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April 10, 2001
House Committees
Meeting topics: 
SUPPLY -- Tue., Apr. 10, 2001

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2:27 P.M.


Mr. David Wilson

MR. CHAIRMAN: Order, please. The Committee on Supply will now reconvene. We will again be debating the estimates of the Minister of Health.

The honourable member for Dartmouth-Cole Harbour.

MR. DARRELL DEXTER: Mr. Chairman, I want to ask the minister first about a very specific issue and that is with respect to the issue of hepatitis C compensation. The federal government had pledged some $350,000 for medical assistance to hepatitis C victims in this province who fell outside the compensation window. We are told, Mr. Minister, that this funding from the federal government has, in fact, been incorporated into general revenues and is not being used for that purpose. Is that true?

MR. CHAIRMAN: The honourable Minister of Health.

HON. JAMES MUIR: The answer to that is no, that is not true, Mr. Chairman. That money was given to us and it will be drawn down as it is distributed.

MR. DEXTER: If that is not true, could the minister please tell us what programming specifically aimed at hepatitis C victims outside the compensation window is going to be put in place with that funding?


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MR. MUIR: Mr. Chairman, I have to think about that question. The money that we received is within the compensation window. You are talking about outside the compensation window - has our department put in place specific programs? There are a number of ongoing programs in the province. Our position has basically been care, not cash, and over the next 20 years Nova Scotia is going to receive about $6 million, roughly about $300,000 a year, to provide therapeutic services to people infected with hepatitis C. The Atlantic Hepatitis C Coalition, I believe that may be where you got your information, is aware of this funding, and they have requested access to it.

[2:30 p.m.]

MR. DEXTER: Perhaps the minister misunderstood my question. My question is, what specific program is this cash being used for that does not fall under the general programming of the department?

MR. MUIR: Mr. Chairman, the specific programs and the programming available would be provided through the district health authorities under the acute care section.

MR. DEXTER: Mr. Chairman, the Premier, when they were in Opposition, said that the victims of hepatitis C in Nova Scotia should not be forced to wait. They promised at that time a fair, just and speedy settlement. That has not happened. It has not happened at all. A certain amount of money the minister has identified was to be provided to assist those individuals with care specific to them. I want to know whether or not the minister has given instructions to the DHA to see to it that that money is used specifically for that programming?

MR. MUIR: Mr. Chairman, the DHAs have been given that money and they will provide the programming which is appropriate.

MR. DEXTER: Mr. Chairman, I am not sure whether the minister understands that this is essentially an abandonment of those people who placed their faith in him. He has a responsibility to those hepatitis C victims to ensure that that money is spent on programming that is appropriate to those individuals and he cannot simply wash his hands of it and say we are leaving this up to the DHAs. If he has made no effort whatsoever, then he should say so, but if he has made some effort to see to it that that happens, then I would like to know what it is?

MR. MUIR: Mr. Chairman, I guess I would say we have relied on the DHAs. They know their patients and what programming is needed. I can get some information on that for the honourable member from the DHAs if he so wishes.

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MR. DEXTER: Mr. Chairman, this was specifically for individuals outside of the compensation window. What specific programming is being put in place for those individuals outside the compensation window?

MR. MUIR: Mr. Chairman, as I say, we have distributed and will continue to distribute that money through the district health authorities. I suspect, and I have to get the detail of this, but we have, among other things, provided $40,000 to the Atlantic Hepatitis C Coalition as part of their programming. I suppose that might be one specific program.

MR. DEXTER: I want to mention to the minister so that he understands clearly that those in the hepatitis C community do not see where that funding has gone and are deeply concerned that this money has simply been absorbed into the general revenues of the province and is not being used in the manner for which it was specified. I am not sure, Mr. Chairman, where is my time at?

MR. CHAIRMAN: Order, please. The honourable member's time has expired.

The honourable member for Dartmouth East.

DR. JAMES SMITH: Mr. Chairman, I thank the committee for the opportunity to address the estimates of the Minister of Health. I would like to congratulate him on a $1.8 billion budget. If it was not for that terrible debt load they had to carry, that would be even more money that would be there to address the many issues and the challenges that the minister is facing. So we have some time during the estimates and we will address the issues. I find the last issue is a very interesting one and a very challenging one because, again, you know, speaking about not enough money from the federal government, that is always the issue, but then when it does come, it is really hard to follow it and I think that is the issue that is being made here today, these monies that are coming for hepatitis C.

The minister, I understand, has said that it will go to the district health authorities and they will decide what to do. I guess the honourable member for Dartmouth-Cole Harbour was sort of saying, well, what is the program. So I think it is that sort of thing that really sometimes makes the federal government a little cynical as to how that might be tailored. Now, I might have missed some of it and maybe we can go back to that later on.

Anyway, I found it a difficult year to follow through because of the disbanding of the regional health boards and moving into the district health authorities, but we have tried to make some sense of it and address some of the disparities that we see in the funding that had been within the four health boards and then being transferred into the district health authorities, but there are a lot of issues and every day something is new in health. If it does not come from the community, it comes from the minister and his musings about doctors treating patients who smoke and all of those things. On a slow news day the minister always has the option of giving it a kick and away it goes. I got a call here from Oshawa, Mr.

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Minister, but I thought it was more important that I be in the House in my place than addressing the concerns of Station AM 1315 in Oshawa. Obviously, you have some fans there.

I have many areas that one would like to address in the short period of time that we have, but the area of the status of the single entry, it is certainly an issue; the status of the nursing strategy; the health information; the issue of the privatization or the looking at, at least, of the privatization issue that was touched on yesterday regarding MRIs and CAT scans and all those other initiatives now that have become commonplace in our everyday conversation, that whether we know what they do, or whatever, but certainly patients have been led to believe that it is very important that they have one if there is any indication whatsoever.

The whole issue of the clinical footprint is an area that has occupied our caucus, our interest in that and the $0.5 million funding for the health core group and the clinical footprint and then the realization that it was one phase of that work and yet with really very little information. What was touted for over a year by the minister, all the answers that were going to be revealed to us regarding the plan for health care, turned out to be, even by the minister's own words, a planning tool. I think one could not be blamed for being sceptical that there must be lots of information that the health core group had gathered back in the department that is not being reflected in this report because it really was an old rehash of length of stay and all that. They are still in that culture of measuring wellness and the outcome of patient care by how many days you spend in a hospital. They rehash, well, Cape Breton, you know, they smoke more cigarettes and they have worse lifestyles and they stay longer in hospital. The only thing you can conclude from some of that is that hospitals are dangerous to your health and I think a lot of people figured that out a long time ago.

So, Mr. Chairman, I compliment the minister in having a budget that is increasing overall. I guess we lost the election in 1999 for different reasons and I think probably the people of Nova Scotia had an agenda that maybe it was time for the Liberals to take a backseat and bring in the group that said they could fix health care for a few million dollars with no discomfort to anyone at all. I would ask the minister, since he has been minister, does he have any idea how much the health care budget has increased? I am referring basically, I will just lead where I am going on that because we felt that we had committed in our budget - the budget that that honourable minister helped defeat - that over three years we were going to put in $600 million.

So while I compliment the minister in convincing his colleagues that his department is worthy of more finances, really the whole election promise that health care was going to be fixed for $46 million of administrative money, taken out of administration, cut the fat out of the health care system, we still see in spite of that the Health budget increasing quite dramatically and I just wonder, has the minister any idea how much his budget has increased since he has taken over the ministry, and how has it been disbursed?

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I guess that is the thing about estimates. The devil is in the details and how you look forward and why the estimates I think are getting a little more complicated to follow, particularly this year, with the change from the regional health boards to the district health authorities, there seems to be sort of a band-aid approach to the whole health care system. It really seems to try to please everyone as well as one can and not to leave anyone out, and if that is really the intention of the minister. I guess I will go back to my question. Keeping in mind the promise of the government and the Premier that for $46 million the health care system would be fixed, how much extra has gone into the health care system? What is the understanding of the minister?

MR. MUIR: Mr. Speaker, I thank the honourable member for Dartmouth East for those comments and for his question. One thing I just want to address before I actually get into the substance of the question because it was raised by his colleague, the member for Lunenburg West, the other day - and I think a third time - was the $46 million figure that it is alleged we said we could fix health care. I have to say honestly that I don't know where that statement came from because I don't really recall anybody in our Party making it.

Basically, Mr. Chairman, I can provide more specifics to the honourable member for Dartmouth East, but I don't have the 1999-2000 numbers with us. In general, the amount of money that we spent last year was the same as the amount of money that was spent the year before. So I guess from 1999-2000, from 2000-01, basically the increase would be marginal or it was basically about the same. Actually the forecast in 2000-01, as the honourable member can see, is $1.75 million. The actual in 1999-2000 was $1.767 million. So our expenditures went down $17 million, forecasted to go down $17 million from 1999-2000.

DR. SMITH: Mr. Speaker, looking across the province and the various areas we see the nine district health authorities. We see three increases in the acute care budget. I will address acute care issues at this juncture and an increase in district aid, that is Cape Breton, and increases at the QE II and the IWK-Grace. All of the remaining districts have seen a decrease, including the facilities in the capital health district other than the QE II. The question for the minister, just recently the minister was speaking to a Progressive Conservative annual meeting in Digby, where he indicated that the district health authorities would not have to cover the deficits that were accumulated by the regional health boards - I think that has been reported in the local media - given that the regional health boards have not existed since October 1999 and we have gone through one complete fiscal year, actually we have been through one and one-half fiscal years, with the purse strings being controlled by downtown Halifax essentially, and the minister's office, will the minister clarify for us whether he meant that the district health authorities will not be responsible for the deficits accumulated by his office or whether he was merely trying to somehow cover up his own mismanagement by blaming structures that did not exist?

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You have to realize that we are dealing with windmills here, Mr. Chairman. There is no health plan, but all of a sudden the clinical footprint was going to come on the scene and it was going to give us the plan, and it hasn't done that. Everything bad that was happening, well the boards did this or the boards decided that. So it was to get away, get the hot-ticket items out, but we know the decisions were being made in downtown Halifax. Part of the strategy was bring in a new deputy, pay him big money. I don't know if there is anybody left in Nova Scotia who can run a health care system. Every time you look around there is somebody new coming from outside of the province, with due respect to all people present. So can the minister clarify what he meant, that the district health authorities will not be responsible for the deficits that were accumulated and were actually blamed on the regional health boards?

MR. MUIR: Mr. Chairman, when we passed Bill No. 34, which created the district health authorities, the actual implementation and the establishment of the district health authorities with their own boards and their own CEO didn't really take place until the year 2001. There was an exception for that; the capital health authority had a board and a CEO up and running. Similarly, up in the Cape Breton area, up in your area, Mr. Chairman, that was up and running, but effectively until that point in time they were still run on that regional model because the structure had not changed. There were deficits that were incurred in the 1999-2000 fiscal year - I am sorry, 2000-01 fiscal year, Mr. Chairman - and what we did, we picked up those deficits so the DHAs could start with a clean slate.

DR. SMITH: I guess it has just been something that sort of grated on me that in the middle of the night the regional health boards are cancelled and yet months later they are still being referred to as the regional health boards. I mean the staff is there, which is an extension of the office from downtown. Anyway, clean the slate and away we go.

Going to the district health authorities under the new estimates - which we have tried to make a little sense out of here as well as we could with the way it is presented - going to the western region and Districts 1, 2, and 3, which really make up the previous western region and the regional health authorities being now 1, 2, and 3, it would appear that the acute care budgets for the Districts 1, 2, and 3 have been reduced by $1.5 million. Given the switchover from the four regions to nine districts, would the minister confirm that that is so? Then I will have further questions.

MR. MUIR: Mr. Chairman, I am going to have to take one minute to find that detailed information. I apologize, I did see this information.

MR. CHAIRMAN: Order, please. Perhaps the honourable minister would like a minute. The honourable member for Dartmouth East, would you like to add anything to that while the minister is looking?

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DR. SMITH: Mr. Chairman, I would be interested in knowing, we have transition for the four regional health boards to nine district health authorities - I think we should have a paper trail here of some monies that we can really discuss - we have discussed how hepatitis C money from the federal government will be flowing through to these districts, so I think we should know it is very clear that the western region is the same as the two district health authorities.

We have attempted ourselves to come up with the monies as to what those budgets will be and we are discussing estimates. I have some line of questioning that will impact on other regions as well. I don't mind waiting for the answer a bit, but I think it would be important that we have some sense of the current funding because certainly some of the district health authorities that were in the previous region, regional boards, are increasing and others are decreasing, and I don't think we can have a meaningful discussion unless we know where the dollars are flowing there.

MR. MUIR: Mr. Chairman, I am going to have to get some specifics on the question that the member for Dartmouth East has raised. One of the difficulties - and the honourable member has alluded to that - is switching from one set of structures to another and trying to translate the figures in a straight-line fashion, and it is not that easy. In the case of the former Western Regional Health Board, which basically comprised Districts 1, 2 and 3, the forecast for 2000-01 was roughly about $131 million. The estimate for next year is about $130 million, but some of the initiatives that went in there have been translated into provincial health initiatives, so there has not been an actual reduction.

DR. SMITH: So provincial initiatives that are driven from the Health Minister's office, I would gather, which is contrary to what the thrust of forming district health authorities was, to get the decision-making closer to the people in the communities, so now we hear that we have an increase in provincial programs because, according to our calculations, we see those three districts receiving $1.5 million less. I will take the minister's word for it. We will have to track it later through what type of programs.

I know he did mention that there was a transition program that was a provincial program and that was to pay Healthcor $0.5 million for some so-called study or technical aid, as he told the media. If that is the sort of thing that their money is being spent on, then I am not really very impressed, Mr. Chairman, with that. If there is a determination made in the minister's office to hire an out-of-province, Ontario group, to come in here and waste a lot of money on $1,200 and $1,500 airplane flights between Halifax and Toronto, and wining and dining, and spent $0.5 million in some sort of a half a study that when it comes out, it looks like a skeleton - there is no flesh on the bones of anything - then you are going to attribute that as the reason you have cut back three health authorities here $1.5 million and it is in provincial programs you identify - I had it underlined if I can find it here, the provincial program that last evening was referred to was part of that transition. Yes, we have

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it on Page 15.11 of the Estimates - the transition support was Healthcor, as I said. I will rest my case.

I think some provincial programs need to be coordinated. The smoking programs, those types of initiatives, certainly are to be commended. You have on that other programs. You have the Provincial Health Council, and that is something that we responded to requests for when we were in minority government, requests for this from this PC Party that was the third Party at that juncture. We went along with that initiative and now I see we are spending $362,000 a year under those other programs. Those are things that are being distributed, I suppose, the responsibility throughout all the districts, so, so far it is not a full answer. We will move on.

I guess my question is, supposing that - and I gather the minister does agree - there is a reduction in the western region, one of the better managed regions I would say of the regional health boards, and people I have spoken to in that area because that is where I grew up, in that western region, although there had been earlier problems with the regional boards working, they felt, and this person was a physiotherapist who travelled the region extensively, things were coming together well and it was working. So now we have another system, and I just hope it is not being used to take real needed money in that western region in Digby, Yarmouth, and Shelburne, as we call it, the tri-county area.

