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HALIFAX, TUESDAY, APRIL 27, 2004

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

2:15 P.M.

CHAIRMAN

Mr. William Dooks

MR. CHAIRMAN: The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, would you please call the estimates of the Minister of Health.

MR. CHAIRMAN: We are continuing with the estimates of the Department of Health. We are going to give staff members and the minister an opportunity to be seated, and then we will start the process.

The honourable member for Dartmouth North. You have one hour in turn.

MR. JERRY PYE: Mr. Chairman, I want to thank the minister and his representatives, the administration, for being here during the budget estimates of the Department of Health. Also, I want to thank my colleague, the honourable member for Halifax Needham, who is the NDP Health Critic, for giving me the opportunity to speak on this very important issue.

Mr. Chairman, I want to go back to the election campaign between July and August 2003. The reason I want to take that step back is because it was during the 2003 election campaign - less than a year ago - that we were out there on the campaign trail. It was then that we heard a whole host of issues around the Department of Health. We have heard the issues with respect to the increased cost of Pharmacare, we have heard the issues with respect to long-term care, nursing home fees that were being charged to seniors over and above their shelter component, all those fees that were charged to them that should have been a component of the Health budget and should have been covered under the Department of Health.

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We also heard from many individuals during campaigning in the constituency that I represent, a whole host of issues around the Department of Health. I want to say that some of the issues centred around alternative medicine, some centred around the concern with respect to the Department of Health and funding for wheelchairs - should they be covered under the MSI campaign - issues with respect to seniors' housing accommodations, wait times in hospitals, elective surgeries with respect to seniors, Mr. Chairman, a whole host of issues. They ran the gamut during that election campaign.

During the budget for the 2003 fiscal year, the Minister of Health did not raise Pharmacare fees and during the estimates for that budget, I did have the opportunity to get up and speak, as Hansard will record, that I have said that this is an election year, and there will be no increases in our Pharmacare. I said, you can be assured that next year, in the fiscal year of 2004-05, there will be increases in Pharmacare. Mr. Chairman, when I was out there on the campaign trail, I warned the seniors who were contributing and who were a part of the Seniors' Pharmacare Program, that there in fact would be an increase in the Pharmacare, and it was only during an election year in which the government would lapse from that.

My hope, Mr. Chairman, was that would not be the case, and that I would not be standing here in this Legislative Assembly talking about an increase in Pharmacare. I do know that the minister has said that that increase in Pharmacare resulted in approximately, I believe, 787 other individuals being removed from the cost of the premium for Pharmacare because the income level would now be set at $24,000, for a single person, and approximately $28,000 for a family, two persons, a married couple.

Mr. Chairman, I have received some e-mails with respect to that very issue, and although it may not appear as though it is a lot, for a person who earns an income of $28,000 a year, particularly living in the metropolitan area, there are significant costs. That again is an added burden because I believe that the increase has gone to an additional $54 for each member of that family. That would have brought it up to approximately $390 for each of those members of that family to pay into the Pharmacare Program, and if you have two people, that's approximately $780 that comes out of their budget that they now have to budget for.

I know that when I talk about this very important issue, and I do want to hearken back to the 1993 election campaign at the federal level, the then federal Liberal Party had talked about a national Pharmacare Program, one that would be consistent across the country. I do know that that national Pharmacare Program is obviously off the table. I do know that the minister will probably respond to this particular issue that I want to bring forward first, and that is that, number one, how the government justified the increases to the Seniors' Pharmacare plan, and, number two, if in fact during the ministers Conferences on Health, if the minister or any other province has talked about a national Pharmacare Program, and if they have, if there are ongoing discussions with respect to a national Pharmacare Program across the country?

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I believe the reason why, Mr. Chairman, this is significantly important is because there is an inequity across the country with respect to the delivery of Pharmacare Programs that are available to people across the country. Some of the wealthier provinces have better, some of the poorer provinces do not, and that in itself creates an inequity across the country and my hope is that our Minister of Health would have had some conversation at ministers' forums or discussions with respect to this.

Mr. Chairman, I will start off by asking the minister, and I think the minister has duly noted, the two questions that I had asked him. Number one, once again to repeat, how did the minister arrive at the cost to each individual with respect to the increase in the seniors' Pharmacare Program? Number two, are there ongoing talks at the federal level with respect to a national Pharmacare Program?

HON. ANGUS MACISAAC: Mr. Chairman, I want to thank the honourable member for his interest in this, I know it's a genuine interest. The first thing we should note, is what we strove to achieve with respect to the amount of money that is charged to seniors was to maintain a ratio that has existed with respect to the amount paid by government and the amount paid by seniors in this province. That ratio is approximately a three-quarters to one-quarter ratio and we have achieved that with the changes that were made in the current year relative to the changes in the premium level. I do want to point out that there was no change or alteration of the co-pay with respect to seniors.

So the reality of the situation is that the cost of drugs are projected to be $146.5 million in the coming year and that's a significant increase over the previous year. The amount paid by government of that $146.5 million is $108.9 million and the amount that is paid by the seniors of the province is an amount of (Interruption) Yes, well, with the premium, what is the premium amount? (Interruption) Yes, with the premium it's $15.8 million, but with the co-pay it's estimated about $24 million would be the amount that's paid and that helps to retain that ratio.

Mr. Chairman, an extremely challenging aspect of the delivery of health care in this province, is our capacity to be able to provide coverage to our seniors. At the time when we were making the announcement, we, of course, took time to look at what takes place in other jurisdictions relative to these programs and it immediately became clear that it's very difficult to compare precisely one program to another, especially in Atlantic Canada because that's where we tend to look, but what we were able to say in a very definitive way about our program is that it is the most comprehensive program that is provided in Atlantic Canada and for most seniors it is a more generous program. I can't say that in all cases because there are certain circumstances in some provinces. The way it is administered is different with different categories. Ours is a more straightforward, simple presentation, but it is accurate to say that ours is the most comprehensive program that is delivered in Atlantic Canada.

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Now, in terms of the national scene, the agreement that was reached by the First Ministers was an agreement to address the catastrophic drug situation in the country. That is something that is still under the health reform fund. We believe that the federal government has a role to play in this and planning is underway now for an expanded drug plan for Nova Scotia. We're working with other provinces and the federal government on program details, including what portion of the health reform fund is for drug costs and who will be eligible. I'm not so certain that it is a national drug program in the sense that the honourable members are referencing it, but it is a national approach to addressing the provision of Pharmacare to the citizens, not just of Nova Scotia, but of Canada and the catastrophic drug scene is the thing that is capturing most of the attention at this juncture.

MR. PYE: Mr. Chairman, it's always a pleasure to hear that the government is looking at an expansion of the Pharmacare Program and the reason why I say it's important to recognize that there needs to be an expansion of the Pharmacare Program is because a number of people are left out. I don't know if the minister or his department has actually put any work into finding out what kind of a program, if the federal government is not interested in a national Pharmacare Program, but through the catastrophic drug initiative it might be able to enhance some of the drug program services.

[2:30 p.m.]

I guess the thing is this, has the minister or his department done any work with respect to looking at a province-wide Pharmacare Program or a Nova Scotia Pharmacare Program similar maybe to the program in Quebec? The reason why I say that is because we do know that a large number of citizens in this province, because of the aging population that we have, we do know that seniors are covered under a Pharmacare Program. We do know that disabled people who are not employed are covered under a Pharmacare Program, their costs. Persons on social assistance are normally covered under the Pharmacare Program as well and we do know that people who are employed primarily with major corporations and people who are unionized usually negotiate a benefit package in their collective agreement which covers their drugs and Pharmacare and so on.

So having looked at that picture, there would only be a small sector in the Province of Nova Scotia who would need to be covered under such a program and that would primarily be the sector of low-income earners, you know, people who do not receive benefit packages from their employer. So I guess, Mr. Chairman, through you, although I'm not sure if your department has looked or done any analysis with respect to that, but I'm wondering if you can enlighten me as to what your department has done with respect to looking at it on a national level?

MR. MACISAAC: Mr. Chairman, a couple of points that I can make in response to the honourable member's question, again on the national scene, the work that's being done on the catastrophic drug program would address those drugs that are most expensive for

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people and, obviously, would address the people in the category to which he refers, those who are not covered in any way by a program. So there definitely will be some improvements with the implementation of a catastrophic drug program throughout the country relative to those individuals.

Again, you know, this whole discussion and the whole discussion around the estimates focuses on the budget that we have and a great deal of that discussion, of course, will point in the direction of things that we're not doing because of the resources that are available despite the fact that we're adding an additional $230 million to the Health budget. There are a lot of things that are still outstanding challenges for us and some of them are huge challenges. If we can implement the catastrophic drug program, and I am confident that that will happen, we will address some of that, but we have to remember that we're starting with a figure of approximately one-fifth of Nova Scotians who do not have coverage of any kind and that is a significant number relative to the resources that we have available.

MR. PYE: Mr. Chairman, I do know that the government has increased the Health budget and that the Health budget at present is some $2.36 billion, I do believe, and represents 40 per cent of all of the revenue that comes into the government to deliver the health program or the health services that are needed by Nova Scotians.

The reason why I wanted to do the follow through with respect to the drug program is because I do know that I received a letter not so long ago from a group of individuals called the Fabry's support group. As I say, a unique disease, it affects some 65 Nova Scotians and I believe there are approximately 16 Nova Scotians who are on a Pharmacare pilot project or some sort of an initiative project who are in fact receiving the drug treatment and not having to concern themselves with the cost.

However, that program, I guess, comes to an end at the end of April of this year. I do believe that the timing is appropriate that the budget for the Minister of Health should be here at a time when we're talking about this. Now I do believe that the minister's department has made comment with respect to possibly having a look at this particular issue. I ask the minister, would that be one of the concerns that could be addressed under the catastrophic plan and if it could be under the catastrophic drug initiative program and if it can be, can the minister give us an indication today whether his department is looking at this very important issue and if the minister is going to come to a conclusion sometime in the future? I believe there might be an answer and I believe the minister's department might have already said there might be an answer by April. We do know that every life is important in the province and we do know that if we can assist those individuals that it's significantly important to do so.

Once again, my question to the minster is, where is his department with respect to addressing what I would term - and the minister can correct me - as rare diseases that occur in the province that need special treatment?

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MR. MACISAAC: First I should establish that any benefit that we might expect to receive from the catastrophic drug program is a benefit that we would not see for another two years. In terms of there being money available to us in the short term, the answer is no. In the longer term, obviously, we hope that we would have a program in place that would be of assistance to us with respect to this difficult challenge that's before us.

There are a couple of dates that are relevant in terms of the Fabry's Disease question - one of those is a date that relates to the drug Fabrazyme which six patients in this province are currently receiving. The company that manufactures it - I'm not going to get into a long, protracted discussion about what's gone on with them - but unlike the company that provides Replagal, who have agreed to extend coverage until such time as another decision which I'll address in a moment is made, the first company that manufactures Fabrazyme has not made that commitment to us in a manner that we felt appropriate.

We have, of course, been in discussions and constant contact with the doctor who is treating these patients and he is confident that their needs can be addressed in the short term, despite the decision taken with respect to this drug at the end of April and from that period on. He's confident he can address their needs.

The real date that is significant is, of course, the final process and this comes forward in July when the national Common Drug Review is expected to be complete on these two drugs. It is only at that time that we would be in a position to look at their decision, whether it is a positive or a negative decision, or look at everything that they have to say with respect to it. It is only at that time that we would be in a decision-making mode relative to these drugs for the patients who are suffering from Fabry's Disease. So, there are two dates - one with respect to a single drug, the other is a date that relates to the review process and the results of that review process will determine what attitude we would take relative to a final decision on the use of these drugs.

MR. PYE: Mr. Chairman, I'm pleased to see that the minister has enlightened me, that in fact, the funding or monies that would be available to provinces is some two years away with respect to catastrophic drugs. On the other hand, I guess I can ask the minister this short snapper. If the money were available today from the federal government and dispensed to the provinces to use on catastrophic drugs, would this be one of the areas that would be covered under that catastrophic drug definition?

MR. MACISAAC: I appreciate the concern of the honourable member. It is a genuine concern. However, the question he proposes is slightly hypothetical in the sense that it is presented out of context relative to the entire decision-making process that would have to be undertaken. I don't mean to not be as straightforward as I'd like to be in terms of answering your question, but I have to put the answer in context of the total decision-making process that would be before us at the time when the funds would be available and, of course, all of the needs that are there.

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Obviously, it is a question that would have a very high priority relative to any decisions to be made with respect to funding, but I can't just take that single situation and make a response to it without doing it in the context of the whole situation that would present itself at the time when funding would become available.

MR. PYE: I can appreciate what the minister is saying. Obviously, his department has not looked at what will be all-encompassing within the funding that will become available through the catastrophic fund allocation.

I don't want to get into areas whereby we identify individuals on an individual basis but the minister is aware that individuals contact their local constituency offices - they contact them to talk to government departments on particular issues that may affect them. I do know there was one particular individual who suffers from a traumatic brain injury and a very serious one and I do know that the minister's department has corresponded with the individual. The individual is not a member of the Dartmouth North constituency, but has brought the issue to my attention. I do know that the individual is looking at alternative sources of medicine with respect to therapeutic therapy and those sorts of things that are not presently covered under the Department of Health. It may seem somewhat vague without identifying the individual but I don't think it's the appropriate place during budget estimates to identify the individual, simply because I did not ask permission. I'm wondering, through the Department of Health, are there funds available for alternative medicine or alternative sources to health rehabilitation and medicine for individuals for example, with respect to brain injuries and serious brain problems.

[2:45 p.m.]

MR. MACISAAC: I've learned that there's no point in talking unless the red light is on. I was waiting for it to come on. I may not have clearly understood the honourable member's question and if I haven't, I apologize. My sense of the question is, are there alternate treatments that are available with respect to brain injury and the answer is no, there are not alternate treatments available. Is there more to be done with respect to the treatment of brain injuries? The answer is obviously yes. It is a matter that when funds become available, that we would want to move forward on. However, it's not something that we've been able to include in this year's budget. However, it is definitely something that is very much on our radar screen and something that we would like to be able to address in the very near future because there is an obvious need to do that. I hope that I will be Minister of Health long enough to be able to come forward to the House and say that we have, in fact, addressed that because it's a priority of mine.

