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MR. CHAIRMAN: Order, please. The Committee on Supply will now be called to order.
The honourable Deputy Government House Leader.
MR. DAVID WILSON: Mr. Chairman, I now call the Estimates for the Department of Health, Resolution E11.
Resolution E11 - Resolved, that a sum not exceeding $3,634,935,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health, pursuant to the Estimate.
MR. CHAIRMAN: We will now be debating the estimates for the Department of Health. I'll be calling upon the minister to make some opening comments, if she so wishes, and to introduce her guests to the members of the committee.
The honourable Minister of Health.
HON. MAUREEN MACDONALD: Mr. Chairman, I'm very pleased to be here today to discuss the budget for the Department of Health for 2010-11. I would like to introduce to members my deputy minister, Kevin McNamara, who would be known to all of you, I assume, and as well our chief financial officer, Linda Penny. Linda and I were just saying it seems like yesterday that we were all here together doing Health estimates, and I guess in a way it wasn't that long ago, but we're very pleased to be back here today to talk about the Department of Health's expenditures and our plans for this year.
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Mr. Chairman, our vision for today's families is to ensure timely access to quality public health care for all Nova Scotian families. That is the goal we share with our partners in the health system, the district health authorities and the IWK, as well as the continuing care sector through whom we work to deliver health care treatment and services to the people of Nova Scotia. The budget for the Department of Health for this year is focused on protecting critical health services in the midst of challenging economic times.
Mr. Chairman, we have much to be proud about in Nova Scotia. We have a robust and responsive health care system. We provide thousands of services to thousands of Nova Scotians every day. Last year, in this province, we performed 100,000 in-patient operations and day-surgery procedures; we delivered over 1.2 million diagnostic imaging tests; we served more than 665,000 people visiting in our emergency rooms - I am presuming this would be 665,000 visits, not necessarily all different people, some people may have been there more than once; we performed almost 100,000 ground and air ambulance transports; and we served almost 100,000 calls with our new 811 service.
I want to take a moment to thank the personnel at 811 - we say "Dial-a-Nurse" - because they provide an excellent service at all times, but they were a very, very important feature of our successful campaign back in the Fall with respect to the H1N1 virus and the need to get the right information to people quickly. At the same time we know that there is much more to be done if we are to keep up with demand and the needs of our population.
Mr. Chairman, health care costs have been allowed to increase faster than our economy is growing. Health care spending has doubled in the past decade. Nova Scotia spent $1.8 billion on health care in 2001; today our budget is $3.6 billion. This, as our Finance Minister likes to remind us, is an unsustainable path. We, in the Department of Health, certainly understand and recognize that this is the case. This government will bring these costs under control in order to ensure reliable public health care for the years ahead. This government will manage health care spending better to ensure a strong public health care system for the future.
Improvement and investment in our health care system is not easy at a time when we must consider many difficult decisions in order to live within our means. However, we are motivated by the knowledge that being more efficient allows us to maximize health care investment for front-line health care. We will help families stay healthy, get healthy, and manage chronic conditions, and we will do this while still living within our means.
We will begin to develop internal audit support for the department and for the district health authorities. This will ensure better monitoring and accountability of our health care dollars and, if my memory serves me correctly, I think this is a matter that the Auditor General in the past has had some things to say about and some advice to give. As you know, Mr. Chairman, I sat on the Public Accounts Committee - I chaired the Public Accounts
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Committee, actually, for a number of years - and I do remember that we had audits of various DHAs from time to time.
So this is a very important function, particularly when you get into a large organization like a district health authority. Take, for example, the Capital District Health Authority. That district health authority serves more than 440,000 Nova Scotians - close to half of the population in the province, really - and has a budget of approximately $770 million on its own. It is quite a significant financial entity in terms of the resources, the expenditure that it has, and so I think it is very important that we have internal audit support for DHAs, as well as for the department.
Mr. Chairman, we will also focus on quality and patient safety. A health system that puts quality and patient safety first is better managed, more effective, and more attractive to health care providers. Better management and effectiveness are key to helping Nova Scotia live within its means. Our challenges are no different than those faced by governments around the country and across the world. The difference is that we are going to do something about it. As part of our commitment to patient safety, our quality program will ensure that all existing national and provincial reports on patient safety will be carefully reviewed and acted on, as required. Our initial efforts in this area will focus on pathology and diagnostic imaging. We will work to ensure appropriate standards and quality programs, to ensure that they are in place and that Nova Scotians are protected.
[3:15 p.m.]
The province is taking steps to improve the safety and quality of care received in hospitals and long-term care with the creation of a provincial Infection Prevention and Control Centre. The centre's work includes setting province-wide standards and providing oversight and support to health care providers to ensure the best infection prevention and control practices are applied. This centre and its staff have already been an invaluable resource for infection control practitioners during the H1N1 pandemic.
We will continue to invest in health information systems. We will focus on investments that support improved quality, patient safety, reduced waits, and increased access to care. Health information systems can facilitate patient consultations, deliver test results faster, and support safe and appropriate drug therapy. In particular, this year we will begin work on a new drug information system which will allow us to deliver prescription drugs more safely to Nova Scotians by reducing or eliminating the risk of error associated with unclear handwriting or dangerous reactions from multiple prescriptions. Quality and patient safety is a lens through which we will consider all of our work.
Mr. Chairman, nowhere is quality and patient safety more important than in our emergency rooms, and I am very pleased with the progress Dr. John Ross, our emergency room advisor, has been making in his work. It was a pleasure to table his interim report today
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in the House. I'm particularly impressed with some of the themes that have come up from his initial work, those being: the need for clear provincial emergency room standards to support quality patient care; the need for increased access to primary health care services to provide better care to people with non-urgent medical and chronic care needs; the need to collect and share reliable data on emergency services in order to provide safe, quality care; and the need to address emergency services as a provincial system so that all Nova Scotians can have equal access to quality care.
I would be remiss if I didn't mention that I was also very pleased that, although it was a very short line in Dr. Ross' report, he identified emergency mental health care as a need in his report. We know that that places a great burden sometimes on our justice facilities, on our emergency health services personnel, on our emergency rooms and, Mr. Chairman, it isn't necessarily an area that we have standards in. I'm very much looking forward to the kinds of progress we can make for individuals in crisis with a mental health disorder and in need of emergency health care - and we know that we have a long way to go in this regard in Nova Scotia.
Doctor Ross' report reflects the candour and professionalism we expected from him when he was selected to lead this work, and I want to again thank him for all his efforts. I was saying to someone earlier today that the other thing that I really admire about that report - I like so much about this report - is it's an accessible report. You don't have to be a health care policy analyst to be able to understand that report. It is written in a very accessible way and it's so obviously a report that has been done with the care of a member of our health care community who is passionate about emergency health services, and has not approached this issue as an accountant with a scalpel but as a competent, highly qualified emergency room physician. I think this really does reflect the person who Dr. Ross is, and that is what we expected from him and I'm very pleased to have seen that in his work.
While we have not yet seen Dr. Ross' final recommendation, we know he will have findings and we will have significant work to do to apply his findings. However, we are prepared - we have dedicated resources in this budget through the Emergency Department Protection Fund to ensure we will have the needed investment to address this important work. I believe Dr. Ross' work is an important step in providing direction to help address the issue of chronic closures in our rural emergency rooms, and long waits in our emergency rooms in and around Halifax. I wasn't at Dr. Ross' press conference, but I understand at the press conference he indicated that all of our emergency services that he has visited perform a vital role in our communities.
We also fulfilled our commitment to ensure ministerial accountability for emergency rooms, with the tabling of legislation last Fall. Consultation between district health authorities and communities is taking place on chronic closures and I will table our first annual report this Spring, detailing dates and reasons for emergency room closures last year.
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We will follow through with our commitment to relieve stress on overcrowded emergency rooms, with the implementation of 13 new acute care beds; we will establish a rapid assessment unit at Capital Health to help patients move faster through the emergency room to admission, so they will receive treatment and get well sooner; and we will ensure emergency rooms are kept open by implementing enhanced local funding for physicians where it is needed across the province, but particularly in rural and remote areas.
A facility like the Cobequid Health Centre - a very, very important facility in the ever-growing communities of Middle and Lower Sackville and Hammonds Plains and, I know, near and dear to the hearts of my two colleagues, the members for Sackville-Cobequid and Hammonds Plains-Upper Sackville, and they talk to me about the centre frequently - is improving access for a growing suburban population and reducing pressure on the province's largest emergency room. We're in the process of conducting a full review of patient care and patient safety in regard to enhanced services for the emergency room at the Cobequid Community Health Centre.
Mr. Chairman, HealthLink 811, our 24/7 service to access health advice and information from a registered nurse is proving to be an important part of this province's emergency care system. This service was critical last year in providing timely information to Nova Scotian families on how to protect themselves from the flu, how to recognize the symptoms of H1N1, and how and when to access care if they were ill.
Mr. Chairman, as you know, as Minister of Health I get many, many pieces of correspondence, both electronically by e-mail and through snail mail - they tell me that it is roughly 500 a month, and I think during H1N1 it was more like 500 a day. However, one of the e-mails that I received that stands out in my mind was a very short e-mail that I received fairly recently from a young woman who is a young mother with a young daughter - and in many respects H1N1 is the kind of service that is tailor-made for young families, young parents with children - and she wrote and told me about what a fantastic experience she had had with the 811 service when her daughter was unwell and she didn't know what was wrong and what she should do. She called 811 and she had a superb, rapid, very professional and very effective response from a very caring health care professional, a nurse. This e-mail was very touching - that she took the time to write me and to tell me what a wonderful service this was and how much she appreciated that she had access to this service.
Mr. Chairman, the third part of Nova Scotia's emergency care system is our world- class ground and air ambulance system. In November, Nova Scotia successfully launched the first system in Canada to give paramedics instant access to MedicAlert health records. This means that paramedics can access potentially lifesaving information, on things like allergies and medications, from an ambulance.
I was at the launch of this particular service and it was really very interesting to talk to the paramedics and have them describe to me what this would mean for their ability to
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respond more effectively, in a more timely fashion, when they are on their way to somebody's home or work place where an accident or an incident has occurred and they are able, prior to arriving where the patient is whom they must treat, where they can actually get access to information about whether that person has a history of diabetes, has a history of allergies, has a response to particular kinds of drugs, and what a difference that makes in terms of their being able to prepare themselves to deal effectively and in a very rapid response to the individual whom they have been called to attend to.
Mr. Chairman, this year we will celebrate the first long-service awards for our paramedics, giving us a wonderful opportunity to publicly acknowledge the tremendous skills, dedication, and professionalism of this very important group of health care providers, and I'm very much looking forward to this particular occasion. It will be, I am sure, a very moving occasion, and I have had opportunities to attend other award services with our paramedics - we do one in the Red Room annually where paramedics are recognized by their peers and a series of awards are handed out. I was able to attend that last year - it was one of the first official functions that I attended as Minister of Health and it was a wonderful afternoon. These women and men are such dedicated, and caring, and capable professionals; it is always very inspiring to be around them.