How does the minister expect Districts 1, 2, and 3 to reduce their budgets given the added cost pressures of wage negotiations, new operating costs associated with equipment, even though the federal government has bailed out the province a bit and $15 million that will allow the minister to go around announcing various new equipment initiatives and I would say increased administration? Here you had one region with administration in those tri-counties and now you have three. It looks like there is more money coming down and that is the message, but in reality we start looking, and in the detail of the budget we see less money, and the same money is less money really, and some of it going into provincial programs where I don't think the district health authorities will have any input, so how does the minster see this evolving and what sort of response is he getting back from those district health authorities when they see their budgets being cut like that?

MR. MUIR: Mr. Chairman, I said in my opening remarks that nobody in the province got the amount of money that they would have liked to have had and we recognize that. However, we do believe that the increase that has been allocated will enable the district health authorities to carry out their responsibilities in an approved way. Going back to DHA 1, and for the member for Dartmouth East, the budget target for DHA 1 in the acute care is roughly about $29.6 million. The actual increase in that total of DHA I think is roughly more than $2 million over last year. I believe it was $32 million last year and the total this year is $34.1, so there has been an increase.

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Secondly, in response to the point that the honourable member made, that he questioned if there were wage increases negotiated as a result of the ongoing negotiations, that that would put pressure on the district health authorities. Mr. Chairman, I am sorry if we didn't explain this fully in the beginning, the money for wage increases is being held apart from the money that was allocated to the DHAs.

[3:00 p.m.]

DR. SMITH: I think, in all fairness, the minister had mentioned that; it sounds familiar. There is certainly going to be increases and with new equipment, as the minister well knows, comes more operating costs and just increased administration costs. Following that, can the minister indicate how much the CEO for instance, for District 1, will be receiving, is being compensated and what budget item do we find this salary in? Where do we look to get that information on what the CEOs in these nine - going from four to nine - what sort of costs we are looking at there with administration? That is a broad question, so I will focus on the CEO which might be symptomatic of what is happening across the board.

MR. MUIR: The salary range for the CEOs for the eight district health authorities, excluding the capital district, were determined. A national survey done by Mercer & Associates determined the going rate for people across the country. The range which was arrived at was in the lower 25th per cent of the national average. In the case of DHA 1 - I stand to be corrected on this - I understand that the CEO's salary is about $135,000.

DR. SMITH: So we see a range from one to another, other than the central region. Still staying in the western part of the province, could the minister indicate who is responsible for the overall running of the District 3 now, at this juncture, as I believe they are without a full CEO to take over, who is actually running the District Health Authority 3?

MR. MUIR: Are you referring to the Kentville area or the Yarmouth area?

DR. SMITH: District 3.

MR. SPEAKER: Just for the record, Mr. Minister, if you don't mind. The member for Dartmouth East, I think the honourable minister had asked you a question.

DR. SMITH: In that area, it encompasses Annapolis, so the CEO in District 3 would be responsible for Annapolis as well. I didn't want to answer just Kentville.

MR. MUIR: The CEO is Marguerite Rowe.

DR. SMITH: Thank you for that, Mr. Minister. Again, looking at moving to 4, 5, and 6 and the estimates. According to our calculations - again, I suppose it is the same answer, but it is essentially the same less amount of money for acute care, their budget is at $1.2

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million - we make it less this year. I expect it will be the same answer, but do you agree with that? I understand the wage negotiation that you mentioned before, but there are increased expenses, especially with administration, and how does he see coping with that initiative? With that amount of budget they cut, we have those three budgets in the District Health Authorities 4, 5, and 6, cut by $1.2 million.

MR. MUIR: In DHA 6, the actual increase on the acute care side of things would be about $2 million, or closer to $1.9 million.

DR. SMITH: I have grouped them together - 4, 5, and 6 - as being, the best calculations we could make of the previous health board. Anyway, we went through the same scenario, and the point is that there is a trend here that is evolving, that there is not a lot of extra money floating down into these regions when the challenges that they are meeting, and even though the good news is some of that is equipment, but operating that equipment is going to put more costs and there will be more administrators, instead of one administrator now we will have three and all the support services that they need.

I guess my question, rather than go through asking the same thing over, where would we find the salaries of the CEOs for the various districts? Where in the budget would that be? I know it will show up in another year or so, but where is it projected in the budget now?

MR. MUIR: The District Health Authorities, under the line entitled Acute Care. In the Estimates Book, in the Supplementary Detail, the salaries are not listed individually, no.

DR. SMITH: It looks as though the reduction in the acute care budget for the District Health Authority 7 looks rather dramatic. The Guysborough area - and I do find this whole process rather confusing - could the minister indicate whether indeed the District Health Authority 7 is seeing a reduction in the order of $12 million and, if not, can he explain how otherwise we could determine that?

MR. MUIR: When the DHA structures were put in place last year in the old Eastern Regional Health Board, the northern part of Inverness County or the far eastern part of Inverness County was then included as part of the Eastern Regional Health Board and those particular services have gone to the Cape Breton District Health Authority and that is the main reason for that. For example, the acute care facility in Inverness no longer appears in that budget; it has been transferred into the Cape Breton District Health Authority.

DR. SMITH: So maybe in another year we will get through this transition period, but I am always leery when you see money disappearing that some of it that maybe still should be sticking in a particular area is moved into more of a central area.

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MR. MUIR: Just to clarify something for the honourable member for Dartmouth East. In the process of establishing the boundaries for the district health authorities, the communities were consulted and they agreed that those services would go more toward the Sydney area and less back to the mainland. It was not necessarily dictated from the Joseph Howe building.

DR. SMITH: No, other than the disbandment of the regional health boards, when you get into the district health authorities, if there is a positive of it all it is that they reflect the interest of the local community and that the flow of where the people go to school, church, and buy groceries, and that is reflected. So that is really not an issue and I would agree with the minister there. It is just that the monies that are designated for certain regions, if they are going out to a more central region - I mean this area essentially has lost $12 million - that it is really somewhere in benefit is finding its way back to that particular community, those small communities. When you see programs not being expanded into those communities, whether it is diabetes programs, smoking cessation programs, whatever, mental health, you want to know that those are on the ground in those communities. It is one thing to lose the services and to transfer them out as long as the benefit is in that local community.

On March 29th of this year, the Premier stood in this House and stated that the district health authorities had their preliminary budgets in advance and, as well, received their final budget. We all know the chaos that erupted last year when the health boards had been given their final budgets resulting in closures of beds and a reduction in services. The Minister of Finance was also sending out mixed signals with regard to the health care budget this year particularly, going to be tough on health and then everything was fine obviously. Maybe that explains the big bill to Bristol Group for a little polling that maybe gave them some information, but however there was a change in direction.

Could the minister though please advise - we are referring to the Premier and the Minister of Finance - whether the district health authorities received a different preliminary budget number than what we see here in the estimates, or are we seeing the true number that the district health authorities have to work with? I don't know if that is clear, but I will try to be clearer if it is not.

MR. MUIR: Yes, the honourable member is correct, Mr. Chairman, the initial budget target that was given to the district health authorities was different than the budget which appears in the estimates. We gave them targets as part of a business planning exercise. The process was, given this much money, what does it mean to you? They came back to us and said what it meant to them. We examined the message that came back from the DHAs and from that point I was left with the task of trying to convince my Cabinet colleagues that we needed to add a little bit more into the Health hopper if we were going to meet the concerns expressed by the DHAs.

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DR. SMITH: So we are dealing as preliminary budgets - and I had a bit of an interruption and I lost some of the minister's words there - when does the minister expect to receive business plans from the district health authorities, and when can the district health authorities expect to hear back from the department with regard to whether the business plans meet with the minister's approval? If he had said that, if he had answered that question while I was speaking to one of the Pages, then I would apologize, but when does he expect to receive the various plans and, more importantly, when can they expect to hear back from the business plans that meet with the minister's approval?

MR. MUIR: Mr. Chairman, we expect to receive the final business plans from the district health authorities by the end of April, the first of May, and indeed a couple of the larger ones will be in before that. We will be making a staged release during the month of May.

DR. SMITH: Mr. Chairman, I thank the honourable minister for that target date. I hope it is not like the clinical footprint, but it can never be because hospitals had to close down by the time you heard from that. There is an issue on privatization and the House touched on that issue last evening, but I would like to make a few comments on that as we go through our budget here because it very much impacts on the budget, managing the budget, and the future direction of health care in this province. The issue of privatization of health care services and of laboratory tests, X-rays, MRIs, those types of things, we see the stories coming out of Alberta particularly, where private clinics are offering services and tests for a fee. They can go out and purchase; they don't have to wait at the hospitals and they go out and purchase these.

I just want to say, Mr. Chairman, to the committee, that our Liberal caucus does not believe in a two-tier health care system. We don't think it meets the needs of our people and that people should not be able to buy health care services while those who have no resources, or limited resources or few resources, have to wait in line, because I think there are a lot of administrative changes within the health care system that can allow the system to be more efficient, and whether that is replacement of physicians, or addition of physicians or other members of the health care team, but it certainly is impacted by information technology and the many miles that we are behind in that initiative.

So before we get into bowing to the needs of various companies and interests, whether that be physicians, in some areas there is quite a group of physicians who would at least partially leave the public system and move into the private side. We see this locally in ophthalmology with the recent problems. It is almost comforting to hear that some of them are having problems getting their money, because it seemed like more and more if you went to talk to your friend, the ophthalmologist, he or she was not in their office where they would regularly be, but they are down at the private clinic doing all the new high-tech stuff. Not that I would want any of them particularly to go bankrupt, but some of them could afford a hit or

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two. I am saying this mainly for the comfort of the minister, just to let him know that we realize that these are some challenges that he sometimes has to face.

We don't believe certainly on this side of the House, Mr. Chairman, that the health care system should be (Interruptions)

MR. SPEAKER: Order, please. The member for Dartmouth East has the floor.

DR. SMITH: Thank you, Mr. Chairman, I refer to a group, particularly radiologists, which seems to be, like I say, the MRIs and CAT scans, and this has become common knowledge. It seems to be the thing to do, to have one of those. I think there are many advantages to it, obviously, but I am sure there are areas where they are doing for patient satisfaction because people have learned this from the Internet, or certainly from the local print, or television, radio, media, that this is sort of the thing that, if you have a certain symptom, this should be done and it is certainly a growth industry. We see groups of physicians getting together, like in Edmonton, radiologists in Edmonton formed their own company and are offering MRIs to those who will pay.

Last evening in the House, the honourable member for Dartmouth-Cole Harbour brought up the issue on whether or not the minister had been approached by a company interested in providing MRI services to the province. So, Mr. Chairman, my question to the minister is quite straightforward. Has the minister been approached by a company by the name of East Penn Inc. with regard to providing a mobile MRI scanner to the province?

MR. MUIR: Mr. Chairman, I will just check with my staff. I don't remember that name and I don't want to discount it totally because it may not have come from a company name, it may be the name of an individual I do know. So if the honourable member wants to tell me a name, we might be able to better match it.

DR. SMITH: Mr. Chairman, yes, I will proceed in that direction. I thought the name itself might be identifiable to the minister. This company is in the process of purchasing a mobile MRI scanner, I understand, and it would make scheduled stops outside the hospitals around the province to reduce the waiting time for patients. I think this is the understanding of the proposal. I am not sure what they do there, whether they have a Tim Hortons attached to them or not, that might be a business venture. That is the sort of thing that would be innovative.

We are not clear whether they are proposing to bill the hospital for the procedure and move on or to actually bill the patients for the service. In either case the profits would go to the private business side. So whether that would be a local hospital cost or a direct cost to the patient with the proposal, certainly the profits would be going to the particular company, East Penn Inc., or whatever company proposed such a venture. It is my understanding that

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it also provides biological research services to companies and other non-medical applications as well.

Mr. Chairman, when our government was in power, we did provide mobile breast screening units. These units were owned by the province. They are run by the province and they are available to women throughout the province who chose to use those breast screening services in their own communities, but the difference - and I don't need to point out to the committee or the minister - is this type of program is not owned by the private enterprise and, obviously, this is for obvious reasons that these applications are coming forward. They were scheduled according to need and the issue of access was one of openness. It was not what you could afford to pay.

The difficulty, Mr. Chairman, as we all know, with the private interest is that they govern themselves according to where the largest profits could be made so they target the business which may or may not address the issues of the length of waiting lists or not. I think that is why when you set up the private side, you can generate income and you can generate work while there can be a whole group of people in greater need perhaps still having lengthy waiting lists.

For example, this group is proposed to, I understand - or not, I know the minister said earlier, and I don't want to repeat, that he has received proposals; I am not saying that, I will use the term approached by - and that they would also be involved in non-medical applications and biological research. So they would have a multiplicity of customers rather than those who are ill or suffering illnesses. If this is more profitable, that is the way that direction would go. That is what I meant earlier. They will follow the market and they will target the market. So whether that will serve the best interests of Nova Scotians in need of health care would be debatable.

My question, I guess, to the minister would be, Mr. Chairman, has he received correspondence from George W. MacDonald or John Gordon Buchanan re the possibility of setting up a private mobile MRI scanner?

MR. MUIR: Mr. Chairman, we did meet with Mr. Buchanan and Mr. MacDonald back some time ago, but they didn't present a proposal. Basically - and I guess the honourable member recognized that or acknowledged that - they didn't express an interest. Once the province gets its provincial plan for MRIs in place, if there was a place for a private operator, they would at that point perhaps do something more formal.

DR. SMITH: Mr. Chairman, I would ask through you to the minister, did you give some encouragement to Mr. MacDonald and Mr. Buchanan that there may well be, or there could be, a place for them in the MRI program as we know it here in Nova Scotia, that would be developed in the immediate future, that there may be a role for a private company? I would suspect what is being proposed is that there would be a lease that if they were

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purchasing the MRI, that the services and perhaps even the staff would be contracted by the company, East Penn Inc., and that there would be a straight fee for that, or would there be a place for this type of proposal in the plans for MRI health care in Nova Scotia?

MR. MUIR: Mr. Chairman, in the meeting we had with Mr. Buchanan and Mr. MacDonald, some of the details which the honourable member for Dartmouth East has just articulated about fees and that type of thing, that was not part of our discussion. What we said to them is that we are trying to put together a plan to expand MRI service provincially here in the province. Once we decide basically what services we need, the second stage is to consider how those services will be delivered and whatever it is would be an open and transparent process.

DR. SMITH: So I can take by that that the contract is not signed yet. I guess that is what it means, but at the same time, you didn't feel that they were missionaries who were just coming who wanted to do good and offer their services for nothing. You probably had that, but you must have had some little smell for it that something was afoot, that they were business people and they wanted to make some money off this and that there might have been, apart from it, because you must have been getting, at the national meetings when you met with particular Health Ministers from Alberta and those places, did you have any discussions with them and their experience with privatization of services there and, if I could ask two questions in one to maybe save some time, have there been any serious conversations with the federal Minister of Health on privatization of services, how that might work within the Canada Health Act, and have there been serious initiatives in that area?

So I guess I am asking the minister to maybe share with the committee conversations he has had with other levels of government, particularly ministers or their staff in Ontario, Alberta, those types of provinces that seem to be leading the charge towards privatization of health care and also would include in that the federal government?

