the end of September you have had 250 surgeries. I had the opportunity to talk to a couple of patients and they were certainly very satisfied. So my question is, have you received any feedback from patients who have had surgery?

MADAM CHAIR: Mr. Almeda.

[Page 18]

MR. ALMEDA: Yes, thank you, Mr. Dunn. We do, as I stated earlier, get a monthly report from the orthopaedic manager. I have some of that information with me and I can tell you without even looking at it, upwards of 95 per cent to 99 per cent of the people who have gone there were happy with the location, they were happy with the fact that there was free parking, they were very satisfied with the facility itself, and extremely satisfied with having the surgery done there. The majority of them state that they had their surgery done sooner than they expected. I think there were two people out of 246 who said, no, it was no sooner than I expected. But otherwise, I say to my colleagues sometimes, I think it's like the old Ivory Snow commercial, that about 99 per cent of the people are extremely pleased with it - they go there, it's specific to that need, that's all that's going on there.

MR. DUNN: Thank you. So listening to your answer then, you're saying the project is making an important difference in the quality of life of patients in the province, and at the same time reducing our long wait list in the province?

MR. ALMEDA: Yes. What it does in addition to reducing the wait time for what we call minor procedures, that is non-in-patient procedures, it also frees up additional time at the Capital District Health Authority to do more arthroplasties than they otherwise would have been able to do.

MR. DUNN: In your initial comments, or when answering a question, you made reference to the hospital in New Glasgow dealing with orthopaedic difficulties. I'm going to get you to, if you will, expand on that and at the same time, are we having the same type of difficulties in other locations across the province? Are there any foreseeable remedies, especially in the New Glasgow area?

MR. ALMEDA: I'm sorry to answer a question with a question, but are you referring to the orthopaedic surgery program that I spoke of?

MR. DUNN: Yes.

MR. ALMEDA: The orthopaedic surgery program, going back at least seven or eight years, has been opened, has been closed, has been opened, has been closed. They reached an all-time high of three surgeons two years ago. It soon became very evident that those surgeons were only interested in getting their accreditation with the college and moving on. One of the fellows, a Canadian-trained surgeon, has stayed and will stay; the other fellow who is there seems intent on staying at the present time. The CEO there - I just spoke with him on Monday - he, in fact, has had several people in to look at coming there, but doesn't anticipate that they'll get a third surgeon there until the Spring of 2009. We've also assured them that if they get a third surgeon there and they can continue that service without interruption, we will provide funding for a fourth surgeon should they be able to recruit, and that's what we want them to do.

[Page 19]

When I talked about the orthopaedic surgery that's being done there on weekends, I was referring to WCB patients who are being done there. I can tell you, it should be a matter of public record, the cost for those patients down there is three times the cost of what we're paying for the procedure at Scotia Surgery; that, of course, is because WCB is willing to pay the freight on that.

MR. DUNN: Thank you. How long is the wait list for orthopaedic surgery at Capital?

MR. ALMEDA: I just got some figures this morning and there are 4,000 people waiting for orthopaedic surgery as of today; 55 per cent of those are in-patient procedures, 45 per cent of them are outpatient procedures. As I said earlier, if we were able to continue to provide the services at Scotia Surgery and, in fact, enhance it - not even double it - take it from 528 a year to 880, we could get the arthroplasty needs at Capital District within accepted wait times - that is, six months or less.

The current wait time is obviously longer than that but I don't know the exact specifics of how long it is. Presently they're still operating on this doctor's list and this doctor's list. What we're doing with the Orthopaedic Assessment Clinic, as Ms. MacLeod explained, was people are coming in, the referrals are coming from the GPs to the clinic and they are willing to take the next surgeon on the list.

As you know, surgeons' times are allocated not necessarily on how long their list is, but on an equitable basis across the spectrum of folks who do arthroplastic surgery. So if we have them coming in to the next surgeon on the list, it will be much easier for everyone to get through in the same amount of time.

MR. DUNN: Often it has been the norm, I think it's fair to say, that the costs of initiatives escalate. You mentioned this particular project, I believe, is under the ceiling of $1 million. Is there any chance that this particular yearly project could go over $1 million? Could it cost more?

MR. ALMEDA: Within this contract?

MR. DUNN: Yes.

MR. ALMEDA: No. We simply are not allowing anything more difficult than what they're doing at present and we're not allowing any additional numbers. In fact, we may see the cost go down slightly. If we start doing a preponderance of knee or foot surgery, where they are basically putting in some hardware, removing some hardware from somebody's ankle or foot, as opposed to the shoulders - but the shoulders are very important to do, so we're quite happy to pay that extra cost per case to get those shoulders done.

MR. DUNN: Are the ORs at Capital Health running at full capacity?

[Page 20]

MR. ALMEDA: Again, capacity - Ms. MacLeod is the expert on capacity and wait times and she speaks of 85 per cent is what should be considered capacity for an OR. Whether they are all running at 85 per cent at this point in time, I can't say.

MADAM CHAIR: Ms. MacLeod.

MS. NANCY MACLEOD: My understanding is that the five operating rooms at Capital District that are devoted to orthopaedic surgery are running at their capacity at this time.

MR. DUNN: We have operating room capacity in other areas, other districts. Would it have been less expensive to perform surgeries there?

MR. ALMEDA: Compared to Scotia Surgery? Absolutely not, and I'll explain to you again the cost - I have the figures here - of WCB doing their surgeries down there. A case is costing about $3,800 for the same type of case that's happening over here for $1,200 to $1,400. The reason is the surgeons will not go there without being premiumed because the patients they're doing down there are WCB. They are not covered by the Canada Health Act and WCB is willing to pay that amount of money to have those patients looked after. According to their vice-president, he tells me that yes, we know it's expensive but it's still worth it to us to get those patients back to work.

