MR. CHAIRMAN: The honourable Government House Leader.
HON. RONALD RUSSELL: Mr. Chairman, would you please call the Estimates of the Minister of Health.
MR. CHAIRMAN: Thank you. I would like to call the Estimates for the Department of Health. We were talking last evening in the Liberal caucus, and the time remaining I believe is 39 minutes - I will check that as we go on.
The honourable member for Cape Breton Nova.
MR. PAUL MACEWAN: Thank you, Mr. Chairman, and welcome to the Chair and welcome to this happy afternoon session of the committee. Yesterday I asked the question and the minister gave a rather extensive answer. I don't know if I should make the mistake of asking him another question, but my sense of discretion is such that in anticipation that perhaps I may take a rather lengthy time framing the preamble to my next question, which may last the whole 45 minutes, I don't know. I can speak at least as long as he can, within the time parameters of the committee of course.
Yesterday I was talking on two subjects - the first was ambulance services and the adventures of John Chaisson and his son Braydon - and I have the file on that here this afternoon, a rather small file - secondly, I was talking on the minister's plans to introduce the urgent-care-centre concept at the New Waterford Consolidated Hospital and I have my file on that subject here, which is a rather extensive one, although it's not as big as my Devco or Sysco files, but it is my largest file certainly on anything else. If I get through these two matters in time to pose him a question just when my time runs out, he can take the next Party's time if he wishes answering it, even as I allowed him to answer some of the questions from the NDP when he began last night.
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As far as the Chaissons go, I did get a letter from the Minister of Health that came to my attention since I last spoke on this matter and it reads - I'm going to table all this stuff anyway, Mr. Chairman, so I trust I can read the letter. It's to me and it says: "This is in response to your March 7, 2002 letter regarding an ambulance bill for Mr. John Chaisson." - It was actually for Mr. Braydon Chaisson, John happens to be the father who has to pay the bill - "The Ambulance User Fee Appeals Committee had an opportunity to review your correspondence at their March 22, 2002 meeting. They have requested a medical opinion from the Provincial Medical Director. Once the Appeals Committee receives this information, a letter will be forwarded to your (sic) with their decision."
I guess that's where the matter stands at this point in time - I haven't received anything more on the matter but, as I stated, Braydon Chaisson was taken to the nearby hospital by ambulance. He did not call the ambulance; he did not want to get into the ambulance; he did not feel good. He was injured, his father was driving out to the accident site to pick him up and take him home, and when the father got there the ambulance had just whisked off, son aboard, lights flashing and sirens screaming. For that little drive up to the hospital, which you could walk on foot in probably 20 minutes I would think - the ambulance might have taken two or three to get up there - the father receives a bill for $500. Such are the stimulating new times in which we live and we in the Opposition intend to try to do something about that. I am going to table this file of correspondence here, for any who wish to read it, about the adventures of John and Braydon Chaisson.
That's the first part of my question. The second part relates to the New Waterford Consolidated Hospital. Mr. Chairman, I've been a member of this House for quite a few years now; I probably shouldn't tell you how many, but it's more than 30.
AN HON. MEMBER: How many?
MR. MACEWAN: I think it's 31 and some. I can't count quite that high so I will say it's 30 and a bit. During that time, for some reason or other, the New Waterford Consolidate Hospital has been the focus of attention and of difficulty over those years. I don't know why - it's a good hospital. It's new; it was built in the 1960s as I recall it. It has the look of a new building compared to many of the hospitals and schools that you see. It was built to replace an older hospital which is now long since gone. A wooden building, a former school I believe it may have been at one time - the old hospital - but anyway it was a wood-constructed building and it was torn down. So the new hospital was built in the 1960s. It was a community hospital, it was built by subscriptions from payroll deductions and bequests and contributions and that type of community support, as well as I am sure government support from the town, and the County of Cape Breton, the two municipalities that were involved, as well as the Province of Nova Scotia.
It is a relatively small hospital, it's not as tiny as perhaps Buchanan Memorial Hospital in Victoria County, but it's certainly not on the scale of the QE II or even the Cape Breton Regional. It has three stories to it and I'm not sure of the exact number of beds in it, but I think it would be less than 100. We have seven or eight doctors that practise from that hospital - one recently arrived there is Dr. Atiyah, who is the first plastic surgeon to practise in Cape Breton Island, and his clinic was set up in that hospital because space was available there for him.
I recall asking the fire marshal to give me an appraisal of that building during the time that it was under attack from a previous Conservative Government that wanted to close it. I asked the fire marshal to give me the straight goods on what kind of condition that building was in from a fire prevention point of view. The answer I got from the fire marshal was that the building was A-1. There were a few structural repairs that were recommended, it wasn't perfect - there's nothing perfect I suppose - but it was in pretty good shape. It was certainly in better shape than the other hospitals in Cape Breton at that time, which would have been the old City of Sydney hospital, St. Rita's Hospital and other such buildings. This was a new building, it was in better shape and it was being well utilized.
There's been a problem with the loss of certain departments over the years. I know my good NDP friend, my neighbour for Cape Breton Centre blames the Liberals for closing the obstetrics and paediatrics units at the New Waterford Consolidated Hospital, but I checked it out and I found that one of those two was closed under the Tories of Donald Cameron and the other one, it was closed during the Savage period, the early years - 1994 to be exact. The reason why was that there apparently weren't any babies being born at that hospital, the mothers were all going into Sydney to have their babies. I guess the facilities were better or something and it was closed. There wasn't any controversy at that time, I don't recall any public rallies of protest or parades down the main street. It happened and people have been going into Sydney to have their babies anyway and it continues.
The hospital was not threatened with closure to my knowledge during the Liberal years from 1993 to 1999, but I will say this, that when the Liberal Government came to power in 1993, they discovered - the Minister of Health, the Honourable Dr. Ron Stewart - a document in the files of the department scheduled for implementation and it was this document here, "Proposal To Reform Health Care Facilities in Nova Scotia." It's not signed, not even dated. You have to date it I guess like they tried to date the date of the writing of the Gospel of Saint Mark from a historical perspective to see what events were contemporary at that time and see if it fit in at about 50 A.D., or 52 A.D., or somewhere around about that time.
Now, this one here, you can tell is a Tory document because of the date on it referred to consistently as 1993-94 for the implementation of these plans. So they must have been hatched in 1992, but when we came to power in 1993 we knew nothing about that document because it had never been announced. It had never been made public. Nobody knew anything
about it except the savants and bureaucrats in the Department of Health, that was all. The Minister of Health came to Russell MacNeil and myself one day, sort of trembling and saying, I think I've found something you guys should be aware of, and then he showed it to us. He says what should I do? We said don't do anything, leave it, don't do anything with it at all. Because it was a plan not just for closing the New Waterford Hospital, it was the most drastic health care purge that has been ever planned or contemplated in the history of Nova Scotia. They were going to close hospitals all over the province, not just New Waterford. (Interruption) Yes, they were going to close the New Waterford Hospital. The proposal, Page 6, under the heading of Proposed Changes states under heading a, "Close New Waterford - Transfer O.R. . . .", that's operating room, " . . . Funding to Cape Breton Regional or Northside," saving $6,900,000.
Then they go on at Page 10 to say, "Regional Utilization Plan, Service Reductions, Close New Waterford," saving $6,900,000. Then again at Page 18, I believe it is, they state once more, no, I'm wrong, it's not Page 18. What's wrong with my memory? It's starting to get into that middle age memory lapse phase. Oh, Page 17, my memory was wrong by one number, "Summary of Reductions" is the heading.
HON. JAMES MUIR: . . . if you're only out by one number you're far ahead of the rest of your colleagues.
MR. MACEWAN: Well, no comment to that. I would like to be as far ahead as I could be, I will say that. "Principles . . . Full closure of - New Waterford." Then finally at Page 20, I know that one by memory, Mr. Minister, ". . . Reduction by Region/Facility, . . . Cape Breton ? Close New Waterford," loss of full-time employment positions, 197.1, 0.1 of a full-time position would be lost, 197.1 jobs to be lost by doing that.
Now, in a broader contest what this Tory plan of 1992 called for was, let's take Appendix Six and read through that, "Cobequid ? Close North Cumberland ? Convert All Saints" at Springhill "to Detox . . .Cape Breton Close New Waterford ? Sacred Heart ? Inverness ? Close 2 Units Glace Bay ? Close 1 Unit Cape Breton Regional ? Close 1 Unit Northside Harbourview ? Victoria County . . ." I guess that's Buchanan Memorial, hospitals like that. The southwestern region, "Close Digby Surgery ? Close Roseway Surgery ? Close Fishermen's Surgery"
Valley - the Valley members want to pay attention to this to see what the last Tory Government planned to do to the Valley, Close Eastern Kings Memorial ? Close Western Kings Memorial . . . Close 1 Unit Hants Community ? Close Annapolis General." Northumberland, Close Sutherland Harris ? Close (Inpatient Unit) Guysborough ? Close (Inpatient Unit) St. Mary's ? Close unit St. Martha's." That's the end of the Northumberland area. The Halifax area: Close Twin Oaks ? close unit C.H.M.C. ? Close unit of the Victoria General ? Close unit of the I.W.K.
Now, combined with all those closures they were also going to close the dietary and laundry units at all the hospitals and privatize that by contracting it out. Totalling all of these things, the loss of 1,032.1 full-time employment positions of which about a third, 336.5, were to be in Cape Breton; one-third of the whole call for the whole province. In New Waterford, as I've already mentioned, 197.1 jobs to be lost, 200 in round figures, one-fifth approximately of the entire total. So that was the Tory plan for health for Nova Scotia in 1992. Since I've quoted from it extensively I think I will table this copy. I have many more in my library. Honourable members who want an extra copy can get one either from me or from the Clerk, as the case may be.
So when our government came to power in 1993, Mr. Chairman, that's what we were faced with, a government that had adopted that plan and was going to implement had Donnie Cameron and company been re-elected in 1993, but instead they weren't. We came to office not knowing about it, never having been briefed about it, never having been shown a copy of it, but the Minister of Health, when he occupied his office, found that on his desk. So it was stopped.
Now, the full story of how it was stopped was never really made public because the news media didn't know about it in the first place and so it wasn't considered to be a news story. It just happened. I can't tell you that I have a selection of clippings saying, Liberals save hospitals across Nova Scotia, on the front page of The Chronicle-Herald where it should have been, but it wasn't, because The Chronicle-Herald didn't know anything about that plan, nor did any of the other news media. Anyway, we stopped that from happening.
During the time we were in office there were strains and there were stresses and there were financial problems and I know all about it, but I can tell you that when the day was done and when our government was finally pulled out of office by the unholy alliance of the NDP and the Tories, when that finally happened, the hospitals that we fought to save were open; they were functioning.
AN HON. MEMBER: Remember it was the people of Nova Scotia who threw you out, Paul, remember that.
MR. MACEWAN: The people of Nova Scotia never threw us out. It was the Tories and the NDP that did it right here in this room, a vote right here in this Chamber. That's how we got thrown out. (Interruptions) He's trying to rewrite history once again.
MR. JOHN HOLM: Mr. Chairman, on a point of order. For clarification of reality, I'm just wondering if you could decide for us, when the former Opposition Parties, the Official Opposition, the NDP and the Conservatives defeated the government that was in this House, does that not mean that we defeated the government but they were still technically the government until the people of Nova Scotia, at the next election, threw them out?
MR. CHAIRMAN: Thank you member. That's a question directed to the Chair and it's not the Chair's responsibility to answer questions in this session, but I will direct that question to the good member for Cape Breton Nova. I'm sure he will have a very interesting response.
MR. MACEWAN: Mr. Chairman, I would say this in response to that, that the honourable member and I both probably are past the halfway point in our careers in this House. I think we could safely say that. (Interruption) All right, speak for myself, I will say I'm past the halfway point, I believe that, I think he is too. Now, there will come a point, if God spares us, that we can retire. I wouldn't say be defeated, but I would say retire, and when he retires and when I retire we can go to our computers and we can each write our versions of the history that happened during our careers in this House.
I'm sure that in some details, not too many, his version of the history may be slightly different from mine. I recognize that. That's why there will be two different books and not one, but in any event he can explain it his way, I will explain it my way. I remember a certain day that I was here, it was in 1999, a very hot summer day when we should have been home but instead we were up here listening to more and more filibustering from the NDP, but finally it came to a vote and the government was defeated on a budget that wanted to put $600 million into health care. That was the issue on which our government was defeated, and they were so much against it, they were so much against doing that for our health care system that they brought our government down and pulled it out of office because they did not want to see $600 million spent on health care and that's how our government came to an end.
Now, that's my version of the history. I know that his version is different. I think he will probably tell you about how the Tories said that if they ever got in they would sing The Internationale and wave the red flag and all would be well, but it wasn't quite like that.
MR. CHAIRMAN: Order, please. I would like to recognize the member for Sackville-Cobequid on a point of order, or a question, or a clarification?
MR. JOHN HOLM: Or both, or all, Mr. Chairman, I just want to, first of all, clarify that I have no intentions of writing a book, but that having been said, I seem to recall that the dispute at the time when the former Liberal Government was defeated, the issue was not just the money going into health care, but it was a fact that it was called off-book booking and that the monies that were being spent and borrowed weren't going to be as accounted for as part of the so-called deficit that they were projecting. It was off-book booking, and I think that accountability was a big part of the issue, not just the monies for health care.
MR. CHAIRMAN: The debate is rather bizarre today. It seems to be going between the NDP and the Liberals rather than the Progressive Conservative side, but we're going to tolerate that because we're here to inform Nova Scotians not only of the now, but of the past and the future.
MR. MACEWAN: That's an excellent question. Let me give an equally excellent answer. When I'm writing my book on those days, I will be accounting more than off-book booking, or whatever it was - off-track betting I thought he was talking about. What I would concentrate on is the Epstein factor, where Mr. Epstein said, I am going to vote against this budget - this is before it had ever been released or published - no matter what it contains. You know, the budget could have provided jobs for all. He was still going to vote against it. The budget could have provided for the complete abolition of taxes. He was still going to vote against it. Whatever the budget contained, he was against, and that's why the government fell.
I think that's part of the picture, too, Mr. Chairman, but let me return to the estimates on the Department of Health here in 2002. When I was telling you about that history, it was simply because of the crisis we stand at today where this government, for some reason, has gotten it into its head that what we need to fix our health care system is not $600 million, like Russell MacLellan wanted to obtain, but rather the conversion of the New Waterford hospital into an urgent care centre. Now, what is an urgent care centre? Well, I asked the minister that question and he gave me a very good answer. It had much more meat and substance to it than the question we just heard from my honourable friend opposite.