MR. PYE: Mr. Chairman, I just wanted to tell the minister that, in fact, the type of therapy that the individual in question had asked the Department of Health to assist him in, because the individual has a traumatic brain injury where the individual has constant headaches - they're a very serious problem. The only way apparently to address the issue, and

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he has consulted medical expertise in the field with respect to what can be done, only to come to find out that it's not available to him, certainly in this province, but in another province. Hyperbaric therapy is what it's actually termed. Someone in the medical field would obviously know that. It's a therapy that, in fact, gives the individual an opportunity to at least have some semblance of sanity because of the traumatic experience they went through, because of the pressure on the brain and so on, that causes these very severe headaches. This kind of therapy addresses that particular need, yet is not funded by the Department of Health.

I'm pleased to hear the minister has made the comment that he would hope in future that may be covered, but it's of no consolation to the Nova Scotian at present. I guess my question is, once again to the minister on this particular issue, if in fact the department does not cover it, how does this Nova Scotian get to enjoy a reasonable quality of life, knowing that the medical treatment is not available to this person in this province?

MR. MACISAAC: Mr. Chairman, I must say to the honourable member that he is speaking of a treatment with which I'm unfamiliar, in terms of the nature of the treatment, how it's administered and what the expected outcomes of that treatment are. What I will undertake to do, is to do our own research and find out precisely what the treatment is or at least gather as much information as we can relative to the treatment, and give you the department's response relative to it, if that's satisfactory to the honourable member?

MR. PYE: Mr. Chairman, I thank the minister and I'm sure I can refer the individual to the Department of Health so that the Department of Health may be better able to understand the needs of the individual and the individual's request for the kind of treatment once again.

The question of persons with disabilities and I do know that I've brought this issue forward before. It's a very important issue to me, Mr. Chairman, and I, for the love of me, can't understand why the Department of Health cannot provide funding under the Medical Services Insurance or MSI in this province for this particular need. The need that I'm talking about is the need for disabled persons to have wheelchairs covered under the Medical Services Insurance in this province.

I don't know if the minister is aware, but it has become increasingly difficult for charitable organizations and persons with disabilities on fixed income and persons who have no incomes at all, who are disabled individuals, to fundraise for wheelchairs. We are in the 21^st Century, we are still asking individuals with disabilities to come up with a portion of that cost-sharing fund, something that I find reprehensible, Mr. Chairman. I just simply cannot understand why this item cannot be covered under the Department of Health Budget. I would like to have the minister or his department give me an explanation as to why it can't be covered.

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At one time we could be assured and rely upon agencies like the Lions, the Kinsmen, the Kiwanis, Rotary, a number of organizations, not to mention those who could come forward and help assist in cost-sharing the funding for a wheelchair. However, that doesn't happen. Fund-raising is extremely difficult. It's extremely difficult to get the money from those agencies and organizations in this time. Unfortunately, many disabled people are not only coming begging to their government to be compensated for a mobility assisted device, but they're also going to any agency to seek that compensation as well. I think that the minister needs to explain to me and to his department, why we cannot fund those wheelchairs?

MR. MACISAAC: Mr. Chairman, the honourable member speaks about something with which I am familiar through my own constituency office and have individuals who are struggling in order to be able to afford mobility devices and we sometimes wind up finding very unique ways to provide them with some assistance. The situation the honourable member describes is a situation that is real, it is a question that relates to resources and the amount of funding that is available.

We do a great deal of work with respect to restoring mobility through prostheses devices, that's a significant expenditure within the department. One of the first things I learned when I became Minister of Health is that there are always new directions in which you could go in order to meet the demands that are out there. In answering the honourable member's question, I answer it not without sympathy to the situation he describes, because I've encountered that, as I indicated, many times in my own constituency work. However, there are limits to the resources that are available and, again, that is the best answer I can provide. It's a resource question and I wish it were otherwise.

MR. PYE: Mr. Chairman, it's unfortunate that this is looked upon as a resource issue. I don't know how the minister ranks the delivery of services with respect to health in his department, and why it is that disabled persons who have mobility problems are at the bottom end of the resource funding in his department, or the utilization of resources to those individuals. I will tell the honourable minister that he is absolutely right, his department funds prostheses 100 per cent. Anyone who's injured in an automobile accident and so on, who does not have insurance to cover prostheses, is covered by this province and is covered under the MSI program.

However, orthotics are not covered under the MSI program and, in some particular cases, are less expensive than in fact the prosthesis and, again, all these are used to make disabled persons mobile. It's a mobility device. It's something that the government should have on the top of its priorities. It should be ranked number one or two, with respect to giving persons the opportunity to live in an environment and be able to enjoy that environment the same as all other able-bodied citizens and, in fact, orthotics as well as wheelchairs, and I cannot for the sake of me accept the minister's response for the fact that this is a matter of resources.

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A matter of resources also implies that there is a hierarchy within the department and a hierarchy on how the government is going to spend its dollars. I don't know if the department has given consideration or measured out just exactly the number of disabled persons in Nova Scotia who would be in need of a mobility device and if, in fact, the Health Department has done an assessment of what those costs would be. It would be comforting to me, as I sit across this floor, to hear the minister tell me if there are costs, what those costs are to deliver such a program to those Nova Scotians who most need that program, and if the minister has done that, I would certainly appreciate hearing from him.

MR. MACISAAC: Mr. Chairman, I don't have such numbers with me this afternoon. If those numbers are available within the department, I will be pleased to share them with the honourable member. But I would like to point out that we do work with and through the Red Cross to provide mobility devices in nursing homes, and we are currently working on extending that to people who are in-home-support clients of the department. So you know we're pushing the threshold out there, if you like, with respect to this coverage, but it is not available to the general public currently.

[3:00 p.m.]

So, some low-income individuals are eligible for some assistance through the Department of Community Services relative to this, but in answer to the specific question of the honourable member, I don't have such a number with me today. If it does exist, I would be pleased to share it with him.

MR. PYE: Mr. Chairman, I will go one step further. If it doesn't exist within the department, the numbers that I am asking for and the assessment if there has been one, an evaluation - I should say analysis done with respect to the cost of delivering such a program, will the minister entertain the thought of at least looking at it and coming up, through his department, with some sort of a cost formula so that we in this Legislature would know what the costs are out there to deliver a wheelchair program to disabled persons, and an orthotic program to disabled persons in the province. That's number one.

Number two. I'm wondering if the minister has given any consideration - and it should come through the Department of Health, although there's some argument whether it should come through the Department of Community Services or not, but I think it should come through the Department of Health because it is a health-related issue, and those are the technical aids like the minister has recently talked about, the walkers and so on, that he has a program, in fact, with the Red Cross - would the minister be interested in entertaining a notion of developing a technical aid program, a pilot project, something to see how successful it may be with disabled persons engaged in the delivery of such a project?

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MR. MACISAAC: Mr. Chairman, I want to thank the honourable member for the question. We work and we are a part of the Disabled Persons Commission in the province in the sense that a number of the ministers meet with them on a regular basis. I will undertake to bring the request, that the honourable member has made, forward to that commission for their discussion and enlightenment with respect to the issue. Any information that we have within the department, we will be very pleased to share it with the commission.

So I guess what I'm saying is that I think it's an appropriate matter to be brought forward. We have many items that we don't have the resources to fund programs, but we still know that at some stage we need to address certain programs and we are always doing the planning that's required in order to achieve that. With respect to his questions, those are matters that we would be pleased to bring forward, not just within the department but through the Disabled Persons Commission as well.

MR. PYE: Mr. Chairman, I'm pleased and I do apologize for being remiss in not mentioning the Disabled Persons Commission of the province which I do know, approximately I believe, five ministers at least are in on the table discussion with the Disabled Persons Commission. I do know that the Disabled Persons Commission works very hard on behalf of disabled persons and that, in fact, it receives funding from the province to do its work. I do want to say that they have probably talked about the very issue that I talked about. All I want to know is if there has been some correspondence, if there has been some analysis done with respect to costs of some of these issues that I have brought up in my six years in this House. I think it's significantly important that disabled persons know that they are on a priority list with the government of this province and, that regardless of what department it is, their issues and their concerns are going to receive equally as important attention as any other issue that is the issue of the day for government.

That brings me to another very important issue again in which I do know that the Health Department has addressed and that's with respect to home care services. The number of people, during the election campaign, who felt that the home care services that they have been accustomed to, and had been delivered to them, had now been reduced. They go in and there are assessments done of the individual seeking home care, a number of those individuals who may have had three or four days of home care, may have had 15 or 20 hours of home care services, are now consistently seeing themselves cut back and not receiving the level of home care treatment that they received before - I don't know how many files I have in my office on that issue.

In particular, individuals who are disabled who go through a process. The caseworker comes out, does the evaluation. The individual goes through a process of evaluation - I believe it's termed the Minimum Data Set. It's a national assessment evaluation form that's placed out and does an evaluation and assessment on individuals who are receiving home care and then, all of a sudden, some of these individuals who are disabled, the questions that are asked through that - and I don't have, Mr. Minister, but your department would have the kind

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of questions that may be asked of individuals with respect to doing that evaluation. Many of the disabled individuals who have gone through that process have told me that it is certainly dehumanizing. It certainly implies because an individual is disabled that somehow they have an intellectual problem as well. Therefore, some of the questions are evaluated and assessed on that.

I don't know, Mr. Minister, if your department is aware, if you have had concerns and so on, but I do know that in one particular case your department did restore some of the home care services to one of the individuals who appealed the process. But there are many individuals who are going through this assessment and then, all of a sudden, find that their home care supports are reduced. I don't know if this is a way for the minister's department to save money or if this is a way to reduce the kind of supports given to those persons in need, but this crosses the boundary of not only disabled persons, but seniors as well. I'm sure the minister and his department has had those calls and heard those complaints. I've heard them all across the province, with respect to the reduced level of services in home care supports for Nova Scotians.

MR. MACISAAC: Mr. Chairman, I can indicate to the honourable member that indeed there are a number of inquiries that come forward to the department relative to the process. The balance and the challenge that the department has always is to, on the one hand, ensure that they're doing their very best to address the needs of the individuals that they are serving, but on the other hand, ensure that they're serving as many people as they possibly can. It is appropriate to re-evaluate the needs of people who are receiving the service from time to time. We are employing - and it's not just a national standard - an international standard with respect to the assessment that is done.

The reason for doing reassessments from time to time is that it's appropriate to ensure that our resources are being deployed throughout the province in a manner that best meets the needs of everyone who requires these services. Circumstances change; the circumstances of individuals change - for some, their circumstances improve; for others, their circumstances may deteriorate; and for others who are not receiving a service, they come to the point where the service is necessary for them.

So it is appropriate that reassessments be done. I believe that the fact that the standard that's being used is one that is used internationally gives it some credibility. It's not the first time that - as I indicated at the outset of my remarks - I have heard individuals express concern about the process; however it is appropriate for re-evaluations to take place. I can point out to the honourable member, and I think he implied that in his comments when he said that some services were restored to individuals, that there is an appeal process, and the appeal process at times is there in order to assure that people's needs are being appropriately met.

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MR. PYE: Mr. Chairman, I didn't realize the hour went by so fast. I have so many other questions to ask, and now I'm being advised that I only have three minutes left and I really wanted to dwell a bit more on this - and I might get the opportunity to come back at a later day, but in the event that I don't, I want to ask the minister if he can give me some insight with respect to the Senior Citizens' Secretariat. I do know that in the speech from the Minister of Finance that there's an additional $150,000 set up in the Nova Scotia Task Force on Aging to launch new efforts into the prevention of elder abuse. That's done by the Nova Scotia Senior Citizens' Secretariat, and I want to commend the government for that.

I think this is a positive approach, it's a proactive approach. I think the minister and his department, along with the Nova Scotia Senior Citizens' Secretariat will do a fine job, but I'm wondering if he can enlighten me briefly - with the period of time that he has - on how the task force is going to work. Is it going to go out across the province, how is it going to be managed and, when the information comes back, is there going to be a final report to the Legislature on its findings, and if the minister is committed and obligated to supporting those recommendations that might come forth? Nova Scotia's been very lucky in that we haven't really seen elder abuse within institutions in this province, or have encountered very little of that, but we do know that it exists in this province to some extent. So if the minister could respond.

MR. MACISAAC: The honourable member is correct. The task force has been established and it will review and do an analysis of publications and approaches in other jurisdictions, so that we'll see what's happening elsewhere with respect to the aging process. We will do public consultations and that will be carried out - there will be an analysis of the feedback from consultations completed and a summary report prepared and there will be a strategy for positive aging that will be put forward and implemented. I am pleased to say that there are two things, but not just the additional money that we've been able to put into the Senior Citizens' Secretariat this year, but on a procedural point, it is a separate line item in the budget. I don't know if we're in order discussing it now or not, but rather than stifle discussion, I chose to answer the question at this time.

MR. CHAIRMAN: I now recognize a member of the Liberal caucus, the member for Richmond, for the next hour.

MR. MICHEL SAMSON: Thank you, Mr. Minister, I'm sure you'll recall this document - I think you may have seen it before - Strong Leadership . . . . a clear course, what's been referred to as the blue book. It was called, I believe, John Hamm's Plan for Nova Scotia. On the front page of that it says: "As your premier, my first priority will be to fix the health care system." Five years later, under your government, I'm wondering if the Minister of Health could tell us: Is our health care system in Nova Scotia today now fixed?

[Page 70]

[3:15 p.m.]

MR. MACISAAC: Mr. Chairman, indeed the health care system in this province, relative to what it was in 1999, you could use a whole myriad of words to describe the situation that we have now relative to what existed in 1999. What I can tell you is this - there is a very real focus and direction with respect to the Department of Health in this province, and that did not exist in 1999. The extent to which that has been improved, we can say that the health care is fixed. There is a plan of action relative to the provision of health care in this province, and there was no plan of action in 1999 - there was the philosophy of throwing money at it. So the extent to which there is a plan of action, and that there is a regular reporting to the people of this province relative to activities of the Department of Health, then I would say it is fixed.

With respect to the resources that are available to the citizens of this province, there are more doctors available now, there are 800 more full-time nurses practising in this province than there were in 1999. So the extent to which we have improved the resources available for health care in this province, then I would say that it is fixed.

If the honourable member is asking if there are tasks that need to be done into the future, then the answer obviously is yes, because the more focused you become, the better you plan, the better you establish your priorities, then the more you understand the need to not only address those additional priorities, but to change the manner in which you approach the delivery of health care within this province. Yesterday in the examination of these estimates, there was considerable discussion relative to the issue of planning in health care, and I'm quite pleased to take this opportunity to address the issue of planning relative to health care.