[10:00 a.m.]

I won't give you the specifics on the numbers that the physicians are charging, although I can tell you it's nothing like what we pay in the public system. As I said earlier, they are private entrepreneurs, they put their services out there, they charge basically whatever the system will bear, on the private side. That facility at New Glasgow is being used on off hours by nurses on off hours, and the equipment is all paid for through WCB and everybody is being paid premium.

MR. DUNN: Wouldn't it have been a better investment to do surgeries at Capital Health by hiring more surgeons, more nurses, and perhaps providing the necessary equipment?

MR. ALMEDA: It absolutely would have happened, sir, had the nurses been available. When this project was first discussed, pretty much a year ago this month, that it would be something useful to do, I met with the CEO of the Capital District Health Authority and some of her clinical leads, including Dr. Bonjer, and we discussed the possibility of doing something at a place like Scotia Surgery, what that impact might have on their facility, and also that we would pay the cost if we did something like this.

[Page 21]

As I stated earlier, her director of finance at the time challenged me with, why can't we do it here, we could do it for the same kind of money, so she thinks. I don't think they can. But, the CEO was very adamant of the fact that they cannot, could not, recruit any orthopaedic nurses, and there were no orthopaedic OR courses going on at the time.

MR. DUNN: I believe I heard you mention the volume of surgeries being performed at Capital Health have not decreased. If that's the case, this project will increase the Capital District's capacity for other complex surgeries in lieu of that?

MR. ALMEDA: Absolutely. Yes.

MR. DUNN: Are there any results to show how many?

MR. ALMEDA: It's what helped them do the extra 1,000 procedures this past year, starting in the Spring.

MR. DUNN: Okay. It's well known that Nova Scotians don't support private organizations having a role in health care. Is that going to continue to be a difficult initiative, to continue doing this, if this continues to be a success as we are seeing, and perhaps implementing another initiative for another year, continuing on with this particular organization, do you foresee any difficulty?

MR. ALMEDA: It's a very good question. I don't believe that Nova Scotians are against it. All I have to do is look at the evaluation of what's going on at Scotia Surgery. We have 99 point-some-odd per cent of people who are 100 per cent satisfied with having gone there to get their procedure done in a timely fashion and in a facility dedicated to doing that type of work with the same physicians that would do it if they were getting it in a public place.

MR. DUNN: Have you any data from any other provinces across the country in regard to initiatives they're working on with regard to decreasing the wait-time list?

MR. ALMEDA: I'm not positive that any other province has done it the same way we have. What we've done is something different. I can assure you of one thing, we're probably paying half of the facility costs that they're paying in western Canada for using private facilities. However, I don't know that in those provinces that the patients are coming directly off the wait list as they are here. No one can jump the queue here. You're either a patient from the public system or you don't get into Scotia Surgery.

MR. DUNN: One of my colleagues mentioned earlier this morning about the public health care system losing nurses, doctors, et cetera to these private clinics. Is this going to cause a widespread shortage of personnel in the public health?

[Page 22]

MR. ALMEDA: Under this type of contract, absolutely not. They're the physicians from the public facilities who are doing publicly funded services. It's nothing more than the location.

MR. DUNN: Could you go over again the types of procedures that are being done at Scotia Surgery?

MR. ALMEDA: Yes. It started out when we costed it. Of course, we have to look at something to cost it from so what we did, we took the maximum cost that would be associated with the types of procedures they wanted to do and those were knee scopes.

The other thing they're doing, there are a lot of people - in fact, I had it done myself - who have wires put in their feet to correct deformities, whatever, or they have broken ankles and they have some hardware in their ankles, or in their feet, and those things have to be removed. We have people who have problems with fingers, the same, that they get fixed. They're not as expensive as the knee, so we costed the project out on what it would cost for a knee. As I stated earlier, the reason the costs went up slightly is because we agreed to elect them to do ASA 2 patients, which are a level higher, and those would be the shoulder scopes.

As I said before, each shoulder requires a number of pins - there are about seven of them - that are put in place to hold the rotator cuff in place when they do a shoulder. Those pins stay in there, of course. It's quite amazing, even to me today, after all these years, when I see the price of equipment, what it costs is quite incredible. That's the total type of procedure that we've done over there.

MR. DUNN: Is there a possibility for other types of surgeries, any expansion of the other types?

MR. ALMEDA: Absolutely, absolutely. We could be doing, I'm going to give you an example, the cochlear implant program that we have here in the province - today it's still done as an in-patient procedure but it can be done as an outpatient procedure. The BAHAD - that is the bone anchored hearing assistive device, I'm not sure if you're all familiar with that - it's basically a metal box that's implanted at the back of your skull. It's for people who are very hard of hearing and can't benefit from hearing aids like I can. So they get those things done. It's an outpatient procedure. It could be done easily over there.

They could also do E and T procedures, small E and T procedures that are taking up a lot of time in tertiary care facility and, you know, that's really the rationale behind going to Scotia Surgery - to have an operating room outside of that facility and on a longer term, I would suppose one day in this province we'll have stand-alone surgery centres as opposed to large hospitals like we have today.

MR. DUNN: Will any Capital Health nurses be losing their jobs?

[Page 23]

MR. ALMEDA: Losing their jobs? Absolutely not, they can't hire them fast enough. The way this was explained when it became a bit of an issue with the union, there's no job loss because what we're talking about is an activity that should be doing this and it has been doing this. What we're attempting to do is to level that off to get back to where we want to be. So we're basically taking out the bump and that's the extra surgeries that are going to Scotia Surgery. Not all of them are going there, unfortunately in my opinion, but you know, 528 is better than none to get those people out of the queue. More importantly than getting them out of the queue is to get them back to an active lifestyle.

MR. DUNN: Do you expect any nurses in the public system to leave their jobs to go to work at Scotia Surgery?

