HALIFAX, MONDAY, APRIL 14, 2003
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
3:24 P.M.
CHAIRMAN
Mr. James DeWolfe
MR. CHAIRMAN: The honourable Deputy Government House Leader.
MR. WILLIAM DOOKS: Mr. Chairman, would you please call the estimates of the Department of Health.
MR. CHAIRMAN: Madam Minister, we will give you a few moments to get your staff together.
The honourable Leader in the House of the Liberal Party.
MR. WAYNE GAUDET: Mr. Chairman, this afternoon I want to talk about some local issues. We know that this Tory Government, last election campaign, in replacing the four regional health boards with nine district health authorities, as the minister is aware, in the blue book, the government promised to give more responsibilities to communities over health care decision making.
I just want to review or go back over what happened to our DHA, the Southwest Nova District Health Authority, last year. We know that technically they were not in control in making decisions. I don't know how many times - I lost count after three times - they resubmitted their business plan to downtown Halifax to the Minister of Health before any decisions could be made public. Going back to one of the headlines in the Yarmouth paper: Health authority facing $3.3 million shortage. That was at that time, $3.3 million, initially, when they were looking at the budget.
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What we know, Mr. Chairman, with ongoing discussions between the DHA and the Department of Health - and, of course, this was before the annual meeting of the Tory Party that was coming very shortly - we know just before their AGM that the Department of Health came up with $22.5 million. Of course with this additional funding, the DHAs - ours, anyway, Mr. Chairman - that shortfall was reduced to $1.8 million. Before any decisions could be announced at home, these revised business plans had again to be approved by the Minister of Health or by someone in the department.
Mr. Chairman, I want to start off by looking at some of the final decisions that were announced and I will table this. This was the press release issued by the Southwest Nova - I'll table it after I'm done, thank you - District Health Authority, dated March 21, 2002. So this was with approval from the Department of Health. So they had to make up the difference of $1.8 million.
So by making up the difference, there are a couple of items here on this list - I know I won't have time to go over all of them but I want to start off with the satellite blood collection fee. The DHA was planning to raise $80,000 by introducing the $7 blood collection fee in four of our communities - in Lockeport, Barrington Passage, Meteghan and Freeport. Meteghan is in my riding, in the constituency of Clare. I've had an opportunity to raise this, to bring it to the attention of the House on several occasions. This announcement came down last March. It was indicated to the people in our riding as well as the people in Shelburne County and in Digby County. The people decided to drive up to the Roseway Hospital in Shelburne or to the Yarmouth Regional Hospital or to the Digby General Hospital. Blood fees would be free but at the same time, if individuals decided to go for blood work at these four blood satellite clinics, a blood fee of $7 would be charged.
I raised concerns about it. There are many individuals in these communities through these counties and tri-county - Digby, Yarmouth and Shelburne Counties - who don't have a choice to drive up to the nearest hospital for free blood work. A lot of these individuals don't own vehicles and, as you are probably aware, Mr. Chairman, many rural communities throughout our province don't have a public transportation system. So for a lot of people, that choice doesn't exist. For a lot of people to basically be charged $7 for blood work, I think and I still believe that this was wrong, that a lot of people, unfortunately, because of transportation, had no choice.
[3:30 p.m.]
At the same time, in terms of who basically is going to these satellite blood clinics, we know, Mr. Chairman, a lot of these individuals are seniors living on limited income. We know that there are individuals living on disability pensions, again, individuals living on limited income. So for them going for blood work once a week or twice a week or every week, where will these individuals find the money to get their blood work done?
I have said time and time again that I hope no one will put their health at risk, Mr. Chairman, by having to turn to these blood clinics and pay $7 for their blood work. As one individual had indicated to me, and I had several calls and I still do from individuals who don't believe this is fair. This is purely discrimination why some or most people have it done for free while others are being charged $7 for getting their blood work done. This individual, I recall - he's now retired, of course, a senior, worked all his life, paid taxes all his life - he told me he just hoped that one day when he did retire that the health care system would be there for him. But was he wrong. He was asking me, where am I supposed to find this money in my limited income coming in to pay for my blood work?
I guess my first question to the minister, I'm sure the Department of Health, the local district authority has had a chance to monitor these individuals who are going to these satellite blood clinics, who are not driving up or going to the hospital for free blood work. I'm just wondering, has the department, with the DHA and probably with the doctors in those areas, have they been monitoring these individuals to make sure that no one is jeopardizing their health, no one is putting their health at risk.
I guess my first question to the minister is, could the minister indicate to me if there is some follow-up done to make sure that no one, Mr. Chairman, is putting their health at risk?
MR. CHAIRMAN: The honourable Minister of Health.
HON. JANE PURVES: Mr. Chairman, first of all, I would like to point out again that the satellite clinics that exist in the DHAs are there for the convenience of the population and if they weren't able to charge a small fee for the convenience, then they wouldn't be able to exist. We are not in a position to be able to expand all services as much as we might like to. So, in answer to the question about an assessment, we have not done an assessment as yet because in some areas these satellite services have not been in place for even a full year. Obviously they will be assessed both for their cost and their convenience to see if they are generally appreciated or not and if they are worth doing from a health perspective. As I say, for those who may mind paying the fee, I do understand that, but before these were set up, they certainly wouldn't have had a choice, they would have had to go to the hospital for the blood tests regardless.
MR. GAUDET: Mr. Chairman, I agree with the minister. This is probably seen by many as a convenience for individuals in these communities or near those communities, to go in for blood work so these individuals won't have to travel to their nearest hospital to have blood work done for free. At the same time, there are individuals who don't see this as a convenience. The fact that they don't have a choice, they know they have to have some blood work done. Unfortunately, as I pointed out earlier, because of transportation available to them, they will basically have their blood work done at home. Does the minister recognize
that some individuals attending these satellite blood clinics don't see this as a convenience to them?
MISS PURVES: Mr. Chairman, as I believe I indicated, I am sure there are some individuals in many areas who would like to see such services offered for free, as they are in hospitals. In an ideal world, that would be the case but what DHAs are trying to do here is to offer a convenient service to the majority of the population and to do that, they need to recoup the costs of providing that service.
MR. GAUDET: Mr. Chairman, I'm glad to hear the minister indicating that they haven't done some assessment but they certainly are looking in that direction. This new blood collection fee was introduced several months ago. Maybe with the data that's coming in, especially the fact that the department, along with the district health authority will be doing an evaluation just to make sure. One of the concerns that I have is just as I've pointed out, I'm sure no one in this House would want to see one individual risking their health because they can't afford that blood work done for the $7 blood collection fee.
My next question to the minister, with this evaluation, with this assessment, is the department ready to acknowledge it? I'm sure that they have had some calls, because I have, and I'm sure the members from the neighbouring constituencies have received calls as well from individuals complaining that they can't afford to pay for this blood collection fee. I'm wondering, is the department looking at either waiving the fee or providing some assistance for individuals who have difficulties coming up with this blood collection fee?
MISS PURVES: Mr. Chairman, my staff are not aware of any calls coming to the department complaining about this fee. As I said, given the costs of health care, if an assessment or an evaluation reveals that the clinics are not helpful, then perhaps the clinics will be discontinued. The issue of some people having to obtain transportation to a hospital for blood collection would continue. I doubt very much that we are at a stage yet in Nova Scotia or in Canada to be able to provide satellite blood collection clinics without being able to recoup the cost. That being said, certainly in the primary care initiatives that we are looking at introducing over the next few years, which they include the idea of collaborative practice with a number of different clinicians practising together, it is possible that blood collection service might be a part of that but a movement in that direction is still very far from complete, in fact, hasn't even begun in some areas.
MR. CHAIRMAN: The member has approximately three minutes left.
MR. GAUDET: Mr. Chairman, in the DHA's present lease of March 21, 2002, they indicate that they are planning to raise $80,000 from this blood collection fee. I don't know if the minister is aware but I guess my question would be, could she indicate to the committee how much the DHA, the Southwest Nova District Health Authority has collected in this past year?
MISS PURVES: Mr. Chairman, that is not information we have with us but that is information that is easily obtainable and I undertake to provide it to the House.
MR. GAUDET: Mr. Chairman, if the DHA has not raised the $80,000 as they had projected for this current year, I'm just wondering, will the DHA have to cut somewhere else or will the department provide them with additional funding to help them with their deficit?
MISS PURVES: Mr. Chairman, the government has already this year helped the DHAs with their general deficits but referring in particular to this program, I think obviously this DHA would look at this program and see whether it was covering its costs and make a judgment about the service based on that and they are the best ones in a position to do that, not the department.
MR. CHAIRMAN: Honourable member, you have approximately one minute and I will remind you that you have indicated that you would table a paper you were reading from. Just a reminder, please.
MR. GAUDET: Mr. Chairman, I guess my last question with the minister indicating that the department will certainly be undertaking some assessment, some evaluation on this new blood collection fee that was introduced in 2002, will the minister commit to table a copy of that assessment in this committee or in the House at a later date so that members will have an understanding exactly how this new blood collection fee has worked in the DHA?
MISS PURVES: Mr. Chairman, when the evaluation is done, we would be glad to inform members of the House about it.
MR. CHAIRMAN: The time has now expired for the Liberal caucus.
The honourable member for Dartmouth North. The time is 3:44 p.m.
MR. JERRY PYE: Mr. Chairman, my time will be somewhat brief and I will share my time with the honourable member for Hants East. Before I begin, I want to say welcome to the minister to her new portfolio. I won't congratulate her because it might be premature and she may not wish to be congratulated on moving from Education to Health. Both are giant portfolios. They require a tremendous amount of one's time and a tremendous amount of work and both are very critical portfolios, ones that meet the challenge and the test of time.
I will also want to make mention now that for the public record, the former Minister of Health and I had an excellent rapport with respect to issues that affected my community and I want that to be a matter of record. On a couple of occasions when, in fact, I had asked the Minister of Health to address a couple of issues in the constituency, I was quite pleased
with the way that those matters were addressed and so were the constituents who were affected by those particular issues.
[3:45 p.m.]
I want to tell the minister that I'm dealing with the Supplementary Detail Estimates Book, Page 12.12. I want to talk about the Senior Citizens' Secretariat. Again, I want to compliment this government on hiring the Executive Director of the Senior Citizens' Secretariat, a very capable individual by the name of Valerie White. I want you to know that it was four years under the Liberal Government that in fact we did not have an Executive Director of the Senior Citizens' Secretariat and I also want you to know that very little to nothing was done as a result of that. I want to tell you . . .
AN HON. MEMBER: I think he's going to cross.
MR. PYE: No, I want you to know that there is no hope of my crossing the floor but I do want you to know that I believe that we ought to acknowledge competency when, in fact, it comes forward. I acknowledge support when it comes forward as well. That, I want to say, is what's happened here under the Senior Citizens' Secretariat and the hiring of Valerie White.
AN HON. MEMBER: You just called them a competent government.
MR. PYE: Well, Mr. Chairman, I'm not going down that road of rabbit tracks. I'm talking about the competency of the executive director who was appointed to the Senior Citizens' Secretariat. I want to tell you though, I see that there has been an increase in the budget from the forecasted year of 2002-03 to the fiscal year coming up of 2003-04. It's not a major increase but it is an increase in the Senior Citizens' Secretariat's budget.
Now I know that the seniors have ongoing meetings with the Group of Nine citizens across this province who represent a large number of senior citizens through various organizations. I also know that the Senior Citizens' Secretariat produces a seniors' program which, in itself, is an excellent program. Allow me to tell you that many people who come to my constituency office who are seniors, pick up this program because the wealth of information that it has is second to none. It certainly lets them know of the agencies and organizations by which they can make contact with respect to reference.
I also know that the Senior Citizens' Secretariat works with the seniors' expo program each and every year. Here is an issue that I want the minister to be aware of. One issue is that the Senior Citizens' Secretariat, my understanding is that they are going to be holding the seniors' expo at Exhibition Park at the Atlantic Winter Fair site. I don't know if the minister is aware - first of all, I guess, let me backtrack.
One, I would recommend that the minister advise me as to what the increased dollars represent and number two, if in fact the seniors' expo is going to held at Exhibition Park and if in fact because of that, the minister thinks or believes that this restricts a number of seniors from partaking in the seniors' expo because of the distance outside. Number three, is it possible for the minister to make arrangements with the World Trade and Convention Centre where the Senior Citizens' Secretariat has always been held for many years with respect to parking and accessibility for seniors to be available there? So that's just a minor start for now with respect to that issue of the Senior Citizens' Secretariat.
MISS PURVES: Mr. Chairman, actually I agree with you about Valerie White. She is an excellent person and always brings seniors' concerns to the table quickly. The main reason for the increases the member for Dartmouth North asked about were MCP merit increases, 3 per cent salary increases and increases in some operational expenses such as advertising and other miscellaneous expenses that would be in various publications including the publications that they put out.
In terms of the holding of the seniors' expo out at Exhibition Park, I believe that that was a suggestion put forward by some seniors themselves who didn't like coming downtown, necessarily, and I will get back to the member about future plans. I know we had some busing arrangements to take seniors from town out there so I am not sure if it's a wash in terms of numbers preferring it out there or numbers preferring it in town but I will get to the member about that.
MR. PYE: Mr. Chairman, again through you to the minister, I'm pleased that the minister will get back to me. If the minister is going to get back to me on this particular issue re Exhibition Park versus the World Trade and Convention Centre, I hope that there has been some assessment and an analysis done with respect to attendance at the Atlantic Winter Fair because I do believe that last year may have been the first time - this is not the first time, last year was the first time - it was held at the Exhibition Park. I'm wondering if, in fact, there are attendance records that indicate that this is a wise move and that, in fact, there are more people participating as a result of that and there are greater venue avenues for individuals promoting their wares to the seniors' community. So if that is in fact something that the minister is prepared to do then fine and I appreciate the minister getting back to me on that issue.
The other issue with respect to the Senior Citizens' Secretariat and I say this in a way to let the minister be aware because I had spoken with the Executive Director, Valerie White, on this issue and that's the issue that all seniors do not feel as though they are represented at the table by the Senior Citizens' Secretariat. We know that there's a Group of Nine and we can identify the organizations that they are in fact a part of but there is a group, and I'm not totally familiar with this, but my understanding is that speaking with some seniors, particularly around seniors' housing, seniors who are living in seniors' housing complexes, that they are somewhat excluded as a result of their association of some nature. I wish I could
be more specific on it but they feel that their voice is not being heard at the Senior Citizens' Secretariat.