I want to take a few minutes to talk about the planning efforts that are underway within the Department of Health and which have been underway for a number of years. These initiatives have resulted in real positive change in the health of Nova Scotians. My concern is that someone listening just to the comments of some Opposition members would believe that the health care system in Nova Scotia is in total disarray, and I would like to set the record straight, Madam Chairman. I would direct the members of the House to the document Your Health Matters. The honourable member likes to hold up documents - this is a document, Your Health Matters, and that is the plan that was presented by my predecessors to the citizens of Nova Scotia, and it sets out a plan with respect to the delivery of health care.

The government's health plan was released in March of 2003, and it laid out the priorities and directions to guide health care funding for three years. Our plan stated that better information is critical in good decision making.

[Page 71]

Our priorities for the health care system as outlined in Your Health Matters include the following: helping people stay healthy - and there was a significant announcement made today by the Minister of Health Promotion and the Premier with respect to that objective, and it is reflected in this document, Healthy Nova Scotia; training, recruiting, and keeping more doctors and nurses and health care professionals in this province. I have already made reference to those numbers; shortening wait-lists for tests, treatment and care; investing money where and when it counts; caring for our seniors and community-based planning. All of those items are being addressed and have been addressed in this particular budget, and we will continue to address them into the future.

The creation of the Office of Health Promotion by this government was an important step in health planning to work to prevent disease from happening and to help make and keep Nova Scotians healthy. Today, on April 27^th, the Premier and the Minister of Health Promotion, Mr. Rodney MacDonald, announced a new $500,000 grant program to get people more active, as part of the province's plan for a healthier Nova Scotia. The plan is supported by $3.6 million in new funding, a 24 per cent increase that the Office of Health Promotion is receiving in this year's budget. So we are well on the road to addressing and fixing the issue of healthy Nova Scotians.

We know we can make a difference when we concentrate efforts. We see that in the public education initiatives to stop smoking. In 2001, we launched a comprehensive tobacco strategy with the help of a wide range of stakeholders, and in just two years the province's smoking rate has dropped by 5 per cent. This is a significant accomplishment. This past year, 46 new physicians were recruited to Nova Scotia through our Department of Health recruitment efforts, working with the District Health Authorities. Not only are we attracting more doctors, but they are staying - we have more doctors per capita than any other province in Canada, except Quebec.

We have also seen progress in our health plan in the area of the number of nurses working. We have 156 more RNs working at the beginning of 2004 than 2003. Since 1999, we have almost 800 more nurses working in permanent, versus casual, positions compared to 1999, and that, Madam Chairman, sounds like a good fix to me. Last year we funded an additional eight seats in the first-year class of Dalhousie Medical School, and we will sustain that increase for this year's first class of medical students, and that is a significant element of a fix for health care. We also invested in spots for 25 Nova Scotians in the Medical Technologist training in New Brunswick, and that will add to the fix in health care.

We made a commitment in Your Health Matters to address wait times and to begin to work to set province-wide standards for wait-time information. A committee, consisting of physicians and senior health care administrators from across the province, and Department of Health staff, met throughout the year. Their recommendations to government were released in January of 2004. In this budget, we are investing $465,000 to begin development of an approach to gather standardized province-wide wait-time information. Madam

[Page 72]

Chairman, that will put us in the position this summer when we will be a leader in this country relative to addressing the issue of wait times and meeting the concerns of the Government of Canada.

Through evidence-based decision making we were able to focus our resources where they would have the greatest potential to improve the province's health. We have seen progress and the successes are noticeable. As a result of a $4.4 million investment in Capital Health's Cardiac Catheterization lab, Capital Health's wait times for cardiac procedures have been brought to within national wait-time standards, and that, Madam Chairman, sounds like a fix to me. In many cases, reducing wait times by one-half to two-thirds from a year earlier - that is a great accomplishment.

With the purchase of two MRIs, one for Cape Breton and one for the IWK, access to MRI services has been enhanced, and wait times are improved. In Capital Health, the average wait time is 45.2 days, almost three times less than the 148.2 days people were waiting in March of 2003. I want to assure members that urgent or emergency MRIs are done immediately.

In Nova Scotia, one in seven people is over the age of 65; we have one of the fastest growing seniors' population as a percentage of the total population in the country and these demographics are important to our health care planning. We have been increasing our long-term care budget to help meet the needs of that growing population. We have one of the most comprehensive Seniors' Pharmacare Programs in the country. Our staff consults with representatives of seniors' groups concerning changes we may be recommending.

Over the years, one of the requests for coverage was Alzheimer's drugs, and last year we became the first Atlantic Province to add coverage for these Alzheimer's drugs.

As you know, with this budget we have committed $9.2 million to the cost of care initiative, allowing the province to full subsidize the cost of the health care for seniors in nursing homes as of January 1, 2005 - two years ahead of our schedule.

Madam Chairman, I would be remiss is I did not note the importance of the business planning process and the budget process. As a department, Health has embraced business planning. We prepare a business plan each year for the Department of Health, the most recent is on our Web site. We look at the health care system, from a provincial perspective, as one whole system.

Furthermore, district health authorities are required to develop business plans regarding what their priorities will be in their region and their communities. A great deal of time and expertise goes into these plans, and priorities and spending are analyzed and weighed before we get to the final business plan.

[Page 73]

As a member of the House, and as a minister, I also feel it necessary to point out the planning process inherent in the budget preparations. As a department, Health is accountable for 40 per cent of the provincial budget, and this is a responsibility we do not take lightly. Time and effort is put into developing the budget, preparing documentation, and preparing for your questions. We spend approximately $250,000 every hour on health care in this province, investing more money into community mental health resources, treatment closer to home, and more long-term beds.

I feel confident, as a public servant, that tax dollars spent on health care are being spent wisely. I believe the hallmark of health care in this province, for the last five years, has been evidence-based planning, to the extent to which there was no planning prior to 1999. Madame Chairman, I submit we have fixed health care from that perspective.

MR. MICHEL SAMPSON: Madam Chairman, it might be a bit more sincere coming from the minister had he actually been able to talk off the top of his head out of sincerity, rather than from text prepared by one of the obvious new spin doctors that he has been spending money on in the department.

Let me point out, Madam Chairman, it took me two minutes to ask the minister a question and I received a 10-minute reply. For those watching here today it's important to know that it was done intentionally.

MADAM CHAIRMAN: Order.

MR. MACISAAC: Madam Chairman, the honourable member objects to the length of my answer. As a matter of courtesy, yesterday his colleague spoke for almost an entire hour, ran out the time, raised issues that are appropriate for me to respond to and had I used this opportunity and the question to respond. I think it's entirely appropriate for me to be able to do that.

MADAM CHAIRMAN: Order. The Minister of Health can talk as long as he's required to in preparing his answer.

MR. MICHEL SAMSON: He certainly can, Madam Chairman. I think what's important to know - and a little bit of poli-sci here - is that when they had a majority government, he could get away with that. And I just want to remind the Minister of Health that under minority, we will remember his tactics come budget vote time, where our vote does make a significant difference on this (Interruption) and if the Minister of Natural Resources wants to use the same tack, we'll remember him also.

You received $230 million additionally this year. Is this the amount of money that your department asked for from the Department of Finance as part of your so-called plan?

[Page 74]

MR. MACISAAC: Madam Chairman, obviously the list of priorities that we have relative to health and the matters that we would like to address would go far beyond the $230 million. There are limited resources, and I know that members opposite do not like to be reminded of the fact that Ottawa has not provided one additional cent relative to health care this year than they did last year, but that was a limiting factor in the amount of money that we were able to receive through our budgetary requests.

[3:30 p.m.]

MR. MICHEL SAMSON: How much more money does health care need, Mr. Minister?

MR. MACISAAC: Madam Chairman, the question as to the amount of additional money that health care needs - if we don't embark upon some fundamental and essential planning relative to the delivery of health care, then there isn't an answer to that question because we could - the way that the nation is currently spending money on health care, spending health care dollars, it will go on and expand considerably beyond the current capacity.

All governments in this country have a huge challenge relative to how we deliver health care and that is an important question that's raised by the honourable member; indeed there is a need to be able to sit down. In the short term, we have fundamental needs that have to be addressed. The honourable member's colleagues mentioned some yesterday, and some were mentioned today. The funds for some of those needs are not being met in this particular budget. The real challenge for all of us is, first of all, to look at how we deliver health care in this country, but secondly, and more importantly, is to develop a culture of healthier living for all citizens of this country. It is only when we do both of those and we address both of those as we move forward as a society that we are going to be able to come to the point where there is a definitive answer with respect to the honourable member's question.

That is a huge challenge, but it is one, as I indicated on previous occasions, that we're ready to go and sit down with other governments in this country - tomorrow if necessary - in order to begin addressing these challenges, and we as a government have taken significant initiatives and leadership relative to the healthy living challenge that is before Nova Scotians and indeed all provinces in this country.

I can say that we get a considerable number of inquiries from other governments relative to our health promotion program and they are showing a keen interest in that, and we believe that we have started a ball rolling that will have significant positive impact on health care in this country.

In conclusion, Madam Chairman, the honourable member puts his finger on an extremely important question relative to the provision of health care in Canada.

[Page 75]

MR. MICHEL SAMSON: We're not talking Canada, Mr. Minister. You see in 1999 your Premier, your Leader, said health care doesn't need more money, health care needs better management. He criticized the government of the day for wanting to invest $600 million into health care saying it doesn't need that much more money. We'll put in $48.5 million, we'll stabilize health care, we will fix health care. Well, Mr. Minister, $600 million later that is what your government has spent on health care.

You chastised the Opposition, saying that health care is not in the dire straits that the Opposition would have it. You tell us you have a plan, yet when asked how much money does health care need to fulfill your plan, you're unable to answer that question. I would submit to you that your plan is not much of a plan if you cannot answer that, and that Nova Scotians have cause to be concerned when you, as minister, and your own government sends out a brochure telling Nova Scotians that, at the current rate, the health department will assume the entire provincial budget by the year 2025. I'd like you to tell me what part of your plan indicates that we're going to take over the entire provincial budget. I would submit to you that is not a plan.

So let me put this question to you - you continually refer that Ottawa is not investing enough money into health care, and no one disagrees - let me ask you now, if you go in front of the Prime Minister or the Minister of Finance and say I need money to fix health care in Nova Scotia and stabilize it so it does not need any more money, how much money would you be asking from for the federal government and what is that figure under your plan of health care?

MR. MACISAAC: Madam Chairman, we believe that Mr. Romanow and his report identified a number that would be appropriate to our needs and that would be one-quarter of the cost of delivering health care in this province and I believe our share of that money would be in the vicinity of an additional $250 million. Having said that, I again want to reiterate that that will address our concerns in the short term. In the longer term we need to make some fundamental changes in our culture relative to healthy living and lifestyles and with respect to how health care is delivered in the province and, not just the province, it's a national problem that we need to address. We, obviously, have our responsibilities within the province. So that is the number, Madam Chairman.

MR. MICHEL SAMSON: So if you get $250 million from Ottawa tomorrow, health care in Nova Scotia is going to be fixed for how long?

MR. MACISAAC: I would say that it may carry us for a period of somewhere between five and 10 years without some fundamental changes in how we do things and so it's not simply a question that can be projected into the future, it has to be projected within a context that there are going to be real changes made relative to the delivery of health care and relative to the attitude that citizens have respecting their health.

[Page 76]

MR. MICHEL SAMSON: One issue I would like the minister to clear up for me, in this famous blue book it does refer to wasted spending in health care and, as I said, the Premier was on record as saying that health care didn't need more money, it needed better management and he referred to administrative fat, yet in this year's Budget Address, your colleague, the Minister of Finance says, "Mr. Speaker, let me take a moment to address, hopefully put to bed, a popular myth." Unfortunately, if he could have been reading this back to the Premier in 1999, he may have had a different tack, but he said, " Nova Scotia does not have, as many believe, a bloated health-care bureaucracy. In fact, independent studies have confirmed that Nova Scotia has the smallest health-care bureaucracy in the country." If that is the case, why would the Premier in 1999 have said that Nova Scotia had administrative fat in its health care system which was the solution to all of our health care needs and not the additional $500-plus million that your government has put into health care and is asking for more money?

MR. MACISAAC: I expect, Madam Chairman, that we have made considerable progress since 1999.

MR. MICHEL SAMSON: Could the minister table with this House all the administrative fat that has been cut under his government, including any positions or spending that has been eliminated that has resulted in the significant savings the Premier seemed to make Nova Scotians believe he could achieve in 1999? You had prepared statements for the previous question I had, I'm assuming you must have a prepared text to show us all the administrative fat that you were able to take care of since 1999.

MR. MACISAAC: I think, Madam Chairman, what is significant with respect to the difference in the discussion surrounding health care in 1999 and the situation in which we find ourselves today is that the expenditures that we're making on health care are coming from the revenues that come to this province and they are not monies that were going to be borrowed in order to address the needs of health care. The money we're putting into health care today, the additional $230 million, all of which comes from the resources of this province, is money that is paid for and the revenues to address that are accounted for in the budget and that's the fundamental difference between the situation that was described in 1999 and the situation that exists in 2004.

MR. MICHEL SAMSON: Madam Chairman, that is just a nice little game that the government likes to play because while he says he's paying for additional money in health care from revenues, they are paving roads and fixes bridges and adding it onto the debt of this province. So, you know, whichever way you do it, we are actually paying for our roads and paying for our bridges out of revenues and paying for health care out of revenues. So this government has just done a bit of an end run on that system.

[Page 77]

One of the other issues, Madam Chairman, when the Premier was the Leader of the Third Party in the 1990s, he criticized the Liberal Government of the day for actually introducing the Pharmacare Program and charging seniors a premium for their drugs. I'm curious, the Premier made it quite clear when he was the Third Party Leader that he felt it was terrible that seniors would have to pay for their drug costs. I'm just curious, in 2004, after five years under this government, is it the intention of the Minister of Health, or of his government, to eliminate the premium for Pharmacare for Nova Scotia seniors as advocated by John Hamm back then?

MR. MACISAAC: Madam Chairman, as I indicated previously, the expenditures that are being undertaken by this government relative to health care are expenditures that are focused and planned and they follow a plan. We've outlined a plan to Nova Scotians called Your Health Matters. That is the guiding light with respect to the delivery of health care in this province and we also have a Healthy Nova Scotia that sets out strategic directions with respect to the Office of Health Promotion. So the approach that exists today is a much more focused approach than had existed previously.

The other issue that the honourable member mentioned is related to the Pharmacare Program and, as I indicated earlier this afternoon in answers to the member for Dartmouth North, we have one of the most comprehensive Pharmacare Programs anywhere and what we have been able to do is keep the co-pay for senior citizens flat. It has not increased. Yes, there have been additional monies required relative to the premium. That whole program was one which we did, in fact, bring forward, but we did it after consultation with seniors' groups throughout the province. Nobody likes to see increases. We don't like to see increases in the cost of providing health care to the citizens of this province, or Pharmacare, but the facts are that costs have increased by over $12 million and that is the fact of life.

