MR. CHAIRMAN: Order, please. The honourable Deputy House Leader.
MR. WILLIAM DOOKS: I call for the estimates for the Department of Health.
MR. CHAIRMAN: We will continue the estimates of the Department of Health.
The honourable member for Cape Breton Centre has 11 minutes left.
MR. FRANK CORBETT: Mr. Chairman, when last we spoke and I was asking this minister some questions around the Murray report dealing with the emergency rooms in and around industrial Cape Breton's four emergency departments, the one thing that I wanted to lay out to the minister is the fact that of the three outlying emergency departments - North Sydney, Glace Bay and New Waterford - New Waterford was the only one that has not seen downtime or darkened rooms. Yet in Dr. Murray's report, it's the only emergency department singled out for closure. It was a department where all the staff were willing to participate in emergency hours, I think with the exception of one who for medical reasons couldn't participate. I want to ask the minister, while this was a report that was commissioned by the Medical Services Committee of the Cape Breton District Health Authority and not your department - but I want to ask the minister's opinion on that. Why would it be that the one department that has not gone dark is the one that - and, as we all admitted to, there were faulty numbers used. Why would Dr. Murray particularly choose the New Waterford Consolidated Hospital emergency department to close as opposed to another one?
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MR. CHAIRMAN: The honourable Minister of Health.
HON. JAMES MUIR: As the honourable member for Cape Breton Centre has acknowledged, the report was done at the request of the district health authority. As I indicated to him when we last spoke, I have read the report. I have not discussed that report with any member of the Cape Breton District Health Authority. The only thing that I could tell him by way of answer to that, was that they were looking at the four sites for emergency services, one, basically, emergency department, and I believe the honourable member did mention that in a question about fees or compensation for physicians last week. That's the only thing I can tell you. I've not spoken to Dr. Murray and I've had no conversation with anybody in the district health authority about their report nor their process for assessing the report.
MR. CORBETT: One of the real, great problems that we look at when we get into Dr. Murray's report is that he talks in terms of fee-for-service. I'm sure I don't have to explain what fee-for-service is to this learned minister, so I won't go down that road. But in a study back in 1995 it clearly stated that fee-for-service for small community hospitals is really a recipe for closure. The fact is, if you're in there as a physician and you're working on fee-for-service, the reality is that you may only see two or three patients all night at a rate that would certainly be detrimental to keeping and attracting people. Minister, what is your position and your department's position on a straight fee-for-service for emergency departments?
MR. MUIR: I apologize for my delay in response. My answer is not going to change much because of the consultation, but I just wanted to make sure that the information that I was working from was correct. There are very few situations in the province where there are fee-for-service emergency rooms, flat fee-for-service. We really haven't supported them and the reason for that is that even in the more rural areas where there are centres where physicians are on call, they get on-call dollars by the hour for being on call. Then when they come in they would get the unit value of their fee-for-service, so I don't think there is any emergency service - I'm talking about designated emergency service - where it solely operates on fee-for-service in the province.
MR. CORBETT: I guess you kind of answered it but not really. I specifically said what's your department's position on it? Do you support fee-for-service? And the part that worries me about that, minister, is this. Out of the Murray report, and I appreciate that this is one side's interpretation of it, the physicians in the New Waterford Consolidated Hospital, the position as presented to them was that if they were wishing to keep that facility open, its emergency department, they would have to go for a fee-for-service arrangement. In a public meeting, the chief of staff representing the physicians in that facility said that what was offered to them by the DHA was fee-for-service.
Now, as I stated earlier in my second question to you today, we see fee-for-service situation as quite detrimental to a community hospital for the very reason that I think most people understand. While the CTAS numbers are relatively high in New Waterford, could you imagine trying to attract a physician to work the hours from roughly 6:00 p.m. to 6:00 a.m. on a fee-for-service basis? You would literally be working for nothing. As this forms part of the Murray report, it makes me afraid that's what the Department of Health is contemplating. I am, for sure, more worried about the New Waterford Consolidated Hospital than I am about other ones, for reasons that should be obvious. Is your department now going to go back and start revisiting rural and community hospitals and start working them on a fee-for-service basis?
MR. MUIR: Mr. Chairman, the department is not contemplating that, no. I can tell the honourable member and all honourable members that wherever people are on an alternate payment program, i.e. not on fee-for-service, then there is a shadow billing process. Not in the emergency rooms, it hasn't fallen to that but, in some cases, where people are on alternative funding arrangements - and we have a lot of those - technically the amount that one gets in an alternative funding arrangement shouldn't be greater than what they would get if they were on fee-for-service. Now that's not the case in the emergency departments obviously because, as you just pointed out, if a person probably was working the midnight to 6:00 a.m. shift, a fee-for-service might not be particularly viable, financially.