MR. MUIR: I believe federally Minister Rock has made his position very clear, that he does not support something that would be considered to be two-tiered health care. I did discuss Bill No. 11 with the Honourable Gary Mar who is the minister in Alberta. I had read the bill actually two or three times and, to be quite frank, I wasn't entirely sure what people were getting all that excited about. I know that there is legislation in four or five other provinces that is more liberal in the approach being taken than that which was being proposed in Alberta.

For the member for Dartmouth East's information, I was informed this morning, actually just at lunchtime, an anecdotal thing is that there were some private clinics operating in Alberta, and I can't give the details, where people did apparently pay some sort of a fee and the Alberta Government has just basically written a cheque for $8 million to give those fees back to the individuals. Now, I was told that at lunchtime and that is sort anecdotal evidence. I didn't get that from the people in Alberta, but as I say, in terms of discussing

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privatization with then Minister Witmer in Ontario, I did not, nor Minister Furlong in New Brunswick. The person who I had the conversation with was Minister Mar and basically it revolved around when they introduced Bill No. 11.

DR. SMITH: I don't know, I thought I was trying to get my hands on the minister's notes; I think he got his hands on mine. We must have a leak in the Liberal caucus somewhere. It is supposed to go the other way, not back. There is something not right about this picture because my next comment was going to be on the money. Apparently the minister is right, we learned today that Alberta, in fact, has paid back I think some $8 million, or whatever, to patients actually who purchased MRIs from a private company. (Interruptions) I think so. Well, there may have been more, but at least that was part of it. So we just hope that we don't really get to that stage of the game and that we move in that direction.

[3:30 p.m.]

I guess you realize - and the reason I bring this up, this government initially, I hope maybe some of it is fading - initially they seem to be quite taken with the Harris Government, sometimes the actions of Ralph Klein who, while being a friendly, jovial-looking person can be rather nasty on other occasions, particularly in his attitude toward people such as ourselves in the Maritime/Atlantic Region. You sit around at these national meetings and you can sometimes hear all these great stories and think it is so great, but I was looking the other night at one of the justice ministers from Manitoba, now a critic for the Alliance. People say there is something scary about the Alliance, with all due respect to members here - I know some are listening very intently, wondering what great words will follow - but I remember sitting with that person when I was Justice Minister and I quite liked him as a person, but we started talking about the Young Offenders Act, and his attitude towards young offenders was just totally scary. I see that gentleman now on the national scene as an MP - time is running out, is it?

MR. CHAIRMAN: One minute.

DR. SMITH: Okay, then I probably should end on a health note. We will have the opportunity to come back. I think the minister and I agree on, what I am saying is that sometimes you meet people who are very impressive when you first meet them and they are basically nice people, but they get terribly misdirected in certain areas. Mr. Toews on the Young Offenders Act is the one I am thinking of and he now sits as a national person on that area. I guess my point is not to be impressed, to look at what Alberta has had to do, for whatever reason they have refunded money to people who have paid out to a private company. So, really, this just creates a whole bunch of wasted money. Even with a lot of money, they don't have that much to throw away, particularly when it comes to health care.

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MR. CHAIRMAN: Order, please. I would like to thank the member for Dartmouth East. Now I would like to recognize the member for Dartmouth-Cole Harbour. The time is 3:34 p.m. You have one hour.

MR. DARRELL DEXTER: I just want to follow up very briefly on some comments made by my colleague, the member for Dartmouth East, because I happen to agree entirely. There has been an awful lot of damage done in this country and in other countries by very nice people. They may be very nice individuals, but it doesn't stop them from punishing those who get in their way, whether they happen to be the poor or the sick or the elderly; that is just an unfortunate fact of life.

I want to begin by tabling a document here that comes from the Canadian Institute for Health Information, and I want to forward it over to the minister because the minister took a great deal of time in this Chamber, when he introduced his estimates, to explain to us here and I guess, by extension, from us to the people of the province. In fact, I have been listening intently, not only to his speeches but to the speeches of the Minister of Finance and they continue on this questionable tirade about how if health care costs continued, they were going to strip the province bare of every last cent and there wouldn't be anything for any other program. Mr. Chairman, if it weren't so utterly and profoundly ridiculous, it would be laughable.

What the Minister of Health has in front of him is a report that shows exactly where our provincial government spending in health stands. The reality is that the Hamm Government this year - or I guess in the last year, the year 2000 - will spend per capita $1,835.47, per individual. That is 13 per cent less than the national average, it is 23 per cent less per person than Manitoba, and it is 20 per cent less than the Province of Newfoundland. So what the minister says, besides being misleading, is just profoundly incorrect, and I find it difficult to sit here in my seat every day and listen to the rhetorical remonstrations of the minister when he is clearly misleading the people of the province with respect to health care spending in the province. Or he is misinformed, I guess is a better way to put it. So, I want to straighten that out for him.

Nova Scotia, in fact, is the only province that cut health care spending for three of the last ten years; had real cuts to health care spending. The reality is that this government inherited below average health care spending, there is no question about that. Surely to goodness, the Minister of Health, as he sits there today, remembers what happened when Bernie Boudreau was the Finance Minister, surely he remembers when all the nurses were laid off, when the beds were closed, surely he remembers what kind of impact that had on the health care system of this province. If he doesn't, he ought to take the time to go back through the files in his department or go back through the media releases, or the film libraries of the CBC - pick your medium of choice - but go back and have a look at what kind of an effect that had on the confidence of the people of this province in the health care system. That is the first thing he ought to do.

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Instead of that, what he does is he embarks on this pious fraud. He embarks on this farce where he tells people that they have everything to fear from the health care system gobbling up every cent that the government brings in. It is also true that the Minister of Health, as a member of this government, inherited a massive debt from the province which was, in part, built up over years and years of a Conservative Government, and that means there are tremendous debt servicing charges to be paid in this province. That is also true.

Now that the minister has had a few minutes to look at the documentation, will he admit for the purposes of our examination of his estimates that Nova Scotia in fact has below-the-national-average health care spending?

MR. MUIR: A couple of things about the kind of CIHI data that I should point out. Just for information purposes, the last two years - 1999-2000 - I believe are projected, they are not actuals.

Secondly, that data is accumulated sort of on a calendar year, I believe, as opposed to our fiscal year, so when we are doing the matches, you just can't do the straight match. Having said that, I will acknowledge that the amount of money that we are spending in Nova Scotia probably is somewhere around the middle of the road; we are slightly below average according to CIHI data. On the other hand, I think there were two things that the honourable member has to take a look at when he does this. One is a percentage of health spending as a gross budget and, secondly, is the ability of the province to pay.

I believe that if the honourable member will take a look at Nova Scotia's gross national product he will find that, in terms of percentage of the gross national product, our spending is third, which does put it in a slightly different perspective.

MR. DEXTER: As the minister, I am sure, is aware, you can dress up the statistics any way you want, but the reality is that the most comparable figure is the per capita spending. If anything, Mr. Chairman, given that our demographics are not as favourable as those in other parts of the country, if anything, having the base population statistical information we know, we should probably be spending more just because of the age cohorts that make up our population and also because of some of the lifestyle issues that he has spoken on.

The Premier went to the federal government and said you can't just fund us on a straight percentage basis, you can't use the current formula, you have to recognize that there are demographic differences about the Province of Nova Scotia and perhaps the Atlantic Provinces that require a higher investment than in other parts of the country. So you can't have it both ways. What you have here is a government that is investing among the least amount per capita in the country in health care.

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The first thing that the minister does when he comes in is he brings forward a budget that actually subtracts or takes away from, provides less investment per capita than his predecessors. What I am really wondering about that, Mr. Chairman, is this, does the minister understand how it is that the increase in the costs of health care are determined? I want to ask him what the effect of an increased population growth on a health care budget is if the amount of funding stays stable, does he know what the result of that is?

MR. MUIR: The issue of demographics on health care costs is variable and the member for Dartmouth-Cole Harbour knows that, Mr. Chairman. Obviously, the younger the population and the better educated the population, then the less the demand on the health care system. The impact of an increasing population, if it was a younger population it would probably not be too great. In other words, if the increase was at the upper end, we know that as people get older they put a greater demand on health care services.

MR. DEXTER: I am not sure that the minister really answered the question, but I am going to help him out. Population growth is an accelerator. What it does is it puts pressure on your health care dollars. Does the minister know what the effect of an aging population is on your health care budget if you don't increase your funding?

MR. MUIR: I think probably the answer to that, Mr. Chairman, could be best stated that I think in terms of long-term care, home care, et cetera, our commitment next year is somewhere around 20 million new dollars. So, clearly, if we have put money into that sphere, it is in recognition of the increase in the number of older people - in most cases older people - although those things do provide care to people of all ages.

MR. DEXTER: We have talked about population growth. We have talked about aging. We have talked about both of those in the context of a zero budget increase or less. There are also increases in the consumer price index. Do you know what the effect of increases in the consumer price index is on the budget if you don't build in increases?

MR. MUIR: Mr. Chairman, obviously the consumer price index has an effect on the costs of health like it does the cost of any other services. We recognize that and clearly that has been a topic of discussion between officials in my department and officials in the district health authorities and also the IWK Health Centre. We also believe, in light of that, when we went to the district structure, that there are some efficiencies that can be gained and I think actually part of the thing was that we would hope that the increase in the consumer price index, although we did increase the budgets this year, would be partially compensated, maybe fully, by administrative efficiencies that could be gleaned from the new structures.

MR. DEXTER: I understand that the minister is in the unenviable position of having to try to justify a budget that does not adequately address all those factors. I am sure he knows this, but just so that we are absolutely certain he knows it and it is not a rumour, like doctors refusing to treat patients who are smokers, that kind of information, so it isn't

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second-hand or third-hand or picked up on the cocktail circuit, or at the local Tim Hortons, let's just make sure he understands what all of those things means.

What they mean, Mr. Chairman, is that these are the internal pressures that are put on the health care budget. What it means is that all of the services that are being required by your population, the cost of providing that service is continuing to grow. When your budget doesn't grow, what happens is somewhere in your system you have to find ways to cut out some of the services, or off-load them somewhere else in order to allow the core ones to continue to function. That is essentially what the minister has been doing. In a very clever little ploy here, what you do is you hand that over to the district health authorities and you say here is your budget and now you have to decide.

What they are really doing is they are turning over to the district health authorities essentially, as I think I said before, Mr. Chairman, the clinical services footprint was essentially, the minister wanted to call it a tool, and I said, it isn't a tool, it is a knife, this is the knife that they are turning over to the district health authorities in order to say look, here is the programming that you are going to carve out of the individual district health authorities. That is the effect that all those stressors, all those accelerators, have on the individual district health authority budgets.

The minister knows that there were decreases in the Department of Health budget, I think in 1993 and 1994 they went down, I think 3 per cent one year and 3.5 per cent the next year, and those were the years, Mr. Chairman, when the biggest hits were taken in health care in this province. Those were the years when we lost the most front-line health care staff, those were the years when the people of this province, their faith in the health care system was truly shaken.

One of the very regrettable parts about these budget estimates is that it is very difficult when you don't have a year-over-year analysis to be able to find out where the differences lie. I did listen intently when the minister was making pronouncements about the money that was going to be forwarded on to the district health authorities, because originally what he said was that there was going to be no growth in those budgets. He said that we are going to hand just the budgets that they had last year. They didn't distinguish between the actual budget that was provided last year or what the forecast budget was after they had run deficits, so we didn't know to begin with which of the budgets he was handing back to the district health authorities.

But we do know, with respect to the Capital District Health Authority, he handed that budget off to that group of individuals and they went away and they did some preliminary work and they came back to the minister and they said this is what it is going to mean. This is what this is going to mean and look out, because as soon as the minister realized what that was going to mean was real cuts in services in the Capital District Health Authority, then he knew that he was in for more than he had bargained for. The reality was that they weren't

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going to be able to get away with doing that and that politically it was just going to be unpalatable.

So instead, if we look at the estimates for the various district health authorities and we go to the Capital District Health Authority, you will see that, first of all, I think the most startling thing was just how bad the ball was fumbled in the 2000-01 estimate and forecast. What was estimated was $388 million; what actually happened was they spent $408 million. They went to the minister and they said that it doesn't matter what you tell us our budget is, we have a job to do here and we have to provide this service, and the reality is we are going to run a deficit. We have to run a deficit, we have no choice. We have people who show up at the emergency room and they must be treated.

So that was handed off to the minister and the reality is that that resulted in the deficit that appears in the books. When the minster made his pronouncement about last year's budget, whether it was $408 million or $388 million, when they came back they said this can't be done. The minister scribbles in his estimate, $416 million. Whether or not this is an accurate forecast for the future, we don't know, and we won't know until we see the details of the plans for the district health authorities. We can only say that if they are as accurate as last year's, there will be considerably more spent than was forecast.

So I want to ask the minister, can he explain what the major blunders were that were made in forecasting last year's estimates and whether or not we can expect the same this year?

MR. MUIR: I don't think there were any blunders made last year and to categorize the business planning process that way probably it is not only inaccurate, I believe it is an unfair reflection on those people who entered that process. Including the people in the then, I think it wasn't the Capital District Health Authority, he was probably referring to the QE II Health Sciences Centre and I think that is probably what you are specifically referring to, primarily referring to.

One of the things that happened last year is that in the implementation of the business plans, some of the business planning initiatives, in order to make those things go, it took some time. There was a transition period and the savings that were predicted to come from some of those efficiency initiatives were projected on a 12 month basis. They didn't get the system in place for the 12 month period and I would think that would be the substantial portion of that.

MR. DEXTER: Well, whether or not they were blunders, I guess they were miscalculations. The minister has the responsibility to sign off on these plans. He is the one who is ultimately, in our system of government, responsible for the work of his department and for the work of those who enter into contracts with the department, and I would suggest to you he is responsible for approving the business plans of the district health authorities and

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therefore responsible for their work, as he should be. I am sure he would be only too quick to point out that the safety of the health care of the people of this province is a responsibility that he takes on willingly.

I wonder, can he tell us if he knows what the value of the step increases alone in the Capital District Health Authority will be for the coming year?

MR. MUIR: The step increases are projected and I guess an estimate would be 1 per cent of total budget.

MR. DEXTER: Perhaps he could give that to us in real dollars. Are we talking about $4 million?

MR. MUIR: It would be approximately $4 million.

MR. DEXTER: Glad to know that my quick mathematical adroitness was recognized. So that alone accounts for at least half of the budgeted increase in the coming year, and my suspicion, quite frankly, is that is probably underestimated by 50 per cent. I am betting that the step increases are more in the area of $6 million or $7 million and will essentially eat up almost all the increase that the minister allows for in his budget estimates.

I want to ask the minister - and I just want to confirm this - is it the case, Mr. Minister, that you have also agreed with respect to the contract negotiations that are underway with the district health authorities, that any increase in the collective agreement that is eventually signed by the government, those increases would be covered over and above the estimates that are contained here?

MR. MUIR: As for all negotiations that the government is undergoing at this present time, whether it is in the health sector or in other sectors, there is a pool of money called the restructuring fund and increases would be paid out of that.

MR. DEXTER: Just so I am absolutely clear about this, I think what the minister just said is yes, that the funds for any increases in collective agreements will come out of another pool of money and is not contained in the $416 million, but I just want to get him to stand up and say that.

MR. MUIR: For the fourth time, that is correct.