MR. ALMEDA: I do not. He has enough nurses in his employ right now. If we were to increase it, there might be a requirement for him to look for some additional support but these would only be part-time jobs and a lot of our nurses as I think Mr. Wilson spoke to, I'm not positive, a lot of people like to do extra work outside for the same reasons most of us do - for financial reasons. I guess it was you, sir, wasn't it?

MR. DUNN: Some of the nurses or all of the nurses working at Scotia Surgery, did all of them come from the public system?

MR. ALMEDA: Some of them are retired nurses. A couple of them did come from Colchester but they elected to leave their jobs at Colchester previously and went to work for this clinic when it started up. The nurses who work there - in fact the nurse manager there is a former Canadian Forces' nurse, whom I knew in the Forces, and she had decided when she left the Forces, she was not going to work in a public system and got the job working with Dr. Cyr to develop this clinic and she manages it for him. There are some people who just simply aren't interested in working in the public system any more, they get tired.

MR. DUNN: What can the department do to ensure our doctors and nurses don't leave the public system to work in private care?

MR. ALMEDA: Well, there's nothing that we can do to absolutely ensure that they won't leave. I think that they're well compensated. We have a very good agreement with our physicians here, as Ms. MacLeod referred to earlier in her notes. We have more physicians here per capita than any province in the country, we have less people without a family physician here than any province in the country and I would say to you that the majority of physicians - much as they might like to say it isn't all that great sometimes - don't leave here because of the fact that, to quote the Honourable Jamie Muir one time, "It's a great place to live." The compensation is very good for both physicians and nurses. Nurses aren't the highest paid in the country but they're well paid compared to the average.

[Page 24]

MR. DUNN: The next question I have is dealing with the standards and quality of service. How can people be sure Scotia Surgery is a safe place for surgeries to be done and in their other practices at the same quality, the same standards as Capital Health?

MR. ALMEDA: It's a very good question and I can assure you that before a contract was entered into, the people who are responsible for quality of service at Capital Health reviewed their documentation. There is an accrediting body in Ontario that accredits surgical clinics. The physicians, of course, are still physicians who are from the public system and have the same requirements that they do for working in our facilities, that is that they are credentialed - the college is responsible for that, but the facility is accredited. We had teams go over there and review every one of their procedures to ensure that what they were doing was as good as, if not better than the processes that are happening in our hospitals.

MADAM CHAIR: Order. The time has expired for the PC caucus. The next round of questions will be 15 minutes. I recognize Mr. Wilson for the NDP caucus.

MR. DAVID WILSON (Sackville-Cobequid): Thank you, Madam Chair. I'd like to actually go back to something that you ended with, I think, during my questioning. You had mentioned Stadacona, so I'll ask a few questions on that.

I'm interested in one of your comments just a few minutes ago - is it true, or maybe you could state it again, that you foresee stand-alone surgery facilities here in this province, many more, in the coming years?

MR. ALMEDA: Yes, I did say something like that, but what I was referring to would be public facilities as opposed to continually building big hospitals. They are multi-faceted - we have clinics in them, we have surgeries in them, we have outpatient services in them that are non-surgical. We have all kinds of things in hospitals that make them kind of not as efficient as they could be if they were strictly built for surgery.

MR. DAVID WILSON (Sackville-Cobequid): Do you foresee those owned by the public system, or do you see a similar relationship that we have today with Scotia Surgery, these facilities being owned and operated by the private sector?

MR. ALMEDA: I would answer that question by saying that I spent most of my life in the Canadian Armed Forces as a health care administrator and I believe everything belonged in the public system, that's my opinion. The facilities that I talked about, yes, I would see them as being part of our facilities - for example, Capital District Health Authority, we all know the state of those building and eventually they will be replaced and I believe they won't be replaced to look like they are today, that they would take advantage of some of these possibilities to have stand-alone facilities to do medical work versus surgical work.

[Page 25]

MR. DAVID WILSON (Sackville-Cobequid): I agree; I think that would best address some of the needs in the province, but my emphasis is the fact that the public-funded system should own these facilities, should run these facilities.

Your background is interesting, so I'd like to go to a facility that is just down the street from us, paid for by the taxpayers of Canada and that is Stadacona. I've always wondered why there wasn't more of an attempt - I know that we're utilizing that facility on a small scale right now, so maybe my first question is how many surgeries are we currently doing at Stadacona?

MR. ALMEDA: None. The agreement was just signed recently. I can tell you a lot about Stadacona, my very last job before I decided to leave the Forces, I was the administrator of that facility when it was a 110-bed hospital. At that time we used to bring patients from the public system here to use our ICU because we simply didn't have the kind of patients - we had basically healthy young men and women. There were 110 beds and they weren't very well utilized and at the same time - that was during the Bosnia War - we had our staff working in the facilities here so that they would see more trauma than they would see, again, at the base where they are all fairly healthy.

It is no longer a 110-bed hospital - as I'm sure you're aware - the Canadian Forces downsized their medical facilities in the mid-1990s and it's now a 20-bed clinic. They do have operating rooms still available and they do some minor surgeries there themselves, but nothing that requires an overnight stay. They do scopes there, they do ankle work there - and when I say scopes, I'm talking about not just surgical scopes, I'm talking about colorectal scopes, bronchoscopes, that sort of thing.

[10:15 a.m.]

MR. DAVID WILSON (Sackville-Cobequid): When will we see patients going from our system to utilize that facility? I know you said they recently signed something - when will we start to see patients going over to Stadacona?

MR. ALMEDA: The memorandum of understanding is being signed between the Admiral and Ms. Power next week. At that point we expect to find out from them what they're going to do there. To my knowledge, now working with Dr. Bonjer, it will be hernias and it will also be scopes - again, not knee scopes.

