MR. CHAIRMAN: Order, please. Before the committee this afternoon we will continue with the estimates of the Minister of Health.
The honourable member for Dartmouth-Cole Harbour.
MR. DARRELL DEXTER: Thank you for this opportunity again to speak with the Minister of Health with respect to his estimates. I think perhaps he may have addressed this question before and I want to ask it again, I don't recall his answer and perhaps didn't have an opportunity to hear when he responded to my colleague, the member for Dartmouth East. It has to do with the line item in the budget with respect to hospital equipment and I guess what I noticed about it is that there is no line item for hospital equipment. I was wondering what that means to hospitals and why this is. I think to some degree I understand what it means that it may be in part that they are relying on receiving funding for hospital equipment from other sources, but I would like him to explain it if he can.
MR. CHAIRMAN: The honourable Minister of Health.
HON. JAMES MUIR: The practice now is to roll what normally would have been isolated as capital grants into the operating lines to give the facilities more flexibility.
MR. DEXTER: I wonder if you could indicate to me whether or not it is a change in the policy of the department. My understanding was that the various hospitals had, in fact, very separate budgets to prevent them from using money that would otherwise be used in capital to be used in operating.
MR. MUIR: That policy has been in effect for some years now.
MR. DEXTER: Does he know then how much has been set aside for hospital equipment, capital grants, in total? I understand what he is saying. He is giving them the option to spend it, I assume, on equipment or to use it in operating, but he must have at some point in time come up with a figure in terms of what the department felt their commitment was to hospital equipment.
MR. MUIR: Mr. Rafuse, who can help me find that information is on his way and perhaps if the member could give me another question, we can come back to that one.
MR. DEXTER: I have a series of questions that I wanted to deal with, with respect to your deputy minister. I know that when we asked in the past about the costs that were associated with the new deputy, at one point in time I believe the reply was, well, all of those costs aren't in yet and we haven't received all the bills. Have you now received all of the accounts with respect to bringing on Dr. Ward? If you have, what are the totals and do you have them broken out? If you do, will you table them?
MR. MUIR: The deputy is basically hired by the Premier's office as opposed to the Department of Health. The budget items probably were picked up in here, but I will have to get that information for you.
MR. DEXTER: I think I saw the Minister of Finance just pointing out to the Minister of Health although they are hired through the Premier's office, they are actually paid through the Department of Health. I have a number of questions in respect to that and you will have to tell me if it is the fact that you don't have this information in your departmental budget, but I would want to know what his salary is, what you paid out in terms of moving costs, what vacation he is entitled to, what the cost of any other benefits are that accrue to him, whether or not there was a moving allowance, if there was, how much? I would like to know what the cost of the new deputy minister is.
MR. MUIR: We will provide that as we are able. There may be something, I don't know, that we are not allowed to provide, but I don't see any reason why it couldn't be made available.
MR. DEXTER: I appreciate that and I wonder if the minister will just undertake to provide it at the earliest opportunity. I would hope before we are out of estimates, would be useful. (Interruption) I am fine with that if you would like to do that. Would you like to have a recess for 30 seconds or so?
MR. CHAIRMAN: The committee will recess for 30 seconds or so.
Is it agreed?
It is agreed.
[3:00 p.m. The committee recessed.]
[3:01 p.m. The committee reconvened.]
MR. MUIR: I have requested one of our staff members to try to get that information and I explained that we needed it right away.
MR. DEXTER: The minister may remember that some time ago the Auditor General talked about the need for the Department of Health to actually have a plan and talked about strategic planning initiatives and the fact that they were necessary in order to get the costs of the Department of Health under control. I wonder if the minister can tell us if that is under way and if it is, when it is that we can expect to see from the government a plan for health care, one that we can see and examine for its viability and hopefully its positive effect on the people of Nova Scotia.
MR. MUIR: There are a couple of aspects to that. One is the restructuring of the department, but we do have available right now the document entitled Mission Goals and Priorities of the Department of Health for 2000-01, which if the honourable member is interested in seeing it, I would be pleased to make it available.
MR. DEXTER: Well, if the minister would like to table that, I am not sure if it has been released before or not. If not, my understanding of what the Auditor General had recommended and was looking for was a detailed plan and I understand that you are going through a process at this point whereby you are putting in place district health authorities which would be part of any kind of a planning initiative. That having been said, I would have thought, given that there was so much money set aside in this budget for strategic planning, associate deputy ministers, assistant deputy ministers - one says Strategic Direction and Program Coordination which is $339,000 as I understand it. I would have assumed what that was going to mean was that we were going to see some kind of an actual plan. Perhaps I am wrong.
MR. MUIR: That particular budget line, $339,000, is an internal thing and it covers one of the sections of the Department of Health headed by Mr. Bill McKee.
MR. DEXTER: I am sorry, perhaps it is just my hearing, but I didn't hear the last part of that response. Perhaps the minister wouldn't mind repeating himself.
MR. MUIR: I did answer that yesterday, I guess it must have been for the member for Dartmouth East. It is the operation of one division in the Department of Health and also involves full salary units. Included in there is the intergovernmental affairs work that is done in the department, that is part of that.
MR. DEXTER: Mr. Chairman, I actually do remember that answer from yesterday. I understand that negotiating with the federal government is an ever-increasingly important part of the Department of Health's role, in terms of making sure that its budget is sufficient. I think I also recall the members of the government being particularly harsh and critical of the former government for not being able to get money out of the federal government. I am not sure if that is the same thing as developing a comprehensive plan for health care in Nova Scotia.
I am going to move on from that because certainly a part of any kind of overall plan for health care in Nova Scotia would include a plan for the retention and recruitment of nurses. I think one of the things I have heard over and over again is the question, where is the plan for the retention and the recruitment of nurses. I guess what I would like to know is whether or not there is such a plan and if there is, would the minister table it, and can he tell us where in the budget items is the allocation of money that he has set aside for the program of recruitment and secondly, for the retention of those nurses once they are recruited?
MR. MUIR: Mr. Chairman, yes there are documents on that and I am pleased to say that the training and retention of nurses in Nova Scotia is still one of our priorities and I think we are making some fair progress on that. As the honourable member knows, according to the platform commitment, we hired a nursing policy adviser and she continues to work with the professional associations, as we try to resolve this particular problem.
Among the things we have put in here is $1 million for nurse training seats; we have $3 million, which is in the acute care budget for full-time nursing positions; $100,000 for nursing bursaries and I can tell you that I received a briefing note today indicating that the people who are to receive those bursaries for this year have been selected and notified. I received that information this morning. The update on the nursing position from the nurse policy adviser is that we have begun work on a provincial strategy; there was a nursing job fair at the Sheraton from March 31st to April 1st, in which we participated; we have a provincial website for nursing vacancies being developed and it is www.acc.net/nursing.
The new provincial nursing network has been established and is comprised of employers, educators, professional associations, and unions that met for the first time on April 3rd. They are working with the nurse policy adviser to enhance cooperation on all issues related to nursing. The new provincial health/human resources advisory committee will soon be struck and will have nursing as a key priority. The nursing bursary program is available and as I said, that is now up and running and is for RNs, LPNs and the people have been notified. The Baccalaureate School of Nursing, we expanded the number of seats last fall by about 30 per cent, there were 75 new seats. By the way, that is the largest percentage of increase of any province in Canada.
We have a new nurse practitioner program under way at Dalhousie, it is supported by this department; we have ongoing continuing education through Telehealth. The types of things we have done to try to retain, recruit, and work with the nursing profession, I think we have done a fair bit in a short period of time. I can tell you that there are more nurses employed in Nova Scotia now than there have been the last number of years.
MR. DEXTER: I wonder if I could just have the minister explain the last statement he made. Does he mean there are more nurses employed full-time in this province and that there are more positions filled, or does he simply mean that nurses who had been employed on casual contracts have become full-time permanent employees? There is a substantial difference. I know in the conversations that I have had with members of the Nurses' Union and various associations, I believe the number they used is somewhere in the vicinity of 400 vacancies around the province for nurses. So, I would like to perhaps have the minister, if he can, just explain that to me.
MR. MUIR: Mr. Chairman, from the RNANS registration database in December 1999, the number of RNs employed in Nova Scotia is 101 greater than the previous year. This is a small but significant turnaround representing the greatest increase in nurses since 1992. Regular full-time is up 122 positions, while casual part-time dropped by about 64 positions. The number of nurses employed in hospitals increased by 100, and in long term care facilities there was an increase of 31 positions. The registered nurses in Nova Scotia last year were 8,840 and that is up 101 from the previous year.
Notwithstanding the honourable member's question that one of the significant things that we had been asked to do, that was felt to be advantageous was to convert a lot of those casual positions to full-time, there have been a significant number of casual conversions, upwards of 130, I think. However, I think it is fair to remind all honourable members that particularly here in the metro area - and I guess, to a lessor extent in some of the other areas - there are nurses who prefer to work on a casual basis, rather than on a full-time basis. So when we talk about the number of casual nurses I think it is important to keep in mind a number of these people are casual by choice, rather than by only one option.
MR. DEXTER: Mr. Chairman, there is certainly no question that it is important to have a pool of nurses who can form a workforce of that nature. That doesn't necessarily mean that everyone who is in a casual position is there by choice. There are people who may indeed prefer that but I would suggest to you that it is unlikely that all of those who are in those positions would choose to be so employed, considering the obvious lack of benefits and other attendant kinds of uncertainties that go along with being in a casual position. I had asked the minister earlier about business plans, whether or not they had been submitted from the various institutions, and I am told that staff at the Dartmouth General Hospital have been told their institution is going to take about a $2 million cut in their budget this year. Have the institutions been given their budgets now?
MR. MUIR: Some of them have, Mr. Chairman. The Dartmouth General Hospital is still under the auspices of the Central Regional Health Board so would get its funding that way; whereas the Killam and the QE II and the Nova Scotia Hospital are still stand-alone institutions for this part, so they have been given their figures.
MR. DEXTER: So, has there been a business plan submitted on behalf of the Central Regional Health Board and, if there has, can you table it?
MR. MUIR: The Central Regional Health Board, like the other regional health boards, received their budget figures only a short while ago, although they were given some indication there would be less money than there was last year. But the plans are currently being prepared.
MR. DEXTER: Well, they seem to be far enough along that the staff at the Dartmouth General Hospital know that they are going to have $2 million less in their budget. Does the minister know what this means for the Dartmouth General Hospital and, if he does, can he tell us?
MR. MUIR: Some of the specifics to which the honourable member is referring are going to emerge. As he knows, we have the clinical services footprint, which is ongoing now. We are also, as he knows, allowing some money for the expansion of their emergency department which will make some sort of difference. But the capital health authority is being formed, and we are looking at shared services in this capital health authority. As the honourable member knows, I think the budget showed a projected savings somewhere along the line of about $10 million in terms of shared services here in the capital health authority.
MR. DEXTER: I would like to explore this a little bit further with the minister if I can, because my understanding from the minister yesterday was that the money for the expansion was coming out of the hospital construction budget. So, that doesn't have any effect on the operating budget of the hospital, to the extent that there may be some disruption that may have some effect on the hospital services itself, and then you talked about savings through shared services. Well, the way shared services work is that you achieve, or at least work at achieving some efficiencies by volumes. What that means is that those are cut out of one institution and are centralized in one place. If that is the case, can you tell us whether or not there will be services that will no longer be offered at the Dartmouth General Hospital? If there are, which ones are they going to be and when are they going to cease?
MR. MUIR: Regarding the shared services, somewhere around 35 per cent of the capital area health authority is services which one might deem to be sharable. The plans for that are still ongoing, and the business plans are still developing. They are just coming to the table now to talk about shared services, and hopefully I would be able to give him a better answer in three months or something like that than I can right now.
MR. DEXTER: Perhaps he can tell me what the intention of the government is. Is it the intention of the Department of Health that services now available at the Dartmouth General Hospital may cease to be available at the Dartmouth General Hospital and offered somewhere else?
MR. MUIR: I think, Mr. Chairman, there would be a collaborative approach here. This was the idea of setting up the capital health authority, that certain services could be shared. If he is talking about clinical services, in other words, the actual delivery of patient care - and I don't know if that is to which you are referring - there may be, as this health authority becomes fully functional and this clinical footprint is established, what services will be offered in which facilities will become apparent then; that has not been pre-determined. We have a group working on that, and we hope to have a report by the end of the summer so we can move ahead with that. But there is an informal group of CEOs working on these preliminary plans about the sharing of services.
MR. DEXTER: I think I can take from what the minister just said that the answer to my question is yes, and that in fact there will not be the same kind of clinical services available at the Dartmouth General Hospital as an institution as prior to the establishment of this so-called clinical footprint. As I have said to the minister before, the problem with the clinical footprint is who gets trod on by the clinical footprint? Who ends up under heel? The minister looks perplexed by this as if I am restating it in error and, if I am, I want to give him an opportunity to correct me, because we went through this yesterday on another issue, and I think it seems pretty clear. My question was very simple. Are some of the services that are now offered at the hospital going to cease to be offered at the Dartmouth General Hospital?
MR. MUIR: Mr. Chairman, there is now a considerable portion of the budget allocation in what I will speak of as the capital health authority, quite a percentage of those items or things that could be deemed as shared services. The determination of the clinical services footprint for the capital health authority, like for any other region in the province, has not been determined. I think for the member to imply there would be less services or something, or that the Dartmouth General Hospital would lose clinical services, is an inappropriate comment at this time. Looking at some of the overload on some of the other facilities, I would tend to think a better speculation was that something else might happen there.
MR. CHAIRMAN: The honourable member for Dartmouth-Cole Harbour has approximately five minutes left.
MR. DEXTER: There are, of course, three choices: they can remain static, they can decrease or they can increase. If you are telling me that services at the Dartmouth General Hospital may increase in order to supplement services that are being provided at other institutions, I would be happy to hear that, except I don't understand how that can happen if what is happening is the Dartmouth General Hospital is being told they are going to lose
$2 million out of their budget, which I understand to be the case. Does the minister know and can he tell us whether or not there will be job losses at the Dartmouth General Hospital?
MR. MUIR: Mr. Chairman, I don't know where this $2 million figure came from unless it came from the member for Dartmouth East, because he was spreading all kinds of things about that hospital, he seemed to yesterday anyway. I don't know where he got the $2 million figure. Certainly it is not a figure that has been given to us.
MR. DEXTER: I am certainly not in the business of fear-mongering with the minister. I received the information from an employee at the hospital. They said they had a staff meeting and were told that this is what was going to happen with their institution. So that is as good as the information gets on my side and I am asking the minister, who should know better, seeing how these people work for you, whether or not the reality is that that institution is going to take a $2 million hit?