[4:00 p.m.]

MR. DEXTER: We are starting to get there, Mr. Chairman, because I think it is important that the minister recognize that these are stressors on the system that are going to continue to have to be recognized by this government and are going to have to be

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accommodated by this government. What it means for the individual district health authorities is that they are going to have to make decisions based on what are essentially, declining budgets, essentially budgets that don't have sufficient growth in them to keep up with the accelerators that I talked about: population growth, the age of the population, the consumer price index and other costs.

I am sure the minister knows that the actual cost in institutions over the last 10 years in hospitals has only been about 16 per cent. He has pointed this out to me on many occasions, that the biggest growth has probably been in the area of drug costs, which have escalated dramatically. Of course, one of the problems with that comes back to government policy, as well, with respect to the question of generic drugs and drug patent legislation. I think there is a direct correlation between the increase and the legislation.

I want to ask the Minister of Health, Mr. Minister, have you seen a draft plan put together by the Capital District Health Authority?

MR. MUIR: I would like to do two things while I am on my feet this time, Mr. Chairman. First of all, I will answer his question and say, yes, we did have a draft plan and from that we were able to arrive at a final budget figure. It gave us some guidance in our deliberations. Secondly, I think the member indicated there was something like a 16 per cent increase in acute care costs over the past number of years. I believe you did say that. (Interruptions) Well, whatever. One of the things I think has to be put in perspective is that the number of beds in the province in that period of time decreased by about 45 per cent. When you are talking about a relative increase, there have to be some other things factored in to fully understand it.

MR. DEXTER: I am sure the minister has read this, but I will just refer him to a document that is on the Department of Health Web site called Understanding Canada's Health Care Costs, an Interim Report, which I thought was quite interesting. It doesn't actually have data specific to the Province of Nova Scotia, but it does look at data from across the country. It is a very interesting report and quite informative on how to look at health care costs and their growth across the country.

If the minister has seen the Capital District Health Authority draft plan, I wonder if he could indicate to us whether or not that draft plan calls for the closing of any of the existing institutions in the Capital Health District?

MR. MUIR: Mr. Chairman, in the preliminary plan, which we saw and did review, there were no closures included in that.

MR. DEXTER: I wonder then if the minister could indicate, if in the draft plan he has seen, which services are going to be consolidated and out of which institution will they come and where will they be consolidated to?

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MR. MUIR: Mr. Chairman, I am not going to answer that question and I will tell you why. What we received from the Capital District Health Authority and, indeed, with all of the DHAs and from the IWK, was a preliminary plan which was used in a budgetary process. We will receive a final plan from the Capital District Health Authority, indeed the others and the IWK Health Centre. I don't think it would really be appropriate to talk about what might be in a preliminary plan as opposed to what might be in a document that is going to become a guide for the conduct of the authority.

MR. DEXTER: For anybody who wasn't paying attention, I will translate that. What he means is that he is not going to release any of the plans from the district health authorities while the House of Assembly is in session. Do you know why that is, Mr. Chairman? That is because he doesn't want to have those plans scrutinized by the members of the Opposition, scrutinized by health care consumers, scrutinized by those in the health care community who may disagree with the direction that this government has taken. That is why the Minister of Health doesn't want to release the draft plan.

This is a government that got elected by talking to the people of Nova Scotia about being open and transparent and consultative and working with people. This is the antithesis of that. Having a draft report in his possession could only be augmented by putting it out there, allowing people to see it, offering suggestions, bringing that information together and listening to them. Instead, the minister wants to hide behind the idea that this is a draft report and, therefore, subject to some changes. He knows very well which of the proposals in that draft he has approved and which he has sent back. My question to him is, even if you can't tell us which ones haven't been approved, tell us which ones in the draft plan you have approved?

MR. MUIR: Mr. Chairman, the Department of Health, in the budget planning process, did not approve anything on a line by line basis. So in terms of us looking through the business plan for the capital district and saying, yes, yes, yes, no, no, no, maybe, maybe, maybe, what we asked them for was what does this mean to you if you have to live within the same amount of money that was budgeted for you last year. They came back and said this is what it means. We made adjustments to the budget and, I think, as the honourable member will recognize, the preliminary plan, which they did submit and is used as part of the planning process or in the planning process for us determining how much money would be allocated to help this year, was based on things which are different than what exists. You are talking about something and something else. They are not the same.

MR. DEXTER: I must say, again, and I am not exactly sure that I understood the answer from the minister - based on things that didn't exist. I guess I ask this question with respect to the Capital District Health Authority and I am going to ask it with respect to the other health authorities too. Have you received draft plans from the other district health authorities as well?

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MR. MUIR: As part of the budget planning process, Mr. Chairman, we received some preliminary plans. I think it's important to to keep in mind that this year there was a district health authority that is up and functioning; last year there was not. Anyway, we have not received from any of the authorities, the final plans based on the amount of dollars that they now know they are going to be able to spend.

MR. DEXTER: Just so that we are clear on this, Mr. Chairman, I wonder if the Minister of Health could indicate to us when he expects to receive those plans?

MR. MUIR: Mr. Chairman, we expect to start to receive those plans, probably from the larger units, in a short period of time. We expect to have them all in by the first week of May. We expect to turn them around - which I suspect is going to be your next question - we hope to have the total roll out completed by the end of May.

MR. DEXTER: I am going to ask this question because I want to get the minister to indicate on the record. He has now seen the draft plans from all the district health authorities, as he said is part of the planning process, and I would ask the minister whether or not he can indicate if any of those plans for the district health authorities across the province call for the closure of any of the institutions presently operating in the province?

MR. MUIR: I guess the reason I am hesitating is that I am not sure whether it is really appropriate to release details of those preliminary plans that were submitted as preliminary. However, I guess I will answer the question for the honourable member, and the answer to that is no. I would sooner not get into the details of these preliminary plans. I am not sure, because they were preliminary based on last year's dollars, that they are ones that we should recognize as being - I just feel a little uncomfortable.

MR. DEXTER: I am not sure why the minister feels uncomfortable when answering a very straightforward question about the document that he is using in presenting his estimates to the House of Assembly. We all understand and know that there may be changes as a result of further deliberations between the Department of Health and the various district health authorities, however, again, I would remind the minister of the Premier's pledge throughout the last election to be open and accessible and accountable and transparent in all of their dealings. After all, the purpose, as I understood it, of setting up the district health authorities was to allow for greater input, to allow for a better process for determining the way in which health dollars were going to be spent right across the province. Whether he likes it or not, the reality is that the Opposition, the loyal Opposition, is entitled to participate in that process. In fact, that's the reason why we are here. We are here to lend assistance and to be of any aid we can be to the Minister of Health in the course of his deliberations so that he may make wise decisions. Certainly, that is why I am struggling here every day to try to help the minister whenever I can.

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I want to go back to yesterday evening when the Minister of Health made his opening statement with respect to his estimates. During the course of the lecture - I was going to call it a lecture but I guess it's not really a lecture - during the course of his opening statement, his introduction, invocation or however you want to look at the . . .

AN HON. MEMBER: Inspiration . . .

MR. DEXTER: I think he said inspirational - I didn't catch the last part of that. The reality is what he talked about, at least in part, was something that he called self-managed care. Maybe I mistook that, but I thought he said self-managed care and I am not exactly sure - it seems as though the Department of Health is fairly good at spinning out a new piece of jargon every week and I would just get the minister to explain to me - I mean, self-managed care to me sounds as though you are on your own, now I am sure that is not what he meant. I wonder if the minister could just tell us a little bit about self-managed care?

MR. MUIR: I appreciate the opportunity to, again, make these points. I could do it in a rather prolonged period, it took me about 38 minutes last night I think and I am prepared to spend that time again, if the honourable member would like that. I guess I won't. Two things, we are talking about self-managed care and I think we used responsible and evolution. What we have done is tried to put a lot of the health decision-making back into the communities. That the people whom those health services are being delivered to will determine their own future. A lot of decisions will be devolved.

The second part of that that I tried to make in my opening comments was that I believe that a good deal of the health and well-being of Nova Scotians is determined by individual lifestyles and choices. One of the things we have tried to do in our decision-making and in our approach to the operations of the Department of Health is education and awareness of wellness and health activities. As the member will remember, last evening when I began my comments, I read from and I apologize, whether it was Canadian edition of Newsweek or Maclean's or Time, there was a section in that because April is Cancer Month in Canada and there were eight principles of good health that were articulated in that article, and that's where I began.

I would think, Mr. Chairman, that if I could do one thing as a Health Minister that I think would have lasting effect, in addition to the structural change and the emphasis on returning the responsibility for health decision making to the communities, if we, as a government, in conjunction with the district health authorities and community health boards can get a greater emphasis on wellness and people to take their responsibility for their well-being more seriously - I don't think the honourable member or anybody is going to disagree with that - then we will have improved the health care system, I think, significantly.

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MR. DEXTER: I thank the minister for that explanation. It turns out I was right. That's exactly what it means. It means you are on your own. I guess that is part of what the minister was talking about when he was indicating, over the last couple of days, about this conversation he had with people whom he can't recall, around doctors who wouldn't treat people who were smokers and then solicited or caused to have the apology that was made. Which was very well received, I might add, by the House.

I want to move now because I only have a few minutes left in this time and I wanted to talk about a very specific instance with the minister. I wanted to cover off a situation that has arisen down on the Eastern Shore and this has to do with Coverall Home Services Incorporated. They were providing, as the minister probably knows, non-emergency medical transportation on the Shore. For some reason that service came to an end. I know and I think many members of this House, yourself included, Mr. Chairman, have seen some of the correspondence that has gone back and forth on this. I wonder if the minister could explain to myself and to the other members of the House and perhaps to the principles of Coverall why it is that that much-needed service was cancelled?

MR. MUIR: Mr. Chairman, that particular company, which did provide a service, did have discussions with the Department of Health. Why that service was cancelled, you would have to discuss that with them. They made that decision; the Department of Health did not.

MR. DEXTER: Well, Mr. Chairman, I must say I am quite surprised by that answer because it runs exactly counter to all the information that I have seen, which is to say that the principles of Coverall Services, in fact, received communication in which they were told, after having provided this service for some consideration period of time, I believe a couple of years, in which they had billed the Department of Health and received payment, that they were no longer going to be funded by the Department of Health. In fact, I believe there is on record a letter from the Minister of Health, himself, that says that they are not going to continue to pay the invoices submitted by Coverall Services Incorporated. So I am very surprised by his answer. I wonder if he could explain, if that is what he means, if he means that they made the decision to stop providing the service because the Department of Health decided to stop paying them?

MR. MUIR: I am reluctant to discuss individual cases, Mr. Chairman, as I think you can understand, and you would probably even have a greater understanding of it because that is in your particularly consistency; I believe the principles of that. The point is that that was a private operator who delivered a service. It was not a service delivered by the Department of Health and, thus, my answer, you would have to go to the principals of that service to find out why they discontinued it. The Department of Health did not make the decision to discontinue that service.

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MR. DEXTER: Mr. Chairman, I have here, and I will table it for the minister, his own letter dated September, 6, 2000, which says that I do wish to make it clear to you at this time that the department is not supporting independent, non-ambulance transportation initiatives except as stipulated through the CBTAP initiative. Now this was a program, the Coverall Services Program, was previously being billed to the department. The department had approved it at the time. I want to know why it is the minister, in his letter of September 6th, decided to stop funding that particular initiative?

MR. MUIR: Mr. Speaker, I am going a bit from memory, but if the honourable member would be good enough to read the last sentence of that letter, I think it is the last sentence that refers to the department not funding outside of CB-something initiatives. I would assume that probably that was not part of that initiative.

MR. DEXTER: Of course, this is circular reasoning. If you don't include them, they are not part of it and then you don't fund them. What you said in that letter was that should a program be recommended and should it be approved by the government, it would be termed an approved program. In this case, these individuals met with the officials at the Department of Health, as I understand it, on a number of occasions, operated this service successfully, were needed in the community, put forward invoices to the Department of Health, the Department of Health routinely paid them, they assumed, I think, quite rightly, that they were an approved program. Then along comes this minister, after the 1999 election, and all of a sudden, they are no longer an approved program. I guess my question to the minister is why?

MR. MUIR: Mr. Chairman, again, I am trying to remember details of this. It was sometime ago when we had, at least I last had some communication with the principals of the Coverall Services. Their arrangement, as I understand, may have been with Emergency Health Services, as a sector of the Department Health. The arrangement of that, rather than, you quote, "generally the Department of Health" - I see the honourable member nodding his head and I guess that is correct - the decision at that time, and I can say, as well, I believe, that when the principals of Coverall approached me, and I do remember actually meeting with them and I believe my staff did meet with them several times and I believe my then executive assistant, Mr. Montgomery, met with him on a number occasions, that a good many of those invoices were a carry-over from a period when we were not in government.

So whatever that decision was in terms of that, it was made some time in advance. I am not so sure, I think the honourable member is saying that I had made that decision, or had made that decision arbitrarily. I do know there was a discussion between the principals of Coverall and officials in the department. We can get more information on that for you, but a lot of the invoices, I believe, were a carry-over for some period of time, Mr. Chairman.

[Page 315]

MR. DEXTER: Mr. Chairman, I want to carry this through to its conclusion. The reality of the situation is that service was continued to be provided by the principals of Coverall. What happened was when the invoices that had been submitted and paid previously were submitted, the department denied payment, so without notice to them, without telling them that the service had to be terminated, putting incredible financial strain on those principals. I understand, regrettably, that it caused them great financial hardship and continues to cause them great financial hardship. I think they deserve some kind of explanation from the Minister of Health, given that you have a program underway that was approved last year and the year before last, through the estimates of this House, why it is that this program and these individuals were not provided with an adequate explanation as to why the service was discontinued.

MR. MUIR: Mr. Chairman, what the honourable member is asking me to do is make a judgment on conversations that I wasn't party to. What may be an adequate explanation in the minds of those who were delivering the service and an adequate education from the Department of Health's perspective, may be an entirely different thing. What I can tell you is that when I become Health Minister, the issue of Coverall Services came to my attention very quickly and, as a matter of fact, I can tell the honourable member, not only well in advance of him making any mention of Coverall, the member for Eastern Shore was a strong advocate on behalf of that service and drew it very much to our attention. So I want to assure the honourable member that it was raised, indeed, first by their own MLA in a very strong way. It was he who facilitated the meetings between the principals of Coverall and our staff to try to work out an understanding of where this all went. To be quite frank, Coverall felt that it had not been treated fairly with respect to some of the invoices that it had submitted to the former government and our government.

[4:30 p.m.]

Dr. Mike Murphy, who was then head or Director of Emergency Health Services for the Department of Health, and Mr. Montgomery of my office staff met with them in order to try to clear up any confusion. The agreement was that a number of the invoices that were in dispute would be settled. There was no record - and I believe the honourable member for Dartmouth-Cole Harbour is aware - of any formal agreement between the principals of Coverall and the Department of Health or any portion of it.

MR. DEXTER: Mr. Chairman, I think that, in fact, is the nub of the problem, because they felt they were operating under an approved program, based on their experience with Dr. Murphy and on the fact that they had submitted these invoices and that they had been paid. If they had one question for the minister today it would be, can the minister provide an adequate definition of what an approved program is?