[3:30 p.m.]
Mr. Chairman, one of the things that our government was very clear about and very committed to in the last election campaign was the importance of improving access and reducing wait times. Nova Scotia, as you know, has some of the longest wait times in the country for some treatments and services. Reducing these wait times is a top priority for this government. We know that orthopaedic surgeries like hip and knee replacements is one area where we are not meeting national benchmarks and where individuals are dealing with extremely long waits - in some cases up to two years. We have had discussions with the Capital District Health Authority, where the waits are the longest, to talk about how best to reduce these waits.
We will tackle the waits in other districts with the development of pre-hab teams. Mr. Chairman, these teams, which are already seeing some success in Capital Health, will ensure patients are fit and ready for surgery or, in some cases, will provide other treatments to avoid the need for surgery altogether.
I am just reminded, Mr. Chairman, and I think it was on the day of the official opening of this session that we are currently in, I met a lady who was a guest here at the reception afterwards. She told me that she had been on a wait list for quite a long time and had been sent to one of these pre-hab teams and was doing exercises with a physiotherapist - I believe it was an elbow or an arm, a shoulder perhaps, and she had been in quite a bit of pain - and the surgery that she was waiting for, working with the physiotherapist resulted in
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her not being in need of surgery any longer, there was so much improvement through physio, and she was able to come off the list.
I hear stories like this quite often, Mr. Chairman. There is a lot that we can do to shorten our wait list, but also to improve the quality of life that people have while they are waiting for their surgery if they are unable to be diverted into other therapies.
Mr. Chairman, Nova Scotia already has one of the best breast-screening programs in Atlantic Canada. This year Nova Scotians will benefit from the installation of five new digital mammography units - in Bridgewater, Truro, New Glasgow, Amherst, and Antigonish. I believe, when these machines are in place, this will result in a completely integrated screening and diagnostic service for breast screening in Atlantic Canada.
We are also proceeding, this year, with changes to the Pharmacy Act that will allow pharmacists to play an expanded role and will result in Nova Scotians having improved access to care. The amendments will allow pharmacists to administer drugs, including vaccines; to order and interpret certain diagnostic tests; and to adjust a patient's medication without them having to go back to their doctor. All of these improvements will help Nova Scotians access services faster and often closer to home.
We know that cancer places a great burden on families and that families in Nova Scotia face this burden more often than families who live in any other province in Canada. Cancer patients in Nova Scotia will soon receive better care, and experience shorter wait times, thanks to the expansion of the radiation therapy services in Halifax and Sydney. Nova Scotia has some of the best clinicians in cancer care - now we also have some of the best treatment options available. Through our investment in new equipment like linear accelerators and expanded bunker facilities, Nova Scotians will benefit from the newest and the best technologies to treat their cancer.
Mr. Chairman, sometimes specialized treatment is not available in Atlantic Canada, and we understand that when patients have to travel out of the province to receive care that it is stressful for them and their families. That is why I was pleased to announce our new travel and accommodation assistance policy, which started April 1st. Under this new program we are reducing the financial burden on patients by reimbursing them for some of their expenses related to getting to, and living in, another province or the United States while they receive medical care that they cannot get here in Nova Scotia. We will make even more improvements to this program in the coming weeks as we seek a partner who will help us deliver this program. Our goal is to eliminate families having to pay for expenses up front before they can be reimbursed.
I want to talk briefly about mental health. Mental health is another area in need of significant enhancement. Depression is the second most common cause of disability in the developed world and it has been largely ignored by previous governments. My government
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will improve support for individuals with mental illness and for their families. We will continue to work with all districts to reduce waits, and particularly with the IWK to address wait times for children and youth in need of mental health services.
This year we will lay out our course in a mental health strategy, which will provide clear direction for the steps we must take to improve mental health and addiction services for Nova Scotians. This year community-focused living bungalows are moving ahead. They will provide appropriate, respectful care for individuals coping with mental illness. This Fall we will also host a mental health conference for providers from across Atlantic Canada, and this will give us an opportunity to not only network, but to learn from each other with respect to the best practices that we have available right here in our own local region. Mr. Chairman, mental health service is a priority for this government.
Another pillar of a solid health care system is infrastructure, and this year we will enhance efficiency through the creation of a better process to assess and prioritize capital projects including equipment. We cannot afford to have a cost overrun such as the one that has occurred with the building of the new Colchester Regional Hospital, therefore we will put into place a transparent decision-making process so that all Nova Scotians can understand how these important and expensive projects are implemented. We will also be reviewing the Colchester Regional Hospital situation carefully to ensure we learn from the mistakes of the past so that they are not repeated.
In order to provide the modern health care services that Nova Scotians need, we will continue to invest in infrastructure, whether that be in the form of equipment, bricks and mortar or information management systems. This year we will expand our investment in the electronic health records system for family physician offices, and we will also invest in a new drug information system - both of these investments will support better, safer patient care.
I also want to take this opportunity to thank all the district health authorities for their work in implementing the new finance HR and materials management system, known as HASP. I think we had an opportunity to talk a bit about technology when we were here in the Fall. This project completed the final phase of its rollout less than one week ago. HASP will provide a foundation to support province-wide future planning and decisions for the health care system.
I'd be remiss if I didn't speak to the issue of seniors and senior care, and there again this was a feature of Dr. Ross' report today when he talked about seniors in emergency rooms having to wait great, lengthy periods of time to be admitted into a hospital bed. He raised the question of quality and the way we treat our seniors in the health care system - I was so pleased to see this raised as an issue by someone who knows only too well the realities of what that looks like.
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Seniors, too, are another growing population in need of specialized care and services. This government is committed to giving seniors options to stay in their homes and communities longer. We will support the continued development of new long-term care beds to give seniors more options closer to home when home is no longer an option. We will hire nurse practitioners to work in nursing homes to provide better access to care for seniors and better management of their chronic and other complex conditions. We will launch new self-managed care and personal alert assistance programs to allow individuals and families to better manage their own personal care needs.
This year we eliminated the unnecessary burden of security deposits charged by nursing homes - bad debt has not been a problem for nursing homes, so eliminating deposits that range from $900 to $4,700 per client is common sense and it makes a real difference to these families.
I was speaking with somebody the other day about this very policy and I was saying I just can't understand how any government would ever have allowed a health care facility to put in place a policy that could be a barrier to someone whom we have assessed and we are very aware are in need of a long-term care bed. Imagine if you were unable to be cared for any longer in your home and your only option was to have admission into a long-term care facility but you were required to pay anywhere from, $900 up to $4,700 - imagine being denied health care because you could not come up with that kind of money, you or your family. I don't know how we ever allowed that to happen, but nevertheless we don't allow it to happen anymore and this, I think, is a very significant advance for the seniors in our province.
Mr. Chairman, we are also taking steps to keep prescriptions affordable for seniors. We know the cost of prescription drugs is often a concern, so we're holding the line on premiums and copayments this year in the Seniors' Pharmacare Program, and if memory serves me correctly, I don't think that area has seen an increase since 2007. So we have been able to hold the line on that. We will continue to work with the Group of IX and other seniors' organizations, such as ACE, as we continue our efforts to make life more affordable for seniors and ensure that they have high-quality, accessible health care services.
[3:45 p.m.]
Mr. Chairman, retaining and recruiting the right health care workers, health human resources, is a challenge that faces every province and most every country. It is my belief that Nova Scotia has some of the most experienced, skilled and passionate health care professionals anywhere, and I thank them for the work that they do and for choosing to do it here in Nova Scotia.
Mr. Chairman, health human resources will continue to be a challenge, particularly when we look at the demographics of retiring baby boomers over the next number of years.
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We have through the years, in the department, looked at expanding the number of seats in the medical school, in the nursing schools, and we continue to support new medical school seats that had been added a few years ago and that commitment continues.
Mr. Chairman, investment in health information technology will support the creation of high-tech jobs in Nova Scotia, jobs that allow our young people to stay and build a life here. Since 2006 government has created 155 high-tech jobs in the health care sector in Nova Scotia. Through continued investment, we can do even better.
The most important part of any system is always the people, and at the heart of Nova Scotia's health care system are more than 41,000 dedicated men and women who bring skill, experience and compassion to hundreds of patients every day. This government is committed to ensuring these health care workers have the education and support they need to best serve Nova Scotian families.
In closing, Mr. Chairman, I would like to say that health care is one of the services that Nova Scotians value most and it is a service about which they have the highest expectations. This is an important public trust and one that this government takes very seriously.
When I reflect back over the last number of months that I have had the privilege to serve the people of Nova Scotia in this capacity as Minister of Health, I sometimes chuckle. Mr. Chairman, I think my first week in the department the deputy minister, who had been there for a number of years, it was her last week before retirement, and we had to find new leadership in the department - we had an H1N1 crisis looming that the Auditor General indicated we weren't prepared for; we had no isotopes because of the whole debacle around the Chalk River situation; we had problems in the emergency room departments; just about every labour agreement in the health care sector had expired or was about to expire; and we had an untold number of AFPs, contracts with our specialists that had expired and were yet to be finalized and negotiated.
Mr. Chairman, I could go on. Every day brings a new challenge in the Department of Health, but I have to say two things: The first thing is I have to say what a privilege it is to be able to work on behalf of the people of Nova Scotia and attempt to address and deal with these many challenges; and the second thing I want to say is what a privilege it is to work with the staff in the Department of Health who also bring to their work the absolute dedication to doing their utmost to provide the best public health care system and services that they possibly can.
It has been an incredible opportunity to work with a truly dedicated group of people who have great expertise and professionalism. It certainly gives me the energy to face the challenges - and there certainly are challenges, but there's a very great reward in doing this work.
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With those few comments, I will take my place and I welcome the questions from members opposite.
MR. CHAIRMAN: The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: I do thank the minister for her opening comments, which summed up an awful lot of the programs and activities of the Department of Health and set the stage, as well, for the size and scope of the work that is done by the Department of Health.
We all know that this department takes up pretty much the lion's share of our budget. It's the single biggest department; the single biggest expenditure. It's providing services that are so important to all Nova Scotians, to each and every one of us at all stages of our lives. It is very important to us that we see it well run and that the costs are kept under control.
I want to look initially at a number of the things - a few of the points that I had right off the bat are items the minister has touched on in her opening comments, so I thought we could go to some of those right now. We will have many hours here with the minster, and she knows that and so does my colleague from the Progressive Conservative Party. We always have Health as one of the major departments to come before this estimates committee, because we know there's so much to look at and examine.
As the minister knows, I much prefer the kind of dialogue and discussion we have here to the sort of discussion that we may have the opportunity to have in short exchanges in the Legislature, which I don't think are nearly as productive as what we do in estimates, is really what I'm saying, so I always appreciate the opportunity to look at subjects that I know we both share an interest in and want to see the success of here in our province. We actually want to see something delivered in communities that is going to make a difference to the lives of Nova Scotians, otherwise we would not even be here in the first place because there would be no point. We are here to see if we can't find ways to redirect the resources that are at hand.
