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HALIFAX, MONDAY, MAY 2, 2005

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

4:06 P.M.

CHAIRMAN

Mr. James DeWolfe

MR. CHAIRMAN: The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, we will continue with the estimates of the Minister of Health.

MR. CHAIRMAN: The honourable member for Halifax Clayton Park.

MS. DIANA WHALEN: I appreciate the opportunity just to ask a couple of questions today. My colleagues have allowed me to jump into the queue and ask some of these questions. The main area that I wanted to explore today was the self-managed care, both the program that has been proposed by the government this year and maybe the shortcomings of the current situation. I'd like to really explore whether the proposed program is going to answer very many of the problems that we've experienced over the last year.

The minister is, I think, quite well aware of a constituency issue in the Clayton Park riding, and I know that there is more than one person in my riding who will be needing this service. The issue came to my attention and came to a head in the Clayton Park area because of a gentleman who is a constituent who is unusual in the circumstance that he actually has a job although he is confined to a wheelchair and is requiring home care every day in order to maintain that work schedule.

What came about after something like 20 years of receiving home care, this past Fall he had a falling out of some sort with the VON and the VON refused to continue to provide service. What came to my attention as a result of that was that even the Minister of Health of Nova Scotia was unable to reinstate service or provide an alternative service to the VON that is, as I understand, our contracted service provider.

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I thought it was really a terrible omission on the part of the government that we don't have any backup in place or any other facility to meet that need when and if this one single provider can't make it for some reason, for whatever reason, there's a falling out or a dispute or something that becomes a terrible obstacle in the delivery of the service.

So the question I would like to pose to the minister is whether or not we've now gone beyond that and there are alternatives to my constituent and to any others who find themselves at that impasse?

HON. ANGUS MACISAAC: Mr. Chairman, the honourable member would appreciate that I'm not in a position to discuss individual cases on the floor of the House. Having said that, I do want to, for a few moments, if I might, address some of the challenges that exist with respect to the provision of home care and the fact that there is a provider of home care services. One of the responsibilities we have, in addition to doing our very best to make sure that the services that clients require are in fact delivered, we also have a responsibility to ensure that those who are providing the service are in fact secure in their feelings about what it is that they're doing. That, sometimes, becomes a very real challenge. Unfortunately we are dealing with situations where personalities don't always harmonize in a manner that we would like. That does create some difficulties.

Now without delving into details of a particular situation, I want to also suggest that the self-directed home care program, which we are providing for in this budget, would provide an option that may be considered in circumstances as described by the honourable member. The honourable member does point to the challenge that exists when there is an impasse. Sometimes the impasse is one where those receiving the service need to recognize and accept the rights of those who are providing the service. At other times the impasse may be of a nature where, as the honourable member suggested, there is no apparent resolution. In those circumstances, it becomes a bit difficult to provide the solution that is required. I do know that every effort is made when those situations arise to try to create an environment where the service can be provided, both to the satisfactory benefit of the client and to the satisfaction of the caregivers with respect to their own situation in terms of providing that care.

The self-directed program does provide us with an alternative to consider in circumstances such as this. Whether it is going to be the cure in those circumstances, I can't make that determination. I think health care professionals would have to make that determination.

MS. WHALEN: I would like to pursue this a little more. I'm glad the minister has made the mention that we can't talk about specific cases. The case I have in my mind, I think, is illustrative of other cases that are across the province. That became clear when we had a discussion about home care at one of the legislative committees a few months ago. It was

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clear that every MLA who sat in the committee had at least one or two they could think of right off who fit this scenario.

There's two things I'd like to ask specifically. One is that during discussions around the provision of home care, I was told specifically that home care is not an insurable service. That was said in a way that I thought was kind of ambiguous. I'm not sure what was meant by a Department of Health employee saying that, it sounded to me like we're saying home care is not a right, a person isn't entitled to home care. I was really quite shocked, if that is the interpretation of it, because if a person does not get the home care they require, they will be hospitalized or they will be institutionalized, and that is a cost to the government when that occurs.

[4:15 p.m.]

So I just wonder if you could explain further what an employee would mean when they say home care is not an insurable service and if you could explain it. As I say, it sounds somewhat like a threat that it is something you are getting maybe because you are lucky to get it and if you cause any trouble you won't get it. It's not an insurable service. Perhaps you could just tell me if that is true or what it means.

MR. MACISAAC: Mr. Chairman, I thank the honourable member for the question. The facts with respect to home care are that it is not a service that is covered under the provisions of the Canada Health Act so it is not something that MSI pays for, but it is something that is funded by the Department of Health and we provided approximately $100 million toward home care last year. So there shouldn't be any intimation of threat with respect to a statement of a fact like this. It simply refers to the fact that it is a service that is not covered under the provisions of the Canada Health Act.

MS. WHALEN: I would like to explore that just a little further. Although it's not covered under MSI, does the Government of Nova Scotia feel that that is, I guess, a right of Nova Scotians who are disabled and need home care? Can we regard it as a right for them to have that service and remain active in the community?

MR. MACISAAC: Mr. Chairman, the government's view of home care, the issue as to whether it is a right or not a right is not how we view it at all. Our view of home care is that the more services that we can provide in homes, the better job we are going to do of ensuring that people do not need acute care services in our hospitals. The more money and more resources that we can commit to home care, obviously it is a much more efficient option with respect to expenditures of dollars than allowing individuals to deteriorate to the point where they require acute care. So our view of home care is that it is a service that should be enhanced.

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We are not without our challenges in terms of being able to provide that service in the manner in which we want to provide it but we are certainly committed to providing it, expanding it and currently that continuing care department of the Department of Health is involved in a province-wide consultation. A very important part of that mandate is to look at ways that we can expand home care services and provide alternate levels of care to acute care so that we are keeping people in their homes for a longer period of time and out of institutions, whether the institutions be acute care facilities or whether they be long-term care facilities or residential care facilities. If they are in the home, that is obviously a much better option, both from the perspective of the commitment of resources but more importantly from the perspective of the individuals who are able to receive care in their home and remain in their home environment for as long as possible.

MS. WHALEN: I wasn't aware that you are doing the province-wide consultation. I hope that you are touching many of the stakeholders, including those who receive service. I will look into that afterwards. What I'm wondering is whether the Department of Health does any surveys at all about the customer satisfaction of those people who are receiving home care, independently, not having the VON themselves do it, but do you do any yourselves to see if those customers, those clients, the patients who require home care are, in fact, satisfied, comfortable, trusting of the care they receive?

Too often, I think, there is a feeling that because we put all of our eggs in one basket and we depend only on the VON to provide this service that the recipients of the service are frightened to speak out and they are frightened to make their feelings known if they feel it is inadequate in any way, because they will become known as a difficult person or a difficult client to satisfy and ultimately you could lose your home care if you are too difficult. So I think there is a sense of unease about expressing their views. I would like to know if you have any statistical surveys, any customer satisfaction surveys that were done.

MR. MACISAAC: Mr. Chairman, the honourable member raises a question which is very appropriate and that is related to our capacity to be able to measure how well we do in the provision of the services that we provide and being able to get the level of feedback that will help us improve the level of service that is being provided. We do not have the statistical information the honourable member references; that is not to say that we wouldn't want to have that. We are working at improving our capacity to gather that sort of information and we view it as being an integral part of what we need to do relative to the provision of home care so that we can do a much better job of, first of all, satisfying ourselves that we are doing for our clients what we should be doing but, secondly, to ensure that the contractual arrangements that we have with the providers of care are living up to the standards that we want to see provided.

It is only when we are able to clearly articulate those objectives and find a method of measuring ourselves to those objectives that we will be in a position to effectively deal with those who contract to provide services on our behalf. So the member is correct in

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identifying a challenge that we have. It is a challenge that we are working on and one that we are committed to meeting.

MS. WHALEN: I have just a couple of questions still centred around this, if we could. Again, we have made what I understand is a contractual obligation or arrangement with the VON to provide our province-wide home care services. There may be a few pockets around the province where another agency or group is doing it but I think they are fairly isolated. What I would like to know is why we haven't opened this up to other care providers so that again it would give the department and the minister himself more flexibility when real complaints emerge and an impasse is reached, and it may very well be personality conflicts.

One can only imagine the frustration of people who are disabled having to deal every day with their infirmities, their inability to do things when they are mentally fit and able and yet they can't do a lot of things physically. It's natural that there would be some frustration and perhaps sometimes some anger. I think that even then the home care workers, I'm sure, receive training and if they don't, they certainly should be receiving training in dealing with difficult people, just as you would in a hospital where people are sick and perhaps their personalities are strained.

What I would like to know is why we haven't opened up to other care providers, why we don't have any other contracts. In fact, I think it's worth noting. I don't believe there is a signed contract with the VON. I think it's an arrangement or an understanding but we had asked earlier in the year if you actually have a contract with the VON, and you might want to answer that question at the same time. It seems that we feel we are obliged to work with only one care provider and I would like to suggest that we open that up and that more companies be given the opportunity so that again there is flexibility built into the system. So if the minister could reply to that, please.

MR. MACISAAC: Mr. Chairman, the contract that does exist is indeed an old contract and it is quite dated. Before we are in a position to be able to renew a contract, we need to clearly articulate the deliverables that we want to see contained within such an arrangement or such a contract and that is the focus of our efforts at the present time. We very much want to reach the stage where it will be possible for us to, because we are clear about our deliverables and what it is we want to achieve, to bring forward a request for proposals relative to the provision of the services. But we still have a little more work to do in terms of articulating the deliverables relative to this service and when we have done that, as I indicated, our objective would be to put ourselves in the position where we could call for proposals if we wished or at least sign contracts that allow us to be assured that we are meeting those deliverables.

So the honourable member does, as a result of her experience, point to an area where there is room for considerable improvement but I want to be fair to the individuals who are providing the service to our clients. The number of cases that my office winds up having to

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deal with relative to these circumstances, are not great in number. There are a few where it is necessary to try to arrange some resolution and in those circumstances we work very hard at trying to do that but by and large, when you consider the fact that the expenditures are in the vicinity of $100 million to the provision of this service, the number of complaints that we get are relatively few but as long as there is a single complaint, then there is room for us to be able to continuously improve and, as I indicated earlier, we can do more work and we are doing more work with respect to articulating deliverables and then finding a vehicle or contract method of providing those deliverables.

I would like to point out to the honourable member that in last year's budget there was an amount of money allotted to help with the management of challenging behaviours and assisting personnel who are providing the care to be able to cope with those circumstances. Very often, if a person is properly trained, then they themselves can develop the capacity to be able to overcome the challenging behaviour incidents and bring about a resolution without having to go to a third party, but that requires training and we have begun the process. I understand that money is in the base and it's ongoing so that we can expect to see a level of improvement in that regard simply because our providers will be better equipped to be able to respond to these circumstances.

MR. CHAIRMAN: The honourable member's time has expired. I have to say that there was a bit of confusion as to how much time should have been allotted to you and we made a decision based on the best possible information we have. We have to move on from there. It was beyond our control.

The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Mr. Minister, The Daily News today is reporting that the federal Minister of Health has written a number of provinces, including the Province of Nova Scotia regarding concerns about private-for-profit health care delivery in the area of diagnostic testing. I'm wondering if you would inform members of this House what specifically the federal Minister of Health has said his concerns are and how you intend to deal with these concerns.

[4:30 p.m.]

MR. MACISAAC: Mr. Chairman, I thank the honourable member for the question. Indeed, the federal minister did write to me and I can tell the honourable member that between getting from my constituency office to Halifax today, I was rather rushed in terms of what I was able to be brought up to date on but I did read what could be considered the operative paragraph of the minister's letter. I have yet to have an opportunity to go through it all. I am told that he, in a general way, wants to become familiar with the issues as they exist within the various jurisdictions across the country.

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The operative paragraph that I read was one where he requested that his deputy minister meet with the deputy minister of this province to explore this and other issues related to the provision of service and I can assure the honourable member that my response to the federal minister will be of a positive nature, that we have, in fact, through the deputy's office, been meeting with officials of Health Canada on a regular basis. They are very much aware of the circumstances in this province. We have been as forthcoming as we possibly can be with them and if it's the federal minister's belief that a meeting of the deputies be held to explore this particular situation, then we would be quite happy to provide that opportunity.

I will also point out that it is the subject of discussion among the Deputy Ministers of Health right across the country. We are very much prepared to have that discussion and we are looking forward to being able to develop a common approach with respect to dealing with this.

I believe that our common approach might be somewhat challenged as a result of some diverging views that exist relative to the provision of services like this across the country. Certainly the view of the Government of Nova Scotia compared to the view of what I see coming from a province like Alberta is quite different. So whether a common approach can be possible or not remains to be seen, but certainly we are in no way reticent about sitting down with the federal Department of Health. As a matter of fact, I extended an invitation to the federal minister to come to Nova Scotia to see what we are doing with respect to the whole issue of wait times and I am hoping that he will have the time to be able to respond to that invitation in the near future, but this week might determine whether that time would be available.

MS. MAUREEN MACDONALD: I want to thank the minister. Mr. Minister, I would like to know how many people inside your department are responsible to monitor the private delivery of health services in Nova Scotia and particularly with respect to the private MRI, what has been happening? The private MRI has now been in existence in this province for several years and I would think that there would be ample opportunity to really explore what impact that private facility has had on the public facility with respect to any queue jumping that may have occurred, any leaching of health human resource personnel from the public system into the private system, et cetera.

I would be most interested in knowing how many people in your department are responsible for following this and to what extent have they been able to monitor and to get a pretty good handle on what the implications have been? I would assume that if the federal minister is interested in knowing what the situation is here in Nova Scotia, this would be information that he will be looking for as well.

MR. MACISAAC: Mr. Chairman, the first question of the honourable member was how many people are involved in it. It's difficult for me to provide a precise number. Perhaps I can describe how it is monitored and it will assist the honourable member in understanding

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what goes on. We have, of course, an acute care division of the department and we have a division for medical services within the department. We work very closely with the district health authority and with Doctors Nova Scotia and the College of Physicians and Surgeons who have their own regulatory role to play. Now the services that are provided by the clinic mentioned by the honourable member do require the services of individuals who provide service on behalf of Capital Health. To the best of our knowledge, we are not involved in the situation where resources are being taken away from Capital Health in order to provide services in that facility.