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MR. MUIR: Mr. Chairman, I would think that an approved program in the Department of Health would be one in which there would basically be a formal exchange and some sort of formal agreement recognizing that a service would be recognized. I can tell you this is not unusual, that the Department of Health recognizes a number of things.

It recognizes approved long-term care facilities; it recognizes that sometimes there are some that are not approved. We had a case not long ago, and I suppose it's different but similar, somebody who received some medical treatment up in New Brunswick. The facility from which they received that treatment was not an approved facility by the Department of Health. We also have, as well, instances that come up fairly frequently - looking up in the northern part of the province, indeed, the Speaker drew one to my attention the other day, one of his constituents who went to Moncton to receive medical treatment; that, by the way, is a rule not an exception for the people in Cumberland County, because there is a greater collection of services up there and we are fortunate to be able to make that exchange. We also accept people from New Brunswick down here. It came to filling a prescription for narcotics. The particular physician who wrote that prescription was not on our approved list of physicians, therefore, the prescription could not be filled here in Nova Scotia. This would be an example of it. Mr. Chairman, there was a process, and that particular physician can get on that approved list. He wasn't on it.

MR. CHAIRMAN: Thank you, Mr. Minister, and I would also like to thank the member for Dartmouth-Cole Harbour, whose time has elapsed. We will now turn it over to the Liberal caucus.

The honourable member for Dartmouth East.

The time is 4:34 p.m., you have one hour in your turn.

DR. JAMES SMITH: One hour in my term, I suppose someday that will be true. Thank you, Mr. Chairman, for the kindness of your (Interruptions) I am waiting for an offer from the minister to set up some of these private health care systems. Actually one of the big reasons I wouldn't go back to practising medicine again was the fee-for-service. The honourable member for Hants West always said I was cheaper to the government being in politics than in medicine. I was costing too much money as a doctor. I was cheaper staying in here, even though it meant one less member on that side.

I will be looking for a little information here. I just want to start off with long-term services to women with addiction, multiple addictions or addiction problems. The question I would like to ask the minister, if I could - is which seems to be, for some reason, very difficult for people in the field to access - the cost per day of detox for those patients involved in detox? I don't expect the minister would have that here, maybe he does. If he does, I would like that information. If not, perhaps we could have an undertaking that we could get that before his estimates are finished.

[Page 317]

MR. MUIR: Mr. Chairman, Addiction Services is being devolved to the DHAs, and we are currently trying to get better information flow from the DHAs. I can tell the honourable member for Dartmouth East that we don't have that information. I have been informed that it is currently not available but, when it is available, I would be pleased to make it available to him.

DR. SMITH: I can accept that because other people are finding the same difficulties as the minister. I really think that is unacceptable, that we don't know the per diem on detox services here in this province. It makes it very difficult to plan programs. Anyway, where I am coming from, and the honourable minister may know this, is that Exodus House, for a period of time, the Sisters of Notre Dame have had a long-term care service/program for women with addiction. We have Freedom House in Dartmouth that is now becoming well established and is gaining in credibility. It has been a long haul for the board there, Rev. David Ferguson and all those other persons; Mr. Myers and others who are currently on the board; Joe Gibson and his staff, who have really gone in an area of care where a lot of other groups don't seem to want to go.

The thing that disturbs me and maybe bothers me a bit more about this is that they seem to be isolated and put down and marginalized in many ways. They are almost made fun of in some circles, that somehow or other we have a system going, it is the best system that's at least possible under the resources that we have, and this whole issue of marginalization of those people in the long term.

I am sure there are those who respond and are ready maybe to give up their addictions or are able to, at some particular time in a short program, a week's program or a 28 day program, but there are others with multiple issues, often including gambling, who really need special care. We have Alcare Place and we have the Freedom Foundation in Dartmouth. I know that members of this House, the honourable member for Dartmouth North and Dartmouth South, we were all there gathered the other week celebrating the anniversary of that establishment. It has been a long haul. I know as Minister of Health and as Minister of Community Services - they are getting bounced back and forth. Our government was as responsible as any other government. I think they are a little more focused, I think the federal government's program on homelessness has freed some money in this particular area.

I go back to the reasons for bringing this forward. Number one, I think we should know, accurately, truthfully and transparently what the cost is for the current detox program. Number two, recognize the need for a longer-term program. All of sudden, you are putting these people like a revolving door, in and out of these 28 day programs, or whatever. That will work for some but for many it will not. There is more needed. Women have special needs, often with children. I think the programs have to be coordinated with child care, particularly the YWCA and those other initiatives.

[Page 318]

I will just say to the minister that I am sure he is aware of the current group, and I don't have their exact name now that they are incorporated. It has grown out of the Exodus House and is very credible, run by sisters who have been there very quietly. (Interruptions) Yes, the Sisters of Notre Dame. I don't think it will be talking out of turn to say that I am aware that they have a proposal before the federal government with monies, and I think they are going through that process. I don't think they are asking a lot from the province at this time but, I think, as a society issue, we have to recognize this is a special issue of women. It is not compatible that they be just incorporated in programs with males. There are special issues surrounding the addiction, the pattern is often different, so the assessment is different and the care plan and case management, if you will, of individual women with addictions have special needs, particularly with children involved, and so many times it involves the isolation of their children.

So I think I will just ask the minister if he will make an undertaking that would provide an assessment of what the per diem for detox is. I think we should know that in this province. I would ask that part of the addiction services of this province incorporate and fully endorse and support, even if they are unable to free money, and money resources to target specifically, but that it be part of the program, and not marginalize these groups.

I think the sisters have been accepting that they work very quietly and almost unheard of, really; most people probably haven't heard of Exodus House, but they have done this. Times are changing and time is moving on, people are getting older. I think that when you look at the bridge, to bridge through the transition period into long-term, established, sustainable programs for women with addictions and long-term care whose needs are special and need long-term care, that this province has to make a commitment to that.

I don't think we did a good job with it. I was aware of the programs, but I think we have allowed these groups to be somehow marginalized, not as credible. I know their statistics, not this particular group, but I know Freedom Foundation's statistics have been questioned very often and they will stand up and they will tell you very forthright. They have the information and it is not 100 per cent success, but when they are dealing with the focus group of very difficult addictions and multiple, perhaps, disabilities, if you will, that they have done a great job and so have the other groups as well.

So with that as an introduction, without going further, I would just like to ask the minister for that commitment, that he inform the committee, before the end of his estimates, the cost of per diem of detox for addiction services in this province?

MR. MUIR: Mr. Chairman, I have just spoken with my staff and we believe that we can get that information for you. We will provide it as best we can and it may be manual calculations, if that's okay. I would just like to pick up on something that the member for Dartmouth East mentioned, and that is the ongoing services, including residential services for women in this province. In general, I think our department recognizes, as the honourable

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member has pointed out, that there are probably some significant differences in the delivery of services for women who have addictions, and men. Now that is not to say there aren't some things that perhaps are common, but, by and large, we do recognize that. I thank the honourable member for bringing that to the floor of the House.

One of the things we wrestle with, and I expect he also wrestled with, is that there is still a sector out there which would argue whether to build a system which targets women as opposed to men, or distinct from a system that targets men is really appropriate, or if there is more commonality than we presently think. There are a range of women-specific addiction services across the province. I was just interested, and I believe it was Exodus House that you referred to that was run by the congregation of Notre Dame, and you speculated that that was not a well-known service. I don't know if the member for Dartmouth North knew about it?

AN HON. MEMBER: Absolutely unaware of it.

MR. MUIR: Absolutely unaware of it. I checked with my colleague for Dartmouth South. He was not aware of it either, and it certainly reinforces the point that you made and it probably does deliver a very good service. I think one of the other things that I would just like to comment on, it is quite appropriate, Mr. Chairman, that the member for Dartmouth East raised that issue of mental health and addiction services this afternoon, because the reason I was late for Question Period was that there was an economic round table, the Atlantic Canadian version of a round table - the Business & Economic Round Table on Addiction & Mental Health is a new organization which recognizes that addiction and mental health is not only an issue for my department and the district health authorities, it is a very big issue for the business community.

At noon hour today, there was a meeting at Pier 21 where that was the topic. The guest speaker was organized by the Department of Psychiatry with some other support people. It had major sponsors such as the Royal Bank of Canada and some other major corporate sponsors. Of course, they don't do this just necessarily for health reasons, although they are very generous to a good many charities. There is a recognition now that the financial price that our economy pays because of mental health and addiction issues is great and it is going to become even greater if we don't manage it.

I had difficulty getting it out, but I did say a few words down there, that probably within five to eight, the single illness that will have the greatest frequency in Canada is going to be depression or it is a mental illness. It is rapidly climbing to number one among the illnesses here in Canada. It is gratifying to see that not only are we, as government, and the Department of Health recognizing that, but the business community has also seen that as one of their priorities. Again, I thank the honourable member for allowing me to make that little pitch in response to his question.

[Page 320]

DR. SMITH: Mr. Chairman, I would like to thank the minister. I think this is the type of thing in estimates that it is not the mutual admiration society taking over, because we can switch pretty quickly back to a more assertive mode, but there are things really that cross Party lines. I don't think there is any more than mental health, child health issues, adolescent and youth, particularly. When I did my family practice for 30 years, this was the group who I really enjoyed the most. In fact, I was just down to pick up my daughter's passport and I met people who were young families at that time, back in 1964. We shared the issue of breech deliveries and all the other things that go with it, but that's been a large part of it.

As I told a group of adolescents the other day, when I was a family doctor I liked to deal with adolescents because they were so difficult. I think they knew what I meant. They were often reserved, often angry, but the problem was when they became depressed, they were either acting out or doing some behaviour that got them into trouble and yet they were crying for help. Of course, suicide was the issue. I know the honourable minister shared with me where he was today. I don't think that Mr. Wilson would mind us sharing and he shared across this country that he, in turn, lost a son to suicide, a young, adult male. He is doing such a great job, and for all of this in this Chamber to think there isn't a life for us after, remember all those good budgets he used to bring in and then Mulroney would go and ruin it all?

Well now he has found purpose in his life. What a better way to use your name, influence and credibility that Michael Wilson built up in all Parties. We all admired Michael Wilson and yet the tragedy that he and his family suffered. If our families are going to be impacted in any real way, other than old age and heart disease and cancer and all the other things, in our early days it is going to be mental illness and drug additions that are going to impact. There is no member here in this House whose family will escape that, that is a given, and it is major, big time, when it hits, particularly with young people.

The support I would like to give the minister is that I know that when you are sitting around the budget table - and we are talking budgets here - the things that fall off early are the things related to children and children's health, mental health, addiction issues; those are the soft ones that will often get pared down and moved. That is why I want to follow up, I think we need to know what the costs are and move on, because that is not the issue, what the costs are in a particular budget, it is the cost in human terms.

I just want to thank the minister for his comments on the residential facilities for long-term care for women with addiction. It is different. Many of them have been raped, I know men have been raped as well, young boys and males, we are realizing that more as time goes on. That was a hidden fact for a long period of time, now we realize that. There are different issues, there are different issues like prostitution, often if the person is needing quick money for an addiction problem.

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I would say to the minister that I agree with his statements, there are many similarities for male and female addictions, but there are major differences, especially around sexuality issues that separate the genders. I would thank the minister for his comments. I will do whatever I can on this side of the House to support him in his budget for those types of initiatives. Goodness knows it has been long enough coming.

Switching, I would like to just address the issue, not totally but somewhat, in nursing. I have made a few notes, nothing too formal, on the nursing strategy that was announced. I would like to compliment the minister for re-announcing our Liberal initiatives, and also the fact that out of the five, I think that he did get one original one of their own. That government is paying $5,000 reallocation. I would like to compliment him, one out of five isn't bad. Next time it will be two out of five. Sooner or later, he will be finished rolling out our budget and our health investment fund.

MR. MUIR: We're not adverse to good ideas; it doesn't matter what the source is.

DR. SMITH: That's right. The minister said, for the record, that he is not adverse to good ideas, and he doesn't even care about the source of them. Seriously, I think that is a good initiative, it would be a stimulus to have some people come home. I think when you create a good working environment and good relationships within the team approach to health care, where nurses are equal partners that that is one of the really big attractions for nurses to return to this province. We found this with oncology, on alternate funding, where we were down to 9 or 10 positions for oncology physicians, and by moving to alternate funding, I think there is now a full complement. I think alternate funding had a lot to do with that. I think the minister would agree with that, and I have just asked him to maintain that.

These types of initiatives, I think it is a multiplicity of programs. I think you take the good ones that work. I know that a lot of other provinces in Canada have looked at our physician recruitment and will also share our nursing recruitment. I would just ask the minister, moving on this, as we speak in terms of helping to create an environment that is stable in the health care system, it is so important, these people are global now.

Last night I met two teachers, two young women graduating from Mount Saint Vincent University, they were at the Nova Scotia Teachers Union, metro branch, over in Dartmouth. They were both going to England. Number one, they sort of wanted to go anyway, but the fact is they couldn't get jobs here. But they will be back, that was their plan. There is nothing wrong with people going to another province, many of us did that; I did that. You do find your way back, but you won't come back if the environment is not satisfactory. That is why the commitment of this government to stabilize health care and to properly resource and have a plan for health care, where nurses have their rightful place not only as nurse practitioners but as the skills and the training nurses are allowed to develop as they grow in their job, and that they are properly recognized.

[Page 322]

I think the nursing profession has felt unappreciated, not worthwhile; I think their esteem has suffered largely. Nursing itself, as we all know, has undergone many changes. We have moved to a university program, without adequate clinical experience. It is not only taking nursing students out of the hospitals. People look around and ask, where did all the nurses go? Well, a lot of those students - albeit it was a bit of slave labour, I know our internship in medicine was - at the same time, you did learn. These people are now graduating and having to upgrade.

I want to compliment the minister. I am reading between the lines here, but I think they have incorporated monies into this budget to upgrade and clinically train throughout the program, more clinical experience. That is absolutely necessary. The nursing profession, I compliment them on their initiatives for more education, but I think there has to be a realization that these nurses are graduating from university not properly clinically trained to go into a hospital such as the QE II or even a long-term care facility, specialists.

We have always recognized intensive care nurses and cardiac unit nurses and all of those as needing upgrading, but nowadays with the variety of medications, the technology, the high-tech, the understanding, the tests, the interpretation, all the things that a good nurse practitioner has to do - I use that term loosely, practitioner - I think with a lot of nurses it is the upgrading of their basic skills that is really the issue. They don't necessarily have to be practitioners because they can be equal members of the team without being designated nurse practitioners. I think that is another issue, and it is one that we support as well.

Anyway, I think the whole strategy of nursing is comprehensive. I think the minister has laid it out, he has added another extra one on to the initiatives we had done, and I compliment him on that. I know the costs to the hospitals, like the QE II, has increased. I know there are nurses graduating. I know there was a male nurse someone spoke to me about who had graduated, who had not given an injection for 12 months prior to his graduation. He came into the QE II, was hired, and had to go back to practising on oranges again, like we used to do. We don't talk about that much.

Seriously, all nurses have to be upgraded. That is accepted, but there is a level that the training of those years, doing their Bachelor of Science degree in Nursing that would involve clinical training. I think there is no better place to learn than in the hospital or in the community, in the physicians' offices if you will, and various community health programs. I think, early on, to have the nurses as an integrated part of the community health team, along with physicians in training, occupational therapists, physiotherapists, social workers, those people training together at the student level, I think has been missing and I think it has to be integrated.