I'm wondering if the minister has heard anything with respect to that and if she hasn't, will she speak to the executive director on this issue because I know the executive director is aware of it. The number is, I believe, some 5,000 seniors. I do know that the member for the new electoral district of Dartmouth South-Portland Valley - that's a mouthful - has five seniors' complexes in his constituency and he is aware at meetings that there are some seniors who feel that they are not represented by the Senior Citizens' Secretariat.
My question is, after all that preamble, my question to the minister is, will you look into this matter, apprise me and let me know if, in fact, it is your opinion that all seniors are fairly represented or if there is a need to have more seniors' views being put before the Senior Citizens' Secretariat. Rather than stand up here again so that the minister will be aware, that's question number one.
Question number two would be, does the minister keep a record of the number of recommendations that are forwarded by the Senior Citizens' Secretariat and those recommendations that have been approved and those recommendations which are still outstanding? I guess it would be somewhat like a report card whereby you would report to your government, if not the Legislature. I know there is not an annual report put out by the Senior Citizens' Secretariat, or I haven't seen an annual report, and there may very well be but if there is an annual report put out by the Senior Citizens' Secretariat, briefly what kind of statistical information does it contain?
MISS PURVES: Mr. Chairman, I will answer the second question first. The Senior Citizens' Secretariat does have a statistical officer so they would certainly have a record of the submissions that they have made and recommendations that have been put forward to the department and certainly they would know which recommendations have been accepted and which have not and which are pending. I will endeavour to get that information for the member for Dartmouth North.
On the first issue of seniors, particularly seniors in some housing facilities feeling that they are not represented, I have not personally heard that. The two seniors' residences in my riding, they do complain about not being represented. They don't think sometimes the Department of Community Services listens to them or the Department of Health listens to them or Housing Services listens to them. I haven't heard specific complaints about the secretariat but I'm sure that is probably true, that they feel that their voice is not heard on their issues as strongly as it might be and that is certainly an option to look at what we might do to effect some change there, if we can find a way to do that in a fair way. I know that there are a lot of issues that bother seniors in some of our housing complexes and one of the big ones has to do with the age of some of the new residents, for example, but there are many
others. Certainly I can undertake to look into that and discuss that with the Senior Citizens' Secretariat.
MR. PYE: Mr. Chairman, to the minister, I specifically didn't bring up the issue with respect to age of some of the residents that are now living in seniors' residences because I want to deal with that through the appropriate channel of the Minister of Community Services and Housing Services because as the minister has acknowledged, it is a very serious issue along with a number of other serious issues that the seniors brought up. I didn't think it was in the domain of the minister but yet I was pleased to see that the minister had made comment to that.
I want to go to the Supplementary Detail Estimates Book again. I want to go to Page 12.9. Page 12.9, of course, is the Pharmacare Program. As you know, this government has significantly increased the Pharmacare Program, both the co-pay and the premium rate with respect to Pharmacare over the term in which this government has been in power. It's ironic that this year is an election year and I had already told a number of seniors, not that I have some kind of a crystal ball or some sort of magic wand which opens up the skies and tells people what will or will not happen but what I do have is this. I did tell many of the seniors not to expect an increase in their Pharmacare payments this year because it was an election year. Now I know that the minister would not, nor her government, would have ever done anything like that or even contemplated taking such an action. I'm sure that that would not be the reason why there has been a freeze this year on Pharmacare, both the co-pay and the premium, that there is no increase in Pharmacare.
[4:00 p.m.]
I want to ask the minister if, in fact, this is a freeze for this year only on both the premium rate and the co-pay or if there will be an increase in the future years of the Pharmacare Program and how much did it cost? I think I already know that number but I would like that number to be put on the record as to how much it cost the minister and if the minister can tell me that this is a one-time budget item which will result in a freeze or if, in fact, seniors can expect for years to come that there will be no increase in both the premium and the co-pay.
MISS PURVES: The simple answer first, the amount that this policy this year will cost the taxpayer is about $9.7 million. Obviously I can't predict the future - I wish I could. What we've been trying to do over the last number of years is to maintain the 70/30 split whereby the government is paying 70 per cent of the costs, roughly, and the seniors are paying 30 per cent of the costs. If we can keep doing that, that would be one measure of success but one of the difficulties is even though we do review drugs and if cheaper, equivalent drugs come along, we encourage people to use those. We try to keep the costs down.
MR. JOHN HOLM: Getting rid of the drug patent law.
MISS PURVES: Getting rid of the drug patent law, the member for Sackville-Cobequid says. The issue is going to be a struggle every year. It's going to be a struggle for any government not only because of increased utilization costs because of an aging population but it's the discovery of new drugs, some of which are very expensive. For example, there is a lot of desire on all sides of the House, I believe, to have certain new drugs come into the system and to be paid for. The thing is that somebody has to pay for them. People at the Senior Citizens' Secretariat or at the Group of Nine know that they have to pay their fair share but they want their fair share to be an affordable share. That's the issue with them. So to make a long answer short, I can't guarantee the future but I can guarantee that we will continue to try to keep the 70/30 split and that we will try to keep the drugs as affordable as possible for the seniors who need them.
MR. PYE: Mr. Chairman, far be it for me to put words in the minister's mouth but the minister surely doesn't believe that this is just an election campaign ploy to freeze it for the one year, the $9.7 million, so that everybody walks away happy during an election year, then if the government should come to power again, to put increases on the Pharmacare, both the premium and the co-pay. I would like the minister to know and be aware, and I know the minister is, but I don't know how many members of this Legislative Assembly are aware that no senior escapes paying a portion of the Pharmacare.
Now seniors who are on the premium pay the premium rate plus the co-pay and those seniors who are exempt are only exempt on the premium rate and not the co-pay. So the co-pay is $315 a year and those seniors who are living on fixed incomes have extreme difficulty coming up with those additional dollars and now some seniors are very fortunate that the co-pay may be eradicated in about three or four months simply because of the amount of drugs they use. There are other seniors who can continue to pay this co-pay for eight or nine months because of the $315 co-pay that's there.
When you have to put $5 or $10 or 10 per cent or 20 per cent to the cost of the drug and you don't have the money and you have to hold off until the end of the month, believe it or not in Canada, the only people left in this country to be paid on a monthly basis are those people who are paid by the federal government their Old Age Pension and Canada Pension. They are paid once a month on the 27th. In the meantime, these individuals need drugs and prescriptions can't wait. So they have the difficulty of going out there begging and borrowing from friends and relatives with respect to maybe $5, $10 or $20, depending on their drugs and so on.
As a citizen, I find this to be extremely embarrassing when people who are proud individuals, who have worked all their lives, have to come to my office to see if there is something that I can do to help them get that money for their drugs. The Department of Community Services, simply because they don't qualify for benefits, may not, will not and
cannot provide them with that money so they have to go to an agency or an organization. All of this is extremely embarrassing and I'm sure that every one of us in this Legislature has encountered at least a couple of individuals who come to our office with respect to this issue.
I want to say to the minister, you know in a country that prides itself, and a province that prides itself with one of the best health care systems in the world, I guess my question is, why do we torture seniors into putting themselves into these kinds of embarrassing situations to come up with the money and if there isn't some other way in which this issue of having money to pay for the co-pay can't be addressed.
I know that the minister has indicated that the Group of Nine, through the Senior Citizens' Secretariat, has studied the Pharmacare Program and she does believe that we all should pay our share and seniors, being the proud individuals that they are, agree that they should be paying their share and, for the most part, that is often the speak of individual seniors who can afford to pay their share. It's not those seniors who can't. That's the kind of message that gets across. So I guess if there were a formula set up whereby you could do some assessments and maybe exempt some individuals from even paying the co-pay, then that might be something your government might want to look into immediately or in the near future.
MISS PURVES: Mr. Chairman, I can't disagree with a lot of what the member for Dartmouth North said but I can say that the secretariat recommended a cap on the price per prescription this year so that we have put that at a $30 maximum for each prescription and that cost the province not that much money, actually. It was a very good way to make things easier for some people. It cost us about $100,000, a little more than that, so that that does help the cash flow for some people on very expensive drugs so they don't have to pay it all up front at once. I would say also that even though it's not perfect, paying 70 per cent of costs is better than many provinces.
Although I wouldn't want to raise expectations, because it wouldn't apply for several years, but we will be in federal-provincial negotiations over what a catastrophic drug plan might look like for all citizens of Canada. Since we don't know yet what exactly that will mean, what drugs will be covered, what will be considered catastrophic, because they will have to be national definitions, but I'm sure that, although it may be no comfort for the next couple of years, after that there will be cases of hardship that that fund will be able to help out and I'm sure it will help some seniors when it is finally developed - people of all ages, actually, but including seniors.
MR. PYE: Mr. Chairman, the minister touched on the national Pharmacare Program which was supposed to be introduced in 1993. I remember the present-day Prime Minister campaigning on a national Pharmacare Program and that that national Pharmacare Program would be country-wide, that in fact it would cover not necessarily all drugs but there would be a basic coverage across the country. That never did happen and much of the money that
comes down through the CHST transfer allotment is part of the health care budget that addresses a Pharmacare issue.
The minister is new in her portfolio and obviously she didn't have the opportunity, I'm sure, to speak with the federal government and her counterpart, the minister, with respect to where the national Pharmacare Program is today, if it's on the radar scale or not or if it's off, or if it's just simply a bleep somewhere that we just look at for now and the federal government believes that the provincial government should do that through the CHST health transfer tax and that they should look at individual Pharmacare plans.
I do know that Quebec has often talked about us having the most comprehensive Pharmacare plan provincially and I don't profess to understand or to know all of theirs but I guess my question to the minister is, are you going to have future talks with the minister with respect to a national Pharmacare Program and has your government done an assessment in the Province of Nova Scotia with respect to a go-it-alone Pharmacare Program so that there would be full coverage for all citizens across the province because, as the minister is aware, there are many people who are employed, who are the working poor, who are employed in this province, who are low-income earners who have no health benefit packages or drug plans or anything of that nature and that many of these individuals are excluded from being able to purchase drugs simply because of the high cost of them.
Madam Minister, your portfolio is new, there is no question, but I do know that you are on top of these issues and I do know that you or your department obviously has some data or information with respect to the cost of a Nova Scotia Pharmacare Program if, in fact, that were the case and if, in fact, the government has even contemplated such.
MISS PURVES: Mr. Chairman, I believe that there has been, at least a few years ago, some initial work done on such an idea, not only a Nova Scotia one but possibly an Atlantic one, and I do know the idea comes up from time to time. I can't say that we have any costs because there are so many variations on what that could look like. It certainly is one of the things that is needed in health care. As the member knows, drug costs are not covered under the Canada Health Act unless they are administered in a hospital and I do know that a lot of people would like a national Pharmacare Program.
I haven't heard or been told of any willingness for that kind of a program to happen, probably because people know how much it's going to cost. I do think that the move toward including catastrophic drug costs in the so-called health reform fund that has been announced recently, and the funds of which increase every year over the life of the health accord, is a way of trying to address some of those costs but certainly it would not be the equivalent of a Pharmacare Program because of the use of the word catastrophic. I know it's going to take a great deal of work to try to figure out what that is because obviously catastrophic to one person is not to another and it's going to be very hard to come up with that definition.
I think every member of the House knows that new and better drugs have enabled people to live better, to live longer and to help decrease hospitalization costs and other costs but even so, they are very expensive and to some people, sometimes, not available. There are issues about drug coverage. Probably that's the single biggest number of letters that come to my office are about individuals who either aren't covered by Pharmacare, who aren't covered by community services, sometimes the working poor, even not so poor people, but they reach the max on their insured drug costs and they can't afford the drugs they need either for themselves or their children. It's a real issue. It's not just more funding for programs that exist but trying to find ways to fund programs that right now don't exist and that people feel they need. Everyone is aware of it. We try to keep at it but that doesn't mean there aren't people suffering out there because they can't get the drugs they need.
MR. PYE: Mr. Chairman, the Pharmacare Program is certainly a very important one in that it does save individuals from having to enter into hospitals where the cost is extremely enormous to the taxpayers and so on. So whenever we can provide drug services for individuals to take at home, like Pharmacare drugs, then we're much better off as a society and we're much better off with cost.
[4:15 p.m.]
I know there are some drugs which in fact are excluded from the formulary and I do know that there is a committee that reviews what's going to be added to the formulary and what's going to be excluded from it. Again, I would say that the minister and her department obviously are very much aware, because my colleague, the member for Halifax Needham, the Critic for the Department of Health, has talked about this very issue with respect to particular drugs around persons with Alzheimer's, Parkinson's disease, and the whole picture of persons afflicted by long-term disease. There's no question that we could debate that one here for a whole day.
To finish off this part of your budget with respect to Pharmacare, I guess my question would be, has there been any conversation with the federal government - I do believe it's their jurisdiction to deal with the major pharmaceutical companies across the country - to ask them with respect to the pricing of those drugs. Has there been any talk with respect to that area? I do remember, I believe it was under the Liberal Government again, in 1993, that brought this 10-year protection program into pharmaceuticals for R and D, research and development, to be able to have a hold on their patented drug for approximately 10 years before it became a no-name brand drug. So I guess there's a whole host of problems in that area with respect to pricing, which affect a lot of provincial budgets in dealing with pharmaceuticals.
MISS PURVES: Mr. Chairman, in terms of the drug patenting process, I haven't been informed of any recent discussions in that area. I will ask and if there is some news there, I will report back. The only real progress on a national level that is in sight, aside from
potential catastrophic drug coverage, is a national drug review that's going to be taking place, not just the Atlantic one which we've had, but a national one which, although provinces would obviously be free to not go with the recommendations, at least it would attempt to put Canadians on a more equal footing in terms of what drugs are covered or not covered by their province. That, I believe, is a step forward and every little step forward you take on these areas of national importance perhaps, in the end, does lead to a national drug plan. That being said, I see no quick end in sight to the high cost of some drugs.
MR. PYE: Thank you for the frankness, Madam Minister. It's one of those areas where it's difficult to touch because it's within the federal jurisdiction, as well as the province, for providing input.
I want to continue on Health, Page 12.9, with respect to the Children's Dental Program. The Children's Dental Program reflects exactly the same number of dollars, $5.4 million in this year's budget as the previous year. I guess there used to be a Children's Dental Program that came into effect under the Liberal Government, or even before the Liberal Government, I'm not sure, but it used to provide dental protection services or dental programs to children from the ages of zero to 16. Then, under the Liberal Government, it was reduced from 16 down to 14, I believe. Now, these numbers may be somewhat different and now I believe, under the Conservative Government, they have been moved from 14 to 12 years of age. Now, I don't know how true that is, but I'm sure the minister will give me clarity on those numbers and I'm just trying to grasp from memory those particular numbers. If, in fact, there are some real numbers that I should be aware of, then the minister can tell me.