MR. DAVID WILSON (Sackville-Cobequid): Why have we waited this long to utilize that facility? We all knew, and in your case you knew the capability there, the state-of-the-art equipment there, the proximity - you mentioned earlier in a comment that it's hard to have our physicians travel - so why has it taken so long to break the barriers down to utilize a facility that is down the street and funded by the Canadian taxpayers?

[Page 26]

MR. ALMEDA: Well, when you speak of the state-of-the-art equipment, it isn't exactly state of the art any more, especially the surgical equipment, because surgeries haven't been going on there for a long time - that is, major surgeries haven't been going on - but they are well equipped.

Why hasn't it been? Mostly it was because the Canadian Forces wouldn't discuss it. Back a few years ago when there was an impending work stoppage here in the province, I dealt with the folks there and in Ottawa about the possibility of using that place to put some people in and it didn't pan out - they didn't want to go there.

It's only because of the Admiral who just left, who resurfaced the talks - when we started meeting with those folks, when the first force of soldiers from New Brunswick and the Atlantic area went to Afghanistan two years ago, as you know, those soldiers when they're injured come back to Canada via Germany, and if they're from this area of the province it would be silly for them to keep on going to Alberta for care, so we set up an agreement here at the hospital in Halifax, with Stad, that we would take those people here and we would do all the things that are happening in the hospitals across the country for those soldiers - as a result of that discussion, it just led to the natural progression about you folks want to come over here and work at our facilities, we want to do some work over there, we want to use the space you've got.

It took some time, we had to get an R&R to get the indemnity clause approved, because while the Canadian Forces were happy to let us use that facility, and have their folks use our facilities, they weren't going to do it and have the risk of anything happening, so we had to go through Cabinet to get an indemnification clause. That has happened, the agreement has finally been put together and, as I say, it will be signed next week.

MR. DAVID WILSON (Sackville-Cobequid): Definitely I think we should have seen something a lot sooner. I'm glad, and I know Dr. Bonjer has worked tirelessly on making this possible. So are you aware of any other private health care clinics wanting to open here in Nova Scotia?

MR. ALMEDA: Yes.

MR. DAVID WILSON (Sackville-Cobequid): Are there going to be any opening in the near future? The reason I ask, one clinic that I know about is the Copeman Healthcare Centre, which will be opening a private facility in Calgary. On its Web site it states that expansion is going to happen in Nova Scotia and Halifax, I believe. How come we haven't heard anything from the Minister of Health on a new and another private health care clinic opening here in the province?

MR. ALMEDA: I guess I would respond by saying, sir, that it's easy to put that on their Web site - a little different to actually make it happen. Not that I know everything that's

[Page 27]

going on in the Department of Health, but any time it comes to things like clinics or hospitals, I'm usually the person the minister consults with about it.

It has never come up as an issue. The only place that was mentioned to us recently, our meeting with District Health Authority 3, that there was somebody in, I think it was in Kentville - I'm not positive - who has a clinic and they're wondering at the possibilities of doing the same thing there that we do in Scotia Surgery. My comment to them at the time was Scotia Surgery is a pilot demonstration project.

There is no Act - I should say no legislative authority in Nova Scotia to either agree to have one or to agree not to have one, so we have lots of private clinics in the province. We have people who open up physiotherapy clinics every day - they are private clinics, and we all accept those. We have some people who have opened a sonogram ultrasound clinic. There are various things going on that are private clinics, but there has been no request to us to open another clinic at this time.

My belief, from dealing with this minister, is that we would not consider it until we've done the full evaluation on Scotia Surgery and determined what the outcome is there - is it good, is it bad? Kind of hard to evaluate if we open half a dozen at one time - it would be pretty tough to evaluate it.

Once we evaluate this, if there is a desire by government to do more, personally, as I've said earlier, I would certainly be in favour of doing more, just to get it out of our tertiary care facilities, but it would be based on criteria developed within our contract. It would all have to be done within the public system and not private-for profit.

Having said not private-for profit, obviously Dr. Cyr does make some money. The money that we pay him pays for his staff, it pays for running his facility and, if he makes anything more off it, I won't say it's chump change, but it isn't very much money.

MR. DAVID WILSON (Sackville-Cobequid): In the contract, since you mentioned it, is there a window of what's acceptable - are they going to have to report back to government that we made a profit of 20 per cent on top of the cost of running the facility? Is there anything in the contract that states or limits the amount of profit this private clinic is allowed to make from the public system?

MR. ALMEDA: I would have to look at the contract and get back to you. I actually negotiated the fee myself with Dr. Cyr before the contract was signed, asked him what he was thinking of charging. The contract itself says that we're contracting six hours a day. We did do an amendment to the contract because the folks at Capital Health who told us how many hours they needed, they only talked about six hours to do six surgeries. What they forgot about was the set-up time for the first patient to the final recovery time for the last patient.

[Page 28]

Then they said they needed eight hours, so Dr. Cyr called me about it and we had, what I like to refer to as my Turkish rug salesman conversation and between us, we decided that what we would do is pay for one additional hour, not two. Basically, we're getting eight hours for the price of seven.

MR. DAVID WILSON (Sackville-Cobequid): In Ms. MacLeod's opening statement from the deputy minister, she had made mention - this is another topic - to the QE II ER and we know the construction is ongoing. Can you quickly tell me - do you have a completion date for that project? Do you know, have they set down a date for the opening of that facility?

MR. ALMEDA: Yes, sir. The plan is that it will open in April 2009.

MR. DAVID WILSON (Sackville-Cobequid): Okay. What other changes are being made to improve the flow of that emergency room? We all know, and in a recent media story, Dr. Ross, who is head of the ER there, said, it's great to have more beds, but without other changes to how the flow happens in the ER, really it's just more beds for people to wait in. Can you tell us, maybe, a few of the changes that government needs to make to improve the flow of the province's busiest ER?