I do worry, of course, that we're at a time that's very different from my arrival here in the Legislature in 2003, because in 2003 until about 2008 we had expanding revenue sources and times were actually better. I would not say that provisions were made during that time for the rainy day which has come, and we knew as of the recession arriving that our revenues would drop precipitously, as they did, primarily from our offshore resources, but also because people were purchasing less and we were exporting less because of our international markets being affected.
That's come home to roost. All of the increases in spending which are for good and worthwhile programs I would say in the Health Department, by and large I think we can say, we can't sustain it. The minister's right in saying that we can't sustain the growth. We do
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have to think smarter, we have to think of new ways to get to the same outcome, to try and provide those services in new ways - maybe using other medical professionals, making the best use of the people that we have available and so on.
I note the minister talked about the pharmacists and the changes that are coming in that profession, and I know we will have an opportunity to discuss the new bill that is before us about changing the scope of pharmacists. It is something that I think is a ray of hope, really - that we can look at not only pharmacists but other medical professionals, but you can start with the pharmacists because they're highly trained, very smart in what they do, and can really provide a lot of value, and we haven't used them to their full potential.
I think it is rather interesting that I have a son who is studying chemistry right now, who has an opinion of pharmacy that is very narrow - that they count pills, that all they do is dispense drugs. I have been saying to him what a great profession it would be for him to look at. I am hoping that he will review that again in light of the fact that there are a lot more ways that pharmacists can play a role in the health care system. I think that it does really present an opportunity and a whole new vista for people who want to look at that as a profession. So I am hoping that perhaps not only my son, but many other young people will see this and we will have an expansion in the number of people.
Mr. Chairman, I know that I have an hour with the minister to begin with, so I just wanted to go to a couple of clarifications because we didn't get copies of her opening statement and I didn't get all the figures down. I wonder if the minister, just by way of clarification, could give the figure again about where we were - you had said how much the budgets had increased over something like 2001 or 2002, I think you started with, until today. I would really like to be able to put that down in context to the spending that we are here to discuss, because although there are a lot of really interesting programs and initiatives and ideas that we will talk about here, our main purpose is to examine the budget and the numbers that are presented to us - so I wonder if you could do that by way of comparison?
MS. MAUREEN MACDONALD: Mr. Chairman, yes, the figures that I used were that Nova Scotia spent $1.8 billion on health care in 2001 and today our budget is $3.6 billion. Actually, I think when I arrived in this Legislature in 1998, if memory serves me right - and I can't believe I still have this number in my head - I think the health care budget at that time was $1.4 billion.
MS. WHALEN: Mr. Chairman, that certainly is an astounding difference. I mean, really, the figure you gave us is the point at which it doubled - in 10 years, it is a complete doubling of the budget. I think that that helps sets the context as we go through.
I will say, as you look at what we received when the budget was introduced, that there is a great stack of books and supplementary books and every other book, but when I came down to just the Health section, it is pretty light. I have taken out just the pages relating to
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the Department of Health and I think there are 16 pages. So it leaves a lot of questions to us in Opposition, and I am sure even to the members on the government side, if you're not in the Health Department, if you're not the Minister of Health.
Those figures - and I would know this, just having been, maybe not an active accountant, but I am a CMA, I've studied accounting - the figures are rolled up to a really high level. Everything is consolidated and rolled together, and a great deal of the spending will be a one-line item for a DHA, for example, where you have all of the front-line health delivery rolled into a single figure for that entire part of the province. I have now been the Health Critic for almost a year, three quarters of a year, but I still find the department is pretty confusing the way there is a sort of a division of duties between DHAs and what is done at the Department of Health itself - and I see other members nodding.
It really is a complex department. I think there is a lot of confusion, and then we have Health Promotion and Protection, which we will deal with soon as we go along here, concurrently, I suppose. But that, again, is another one, and I know the other day in a question I didn't differentiate between the Department of Health Promotion and Protection and Health itself, and they are really two different departments. So we always have to keep in mind that you have two separate budgets you're administering, and even though they seem like a great overlap, there are different responsibilities. So it does become a bit confusing, and I am sorry that we can't get more of the depth, but I am going to try to drill down into some of the individual figures that we have in here.
To begin with, there are a few items that are almost carry-overs from last year to an extent, and I wanted to follow up on where they are. One of them would be the support for the medical students, and the minister will know, Mr. Chairman, that that was something that we had promoted in the Liberal Party. We had noted very quickly, with New Brunswick setting up their own medical school in their own province, they had previously paid for 20 seats at Dalhousie Medical School and they were reserved for New Brunswick students. With them setting up their own - it's sort of a satellite really, because Dalhousie will still be the school administering it, but they will be studying in New Brunswick - it has freed up a capacity at our medical school at Dalhousie.
We had previously in the budget - it's on Page 13.7, Estimates and Supplementary Detail for anybody who's following along and anybody who wants to see where we are - 13.7 has a line item about the support for that program, I believe it is anyway, and again I know you have your financial staff with you today, too, who can help. There is a single line item called Physician Training Seats and it was, by way of context, it's been $3,005,000 and it's now down for this coming year, 2010-11, it's gone from $3 million to $540,000. There's a big question there about what has gone on. I know sometimes the funds have moved to another line item, or some other way of showing it, but that's a precipitous drop and I really want to know about your commitment to maintaining the program where the Government
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of Nova Scotia gets contracts with medical students and asks them to stay in this province in return for this kind of support in paying their tuition. I think it's a win-win situation.
[4:00 p.m.]
I've mentioned before - I'm not sure if it was here in the House, but I certainly have told others that in the 1950s my father signed just such a contract with the New Brunswick Government and we returned to live in Campbellton, New Brunswick, for six years because he had a commitment. I think we stayed beyond the commitment time - but he was from New Brunswick and he gave time back to New Brunswick because he had help. So this is not a new idea. It's always been difficult to get medical training, it's expensive and it takes many years, and young people need help to do that.
I wonder now if the minister is ready to talk about that program and the funding that's there.
MS. MAUREEN MACDONALD: Mr. Chairman, I think there are a couple of things that I want to say. First of all, I want to say that the existing and the ongoing training seats at Dalhousie are not being changed by this budget. There are 161 existing seats and as we go forward into this coming year, with the budget here, there will continue to be 161 training seats funded by our department.
Now having said that, that line item that the member is referring to has seen a reduction, but it's related to research and as I understand it some time ago, quite a long time ago, the Department of Health provided a grant to Dalhousie for research. This predates the AFP, the alternate funding plan, so what happens is under these plans now there is a great deal of revenue allocated for research purposes. My understanding is that, because there was a duplication of payments for research, this was one of the items that was picked up in the expenditure management process. I think in grants, when grants were reviewed from the Department of Health by the expenditure management folks, they picked up the duplicate payments that were being made for research and it was reduced accordingly, but no reduction in physician seats - it's 161 this year and 161 next year.
MS. WHALEN: Mr. Chairman, this is always the fun of estimates, when you start to peel the onion there are so many different things - like that would have appeared to me to be the seats that we were talking about, which was where the Government of Nova Scotia engages in a contract with an individual medical student to stay in Nova Scotia, so I want to go back to that. I am also interested in the research aspect that you raise, but I would like to go back and perhaps, even while I'm speaking, you could look and see - is there any money in the budget for those contracts between the Government of Nova Scotia and students who are in the process of getting their medical degree to stay in Nova Scotia? I'm thinking that 161 students that you're talking about is just the subsidy we give to the school. I may be wrong, but I'd love to have a further discussion on this.
[Page 15]
It was my understanding that although they pay something like $20,000 tuition a year, the actual cost, the incremental cost per student, is about $65,000. Are we talking here about the general sponsorship of every seat without the contract tied to the individual in tuition support to bring them back to work in our province as physicians when they graduate or to have them stay here when they graduate? So there might be two different things: one is just an overall subsidy of every single seat in the medical school, and the other would be a contract to tie them here, essentially, if they choose - those who choose, who want to have tuition support from the Government of Nova Scotia directly to pay their tuition and then stay in the province.
Maybe you could clarify the 161, because my question is really about the 20 seats that have come free and the commitment that we had that was between five and ten physician seats that were going to be contracted and supported by us so that people would stay in the province, so I need a clarification about those numbers.
MS. MAUREEN MACDONALD: First of all I want to go back to the previous question because I misspoke and I provided information that's not accurate. The reduction in that line item on Page 13.7 is actually a reduction that relates to where the funding for physician training seats is coming from. There has been a transfer from the Department of Health to the Department of Education for a certain number of seats, so that reflects that. (Interruptions) Actually it's not a transfer, we were paying for seats twice, so seats were being paid for both through the funding formula in the Department of Education and the Department of Health.
The second question you had is about resident positions, all funded by the Department of Health - we had 86 last year and again 86 this year. In terms of undergraduate positions - and I believe, let me double-check if these are the positions that have the tuition obligations that people practice - there has been no change. It was 86 last year and 86 again this year; and undergraduate seats, 75 existing and 75 going forward. Again, it adds up to 161 existing seats, so no additional seats have been added, but no seats have been taken away.
MS. WHALEN: I still would like to explore a little further about the new school in New Brunswick and the fact that there are 20 seats that were freed up at the Dalhousie School of Medicine and they have the capacity to fill those seats. There had been a lot of discussion about a year ago, or even a little more than that, around Nova Scotia filling the seats with dedicated people whom we signed a contract with - I think you understand what I'm saying. I haven't heard about the five or 10 or up to 20 seats and I don't think that the school of medicine wants 20 seats. I think they felt they couldn't expand to fill the full 20.
I was in to see Dr. Marrie at Dalhousie to try and talk to them about their work and this human health equation that we have for health specialists - we're definitely in a crunch for nurses, doctors, and every other person working in the health care field. I wanted to talk to him about what they could do to expand their services. They don't think they can take up
[Page 16]
the full 20, and their reason given was that they need to provide residency spaces for the students. So they're looking not just at the space in their first year class, but can they provide residency positions, especially if they're still supporting the ones who are doing their first four years medical training in New Brunswick. But, again, there is capacity there to be filled if they had the support of this government to fill the seats with people who want to stay in Nova Scotia and be family doctors here where we need them, at least for a few years.
So 161, you know, I appreciate knowing that number, but that doesn't address the added capacity at Dalhousie so I wonder, could the minister try to just go to that narrow part of that?
MS. MAUREEN MACDONALD: Mr. Chairman, there is a new medical school in New Brunswick now, and students from New Brunswick who previously were here studying at Dalhousie will be studying in New Brunswick, and those spaces have gone to New Brunswick. We are not financially in a position to expand the medical school, notwithstanding the fact that now they have the capacity to take additional seats.
It is a bit of a misnomer that we have a doctor shortage in Nova Scotia in terms of our overall numbers - we actually have one of the highest per capita doctor/patient ratios of any province in the country. But, what we don't have is we don't necessarily have doctors in some of the underserviced communities, so it's partially about getting people into those areas and recruiting into those areas. So, no, there are no new seats being added to Dalhousie Medical School in this budget, but there are no seats being taken away from the medical school either.