I guess this is in anticipation that there is no increase in the child population with respect to this Children's Dental Program. If there is the exact same cost, have there been cuts in the program that we're not aware of or that we should be made aware of, that this Legislature should be made aware of, to provide the same level of service as the previous year? I guess because my time is running and naturally I've taken more time than I can, would the minister explain to me the Children's Dental Program in brief detail as well as the Special Dental Plans, both of those, and I see the special dental program has taken a huge jump. I will come back at a later date with respect to a number of other issues that I have on that, but right at the present time I would ask the minister to bring me up to speed with respect to the Children's Dental Program so that it can be a matter of record, as well as the special dental program. For the minister, that is the estimates in the Supplementary Detail that I'm speaking from.
MISS PURVES: Mr. Chairman, in terms of the Children's Dental Program, we did move to make some changes last year that we thought better of and reinstated some coverage so that we're looking at the same budget this year and the member is right, the age is 10 now, I believe, for costs being covered. In terms of the special drug programs, there was a cost transferred there for prosthetics services for dental needs, and you will see a decrease in
prosthetics services payments, but it's simply a transfer to a category that is more transparent. So it looks like that program has gone down, but it has simply been transferred because I'm talking about dental prosthetics.
MR. PYE: The reason I was hoping that this special dental program might give me light as to what's going on there is because I'm sure the minister is aware of this, we have a dental school at Dalhousie University, the Dalhousie School of Dentistry, and we do know that many individuals who are on social assistance end up going to Dalhousie University because it's much cheaper, but those individuals are expected to pay a percentage of the dental bill and, once again, there is no income because those individuals who are on social assistance, their budget has already been allotted out to them and the specific requirements of their budget allotment spells out exactly how their dollars should be spent, yet these individuals are compelled to pay - I do know that the Dalhousie School of Dentistry does not provide the dental service unless those people have the money up front.
My question to the minister is, if the individuals don't have the money up front, then how can they afford to pay for it? They have to go begging, like I've said about the seniors, and being tortured as to agencies or organizations who might assist them in funding for that, and it will not be covered by the Department of Community Services. As well, those individuals who are on social assistance, who need severe dental restorations as a result of deformities that they encounter. Although the department, through quick pay, may determine that those individuals are not entitled to it and it has no serious effect, they are not the ones who are faced with this very serious dental problem and they're not the ones who have to live with it all their lives. Is that part of the special dental program that I can possibly look at, or that I can possibly believe is where some of those costs can be picked up, or is this simply something else and those individuals are still left on their own?
MISS PURVES: Mr. Chairman, again we're talking about an area of medical care that is not covered by the Canada Health Act. The Dalhousie School of Dentistry does provide services at a much lower rate than you would get at a regular dentist, obviously, but simply put, when people go to the dentist they have to pay up front or they don't get the work done. That's the harsh reality of the way our system works, except under certain circumstances. For example, there is a program at the IWK that we fund that does help children with severe dental deformities, and also work for handicapped children if they have to go under anaesthetic in a procedure in a hospital as opposed to a procedure in a dentist office, then that is covered.
It is certainly one of the aspects to our system that it would seem that we don't like to talk about a lot of the time, because obviously there are a lot of problems with teeth and jaws that need to be fixed and yet there is usually not enough public money to help people. The member for Dartmouth North has asked some very good questions and, with the exception of some help Dalhousie is able to offer and help that kids get at the IWK for their deformities, there is not much in our system to help people with dental bills.
MR. PYE: Mr. Chairman, I am now going to pass the remaining portion of our time over to the honourable member for Hants East, my colleague, and thank him for allowing me to have this time to present the questions.
MR. CHAIRMAN: The honourable member for Hants East.
MR. JOHN MACDONELL: Mr. Chairman, could I have the time?
MR. CHAIRMAN: You have 15 minutes.
MR. MACDONELL: My colleague doesn't need to thank me for the time he was given. Madam Minister, I have a few questions around nursing home care in my constituency. Looking at the Senior Citizens' Secretariat booklet that comes out for seniors, under long-term care it has nursing home care and residential care facilities, and I'm wondering if you can tell me the difference between the two.
[4:30 p.m.]
MISS PURVES: I had to double-check on the answer to that, because I didn't think it could be so simple, but it is. The residential care facilities do not provide nursing care, and nursing homes as we know, do, and that is the big difference. Perhaps 30 years ago there was not such a distinction, but there certainly is now.
MR. MACDONELL: Mr. Chairman, we would be looking at, probably the more specific way would be people would be referred to as Level 1, Level 2, Level 3 in terms of their needs and, therefore the facility, that would be represented by the staff they have and what level of either RN, LPN or whatever. Can you give me a definition of Level 1, Level 2, Level 3?
MISS PURVES: I can get the member technical definitions from staff, but the essential difference is that Level 1 will very likely require some personal care assistance, but not necessarily nursing care; Level 2 is heavier care; and Level 3 is essentially 24/7 nursing home care, whether it is always provided by an RN or whether that's helped by an LPN and personal care workers.
MR. MACDONELL: If you could get me something from staff, I would appreciate that. It's my understanding that for nursing homes in the province, there are somewhere around 75, with pretty near 6,000 seniors in those facilities and I'm wondering, is it possible to get a list of those facilities? We have none in Hants East, and I would really like to know where they are in Nova Scotia. It's been a real issue, actually, for us in Hants East, because for seniors to get this level of care, they have to leave the constituency and they usually go either to Truro, Musquodoboit Harbour, Windsor or Halifax. There are people interested in
providing those facilities, but they can't get them licensed. Could you tell me, is there a moratorium on licensing of nursing homes?
MISS PURVES: Mr. Chairman, there has been a moratorium for a number of years. If someone does apply for a licence, we will review it. One of the issues we want to really move forward properly on is good demographics and good studies on locations of where nursing homes should be. I don't mean they should all be in the city - I mean the opposite actually, but you have to be very careful about building spaces if they're not required. That was one of the reasons, in spite of its flaws, that it was good to go to single-entry access, because people weren't doubled up on waiting lists and we weren't having sort of manufactured waiting lists.
We know we need more nursing care facilities, but we want to be more careful about where we build them. We do need some nearer to where people live or where their families live, and in that case they may need to be smaller than some of the ones - they obviously have to be smaller than some of the ones that we would build in the metro area. Even in the metro area, it can take too long for someone to get from, say my constituency out to Eastern Passage, it's just as hard for that to happen before and after work, during the week, than it is to travel longer physical distances, and I know that our executive director of long-term care is very concerned that any new facilities really answer the demographic needs.
MR. MACDONELL: Well, I will take from that and I like the way your department is thinking, or maybe I should say the way the minister is thinking. (Interruption) Unless I get into some other reason to think it's not the minister, I will acknowledge the minister, but I want to know - I said there used to be a moratorium so I'm assuming there isn't one - if that applies to residential care facilities as well or does the department make much differentiation in that regard as far as the moratorium?
MISS PURVES: Mr. Chairman, there really isn't a formal moratorium anymore. We will look at anything and try to assess it based on the actual need. We don't want empty facilities, but certainly we will look at any request.
MR. MACDONELL: Madam Minister, I appreciate that and I certainly will take that message back. I know there are people who are interested in this issue and certainly I think the corridor area in Hants East and Kennetcook would definitely be locations. Actually I had a senior a couple of years ago, and this is an individual who certainly if she has something on her mind, she makes it very clear to me what it is, but the thought for her was that she presently is in her 80s and in fairly good health, but she is concerned about the future. She would like to stay in her community even though her needs are going to increase and so for her it's a real issue.
I was glad to hear you mention about studying the situation so that you weren't going to have facilities that weren't going to be filled and that they'd actually meet the needs of the area. So I'm curious, is there a study going on presently by the department on this issue?
MISS PURVES: Mr. Chairman, we could look at any area. I mean there are lots of areas that want and need nursing homes and facilities. The only formal study that we're involved in right now is one with Cape Breton because we know they have the highest demonstrated need of seniors who need to be admitted to nursing homes and that is a priority. We already know and we're looking at all the details. Our health services plan - it used to be called the clinical footprint - looks at all types of continuing care provided in all areas of the province and we are involved in that right now, but in terms of a formal plan for nursing homes, Cape Breton is the priority right at the moment.
MR. MACDONELL: Madam Minister, I'm curious then, if someone was interested in either building a facility or getting an existing facility licensed, who would they contact in the department?
MISS PURVES: Mr. Chairman, they should apply to continuing care and Keith Menzies is in charge of that area of the department.
MR. MACDONELL: Is it possible to get from the department a list of criteria that they would have to meet?
MISS PURVES: Yes, they're for licensed facilities, there is a list of criteria that have to be met and they are public documents. So, yes, Mr. Chairman.
MR. MACDONELL: One of the things I recognize in differentiating nursing homes from residential care facilities, I think, seems to be the number of people you can have in them, is that right, more than three, less than three?
MISS PURVES: Mr. Chairman, I know it is confusing, believe me, I know. Small options homes can have up to three people requiring a fairly intense level of care. Residential care facilities can have, I believe, four. Some of the difficulties that occur is when the numbers get above four to six, or get above three to five because, depending on people's conditions and how old they are, their care needs could change quite dramatically within just a few months.
This whole issue, obviously is one that we've been struggling with all along, but more publicly recently because a lot of the operators of the homes don't know where they stand either because, occasionally, hospitals will even send people back to homes where the owners know they're not equipped to take care of the people. So there are a lot of individual situations that require a lot of attention and some of the work that lies ahead involves changing, updating the Homes for Special Care Act, trying to resolve some of the middle
ground between the Health Department and Community Services and trying to bring some clarity to all these facilities that exist, some of which, because they're not licensed or even registered, aren't necessarily on anybody's radar.
MR. CHAIRMAN: The time has expired for the NDP caucus this afternoon.
The honourable member for Cape Breton West. You have one hour in turn.
MR. RUSSELL MACKINNON: Mr. Chairman, I will be sharing my time with one of my colleagues, possibly more, but for the time being I'm first at the batting lineup. I'm looking at Page 12.18, that's in the Estimates Book. It's under the title Emergency Health Services and that is essentially for providing funding for ambulance services in the province as well as air medical transport, centralized communications and dispatch and other related services. I notice the bottom line for the estimate for the upcoming fiscal year is $65.624 million. Now, I compare that to the estimate for when the Progressive Conservative Government was first elected in 1999 and the estimate at that time for 1999-2000 was $43.468 million. So we're looking at an increase of over 50 per cent in the cost of our EHS for the Province of Nova Scotia during the term of this government.
I realize that there have been some wage increases for staff and the like, but would the minister be able to give me the rationale for why there was a 50 per cent increase in the cost of that service?
MISS PURVES: Mr. Chairman, obviously, that is not a year-to-year increase as the member for Cape Breton West said since we took power. The bulk of that increase is accounted for by two settlements with paramedics and other staff and, as well, the increase in the flight costs, mainly because of the increased number of flights, but also because of fuel prices and the general increase in the cost of air travel. But as I say, the large percentage of it, even this year, is wage increases.
[4:45 p.m.]
MR. RUSSELL MACKINNON: Mr. Chairman, just a point of correction; I think the minister would agree that my statement was a 50 per cent increase for the life of the government, not that it's on life support, but there's a 50 per cent increase in that particular budget which is quite significant.
I'm particularly interested in the ground ambulance service because, as we know over the last year or so, there was considerable concern about this $500 fee when somebody would go pick up somebody at the scene of an accident, depending upon whether there was insurance or not insurance and other factors. Are we dealing with about the same number of ambulance calls to the scenes of accidents as we did the previous year and how is that broken
down, the total cost of this particular EHS service that we have? Not the air ambulance, we dwelled on that the other day.
MISS PURVES: Mr. Chairman, the levels for ground ambulance are about the same as they were and we're not looking at an increase there or decrease, they're about the same.
MR. MACKINNON: Mr. Chairman, I realize it might be a little unfair to ask the minister if she would have that detail in front of her, but is that essentially the same number each year for the last four years? I know there could be a slight increase or maybe a slight decrease, I'm not sure. I'm just trying to break it down.
MISS PURVES: Mr. Chairman, I'm sorry, the question I answered was a year-to-year question. We don't have four-year breakdowns with us for all these costs that the member is asking for, but we can certainly get them.
MR. MACKINNON: Mr. Chairman, just looking at the one year, going from $56.9 million to $65.624 million, that's about a $9 million increase over last year for the service. That's looking on Page 12.18 from last year to this year. That to me would be, well, about a 15 per cent increase over last year, I'm just roughing numbers here. What was the increase in salaries for this anticipated year?
MISS PURVES: Mr. Chairman, we have part of the wage increase included in here and part of the wage increase is being held centrally until the contract is finalized, but there are a number of smaller items that have increased. Ambulance premium, repairs, maintenance and lease extension, for example, for $236,000; we have a fuel increase of $300,000; there are a number of $100,000 or $200,000 items in there; but the biggest single item will be wages.
MR. MACKINNON: Mr. Chairman, the minister indicated that there were ambulance fee increases, premiums. Did I misunderstand what she was saying, that there was an increase in the ambulance fee over the last year or contemplated for this year?
MISS PURVES: Mr. Chairman, no, what I said was that the ambulance premium increased, which has to do with the cost of the ambulances themselves and that was an increase of $145,000.
MR. MACKINNON: As I understand we have EHS as the service provider for ground ambulance, or EMC, I'm not sure what the acronym is, but I believe we understand the intent of my question. What was the total dollar value paid to this service provider in the last year and what's contemplated for this year?
MISS PURVES: Mr. Chairman, our forecast for this year is $57.872 million approximately and the budget we estimate for 2003-04 will be $60.0678 million.
MR. MACKINNON: I'm not sure if the minister is in a position to answer this question or not, but what is their profit mode? What's calculated in? What are they entitled to for profit? Is it 5 per cent, 10 per cent, 7 per cent or what is it? What do they get for providing this service?
MISS PURVES: Mr. Chairman, I'm told that that's a very complex formula and staff would be quite prepared to write that out for the member.
MR. MACKINNON: Can the minister tell us what the company's profit was for last year?
MISS PURVES: Mr. Chairman, we do not have that statement with us, but certainly we can get that statement. I would like to reiterate that the formula is complex and it's not as simple as a guarantee of 2 per cent or 7 per cent or 50 per cent or such. It's performance-based and it is complex.
MR. MACKINNON: Mr. Chairman, would the minister be able to provide that information tomorrow?
MISS PURVES: Mr. Chairman, we can do our best for tomorrow, but we do not have the audited statements yet for 2002-03, but we can certainly do for previous years and do our best guesstimate on that.
MR. MACKINNON: Mr. Chairman, the total funded staff for the Department of Health, I believe, is 652.3; is that up or down from last year? It escapes me looking in the detail.