MR. ALMEDA: Well, as you're aware, sir, we set the direction for the health authorities, but we don't tell them how to operationalize. That's what they're paid for and that's their responsibility to do.

It will provide more space and it will provide additional stretchers. But, do we want it to be just a place that houses more people waiting? No, we don't. We want them to work on their internal processes, that is, getting their patients discharged quicker so they can be moved from there to the floors.

I can tell you one process that's going to happen that will make a great difference, is that the orthopaedic surgeons have agreed that when that facility opens, they're going to have a trauma surgeon stationed in the ER. A lot of the cases that come into the ER are fractures and as you can understand, when people are waiting to see a surgeon or a medical consultant, that bed can be occupied for quite some time. That's one piece they put in place.

That means that fellow, who is the orthopaedic surgeon, can see that trauma case right away, take them upstairs, get them out of the ER. We hope the same thing will happen with medical patients. The detail of what types of extra clinics are going to be set up in there are unknown to me at this time, but I work very closely with John Ross and I suffer with him his frustration and I know that the facility itself will make some difference in people's attitudes to working there, people's attitudes to having to be waiting there because it is going to be a state of the art facility so people aren't going to be stuck in an old waiting area. There will be a nurse who roams around constantly checking with those patients to make sure they're okay while they're waiting.

[Page 29]

MR. DAVID WILSON (Sackville-Cobequid): That kind of leads me into one of my last questions and that's around the replacement of the VG Hospital. Has a decision been made by government, by the minister, that the VG Hospital will be replaced? Or, do you envision, as we spoke about earlier, a change on how we'll see services delivered in smaller clinics? So, has a decision been made yet to replace the VG, if not, when will we know of a decision by the government on this issue?

MR. ALMEDA: No, a decision has not been made at this time. As you can imagine, it's going to be very, very expensive. There is a very complete planning process being conducted by the Capital District Health Authority; they quite know what they need. What will happen for sure, all of that facility will not be replaced at one time. The province simply couldn't afford it. It will be a phased in approach that those things, like the Centennial Building, which are the ones that we normally hear the complaints about, would be first up on the list to have something built to replace what takes place in that building.

MADAM CHAIR: Order, the time has now expired for the NDP caucus. I recognize Mr. Colwell for the Liberal caucus. You have 15 minutes.

MR. KEITH COLWELL: I will be sharing my time with my colleague. During the discussion, at one point you indicated that some of the problem with the ER - and you've been talking a little bit more about just now - is beds available for recovery. Is that correct?

MR. ALMEDA: I'm sorry, I don't know what you mean by recovery?

MR. COLWELL: Well, after surgery, if someone has to stay in hospital for awhile, and you talked about the overall picture where you have to have everything in place before you can take someone in for an operation.

MR. ALMEDA: Yes, it doesn't change the picture on the operation. I mean that person is still going to need a bed, but as far as the ER goes, a lot of people get admitted directly from the ER. The ERs used to be considered the back door to the hospital, today they're considered the front door to the hospital. More admissions take place through the ER than in any other manner. So what's needed in terms of beds is to have a good process internally that would see the patients who are being discharged, discharged earlier in the day so that the backup in the ERs don't happen. That's what I was referring to.

MR. COLWELL: Yes. So basically, you have said in different words what I thought you said earlier, that the ER can be backed up because there's not a bed to put somebody in because of not discharge earlier, or whatever the case may be, is that correct? Did I hear you correctly?

MR. ALMEDA: Mr. Colwell, I'm sorry, if you're referring to the patients who have surgery and who are in those beds, those are not the patients I'm talking about. I'm talking

[Page 30]

about medical patients, the patients who have been in bed for quite awhile after surgery who are ready for discharge. It's a matter of the hospital developing its own procedures to try to get those patients discharged earlier in the day. Dr. Ross would tell you that the problem in ERs usually happens mid-afternoon to early evening. That's when they get the biggest amount of patients, the biggest number of patients who are admitted and held in the ER waiting for a bed upstairs. So once those beds are available, and if they discharge earlier in the day rather than later in the afternoon, obviously the rooms are clean, the beds are available earlier, and it would assist with that flow.

It's like Mr. Wilson was asking me about, what kind of things do they have to do. Those are the kind of things they have to do. They have to change processes, you know, consultants have to come down quicker and I think that will happen with this new facility. Some of the agreements with the physicians who are on AFPs these days, part of the deliverables is the respond of the ER earlier because there has got to be a system-wide process in there. It can't be just the ER knocking on the door asking for a bed upstairs. The people upstairs have to be thinking about discharging their patients so as to assist the flow of the facility.

MR. COLWELL: I fully understand this, I totally understand, I just wanted to reaffirm what you're saying. The concern that I have with this whole thing is we've got approximately 1,000 seniors occupying hospital beds right now that should really be in nursing homes or in other facilities, at home longer, or whatever the case may be. This has to have a negative impact on the operating rooms, the hospitals in general, and it's a very expensive process keeping these seniors in hospital beds when indeed they would be better served in a nursing home. Is this correct?

MADAM CHAIR: Ms. MacLeod.

[10:30 a.m.]

MS. NANCY MACLEOD: Yes, part of the challenge with bed availability for surgery patients, or emergency department patients, is patients in hospitals waiting to move to nursing homes. Part of the continuing care strategy for the department is adding nursing home beds over the next number of years. We'll have more than 1,100 new beds once the process is complete. We're also opening more day programs across the province, and respite care programs across the province, to try to keep people in their homes as long as possible and make sure that the care is available closer to their homes. So that's part of the system approach. We have to add capacity and, yes, the beds are coming, but they don't happen overnight. Some are under construction now. It will take time for the additional beds to be opened, but that's one piece of the puzzle when it comes to beds in a hospital.