AN HON. MEMBER: Listen, can you excuse me for a moment? I have to leave.
MR. MACEWAN: Yes, I can. There's the door; all right, be gone. Va-tén. Where was I? Oh, yes, I was talking about the urgent care centre and asking the minister what that is. Well, he said, it's a place that can operate maybe 16 hours a day, or perhaps 12 or eight hours a day, or maybe it can be moved somewhere else altogether if that approach doesn't generate much business. That's what he told me an urgent care centre was. It's in Hansard, and I can circulate that Hansard to my friends and neighbours so they get the picture of what we're fighting against here.
If that is the plan for the New Waterford hospital, all I can say is God help us. I believe in that hospital. I want to see it continue there as a hospital, not as an old folks' home, a home for the convalescent or some sort of a glorified senior citizens' residence. I want to see it as a hospital. It has an operating room in it. It has doctors. It has Dr. Atiyah's plastic surgery clinic. It's a useful facility right now, playing a major role, I think, for its size, in our health care delivery system.
We heard in the House here the other day from the member for New Waterford about someone who had a heart attack and was taken up to the New Waterford hospital for urgent care. No, I won't say urgent care - emergency care. Emergency care is what they give there now and it saved his life. I know the gentleman he's talking about because that gentleman, a couple of elections back, ran against me on the Tory ticket, so I know who he is. But I'm very glad that that hospital was there to save him and was not shut down, as Donnie Cameron wanted to do, so it wouldn't have been there to save him, because if it hadn't been there, he
wouldn't be with us today, I don't believe, from what he has said himself. So we want to see that hospital protected and kept as a hospital.
There are four health care delivery sites right now in industrial Cape Breton. There's the Cape Breton Regional Hospital in Sydney, the Glace Bay hospital, the New Waterford Consolidated Hospital in New Waterford, and the Northside General Hospital on the Northside. There are concerns right now at three of those four that their future is threatened. There are concerns on the Northside. John Malcom, spelled M-a-l-c-o-m, no second 'l' in it, is the Chief Executive Officer of the Cape Breton Regional Health Care District. (Interruption) District Health Authority all right, he got me that time. I didn't have the term quite right.
But Mr. Malcom is featured in today's Cape Breton Post - I have the electronic issue of it here - to the effect that the Northside General Hospital is here for the long haul, claims Mr. Malcom today, but why did he have to make that assurance today? Because there was widespread doubt in the community that it had any future. The second time in less than a week that Chief Executive Officer John Malcom of the Cape Breton District Health Authority met with Northside residents to reaffirm the long-term viability of the Northside General Hospital - that was Cecil Clarke's pep rally of 25 held in the Northside last night, and why was the pep rally of 25 held? Because the people are concerned and wanted to hear from somebody like Cecil Clarke or John Malcom that the hospital is not going to be shut down in spite of all the obvious signs that there's a problem there.
Some of these problems include the closure of the obstetrical unit, the switchboard, and I could go on and on. Mr. Brian Boudreau knows it better than I do, but I'm following it from a distance from my side of the harbour and I know that all is not well over there despite the fulminations of the honourable member for Cape Breton North, who would tell you that from the day he was elected, and not before, suddenly all turned well. It reminds me of John Buchanan's motto - don't worry, be happy; all is well as long as I'm here to lead you and guide you.
Well, the reports I get from the Northside don't indicate quite to that effect, Mr. Chairman. There are concerns in the Northside about their hospital. There are concerns in Glace Bay about their hospital. The emergency department in Glace Bay shut down, I think, for 24 hours yesterday. Wasn't it yesterday? (Interruption) You don't know. Well, it was shut down for 24 hours. I think it was yesterday; it was very recently, and there are going to be further such shutdowns at Glace Bay of the emergency services because there's a failure of the system to work properly, I guess. I don't know what else you could say. If our schools had to be shut down for 24 hours here and 24 hours there and it wasn't on account of an in-service or one of these snowstorms that seem to develop at this time of year and all the schools have to be shut down, but just for no reason except that they couldn't find any teachers to teach that day, I think we would have troubles in our education system. Well, the same thing, I suggest, by logic applies to our health care system.
We see the same concerns on the Northside and in Glace Bay as we see in New Waterford. The three peripheral hospitals are not getting equal treatment to the central hospital, the Cape Breton Regional Hospital. The doctors who perform emergency services are being paid a higher pay to work at the Cape Breton Regional Hospital than to work at the New Waterford Consolidated Hospital, where they get a much lower rate of pay. I know we're told, well, the doctors agreed to that. Well, sometimes you have to agree to things that you don't like just to maintain what you've got. I know about that, but it's not right that within a four-centre or four-hospital health care delivery system there should be different wages to work here as compared to there when the two are only 10 miles apart. How are we going to get new doctors to locate in New Waterford if they can't get the same pay there as they would get working at the hospital in Sydney?
AN HON. MEMBER: Teachers get paid the same.
MR. MACEWAN: Teachers get paid the same. There's a voice of experience of many years. I only stayed in it for seven years myself, but even there I knew that the teachers were supposed to get paid the same, although, unfortunately, they got more money to work in Sydney than they got if they were out in the county, past the city limits.
AN HON. MEMBER: That was back in those days.
MR. MACEWAN: That was back in those days under the good Stanfield Government, yes. (Interruptions) Well, I was, but anyway we won't get back into the years of R.L. Stanfield.
[3:00 p.m.]
Let me say in a general sense, Mr. Chairman, that there are concerns in the New Waterford area today about the report of this Dr. Murray. Dr. Murray is the consultant who was retained by the district health authority to make a recommendation for their consideration. Dr. Murray is reported to have gone to the New Waterford Consolidated Hospital, remained out there for every bit of 10 minutes and then retreated back to Sydney.
AN HON. MEMBER: He wants me to ask you a question.
MR. MACEWAN: He wants you to ask me a question?
AN HON. MEMBER: He's got a question for you.
MR. CHAIRMAN: Order, please. Honourable member, you have the floor. I don't know what the good member is speaking of, but continue your debate. I am waiting for the question for the Department of Health.
MR. MACEWAN: How much time do I have left?
MR. CHAIRMAN: Eleven minutes.
MR. MACEWAN: I don't want to deny the minister an opportunity to respond, so let me wrap it up and give him about 10 minutes to give a reply to these matters, if he wishes to. I think I have outlined the concerns. Dr. Murray did not make an extensive study of the New Waterford Consolidated Hospital. He went there one time only, I am told, and stayed there for 10 minutes. He avoided opportunities to meet with staff and concerned citizens, and he used the pretext that it was a very snowy day and cold and that he had to get back to Sydney. Now, I could be wrong on that, but I don't think it was warm or hot, because it was that time of year - winter. So it was probably cold. I will defer to that.
The point is that he went to his computer and drafted his report, 59 pages long, without having gone back to New Waterford to do a full-scale inventory of just what was going on out there, at least insofar as the information that I have is concerned. If I'm wrong, I'm sure the minister will want to correct me, because if he has a log book or something to show that Dr. Murray went from stem to stern through the New Waterford hospital and examined every facility and every significant component, I would like to know that. The people in New Waterford right now think that that did not happen before Dr. Murray went to print with his recommendations. Now I think that question is probably long enough for my opening question. We can return with supplementaries next time around.
MR. CHAIRMAN: Thank you. That ends your time, and now I am going to recognize the member for Halifax Needham.
MR. MACEWAN: The minister has not responded.
MR. CHAIRMAN: Oh, I'm sorry. I apologize, honourable member.
MR. MACEWAN: That was a question.
MR. CHAIRMAN: It was a question? I didn't really recognize the question in that, but I will recognize the member and also the Minister of Health. It was back and forth.
HON. JAMES MUIR: Mr. Chairman, I thank the honourable member for Cape Breton Nova for that very comprehensive history lesson. I will take a look at the document he tabled. I've checked with my staff. Certainly we didn't know that it was in existence. I think he indicated that the previous Health Minister - or at least two or three of them ago, whatever, they had a bunch of them there - took it out of the files. I notice that what the honourable member referred to was the rationalization of some of the health care facilities in the province. There is no question. The Liberal Government did make some modifications.
I would suggest that if you were to go back and look at Hansard, at what the honourable member said, you would find that that Liberal Government did, basically, remove a lot of beds. I am not saying that was necessarily a bad thing, Mr. Chairman, but they did. Just for what it is worth, I happened to be down in the Annapolis Valley a little while ago and I visited the health clinic in Wolfville, and a very interesting place it is, too. One of the comments that I heard from people who know that clinic very well is that - I don't like to support what the Liberal Government did because they didn't do much that was good for anybody, but the reference to the decision that was made about the Eastern Kings Memorial Community Health Centre, or the former hospital in Wolfville, was that it was an appropriate decision. The facility as it is now, a community health centre, is really serving the community and meeting community needs to a far greater extent than it had before.
Although I do understand that we subsequently learned from one of the physicians down there that it had been a bit of an ambulatory care centre; somebody categorized it as a nursing home called a hospital simply because the people who were in there were not necessarily people who, given an appropriate facility, would have been in a hospital. So I will take a look at the document, Mr. Chairman, and read it. Like I say, we didn't know it existed, so I do thank the honourable member for bringing it to our attention.
He talked specifically about my colleague, the honourable member for Cape Breton North, who is indeed an excellent member. It is very interesting and commendable that he called together a community group last evening to talk about health care concerns in his constituency. He had a very informed group. He also brought the CEO of the district health authority and, indeed, the member for Cape Breton The Lakes was there. It is a good thing he went there because, clearly, he does need to be educated about some of his thoughts about health and the delivery system. His knowledge base, to be quite candid, Mr. Chairman, often appears to be a little bit weak.
The honourable member for Cape Breton Nova did talk about the obstetrics program at the Northside General Hospital. The reason the obstetrics program is being suspended there is not a decision of the Department of Health. It was a decision of the Cape Breton District Health Authority, and the fact is that they didn't feel they had a sufficient number of physicians who were willing to continue delivering babies. The drive from the Northside over to the regional hospital is probably about 12 minutes on a good day. It just made all kinds of sense to consolidate that program for this year until they can get a group of doctors together who provide the critical mass necessary to deliver an obstetrical service.
It would also say, I believe, Mr. Chairman, looking at the obstetrical service on the Northside, clearly, if you're going to have a full-scale obstetrical service, you need to be able to do high-risk obstetrics. The high-risk cases were going to Sydney anyway, so the issue of the Northside was something that was agreed to, I think, and recognized as an appropriate decision given the availability of physicians.
Mr. Chairman, he also talked at great length about the report on the emergency service that was commissioned by the Cape Breton District Health Authority. I think this was a very appropriate thing for that authority to do. Apparently, it was done by a gentleman by the name of Dr. Murray, who is an expert in emergency medicine, and I think the honourable member indicated he came from London, Ontario. I stand to be corrected on that. What he was asked to do was to say how we can rationalize or what would be an objective evaluation of the delivery system that we have for emergency medical services in the Cape Breton industrial area, given the fact, as the honourable member pointed out as he began his comments, that you have four hospitals basically within a 10 minute drive of each other. Is that what you said?
MR. MACEWAN: I wouldn't say 10 minutes. To get from New Waterford Hospital, it would be about 15 to 20 . . .
MR. MUIR: Okay, 20. I was out in New Waterford . . .
MR. CHAIRMAN: Order, please. Honourable member, would you direct your questions through the Chair. The honourable minister has the floor.
MR. MUIR: The fact is, that in a geographical area, you have four 24-hour emergency departments. I just want to clarify something for the committee. I am just going to quote from Hansard. The honourable member asked me the other day what the difference was between emergency and an urgent centre. I quote, Mr. Chairman, "In reference to the distinction between an emergent and an urgent care centre, I can give a layman's interpretation of that, but the honourable member may wish to consult with an expert in emergency medical care to get a more precise definition. Emergency, and I will give you the layman's definition, is something that has to be done immediately. Urgent means it is a high priority; there is a need to do it but you can take a bit of time in doing it."
Now I happened to be out later on that night and I met one of the leaders in medical education in this thing and I said, I had been asked this question this morning, I really didn't have time to go out and approach staff about it but I said, how I distinguished it was the difference of time. Emergency implies that it has to be done right away, whereas urgent means it needs to be done but it doesn't have to be done right away. She said yes, that was a very good definition of the distinction between urgent care and emergent care.
Now what I want to point out, Mr. Speaker, and I did in another answer, to the honourable member for Cape Breton Nova's question, or it may have been the member for Cape Breton Centre who asked a question about the same thing, I believe, on that day; we were . . .
MR. CHAIRMAN: Order, Mr. Minister. I am sorry to have you take your - are you okay with that? Thank you. Go ahead, Mr. Minister, finish your . . .
MR. MUIR: I just wanted to clarify - I want to get back my train of thought here, about that thing and I said, one of the unfortunate situations we have in Nova Scotia and in every other province and territory in this country is we have things called emergency rooms but they aren't being used as emergency rooms. They are being used for something else. It may be urgent, it may be elective. If these emergency rooms were really doing emergency service, then about 90 per cent of the things they would see in the course of a shift would not appear to them, would not be presented to them. About 90 per cent of the so-called emergency things that are seen in our hospital emergency rooms are not things that would be triaged as being an emergency. Therefore, the designation of one facility as an urgent care centre, where you have people who do urgent things, versus another centre where they have skilled personnel to do those high things that are immediate, trained staff to deal with what we will call emergencies, Mr. Speaker, that may not be such a bad observation, given the fact that these opportunities, these facilities are relatively close together.
MR. CHAIRMAN: Thank you, Mr. Minister. I would like to thank the member for Cape Breton Nova. I would now like to recognize a member of the NDP caucus.
The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I would like to pick up on this discussion around the use of emergency rooms and emergency departments because I think it is a very important piece of what is required to improve, I guess, upon the medical services available to people in Nova Scotia and, in fact, the health of people. I think we all recognize that part of the problem, in fact a large part of the problem, in terms of people going to emergency departments when they are not well but they are not necessarily requiring emergency care, is the lack of an alternative. The fact that we don't have any longer in Nova Scotia physicians who make home visits, for example; for the most part that is a very rare occurrence. The fact that there are no 24 hour walk-in clinics, there are very few services available to people outside of regular doctors office hours is a very big problem. It seems to me that it is very important for the department to have a plan in place to improve primary care around the province and to spell that out.