It's a scenario where we're essentially holding the line and, you know, Mr. Chairman, the member started off by acknowledging the financial situation that this province faces. This province faces a significant decrease in offshore revenue, and we're coming out of one of the harshest recessions that we've seen for many, many years - revenue has declined. So it's very expensive to fund seats at the medical school; it's a long-term commitment - and it's one we have to make, and I have no difficulty with that. We have a fantastic medical school here, an excellent dean, he's got a great vision for the school. It's very important that we support Dalhousie Medical School, but an expansion of the seats at the medical school at this time is definitely not in the cards. It's certainly not in this budget, and really it's all about our ability to do what needs to be done and what the priorities are, and this would not be top of the list.
Really, when you think about the incredible need we have to try to get our emergency departments functioning properly, and the people who are in acute care beds inappropriately out into community placements, and the services that are required to support that flow to make that system work, it's very important. Additionally, Mr. Chairman, we have to be able to allocate some resources into health promotion to improve the long-term prospects for our population to take some pressure off the health care system.
[Page 17]
So there are many, many areas of need, and I appreciate that Dalhousie has a vision and aspirations for their own ability to grow and expand, but I think it's very difficult at this time to be asking for very, very limited public resources to go in that direction.
Moreover, I think it's not unreasonable, and it's no secret that we're asking our stakeholders, our partners - and the medical school is one of those partners - to help their province deal with a very difficult financial situation and to look at ways that they might be able to contribute to some of the solutions. The problems we face are not problems that we're going to be able to address on our own.
[4:15 p.m.]
I want the honourable member to know that we do have a program under development for tuition support related to rural retention of physicians in this budget in the amount of $300,000. It's a program where funding will be provided as an incentive to medical school students and/or residents in exchange for a return of service commitment to designated underserviced and rural communities on completion of their studies. It's for family physicians as well as other designated types of specialists that are under- resourced in rural communities.
I'm also cognizant that the people who are studying in these situations will probably have access to the student tax credit that the government announced, which I think amounts to about $15,000 over a number of years if you stay and work in Nova Scotia. These measures may not be as large as we would like, but they certainly will have an impact. I can tell you, because I know a few people who are students at the medical school - and what an amazing group of young people are in those programs - there are many, many students who really aspire to stay in Nova Scotia, practice in Nova Scotia, return to their home communities. I think these measures are an indication that we will be supporting them and we value what they will bring to our province as past students from Dalhousie Medical School have.
MS. WHALEN: Thank you very much. We've uncovered a few things and one would be that there are no students right now with separate contracts to stay in the province and to work in underserviced areas. That was what I thought was in place - I don't know if other members of the House were thinking the same thing, that it had been put in place previously, but apparently it's not there. I know it's only a few seats, but I think it's important that we be clear that there are none of them now.
I appreciate what the minister said about it being expensive to fund the medical school, but right now we're funding and subsidizing every single student in that medical school and many of them will not be in our province after they graduate - they'll go elsewhere to do residencies and they will not stay here. We don't have any sort of system in
[Page 18]
place, other than the $300,000 program that the minister mentioned, to help direct them to some rural and underserviced areas.
Today is not the time to have a discussion about whether we have a large number of doctors or whether they're properly deployed. Even in the city, I can tell you it's difficult in HRM to get a doctor if you want a family doctor. I recently had looked at all the clinics and all the places in Clayton Park and there was no doctor taking any new patients. I've been checking for over a year - and I was lucky to have a doctor, but I wanted to change and there was nowhere to change to, and I had to wait until a new doctor opened a practice. I don't think that shows a great surplus of doctors in HRM at the family practice level.
We may have a lot of specialists and I think what skews our numbers is a high number of specialists because we have regional hospitals, like the IWK, that serve the entire Atlantic Region, and many people are brought here from around Atlantic Canada to the QE II. So it's not as simple as saying - and I know that the minister often says that it's very complicated, but it is not simple to say that we have a lot of doctors.
Mr. Chairman, I am just still wondering about where we might find a few of these other figures. My one first question - since I really was trying to drill down on the physician training seats - is that you said this is a funding formula that was repeated in the Department of Education, so just to double-check, if the Department of Education had been paying it and so had the Department of Health, does that mean that now the Dalhousie Medical School is getting less money than it did? Is it getting $2.5 million dollars less?
MS. MAUREEN MACDONALD: Yes, that is correct.
MS. WHALEN: Thank you, I think that must be a pretty significant part of their budget to be losing, $2.5 million - I haven't spoken to them but I hope they're going to be able to maintain their work and what they're doing because that is a big change. I wonder if there wasn't some way to cushion that but, again, you're looking for duplication and I do understand that.
I wonder if I could look again at the other research versus the research grants and the AFP and where that might be, since this was initially what you thought it might have been, and it's got to be somewhere else in the budget where we have discovered that because you're paying doctors now an alternate funding arrangement and that will include, I think, time that they spent at Dalhousie or research that they do at Dalhousie - it appears that you may have cut the grants because many of those doctors are receiving an AFP, so where would we find that, where there has been another savings evident in the budget?
MS. MAUREEN MACDONALD: Thank you, and while we're getting that information, I want to go back on physician recruitment and retention and what have you in the various DHAs and tell the honourable member that last year we had 18 new family
[Page 19]
physicians in the Capital District Health Authority recruited into this DHA, but when you look at other DHAs it's pretty dismal - it's zero, maybe one or two, five up in Cape Breton, it's a real challenge.
I appreciate what the honourable member is saying, that maybe it's no picnic in Halifax finding a family doctor, especially, I think, in some very fast-growing areas like the honourable member's. It can be a challenge for newcomers to be able to find a practice that's close to where they live. Probably one of the things that we need to do is we need to have a better system of communication, and making information available so that - I know there are often physicians out there who are, in fact, accepting new patients but it's really hard to find out who those people are. We have such a culture in Nova Scotia of word of mouth and if you come here from another part of the world, or another part of Canada even, it can be very difficult trying to negotiate your way to a new family physician.
But the other thing that we have here are the walk-in clinics - we're seeing a real growth in walk-in clinics throughout metro and, I'm finding now, in some of the other small urban centres around the province. These clinics are really fabulous in that they certainly have flexible hours, and it's an opportunity for people who need to see a physician in the evenings and the weekends to be able to get primary care. I'm told that when a clinic opens in a community where there hadn't been one before, it takes an enormous pressure off the emergency departments - the numbers in the emergency rooms just drop like a cement block.
So this, I think, is proof that one of the problems that we have around emergency room use is the lack of access to primary health care. It just reinforces our need to do that and we really need to find and incentivize, as much as we can, primary care, group practice, flexible practice and, certainly, practice outside the urban core here in metro.
The honourable member knows that I grew up in the Antigonish area. This is an area that has a fabulous history of being able to recruit and retain family doctors. They have, actually, very good numbers in that particular area. So I think we need not to overstate that every place is in crisis - there is a lot of stability in our health care system and access to health care providers. I think, as well, we need to learn from those areas and those communities, because I think that is very significant.
The honourable member had asked a question as well about where the reduction is around research and the AFPs, and that reduction, I am told, is in Other Programs, Page 13.8 of the Estimates and Supplementary Detail. If I could just elaborate so the member would be aware, there was a grant to the medical school which the medical school used to pay research assistants and what have you, which is also part of the payments to physicians through the AFP process, where they get a certain portion - well, they don't necessarily get a certain portion but there is an envelop that is paid and a certain portion of that envelop is for clinical administration and research. So, again, over the years, as the funding arrangements change,
[Page 20]
there was some duplication, but there was never any adjustment for the fact that there was a duplication.
In terms of the amount, in 2008-09 it was $3 million; in 2009-10, the year just completed, it was $1.5 million. We reduced that in the budget back in the Fall and it is now zero in this budget.
MS. WHALEN: It is interesting that it is in Other Programs, because that is where I wanted to go to next. Again, Page 13.8, which has a line item for Other Programs and it does say in the note to it: "Provides funding for other programs such as Autism, Methadone Direction 180"- which I think is in the minister's riding - " and Oncology." So I wondered if we could get a breakdown of that. I would like to know, really, what it is - and, also, it has gone down. Yes, it is down about $1.6 million, I think, from last year. So I wanted to know, really, where that was - I guess we now have identified $1.5 million, the majority of it, right? I did want to explore and see what had changed in that.
Since, again, it is a bundle of things - there could be a few others that have gone up or down, that $1.5 million might have seen another program go up a little bit, so if there are any that have moved within that, of the significant items, you may a huge list of them, I don't know - perhaps the minister could make available the list of those programs for us. I would welcome that as well, if we could have a breakdown of that, but for today if you could answer?
MS. MAUREEN MACDONALD: Thank you very much. I believe that there is not going to be a cut to the methadone programs, for example, but there was a transfer to the DHAs. I do have additional information here, that I can table, which outlines all of the things that are in this particular area, so perhaps I'll get a copy made and we'll table the copy for the member.
MS. WHALEN: Yes, I would appreciate that from the minister, because then I can look myself and see if there are any other items that jump out at me as having been altered or even to explore what they are for, exactly. I mean those programs for autism are tremendously important and I will, at another time, come back to that as a subject for discussion.
[4:30 p.m.]
As I indicated at the outset, we have a number of hours that we will spend exploring different programs, but if I had the line item on autism that would help as well - oncology is another one, clearly a very important item for us to look at. Now again, I don't know what is in that because a lot of the direct service to cancer patients happens at the DHAs, so I'm not sure what exactly is in the oncology but if you table that, and I could perhaps ask the
[Page 21]
Page to get a copy of it for me, it would be very helpful and we'll go back to that item either today or tomorrow, when we're coming back again to look at this.
I will leave that just for the moment and I want to go to the caregiver allowance, which the minister remembers we had a lot of discussion about. I think there was a lot of confusion last year about what exactly the caregiver allowance was, who was going to be eligible, building up a lot of expectation and hope for some families who applied for the caregiver allowance and didn't receive it. Page 13.15 of the Estimates and Supplementary Detail, Health estimates, and it is a line item there at the bottom, after all the DHAs are listed, under Home Care Services - there is a line item that says Caregiver Allowance Program.
I am perplexed by it and I guess things have changed, something else has been rolled into it because it was, last year, first estimated for the 2009-2010 year at $2,700,000 - we actually spent only $1,200,000, so it was underspent by $1.5 million. Then this year we bumped it up to $4.6 million, so we bumped it up another $3.4 million. So I'm not sure. We had a lot of discussion here in the House because we had constituents who were calling us. The minister knows - she probably had her own constituents calling, having applied for that program and not getting it. We had a lot of discussion about who it was really intended for and whether it was the right program, and a lot of people were disappointed.