MR. MUIR: Mr. Chairman, as I said earlier, we still don't have an individual business plan from that Central Regional Health Board; we don't have that yet. I tend to think, regardless of what he says, that that information is probably a little premature.
MR. DEXTER: Well, it may be premature, but there is a difference between being premature and being wrong, I guess. That is the other part of it. I only have a few minutes left, so I want to ask a straightforward question. Has the minister made allowance for the payment of the victims of hepatitis C? If he has, where, in the global sense, is it in the budget?
MR. MUIR: I just want to confirm. My understanding is that in our budget, you won't find a line for hepatitis C. The province's role is to assist the federal government in distributing the funds to those who need it.
MR. DEXTER: How much time do I have left?
MR. CHAIRMAN: Approximately one minute and 15 seconds.
MR. DEXTER: The first thing I would like to ask the minister is if he would table for me the document that he had referred to earlier as one of the planning documents for the Department of Health. The other thing I would like to receive from the minister, if he would be prepared to table it, is the ground ambulance budget for the year; the plan, both in terms of what it is going to cost the government and what it is that is going to be raised by EHS over the year?
MR. MUIR: Mr. Chairman, I think that request, as I understand it, is in the budget. Did the little sheet of paper you showed me the other day have fees on it? The income was listed among that. If that is not sufficient, I need a little bit more clarification.
MR. DEXTER: I am sure that he must have gotten a document from EHS setting out what it is that they are going to require to cover the increase. I realize some of this is listed in the budget. What I am looking for are the actual documents that come from EHS saying how much it is going to cost them, how much they intend to raise the user fees; it breaks out all of their line items, how much is going to be spent in Digby, how much is going to be spent in Cape Breton. That is what I would like to see. Is there an actual document for providing service for the next year?
MR. MUIR: We can provide details for him. As the honourable member understands, we contract with Maritime Medical Care to provide this service and we give a grant to Maritime Medical Care, a fixed fee. So if he is looking for the details, that type of detail would have to come from Maritime Medical Care. Are you talking about operational in our department? We give a global amount to Maritime Medical Care on the contract.
[3:30 p.m.]
MR. CHAIRMAN: Order, please. The honourable member's time has expired.
The honourable member for Dartmouth East. (Applause)
DR. JAMES SMITH: Thank you, Mr. Finance Minister. It is nice to see you have both hands outside of somebody else's pocket these days. (Laughter) Warm weather does that. I thank you for that. Mr. Chairman, I wanted to go back to the 911 user-fee tax issue. The minister, last fall, brought in legislation and he indicated, in Question Period today, that he may have some answers. I just want to pursue that a bit because I am so frustrated in trying to deal with the other issue of the continuum of care and how the funding of that will move people into more appropriate levels of care from the acute care system. Perhaps, we can go back to some of that. While it should be a continuum of care, we seem to be going around in circles and not getting the answers about what will happen with all of the acute care cutbacks and how that will impact on levels of care.
I have given the minister, maybe, some moments to readjust his papers, but last fall the minister withdrew the bill and seemed to suggest the province had no plans to go further. Why did the minister change his mind and now we are moving toward that 911 user-fee tax?
MR. MUIR: Mr. Chairman, I thank the honourable member for that. Let me go back to last spring. We didn't withdraw the bill. There was some unhappiness, I think a lot of it on the mischief type of thing by the Opposition, with one of the clauses in that bill. We had no intent, at that time, to introduce a cost-recovery fee. During the budget process, we realized what kind of a bad financial situation we had been left with by the honourable member and his colleagues in government, and we are trying to restore financial responsibility to the province.
One of the things that the previous government did, Mr. Chairman, which we are trying not to do, and all we had to do to understand the attitude of that bunch was to take a look at the debts that we picked up for the regional health boards; close to $1 billion that that government had to swallow and they never went to those organizations to talk about financial responsibility. In this case, what we are doing is that we have a very good 911 system. To protect that system and to provide, I guess, for public safety, it was felt that people in Nova Scotia probably wouldn't object to having a first-class emergency communication system for less than the price of a cup of coffee a month. We are currently the only provincial jurisdiction in Canada where there is not some cost-recovery fee already associated with 911.
DR. SMITH: Mr. Chairman, one of these days, the minister is going to have to realize that they are the government now and you can criticize your staff as much as you want to. I see you have a new CFO there. God bless him. I hope he is on Prozac, no personal offence. I will take responsibility as an elected official, but I thought the staff was very good at developing business plans and having people accountable. But he will switch to that mode pretty soon. People outside, like today, will remind them that they are the government and you make the decisions. This is the thing, I guess, with legislation. I think there are a lot of things that we would have liked to have done in 1998-99 and we couldn't do, and mainly it was that government - the government being the Third Party - that obstructed that. So any legislation you want to pass now, you can get it through, Mr. Minister, don't forget that.
We are going to have a Tim Hortons user-fee tax on 911, that is what he said. We are going to have it the price of a cup of coffee, whatever that is, and that is what it will be. Can you tell us when the charge will come into effect?
MR. MUIR: Mr. Chairman, there is a committee that is functioning, which includes representatives from Health, Justice, and I think Business and Consumer Services is part of that. We are not really in the roll-up-the-rim-to-win business. It is not a tax. That is the type of thing that disturbs me about certain members of this Opposition. They know absolutely it is basically cost recovery. What we have to do is we have to get the authorization - we think we do, at least our initial information was, and we are checking it out - of the CRTC before we can implement this. Personally, I would like very much to implement it this month, but it appears that it is going to be a little bit of a period of time. If we have to go through the formal CRTC process, then it is going to take a little bit longer. As I said, we are negotiating with the Department of Justice, the Department of Community Services, our department and the local carriers; there are about four local carriers which now have to be involved too.
I would remind the honourable members, including the honourable member for Dartmouth East, that the local phone bill he receives now does have a quote. You can call it a tax, but I am sure that if you speak to the local carriers, they would tell you it is a cost-recovery service. The local carriers expended about $16 million. They don't make a profit on it, they charge some small administrative fee.
DR. SMITH: I assume this will be on top of the administrative fee for MTT and all the other providers. That was one of my questions, and I think the minister has answered that, at least in part. We will be seeing MTT probably keeping their amount now. I am not quite clear. I think we had debated that a bit last year. If the minister knows what MTT is charging now, maybe he could inform the committee - I had some research, and I don't think we have been able to come up with it right at this moment - of the other groups that would be involved, such as AT&T and those particular groups.
I wasn't quite clear if he said that wireless phones would be or would not be taxed, so we are looking at faxes, business phones, residential phones, modems, computer lines, those types of things. Will the fee be on all of those or part, or what?
MR. MUIR: The intent is that it would be on those things. As the honourable member well knows, currently with the wireless phones you don't have to pay that administrative fee and the cost-recovery fee for the 911. The number of wireless phones or cellular phones in the province has increased dramatically. As a matter of fact, the number of wireless phones far exceeded the suppliers' estimates. There is a fair percentage of the 911 calls now that is delivered through cellular phones, a lot from highways. The answer would be, with the blessing of the CRTC, if we need it, certainly we would bill each of the phones.
DR. SMITH: I kind of thought that might be, and the minister said today that they would not be. Now he has clarified that, and I think there were interruptions in the House at that time. That is quite a market out there to tap into, for the minister's government to do that. Wireless phones will pay the price of a cup-of-coffee-per-month fee. Is this the reason for all the wage arrangements and commitments that will have to be made or are in the process of being looked at with Emergency Health Services, will this go to offset that? The budget for Emergency Health Services, on Page 13.5, most of those areas are decreasing. Will this fee go for Emergency Health Services? I will come back for another question. Is this going to pay for Emergency Health Services?
MR. MUIR: Mr. Chairman, I think we have some confusion here. The 911 system is administered under the Emergency Measures Organization, so the money for that line item for the costs associated with 911 appear in that budget. They are not in the Department of Health.
DR. SMITH: This government is quickly becoming very innovative in how it is moving monies around. I don't think I could be accused of suspecting, and it would lead me to another question later as to where the money is going to come from for the paramedics, the dispatchers and the other people who still haven't received that increase.
The minister has had some time to reflect. Has the minister or the government had discussions with MTT? I wasn't clear when we left that in Question Period today. Has there been pre-budget discussions on this matter with MTT? Are there arrangements that MTT will
keep administering their fee and receiving the benefit of that? Have there been discussions on bringing this 911 fee forward?
MR. MUIR: There is a committee of Emergency Measures Organization, Finance and Justice, as I have said, that was struck to deal with this. That committee will meet with the local carriers, and I believe there are about four now, to determine the volume that they have. MTT have about $10 million in capital invested in that 911 service, and the cost-recovery fees that they are getting are to defer what they spent. I expect that MTT would probably negotiate with the other local carriers. If the other local carriers are being used for that 911 service and MTT is not getting a piece of that, I would expect they would enter into some agreement, although I haven't talked to MTT about that.
DR. SMITH: Mr. Chairman, in leaving this for now - other members may want to come back - it is really that they have struck gold in them there hills. Wireless phones are now going to be subject to that. They will be pretty expert, after they get a couple years of experience at this. I was wondering, how long will they let wireless phones go unchallenged?
MR. MUIR: Mr. Chairman, I know he is not doing it intentionally, but I would like to explain. This is not a profit centre. What it costs is what you are allowed to recover. To imply that tapping into wireless phones is a gold mine for EMO or anybody else - I don't know what the profit margin is that the suppliers of the cell phones make, but I can tell you that, for example, the member for Dartmouth East, if I have a land line and he has a cell phone and we are splitting the bill, if I was paying for it myself and now I have to share it with him, I know my monthly cost is going to be less.
DR. SMITH: We could go in a lot of different directions right here. Who will control this? Is this going to be the URB? Who will determine those charges, will that be government, or will it be passed over to the URB?
MR. MUIR: I would hope that the Emergency Measures Organization would be able to determine the costs. We will be getting feedback from them. I would expect that there would be certain conditions. We are approaching the CRTC, and if we are forced to go that formal route, I expect that the CRTC would put it on. Again, I want to emphasize that this is a recovery of costs associated with that service. It is not intended as a revenue generator other than to cover costs.
To be quite frank, we have a very good 911 service here in this province. I don't think for a minute that there would hardly be a person in this province who would not be willing to make a reasonable contribution to see that that 911 service can be maintained and even enhanced.
Just let me give you an example of the fees that are across Canada, and as I say, we are about the only jurisdiction that doesn't charge this at the present time and I am not so sure why the previous government didn't get into it. For example, the subscriber fee in Ontario is currently 32 cents; in Manitoba it is 25 cents; Saskatchewan - surprise, surprise - proposes $1.00; New Brunswick 44 cents, Prince Edward Island proposed 75 cents; Alberta is 19 cents; British Columbia 23 cents; and the Northwest Territories is 37 cents. These are not per-call charges, these are basically sort of monthly things that would be attached to a phone bill. So when I was talking about the price of a cup of coffee. (Interruptions) Well, it could be that high but, again, it is going to depend on the cost of the service and I am not entirely sure how many phones are in Nova Scotia but if there were half a million, then it wouldn't be substantial.
DR. SMITH: I am pleased to see the coalition that has developed between the Tories and the NDP now. For the cup of coffee, I don't know if it is 34 cents in Manitoba or not but it is funny that when you go across that border into Saskatchewan it is $1.00. For the benefit of the NDP there that haven't picked up on that, it looks like they have taken the lead in Saskatchewan, where it is a $1.00 fee.
Yes, people would like to pay their way, those who can, but it is interesting when you keep hitting people on co-pay, Pharmacare and premiums increasing and hospital beds and it just keeps going and going; there is going to be a limit, the straw that breaks the camel's back. So there is a limit on that.
I think it was on the CBC, a call-in at noon, in the last day or so and maybe it was a replay from the morning or something. This guy had all the answers; you just charge people heavy user fees, open it up, because it is like a toll highway - if you use it, you should pay for it. Then you fire the civil servants because you really won't need them. You will have lots of money and what you will do then is you will put them as welfare cops and stop all this welfare fraud. That was the simplistic answer, and I don't know if he was advising the Tory Government or not. He didn't identify himself on the radio but I said, boy, I have heard that before.
Anyway, Mr. Chairman, just a point of clarification on another issue that has come up and the member for Dartmouth-Cole Harbour has been addressing this issue as well; I am still not clear on that issue of turning acute care beds into long-term care beds, how extensive that will be and the projected revenues of $5 million. Now the minister said that people are staying in acute care hospital beds and they won't move out - you get them in and they won't move. Well, I really can't believe that would generate $5 million a year. So, in simple terms, so that even I can understand, can he explain to me, that $5 million program, where will the acute care beds be changed into long-term care beds? Please don't say New Waterford, we know all about that. Is there another area, because it may solve some of this issue of how he is going to fund home care and all these other things.
MR. MUIR: Now let me say, Mr. Chairman, that one of the things that the previous government did, rather than trying to address a problem, was to toss more money at it. The particular example of that, which I would like to remind him of, was tossing more money in, in terms of that Health Investment Fund, to the tune of $600 million which the people soundly rejected in August. (Interruptions) Resoundingly defeated.
Anyway, to try to get back to the question, there seems to be some misunderstanding about the conversation and the question last night. What happened, and I will try to go through this; the Department of Health met with health care providers in budget preparation. What they did was, the health care providers said we think we could perhaps create ways to come up with $10 million. Part of that was increasing the rates of semi private and private rooms, things that are quite often insured services: parking lots, televisions, phones or whatever.
In the course of budget deliberations, when we were budgeting we thought that was perhaps a little rich, so we cut that estimate in half. That is in the budget line that refers to some sort of a revenue volume savings which includes revenues from volume purchases and all those things that in the course of the budget preparation, right across the province, that maybe $5 million could be accumulated from that.
DR. SMITH: Okay, well that's a little broader. Are there areas in the province in acute care that the minister's department will be moving into long-term care - I guess I go back to the original question there - that would allow a charge, more like that of a private health care system within acute care facilities, moving to long-term care? Is there a plan to change the designation from acute care into some sort of other type of care?
Now I know I have asked this before but I don't think I really got an answer. Is it part of the plan that we will be seeing that happen in various facilities in the province, that will move acute care into some other form of care for which they could bill private insurance firms, that type of thing?
MR. MUIR The facilities review indicated, as the honourable member well knows, it provided some concrete evidence to something that was generally held to be the case anyway. Somewhere from 20 per cent to 25 per cent of people who are in what we will call acute care facilities, it appears that they could receive adequate care if they were not in an acute care facility; in other words, medical discharge.