MR. COLWELL: I realize that and I'm going to just cut you off because we have a very short time here. Basically with 1,000 seniors sitting in hospital beds, it is causing a

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backup, period. I mean it just maintains a facility, it holds up facilities, it holds up staff and all the things that go with that. We really have to look after our seniors properly and that's not an issue here for me or anybody, I don't believe.

The point is, the government made a very conscious decision, in early 2000, not to build nursing homes. They now just announced, after they realized they've got this huge problem on their hands and long, long waiting periods, which has been approached in some part by this private arrangement, and that's something that's up for discussion as time goes on, whether it was a good choice or not. There are some people who believe it is and some people don't. If we didn't have those thousand seniors in that hospital, would we be as far behind in operations and wait times as we are today?

MS. NANCY MACLEOD: I can't give you a specific answer to that question other than to say that beds are part of the equation, but other resources are as well. It's physician availability, it's OR availability, nursing availability, physiotherapist, occupational therapist availability. There isn't one piece of the system that determines whether or not you can do more surgery, but not having beds to put patients in post-op, absolutely, it has an impact.

MR. COLWELL: Yes, and with that amount of people - I mean if we were talking 10 seniors in a hospital, that's one issue, that would be insignificant - when we're talking on average around 1,000, that's a pile of beds that are tied up at a very significant cost to the taxpayers as well, so it doesn't free up money to do the other things you have to do as well.

So you've got the problem with the bed being occupied, plus you got a problem with cash, which is reality. So you can put the cash in place to maybe buy new diagnostic equipment or hire new staff, whatever the case may be, so you get a two-sided problem here created by government decision some time ago. So I'm going to just leave that at that.

I had some dental surgery done at the private clinic and was very happy with the service I received and they did a great job. I ran into a nurse there who was an OR nurse. She pointed out a problem, the reason she left the public system to go to the private system - and this is not anything negative against our nurses, I think we have the best nurses, the best professionals possible in this province and I speak from experience. My wife was very ill and she couldn't have received any better care on a timely basis and it did save her life on more than one occasion. So I believe that the people in our system are incredible.

I do feel, however, that based on what this nurse indicated at the time, that possibly the Department of Health, or the health authorities, have not done a good job negotiating arrangements for operating time. She indicated - and you can confirm if this is true or not - there's some kind of a problem with nurses, not in the OR, not working past the hours they're supposed to work. Now I don't know - I didn't really get a straight answer from her, whether it was an overtime issue that hasn't been negotiated properly or what the case has been, but in some cases she indicated to me that operations would be held up because the OR nurses

[Page 32]

had a lot longer shift that day than they should have had, maybe nobody replaced them and even though they were willing to work, under the union contact that they had - which is a good contract, I'm not knocking the contract here at all - that they couldn't move forward with some operations and indeed, maybe just as simple as paying a nurse, or the team of nurses that are working there, some overtime, to finish an operation that may take two or three hours longer than they anticipated - is that a problem? I'd just like to confirm this because hearing from somebody and actually knowing what transpires is two different things.

MS. NANCY MACLEOD: The way I can respond to that is that each of the districts has a resource base that they have to allocate to ORs on a daily basis, and on a particular day, maybe using overtime to finish cases is appropriate, on another day, maybe there aren't nurses available who are willing to work overtime to finish cases.

The operational aspects of the surgery program, really the districts have to manage it on a day-to-day basis and that's what they do. An individual circumstance, I can't address a specific, but they do due diligence every day to try to not cancel cases and to make sure that they get as many cases as they can through their operating rooms.

MR. COLWELL: I would just hope that it's not a case of just not quite having enough resources, especially when you have this $54 million-plus to address wait times, for something so simple that could maybe move this operation forward today. If it's not done today that means it backs up everybody behind them for the next two or three weeks, or whatever the case may be. If that's an ongoing problem, it's a serious problem. So that's something that really, I think, needs to be addressed. I'd like to get more information on that because if that indeed is happening, that's just a poor use of human resources. No reflection on the nurses because they do what they can do when they possibly can. If they have an agreement in place under a union contract, they have to abide by that and if the DHAs aren't providing the extra resources they need because it's a budget issue, a budget issue that's very tiny in comparison to the hold-up that there would be for operations, it doesn't seem to make any sense whatsoever.

MS. NANCY MACLEOD: Again, it's an operational, day-to-day management issue. I worked as a nurse in the public system for 15 years and there are days that you can work overtime and there are days that you can't - you have other obligations and family commitments. What happens on a particular day, I can't comment on.

I would like, if I could, to go back to the nursing home number for a second - I did check my notes after answering your question. As of the long-term care statistics that we have as of November 5th, of the approximately 1,000 patients waiting for nursing home for long-term care placement, 747 of those patients are actually in the community and only 194 of those patients are in hospital, so I just wanted to clarify those numbers.

[Page 33]

MR. COLWELL: Still, 194 is way too many - it should be zero, unless they need some kind of medical treatment that they have to be in hospital for. That's still 194 people who are tying up the system and stopping operations, stopping other people getting admitted for other things and that's a serious issue as far as I'm concerned. With that, I'm going to turn it over to my colleague.

MADAM CHAIR: Mr. Glavine.

MR. GLAVINE: Thank you, Madam Chair. Just a couple of things to go back to from the first questioning. I was wondering how many times a year that you met with CEOs and DHAs to address wait times from a provincial perspective, where that is the only topic or issue that you try to drill down on?

MADAM CHAIR: Mr. Almeda.

MR. ALMEDA: Yes, the CEOs have a monthly meeting at the Department of Health, chaired by the deputy minister. Program people like Ms. MacLeod or myself are brought in as required. There is always a fairly aggressive agenda and I would say exclusively, wait times will be on there. For the purposes of just discussing bed availability, I can't say that we've had too many meetings. The meeting that I referred to earlier that we took part in a few weeks ago with District Health Authority 3, it wasn't just about beds, it was about basically most things that are going on in their district. It's a bit of an update, they tell us what their challenges are and we discuss things that we can work with them to assist and basically, I can't say that I've ever had a meeting recently with a CEO that's simply about the wait times.