I'm sure the minister could talk, at least initially in broad terms, about why did it not get spent when there was such a demand for the program and then, being underspent, why is it jumped up - what else have we added to it? Some other program must be in that Caregiver Allowance Program line, so could I ask the minister to please give me that?
MS. MAUREEN MACDONALD: I'm very happy to talk about the Caregiver Allowance Program and the numbers that the member has identified here. When we launched the caregiver's program, you may remember that back in the Fall session I said many times in this House that we had made a commitment in the 2009 election to have our own program to assist people, a Self Managed Care program, and a personal alert assistance program as well as - well, the Self Managed Care program was our version of the caregiver's program.
We had in the campaign said that this was a commitment that we would keep in the first year of our mandate and we had allocated a certain amount of money to cover that commitment, so that is reflected here in the increase that you see from $2.7 million to $4.6 million - almost a doubling - not quite a doubling. We are in the process of reviewing the caregiver allowance and of developing these other programs - those will be decisions that will be made in the future during the year, and there will be a rollout once decisions are made.
With respect to the caregiver allowance that was introduced in August and the member indicating that it was significantly underspent, the money that was allotted - I can't
[Page 22]
remember for sure, but I believe that we allotted funds for a full year. The program was only introduced in August, and so it was late being introduced and then there was a period of lag before the first people came into the program. We are not that far off the target in terms of the numbers of people who are intended to be assisted by that program. The department staff who designed the program projected that just slightly under 750 people would be eligible for that program in the first year, and the last briefing I've had with respect to the Caregiver Allowance Program we were at about 640 people, so we were off maybe 100 to 110 people and, at the last briefing I had, we still had at least a month or two to go in the fiscal year that we were in.
We haven't been withholding funds. We've tried very much to be fair, and what I mean by "to be fair" is that the program was designed, it had a set of criteria, and in spite of the very compelling cases that exist for people who didn't meet those criteria we did not open the program up because we didn't have the capacity to open it up to everybody who missed the criteria. In all fairness, we would have been picking winners and losers in that process, and we decided the best thing to do would be to keep the criteria where it was as it was introduced - let the first year of the program run its course, evaluate how that program worked and, where people missed out on qualifying for the program, do some consultations with stakeholders who had been involved in the initial development for the program and look at moving forward with the program.
The Caregiver Allowance Program is a very valuable program to many people in the province. We know there is a great need and a great appetite for an expanded caregiver program, and we are working toward addressing some of the concerns and looking at where we might go from where we are today.
MS. WHALEN: Mr. Chairman, I do want to explore a little bit about the 640 people who have now been accepted into the program and just get some other numbers on the old Caregiver Allowance Program. I understand that the minister says there have been consultations and a new program is going to come in, so I'd like to explore that part a little later, but if we could get a little bit more background. I now accept why you said you underspent. We started late in the year so the budgeted amount for a full year didn't materialize because it just looked - given that we knew how many people were applying and the number of people who were being rejected, it seemed kind of out of whack that we'd have half the money not spent and the government not accepting people into the program.
At the end of the day I guess I would like to know, if we could - and I'm not sure if the minister has this, although I imagine she would have anticipated this question - how many applied by DHA and how many qualified? I think that's something that we have been asking about and we got some preliminary figures during the House in the Fall when the Legislature was sitting. I think it would be useful to know where we are in terms of the number of who applied, the number who were qualified, and it might even shed light on where the demand is for the new Self Managed Care program because a lot of those people
[Page 23]
may be candidates for that as well. So, could I ask first the very pointed question about whether you have the figures on the number who applied and the number who were accepted into the Caregiver Allowance Program?
MS. MAUREEN MACDONALD: Thank you, and I'm just going to ask the deputy for his book for one moment. As of the middle of March, there were 661 recipients of the caregiver's allowance. We had 933 persons - this is, I'm presuming, from the inception of the program, from implementation until the date mid-March - referred for assessment, whether or not they would qualify.
It's very difficult to have an accurate picture just through those numbers. There may be people who were never referred for an assessment who applied, who in no way, shape, or form would come within a country mile of being eligible; there may be people out there who heard, oh, there's a Caregiver Allowance Program and I'm a caregiver, and they would call up and go through kind of an initial assessment, and perhaps they have an income that's far beyond the income cut-off so they wouldn't be referred. So these are the numbers that tell us that 933 people were taken a look at by the single-entry point - because that's where they would call - and referred for an assessment with the thinking that they may qualify for a caregiver's allowance, that they would fall within this and we have, as I said, the 661 people receiving the caregiver's allowance.
Did the member ask for, by DHA?
MS. WHALEN: By DHA.
MS. MAUREEN MACDONALD: We can provide that. I don't have that information here with me, but I certainly can provide by DHA to the member.
MS. WHALEN: Thank you very much and I would like to have that by DHA. If you don't have it, we can receive it in the next little while.
I would like to ask you now about, you know, obviously the item remains here on our line item. We know that there are - what did we say? - 661 now in the program receiving benefits and that, I'm sure, is a great godsend to those families receiving it. Even though it's not a lot of money, it certainly will help each family. I would like to know what's going to happen to them - will they remain in this Caregiver Allowance Program or do you see them becoming part of a new program that you're bringing in? Will they be grandfathered? Are they guaranteed? I mean they've already been assessed and gone through probably a pretty rigourous program. I just want to look for some assurance that they will remain in one or the other, and perhaps get the minister's view on whether you want them all in one program that you feel is more an NDP-designed program - one that you take more ownership of?
[Page 24]
MS. MAUREEN MACDONALD: Mr. Chairman, I want to assure the honourable member and assure people who are receiving the caregiver's allowance that no decisions would be taken to disadvantage people in terms of the services and the programs that they have right now. I don't know precisely the details of where caregivers will go, "Caregivers II" if you will, at this stage because we are still doing the assessment of what all of the possibilities are and these are decisions that are yet to be taken as we refine the information that we have in terms of what is possible, what would make a difference, and what is advisable.
But it is the case that certainly many groups that we have had contact within the department are very appreciative of the program, and for the people who are receiving the program, who have been able to qualify, it has served a very important function for many of those people. So we recognize that in the department, and we would always take that into consideration as we develop new programs and move forward with any new services.
MR. CHAIRMAN: Honourable member for Halifax Clayton Park, I would remind you there are about five minutes left in this round.
[4:45 p.m.]
MS. WHALEN: Thank you, I was going to mention that to the minister, that my time is growing short, and I know we have more than enough questions to finish up with this caregiver allowance, but there are so many other areas to come back to - I wanted to ask, right off the bat, have you any idea when the new and better program will be launched? A quick question.
MS. MAUREEN MACDONALD: Mr. Chairman, I have no idea when the new program will be launched; I wouldn't want to hazard a guess.
MS. WHALEN: Well, Mr. Chairman, again, the amount in the budget has gone up significantly, so you're intending to increase the program and that has to reflect an idea that a new one is going to be in place for the year - are you expecting that to be half a year that you're budgeting for again, maybe just carrying on with the 661 that you currently have and not adding more? I don't really understand, if you're that close to budgeting a dollar figure, why we don't have an idea when it's going to be introduced?
MS. MAUREEN MACDONALD: Mr. Chairman, I think we would all agree that last year was kind of a unique year in many regards - it certainly was for me; I don't know about anybody else.
In terms of the introduction of a new program, we will follow the usual pattern. We want to make sure that we have done the development work that goes into a new program, and there's considerable work. The staff in the department, particularly in continuing care,
[Page 25]
are to be commended for the tremendous amount of work that they have done over the past ten months. It is really pretty significant. So we will have a new program and we will unfold this program when it's ready, when we know what it will involve.
MS. WHALEN: I appreciate that and I guess this is one we're just going to have to watch and stay tuned as you announce a new program. But I would like to know if right now you're considering family members as being eligible for the support that will come through your new and better Self Managed Care program - and I'm using your words "new and better" because that is how it has been defined. We're hoping it will be, but I'm just asking, will family members be among those who will qualify?
That, as you know, has been a big stumbling block for many people, and I don't need to remind the minister about the people who give up their own work, family members who won't leave their loved ones without an attendant and will actually give up their own ability to earn money in order to stay home, and it's a big sacrifice for them in the long run, for a lot of women who end up with no pensions and no way to retire. They sacrifice a great deal, so I want to make sure family members are being considered.
MS. MAUREEN MACDONALD: Mr. Chairman, I would say to the honourable member that when we design and develop a new program we look at all of the possibilities; we look at a whole range of options and we weigh those options very, very carefully. We do as much research and analysis, gather as much data as we can, and we try to make as accurate a projection as we can based on the information we have in terms of what we're looking at. So, you know, we cast the mould very broadly, I would say, and then we start, as it becomes clear what it is that we're dealing with, to hone in on what exactly will be provided at the end of the day. We don't rule anything out, initially, when we look at designing a program. We have objectives and we have a range of possibilities of how to meet those objectives, but it's still too early to say what the program will look like at the end of the day.
MS. WHALEN: I know this is my last chance in this hour but I would like to ask - in your platform there was a $1.8 million commitment and it was for seniors with self-managed care, specifically seniors, and the personal alert systems, so can you give me an idea how that broke down in terms of the $1.8 million? I realize I'm going back to an estimate that was in a platform rather than what you may have, but I'm wondering if you can answer me, today, the relative breakdown of those two and whether the personal alert system is also going to be in that caregiver allowance line item?
MR. SPEAKER: Order, please. The time allotted has expired.
The honourable member for Argyle.
HON. CHRISTOPHER D'ENTREMONT: Thank you, Mr. Chairman, and I just wish the conventions of this House would allow me to give her my next hour and she would just
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keep going because, ultimately, I think she had a number of great questions and I do want to thank the member for Halifax Clayton Park for her questioning, but I will probably move around to some different things and I'm sure she'll pick it up as the next hour rolls around.
First of all, I want to welcome the minister for her second round of estimates as Minister of the Department of Health. I do want to welcome, of course, her deputy minister for his second round, but congratulate him this time because when he was here last time he was acting deputy minister and this time he's full-fledged - I don't know if you got any more money for that, but I'm glad to see you here. Linda Penny, it's always good to see you here again. She is second to none and the dollars that are in her head - I tell you, the numbers would scare anyone - to know the dollars that she keeps track of within the Department of Health.
Mr. Chairman, I do want to hit on a few of the interesting parts within the department, things that may be left over from my time as minister, things that were started by our government and things that, I think, have made life better for Nova Scotians in the long term. Of course, I'll probably be talking a little bit about the Continuing Care Strategy and maybe get an idea of where that strategy is today when it comes to bed placements and, of course, the other programs that are within it.
I'll probably be talking a little bit about the Pharmacare Program and, more specifically, the Family Pharmacare Program, one that I was very proud to stand with Premier Rodney MacDonald at the time and bring that to Nova Scotians, as well as talking about HealthLink 811 and how proud I was to see the phone lines turn on when the minister announced that over in Burnside - it doesn't seem so long ago, but we're getting close to the year when you really get down and think about it - and maybe have some idea of the benefits that Nova Scotians are reaping from this very important service.