MISS PURVES: Mr. Chairman, I do know the staff is up, we're just trying to locate the funded staff page in the book right now so we can be more exact. The total funded staff has actually gone up one from estimate to estimate.
MR. MACKINNON: Mr. Chairman, sometimes there are occasions when the Department of Health has to charge back a fee to the Workers' Compensation Board through its accident fund. How much money did the Department of Health collect from the workers' compensation system last year?
MISS PURVES: I may have misunderstood the question, Mr. Chairman, but we don't collect from the Workers' Compensation Board. So perhaps the member for Cape Breton West could explain what he's trying to get at and then I could be more helpful.
MR. MACKINNON: Mr. Chairman, my understanding is that if an employee is injured on the job and he or she goes to the hospital and receives surgery, it could be for a broken leg, after that it could be some physiotherapy, or what have you, through the accident
fund at the Workers' Compensation Board, does the Department of Health not charge that back to the Workers' Compensation Board?
MISS PURVES: Mr. Chairman, I understood the confusion here was arising, that you were speaking of employees in general, not employees of the Department of Health. (Interruption) Right, employees in general. There's a direct relationship between Workers' Compensation, as I understand it, and Atlantic Blue Cross, and it doesn't come through the Department of Health per se.
MR. MACKINNON: Does the Department of Health have a contract with Blue Cross to provide service?
MISS PURVES: Mr. Chairman, we do have a contract with Atlantic Blue Cross for the services they provide to us, but the services with Workers' Compensation is a direct one with Atlantic Blue Cross. So the Workers' Compensation aspect doesn't come through the Department of Health.
MR. MACKINNON: Well, who pays the Department of Health for providing that service? Is it Blue Cross, since it's not the Workers' Compensation Board who pays the Department of Health for providing that service?
MISS PURVES: Mr. Chairman, no, the doctors get paid directly. This money doesn't come through the Department of Health. The Department of Health is not involved in that. It's another system entirely.
MR. MACKINNON: Mr. Chairman, is the minister telling us that aside from who pays the doctor for his service, a fee for service, or service for fee, there is no charge from the Department of Health for the hospital stay and all the other services that are provided in relation to that particular injury?
MISS PURVES: Mr. Chairman, staff tell me that Workers' Compensation pays the hospital directly, pays the doctor directly, the physiotherapist, whatever is needed. It's not something - again I'm sorry to repeat myself - that goes through the Department of Health.
MR. MACKINNON: So I need some clarity here. What the minister is saying is that the Workers' Compensation Board pays the respective health authority, whether it be the Capital Health District, or the Cape Breton Regional Health Authority and so on, is that what the minister is saying?
[5:00 p.m.]
MISS PURVES: That's correct, Mr. Chairman.
MR. MACKINNON: Mr. Chairman, does the department have knowledge as to how much money these health authorities collect province-wide in the run of a year?
MISS PURVES: Yes, Mr. Chairman, we do get that information as part of the information that the district health authorities provide to us; that information, as well as information say from the Department of Veterans Affairs and so on. So we do have access to that information.
MR. MACKINNON: Perhaps if it's possible tomorrow as well, the minister could provide us - it doesn't have to be an exact figure, but just as close as possible - how much was paid by the Workers' Compensation Board on a district-by-district basis? It helps to be able to analyze what parts of the province have the highest incidents of injury on the job and the cost to the employers and indeed to the Department of Health. Is that possible?
MISS PURVES: Certainly that's possible to do that, although I would caution that - if it's possible, we will do it - sometimes people are hurt in other parts of the province who come into Halifax for treatment, so those workers' compensation figures wouldn't be entirely representative of costs incurred in each district.
MR. MACKINNON: Mr. Chairman, I understand - well, before I leave this topic, that would also apply for insurance companies. Most of the insurance companies in Nova Scotia, their parent companies are in the United States, I stand to be corrected on that, but that's my general understanding. It would appear to me that in some cases if somebody was to go out and get in a car accident, I'm not sure if the Department of Health charges that back to the insurance company or not - not that I'm suggesting that, I don't know the working formula. It would appear to me at first glance that the American insurance industry would be getting a free ride, not entirely, but to a certain extent. If you look at the United States, when someone goes to the hospital with an incident, unless they have this Medic Aid, or certain programs, the first thing they want to know is if you have insurance, and they charge that directly to the insurance company. I'm just wondering what the situation is here in Nova Scotia. Is there any possibility of deriving cost-efficiency to the taxpayer of Nova Scotia by looking at this issue?
MISS PURVES: Mr. Chairman, if there is an award, we do try to recoup the costs, but there is not a claim back directly to the insurance company.
MR. MACKINNON: Does the minister have any idea of how much money could be saved by the taxpayers of Nova Scotia if this issue were to be examined? I know we spend a lot of money on studies in the Department of Health. Maybe it's because it's the biggest
department that it has the most number of studies. I've never seen a department, where every time you turn around the Department of Health is doing a study, a study for this and a study for that. Now we have the Nova Scotia Health Research Foundation and that's essentially for more studies with about a $4 million to $5 million budget. This is an issue - I could be way off the beaten trail on this, but it would seem to me that the taxpayers of Nova Scotia could perhaps get better value for its dollar if the department were to examine this particular issue. So do we have any sense of how much money the Department of Health is paying out because of, let's say, automobile accidents or that sort of thing?
MISS PURVES: There was a change in regulations last summer that required a record for admissions to hospital as a result of car accidents, so we do have better record keeping.
MR. MACKINNON: Yes, would the minister table that information, perhaps tomorrow, so that members of the Opposition would have a chance to observe it? If she has it for the last two or three years, that would be appreciated as well.
MISS PURVES: Certainly, if it's recorded on the system, we can provide it to the House.
MR. MACKINNON: Mr. Chairman, could the minister tell us how many studies were carried out by her department? I notice different line items in the Supplement to the Public Accounts. We have that Nova Scotia Health Research Foundation. I'm not sure, perhaps 150 or 175 studies were undertaken, grants were issued last year and still we have all these other studies that are carried out within the Department of Health. How many studies were carried out by the Department of Health last year and how much did they cost?
MISS PURVES: I think we'd have to do a study on that, it depends if the member for Cape Breton West means a formal study. I expect that we can get that information on how many studies our department carried out last year, but I think he realizes that he is asking for a lot of information that is not necessarily recorded in the form that he is asking. We will do our best to provide it, but not all the information can be provided by tomorrow.
We do either formal or informal studies in the department on almost everything we do. If we didn't do that, we would just be going from pillar to post without any plan and that is not the case. In terms of the Nova Scotia Health Research Foundation, yes, some of the grants go to fund, if you like, studies. Research studies and research grants, whether it's to that foundation or whether it's through the universities or the community college or the hospitals, these are the lifeblood of the advancement of medicine.
On an administrative level or a bureaucratic level, obviously we need to do studies. We need to do studies on wait lists and why they're there, and try to standardize. That's one example. In terms of research grants, this is a huge industry for Nova Scotia and Halifax and
I hope the member for Cape Breton West isn't suggesting that health and scientific research is not important to the advancement of our society.
MR. MACKINNON: Mr. Chairman, I think the minister would be rather naive to think any member of the House would think in that form. It leads to the next concern that I have, and that is information systems and the information system technologies that we have within the Department of Health. We've spent a lot of money on upgrading our information systems and management of information within the Department of Health. I'm looking on Page 71 of the Supplement to the Public Accounts, it has Medical Information Technology Inc. Now, that may have nothing to do with information systems, but I guess what I need to know is, and perhaps the minister can't answer here today, but how much money has been spent on managing our medical information and statistics and everything else?
Every year, it seems to be study upon study - if you do a study then that study will come in with a conclusion, we should do another study and that one will come in and we'll have two or three options and maybe we'll need another study to determine which one is the best. (Interruption) Perhaps so. We've already had one Royal Commission, and I'm not sure how many millions of dollars we spent on the Royal Commission to do what we're supposed to be doing effectively today. I need to know, how much money is spent on information systems and management of our information that we have within the Department of Health?
MISS PURVES: Again, as one example, our MEDITECH system will cost about $56 million. When you talk about information systems, you're also talking about just ordinary day-to-day management of organizations, of all the DHAs of the Department of Health. Everything these days - I know the member knows this - is based on the use of information systems and computer technologies.
An example of an expense that is relatively new in the DHAs is the ability to send the results of X-rays and CAT scans electronically from a place like Liverpool to Lunenburg or wherever in the system so that the patient doesn't have to go out to the Cobequid Multi-Service Centre, pick up a copy of her ultrasound and get in the car and take it physically to the VG to show a technician there. These can be sent electronically now. There are huge investments in information systems. This does make life easier for the patient and easier for the doctors, but it requires technicians and it requires an investment not only in the capital of the technology side, but the operating side.
This is a huge expense to all businesses and to all institutions in society today and it's only going to get bigger, as I think I mentioned earlier. To have the kind of information system on patient records available that ideally we would like across the country, it would be a national expense of about $4 billion, and certainly, we are developing our share. We want good patient records and we want the kind of information that a lot of people think we already do have, but in fact we don't.
MR. MACKINNON: I appreciate what the minister's saying and I agree - that type of technology and information system probably saved a lot of lives and cured a lot of people a lot quicker than if they had gone through the old, get the X-ray in Sydney or Yarmouth and then tuck it under your arm and drive to Halifax and hope you'll be able to receive the service required.
I've asked about the air ambulance system. We weren't able to get complete details on that when we needed it. I asked about the doctors, I wasn't able to get details on that when I wanted. I asked about the WCB, the minister doesn't have that at her fingertips. I asked about the ground ambulance system. I know I've asked about quite a few issues and she's talking about more than $50 million spent on these new information systems. She can appreciate my concern, we're spending more and more and more but we don't seem to be achieving our goal. Some basic information, statistical information, should be readily available by just a punch of a few keys on the computer, I would think, after spending tens of millions of dollars.
[5:15 p.m.]
Bearing in mind - and this may appear to be a political statement and perhaps it's meant to be because we're in the business of politics - when the minister and the government came to power it said $46.5 million was going to solve the problems. Now they're after spending close to $600 million more than when they first came to power. I know we've had an aging population, I know there have been a lot of pressures on the government about the paramedics and so on, but it seems a little unreasonable that the minister doesn't have that type of detail that she could access on short notice.
I see individual members in the House here with their laptops, I'm sure they're able to access information from their office systems and statistical data they would have on file at a moment's notice. Why in the name of heaven don't we have somebody from the Department of Health to be able to communicate electronically with the department so we can get that information in a timely fashion? We're talking about information systems and modern technology (Interruption) The Minister of Natural Resources says the Speaker won't let him. Well, he has one in front of him. If the Speaker's not letting you, I beg to differ. I think that the minister and her staff should be like they do in other jurisdictions; and federally they have that information at the touch of a button. As the question is being asked, the information is being downloaded from the respective department. If we've achieved so much, why are we so slow in providing that vital data? I don't think that's an unreasonable request.
MISS PURVES: Mr. Chairman, I agree with what the member says. The last I recall, the ruling, at least for Question Period, was that we were not to use laptops and Blackberries and so on and so forth. I didn't realize the rules were different for estimates debate.
That being said, the member for Cape Breton West is asking questions over a 10-year period, over a five-year period, over a four-year period, and that is not information that is contained in the Estimates Book or information that is necessarily available at the flick of a switch, because the information has to be compiled in a certain way in order to access it that way.
That being said, we have been tabling answers on a very timely basis. We do have answers to estimate debate questions here that were asked at the end of last week, including air medical transport and I'm going to be tabling in a second the information project, the legal services explanation to the Supplement to the Public Accounts, the physician age break-outs, and so on. That information is available and I will table it. Even if I did have a laptop computer here, Mr. Chairman, some of that information would have to be reorganized in a systems way in order to provide it in the way the member has asked.
MR. MACKINNON: Mr. Chairman, with all due respect, that's simply not good enough. After spending tens upon tens upon tens of millions of dollars, to come in and say that our system is still somewhat archaic, that doesn't wash, it simply doesn't wash. I'm not putting it all on the shoulders of the minister, because she's relatively new to the department, but the buck stops at the top.
We have 650-some employees in that department, surely to heavens, with all that brainpower we should be able to get our act together. Information systems, technology, that was a big budgetary item four to five years ago. I just can't accept, quite frankly, why the taxpayers of Nova Scotia - and I would submit there's a lot of waste that we have to continually double-track every time we want to get some information.
Yes, I agree with the minister, Mr. Chairman, that sometimes if I ask a particular question looking for statistical data, whether it be four years or 10 years, it may not be always readily available, but I dare say some information at the time of questioning during the budgetary process is a lot better than nothing or waiting a couple of days. It just absolutely behooves me how the department can continue to go on haphazardly. That's what it is, it's haphazard. I will leave that particular issue for the time being.
Another issue is with regard to the number of people who come from outside of metro to the QE II, whether it be the old VG or the new Infirmary or whatever. At one time that represented about 45 or 55 per cent - I'm not sure what it was - of the total clientele there. Can the minister give us some information as to what percentage of clientele going into the QE II facilities would be from outside of metro?
MISS PURVES: Mr. Chairman, I wish I could just flip a switch and get that one. We believe the breakdown is two-thirds inside the metro area and one-third out. Again, I believe the member's asking "in general". I believe that answer's accurate. If it's not accurate, staff can correct me.
Again, it would depend on the procedure - for the cardio stuff, you know that's only performed, a lot of it, at the QE II, but there are many other procedures that are performed outside the metro area now that weren't in the past. It would be about right. Then we'd have to figure in the out-of-province admissions into that total to be entirely accurate.
MR. MACKINNON: One final issue I have, Mr. Chairman, and I'll turn it over to my colleague, the member for Clare, is with regard to the liver transplant program. The province doesn't do that any more and patients would have to go to Ontario, I believe is the location, I'm not sure if it's Windsor or somewhere in that general - London, I'm sorry. There's a bit of an additional cost burden to individuals who have to go there for themselves and their families. That is to be rated as to where they would stand on the priority list in terms of severity of the illness, to go up and to get tested to see if there would be a match, that sort of thing. They get a call and they go up there. If there's not a match for whatever reason they don't follow through with the operation, my understanding is that the individual patient or patients have to pay their own way home and they have to pay their own hotel bill afterwards. If they go through with the operation then they don't pay. Is that correct?
MISS PURVES: Mr. Chairman, my understanding is that the patients will always pay for the travel.
MR. MACKINNON: Mr. Chairman, I'm going to turn it over to my colleague. I'll come back to this issue a little later with the minister. Thank you.
MR. CHAIRMAN: The honourable Leader in the House of the Liberal Party. You have 17 minutes left in turn.