I guess one of the issues that I assume the Cape Breton District Health Authority, and one of the reasons they commissioned that report is they are running four, 24-hour services up there in North Sydney, Glace Bay, New Waterford, and the Regional. The question is really, do you need four, 24-hour services up there? - and I assume that was part of the question that they were asking. Again, I haven't discussed it with them, but we have three in very close geographical proximity.
MR. CHAIRMAN: Order, please. The time allocated for the NDP caucus has expired.
The honourable Leader in the House of the Liberal Party.
MR. WAYNE GAUDET: Mr. Chairman, I have a few questions for the Minister of Health. This Tory Government promised Nova Scotians back in the last campaign that they were going to fix health care. I think a lot of people out there believed them, that they were going to fix health care, but unfortunately that has not been the case. I think we just have to do a survey around this province and ask Nova Scotians if they feel they are being better served by the health care system today than they were back in 1999. I'm sure a lot of people would probably disagree with the minister.
As a caucus and individual members from this side of the House we have acknowledged time and time again that, yes, government has invested new money in the Health budget. This year the Health budget is pretty close to $2 billion, so with all of the additional money that has gone in the system have we a better system today? There is one sensitive issue that I wish to raise today to the minister's attention and it's regarding recruiting doctors, not just for communities in southwestern Nova Scotia but in many rural communities across Nova Scotia.
There are a lot of people in Digby and Yarmouth Counties who have a family doctor, but there are a lot of people in those two counties at home who don't have family doctors - I'm sure the Minister of Health is aware of this - and not just people in Digby and Yarmouth Counties, I'm sure there are many people across this province who don't have a family doctor. Quite often, and I'm sure, Mr. Chairman, you probably received some of those calls too, from individuals, from people who are looking for a family doctor. But quite often these individuals want to know where they have to go for medical help if they don't have a family doctor.
[3:00 p.m.]
Right now, at home, people have two choices. They can either go to the emergency service at the Digby Hospital or Yarmouth Hospital and quite often in Digby there's a sign outside - for emergency you have to contact your doctor because the emergency of the Digby hospital is closed. So that's one choice the people have, to go to the hospital and hope that they will be able to see someone. The other choice they have, I know right now in Clare and in the Weymouth area, there's a doctor on call, a walk-in clinic, that's over and beyond his regular patients for any given day and those doctors are certainly overworked. The question always comes back, we don't have a family doctor, so they want to know why they can't have a family doctor and others do have a family doctor. Mr. Chairman, that's very difficult to tell people why some people in Nova Scotia have or can have a family doctor and others can't have a family doctor.
Yesterday there was a gentleman from home, an older gentleman who has no family doctor, called our office. He was just coming back from the hospital here in Halifax. His doctor from Weymouth retired because of health problems and his doctor, the specialist here in Halifax asked this gentleman where he should send his report. This gentleman started crying because he didn't have a family doctor and he could not tell his specialist to whom he should be sending his reports. I'm quite sure that this gentleman is not the only one who finds himself in this type of situation in the Province of Nova Scotia, and I'm sure the Department of Health and the minister are aware of this.
There are a lot of people who are frustrated out there without family doctors and, like I said, this is not just a problem that basically happens in southwestern Nova Scotia. I'm sure many rural communities in this province, many people in those communities, find themselves with that problem.
When this Tory Government was elected back in 1999, they continued with the former Liberal Government incentive for attracting general practitioners in under-serviced areas. Under that program doctors were offered guaranteed income, they were offered moving expenses and a signing bonus. I know that this incentive program helped the Municipality of Clare to recruit two new doctors after Dr. Philip LeBlanc and Dr. Belliveau both retired from their medical practice. I know many people from home, from Clare, worked with the office of Frank Peters and the minister's office in trying to recruit two new doctors. There were many people involved: the local doctors; the local nurses; paramedics; the community health board; the chamber of commerce; the municipal council; and many other community groups were involved in helping the Municipality of Clare in recruiting two new doctors.
Doctor Marie-Josee McGraw and Doctor Lesley Griffen were recruited under that program. Also under that incentive program, it helped to recruit Doctor Albert Comeau to return to practicing medicine after he spent a number of years in his car business. Right now the Municipality of Clare is short one doctor because Dr. Griffen returned to do some further studies. Also, the Municipality of Clare - I don't know the exact number but - many of our residents share a doctor in the neighbouring community of Weymouth.
Doctor Felix Doucette from Weymouth is no longer practicing medicine because of his health; the community of Weymouth and surrounding areas are now only served by one doctor, Dr. Donald Westby. So, Mr. Chairman, you have to really wonder how long can Dr. Westby continue to keep up trying to look after his patients and most of Dr. Doucette's patients. Dr. Westby, the people of Weymouth and surrounding areas, are definitely in need of help from this Minister of Health.