[3:15 p.m.]
The minister will know that in my constituency there is the North End Community Health Centre. It is an organization that is near and dear to me, not only because it happens to reside in the constituency I represent, it is also the health centre where my own family physician is and it is a facility I have had a long association with, as a member of the Board of Directors and also as somebody who was employed as the Health Education Coordinator for that community health centre back in the late 1980s.
As wonderful as that community health centre is, it is quite limited in what it can offer that community. For example, it doesn't have any longer office hours on Saturday. There was a time when the service was available on Saturdays on a walk-in, non-appointment kind of basis. Over the past, I would say, the past 10 years the financial situation for that particular organization has been very difficult. The North End Community Health Association, just like the QE II and the IWK have growing demands on the service but have seen their budgets essentially frozen. Staff have gone without pay increases for periods of time, then finally there were some pay increases. The kinds of demands and needs that that particular health centre faces as a community health centre, in a community of very high levels of low income, high levels of immigrant populations into the metropolitan region - quite often people coming to the health clinic who require not just health services but also an interpreter who is able to help people interpret the language and understand the instructions and decisions being made by physicians and other health care providers is really pretty important.
Now, as the minister will know, that is one of the four sites in the province that has been chosen as a site for a nurse practitioner, the primary care pilot project. The nurse practitioner certainly has been a very welcome addition into that community, but nevertheless, I think that these kinds of services could do with greater support so they can actually expand the role they play in the community, can offer services outside Mondays to Fridays, in communities where certainly people are not only sick between 9:00 a.m. and 5:00 p.m. I think that just my own knowledge of, let's say, some of the single, mother-led households with young children in that community tells me that a fair number of those families with sick children present themselves in emergency departments on the weekend. So do mental health consumers, whose normal place of seeing a family physician would be at the North End clinic, their only alternative outside of 9:00 a.m. to 5:00 p.m. hours, or evening hours, is to present themselves at the emergency departments.
I guess my question to the minister, Mr. Chairman, is about where is the department's commitment to expanding the current handful of community-based health care clinics around the province and where is the plan and the commitment to building a network of community health centres around the province that essentially would take the very real pressure off emergency departments and allow services to be provided in the communities at a far reduced cost than the cost of emergency services?
MR. MUIR: Mr. Chairman, the honourable member for Halifax Needham has outlined some very real concerns that are shared by the Department of Health and they are certainly items with which we are making progress.
She mentioned 24 hour walk-in clinics. As far as I know, there aren't any in the province. Now there are some walk-in clinics; I believe there are a couple, I guess they are commercial ventures. A couple of the Superstores have walk-in clinics (Interruption) There
is one in Sackville, and there is one out in the Halifax Shopping Centre, or someplace, is there? (Interruption) Portland Street, is it? Anyway, there are a couple of these things.
I have been approached by a couple of other groups looking for funding to set up a walk-in clinic. The issue with walk-in clinics, and there are strengths and weaknesses to those things. People who have had a good deal of experience with them say some good things about them in terms of access, but there are other elements about them that aren't as good as having your own primary care physician. Obviously that's where we would prefer to go.
There are also groups of doctors - I know here in the metro area, I happened to encounter a couple of them recently - who run seven-day services, including Saturday and Sunday. I know in a couple of cases they did have people without appointments arriving on one of those days. They had a period of time where people could come without appointments and they were basically a walk-in clinic at one time but I think in a couple of cases they found that it was fair enough to work without appointments, but the demand became so great they had to restrict it to people who were in their own practices.
The issues of the series of clinics like the North End clinic - she has spoken quite positively of that North End clinic and we recognize that it does provide a valuable service. I've spoken of that clinic and also the Cobequid Multi-Service clinic in talking about potential models for health care delivery in forums - not only here in Nova Scotia but I've talked about it in other provinces as well. We do appreciate those things and, of course, as the honourable member mentioned, the North End clinic is one of the demonstration sites for our primary care projects.
Last year, the department, in looking at the Cobequid and the North End models, had written a proposal to the federal government, and I say expressed an interest in finding out their interest in what we had done, and was basically what we would like to see, as you say, to take the pressure off the emergency rooms. She's indicated they've become family doctor's offices and that was the point I was making in response to the question from the honourable member for Cape Breton Nova to set up a series of six or seven of these in a sort of circle around Halifax to take the pressure off the emergency rooms. We had looked at one in Spryfield as well as the North End - even going out as far as the corridor out in the East Hants area and then coming back because that's really a very, very strong growth area.
Unfortunately, there were primary health care funds being made available from the federal government, and we didn't really get a very positive response from them on that. We thought it was a very good project which would have not only been good for us here in Nova Scotia but would have been a model and an experiment that a lot of other jurisdictions could have learned from. I will continue to advance that and I hope to get together with the federal Health Minister sometime before too long. We had a meeting scheduled and it had to be cancelled in which I would advance that.
Two other things that we're doing is that we expect to have more nurse practitioners in the field this year working in collaborative practices. I can tell the honourable member that the four sites include Springhill, Caledonia, Lyons Brook as well as the North End clinic. The feedback on those initially has been very positive, however we do have to recognize that not all physicians wish to work in partnership. It has to be a partnership agreement, we don't have stand-alone things.
I can also tell the honourable member one of the things that has happened this year with the co-operation of EMC and with the support of the nurses associations and the medical community is that down on Long Island and Briar Island, in the constituency of the honourable member for Digby, we are using paramedics to provide some limited range of services to the residents on the islands which means they don't have to travel to Digby to get them.
The reason for that was, to be quite frank, we did have highly skilled personnel on the islands and their requirements for transport as an ambulance service, as an emergency transport service, was very, very limited. Fortunately, the calls down there are, quite literally, very few and very far between. So, they did have time and we were able to do that.
This year in our budget the honourable member will see a provision for continuing support to the four demonstration projects that we've had. We continue to learn from that but we have to find alternative health care providers or methods of changing the delivery system that, to be quite frank, by the time we have enough general practitioners or specialists in the province, everybody has their own family practitioner and without waiting five or six or two weeks. I can give you a personal illustration.
I phoned my family doctor in Truro, I think it was about a year ago, I had seen him in December and decided I hadn't seen a doctor for some period of time, I probably should get checked and I think it was about somewhere around November 12th when I called and she said, sure that's no problem at all, maybe it was November 13th and she said come on in the 16th. I said you're going to get me in on the 16th? She says, yes, December 16th. So it was about 34 days. I wasn't sick so that wasn't a problem and I can also say that had I had a reason to go see my family physician, I think I would have been worked into the schedule if I really needed the care. This is an issue right across the province.
I guess what I'm trying to say is that as far as the member for Halifax Needham, her thoughts about the need for an extension of primary care service and that of the Department of Health are very similar; we're actually singing off the same song sheet on this one and I very much appreciate her support for the directions the department is going.
The other thing I'd like to mention is that there is a group getting together from the Atlantic Provinces and we have regular meetings among officials of the Departments of Health in the Atlantic Provinces. We are investigating when we will probably be proceeding
with a 24 hour a day nurse triage telephone system. I'm told that's worked relatively well in some other jurisdictions and it's something that we hope we can proceed with here. A lot of times when people present themselves at emergency rooms, they just don't know the answer and they have no other place to get the answer other than go there and see somebody about it. If they could pick up a phone and call somebody and say, no, you can wait until tomorrow morning or it's a normal thing, then some of the pressures in these rooms would be taken off.
MS. MAUREEN MACDONALD: I want to thank the minister, Mr. Chairman. He certainly has provided lots of food for thought and discussion. I want to come back to the issue of community health centres because I'm aware that the department has been working on terms of reference or a framework document of some kind with respect to community health centres, also given that the funds for community health centres flow through the districts rather than directly from the Department of Health to centres.
I want to talk a bit about the tensions, I guess, the tensions of being funded in that way. I think everybody recognizes the usefulness of decentralizing health care provision into the districts. That's something that we support in this caucus, the decentralization into the regions. At the same time, you can't help but be aware, using the North End clinic in the Capital District, that it's a very small fish in a very big pond. It's in a situation where it has, as an organization, really come very much from the community. It has been an initiative of the community. It soon will be 30 years old. The staff and the board of directors feel that their responsibility and their accountability is as much to the community as it is to the bureaucracy, I guess you would say, in some ways.
[3:30 p.m.]
I think that there is, I know that there is, concern about any shift in the relationship between the clinic, for example, with respect to its accountability to the community away from its accountability to the community and its sensitivity to the community and the possibility that it has to worry more about accountability toward the Capital District - the potential for a loss of autonomy, the potential for the loss of control over its own hiring practices, its own programming decision in terms of maybe developing new programs, addressing new needs in the community.
So I'm wondering about the framework that the Department of Health is developing for community health centres that will guarantee, that will reassure these communities that they will be able to maintain some degree of control and autonomy over those features of their operations that allow them to respond in a sensitive and realistic manner to what's required in the community. I know that the North End clinic isn't the only clinic that has these issues, that there are other clinics like Hants Shore, I'm sure my colleague, the member for Hants East, will have an opportunity to ask some questions about the clinic in his community. People in those communities have built themselves, they've built them with
bake sales, bottle drives, and they're important elements of maintaining community involvement and support.
When you are in a situation where you're such a small fish in a big pond that is so institutional in lots of ways, like the Capital District and, you know, not being pejorative about the Capital District, but it's just a reality when that district is dealing with a large institution like the tertiary care facility at the QE II, that the needs and the requirements of a very small community-based organization can get lost in the shuffle. So I want to know from the minister what reassurances he can provide to community health centres like the North End clinic that they will be able to continue to operate and do the kinds of work that he has been able to go around the country and talk about.
MR. MUIR: Mr. Chairman, welcome to the Chair.
MR. CHAIRMAN: Thank you.
MR. MUIR: I guess I would like to begin by saying that I do understand the concern that the member has, but in terms of the North End clinic, of course, it retains its own advisory board and that has not been changed. Secondly, I think the relationship between the Capital District Health Authority and the community health boards and probably its relationship or its responsiveness to community issues is unequaled elsewhere in the province. Clearly the Capital District, despite its being the largest one, has certainly shown considerable leadership in working with its community health boards and being responsive to community issues.
It was very interesting, Mr. Chairman, not that long ago I was speaking to, I think it was the day that the Prince was visiting over at the Infirmary, we were over there, Prince Michael and a couple of other people, and we were talking about health matters here in Nova Scotia and we were talking about community health boards.
There was a meeting of community health boards in Halifax that afternoon which the chairman of the board and the CEO attended and they were trying to set up, the comment was something like this, the district health authorities, the CEOs meet as a group and board chairs, and they were trying to ensure that they had very good relations, or the integration between the community health boards and the relationship between the community health boards and the district health authority was solid. They decided that the model that they were using in the capital region was the one that should be adopted for the rest of the province and I'm not saying that it might not have to have some modifications, but certainly they had done an excellent job in this area and the others were looking at it. So I hope that gives the member some comfort.
MS. MAUREEN MACDONALD: Mr. Speaker, I just want to be really clear here with the minister, that I'm certainly not being critical of the community health boards or the Capital District board in this area in terms of their desire to be responsive to community issues because I can say based on, not a great deal of contact, but to the extent that I've had contact with the folks in the community health boards and the district board, there is a very strong desire to work with the community and to work in partnership with community.
So, without any question, I would never raise any issues or have any concerns about that aspect, but I want to say that it's a very big district. I guess the point I'm trying to make is that it is a very big district and that within the district the needs are quite diverse and the circumstances can be quite different and that is the value of, let's say, a community health centre that operates in a particular area. Those folks every day see the people who come through the doors who not only bring their medical care needs, but they often bring a lot of other needs with them as well that are very connected in terms of I would say are the determinants of health.
So you can talk to physicians at the North End clinic and they can tell you that people are bringing in, you know, they're coming in and they're not feeling well. They're quite stressed out and it turns out that a source of many of their problems is income problems, housing problems, employment problems, education and training problems, addiction problems, these kinds of things.
Now, to use again the example of the North End clinic, the North End clinic is situated on Gottingen Street. It's in the inner city of Halifax and in this community we have a problem with drug abuse and addictions and we have a problem in that for our young people who are involved in drug abuse and the whole drug culture, these young people are not apt to get on a bus and cross the harbour and go over to the grounds of the Nova Scotia Hospital and participate in the addiction services programs there. They're just not going to do that and people at the North End clinic and people in my community recognize that. They recognize that here we have a group of young people who really need addiction services and they need a different kind of addiction services. They need addiction services that are very grounded in the community, that are very sensitive and specific to race and class issues, if you will, and they're not available.
So they're not available and a very important role of the North End clinic has often been to identify, through the workers in the clinic, these very serious problems and then they do a lot of community development work in the community looking for ways to address these programs.
The North End clinic did research. They had some young people on a summer student program working with one of the physicians who has been in the clinic for many years, who is very dedicated to families and youth. They developed a very nice proposal for a youth addiction treatment program that would be community based, that would be offered in the
community, and they were unable to secure financial support through your department and probably through the Capital District. Not because the Capital District is mean or miserable, or anything like that, but that people had this idea that maybe the better place to offer those services would be in the high schools, associated with St. Pat's High School or Queen Elizabeth High School. To most people that would sound like a very reasonable idea, but let me tell you what's wrong with that idea, that people in our community know, but people from outside our community don't know.
What they don't know is that the kids we're talking about who need these programs don't make it to high school, believe it or not. They quite often leave school at the junior high level and that's actually part of what we need to address with community-based addiction services in our community. Actually catching kids when they're 12, 13, 14 and 15, at that level, and doing it in an environment that they're in every day and that they feel comfortable in. I know because I've had the discussion with the chairman of the community health board and I've had the discussion with others, just trying to make people understand that you have to trust the community when they identify a problem and they work out the solution to that problem that makes sense to them.
We're not trying to be difficult and we're not trying to be contrary. We're trying to say this is a different set of circumstances and realities that we understand because we live it every day and so I guess, to use that example, that's the point I'm trying to make. I think that there is a huge amount of desire on the part of community health boards and district health authorities, but there also is, I think there just is a bit of a disconnect perhaps sometimes. I'm wondering how that can be addressed so that community organizations - the minister said in response to this earlier point that the North End clinic, for example, retains its own advisory board.