When it comes to the issue of queue jumping, one of the things that we need to do, and the department has been working on this, is to develop a legislative capacity to be able to effectively monitor, regulate and control circumstances such as a clinic like this one or others that may exist now or may exist in the future. The department's target with respect to that legislation was to have it ready to bring forward in Spring 2006. I have requested that they try to revise their objective to Fall 2005 with respect to that legislation.

I'm not committing to that date because I don't want to put us in a circumstance where we are not doing the level of consultation once we provide a document or set of guidelines, that we are not hastening the consultation process in such a way that it is compromised. My target is the Fall. I may miss that target because the interest and the reaction to the consultation and our capacity to consult may require us to go a bit longer than that, but certainly we would be looking at Spring 2006 at the latest with respect to bringing that legislation forward. I would very much like to be able to bring it forward in Fall 2005.

What I might wind up doing, of course, in Fall 2005, is tabling something that we could get reaction to across the province and then proceed further in Spring 2006 but that remains to be seen. I can assure the honourable member and other members of the House that from a legislative perspective, it is a priority of the department and something that we need to resolve in a manner that gives us the capacity we need to deal with these situations.

MS. MAUREEN MACDONALD: It's unfortunate that it takes such a long time, I think sometimes, for government to respond to concerns that the public and members of the Opposition express. When the private MRI clinic opened, we were very concerned here in this caucus about the implication and I think probably, rather than ask you how many people in the department are tasked with the job of monitoring and analyzing the impact, I should have asked maybe has anyone in the department been tasked with the responsibility for monitoring or analyzing and I think the answer to that is that that isn't the case. There is nobody who has been tasked with the responsibility. I think that that is unfortunate because now we have a lot of confusion around this additional facility that is about to open and I want to ask you some questions with respect to that facility as well.

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I think we all are aware that the public system has been used, not only for the provision of public insured health services, but also there have been some private, uninsured services provided from time to time in our public facilities. I don't know if the minister had an opportunity to hear a three- or four-part series that was carried on CBC's The Current sometime this winter but they did a series on the use of operating rooms across the country by physicians, surgeons, often for non-insured procedures, primarily in the cosmetic surgery field, plastic surgery field, and that certainly in some provinces, some of the surgeons in certain facilities were raising their objection to the fact that public operating rooms were being used for private provision of health care, uninsured services and that the amount of money that was being charged for the use of the operating room in the private facility was quite minimal. I think I heard $150 an hour in terms of British Columbia where I think some of the concerns that drove this program initiated.

When I listened to the program, I was interested to learn that places like the Dartmouth General Hospital, for example, I believe was cited as a place where there was some provision of private health care, uninsured cosmetic surgery, and no doubt this may be true as well at the QE II. The explanation was being put forward that the surgeries that were being conducted were being conducted at unsociable times, like maybe 2:00 a.m. or 3:00 a.m. or on a weekend when the operating rooms were not scheduled for the public provision of health care services. So I think that there is confusion in the minds of the public about what this new stand-alone cosmetic surgery clinic means in terms of our public system.

So I'm wondering if the minister has been briefed further from on Friday when I wasn't here for the questioning from my colleague in the Liberal Party but I understand was somewhat unaware of this new facility opening in Dartmouth. I'm wondering if you have been briefed now on the cosmetic surgery clinic and if you could provide us with a better explanation for the impetus of the establishment of that clinic, vis-à-vis the use of the public system where I understand many of the surgeons previously had access and probably some limited access for uninsured services?

MR. MACISAAC: Mr. Chairman, I want to thank the honourable member for her question. The facility to which the honourable member refers is intended to provide mostly oral surgery, dental surgery, which is privately operated and privately delivered in this province. I understand that the proponents of the clinic intend to provide opportunities for others to use the facility to provide uninsured elective surgeries in this particular facility. For as much as we know about their intent - and the intent is as I described it - we do not have a concern that it will wind up providing insured services or that people will be charged for insured services while at that clinic. The intent of the proponents is for the service that is provided to be uninsured, elective surgeries beyond the oral dental services that are intended to be provided.

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[4:45 p.m.]

So as I indicated on Friday during a scrum, it may well be that there could be some positive outcomes to this particular facility inasmuch as it might move resources away from the publicly-funded system to this system for non-insured elective procedures. However, it does raise the issue, and the honourable member referenced it earlier, of the need for vigilance with respect to how resources are deployed and to ensure that the resources are not a drain on the resources provided through the publicly-funded system. So we are very much aware of that.

I do want to correct an impression created by the honourable member that no one is responsible. There is a chain of responsibility within the Department of Health and that does create the responsible channels with respect to how matters of this nature are dealt with and are answered within the department, so everyone knows what their responsibilities are.

MS. MAUREEN MACDONALD: I want to ask the minister about the work on wait times. Wait times are something that are of, I think, primary concern to Nova Scotians. It's the number one health issue that I often hear about, wait times for diagnostics and wait times for treatment. It seems to me that we have been waiting a long time for the implementation of the Wait Time Monitoring Project Steering Committee. The Wait Time Monitoring Project Steering Committee, as the minister would know, issued a report back in January 2004 and one of the recommendations of that report was to set up a Wait Time Monitoring Project advisory group, and I believe that only happened in March. I've looked on the government Web site and I did notice that this has occurred, or maybe I noticed it has occurred because I read the Department of Health's Business Plan, but I don't remember any public announcement that this committee had been put in place. So I have a number of questions with respect to this.

It has taken more than a year to put in place an advisory committee, coming out of the Wait Time Monitoring Project Steering Committee report, which seems to me to be an extremely long period of time. I understand that this committee now is being chaired by Mr. George Cooper, a former Member of Parliament and a practising lawyer here in Nova Scotia. I'm wondering, who else is on that committee and how soon will we see the plans to actually implement many of the recommendations in a report that is now more than a year old?

MR. MACISAAC: Mr. Chairman, the honourable member indeed is correct that the committee is operating under the chairmanship of Mr. George Cooper. It includes physicians and administrators from the district health authorities, from the Department of Health and members of the general public. They did get underway in March. I can say that a great deal of work was done leading up to the formation of the committee itself and they are, so to speak, almost hitting the ground with wheels turning full tilt in terms of the amount of information that they require to be able to begin their work so that they will be able to take a great deal of this material and start doing some work right away. We have employed a Web

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master to develop the Web site for us so that this can be up and running and make information available to Nova Scotians. The report identified the process for standardizing collections of data and much has been accomplished. So, as I indicated, they will be able to work.

What's important is that the data be data that is clearly understood by all who are involved in the issue of wait times, from the patient to the family physician, to the specialist, to the district health authorities and the Department of Health that when we view a number related to a wait time, that we all have the same understanding of what that number means and, given our commitment under the terms of the First Ministers Agreement in September 2004, we would also want to ensure that the federal government would have a clear understanding of what is meant by all of this.

So the data is available in a number of surgical and diagnostic procedures as well as the time for referral from GPs to the number of specialists. Those are all areas that are priorities with respect to the committee. I believe that while the honourable member does point to the fact that perhaps a longer period of time than she thought has elapsed with respect to the launch of the committee, that the launch of the committee will coincide with a collection of data that will allow the committee to really go full speed ahead in terms of its responsibilities and I look forward to the development of the Web site and beginning the process of sharing all of this information with Nova Scotians.

MS. MAUREEN MACDONALD: Well, perhaps we can take this opportunity for the minister to expand a little more about what precisely will be on the Web site. I find that the January 2004 report is really quite good for a layperson like myself to read, to try to understand what the complexity is and how to get a handle on really addressing wait times. I know we have talked here before about how you define a period of wait. Is it from the time that you first fall sick and then you get to see your GP or you get the referral to the CAT scan or the MRI or you get to see the specialist? When do you start the clock ticking for what the wait time is?

One of the really excellent things about this report is it looks at the various areas, not all of the areas that people are in our health care system for but it certainly looks at some of the priority areas where waits have been a concern and it recommends what the wait time should actually be; if it is the time from which you are referred, for example, for diagnostic testing, from the time that the referral is made until you actually have the test, which seems like quite a sensible measurement for a wait time. And that isn't going to be the same measurement for actually having surgery, there will be another kind of definition that will define what an appropriate wait time is.

I know that all of the information that I read and what I'm told by people who work in the system and pay a lot of attention to this is that we have to manage our wait lists better; not just do we have to have a common definition, but we also have to have a system in place

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that will allow us to manage those wait lists better. Over and over again, various bodies like CIHI and other groups recommend that we have centralized waiting lists.

I'm wondering what the relationship is between setting up a Web site that people will have access to - the average Nova Scotian can go on-line and find out what the wait is for whatever - and getting on with organizing a centralized wait list that will actually contribute to much more efficient access to people getting care. It's one thing to have information about how long waits are, I'm not sure that that is enough for people who are waiting. What they really need is the service and they need it in a timely fashion. What we really need is to get on with doing what all of the evidence and information tells us needs to be done, which is centralized wait lists.

MR. MACISAAC: I thank the honourable member for raising the question. Indeed, she raises some very good questions that need to be addressed and we are addressing them. The fact that she points out the need for there to be a standard that is clearly understood by all, that is our objective, so when we speak of wait time we know the beginning point and the end point, and that is something that all agree to and all understand. We are in the process of gathering that information.

The information that we would provide on the Web site would be information that would be based on the province-wide statistical availability. I believe what the honourable member is referencing, that it be centralized, the information will be available to all and it will be gathered from various sources. For instance, if we would consider the provision of orthopaedic services in the province and we were to provide information there, then there are four sites where orthopaedic surgeries are provided in Nova Scotia.

The Web site would be able to tell physicians and patients what the wait times are at each of those locations. The general practitioners, in consultation with their patients, would be able to make suggestions to them as to what their alternatives are, relative to wait time. Some people may still decide to wait a longer period of time to go to the doctor they want to go to, well, that may happen. Others may decide, if I can go to this location and have it done quicker, then that is where I would like to go. There is power in the information and the power will rest with the patients, ultimately, in the sense that they should know and should be able to request their preferences based on the information available to them. I don't know if that answers the member's question or not, but that's certainly our intent.

MS. MAUREEN MACDONALD: How many people in the department have been tasked with the responsibility for developing and implementing the wait list strategy?

MR. MACISAAC: Again, to get into numbers is a very difficult thing because there are a large number of people within various parts of the department and within district health authorities who would be spending some of their time on the wait time project and addressing that. So to come up with a number that says there are 32.5 people who are

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committed to this is difficult to provide a precise number. I can tell you that officials from the district health authorities are involved; officials from the Department of Health are involved; we have physicians involved in the process; we have other health care professionals who are involved in this process and have worked very closely with us throughout the period of time that it has been under consideration.

The individual within the department who is working on it on a day to day basis is Brenda Ryan and she has done an extremely good job of this entire project, she's extremely enthused about it, she has the details of the program and is moving it forward very effectively. She also works very closely with Mary McKeen, who is in our Information Technology branch of the department, because they obviously will form an integral part of this service when it is up and running.

[5:00 p.m.]

It is really about getting as much information as we can and ensuring the information is standardized so that it is understood by all, and making that as available as we can to all who are concerned throughout the province. I can tell the honourable member that I don't know the exact number but there are quite a few people involved in the delivery of health care in this province who have been involved in the wait time project.

MS. MAUREEN MACDONALD: I'm sure many people are involved but it's always good to know that there are a few people in the minister's department who are dedicated to overseeing this project, which is, I think, of paramount concern to the people of Nova Scotia and can't be allowed to happen through disorganized good will or something like that, although I'm sure there's a lot of good will out there to try to deal with this. You really need to have somebody who has the ultimate responsibility to make it happen and to see to it.

I did hear the name of one person in the minister's department, who is dedicated to working on this, I believe, and hopefully there would be more people than that. (Interruption) Great.

One of the things that the minister has just said is that these various work groups are tasked with getting as much information as they can. That opens up the question of how are you going about getting the information? One of the things that I read, when I read about dealing with wait times, is in fact getting the various health care providers, particularly physicians and surgeons, to buy in and agree to providing information about their patient loads and their wait times.

Family doctors and surgeons are very busy people. They have a tremendous amount of paperwork as it stands, and they also, in many cases, are lacking in office technology and computerized systems, and they also, in many respects, view their work and the domain in

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which they work in an entrepreneurial way, as if this is their clientele, their information and what have you.

I know that just recently we had a little publication we get as MLAs on a regular basis that comes to us from the Canadian Health Services Research Foundation. The last one that came out, their last series, was what they called their Evidence Boost, Manage waiting lists centrally for better efficiency. In it one of the things they indicate, "Moving to centralized waiting lists . . .", which they promote, " . . . will not be easy. To bring about lasting change, doctors might have to agree to take patients from a central referral service, which would be a huge cultural change, as well as a big administrative task. And no matter how well-managed lists are, or how carefully assessed patients are, in a system where resources are finite, everyone waits for care." I'm wondering how the department is dealing with the issue that is raised here by the Canadian Health Services Research Foundation, based on their work here and across the country, looking at various attempts to better manage wait lists?

MR. MACISAAC: I just wanted to take the time to ensure that what I was going to say to the honourable member, that my deputy had the same understanding that I had with respect to what we're saying on the matter. I think it's important that I provide the information only once and that it will be as accurate as possible. I thank the honourable member for her patience in that regard.

The honourable member in quoting from the document does, indeed, put her finger on a very real challenge with respect to handling the issue of wait times. To date, we have been very fortunate in this province in the level of co-operation we have received from our health care professionals, in particular the GPs and the specialists relative to this entire matter. We recognize that there are some challenges to overcome relative to the provision of this information.

The approach that we will be taking is that the information that will be provided publicly to everybody in the province, will deal with global statistics so to speak. You will be able to look at the facility in the Valley - if we're dealing with orthopaedics - and you'll be able to see what the number is there, relative to the wait time, or you can look at Cape Breton, New Glasgow, or in the Capital District.