MR. MICHEL SAMSON: Madam Chairman, I just want to put on the record - just another broken promise by the Premier of how easy it was when he was sitting in Opposition to make all these fancy promises about not charging for Pharmacare and under his government, I believe, there have been at least two increases - so much for giving seniors a free drug cost.

Madam Chairman, the in-home support program was a program put in place by the Liberal Government to provide caregivers with a monthly allotment of money to assist them in the caring of loved ones at home. This particularly applied to people who were staying at home with parents who were elderly and who were in need of constant care and constant supervision. In 2000 this government decided it wanted to review the program, feeling it wasn't being properly administered throughout the province, that it had to be a standard that could be applied provincially. That was in 2000. Welcome to 2004.

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The Minister of Health can't understand why health care costs are out of control, can't understand why more people are looking towards long-term care, and yet they still haven't caught on that this program was a means of saving the health care system money. It was a strategic investment which at the end of the day paid big dividends for the taxpayers of Nova Scotia and at the same time allowed seniors and loved ones to remain in their own homes for as long as possible before having to turn to long-term care. In Richmond County long-term care is a last resort, not a first resort. Yet this government has failed to address those concerns again in this budget to try to bring stability to the health care system.

I'm going to give a scenario to the Minister of Health, two scenarios in fact. I had a call from a lady whose father is quite ill and needs 24-hour supervision, but they want and he wants to remain at home with his wife. Home care provides so many hours per week during the day. They pay for a caregiver to also come during the day and they're asking who will be there to spend the night to make sure nothing happens? What program or assistance is there for us to have someone stay with him rather than going to a nursing home which would cost the taxpayers thousands of dollars per month?

[3:45 p.m.]

Another young gentleman called me and said that his mother-in-law was now suffering from Alzheimer's and they wanted to keep her at home where she was comfortable, where she knew her surroundings. His wife had to leave work, they're living on a limited income as it is, both of them having to work, she's now left her employment, he is asking me, what assistance is out there for my wife to stay at home with her mom, saving the taxpayers and the health care system a ton of money per month, yet she's not working, we cannot survive economically under these circumstances, what can be done? My answer to him was, before 2000, there was a program. There was a means to assist you, it's now gone. They can't understand because the frustrating part is, those who were on the program before the freeze are still on it. They see neighbours that are benefiting from this program, keeping their loved ones at home and trying to ease the financial burden to them.

So I ask the Minister of Health, what do I tell the lady with regard to her father and who's going to take care of him at night and what do I tell the young gentleman about his wife who's not earning an income, they can't make ends meet and they feel that this government is forcing them to put his mother-in-law into a nursing home? I ask the Minister of Health and I can tell the Minister of Health he can speak directly to them because this tape will be shown on cable TV in Richmond County so I encourage you to speak directly to them and give them your answer as to what they should be doing and what this government is doing to assist them in this regard.

MR. MACISAAC: The program to which the honourable member refers indeed is one that came out of the municipal programs that were being delivered by municipalities. It was incorporated within the province's responsibility at the time when changes were made relative

[Page 79]

to the changed responsibilities of the province and municipalities. The impact at the time the program was taken over is that there were no consistent standards that existed throughout the province.

Also, at the time, there was not an in-home support program that was in effect. We have developed that in-home support program and we are implementing that and it is available to citizens of this province. We are also looking at the programs which the honourable member refers, I'm sorry, home support is what I should be saying, not in-home support. But, the in-home support program to which the honourable member refers, we are looking at standards relative to that program. The standards need to be created before any further consideration is given, relative to it. But I do want to point out that the home support program is something that does exist now which had not previously existed.

MR. MICHEL SAMSON: Madam Chairman, I consider it to be a disservice to the hard-working bureaucracy of Nova Scotia for the minister to suggest that the bureaucracy has not been able to establish standards for this program in four years. I believe our hard-working civil servants are much more competent than that. This is a lack of political will on behalf of this government, not the blame of anyone in the Department of Health or of any bureaucrat. This is a political decision. It's hurting Nova Scotia families, it's hurting families in my riding and it's hurting families throughout this province. What is it doing? It is forcing families to put loved ones in long-term care facilities where they do not wish to go and where their loved ones do not wish them to be.

How can this government not understand that $400 per month is a lot better than $3,000 per month, which is what it can cost to put someone in a nursing home? This is a strategic investment. Families have been asking for this ever since 2000 when this government froze this. Back in Richmond County, they want to keep their loved ones at home, but there's an economic reality that comes with that. The idea of asking someone to leave their employment to care for a loved one for years at a time with absolutely no support, while at the same time saving the Health Department and saving the taxpayers of this province thousands of dollars per month, is simply unacceptable.

To hear the minister say today they're still working on standards for the program is laughable if not another insult to all of these families who have waited so long from this government. It's an insult to even suggest that somehow it is the bureaucracy in Health that hasn't been able to put together standards for four years now on this program. It's clearly unacceptable. This minister's predecessor, the now Minister of Education, wrote to me in 2001 saying they had the standards and they were ready to roll out the program. It hasn't been done because of political will, not because of any bureaucrat's fault.

Let me go to another issue now that we're on long-term care. Could the Minister of Health tell us what the status of the new Richmond Villa is today, April 27, 2004, at 3:51 p.m?

[Page 80]

MR. MACISAAC: Madam Chairman, I appreciate the honourable member's - I think it's appropriate to say - frustration with this issue. It's one I know that he has lived with for some period of time. I would also suggest that while I don't have the same level of frustration that he has, it is a source of frustration for myself because the issue is taking much longer to resolve than we would want. I have had private conversations with the honourable member and he is aware, of course, that there are unfortunate legal issues relative to the property itself. There have been some design questions that have been problematic - I understand that they have been overcome and it is still our intent to proceed with this construction so that the facility would be open in the Spring of 2006.

MR. MICHEL SAMSON: Well, let me give you a bit of an idea of the frustration the minister talks about. Under the Department of Health's own plan, when the Minister of Education was the Minister of Health, under the plan that they presented to the people of Richmond County, construction of this facility was slated to start in November 2002. Let me say that again, it's April 27, 2004 - it was scheduled to start November 2002. Now we're being told the Spring of 2006 (Interruption) Completed by 2006. Well, one can only hope that time frame is even something that can be maintained by this government.

We've been down that road before, Madam Chairman. I can tell you, it would be so easy for myself, the municipal council and the residents of Richmond County to be screaming from the hilltops on this issue. The frustration that the family members, the residents themselves, the staff of the facility, the municipality and the community of Richmond - it's incredible what they've been put through by this government on this facility.

I use this reference again and I've got to say, in 2004 we know how to put a man on the moon, but we can't build a long-term care facility within a reasonable time frame. The minister refers to legal problems. Well, we're a $5.4 billion corporation, this province. That is what we are, a $5.4 billion corporation and yet we're allowing one project to be bogged down in some design issues, some land issues for years at a time. It is simply unacceptable. If the minister wants to deal with this frustration and take care of it, I only remind him he is the minister - give the order to your staff to take care of this and get the facility built. That is why you are minister. You have that authority. You have that power. If someone's dragging their feet, then discipline them for dragging their feet or chastise them for dragging their feet and give the ministerial order, this facility is to be built by this date and I demand this be done.

Is the minister prepared today to give his own word, in his own name, to the people of Richmond County who he knows well, that as Minister of Health, he will give his word that he will do his utmost - I won't say the word guarantee because then he'll say he won't say guarantee - but that he will give his personal word to do his utmost as Minister of Health on behalf of the people of Richmond County, the residents of the facility, the family members, the municipal council - which has been more than patient with this minister - that the new

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Richmond Villa will be open by the Spring of 2006. Is he prepared to make that commitment today?

MR. MACISAAC: Madam Chairman, I want to make it clear that there has not been any undue delay on the part of staff within the Department of Health relative to this project. It is probably one of the most difficult projects that I have encountered in my time in government. If there was something that was going to go wrong with it, it managed to go wrong with it. I present that, not by way of excuse, but simply as a statement of fact. I believe the honourable member is familiar with a lot of the frustrating events that surrounded this.

What I would be quite comfortable in saying to the honourable member is that the Spring of 2006 completion date is the objective of the department and I will do everything within my power to ensure that completion date is met because, I don't want to be talking about this next year - I want another issue. We sincerely want this project started and completed and we're doing everything we can to ensure that happens and we will continue to do that. I don't blame the honourable member for being frustrated, I'm extremely frustrated myself.

MR. MICHEL SAMSON: I'm pleased to hear the minister say that. There have been some problems, but what we've been left - the municipal council, myself and others - is to wonder what is the political direction being given to Department of Health staff and how much of a priority is this being said to them or is it just one more item on a list of, I'm sure, a ton of items that Department of Health staff have to deal with on a regular basis. What priority is being given to this? That is the issue that we're left to ask ourselves and I remind the minister again, at the end of the day, you are the single largest department of government, you're the single largest department of a $5.4 billion corporation. It is unacceptable to allow land issues to become an issue.

When you're the Province of Nova Scotia and you're the government and you're saying we're allowing land issues to be a concern, who is in a better position to expropriate land than the Province of Nova Scotia and the government if so need be? If it were anybody else, I could sympathize as a lawyer and say, yes, it's a difficult position you're in and if there's problems with the land it's hard to clear it up. You're the government. You're the Crown. Who better than the Crown to take care of these issues?

Yet, we continue to see these delays and then arguments over the design. Is this the first nursing home that we're building in Nova Scotia? I would think not. So how can we allow design problems and arguments to hold this up for six months?

Let me put another issue to the Minister of Health. Not that I want to reopen the whole design issue. But, one issue that's being asked now by the people - the residents, the staff at the Richmond Villa - the fact is that we realize Richmond County has an aging population. They're not getting any younger. Yet, right now the Richmond Villa is full - I

[Page 82]

believe it has 75 beds. The new facility would have in the range of, I believe, 62 beds or 65 beds - a reduction of over 10 beds. I wonder if the minister could explain to the people of Richmond County what logic was used by his department, knowing the demographics of Richmond County, knowing the number of people who are on a waiting list right now to get into this facility, knowing that they hardly ever have an empty bed, why they would suggest building a facility with less beds than what exists right now?

[4:00 p.m.]

MR. MACISAAC: Just to go back to the previous discussion and update the honourable member, the purchase of the land has been complete and it is in the hands of the appropriate owners at this time. The design is ready to be presented to the board and I understand they will be considering that at their next meeting. That should be the last hurdle that would be required.

The determination of the number of beds in the new facility is based on the planning process. That planning process involved those people interested in the local community relative to the expected needs in that area. So, it is the result of the planning process that took place there.

MR. MICHEL SAMSON: I have to agree with the Minister of Health. While he doesn't want to be talking about this issue much longer, neither do I. I sincerely don't. Nor did I want to be talking about closures of the emergency room at the Strait-Richmond Hospital as often as I had to. It was not an issue which I liked talking about. Finally we do have some stability for the time being at that facility and I hope that continues, but my big fear is that once this facility is built, within a few years, possibly the first year of it being open, the reaction will be, it's not big enough, the waiting lists are too long and there's not enough beds at that facility, which would be extremely unfortunate. I know more and more people are questioning the planning process that went in that would result in a reduction of beds.

At the end of the day, right now, the residents of Richmond County will take any new facility. It was very difficult this winter - receiving calls from the families of residents in there that their parents and their loved ones were frozen in the Richmond Villa during the cold spell that we had, because the heating system just could not keep up. Yet, they kept asking, when will we get the new facility? Where is it? How much longer do we need to wait? How much longer do we need to be patient? As an Opposition politician, it would have been so easy to get up and go to the media and criticize this government from one end to the next on what it's been doing for this facility. Yet, we've all tried to hold our tongues, to be optimistic - whether it be municipal council, the staff at the facility, their families.

My only hope today is that the minister clearly appreciates the frustration involved here at all levels. He indicates he's frustrated also, I submit to him, there's one person that can take care of that frustration, sir. If you're not familiar with him, I encourage you to find

[Page 83]

the nearest mirror and introduce yourself. That gentleman can take care of this frustration, he can take care of this problem if he gives the political will. I've heard his booming voice on his radio ads, it is intimidating, it's scary - more than one person fell out of bed hearing his radio ads in the morning at 8 o'clock when the big voice came on - but, anyway, it got him elected somehow. So, I encourage him to use that same voice with his bureaucrats and make it clear - this is a priority, he is frustrated and like all of us, he wants to get rid of that frustration in the best interests of the people of Richmond County.

With that, Madam Chairman, I thank the minister for his responses. I will pass the remainder of my time to my good friend and colleague, the member for Victoria-The Lakes.

MR. MACISAAC: Madam Chairman, first of all, I would say that I (interruption) I'm sorry? I've had that conversation, yes, a number of times. I would like to say that the honourable member has been reasonably co-operative with respect to this. He's not shared his frustrations in a public way. I think that's because he has a pretty good understanding of the real difficulties that have been encountered with respect to the project. It doesn't matter what the volume of my voice is, there are circumstances when that approach is not an appropriate approach. There are circumstances when the nature of the problems are such that they need to be worked through. I'm becoming reasonably satisfied that they are in fact being worked through.

I do want to add something to what we said about the numbers with respect to Richmond Villa. There are a number of clients at Richmond Villa who come from jurisdictions outside of Richmond and those clients will be repatriated and the projections are made based on the demographics of the community for which the facility has been designed to serve.

MADAM CHAIRMAN: The honourable member for Victoria-The Lakes.

MR. GERALD SAMPSON: Madam Chairman, I'd like to take the time allotted to me to focus on the proactive approach for the health care problems in the province. With that, I'd like to focus on chronic diseases, that an estimated that 40 per cent can be prevented through a proactive approach and active is the operative word.

I remember when my group in my community, we put on a health fair and through officials that came there we were informed that there were two people on the preventative side, one in Antigonish and one in Cape Breton, and there were 50 people employed on the cure side. It's kind of the wrong approach, I think. We should try and look after our health while we're healthy, rather than trying to cure it after we get sick.

What I would like to do, on behalf of the Nova Scotia Heart and Stroke Foundation, is just issue some reminders and use some statistics, Madam Chairman, that over 55 per cent of the residents in Nova Scotia are physically inactive and one in 10 students by the time they

[Page 84]

get to Grade 11. The gymnasium, as we use to call it, or going to gym is not even mandatory anymore in school, and just 15 per cent of the high school students take physical education.