I would submit to the minister that the board of directors at the North End clinic see themselves as much more than advisory. They are the stewards of that organization. They essentially get elected from the membership and it's their job to oversee all aspects of the operation, including the accountability piece, that they ultimately are accountable for the health dollars that they spend back to government and to the taxpayers of Nova Scotia. They also are very accountable to the membership of the North End clinic who are drawn from the community and from the patient base for the array of services that are provided from the clinic. Many of those are primary health care but a lot of them community-based development, to address things that are features of the determinacy of health like the whole question of addiction in our young people.
MR. MUIR: Mr. Chairman, let me begin by acknowledging that I did use the wrong terminology - as an advisory group. I do know that they are a board of directors and I substituted one term for another and I do know that they are accountable and we've seen some actions of their accountability in recent years since I've been here.
The honourable member does bring to the floor of the House a very important thing and this is the whole issue of population health. I'm pleased to say, Mr. Chairman, that the Department of Health has formally endorsed a population health model for the improvement of the health and health care of our citizens. The honourable member quite correctly points out that health is not a matter of just sitting next to somebody and getting a cold, that there are many other factors such as, you know, the relationship between income and health. Quite frankly, the lower the income, in general, the higher the health care need. The lower the education, the higher the health care need, we know that and we are building those factors into our planning. I'm delighted that we are getting support from the other Parties as we move forward.
[3:45 p.m.]
Indeed, I guess I want to talk about just our tangible commitment to population health indicators next year. We have Dr. David Rippey heading up our population health section and we've committed $1.1 million to the formalization and development of a plan or a model that is tangible, that can be implemented, and that really makes a difference. The honourable member talked about addiction problems in reference to the northend of the city and that the community health clinic there, you know, people really couldn't get on a bus and go over to the Nova Scotia Hospital, that services in the community were more appropriate, and I guess sort of in recognition of that, not only that, but in other jurisdictions as well, the government this year as part of our, I suppose you could call it our population health initiative, has allocated an additional $1.8 million for addiction services with particular reference to adolescents and women.
We also have a blended mental health approach and we've beefed up addiction services. We have a 24-hour call-in line. I know that that's not appropriate for everybody, but we do have some things and it does serve some people. We've also funded some research about various types of addiction. We tend to think, I suppose, in addiction most people tend to think of drugs and perhaps tobacco. When we're talking about those things as addiction, we know that they have a direct relationship or a negative affect on the physical health. We also are concerned about gambling addiction. There are a number of people who have those and we've done work to try to recognize that problem and to lessen that impact.
Just about everything that we do now in the Department of Health in terms of programs and new initiatives, we examine through a population health lense. That's a commitment that we made and something that we are doing and sometimes the trouble is with population health, you don't always get an immediate feedback on it and it's a long term thing. If you've got a broken leg and you go to the hospital, somebody fixes it today, then it's fine. We have the highest rate of obesity in the country here in Nova Scotia and we know the relationship between obesity and a number of other chronic illnesses. We preach that - not only the government and the district health authority and whomever it is responsible for
delivering - the most important thing in health service in this province is going to be how individuals accept the responsibility for their own well-being.
We can influence a very minor part. I think I talked about this last year; about 95 per cent of health anywhere depends on the individual. You've got some things with genes that you can't deal with; you know, some people have inherent dispositions for certain diseases. We're in the business of genetics and stem cell research and all of those things; sometime in the future maybe we will be able to deal with those. Then there is the amount that has to do with health that is delivered in a formal way by the health care system, but by and large, and I think this is what the honourable member is pointing out, we know that the great majority of a person's well-being depends on how they live their life, if they exercise and eat good food.
Eating good is one thing. Good food doesn't overcome the lack of exercise, but exercise will overcome or at least help combat the lack of good food. So, you know, we say get up and exercise. That's probably about the most important thing. That's what the people tell me and, like everybody else, probably, in this room, we don't have the time. (Interruption) Yes, we should be having a calisthenics break, Mr. Chairman, is what we should be doing in this House.
MR. CHAIRMAN: Well, honourable minister, if there's unanimous consent, we perhaps could give that consideration.
MS. MAUREEN MACDONALD: I agree with what the minister had to say, and I want to go back to a point, though, that he made earlier because he was speaking about alternative health care providers and the need to really address this. I was listening to Roy Romanow, I think, on CPAC one evening during the hearings in one of the other provinces. He was expressing some frustration with the snail's pace of change that has occurred in the Canadian health care system with respect to moving in the direction of alternative health care provision.
Certainly in Nova Scotia we have had an opportunity that we haven't played to our advantage and that is the introduction of midwifery. When I was first elected, there was great optimism in the midwifery community. They had done a lot of research and they were feeling that in fairly short order there would be some change in this province. There would be the introduction of legislation that would recognize the valuable role that licensed midwives and practitioners could play in our health care system, and yet we have not seen any legislation come forward. I think it would be fair to say that many members who were so optimistic are feeling quite demoralized.
So I'm wondering why it is that we have not seen any advance in the regulation of midwifery or the introduction of legislation that would legitimate and involve licensed midwife practitioners in our health care delivery system? Why haven't we seen it and when we could look forward to some change?
MR. MUIR: Mr. Chairman, the honourable member raises an interesting question and I just want to indicate, for what it's worth, that we do have a primary care planning group going on and representatives of the midwives are part of that. So in the primary care planning group, one of the things that I think will come from that is some sort of role clarification for midwives. Once we reach that stage, I don't think there's any question in my mind that not only midwives but a number of others, what we right now call alternative health care providers, will begin to play a larger role in our health delivery system. You know, people use them all the time. No, they don't use midwives all the time; that's not true, but we've got a whole array of what we would call alternative health care providers, whether it's a massage therapist or a midwife - there are all kinds of them - doctor of herbal medicine, naturopathic.
I've met representatives of those groups and, you know, I really believe that the blended approach to medicine is probably something that will come. It's not going to happen overnight, but I can remember that when I was a young person, the practice of chiropractor was not seen as really adding any legitimate or real value to the medical field and now, you know, we just did something with the Chiropractic Act here, either last year or the year before. They're recognized by insurance plans and everything else. It took the chiropractors a long time and it's going to take some time, but I think it's going to come.
MR. CHAIRMAN: The honourable member for Dartmouth North.
MR. JERRY PYE: Mr. Chairman, I want to thank my colleague, the member for Halifax Needham, for allowing me some intervention time during her hour of Budget Estimates. My questions will be going through to the Minister of Health, but first I want to go back to the Tory blue book, Strong Leadership . . . a clear course. Under Seniors I just want to make some general statements to begin with.
In one of the bullets under seniors, during the election campaign, the government of the day decided to state that it would "ensure that input from seniors and the interests of seniors are at the forefront of all government decision-making affecting the future of our province." I want to also go to an excerpt from Hansard with respect to Wednesday, June 10, 1998, and I will table this if I'm requested. There the Premier, Dr. John Hamm, was posing a question to the then Minister of Health, Dr. James Smith: "Mr. Speaker, I have a question for the Minister of Health. The Minister of Health has created a lot of confusion in the minds of seniors as to what is going to happen to the cost of participating in the government's Pharmacare Program. I want to, by way of my question, give the minister an opportunity to clarify this situation. Is the minister prepared to commit here today that seniors in this
province will not have any increase in participating in the Seniors' Pharmacare Program, either in the premium or the co-pay for as long . . . as this government is in power?"
He goes on to ask another question. Dr. Hamm again asks the Minister of Health, "When the government announced its program in 1995, it announced it was going to share the cost 50/50 with seniors. Has that policy changed, or is he prepared to guarantee seniors for as long or as short as this government is in power that they will not face an increase in either premiums or co-pay to participate in the Pharmacare Program of this province?"
MR. CHAIRMAN: Order, please. Did the honourable member for Dartmouth North indicate that that document is public record?
MR. PYE: Yes, it is public record.
MR. CHAIRMAN: It won't be necessary to table it then.
MR. PYE: And I did indicate that only if it was necessary to table it that I was quite prepared to table it as well.
Of course, what do we have? We have, in fact, the Hamm Government, the Minister of Health, has announced that there will be an increase in seniors' co-pay, and as a matter of fact, it has gone from 20 per cent to 30 per cent that seniors will have to pay. You know, he said that this would in fact benefit some 7,000 seniors and that seniors with an income of $24,000 or less, single seniors, would have to pay and seniors with combined incomes of $28,000 would have to pay.
[4:00 p.m.]
My question is to the Minister of Health. Does he really think that this government is doing justice to the Seniors' Pharmacare Program when, in fact, he is placing a 10 per cent increase from the last time the increase had occurred on seniors who are now expected to make that co-pay?
MR. MUIR: I welcome the honourable member for Dartmouth North to the debate on the estimates. He's quite correct. This government does put forethought into a good many of the health care decisions that are made and not only decisions in my department, but decisions in other departments as well.
With reference to the Seniors' Pharmacare Program, the cost of that continues to go up. The honourable member did say in his comments, when that program was introduced, it was supposed to be on a 50/50 basis. That was the case. You know that when that program was first introduced, there was neither premium nor co-pay associated with it. It was 100 per cent paid by the government. The issue was that at 100 per cent pay that program was not
sustainable and that was really the whole issue. Not only in terms of the formulary which did expand, which is probably a good thing, a good many of the pharmaceuticals that are on the formulary continued to increase in cost. In addition, the number of seniors was increasing as well.
The program right now, I think there are about 95,000 seniors in the program and indeed, we have consulted with seniors' groups in arriving at decisions in Pharmacare. That is not to say, I don't want to give the impression that all of the seniors with whom we consulted would accept or indeed, endorse the changes that have been made. I'm not trying to imply that, but I do believe that they do understand why they have been made. This year, there will be roughly about 55,000 of the 95,000 seniors who are eligible not to pay any premium or have their premium reduced. That program is escalating the cost at roughly around 10 per cent per year. It's about a $125 million ticket item next year, that's the cost of the program. I think the participation of the seniors is around 40 per cent and the government picks up the rest. Right now, I think the seniors are paying roughly about 30 per cent, the government's paying about 70 per cent.
MR. PYE: Mr. Minister, you're absolutely quite right. In 1990 seniors paid 0 per cent, the government paid 100 per cent of the Seniors' Pharmacare Program. That cost in excess of almost some $65 million. There's absolutely no question. The problem that we have today is that we recognize that the population is becoming aged as we move on. The unfortunate part of it is, many seniors are on fixed incomes and those fixed incomes have not kept pace with the cost of living. What government has done is they've simply continued to deliver the program, but they've added that burden onto many of the seniors who simply can't afford to pay that Pharmacare fee. What I'm saying to you is that through my office, a number of seniors have simply said to me, there is no way that we can possibly afford that cost. So the question to the minister is, is the minister aware or does the minister know how many seniors have opted out of the Seniors' Pharmacare Program because they can no longer afford the cost of participating in the Seniors' Pharmacare Program?
MR. MUIR: No, I don't have that information. All we know is that we have the numbers of people that enrol from year to year. I don't have that information right in front of me. As you are perhaps aware too, Mr. Chairman, and I think the honourable member is, the government three or four years ago went to be a payer of last resort. In other words, if a person had a private insurance plan, they were to kick that in before the government. Thus, you will see if you take a look at the chart and the expenditures, one year there's a drop in enrolment, it's simply because people stayed with their private plans. In some cases, quite frankly, I guess a private plan is better than the government plan and that's a decision people have to make.
We have not heard of many people opting out of the plan. I think part of the reason is that the premium is on a sliding scale. They can register in the program and it may not cost them anything to register, or very little. In other words, if they are below a certain income
level, then they don't pay a premium, effectively the government pays that premium. If they go up to another level, then the amount of premium that they pay is pro-rated. Perhaps the question is, can they afford the co-pay and we haven't had many reports of that, although there's some suggestion we're close to the point now where it might make a difference.
MR. PYE: To the minister, if you know that you're reaching that point where it may make a difference, I'm wondering if the minister has given any consideration to re-evaluating or looking or making an assessment after this year with respect to the increase of the co-pay that is paid by seniors to the Pharmacare Program and if there will be a review of the impact that this may have on the seniors limited ability to make those co-payments?
MR. MUIR: That Seniors' Pharmacare Program is reviewed every year and clearly this year when it was realized that the program was to be sustainable then users had to participate more. The decision was made to go with the premium as opposed to the co-pay. We say this in Question Period every once in awhile, but I want to reiterate for the members of the House and I think everybody knows this, is that if I had my druthers as Minister of Health, I would have a universal drug plan for every Nova Scotian and that's something that we are looking at. I won't call it a proposal, but some thoughts have been put together that I haven't seen yet but I do know that we had asked some people to put them together if we were to proceed with that initiative, what would be the best way to go about it? Similarly, in terms of the seniors' plan, to be quite frank, my druthers would be that we would go back to 1990, or whenever it was, system where there was no premium and no co-pay. That's just simply not practical now unless our friends in Ottawa want to come down and pick up all the Pharmacare costs and I will tell you I have suggested that to them, but for some reason they seem to be reluctant to do it.
Notwithstanding that, the program that we have in Nova Scotia is one of the most generous in the country. For example, in New Brunswick, to get the same coverage that they have here in Nova Scotia, the annual premium for seniors has just gone up to $1,068. I saw in Quebec they upped their premiums considerably. We have a very, very generous plan. I know that it's tough for people, but comparatively speaking, Nova Scotia still has a very generous plan and obviously, I would prefer it was more generous, but we just can't do that right now. Health care costs are going up so much, we have to have people participate, that's a fact or we aren't going to have it.
MR. PYE: I would say to the minister that we have to have people who are able to participate and be able to afford the premiums as well. I do know that the minister made reference - and I'm very pleased to hear the minister say that if he had his druthers, that he would prefer a universal Pharmacare Program in this province. I want to say that in 1993 there was a Pharmacare reform working group. I know that the minister was not around at that particular time - or I don't think the minister was around. He certainly wasn't in this Legislature in 1993 - in spirit, of course, indeed.
I wonder if the minister has actually looked at that working group's recommendations and if, in fact, some of those recommendations can ever become reality in the Province of Nova Scotia?
MR. MUIR: Mr. Chairman, we do have people in our Pharmacare section who obviously would be familiar with that. It was the people in the Pharmacare section who put those preliminary thoughts on paper for us to take a look at. I would be very doubtful if they did not take the work of that planning group into consideration when they were doing it.
MR. CHAIRMAN: Thank you. That concludes the NDP time at this point.
The honourable member for Glace Bay.