Mr. Chairman, as you know, for many years now I've been advocating for the Continuing Care Strategy in the province and I was very happy to start a process in what we felt was the largest construction of health facilities in the province for many years, with the addition of about 800 beds in the province.
MR. SPEAKER: Order, please. The chatter in the Chamber seems to be rising a little bit and it's getting hard for the member to pose his questions.
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I've been sitting here for many hours and I didn't even notice, so thank you for that.
AN HON. MEMBER: You're delivering it.
MR. D'ENTREMONT: Normally I'm delivering the noise, yes, I know it's probably the most civil you guys have seen me in probably the last number of months and actually
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some of my first Health questions really in this sitting - and to tell you the honest truth, I haven't had many issues with the Department of Health over the last bit - and I do want to talk about, specifically again, when it comes to the long-term care facilities and the process that is forward.
So I was wondering - maybe I'll give the opportunity to the minister to give us a little update on long-term care construction and then she knows I'll probably go toward a couple of the facilities that are in my region - so maybe an update on long-term care.
MS. MAUREEN MACDONALD: Mr. Chairman, first of all, I welcome the honourable member to the discussion about our budget, and I know you know a lot about the department, having been a former minister. I know that continuing care is an interest of yours, and I suppose a legacy as well in many respects - the Continuing Care Strategy as well as the 811 line, a very good move indeed.
Long-term care represents 13 per cent of the health care budget. I don't think that really has changed proportionately from when you were a minister, and it constitutes $472 million - a fair chunk of change. The Continuing Care Strategy will have committed over $260 million by 2016 to enhance home and long-term care. In total, 1,320 new long-term care beds will be added by 2015, and this will be in addition to previous commitments: 125 new beds in Cape Breton and 150 beds in the new Northwood Bedford facility.
I would say to you and all members, I toured the Northwood facility a few weeks ago and it is phenomenal. I said, I have my room picked out. It is just unbelievably beautiful. I was there with the member for Hammonds Plains-Upper Sackville, and he has his room picked out as well, but he is going to have a long wait. (Laughter) We'll put him on the wait list for a long time.
Now I know the member is interested in knowing where we are in terms of getting to completion, in terms of getting beds up and opened - 840 new beds were committed to be opened by March 31, 2010, and the remaining 480 beds were committed to be opened by March 2015. We are not going to have the 840 new beds opened by March 31, 2010, but we're going to have quite a few new beds by March 31st. We're going to have 362 new beds opened then and 360 more will open by the end of this fiscal year.
There have been some delays, as there often are when you're undertaking so many construction projects around the province, and they've all been - I shouldn't say that they've all been different, but in some communities there have been issues that have come up in terms of trying to get the right design and to bring a project in for the amount that has been budgeted for. It has been a challenge, but I have to say that as tough as it has been from time to time on some of the projects, the staff in the department and the people in the community are very dedicated and are very purposeful in ensuring that they complete a project and they do the right thing for their community, that there is a meeting of the minds that happens
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there, even though there may be some bruised feelings once in a while in the give and take in the planning of this.
We have staff in the department who aren't spending their money, they're spending the public's money and they need to ensure that we're getting as much value for dollar as we possibly can. You have the folks in the community, and they are - it's not that they're irresponsible around money, but money isn't their primary consideration. Having a good health care facility for their loved ones, their seniors in their communities, is their motivation.
I find it's quite a dynamic process and it's going quite well. There have been delays along the way, even the Northwood project, I don't know how many dates I've seen scheduled for the opening of the Northwood project. I was kind of rushed out there to get a tour before it opened, to see the facility, and while I was there I think I was given perhaps today's date as the date for the opening.
[5:00 p.m.]
It's been an interesting process. For this year, new and replacement beds, I'm told there will be 797 at an operational cost of $39.3 million - an increase of $39.3 million. One of the things that people want to know is, okay, so we have a financial problem and challenges in Nova Scotia, yet the health budget grew by $212 million - why is that?
Partly why that is is we still have to provide health care services. We know that many long-term care facilities were old and didn't come close to meeting good quality standards for care, and without those standards workers get injured, our Workers' Compensation costs go through the roof, and the quality of care for seniors can be jeopardized. We need new facilities, but when you bring new beds and replacement beds on stream, quite often your operating costs will go up.
But I have to say, these facilities, the ones I've had the opportunity to tour, are just phenomenal. They are the kinds of places that our seniors deserve and our health care workers deserve. I think people will be very happy in terms of the quality of health care that they will receive in these facilities.
MR. D'ENTREMONT: I appreciate the answer on that one. I also can see that this is a major concern for the minister and I know she will do her best to make sure seniors in this province are treated with respect and in the facilities that they deserve.
I too had the opportunity to visit many of the homes. There was a list of people who wanted the minster to visit their facility and list off the deficiencies within those facilities. I can tell you, there were a lot of places that you went to and you sort of shook your head, which ensures even more that you would make those changes in those areas. I don't have to
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go very far from my community to visit Ville Saint Joseph-du-Lac, to visit Tidal View Manor, two of the replacements that we do have going today. Ville - a great history for those of you who have visited Yarmouth on many occasions - as you go up Lake Milo you see this beautiful facility at the end of the lake. This was an old CP hotel and it was converted into a long-term care facility.
Now, 46 years ago, when the sisters first started the facility, the care needs were far different; today we ask for a Level II facility. I know the Minister of Fisheries has been to the Ville on a number of occasions as well. It's not just a bad situation for the residents who have to climb down stairs - as you'll remember, some of these hotels are half floors and all kinds of stairs and when you're in a wheelchair, or your mobility is challenged, the opportunity to get down or visit in the common room is very infrequent. As the minster was saying, the workers' incident rates go up because they're trying to lift and move and do all the things they shouldn't be doing, because the facility is not adequate.
Mr. Chairman, the numbers are looking good. I can't say they are perfect, but they are looking good. If I was ever to have a "do over" on processes - because I can tell you as processes were presented to us when we were looking at the construction of homes in the province, there were many aspects that were brought to us, and not being an engineer and
not being an architect, it always felt it was good to have some of these people in it, and today I would be less than happy with some of the processes that have been in place, because I've seen the impact of a lot of discussions and maybe lack of oversight. And I don't mean that in a mean way, it's just that there was so much to do with the staffing that we've had that we did have to farm it out to other organizations to try to take care of.
Through the process, and I'll get to the example, it was really difficult for those community groups to know who was working for whom. I think in some cases, not being those professionals, that people have fallen into some traps. The Elms, I know the member for Hants West will be talking about the Elms when he has the opportunity and I'll be talking about Nakile later on - I think we've fallen into some traps in some of those places. You really can't blame anybody for it, but I think the process - if I had to do it over, I would have changed some of the processes that were in there.
The Minister of Fisheries would know also, even in the construction of his facility, the biggest log-jam was really the engineering and the architecture, to make sure that we had the information to meet the specifications that were set forward, so there were a lot of things there.
I will go closer to home right now and talk about Nakile Home for Special Care and the ongoing saga of the 22 beds, the 12 beds - and now who knows what beds? I am just wondering, maybe you can provide an update on my specific facility, Nakile Home for Special Care.
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MS. MAUREEN MACDONALD: Mr. Speaker, right off the top I would say we are committed to working with Nakile. There is no question that there is a need in that area, and it's not just about a need - there's a need, but there's also an existing operator who is very competent and appropriate to be providing services.
As I understand, this home for special care had a 12-bed allotment that was increased by 10, so a 22-bed expansion and then, because of budgets, the difficulties of bringing the project in at 22 beds at the budget that we have available, then a decision was taken - a difficult decision for that board, I recognize that - to scale it back to the initial 12-bed expansion.
I believe that tenders have gone out, have they not? No, tenders still have not gone out. We're working, I think, toward that process, to be able to get tenders out for that expansion.
Let me say this - the money isn't going away. The money is in the budget. The money is there, the commitment is made with the operator, and it's back to what I was saying earlier - the staff in the department are totally dedicated to getting these projects done. I think there will be a big party in the department when some of these places have been able to complete their projects, because then, frankly, we'll be able to go on and focus on other areas of need and other things that need to be done.
People are working really hard, and I want to assure the member that if there's anything I can do to facilitate that process I certainly will, but it is also the case that I don't have money under the cushions to grease the wheels and make it happen quickly. We do have a budget and we do have to bring the projects in on budget.
It's a very expensive undertaking, the whole Continuing Care Strategy, and we have a long way to go yet. We'll continue to work with Nakile, and I think at the end of the day everybody will be happy because, as I said, these new expansions are phenomenal and people are genuinely so happy to see that they can provide a better-quality living arrangement and working arrangement for people in our communities. These projects will hold us in good stead, then, for a number of years forward.
I don't know if that provides the level of detail that the member is interested in, but we'll start there and then we'll see what else is required.
MR. D'ENTREMONT: I do appreciate that update. The added piece that maybe I would ask is that I know that the administrator and the board chairman were in to see the deputy, probably a month ago now, and the concern that they brought forward really wasn't the - I mean, I think they have faith that things will get worked out and we will have the 12-bed expansion move forward, the concern that they have today is that through this process they've accumulated somewhere close to about $600,000 worth of debt. That was attributed
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to the project manager, some of the architecture, and a water problem we've had Nakile - it was always there at Nakile and, as a matter of fact, probably if we would go back 30 years or 20 years when Nakile was first put in, I think they probably would have picked a different site because of the water issue that's there.
The concern they have today is that they have this debt, they're sort of stalled in trying to figure out the cost containment and trying to figure how to get the tenders out, that they took out this mortgage - I believe it was at Royal Bank - for somewhere close to a million dollars, where they've spent approximately $600,000 of it. It was basically a term loan and that term loan is due at some point this summer, so as time goes on I think they're taking dollars out of their operating budget to pay the interest on that loan. Normally what would have happened is, because the construction would have moved forward in a timely fashion, once the service agreements were done, construction began and all those dollars could have been rolled over in the new mortgage for the whole facility, but since that hasn't happened they're now holding the $600,000.
I was wondering if you're aware of those dollars - and I'll keep talking until you have the full information in front of you - and I'm just wondering if there's a way to help Nakile so that they're not taking out of their operating budget to pay for this leftover loan that they can't roll over into the new mortgage until such time that they can begin that construction.
MS. MAUREEN MACDONALD: Mr. Chairman, I am advised that we don't have the ability to advance loans to private operators, any operators that don't have a mortgage. I guess the mortgage is used as a way to secure in some way your interest in a venture. I do know that this was an ongoing concern even back when we were having the discussion about 22 beds or 12 beds or what was going to happen. As I said earlier, I see the staff, the deputy and the staff that he directs, as problem-solvers. They really have proven themselves over and over again in terms of problem-solving, and they're there to look at the problem as it exists and to look at what our ability is to address those problems. There's a lot of give and take in these processes, but at the end of the day I have not seen too many problems that haven't been sorted out through that kind of process.
I thank the member for bringing this to our attention, and I am sure that we will embark on some process to see what, if anything, can be done.