I think what the minister has done will probably encourage that, at least from the nursing side, if the other professions really follow suit. My question to the minister. What is the status of the current contract with the VON, in the nursing services, in home care?

[Page 323]

MR. MUIR: Mr. Chairman, the relationship with the VON in delivering home care services remains unchanged at the present time. As the members of the House may realize, the VON is an organization which had to do some soul-searching, and it has undergone some restructuring initiatives itself to try to gain some operating efficiencies. Right now, the relationship is unchanged.

DR. SMITH: That is a very good answer, but I don't know what that means. I would ask, is there a current contract signed with the VON and, if so, what is the life of that contract?

MR. MUIR: There is a contract, and that contract is open-ended at the present time. There is no ending.

DR. SMITH: I am going to pass the floor over for the remainder to our time pretty quickly, but since we are on contracts - and I know it is a little bit out of sync - teleheath, what is the status of that contract now with TecKnowledge or whoever is involved with the administration of that? Is it true that they were granted a six-month extension? What is the status of that currently? What are the plans for the future on telehealth?

[5:00 p.m.]

MR. MUIR: As the honourable member knows, TecKnowledge ran into financial difficulty earlier this year. Basically, what the Department of Health was doing at that time was paying its bills, and TecKnowledge was operating through a receiver and delivering our teleheath service. To be quite frank, the department became a little bit nervous about the way that was being delivered because, as the honourable member for Dartmouth East would know, there were some pretty able people associated with the delivery of that service and we did hear some rumours that some of them were being approached by other agencies. We couldn't afford that - given the status of that program and its importance to us - until there was another structure in place. So what we did is we hired those people and brought them into the department, so that program is basically being run out of the Department of Health at the present time. We will be going to the market later on this year for the continuation of the service.

MR. CHAIRMAN: The honourable member for Cape Breton The Lakes, with 31 minutes left.

MR. BRIAN BOUDREAU: First of all Mr. Minister, I had an occasion over the past year or so to meet not only with yourself, but with your staff with regard to the Northside General in particular and the regional hospital in the CBRM. I have always been extended courtesy from your staff and yourself. I have always been treated very fairly and the questions that I asked were always answered straightforward, and I want to express my gratitude to you and to your staff for that.

[Page 324]

After having said that, just a short while ago, of course you were in Cape Breton on a regular basis, campaigning in the Cape Breton North by-election and you made several commitments in regard to the Northside General Hospital. My first question is simple. Do you remember what those commitments were?

MR. MUIR: I made two visits to the Northside General Hospital in the last two months. One, I had the opportunity with the CEO up there, Mr. Malcom, to present - I believe it was - Best in Nursing to the surgical nursing staff at the Northside General, and I had the opportunity to present that award to them. One of the things that I can tell the honourable member is, as you know, the Northside General is part of the Cape Breton Regional Health Care Complex and that complex was recognized by a Canadian organization for being best in certain categories, and I was delighted to have the opportunity at that time.

I can tell the honourable member, not only did I present an award for that, I went down and congratulated one of the people who had a birthday that day and gave her a certificate as well. I remember that well because all over the halls was happy birthday to whomever it was; perhaps one of the relatives of the member for Cape Breton West, I don't know.

Secondly, I met with representatives of the foundation board one night, I suppose about six weeks ago, and we discussed the future of the Northside General Hospital and also the role that the foundation might play in serving that. One of the concerns that the foundation had expressed at that time was - like most of these foundations, they are an extremely committed group of volunteers who do a valuable service to our province - one of the things that they were concerned about is if they went ahead and made an improvement, or bought a particular piece of equipment for the Northside General, that it would be for that hospital and not picked up and moved to where the member for Victoria comes from, up there to Neils Harbour or some place like that, but quite seriously, back into Sydney or something like that. So, no, in terms of actual commitments I would have to ask the member for Cape Breton The Lakes to remind me of the actual commitments.

MR. BOUDREAU: It is certainly no surprise to me that they are presenting best certificates. That staff in that particular hospital excels and works very hard to be the best, as it is in every facility that I am aware of in this province. Being an elected representative, I am very proud of their efforts, that is for sure, and I am sure that effort is not uncommon throughout the province.

In regard to the cutbacks, you really didn't answer my question. It was nice that you told the foundation you weren't going to rob any equipment from them, and I appreciate that response, and I appreciate, seriously, delivering the birthday card personally; I really do. However, I want to know about the commitments that you made to the staff, to the foundation, to the community during the by-election, what those commitments were. Do you remember what those commitments were?

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MR. MUIR: I guess I can say, first of all, that when I met with the foundation members at the Northside General Hospital, we talked about a variety of issues. What they were concerned about was that if there were decisions made about future services at the Northside, they quoted the staff, but I think also one of the things that they were concerned about at that time, if I remember correctly, was how busy their emergency room was and that they wanted to be assured that those needs would be considered. Of course, that is part of the Cape Breton Health Care Complex, which is under the DHA 8 and what we did was we encouraged them to make sure that their concerns are known to the DHA 8.

MR. BOUDREAU: It concerns me a little bit that perhaps the minister is having difficulty with his memory. However, I can assure the minister that my memory is not that short. Your commitments to that facility in that community are very well-documented by my office and we will be holding you to your word, sir, with regard to that facility.

I would like to move on. There are renovations taking place on the fourth floor. Could you please explain why these renovations are taking place?

MR. MUIR: I believe the reason those renovations are going on is that there are a number of people who are in an alternative level of care and the renovations were to better provide for the comfort of those patients.

MR. BOUDREAU: I would like to be clear on this, if I could. Are the renovations taking place to make people more comfortable, or is it to make $50 a day from the helpless people in our community? Which is it, sir?

MR. MUIR: I want to tell you, Mr. Chairman, I never thought of the people in the Northside General Hospital collectively described as helpless; I would indeed not categorize them that way. The renovations, I believe, are for the comfort, to see that those people who are there are better accommodated and more comfortable.

MR. BOUDREAU: Indeed, in fact, Mr. Minister, I can assure you that the good people in the Northside General Hospital are not helpless. However, there comes a time when we get old and feeble, and we do become helpless. Your government brought in a new measure this year to pay the fee or the tax - whatever you want to call it - it is $50 a day. Will this new fee be charged against these new comfortable beds that you are speaking about?

MR. MUIR: Mr. Chairman, in the budget that was announced there was the announcement of the implementation of a $50-a-day fee for people who are medically discharged from a hospital. Those particular beds have received a temporary licence. So if people are occupying them, then it would be my understanding right now, without looking further, they are in a long-term care bed. They are not in a bed that is classified as acute care, so they would not be subject to that charge.

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I just want to say a couple of other things about that, and I thank the honourable member for giving me this opportunity. That particular budget item was generated from the district health authorities themselves; they did it. I think the honourable member knows that the pilot area has been up in District Health Authority 8 where they have been doing this for some time. This, in that particular area, is not a new practice, but I want to assure the honourable member that this particular fee which will be charged to people, and it is done in other places on a much higher level, the idea for that came from the district health authorities themselves.

MR. BOUDREAU: Mr. Chairman, I am wondering if the good minister was in a consultation with these health boards, I am sure there must be some paper where these health boards recommended that this fee or tax, whatever you want to call it, be included in your budget. So would the good minister be kind enough to table any correspondence from the health boards in regard to this $50 tax?

MR. MUIR: We can certainly validate that that did come in, Mr. Chairman. It was incorporated into many of the preliminary plans, but we are not prepared to table those preliminary plans, but it will also be in the final plans which you will have the opportunity to see. If the honourable member would accept that, then it will be available before too long.

MR. BOUDREAU: Mr. Chairman, could the minister indicate why he would not be willing to table the information that you have today?

MR. MUIR: Those are preliminary things. The honourable member wasn't in the House when we discussed this with the member for Dartmouth-Cole Harbour. What we did during the budget planning process was to give the district health authorities, basically ask them to create a preliminary plan that was based on the budgets that they had last year, which they did submit. We took the information that was in there and there were about four factors that we considered. On the basis of that, those preliminary plans, members of the department and myself were able to go to my colleagues in Cabinet and say well, to deliver a minimum health service it looks as though the preliminary numbers are not satisfactory. So those were simply preliminary working documents, and I do not believe that it would be in the best interest of anybody to table them.

MR. BOUDREAU: Mr. Chairman, I guess, if my intelligence level is good today, that means no. I am willing to accept that the good minister has committed to this House that he will table the completed document.

I want to go back to the Northside General Hospital itself in reference to the beds on the 4th floor. From what I understood you said, Mr. Minister, this $50-a-day tax does not pertain to the beds on the 4th floor of the Northside General Hospital, is that correct?

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MR. MUIR: I think, Mr. Chairman, in general that is a fair statement. I think you perhaps have to look at the individual cases. What I said was that those beds on the 4th floor, at least a certain number of them, are licensed beds, so people who are occupying a licensed bed would not have to pay. On the other hand, if there was somebody there who has been medically discharged and, for one reason or another, refuses to exit, then they would be subject to that charge.

MR. BOUDREAU: Mr. Chairman, would the good minister please indicate how many beds, these beds he is talking about - he is not providing any numbers - will you commit to not changing the classification of these beds after your investment? I don't know if it is an investment, either you are making the place comfortable or you are going to make $50 a bed or $50 a head. Which is it, Mr. Minister? Are you agreeing to allow the classification of the beds that are presently on that floor to remain the same?

MR. MUIR: I think perhaps that classification is going to be determined by the district health authority; it is not going to be determined by my office. Secondly, the honourable member for Cape Breton The Lakes has talked about a $50 charge, but if those beds are licensed, which they are now, Mr. Chairman, then the rules pertaining to long-term care apply to individuals who occupy those beds.

MR. CHAIRMAN: The honourable member for Cape Breton West.

MR. RUSSELL MACKINNON: Mr. Chairman, as my colleague would say to the good minister with regard to the air ambulance service, or as it is sometimes known, the shock trauma air rescue issue, that with regard to the services on the offshore oil activity in particular, the Sable offshore by EHS, is it the position of the Department of Health that those operations are within a provincial responsibility and as such the provincial Department of Health is providing that emergency health service when called upon?

MR. MUIR: The answer to that, as the honourable member for Cape Breton West knows, the oil thing is deemed as Nova Scotia territory and rightfully so. It is Nova Scotia and we provide service for Nova Scotia.

MR. MACKINNON: So the minister would disagree with a memo issued by departmental staff, Marilyn Pike, Director of Provincial Programs, Emergency Health Services, on March 15, 2000, stating that it is a federal responsibility and not a provincial responsibility? If the minister doesn't have that particular letter, I will certainly provide a copy to him.

MR. MUIR: We would disagree with that position. It has been corrected.

MR. MACKINNON: When the minister says it has been corrected, what does he mean by that?

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MR. MUIR: What it means is that the memo was not accurate; it reflected a situation that was not the case.

MR. MACKINNON: That concerns me a little bit because we have a rather large legal bill charged to the Department of Health. So large that I am almost afraid to start itemizing, but I will just give a snapshot on a number of invoices that have been submitted by the law firm of McInnes Cooper. Starting off with the first one, over $5,900; the next was $2,200; the one after that was $5,000; the next was $6,400; $4,700; $3,300; $1,900; $1,900 again; $2,300; $3,700; $3,400; $6,400; $2,800; $3,700; $383; $2,900; and $6,900. Now, that is a lot of legal expense for something that the government says is no good, and that bothers me.

It bothers me that the government, the Department of Health, hired a law firm and paid such an exorbitant amount of money for legal services for something that the government claims is of no value to them. Why is the government paying out that amount of money, from much-needed Department of Health dollars that could be used on the front lines, to a law firm that the government has already stated unequivocally, the legal opinion is of no value to them?

MR. CHAIRMAN: Member, are you going to table the documents?

MR. MACKINNON: Yes, absolutely.

MR. MUIR: One of the things that the honourable member did not do in reciting those documents was to list the dates of the particular charges. You might find that quite a number of those were incurred when you and your colleagues were (Interruptions) because these estimates, as you know, do basically split the thing. Anyway, the explanation for that is, the agreement between EHS and EMC was concluded in January 2000 and McInnes Cooper did represent the department in those negotiations. The second thing was the negotiations with the Province of Prince Edward Island about the air ambulance charges.

MR. MACKINNON: Clearly, if the minister were to check those invoices, at no point in time does it cover anything during the tenure of the previous administration. The billings are quite explicit and perhaps the minister would be willing to withdraw those comments once he sees the documents that came from his department.

My concern is the fact that the government, when claiming to have a boundary between Newfoundland and Nova Scotia, has put itself in a rather precarious position by, on one hand stating that it doesn't have jurisdiction over Sable, and the minister now saying that it does and is going to provide that emergency service. (Interruptions) And you have. The minister is saying yes. Okay, so I would suggest that perhaps the honourable minister may want to re-examine some of the activities within his department in terms of value for dollar.

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The next issue that I would like to draw to the minister's attention is with regard to - if I can find it here, because I know the minister would be quite excited about it - a particular memo that was issued by the provincial Department of Community Services with regard to the coverage of certain medications and drugs. I understand that - and I stand to be corrected on the generics, the language - here we go, a directive issued April 3, 2001, and it is to all social assistance caseworkers community supports for adult care co-ordinators and it is from Mary Lou Griswold, Director of Income Assistance, and it is re payments to pharmacies. I am not sure if the minister is familiar with this memo? No? He is not familiar with this one either, so I will table it and I will provide a copy.

Essentially, what is happening is that certain medications and medical supplies are no longer covered by the drug card for social assistance recipients and those who have the medical card. For example, Celebrex, diabetic supplies, certain supplies that would be required for high blood pressure and so on, they are not covered by the card; the Department of Community Services, as I understand it, is no longer going to be covering those medications. Is the minister aware of this particular directive? And I will table it; hopefully I will get a copy back. We will table it and get a copy for the minister and a copy for myself. Is the minister aware of this directive from the Department of Community Services and what implications it will or will not have on his budget?

MR. MUIR: I respectfully suggest that the honourable member for Cape Breton West may better address a question about the origin of that memo to the Minister of Community Services, as Ms. Griswold is an employee of that department. I would hope that it would not have much of an effect on our department. I think what the member is alluding to - and he may wish to get into it at a later time when the other department is called - is what would be the result if some of these drugs that are currently covered are not, and that is speculative.

MR. MACKINNON: So what the minister is telling the committee is because he is not familiar with the memo and the implications of the document and the fact that it originated with the Department of Community Services - despite the fact that it has an implication on health care costs - is not a matter that he is dealing with in his budget at this juncture that he is aware. It seems to be segregated from the Department of Community Services, is that essentially what the minister is saying?

MR. MUIR: In the Department of Health there are a number of individuals who have particular requirements, some of a minor nature, some of a very major nature, that are not covered under programs administered through the Department of Health nor through the Department of Community Services. While I have a great deal of personal empathy for anybody who finds themselves in that situation, we cannot quite frankly be all things to all people. Clearly, if that decision was made, those who had the information that would enable them to make the decision felt that it would not have a tremendously negative impact on the individuals to whom it might apply.