MR. DAVID WILSON: Thank you, Mr. Chairman. I should notify you at the beginning that I will be sharing some of my time here with my colleague for Cape Breton The Lakes in approximately 15 or 20 minutes time. I would like to go on the record as saying a few things and perhaps get the occasional question in for the Minister of Health as well.
First, Mr. Chairman, I am sure the minister is aware that one of the most popular headlines in the Cape Breton Post these days, especially on the Glace Bay page, would read something to the effect of how this headline reads here, that a shortage of doctors will force residents to travel to Sydney and New Waterford this weekend. Of course, as the minister would well know, that would be because the emergency department at the Glace Bay hospital is closed, forcing residents to go to either the Cape Breton Regional Hospital in Sydney or the New Waterford Consolidated Hospital.
Now, Mr. Chairman, I guess at one point in time - and the minister has made reference to my recent experience in the emergency room at the Glace Bay hospital - as unbelievable as this may sound, the administrative staff at the Cape Breton Regional Hospital actually contemplated setting up one of those neon glow signs at the bottom of South Street in Glace Bay that would alert people whether or not the emergency department at the Glace Bay hospital was open on that particular day. In other words - and I would liken it to travelling home to Cape Breton, when you see the flashing lights telling you whether or not the Englishtown ferry is operating and in service at that particular time.
I am sure the minister could confirm that with administrative staff from the regional hospital, that they actually did contemplate setting up that type of a system, so that residents would know whether or not their emergency department was open at that particular time. If we have reached the stage in this province where the minister considers that to be adequate, good health care in this province, that the residents of one particular community or, in this case, several surrounding communities, do not know and may not be aware whether or not their emergency department, emergency room, outpatient department, whatever you want to call it, is actually functioning with a doctor on duty at that particular time, perhaps at the time
of a severe injury or when emergency medical treatment is required. If that is what the minister categorizes as good health care, then I guess he and I are at odds and disagree somewhat vehemently as to whether or not that is good health care in this province in 2002.
One of the things that has happened of late at the Glace Bay hospital and it also affects the Northside General Hospital and the New Waterford Consolidated Hospital, but I am not going to touch on those topics because I am sure my colleagues from those particular areas will cover them. The Glace Bay hospital is among three or four hospitals in the regional health care complex that have been the subject of a study that was done by Dr. Michael Murray, a physician from Barrie, Ontario. The work was completed and he was, in effect, an independent reviewer on behalf of the regional healthcare complex in Cape Breton. The conclusion of a 59-page report on emergency departments at the Glace Bay hospital, the Northside General Hospital, the New Waterford Consolidated Hospital and the regional hospital - and I am sure the minister has seen that report - was that emergency departments at busy community hospitals will be negatively impacted if physicians aren't compensated for heavy workloads.
[4:15 p.m.]
That report found that, number one, physicians are under increasingly heavy workloads. In some cases a physician on duty at the Glace Bay hospital, for instance, is doing the job that would normally take two physicians, at least two, and there is a shortage. It also found that if you don't compensate that doctor, if you don't pay that doctor as much as you pay that doctor to work in the emergency department at the regional hospital or at other regional hospitals throughout this province, if you don't pay them as much to work at the Glace Bay hospital, the New Waterford Consolidated Hospital or the Northside General Hospital, you are not going to have those doctors. It is as simple as that. This was an agreement that the Department of Health, I understand, negotiated with the Medical Society.
Now I also understand, at this point in time, that there has been, thankfully, someone in the department who came to their senses. It may have been at the urging of the Cape Breton Regional Health Care Complex, which was faced with this crisis, but someone in the department came to their senses and said, this deal is not right; we will renegotiate it.
I would like to ask the minister if he could rather briefly tell me whether this is indeed under renegotiation, whether there are going to be changes and if doctors at the Glace Bay hospital, specifically - as I said, not that I am not concerned, but I know my colleagues who represent the other areas will do their job of asking those questions - are going to be compensated on a level equal to those who are working, for instance, at the regional healthcare complex that is part of the overall Cape Breton Health Care Complex.
MR. MUIR: The issue of compensation for emergency room physicians - again, I am calling them emergency rooms and everybody in here does recognize that most of what goes on in those things is not emergency service - was a table item for discussion between the Department of Health and the Medical Society of Nova Scotia, which represents the physicians. The Medical Society, I believe - I perhaps stand to be corrected on this. I understand that the differential - and it was increased a bit this year under the terms of the new contract - was something recommended by the Medical Society, but it was, in my understanding, sort of a national pattern right across the thing. I think the reason for it was probably that if you are going to have an emergency room, then an emergency room should literally be treating the crisis instances as opposed to necessarily delivering outpatient services; therefore, you needed people who were highly skilled in particular sites.
I can tell you, though, that clearly that was a problem. It seemed to be a problem up in the Cape Breton District Health Authority. In conjunction with the Department of Health and with the cooperation of the Medical Society, I believe a solution has been found to that. Basically the solution is pretty simple; they have taken the money, they are pooling it and they are going to dole it out.
MR. WILSON: I would take that, Mr. Minister, as the answer being that from here on in, physicians who work the emergency department at the Glace Bay hospital are going to be paid the same as physicians who are working at the emergency department at the regional complex in Sydney. Is that correct?
MR. MUIR: Mr. Chairman, this is a matter for the Cape Breton District Health Authority, and their Medical Advisory Committee is taking these matters under consideration. Exactly what the final solution is, I don't know, I can't give a specific answer to that. As I say, this is being administered through the DHA and you would have to get the most up-to-date information from them.
MR. WILSON: Mr. Chairman, I'm baffled a bit because the contract with the physicians in this province is negotiated by the Department of Health to my understanding. It's a province-wide contract with the Department of Health that's negotiated with physicians in this province. Therefore that fee structure was negotiated on a provincial basis with the Department of Health. It's Department of Health officials and officials from the Medical Society of Nova Scotia who agreed to that fee structure that saw a differential as a matter of fact between Glace Bay, North Sydney, New Waterford and Sydney, but now you're saying that it is not the responsibility of your department, Mr. Minister, to correct that situation. Is that what you're telling me?
MR. MUIR: When you say that it has to be corrected, it implies that it does need to be corrected. It would imply that there might have been something the matter with the negotiations and I'm not going to comment on that. What I can tell the honourable member is that the Cape Breton District Health Authority did express some concern. It expressed that
concern to the Department of Health and also to the Medical Society and they are trying to work out a solution to that problem with the support of the Department of Health and the concurrence of the Medical Society. I can tell you, if you're asking is the agreement changed, the answer to that is no.
MR. WILSON: So, again, I would like some clarification, Mr. Chairman. If the minister would clarify, I am saying it is a problem. Officials of the Cape Breton Healthcare Complex, specifically the chief administrative officer there, John Malcom, had been quoted in the media as saying that it is a problem, that there is a problem with the fee structure. I attended a meeting in Glace Bay at which about 50 people attended. Mr. Malcom stated at that meeting that there were negotiations taking place to try to change that, and they were optimistic that it could come about, that the fee structure would be changed.
So, obviously, it has been recognized as a problem, perhaps not by the Minister of Health, Mr. Chairman, but it has been recognized as a problem by the administration of the Cape Breton Healthcare Complex and John Malcom, the Chief Executive Officer, says that there is a provision apparently to allow the four hospitals within the Cape Breton Healthcare Complex to be classified as one. Therefore, that would lead to a change basically in the wording of any contract that could be made by the Department of Health and by the Medical Society of Nova Scotia. With some simple contract wording, it would be possible for that to be changed, but again the clarification that I'm looking for here is whether or not the minister, and surely the minister agrees that this is a problem area, that this has to be corrected?
You can't pay doctors one fee at one regional emergency department because Dr. Murray in his report said that the Glace Bay hospital should be treated the same as any regional facility throughout this province. It has the numbers that it's dealing with. There are close to 30,000-some people a year who go through the emergency department of the Glace Bay hospital. The numbers are basically the same on the Northside and the situation for emergency care is quite evident in New Waterford as well. The minister must be in agreement, has to be in agreement, that that fee structure is a problem, it's going to lead to bigger problems and has to be changed, Mr. Chairman. Surely the minister can agree with that statement?
MR. MUIR: Mr. Chairman, let me back up a little bit. I take it that you're endorsing Dr. Murray's recommendations wholeheartedly in all of the report, just from your last comments. (Interruption)
MR. CHAIRMAN: Order, please. Would the honourable member for Glace Bay wait until his turn.
MR. MUIR: I thought I heard him say that, Mr. Chairman. Anyway, let me continue on with the thing, what it is, is that certainly there was a concern expressed by the district health authority about the differential pay schedule. With the department and with the cooperation of the Medical Society and their own medical management committee, they believe that they are coming to a solution.
MR. WILSON: Mr. Chairman, let me clarify one point that the minister has brought up and the minister knows full well that I did not say that that report should be approved in its entirety. That's not what I said. I said from the outset that I was dealing with matters pertaining to the Glace Bay hospital. If I were to agree, and perhaps the minister is agreeing with that report, I don't know, but if I were to agree with that report, then I would be calling for basically the shutdown of the emergency department of the New Waterford Consolidated which, of course, I'm not, and the 1,000 people who showed up at a meeting to protest that are not calling for it either.
The minister knows that, but the minister knows that an integral part of that report dealt with the subject of these fees for physicians, for doctors who are working at the emergency rooms in those various hospitals. The minister knows, and the minister I would assume has been told by his staff and by the administration of the Cape Breton Healthcare Complex, that this is a serious problem. This is a matter that has to be corrected because it can spread pretty fast and take off when you're paying doctors one salary in one emergency department in this province and paying them another for doing the same type of work and the same volume of work.
Now, I have asked the minister, and he has skirted around the issue for the last three or four questions, as to whether or not he is going to address this issue. I have been told, and other people have been told, and the media has been told by the chief executive officer of the Cape Breton Healthcare Complex, that this matter is now being negotiated and is on the road to resolution, that it is a subject of negotiation between the Nova Scotia Medical Society and between the Department of Health and that, indeed, the Department of Health is leaning towards changing the fee structure again to more adequately reflect what doctors are doing at the Glace Bay General Hospital, at the Northside General Hospital and the New Waterford Consolidated Hospital. So, again, I would ask the minister to confirm that and to bring us up to date on what's happening in those negotiations?
MR. MUIR: Mr. Chairman, I will repeat, I'm going back on this and I think I've given the answer about four times, and I don't know why he keeps repeating the question. (Interruption) He doesn't like the answer or I don't know what it is, but certainly I think I have answered at least four times. The fee schedule is negotiated between the Medical Society and the Department of Health. The Cape Breton District Health Authority has expressed some concern about the fee structure for emergency room physicians, the applicability up in that area and basically what it is, well, everybody knows what it is. They have expressed that concern to the department and they've also expressed concern to the
Medical Society. As a result of the expressing of concern and with the support of the department and the Medical Society, they are trying to work out a solution, a solution done locally.
The fee structure as per the agreement was negotiated with the Medical Society. That fee structure is not the thing that is being negotiated. What they're trying to do is everybody is a bit flexible and they're trying to find a local solution to a local problem with the support of the Department of Health and the Medical Society. They've got their own medical management committee, or whatever it is. It is really the one working on the solution. Is there going to be a solution, as the chief executive officer has said, that is acceptable to physicians there? I believe there is.
MR. WILSON: Mr. Chairman, as I indicated, I am going to share my time today, but I thank the minister. I will summarize what the minister said and that, you know, if the minister and department officials on the provincial level screwed up and you're looking to the local authorities to finally fix things and put them back the way they should be, if that's what the minister is saying, then it's good to have the minister stand up and admit that mistake, that it did happen, and that it will be corrected by the local authorities who have that flexibility as the minister stated. They will finally fix things and make them the way that they should have been from the very beginning. (Interruption)
With that in mind, Mr. Chairman, I would now like to turn over the rest of my time to my colleague, the member for Cape Breton The Lakes.
MR. CHAIRMAN: The honourable member for Cape Breton The Lakes.
MR. BRIAN BOUDREAU: Mr. Chairman, knowing full well that my time is limited, I'm going to get right to the questions directly to the minister and I would like to ask the minister my first question. Are you in support of community hospitals?
[4:30 p.m.]
MR. MUIR: Mr. Chairman, I would like to perhaps address that question in two ways. I guess the obvious answer to, am I in support of health care being delivered in communities, the answer is yes. The problem with the question - and I don't think the honourable member knows this - is that one of the problems we have had in Nova Scotia is equating hospitals and health care. That system has changed.
A more appropriate question would be should there be health services for communities, rather than counting numbers of hospital beds or calling them hospitals. We are committed to that. I just think it gives the wrong connotation. That is something that is gone. I explained to this House one time that I was at an emergency medical conference in Toronto and there were some people there, actually, from the IWK. I had met them before.
I ran into them and making conversation, I said, well, how many beds are in the IWK? She said, I don't know; we don't talk about beds any more. We talk about services; are services available to children? So I think that is probably a more appropriate question. Do I believe in community-based services? The answer is yes.
MR. BOUDREAU: I would like to ask the minister, then why would you negotiate a contract with the doctors to pay them more money at regional facilities and less at community facilities?
MR. MUIR: Mr. Chairman, there are two people at the negotiating table. As I explained in an answer to his colleague, the honourable member for Glace Bay, this type of distinction in the acuity of services and the volume of services is a national trend. This is not something that was done in Nova Scotia; this distinction has been supported by medical practitioners or medical associations right across the country. I think one of the reasons for it is - and I don't sit on the other side of the table; I didn't sit on this side either, to be quite frank, in the negotiations - is that they recognize that emergency rooms ought to be for emergencies and there should be a system which, if you are delivering emergency services, which is, according to the Medical Society, different than delivering the outpatient services. In so many of our facilities, so much of the volume is that, and that is probably the reason for that national trend.
MR. BOUDREAU: Mr. Chairman, I agree with the minister but the minister misunderstands something. Those emergency rooms should still be open in order to provide the service. I would like to ask the minister how much money he will save this year in his budget by closing the maternity ward at the Northside General Hospital?
MR. MUIR: Mr. Chairman, the Department of Health did not close the maternity ward at the Northside General Hospital. As the honourable member is well aware, that service was suspended because there were not enough physicians to carry on the service. Now if he wants to carry on delivering the babies when there are no people to deliver babies, then that is probably not a good idea.
AN HON. MEMBER: Midwives. Why don't we bring back midwives?