I can say to the honourable member, he talked about insurance companies. I will tell him that part of our business plan is that where insurance companies are expected to pay or can pay, we expect them basically to pay the full cost. In other words, part of our business planning was to get out of the subsidization of insurance companies. Where there are cost recoveries, we have done some things in the fees for EHS. Basically we are in the business
of providing health care to Nova Scotians and to others from the Atlantic Provinces in some of our tertiary care institutions. We do have that.
We don't have any plans right now, and I guess this is really what the honourable member is asking, that we are going to turn acute care beds into long-term beds. Now I am not saying that some time down the road we may not have another case like New Waterford, which has worked out very well, but right now we don't have any real plans to do that.
DR. SMITH: I thank the minister for that response, and it does clarify at least the immediate future, but still leaves the puzzle about the $70 million cut within the acute care system and how that money will be transferred somehow into long-term care or home care or primary care in the home somewhere. That part of the equation, I guess I don't understand that. Maybe the government does and could explain it, but I haven't heard the explanation yet other than savings within administration.
On Pharmacare and the drug inflation index, can the minister tell us who will be involved in setting up this drug inflation index?
MR. MUIR: Folks from the Department of Health who are normally involved in that type of thing, in conjunction with a representative group of seniors, and we expect it will be based on costs. We can project the cost, for example, this year, the cost of pharmaceuticals, at least Pharmacare, and the seniors program went up $12 million.
DR. SMITH: So, will the rising costs of the Pharmacare Program be considered when constructing the index, or will the drug inflation index be used merely as a guide in setting the Pharmacare premiums and rates, or will the minister set the rates based solely on this index?
MR. MUIR: Mr. Chairman, we have two or three groups that are involved, and as he knows, there is a provincial formulary committee which actually puts drugs on the formulary, I guess you could say, and also takes some off. We have that formulary management committee in there, and there is also a Drug Evaluation Alliance of Nova Scotia which works with physicians, pharmacists and other health care professionals to look at ways to improve drug therapy for Nova Scotians.
Medical research is pretty good. We are getting a lot better drugs than we ever had before, and indeed one of the statements I heard when I was in Markham a couple of weeks ago by one of the people who should know a little bit about it, he said it won't be too many years before a lot of the surgery that we now do will be treated chemically as opposed to knives. This is excluding things such as broken limbs and whatnot, but some of the internal parts, when they get to be a problem, we will be doing drugs rather than surgery to do that. We also have a very vibrant research community here in Nova Scotia, and a lot of that is funded by the pharmaceutical companies.
In terms of the actual cost, we will be going through the same thing, I think, Mr. Chairman, and looking at the advice of those committees to see what drugs are going to be available and what the increase in cost will be when particular drugs go on the formulary and certain ones come off. We will have to make an adjustment to try to balance the protection of having a Pharmacare Program for seniors in Nova Scotia, and that is really what it is.
We have to keep in mind that this year the premiums and co-pay had not increased for some years. When that program was introduced, it was supposed to be on a 50/50 basis. Right now, our government is paying somewhere around 80 per cent of the cost of the Pharmacare Program. Like anybody else, I wasn't really keen on increasing the cost of the co-pay. But, the fact is, if this program is to be sustainable, then we have to have greater participation than we had last year.
DR. SMITH: Thank you for that review. I am quite aware of the amount the seniors are putting into that program, and that is why it is so ironic that this government, when in Opposition, was so adamant about no increases in that Pharmacare Program and implored us to take away the premium. We will see the cost of drugs increase in the next few years, and the premiums as we know will rise accordingly, based on the drug inflation index. So we have seniors on fixed incomes, and I could ask the minister how he expects seniors to keep pace with the increased cost of drugs, but I think he has answered enough that we know where he is coming from on that. We have seen the increase this time, and if we are moving toward sustainability within that program, seniors under this government will certainly be paying an increased amount.
[4:00 p.m.]
So, we have Pharmacare and we can project, as with education costs, as the Leader of the Opposition today outlined the increased costs for the years ahead, that people depending on Pharmacare can well expect that increase to be coming within the premium and within the co-pay, and how that will be determined. So, I think it is important that whoever makes these decisions sees that cost recovery is where the emphasis is put. Certainly on research, and that was my concern the other day when I was linking the dismantling of health care along with the dismantling of the education system, and the people who would do good research here, we would lose these people. It is a global market, and we will lose them. We already know there are people taking a second look at Nova Scotia because of all the kerfuffle around education and health, so it is important that those two are linked and nowhere are they better linked than in research.
The minister mentioned pharmaceuticals, and they have been very generous and play a great part in all of this, but there is another component to research that depends on adequate funding of the health care system. If you just rely on the pharmaceuticals, then you are going to have targetted research that is not necessarily in the best interest of the population. So, while I compliment the pharmaceutical industry, I think, as I always told them, as long as we
know where we want to go as a government or where governments want to go, then you can be a player with the pharmaceutical industry. But if you let them dictate exactly what is done, then their priorities might be slightly different than in the best interests of all Nova Scotians. It is a major issue, and that is really what concerns me when I see the dismantling of this health care system.
You can make fun of the Health Investment Fund, but how a minister could stand up and make fun of that when his department took $208 million and dumped it into the old system. We won't get into that now, but that is being hypocritical, and he knows that.
I did want to go back to the Emergency Health Services, on Page 13.5 in the Supplement, which shows a small reduction in expenditures. This is surprising, Mr. Chairman, considering that in the settlement just reached with the paramedics the government is obliged to pick up the wage increases. This means the high-performance contract will likely be modified to bring in the upgrades of the paramedic. Remember, these are the groups we were going to upgrade from one, two and three levels, and some of the debate we had in this House went until midnight. This means the high-performance contract will likely be modified to upgrade paramedics and response times as originally planned. So, we have those two major factors in that contract, response times and the upgrading of the paramedics.
The ambulance fees are going up by about $3 million. So, even if that covers the current year's wage increases, what is going to happen in future years? Will we see continued increases? That is why the same people being hit for co-pay are being hit on ambulance fees. My first question is, how much of the current year's budget covers wage increases to the paramedics?
MR. MUIR: That is approximately $9.8 million, Mr. Chairman.
DR. SMITH: I am sorry, could I please have a clarification on that, Mr. Chairman?
MR. MUIR: The cost to settle in year one was $9.8 million.
DR. SMITH: So, I understand the current year's budget includes $9.1 million for wage increases to the paramedics?
MR. MUIR: No, $9.8 million.
DR. SMITH: So, the current year's budget that we are discussing, 2000-01, is $9.8 million? Okay.
So we are doing that with last year's estimates being $50 million and this year's being $49 million. So, with the reduction, we are seeing a 9.8 per cent increase. So what is the anticipated increase in wage costs over the next three years and will they also be covered by
increases in ambulance fees? So we have education built-in escalating costs going. We have the premiums in Pharmacare, the formula is there so every year, seniors will be hit again and again. So now here, within this, are we seeing the ambulance fees that will increase to cover the anticipated increase in wages?
MR. MUIR: Mr. Chairman, we do have a three year projection of increasing costs that is not in this briefing book, but, clearly, we had it last year when it came down with the arbitrator, Chief Justice Clarke's decision on the settlement. The increase this year, as you can see, we are looking from estimate to estimate and it is a little bit different and, of course, that is kind of a netted figure with the increase in user fees thrown in there.
In reference to the forecast, and he did refer to the forecast and, obviously, that in forecast is built on the user fees which were in place last year. But it also incorporated a wage settlement. The wage settlement kicked in last year, not this year. It went back. So there was a lump sum payment.
DR SMITH: Mr. Chairman, do we have an anticipated increase in wage costs over the next three years and will they be covered by increases in ambulance fees?
MR. MUIR: Mr. Chairman, the honourable member for Dartmouth East has asked me to speculate about next year's budget and its content and I am not prepared to do that right now.
DR. SMITH: So we are not sure if this will follow like the Pharmacare and see the premiums and the escalating clauses in there. So the minister may have some other ideas of where he will get some money out of that to cover those increased costs.
Mr. Chairman, to the minister, have the original terms of the high-performance contract been modified to meet this budget?
MR. MUIR: EMC is still negotiating to find out what the final effect of this budget will be. The high-performance contract that was in place last year is still in place at the present time.
DR SMITH: So this budget is not predicated on changing some terms in that high-performance contract, such things as the issue of training of paramedics, response times. Can the minister guarantee that there will be no negative impact on response times to meet this budget, this budget that shows a decrease, rather than an increase, in spite of wage increases? I know there was a settlement there and I heard the other answer, but this is really quite crucial that the high-performance contract, if it is changed, that it is clearly understood by Nova Scotians what they can expect from that system.
MR. MUIR: The reduction in funding should not affect the response times and it may have some effect, I suspect, on non-emergency transport, but we intend to do everything we can to maintain the current level of service. There will be some adjustment, notwithstanding that, obviously, there are going to some adjustments, but the advice that we have is that these adjustments can be made without affecting the performance standards.
DR. SMITH: Mr. Chairman, medical payments is an area that has seen some moderate increase. Maybe, just for the information of the committee, when is the contract for physicians up for renewal and what are the expectations relative to those negotiations?
MR. MUIR: The contract with the physicians expires in 2001. There have been some preliminary discussions, I know, with the Medical Society about this, but we do have actually about another 11.5 months to resolve this. Clearly, we would like to have it resolved as quickly as possible.
DR. SMITH: I just have a bit of time left of this hour. I did want to touch on Pharmacare. I just had a note here. Maybe we can go back a little bit. I think we spoke of this the other day. Can the minister inform the committee, how much the government is budgeting to increase total fees collected from seniors? We might have already informed the committee on that, the government's budget expenditures is equal to the prior year in Pharmacare. Presumably, increases will be offset with increased fees, which are not reflected in the supplement. It is also likely that no new drugs will be added and I think he spoke of Aricept. My question then is, how much is the government budgeting to increase total fees collected from the seniors?
MR. MUIR: Mr. Chairman, $8 million.
DR. SMITH: Mr. Chairman, the revenue and recovery, there is $4 million in there for that, for providing services to other provinces. This is the out-of-province agreement. I know the minister mentioned about insurance increasing. Is the government planning to increase the fees for out-of-province and for out-of-country patients?
MR. MUIR: Mr. Chairman, within Canada, there is a national committee that considers medical costs to Canadian residents when they move from province to province. It is not something that this province can arbitrarily adjust. The committee is currently meeting, nonetheless, and I suspect that they may recommend some adjustment in the rates. The position of Nova Scotia is that it is kind of like education where we provide a lot for which we don't get all the revenue and this would be one of the things that is under consideration. So that committee is meeting. The rates are standardized across Canada, pretty well. The other question that he asked about that was for out-of-country folks and it would be our intent to try to recoup costs of the service delivered to out-of-country people.
DR. SMITH: That is always a challenge, because it is really interesting. It is difficult to put a cost on these issues, these various forms of treatment. It is one and I hope that is not to recruit, but service people as their care is required.
We know, Mr. Chairman, certainly the largest reduction comes in acute care. We have discussed this several times and $70 million has been taken out of the budget and part of that was Y2K. But, in spite of all of that, you can talk about the big footprint or whatever it is called and the Y2K and all this, and that has been very useful to the minister to cloud the waters, but cutting right through, there is a $25 million to $30 million increase in wage pressures as well as the commitment that the minister has to hire more nurses. In addition, the information technology is lacking; there are some monies in there over the next few years. Does the minister still stand today, like the Minister of Education who says there will be no firing of teachers or no need to be or whatever she still claims, I don't know what the latest is on that? Is the minister adamant there will be no bed closures to meet this $70 million reduction in acute care?
MR. MUIR: Our position remains unchanged, Mr. Chairman. We know there is less money being made available for health care. We committed to do our very best to preserve patient services.
DR. SMITH: As my illustrious Leader once said, these guys, Oh, Reveen, Reveen. They used to say up in Port Mouton, a certain fellow could make breakfast out of two quarts of salt water. We are sure going to see some magic on this one. However, I don't want to belabour it. We have been around and around and around. It gives continuum of care of new meaning.
The issue of out of province, that is always the issue at the IWK-Grace, and looking for direct payment on that. It does lead into another area of the major services that may well be cut. If you look at these types of cuts, the $25 million to $35 million minimum, $70 million overall in the acute care sector, you can't do that by nickel and diming; you have to curtain services. Someone said to me the other day, this budget will take us back not a few years, it will take us back 25 years when people on the South Shore and the southwestern part of the province and Halifax went for their specialized care. They went to Boston for a heart, eye surgeries and those other issues. People in other parts of the province went to Montreal. They predict that is where we are heading, because some major services will have to be cut. What concerns me particularly is the issue of services to children. We look at major cardiac surgery and those types of initiatives. Those services are cut, and that is the only way the hospitals are going to save this kind of money or find that kind of money in their budget. You can't nickel and dime it. You can fire all the administrators and you are not going to get that kind of money.
So, we are seeing major programs in this province jeopardized and we are looking at people more frequently going out of province. We have our forensic unit out there now and that is another issue. Certain specialized surgeries need to go out; opthomology occasionally, some of the others. But we have done very well. Those of us who can remember and have worked in the system - my first aortic valve patient who needed that done was sent to Edmonton. I always remember that. We have made great strides. I know the minister said I was fear-mongering the other day, but when you come here and hear so and so is looking at three or four places, one is in Nova Scotia, but they have just marked Nova Scotia off the list, and that heart surgeon or that eye specialist is not going to come in here because number one, their programs are being threatened.
If the minister doesn't understand this right now, he better get this through his head today that these programs are being threatened in this province by taking $70 million out of the acute care system. You can call it Y2K and you can say the footprint committee - I call it the Sasquatch committee or whatever they call it in B.C. You are looking at people going out of province for care. For children, particularly, I think this is a catastrophe, and that is what we are facing.
We know the minister is saying to the hospitals, we are going to take this, let's say $25 million to $30 million, whatever it is, out of the system, and they are not going to allow any closing beds. We have established that. He and his Education Minister are holding hands on that one, secretly under the table hoping which one is going to break first. So far, they are sticking to their story. We are not going to cut beds back. Any changes in programs have to be approved by the department. So, the hospitals are closing beds, there is no more money for home care, there is no more money for long-term care, and cannot take more people because of the budget restraint, where will the people go? When someone comes forward and says we have to disband this major program, say cardiac surgery or something for children, particular types of electrical problems with their hearts and those types of things, as well as valves and other initiatives, various issues. Where will the people go, Mr. Minister?
MR. MUIR: Mr. Chairman, the honourable member has made that speech on three or four occasions between yesterday and Friday. The fact is that I don't think there really is any bed closure in the province that he can identify other than those right now that unfortunately occurred because of the nursing shortage at the QE II and down in Yarmouth. I have to remind him that spending more and more of the taxpayers money without a plan really hasn't taken Nova Scotia any place except to the poorhouse. We need a new approach, and health care is no different, one that focuses on priorities and on results. That is exactly what we intend to do. We could have continued to dump all kinds of money into health care without making the tough decisions that need to be made, to make sure we have health care, not this year, but next year and the year after and the year after. We are looking at a health care system that is sustainable, it is responsive, and it has to be one which we can afford.