Let's go to some areas, let's talk about obesity, 27.9 per cent in Lunenburg. Why down there? Shelburne, Queens and Lunenburg Counties, 27.9 per cent of people are obese, 47 per cent of Canadians. Almost half of Canadians are overweight or obese and 6.8 per cent of the provincial Health budget, or $129 million a year, going towards preventative measures when it could be going into proactive courses. One thing I must say, that the strategy that the honourable Minister of Health Promotion announced today is a point in the right direction. I see the honourable minister and his colleagues there with a smile on their face, I guess they're probably looking at me and saying, here he is talking about being obese and look at him. I'll use myself as an example, I won't point to the minister over there on the other side. I think there's more booming for the minister than his voice, Madam Chairman.

Let's talk about some economics, $3 billion medical care costs with chronic diseases accounting for 60 per cent of the total of medical care expenditures, and $247 million physical inactivity costs to the Nova Scotia economy. What we would do with $247 million; $7.5 million, 10 per cent fewer Nova Scotians are physically inactive. We have a population of, lay down, eat your french fries, watch TV, and we're paying for that. If we took a billion dollars tomorrow and put it into the health care system, it wouldn't resolve the problem, because the focus is on the cure, not on the preventative side. Hopefully over a period of time, if we took a dollar away from the cure side and put it into the preventative side and eventually swing the tables the opposite way so that there was more emphasis on prevention than on cure, the prevention side is going to save the dollars. Therefore, with the same amount of money that's in the budget and reducing the cost through people being more physically active and healthier, then the money could be put to better use.

I'll just focus on stroke, and these figures, by the way, are from the Nova Scotia Heart and Stroke Foundation, about the 2,800 deaths per year from heart disease, 36 per cent of all deaths, the biggest killer in Nova Scotia. Cardiovascular disease. One would think off the top of their head that it would be cancer, $3 billion in health care costs for Canada alone because of inactivity that mainly resulted in institutionalization which results from strokes, $250 million in health care costs for Nova Scotia, circulatory diseases. It's all basically, not all, but an awful of it can be pointed to inactivity and as I say, Madam Chairman, the focus is always on the cure and never on the prevention.

The statistics that I quoted are all legitimate, Madam Chairman, they've come from the Hospital Morbidity Database, the Canadian Institute for Health Information and a report on the Nova Scotia Integrated Stroke Strategy Committee. These are all legitimate statistics that I quote, but what I want to do is show the proven example that was given by the Nova Scotia Heart and Stroke Foundation in their using of the example of the North Karelia Project, which is located in the eastern part of Finland. It took 30 years to get to where we are today with their statistics, but having the example put before us, we have something now

[Page 85]

to follow that's been tried and proven correct, then we should take no more than 10 to 15 years to achieve basically the same results.

The statistics that they've provided us with and the results are almost staggering. Over there they passed anti-smoking laws which we are doing in Nova Scotia, Madam Chairman. Their dietary transitions were supported by the Finnish food industry and it created ways that they would reduce the low fat products - instead of giving somebody a product that was supposedly low in fat, they gave them a salad. They created the emphasis on improving health and they supported the community at a community level.

The unprecedented results Madam Chairman, over a 30 year period were as follows: Cardiovascular disease mortality rates declined by 68 per cent. That's far exceeds 50 per cent, that's a phenomenal success rate. Coronary heart disease mortality declined by 73 per cent, another one way over the 50 per cent mark, staggering figures of success. Cancer mortality declined by 71 per cent. All cause mortality declined by 49 per cent. The figures are almost unbelievable. Approximately 3,800 premature deaths in North Karelia and 50,000 through all of Finland were prevented, all by changing their diet and becoming active participants in everyday living.

Social costs generated by cardiovascular disease in Finland have decreased annually by U.S. $100 million. I'm sure the honourable minister would like to have U.S. $100 million every year to put in his budget and maybe help with the ads that he has on the radio, but all insinuations aside, $100 million in savings is phenomenal. Social costs generated by cardiovascular disease in North Karelia have decreased annually by $40 million. We have individuals over the age of 35 and then the $60 million was saved for the age group 35-64. Imagine what we could do with the health care budget, if we could save anywhere near 5 per cent or 10 per cent of our budget each and every year over a period of time until we could amass the figures that I've just quoted here, and maybe eventually get to the point where we could provide more health care for less dollars than we are spending right now and the dollars that would be over and above could go into more and deeper community projects and maybe hopefully surpass the figures as shown by North Karelia.

I want to just compliment the Nova Scotia Heart and Stroke Foundation for their success in what they're doing, and compliment the Minister of Health Promotion because he announced today and it's a good start, going there, to reduce the health care costs. I'm just wondering what the minister would reply if he wanted to comment on that. But the costs of physical inactivity in Nova Scotia is . . .

[4:15 p.m.]

MADAM CHAIRMAN: Would the honourable Minister of Health like to make a closing remark before we move on to the next speaker? I thought I heard a question at the very end there, but maybe I didn't.

[Page 86]

MR. MACISAAC: Madam Chairman, you're anticipating that the time is running out relative to this and . . .

MADAM CHAIRMAN: It has run out.

MR. MACISAAC: . . . there indeed is (Interruptions) Yes I understand, but you then go to the NDP, so I don't want to be answering his questions when I should be answering their questions, and I'm wondering if the honourable member would be satisfied if, when we go back to them, I were to take some time to address the concerns that he raised, because there is a considerable amount that I would like to say about it, and I don't think there is enough time left in your allotment for me to adequately address that at this time.

MADAM CHAIRMAN: The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: When I was last speaking to the minister about the Health estimates, I was looking primarily at acute care. I'd like to finish off in that area somewhat before I move to long-term care, where I have some questions.

I've noticed yesterday we've received the Supplement to the Public Accounts for last year. In that, on Page 72, it indicates out-of- province claims of approximately $17.3 million. Out-of-province claims in U.S. claims of $474,000. I think we all appreciate that from time to time residents of Nova Scotia require services out of province, for example the loss of the liver transplant program over at the QE II certainly would be a feature of this, I would assume, but this is a very large figure of expenditures for out-of-province claims.

I'm assuming that a fair number of Nova Scotians have been treated for health care services in other provinces. I would like to ask the minister if he could provide some more detailed accounting of what's occurring and why it's occurring in these areas, both in terms of out-of-province claims in other Canadian jurisdictions and in American jurisdictions?

MR. MACISAAC: I don't have the kind of detail that she's looking for with me at the moment, but we'll be pleased to get it. We can give a breakdown by jurisdiction, that is by the areas that provided the service to us and we should be able to have something to say about some of the nature of the claims that were addressed relative to that. I would ask for the member's indulgence to be able to put that information together. The amount of money paid out for claims for services provided to Nova Scotians outside of the province is $17.3 million, and for claims in the U.S. jurisdictions it is an amount of $474,000, but as to the breakdown on the detail of that, we'll provide that at a later date.

MS. MAUREEN MACDONALD: I'll be looking forward to seeing that information. I think that certainly it's something that we need to be concerned about, because I think it will indicate what areas of health care services we are unable to provide in our own province. Perhaps it's understandable that we won't be able to provide every service, but I think that

[Page 87]

the principal assumption for Nova Scotians is that we have a comprehensive health care system that's able to meet their needs, except in the very extenuating kinds of circumstances.

I have two other questions that come from the Supplement to the Public Accounts. I'll tell the minister that he will be relieved I haven't added up all of the places where coffee and sandwiches were ordered in, although the Department of Health could rival the Department of Education in this regard, I suspect, if I did that.

What I want to ask about is the Nova Scotia Health Research Foundation. The Nova Scotia Health Research Foundation, in the Supplement to the Public Accounts for last year, indicates $2.5 million in expenditure, yet in the Estimates, the Supplementary Detail, the Health Research Foundation Grant, every year has been for $4.5 million estimated forecast and it continues on. I want to know, why is there this discrepancy of $2 million that appears between the estimates and the actual expenditures?

MR. MACISAAC: It's important to bear in mind that the Supplement to the Public Accounts is for the year 2002-03. The figures that we are dealing with in the current budget are 2004-05, and the amount of money that was expended in 2002-03 was $2.5 million, the estimate for 2003-04 was $4.5 million, and the amount that is budgeted for this year is $4.5 million. The other point I want to make is with respect to claims. We also have to bear in mind that when you travel to another Canadian jurisdiction and you receive treatment at a time when you are travelling, that shows up in that particular figure as well.

MS. MAUREEN MACDONALD: Indeed that's unfortunately the case sometimes. I have a question about Quickcard - on Page 76 of the Supplement to the Public Accounts there is an expenditure for Quickcard TM Solutions Inc. in the amount of a little more than $400,000 - almost $445,000. If you look in the Department of Community Services - and I understand that's not your department - but Quickcard also shows up there with an expenditure a little more than $110,000. I understand this is a company that the Department of Community Services is using with respect to the administration of a dental program for persons who are in receipt of income assistance, so I'd like to know - this is quite a significant expenditure to this company from the taxpayers of Nova Scotia - I would like some information about who this company is and what it is that they provide to the Department of Health for this particular line item?

MR. MACISAAC: The particular company to which the honourable member refers is a company that's not unlike ABCC - Atlantic Blue Cross Care. They administer for us the dental program for children, which is a line item with respect to the Department of Health. The Department of Community Services uses the same firm, but, of course it is for clients who are in receipt of Community Services and would receive dental services. So that is the service that they provide for the Department of Health.

[Page 88]

MS. MAUREEN MACDONALD: I want to thank the minister. That brings me then to the Children's Dental Program, which the fiscal year we're currently in, was estimated to have a budget of $5.4 million and next year the estimate for the Children's Dental Program is only $4.692 million. I want to ask the minister why, on earth, would we reduce the amount of expenditure for children's dental health in the Province of Nova Scotia? I want to know what kind of value for service we're getting from this private company in terms of it's a rather large expenditure for the administration of the Children's Dental Program.

I have some questions about this government's priorities in terms of our commitment to our children and our children's future. We have the Premier and various ministers making announcements every day: we're going to improve the recreational opportunities of young people so that they'll be more healthy; we're going to make access to our schools so that they will have more recreational opportunities to be more healthy. Yet, at the same time, we're actually reducing the expenditures for the Children's Dental Program, which is a very important program. It was a program that your government actually reduced when you initially came to government. There was some partial restoration of services, but now, again, it looks like this is a program that will sustain a certain amount of reduction in services to families, and I want to know, what is your justification for this decision?

MR. MACISAAC: The honourable member raised two issues in her comments. One is with respect to Quickcard. That company was given a contract - the services used to be provided by ABCC, but it has been determined that they are able to provide it more efficiently at a cheaper cost, and so we went to them in order to provide that service.

The second item - if the honourable member would consider the estimate for 2003-04, you'll see that the estimate was $5.4 million; however, if you look at the forecast for 2003-04, the forecast is for $4.5 million. That reflects the usage of the program, i.e. the demand that exists for the program. We feel quite confident that the estimate for this year, of approximately $4.7 million, will be sufficient to meet the demand on that program as we move forward. There simply are fewer children demanding the services under the program - that does not, in any way, reflect a reduction in the service that is provided under that program.

[4:30 p.m.]

MS. MAUREEN MACDONALD: Well I can appreciate what the minister is saying, but I guess I would say to the minister that perhaps you and the Minister of Community Services need to get together and have a discussion about the underutilization of the Children's Dental Program. I say this for the following reason: I've had numerous calls from people throughout my constituency, but not only in my constituency, in other constituencies as well. I can think of one particularly compelling situation that came to me from the riding of the member for Halifax Atlantic. A constituent from Halifax Atlantic was very concerned because his daughter, who is a single mother with young children, had run into a situation where his grandchildren required dental work and, in fact, received dental work, but did not

[Page 89]

have the cost of the dental work covered through the vetting program of the Department of Community Services, which essentially went through Quickcard.

In this situation, this family required additional work and they were deterred from seeking the services that they required, even though the dentist was recommending that the child needed these services. These are children who did fall within the parameters of the Children's Dental Program and yet they were unable to secure services. I think this is an area of concern. When you have such an important feature of our health care as dental services, then I think it is very important that we make available these programs. If we're under-spending in those areas, when you think about low-income families with kids, single parents who are working maybe in and out of the labour force in the kind of work environment that we now have, which is pretty well a revolving door for a lot of people in terms of the kind of instability in employment that often exists, we need to make our programs very flexible and capable of meeting the needs of these children.

I would hate to see us reduce this money that is available without really addressing the fact that there still is an unmet need in our community and in our province in the children's dental area. I just need to say that and leave that at this point and look at another area - it's not something that really requires a response.

I want to go to long-term care, and I want to ask the minister some questions about what the future holds for long-term care. I want to start by saying that when I first came to this place, approximately six years ago, there was a moratorium on adding long-term care beds to the system under the MacLellan Government of the day. Although your government has lifted that moratorium, very few new beds have been actually added and, of course, we've seen the public debate around the financial assessment.

Last year, your predecessor, the then minister, the Honourable Jane Purves, on April 7^th - and I will table this news release when I finish - came into my constituency of Halifax Needham, Northwood Manor, a wonderful long-term care facility, and made some announcements about what the government's plan was at that time, which was to put an additional amount of money into the long-term care system, and part of that was for the province to pick up a certain portion of the daily per diem, and to have that then, annually until the year 2007, increase so that in fact there would be some relief for seniors, particularly those seniors who were self-paying.

The first portion of that subsidy came into play, but I believe that it was at that time announced that there would be, in April of this year, a further portion of that come into play. With the announcement of the government's taking over of the health care component of long-term care as of January 2005, I wonder is the plan to continue to pick up that additional portion in this transitional period. So, maybe I'll ask, will the government pick up as was planned in this announcement last year, or is this now in doubt or in a state of flux?

[Page 90]

MR. MACISAAC: Madam Chairman, if I could for a moment go back to the previous discussion. I just want to make it clear that relative to the Children's Dental Program the only criteria is an age criteria. If you're nine years of age and under, you're covered by the province's Children's Dental Program. The circumstances to which the honourable member refers is one that I don't quite follow if indeed the children were within the appropriate age group. If they were beyond that age group and they were clients of Community Services, then if the minister was here when she raised the issue, I'm sure he'd be pleased to address it at the appropriate time.