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[5:30 p.m.]

Mr. Chairman, I would certainly have to take issue with the minister on that particular point, because anyone who would require arthritis drugs or any of the diabetic supplies or anything to do with high blood pressure, anything to do with the control and function of the heart, I would think that would be a very important medical consideration and one that the minister should be concerned with. To dismiss it as if it were just a bureaucratic decision that was based on certain clinical and analytical and financial data would be highly inappropriate, because we are dealing with the lives and the well-being of our citizens. I would ask the minister, perhaps in passing if he would reconsider and revisit this particular issue with the Minister of Community Services, because to put thousands of Nova Scotians out in the cold with the stroke of a pen is not very humane for starters, and I don't think that is what Nova Scotia is all about.

That having been said, I noticed the minister does have the memo now, does he wish to comment on it, or I could just move on to another topic? I realize my time is getting a little short.

MR. CHAIRMAN: Two minutes.

MR. MACKINNON: Two minutes. I guess I will fast-forward to the issue of the negotiations with the nurses here in Nova Scotia. Would the minister be kind enough to apprise the committee as to what the status of that is? Is there some type of a time frame, or is he going to allow it to play out to the point where he anticipates it will either go to mediation, arbitration or, in fact, binding arbitration? Are senior officials in his department taking hands off and letting his lead negotiator do all the work on this?

MR. MUIR: Mr. Chairman, I would just like to return, and at a later time perhaps we could put the question about the negotiations. I have read those two memos to which the honourable member referred. As I read them, it simply indicates that only drugs that are on the formulary are going to be covered. The memo simply says to people that pharmacies can't bill the Department of Health, they go through the Pharmacare Program, and if there are services and other things the pharmacies are delivering that are not on the approved list of Pharmacare, then the department is not going to pay for them.

I would interpret that - and I see my colleague nodding - as the pharmaceuticals, the drugs will continue to be paid for; it is not cutting them off, it is simply saying that if they are not on the approved list then you are not billing the Department of Health for them, you will have to make due some other way. In other words, it is going through the Pharmacare Program.

Mr. Chairman, in regard to . . .

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MR. CHAIRMAN: Order, please. I would like to thank the minister and also thank the member for Cape Breton West for the questions. I would now like to turn to the NDP caucus. The time is 5:34 p.m., they have one hour in turn.

The honourable member for Dartmouth North.

MR. JERRY PYE: Mr. Chairman, first I would like to set aside some formalities. I am wondering, would the Minister of Health introduce the people who are present with him today?

MR. MUIR: Mr. Chairman, my colleagues in the Department of Health, Mrs. Cheryl Doiron, Associate Deputy Minister; Byron Rafuse, Chief Financial Officer; and the gentleman who has just begun to ask the questions is Jerry Pye, MLA for Dartmouth North.

MR. PYE: Mr. Chairman, the reason why I asked the question is because I know the minister hired, last year, a high-priced deputy minister, somewhere around $180,000, and I haven't seen him during the budget estimates. I am just wondering where that high-priced deputy minister might be today? This is no reflection on the competency of the individuals who are present with you.

MR. MUIR: I am pleased, I have, indeed, two very able people accompanying me, and you will get your questions answered. (Applause) I am pleased to see that the honourable member simply wants to know the whereabouts of the deputy minister. I can tell you that the deputy minister, this afternoon at 4:00 p.m., as I was, was scheduled to meet with members of the Acadian community. Unfortunately, you people called estimates and I chose to be with you rather than that. Secondly, the deputy who was scheduled at that meeting, there is an emergency meeting of the JAG committee. He is representing the department's interests at JAG, and that is where he is or was going at 4:00 p.m.

MR. PYE: Mr. Chairman, some of my questions, when I originally start here today, will be centred around transition homes. Transition homes are primarily for individuals who have addictions, particularly individuals who have alcoholism, drug addictions, and gambling addictions. As the minister is very much aware, some of the funding for the transition homes, particularly with respect to per diem rates, comes from the Department of Community Services, and because those funding rates are inadequate the Department of Health then provides an allocation of funding to offset some of the costs of those transition homes.

Much of that money that goes through to the transition homes follows this path. It follows the path going from the Department of Health into what is now called the capital health region, particularly in Halifax, or it is called the regional authorities . . .

AN HON. MEMBER: Capital health authorities.

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MR. PYE: Right, and then it is channelled down through to what is called the Nova Scotia Drug Dependency. Now, I don't know if this exists throughout all of Nova Scotia, but I would say that the same pattern exists. What happens over the period of time is that the allocated funding that has been requested by a number of the transition homes ends up not being the amount of funding they had requested. Often this causes particular consternation among individuals trying to get the allocated dollars they have seen.

Many times, this takes a consuming period of time, particularly among the board of directors and also the executive directors of transition homes. What happens is on many occasions the problem even evolves so far as to talk with the minister's office, and to consult with the minister in providing that additional funding, or trying to track that additional funding they had originally requested as part of the overall funding package.

My question to the minister is, if we recognize that alcoholism, drug addiction, and gambling are health-related issues, and in order to solve this problem totally why are we not providing the total funding through the Department of Health to these transition homes and persons with addictions?

MR. MUIR: Mr. Chairman, I appreciate the question from the honourable member for Dartmouth North. I do know that he has a very great personal interest in that, because he and I have discussed this topic and various aspects of it on a number of occasions in the period of time that he and I both had the privilege of serving in this great House. The Department of Health spent about $17 million last year on addiction services, and a portion of these funds was allocated to eight major treatment facilities and to 33 major satellite offices, to provide services to people who have addictions, and their families.

The question that the member for Dartmouth North has, he has raised a real concern. One of the things that has happened is that there was a very loose structure in the province for addiction services, and I don't say that to be critical of those who were working in it. I think this is what the honourable member is saying, that the stability of funding was not there and people would go partway through the year and suddenly found they had empty pockets and they would wind up in the office of the Minister of Health or the Deputy Minister of Health. Indeed, that did happen and we were able to resolve an issue last year and it was drawn to my attention by my good friend, the member for Dartmouth South, and you also made me aware of it as well and we were able to do that.

But we don't think that is the way that ought to go. We think that these facilities that are providing a recognized and a good service should have some long-term stability. This business of basically setting up services and then hoping to heck that someone can provide ongoing funds, what we as a department have done is that we think that long-term stability, if we are devolving the addictions services to the district health authorities, then there is a better chance that a long-term relationship or a continuing and understanding relationship, that they understand what these facilities provide - these transition houses to which the

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member for Dartmouth North referred - we think that is the best way. We are trying to devolve it that way. We think this provides a better opportunity than sort of the one-offs. I guess it really is a one-off; if you look at it, it has been a series of one-offs to do this and we don't think that is appropriate. We are trying to put some stability in the system and I appreciate that the member has raised that.

MR. PYE: I also think it is significantly important to acknowledge the minister's intervention about a year ago; also the member for Dartmouth South. It would be improper of me not to stand in this House and acknowledge their intervention in order to bring forward the funding, but my concern is that it continues down that path. Hopefully, the capital health authority board will be able - and I am glad the minister spoke about a designated amount of money going through to the capital health authority designated for transition homes.

The other portion is with respect to the long-term planning. The minister has quite clearly stated that in fact there is an issue. Often the transition homes are living on a three-month basis; they want a long-term plan. They don't want to have to go out there worrying about where the next dollar is coming from. They want to be able to provide the kind of services and programs that are needed in transition homes. The only way that they can do that is if there is a guarantee for long-term funding, a three-year, long-term funding program.

I believe, if I am not incorrect, the previous Minister of Health and a previous government in 1993 looked at the Department of Community Services and the Department of Health developing a policy that would deal with this very issue as to where responsibility lies with respect to the appropriate funding and where that funding was going to come from. That was the question. So, my question to the minister is, is there a policy? Have you been looking at a policy? And if you haven't been looking at a policy, why not? What assurances can we have that if no policy is developed, or can people who operate transition homes - the executive directors and the board of directors - what kind of assurances can they have from the minister that something will be in place so that they don't have to come cap in hand to the minister each and every year?

MR. MUIR: The Department of Health and the Department of Community Services are holding ongoing discussions about the very issue that the member for Dartmouth North raises. I cannot give him a timetable, unfortunately, as to when those discussions will be concluded. I can tell you that for our purposes it is a priority, and I think for my colleague in Community Services that it would be a priority for him too. We will make every effort to have a timetable and a conclusion as quickly as we can.

MR. PYE: I appreciate the minister's statement with respect to not disclosing a time frame because, obviously, there are ongoing talks. I do know that this creates a problem with transition homes. There is also the problem with respect to the funding that is provided the transition homes as well. When one compares the cost to having persons with addictions based in transition homes as opposed to institutions or jails, we know that we are getting the

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bang for our buck. My question to the minister is, when we look at the cost and we can analyze and evaluate those particular costs and we know which is the best cost to Nova Scotian taxpayers who are footing this cost, how can we be assured - and I shouldn't use the word "we" - how can transition homes be assured that they are going to get the adequate funding?

It might be the same as last year but you, Mr. Minister, and I know that the cost of living has gone up 2.9 per cent. The cost of fuel and heating those transition homes has skyrocketed. There are tremendous ongoing costs that are borne that are not carried out, I don't believe, in your budget, to this day. I believe that what you are now providing - and correct me if I am wrong - is the stable funding, a level of funding that you previously provided as of last year. So, if you can clarify that, I would certainly appreciate it.

MR. MUIR: The addictions budget this year has gone up by about 2 per cent, so we do recognize that number. Notwithstanding 2 per cent, I do understand the position of the transition homes and everybody else in Nova Scotia looking at our limited financial means.

The very reasons that the honourable member points out are the reasons that we are trying to integrate the services that are provided by the two different departments. Secondly, and I guess perhaps the honourable member wasn't in here, the member for Dartmouth East asked about the average daily cost of an addiction centre in the province. We are going to try to provide that information - we don't have it right at our fingertips - when we get that information. I have said all along that one of the things that we are trying to do and we believe is essential to improve our delivery system is a better information system. I think what the honourable member for Dartmouth North is saying is that these services are delivered in perhaps a more cost-effective way than some of the other services that we would be doing elsewhere. Therefore, it makes some degree of sense to provide the balance of funding, to take a look at that information when the funding allocations are being made. I can tell you, obviously in the district health authorities that will help them too.

One of the things it gives me an opportunity, we have used the terms "benchmarks" and "best practices" and this, I think, is what the honourable member for Dartmouth North is really supporting. That it is important to have this information and to have these benchmarks against what, you know, make assessments about what practices are going to be best. Thank you.

MR. PYE: To the minister, once again. I believe that the minister, your department, is charged with the responsibility of dispensing the monies from the gaming authority. If, in fact, the minister's department is responsible for dispensing the monies from the gaming foundation, I want the minister to know that many organizations have told me - and I am sure the minister has been called on this as well - that anyone who makes application to the gaming foundation for funding gets a 62-page application - well it might not be 62, but it is a thick enough page application. You need to be a Philadelphia lawyer in order to determine

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what kind of request you are trying to make to the gaming foundation for application for funding. I will tell the minister as well, that the number of applications that have actually been successful are virtually non-existent. I can tell the minister myself, as a member of this Legislative Assembly, I know of no one who has actually received funding from the gaming foundation.

My question to the minister is, if the minister is responsible for the dispensing of dollars or funding or grants to agencies and/or organizations, how much money is in the gaming foundation's bank account now, and who has received money from the gaming foundation's bank account, and will the minister be making an announcement in the near future, or has the minister decided how this money ought to be spent?

MR. MUIR: There are a number of questions in there, and they are all good questions, too. I guess the whole thing around the gaming foundation has been a bit problematic to me as the Minister of Health, since I have arrived. I can tell you that one of the difficulties with the gaming foundation when you look at the bylaws under which it is operated - and the honourable member and I had this conversation, probably back when I was sitting on that side of the House - was that they used to give money for one-time start-ups. They would make a commitment, and say okay this was allowed from that gaming foundation, we will give you one-time start-up money.

What happened, and we had the case of the one up on Brunswick Street with Mr. Murphy and his company, an outreach program, they got the start-up money, but that foundation was not to provide ongoing funding. It did create some difficulty for some organizations, that type of thing.

What we have done is we have reviewed the operation of the gaming foundation. A large portion of that money was supposed to go for research into gaming, problem gaming, indeed, as a matter of fact that is pretty well what it was. Indeed, I think if you got one of these start-up grants you were supposed to write a proposal that says I want to investigate something about problem gaming or dealing with gaming, and this is how I propose to do it in this centre. Then you were supposed to say, at the end of the year you would write up a report to justify that they were in the research business.

Quite frankly, we have had a lot of discussions about how that money can be best used. We have now, I believe, got the gaming foundation board in place and there will be announcements and decisions coming from that in the near future. The honourable member is quite correct, there has not been money given out from the foundation probably in the last six to eight months, and perhaps a little bit longer than that.

MR. PYE: Mr. Chairman, I will say to the Minister of Health that there are a number of transition homes out there that will be listening to the minister's comment because, as the minister is aware, gambling addiction, simply by virtue of having the VLTs and the casinos

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here in Nova Scotia it has created an increase in the people who are addicted to gambling. It is a trying exercise for transition houses, who receive no funding from the gaming foundation, to continue to provide rehabilitation programs to individuals addicted to gambling. It is almost impossible without any funding from the gaming foundation.

I want to thank the minister for at least having the opportunity to make a reassessment of that. I am pleased to hear that that reassessment will, obviously, turn into rolling some additional dollars back to where they are properly needed. Even if the minister will take it under advisement from me that it ought to be tied to the individual addicted to gambling, if in fact it is tied to the individual addicted to gambling then we can very well say that that is money well spent. Money that is spent in many other jurisdictions, both in Australia and in Europe and the United States, where gambling is taking place, the money is tied to the addicted individual. I don't have to tell the minister that, because the minister is very much aware. That is, in fact, a part of the whole process.

I guess the other concern I have is that I received a number of calls. When I served on Dartmouth City Council, when we first introduced the first transition home for individuals with addiction in Dartmouth North there were many women's organizations who wanted a transition home at that time for women with addictions. I did hear the conversation between the Minister of Health and the member for Dartmouth East. The member for Dartmouth East put it far more succinctly than I could, he simply pointed out quite clearly the differences between the addiction problems that are associated with women and those addiction problems that are associated with men. We all know that with women often there is family involved whereas at times men tend to be separated from that particular crisis section that follows the addiction.

I guess my question to the Minister of Health is, has the Minister of Health considered providing funding for some women's transition homes or centres with respect to addiction problems in Nova Scotia?

MR. MUIR: In my answer to the member for Dartmouth East, we talked about the department's recognition that many of the services which are appropriate for women addicts differ from those that are appropriate for addicts who are men. We have advisory committees at both the district and provincial levels which are going to make recommendations about strategies for addicts who are women and their needs. That is an ongoing process for us. One of the interesting things that was mentioned, and the member for Dartmouth North was in when the member for Dartmouth East mentioned I believe it was Exodus House. I don't know the source of funding, because other than the member for Dartmouth East, I guess none of us in the House had ever heard of it before.

Clearly these transition homes and, as I said, if we are talking about evidence, if that appears to be the best bang for the buck, then the district health authorities, I think, are going to have the information upon which to make decisions, hopefully on a long-term basis.