MR. WAYNE GAUDET: I want to start off with looking at the mental health services for western Nova Scotia. As I'm sure the minister is aware, the tri-county area used to be served by six or seven psychiatrists. Now our area, Mr. Chairman, is being served by only one psychiatrist. We know that one person can't do it all. People more than likely are not getting the help they need. I guess my first question to the minister is, what's happening to the people in our area who need help?
MISS PURVES: Mr. Chairman, the issue in some parts of the province of not enough psychiatrists is a serious one. That being said, we do continue to provide many services for people who need mental health treatment, that we make every effort to ensure that the urgent cases are treated first, and we continue with a physician recruitment program to try to attract not only psychiatrists, but other medical specialists and professionals to Nova Scotia. We are successful in a sense that we have been able to increase the number of doctors by about two per month. That being said, there are deficiencies in various parts of Nova Scotia and I wouldn't try to pretend otherwise.
MR. GAUDET: Mr. Chairman, the Department of Health, the government back in February announced a new policy for mental health services for the province. I guess my question would be, is the department still committed in providing service for the tri-county area, that's Digby, Yarmouth and Shelburne Counties?
MISS PURVES: Mr. Chairman, we do have designated beds, 16 in Digby and Yarmouth but the numbers that we have for mental health beds don't include general medicine beds that may be used to treat persons with psychiatric illness, nor do they include long-term beds at the MacKay Unit of the Nova Scotia Hospital. So we do have beds for people requiring that kind of care and we do have Community Services and GPs working in partnership with mental health teams and that's one of the approaches that our recent announcements of money for mental health were intended to address, the idea of not thinking solely in terms of psychiatrists for treating all aspects of mental health, but to try to get teams together that can support each other and treat people very, very quickly. We do also continue to support consumer groups to the best of our ability in this area. It's an extremely important area to try to move forward on because, for the most part, it's not just the patient that requires the help, it is often the family that requires help and we need people to be able to work with all of them together.
MR. GAUDET: Mr. Chairman, as the minister indicated, we have 16 mental health beds in the Yarmouth Regional Hospital. We used to have 22 mental health beds when we had six or seven psychiatrists. Now with only one psychiatrist, we have 16 beds, as the minister indicated. I understand the doctor now is basically responsible 24 hours a day from Monday to Friday; weekends, we have GPs who basically are covering weekends. So I went to check on the Web page of the department for what postings were available, especially in the tri-county area and I noticed, Madam Minister, that you only had one posting looking for one psychiatrist.
[5:30 p.m.]
Looking back at providing a service to the people of the tri-county area, when you look back, Mr. Chairman, in the last several years, probably in the last five to 10 years, we had seven psychiatrists providing that service to the people in our counties, and unfortunately we all recognize that one doctor cannot continue to provide the same level of service, it doesn't matter who you are. Again, looking at the Department of Health trying to help this doctor and trying to recruit someone to come in and help this individual to provide an appropriate care level for the people of the tri-county area, I thought it was kind of bizarre that the Department of Health would only have one posting looking for one, trying to recruit one psychiatrist for the tri-county area. So my question to the minister is, why is your department only looking at recruiting one psychiatrist and providing benefits to only one individual who would be interested in coming down and providing services to the people of those counties?
MISS PURVES: Mr. Chairman, in the most recent round of negotiations and the most recent alternate arrangement, we are actually in the process of looking for 12 to 15 psychiatrists for the Province of Nova Scotia. We believe that the recent fee schedule will allow us to attract new psychiatrists to Nova Scotia. In terms of the bed reduction, that is fairly typical of all parts of the country in an attempt to move to more community-based treatment and not base everything on beds per se. That being said, I think all of us are aware that with the deinstitutionalization of many patients with mental problems, there are people who fall through the gaps. I know there was a recent interview with a psychiatrist from the Yarmouth area on Information Morning within the last month and a half or so, and he does need help it would seem from that interview. He was particularly interested in receiving more support in working with youth. He did recognize that the new facility that we will be building in the metro area could be of benefit to him, but there's no question that he needs more help for all the work that he's trying to do in that area.
MR. GAUDET: Mr. Chairman, as the minister is aware, you know, and I don't believe that the tri-county area is the only rural area in the province that is in need of specialists in the mental health field, I understand there are other parts, especially in the Colchester area. The minister certainly understands there is a need to try to provide those extended services out to many parts of rural Nova Scotia, especially when you're trying to recruit, as the minister indicated, a number of psychiatrists, specialists in this field, to help the people of Nova Scotia, that there's definitely a greater need to provide this service especially to areas away from the metro area. I guess what I'm trying to find out is, what is the department offering in trying to recruit someone to maybe work in those areas that are maybe three, four or five hours away from metro Halifax? Is the department offering any specific benefits or does the department have a focused campaign in order to try to attract these specialists to areas of the province where they are greatly needed?
MISS PURVES: Mr. Chairman, we have negotiated a fee increase for psychiatrists with the Medical Society, about a 26 per cent increase actually. We were way behind in Nova Scotia in what we were paying psychiatrists and we believe that this new salary level will go a long way towards us being able to attract new psychiatrists to Nova Scotia.
MR. GAUDET: Mr. Chairman, the minister indicated earlier, especially in our area, that there is definitely a shortage, and I think everyone agrees with the minister. I'm not blaming this minister for the shortage. That shortage has been created over the years, but there is definitely a need to provide this service to the people down in the western end of the province. Earlier, the minister talked about these mental health teams, not just psychiatrists, but other people involved in providing this service. I guess my next question to the minister is, what are the department's future plans in providing mental health services for the tri-county area.
MISS PURVES: Mr. Chairman, the overall cost over the next number of years, we estimate to be about $17 million. Right now the funding for mental health services is administered out of the Department of Health. It probably won't stay there, but right now we're trying something new and we want the plan to work. As we develop the teams in Cape Breton, in Halifax, we will be able to have a better idea of how the teams work and what would be the most essential aspect of these teams, which would include psychologists, social workers and other people, as the best kind of team to have in some of the less populated areas.
The standards are ours, the operations are not and gradually as we learn more about what works and what doesn't, and what has the best outcomes, we will be able to transfer these funds to the district health authorities to administer themselves. That's generally the way it has worked in the past when we've developed something new, we hold the funds until the system is working reasonably well and then transfer them in a way that we know they're fairly allocated to the districts.
There is one aspect of mental health services that we haven't talked about much, actually we haven't talked about it in terms of health care much at all in these estimates yet, but that's the development of Telehealth, which does work in some cases with mental health patients as it does with other patients. In other words, the psychiatrists or psychologists or the person whose expertise is sought, can talk with the patient and his or her doctor, or his or her social worker, electronically. I mean, this obviously doesn't substitute for the ordinary direct care we all think about all the time, but it's becoming more common, and it's reasonably popular to patients and providers because the patients care about getting treatment. It's certainly a lot better, rather than driving to Halifax and having to wait in a doctor's office or a hospital, to be able to make your appointment with your own doctor at home and do this through the use of modern technology. So it's something that we will be using more of, but not obviously a total substitute.
MR. GAUDET: Mr. Chairman, as the minister indicated - and I will come back to that later - the provincial budget for mental health in this province is $17 million, is that correct?
MISS PURVES: The standards that we have recently developed for mental health will take about $17 million to implement.
MR. CHAIRMAN: Order, please. The member's time has expired.
The honourable member for Halifax Atlantic.
MR. ROBERT CHISHOLM: Mr. Chairman, to the minister, I have an issue with respect to the brain injured, a group of people who have been fighting for proper services in the Province of Nova Scotia for many, many years. There continues to be a real scarcity of
appropriate services for people, who as a result of accidents or other incidents find themselves in a situation where they require different types of care. I wrote the minister, I think she and her officials know about this issue, it's regarding a young gentleman by the name of Ryan Sullivan, who back in 2001 had an accident. He nearly drowned or did drown, but then recovered and has suffered brain injury as a result of that accident.
The accident happened in New Brunswick, but he has been back in Halifax, his family lives in Herring Cove and he has been receiving care at the rehab centre, very good care from doctors - Dr. Brenda Joyce, in particular, and others at the rehab centre - appropriate care at the different levels. But most importantly, his parents have been front and centre for him and providing 24-hour care since he came out of the rehab centre and has been at home; they have been looking after Ryan.
What he has been receiving now for a few months, as a result of the advice from the rehab centre, from the doctors is, he has been receiving attendant care, someone who comes in. They paid for and hired, as a result of very clear recommendations from the staff at the rehab centre, an individual who comes out and works with Ryan on a part-time basis, twice a week, three hours a day. This person takes Ryan out and they do various things, like go to a movie or to the shopping mall. They do various activities and one purpose of these activities is to help Ryan with areas where he has deficiencies, to initiating things. He has a problem with distractions, disengaging himself from activities once he starts. She puts him on a timer and says go into this store and buy this list of things and you have 10 minutes to do it, because it's difficult for him to follow those kinds of specific tasks and do it in the time required.
[5:45 p.m.]
So that's what he's been doing, that's what they've worked through with the rehab centre. We've requested the department pay some attention to the situation and the particular needs of this young man and his family, to provide them with some assistance. Someone from the department did go out there earlier this year and talk to them about what kind of services they needed, but primarily they were looking at home care services. As his parents have said in a letter to myself and I think to you, Madam Minister, they don't need home care services, they can look after him fine. It's just for that period of time that he goes out under the responsibility or under the guidance of someone who is paid and trained where he goes out and does things.
What they're trying to do, of course, and what the professionals are trying to do, is help Ryan reintegrate so that he can live independently and look after himself and make the kind of contribution that he used to make and would like to make in the future.
It seemed to me that there was some willingness to provide home care for this family, for this young man, but they don't need that, they need attendant care. They've asked and I've asked the minister in a letter dated March 25th, if her officials would consider providing financial assistance for the therapeutic attendant that their son needs in order to continue with his rehabilitation. Again, this is rehabilitation that has been specifically recommended by Dr. Brenda Joyce, Head of Physical Medicine at the rehab centre and by Jill Robbins, Director of Clinical Services at the rehab centre.
He's been getting this care now since 2001, it's progressing and they need some support from officials. As I indicated to the minister in my letter, the programs can't be too rigid that they are not adaptable to the actual needs of people who require care. I think this is a good case and I'd like to ask the minister if she and her officials have given this matter some consideration? I know they haven't had the opportunity to advise the Sullivans, but I wonder if she could bring me up to speed on what her thinking is and her officials' thinking is, with respect to this issue.
MISS PURVES: The member for Halifax Atlantic has brought up a very good point, a very good area in which we have a lot of work to do. In terms of in-hospital care and short-term rehab, we do a fairly decent job. But in terms of the amount that we do for the brain injured, in some particular cases, is not what it might be. We do have a proposal in from the QE II for a more intensive rehabilitation program and we're looking at that.
In terms of individuals with particular problems, I agree with the member for Halifax Atlantic that the rules can't be too rigid because the circumstances do vary considerably. All I can say is that we're always willing to go back and look at individual cases to see what we can do. It's an area we don't necessarily have a lot of rules, so we can't necessarily be breaking them. It's a growing problem, as well as a heart-wrenching one for families. I think most members of the House realize that with the explosion in the number of all-terrain vehicles in our province, the number of accidents caused by them has increased the number of brain injuries that we're seeing in our hospitals. Car accidents are the largest source, but not the only source, it is an area that we need to do a lot of work on.
MR. ROBERT CHISHOLM: Mr. Chairman, let me just say that I've heard this from a number of Ministers of Health. We had a case of a woman from Herring Cove who was in a very serious accident many years ago and her husband fought tooth and nail throughout the 1990s for an appropriate level of care for this woman. She finally is in a private facility out-of-province that is being fully subsidized by the province, and appropriately so. But it took a lot of heartache, a lot of anguish, a lot of his own resources in order to get to this situation.
There are other cases and if this young fellow was in the centre or in some kind of an institutional setting then the care would be provided. Or if they wanted, they could - as they were told by the official from continuing care - if they required it, get resources for home care. What they're saying is, they don't need that, they would like to see you spend some
money to help them because it's extremely important for his family. The father retired, he's there constantly in order to provide the support that his son needs. They are going above and beyond, but I'll tell you that they want to see some sign from this government that they recognize the contribution and they want to see this young fellow continue to be cared for in his home and to move forward in his rehabilitation. They are prepared to provide some support.
We're not talking about great sums of money here. We're talking about ongoing support at a level that surely is well within the responsibility of the minster. Again, they were told by the official from continuing care that their request for a therapeutic attendant was outside the programs currently provided. As the minister just acknowledged, there aren't very many programs currently provided.
I had a long discussion with the deputy about this last Fall. He acknowledged as well that there just simply are not programs available for this group of Nova Scotians. There is room there, I think the minister has acknowledged that and would agree to it. I ask her again, if she hasn't considered the case of Ryan Sullivan and his parents, that she and her officials give serious consideration to the merits of providing financial assistance for the therapeutic attendant that is so desperately needed for the rehabilitation of their son, Ryan?
MISS PURVES: Yes, we will always look at individual cases and we'll certainly take another look at this particular case. Thank you.
MR. CHAIRMAN: The honourable member for Cole Harbour-Eastern Passage.
MR. KEVIN DEVEAUX: Mr. Chairman, my questions for the Minister of Health relate to dental hygiene and particularly the Nova Scotia Dental Hygienists Association. I know that they have been attempting to get some form of self-regulation. I was hoping the minister may be able here today to tell us, from her understanding, what stage the process is in, any legislation or ongoing discussions with the Dental Hygienists Association?
MISS PURVES: Mr. Chairman, I know that the department is looking at some form of omnibus legislation for the Fall that would cover a number of health care groups that currently don't have their own legislation. As to specific discussions with the dental hygienists, I have not been informed about that and if there is something recent, I will let the member know today or tomorrow.
MR. DEVEAUX: Mr. Chairman, the dental hygienists are taking the opportunity, I believe, to meet with all the caucuses. They met with ours in the last couple of days and from that we got an understanding they are interested in proceeding with legislation. Can the minister tell me if she has met with the dental hygienists and, if not, is it something she's prepared to do in the next little while in order to get a better understanding of their situation?
MR. CHAIRMAN: Order, please. Just before the minister replies, perhaps we could just keep the conversations to a dull roar, please.
MISS PURVES: Mr. Chairman, certainly there are a number of groups that I've been meeting with and continue to meet with, and we don't refuse to meet with groups of people who want to meet with the department. So I can't give a commitment as to the exact time, but certainly if they would like to meet with the department, we would be glad to do that.