MR. D'ENTREMONT: Mr. Chairman, just to give you a little history on that. Originally what would happen is that for 30 years the department advanced money for construction and we were informed, when we were in government, by Treasury Board all of a sudden saying you can't do that and it's like - and I can' swear, but I said something else other than what I should say in this House - it ended up that all of these independent organizations had to take out loans in order to get some of the work done, the preliminary stuff, in order to move into the mortgage when such time came. So, anyway, just to say that Nakile was caught in a little bit of a conundrum here and needs a little bit of help to get
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through it. I know that the deputy is aware and you are, and I am sure that the staff will find a solution to it.
[5:15 p.m.]
I also want to thank you for your comments around the new Northwood - or what do we call it now? Northwood Hammonds Plains? I don't know what the new name for it is - in Bedford. Mr. Chairman, it was actually kind of funny, the last time I was there was when the construction was just getting going and the foundations were just getting going, and at that time there had just been a press release by the Official Opposition of the time, and it was really nice of the Official Opposition to put out the press release wondering about the new Northwood - there has been nothing going on - and I was really happy to bring to the House pictures of the foundations that were put in. So, I always got a kick out of that because that really - you know, a lot of times we get to have fun here and that one was actually kind of fun.
But I do drive by the Hammonds Plains Road quite often as I head home. If I do run down to Bedford to visit my family, or drop into Bicycle Plus, I do head up the Hammonds Plains Road and what a facility. I think Nycum and Associates, who are the architects on this job, have outdone themselves - and when you drive by, for those people who really don't know what that organgy, yellow, and a whole bunch of colours, building is as you drive by it, it is made in such a way that a senior who is in the facility can say to their grandchildren or relatives who are coming to visit them, I live in the second floor in the brown one with the hatch roof and, honest to God, you go there and it is that one with the round window, because that is how they designed it on the outside.
The inside, and I have only ever seen the foundation so I can only imagine from the visualization that Ben Nycum was able to give us that day, okay, this is where the great room is going to be, this is where the courtyard and this is how things are going - wow, it is a design that I think will last forever and, knowing how it was built, it probably will. It is probably better than any bomb shelter I think we have ever had in the province because it is a lot of concrete. But it is going to be a home for - I forget how many residents, but it is quite a large facility. But if it does open, I would love to get to see it sometime; I really would like to see that.
I'm gong to change a little bit to the French language policy for a second, because also as being the Critic for Acadian Affairs and, of course, having brought in the French language policy, and I'm not going to use names in the House either, but I was brought this file just the other day, an individual who was brought to Nakile and Nakile used a vacation bed - and we know the problem with using vacation beds, sometimes people get comfortable in those vacation beds because they were there for a month and, of course, expect to stay, and stay longer. But the problem that I think I have seen here is that that person, even though they are in a vacation bed, could have turned down the first placement and waited until another
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appropriate placement, whether it be at the Villa Acadienne, in Meteghan - this individual is 92 years old, speaks French and would like to stay in the area.
Unfortunately, this individual - and I don't know whether the assessment staff provided them with the right information or not - ended up in Mahone Bay, and I know that the member for Lunenburg West would love to have more population in her area as well, but if I remember correctly he does vote Liberal, so I don't think it would help. Anyway, there you go. But, ultimately, now an individual who is from West Pubnico who finally had made his decision to go to a long-term care facility, who wanted Nakile, or Villa, or Tidal View if he could, has ended up in Mahone Bay. I'm just wondering how the French language policy didn't work in this case - I'm just wondering if you have maybe an update on some of those placements?
MS. MAUREEN MACDONALD: As the honourable member knows, I can't discuss any individual cases, but certainly this is something that I'm prepared to investigate and talk with the honourable member after the session this evening, or later on in the week.
We are very mindful in the department and in the district health authorities of the diversity of our province and of the absolute importance of treating all of our seniors very respectfully, particularly when it comes to their first language - and being able to provide services to francophone members of the province is very, very important.
I have to say I perhaps erroneously make the assumption that things are going well because I hear so few criticisms, or not criticisms but I'm not called on frequently to intervene in any way in these situations. I know that my colleague, the honourable member for Halifax Fairview, who is also Minister of Acadian Affairs, has been briefed several times in the department on various specific issues, because sometimes things come to him in his capacity as minister and he feels, as well, very strongly that we have culturally appropriate health care services in particular.
If there's ever time that people are vulnerable, it's when they aren't at their best, when they have health care needs, and so I think this is very important. I can't imagine how disorienting it would be to find yourself far removed from your community and then not to have your culture represented in either the language or customs, understandings, that kind of stuff. If the member would like to provide us with additional information we'll certainly look into it.
Then the larger question of respite care and opportunities to place people is something that I think we can certainly talk about more broadly as well, because we have so many Acadian communities around the province, with some very great distance between Cheticamp and your end of the province - that's a long way - and it's important that we have probably some fallback positions if we find ourselves in a situation where the facilities, and this is the world we live in now, where it's not unusual for a facility to be full to capacity,
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but what ability do we have, what are the wishes of the family, what are the wishes of the individual?
One of the things that I think I'm hoping will be a really useful feature of providing health care is now the personal directives where people can - and I'm hoping that all of us take responsibility to learn a little bit about how these personal directives work, and getting the word out to encourage people to make their wishes known and to get those forms filled in before you get into a situation where you have lost the capacity to be able to act on your own and make your views known. And I think, particularly for members of populations that exist in our province in a minority status, it's really important to have those personal directives - it gives a very concrete representation of the will, of what the person wants.
I think it will influence caregivers. Caregivers in this province will bend over backwards to meet the requirements of the person who needs care, if that can be articulated in some way by the person themselves. It makes a big difference if they think that comes from the person themselves rather than the bossy daughter who's here from Toronto for the weekend, or whatever - you know what I mean? So, I think, let's use those personal directives as well.
MR. D'ENTREMONT: That was always a concern too, that when the French policy was designed the challenge we always had was there had to be a fallback to it. If you're saying you have Nakile, you have Villa, and then in the next francophone one, I think it's actually Pomquet - I think there's some stuff going on there, I'm not sure - and then Cheticamp or Arichat, somebody in Argyle, being Acadian, ending up in Arichat, even though the language is pretty close, culturally it's still different because of the way the Acadians were expelled and brought back and being in such large distances in this province.
I will bring the name forward to you and see if there's anything we can do, or just to get an update. I understand first placement, second placement, and eventually trying to move the person back to the facility of choice. Heck, I also know the issue that sometimes people get comfortable in places - I know a number of individuals who were actually from Bridgewater and they ended up in Meteghan and didn't want to move out of Meteghan. They thought that was pretty good, they liked the people there, they liked the care they were receiving and didn't see a reason to have to go back home. It's always a funny little world to be in.
The final point on long-term care for today, as I requested through your senior policy advisor, a meeting for next Wednesday for some individuals who are looking at another long-term care facility in the Yarmouth area - there's an existing facility that might be apt for renovation or change of usage. That's about as much as I'm going to say today on that one, but I'll talk to you a little more after, as well, to see if we can make that happen for these folks next Wednesday.
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I'm going to change to orthopaedics for a minute. I know we can talk to wait times and I can talk to the 2004 Accord of First Ministers and talk about the five priority groups, blah, blah, blah. I know we've done really good in a number of those fields and we've really fallen back in a few of them, and are just as much to blame for some of the things that we're seeing today.
I did though, think that we had done a good job when it came to the assessment clinic for orthopaedics through Capital Health. Yet, when I do sometimes hear from constituents they say I'm waiting to see the specialist for the first time or I'm waiting for shoulder or elbow or whatever surgery they're waiting for, and I'm still hearing it's been 18 months, it's been a really long time, and the idea of the assessment clinic was that at least they could be seen in a quicker manner and be triaged out to the most appropriate service that they needed. We all know that half the people that ended up in the orthopaedics line didn't actually need a full replacement, they needed some kind of physiotherapy, they needed some kind of scope - they didn't need the full meal deal.
I'm just wondering where that process is, if it's up and running, what kind of patients they're seeing today and if we're seeing a reduction there or not? At this point I'm not seeing the benefits that we thought would accrue from that process.
MS. MAUREEN MACDONALD: I thank the member for the question. This is quite timely. I met not so long ago with the CEO from the Capital District Health Authority and other members of her staff. They have a new person there responsible for patient-centred care, a real crackerjack in terms of a problem-solver, somebody who sees the problem and says I don't need to know why we can't do it, what I need to know is what we can do. I'm very optimistic that we're going to see some really good things occur with respect to reduction in orthopaedic waits.
I think there are a number of things in terms of - like everything in health care nothing is simple. It's always complicated, there's always more to the story than the 30-second sound bite. There are different kinds of wait times. You can go to your family doctor, you're in pain, it's been going on and on and on and your family physician refers you to a specialist - that can be just an horrendous wait.
[5:30 p.m.]
However, as I understand it that wait has been reduced now, in fact, because of the assessment clinics. You get referred to an assessment clinic, which has a group of multi-skilled providers - it can be a nurse, a physiotherapist, there are different health care professions in the clinic - and they do an assessment and they triage, and this can result in people with the most serious pains and difficulties getting to see a specialist much more quickly. These waits to see the specialists have actually been reduced, certainly for some people - people with the highest need, the highest range of needs.
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We're still not doing very well in terms of people who have low - it's not that they have no need, Mr. Chairman, it's that they aren't on the high end, they're not people who are in constant pain, perhaps unable to get around their kitchen, stand up long enough to make a meal. It's been a very successful program in getting people to see the specialists, especially at the high end.
The next problem is getting people into surgery, getting the list of people who have high need, getting them into surgery - and doing something about the cancellation of surgeries, because I may be on a list, I may have waited for six months, I may have my surgery scheduled, I show up, there has been an automobile accident or there has been an ATV accident, you have somebody who has trauma and these folks have to be taken to the OR. I've prepared myself for months for surgery and then just in the last day or two I've gotten everything organized, I've taken time off work, I've rearranged my life and my surgery is cancelled. So there are different problems.
One of the things that's going to happen as a result of this budget and the discussions with the Capital District Health Authority, in fact, is we're opening up an additional operating room over at the Capital District Health Authority for trauma surgeries. This won't displace, and I suppose if there is no trauma it means you can book.
They're also doing some other little initiatives that could make a huge difference. For example - and I'm trying to remember the technique - rather than bringing somebody into the hospital and cancelling their surgery on the doorstep, it's having the information in advance, the evening before at least, and not putting people through the trip of coming to the hospital, sitting there and finding out that their surgery has been cancelled, but getting the information a bit in advance.
One of the commitments our government made in the election campaign was to set up pre-hab teams to reduce waits for surgery. We have put in this budget $700,000 toward that and these teams will be in the other three DHAs that do orthopaedic surgery - Annapolis Valley, Pictou County, and Cape Breton. So Capital Health, as I said, they already have one, and it's working well. They have a plan to do some additional things to reduce their orthopaedic waits, and this is what will go forward in the other DHAs.