We have to balance the needs of today, Mr. Chairman, against the anticipated needs of the future. We are talking about cuts to acute care, and he knows the total projected cuts were $70.2 million. We know as well that part of that, a substantial portion of it, more than roughly about 33 per cent was due to Y2K alone. We also have somewhere in this capital area roughly around 35 per cent in terms of services that could be shared. Our consultation with the acute care facilities is that we wish you to get to the table and let's see what we can accomplish together before we get out there and start talking about slashing programs. I am always surprised at the honourable member who will get up and say something like that statement he has just made about the IWK because I do remember most vividly last year, there was nobody in this House that got up and talked more, was more indignant and used the word fear-mongering more than that honourable member.
DR. SMITH: The trained seals in the back row can be clapping next week after they spend another weekend at home, but like somebody said, just make sure you go in pairs. The minister said about throwing the money in. Does he not realize, does he not admit that he threw $208 million in? Tough decisions? No, not likely. I just want to be clear on this that there is no need to invest any extra money into health care, this is going to be solved by saving the monies here and there and no change to acute care beds and no extra money for home care. Speaking of home care, there are some very modest increases. When you look at the increase of wages - and probably it really amounts to a reduction in home care, really - this is what I find so ironic about the minister's statements about fear-mongering. Now if you came in and said you were going to invest some more and you had a change in the system but you haven't had a plan, you haven't tabled it here. We are going through these budgets and I don't see any plan, and you threw $208 million last year. Now, to keep a bunch of election promises, you were going to give - in the election promises you said you were going to give that money from out of the province to the IWK-Grace, you were going to give them the $14 million. Your Premier said that. Have you done that? Have you given them the extra $14 million or, when they come back - no, don't bother answering because I know you didn't. That is a rhetorical question.
So, considering the increase in their wages, I think just on home care we are looking at a reduction and waiting lists. Is the minister going to return to the waiting lists that we worked so hard to do away with? If you are not putting extra money into home care and you are going to put the squeeze on acute care and the long-term care beds are filled, they are going to go somewhere, how are you going to do it? So you are going to increase your waiting lists, is this what we are going to see? Is the minister convinced he can do all this without increasing waiting lists or is he willing today to accept and go back to waiting lists in the Home Care Program?
MR. MUIR: Mr. Chairman, I can assure the honourable member for Dartmouth East that Home Care Nova Scotia will continue to provide acute and chronic nursing services to Nova Scotians. I can also assure the minister that we are most concerned about the future of
health care services in this province. As mentioned earlier, the great increases of money really didn't take any great deal of pressure off the waiting lists in this province.
We have a plan that I think is particularly important, Mr. Chairman, and I think that Nova Scotians understand - some don't but the average person who pays attention does - we are trying to make our decisions in health care based on evidence; not because it feels good, not because somebody else wants it, but we would like to make our decisions based on evidence. If we can make those decisions based on evidence, we are going to make a lot better decisions than we will if we make the decisions not based on evidence. We are moving towards an evidence-based system.
I can go on, Mr. Chairman, about the single-entry system for long-term care. The honourable member and his Leader have gotten up and they both supported that initiative. Now he stands up and he wants to criticize it. You can't have it both ways; either he has to say yes, I will work with this government to support the introduction of a single-entry system and I am really pleased and I congratulate you for taking it off the planning books and finally doing something about it, something that we couldn't do during the years we were in government.
DR. SMITH: Well, Mr. Chairman, I have never heard such baloney in all my life as this. He is coming in here today with this hocus-pocus about an evidence-based system. He doesn't even know what acute care is, for goodness sake. He stands here and talks about evidence-based, the best practices of medicine determined on evidence-based. I mean I am just going to pass my time over to somebody else. It is a waste of time. The minister doesn't know what acute care is and he talks about evidence-based medicine, he doesn't know what he is talking about.
[4:30 p.m.]
MR. CHAIRMAN: The honourable member for Dartmouth North.
MR. JERRY PYE: Mr. Chairman, I will be sharing my time with the honourable member for Halifax Needham. I am going to take just a few minutes. I do want to do a follow-up with respect to some of the questions I asked the honourable Minister of Health yesterday. One was the question with respect to funding for the Seniors' Expo, and I believe the Minister of Health may have that number available now. What has the Department of Health committed to the Seniors' Expo?
MR. MUIR: I thank the honourable member for that question. I am looking in my book, trying to get a date for this thing. It isn't called the Seniors' Expo any longer, it is called something else and I am looking for the name change. I wrote it down this morning. I'm sorry, the 50-Plus Expo, which would invite a whole lot more people in this Chamber,
I think, to participate in it. Anyway, that money is allocated by the Senior Citizens' Secretariat, Mr. Chairman, and it is the same allocation as last year - $47,500.
MR. PYE: Mr. Chairman, I neglected to thank the honourable member for Dartmouth East for, in his haste, giving us an additional 45 seconds of time. To the Minister of Health as well, I asked the Minister of Health yesterday if he would provide me with the funding for the Senior Citizens Secretariat and if, in fact, there was funding set aside for an executive director of the Senior Citizens Secretariat. As the minister is aware, presently the Senior Citizens Secretariat has a coordinator by the name of Valerie White. I am wondering if, in fact, that funding is set aside.
MR. MUIR: The budget was transferred to the Department of Health from the Department of Community Services, Mr. Chairman. The budget last year was $540,000 and that was not altered this year. There are four positions funded as part of that.
MR. PYE: Mr. Chairman, so the answer is, no, there will be no executive director's position and the coordinator will continue on if, in fact, there has been no change in the three members - the two members who are in the steno pool and one adviser. So I guess there has been no change with respect to that department.
MR. MUIR: Mr. Chairman, there is one vacant position in that complement of four.
MR. PYE: Mr. Chairman, I assume from the minister's comments that the one vacant position might very well be funding that is available to hire an executive director in the future? Okay.
Now, once again through you, Mr. Chairman, to the Minister of Health, I want to go to the Estimates Books, Page 13.16. The Minister of Health has probably already mentioned this and I may have been absent at the time but I do want to know, there appears to be in Other Programs, a significant drop in the budget funding for this particular program; it states that in the year 2000-01 there is approximately $18,261,000. In the year 1999-2000, there was $33,918,000. That is a shift of some $15,657,000. Mr. Chairman, through you, I wonder if the minister can explain this particular shift?
MR. MUIR: Mr. Chairman, I am trying to pick up some of these things. The Y2K was a one-time $8.3 million; the provincial grants for two organizations were one-time, $11.6 million and they were offset by the Medical Students Bursaries Program. The audit for the ground ambulance service, we put in $2 million for autistic children or children who had some other developmental delay; the Provincial Health Council $60,000, and there was some transition support allowance for the elimination of regional health boards of about $1 million.
MR. PYE: Mr. Chairman, I suspect there has been some shifting and that is the reason for the variation in the number to other sections of this budget.
On a more personal note, normally dental programs are covered for families on social assistance through the Department of Community Services. But often if, in fact, the Department of Community Services or MSI can't cover the case, there is an appeal made to the Department of Health, and the Department of Health usually makes a final decision on whether this dental surgery will be covered or not. I just want to for the record, and I do apologize for taking some time from my colleague, the member for Halifax Needham, but I do want to read for the record a particular concern from a single parent on family benefits who has been asking for dental surgery. She says her application has been rejected by MSI. She says, it is her opinion that the decision made by MSI through the special consideration committee was based on very little information.
She said, my situation is a lot more complicated in that I suffer severe TMJ which is temporal mandible joint problem at a more constant state. The pain has become extremely unbearable, and is affecting my normal human ability. My jaw is locking shut at times, usually after a night's sleep, but lately it has become more frequent and very embarrassing when it happens in public. I now have pain not only in my head, but in my face and eyes as well. Eating has become a painful task, not a pleasure, because I need to eat to survive. I am losing weight rapidly. My state of mind has become far from normal. I am withdrawing from my son because the pain prevents me from assuming my responsibility as his mom. Being a single parent, this is not advisable. I am ashamed to go out in public, and I can only leave the house when it is absolutely necessary. My facial structure is changing because of the pain and difficulties I have in my jaw. I believe my problem is affecting me, not only physically, but mentally, and I do not want to end up in an institution where unnecessary costs and therapy won't help. I need the orthodontist treatment to correct my problem and without it my condition, will deteriorate, affecting my overall health, both physically and mentally.
This condition is affecting her and her son's relationship. I wrote on her behalf to a Mr. Almeda who is the insured ancillary program manager, indicating the severity of her problem, and I will table this to the committee. He writes back, indicating that he regrets that his response will not be a positive one, and he thanks us for the opportunity of addressing the problem.
My concern is that I called the Department of Community Services. The Department of Community Services says it is a health issue. I called the Department of Health. The Department of Health doesn't address the issue. Whose responsibility is it, and where does this single mother get the opportunity to have the dental surgery that is needed to address this particular problem?
MR. MUIR: Mr. Chairman, I would feel a little awkward trying to talk about an individual case on the floor of this House, so forgive me for going into the broader picture. If a person is receiving social assistance, it would be a decision, I believe, made by the Department of Community Services. As I understand how that system works, if a person has a medical or dental problem which is not normally covered or for which a person has been
refused service, they have a right of appeal. Other than that if it is a matter of a "medical necessity" referred by the family doctor whomever it would be, I guess it would probably come into our shop, and I don't know enough about the specifics to make a comment, really.
MR. PYE: That is the reason I stated this in general terms. I am going to table this for the Minister of Health. This individual has exhausted all avenues, including the appeal process. The supervisor of the Department of Community Services implies it is a health issue. Her orthodontist, a specialist in the field, has recommended that there is no other choice but to go through this particular dental operation, and that is the reason why this particular individual says, I don't care anymore. Whichever way you can do it, bring it to the attention of someone in government because it is such an embarrassing situation that I am in now, somebody has to address it or else I am going to get a little upset. The problem, Mr. Minister, is this, she has already exhausted the avenue of the Department of Community Services. It has gone to the Department of Health. I have already told you, in fact, the manager of the Department of Health in which it has gone to, to appeal the process in accordance with the policy set out by MSI. So we followed that policy, we followed that procedure right to this very end.
The bottom line is, ultimately, the Department of Health has the final say in this issue. Mr. Chairman, I am going to give up my time to the member for Halifax Needham, but I want to table this so the minister will have an opportunity to have a look at this personally, and maybe, at some time in the very near future, advise me, as her MLA, in what direction I can go to address this particular problem.
MR. MUIR: I would be pleased to look at it or have staff look at it, Mr. Chairman, but I would suggest rather than tabling it, it would probably be more efficacious if he wrote me a note, and I can deal with it in an appropriate fashion.
MR. CHAIRMAN: The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Mr. Chairman, I will be sharing the remainder of the time with my colleague, the member for Cape Breton Centre. I would like to start first by laying out a few of my concerns about health care in Nova Scotia, and this budget in particular, and then I will have some specific questions for the minister. It is true that the failure of government to deal effectively with health care in various provinces or even other jurisdictions internationally has been the Achilles heel of more than one government. That certainly was the case I think in the U.K. where the reorganization of the National Health Service made an enormous difference in terms of contributing to the eventual defeat of John Major's Government by Tony Blair. I think we have to remember people have real needs, not wants, real health care needs, and they expect high-quality services to be there when they need them. I am certainly clear, given the calls I get in my office, that Nova Scotians are increasingly concerned that they are finding health care services are not there when they need them.
We are watching the spectacle unfold in Alberta. For many of us, it was somewhat comforting to see last night in the Legislature in Alberta many, many Albertans coming to their Legislature, filling the galleries and making their views known on where Ralph Klein intends to take health care in his province and by implication where that could lead health care in other provinces, including Nova Scotia. I wish the best of luck to those Albertans who are trying very hard to prevent two-tier health care in that province because of the implications it will have for the rest of us.
It is not an exaggeration to say that there are private sector interests throughout the world who are literally drooling at the possibilities for profit making in health care in the developed world - the potential to operate private facilities, to manage public facilities, to provide pieces of services, the pharmaceutical industry, the waste management field, supplies, blood substitutes, for example, information technology and all of the kinds of consulting that we have seen that have really been cost drivers in the health care system. Many of these cost drivers are directly a product of private sector interests that perceive the potential to realize an extraordinary amount of profit in our public health care system in this country and elsewhere.
I am really hoping that Canadians and Nova Scotians can hang in and can do the kind of work and mobilizing to prevent the further erosion of our health care system and prevent us from sliding further and further into an American-style health care system which is not only inefficient and ineffective, but the vast majority of citizens of low and moderate means in that country cannot get access to health care when they need it and where they need it. That is not something that Canadians or Nova Scotians should tolerate.
Having said that, when I look at the particular budget that is being brought forward here, there are a number of things that I am fairly concerned about because it is true that we have a fiscal responsibility, as the minister points out. We need to be fiscally responsible, but we also need to be able to find that balance so that we continue to provide the good quality care for people in this province where they need it and when they need it. So one of the major concerns that I would have about the particular budget that has been introduced is the absolute absence of a multi-year plan. We will never get a handle on our health care system in this province unless we have a multi-year plan brought forward and there is no multi-year plan here.
What I see in this particular budget is the same thing, Mr. Chairman, the same mistake that was made by the Savage Government who proceeded to cut acute care fairly severely without having done the necessary groundwork - the investment in the long-term care and the home care programs that would be required to sustain and support these kinds of cuts and the impact of that will be felt by patients and they will be felt by their families and they will be felt by the communities where those people live. This is a very big problem. It will also be felt dramatically by people who are working in the system - nurses, doctors, all of the other support services that go along with this.
Mr. Chairman, the other feature of the Department of Health budget that is of concern to me and it will be of concern to people in my riding and certainly I am getting a number of phone calls from people about this, is the introduction of user fees; in particular, ambulatory care, the increase in the user fees for using ambulances.
The increase in Pharmacare costs, I don't think that there is any other issue that I have taken more calls on since I have been elected, in the time I have been here, than the increase in Pharmacare costs. That, in part, reflects the large seniors' population in my riding and the fact that most of these people are people with low and modest incomes, I am sure is a part of that, and people are very upset about this. It will result in people not getting medication and then when people don't get medication, they will become ill and they will be seen in other parts of the health care system.