What was announced by my predecessor is a program that was intended to be phased-in over a period of four years. The initial payment, $12.75 per day, of assistance toward residents of long-term care facilities is something that was intended to be increased beginning this year as we moved with the implementation of a four-year program. The budget made it clear that, because of the government's ability to find resources, we intend to implement full coverage beginning January 1, 2005. What we will be doing is continuing the $12.75 per day subsidy until January 1, 2005, but because we've announced a new program, then the rest of the staged implementation of the previous four-year program will not be implemented.

MS. MAUREEN MACDONALD: I want to thank the minister, that clears that one up. The next question is around the personal use allowances. The personal use allowances have been at $105, so there has been a decision taken to increase those personal use allowances to a minimum of $150, if I read the budget correctly. I want the minister to tell us, when will this new practice, with this new amount of money, go into effect for people who are in nursing homes? When will they start receiving an increase in their personal use allowance? I want to know what the department's thinking is with respect to the personal use allowances after the health care costs are taken out of the seniors' responsibility - so after January 1, 2005, will seniors and others who are in nursing homes be left with money that they currently have for their personal use? And I want to ask about the department's policy with respect to the restrictions on how that money can be used, whether or not the department plans any kind of process that will consult with residents and seniors in the homes with respect to the parameters for the use of personal use allowances?

MR. MACISAAC: Mr. Chairman, what will happen in January 1, 2005 - we will no longer have what we describe as a personal use allowance; in fact residents will be able to retain from their income an amount money, the minimum of which will be $150 month. It's not an allowance or anything else, it's simply that amount of money that they will be able to keep, and it goes up to, I guess, 15 per cent. The minimum amount is $150. It's no longer what you would describe as a personal use allowance after January 1, 2005.

From now into the future, the current personal use allowance does not have any restrictions on it in terms of how residents are able to use that money; those restrictions have been removed. With respect to the issue of consultation, what we're saying is there are no restrictions so there is no need to consult relative to what it would be. From now on there

[Page 91]

aren't any restrictions on the personal use allowance - from January 1^st on, it's simply a matter of people retaining their income to use in whatever manner they see fit.

MS. MAUREEN MACDONALD: Thank you very much, Mr. Minister, that's great, that does clarify the plan.

I have some questions around how the per diem is actually going to be established. - this is the room and board per diem in the homes for special care. I'd also like to table a piece of information that I've been given that shows that Nova Scotia has the highest per diem cost for long-term care and residential services in the country. The per diem costs range from $110 to $199 a day and as we all know, the cost to be in these continuing care facilities is expensive.

There has been some speculation, and some musing - I don't know if you read Peter Duffy's column in The ChronicleHerald, but he had a little piece where he indicated that perhaps what would happen is that the room and board portion would not be controlled in any kind of way and that this would place quite a serious burden on seniors and their families.

[4:45 p.m.]

Certainly, with the seniors' population and people who are very interested in knowing

exactly what's going to happen January 1^st, there is a lot of discussion about how do you establish the room and board component and whether or not it will be a manageable component. Given the already large per diem cost in the Province of Nova Scotia, and the fact that we do have the highest per diem costs of any province in the country for residential care and long-term care services, I want to ask the minister how you're going to approach this, and what kind of assurance can you give to Nova Scotians that the room and board costs will be fairly set, that you will take the kind of approach to establishing the per diems in these private facilities as you've applied inside some of your own programs and departments in terms of making people count the paper clips and make sure there isn't a lot of excess expenditure, where it doesn't have to be, that gets passed along to seniors and their families?

MR. MACISAAC: I had a look at the same column to which the honourable member refers and I can say that the circumstance that was described in that column is not what will be happening within this province, because we will still set the per diem charge relative to room and board for residents of long-term care facilities in this province. Another cautionary note I guess, when it comes to doing comparisons of one jurisdiction to another in this province, you are looking at the total cost of room and board plus health services, as it is now provided.

The determination of the appropriate breakout of that is something that of course we will have to do in determining the amount that we would charge for room and board, but I would say that that is an amount that will be determined by the department, it will be part of

[Page 92]

our responsibilities. I can also indicate to the honourable member that it is something that would be reviewed on a continuous basis. We should not in any way assume that we're going to be dealing with a static figure, because costs do change and it's appropriate for those figures to be recovered. We will retain total control, we'll be setting the rates and we have control over the budget, and the figure will be an average figure for room and board across the province when it's implemented.

MS. MAUREEN MACDONALD: Not so long ago, the Deputy Minister, Dr. Ward was at the Public Accounts Committee. He spoke at that time - I can't remember if it was here in the Chamber or if it was outside, to the media, afterwards in the scrum - he certainly talked about the need to consider smaller residential options rather than large residential or institutional settings for continuing and long-term care. He indicated that other provinces are looking at this, and he indicated that certainly other jurisdictions around the world have these kinds of arrangements in place. It was his feeling I don't know if he was signalling a shift in government policy or the beginning stages of a dialogue that probably needs to occur around modernizing long-term and continuing care - that this is something that we really need to talk about.

What I want to ask the minister about is where do small operators fit in the reorganization of long-term care now that the health care component will be picked up by the department - and there is some suggestion in the Budget Speech that a process for engaging in the overhaul of long-term care, to modernize it, to bring in better standards, to look at the most appropriate deliverer of services and what have you - where do small operators fit in this process? And I specifically refer to those groups of seniors' homes, primarily seniors' homes that from time to time have been in the news for violations of fire regulations, and where there have been questions raised about whether or not they are an appropriate provider of services to seniors and people who are in need of a more residentially based kind of living situation. Could you tell me if that is part of the plan if there is a plan?

MR. MACISAAC: When you look at the province and the distribution and the demographics of the province, we have areas of the province where citizens who might want to receive the level of care that can be provided in a nursing home may not be able to receive that without having to be, in a very significant way, relocated outside of their homes. I relate that particular situation simply to point to the need for us to be doing some strategic long-term planning related to how we go ahead and provide services in the future. Obviously, if we were to try to ensure that those folks would have some continued connection to their communities, then it might be appropriate to consider a model different than the traditional model that we have now.

There is planning work being undertaken in the coming year and we are going to look at best practices relative to this, look at people being able to remain in their communities and receive the level of the care that they should in those circumstances.

[Page 93]

I think I've addressed the major concerns that you have brought forward. We will be in a planning process - we're never static and we try not to be, and we try to ensure that the best options for citizens in the long run are being made available, or we hope to be in a position to make them available as we move forward.

MS. MAUREEN MACDONALD: I want to thank the minister for that. I want to let the minister know that there's a member in my constituency who has lived here in Canada for many, many years and recently went back to England, where he was originally from as a young boy, for a visit. While he was there, he was visiting with his sister who is in her 80s and was in a small residential care facility of some kind. He picked up some information from the particular section of England that he was in, a kind of directory of residential facilities and continuing care facilities in the U.K. They were all very small - no more than 34, 35 beds, I said that bad word, but that's how it appeared in the information.

Anyway, he brought this in and he was really quite excited about this idea of having smaller facilities and he certainly is somebody that I got to know when his wife had to go into one of the larger nursing homes. He used to go and visit her every day and while he didn't have negative things to say about the care she was getting in the nursing home in terms of bad treatment, I think that he always felt that this large setting was very difficult and maybe inappropriate setting for his wife. It's certainly something that we hear all the time - I'm sure the minister must hear this, that as much as we've brought attention to the financial assessment and that whole process and having seniors have to pay for their health care, there certainly is a concern about standards of care and trying to bring into our continuing care system the kinds of practices that are actually based on care, dignity, respect and a quality of life that we would all desire for ourselves and for our parents and our loved ones.

So, that brings me to some questions around standards of care. The current policy of the department with the single entry system is that you don't have a lot of choice in many circumstances of which care facility you go into. There is a commitment to keep a family member within 100 kilometres of their family or home environment. We have no real standards right now that require that spouses not be separated, for example. We may attempt in practice to be as flexible as we can, but there's no requirement and there's no reassurance. The system is more developed to facilitate the system in some ways than it is to facilitate what the individual member needs at any given time.

I want to ask the minister whether or not the department is planning on a rigorous review of standards of care and standards of practice that will involve the public and all of those groups who are advocates with and for seniors and family caregivers so that we can arrive at a modernized set of practices and standards that bring some of the social concerns and some of the human concerns back into a system that has, sadly, lost some of these considerations. It has more often been reduced to ideas of efficiency and cost saving than about care.

[Page 94]

[5:00 p.m.]

MR. MACISAAC: Mr. Chairman, I do want to say to the honourable member that we are embarking upon a province-wide consultation with people. It's related to standards of care and best practices that can be found. Of course, it's best practices, not just here but elsewhere as we are made aware of them.

The concept to which the honourable member refers relative to the situation in the U.K., the smaller units, is a part of the philosophy of aging in place and that is something that I know I had discussions with when the ministers responsible for seniors from across the country met here in the Fall. It is something that we will continue to address at the national level, but we are also doing it here in the province. First of all, the longer we can keep people in their own homes and the more we can keep them plugged into their communities, the better it is, not just for the individuals but for families also.

I want to point out that the 100 kilometre rule is one that applies only to those who are in hospitals. You are making application from your home, then of course you have the option of being able to move to the home of your choice. I know that I have dealt with a number of individuals and families who have called my constituency office, not in my capacity as Minister of Health, but over my most recent term here and they were quite naturally concerned that the parent or loved one was going to be transferred some distance - either to Sherbrooke or to Guysborough or wherever - and we were able to assure them that as soon as beds became available in Antigonish that they would be able to come back. I can quite frankly say to the committee that I've not heard from these people again saying that what you said didn't happen because in fact it did happen. It usually happened reasonably promptly.

What's interesting also is that in some instances the people go to a home that's not always to the satisfaction of the families involved, but they go to a home and they wind up liking it there. They find people there who they know are there or the service is good and they wind up liking the environment and they make a decision to say, I don't think I'll bother going back, I like it here, I'd like to stay here. That's possibly a function of people being resistant to moves and getting comfortable and saying, I'd like to stay this way.

But, to the broader question - consultation - most definitely.

MS. MAUREEN MACDONALD: I want to thank the minister. Of course, I know that there is literally a body of research that I think pretty well establishes that multiple moves for seniors aren't good. In fact, it can result in mortality in some cases. I think it's something we do have to be concerned about.

I don't have a lot of time left in this particular time frame. I want to ask the minister about a particular group, I guess I would say for want of a better word, that doesn't necessarily belong in a discussion about long-term care, but end up in part in this discussion

[Page 95]

about long-term care because we don't have, I think, a well-thought-out policy with a commitment of resources to deal with their particular needs. There are people with brain injuries in Nova Scotia. The minister will be aware that the department had a working group on brain injury and there are a limited amount of options available for people with brain injuries. Sometimes people will be at the rehabilitation centre for a period of rehabilitation services and therapies, very expensive but very much needed, but then, where do they go from there? Sadly, people frequently end up in a long-term care facility. These individuals may be young people, they may be a young person who was in an automobile accident or an accident swimming or diving or whatever. It could be a young mother.

In the course of my time as a member of this Legislature, I have had contact with a number of families who have young family members with brain injuries. They are, I think, justifiably beside themselves when the only option that is available to them is a long-term care facility which, without getting too maudlin, are often inhabited by people in the final stages of their life - maybe seniors who have terminal illnesses, chronic diseases and a limited ability to engage in certain kinds of activities. Yet here is this young person, who has had this unfortunate accident, generally, or some other situation that has resulted in a serious brain injury. The lack of residential rehab facilities or options for persons with brain injuries in our province, I think, is regrettable to say the least, and I understand that these services would be expensive. I've been to Peter's Place on the South Shore, it is a wonderful facility and I know that it is expensive to be there, but, Mr. Minister, cardiac care surgery and health care is expensive and cancer care is expensive, these services they are expensive.

I'm very concerned that we have not moved at all, really, in terms of implementing any of the recommendations on the working group with respect to brain injury. We see no plan, no allocation of resources, no real political will to address what may be a very small number of people but nevertheless they are citizens of our province. They have the right to live as full a life as they can, given what their individual circumstances are. Generally speaking, in the right kind of environment, they in fact have the ability to really thrive and not sort of be strapped into a chair vegetating some place in a long-term care facility.

I feel quite strongly about this issue, and I want to ask the minister, why this has not been addressed and when can we expect to see some movement with respect to the recommendations of the working group on brain injuries?

MR. MACISAAC: Mr. Chairman, the honourable member has inquired about a subject matter that is of concern, obviously. The treatment of people with brain injuries, when the resources are found will be an investment in terms of the long term, because many of these people with the proper sort of intervention, in fact, could wind up avoiding other care requirements in their future. It is a discussion that I was involved in recently with the Disabled Persons Commission. It's an issue that's very important to them. I can say that it's an issue of importance to the department.

[Page 96]

We obviously don't have unlimited funds, but we are taking the steps that are necessary for us to be able to proceed when funds become available and, indeed, if we do receive additional monies as a result of any discussions that may take place this summer, that would be an area that I know the department would like to address and it's an area that I would be very comfortable in bringing forward to my colleagues with respect to addressing it. As the honourable member points out, it is a relatively small portion of our population, but it is a portion of the population where we could, in all likelihood achieve long-term savings relative to these individuals.

We are developing the standards that are required with respect to these treatments and we have some money this year in the budget with respect to the IWK, with respect to rehabilitation which will address, to some extent, children's needs in this. There will be some benefits that flow from the stroke strategy, but it's not a full-court press with respect to dealing with this matter. Anyway, one of the frustrating parts of this job, there are all kinds of needs out there and there aren't resources to meet all of them.

MS. MAUREEN MACDONALD: Mr. Chairman, very quickly, my last question before my time expires is with respect to diabetes and a program for low-income diabetics. I know that the Diabetes Society every year for the past few years, have really tried to educate members of the Legislature about diabetes. It's a disease that is very prevalent in Nova Scotia as you know and particularly in some communities more so than others.

To manage this disease, it can be quite a challenge, because of the testing that's required on a daily basis to really keep very good track of insulin levels - the strips and all of those kinds of aids which allow people to manage their diabetes is very expensive.

I can't find anywhere in the budget an allocation of money for a low-income diabetic program and I want to ask the minister, have I missed something, or has there been a decision not to fund that?

MR. MACISAAC: Mr. Chairman, the commitment that was made was a commitment in the blueprint and it was a commitment a year two commitment with respect to government. We have met with the Diabetes Association, we've indicated that we want to work with them relative to the development of a program and our objective is to have that program develop to the point where we would be able to implement it in the next year.

[5:15 p.m.]

MR. CHAIRMAN: The honourable member for Halifax Citadel.

MR. DANIEL GRAHAM: Thank you, Mr. Minister, for your comments. This must be quite an endurance challenge for you. I'm not sure if you prepare through some health promotion manner to get ready for these kinds of days.