The general practitioners on the other hand, through the Doctors Nova Scotia Web site, will be able to look at a list that will tell them the numbers of each specialist that is providing the service. The patient will be able to look at the numbers globally and be able to approach their general practitioner from that perspective, the GP on the other hand will have the specific knowledge. That is an approach that is receiving the level of co-operation that we feel is necessary to allow us to move forward. It avoids some of the challenges that are being experienced in other jurisdictions.

[Page 77]

I would not want to suggest that we are not without some challenges, but the level of co-operation that we feel we are receiving, compared to some other circumstances throughout the country, has been considerable. We believe that through this approach the appropriate information can be provided and that's where we want to begin in terms of our approach to the issue raised by the honourable member.

MS. MAUREEN MACDONALD: I'm wondering if the minister would elaborate on what some of the other challenges are that he's dealing with, that he has referred to generally?

MR. MACISAAC: I raise the doubt that it is appropriate that the honourable member should ask the question. The other challenges I'm referring to - the biggest one always - is getting people to find the time to be able to commit to the process, especially those who are outside the Department of Health. Even those in the district health authorities, perhaps it's a little bit easier for them to find the time but when you get into the providers of health care it's a challenge. It's not that they're unwilling, but they're very busy people and to get them to provide the time is a significant challenge.

Communication, generally, is very important. You do not want to move forward unless you're as clear as you can possibly be that everyone understands the issues that you are moving forward with. If you have to stop to start clearing up misunderstandings, then you can find yourself really delayed by quite some period of time, so we're choosing to invest the time up front to make sure we get the communications right in the first instance, rather than having to go back and recommunicate and get people off a misunderstanding, and get them convinced that their misunderstanding is in fact a misunderstanding, and that the facts of the situation are as we would like to have had them communicated in the first place. So those are the sorts of challenges that we're talking about and as long as we're able to meet those, especially the issue of communications, we feel we can continue to get the level of co-operation that is essential for this to be successful.

MS. MAUREEN MACDONALD: When will the Web site be up? When will GPs, for example, have access to the information you have referred to? I think, more importantly, how long do you anticipate it will be until we start seeing some concrete results, in terms of a reduction of wait times and more efficiency in the system after this occurs? What are you anticipating?

MR. MACISAAC: I can tell the honourable member that the Webmaster has recently been hired and I'm quite certain I am accurate when I say recently been hired, as opposed to being hired in the very near future. I think there is something about the beginning of the month as being an important part of that. I will confirm that and if it is otherwise, I will convey that to the honourable member. If the Webmaster is not at the desk today, then it's going to be in the very, very near future that that desk will be occupied. Once the Webmaster

[Page 78]

is there, we feel that we have garnered sufficient information that we can start posting that information.

I don't know enough about creating Web sites to know just how long the person is going to need, but what I would like to do in the interest of accuracy is to perhaps take it upon myself to provide the honourable member with a more detailed answer to those questions in the near future.

MS. MAUREEN MACDONALD: Thank you. I would like to move off the topic of wait times for a bit and ask about a few of the items in the budget that I expect people will want to know a bit more about.

[5:15 p.m.]

One of the things that I have noticed in the Department of Health budget is that the cochlear implant line item of $500,000 has disappeared. I'm wondering if the minister could tell us where it went because I can't seem to find it anywhere?

MR. MACISAAC: I understand it has been transferred to the Nova Scotia Hearing and Speech line.

MS. MAUREEN MACDONALD: I should have thought to look there, I must say. I want to ask a bit about the department's plans with respect to the allocation, I know monies were allocated, $300,000 to examine the pain clinic problem. As I understand it there is a two to three year wait time for this clinic. I also understand that they had a particularly well-respected member of that staff leave the province not so long ago. I'm wondering how the department anticipates that this amount of money will be used to deal with the two to three year wait for that particular service?

MR. MACISAAC: I can tell the honourable member that this allocation of funding is really a step in the process, it is not intended that this will, in any way, fully address the wait time. For us to effectively address the wait time, we felt it was necessary to do appropriate planning around that. Some of the $300,000 referenced in the budget is to allow that planning to take place, but we're also hopeful that a good portion of it will go to providing service to clients directly. We anticipate with the completion of planning, this is a number that would be enhanced in the future so that we can effectively address that wait time. It is one I can tell you from a personal perspective that I take considerable interest in and want to see that wait time brought down to a reasonable period of time. Certainly, individuals who are suffering pain for long periods of time - having suffered some for short periods of time I can only imagine what it is like when no relief is in sight.

[Page 79]

MS. MAUREEN MACDONALD: I think from the perspective of representing a constituency where you hear from people all of the time, this is certainly one of the areas where you hear some horrendous stories of people who are living with just inordinate amounts of debilitating pain that really renders them immobile, unable to get out of the house, unable to go to work, unable to look after their children, unable to really have any quality of life. I think it's truly shocking to know that there is this kind of wait for a clinic that could provide relief. I would look at this amount of money as being just a very cursory drop in the bucket to what probably is required.

Having said that, I accept that it's important that the problem needs to be addressed, needs to be understood. I would think that in that mix it was very disturbing to learn that a well-respected member of the staff from that clinic was lost and I think we really can't afford to lose qualified and skilled people out of the province for whatever reason, I really have no idea what the issues were around that. All I do know is that the wait lists are unacceptably long for that particular centre.

I want to ask the minister about another group who are waiting, this time for a different kind of relief, and that is the people with Fabry's disease here in Nova Scotia. I think the minister would be very aware of the group of people I refer to because I'm sure you get the same phone calls and letters that I do from people who suffer from Fabry's disease, who have found this new drug therapy that has made a tremendous amount of difference in their lives. While I recognize the enormous financial cost of this medication, I think it really does speak to the need for a catastrophic drug program and in the interim, some kind of response that would make sure those people don't lose this therapy which has made such a difference in their quality of life.

I think somebody wrote me an e-mail on this the other day and they said, if there was ever a reason for a public health care system it was to provide health care for people who had absolutely no ability to be able to absorb the cost personally, and if there is ever a case in point, then certainly this would seem to fit that characterization of why we have public health care. I'm wondering, why is it that we haven't heard any movement on this in Nova Scotia and when can those families expect to hear what they hoped to hear in that their drug therapy will not be lost to them?

MR. MACISAAC: The issue raised by the honourable member is indeed an issue that, as she indicated, points to the need for us to have in place an approach - and we believe it needs to be a national approach - with respect to the issue of orphan drugs and orphan diseases. Typically, those are diseases which are very rare and diseases which require considerable expense in terms of treatment.

I have not only heard from people with the disease through letters, I have had the opportunity of meeting with them and listening to their descriptions of the disease and the impact that it has on their bodies, it's an extremely difficult situation for them. I find it very

[Page 80]

difficult in any way to have the capacity to understand what they're going through because the disease is very devastating in what it does to their lives and their bodies. How it attacks their bodies is something that is truly regrettable. In this country we need to find a more comprehensive approach than is currently the case.

The situation, as it is now, is one where treatments of this nature are referred to the Common Drug Review Agency in Canada, established by the provinces and territories to evaluate treatments that are brought forward. That evaluation has indicated, from a scientific perspective, that there is no impact on the affected organs, i.e. the heart, lungs and kidneys,

and from a scientific perspective there is no change with respect to the functioning of those organs which are affected by the disease. That is not to say that the methods could not be improved relative to the assessment process, and there is another step that is referenced by the companies that produce this. Certainly, if it goes to another level and there is another reference and it is deemed that there is a positive result, meaning a good result for the effects of the drugs on the disease, then I know that all jurisdictions in the country would be looking at the situation again.

What we have done as provincial and territorial ministers, there are really two initiatives that we've developed. One is that we have written to the federal minister requesting that Health Canada become involved in a process with the provinces and the territories to develop a common approach with respect to a strategy that would deal with orphan drugs to treat orphan diseases. That would require the involvement of the Government of Canada.

We invited the federal minister to become involved with us, with the view to being able to address a common strategy at the federal-provincial-territorial ministers' meetings that are held in September, annually. We had hoped that the federal minister would have been at our meeting in Toronto about three weeks ago. The federal minister was not there, unfortunately. I did have a telephone conversation with him and he assured me that the officials of his department would be working with the provincial and territorial officials with respect to formulating an initiative that could be brought forward to the federal-provincial-territorial meeting in September, with respect to the development of a national strategy.

In addition to that, we, as provincial-territorial ministers, recognize that while the Common Drug Review Strategy is what we have to evaluate these drugs, that there may well be some room for improving that particular process, particularly as it relates to the numbers of individuals who are available for a test of these pharmaceuticals. We are currently developing, through the provincial-territorial ministers, a further approach to the Government of Canada and the pharmaceutical companies involved. I hope to have details of that approach worked out that I can share publicly in the very near future. Until such time as it is all worked out, I don't want to get into talking about what it's going to look like, until such time as it is brought forward.

[Page 81]

I can assure the honourable member and everybody, it took a considerable amount of time at the recent provincial-territorial ministers' meetings and we believe that the whole approach to how these drugs are assessed needs to be looked at and that needs to be dealt with through a national strategy.

MADAM CHAIRMAN: The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Thank you, Madam Chairman. I guess before I start just a few comments. I probably may have to go back and review Hansard to clarify some of the stuff that I've heard so far this afternoon, not just from the minister but from my good friends in the NDP as well.

I am glad that they have now finally realized that wait times are an important issue in health care, which is something we've realized for some time now. It has been quite a while since we initiated our round table on health care wait times, then did a report, and dealt with some of the issues concerning wait times. Along with that revelation this afternoon - I don't know if the minister is telling us or if they have actually bought this from the minister - that actually putting the length of wait times and where they exist on a Web site is going to cure the issue of wait times in Nova Scotia, that's totally unbelievable.

I'm the first person in the world to argue in favour of communication and letting people know, but simply by posting how long wait times are going to be and where they exist on a Web site for everyone to visit does absolutely nothing to even put a dent in the problem or try to solve the problem of wait times. As my colleague from the NDP did state, there is even a problem identifying exactly what wait times are in this province, and a committee that is struggling with that issue as well.

I also have to point out - and this I will really have to check Hansard for - is I find it rather unbelievable and actually flabbergasting and I turned somewhat weak in the knees when I did hear my good friends in the NDP say that they don't have a problem with private clinics in this province and that indeed they agreed with the minister that there shouldn't be a problem in that area. I did say that . . .

MS. MAUREEN MACDONALD: Madam Chairman, on a point of order. The honourable member knows full well that there was no statement made that the NDP has no problem with private health care clinics. I would challenge him to find in Hansard where that statement was made by me, or any other member of this caucus.

[5:30 p.m.]

MADAM CHAIRMAN: Thank you. It is not a point of order but it is a disagreement between two members.

[Page 82]

MR. DAVID WILSON (Glace Bay): As I said initially in my comments, I'm going to check Hansard just to make sure that my hearing is correct. To think that private clinics are going to start springing up in Nova Scotia and they won't cause a drain on our already depleted human resources that we have in the public health care system, is totally unbelievable.

In a rather pertinent question from my colleague from the NDP regarding Fabry's disease, the minister went on for quite some time just in the last 15 minutes or so, and I will check Hansard as well because I don't think the minister actually gave the people who are suffering from that disease right now an answer. You can blame it on the federal government but I think one of the questions - and I'll ask it again later on during my time here - was what is being done about the problem, what's going to be done to help these people suffering from this disease. I think the minister talked circles and circles around that question and I'd like to go back to that sometime in the not too distant future.

Let me begin with stating that this government has signed a couple of health accords with the federal government, one which provided $30 million for medical equipment and the second accord, which was signed in 2003-04, that provided another $45 million for the equipment. So one for $30 million and one for $45 million, is that correct, Mr. Minister? Are those the two accords that were signed and was that how much they were worth?

MR. MACISAAC: The first agreement provided $45 million and that was $15 million per year, over a period of three years. Subsequent to that, there was an additional $15 million provided as a result of the last agreement.

MR. DAVID WILSON (Glace Bay): Let me ask the minister, Madam Chairman, if he could turn his attention to Page 11.23 of the Supplementary Detail. Out of the $15 million that was provided, from what I can see indicated here anyway, only $4.8 million was actually spent in 2003-04. Could the minister tell us, where did the remaining approximately $10.2 million go, and where, exactly, is it?

MR. MACISAAC: Madam Chairman, the remainder of the money is in a trust fund. That's the method that's employed for the expenditure of these funds. They are transferred to the province, and the province puts them in a trust fund that is created, and then draws upon that trust fund. The remaining money to which the honourable member refers will be allocated in the course of the coming year.

MR. DAVID WILSON (Glace Bay): Let me ask the minister then, if that's correct, the $10.2 million did go into a separate bank account, is that bank account now collecting interest on the money that's in there?

[Page 83]

MR. MACISAAC: Madam Chairman, the money that is received is put in a separate fund, it's referenced as a trust fund, and that is set up in such a way that it accumulates interest as long as it is in there.

MR. DAVID WILSON (Glace Bay): Madam Chairman, let me ask the minister then, why isn't that money spent? Why not spend the money instead of having it in that trust account?

MR. MACISAAC: We work with the district health authorities to establish their priorities with respect to the expenditure of this money on the funds. We're currently, for instance, involved in discussions with Capital Health relative to the expenditure of funds there. Although we're moving very close to it, we have not reached a final agreement with respect to what they believe is the best expenditure of those funds. I can assure the honourable member, the amount of money that's available in the funds is not the amount of money that we would like to have to meet all of the requirements of the district health authorities.

MR. DAVID WILSON (Glace Bay): I can understand that, Mr. Minister, but, again, on Page 11.23, for the 2004-05 year, it appears that the government has not spent its full $15 million. So, why not?

MR. MACISAAC: Madam Chairman, sometimes there is a gap between the decision to spend money and the time in which the money would actually flow. For instance, the MRIs that were announced, it is our intent to spend the money for the purchase of those MRIs. However, the scoping work needs to be done with respect to the district health authorities' desire relative to the actual MRI that they would prefer to have. There is work being done by the department to see whether or not there are ways in which we could make those purchases to save the greatest amount of money relative to the purchases.