MR. DEVEAUX: I'm trying to get some understanding as well, Madam Minister, with regard to exactly how dentistry, dental hygiene, dental assistants, fall within the scope of the Department of Health. Is there a separate branch or division that deals with oral hygiene, for example, or is it someone in a policy position? Who is it, if they have particular concerns or questions in the department, they can go to as the person who's an executive director or something in charge of those issues?
MISS PURVES: Mr. Chairman, a lot of the issues to do with dental hygiene are under the umbrella of public health. We do some public health education on dental hygiene. Under ancillary programs - and, of course, as well, there is a connection with the university and the health professions and any funding we provide there. So there are a couple of different areas. There isn't really a dental division, but it's mainly under Public Health and ancillary programs.
MR. DEVEAUX: Mr. Chairman, maybe the minister can clarify - there's Public Health and then there's a separate area called ancillary programs. Are they separate? Can you give me an idea as to who the person is in charge of ancillary programs, who's the person, the executive director?
MISS PURVES: Mr. Chairman, that person would be Abe Almeda. He is the one - the member is nodding his head. He has probably talked to Abe or met with him - in charge of ancillary programs.
MR. DEVEAUX: Does the minister, as a position - obviously she's not going to comment specifically on dental hygienists or we would have legislation before us to debate - can the minister say whether her department, as a policy, supports health professionals being able to be self-regulated? Secondly, in the case of dental hygienists, it's required that they be supervised by a dentist, which in this day and age seems quite unusual. I wonder if the minister would comment on whether she sees that as something that in this day and age is antiquated and should be changed.
MISS PURVES: Mr. Chairman, we have looked at, and supported the self-regulation of professions in the past. I understand the point that the member is making about the supervision by the dentists. It's one of these areas of scope of practice that - well, it has been difficult to deal with because people like to guard their turf in the health profession. It is an
issue that Mr. Romanow talked about, how there was going to have to be an attitude change if health reform were actually to take place. But attitude changes can take a couple of decades sometimes, so it won't be easy.
[6:00 p.m.]
When I said we're looking at omnibus legislation or umbrella legislation, we're looking at how we could accommodate all groups looking to have their own societies and self-regulate themselves. There are so many branches of health professions now and we're looking at a way that we could have legislation that could be adaptable enough to include most of them. We're certainly not down to the fine print, but we're looking at a way that we're not going to come into the Legislature with 20 different Acts next Fall, we would like to be able to do better than that. So that's about where we stand on that right now.
MR. DEVEAUX: Mr. Chairman, well, as the member for our caucus who has a tendency to be the one to read these things, I will be glad if you can find a way to avoid 20 pieces of self-regulatory legislation. I think we see already, on the direct medical side, physiotherapists, a few years ago they changed the legislation so they don't need referral from doctors. Maybe in some ways medical doctors have already begun to accept the requirement of other health professionals, and I wonder if dentists now are in a position where they need to have that same understanding.
Sometimes that takes political will, obviously from all parties, given the role that dental hygienists can play. They were talking about smoking cessation. They were talking about, obviously, preventative and, as you noted in Public Health, they go into schools and into other facilities in order to educate people about good oral hygiene. It seems very important that they be given a role to play and one that isn't only supervised by a dentist.
I guess my last question to the minister, before I hand it over to one of my colleagues, is the minister prepared to recognize that even as we move forward in terms of oral hygiene and medicine generally, that as a bottom line, can she recognize that dental hygienists should be able to operate on their own without direct supervision from dentists?
MISS PURVES: Mr. Chairman, I think that's still part of the discussion going on between dentists and hygienists. I'm told that actually the dentists in this province and the ophthamologist in this province are somewhat more forward-looking on these issues than in some other provinces. The direction would be that the dental hygienists would be self-regulating to some degree, but I think there would have to be some parameters there for what procedures could be done and I don't think anyone would argue with that.
MR. CHAIRMAN: The honourable member for Dartmouth North on an introduction.
MR. JERRY PYE: Mr. Chairman, I want to thank the honourable minister, my colleague, the member for Cole Harbour-Eastern Passage, and my colleague, the member for Halifax Fairview, for allowing me to intervene on an introduction. I would like to introduce in the east gallery the NSGEU Civil Service Provincial Council. They are Wanda Pulsifer, who is the chairperson, Roy LeBlanc, Susan Kidston, Carol Anne Gaudet, David Brewster, and Brad Crewe. They are here in the gallery watching proceedings and they are also here to talk with MLAs about the civil service issues such as the amendment to the Civil Service Collective Bargaining Act and the reinstatement of the Transition Support Program, and I would hope that this House would give them a warm welcome. (Applause)
MR. CHAIRMAN: The honourable member for Halifax Fairview.
MR. GRAHAM STEELE: I'd now like to turn to some fairly detailed financial questions, and it's going to be a little bit like pulling teeth. I thought I'd warn you about that in advance, but somebody's got to do it and it has to be done.
The difficulty I have with the books that we're given as MLAs is that they don't answer a lot of the most obvious questions. I'm not saying there's anything wrong about what the Department of Health is doing or the Department of Finance, they're producing the books in the same format that they've been produced for years. The problem is they give almost no information on very important questions. Sometimes if you hunt and hunt and hunt, you can - to coin a phrase - "ferret out" certain bits of information, but I've said it before and I'll say it again, elected members of the Legislature should not have to hunt, and hunt, and hunt for important information.
I want to say again that I'm not suggesting that the Department of Health is doing anything wrong - they're not - they're just producing this material the same way they have for years, but it's a $2.1 billion budget and at the very least it should be easy to follow the flow of money from one year to the next. I've complained in this House before, especially after restructuring the government, how it was absolutely impossible - literally impossible - to compare the budget for one year to the budget for the following year, and that's no way to make public policy.
Let me start with an easy one. In the last year-end forecast update for 2002-03, there was an item for $11 million, which had a fancy name, but I'll refer to it as district health authority overspending. It appears to have disappeared in this year's budget documents, so my first question to the minister is, where is that $11 million line item in this year's budget? Where has it gone? The twin question to that, is a similar allowance being made for the 2003-04 fiscal year?
MISS PURVES: Does the member mean the deficit for the current year?
MR. STEELE: I'm referring, Mr. Chairman, to the item referred to in the year-end forecast update - the last one of December 2002 - that was called Consolidation and Accounting Adjustments for Government Service Organizations - Health Authorities Operations. If the minister needs some help in figuring out which number I'm talking about, I'm going to send it over to her with one of the Pages so that she can see exactly what I'm talking about. Madam Minister, I'm sending over the number and if you could let me know where that is in the estimates and has an allocation for that item been made in this year's budget?
MR. CHAIRMAN: Before I recognize the minister, is the member looking for this item to be tabled as well? To simplify things, let's table the item and provide another copy for the minister, can we do that? We'll provide the honourable Minister of Health with the document now so she can reply if she wishes.
MISS PURVES: In the Estimates Book, Page 12.21, District Health Authorities . . .
MR. STEELE: That can't possibly be it, Madam Minister. That's not the figure that we're talking about; that can't possibly be right. What I'm going to do while the Page is making copies, I'm going to move on to my next question, but I don't want to let this one go because this is an example of an important item - an $11 million item - that seems to have vanished from the estimates and I just want to know where it is and, also, has an allocation through DHA overspending been made this year as well since it was necessary last year?
I'd like to move on. One of my other pet peeves - I have so many, it's hard to know where to start - about the Estimates Book is that everything is showing as a net figure. It's not shown as how much is being spent and then in a separate line item, how much is being taken in, it's shown as a net amount. Now I hasten to add, again, there's nothing wrong with that, the problem is it's just not very informative for those of us who are sitting here trying to make decisions about the government's budget when we don't have those numbers separated out.
The department's budget this year is $2.1 billion, but as a matter of fact the department is spending more than that, but we don't know how much more because we don't see the revenue numbers separated out anywhere, certainly not in any kind of detail that's useful. So let me start this part of the questioning with a high-level question, what is the gross departmental expenditure this year, not counting any revenue that's coming into the department?
MISS PURVES: We'd have to get back to them on that because we have recoveries built in all the way through the Estimates Book. We'd have to take all the recoveries out everywhere and that would be very time-consuming. We can certainly do it, but for every health authority, for every travel expense paid for by the federal government for example, we'd have to take all the recoveries out and all the way through.
MR. STEELE: I'll have to respectfully disagree with the minister. It's not that complicated; it's not that big a deal. Somewhere in the Department of Health, that budget already exists. It has to exist; the department couldn't do its job if it didn't know what its gross expenditure was and if it didn't know as a separate item what the revenue is. All we know here in the Legislature is it's reported as a net figure. So somebody in the Department of Health has it right on their desktop - either their computer desktop or their actual literal desktop - the figures that I'm looking for and all I'm looking for as a member of this Legislature is that information. I know it exists, it has to exist - it would be crazy to expect that it doesn't exist, and all I'm asking for is if the minister will table it in this House.
Another way of getting at this would be to ask the minister if she would table an itemized list of departmental revenues. An itemized list of departmental revenue, is that possible?
MISS PURVES: We certainly can provide a list of all the recoveries and we can provide the information the member for Halifax Fairview was asking for, but our chief financial officer will need the time to go back to his office and get that information in order to supply it to the member here, probably tomorrow.
[6:15 p.m.]
MR. STEELE: Mr. Chairman, tomorrow would be wonderful and I accept tomorrow. Tomorrow would be great. I know that's not a promise, it's "the department will attempt to provide it by tomorrow" - but, my golly, getting information out of this government in one day is something I gladly accept since it's not something we usually see. Usually we get dragged, kicking and screaming, through the FOI process for months and months and, in some cases, years, so if the minister says she will deliver that information in a day, I say great, great, that would be a nice change.
One of the other items that I think members of the Legislature should be able to see and identify easily is the difference between recurring payments and one-time-only payments, payments that will not recur in the following fiscal year, and every department has some of these - it may be a grant that's just made once, as opposed to say the Pharmacare budget where you know that the Pharmacare budget and what they pay for recurs year after year after year. But there are many items in every department's budget that are one-time-only payments, and I wonder if the minister has a list of one-time payments, that is payments that will not recur in the following year, and if the minister can provide that list?
MISS PURVES: Mr. Chairman, yes, it can be done, but it is very time-consuming and I couldn't make that commitment by tomorrow. Every vendor code would have to be checked to make sure that it wasn't something that had occurred in a previous year or a year before that, to make sure it actually was a one-time payment as opposed to two or three times, or whatever.
MR. STEELE: I'm not asking for anything difficult. I'm not asking for something that the department shouldn't already have. I'm not asking the department to go through every vendor code. I'm looking for what accountants would call material payments - whatever that is in the Department of Health. Material payments, in other words very large payments that will not recur the following year, and I know the department knows this because you can't do any kind of planning in a $2 billion department without knowing which part of your budget is going to occur again next year and which part is not.
You can't possibly plan without knowing those things, and so again I can't agree with the minister that what I'm asking for is going to be terribly difficult. I'm not looking for reams of paper listing, item by item, every $2 expense report that's not going to recur, I'm looking for material items so that I, as a member of the Legislature, can have a better handle on this department's budget, because this minister is asking this Legislature to approve spending of over $2.1 billion and I would think the least the department can do is provide, fairly quickly and easily, material items that are one-time-only payments. The minister said she will produce it when she can, but I don't want the minister going away thinking that I'm asking for something difficult or impossible that's going to take hundreds of hours of staff time. I'm asking for something that has to be there already, because I can't imagine how the department does its planning if it doesn't know already which payments aren't going to recur.
Another item that is not clear, and this is one you really have to hunt for. You can probably discover it if you really hunt very, very carefully through the budget and you shouldn't have to. I shouldn't have to, Mr. Chairman, you shouldn't have to, no member of the Legislature, and no member of the public should have to hunt for items from the department's budget that have been transferred to other departments. Some of the department's budget has been transferred to the Office of Health Promotion. Some of the department's budget has been transferred over to the Department of Education. Something that probably most people don't realize is that part of the increase in funding for post-secondary education this year isn't new money, it's just money taken from the Department of Health and moved over into Education. So it's not new money, nothing new is being bought with the money, it's the same thing being bought, it's just moved from one department to another, but it's included in the amount by which the government claims it has increased post-secondary education.
Well, how do you like that, Mr. Chairman? It's good if you can get away with it but, at any rate, can the minister list specifically which items from the department's budget last year have been transferred to other departments this year, which items and how much?
MISS PURVES: Mr. Chairman, we can certainly provide a list of what got transferred over to Health Promotion and - you're looking for things that were transferred "from" the Department of Health as opposed to "to" the Department of Health?
MR. STEELE: Yes.
MISS PURVES: The Dalhousie School of Nursing, $1.7 million transferred to the Department of Education. We had funding to the Office of Health Promotion of $7.043 million and that is the major transfer - the breakdown of what was transferred to the Office of Health Promotion is not a problem to provide.
MR. STEELE: Mr. Chairman, I will assume that since the minister's list stopped at those points, that those are the only material transfers from the department. I'm assuming that the minister is not just giving me examples, but that is in fact the complete list and the minister is nodding her head so I will take that as a yes.
I would like to turn to - and the minister will have to excuse me if she has answered this previously, but I'm going to ask again - on Page 12.12 of the Supplementary Detail, the budget for Other Programs has gone from a forecast of $10.4 million to $17.3 million, almost a $7 million increase under the unhelpfully titled line item Other Programs. So I wonder if the minister could enumerate what are those Other Programs that are being funded to the tune of $7 million?
MISS PURVES: Mr. Chairman, mental health, early identification autism - $1.9 million, that was an increase of spending; we have wage increases in the Icons Project; we have $375,000 for children with complex care needs; we have a home care arthritis grant for $150,000; we have a transfer of the Multiple Sclerosis Society grant from Grants and Assistance; Senior Citizens' Secretariat, operational and wage increases; and we have a couple of things in here with initials that I have never seen before in my life, and I will have to get back to you with what exactly they mean when I have them translated into English.
MR. STEELE: Mr. Chairman, it would be very helpful if the minister could table the written list rather than trying to read out $150,000 at a time and how it adds up to $7 million. I know the minister and/or her department have that list somewhere and it would be very helpful if the minister could actually list them. (Interruptions)
MR. CHAIRMAN: Order, please. Thank you. The member for Halifax Fairview has the floor.
MR. STEELE: Now, I'd like to move to Page 12.21 of the Supplementary Detail. This may - I say may because it's impossible to know just by looking at it - this may circle back to the question that I started with. There's a line item there worth $28.5 million. It's actually $28.5 million counted to the good, it's on the revenue side. It's called Consolidation and Accounting Adjustments for Government Service Organizations. My question to the minister is simple, what is that? What is that item?