So it is one of those kinds of policy approaches that is profoundly short-sighted in terms of the implications it has for the effective and efficient operation of the health care system, never mind people's actual health. Of course, as well, I am concerned about the implications of lay-offs, displaced workers, but also for workers who are left and the enormous amount of stress that workers in the health care system are already under.
There are a number of other things that I could talk about. The moving of all of the seniors' programs into the Department of Health is an issue that has not been discussed here and the possibility of the medicalization of seniors as a group, when seniors need to be approached in a much more broad context, that seniors need to be placed in a social context, not necessarily a medical context, I think is something that needs to be said and it is something that we need to watch out for as this new reorganization is attempted.
The final thing I would like to identify is the fact that midwifery has been abandoned as a sphere of practice by this government. So with those remarks, I would like then to ask the Minister of Health, why is there no multi-year plan presented here? It would seem to me that if one is going to attempt to deal with the reality of fiscal responsibility and the increasing pressures and the kinds of restructuring that is going on in health care, one would need a multi-year plan and we don't see that.
MR. MUIR: Mr. Chairman, the honourable member made a number of points in her opening comments. She began with the legislation, Bill No. 11, in Alberta, I guess it is, I think it is Bill No. 11. It is interesting that that has come up and I mention it for two reasons; first of all, because it has created a tremendous amount of debate about doing some minor medical services outside an acute care facility and it has created some national debate, and it is putting the frame of commitment to the Canada Health Act and all of that type of thing.
One of the interesting things that we discovered, Mr. Chairman, when we were taking a look at this, is that that legislation exists in a much more liberal form in at least four other Canadian Provinces, British Columbia, Saskatchewan, Manitoba, and Ontario. I have not
looked at the legislation in those things, and I am not making any comparison, but this is what we were told. I am not really even sticking up for Alberta, I am just simply saying that they weren't first off the mark. I have read the Alberta legislation, and I want to tell you that Nova Scotia is firmly committed to the principles of the Canada Health Act.
Notwithstanding that, I guess one of the points that I wanted to make, and the reason I went there in the first place, is that Alberta is a very wealthy province compared to Nova Scotia. The honourable member for Halifax Needham mentioned fiscal responsibility and, indeed, I am really pleased to hear her make that her second point. I think that is extremely important. The point is that if the Province of Alberta, being the wealthy province that it is, makes a statement that costs of health care are increasing so fast that in 10 years they will be spending every nickel, at that rate of increase, on health care in Alberta, that the health care costs are a problem for them. I think Bill No. 11 was a reflection of, in their case, trying to deal with that.
I think that Nova Scotians understand the pressure that we are under here, to try to get our fiscal house in order so that we can have a health care system in the future. The steps that we have taken with this budget are steps towards that. The honourable member, I know, has a large number of seniors in her constituency and, indeed, the largest seniors' complex, probably, in the province, Northwood, is smack in the middle of Halifax Needham. I have been in that complex, and I admire that organization. Anybody who hasn't been there, it is kind of a treat to go in there and see what a non-profit agency can do and how they manage things. I think, too, we remember that Northwood may be non-profit but it is really big business in terms of the services they provide and their annual budget. We think of a little group of volunteers running around doing this and doing that, but it is very well run, it is run as a big business.
With the Pharmacare costs, the only response I have for the honourable member is one which I have said before, I would love to be able to stand up here and say that we could continue, and not make any adjustment in the Seniors' Pharmacare Program in terms of asking the seniors to participate a little more. The Pharmacare costs are increasing so substantially that we have to have some additional revenue. She made the argument saying, well, gee, if they can't pay for their drugs, they are in some other part of the system. That argument was also advanced the other night by her colleague, the member for Dartmouth-Cole Harbour.
When you are talking about this, what would happen if there was no Seniors' Pharmacare Program? That is really one of the things that we are trying to preserve, the Seniors' Pharmacare Program. Costs are escalating so far, and if our province had continued to spend money at the rate it was doing and not try to provide some stability or get our fiscal house in order, there is a good chance that in five years there may not have been a Seniors' Pharmacare Program, or we might be paying as much as they are in Saskatchewan.
Notwithstanding the increases in ours is that our program is still not out of line compared to the rest of Canada. I think the honourable member appreciates that as well.
She also mentioned midwifery. We have not written off midwifery. We were approached by a number of midwives here in the province, I am told there are about four who practice. They wanted to set up a self-regulating body. Our opinion was - we sat down with them - we are not against midwives, indeed, the time may come. Some of them do practice here in Nova Scotia, but you do need a critical mass if you are going to have a self-regulating body, and the critical mass is not there. There may be others who are in the province who want to get involved in that, and if that is the case, the numbers increase substantially, then there may be something we can do about that.
The last point the honourable member mentioned, she was talking about multi-year planning. Indeed, she is absolutely correct. If we are going to do what needs to be done here in health care, we can't look at it on a year-by-year basis, we have to try to get some sort of a picture of where we would like to be in three years or two years. The multi-year planning, once we get through the establishment of these district health authorities, and get that legislation passed, and we get into community health boards, this is the direction - you are absolutely correct - we would like to go in.
[5:00 p.m.]
MS. MAUREEN MACDONALD: The first thing I would like to say, and I don't want to get into a big debate about Alberta, but Ralph Klein has lots of options besides what it is that he is doing. I think that it is pretty hard to argue that he is doing what he is doing because of cost, that cost is the driver here. There are many other factors at play besides cost, including a little dispute he is in with the federal government about how much money the feds are going to put into health care. It is a very dangerous game of chicken, because he is playing with the future of health care in this country. That is the last point I would like to make about Ralph Klein.
Going back to the minister's points about Pharmacare costs and if we are going to preserve a Pharamacare Program then we need to look for ways to be fiscally prudent. I want to ask the minister why is it that $26 million in overpayments to doctors was written off? If he could expand a little bit on what exactly is an overpayment with doctors, how do they occur? What steps does the province take to recover overpayments, rather than allowing them to accrue into situations where they are written off like this? Again, I would like to point out that it was $26 million, a substantial amount of money in our health care system that was written off.
MR. MUIR: Mr. Chairman, I think the honourable member probably knows, in asking that question, that was something that was accumulated some years ago. In our case, it was a matter of cleaning up the books, it was not something for which we were responsible.
Basically the reason for it was this, the reason it was an overpayment is that the budget allocated so much money for payments to physicians; the payments exceeded that. Therefore, it was left on the books, it was 1994. It was a carry-over from there.
MS. MAUREEN MACDONALD: Mr. Chairman, nevertheless, that is a substantial amount of money to be written off. My question is, why did it have to be written off? How do overpayments occur? I am somewhat familiar with the Department of Community Services. The Department of Community Services continues to carry over-payments to people on social assistance, dating back to the very beginnings of the Canada Assistance Plan in the mid-1960's. In fact, they continue to pursue over-payments. It is the policy of government not to write off those over-payments, but to continue to carry them and to continue to look for them. If we have a situation where we have such a need to squeeze money out of the system, and we are prepared to squeeze money out of senior citizens around their drug needs, why don't we pursue other alternatives and look at line items such as this? Twenty-six million dollars is a substantial amount of money in the health care budget.
MR. MUIR: The honourable member raises, I believe, a good point and one which we continue to think about as we move ahead, trying to restore some fiscal order to this province. It was not just, unfortunately, an overpayment to the physicians that was written off, Mr. Chairman, there was additionally about $317 million that was written off during that period of time, the debts and deficits which were of the regional health boards and the NDOs that were assumed by this government, to try to restore fiscal order.
In the social services, Community Services overpayments were done in error and I guess that is the reason they tried to recruit those. This was, for the physicians, a contractual agreement and, unfortunately, the budget allocation didn't match the contract.
MS. MAUREEN MACDONALD: Well, I am still having some difficulty with this because there is a qualitative difference between the debt of the hospitals and the hospital boards that was written off and salaries to the highest paid group of people in the health care field, I think. I guess I want to know why some discussions were not initiated with the Medical Society with respect to this situation, in an attempt to recover some of that money. To me, we are here today, earlier we were dealing with education, we are seeing the hammer put to the school boards; we have seen the income levels for people on social assistance cut; we are seeing user fees and all of these things entering now into the health care system.
If we are going looking for money in every conceivable place - this is what we are being told - then I don't understand really why you haven't pursued the route of sitting down with the Medical Society and opening up a discussion about recovering this $26 million, rather than just writing it off.
MR. MUIR: I don't know, Mr. Chairman, so to speak, the bookkeeping elements of this thing so she will have to forgive me when I can't speak to the accounting principles. The $26 million was something that was accumulated under the previous administration and I am told that it was part of the negotiations of the new, four year agreement that extended from 1997 to 2001 and so there were discussions with the Medical Society about that back then. We ended up, I guess, with the task of straightening out the books.
MS. MAUREEN MACDONALD: With all due respect to the minister, couldn't you have said, this deal is too rich for our blood, look at the situation, this is the situation we find. That is what you are doing, you are going to the Nova Scotian public, you are going to senior citizens, you are going to people who are sick and you are saying, this is the situation we are finding ourselves in and it is too rich for our blood and we need money out of your pocket to preserve this system. Why couldn't you have done that and said that equitably to other groups in the health care system who benefit tremendously from public expenditure. You did not have to just accept passively what had been done by your predecessors. You are the government now, you have the ability to say this isn't good enough.
MR. MUIR: The debt was accumulated, as the honourable member acknowledges, before we came to office. Our role was simply to clean up the books, but it was, I am told, during the subject of discussion, during the negotiations which led to the agreement between the Medical Society and the province on physicians' fees, the contract that went in place from 1997 to 2001.
MS. MAUREEN MACDONALD: I want to ask the minister if there are still any debts in the regional health boards, the old regions? If there are still debts in the regions, how will they be divided among the new district boards?
MR. MUIR: We picked up the debts, Mr. Chairman, and this past year the basic information we have is that there was no debt, that the people met their budget targets and they are on target at this particular time.
MS. MAUREEN MACDONALD: I have three short snappers, sort of, I hope you talk a bit about evidence-based decision making, I would like to know what your benchmarks are, what will you be measuring and how?
MR. MUIR: There are a number of things that we will be looking at as we move into this. Obviously one is a population-based system of services, adjusted for the burden of illness in a particular area of the province and obviously reasonable access or geography would be another criterion. A fourth one would be the province's ability to pay, live within our fiscal resources. Obviously the other one is what constitutes, I guess I would say, population health practices. Those would be five.
MS. MAUREEN MACDONALD: Well, I guess we could talk about this one all day but I hope I will have lots of time in the future to discuss this. I want to ask a question about the number of ambulance trips annually in Nova Scotia. What is that number? How many ambulance trips are made annually? I would like to know if you can break it out between the number of ambulance trips around the metro area and the number of ambulance trips from rural areas into the metro area.
MR. MUIR: Mr. Chairman, that is not a short snapper, that is a good question, though, and we do have that information. I am just going to see if I have it - if she could just be patient for a second. There is one thing, one part of our medical program where we are evidence-based, it is in the delivery of that ground ambulance service, that I can tell you.
Mr. Chairman, I am afraid I don't . . .
MR. CHAIRMAN: Would the honourable Minister of Health perhaps want to come back to that question?
MR. MUIR: I am going to have to get that. I guess I can say right now that there are about 860,000 unit hours in the system.
MS. MAUREEN MACDONALD: In terms of the breakout between metro and that kind of stuff, where I am going with this is I am trying to understand if we are seeing an increase in the user fee or the cost for using an ambulance, trying to understand whether or not people who live in my riding, for example, will be paying this increased cost, and, in fact, they will be subsidizing users from other parts of the province who are using ambulances. That is certainly something I would like to know more about.
The last thing I want to ask the minister is about whether or not the department has any in-house capacity to design and maintain patient information systems in hospitals?
MR. MUIR: We recognize there is a deficiency there, Mr. Chairman. To try to deal with that, the health information system in the province does need to be improved, and we have allocated $4 million to that project this year, and $10 million next year, so we have a committee that is dealing with the whole thing of health information. On top of that, there is a Maritime Committee on Health Information. Our hope would be we could establish a system - whatever it is that the honourable member for Dartmouth East mentioned yesterday, it is in my briefing notes - that whatever is done would work for the whole of the Maritimes, not just Nova Scotia.
MS. MAUREEN MACDONALD: I guess what I was trying to learn was, what is the status of the patient administrative software support group? I understand that within the department there is a small contingent of employees who, in fact, do have the capacity to design and maintain information systems in hospitals, and they have, in fact, been doing this
for a number of years. But, in more recent times, they have not been fully utilized, and they are being told to simply maintain at a very minimal level some of the existing systems. So, I am wondering if the minister is aware of this, and what is the intention of his department with respect to that particular group?
MR. MUIR: Mr. Chairman, in the system she just referred to, the group that is up and running is not just a departmental group, it is an inter-agency group. The group has members from other health care institutions and facilities. I will have to take under advisement the comment about our staff being under-utilized. I haven't heard that, but we can find out a little bit more about that. All I can tell you is that we have allocated in the next two years, this year $4 million and next year $10 million. We take the point the honourable member has made about the need for improved information very seriously, and we are financially committing to it serious bucks.
MR. CHAIRMAN: The honourable member for Cape Breton Centre.
MR. FRANK CORBETT: Mr. Chairman, I am going to give my time to the member for Hants East.
MR. CHAIRMAN: The honourable member for Hants East.
MR. JOHN MACDONELL: Mr. Chairman, I want to thank my honourable colleague, because I really appreciate the effort on his part. I will be brief. I know the minister is aware of concerns in my constituency around health care and health care delivery. In particular, I want to draw his attention to ambulance service in Hants East. I know the minister is aware of the meeting between the community of Maitland and the surrounding area and Emergency Health Services. I think the community was very pleased that they showed up to address concerns by the community. I did write the minister and I know he responded to my concerns about the lack of an ambulance in the Kennetcook area, and I never got any qualified response. I got a response, but it wasn't clear to me as to exactly what the minister was saying.
There were approximately 75 calls that required an ambulance in a 10 month period in that area, and I think somewhere less than 20 per cent of those were in the daytime, and the ambulance is stationed in Kennetcook through the day and then moves down to the Milford area through the evening. So, the people are wondering, where two-thirds or more of those calls happened in the evening, and that seemed to be the times when we have run into these problems about trying to get ambulance service as quickly as possible. The ambulance originally had been in the Upper Rawdon area, and it was moved to Kennetcook on the idea that that would still serve that area. Now, in the evenings, it is moved over to Kennetcook.
The proposal by the people in the area would be to have an ambulance stationed in Kennetcook all the time. I am wondering, this is a case where the formula doesn't seem to fit. I wonder if the minister and his department ever consider that there are those places that require a slight adjustment in the formula in order to accommodate the needs. I want to know what the minister's response to that is. If you consider the size of the area and one ambulance to do all the Rawdon area and the Maitland are as well, it is quite a big area and quite a number of people.