There is a gap in time between the decision to spend money and when the money will actually flow. That is why the money was given to us in the form of trust accounts, because that recognition existed on the part of the federal government, that the flexibility was needed by the Departments of Health right across the country to be able to have the flexibility they need to flow the money in an appropriate manner. If we had to do it all in a given fiscal year, then some of the decision making processes that are required relative to such significant purchases may be rushed inappropriately and the best decisions may not be taken.

I can assure the honourable member that every cent of the money provided to us by the Government of Canada will be spent on the purchase of medical equipment for the people of this province.

[Page 84]

MR. DAVID WILSON (Glace Bay): Madam Chairman, I guess I'll accept, in part, that answer anyway. What I'm wondering is that if you have the money, what are you waiting for? Obviously the need exists out there. This is meant for medical equipment. If you take a look at it, of the $75 million that has been allocated from the federal government to the provincial government for medical equipment, in estimates, since 1999, will show you that only $35 million has been spent, of that $75 million.

Let me ask the minister, the other $40 million that's there, can you give us some indication of what's taking so long? What are you waiting for? Why haven't you spent that money, because we know that it's needed? As well, another question, can you give us some indication as to a dollar amount that was requested, for instance, last year by the district health authorities, and how much they're looking for in medical equipment?

MR. MACISAAC: Madam Chairman, the amount that was committed in 2003-04 is $14,957,538. The amount committed in 2004-05 is $15.795 million. We have, in 2005-06, $14.6 million. But, a very significant portion of that $14.6 million is in fact committed. The decision has been taken to spend the money. But if a district health authority needs to do a renovation such as they had to do in the Cape Breton Regional Hospital, for instance, to accommodate their MRI, then it takes time to get that renovation done. You can't begin the renovation prior to the commitment of the money.

So, I'll point out to the honourable member again that between the decision to commit the money and the opportunity for the money to flow; very often a lot of work has to be done in order for that to happen, and whether it be a renovation or whether it relates to doing the necessary research to identify the best equipment to meet the needs of the district health authority or whatever the case may be, due diligence is required relative to that.

In expenditures of this nature, it is not unnatural for the process to take longer than a single fiscal year, therefore, we will always be in a situation where there is committed money, which remains unspent but nevertheless will be spent when the time comes to make the purchase of the equipment in question.

MR. DAVID WILSON (Glace Bay): Madam Chairman, I'll accept the minister's word for now, that every single dollar that has been allocated by the federal government will be spent purchasing medical equipment in Nova Scotia, every dollar. What happens to the interest on the money that's now in trust? Is that also spent for purchasing medical equipment?

MR. MACISAAC: Again I will repeat, every single penny that we receive from the federal government goes to the purchase of medical equipment for the people of the Province of Nova Scotia, including all interest that is earned through that money while it is in deposit.

[Page 85]

[5:45 p.m.]

MR. DAVID WILSON (Glace Bay): Madam Chairman, also, there was a question - the minister may have missed it when I asked it because it was on the end of my last question concerning the money - could you give us an indication, and as close of an estimate as you could, of the dollar amount that's requested by district health authorities for medical equipment?

MR. MACISAAC: It's a huge number. However, if you start to boil it down in terms of what is essential from one period to the next, we hope that in the short term we are meeting the essential needs, and in the long term there is a significant gap relative to the funds that are available for the purchase of capital equipment and the province's capacity to be able to meet those purchases. That is why we have, on every occasion that presents itself, commended the Government of Canada for their program of capital equipment purchases, because it is something that all provinces are going to have a continuing need for as we move forward. I know from my discussions with my provincial and territorial colleagues that the demand that is out there in this province is not different from the demand that exists in other provinces.

I'm sure that if the federal government were to provide us with an additional, we'll say, $60 million over the period of the next three or four years, we would indeed find a very good place for that money. At any rate, Madam Chairman, we are, in the short term, meeting needs, and in the longer term, we have a gap. As I said, in the course of the next three years, if we were to get an additional $60 million, we would find places for that very easily. So it is a challenge, it's a national challenge that we face.

MR. DAVID WILSON (Glace Bay): Mr. Minister, I understand that, but I didn't hear a figure there. If you could, could you possibly put a figure on it? Just an estimate of how much we're looking at. District health authorities must put in requests for medical equipment, each DHA. We know we have problems in terms of how late it is getting business plans approved for district health authorities, from the government. But what I'm looking for here is a dollar amount that's requested, at least last year's, the requests last year by district health authorities for medical equipment, the dollar amount, please.

MR. MACISAAC: Madam Chairman, on an annual basis, we ask the district health authorities to submit their top three priorities to us. If you were to examine the top three priorities presented by the district health authorities, then the number is in the vicinity of $120 million.

MR. DAVID WILSON (Glace Bay): Let me ask the minister, each district health authority would submit three top priorities, could you give me the process in place to determine what of those three are selected, how many are selected, and is it always that the top priority gets the funding? What comes into play there, Mr. Minister?

[Page 86]

MR. MACISAAC: There is a rather detailed process that is followed by the Department of Health in consultation with the district health authorities. One of the principal criterion, for instance, that is applied is related to safety, in terms of the health care workers and the patients, another is related to how the equipment that is being requested will fit with a broader regional need that might exist, in terms of what is required, so that we're not providing equipment that might not be fully utilized in one area but if provided in others it would be.

For the most part and most of the time, we are able to address the top priorities of the district health authorities. But, again, it's not simply a matter of them submitting a list and we say yes or no to it. We do sit down and go through a very thorough consultative process before the final decisions are made.

MR. DAVID WILSON (Glace Bay): Madam Chairman, just to end on this topic, for instance if the Cape Breton District Health Authority submitted three top priorities and the Capital District Health Authority submitted three top priorities, it's not necessarily the case that any one or all of those three priorities would be selected for funding by your department, is that true? Could there be other priorities that the department sees as being higher on the list and would be funded, not necessarily those recommended by the district health authority?

MR. MACISAAC: As I indicated previously, for the most part we are able to meet the priorities of the district health authorities when they are submitted. Sometimes we will look for sort of a theme, if you like, in terms of what the district health authorities are placing an emphasis upon across the province. If we see that there is a commonality to that, then sometimes it is appropriate to look at a decision that favours a number of districts at the same time.

As I indicated, for the most part we are able to meet their priorities. In situations where we may not be able to clearly meet their priorities, a decision to do otherwise would be taken only after there was thorough and complete consultation with the district health authority.

MR. DAVID WILSON (Glace Bay): Madam Chairman, let me shift my focus here for a moment to a matter that the minister referred to in some previous remarks, about wait times, saying just how important communication is. I think you made that reference anyway, the communications and posting of information on Web sites and making sure that the general public knows what's going on. Back in the 1999 election campaign, if you recall, and if not then let me remind you, the Leader of the Third Party at the time, Dr. John Hamm stated that we needed fewer spin doctors and more doctors in Nova Scotia.

[Page 87]

Madam Chairman, since this government came to power in 1999, the communications budget for the department has increased by over 90 per cent - a 90 per cent increase since 1999. It's now budgeted at just a little over $799,000. Can I ask the minister, then, back in 1999, how many communications officers were in the department at that time?

MR. MACISAAC: In the interest of accuracy, I would take that question on notice and get the precise number for the honourable member. I don't have it - at the time I consulted with the former Minister of Health, he suggested a number but he wasn't entirely sure of its accuracy. I think in the interest of providing the committee with the best detail we can, I will take that as notice and get back to the honourable member.

MR. DAVID WILSON (Glace Bay): Madam Chairman, it might be wise for the minister to consult with the former Minister of Health. He may very well have been the one who started the ball rolling on increasing the department's budget by over 90 per cent. I would also like to know, and you may not have those figures with you today either, just how many communications officers there are in the department today. The communications budget is increasing by $176,900 and I would like to know from the minister, why the increase? He has promised that he is going to tell me how many more communications officers there are now compared to back in 1999 but he must have some sort of a plan or someone somewhere must have some sort of a plan, just what they intend to do with that increase and for what purpose. What would be the reason for taking a 90 per cent increase in a communications budget? Is there a plan in place and if the minister perhaps could fill us in on the details, what that's going to be used for, that additional money?

MR. MACISAAC: Madam Chairman, I understand there are now seven communications officers in the Department of Health and I will get the number for 1999. One of the challenges in a department that is as huge as the Department of Health, we have somewhere in the vicinity of I believe 38,000 people who derive their income from this department just as one indication of the amount of resources that are required to keep this department going. There are large numbers of issues that arise every single day within the department and I can assure the honourable member that in order to be able to try to respond effectively to those issues that it is necessary to have communications resources to be able to assemble the facts of the situation, the background of the situation, and to assist in ensuring that the information we provide to Nova Scotians is the best information we can possibly provide to them.

In terms of our planning, we have developed something that did not exist previously in the Department of Health and that is the plan. The plan is entitled Your Health Matters and a very important part of that plan is to be able to communicate its contents to Nova Scotians and also to be able to provide answers to Nova Scotians relative to the issues that are in the plan. So I can say to the honourable member that we are challenged within the department with respect to being able to respond to issues that come forward on a daily basis and there are indeed many issues that come forward on a daily basis but also it is necessary for us to

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try to ensure that Nova Scotians have the very best information available relative to the workings of the department and the issues that are being addressed by the department as we conduct our business on a day-to-day basis.

[6:00 p.m.]

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I understand what the minister is saying about needing communications people but I find it a little hard to believe that the Department of Health and the various programs that are under it, which are scrutinizing every dollar, I would hope, that is spent in their department, and asking Nova Scotians to understand things such as wait lists and asking Nova Scotians to understand that from time to time we have to close emergency rooms, from time to time there will be doctor shortages, from time to time there will be nurse shortages, there will be technician shortages, but how do you understand a 90 per cent increase since 1999 in a department? It wasn't me who made the statement, I didn't make the statement that we need more doctors than spin doctors.

As a matter of fact, spin doctors is a rather derogatory term, you know, for people who work in public relations. I didn't say that statement. It was a guy who was running for Premier in 1999 who made that very statement. So how can you justify in a department that you are looking at possibilities of whatever has to be done to try to save important health care dollars that flow into this province and that come from this province, how can you possibly justify an increase of over 90 per cent? What are you going to do when you increase another $77,000? Just how many communications officers does it take to try to put a positive spin on the fact that the health care system is in trouble in Nova Scotia, Mr. Minister?

MR. MACISAAC: Mr. Chairman, I want to welcome you to the Chair. In terms of the increase, the variance between the estimate of 2004-05 and 2005-06, we have a transfer of a Program Administrative Officer II position from the IT services and that relates to the increasing role of information technology in health care and again relates to the importance of everyone involved in the delivery of health care having appropriate information available to them. There is the professional services due to three additional communications officers positions and one of those is the Senior Citizens' Secretariat communications officer who was employed between the Department of Health and the Senior Citizens' Secretariat. There is also a wage increase of 2.9 per cent in that figure and pay for performance as well as other natural increases that would occur. Those are the main items that constitute the increase with respect to this year and I can assure the members of the committee that this department is probably one of the hardest working divisions in Health, and part of the reason they are taxed to the extent that they are is that there is a growing demand for information on the part of citizens with respect to the provision of health care.

Health care in the period of the past five to six years has become a national priority like it has never been before. That has piqued the level of interest on the part of all citizens with respect to the provision of health care in a manner that we have not previously seen. So

[Page 89]

as a result of that, you need to be able to respond with the provision of information and provide citizens with the best information you can. You also need to be prepared to provide the kind of technical background related to some of the complicated issues surrounding health. I could just point to one recent experience we had with CJD disease, one where it was extremely important that Nova Scotians understood the issue at hand, understood the fact that everything that should be done was being done with respect to the control of that situation and that the confidence of Nova Scotians be maintained throughout with respect to our health care system. So the challenge of communications is very significant and it does relate to the fact that health care has become the number one issue right across the country and it's as high here as it is in any other part of the country and when there is that level of concern, it is appropriate to have the resources to be able to respond to citizens with the information they require.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, let me change the subject here, if I could, please, and let me state to the minister - as I'm sure he does as an MLA, as a Cabinet Minister, probably on a daily basis, I know we do anyway, or I do - we hear daily how the program of home care seems to be failing to meet the needs of residents in this province, whether it be for disabled people in a self-managed care program or a lack of home support services that result in clients having to be readmitted to hospitals and we have heard of inconsistency in guidelines for home care. Since 2001-02, the home care budget in this province has been underspent by over $15 million. In fact, since the government has come to power in 1999, we have only seen an increase of about 33 per cent in estimate expenditures and the actual expenditures since 1999 have only increased by 23.6 per cent. So let me ask the minister a very simple question. Mr. Minister, why is that?

MR. MACISAAC: Mr. Chairman, I thank the honourable member for that question. The honourable member correctly puts his finger on a challenge that we have within the Department of Health relative to the provision of home care services. Very much it is related to a human resource issue and finding the appropriate resources to be able to provide this service. It is one where we are placing our departmental resources to addressing. I'm not in any way suggesting that we have rounded the corner completely but we are, I believe, moving in the right direction. It is certainly a priority of the department to be able to enhance our capacity to deliver home care to the people of the province because it is very much in our interest to increase that capacity. The longer that citizens can remain in their homes is obviously to the benefit of the citizen and it is the desired objective that they remain there as long as they possibly can but the added benefit for the health care system in the province is that as long as they are in their homes, then obviously it is much more efficient use of the resources of the province. So it is a win-win, both for the clients and for the health care system itself.

[Page 90]

Our objective is to address the resource issue and, as I indicated, a human resource issue to try to resolve this matter positively and part of the province-wide consultation that is taking place undoubtedly will give us some recommendations relative to addressing this concern as well.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, the minister has indicated previously, or the department has indicated that they will invest $750,000 in increasing the scope of home care services. So I would like to ask the minister, what new services will be provided with that $750,000 and where exactly will they be provided?