MISS PURVES: I'm unclear at what the member is looking at exactly. I would like to answer the question, but is it a part of the Health Department estimates that he's looking at?
MR. STEELE: Does the minister have the Supplementary Detail book? The minister says yes. I'm looking at Page 12.21, the fourth item in the right-hand column on Page 12.21, $28.5 million. My question to the minister is simply, what is that?
While the minister's looking, maybe I'll reiterate my complaint that when you have a line item in a government budget for $28.5 million, you shouldn't have to guess what it is. I'm not saying the minister's doing anything wrong. The minister's doing what ministers have done since time began. Maybe it's about time that we rethought this. When you're talking about $28.5 million, it should be clear to everybody in this Legislature what that is. So now I've finished my whining, back to the minister - what is that item?
MISS PURVES: What that is, it's in the item to do with capital grants. We have capital grants for hospital infrastructure totalling $30 million and the adjustment has to do with the amount of amortization. It's reflecting back, $28.5 million, because it's consolidating and the accounting adjustment is the amortization. That's the simple answer.
MR. STEELE: Well, I'm confused, which is a state that I'm getting used to being in looking at this budget because in the year-end forecast update, the very same item which is called - again, rather unhelpfully - Consolidation and Accounting Adjustments for Government Service Organizations is a payment to cover overspending by the district health authorities. Now the very same item under the very same words that the minister is now telling me is amortization. How can you have two items described in the same way in two different documents issued four months apart, that apparently mean such radically different things? So my question to the minister is, how on earth is an ordinary MLA supposed to make any sense of this?
MISS PURVES: Mr. Chairman, I'm told that there are a lot of entries called consolidation entries. This one here under Capital Grants, it's showing money in and money out, like the Diagnostic and Medical Equipment of $15 million, Hospital Infrastructure of $30 million, then the medical equipment fund out again - this is an accounting procedure. The member opposite knows very well I'm not an accountant, but I am here to answer for the estimates. What I'm saying in this particular case is that the $28.5 million reflects amortization of capital costs in this year.
[6:30 p.m.]
This is one of the things that you see going from one type of accounting system to another type of accounting system. He knows that very well. It is unfortunate that things are entitled the same, but in the forecast update, he's right. The same phrase is used to talk about the hospital deficits, but that's not what we're talking about here.
MR. STEELE: Let me then, Mr. Chairman, circle back to where I started because the minister wasn't able to answer the question without looking at the document I provided to her. In the December 20, 2002 year-end forecast update, there's an extraordinary item of $11 million for district health authority overspending. Try as I might, I can't find that item in this year's budget. Can the minister tell me where is it and has any allocation been made for the same line item in this year's budget?
MISS PURVES: We have the deficits for the districts - in each district in order to get the update on the $11 million item the member is referring to, we would have to go through the statements and add up the deficits for each district. They are there, but they're just accounted for separately in each district.
MR. STEELE: Let me just make sure that I understand this. On December 20th, today's April 14th, so less than four months ago, the government reports an item this way and if I understand the minister correctly, if I want to find that same figure, I have to go through the Estimates Book, district by district and add up the deficits, because now they're reporting it differently. Well, I'm not going to do that, I don't think I should have to do that. As a member of the Legislature, I think it should be obvious to me on the face of the documents without having to hunt through the documents. Let me ask the minister this because I refuse to hunt for figures that should be right there. What was the total deficit incurred by the DHAs last year?
MISS PURVES: Mr. Chairman, the total deficit for the DHAs last year was about $17.4 million.I would like to make the point that we did report the deficits for each district in the same way last year as we are doing this year. They were reported individually and that the line from the financial statements issued by the Finance Minister, or his updates, are not mimicked in the Estimates Book. But in point of fact, our Estimates Book, in terms of how the DHAs' budgeting and spending is presented, are the same this year as last year. That deficit represents about 1.5 per cent of the budget. That's $17.4 million.
MR. STEELE: I've said it before and I'll say it again, although it sounds as though I am - I'm not really being critical of the minister and her department. This is the way this kind of thing has been reported for a long time. It's just not good enough. It's just not good enough for us to do our job. It's time that we rethought these Estimates Books that are presented to the Legislature.
Let me move on then to the question of DHA deficits. I may be wrong, I'm not my Party's Health Critic and I may have forgotten or overlooked something, but is it not the case that DHAs are actually by law forbidden to run deficits? It's actually illegal for a DHA to run a deficit. Is that not correct?
MISS PURVES: The DHAs are not supposed to plan for deficits, but a deficit can be approved or not approved, depending on how and why it was incurred.
MR. STEELE: So, here we have a situation, it's illegal for a DHA to budget for a deficit, but the provincial government doesn't actually give them enough money to do their jobs, which is why at the end of a full year we have an accumulated deficit of $17.4 million. Later in the year, just like last year - let's remember what happened last year. In December 2002, the government reported that the DHAs would run a deficit of $11 million, even though running a deficit is illegal - no, planning a deficit is illegal, that is actually writing down in your budget that you're going to run a deficit is illegal, even though most of the DHA CEOs would have known from day one that they couldn't do their job on the money they were being given. That's part of the fiction around Health budgeting this year.
But I'm not sure there is any reason for us to believe that exactly the same thing isn't going to happen this year, that by the time we get to December we will find that the DHAs have overspent by $10 million, $11 million, $15 million, and that by the time we get to the end of the fiscal year we will probably find that they've overspent, just like last year, by $17.4 million. See, the government doesn't have to account for that now, because going into an election all they care about is that they're showing a surplus. It doesn't matter what size it is, it's showing a surplus. It doesn't matter, they don't have to let reality impinge on that.
One of the realities of the health system is the DHAs haven't been getting enough money to do the job. That's why they run deficits. My question to the minister is, why should any Nova Scotian believe that exactly the same thing is not going to happen this year, and that by December we will know that our DHAs are running deficits again? Why shouldn't we believe that?
MISS PURVES: Mr. Chairman, the department is constantly working with the DHAs to try to see where their funding gaps are. We know, in some instances, that there may be deficits. We don't plan for them, and we try to work to reduce them. I think the member knows that there have been much bigger deficits in the past, that two years ago the deficits were about $42 million. We are working very hard to try to bring the increases in health spending, both in the districts and that spending under our own authority, to be at least predictable and sustainable, as much as possible. That's one of the reasons that we've worked out this multi-year funding plan on the non-staff costs of 7 per cent, and we're constantly going through this business-planning process - it seems like we're going through it all year long - to try to see where we can accommodate the districts' requests for new projects and new services, and how we can afford them.
It's true, what the member for Halifax Fairview is saying about perhaps government not funding enough, but enough gets to be so big an amount of money. What we're working to do is to fund enough but not overspend or overfund. We work very hard to try to prevent cost overruns that cannot always be helped, but we're always trying to keep the increases within control. Although we don't like the districts to have deficits, we do think that the situation has improved considerably over the last number of years. This deficit is relatively small compared to the amount of money that the districts are dealing with.
MR. STEELE: Mr. Chairman, I don't hear any words of comfort to think that the DHAs won't do exactly what they did last year, and that is run a deficit. This government doesn't much care about that, because right now it's all about timing. They know they're not going to have to account for this until after the election. It's just one of those big multi-million dollar hits that the new government is going to have to deal with. (Interruption) The Liberals say they will deal with it when they're in government. (Interruptions)
I did have another question, but in the mudslinging coming from either direction here, Mr. Chairman, the last question I had for the minister just seems to have slipped my mind. With that, I will pass it over to my friends and colleagues in the Liberal Party.
MR. CHAIRMAN: The honourable Leader in the House of the Liberal Party.
MR. WAYNE GAUDET: Mr. Chairman, I want to continue with local mental health concerns for the tri-county area. I guess my first question to the minister is, could the minister tell the committee how much funding is being budgeted for mental health for the Southwest Nova District Health Authority?
MISS PURVES: Mr. Chairman, in that district, $2.8 million; $2.8712 million to be precise.
MR. GAUDET: Mr. Chairman, I'm just wondering, would the minister agree - I don't suspect she has that detailed information with her - to provide us with a list of where this $2.8 million funding has been spent?
MISS PURVES: Mr. Chairman, certainly we can do that. We would have to go to the district to get that, because we don't maintain that level of detail. It won't be a problem to provide a breakdown of that spending.
MR. GAUDET: Mr. Chairman, I appreciate the minister's commitment. Earlier this afternoon, in previous questioning to the minister, I indicated that for the tri-county area, which looks after Digby, Yarmouth and Shelburne Counties, our area is currently being served by one psychiatrist. I'm just wondering, what happens to funding that hasn't been spent on providing mental health services for the people in the tri-county area, what happens to that remaining funding?
MISS PURVES: Mr. Chairman, that funding can't be transferred to other services. It would have to be used in the way it is dedicated.
MR. GAUDET: Mr. Chairman, earlier, as the minister undertook to provide us with a list of where the $2.8 million funding is being spent, I will wait to get that information. Before I move on to my next topic, my final question is on mental health. I am wondering,
Madam Minister, when can we expect to see a plan from your department to address the delivery of mental health services to rural Nova Scotia?
[6:45 p.m.]
MISS PURVES: Mr. Chairman, the standards that we announced this winter are designed to encompass the entire province. The announcement to do with teams in the Halifax metro area and the Sydney metro area are one thing, but the plan of the mental health standards and treatments are meant to encompass the whole of Nova Scotia. As this rolls out over time, funding will increase. The cost of achieving these standards is going to be about $17 million. Staff in the department have worked very hard on this plan, and they believe it is a very good plan.
MR. GAUDET: Well, Mr. Chairman, the minister might agree that the $17 million plan is a great plan, but I can tell you that the people of Digby, Yarmouth and Shelburne Counties are currently being served by one psychiatrist. We used to have six or seven psychiatrists over the years. I can tell you that this plan the minister is talking about is not working for the people of the western end of this province. I agree there have to be standards province-wide, but what I'm looking for, is there a plan that will address the need to provide mental health services for people more or less in rural Nova Scotia, and mainly in western Nova Scotia?
MISS PURVES: Mr. Chairman, yes, the plan and the standards are not just for certain parts of the province, they're for all parts of the province. The member for Clare knows that we just made this announcement this year. We did just provide the funding this year. It will take a number of years for this plan to be successful, and it will have to continue to be funded and it will have to continue to be refined. I realize the member's frustration that there aren't enough mental health services in his area, but there aren't really enough mental health services in any area of the province. That's one of the things that we're looking to improve, certainly not just in metro or in Cape Breton but all over the province. It will take time.
MR. GAUDET: Mr. Chairman, as the minister knows and as every one of us understands, we can bring more money into the mental health budget, but more funding is not going to fix every problem. Part of the problem right now is we're finding a shortage of resources to help people, to provide them with the resources in order to look after the mental health services in this province. I don't know if the department or the province has a plan to try to recruit these resources to our province or if they have no plan, but just in terms of putting more money, I don't think money is going to do it in the end. I think we certainly need to have a plan to help try to recruit or attract medical professionals to many parts of this province. My final question to the minister on mental health services is, is the department looking at putting a plan together to help many communities throughout this province attract the proper resources to help with the delivery of the mental health services?
MISS PURVES: Mr. Chairman, I absolutely agree with the member for Clare that throwing money at a problem is not going to solve it. In a lot of cases, the money that you're putting towards a program is money you're putting towards people; I mean some of the health professionals that are needed to provide some of the kinds of services that we want to give. Part of the reason that people in the department who work in the mental health field are excited about some of these new projects is because it will allow them to work on different models of care that won't always involve just a psychiatrist. It will involve psychiatrists, but it will also involve other health professionals, including social workers, for example. That is part of what everybody wants, in terms of trying to reform the health care system, is how we can do things differently. That's what we're trying to achieve here with the approach of these teams.
As I said, the new approved payment schedules for the psychiatrists should help with the issue of recruiting more psychiatrists. That is a different pot of money than what we're talking about here for the mental health standards and teams. It may seem like just throwing money at a problem, but not when you do have a plan for what the programs should be and what the models are that you're trying to achieve for care. We do know we need more psychiatrists. To attract more psychiatrists we're going to have to pay higher wages than we paid in the past, and that requires money. It's not throwing money at a problem, it's finding money to pay the people you need to look after the patients who need the care.
MR. GAUDET: Mr. Chairman, as I indicated to the minister earlier, Friday I checked their Web page, for positions available and positions in which they were trying to attract medical doctors. I noticed, especially in the tri-county area, the Department of Health had only one opening available for one psychiatrist. Could the minister indicate to the committee why the department feels there is only a need to recruit one additional psychiatrist for the tri-county area?
MISS PURVES: Mr. Chairman, the agreement with the psychiatrists is very recent. We know that we're going to be adding, or trying to add at least 12 to 15 psychiatrists, attract them to practise in Nova Scotia. The list on the Web site is going to change.
MR. GAUDET: Mr. Chairman, I want to move to the press release that the Southwest Nova District Health Authority put out on March 21, 2002, and I tabled a copy of this press release earlier this afternoon. First of all, it said that with approval from the Department of Health, the DHA indicated in order to make up their $1.8 million shortfall projected for their 2002-03 business plan, they would have to . . .
MR. MANNING MACDONALD: Mr. Chairman, on a point of order. I would like to call for a quorum count, please.
MR. CHAIRMAN: A quorum count. I count 14 members. I believe, in the Committee of the Whole House on Supply, nine members is quorum. I will check with the Clerk on that. (Interruptions) It's nine members, so there is quorum. (Interruptions) Order, order.
The honourable Leader in the House of the Liberal Party.
MR. GAUDET: Again, going back to the press release that was issued by the Southwest Nova District Health Authority back in March 2002, they indicated that they had received approval from the Department of Health and that they would have to make up a $1.8 million shortfall, projected in the 2002-03 business plan. Part of that, there were a number of initiatives that the DHA brought forward, among those there was one where they were looking at instituting paid parking at all three hospitals in the district. Parking would now be paid for at the Roseway Hospital, at the Yarmouth Regional Hospital and at the Digby General Hospital. My first question to the minister is, could she provide us with how much has been collected at all three sites?
MISS PURVES: Mr. Chairman, I believe I said earlier that we would provide all the information that we had on parking revenues in the various districts. So, certainly, we would go to the district and see what they've collected in parking revenues.
MR. GAUDET: I thank the minister for her commitment in providing that information to the committee. I wasn't here previously to hear if that question had been raised. My next question is, would the minister also indicate to us, when she does table that information, the actual cost to set up these parking lots at all three sites?
MISS PURVES: Yes, there were set-up costs, obviously, not necessarily extensive, but we can also get those.