MR. MUIR: Mr. Chairman, the honourable member for Hants East raises a concern which is, I know, one very dear to his heart and a good many of his community members. Indeed, it stemmed, to be quite frank, from a couple of things that happened, but there was one incident where response time was delayed because an ambulance got lost on the way, and that is what triggered this. It took an extra 20 minutes to respond from what it normally would. I would say, we were very concerned about that incident, and our Emergency Health Services division has investigated that delay and, indeed, we went so far as the emergency health people, as the honourable member has indicated, went out and met with the people in the affected area. In particular, the local fire chief was a person who had some serious concerns about it.
There are some protocols in place now that have been adjusted as a result of the meeting with people in the community and we think that this is going to help. The situation is also to be reviewed again this month to see if the new changes have worked. The local fire chief, who was the person who was fairly concerned about this, he was satisfied with the changes that we made and he agreed to work with department officials on some other strategies to try and improve the situation in the Maitland area. One of them was getting a defibrillator out there, and I don't know if that is there now, but I do know that there was an open discussion between our department and the residents of that area. I hope that the changes that have been made will alleviate the concerns of the residents there.
MR. JOHN MACDONELL: I thank the minister for his response and yes, I was to that meeting and I know that the request for the defibrillator had been approved some time ago and they were waiting to hear about that. Also I think a couple of recommendations that came out of that meeting were that there be a radio system in place that the fire chief could respond or could contact the ambulance directly as it made its way to ensure that it didn't get lost. Also, my understanding was that there is a new mapping system, computerized, within the ambulance and that was to aid that as well.
The minister talks as though they are going to review this in a month and I am glad to hear that. I guess what I am trying to hear from the minister is, if this doesn't appear to work, would the department look at establishing an ambulance in Kennetcook all the time?
MR. MUIR: Mr. Chairman, our ground ambulance service handles approximately 100,000 calls a year, most of them without incident which is a pretty good tribute to the standards that they have. Last year, there were about 75 calls out into the Maitland area and basically, with the exception of at least one, most of them were handled without any degree of difficulty.
I will just go back to the statement that I made earlier. The ground ambulance service and Emergency Health Services, if there was one section of the Department of Health that pretty well has its act together with making decisions based on hard evidence, it is that one. If the changes don't work out, I know they will review that evidence and try to make adjustments that would meet the needs of the people out in the Maitland area.
MR. JOHN MACDONELL: I want to thank the minister for his response and I will take that response of trying to meet the needs as certainly being willing to look at keeping an ambulance out in the Kennetcook area. I am not sure if the minister is aware that, at least to my knowledge, I think there are at least three problem cases - I would say from December until the end of March - that were unfortunate, where ambulances were lost or whatever. I would certainly hope that I can take the minister at his word.
There is a present plan to move existing health services into a multi-service centre that is proposed in the Elmsdale area and I want to know if the department has any funding mechanisms that would allow for . . .
[5:30 p.m.]
MR. CHAIRMAN: SPEAKER: Order, please. The honourable member's time has expired. In the name of fairness, I would recognize the honourable Leader of the Liberal Party.
MR. RUSSELL MACLELLAN: Mr. Chairman, I would like to go to the IWK-Grace for a minute just to follow up on what my colleague was asking, to complete that, with respect to the cut of $10 million that is going to be imposed on the IWK-Grace this year. There are unequivocal statements by the board that they can't absorb those cuts, in fact, they need an increase just to be able to continue the services they are providing. The minister knows this is going to require certain services to be discontinued and that children are going to be sent out of the province for care in special areas. I want to know why he is allowing that to happen and what anticipatory action this government is taking and what he feels those areas are going to be?
MR. MUIR: The adjustment in the IWK-Grace budget was certainly not the figure which the honourable members of the Liberal Party are tossing out and they know better, or at least they should. The difference between the allocation for this year and the allocation for
last year is roughly about 4.7 per cent, which is roughly about $5 million, take the Y2K out and it comes down to that number.
The other thing is that the honourable member has mentioned that services are to be taken from the IWK-Grace and some services are going to have to be delivered out of province and I was wondering if you might tell me what they are.
MR. MACLELLAN: That was the question that I asked the minister because I would expect that he would have some knowledge of this and I think people in Nova Scotia want to know what those services are going to be that they are not going to be able to maintain. They can't possibly provide services that are substandard, they won't do it, yet with the reduction that this government has imposed on them, they can't afford to do everything that they have been doing in the past. I want to know from this minister what services the IWK-Grace is going to have to cut?
MR. MUIR: I will answer it the same way I answered the Leader of the New Democratic Party yesterday. I am not aware of any services that are going to be cut.
MR. MACLELLAN: That is really alarming that not only do they pose this cut, but they don't know what result this cut is going to cause in children's health. I want to tell the honourable member, Mr. Chairman, through you, that the public isn't going to stand for substandard service at the IWK-Grace. You have hundreds and thousands of people raising money for the IWK-Grace every year. You have private companies that work all year long on projects to raise money for the IWK-Grace and they are not going to allow their hard work to be cut back by this government's negligence on the services and the quality of the IWK-Grace. It is not going to happen. There is going to be one heck of a rebellion on this from the people of Nova Scotia who want this facility and they want it first rate. They are going to ask the same question of the minister, what are they going to cut? What is going to have to be cut? What children are going to have to be sent out of the province that are now serviced by the IWK-Grace?
MR. MUIR: Perhaps to extend the comments that I made some time ago to a couple of the other honourable members. We have a real fiscal problem in this province. The IWK-Grace is a major player in this thing. Like the honourable member, I am a fan of the IWK. I had two children born there. I had a grandchild born there and I had a son who had surgery there, if he thinks that I am not partial to the IWK. I would like to keep the IWK, Mr. Chairman, if we continue to spend and spend, there is not going to be any money for any IWK and we will be sending everybody out of province if we don't get the fiscal house of this province in order.
AN HON. MEMBER: You're fearmongering.
MR. MACLELLAN: That is not fearmongering. No, not at all. From this side of the House it is fearmongering, but, from him, it is just qualified and quantitative appraisal of the situation. I can't get over this. How are you going to expect these people to do this telethon? How are they going to do this telethon when what they are raising is being undercut by this government? You have private citizens working all year long to raise money for the IWK and what they are doing is going to be nullified and then some by this government's cuts. How is he going to explain to these people that the hard work that they have been doing is still as important to the government? Because what they are raising is being cut by this government and then some. It is absolutely callous and unfeeling and it is counterproductive. I want to know why the minister is taking this position?
MR. MUIR: Mr. Chairman, I believe the good folks in the Maritime Provinces will continue to support the IWK-Grace. I think the activities of their foundation will continue, they have grown and I expect that they would continue. However, I would remind the honourable member that the money that is raised from the telethon does not go for operational expenses in the hospital, it goes for research and special projects. To say that we are cutting that money because of operations, I am not sure what the connection is.
MR. MACLELLAN: Mr. Chairman, it is the point that these people are raising money and the government is cutting. They are raising because, as the minister says, it is for a different purpose, but they are raising money to keep the quality of this institution to where it is. That is what they want. They want a first-class facility so their children or children of their friends or any child gets fair treatment, the treatment they feel they should get here in Nova Scotia. The fact is, the government is working against this quality issue by the people of Nova Scotia. I want to ask, frankly, has the minister, at any point, talked to the Government of Newfoundland about the Government of Newfoundland sending their sick children to the IWK-Grace?
MR. MUIR: There are regular discussions among the Atlantic Provinces deputy ministers. I have also met with my Atlantic counterparts. As the honourable member knows, there is the Janeway Hospital for sick children in Newfoundland in St. John's. The services that Newfoundland does require from the IWK-Grace, because it has its own facility, are certain specialized services. For example, I think one of them may be cardiac services on cardiac surgery for children where you need a particular critical mass and, to be quite frank, if we didn't have the folks from the other Atlantic Provinces, that service could not be provided because there isn't a sufficient number, thank heavens, I guess, of demand for that service in Nova Scotia, that the clinical standards that you are talking about could be maintained.
MR. MACLELLAN: Mr. Chairman, my understanding is more then cardiac work is being done on children outside of the Atlantic Provinces, from Newfoundland. In fact, these children are being sent to Ottawa or the Hospital for Sick Children in Toronto, but I think it is Ottawa. Also, the minister knows that we are dependent on the services for children being
sent from the other two Maritime Provinces. I am concerned, quite frankly, and I say this, quite truthfully, that if the standard of the IWK-Grace is allowed to deteriorate, then these other two provinces will not feel that this hospital is up to the standard that they want. They will, in fact, send these children elsewhere, because they can. They can pay the cost. These children can go other places. I want to ask the minister, has he considered this when he is cutting the services at the IWK-Grace?
MR. MUIR: Mr. Chairman, I have every confidence that the IWK-Grace will maintain its core services and protect its standards. One of the things about doing joint business planning with other institutions here in the Capital Health Authority is that they move to the table and they can talk about shared services. What we have from the honourable member, unfortunately, is a knee-jerk reaction. Don't try to do anything, the first thing you do is cut rather than protect, and let's get together with the other institutions and see what we can gain from working together.
MR. MACLELLAN: It seems, Mr. Chairman, that when the minister doesn't have an answer, or when he hasn't looked at the right ramifications of what he is doing, that it is the Opposition's fault. It is not the Opposition. It is not the Liberal Party that made those cuts, it is the government. They made those cuts without the faintest idea of how these cuts were going to be manifested in the health care system, let alone what they were going to do for children who are trusting this province to give a certain quality of care. I think that the minister is totally wrong and is being totally irresponsible in jeopardizing the reputation of this institution and jeopardizing the future of this institution to the level that it is right now.
I want to move on to something else. The minister talked earlier about recovering costs for out-of-country patients. I want to know, what is going to be the level for out-of-country patients? Are we, in fact, ensuring that we are meeting the costs of servicing out-of-country patients? Can the minister assure us that this is, in fact, being done and will be done?
MR. MUIR: Mr. Chairman, that is a good question and it does raise one of the points that we talked about, increasing the revenues to the facilities. Out-of-country revenues do accumulate to the facilities; out-of-province accumulate to the province. So what the individual facilities are going to do to, my understanding is, that they are going to go for full-cost recovery. In other words, if somebody came to Nova Scotia as a visitor from out-of-province or out-of-country, and unfortunately had some sort of a serious thing that took them into the QE II, perhaps, for by-pass surgery or something like that, then we would be billing for the full amount.
MR. MACLELLAN: Mr. Chairman, I wanted to check with the minister, too, on the utilization of facilities that presently exist in our hospitals. What analysis has the minister done to see that some of the facilities we have can be utilized by the private sector or jurisdictions outside of Nova Scotia, as an example, blood testing? Has the minister looked at the possibility of blood testing for other jurisdictions? In the United States, the cost of flying
blood samples to Nova Scotia, having them analysed and flying them back the next day and getting them within two days, as opposed to sometimes one week, can be one-third the cost, even with that flight transportation. Has the minister looked into that? Is there any kind of analysis or any kind of information that would show what possibilities exist in that direction?
MR. MUIR: Mr. Chairman, that is a very interesting point that the honourable member raises. I can tell you that there is a working group among the facilities examining revenue opportunities and I expect that is the type of thing that they have considered. Just to make sure that they do, I will see that your comment is passed on to them.
MR. MACLELLAN: Mr. Chairman, it is going to be too late if the minister does what he plans to do here. If he is going to consolidate services, for instance, create one lab, then he is going to nullify the possibility of doing that. Now the Minister of Transportation says you are acting like Ralph Klein. That is not the fact; he misunderstands the whole idea. If we have qualified people who are providing world-class service here and that world-class service isn't common, believe me, in other jurisdictions, particularly with shortages of trained people, then we can do that for a fee in Nova Scotia and put Nova Scotians to work and give that first-class service.
Now we are not going to be able to do that after the minister and this government shuts down access laboratory facilities in Nova Scotia. I can understand it if the minister says, look, it is not feasible, fine, but I can't understand him looking into it after he has closed down these services, so that it would no longer be possible. Why has he talked about the centralization and consolidation before he has looked at these other possibilities?
MR. MUIR: Mr. Chairman, I think once we get to a single organization, that type of thing is probably a little bit more practical. As I said, we have a working group and I expect that that is one of the things being considered.
The honourable member, I am trying to find out a little bit of the consistency. He tells me, through a number of his questions, that our system is operating, we don't have the capacity to meet our own needs and now he is saying well, we have excess capacity and should be meeting somebody else's needs. I am not entirely sure what his message is.
MR. MACLELLAN: This is getting more frightening all the time, Mr. Chairman. It is very clear, if the minister can't understand what I am saying then he is more in the dark about health care than any of us and even on his own side imagine. He is talking about a consolidation of services; he is talking about bringing excess services together, overcapacity in services together to save money - not only administration, he is looking at services.
Now the services are good. We have an overcapacity, the honourable minister knows that. I am not talking about hospital beds, I am not talking about nurses, I am talking about the services like laboratory services. The minister knows that, he just isn't answering the
question. He doesn't understand, there is no critical path analysis in what he is thinking. There is no plan at all. It is really alarming.
I want to just go on to what the minister is saying he is going to do, which, in fact, if he does it, will negate using our services to create funding. He is talking about the consolidation of services. Now the consolidation in the budget is $1-some million, if he is going to consolidate overcapacity in services, where is the money coming from? Where is the money in the budget for that? There is only $1-some million in the budget and that is not going to do the job.
MR. MUIR: There has been about $1 million allocated this year for the transformation from the RHBs to the DHAs. The other saving, the other cost that the honourable member is speaking of, will be picked up as we transition, particularly here in the capital region, the existing institutions get to the table and talk about how they collectively can work together to diminish costs.
MR. MACLELLAN: If he is going to do what he says he is going to do, there is money elsewhere in the budget, or he hasn't thought of the costs of the consolidation. You can't consolidate without spending to have the facilities modified to account for what he wants to do.
Now the budget talks about restructuring. Restructuring costs for this fiscal year are going to be $88 million; for the next fiscal year they are $126 million; the following year they are $107 million and the year after that, $109.5 million. Now how much of these restructuring costs are allocated to the Department of Health?
MR. MUIR: Mr. Chairman, I believe that question would be most appropriately directed to the Minister of Finance.
MR. MACLELLAN: Doesn't he know what his Health Department is doing? Doesn't he know where the reallocation is going to take place with respect to his own department? Now I could ask the Minister of Finance that but I shouldn't have to, Mr. Chairman. The minister should know what portion of this is allocated to the Department of Health.