[Page 97]

MR. MACISAAC: I watch very carefully my coffee consumption.

MR. GRAHAM: I'll bet you do. I see Minister MacDonald doing a mimicked trot as he sits in his chair. I'm not sure if that's a hint to you or to me in the circumstances.

Some of the questions that I am going to be asking will relate in part to Health and Health Promotion. Some of the questions are somewhat historical and, in the circumstances, there is an overlap, as we all know, with respect to Health and Health Promotion. Perhaps we can proceed accordingly.

Squarely on the question of health, first I would like to raise with you, Mr. Minister, the issue of the Cape Breton Wellness Centre. You'll recall that on a number of occasions, this issue has been raised by members of our caucus. The Cape Breton Wellness Centre is an award-winning organization out of Cape Breton and I'm just asking the minister if he's aware of the funding challenges connected to it in relation to cuts that happened back in 2002?

MR. MACISAAC: Mr. Chairman, I, first of all, would want to say to the honourable member that my knowledge of the issue is not extensive. It's an item, I understand, that two budgets ago would have dealt with the decline and funding for that particular facility. It's not something that entered into our discussions relative to the preparation of this budget.

MR. GRAHAM: Mr. Chairman, I would point out that the Cape Breton Wellness Centre has been in existence for many years and it is an award-winning organization. In fact, back in 2002, the Cape Breton Wellness Centre received a leadership award for women's health in Atlantic Canada from the Atlantic Centre of Excellence for Women's Health. My question for the minister relates to the kinds of things that they promote. The preamble to this will be lengthy.

The Cape Breton Wellness Centre initiated the healthy school food policy. It is involved in screening women for cervical cancer. It is involved in research into how recent coal mine closures are affecting the health of people living in Cape Breton. It is working on a plan for the development of bikeways, pathways, green spaces that support and encourage active living. It speaks about increasing access to quality teen parenting education. It talks about post-rehabilitation cardiac patients and it has spearheaded the economy and health project.

These are all issues that are directly connected to the number one phrase that is in the health care system these days and that is, population health. Two years ago this government cut funding to the Cape Breton Wellness Centre to the tune of $150,000 and despite pleas on the part of that organization, has failed to reinstate it. My question for the minister is, when will that funding be reinstated?

[Page 98]

MR. MACISAAC: Mr. Chairman, as I listen to the description that the honourable member provides of that particular facility and as I consider what those issues are related to, it's probably a question that the member might want to present to the Minister of Health Promotion when his budget is before the committee. While that office did not exist at the time the decision was taken, if any change relative to those decisions were to occur, they would occur under the auspices of his budget line.

MR. GRAHAM: Mr. Chairman, I would dare to say that there is an overlap here. The funding was cut from the Department of Health. The Department of Health is directly involved in issues related to primary health care, it's directly related to charting out a vision for population health. It's not just with the Office of Health Promotion, it is squarely a responsibility that exists in the Department of Health. The $150,000 is missing and this organization has continued to try to scramble to find support through other means. Surely when we're talking about screening women for cervical cancer and post-rehabilitation cardiac patients - those are issues related to matters under this minister's portfolio. I appreciate that if there are other concerns - for example, that relate to bikeways and pathways, that's more directly related to the Minister responsible for the Office of Health Promotion - but these seem to be clearly matters under the Department of Health's auspices. If the money is going to flow, surely it will come from the $2 billion-plus that goes into the Department of Health.

MR. MACISAAC: Mr. Chairman, my understanding, as a result of this discussion going on and learning more about it, is that the funding that was provided to that facility was funding in the form of grant funding. I understand that, the anticipation was that the facility would become independent and be able to carry on operations on its own once some funding was provided for a period of time. That did not materialize, it did not realize its own objective of being able to become independent and the decision was taken at that time.

MR. GRAHAM: I'd like to continue on the issue with respect to the Cape Breton Wellness Centre because it relates directly to whether or not we're able to move forward. If we continue to wrap things into silos of whether it's a grant or whether or not there's an obligation to have continuing funding, then we're never going to get to where we need to be when we have an organization like this that has been so successful in the most important areas of health care. So often we hear the comments these days about how it's not just about health care, it's about health. I was commenting earlier today about how so often we seem to be taking people, after they've become ill and we haven't been doing a good enough job in preventing illness. In Nova Scotia it's arguable that our record is perhaps the worst record of any province in this country. The need for us to move to a greater focus on health promotion and illness prevention is greater than any other province in this country.

If one were to look, for example, at the statistics and I know that the minister has heard this over and over, but it bears repeating, that in Nova Scotia we have the highest rate of death from cancer - that's strongly linked to smoking. We have the highest rate of death from respiratory disease, we have the second highest rate of death from lung cancer, we have

[Page 99]

the highest rate of death from circulatory problems, we have the highest rate of several preventable chronic diseases and the highest reported number of disability days in Canada. Nova Scotians develop a health disability at an earlier age and suffers with it longer than do other Canadians. What's most troubling about that is that in Cape Breton the problem is far worse than it is for the general population in Nova Scotia. So if there is an area of this province that requires the greatest attention, with respect to wellness and health promotion, clearly it is in Cape Breton.

Recent studies done through Health Canada and GPI Atlantic - that I am sure the minister is familiar with - suggest that of the several hundred districts that were measured for population health in Canada, Cape Breton has consistently ranked near the bottom. Now we have an organization that is doing tremendous work, exactly in the areas that are supposed to promote health, and a measly $150,000 is not being provided to that group as a consequence of this government finding other priorities in the Department of Health. My question for the minister, Mr. Chairman, is whether or not this minister will agree to sit down with officials from the Cape Breton Wellness Centre, to have a discussion on whether or not $150,000 can be reinstated?

MR. MACISAAC: Mr. Chairman, I must say this is the first time in my capacity as Minister of Health that this particular issue has been presented to me. There are two elements that must be considered relative to his request. One is - as he has agreed - many of the elements of the Cape Breton Wellness Centre would fall under the jurisdiction of the Office of Health Promotion, but the other is that the district health authority has an interest in providing and in seeing that that level of service is provided within their jurisdiction.

What I will say to the honourable member is that I will request that the Minister of Health Promotion and the district health authority, and myself review that particular institution and see that there is a communication that takes place with them relative to how their services would fit with respect to the objectives of - not just the Department of Health, but, the district health authority and the Office of Health Promotion.

MR. GRAHAM: I'll take that as an undertaking that we at least follow up to explore this issue. I see the minister nodding that he's at least willing to explore it. Where the responsibility ultimately rests is something to be decided at a later date between the Minister's Health Department, the Office of Health Promotion and the district health authority, and I thank him for that.

The next issue that I would like to touch on relates to the issue of taxes, and specifically tobacco taxes. I would draw the minister's attention to Page A15 from the budget that was tabled in the House last week. In that, the heading at Page A15 is Revenue Sources. I'd like to talk about a few of these because, frankly, they relate quite directly to the health of Nova Scotians. We have Tobacco Tax indicated in 2002-03 having been $145,425,000, rising to an estimate just two years later of $180,217,000; we also have Liquor Corporation

[Page 100]

Profits that were $157 million, rising to $181 million in this coming year; and we have Gaming Corporation Profits that were $187 million in 2002-03, dropping to the present time 2004-05 of $169 million.

[5:30 p.m.]

Now, if I can focus first on the very troubling issue of smoking and tobacco costs. On the first occasion in April of 2001 - April 5, 2001, in fact, this government raised tobacco taxes and did it largely under the name of improving the health of Nova Scotians. Then in November of 2001, just about eight months later, they did the same thing and raised many millions of dollars more. On January 8, 2003, tobacco taxes rose once again, and on March 16, 2004, tobacco taxes rose once again. Now at least on the last couple of those occasions the question was put out as to whether or not the money from those increased taxes was going to go into improving the health of Nova Scotians, since, after all, at least in these four press releases that I have referenced - and I'm happy to table them if necessary - before the House the increased tobacco tax came as a result of the government's concern for the health of Nova Scotians.

Our calculations determine that the total amount that has been raised is in the range of $90 million, and the amount of money that has been put back into the tobacco strategy has been in the range of $2 million however - approximately 3 per cent of the total value of the money that was taken out in the first place. We see, and some small credit is due to the recent announcement in the area of health promotion, they will deal with smoking cessation. But surely the minister responsible for the good health of Nova Scotians is able to provide this House and this committee with a clear indication where the $80-some million that was raised in the name of better health for Nova Scotians has gone from the tobacco taxes that have been placed on Nova Scotians since 2001.

MR. MACISAAC: Mr. Chairman, I believe that an analysis of the costs associated with the treatment of lung cancer itself would reveal that the cost of providing that service to Nova Scotians is indeed in excess of the amount of money that's raised through tobacco taxes. That's the challenge that faces the people of this province relative to the treatment of illnesses. He referenced the Liquor Corporation - the money that is raised through the taxes in the Liquor Corporation is not sufficient to treat all of the social costs associated with the abuse of alcohol.

That's a reality that faces the province. We are indeed reallocating resources to health promotion and tobacco cessation. We've reduced the consumption by 5 per cent, and indeed the increase in the cost of tobacco is a factor in the reduction of consumption. It plays a very definite role in that reduction of consumption and that relates directly to the issue of health, but the challenge that exists for Nova Scotians is the challenge of meeting the cost of treatment and providing the health care, and those revenues don't do the job in and of themselves.

[Page 101]

MR. GRAHAM: Mr. Chairman, I'm wondering if the Minister of Health would be able to provide us with statistics that support the assertions that he has just put forward?

MR. MACISAAC: The answer is yes.

MR. GRAHAM: Just to be clear, Mr. Chairman, I want to be certain - he made reference to both lung cancer and the cost of lung cancer, and he also made reference to the cost of alcohol consumption - is the undertaking with respect to both of those taxes and the costs in relation to both of those?

MR. MACISAAC: Mr. Chairman, the issue related to lung cancer - and I should have included in my words, cardiovascular disease - we can provide those statistics. I would have to say my reference to the revenues from alcohol taxes are based on figures, that I assume to be true, from some considerable time in the past. I don't know if I can put my fingers on the most recent statistics relative to that, but I feel fairly comfortable that we're coming very close to describing the situation - but we will provide definite statistics relative to the treatment of diseases, in particular lung cancer and cardiovascular diseases, related to the revenues derived from tobacco consumption.

MR. GRAHAM: The concern that I have about the response - and I accept the response at face value that the minister has provided however - is that the treatment is not ultimately going to get us to where we need to be. The secret to ensuring that Nova Scotia is healthier and that the costs are reduced is clearly in the areas of disease prevention and health promotion.

I'll provide a reference for the next comments that I have. Statistics Canada's CANSIM database, Matrix 3783, indicates that only 2 per cent of our health care budget is devoted to disease prevention and health promotion. My question for the honourable Minister of Health is whether or not he believes that 2 per cent, as a percentage, is sufficient in 2004?

MR. MACISAAC: The honourable member is referencing the need for us to be involved in healthy living and promoting healthy lifestyles in this province. That's clearly a commitment that's understood by this government. That is why the Office of Health Promotion was created, and that is why we have provided additional monies to the Office of Health Promotion this year - increased the budget by, I believe, 24 per cent. I was interviewed earlier today - if all of a sudden we were able to come forward with an amount of $90 million tomorrow to put into health promotion, the question is whether or not we would have the human resources to be able to suddenly do that. It's something that we need to be able to ramp-up gradually, and we're doing that. There was a very good year of planning that went into levels of activity. Today, if you look at Healthy Nova Scotia, it's another plan that's intended to achieve that particular objective.

[Page 102]

But what we're really involved in in this whole initiative is to alter the culture of Nova Scotians, and I have considerable faith that we can achieve the objective of altering the culture of Nova Scotians relative to healthy living, in the same way that we were able to affect the culture of Nova Scotians with respect to issues like recycling - where this province, under a program initiated by the previous Liberal Government and set forward by that government through the efforts of the Resource Recovery Fund, set an objective to achieve a 50 per cent recycling of consumed resources in this province. That objective - I happened to be the Minister of Environment at the time that the objective was achieved - was set out by the previous government, and I gave them credit at the time as a very worthy program, what was significant about it is the way in which the culture of Nova Scotians relative to the issue of recycling was altered and changed, and that is something that I believe we can do relative to the issue of health promotion.

But it's not something that's going to be achieved by suddenly throwing huge sums of money at it. We need to build and gradually develop momentum and awareness, and I believe we're moving in the right direction with respect to achieving this.

MR. GRAHAM: One can appreciate that this isn't a matter of suddenly making changes overnight. One can appreciate that these changes happen gradually, and I think the government understands that it's ultimately about changing the culture, and in order to change the culture an injection of resources is required.

I'm sure the minister has heard a lot about the North Karelia project in Finland, where a population in a province in Finland suffered terribly from chronic diseases, and that government committed the resources necessary to ensure the people became healthier, and as a result of that concerted effort to address the problems of chronic disease in North Karelia, Finland, there has been a substantial improvement in the health of the people overall.

I made reference a moment ago to the fact that according to Stats Canada only 2 per cent of the health care budget in Nova Scotia goes toward disease prevention and health promotion. What's interesting to note about the budget that has been placed before this House on this occasion is that there has been $3.6 million that has been devoted as additional funds toward the issue of health promotion. When one takes that additional money and compares it to the $230 million worth of new money that is coming in for health care, we note, despite all the bluster about focusing more on health promotion, that 3.6 per cent of additional money doesn't even represent 2 per cent of the additional money globally that's happening. So it's a question of whether or not this government is prepared to walk the walk when it comes to the issue of health promotion.

In comparison to $230 million of increased funding for the health care machine generally, to put only $3.6 million into the issues of health promotion is, I would suggest, completely substandard. While the minister says that we're going to build this thing gradually,

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surely there are bold steps that need to be taken - I'm going to suggest just a small step and a bolder step for the minister to perhaps consider and to respond to.

The first is that there is a program with respect to smoke-free students in Nova Scotia that's recognized by Health Canada as one of the most impressive programs of its kind - I believe it's called Smoke-Free For Life. Unfortunately, research has suggested that less than 20 per cent of the students in Nova Scotia schools benefit from the education that comes from this program. What would it cost for 100 per cent of the students in our province to receive the Smoke-Free For Life program at the critical age when they're forming their values around smoking and the choice of smoking in their lives? Health Canada recognizes it as a great program. Very little money is committed to it. Those are the small measures, I would suggest and I would invite the minister to respond to that.