MR. GAUDET: Mr. Chairman, one question that has been brought to my attention is, looking at the Digby General Hospital, right next door is a big parking lot in front of the mall; right next door to the hospital is a local drug store parking lot, I'm just wondering if the DHA will raise enough money with the parking at the Digby General Hospital, to help pay for the set-up costs? Maybe when the minister does table that information, we'll be able to see if there is actually a chance for the DHA, for the department, to actually collect the amount that was spent in setting up these parking lots. I'm wondering if the minister could indicate to the committee if there are any talks - there are certainly some rumours out there - between her department and our DHA to raise the parking fee this year?
MISS PURVES: Mr. Chairman, that was not proposed in the business plan for the DHA, so I doubt very much that's the case.
MR. GAUDET: Also, looking at this new parking fee, many seniors and many individuals living on fixed incomes find this new hospital parking fee nothing more than a hidden tax. I'm just wondering, is the government looking at providing a rebate or some type of refund or a discount to these individuals living on fixed incomes?
MISS PURVES: I'm certain that it works in a very similar way in all the DHAs in that, if there's a hardship case, or it's a case where someone is coming to visit someone in a long-term care bed every day or every couple of days, that there are cases in which individuals can be given passes or exemptions from the parking fees or some way in which to ameliorate a particular hardship situation. I think everyone working in the health care field knows that there are instances where if a person has to be there every day or twice a day with a patient and the person doesn't have the means that the hospital and the DHAs are not trying to gouge people, they're trying to get a form of cost recovery that they think is reasonable and, if there's a reasonable case for a person to be exempted, they will be exempted.
MR. GAUDET: I guess my next case, speaking of hardship cases, it's probably more to address a specific need. In Clare, we have a transportation service that has been in operation for seven years now. It's called Le Transport de Clare. This service is provided by a group of volunteers. It's a transportation service provided mainly to people with disabilities, to seniors and others who need help. I was just speaking recently with one of the organizers of Le Transport de Clare. He indicated to me that currently they have two clients who have to have dialysis three times a week at the Yarmouth Regional Hospital. I know Le Transport de Clare has been trying to get free parking at the hospital for some time now. Even as we speak, they still have not received free parking from the DHA. I'm wondering if it would be possible for the minister to help them with their request of free parking for this volunteer organization that's providing free transportation services to individuals from our area?
[7:00 p.m.]
MISS PURVES: Certainly, we can undertake to talk to the CEOs about all their policies for free parking, or "not free" parking, and look at this particular case. I can't commit to change their decision because they are set up to manage their own affairs, but I'll certainly ask about it, absolutely.
MR. GAUDET: Mr. Chairman, again, looking at the list of initiatives that were approved by the Department of Health, there was a $50,000 budget item here listed for alternate funding for the Roseway Hospital switchboard night shift. As I understand, this service was provided at night by the switchboard at the Shelburne hospital, for local firefighters. I guess my question would be, has the DHA been successful in finding this alternate funding?
MISS PURVES: That is funding the department did provide to the DHA.
MR. GAUDET: Maybe the minister could indicate to us - the department did provide that $50,000 to the Southwest Nova District Health Authority - is it the intention of the department once again to provide that same level of funding for 2003-04?
MISS PURVES: Yes, that's part of their ongoing base, so it's being provided again this year.
MR. GAUDET: Mr. Chairman, I thank the minister for her response. Looking at the press release again, there was another budget item, emergency department charges. These new fees were being charged to individuals who needed to go to the emergency departments. Such fees were for casts, drugs, starter doses, collars, slings and braces. Once I am done, I will table a list of these take-home supply charges. I guess my question is, has the Southwest Nova District Health Authority been successful in collecting this projected amount of $150,000?
MISS PURVES: We'd have to get back to the committee on that level of detail. So we'll add that to the list.
MR. GAUDET: I guess the first question that comes to mind, we all know of individuals who, unfortunately, have limited income. These individuals certainly do have to go, at times, to emergency departments at the hospitals, and the fact that sometimes you don't have money with you to pay for these extra supplies that people are provided with in the emergency department, I'm wondering, is it department policy or DHA policy that when supplies are provided to individuals who can't afford them, that they are provided free?
MISS PURVES: Mr. Chairman, I don't think that personnel are told that if a person can't afford these things they would be treated harshly or made to pay for things they truly can't afford. What we're talking about here obviously is not something that is supplied in the hospital when you go into the emergency ward for treatment. It would be to do with take-home supplies, and sometimes it's easier for people - and they're not always very expensive - to be able to buy them in the hospital as opposed to making an extra trip to the drug store to get these supplies for home after being in the hospital.
I will check on the policy, but I think the member knows that not all supplies can be provided to everyone at all times free of charge because they cost. In terms of being treated in the emergency ward, having a cast put on, you don't have to pay for the cast, but you may need certain kinds of bandages. At one time, perhaps, everything was given to people and perhaps it's less so now. I don't think a case of true hardship would be denied by the people in the hospital.
MR. GAUDET: I'm pleased to hear the minister indicating that services certainly will not be denied. I'm just looking at this list - take-home supply charges. The Southwest Nova District Health Authority, in March 2002, indicated these initiatives that were approved by
the Department of Health, there was one budget item here, emergency department charges, they were planning on raising $150,000. I want to make sure people were not denied services. My final question to the minister is, if individuals don't have the money with them in order to pay for these supplies that they take home with them, are they provided with a bill or a cost that they have to pay the hospital at a later date?
MISS PURVES: Mr. Chairman, again, the Department of Health doesn't manage the day-to-day affairs of the health authorities, so we'd have to get back with that particular kind of detailed information. We'd have to have a lot more than 600 employees were we to manage that level of detail in the district health authorities.
MR. GAUDET: Again, the list of initiatives that the Southwest Nova District Health Authority provided to the minister for approval, they had to make up the difference for $1.8 million. I would like to know, has the DHA been able to raise these amounts they stated on their press release of March 21, 2002?
MISS PURVES: That DHA, this year, ran a deficit of about $700,000, so it was able to make up a good portion of the cost, but was not able to make up them all.
MR. GAUDET: So I understand that our local DHA ran a deficit of $700,000 for the year 2002-03. My next question is, will the Southwest Nova District Health Authority have to make up the difference for this deficit they ran into 2002-03?
MISS PURVES: Mr. Chairman, the province is picking up the deficits, so they'll be starting off clean. I would point out that I think all the DHAs - and this one in particular - have done an excellent job of managing their deficits. On its own, it seems like a large amount, but in a total budget of about $50 million, it's really excellent financial management.
MR. GAUDET: Mr. Chairman, I'm pleased to hear that the minister has indicated that our DHA will not be responsible to carry their deficit of $700,000 in the upcoming year of 2003-04. Is it a policy of the department that if a DHA finishes the year with a deficit, that automatically the department absorbs it, or will accept the deficit for any DHAs, as far as that's concerned?
MISS PURVES: No, it's not automatic by any means. Obviously, you work through the year, or the associate deputy and Byron work very closely throughout the year, to try to help manage costs and find ways either to cut costs or find some way of making recoveries. There's no automatic assumption of deficits. The minister has to approve and, actually, the Cabinet, as well, has to approve, if there's going to be a deficit.
MR. GAUDET: Mr. Chairman, that completes my questions for the minister this evening. Could you indicate how much time we have left?
MR. CHAIRMAN: You have a little over nine minutes remaining.
MR. GAUDET: We have nine minutes left. The honourable member for Cape Breton Nova will continue with our questioning. Thank you.
MR. CHAIRMAN: The honourable member for Cape Breton Nova, with nine minutes remaining.
MR. PAUL MACEWAN: Mr. Chairman, I was just discussing the issues of the day with my good friend, the member for Cape Breton Centre, when you came to my rescue, so I thank you. I'm told there are only nine minutes left, which is hardly enough time to get warmed up, but I was thinking that it was good to speak for nine minutes for an opener on the subject of health and how good it is to be healthy and how bad it is to be unhealthy, as demonstrated by the many acts of this government. Perhaps on that theme, I can make a few variations.
As I was saying the last time I spoke on these estimates, Mr. Chairman, there's a great deal of unease where I come from about the future state of our health institutions in that area. We face the same problems in Health that we face in Education and generally because of the downturn of employment caused by the double closure of the two basic industries we had, namely, coal and steel.
AN HON. MEMBER: How much money do you make?
MR. MACEWAN: How much money do I make? That has nothing to do with what happened to the steel and coal industries. I'll tell you, that's irrelevance, Mr. Chairman. You should rule that comment out of order. In any event, we lost the coal and then we lost the steel, and as a result of that, we lost all kinds of children. So our education system is in a free fall down, and we lost all kinds of hospital patients and so I suppose there's also a downturn there; perhaps fewer beds are required, I don't know.
I remember a time when there were 4,500 people working at the Sydney Steel plant. That was in 1974, under the Regan Government, I heard somebody over there say, and they're right; on the irrelevance, I will support them. It was the Regan Government, 4,500 people working at an institution where, today, I don't have an up-to-date employment list, I know there's Alfie and there may be some others in the office, and out on the grounds there are people who patrol, the security types, and there are also demolition workers working tearing the place down for Zoom - wake up, Mr. Minister - Zoom, is that right? (Interruption) Yes, Zoom Developments of India, that want to take the steel plant apart, put it on boats to India, and when they arrive at Calcutta, or wherever they arrive, they're going to put the thing back together again, just like a Meccano set. Did you have a Meccano set when you were a boy? It was all kinds of little steel rods and parts and little screws, and you could put them
together and make something, and then you could take it apart. Well, that's exactly what Zoom, as motivated by this government, intends to do to our steel plant.
[7:15 p.m.]
Now, how does that affect our health care delivery system? The answer is that there are fewer people working and so there are fewer dollars around, but there are also fewer people to get sick because so many have moved away because there were no jobs in Cape Breton, they had to go out to Alberta or some such place. So all this is affecting the future of the Glace Bay hospital, the New Waterford Consolidated Hospital, the Northside General Hospital and I suggest in the final analysis, the bottom line, the Cape Breton Regional Hospital, because that's the foundation on which all these other hospitals come from, I guess. We've had problems in New Waterford. Should I tell them about Dr. Atiyah or do you want to go on that one.
AN HON. MEMBER: You go ahead, Paul.
MR. MACEWAN: Well, all right, Dr. Atiyah, I believe he's from Egypt, was the first plastic surgeon to ever locate in Cape Breton, the first one in history, obtained by the Liberal Government of Russell MacLellan, and they needed a place to put his clinic and there was space available in the New Waterford hospital, so Dr. Atiyah came to New Waterford and did his plastic surgery there. What is the future of the plastic surgery operation in industrial Cape Breton? Well, there have been problems. If I had more time, Mr. Chairman, I would get into them, but I'm sure my good friend, the member for Cape Breton Centre, will fill the breach when my seven minutes have run out, if not today, tomorrow, and tell you about Dr. Atiyah. There have been problems in the emergency department at the New Waterford Consolidated Hospital, in Glace Bay and at the Northside General Hospital, all three. The problems are generally about the same, but there are differences from hospital to hospital. For example, you will find that doctors doing emergency duty in New Waterford are not being paid the same wage for doing it that is paid in Sydney. So if you pay a doctor twice as much to do the work in Sydney as in New Waterford, guess where they're going to want to work? I rest my case on that one.
Mr. Chairman, I have a file, it's bigger than this file here. That's just some of the work I brought up from my constituency to do while I'm up here in Halifax this week doing nothing, as they say. I have a file bigger than that, on the one hospital in New Waterford, about all the problems that they faced there over the last number of years. It includes, yes, some of the good things that were done under the Liberal Government to make those problems better, but since the Tories got in, instead of the upward swing continuing, it has plateaued off and then, now, once again, going down. There is a great level of public concern on this. There was a mass meeting held in New Waterford only a few Sundays ago. I regret that I wasn't there because I was on my way up here - you have to travel sometimes in this
job - the hall was filled. At least one of our members was there. I'm not trying to make commercials for my colleague from the other Party, but he was there.
AN HON. MEMBER: Two nights, Paul.
MR. MACEWAN: Two nights. Well, he has lots to say then to keep these Health estimates under very close scrutiny for at least one hour I should think, I should hope. So how much time do I have left, Mr. Chairman?
MR. CHAIRMAN: The member has three and a half minutes remaining.
MR. MACEWAN: Well, maybe I can move around to Glace Bay for a minute because there are great concerns in Glace Bay, ads appearing in the newspaper - Dr. So-and- so will no longer be in practice. News write-ups saying the same thing - physicians leaving and not being replaced, emergency department closed down; the future of the emergency department in Glace Bay right now - here's the honourable member for Glace Bay, he can tell us all about it.
MR. DAVID WILSON: Sure will.
MR. MACEWAN: He sure will, he says. Well, I rest my case. If the member for Glace Bay is here, he can tell the tale for Glace Bay.
I don't actually have any hospital in my constituency, not even with the new boundaries. I have the site of the former Sydney City Hospital (Interruption). No, I don't, it's on your side of the street. I will say that there are hospitals in action that serve the people whom I represent on both sides, on this side and on that side. So we have lots of hospitals that we can talk about. I see the deputy clerk is waving his hand at me to clam up. My time is just coming to an end, I know that, Mr. Chairman, I know that. That was Churchill's sign of victory. That's what that one meant - victory. Yes, if I had more time, I could get into the Northside General and all the problems they have over there and every health care facility it seems that we're in contact with, they're having problems. Our government, when it was in power, did a great deal to try to make the health care in Cape Breton better. If you give me more than two minutes, then I could start telling you about that.
AN HON. MEMBER: Give him another hour.
MR. MACEWAN: Well, there may be another hour coming, but I must say that this government now stands to be judged on their record since 1999. Did they continue the good work underway by the Russell MacLellan Liberal Government? No, they did not. Did they turn their back on that good record? Yes, they did. Yes, they did. They turned their back on that good record both in Health and in Education and in every other subject you would care to mention and then some. It has not been a very good record.
I am not reassured, Mr. Chairman, by the $155 cheque that I'm going to get in June. Well, I may have spent it already, but that's another story. (Interruption) Give it to the Crown. Well, I raised the suggestion in the House the other day of, give it to the Liberal Party - now you're giving me the one-minute finger signal - give that $155 to the Liberal Party, and if enough people do that, we will have enough money to be able to beat that crowd and take them right out of office. In fact, we could put them right down here where they started from, in third place. So I think that's a worthy project to devote a full hour to the next time we get a turn at bat.
MR. CHAIRMAN: The honourable Government House Leader.
HON. RONALD RUSSELL: Mr. Chairman, I move that the committee do now rise and report considerable progress and beg leave to sit again on a future day.
MR. CHAIRMAN: The motion is carried.
[7:23 p.m. The committee rose.]