MR. GLAVINE: The other area where it seems that I need a little bit more clarification is around the $7 million that is currently over the budget limits. The CEO is attributing the $7 million deficit to increased surgeries, yet you're saying that you don't believe that to be the case. I'm just wondering, which is it? It's one or the other here, I think it's a fairly black and white kind of issue.

MR. ALMEDA: What I said was that they didn't do more surgeries than a certain base that we had expected of them. However, in those surgeries the cost of equipment, you know the escalation in health care costs is huge compared to the normal CPI, it's probably three to four times that amount, so the cost of doing arthroplasty surgery gets more expensive. What I said was that I don't attribute it to simply that, there are other things going on as well that have increased costs, laboratory medicine . . .

MR. GLAVINE: Very quickly, have you approved the CDHA's business plan for this year?

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MR. ALMEDA: I would have to ask the finance people, I don't approve business plans, we make recommendations.

MR. GLAVINE: Thank you.

MADAM CHAIR: Thank you, the time has now expired for the Liberal caucus. I recognize Mr. Dunn for the PC caucus. You have until 10:56 a.m.

MR. DUNN: Just continuing on with some questions from the prior round. Is there any agreement or any assistance that might be necessary between Scotia Surgery and Capital Health - if something went wrong, if there were an emergency at Scotia Surgery with a patient during a particular procedure, is there any sort of an agreement there where they can use the expertise of someone else?

MR. ALMEDA: Absolutely. They're as well equipped as any one of our public facilities. They have the defibrillators, they have strictly-trained staff if somebody has a problem. Like any other non-tertiary care facility or regional hospital, if anything happened, we would have a EHS that would be there in a matter of minutes and would transport them to Halifax just as they would if it were out in Cobequid or any other place distant from the facility.

MR. DUNN: Okay. A question with the contract - the contract expires April 1st?

MR. ALMEDA: Yes, March 31st. I hope I'm correct in saying that, I haven't a copy with me, but I believe that's when it expires.

MR. DUNN: What would happen if the wait lists were reduced to an acceptable level after a year, by March 31st? Would the contract continue with Scotia Surgery?

MR. ALMEDA: The contract can't continue without government approval. We certainly wouldn't have that contract in place if we didn't have a wait list issue at Capital Health.

MR. DUNN: If there is a wait list, do you anticipate the contract being renewed?

MR. ALMEDA: I'm sorry, sir?

MR. DUNN: If there is a wait list, do you perceive the contract as being renewed again?

MR. ALMEDA: Well, the contract for us is, we review the contract with them. The contract is signed between the district health authority and the organization. I would absolutely recommend that we continue it, in fact, I would absolutely recommend that we

[Page 35]

enhance it to do more surgeries there to allow us to get our major surgeries down to the pan- Canadian level by 2010.

MR. DUNN: You've been investing heavily in the continuing care strategy. Could you briefly summarize what the department is doing and the results that are coming forth?

MADAM CHAIR: Ms. MacLeod.

MS. NANCY MACLEOD: Yes, continuing care strategy has a number of aspects to it. We've invested around $260 million over a 10-year period to the continuing care strategy. We are seeing some improvements in different aspects of continuing care.

Waits for long-term care beds are down by approximately 9 per cent right now, which is about two weeks' time. The number of people waiting, at home or in hospital, for long-term care is down about 11 per cent from a year ago where we had a high. We have wait times for residential care facilities down about 13 per cent from a high back in January 2008. The number of people waiting for home support is dramatically down - it's about one-third less than it was a year ago.

District Health Authority 3 in the Annapolis Valley - where there have been significant challenges - are actually down 78 per cent in their waits for home care. The number of patients, there's a significant difference in it. We've added 143 interim long-term care beds and 40 restorative care beds. In the end, we'll have over 1,100 new beds and adult day programs to keep families together and keep patients in their homes, keep people in their communities, getting the support they need from home rather than necessarily moving into a facility.

[10:45 a.m.]

MR. DUNN: How is the department increasing access to doctors in the province?

MS. NANCY MACLEOD: One of the important strategies that's occurring in primary care is collaborative health care teams where groups of practitioners are working together to ensure the patient is receiving the care they need from the right practitioner. Whether it be physiotherapist, occupational therapist, nurse practitioner or a physician, making sure the right resource is available to the patient and that these resources are working as a team.

I think another really important aspect is the new physician master agreement that the province has signed that is working toward compensating physicians for doing things differently, for doing work in hospitals, for helping patients be healthier, rather than only

[Page 36]

treating patients, so giving physicians the remuneration that they deserve for taking care of the total patient and taking care of the total needs of the system.

MR. DUNN: With regard to the medical school seats increased by 10 earlier this year, could you comment on the agreement with regard to these students when they complete their studies, working in Nova Scotia?

MS. NANCY MACLEOD: I am aware that there is an agreement for those 10 seats for the physicians to stay working in Nova Scotia. I'm not able to tell you how long the agreement is after the fact, but there is an agreement to fill those 10 seats that they will practice in Nova Scotia when they're finished. My understanding, as well, is that eight of those seats are for new medical students and two of those seats are for students coming in to third year from other areas, so we will have those two seats putting out physicians sooner than all 10.

MR. DUNN: Wait times, as we certainly know, are a national and a global problem and many provinces across our country are having great difficulty with timely access to quality health. As an example, it is my understanding the average wait times for MRIs in Manitoba have nearly tripled over the past year, despite hundreds of millions of taxpayers' dollars being dumped into the system. So certainly we're not alone, as you mentioned earlier this morning, it's a problem right across the world.