MR. MACISAAC: Mr. Chairman, there are really two objectives and they are very similar. As I indicated in my answer to the previous question, our overall objective is to ensure that people spend less time in acute care than in any other facet of our care. If we can increase our capacity to provide acute care services at home, then we have greatly reduced the cost of providing acute care as well as providing the patients with a much greater level of satisfaction in terms of where they are receiving their care. They would far sooner be at home than be in a hospital. In my own area, in Antigonish, we are pioneers with respect to the issue of providing home care and it goes back to the Martha Home Care Program which was developed by the Sisters of St. Martha and has developed and grown and is now an integral part of the Guysborough Antigonish Strait Health Authority, GASHA. Their delivery model is now referred to as Hospital in the Home and that is a program that works extremely well. So we want to see that expanded throughout the province and this additional funding will assist in doing that as well as providing other services in the home.

So, Mr. Chairman, it is a desire on the part of the Department of Health and government to allow our citizens to receive as much care at home as they possibly can, both for the benefit of the patients involved as well as for the benefit of freeing up acute care beds so that those who need acute care services will be able to receive it in a more timely fashion.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I think I will agree with the minister on a couple of points. One, that certainly we expect a better home care program which would better meet the needs of our residents and it would provide, as the minister has indicated, some much needed support for our acute care sector.

We also, Mr. Chairman, hear a great deal - again I do - from individuals who are on a home oxygen program. They are seeking support for portable oxygen. My question to the minister is, is the department considering coverage for portable oxygen and if yes, then when will we see any coverage?

MR. MACISAAC: Mr. Chairman, that is a matter I would appreciate that the honourable member would allow me to take as notice and I will get back to him with hopefully a more detailed response than I can at the moment.

[Page 91]

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I would also like to bring to the minister's attention a letter that I have that is dated February 20^th this year. It was a letter that was sent to the minister by a Ms. Cheryl Gardiner of Glace Bay. She was writing regarding the Lung Transplant Program. She is currently a patient of the Toronto Lung Transplant Program and she was advised to write to the minister as provincial Health Minister in that she is living and waiting for a transplant in Ontario that she will still remain a resident, of course, of Nova Scotia.

This is her letter. She says: Under these circumstances, I am requesting a written statement to ensure that my home province will provide the appropriate medical coverage and other necessary coverage that I will need until I receive the transplant, plus coverage of the transplant and drugs while in hospital. She highlighted a list of drugs that she takes in the letter and also referred to the, it's called a micro spirometer. How am I doing, Deputy Minister, is that the correct term? This is for your perusal as well. If you require any further information to contact Cheryl Gardiner.

[6:15 p.m.]

I'm wondering if you can explain to me, as I understand it, drug costs are covered, living accommodations are not covered, is that the case? What is the difference between what Nova Scotia would offer to a lung transplant patient compared to other provinces, specifically Newfoundland and Labrador? I understand Newfoundland and Labrador does offer somewhat more than what Nova Scotia offers.

MR. MACISAAC: Mr. Chairman, the services that Nova Scotia provides are consistent with the services that are provided by other provinces except Newfoundland and Labrador and the territories, not just the Northwest Territories. Their distance challenges are considerable compared to ours and as a result, they have had in place, for quite some time, assistance for travel within their jurisdictions as well as assistance outside the jurisdiction for services. Again, what we provide in this province is consistent with what is provided in all of the other provinces in Canada.

MR. DAVID WILSON (Glace Bay): There is a little more, I think, offered by the Province of Newfoundland and Labrador, as I understand it because in response to a letter that was sent to you from my colleague, the MLA for Victoria-The Lakes, back in December of last year, you outlined in the letter that currently Newfoundland and Labrador is the only Atlantic Province that has a medical transportation assistance program within the Department of Health and that helps patients who have to travel out of province for services. Does Nova Scotia offer that assistance as well?

MR. MACISAAC: Mr. Chairman, no, we do not provide a similar program.

[Page 92]

MR. DAVID WILSON (Glace Bay): Let me ask the minister then, why wouldn't Nova Scotia offer to cover the medical transportation, at least and why isn't it covered? In some cases, perhaps Community Services would be able to help out in some aspects with some individuals, if they are clients, but if someone is not a client of the Department of Community Services and in this case I know, at least the person that I'm talking about, she has had to take a tremendous loss in terms of her work, and has no assistance to be offered to her. So has it ever been considered? Is this being looked at, that we could be helping people who are having to go to Toronto for lung transplants?

MR. MACISAAC: Mr. Chairman, there are other circumstances in addition to lung transplants where people, from time to time, require services that are not provided within the province. Indeed, it's a huge challenge for individuals who are facing that prospect. I have requested the department to provide me with some analysis of the costs that are involved with respect to addressing some of these situations. That process is not complete. However, I do know from the information that I have received initially that it is a very expensive prospect to consider.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, if I may, I don't mean to put the minister on the spot because he probably wouldn't recall, with all of the correspondence that he would receive in the run of a year, whether or not you have replied to this individual piece of correspondence but if you could check perhaps with your staff and ensure that you have or will reply to the person in question and that indeed at least you are taking a look at it and the possibility something there may exist or may not exist but at least to reply to the person in question here that I have mentioned and I will provide you with a copy of her letter.

Mr. Chairman, if I may inquire, how much time do I have left, please?

MR. CHAIRMAN: Your time goes until actually 6:30 p.m. At 5:28 p.m. you were to begin but the minister continued to speak until 5:30 p.m., so the Liberal caucus time goes until 6:30 p.m.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, let me shift gears here again and turn to the subject of acute care. Since 2000-01, the acute care budget, DHAs overspent by $140 million according to our figures. Let me ask the minister, how many new programs have been introduced in the acute care program with that $140 million?

MR. MACISAAC: Mr. Chairman, I just want to be clear on the nature of the question. I assume the honourable member is referencing the accumulated deficits that occurred early in the formation of the district health authorities. One of the things that we have been able to achieve is we have been able to move the district health authorities much closer to a balanced situation over the period of time so that for the most part they are coming in with balanced budgets. Now that's not to say that every year we don't have challenges in

[Page 93]

terms of working with them to get them to a balanced situation and at times they are not totally successful in achieving that.

We did take some initiatives with respect to value-for-money assessments over the period of the last couple of years. They have proven to be successful in giving both the district health authorities and the Department of Health some insights into the challenges faced by the district health authorities but if we take even the situation we faced last year in terms of addressing wait times or we can even go back two years ago when we were addressing some of the challenges faced by the district health authorities. We found that the rising cost of cancer drugs, for instance, was a real challenge for the district health authorities and it became necessary for us to recognize that and have that money added to the base so that in years following that, by having it added to the base, it would put them in a better position to be able to meet those needs.

So the real challenge for us has been to assist the district health authorities in reducing those deficits and on the other hand for us to be able to respond when we felt it was appropriate to provide them with additional funds.

In terms of the challenges that are faced by the district health authorities that relate to the growing costs that they face, there is tremendous growth in the provision of dialysis services by the district health authorities or by the Capital District that provides services and satellite services around the province and the Cape Breton District Health Authority. The growth in dialysis services is in excess of 10 per cent a year, so that is a real challenge. We have increased cardiac care in the Capital District that has been provided as well as elsewhere. We have put more resources into orthopaedics. We have more work to do there.

There has been additional funding provided for mental health services in the 2003-04 budget and obviously the member would know that we have added more money to that in this year. There is the issue of addiction services. That's a challenge for the district health authorities and the additional methadone clinics in Halifax and Cape Breton. That accounts for some of the increase.

There are two things that have happened over the time frame referenced by the honourable member. One is that we have been successful in working with the district health authorities to significantly decrease the amount of monies that are in their deficit so that they are more and more coming in with balanced budgets, or nearly balanced budgets, and secondly, there have been the services that I have outlined that have been increased.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, the minister is skilled at making the minutes tick away on the clock. Remind me not to throw him another lob ball like that in the future, would you please, which leaves me with a very limited time.

[Page 94]

So I would like to know on probably my last question on assisting low-income Nova Scotia with diabetes, the government has added $2.5 million for a low-income diabetic program and it's a welcome investment that the 2003 election made a commitment, I should remind you, of $3.2 million. As my question, I would like to know why is the budget commitment $700,000 less than what was promised during that election campaign and I would also like to know in the time remaining, when will families be able to apply, how they can apply and what income thresholds will be put in place for that program?

MR. MACISAAC: Mr. Chairman, I apologize to the honourable member that I attempt to put too much detail into my responses. (Interruptions) I will endeavour to be selective in what I leave out in the future but I certainly don't want to err on the side of accuracy or the level of information that is appropriate to provide to the committee.

Having said that, the honourable member does indeed point out a difference in numbers that were committed. I guess you are quoting the blueprint document and what we have in the budget. As a result of the research that we did within the department, right across the country, in looking at other jurisdictions that have implemented such a program, we were told by them that you will not get the level of uptake that you anticipate in the beginning with respect to those programs. That was a consistent theme that we heard from every other jurisdiction that has a similar program in Canada. Based on that, we have a number less than the $3.5 million. I will also say this to the honourable member, that the program we are implementing - that is with 100 per cent take up of the program and unfortunately we will not get 100 per cent take up but we will do our best to move that to as high a number as we possibly can, that the program - when fully funded and implemented, will cost in excess of $8 million per annum. So we have not, in the long term, in any way backed away from our commitment. If anything, we have considerably enhanced that commitment relative to diabetic care for the province.

I'm just being shown figures here. We have a potential of 6,750 eligible residents and if there were a full take up on that, that would be an amount of $9.286 million. So we can see that our commitment is very significant.

We are in the process of putting together, in consultation with the Canadian Diabetes Association, the criteria related to the rollout of this program and we should be in a position to start processing applications in the fall with respect to the delivery of assistance.

MR. CHAIRMAN: The honourable member for Dartmouth North.

[6:30 p.m.]

MR. JERRY PYE: Mr. Chairman, I want to thank the honourable member for Halifax Needham, the NDP Critic for Health for giving me the opportunity to speak for a couple of minutes on a very important issue.

[Page 95]

Mr. Chairman, I want to go back to the issue relating to wait times. I do know that there had been some extensive discussions on this with the honourable member for Halifax Needham as well as the minister in his response. The unfortunate part of it is that in many of our constituencies, the people who call us do not understand why there is a need for wait times in this province. The province is a relatively small province in relation to population. We have a number of regional health centres and many citizens think it is unimaginable that one would have to wait the periods of time in which they need to wait in order to get into surgery.

For example, on Sunday I happened to be in my office simply because it is now budget estimates and because of the time consumed in the Legislature, I tried to make it appropriate that I will be available to the constituents as much as possible. So sometimes that requires one's weekend time. As a result of a Sunday call, I received a call from an individual constituent who was just so appalled about the wait time that this individual had to wait. The individual had been slated for surgery, I believe, the actual date was December 4^th. I don't want to mention names because I don't think it's appropriate to mention names in this Legislature, but I do want you to know that this is one of many that I have received. This individual had, in fact, had a previous surgery with respect to, I don't know if it is possible, but the individual had stated a total stomach removal, repairs to his esophagus, hiatal hernia, a whole bunch of individual operations which, in fact, translated into him spending some time in hospital and some time at home. Infection had set in and there was a need for nursing around this very important surgery that he had received.

There was also a need for the individual, in turn, to go back and to have surgery rather quickly. The individual called his family practitioner, the doctor, and he also called his specialist. What is far more alarming is that his specialist and his family doctor had indicated that he call his MLA. I don't know, Mr. Chairman, to the minister, if in fact the citizens of my constituency think I have a hotline to the minister, that I can directly call the minister up and say look, this individual has been waiting for a long period of time and that this individual should be in there having his surgery, in this particular case a male. So my question is to the minister, I have heard you say that in fact you are setting up a registry of client wait lists. There is a whole new process going through and this takes some time. I guess at the end of the day, when do we finally see something that is going to be tangible so that the citizens of Nova Scotia can finally say that wait time is a thing of the past?

MR. MACISAAC: Mr. Chairman, the one thing I can say with certainty with respect to wait times is that we will always have wait times because regardless of how efficient we become, it's going to be necessary for people to wait in order to receive the services that they need. The real challenge is to get wait times that are appropriate and fit with medical standards and fit with time frames that are appropriate relative to the individuals and the diseases that they are faced with. We've made some real progress in this province with respect to cardiac wait times and we are now at or below the national standard with respect to cardiac wait times. We have made real progress with respect to oncology wait times.

[Page 96]

In most areas we are reasonable. There are some areas, from time to time, where the wait time gets a bit longer than we would like to see it. We have some challenges that we discussed earlier. We have a real challenge in terms of the pain clinic, for instance, and being able to provide appropriate funding to that. I don't believe I had an opportunity in response to a previous question from the honourable member's colleague, the member for Halifax Needham, that while we are providing $300,000 for that clinic this year, it's our estimate that we could significantly address that wait time with respect to the pain clinic with about $1 million. Officials tell me that with that amount of money we could get that pain clinic wait time down to an appropriate level. So the $300,000 that we are providing this year is simply a beginning with respect to that and our objective is to bring that down to a reasonable level.

Our real challenge is in the area of orthopaedic surgery, right across the piece, and there are a number of things that need to be accomplished with respect to meeting that objective. The work of the Wait Times Monitoring Project and the work of the committee will help us better understand the challenges with respect to those wait times but that, in and of itself, is not going to get us to reduce wait times. The question of being able to do that is to first of all ensure that we are doing the level of recruitment that we have to do to have the medical personnel in place to provide the services, whether that be anaesthetists or whether it be surgeons or whether it be nurses that are required to provide the service or whether it be physiotherapy that's needed to provide the service afterward to get people back on their feet following those surgeries. That's all part of the challenge.

We also need to ensure that the beds that are required, the acute care beds that are required to care for citizens following surgery are in place and that's not unrelated to our initiative with respect to home care and ensuring that we are treating people in their homes for as long as possible so that we can move them away from the acute care sector and freeing up those beds or whether it is in the provision of additional long-term care beds. We have referenced the need for those in the budget. We spoke about the additional long-term care beds that have been provided in the Valley and in Capital District. We spoke about convalescent beds that we are going to commit. There is $1.6 million provided to that. The objective there is to move people from the acute care sector into these convalescent beds so that they can, once their acute care is completed, then the restorative care - that's the term we are looking for - the restorative care can take place and then these individuals can be treated appropriately in beds of that nature. It's a whole host of challenges that face us.