MR. MUIR: Well, your colleague asked about that a minute ago and we did talk about that. With midwives, of course, if there is anything complicated, they have to have some help, too.
So the department, and that hospital, like the others, are in the budget for, in that case, the Cape Breton District Health Authority. I am not sure what figure they have down for saving if the obstetrical unit is closed, but again I emphasize that the reason that unit was closed, so I am told, is that there are not physicians who wish to continue delivering babies there.
MR. BOUDREAU: Mr. Chairman, you know, it is pretty disappointing to me, as a rookie MLA, to have to stand here and remind the minister that it is his responsibility and he is the ultimate individual who is responsible for health care throughout the province, and he can't pass off all the bad stuff onto the health boards. Of course, there is no good news anyway in health care anywhere since this gang took over.
Could you tell me how many acute care beds have been changed to long-term care beds since you came to be the minister of this department?
MR. MUIR: Mr. Chairman, I respectfully ask that he repeat the question; I missed it.
MR. BOUDREAU: How many acute care beds at the Northside General Hospital have you transferred to long-term care beds?
MR. MUIR: Mr. Chairman, I can't give an answer to that question. I believe they were given a temporary license for about 30 long-term care beds. I believe some of those beds were not in service and what they did was open up a number of beds that were not currently being used to try to take the pressure off of the acute care side, not only in the Northside General Hospital but in the other facilities as well.
MR. BOUDREAU: If you recognize the need for long-term care beds on the Northside, then why did you cancel the projects at Miner's Memorial Manor in Sydney Mines and the Northside Guest Home?
MR. MUIR: Mr. Chairman, there was a moratorium on long-term care beds in the province, I think since about 1993 or 1994. I see the honourable member for Halifax Atlantic nodding his head. He has been around that long and he would know.
The issue of Northside General Hospital, as you know, we implemented a single entry access program here into long-term care. One of the pilot territories where that was introduced was up in DHA 8 and the other, of course, was DHA 7. What we have managed to do there is - although there had nominally been quite a long waiting list - once we got into the single entry process and started to assess the need for long-term care beds, that list dwindled to virtually nothing. I think it went down to about one-seventh of its original length.
The issue, and he has raised that twice today, Mr. Chairman, about facilities on the Northside - Miner's Memorial Manor and the Northside Guest Home, I believe those were the two, have been granted licenses to extend by the previous administration. I am checking, but I think that is incorrect. The reason I think it is incorrect is that it may have been an election promise. There may have been an election promise, because the former Premier also came to Truro before the 1999 election and was speaking to the chamber, somebody there,
and whipped out a new hospital from his back pocket that nobody in the department had ever heard of.
I wouldn't suggest that was electioneering, now; I don't want to suggest that at all. So there may have been some electioneering going on. I have staff trying to find out that information. The reason I say that, seriously, Mr. Chairman, is that I have met with both of those organizations; they both presented proposals to me and said that they have proposals in. They did not indicate to me that they had ever been given any indication that the proposal had been accepted.
MR. BOUDREAU: Could you tell me how much the operating budget for District Health Authority 8 has increased this year, please?
MR. MUIR: The non-wage increase to DHA 8 was $3.3 million.
MR. BOUDREAU: How much was the wage increased, Mr. Minister?
MR. MUIR: The estimated wage differential is about $9.6 million. Now, take into account, Mr. Chairman, that that does not include fee-for-service doctors.
MR. BOUDREAU: Mr. Chairman, could you explain to us what cigarette smoke shacks are doing at these hospitals and how much these facilities cost the taxpayers?
MR. MUIR: Most health care facilities in the province have a no smoking policy. As I understand, the only deviation from that would be in the forensic and mental health facilities and also in veteran's wings. To be quite frank, when the Department of Veterans Affairs negotiated its agreements with the particular facilities or the agencies that represent those facilities, the right to smoke was built into the contract.
The honourable member has referred to them as smoking shacks. I have never been in one. We've got one in the Town of Truro, which is not too far from the door there, and it looks like a plastic bus shelter or something like that. You can stand in there and smoke and not get wet. Other than that there is no comfort to it so I don't think there would be a whole lot to maintaining it, but I don't know the answer.
MR. BOUDREAU: Mr. Chairman, the nurses at the maternity ward, why are they being transferred to other departments and facilities and why are they not assigned to other maternity wards so they can maintain the skills that they have today and enhance their skills in the future? Why has that not been a commitment of yours, Mr. Minister? During the last provincial election you people made a commitment and a choice. Why are you treating the nurses at this facility in that manner?
MR. MUIR: I think the honourable member is referring to the Northside General Hospital, where a number of family physicians have indicated that they don't want to continue with obstetrical services and therefore that obstetrical service is being discontinued. The precise answer to that, Mr. Chairman, would lie with the district health authority that manages the system.
MR. BOUDREAU: It is pretty interesting, you know. Have you lost your memory or what? Mr. Minister, it's no wonder that individuals in Nova Scotia are frustrated and have lost the confidence that they had in you, because they don't get any answers. Nobody gets any answers. It's just create smokescreens; you know, you blame it on the district health board or the doctors or the nurses or the cleaning lady. It doesn't matter who; it's just not you.
Somebody should lift the fog from around your shoulders there, Mr. Minister. You're the individual who's responsible for health care at the Northside General Hospital and at every hospital in this province. I think somebody over there should wake up and smell the coffee. You guys have been over there two and a half years. You've already spent more money than anybody in two and a half years. (Interruption) In two and a half years you've spent more money than your previous Buchananettes over there on health care, and it's in shambles. The entire health system in this province must be being destroyed by your government, it has to be. You stand up over there; you're pretty brave you stand up in this House and you just create more smokescreens.
Ambulance service, Mr. Speaker, just last week - and I will table this in the House - there was an after midnight call to the ambulance and apparently it was slow in arriving. I have also, right here, an e-mail from a family that has lost a father as a result of bungling last summer in Bras d'Or on the Trans-Canada Highway; the response time was over one hour for this individual bleeding to death in a drain. The ambulance didn't get there, Mr. Minister. It didn't get there. What are you doing for these types of situations in Nova Scotia?
[4:45 p.m.]
MR. MUIR: Mr. Chairman, I want to assure the honourable member that one of the things our ground ambulance provider does is it's very concerned about response times and has them built into contracts. Wherever there is an unusually long response - and to be quite frank, I guess, unfortunately, it does happen - sometimes they don't meet, but in the number of calls we have in the course of the year, in most areas they exceed the contractual response time.
Now, the particular case to which the honourable member is referring, I'm not familiar with it. Of course, if I was, I couldn't comment on it anyway. If he or members of the family have a concern about response time, I know there was one accident out there where there was a lot of folklore around the response time and what happened. Once it was investigated and documented, including playing tapes for people who were concerned, they
found that indeed what transpired was very much within standard. So if the honourable member has something that he would like officials from my department to take a look into that's new, if it's the case, which I think it may be, I would suggest that the honourable member has his facts incorrect.
MR. BOUDREAU: Do you intend to impose user fees in Cape Breton?
MR. MUIR: Mr. Speaker, we really haven't introduced any new user fees this year, with the exception of Pharmacare and an increase in ambulance. But specific to Cape Breton, the Department of Health is concerned on a province-wide basis. Anything specific to Cape Breton, no.
MR. BOUDREAU: So is the answer is no; is that what I understand? The answer is no? Is that correct, Mr. Minister? You're not going to impose user fees in Cape Breton?
MR. MUIR: Mr. Chairman, we don't impose user fees in Cape Breton or anyplace else. If there are instances where user participation is necessary or needs to be increased, it's done on a province-wide basis. Now, if the honourable member is referring to an increase in parking charges or the establishment of parking charges at one of the facilities, that's not something we do. Again, you can't suck and blow at the same time. You either have some local responsibility or you have central, you know. I think what he is saying is, where it's convenient, I would like to have local responsibility, but where it's not convenient, I would like you to have the responsibility.
MR. BOUDREAU: Do you anticipate any job losses at the Northside General Hospital after the review that is currently ongoing and the reports that are coming in at the end of April? (Interruptions)
MR. SPEAKER: Order, please. The member for Cape Breton The Lakes has the floor.
MR. BOUDREAU: The ongoing review that's taking place at the Northside General Hospital in regard to this business plan that was provided to you and your department, will there be job losses at the Northside General Hospital this year?
MR. MUIR: Mr. Chairman, I don't think we've had any indication that there are going to be any significant layoffs. But again, that is a district health authority, and it may be that people are given the opportunity if a position collapses in one place opportunity, because it is a DHA, to go someplace else.
MR. BOUDREAU: What will happen to the wellness clinic at the hospital and the other clinics that support the maternity ward? What do you intend to do with these clinics?
MR. MUIR: Mr. Chairman, wellness clinics would be part of a primary health care initiative. A wellness clinic is not necessarily directly related to the actual delivery of babies, and there's no indication that that's going to change.
MR. BOUDREAU: Thank you, Mr. Chairman. How much do you anticipate group purchasing will save?
MR. MUIR: Mr. Chairman, they would have, in the business plan that was submitted, roughly $860,000 of administrative savings; exactly what proportion of that is from group purchasing, I don't know.
MR. BOUDREAU: What happens, Mr. Minister, if you don't achieve your goal?
MR. MUIR: Mr. Chairman, I think the question was if the DHA - the legislation says that if they run a deficit, it would be incorporated in its first charge against next year's budget.
MR. BOUDREAU: Mr. Chairman, with the announcement yesterday of extended closures at Christmas, at Easter, and during the summer, what do you anticipate will happen to wait times?
MR. MUIR: Mr. Chairman, at most of the facilities across the province there are seasonal slowdowns, whether it's in the Capital District Health Authority, the Cape Breton District Health Authority, or in DHA 1. Generally the reason for these slowdowns is that staff, both physicians and nurses and other health care professionals, take vacation. There are also periods of time during the year when, if people, are having elective services or have to access elective services, they don't want to have them done the day before Christmas or the week before Christmas or something like that. I see Dr. Smith nodding his head over there. From his experience he would be agreeing with me on that. So there is a pattern.
I know last year, because of a staff shortage, sometimes the summer slowdown, they shut down beds before they originally were ready. They work on an annual budget. I'm sure that when they put their budget together, they're working on volumes, and either they're building in a volume increase - I'm not so sure that they are actually looking at particular savings during the times that they might take beds out of service because of the unavailability of staff.
MR. BOUDREAU: Mr. Minister, do you have a study done in this regard, or do you have any statistics to clarify what you just said, that you're ensuring the residents that the wait times will not increase? Can you table the information that you gathered to justify your decision to allow DHA 8 to allow these extended hours?
MR. MUIR: We don't have tremendously good information on wait times as it is. As you know, the wait time does vary from position to position. Sometimes, if you're thinking of a specialist, a person may have a relatively long wait time. Just to give you an example, I suppose, orthopedic service was reintroduced at the Aberdeen Hospital two or three months ago or something like that; they got an orthopedic surgeon. If you were to come to Halifax or down to the Valley or go up into Cape Breton to have a procedure take place, you would be looking at six months for an elective procedure. If you had happened to be referred to that physician in DHA 6, you might have been able to get that service in two weeks.
MR. BOUDREAU: Mr. Chairman, I guess that's a no, anyway. In reply to a question I asked Mr. Malcom last night, he indicated to me that he had the problem at Northside General Hospital in regard to the doctors' fees corrected. Is that true?
MR. MUIR: I wasn't at the meeting last night, Mr. Chairman, but I know that Mr. Malcom had expressed some concern about this previously. So I assume what the honourable member has reported he did say.
MR. BOUDREAU: Mr. Chairman, if I may, Mr. Malcom indicated that it was a temporary agreement with the local doctors that will last six weeks, approximately. Now, this is a long-term care facility. You're just trying to sit there and justify the existence of it. You say you support it. Does this sound like a really sound deal for the hospital, to come in here with a six-week plan, Mr. Minister? What do you say about that?
[5:00 p.m.]
MR. MUIR: Mr. Speaker, I know some broad parameters of what they were proposing. It's an agreement or a solution that's being solved at the local level. You say it's a six-week solution; then I'm sure that they will continue to find a permanent one.
MR. BOUDREAU: Mr. Chairman, could you table your doctor recruitment plan here today, please?
MR. MUIR: Mr. Chairman, I think that the honourable member is perhaps referring to the rural incentive program. We don't have a - whatever you would call it (Interruption) Well, that's not true. I don't think we have it written down, but we do have a rural incentive program. I don't have it with me right now, but we can get that and I would be pleased to table that.
Mr. Chairman, I just want to go back and say that with regard to physician recruitment, we are the second most successful province in Canada and probably the most successful district (Interruptions)
MR. CHAIRMAN: Order, please. I'm having a great deal of difficulty even hearing any of the comments from both members, so I would appreciate it if the members would take their private conversations outside the Chamber, please.
MR. MUIR: We are the most successful province in the country in terms of physician recruitment. Clearly what we do works better than most other jurisdictions, and I would probably say, just from my experience, that the most successful district in the province in terms of recruiting physicians has been DHA 8. I was up there, I suppose, it was a month ago. I was actually up in New Waterford at the anniversary of one of the long-term care facilities there, and it was very nice. Indeed, the member for Cape Breton Centre was there that night, and Mr. Malcom indicated he was the guest speaker. I think there was someone called a gerontologist, who is a physician who specializes in working with older people. There are only about eight of those produced nationally each year, so you can understand that the competition for the services of these people is very keen. They have recruited a second one for DHA 8 and I suppose, as the department, I should take credit for that.
MR. BOUDREAU: Mr. Chairman, I can certainly acknowledge to the minister it was nothing he did because all members, and I think even the member for Cape Breton North, would agree that without Dr. Naqvi at the district health authority, we probably wouldn't have anything down there, let alone new doctors coming in. It's only because of his knowledge and his commitment to that community that there's any success at all, Mr. Minister, and you know that. Sometimes it takes a man to really stand up and say that. So perhaps Dr. Naqvi really should get the recognition that he deserves from the minister.
MR. MUIR: Mr. Chairman, I have publicly stated my admiration for Dr. Naqvi's ability to recruit physicians to DHA 8. Indeed, I think it was a year ago, last January, they had a new physician reception. There were something like 50 people at that reception. Dr. Naqvi, there's no question, is in a class by himself in this province when it comes to recruiting physicians.
MR. BOUDREAU: Thank you, Mr. Minister. Now, your doctor recruitment plan - are you aware that approximately 10,000 to 15,000 people on the Northside have no doctor? They have no family doctor because your recruitment plan is failing. Now, Mr. Minister, when can I tell the people I represent that they can expect to have a family doctor to take their children to when they're sick?