And if I could go to a bigger one - it relates to something that I've been beating the drum about for two years now - and that's the Healthy Starts initiative that is much talked about, where there's not nearly sufficient action on in this province. All of the research tells us that if somebody's going to have a happy, fulfilled, successful life, the most important years of our lives are the period from prenatal to Grade Primary. We have a program in this province that initially was worth $9 million, and almost all of the money in relation to that came from the federal government. The provincial government has started to add nickels and dimes from time to time, but have not nearly stepped up in the way they need to step up to ensure that all of the children who are at risk from the time they were born, and even when their mothers are pregnant, are getting the kind of attention that they need to ensure that when they reach Grade Primary they have a leg up on life and that they're not suffering.

That, Mr. Minister, requires not nickels and dimes; that requires a real commitment to the promotion of the health of the people in this province. If we'd follow the research we'd realize that if we're going to have a healthier Nova Scotia it needs to start with the children who are from 0 to 6 right now, and putting money - not nickels and dimes like the $3.6 million - a big chunk of that $230 million additional dollars toward truly promoting health and preventing illness in this province.

MR. MACISAAC: The Early Childhood Development Program to which the honourable member referred is indeed a priority of government, and it's worked on between the Department of Health and the Department of Community Services. It has resulted in additional public health nurses being available throughout the province and they of course work with newborns and prenatal activities up to age 2, so that is something.

[5:45 p.m.]

Mr. Chairman, I also want to point out that the North Karelia project, which was referenced by the honourable member, and the honourable member for Victoria-The Lakes previously, the effective strategies that came out of that particular project have played a key

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role in the development of the chronic disease prevention strategy of this province. We're very much aware of that particular project, and honourable members have indeed referenced the fact that the results in that project were not results that were achieved in a very short period of time, but they took a considerable period of time to achieve the objectives that are heralded when that program is referenced. So by this province putting in place a chronic disease prevention strategy and the implementing of that strategy, we indeed will achieve similar results, if not improved results, and I have every confidence that we can do that.

Mr. Chairman, I appreciate the concern relative to the issue of health and health promotions, but I do note that for the past number of minutes most of the time that I have spent is in relation to the Office of Health Promotion budget which, I believe, if members wanted that particular motion to be debated in the Assembly it's one that they should have called to have brought forward in the Assembly, so the debate could take place with the appropriate minister.

MR. GRAHAM: Mr. Chairman, I'd like to turn my attention to the issue that is related to this, related to the budget line items. In response to the minister's comments just now about whether or not this is his responsibility or the responsibility of the Minister for Health Promotion, he can be certain that if and when the Minister for Health Promotion appears before this committee to defend his estimates, then we will be asking him similar kinds of questions. I think it is prudent of us to ensure that these questions are asked squarely of both ministers.

Mr. Chairman, I'd like to turn my attention to the issue of gambling addictions. I made reference earlier in my comments to the fact that we estimate in next year that the Nova Scotia Government will receive $169 million from gambling corporation profits. I would ask the minister to provide this House with an indication of what he understands to be the financial commitment, in this coming fiscal year, toward gambling cessation programs and gambling addiction.

MR. MACISAAC: Mr. Chairman, that clearly is a question that is appropriate for the Minister of Health Promotion. It is not something for which I have administrative responsibility, or is it part of the vote that will be applied to my department

MR. GRAHAM: Mr. Chairman, one of the frustrations that one has when they're dealing with the Office of Health Promotion is that one is left with the impression that they are always hoping for more money. I can recall the discussions that happened 14 months ago with respect to many of issues that are connected to health promotion, and at that time the minister did not have a budget and did not have an office. Eventually various components of government services were cobbled together and a budget was assembled as a result of the merging of the budgets of those various groups, and a budget was ultimately found.

[Page 105]

We do believe, of course, that the issue of gambling and the number of people who are affected by that, the families who are affected by that and, frankly, the suicides that according to the research happen in Nova Scotia every year, are health-related matters. We have circumstances where this province is prepared to put money into communication strategies and advertising to ensure that smoking does not continue but, with respect to gambling, there's hardly any money that is provided to that area. My question for the Minister of Health is whether or not his department would even consider, in light of the number of deaths and how this affects the wellness of Nova Scotians, if this government would consider the possibility of contributing to, in this fiscal year, a more aggressive campaign to ensure that gambling is substantially reduced in Nova Scotia?

MR. MACISAAC: Mr. Chairman, the responsibility the department has with respect to the treatment of gambling is something that's provided through the district health authorities. We provide, through their business plans, appropriate monies to assist them in providing that service. I am told that is an amount of $19.8 million, but that is for the treatment, and the honourable member is asking about prevention. Again, I would submit that questions related to the prevention of gambling are appropriate to put to the Minister of Health Promotion, because the monies dedicated to that activity are monies that come under his vote and not mine.

MR. GRAHAM: Mr. Chairman, my questions now relate to the New Waterford Consolidated Hospital. The minister is quite familiar with the challenges that have been faced by several families in that area. We know, of course, that through the district health authority an inquiry was made, a Dr. Smith was retained, and now the position of the government is that it's not a responsibility of the government to provide compensation in these particular circumstances. I want to ask as a general question first of all: where does the Minister of Health see this matter resting at this particular time?

MR. MACISAAC: Mr. Chairman, perhaps with the indulgence of the honourable member, if he could be more specific in terms of the direction of his question because, to answer it now, I'm just not sure what the focus is.

MR. CHAIRMAN: Could you be more specific, member?

MR. GRAHAM: Mr. Chairman, the minister will be aware of course that our Party has called for a public inquiry with respect to the New Waterford Consolidated Hospital. We have in that community several people, including families who have babies who were in vitro at the time that construction was happening approximately two years ago at the New Waterford Hospital, who have particularly high levels of metal poisoning. Those families continue to say that they are aggrieved, and people have lost their work - there is obviously a need from a health perspective to get to the bottom of this problem. Despite the fact that the Department of Health and the district health authority are claiming that it's not related to the construction period that was happening two years ago, the families certainly don't accept

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that as an explanation. I know that the Department of Health and the district health authority said they think they have some idea of what the cause of this problem is, but certainly my recollection is that there is no certainty, there has been no definitive conclusion drawn with respect to what is the cause of these problems, and I'm asking the minister, could he elaborate?

MR. MACISAAC: Mr. Chairman, I thank the honourable member for his clarification and the focus that he brings to his question. The priority of government and the district health authority and, of course, Occupational Health and Safety Committees in that area is to try and determine the specific causes of the illnesses being experienced by the individuals in that area. That is why as a follow-up to the report of Dr. Smith, to which the honourable member referred, Dr. Ted Haines will be in the area tomorrow - it's my understanding that he'll be there tomorrow - and we have encouraged people who are experiencing symptoms to visit with Dr. Haines. I know that he has spent considerable time in preparation for his visit in terms of reviewing the files, reviewing the cases of individuals who have indicated a desire to meet with him, so I want to make sure that people don't feel that this is a one-day activity on his part. He has invested a considerable amount of time to date relative to an examination of this.

The objective is, again, to see if we can find, in a more definitive way, the causes of the illnesses that are being experienced by people in that area. The district health authority has determined that there are ventilation problems in that hospital and steps are being taken first of all from a design perspective - and I understand there has been some real progress relative to the design - and the district health authority in the near future will be able to come forward with a proposal with respect to improving the ventilation in that building, and that will assist in an improvement of the situation at that hospital.

We are awaiting the results of Dr. Haines' examination of patients and the work that he is doing with respect to this in assisting us in coming to a determination of the cause, if we indeed can make a definite determination of the cause. That is our objective and that is the focus of our activities at this stage.

MR. CHAIRMAN: Thank you, honourable member. I wonder, given the hour, would you agree to adjourn debate for the moment of interruption?

Is it agreed?

It is agreed.

The motion is carried.

[5:59 p.m. The committee adjourned.]

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[6:30 p.m. The committee reconvened.]

MR. CHAIRMAN: We will continue with the Estimates for the Minister of Health. The honourable member for Halifax Citadel.

MR. DANIEL GRAHAM: I would like to continue on a new line of questioning. I see that the responsible officials for the Department of Health are not yet in their seats. The Minister of Health is giving me the signal that it's okay to proceed. Thank you for that.

Mr. Chairman, I'd like to turn my attention to the question of people with disabilities. The minister will recall that in the Fall session past, the issue of people and children in particular being challenged with autism was an issue squarely before this House during Question Period. Many people have written to the minister urging him to ensure that there is funding consistent with the funding that exists in most other Canadian Provinces for ABA therapy. My question for the Minister of Health is whether or not in this budget, he has found the resources to ensure that ABA therapy will be available for people who are challenged with autism?

MR. CHAIRMAN: The honourable Minister of Health.

MR. MACISAAC: The subject matter to which he refers, the resources for children with autism, is indeed a challenge for us to respect to funding. We have continued the $2 million that was in previous budgets; that continues to be available in this budget with respect to the expenditure. There is a plan which has been brought forward, some of money has been identified with respect to the implementation of that plan. To date, we have not identified the funds for that implementation.

MR. GRAHAM: Mr. Chairman, I just want to be clear on the response by the minister. Is there, or is there not, new funding available for the Applied Behaviour Analysis program?

MR. MACISAAC: I thought I had answered the question previously, but the short answer is no.

MR. GRAHAM: Thank you, it is clear now.

The surgery list wait times is the next subject that I'd like to turn my attention to. Mr. Minister, you will recall that there are some disciplines in medicine who approach the issue of surgery wait times differently than others. I think it was cardiac, or cardiovascular - one or the other - surgeons in this province who established a common wait pool for their patients to ensure that the worst patients, the patients who needed surgery the most went first out of that common pool. As a consequence, the wait times in that discipline were substantially

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reduced. At that time it was the only area of surgery that did that, and it was the only area of surgery that was showing real success.

My question is whether or not there is any plan in the Department of Health to ensure that this common pooling of wait times is imposed across all disciplines so that, for example, patients don't simply pick their favourite or most popular orthopaedic surgeon, but they go into a common pool and accept the surgeon who ultimately provides them with the surgery at the end of the day.

MR. MACISAAC: Mr. Chairman, really what we do want our patients to know is the information relative to wait times. The chairman of the committee was with me on the weekend at a wonderful event in New Glasgow, Hip Hip Hooray it was referred to, and it was the first of what they hope will be an annual event in New Glasgow. It was a symbolic walk that celebrated the new-found freedom and ease of movement that those who have been afflicted with arthritis, who had the benefit of orthopaedic surgery and I can tell you, Mr. Chairman, and to the honourable member, through you, that that was a very moving experience.

The surgeons who were involved with the patients who were there, you could see for them the tremendous level of satisfaction that they had as a result of their work being so visual to them. The last time they would perhaps see those patients was only within the context of their hospital bed, and then afterwards in the follow-up visits in their offices, and didn't have a full appreciation of the capacity that they have been able to give to these patients as a result of that. I just wanted to take this opportunity to note that, because it was a wonderful event and if the honourable member had the opportunity to be there he would have been moved in the same manner that we were relative to this major achievement in the lives of these people, and the expressions on the faces of the surgeons and the nurses who were involved in this was equally telling. It was a wonderful celebration.

It brings us to the point - and I focus on that - because at the Aberdeen Hospital there is an excellent orthopaedic program, the challenge we have in the four sites that exist throughout the province is to ensure that patients have the kind of information that they require so that they can make decisions as to where it is that they want to go to receive those services. I'm not certain that we're going to be in a situation where we dictate to individuals where they go to receive services. Certainly the challenge is to make sure that the information is made available to them so that they can make their own decisions, and that is part and parcel of the work of the wait time committee that is currently working in the province.

They are developing standards so that wait times are clearly understood by people and we know precisely what is meant by a wait time of a certain period of time. That means the same thing for the surgeon as it does for the GP, as it does for the patient, as it does for diagnosticians and the families, so that everybody in the piece will understand what is meant by the wait time numbers that are presented.

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MR. GRAHAM: The point that I was making, Mr. Chairman, is that in some fields of medicine we've had success. While it may not be the first step for the department to dictate to orthopaedic surgeons, I think that there is some persuasion that would be of benefit in these circumstances, given the very positive results that they have received in other areas. Which brings me to the next line of questioning - it relates to alternative funding. Many health practitioners, particularly those in primary health care, community health care centres and clinics, signal unequivocally that the funding for physicians drives the costs in the health care system, and if we were to move more to a team approach, in other words if we moved more towards alternative funding the health of the population would be improved, the costs would be reduced and, overall, there would be greater efficiencies.

I realize that alternative funding has been something that has been gradually growing over some period of time. But there are some - and I'm quickly moving to that place myself quite frankly - who believe that if we moved holus-bolus to the alternative funding approach, then costs would improve across the board and, most importantly, the health of our population would be improved because there's a much greater level of co-operation amongst all the stakeholders in the health care system because they are working together with the patient at the centre of the problem-solving exercise. I'm asking whether or not the minister or the department have any clear intentions to drive the issue of alternative funding more aggressively than it has been driven up until now?

MR. MACISAAC: I thank the honourable member for the question. What I can tell him is that we have indeed made some progress with respect to the issues of alternate funding programs, especially in the areas that centre around the academic role of physicians who are here in the Capital District.

We also, as part of the primary health care initiative within the province, have a primary health care steering committee, and that committee has brought together broader stakeholders relative to the whole issue of provision of primary health care. A subcommittee of that group is looking at methods of payment of family physicians and the Medical Society is a part of that activity and they support it.

I can confirm with the honourable member - I don't mean to consume his time, but I want to demonstrate to him how important I think the subject is - the story of the mother who took her teenage daughter to the doctor and this doctor was in an alternate funding program. The young girl was in with the doctor for what appeared to be a very long period of time, and the mother became extremely concerned that something serious was wrong with her daughter. When the doctor and the daughter emerged, the mother appeared quite concerned and the doctor was able to respond to her, oh no, we had a wonderful chat. Your daughter is going from junior high to high school - and the daughter eventually told the mother that the doctor took the time to discuss with her the many challenges that she would be facing as a person going from junior high to senior high, and spent time discussing the

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issues related to peer pressure from a medical perspective, but also as somebody who is a caring individual who knew this child from her early days right to this stage in her life.

That conversation would not have been possible under a fee-for-service arrangement. The doctor would have felt pressure to get her in and out of the office as quickly as possible. There are many benefits to be derived from alternate funding programs - it's part of the primary health care initiative that we're involved in within the province.

MR. CHAIRMAN: The time allotted for estimates with respect to the Department of Health have expired for today.

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 on a future day.

[The committee rose at 6:45 p.m.]