I am getting awfully tired of the minister pleading stupidity. Now if he is pleading stupidity then it has to be that the answers are even worse because it is a heck of an admission to plead stupidity. This is not getting to us; this is supposed to provide answers, this is what this exercise is about.
I want to ask the minister about long-term care. The increase in long-term care is $1.1 million in the budget. Now has he factored into that figure wage increases in long-term care?
MR. MUIR: Yes.
MR. MACLELLAN: So, in fact, the long-term care budget of $1.1 million increase is actually a loss, is a reduction in long-term care, because if you factor in the wage increases, that $1.1 million is erased and there is a further reduction in the long-term care budget, is that correct?
MR. MUIR: Mr. Chairman, as the honourable member knows, the costs of long-term care have been increasing over the past number of years, like everything else. Indeed, over the past three years the cost of health care services has gone up close to 38 per cent, which is an increase of close to 13 per cent a year. Unfortunately, this province cannot sustain a health care increase of 13 per cent a year and, therefore, this government, in an attempt to try to see that there is a health care system that will have long-term care in it in the future and hospitals and physicians' services and things like that left, we have to get our fiscal house in order. As he knows, the health care currently occupies about 42 per cent of program spending. So I go back, we have to make tough decisions if we are going to ensure a health care system that works and is sustainable and is responsible.
I am not like him, I want a health care system that is going to be here tomorrow and the next day and the next day, not only for my grandchildren but probably for my grandchildren's grandchildren. If we were to listen to this group over here, Mr. Chairman, we would have been downgraded so far that we would have spent our way into oblivion. They didn't want to make any decisions, just spend your way and it will go away. However, notwithstanding that on his question specifically about long-term care, last year there were unusual pressures, sort of one time costs of about $6 million. Once they have been eliminated then there has been an increase in the long-term care budget.
MR. MACLELLAN: Mr. Chairman, the minister has said in his own words that 25 per cent to 30 per cent of the patients in acute care don't need to be in acute care. They don't need to be in those beds of $1,000 per night or more, but they could be in long-term care at sometimes one-tenth the price and cost to the Province of Nova Scotia. But they can't be moved because this government says that 99 per cent of the long-term care is taken up, that there is no place for them to go. Instead of creating long-term care facilities, he is saying we are going to cut the money for long-term care. There is a $1.1 million increase in the budget, which takes into consideration increased wages. I want to ask the minister how much is allocated for increased wages and long-term care?
MR. MUIR: Mr. Chairman, that is $7 million.
MR. MACLELLAN: So, there is a reduction, Mr. Chairman, in the long-term care budget of $6 million. I just don't know where he is going to save money. You can't move these people from acute care because there is nothing in long-term care to accommodate them, or home care. He is reducing the long-term care budget by $6 million. How does he feel this is going to improve the cost of health care and service the people of Nova Scotia?
MR. MUIR: Mr. Chairman, the increase in the wage settlement has to do with parity payments, a lot of them. It is basically going to be accommodated because of the one time expenditures we had last year and then the increase in this year's budget.
MR. MACLELLAN: What one time expenditures last year, Mr. Chairman?
MR. MUIR: Mr. Chairman, there were a variety of things that contributed to that one time thing. One of them was Y2K. Another was basically some extra operational funding to some of the homes. One of the things was some emergency projects that were needed, for example, one of the projects funded had to do down in the honourable member for Hants West's riding to put an emergency generator for one of the nursing homes down there, I can remember that coming through. Then there was the assistance with some renovations, accounting for that roughly $6 million.
MR. CHAIRMAN: Order, please, honourable members. We have arrived at the moment of interruption.
The committee will adjourn until 6:30 p.m. and reconvene at that time and continue with the estimates of the Department of Health Resolution E12.
Is it agreed?
It is agreed.
[5:59 p.m. The committee recessed.]
[6:30 p.m. The committee reconvened.]
MR. CHAIRMAN: Order, please. The Committee of the Whole House on Supply will now reconvene. We will be debating the estimates of Health, Resolution E12.
The honourable Leader of the Liberal Party.
MR. RUSSELL MACLELLAN: Mr. Chairman, when we broke at 6:00 p.m., we were talking about long-term care and the increase that was stated in the budget at one point, $1 million, but the Minister of Health has not said that that includes a $7 million wage increase. So, in fact, the increase is not an increase. There is a decrease in long-term care spending and I want to ask the minister why there was this decrease and he talked about special expenditures last year as a reason. I asked him what those special expenditures were, one-time expenditures, and he talked about the fact that one of the nursing homes needed a generator or there were certain renovations needed in other nursing homes.
Mr. Chairman, that is absolutely incredible. These are normal maintenance expenditures. What this minister is saying is that any capital expenditures on any of the nursing homes are one-time expenditures, that they are exceptional expenditures, one-time expenditures that will not happen again. He is now saying that there is not going to be any renovations or any improvements or any upkeep of a capital nature on any of the nursing homes. How in the name of heaven can he say that? Is this budget even worse than we imagined? Is this budget going to cut back all those expenditures to nursing homes?
My goodness, what in fact is he saying? Is he telling us that there is no money for renovations or special expenditures, no plan and that he has reduced long-term care spending by $6 million? Is that what the minister is saying?
MR. CHAIRMAN: The honourable Minister of Health.
HON. JAMES MUIR: Mr. Chairman, no.
MR. MACLELLAN: Well, dare I ask the minister, may I be presumptuous enough to ask the minister, what in the heck is he saying?
MR. MUIR: Mr. Chairman, the honourable member asked me if there was a decrease in the long-term care budget this year and the answer is no.
MR. MACLELLAN: How can he say that when he lists a $1.1 million increase in expenditures in long-term care, but that includes a $7 million wage increase. Now, if you take the wage increase out, there is a $6 million reduction in the long-term care budget. There is no other way to look at it. That is the case, the minister said that.
Let's move on because my time is moving along here and I want to ask him about mental health services. He mentioned, when I talked to him last, that children's mental health, there was an increase, yet the Mental Health Services Program budget is represented by a $1 million reduction. Where is this reduction coming from in the mental health budget?
MR. MUIR: One of the decreases, Mr. Chairman, was the Y2K expenditure, which was $600,000; revenue volume savings, about $2 million; and the underspending in the boards, about $8 million.
MR. MACLELLAN: I want to ask the minister as well about nurses' salaries. In the budgets of the acute care facilities, does the reduction include increases in nurses' salaries and increases in the salaries of support staff?
MR. MUIR: Mr. Chairman, I wonder if the honourable member could repeat the question, I don't quite understand it.
MR. MACLELLAN: I would be glad to. We have approximately, with Y2K, over a $70 million reduction in the spending in acute care facilities: $31 million for QE II; $10 million for IWK-Grace; $8 million for the Cape Breton Health Care Complex. Do those budgets include wage increases for nurses and support staff?
MR. MUIR: Yes, Mr. Chairman, all of the contractual obligations are accounted for in those figures.
MR. MACLELLAN: So once you take out the salary increases, the actual reductions for the acute care facilities are more dramatic. This is alarming, but I cannot say it is surprising. Before I turn it over to my colleagues, I want to ask him about the Cobequid Multi-Service Centre which we committed, while we were in government, to replace. I want to know in this budget what money is allocated this year for a new Cobequid Multi-Service Centre?
MR. MUIR: I am pleased to say, Mr. Chairman, that $2.5 million is allocated in this year's capital budget for that facility.
MR. MACLELLAN: What is that $2 million for? Is there going to be a design of the new facility, is there the actual securing of the site for this new facility to be done this year? What is the $2 million going to be for?
MR. MUIR: Mr. Chairman, those items that the honourable Leader of the Liberal Party just mentioned are indeed the items to which that money is committed?
MR. MACLELLAN: When will the site be selected for the Cobequid Multi-Service Centre? When will the actual design and plans for the new centre be completed? Is this $2 million the total payment of the plans for a new centre and the site of the new Cobequid Multi-Service Centre?
MR. MUIR: Mr. Chairman, no, answering the last question first, the $2.5 million is basically for development. As he may know - and there are a couple of members here who are keenly interested in that: the member for Sackville-Cobequid and my colleague, the member for Sackville-Beaver Bank whose constituents are served by that facility - there is a community committee that is to go through the site selection process and to assist in the planning of that. I am not entirely sure where that committee is with regard to site selection. (Interruptions) They are working on it, I have been informed by my colleague.
Once that site selection has been finalized, then we can get into the planning phase. As you know, the community is contributing 25 per cent of that cost too, and I believe 2002 is the year in which we hope to have that up and running.
MR. MACLELLAN: When the minister says up and running, is that up and running in construction? No. That is the actual construction, is that what the minister is saying? Thank you very much.
I would like to turn it over to the member for Cape Breton West.
MR. CHAIRMAN: The honourable member for Cape Breton West.
MR. RUSSELL MACKINNON: I have just two or three questions. Cutting right to the chase here, the question I have is, where is the deputy minister? This is the first time I have seen with any of the departments where the deputy minister is not here to assist during these budget deliberations. Perhaps if the minister would be kind enough to apprise us, why isn't he part of this process?
MR. MUIR: The deputy is off attending to the strategic direction and other things for the department. I feel quite comfortable with the staff accompanying me here and obviously if we had felt the deputy was needed, then the deputy would be available, but my two colleagues here in the Department of Health are providing the information and back-up I need.
MR. MACKINNON: I certainly don't want to diminish the importance of any staff member within the Department of Health, but I would think, you are paying upwards of $200,000, plus shipping costs from British Columbia to Nova Scotia, so you would expect he would at least show up. This is probably the most important document and it is going to affect everyone in Nova Scotia - strategic planning, I think we have had enough of that coming across the floor - so, with all due respect, I would expect the deputy minister would at least take the time to participate in the financial deliberations that are before the House here, and most importantly, have a sense or some flavour of what the dynamics are of what is happening here in Nova Scotia.
Quite frankly, I have heard people from the Department of Health make the observation that the deputy minister has a very negative view of people working within the Department of Health and I will recap what one statement was. The biggest problem with the people working here within the Department of Health in Nova Scotia is "double double". That was the quote. When he was asked, what do you mean, double double? Well, they are drinking too much coffee, too much coffee with cream and sugar. That is the problem. If that is the type of attitude we have with a new deputy minister, I would think it would be even more important for him to come and understand what is really going on within the Department of Health.
I have watched very quietly how this whole budgetary deliberation has been transpiring over the last two days and I was kind of checking off in terms of the minister in his consultative process. I am not exactly sure what has transpired over there, but I would
suspect the individual to the right is finance and the individual to the left of the minister would be policy and development, or something to that effect, programs and policy.
If you count up the number of times they consulted with the finance person, it outnumbers the person in programs by anywhere from 10 to 1, to 15 to 1. That clearly underlines where the minister has developed the focus for his budgetary deliberations. That, to me, underlines even more so the importance of having the deputy minister here, because if he is brought in to achieve the financial objectives that seem to be focused on by this particular government, then I think that we are not getting value for dollar with this deputy minister, even before the ink is dry on his contract.
That being the case, I would ask the minister, is he prepared to table all the documentation on the deputy minister's contract, his tenure and the total cost of transporting this high-priced individual from British Columbia?
MR. MUIR: Does he want the same document that the honourable member for Dartmouth-Cole Harbour asked for earlier today or does he want a duplicate? I would say that the contract of the Deputy Minister of Health was tabled in this House. I think he is talking about moving expenses, I assume that is one of the things that he is interested in, and we will provide that documentation. Unfortunately, there are a couple of things that are not yet cleared up. We can give a partial accounting, or a full accounting when the total is known.
MR. MACKINNON: A couple of other issues. I know the minister is quite excited about having this new deputy minister; it is good to see 1 out of 950,000 has that pleasure. I would like the minister, if he would be kind enough, to indicate to members of the committee, what was the total amount of money that was spent on health care for Nova Scotians who are outside of Nova Scotia - whether that be out of the country or in other provincial jurisdictions - and, through no fault of their own, found themselves in a difficult situation and required support from the Nova Scotia health care system?
MR. MUIR: Last year, we paid out $14.7 million.
MR. MACKINNON: I thank the minister for that information. Also, would the minister be kind enough to apprise the members of the committee, what was the total that was expended on legal fees by the department in the last fiscal year?
MR. MUIR: The estimate for 1999-2000 for legal services was $130,000 internally and $21,600 externally.
MR. MACKINNON: Would the minister be able to apprise members of the committee as to what percentage of the total departmental budget was the cost of administration, on a percentile basis?
MR. MUIR: One and a half per cent, Mr. Chairman.
MR. MACKINNON: Would the minister be kind enough to table that graph?
MR. CHAIRMAN: The one that the minister used as an illustration? Is he prepared to table it?
MR. MACKINNON: One final issue for myself, Mr. Chairman, before I turn it over to my colleague, the member for Richmond. I notice that there is an increase in the Cape Breton County Homemakers Agency, to the extent of upwards of $200,000 from the previous - well, in the book, on Page 77 of the Supplement to the Public Accounts, I noticed this expenditure, for the fiscal year ended 1998-99, was $1.2 million and the previous year was about $1 million. Perhaps the minister would be kind enough to indicate what is budgeted for the upcoming fiscal year for the Cape Breton County Homemakers Agency?
MR. MUIR: Mr. Chairman, that detail is not broken out. The reason for it is that it would appear in the Supplement. Unfortunately, this was administered under the Eastern Regional Health Board, as opposed to under the Department of Health. So what we basically have in here is last year the estimate for Home Care Program, Eastern Region, General Nursing, was $2.4 million. But the contracted home care services in the eastern region, which is what yours would be, is $2.6 million, so it would be a portion of that. We can chase that down for you. (Interruption) Okay.
MR. CHAIRMAN: The honourable member for Richmond.
MR. MICHEL SAMSON: Mr. Chairman, the minister knows I have already asked him about the Strait-Richmond Hospital in regard to the new bill that he has proposed. I wonder if he can provide more clarification as to why that hospital is not included in the bill. Also, I have received some concerns by staff at the Strait-Richmond Hospital. As you know, the Strait-Richmond Hospital has an outpatients, has the hospital portion, but the other half of the hospital is currently being used as a detox. There was concern that that detox unit would be shut down as a result of this new budget. I am wondering, could the minister clear up that air of confusion?
MR. MUIR: Mr. Chairman, I guess there are two questions. One had to do with why the Strait-Richmond Hospital was not included, and that was a straight omission. It should have been included and the bill will be amended to include that in it. I did appreciate that the honourable member did mention that to me the day we tabled the bill and it was helpful and I appreciate the information, as we were able to carry it back and we will have it adjusted appropriately.
He talks about the detox centre in the Strait-Richmond Hospital being closed. My understanding is that with clinical footprints and all that, it certainly doesn't come to our attention that there is one there that is going to close. I didn't even know there was one there.