Information is a very integral part of that and that is being addressed by the work of the Wait Times Monitoring Project and the Wait Times Committee but they are also going to help us in terms of being specific about our recruitment needs, being specific about where we need additional acute care capacity to be able to meet these needs and to assist us in the whole realm of human resources that are required. I hope, Mr. Chairman, my remarks weren't unnecessarily long. I tried to be as comprehensive as I could.

[Page 97]

MR. CHAIRMAN: There is a new questioner so I'm not sure what his sentiment would be.

MR. PYE: I don't mind your comments with respect to being informative and detailed. The important thing is I want to make sure that I have the appropriate information to go back to my constituents with. However, the most important thing here is, Mr. Chairman, through you to the Minister of Health, that many citizens don't understand the complexity of the bureaucracy and how complex that bureaucracy is when delivering a service to them. They are primarily interested in having made sure that the service is available to them today.

I guess on that same track, Mr. Chairman, through you to the Minister of Health, is that I've heard some discussion around private hospitals and it's something new to me. I must admit that I was somewhat unaware and don't know if this is actually correct or not but I do believe that there are private medical organizations that use public facilities to carry out private medical practices such as maybe cosmetic surgery, plastic surgery and the like, and if, in fact, they use public facilities like the QE II, like the Dartmouth General Hospital or any other hospital within the health service. Is that, in fact, extracting from time which other surgeries would normally fall into place and if it doesn't, can you explain to me why it doesn't and secondly, do you make the revenue off of providing public facilities or charging fees to private specialists for public facilities and is that economically feasible or financially feasible?

MR. MACISAAC: Mr. Chairman, the issue raised by the honourable member is indeed an issue that Nova Scotians would want to understand and I appreciate his question in that regard. First of all, let me make it clear that the topic of discussion in recent days about a so-called private hospital in this province, the facility in question is not a hospital, it doesn't look like a hospital but it does look like an oral surgeon's dental services facility and it does have within it, or is designed to have within it, the capacity to be able to do elective non-insured surgeries. So that is what that facility is about and that's what the intent is with respect to that facility.

Now the honourable member references the fact that many of these services are today conducted in facilities that are publicly funded, i.e. our hospitals within the province. I can assure the honourable member that those surgeries are conducted at a time when the ORs are not booked for normal, everyday operations. Some of them occur late at night or occur on days when doctors are otherwise engaged with respect to meeting the needs of their patients, that is through consultation or in some other way. The administration of the Capital District Health Authority, for instance, does take great care, as with the IWK, to ensure that these elective, non-insured procedures take place at a time that does not interfere with the publicly-funded, insured, elective and emergency services that are required for patients covered under the terms of the Canada Health Act.

[Page 98]

[6:45 p.m.]

MR. PYE: Mr. Chairman, that's all well and good, but those who are out there viewing these proceedings tonight, the Health estimates, would want to know that if there is this time available, and even though there are medical specialists who have other practices and may be practising that out in their offices and so on, is there not the potential to utilize more of the time available in the ORs to speed up the process and/or reduce the wait times?

MR. MACISAAC: Mr. Chairman, the honourable member indeed raises a question that may not be clear in the minds of citizens. The fact is that the times in which these OR facilities are made available for these non-insured, elective procedures are times when the resources required to provide the insured services, whether they be elective or emergency, are not employed or scheduled for those purposes. The resources are not available in terms of scheduling them for those particular services at that time.

So, in order to achieve what the honourable member is suggesting, we would have to have people working around the clock, and that's simply not possible. We are operating in an environment where we are challenged with respect to the number of anaesthetists who are available to us in this province. Our alternative funding program is helping us with respect to that recruitment issue, but it is still a challenge. That has been the subject of discussion in previous days of this session.

MR. PYE: Mr. Chairman, I anticipated the minister's response, however, I had asked earlier, since the private medical practice does not have to provide the facilities, does not have to build their own infrastructure, their own buildings, bring in their own equipment, and the technology that's needed to provide the services to Nova Scotians, all that is in the public facility, are we, as taxpayers, receiving the value of dollars for the usage of the equipment and the facilities, and are Nova Scotians getting a return on the use of those private facilities?

MR. MACISAAC: Mr. Chairman, I apologize to the honourable member. I realize he asked that in the first question, and I answered a number of other questions but it was simply an oversight that I didn't get to that. The district health authorities determine what the charge will be to the medical professionals who are providing the non-insured elective procedures. I can't give you a precise number with respect to how much they charge, but I will undertake to do a survey with the district health authorities to see what they are charging and, indeed, will take a good look at that to satisfy ourselves that it is an appropriate amount in each and every circumstance.

MR. PYE: Mr. Chairman, also to the honourable minister, will he make sure that it's a fair charge in relation to charges across the country? I do know that you had mentioned, and the honourable member for Glace Bay had mentioned, with respect to portable oxygen and the Department of Health supplying oxygen supplies to those Nova Scotians who are unable to afford it, and the minister did indicate that he would get back to the honourable member

[Page 99]

for Glace Bay as to where the department is with respect to this issue. I hope that I can take it that the minister will get back to all members of the Legislature with respect to this issue.

MR. MACISAAC: Mr. Chairman, when we provide information such as the undertaking to the honourable member for Glace Bay, our procedure is to provide the information, supply the member with that information but also to file it with the Clerk. The intent of filing it with the Clerk is to make sure that it is available to all members of the House. So the answer to his question is yes, we will undertake to make sure the information is shared with all honourable members of the House. That is the procedure that we will use.

I want to go back to a previous question. I may not have made it clear with respect to the answer, when the district health authorities charge for the use of their facilities, it's not just for the use of the facilities but all staff who are employed are not paid by public funds. They're paid for by the clinics that are providing this non-insured, elective service to individuals. So all staff, all supplies and the time charged for the use of the facility are all charged out to the people who are providing that service. They, of course, collect it from the individuals who are paying for the service.

Now, the amount of money that's provided to the professionals is a standard fee, and it's set and everything else. What's appropriate for us to find out is whether we feel the amount being charged for the use of the facilities is an appropriate amount.

MR. PYE: Mr. Chairman, I want to move on to self-managed attendant care. I do want to say that for a number of years I've stood in this Legislature and asked questions of the Ministers of Health with respect to expanding on the project of self-managed attendant care. I do want to say that honourable members from the Third Party have also brought this issue forward, and in a more vigorous manner most recently. I want to say that I'm pleased to see that there's some, I believe, $0.5 million that's allocated to the self-managed attendant care program. My question to the minister is, how did you arrive at the number of $500,000? Secondly, how many individuals who are in need of self-managed attendant care are going to be the recipients of these dollars that will now be meted out?

MR. MACISAAC: Mr. Chairman, the number that we have used is very much a number that's intended to get us started in terms of providing this service in this fiscal year. We recognize that self-managed or self-directed home care will be an integral part of the home care service that will be provided to individuals within Nova Scotia. The other thing that is happening in this province is the province-wide consultation that is taking place with respect to the entire issue of continuing care. That is looking at the models of home care that are available or could be available, it is looking at the potential demand for that type of home care, relative to each of the models that might be considered. It is looking at the issue of what is the appropriate number of beds for long-term care in each area of the province.

[Page 100]

Now, in the interim, we recognize, with respect to the issue of long-term care beds, that by providing an additional 100 beds in Cape Breton and an additional 125 to 150 beds in the metro area that we are not meeting the demand fully by doing that, but we are making a start. In the same way, by providing the $500,000 with respect to the self-managed attendant home care, we will not meet the full demand relative to the provision of that service, but it will start us in that direction and we'll be guided by the results of the consultation that is taking place to assist us in where we should move in the future relative to the funding levels and to the variety of home care and type of home care that we should be providing.

I view it, very much, as an interim step with respect to a longer objective and a bigger objective relative to the whole question of home care, whether it be the traditional home care or whether it be self-directed home care or some other model of home care.

MR. PYE: Mr. Chairman, I guess my question is, I didn't get, clearly, how you arrived at the number of $500,000. I guess it's a step and I guess this was the initial step to start the self-managed attendant care program beyond the pilot project of 10. My other question is, will this come out of the consultation across the province or do we already know how many Nova Scotians would benefit from a self-managed attendant care program?

MR. MACISAAC: Mr. Chairman, as I indicated earlier, one of the pieces of information that we hope to get from the province-wide consultation is a more accurate number with respect to the number of Nova Scotians who can benefit from a self-directed home care program. That is what we want to get. Now, the number that we have put in the budget, as I indicated, is an interim number. We are guided, in terms of that number, by the information we receive from the independent living resource centre, which has experience with that. They estimate that it's approximately $30,800 per annum per individual, and that's an average because some require more and some require less.

We're obviously going to start meeting some of that demand. I'm not pretending in the least that we're going to fully meet it, but we will be on the way to doing that. It is a transition, in terms of going from the pilot to the full-fledged program, that is involved. I'm reminded by my deputy, Mr. Chairman, that one of the things we need to do with respect to the consultation process is to do an analysis of individuals who are in long-term care facilities to see whether the long-term care facility is indeed the most appropriate setting for those individuals or whether they might be more appropriately cared for at home through a form of self-directed home care.

That's some of the information and the type of information that we want to get as a result of this consultation. It is very much a work in progress, and I hope that at this time next year we'll have far better details in terms of the number of clients who need the service and our capacity to be able to meet that particular demand.

[Page 101]

MR. PYE: Mr. Chairman, I don't want to speculate on numbers, but I've heard some numbers battered around of some 60 - I'm not sure that those are the numbers. I appreciate the minister at least waiting for some of the consultation to come forward, so that we have a clear picture of what's happening out there. Hopefully in future budgets we will see increases to meet the needs of all those Nova Scotians who would prefer the self-managed attendant care program, all those disabled Nova Scotians.

[7:00 p.m.]

Another issue that is dear to my heart, and I've brought it up through a number of budget debates, was the issue around technical aids. As a matter of fact I brought it up last year, with respect to the minister. The minister did indicate that this was a matter of resources. We now have a budget that has seen millions of dollars come down from the federal government. We do see an agreement with respect to the offshore, and that money going towards paying down the debt which will save an additional $50 million, which can very well go into Health as well as a number of other departments.

When I talk about technical aids, I'm talking about wheelchairs, prostheses, crutches, a number of different apparatus that are required to make a person mobile. That's something that I've continuously brought forward to the Minister of Health, simply because I find it extremely difficult to stand here in this Legislature as a disabled person, watching disabled people who want wheelchairs go out cap in hand to receive some funding. With the exception of the child wheelchair program that was introduced last year, individual adults who need wheelchairs, each specially modified for those individuals, each an identifiable cost, and they're having to go out to service organizations and agencies to assist in the cost-sharing of the funding.

Now some of that comes through Community Services, but I would say to the Minister of Health, I don't understand why this can't be a medical service insured issue, the same as any other application for the needs of citizens. I think that even, Mr. Minister, if you were not to put in the total dollars that would be needed, at least we could have set aside a pilot project for technical aids managed by disabled persons. I think that would have been the best of both worlds. So I'm wondering if the minister has actually - and I believe this was a recommendation from the Nova Scotia League for Equal Opportunities as well, LEO, and I believe that the minister has had ample opportunity to look at this through a Health budget window to see what could possibly be done.

MR. MACISAAC: Mr. Chairman, the issue raised by the honourable member is indeed an appropriate issue and is one that we are attempting to address in the budget. We have allocated, in this budget, an amount of $963,000 for a loan program for equipment. We're doing this in consultation with the Canadian Red Cross. The equipment described by the honourable member would be available for loan purposes, and that allows us to ensure that the pool of equipment will remain intact, because we'll have the proper administration

[Page 102]

and the proper capacity to be able to maintain that equipment and keep it in good working order.

So, we indeed share the concern of the honourable member. Our approach is not precisely as the honourable member suggested it should be, but I believe it is one that will go a long way to addressing the concerns raised this evening.

MR. CHAIRMAN: Would the honourable member for Dartmouth North allow an introduction?

MR. PYE: Yes.

MR. CHAIRMAN: The honourable member for Colchester North.

MR. WILLIAM LANGILLE: Mr. Chairman, I want to thank the honourable member opposite for allowing this introduction, taking up some of his time. Before I do the introduction, I, as a former 30-year police officer in Truro and elsewhere, served in many detachments, and transported a lot of prisoners in my time before we had a Sheriff's Department. I would like to introduce the members of the Nova Scotia Sheriff's Department, and Deputy Sheriffs. I will start with the Halifax Regional Municipality, and I would ask that you stand as I call your names, Jason Elliott, Tammy Robertson, Greg MacRae, Daniel Ray, Jason Bowden, Kimberley Northrop, Earl LeBlanc, Mike Ross, and Brian Tolland. From the Truro Sheriff's Services, we have John Jarvo and Ray Lindsay. From the Amherst Sheriff's Department we have Brian Haynes; from New Glasgow we have Anne Grealey and Bob Greene.

I thank you very much for attending this evening. If I forgot anybody on the list, I apologize. I know that you've come a long way. Right now I want to thank you all for coming and for the service that you provide the people of Nova Scotia. Thank you very much. (Applause)

MR. CHAIRMAN: The members of the House extend a warm welcome, and we hope that you enjoy the proceedings.

The honourable member for Dartmouth North.

MR. PYE: Mr. Chairman, I, too, want to extend a warm welcome to representatives of the Sheriff's Department who are here tonight listening to budget estimates. They can certainly sit in on the details, how minute they may be at times, with resepct to how their tax dollars are being spent. I would also like to let them know that we, as Opposition members, have the opportunity at this time to question the government on the budget they have presented to Nova Scotians. We do that quite frequently.

[Page 103]

I want to go back to the technical aids. Mr. Minister, I do apologize, because I did know that you had allocated some $900,000 to the Red Cross to administer a program. However, one size does not fit all when it comes to individuals who need wheelchairs. They're specially designed mobility apparatus that individuals need in order to make it accessible for them to move around this environment.