Now, if I'm not mistaken, we added a third orthopaedic surgeon in Pictou. (Interruption) Yes, and they are actually looking for a fourth, and it's something that we certainly will look at, you know, because we do have these wait times. We have this initiative to set up a better management of a centralized understanding of our surgical wait lists all over the province. We have the surgical network and I think we're really moving forward in lots of ways with different small initiatives that will make the use of operating facilities more efficient, and everybody in this system understands that this needs to happen. The time that, let's say, a surgeon thinks belongs to him or her is not his or her time, it's the patient's time, and if for some reason they aren't going to be able to provide these surgeries, they don't get
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to trade those surgeries to whom they want to have them - their buddy Fred, whom they golf with.
We have to get those times into the system to get the orthopaedic wait list down, because in many other areas we're doing very well in Nova Scotia in terms of wait times. With the investment in radiation therapy, we're going to meet benchmarks. We're already doing quite well in a number of areas, and it will improve, but orthopaedics - I can't run away from the numbers; they are what they are. I met with the Capital District Health Authority Board earlier this year, and I was very blunt. I said I need to understand why you're not able to get these wait times down, and I expect that they have to come down and I want a plan that will get us there. They were very good, you know, they were very good; they have put together a plan and I will continue to monitor that plan very closely, because we're dead serious that we need to provide more effective access to treatment for people with orthopaedic needs.
MR. D'ENTREMONT: Thank you very much, Madam Minister, for that. I understand the challenge, because I spent three years trying to figure it out as well. Mr. Chairman, every time that you felt that you really were making a gain, another thing came up that really pushed it back another two steps. The added point is that when you take a district like the South Shore or SouthWest, who don't have the orthopaedic programs, they have to depend on Annapolis Valley for their services. Annapolis Valley doesn't have the assessment clinic at this point, and so I'm hoping that as we learn the things here in Capital that that service can be rolled out to Pictou County, to Annapolis Valley, and to Cape Breton as well, because I think there's definitely a value in it - the pre-hab teams absolutely.
I don't know how many constituents I've heard from over the last seven years who've said, I was on the stretcher, I was ready for my surgery, I had taken my three weeks off, or whatever it was that I had to do to prepare myself, I got there, I was hooked up - some of them were even in the OR and had to be wheeled out because something else came up. Anything that we can do to reduce that will create an efficiency within the system because all that time would have been taken up by getting that person prepared.
The OR system was one that I believed in as well, so I am hoping that we will see added investment there to better utilize the resources that we have. It never made sense to me that we had an overload here in Halifax, at either the Infirmary site or VG site, and you had nobody in Windsor, or you had nobody operating in Bridgewater. I mean, everything is within that relative one-hour area that from a travel standpoint wouldn't have made much of a difference, but had you used a specific OR for two hours, that's two hours more of OR time that we wouldn't have had otherwise.
Yes, there are dollars attached to it, but I think we're paying for it in another way. So it is good to hear that some of those things are ongoing and, of course, I wish you the best and if there is anything else that we can do to help out with that one, I know we will try to
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provide it as well. But it is not a simple issue, just like every other issue that you have to deal with on a daily basis.
I am going to change to physician seats for a minute because I know that the member for Halifax - why do I mess that up? Clayton Park and Fairview to me are so close, they are close, you sort of drive through Fairview to get to Clayton Park - the issue of physician seats, and I heard the number of 86 and I'm trying to go back to my discussions with the dean of the day, Dr. Cook, and if I remember correctly, when we basically made the deal with the Liberals to bring in those extra seats, and I bring them full credit for pushing the government of the day, there were 20 seats that we needed to work.
Now, there were sort of two groups of seats, if I remember it correctly, one of them was basically out of the New Brunswick seats, so existing seats that are here that we were able to glean because of one reason or another, and then there was an expansion of ten seats. The facility is such, in the Killam Building at Dalhousie University, that they could possibly accommodate 100 students total, without dramatic change to their facility. I don't remember my numbers exactly, I don't have my briefing book from two years ago, but if I remember it correctly, it was a number that should have been more than 86 - I don't think it was the full 100 that I had committed to, but there should be closer to 90 or 92 and then a few seats out of the regular core of seats that would have been there already.
So I am just wondering, a little further clarification on that, given some of my recollection on that discussion with Dalhousie University at the time?
MS. MAUREEN MACDONALD: We're going to have to get information out of the department that we don't have that goes back further than last year, essentially. But I will say again to the honourable member what I said to the member for Halifax Clayton Park, that we are continuing to fund the same number of seats at the medical school that we have funded all along. There will be some reduction in funding because we discovered that there was some double funding coming through. I recognize that there was probably a little bonus that the medical school had for a while that they are not going to have.
I think that the important point is that we need to be clear that we are committed to seeing that there were seats added and those seats have gone from being undergraduate students now to being residents, and the money continues to follow those students along, so there have been no cuts to that cohort of people who were added. And, additionally, we continue to have the same number of people coming into the system as we've always funded in terms of the number of people at the system. We will get some background information to go back a bit.
Speaking frankly, I think one of the difficulties I've had in understanding this - and perhaps other people, the deputy being new - there wasn't a lot written down about what was being provided. Without really a clear paper trail it was very hard for us. As you know - you
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went into the department as minister, you probably encountered the same items - decisions get made and they're implemented and the paperwork is intended, perhaps, to be done later, and because of all the other things that go on it never gets done. And unless you have an institutional memory on everything - frankly, the portfolio of this department has gone from $1.8 billion to $3.6 billion, so I think even the best institutional memory on the planet is not going to know what that is unless everything is really clearly documented.
[5:45 p.m.]
MR. D'ENTREMONT: I appreciate that and, to be frank, I have trouble keeping my bank account balanced, so I can only imagine what kind of work it is. I'll be up front right here, I don't owe any bills - I didn't take any money from anybody, blah, blah, blah.
The last question I'll ask, because this will probably take it up anyway, will come to DHA funding and, like I said, you have a very capable deputy minister, one who spent a considerable amount of time in the DHAs, one who understands the challenge of providing a business plan on time to be considered. The absolute bane of my existence during my time as Minister of Health was trying to bring in those damn business plans on time, and every time that you seem to be getting closer, boom, it was October, boom, it was November, and you were really working on your new business plans for the next year. I'm just wondering, what sage advice you are going to be giving the DHAs to make sure that their business plans are available and on time and approved?
Now that I sit over here I can actually ask the question, just like you guys did when we were in government, and I know the Liberal Party will be asking the very same question. So, business plans and DHA budgets on time, how are we going to get that to happen?
MS. MAUREEN MACDONALD: Well, the first thing I want to say to the honourable member - and I'm really glad he did raise the DHAs in the brief time that we have left - the Department of Health's budget is $3.6 billion now. DHA budgets make up $1.5 billion of that, so 43 per cent of the Department of Health's budget is DHA budgets. It's obvious why that would be - it's because they operate the big acute care, the tertiary care, the QE II, all of the regional hospitals, all of the small community hospitals.
They are the places where drugs are bought for people who are in those facilities, and transplant recipients often get their drugs in the DHAs, and they have many other programs and services. We've devolved to the DHAs the coordinators for continuing care, for example, and eventually long-term care, continuing care, is going to be in the DHAs - hopefully in the not-too-distant future. Mental health services are in the DHAs, as well as addiction services, primary health care services, and public health and care coordination.
So they are very significant players in the delivery of health care in the province and they consume a lot of the resources. I have had the opportunity to tour many of the DHAs -
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not all of them, I'm still working on that - and I've been very much impressed at the work that goes on in the DHAs.
Now, the member makes reference to the draft plans, or the business plans, and the difficulty of getting approval for business plans. I want the member to know that we in the department have received all the draft plans from the DHAs for this year. Many are in the final stages of being approved and we are working very diligently to bring the budgets, the DHA budgets . . .
MR. CHAIRMAN: Order, please. The time allotted for the Progressive Conservative Party has expired.
The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: Mr. Chairman, there will be many more hours to pursue those thoughts, so I'm sure the member for Argyle will come back to it.
I had left you with a question at the end. We were talking about seniors and money that has been allocated for seniors' projects and improvements - one was in your platform, $1.8 million for self-managed care and also the personal alert program - I was asking if you could split them up and let me know, relatively, how much was allocated for each one and, again, are those two items both to be found in the Caregiver Allowance line in the budget?
MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member for Halifax Clayton Park, the campaign promise that we made, indeed, was for personal care allowances, self-managed care and personal devices, safety alert devices - $1.8 million was the estimate that we had given for that item. We hadn't broken it down into an allotment for either one of those things, and as we prepared our budget, we just went through all of the commitments that we had made for this current year, the costing that we had done for them, and we added them into our budget planning process. So that $1.8 million has been rolled into the caregiver's allowance and is why you see an increase, but in terms of how it will be apportioned as those programs are developed, I can't tell you at this stage.
MS. WHALEN: Just to absolutely be confirmed, it is $1.8 million that you've added to that budget, it has gone up to over $4 million, but there was an underspent portion last year and maybe you're carrying that forward - am I right?
MS. MAUREEN MACDONALD: There is a projected utilization increase reflected there of $300,000 with respect to caregivers.
MS. WHALEN: I only have a couple of minutes, but I would like to touch on the diagnostic equipment. You certainly had talked about the new digital mammography machines. I think that's a great thing to have coming and we are a province where we had -
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I know we're aiming to have some of the highest, if not the highest, utilization of women receiving mammograms at the right time, it's not always annually, but to make sure that they are being screened on a regular basis depending on your age. So I wonder if you could say again, what is the plan for where those are going to go and the amount of money allocated for the digital mammography?
MS. MAUREEN MACDONALD: Mr. Chairman, I think the first thing I would say is that the actual digital mammography equipment, the new additional machines are coming out of the 2009-2010 equipment budget. They were actually part of the capital equipment we had for this year, yet to be spent, but we went through a process of identifying what the equipment needs and priorities were and a decision was made that this would then bring - there wouldn't be an inequity in the services around the various breast screening clinics around the province. This would bring us completely up to date. I think we would probably be the most up-to-date screening program, certainly in the Atlantic Region and perhaps we'd be far ahead of other smaller provinces such as our own.
The units are going to Bridgewater, Truro, New Glasgow, Amherst, and Antigonish. Capital Health have bought their own, they did that large fundraiser, Bust a Move, and they were able to get their own. This, in many respects, is a no-brainer and it is a significant investment in capital equipment, but it's also a significant investment in women's health. I'm really delighted that we were able to do this.
I know that the capital equipment needs are great. There's always a next generation of diagnostic tools coming forward - I'm being given the sign that it's time to adjourn debate.
MR. CHAIRMAN: Order, please. The time allotted for debate of the Committee of the Whole House on Supply has expired.
Is it agreed?
It is agreed.
Would all those in favour of the motion please say Aye. Contrary minded, Nay.
[The committee adjourned at 5:56 p.m.]