MR. SAMSON: Well, Mr. Chairman, I could go on about the Minister of Health. First of all, he tells me, he tells this House and he tells the people of Richmond County that he forgot to put our hospital into his bill - oops - then he tells us a detox centre in your hospital, I didn't even know you had one. So one would hope that the minister will try to pay a bit more attention to Richmond County and to the needs of the people, not only in Richmond but in the entire Strait area, which covers the areas of his own colleagues: the Minister of Tourism, the Minister of Housing and Municipal Affairs, and his colleague directly behind him, the MLA for Guysborough. So I would hope that at least that MLA could maybe whisper in the minister's ear a bit of information.
St. Anne Community and Nursing Care Centre, which I will assume from that last answer the minister has no idea what it is, is a little health care facility (Interruption) You are familiar with it, okay, he says he is familiar with it. That centre has its own community health board to start off with. They want to know where they stand as a result of this new bill and, with the changes going on in your department, will they continue to maintain their autonomy or how are they going to be impacted by these changes?
MR. MUIR: At St. Anne the facility does contain an outpatient department and some long-term care beds. It does have a board and we will be entering into discussions with its board to see that it becomes integrated into the health authority.
MR. SAMSON: Okay, I am not quite sure what that means or how I should convey that to them. They are not in the bill right now, as Strait-Richmond, and I am assuming they are not in the bill because they are not under the Hospitals Act. There is a veterans' wing in there, there is an outpatients, there are long-term care beds, it is a multi-purpose facility and it has its own board. I am not quite sure if I am comfortable with the minister's answer that you are going to open discussions with them about entering this community health board system. Am I to assume that that means St. Anne Community and Nursing Care Centre will no longer maintain the current board structure that it has right now, for that particular facility only?
MR. MUIR: The honourable member, again when the bill was tabled, pointed out to me that St. Anne was not included. I did check with our folks - and at the same time Strait-Richmond was an omission - and I do believe the response was that it was not incorporated under the Hospitals Act, therefore it was not included in that particular section.
Bill No. 34, when it passes, as the honourable member knows, and as Mr. Chairman and the honourable member for Lunenburg West know, it does allow for different partnerships and the partnership between the district health authority - and if we wanted to
perhaps do a little analogy here we could say the partnership between the health authority - and the IWK-Grace, which will probably occur, St. Anne would be that type of partnership.
MR. SAMSON: Well, Mr. Chairman, one could only hope that the minister will stick to that and that St. Anne will be given the same sort of preferential treatment under this bill and by his department that the IWK-Grace is going to be receiving, so I certainly look forward to that. When I meet with the board of St. Anne next Sunday I will certainly bring that to their attention.
I would ask the minister to have staff in his department immediately start communication with St. Anne to let them know where your department is going and where they fall into that puzzle. Right now there are a lot of unknowns. It is a hard-working board, they are very dedicated, they have achieved a lot and these unknowns are not sitting well with anybody. I hope your department will start communication with them right away.
The other thing I wanted to ask you about and I asked you about last year, you couldn't make a commitment at that time but now, with this budget, does the province and your department still have a position for a physician recruitment officer?
MR. MUIR: Yes, Mr. Chairman, we do. Just to go back to his previous question, our staff person in the eastern region has already been meeting with the board and the folks at St. Anne to talk about the new role, so those communications have already begun.
MR. SAMSON: The physician recruitment officer, could the minister indicate to me who that person is?
MR. MUIR: The physician recruitment officer is Frank Peters, Mr. Chairman.
MR. SAMSON: Mr. Chairman, will the minister commit that Mr. Peters will be remaining in that position for this fiscal year?
MR. MUIR: Mr. Chairman, if I had magical powers, we wouldn't be having this debate, but I can say that I don't think Mr. Peters is going any place, but I can't guarantee that he is going to remain for this fiscal year, any more than I could guarantee that I or either of my colleagues (Interruptions) For the position? Oh, for the position. Yes. We have the position budgeted for this year, I am sorry.
[7:00 p.m.]
MR. CHAIRMAN: The honourable member for Cape Breton Centre.
MR. FRANK CORBETT: This time for real? Mr. Chairman, I would like to start with just making a few statements around the long-term care situation in and around industrial
Cape Breton, and probably some of the labour aspects of your department, then we will probably come back with some more specific questions. The idea of long-term care beds and the moratorium not being lifted caused me some concern, minister, primarily because in industrial Cape Breton, where there is an ageing population, and the economic situation being such that at one time it was much easier for the younger generation to look after the older generation in their homes. The real fact is now, there are a lot of people migrating out of Cape Breton because of the economic situation. These seniors are left to look after themselves. They don't have that family comfort to fall back on.
We have a problem there. We have a problem I believe with the aspect of home care. I really don't believe it has been fully operational in the sense that it is doing the most benefit for the most people. While I certainly respect those working in that area, I still don't think they have the supports that go with that.
Now, I know in my riding for instance, we have one long-term care home, the Maple Hill Manor, which is a not-for-profit, plus there is a Level 2 care at the New Waterford Consolidated Hospital. That provides some beds for some of the people in my riding. Part of my riding is in the catchment area of Seaview Manor and Glace Bay and so on. Some would go into the Shannex building, Breton Bay, in the Sydney area, and I will come back with some more questions about that. Really, in a lot of ways, minister, there is a real problem in my riding regarding access to long-term care beds. It is becoming a crisis situation. I don't want to send alarm bells that there are old people sleeping in the streets, don't get me wrong, but it is becoming a crisis situation. This is not just coming from the people that run the facilities. It is coming by direct contact to me from constituents who, for one reason or another would like to see a loved one get into one of these long-term care facilities. So, I reiterate I was kind of put off when there was a freeze put on the long-term care, and I suspect that will be one of my direct questions to you.
The other system, by way of statement, is I always worry when we get into freeze mode or cutback mode in any kind of delivery, whether it is education or health, that the workers in the system suffer, whether it is wage roll-backs, wage freezes, elimination of services or the direct lay-offs where we end up piling onto people, and we are hearing that now in acute care hospitals where nursing staff go well beyond delivery of nursing care, but do a lot of clerical work that would otherwise be done by other groups. That always causes us a problem. It doesn't allow you to focus on your job. The minister knows from a past profession when he taught student teachers, I am sure, that was part of his idea was your ability to concentrate on your work and what you are here to do.
So, I am not going to lecture you, you won't listen to me anyway. What I want to do is ask, and I will ask a very direct question. Why not lift the moratorium on long-term care beds?
MR. MUIR: Mr. Chairman, long-term care services have been increasing. We are moving to a single-entry access system which will help us. We think it is an important part of making improvements in the long-term care system. We also are trying to make decisions on bed allocation based on hard-core evidence. We have struck a couple of committees to help us provide evidence so that we can make good decisions. Notwithstanding that, in the single entry access when it is up and running, the other jurisdictions where they have implemented it, have found there is a tremendous increase in the projected number of long-term beds. There was quite a figure in New Brunswick, it was a very, very big figure, and we would not want to get into that thing. We are not interested, we are interested in capacity, but really not over-capacity. I want to tell the honourable member that we have a number of applications from long-term care facilities in his area. Across the province we have 51 of these applications for either the expansion or for new long-term care beds.
When we decide and decisions are made about the allocation of additional beds, we hope we will be in a position to commit to that sometime before too long, but we want to do it really, Mr. Chairman, based on evidence rather than getting letters saying they are nice people. We get those from all over the province. You name it, anybody who applies, we get great testimonials about why they should have it. I know a couple of facilities up in your area are really leaders in that long-term care industry, and we value their input and are using that in some other ways. As you are aware, I think, in Sydney, the nursing home there is one of our pilot sites for the resident assessment instrument, and we have gotten very positive feedback from it.
In answer to his question, again, we would love to do that, Mr. Chairman, but we want to make haste slowly on the best possible information.
MR. CORBETT: Mr. Chairman, earlier you mentioned about the evidence-based system as it relates to, I would suspect, the single entry. I guess I want to know, how does that work with your - I forget the proper name of your committee - the facility committee, the one I think Brian MacLeod is chairman of. Can you give me how that interacts?
MR. MUIR: The single entry and that committee are somewhat separate. The single entry would go ahead even without that committee. The single entry really means that a person comes into our system and there is a variety of places they might go. They might go into a nursing home, they might go into a residential care facility, they might go into a small options type of arrangement, they might be served by home care. There are all of these things. What will happen is that they will go to one place and that assessment would be made. Indeed, once we get that initial benchmark assessment, it will provide the opportunity for making adjustments in whatever is provided for that person as the needs change and that is part of that.
The facilities committee that Mr. MacLeod is involved with capital, is trying to determine criteria for the allocation of long-term beds. In other words, what criteria should we really take a look at when we make this decision? So, obviously, the single entry access is going to impact that, but it would be what criteria would be used.
MR. CORBETT: Mr. Chairman, I suppose I should have been more exact, I guess. What I am saying is while we realize that we will have an impact on the single entry point, as it affects long-term care, I guess what I am looking for from you, Mr. Minister, is the fact of what is the next step beyond the issuing of their report. If the report says, look, here is the criteria and industrial Cape Breton is short 50 long-term care beds, then look what folds out from the plan from there?
MR. MUIR: At that point, Mr. Chairman, there are a number of planning things that would be incorporated. One would be that report. Secondly, how close we are to the single entry access. Thirdly, the feedback from the MDS rugs assessment instrument and we will get all that together and we will meet with our department and industry and go from there. We hope to have the direction finalized once and for all before too long. We intend to progress in this thing. We are not going to dally in it.
MR. CORBETT: I kind of appreciate the answers. I am looking for if there is going to be, and I appreciate that this is very hypothetical, that if there is going to be from that group, chaired by Mr. MacLeod, that if there is a need for long-term care beds under the criteria, then I guess I am looking for the fact that maybe the lifting of the moratorium, and I guess, by way of a direct statement, that I would ask you to look more favourably on the not-for-profits. I think there has been some discussion whether that committee, how it is comprised and if it is weighted in the direction of for-profit facilities. As well, I see the minister shaking his head and, certainly, that may be your position, but I will tell you that that is not the position of the not-for-profit group.
Has the minister had any updates on the condition of the Breton Bay Nursing Home in Cape Breton regarding the instance of mould in that building?
MR. MUIR: Mr. Chairman, Breton Bay, unfortunately did show some mould. Air quality tests were conducted at the Breton Bay Nursing Home after mould was discovered in certain areas. The air quality experts who did the examination found that the concentration of mould was limited and was acceptable, given the time of year. Recommendations about how to clean up the mould were also put forward. Breton Bay is now in the process of doing some remediation and it is working with its joint occupational health and safety committee and the Department of Health to do that. The home remains healthy for residents and staff.
MR. CORBETT: Mr. Chairman, Mr. Minister, I would like to shift my focus back over to the New Waterford Consolidated Hospital, just for a few moments. I noticed my good friend, the member for Cape Breton Nova has come in and likes to thump loudly about how
the Liberals saved that hospital. I would say to you, Mr. Minister, I think it is because of administrators like Sister Kelly and John Malcolm and the employees. That is why that hospital is saved. (Interruption) While there is some chirping in the background, I put forward to you, Mr. Minister, they have a very unique plan there within the Cape Breton Regional Hospital between the facility in Glace Bay for long-term care and the long-term care at the New Waterford Consolidated. I guess I am looking for some basic generalities from you, Mr. Minister, about where you see that program going and the type of support and encouragement that it receives from your department?
MR. MUIR: The New Waterford experiment, I guess, if we wish to call it an experiment, the information that I have and my observation from a visit up there to open those long-term care beds is working quite well. I think the experiment, too, if we wish to call it an experiment, in which the Cape Breton Health Care Complex, which is geographically fairly widespread, has worked well, too. It presents a unification and an integration of the services in that metropolitan Sydney area, what used to be known as industrial Cape Breton and I guess it still is, an integration of services and the feedback that we have in our observations indicate that that is working quite well and, indeed, I think we have learned some things from that particular operation that we are able to, perhaps, translate into some other parts of the province.
MR. CORBETT: Mr. Chairman, I think you just made a statement there, too, about the geographic layout of the regional hospital and its various sites. I guess a word to describe it would be unique, with a geographic area that size and how it is laid out. One often thinks that the administrator, John Malcolm and his staff have to basically play a large role how they directed the services there. In looking at those facilities, group of buildings, if you want to call them that, does the Department of Health look upon it, I guess, as a success story in their ability to take what was largely a very parochial area and be able to take that and specialize it. So is it considered a success story by your department? Are there, I guess, stories that can be learned from this merger to be spread out to other parts of this province?
MR. MUIR: Mr. Chairman, yes, in my opinion, it is a success story, and there are lessons there that can be translated to other parts of the province, and perhaps even in this particular area. What has happened up there - for folks who don't know - is that the Cape Breton Health Care Complex runs from North Sydney, and includes New Waterford, Glace Bay and these areas. It is a true system; and it is a functioning system. It is one I believe makes very good use of its resources and its physical plans to try to meet the needs of the folks who are up there.
MR. CORBETT: Time is growing short on today's session. We have one of the highest cancer rates in this province, and it is more or less centred around industrial Cape Breton. It is a first that we are not particularly proud of, and I don't think this province is particularly proud of it, but these rates - and I think it was last Thursday or Friday a new study had just come out - shine not a real pretty light on this province. We have the Cancer
Treatment Centre down there and Dr. Padmos' work and so on. Although we have been studied at great length about the cancer rates in industrial Cape Breton, there has never been a study that a great deal of the residents in the area will buy into. There has always been a great deal of discussion. One is the tar ponds, and another is we eat too many french fries; I don't know where we go with that. So, the question I am asking, do you see your department entering the cancer study program in Cape Breton at another level now, or how do you see dealing with that problem?
MR. CHAIRMAN: The honourable Minister of Health, you have ten seconds.
MR. MUIR: I think the cancer care in Nova Scotia, folks up the Cape Breton Complex, I think if you are talking about additional research, I have read some of the research on cancer in that area and, unfortunately, the rates are a little bit higher. Contrary to what may be sort of a popular belief is that the incidence is not just related to "industrial" Cape Breton, but if you spin out into the county, away from the tar ponds, you find them too. The other thing, we have sort of the converse of that because you have an awful lot of people in that area who live a long, long time . . .
MR. CHAIRMAN: Order, please. Sorry, I was giving the minister some time to answer the question, but we are past the hour of adjournment. We are past the time allotted for debate with regard to the Committee of the Whole on Supply. The committee will now rise and report progress to meet again on a future day.
Is it agreed?
It is agreed.
[7:24 p.m. The committee rose.]