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MR. PYE: Mr. Chairman, my time is creeping up on me before the moment of interruption, and I am just getting started here with respect to a question that I don't know if I will have sufficient time to bring forward, but I want to talk about small options homes for seniors. The small options home review that was completed by Dr. Kendrick did not include seniors because they had just been transferred to the Department of Health. The minister surely must be aware that many of the problems facing small options homes, systems for persons with mental health difficulties and persons under the age of 65, are the same problems that face small options homes for seniors. Those who are under 65 have the benefit of having their small options homes system thoroughly reviewed. There were recommendations put forward, the government has the opportunity to make real changes to the system, but unfortunately seniors in small options homes will not benefit. My question to the minister is, why did the minister not include seniors' small options homes in their review?

MR. MUIR: Mr. Chairman, as the honourable member for Dartmouth North has pointed out, that particular segment of care came over to the Department of Health less than a year ago. We are continuing to assess the needs in that. What we have done initially is, for those clients for whom we are now responsible, we are going out and visiting the individual homes to see if the care that is given is appropriate and if the needs of the individuals are being met. We will continue this and, again, there is a lot on our plate. It is an important thing, and we aren't quite as far along in our deliberations as we would like to be.

MR. CHAIRMAN: Whereas the committee on Supply has reached the moment of interruption, we shall recess until 6:30 p.m., and subsequently reconvene for 27 minutes.

[5:59 p.m. CWH on Supply recessed.]

[6:30 p.m. CWH on Supply reconvened.]

MR. CHAIRMAN: I would like to call the committee back to order. The time is now 6:30 p.m.

The honourable Leader of the Opposition.

MR. JOHN MACDONELL: Mr. Chairman, I appreciate the opportunity to question the minister and his estimates for the Department of Health. If there is any document that I would really appreciate the minister being able to provide, it is the one that would outline his concern around the fact that in 10 years the entire provincial budget will be going to the Department of Health. This is a similar thing that I believe we heard from the previous government and the previous Minister of Health. I have to say to the minister that I don't believe you. I recognize that costs go up, and we know that there are factors that we can predict. Any person who has any property at all, a home, anything, they expect that the costs

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of maintaining that facility are going to go up, and they can tell you verbatim what they think will be the reasons that those costs will go up over a certain period of time.

Forgive me, Mr. Minister, but I would have to say it is one thing for me to make that statement, not being in government, but for you to be the Minister of Health as long as you have been the Minister of Health and to make that statement - I know we both came to this House at the same time and I know that you probably think I am still as green as grass, but (Interruptions)

I have to tell you that I think that to make a statement like that is fairly irresponsible. I think there are those cost drivers that we can predict, and there probably are a few cost drivers that we can't predict, but I would see those as being a minimal number. I would say that there would be a range, that the minister would try to say look, here is what we can expect costs to go to, and even if we allow a margin of error it is not going to be the extreme that the minister talks about. In other jurisdictions we can see, especially those jurisdictions that have gotten their health care costs under control, that they are able to predict their health care costs in a reasonable fashion, and if we try to relate those costs on a per capita basis then there is some credible evidence to indicate where those costs are going.

I want to say to the minister that there has been a fair bit of research on the health care system in Nova Scotia, and I would expect that in the next while the health care costs in Nova Scotia are going to soar, and I will tell you why I expect they are going to soar. It is because the evidence indicates that those provinces that did the most cutting prior to 1997 are experiencing the greatest health care costs now. What are we doing? We are still cutting. That means that at some point that is going to catch up to us and our costs are going to soar, but I would expect that they are going to level off at some point. I certainly would not expect in 10 years that the Health budget is going to consume the budget of the Province of Nova Scotia.

If the minister has any documents that would indicate, something that he has that would back up that statement, I have to tell you I would really like to see it because I don't believe it for a second. I would like to hear the minister's response to that, please.

MR. MUIR: Mr. Chairman, I can tell the honourable member two ways to work this out. One is the professional way, which is to have the Department of Finance, and I want to go back and say when we were talking about that statement, when we assumed, government, the increase in the cost of health had gone up about 13 and a fraction for quite some number of years, the Department of Finance, what they did was just extrapolate it, saying what we have said, if it continued to escalate at that particular thing over a 10 year period, charting the increase in revenues, then the Health budget would consume that.

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Getting away from the Department of Finance. My calculations, over a 10 year period, if we had about a 13 per cent growth, and if you take 1.13 and raise it to the 10th power, you are coming up to somewhere around 2.65. The Department of Health budget in that particular year was roughly about $1.7 billion. If you multiplied that by 2.65, it came out to about $4.5 billion. Our program spending in this province, I think, is about $3.5 billion, roughly. At that ratio, that is why I make that statement, obviously you have to toss in the $1 billion for debt servicing.

HON RONALD RUSSELL: And a few bucks for highways.

MR. MUIR: To be quite frank, that is why I made that statement, but it has been worked out formerly by the Department of Finance.

MR. MACDONELL: Mr. Chairman, if I have to go see the Minister of Finance to get his numbers for sure, but I wouldn't mind having a copy of your numbers, something that you have scratched down. I would be interested in having that. Certainly, the comments around a little bit for roads by the Minister of Transportation and Public Works, think of Hants East when you are spreading out that little bit.

I will bring something to the minister. I know he can probably give me a yes or no, but he won't be able to give me a timeline. One thing I do want to bring to his attention is a request by Dr. May, who is working in Upper Rawdon right now, he would like to have a meeting with you, and I just wonder if that is possible.

MR. MUIR: If Dr. May wishes to have a meeting, then he should submit a request through the normal channels, and we will make a decision whether it is appropriate for me to meet with him or whether it is appropriate for staff to meet with him. Obviously, we do try to accommodate people.

MR. MACDONELL: The MLA is not a normal channel?

MR. MUIR: No, not in this regard. As you know we have had a number of meetings, and I really would like to know what the meeting is going to be about, an agenda and things like that. That is why I say a formal request, and we will make a decision based on that.

MR. MACDONELL: I can appreciate that, Mr. Minister. I didn't realize you had met with him, I thought (Interruptions) That is what I thought. I will get something more formal, thank you.

That leads me to where the department is in its search for doctors. I am going to speak specifically around doctors for Noel, Kennetcook and Upper Rawdon, since Dr. May is part-time there. I know the department has suggested that instead of the three communities kind of working against one another, there be more of a co-operative effort. I think a co-operative

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board has been formed that oversees the search for doctors for all three of those communities. I am just wondering, has the minister or his staff anything they could offer with regard to where they are in trying to get doctors for Noel, Kennetcook and Upper Rawdon?

MR. MUIR: Mr. Chairman, I realize the seriousness of that question to him, as the MLA representing those communities. In looking for that particular information, I just want to say that last year, on the average, we have recruited a physician a week in Nova Scotia. Having said that, that doesn't make him feel much better if they have lost a couple of physicians out there. What we have done is that area is on our priority list. There have been a number of visits, as the honourable member would know. They have an excellent local committee out there working to try to attract people into that community. I can tell you that in the family practice opportunities, what we have is the incentive family practice opportunities, listed under the debt assistance plan we have Kennetcook, Noel and Rawdon, so they are included in that, and I hope that is of some comfort to you.

MR. MACDONELL: Mr. Minister, could you explain what the debt assistance plan is for me please?

MR. MUIR: Basically, what it is, Mr. Chairman, is that there are a number of communities that have been designated, after due deliberation, as being in extreme need of physicians. Particularly, rural communities for family practitioners. What it means is a person who will locate there, a newly graduated physician, would go out there and practice and it would be $15,000 a year, basically, whatever you want to call it, as a signing bonus or whatever it is, for a three year period, so it is $45,000. This is in addition to the incentive packages that might be available to anybody going into that community.

MR. MACDONELL: So, am I to understand that would be for someone who is graduating from med school, is that who that applies to?

MR. MUIR: . . . intended for new graduates, but for people who are still in debt.

MR. MACDONELL: Mr. Minister, I appreciate that and I certainly commend you for at least trying. I don't know if that program - is that something new or is that something that has been in the department for some time?

MR. MUIR: We announced that about two months ago and it is new, it is a new incentive program, part of our program to recruit and retain physicians in rural Nova Scotia. It is just been recently that we have actually started to put communities on the list.

MR. MACDONELL: So, it is probably a little too soon to know what kind of uptake you have had by way of physicians who would be interested in making use of that program. If you don't have the information at your hand you could let me know that, whether or not

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you have had anybody show any interest in that particular area of the province, in my constituency?

MR. MUIR: We rolled this out, I believe it was the first or second week in February. I know I went to a family practice job fair in Moncton and I had that in my pocket when I went up. So, we have been rolling it out, the information is available in the normal means and we have been putting it out at job fairs and, of course, we do have a class that is graduating probably in about six weeks' time and hopefully it may be of interest to some of them. So, yes, we are making that information available.

MR. MACDONELL: You were right about the community there and the calibre of people who have been working and trying to get doctors in that area. I don't know if all three communities have a Web site, but they do in Noel for the Hants Shore Clinic, and I haven't been in touch to find out - I know they had some interest shown and a couple of things had fallen through. I just wonder, for doctors who may be interested in moving for other reasons, say doctors who don't necessarily have a debt as to getting out of school but doctors who we may want to attract from other jurisdictions, is there anything the department is offering for more senior physicians?

MR. MUIR: I am going to have to get the specifics of that for the honourable member. One of the things I want to tell him is that I had a rather lengthy conversation with one of your constituents from Kennetcook and - I guess it was probably a week ago because I made the phone call from that room, I can't remember her name, but it will come to me - one of the things that she had talked about and it is another one of the initiatives, hopefully, the legislation goes through, she said, I know a little bit about nurse practitioners, if we could get additional support that would also be a real benefit for our community. Once we get this legislation through, there are some other options which may open up.

MR. MACDONELL: I agree. Nurse practitioners are something our caucus supports and have, on more than one occasion, expressed that interest to both governments in the past that this would be an initiative worth following and we would see it as a mechanism whereby communities could get very good care if they are having trouble attracting a doctor. It may be a mechanism that would attract doctors even if they had someone to work with that was a nurse practitioner, it would help to allow them to tend to some of the more serious things that a nurse practitioner may not be qualified to do. It would relieve a lot of the load that the nurse practitioners would be capable of doing. I certainly would encourage the minister to go that way, and I would see it as a possibility. As soon as that legislation can go through the House, that would be a good thing.

A couple of other issues that have come across my desk, one of them is one that actually that minister has sent me a response on, whether you will remember it, but it is around the exchange of oxygen bottles. When the fire departments are first responders, when the ambulance shows up, there used to be a time when the fire department would have the

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oxygen bottle with the patient and the ambulance would just take the patient and the oxygen bottle and just leave a new oxygen bottle with the department. It seems that now they replace them every six weeks, or whatever, and I think in your correspondence you referred to this exchange going on and I think if my memory is right, it was something to the effect that it was done on a basis so the fire department's number of oxygen bottles didn't get detrimentally low. That has been their concern. They worry they will run out. I don't know if I made my case clear when I wrote, but I guess it is the overriding fear that the exchanges may occur at a point after which they have run out of oxygen.

MR. MUIR: I do remember our correspondence and I do remember having it followed up. I guess I have to ask the question, did you get a formal reply? If I remember reading the information and looking at that, the reason seemed reasonable to me when I read the correspondence before I signed it. That is all I can tell you at this present time.

MR. MACDONELL: It was relatively reasonable, I will grant you that. I guess the point I want to make, I don't think it actually addressed the possibility of them running out. I know it is difficult for you to respond to this but I will leave that with you. The present system, as it exists, runs the risk of fire departments running out of oxygen. If we expect them to be first responders, then if the ambulance is coming anyway, it makes perfect sense to me that they would just exchange the bottle rather than send somebody out on a special trip to do that every five weeks or whenever is the appropriate time. I guess that was part of the reason for the question I kind of batted across the floor, why this new model? If you have a reason for that I would love to know it, because it doesn't make sense to me. Then again, that wouldn't be the first thing that the government did that didn't make sense to me.

I want to touch on your tax to try to discourage smoking. I heard you state earlier this evening that the government has spent about $17 million on addiction services. I think, if I have my numbers right, from the comments you made earlier, you are expecting about $20 million in the collection of tax on tobacco. First of all, can you tell me if I am accurate?

MR. MUIR: The answer to that question, obviously, my colleague, the Minister of Finance would have better information than me. Clearly, what I can tell the honourable member is that those who study this problem very carefully would say that the expenditure related to tobacco use in Nova Scotia exceeds the revenue from the taxes by about $100 million. We are in a rather extreme debt position. I am trying to remember what I read in the papers, you said $20 million, I think it was $15 million.

MR. MACDONELL: Mr. Chairman, probably the shortest distance between two points is a straight line, so I will try to go there. My concern is that if this is more of a revenue grab than it is a deterrent, I think evidence would show that for young people who are smokers that an increase in the cost is a deterrent, even up to university age, at some point, since these people generally are students, a lot of them, this would be something that may deter them from smoking. They would say the heck with it, it is getting too expensive.

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But, there is a large percentage of the population who are poor and this does not necessarily work as a deterrent. Actually, all it does, because they are addicted, is cause them to take money away from other places where they should put it.

I guess the point I want to make is, if the money you collect in your tax is money that goes to addiction services to help with easily accessible programs for these people, then I would say that is a good thing. Also, I would like to ask, are you considering taking the tax off those aids that are promoted to help stopping smoking, like Nicorette or whatever? Is that something that the government has considered, if you are thinking of stopping smoking?

MR. MUIR: Mr. Chairman, we are in the process of basically putting the final stages to a comprehensive tobacco strategy. Just turning to the specific question that he raised about money and, again, I am not trying to hedge on this, the Minister of Finance is the person to whom that would have to be addressed. You asked about the tax on tobacco withdrawal aids, my guess is, and one shouldn't speculate, that is mandated or dictated or classified under legislation which has the goods and services tax, the GST. Whether that can be excepted, I don't know.

MR. MACDONELL: Mr. Chairman, I guess what I will assume is that it is not something you thought about and you haven't investigated or pursued it to find out if there is something that can be done in that regard.

MR. MUIR: Mr. Chairman, there are a number of things we have thought about as to strategy. To be quite frank, I haven't personally thought about dropping the tax, but that doesn't mean that my staff has not discussed it. Indeed, it may have been discussed by my staff because there are some people whose prime responsibility is in that area. There are some other parts to the strategy which would help people who wish to withdraw and, hopefully, we will be able to roll them out before too long.

MR. CHAIRMAN: The Leader of the Opposition, you have one minute.

MR. MACDONELL: Mr. Chairman, it is moving along here more quickly than I thought or I am more long-winded than I thought. Heaven forbid. I guess what I would like to say to the minister is I appreciate what he has said. If he does roll out a strategy at some point, I would be interested in seeing that, to know what that is about. I am sure our critic would, as well. I will get to some of these other questions perhaps at another point. I will thank the minister and his staff for their help, I appreciate it.

MR. CHAIRMAN: I would like to thank the Leader of the Opposition, and I would like to say that today's time for the consideration of the estimates has expired.

The honourable Government House Leader.

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

[6:57 p.m. The committee adjourned.]