MR. MUIR: Mr. Speaker, unfortunately, there are sections of the province where there is an insufficient number of family doctors. I will take the honourable member's word that the Northside is one of those. We continue to work with the people on the Northside, or the people who are responsible for physician recruitment in the communities on the Northside, the same as we do in Parrsboro, Noel, Springhill, New Waterford, or wherever physicians are needed.
MR. BOUDREAU: Mr. Minister, how many nurses did your department hire in the previous government year, your fiscal year? How many full-time nurses did your department hire?
MR. MUIR: The honourable member for Dartmouth East asked that question yesterday, I guess, what was the difference in the active enrolment of the RNs and the LPNs last year and this year. We will endeavour to get that information.
What I want to tell you, Mr. Chairman, is that I tabled in here last week an update to our nursing strategy. We committed $5 million to a nursing strategy and, of course, one of the first things that we did when we came into office was increase the entering class at the RN schools by 33 per cent. I'm pleased to report that applications to RN programs have certainly increased in each of the three years that I've been involved and that applications to the licensed practical nurse programs - there is an oversubscription or an extra number of applications to those.
Mr. Chairman, 80 per cent of the $5 million nursing strategy went toward orientation and continuing in speciality education for practising nurses and LPNs. We've already had 60 student nurses who have completed co-op work terms, and we will have 90 more of these nursing students beginning this Spring. There are 75 RN students who have received bursaries; a condition of those bursaries was a return of service for one year and we have 75 people who have done that. In addition, 46 LPNs have received bursaries because they completed a refresher course or a pharmacy course, and there are 95 more in progress.
The nursing strategy, as you can see, Mr. Chairman, not only dealt with recruitment and retention, it dealt with upgrading the professional skills of our nursing practitioners. I also can say with some degree of satisfaction that the efforts of the department, along with the district health authorities and long-term care facilities, are that more than 90 new nurses have been recruited from outside the province to come and work in Nova Scotia.
MR. BOUDREAU: Mr. Speaker, I am sure that a nurse in a maternity ward is a specially-trained nurse. Could you tell me, Mr. Minister, how many extra special nurses are available to work in maternity wards?
MR. MUIR: Mr. Chairman, that's a difficult question to answer. Obviously, I don't have a specific number, but the other thing is that in a good many facilities there may be some specialized maternity nurses and people who do obstetrical work, but in the absence of babies, they may also be fulfilling functions and valuable roles in other sections of the hospital.
MR. BOUDREAU: Mr. Chairman, I know the honourable minister is a schoolteacher, but I want to acknowledge to the minister in the House and all Nova Scotians that I'm an auto mechanic, and I'm aware that nurses in maternity wards have special skills. They have
special skills. Ask your assistants; I'm sure they will tell you that. Why are you not retaining the nurses you're transferring out of the Northside General Hospital? Why are you not retaining those special skills within the system in DHA 8? Why? Why not?
MR. SPEAKER: The honourable Minister of Health.
MR. MUIR: Mr. Chairman, the administration of the DHA lies with the local governing board and its administration there. That's not something that we in the Department of Health would be directly involved in.
MR. SPEAKER: Order, please. The member's time has expired. The Chair recognizes the member for Dartmouth North.
MR. JERRY PYE: Again, I want to thank my colleague for Halifax Needham for allowing me some of the allotted time during the Health Budget Estimates. I want to go back on my train of thought with respect to Pharmacare. We all know that the significant, high cost of Pharmacare is directly attributed to the high cost of drugs. I do know and I do believe that the minister has had a meeting in Newfoundland with respect to this very topic, about possible joint intervention - I shouldn't say joint intervention, but joint co-operation with respect to the purchase of drugs through the Atlantic Provinces. I'm wondering if in fact the minister can elaborate for this House some of the thoughts behind the discussions that may have taken place there?
MR. MUIR: The subject of discussion there is not so much about purchasing as about putting together a single formulary advisory committee. A structure is in place now in which the four provinces join resources to evaluate the efficacy and cost-efficiency of new pharmaceuticals and, I suppose, old ones too, because sometimes thing come off the list. I believe I saw a report last week that indicated they had already reviewed five drugs and they had - I have to be careful how I phrase this - recommended that some were appropriate to be placed on a formulary and some were not appropriate to be placed on a formulary. The individual decision about which drugs will be placed on a formulary still remains the responsibility of the individual province.
I can also tell you, and I think I did mention this during Question Period the other day, the Premiers have directed that a similar national program be put into place, and I believe the structure of that program is supposed to be finalized by August. The Premiers are meeting here in Halifax at the end of July or the first of August, and I believe the completed proposal is to be ready for the Premiers at that time. I can tell you that the work that has been done in Atlantic Canada, particularly in Nova Scotia, is sort of a prototype of what's going to happen there.
MR. PYE: I guess I'm trying to make clarity around this. If, in fact, there was a joint committee meeting and it was simply to discuss the formulary and what pharmaceutical products may or may not be on the formulary, yet not restrict the provinces as to what they can do so that the have province would be able to continue a pharmaceutical product if it chose to do so, I guess I'm wondering how effective such a body would be with respect to putting those pharmaceuticals on the formulary, those ones that would be dropped off the formulary and so on. Minister, you're very much aware of what I'm presenting; where is the effectiveness, who's answerable and how does it function in that manner?
[5:15 p.m.]
MR. MUIR: The advantage of that is that if the process was being done four times, theoretically it would be four times as expensive. On the other hand, if you bring people together, you understand that there are some expenses associated with that. Similarly, at the national level, the rationale was why should we all be duplicating the evaluation efforts? There are, I think, eleven evaluation processes that currently go on in the country. The intention of the first ministers was that we would go down to two or, at the most, three. The reason I say two is that Quebec has indicated that it would be pleased to make its information available to us or to the other provinces and territories to help in decision-making. They weren't going to participate in a national scheme for single review process. The federal government also reviews, in addition to the provinces. I believe Alberta did the reviewing for the territories and the Yukon. That's why I said 11; it would be 10 provinces plus the federal government.
The saving, Mr. Chairman, would be administrative. Rather than having something reviewed by 10 or 11 scientific groups, it would presumably be one, which should lead to some cost-effectiveness. Just in the price of pharmaceuticals, which the honourable member mentioned in his previous questions, the drugs that we pay for through the Seniors' Pharmacare Program or Community Services, the other drug programs, we buy those or they're provided to the people who use them at cost. The pharmacists make a dispensing fee, but they technically don't make a profit, there's no mark up on the drugs themselves. The cost of the drug to them is what we pay for it.
MR. PYE: That was part of my question and I was wondering if the ministers, when they've met on the national level and actually talked about the impact that the pharmaceutical legislation or the drug patent legislation has had with respect to the cost of drugs and pharmaceuticals across this country. The consumer pays for the high cost of drugs at the pharmacy and not by any particular institution or hospital unless the individual happens to be infirm or on social assistance. I guess my question to the minister is, have you talked about or has your government spoken with other governments at the national level about the impact that the drug patent legislation has on the cost of drugs in Canada?
MR. MUIR: That is a discussion item from time to time at meetings of national health officials, both at the deputy level and the ministerial level, and those discussions continue. The answer is probably not as clear-cut as most people would think. If it was really clear-cut then it might have been done, but there are things that have to be considered.
MR. PYE: I will move off that particular topic and go on to another topic, home care service and home care delivery.
As you know, Mr. Chairman and Mr. Minister, in Nova Scotia, because of the heated economy and a number of call centres and so on, a number of people who were normally home care workers have left employment in home care services and have gone to better-paying jobs. As a result of going to better-paying jobs and not being able to attract individuals into home care services because the jobs are basically at minimum wage or a bit above, less than a normal $10 an hour, I guess my question to the minister is this, do you still have a difficult time, because the number of calls I and others across the province receive - and in certain parts of the province, it may be different than others, but particularly in the metro area - it's difficult to keep the number of home care workers so that clients, when they need those home care workers, are able to have them. So I'm wondering, has the minister done any assessment with respect to home care workers, pay scales and methods or ways to keep them employed within the home care service industry?
MR. MUIR: I'm pleased that the honourable member asked that question, Mr. Chairman. One of the things we've talked about that was an unfortunate situation in Nova Scotia was the great disparity around the province in services that were delivered and wages that were paid for, basically, the same work. One of the commitments of governments, and perhaps the previous government was to try and bring up wage parity. In other words, if you were a home support worker down in Digby-Annapolis and you were a home care worker up in, perhaps, the Cape Breton Regional Municipality, there would be some equality of wages. We did find a very broad discrepancy. As a matter of fact, the wage discrepancy across the province did approach about 100 per cent.
It's kind of hard to right that at one time, but the department, along with the union, has been working with that, and this year we're pretty well at the break-even point. Of course, a lot of the money that we put into salaries had to do with this wage parity issue as opposed to percentage of raises on individual things. We did the same for LPNs and RNs with respect to acute care and long-term care facilities or home care. It was a major issue here in the province. We think now that the salary levels that have been established are going to make it more conducive for people to remain when there is an option for them to go to.
We contract a good many of our home care services to outside agencies, as you know. One of the agencies for which we contracted is up in the constituency of the honourable member for Halifax Needham, Northwood Homecare services, and there are a variety of others. We get some from the VON and a variety of agencies across the province that do
provide that. That was certainly a concern. I think it's going to be less of a concern because the more competitive, and I'm talking about competitive to other things you can do with education and skill. I think the problem of procuring resources is going to be less this year than it was last year.
MR. PYE: Mr. Chairman, I guess that's some comfort, but we still have people who, in fact, when they enter the hospital and then they come out still have this waiting period of time in which to get a home support worker. I guess my question is, if this is going to be a continuous problem, the minister might very well have to up the ante in order to encourage more people to become home support workers. If that means that there need to be improved skills and better ways of delivering that, we deliver it through the private sector and not to imply that the VON, Home Care Nova Scotia and a number that the minister has already made comment on are not delivering home care services appropriately. That's not the case. The case is that they whom you contract the service out to are in a position as well of being unable to attract individuals into the home support programs, particularly to become home support workers, in order to deliver the services to those people who are in need. I guess my question to the minister is, do you see that improving in this fiscal year?
MR. MUIR: I think it will, Mr. Chairman, simply because of the recent wage settlements and the parity that's been built into them. I think the new financial packages are certainly going to be more attractive, and I think more people will come in and stay longer. The demands on home support workers or home care workers, whatever you want - there's no question they vary. Sometimes it's a matter of providing intermittent service, once every two weeks, or sometimes you have to go in and do it three times a day or whatever it would happen to be. Sometimes a home care worker may be an RN. Somebody else may not need that type of training. We think that there will be more people available this year.
In terms of the delays, looking here at the Capital Health District, I think most of those needs are met within a day or two. There are some cases where there are special needs and no question, as the honourable member has pointed out quite accurately, there is a time lag. We work to try and reduce that, as do the people who are responsible for it. On the other hand, if there is an emergency, a discharge coming out of a hospital, I have not heard cases - I'm not saying that there aren't, but none have been drawn to my attention - where those needs have not been met on an emergent basis.
MR. PYE: Mr. Chairman, to the minister, I don't know if the minister is aware or if the minister keeps a record of the number of people who may have been evaluated and then, because of their income, no longer receive home care support service or else are expected to pay for it themselves. I have to apologize to the House that I'm not sure where the cutoff is with respect to people having to get home care services without costs and then having to pay for the home care services themselves. But I do know of a particular individual who is extremely disabled and in fact had been receiving home care services until approximately a year ago. Now that's not only one individual, but I should have brought it and proposed it
to the minister, through the Legislature, to his desk, the number of individuals who have actually called my office to tell me that they are no longer entitled to home care services unless they pay for the home care support worker service.
Surely there must be a record somewhere with respect to the number of people who have been re-evaluated and actually been dropped off the home care services program. If there is, then I'm wondering if the minister has given any consideration to reviewing and making an assessment with respect to the ceiling on the amount of income that one can receive, and not necessarily tie it solely to income, but to special needs that may be required for that particular individual? I guess my question to the minister is, has he given some serious thought to this very important issue?
[5:30 p.m]
MR. MUIR: Mr. Chairman, one of the things that we found, and I've indicated this on the floor of the House more than once, the continuing care sector, there is very little system associated with that here in Nova Scotia and very little consistency from one part of the province to the other. Part of that was simply that at one time, these services were the responsibility of municipalities and every municipality did its own thing. The province, for whatever reason, decided that it will get into the business of taking, perhaps as part of service exchange or something and, of course, if you get into a provincial program then you have to try and set provincial guidelines and standards, and we've been very busy trying to do that for the past couple of years.
One of the things with people who were being dropped off from home care, it's probably - my guess is they were people who were not entitled to home care, that level of service of home care. In other words, they were receiving service over and above that which the policy allowed for or called for. They may have unfortunately been doing this for some time. I don't doubt that, and I know that that happens and discomfort is created when the thing is changed. However, it is part, basically, of trying to make these services accountable and sustainable, Mr. Chairman.
There are always exceptions, we know that, and our people make the exceptions as they see appropriate. In some cases they say that the type of service that was delivered was clearly above that which should have been being provided. We also can say that in terms of the fees that are associated with home care and I think maybe this is a matter the honourable member was concerned about - is that for the nursing service, there aren't fees for that. The fees which are charged would be for, housekeeping services and things like that, and they are charged, really, on the ability to pay.
Now I know you're an MLA and I'm an MLA and the chairman is an MLA, and we get calls from people in our constituency who say I need more home care or I want more home care. I've gotten the calls and you've gotten the calls and I know the chairman has
gotten the calls. Like you, and I am sure like the chairman and myself, when we get these calls we then investigate them or try and help the person who has made the calls so we can get back to them and give them a response. Most of the time, to be quite frank, my experience is that the service that is being delivered is clearly within the policies that are in place, that in very few cases a decision has been overturned. I will also say that in respect to home care services, when they are appealed or whatever, is that the people who make those decisions do seriously re-examine things and if there is a need to make a change then that change is done. I feel very confident in that. Unfortunately there is a big difference really between sometimes what a person wishes to have and what their need really is.
MR. PYE: Thank you, Mr. Chairman, to the minister. I should have acknowledged that there are two levels of services that are provided through the home care. One is the professional nursing service, and the other is a professional housekeeping and home care services that follow through as well.