Mr. Chairman, my question to the minister is, although - and the Red Cross does an excellent job in providing the service - this is over and above the services that the Red Cross would provide, it does not stop these individuals from going, cap in hand, to agencies and organizations out there in the community to partially assist in the funding of their electronic wheelchairs or their wheelchairs, custom made to benefit them. After all, there's nothing more uncomfortable than having to spend time in a wheelchair - the majority of the hours of your day.

My question is, and I do know that last year the minister had indicated that he had introduced a children's wheelchair program, when will Nova Scotians who are disabled and who need the assistance of a wheelchair to improve their mobility see the day when they don't have to go cap in hand to agencies and organizations to receive what I consider to be a service that should be funded under MSI, the Medical Services Insurance?

MR. MACISAAC: Mr. Chairman, what I did not indicate in my response to the earlier question is that the issue of technical aids is something that is not covered under the provisions of the Canada Health Act. I have to deal with the facts that I have in front of me. So it is not an insured service. Having said that, we recognize that there is a need. I want to clarify, the $963,000 is a pool of money that is provided to purchase supplies. It's like a capital fund to go out and purchase these technical aids and to make them available. But there is also funding available to respond to specific needs in certain circumstances.

So there is a recognition that, as the honourable member says, one size does not fit all. There are times when there are unique requirements that need to be considered and responded to. Our efforts will be focused in that direction of trying to, first of all, ensure that there is a supply of technical aids out there to assist persons with disabilities, but also that there will be some funds set aside with respect to responding to special needs that may arise from time to time. I'm sure that through our experience in the coming year, we will learn a great deal about the appropriateness of the amount of money that's set aside for those purposes and whether or not we need to adjust that amount in order to meet the special needs identified by the honourable member.

MR. PYE: Mr. Chairman, I suspect the minister and his department will inform those agencies that are connected to the disabled community of a process whereby they can access the kind of funds needed and the kind of services available to them through the Department of Health.

[Page 104]

I do know that the Senior Citizens' Secretariat falls under the Department of Health, although I see it under what's called the Public Service, as well. I don't know where this stands, but I guess it still comes to the Department of Health but it's a public service that's provided through the Department of Health. Is that the case? When I look at the budget book and I see where it says Senior Citizens' Secretariat, it shows that there's nothing allocated for this year, and then I go to Public Service and it shows that it is in fact allocated, and there is $200,000, additional, added to the Senior Citizens' Secretariat budget.

I want to talk just briefly, because my time is running out and I'm hoping that I will have sufficient time to talk around this because it was very important that the Senior Citizens' Secretariat had taken on a responsibility in conjunction with the Nova Scotia Legions to provide a forum on aging in this province. In fact they had gone out across the province, seeking opinions from seniors on issues that they believe exist out there. They wanted to know if they were hearing the seniors correctly, on these issues, across the province.

As you and I both know, right now there are some 125,000 seniors in this province, I believe, as of the 2001 census. I believe that within the next 20 years, that's going to reach 0.25 million of our population. I want to say to the Senior Citizens' Secretariat that they have done an admirable job in going out there, as well as the Legion for providing the facilities in order for the public to come forward. My concern is that less than 1 per cent of the senior population actually came out to those forums. My concern is, are we going to get the kind of information that will develop a comprehensive report that will be offered in the Fall of this year, 2005, with respect to the issues facing seniors?

Now, the Senior Citizens' Secretariat has, and is inviting, input into that, and right to this very day there can be input provided with respect to seniors' organizations out there. I do know that we have a Group of Nine that advises the Senior Citizens' Secretariat, as well. However, I'm just wondering if, in fact, we are reaching the population of seniors that we should be reaching, those seniors who do not come out to the meetings, and who are in real need of assistance through health, home care, long-term care, drugs, all that myriad of issues that relate to making sure that our aging population is going to be a healthy population in the future.

[7:15 p.m.]

I would, through you, Mr. Chairman, to the minister, ask the minister to comment on whether he's confident that we will get the kind of information that will guide us for the next 25 years?

MR. MACISAAC: Mr. Chairman, as the honourable member correctly indicated - if I could go back, just to something else, to technical aids, just to give a more complete picture. Within our long-term care facilities, we have an annual budget of $6-plus million for

[Page 105]

technical aids within the long-term care facilities, in addition to the money that we're making available to the Red Cross this year for the purchase of the loan equipment. I didn't want people to think that the $963,000 was the only amount of money that was being provided for that.

The honourable member quite correctly raises the question of our capacity to be able to communicate effectively with the needs of senior citizens throughout the province, and our capacity to engage senior citizens. There is one characteristic about the senior citizen today that is changing considerably as their numbers increase, and that is that their capacity and their inclination to be heard is changing and it's changing positively in the sense that the senior citizen of today is not shy about making known their concerns about their issues. Many of them, thankfully, are motivated to become involved in the process of attempting to represent the views of senior citizens in that regard.

Mr. Chairman, I'm reminded of the late Curtis Decoste, a resident of Boyleston in Guysborough County, who hailed, originally, from Havre Boucher. I first got to know Curtis when he was the lead statistician for the rural hockey league in Antigonish, the oldest, continuous operating senior hockey league of its kind in the country. That's the claim they make, and nobody has ever come forward to refute that claim. I do know that it goes back well into the 1930s, and Curtis Decoste played a very important role in the operation of that hockey league.

He went on, after his retirement, to become very involved in representing the issues of seniors throughout this province. Curtis is representative of a growing number of individuals who are seeing it as part of their responsibility to articulate on behalf of the senior citizen population of Nova Scotia and indeed Canada.

I had the privilege today of meeting with the President of the Federal Superannuates National Association of Canada. That is a group that represents retired federal public servants, retired military personnel, retired RCMP personnel right across the country. I believe they have somewhere in the vicinity of 170,000 members. They have a large representation in this province.

With Mr. Jackson today, the President of the Federal Superannuates National Association, was Paul Cadeau and Ken Brown. I've known Ken Brown for some time, since I became involved as a member of the Senior Citizens' Secretariat from my time as Minister of Education and as Minister of Service Nova Scotia and Municipal Relations. He, of course, along with other members of the Group of Nine play a very effective role in advocating on behalf of seniors.

I would point out one additional feature of the consultation that took place by the Senior Citizens' Secretariat last Fall, they are an integral part of the province-wide consultation that's taking place with respect to continuing care that is being carried out by

[Page 106]

my department currently. We're very much appreciative of the spade work that was done by the Senior Citizens' Secretariat, and we're piggybacking on that spade work with respect to the consultation that is currently underway.

I see the member getting anxious. I don't know if he wants me to sit down because he has another question, or whether he's prepared to accept just a bit more information on this. The reason I mentioned Mr. Jackson today is because he made the point very clearly that seniors are much more articulate about their concerns today than they have been previously. That's not to, in any way, diminish the concern of the honourable member with respect to our capacity to be able to get out there and do as wide a consultation as possible. That is the challenge, and we work very hard at trying to meet that challenge. We will continue to do so.

For instance, one of the things we know is that more and more seniors are now using the Web. With that, they're getting more and more information. The honourable member does raise a concern that I share; however, I am satisfied that the Senior Citizens' Secretariat, as well as the Continuing Care division and its consultations are making every effort that they can to get as wide a consultation as possible.

MR. PYE: Mr. Chairman, I do want to mention a couple of names which the honourable minister had mentioned, particularly Mr. Ken Brown, who served on the Dartmouth Community Health Board just across the harbour here. I did have the fortunate opportunity to meet Mr. Curtis Decoste earlier, when I first got elected here in 1998. I do want to tell you that many individuals who speak on behalf of senior citizens and organizations, in fact, are extremely articulate. They are well informed. Many individual seniors are extremely articulate and well informed, and use the Web to communicate right across this province and across this nation, as well as internationally on services that are being provided to seniors.

However, there is a community of seniors in this province who do not have access to computers, do not have access to information, who in fact do not have access to CAP sites or are unable to get to CAP sites that might be in their local libraries and so on. Those individual seniors are the ones who tell me that they aren't being heard. I have said to them that there's some excellent work going on here with respect to the Senior Citizens' Secretariat, with respect to the Group of Nine, with respect to the Nova Scotia senior citizens association.

All those agencies and organizations aside, there are some individuals who still feel that, somehow, they don't want to be overlooked when it comes to preparing a report for the next 20 years as a result of what is compiled now, and will be brought forward to the minister in the Fall of this year.

MR. CHAIRMAN: I'm not sure if there was a question at the end.

[Page 107]

MR. PYE: Absolutely. I do apologize. I would ask the minister to respond, is he sure that all seniors will be heard through this process?

MR. MACISAAC: Mr. Chairman, I would very much like to be able to respond affirmatively to the question of the honourable member, but I think the honourable member knows that for me to give such an assurance would not be appropriate because indeed, as hard as we will try, we will not be able to get the attention of every single senior. I would hope that all honourable members, if they don't have the necessary information in terms of how to communicate with the Senior Citizens' Secretariat or with the Continuing Care division in the Department of Health, if you would ask of us, we will make sure that we get that information available to you.

I think all of us play a role to try to ensure that as many citizens as possible are consulted in this regard and it is not just senior citizens that we need to hear from. Indeed, many who are not in the category of seniors probably have a pool of knowledge that would be very helpful to us as a result of experiences they have in working with seniors or living with seniors or simply their relationship with the senior population. We need to hear from them as well. Indeed, all of us aspire to spending as much time being senior citizens as we spend working, that's the hope of all us, and whether we succeed in that regard or not is going to be decided by somebody else. All of us certainly have thoughts about the needs of seniors and all of us have a role to play in attempting to communicate that.

Mr. Chairman, I'm not going to respond in the affirmative to the honourable member. No, I cannot guarantee that every person who should be consulted will, in fact, be consulted. Are we making the effort to ensure that as many people as possible are consulted? The answer is yes, we are making that effort and working very hard at it.

MR. PYE: Mr. Chairman, to the minister, I would say I simply brought that up because of the poor attendance and the less expression of thought by a number of seniors at those forums. So I'm just wanting to say to you, Mr. Minister, that hopefully the Senior Citizens' Secretariat will be communicating the views of many of the seniors or the majority of the seniors in this province when bringing forward recommendations to your office.

I do know that I have only a minute left and I just want to ask you if you have given some thought or maybe you have already done so and I'm not sure, remember there was a fine for people who opted out of home care services, or didn't call or chose not to cancel their home care service with respect to a 24-hour notice and I do know that there was a $50 fine to those individuals who, in fact, did not cancel at the appropriate time or did not give notification. I'm wondering if the minister and his department had looked at cancelling that out completely or if, in fact, it has proven to be beneficial in any way and if it hasn't been, have you considered cancelling that $50 fine that was initiated some two years ago?

[Page 108]

MR. MACISAAC: Mr. Chairman, the honourable member, I know, was quite concerned about this initiative last year when it was brought forward. I want to, if I might, comment, first of all, on how it is employed. If I could back up just a little bit. We are in a situation where we have resources that are very scarce in terms of providing those services, so it's important that the individuals who are providing those services are employed constructively and positively every day. The number of cancellations that occurred at the last minute, or appointments that were not kept, were rather high. It was a concern that those services that could have been provided in that time frame were not being provided because the appointments were not met.

We did not undertake to callously apply that policy. We have a system whereby, first of all, when an individual misses an appointment, the individuals are contacted and told about the policy, they are informed about the policy. The second time, in the course of a year, when an appointment is missed, they receive written notification of the policy and an indication if there is a third infraction, then the fee will be applied. That, Mr. Chairman, appears to me to be a rather fair application of the policy.

[7:30 p.m.]

The policy has only been in effect for a year, but to date I'm told that it is improving the level of communication with respect to appointments that are unable to be kept and there is a better flow of communication back and forth and the number of missed appointments are decreasing as a result. As I say, it has only been in effect for a year. I would want to have a longer period of time before I were to give a definitive evaluation of the policy.

MR. CHAIRMAN: The honourable member for Kings West.

MR. LEO GLAVINE: Mr. Chairman, I am pleased to have an opportunity to ask a few questions, perhaps more specific to District Health Authority 3. I think my colleague, the member for Annapolis, has already talked about the doctor shortage in our area and certainly not a lot has really changed for us in that regard over the last two years. We have several hundred families just in the Kingston/Greenwood area alone who depend on trips to the emergency room, to outpatients at Soldiers' Memorial Hospital because they don't have a family doctor. Places such as Kingston/Greenwood, which has a very mobile population and a growing population of seniors, are becoming a very key retirement area and I'm wondering if this area is being targeted by recruitment to look at the needs and especially that our present complement of doctors are moving into that period where they are certainly moving to semi-retirement and it's a growing concern. It's one I would put at the top of my list.

I know from reading a little bit of the current literature, not necessarily the detailed reports but certainly everything is indicating that an investment in a GP for a province, or for any jurisdiction in fact, has greater long-term benefits than investments in specialists.

[Page 109]

Certainly now we have many people in our area who no longer have that continuum for several years of family records at a doctor's office, regular checkups and so on. It's basically the outpatient department that has become the mainstay of health for many people in our area. So I would like for the minister to make some comments in regard to recruitment and in particular to looking at the shortage in the western area of Kings County.

MR. MACISAAC: Mr. Chairman, I want to thank the honourable member for his questions. The issue of recruitment and retention is one that is a challenge for all of us and while I appreciate the honourable member's concern for the area he represents and the surrounding communities, from a provincial perspective - and I feel it appropriate for me to put this in context - we are doing reasonably well in terms of the number of family physicians that we have; 96 per cent of Nova Scotians have a family doctor that they are able to go to. So that means that about 4 per cent of the population doesn't. The situation described by the honourable member is one where when you do have a transient population and you do have an area of the province that is attracting a retirement-type community, then there are specific challenges in that area.

Our physician policy with respect to the provincial physician resource plan that we have in the province is doing a lot of pinpointing work so that we do have a good handle on areas of concern with respect to the number of additional physicians that are required in those areas.