Just in some closing comments with regard to Scotia Surgery, from what I'm hearing, patients seem to be very satisfied with their experiences and the project seems to be making an important difference in the quality of life of residents and patients in Nova Scotia. According to information available in September, in a survey, most, if not 100 per cent of patients would recommend surgery to another family member and to another friend or an acquaintance. They found the location very comfortable and convenient and, as was mentioned earlier in one of your answers, patients certainly have felt they've been treated with the utmost respect.

So the project seems to be coming along very nicely and seems to have been a great success. So in lieu of that, I would like to thank the department for not only that initiative, for numerous initiatives that have been undertaken. We certainly are facing difficult challenges, in particular with our aging population, however, your department is taking major steps to improve access, to reducing wait times in the province and I want to thank you for that. Thank you, Madam Chair.

MADAM CHAIR: Oh, you've completed your questions? Thank you. The time has now expired for questions. I would invite the witnesses from the Department of Health to make some concluding comments, if you wish.

[Page 37]

MR. ALMEDA: I'd like to speak to what Mr. Dunn spoke about MRIs in this province, as Ms. MacLeod mentioned earlier, we've gone from having only three to now having eight - five in the rural areas where the wait list is, by all comments, short, compared to anywhere else in the country, that's for elective wait times, urgent ones get in almost immediately, within a day or two days.

In addition to all of those MRIs, we've put in new breast mammographies across the province, six of them. We've added bone densitometry machines, we've added three 64-slice CT scanners in the northern region of the province - Truro, New Glasgow and Antigonish. We've also started a regional urology service out of Truro that will, when it's fully up and running this coming fiscal year, will provide care for urology to people from Amherst right around to the Cape Breton border in Antigonish. Folks won't have to come to Halifax, there are the same trained specialists, there will be three of them.

We've also started our PET program, which is an incredible device for people who are suffering from head and neck cancer. They no longer have to travel out of province, it's totally funded by government. The beauty of PET is that for head and neck cancers, when people were going out of province, the surgeons, or the specialists looking after those folks, were waiting up to 10 days to find out the results - far too long to determine what kind of treatment they're going to start. The PET not only diagnoses treatments, the PET also allows you to stage treatment. When you are on a certain treatment, if it doesn't seem to be working right, you can do another PET that will actually indicate to you that you need another course of treatment. So on equipment, we've made some wonderful strides, however, we still have a long way to go for basic equipment.

MADAM CHAIR: Ms. MacLeod, do you have anything you would like to add?

MS. NANCY MACLEOD: I will just add one thing. Thank you for your questions today and the opportunity to share with you a lot of the initiatives that are happening in the province. I think I need to stress a little bit the needs of technology in health care, the importance of using technology in the health care sector and some of the great advancements that are being made by implementing technology across the province.

We now have Telehealth connecting over 60 health care centres around the province. We have a picture archiving communication system which we call PACS which is a digital imaging for X-ray that can be shared across the province - no longer the need for films, so communication is easier. We have implemented technology in our ambulances that are able to transmit information to the emergency departments so that the information is there before the patients arrive. We're also working on implementing electronic medical records in physicians' offices, electronic health records around the province, and an electronic learning program for nurses. So I don't want to under emphasize the needs of technology, the importance of technology, moving forward with all initiatives across the system and all designed at better access which in turn reduces wait times for patients. Thank you.

[Page 38]

MADAM CHAIR: Ms. Whalen.

MS. DIANA WHALEN: Yes, thank you very much. There is just one point, Madam Chair, that I would like to raise and perhaps make it as a motion for the committee, but this is the Public Accounts Committee and our aim is to look at spending and the financial situation in the province. I noticed several times during the questioning today, we were told that there was nobody here from the finance area of the Department of Health who could answer a number of our questions.

So I would like to make a motion that would be for all future meetings, and not just for the Department of Health but with all departments, that the Public Accounts Committee require the witnesses who come from any provincial government departments to ensure they have financial staff present when they're coming to the Public Accounts Committee. That would be my motion today.

MADAM CHAIR: That motion is in order. I would ask the members if maybe we could refer this to the subcommittee for discussion and a recommendation back to the full committee. The reason I say that, we have a subcommittee meeting happening right after and I have some procedural questions I want to bring to the subcommittee about this and a couple of other similar type matters, if that's in agreement with the members?

MS. WHALEN: I'm certainly very happy with that. I just feel we should be looking at that. I don't think it's the first time that this has happened and, you know, perhaps it's my own background as an accountant, I'm a certified management accountant, and I feel that we are here to ask financial questions.

MADAM CHAIR: Certainly the point is a very good point, we will look at that.

MS. WHALEN: Thank you very much, Madam Chair.

MADAM CHAIR: Yes, Mr. Almeda.

MR. ALMEDA: Madam Chair, I wonder if I could just get a confirmation on who asked for the detailed case costs. Was it Mr. Steele or Mr. Wilson?

MADAM CHAIR: I actually want to indicate to the witnesses that we do have some information that was requested. Mr. Wilson requested a list of the costing for each surgery and, in addition to that, Mr. Glavine made several requests. I believe he was looking for reports to the federal government with respect to how the federal dollars for wait times have been allocated and, in addition to that, the draw down from the $51 million, in the 2007 wait-time reduction fund and how it was spent. I think those were the two, three actually, areas that were raised. So if you could provide that to the clerk of the committee, we would very much appreciate that.

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MR. ALMEDA: Absolutely, thank you.

MADAM CHAIR: So, once again on behalf of the members, thank you very much for your time with us today.

With that, we stand adjourned. The Public Accounts Subcommittee will be meeting at - we will take a 10-minute break - so we will meet at 11:05 a.m. Thank you.

[The committee adjourned at 10:56 a.m.]