Having said that, the most important thing is that when someone comes to my office - and I want the minister to be very much aware - that we do the work that is needed to look at the budget, look at the particular needs of the client and so on before we call the person who's delivering the home support worker to the client, and we make sure that we have all the bases covered. Sometimes it's extremely difficult to justify why one is a need and another is not. I just make that as a general statement because people become extremely discouraged after receiving a level of service - and they were receiving that services for maybe two, three, four years - and then all of a sudden find themselves through re-evaluation that in fact they no longer have that level of service provided to them. Mr. Minister, I don't want you to respond to that, that simply is a general statement; there's no need for you to respond to that particular question unless you wish.
The other area that I want to go to is with respect to the gambling money. We know that gambling has increased significantly in the Province of Nova Scotia and we also know that in fact the Nova Scotia Government takes in revenues of approximately $174 million a year from gambling and that in fact there is supposed to be 1 per cent of the gaming revenue set aside for gambling addictions. I'm wondering if the minister can tell this House if, in fact, the Gaming Corporation hands over to the Department of Health 1 per cent of that revenue to be distributed out to those agencies and/or organizations that are involved in gambling addiction services. As well, has the minister expended all the $1 million that he had, I believe, in the previous budget - and I didn't look in the budget, I do apologize - if there is a $174 million to the provincial coffers in the last fiscal year that would result in about $1.7 million in the minister's Health budget. Can the minister tell us exactly how that money's going to be meted out?
We do know, as of last year - I believe that I asked a similar question around this and I want to thank the minister - that in fact he did distribute much of that $1 million, and much of that $1 million, I believe, may have gone into gambling addiction services. However, my
question to the minister is, does the Department of Health keep assessments on the number of people who have become addicted to gambling and the greater need for services to be provided through the Department of Health to persons with gambling addictions and the programs and services that are delivered by agencies and organizations outside the Department of Health, but come through the Health Department to the Drug Dependency and funnelled on down? I guess my question to the minister is, how much money are we looking at?
MR. MUIR: Mr. Chairman, last year the department took in about $1 million from that, and I think actually it was just slightly less than $1 million, but I use $1 million in round figures. The distribution of that money - it's 1 per cent of the gaming revenues, and half goes to the people, the VLT, and they're supposed to put in responsible programming, do things through their organization to prevent people from becoming problem gamblers or whatever you would want to call it. About half of it comes to us, and I said our share last year was about $1 million. There's a thing called the Nova Scotia Gaming Foundation - you would be familiar with that organization - that has control of that money.
As you are aware, Mr. Chairman that foundation was set up really to fund research into gaming addiction. We had last year - I guess a year and a half ago or two years ago - we funded the Nova Scotia Health Research Foundation to the tune of $5 million a year. Perhaps you could call it ministerial prerogative or whatever it was, I guess I had the right as being minister, I felt that some of that money could be better used than going into straight research, simply because we had now increased the research dollars the other $5 million. To be quite candid, some of the things which I've seen funded as research grants I again, rightly or wrongly - the people that did these studies would say wrongly - didn't feel that the contribution that they were making in terms of bang for the buck wasn't as great as it could be. As a consequence the gaming foundation has received some proposals for operational funds and they have given some of that out this year. I felt that there were some agencies and I believe that one of the ones that may have gotten it may have been an organization on your side of the water.
MR. PYE: Mr. Chairman, I want to thank the honourable minister because the honourable minister did, in fact, meet with the Freedom Foundation last year through a crisis situation and helped them with some funding, and rightly so. We recognize that there are probably other addictions, but I certainly know that alcohol is an addiction. Substance abuse has become a very strong addiction and now gambling has become a very strong addiction as well.
I am pleased to see that much of this money does not go into research, but I believe that we do need to continue putting some money into research, Mr. Minister, and I wouldn't stand here and say that that should not be the case. I do think that people who are the street-front level, who see the people who have come to them with a new addiction, a new addiction called gambling addiction, many of the agencies and organizations themselves are
still in the process of defining how they are best able to deliver programs and services for these individuals to help them through the tough time and to bring them back out of their particular addiction, and it's not easy.
My question to the minister was - and I don't think that you responded, if you did I may not have been paying attention - do you keep a record or an evaluation of the number of addictions that have been created as a result of gambling in the Province of Nova Scotia? Is there - what can I say - a list that implies that it has increased over the period of time? (Interruption)
Let's assume the demographics - that's the appropriate term that I was looking for - did you provide demographics of that kind of a situation, and as it reflects across the province as well, because I do know that sometimes when communities are economically depressed people resort to addictions and one of those might be a gambling addiction, and is gambling greater on Cape Breton Island, or in Sydney versus Halifax, or the metro, or is it greater in Yarmouth, and what kind of an impact does that have across the province with respect to the kind of services that are delivered to people with gambling addictions?
MR. CHAIRMAN: Order, please. Just before I recognize the honourable Minister of Health, once again, and at the urging of an honourable member, I would caution all members to please try to remember to shut your cell phones off, or as the Speaker indicated earlier he would request all honourable members to leave their phones outside and, for Pete's sake, if your phone does ring, please have respect for other members in the Chamber and don't answer it in the Chamber at the very least.
MR. MUIR: Mr. Chairman, I did see a briefing note referring to that this morning. Unfortunately, I didn't bring it with me. The numbers of problem gamblers are generally established - I think this is what you're speaking about - and the particular figures I saw this morning had to do with VLTs. I think it's less than 1 per cent. I'm not saying that 1 per cent is a good number, I'm just trying to go back in my mind, but I will review that and if you would like to ask me that tomorrow, I can have the numbers, at least that are supposed by representatives of our addiction services.
MR. PYE: Mr. Chairman, I guess when you say less than 1 per cent, that's consistent with the norm across the country, and internationally as well, because those are the kinds of numbers that they sort of use with respect to individuals who have problem gambling. However, that will conclude my time for now and I would like to pass my time on to the member for Cape Breton Centre.
MR. CHAIRMAN: The honourable member for Cape Breton Centre.
MR. FRANK CORBETT: Mr. Minister, first of all I would like to start off on somewhat of a negative note and say I'm disappointed once again - and this is not an aspersion on the staff that's with you - the deputy isn't here this year for estimates. God knows this province pays enough for him, and I think, you know he should be sitting here being accountable from time to time.
[5:45 p.m.]
Mr. Chairman, much has been said in the last few days around the DHA in Cape Breton and around the Murray report. I want to go there, Mr. Minister, for a few questions. There has been public discussion around that document, and there have been at least four public meetings that I know of. The CEO and some board members had taken that document around, and clearly when that document was presented to the public in New Waterford it was quite soundly trashed.
There were many mistakes in that document, and they were exposed. I guess one of the first questions I want to ask you, Mr. Minister, is have you discussed this document, or your staff, directly with the people from DHA 8 and have they acknowledged the factual errors that are in that document, especially as it relates to the emergency department in New Waterford Consolidated Hospital? I see you're still looking for stuff so I will pile another question on top of that.
Another one that was fairly offensive to many residents in the New Waterford area, in how they extrapolated some of their numbers and how they used figures, was when they did the other three emergency departments at no time was there a relationship of the age of the attending physicians in those other three departments, but certainly it was used in a negative connotation for the New Waterford emergency. So I find that troublesome. Can you give me a reason, or your department, why they would have used doctors' ages as being over 50. I didn't know we were allowed to discriminate, and on the other side is . . .
MR. MUIR: You have to be careful when you're talking about people over 50.
MR. CORBETT: That's right, Mr. Chairman. So I also want to know what (Interruption) It's your department that's condoning that, not me. So what I want him to answer is the factual errors in the Murray report and the idea of pointing out physicians' ages?
MR. MUIR: There are a number of questions there and perhaps I could answer most of them by making a few comments. The emergency services review for the Cape Breton District Health Authority, you know the real issue I guess, and the honourable member certainly knows it, you've got four so-called emergency rooms there within a relatively small
geographic area. The Medical Advisory Committee and the DHA felt the best way to try to get a handle, or a go-forward plan for this thing, that would meet the needs of the residents was to have an external review. They engaged a Dr. Michael Murray, who is a highly respected emergency medicine specialist from Ontario. The review was commissioned by the medical advisory committee, or the medical management committee, to try to find out how they can deliver emergency services best across the district.
Now, I want people to keep in mind that what the board did was to receive this report and then, as the honourable member has mentioned, go out to the public and say this is what the report says, let's have a discussion about the recommendations and the findings and whatnot in there. I can tell you that I guess what people have to understand is that from the point of view of the district health authority and the medical advisory committee, they are concerned about the delivery of emergency services to the whole area. They aren't concerned about necessarily the delivery of service in New Waterford, nor Sydney, nor Glace Bay, or Northside, or whatever it is. They are responsible for the whole district and they felt that this certainly was a challenge. I mean we know that the rooms have been shut down.
MR. CORBETT: Not in New Waterford.
MR. MUIR: Well, perhaps not in New Waterford, but others have been and the question of how we can maintain the service. Now, to get back to your direct question, I have read the report. It was sent to me. I have not discussed the report with anybody from the Cape Breton District Health Authority and, to my knowledge, none of my staff has. This document was an internal document. We weren't asked for our opinion.
MR. CORBETT: This is one of the few points you and I will agree on, Mr. Minister, I'm sure. Yes, it was an internally generated document by the MAC, but I think it's important, whether it's you or your staff who are perusing that document, that you trust and believe that the figures you're being presented in that document are accurate and true; I think you would agree with that. If we're using CTAS numbers - Canada the triage assessment system numbers - it's important that they reflect the actual acuity on the CTAS scale so that we know what we're talking about, we know whether they're fours or threes or fives or twos or ones, and that those numbers are now accurate. The CEO has agreed to that, as did members of the medical committee at the hospital, and I'm just wondering if they had brought that to your attention when they sent that on to you?
There were many things in that report that the residents found objectionable, and not the least of which was saying that this emerg was staffed by doctors, three who were over 50, and one was actually in his 80s. They found that very repulsive, because they should not discriminate by reason of age.
Another thing - it was in part of your answer - was the fact that there have been closures in emerg. One thing I have to get on the record is that at no time was New Waterford's emerg ever closed because of a doctor shortage; it has never been closed in my history with the hospital. I know that hospital will be 39 years old, if not a few days ago, then sometime in the first or second week of April - that's when that hospital opened in 1963. It's roughly 39 years old, almost to the day.
AN HON. MEMBER: You're not that old, are you?
MR. CORBETT: Yes, I am. I am one of those guys buckin' on 50. Mr. Minister, since time is growing short, I'm trying to get some questions in here today. One of the real frustrations we had with that public meeting was for the public to say, okay, this is fine, this is your report from Dr. Murray as presented by the CEO, who is a very honourable person in his own right, but what had happened was when the local community said look, we want to poll all the board of director members on this and ask both me, through my office, and through the CEO's office for the mailing addresses of the board of directors for DHA 8, they were refused. Is that a matter of policy within the Department of Health, to deny the public access to the mailing addresses and home addresses of boards of directors of DHAs?
MR. MUIR: Just a couple of things getting into this. First of all my staff has advised me that the DHA did correct those numbers that you indicated needed to be changed. Secondly, on the issue of giving out the names and addresses of board members, I think probably the philosophical issue of that would be - not it's not our policy - that the board speaks as one voice. If people have an issue with the Cape Breton District Health Authority, then you're not talking about individual members, you're talking about the board collectively, and I just want to speak to that very briefly.
One of the things that I can say I have admired about the Cape Breton District Health Authority is that the board does seem to speak as a board; unfortunately we aren't at that stage in all other DHAs. We still have some DHAs in the province where members are representing particular interest groups or particular geographical constituencies as opposed to looking at the board as a single entity. Halifax is, I think, pretty much in that category too, but we do have some other boards that have to go some to reach that level. It will take time, but we will get there.
MR. CORBETT: Mr. Chairman, he still didn't answer the fundamental question. Is it the Department of Health's policy not to release those addresses? They weren't released to the public or to members of this House when they were asked for through our caucus office. It's fair to say that they speak with one voice, but they are an unelected board and who are they responsible to? Do they just go to you or whatever? They have to be responsible; if they are going to be a member of a district health authority, then they have to represent the people within that district. If they can't get access and if people don't have access to them, they're not going to get that information. This is not casting aspersions on anybody in that
chain, but it's the responsibility when you take on a public office, whether elected or appointed, you have to be responsible to the public. So I'm going to ask you again, Mr. Minister, is it the policy of the Department of Health not to release those names and addresses?
MR. MUIR: Mr. Chairman, I didn't know that was the case, so I'm not speaking on behalf of the board, I'm speaking on behalf of how I would see the reason for the situation that you're speaking of.
MR. CORBETT: Is it policy?
MR. MUIR: No, it isn't the policy of our department.
MR. CORBETT: Why didn't we get them?
MR. MUIR: It would be a decision of the Cape Breton District Health Authority. What I can say is that I do appreciate or admire them for saying, folks, this is a collective decision, we're speaking as a board, not as individuals. They represent all of the people up there. To be quite candid, if they want to find out who's on that board, that's not a difficult thing to do.
MR. CORBETT: Before I adjourn debate . . .
MR. CHAIRMAN: Well, honourable member, we will go up to 6:00 p.m.
MR. CORBETT: Mr. Minister, you still haven't answer the question whether it's the policy of the Department of Health. Why wouldn't you release them then? It's your department that wouldn't release them to our caucus office. You check; we asked for them and they weren't released to our caucus office. As you say, through the intrepid use of some local citizenry those numbers and addresses have been ferreted out. What you're telling me by a nod of your head is that it's not the policy of the Department of Health to hold back those names and addresses from political Parties?
This is a real problem around the Murray report, that you had citizens trying to find out answers and they were being blocked; we don't know why. Again, I've got to go back and say that in my short life as a politician, probably one of the people that I've admired most in public life in a non-elected way is Mr. John Malcom. I think he's done a tremendous job in a very difficult situation. That's not always a popular thing to say back in my hometown, because they see him as the guy with two horns. (Interruptions)
Yes, but again I want to say, Mr. Minister, that we will be adjourning debate for the day, and hopefully we will be at this again, and maybe the deputy will be here. I move adjournment.
MR. CHAIRMAN: The motion is to adjourn debate in Supply, Health estimates.
Is it agreed?
It is agreed.
Would all those in favour of the motion please say Aye. Contrary minded, Nay.
The motion is carried.
[5:59 p.m. The committee rose.]