The honourable member made reference and it reminded me of a question I posed to representatives of Doctors Nova Scotia and to the College of Physicians and Surgeons recently. I asked, with the diminishing number of family physicians and the increasing number of specialists, is anybody concerned that there won't be enough general practitioners to refer the individuals to the specialists? So it does point to the need for us to find a way of making the general practice something more attractive to physicians than appears to be the case currently. We could certainly have more of the doctors who were graduating focused on the provision of family service than is currently the case. However, I say that within the context of a province that has 96 per cent of its citizens saying that they have the services of a regular family physician.

We try to work very closely with the district health authorities in terms of supplementing their recruitment efforts and that is the sense of how I would describe it because they really, in the final analysis, need to sell the individuals that this is an appropriate place to settle and to work. What we want to focus on is ensuring, for instance, the steps we are taking in the Valley to provide the additional acute care beds, the 22 acute care beds, and that will help that area to become attractive to family physicians, knowing that they have that capacity in terms of the area.

[Page 110]

I'm told that Dalhousie has one of the highest number of students choosing family medicine but that has been decreasing across the country. The federal-provincial-territorial work on this issue is currently taking place. We are working with other jurisdictions in that regard and I do know that this particular issue is an issue that is of concern to my colleague, the Minister of Immigration, because we have, in this province, a large number of foreign trained medical professionals who are not able to practise. The case up until now has been a rather cumbersome one for them through the Province of Manitoba in terms of receiving their accreditation and I do know that that is something the honourable Minister of Immigration is working on, as well as myself and Doctors Nova Scotia and the College of Physicians and Surgeons.

Although that's not providing any solace to the honourable member immediately, I do believe that in the long run we will be in a position to provide more resources but it is not something that you can snap your fingers and make occur. Suffice it to say there is a real recognition of the problem. There is a recognition that there is a resource available to us in the province. We don't have to go outside Canada to recruit individuals. They are available in the province. We need to find a way of making them available to us so that they can provide their services.

MR. GLAVINE: Mr. Chairman, a couple of the comments that you made there in your overview to my question, I certainly appreciate the fact that the Valley Regional Hospital is going to get some additional beds, as you pointed out, and which I spoke positively to the local media in one of my reaction statements to the budget. I'm certainly very pleased to see that.

Last year the remainder of the 31 long-term care beds were opened up at Grand View Manor. However, very quickly we were once again faced with too many of the beds at Valley Regional Hospital being filled up with patients who needed long-term care placement. So again, the wonderment is locally that yes, we will in time get 21 additional beds, but the fact that there is a moratorium on even the development, for example, of other additional nursing home places in our area and in relation to the demographics of the Valley, I just wonder if we still are really going to have a very short-term relief, if any, with those new additional beds, because we are not really providing the long-term care spaces that we need. I know that there is currently certainly a couple of possibilities and proposals for some long-term care, small community-based facilities. I'm just wondering if that is one of the options that is being explored by the ministry or by the district health authority.

MR. MACISAAC: Mr. Chairman, I thank the honourable member for his question. Indeed, the moratorium reference by the honourable member was something that was in effect. We are in a position now where we are doing the province-wide consultation - I made reference to it just a little while ago - and that is a province-wide consultation on continuing care. I anticipate receiving an interim report on that process in the Fall with a final report coming in the Spring. The report that I will receive in the Fall will assist us in terms of

[Page 111]

looking at directions that we can take in terms of the provision of long-term care beds in the province. It's not just a question of number but it's also a question of the appropriate location of those beds that needs to be addressed.

In addition, the consultation is dealing with the issue of other levels of care. Whether it be restorative care, and we are taking steps to address restorative care in the budget with 50 new beds over a period of two years; whether it is an enhancement of the self-managed home care which is addressed in the budget, not in any finalized way, but because we anticipate getting further recommendations from the province-wide consultation; or the more traditional long-term care; or whether, indeed, there are other models that might be considered. I know that there is some imaginative thinking taking place with respect to the nature of facilities that are being built rather than looking at purely a long-term care facility.

The thinking now is that it might be possible to provide a broader spectrum of accommodation for seniors so that it's possible for seniors to establish themselves in a location and as the need arises, move from independent living to assisted living to residential care-type of assistance to the long-term care-type of assistance, with the emphasis being placed on keeping individuals within their home for as long as possible. So that's the sort of information that we want to get from the consultation process and, as a result of that, we will be able to hopefully make much more informed decisions than currently would be the case.

[7:45 p.m.]

While that is taking place, we also recognize that we can provide additional beds in areas where the demand is obvious and the motivation there, obviously, is not just to provide the beds for those who need the long-term care but it is also to free up acute care beds which the honourable member references. The emphasis on alternate forms of care, i.e. home care and other forms of care that may be identified and the provision of additional long-term care beds, will assist greatly in keeping people out of acute care facilities so that they can be available to those who need the acute care facilities.

The honourable member quite correctly points out that the demand is there with respect to acute care facilities but hopefully, if we can successfully put in place the spectrum of alternate care to acute care, then we can keep the demand for those facilities at an appropriate level and dedicated to people who need that level of care.

For example, the new Cobequid home will even have short-term acute care beds and lots of community outreach in that facility. That's the additional 100 to 150 beds that we will be looking at in the Sackville area. So that is the spectrum that I was referencing in terms of services that are available. What we want to do is to prevent unnecessary ambulance trips from these facilities to traditional acute care facilities. I very much share the concern of the honourable member. I hope that I have shared with him also some of the approaches that we have in mind with respect to addressing that in the long term.

[Page 112]

MR. GLAVINE: Mr. Chairman, I thank the minister for that overview, certainly pointing out a number of possibilities for still a major concern in our area as to the directions that will adequately address a very rapidly growing age population in our area. So I thank the minister for that.

One of the areas that certainly the Valley, in particular the Middleton area, has demonstrated a good degree of expertise and has developed some very important educational strategies around autism. Certainly the elementary school, Annapolis East, has distinguished itself with a learning model for those children which has made it, in fact, a centre that has been attracting people from not only different parts of the province, but also military personnel to ask for a posting to Greenwood because of the outstanding work being done there.

I certainly appreciate the work of the government to look at the IBI treatment that is now going to be coming onstream once some of the education and so forth is done. In speaking with Tom MacNeil from Mental Health Services at Soldiers' Memorial Hospital, I know that he is certainly pushing for something in that area to complement the work that has already been done and I'm just wondering if the minister is closing in on the point where you can actually talk about the location of a centre and what kind of time frame for the delivery of that service may indeed be.

I know families are getting very anxious. I've been in correspondence with a couple of families that, in fact, decided this year to actually remortgage homes so that they could hire a private educational therapist to deal with their child who was three or three and a half years of age. So the community, as a whole, is very anxious to get this program onstream and I'm just wondering if the minister could comment on timeline, possible location of where a centre may be.

MR. MACISAAC: Mr. Chairman, I thank the honourable member for his question because he certainly touches on a topic that has received a considerable amount of my attention over the past period of time and obviously my philosophy is that with the intensive behavioural intervention approach, the sooner we can get treatment to these children, then the better off we are in the long term. We will greatly enhance their lives and quality of life and by starting the work very early in their lives, we can achieve much more than is the case if we are only doing it at the school level and beyond.

Now in terms of locations, there will be multi locations throughout the province with respect to the delivery of this service. The delivery of the service will be through the district health authorities. The funding will flow to them. Currently, the challenge and what we are working on is to provide the level of training that is required to deliver IBI and it does require a considerable amount of training. The good news is that as the training takes place, then the children are being treated because you need the children to work with in order for that training to take place. So the professional who is providing the training to the other

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individual is there working with the children in conjunction with the person who is being trained.

Now, obviously, we have two individuals, or three or four, whatever the case may be, tied up in the provision of the service to an individual, but after time that one child who is being addressed through the training process, the capacity will increase to two or three or four children who can be provided with that service. So it is very much something that will grow over time as we put in place the pool of trained individuals with the capacity to provide this service.

It is our objective that throughout the province we will have individuals with the capacity to provide this service for autism. Some of these people may be people who are involved in early intervention in other facets of challenges that children have so that it may not be just autism that they are working with. They will be individuals who have other training who will have the capacity to provide services to children with autism in circumstances where it may not be appropriate to have that person doing just autism, because the number of children who would require the service is so small that you would be wasting the talents while the individual travelled from location to location.

So we are looking at not just individuals who are trained in the provision of autism, but we hopefully will be taking individuals who have the capacity to provide other forms of early intervention and give them the skills to treat autism as well. So it is a process, the training is the emphasis in the early stage of the process and as that training takes place, the pool of individuals with the skills to treat autism will be growing in the province and over a period of a couple of years, we hope to have a fully functional program available to the children with autism in Nova Scotia.

MR. GLAVINE: I didn't quite get there with that question, but it's one that hopefully there will be some announcements forthcoming here because I know the urgency of getting this particular program up to speed. So hopefully we will be hearing some further good news shortly.

One of the areas that certainly has been a bit of a constant in the year and a half or so since I've been in office, has been around home care. I guess I would have to note that perhaps we are making some progress here but I do still get calls in that regard. One of the areas that, again, is most often registered in my office is the fact that people who need it, of course, and have a family member who is anticipating the home care delivery at a certain time of the day are not always getting it in relation to the appointment time that has been established. If you take a look at the geography of the riding that I represent, and if you have a nurse who has a call at 9:00 o'clock and at 9:30 they are supposed to have an appointment in East Dalhousie, well, you know, that's not quite possible, especially with the condition of the Aylesford Road, I may add.

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In other words, the coordination of the home care seems to be certainly one of the big issues and one of the calls that I hear from a whole lot of sectors is that if it were delivered by the district health authority, as opposed to the centralized program now that we have to deliver the service, in fact we may be able to overcome some of those pitfalls. Again, I'm wondering, is there a determination to, in fact, have it delivered through the district health authority and is there a timeline around that?

MR. MACISAAC: Mr. Chairman, I thank the honourable member for his question. We do anticipate that we will be in a position to hand off to the district health authorities in the future. What we are currently doing is restructuring the Continuing Care branch in such a way that the delivery model will be structured under the boundaries of the district health authorities so that we are going to deliver our services with a structure centred around that type of organization so that when the time comes for the hand-off, all of that reorganization work will be complete and it is not something that the district health authorities will have to involve themselves with. Part of the reason that we want to do this, as the honourable member points out, with service being delivered through the model of district health authorities as opposed to the current one of divisions, we feel that we can get a much more efficient employment of personnel relative to providing of the home care service. We are not quite where the honourable member wants us to be but we are preparing the road to get there.

MR. GLAVINE: Certainly one of the services that we do have in our area, and I think I probably can speak for right across the province, is an outstanding ambulance service. However, again, this is a very localized question since we do have the service operating out of Middleton, and I have the document in my office that I guess was handed to me by some of the local people who work for the ambulance service, studies that have been done, looking at the nature of calls in our area. One of the areas of concern is the extremely large number of calls that are requested again in that Kingston-Greenwood corridor where now, I suppose, we have probably 8,000 to 10,000 people and the time that it takes to come from Middleton to the Kingston area.

There is certainly the wonderment and the question coming to my office, on occasion, especially if people have sensed that there hasn't been a timely response to the service is, in fact, is there a possibility of a satellite station or some provision, certainly during the working hours, during the daytime period, of having a satellite-type of provision made in this area? This is, again, one of the questions that does come my way because you have to come from the Middleton-Kingston-Greenwood area, a 9- to 12-minute response time back to the hospital, so it is of a major concern to our area and I'm just wondering if the minister is aware of this and especially with the possibility of building a new site and, in fact, will that make any relief in terms of the time response?

MR. MACISAAC: Mr. Chairman, the question raised by the honourable member is one which is not unique to his area. I think what we all need to understand is that there is a contract with EHS with respect to the provision of the service and that contract says that the

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average time of response should be nine minutes for every call that is received. They are required to live up to that contract. Now that's an average. Sometimes the response time is shorter than that, sometimes it is longer. Obviously there is concern when it becomes too long.

[8:00 p.m.]

Having said that, the actual location of a site that houses the ambulances is not as important or significant as the honourable member might imagine and I will make the offer to the honourable member, if he would like to visit the dispatch centre for EHS then I would be very glad to arrange a visit for him to it because when he visits that site, what he will see is that there is a very deliberate attempt - not just an attempt, a very deliberate action - taken on the part of EHS to make sure that when ambulances are called, for instance if you have an ambulance that's moving in a particular location and it is called to another site, that the other ambulances are redeployed, in order to compensate for the loss of that ambulance, to be able to provide service for as long as it is tending to the needs of the call.

When you go there you will see that they are continuously managing the location of these. It reminded me not unlike what an air traffic control centre is like where there is a continuous management and redeployment of these units throughout the province in order to ensure that they have the capacity to meet the nine-minute contractual arrangement.

So the actual site of the base is not as significant, in terms of the deployment of the ambulances, what is significant is the dispatch centre which - dispatch is not the right term. (Interruption) Okay, the dispatch centre that's there is responsible for redeploying the ambulances. I think if the honourable member had the time to visit that site, he would see more clearly what I'm suggesting now and if it's of value to him, I would be glad to arrange such a visit.

MR. GLAVINE: Just about a minute or minute and a half left so very quickly, I'm wondering when the improvements and the restructuring of the ER at the Valley Regional Hospital is looking at getting underway. I know on my last visit there with the chief of staff, Dr. Robertson, his concern certainly about the overflow, the inability to service people with the capabilities that they have, they have a wonderful staff there but they certainly feel that very often the delivery of the best emergency care perhaps is certainly compromised a little bit. So I'm just wondering again, is there some timeline relief that can be given us at this time?

MR. CHAIRMAN: The Minister of Health has approximately 30 seconds to respond.

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MR. MACISAAC: Mr. Chairman, that's a tall order for me. My understanding is that the facility will be operational in this fiscal year so you have to back everything up from there. I can't give you the precise dates of the other things, the other steps in the process, but that is the objective, to have it operational in this fiscal year.

MR. CHAIRMAN: Order, please. Time has expired.

The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, I move the committee do now rise, report considerable progress and beg leave to sit again on a future day.

MR. CHAIRMAN: The motion is carried.

[8:06 p.m. The committee rose.]