The obvious question is - and everyone is basically asking the same thing - how long can Dr. Westby continue to respond to so many calls? Eventually this poor doctor is going to reach the point where he won't be able to continue to do it.
A few months ago - I think it was in January as a matter of fact - this government announced cuts to the incentive program to help recruit doctors for these under-serviced areas. My first question to the minister is, could he inform us why his department, why his government took these serious measures?
MR. MUIR: Mr. Chairman, physician recruitment is something we take very seriously here in our province and in our department. I know the honourable member would have learned from his colleague on his left, who knows a fair bit about physician recruitment
too. As I've said, we've been very successful, comparatively speaking, in Nova Scotia. If you look at the period of time between 1996 and 2000, only Alberta exceeded Nova Scotia in having a greater percentage increase in the total number of physicians.
Over that period of time, for example, Nova Scotia experienced about a 9 per cent increase in the number of physicians that it had and that's very good. Obviously, as the honourable member said, in Clare they are short physicians, in Weymouth they are short physicians, in my hometown of Truro we need three or four more family practitioners too. When I say Truro, I speak collectively of Truro, Bible Hill, Salmon River, Millbrook, and the surrounding communities whose residents do come in and for whom the Colchester Regional facility would be the home hospital, and of course as you well know, Mr. Chairman, from your constituency a number of residents see the Truro area as a medical site.
Overall in Canada there are about 187 physicians per 100,000 population. There are three provinces that exceed the national rate: Quebec leads the country at 214 physicians per 100,000 population; Nova Scotia is second and I would just like to repeat that for the honourable member and all members of the House - Nova Scotia is second in Canada in terms of numbers of physicians per 100,000 population; and the third was British Columbia at 195.
In terms of specialists in Canada, there are 93 specialists per 100,000 population in Canada. There are three provinces which exceed this figure. The three provinces are: Quebec, they have 108 specialists per 100,000 population; Nova Scotia is again in this category second in the country, we have about 100 specialists per 100,000 population - again I just want to re-emphasize that Nova Scotia is second in the country; and Ontario comes third at 95.
Despite the fact that we have deficiencies and gaps in physician numbers and placement of physicians here in Nova Scotia, comparatively speaking - and I've said this time and time again in this House - we're better off than anybody else in this country, with the exception, in this case, of Quebec. I should also add I was going to ask the honourable member, when they were able to recruit the two physicians for Clare, knowing that he represents a constituency on the French Shore, what was the language of the physicians he recruited? Were they recruited as French-speaking physicians or bilingual? They both spoke French. Just one, eh? The reason I mentioned that was I was told with some of the medical schools now that their training is in the French language, there are people available in the French language and the numbers in Quebec are creeping up and also in New Brunswick, so that might be a source. That's why I mention it.
In addition - looking at family practice physicians in Canada, I just want to go through this too - there are 94 family practice physicians in Canada per 100,000 population. There are four provinces which exceed the national rate, Nova Scotia happens to be one of them, and the others are Quebec, Newfoundland, and B.C.; they also exceed the national rate.
So again, our physician recruitment, while not exactly where I would like to see it, I can say we are doing relatively well.
I just want to continue on with this, with your indulgence, Mr. Chairman, and perhaps we will be answering some of the questions in advance of them coming . . .
MR. CHAIRMAN: Before the honourable minister moves on, and for the chairman's edification, the numbers per 100,000 in Nova Scotia of physicians was again?
MR. MUIR: For Nova Scotia we would have 201 physicians for every 100,000 population - that's physicians overall. For general practitioners, the number is 101 for 100,000 population, so it's roughly about one general practitioner for every 1,000.
In 2001, the recruitment office at the Department of Health recruited 40 doctors, and we've already recruited four in 2002, for a total of 44. This number we expected to have been around 55, but unfortunately the events surrounding September 11th did curtail recruitment in the last quarter of the year 2001. We do believe though that the individuals we had been in contact with will be making site visits in 2002, so we're optimistic that we will recruit at least another 15 people from them.
Other information that might be interesting to the member opposite is that there were 150 billing numbers given to physicians in the year 2001. That's 150 physicians who didn't have billing numbers the year before received them last year. This of course includes not only the ones recruited through the provincial recruiting office, but also those physicians who came on their own - and there were a number of those and there were also physicians recruited by the Capital District Health Authority and also the Cape Breton District Health Authority. Despite the fact we said 44 in that 12 months of the fiscal year period, with 150 new billing numbers I think everybody understands that there had to be a significant number of others.
[3:15 p.m.]
There were 50 site visits arranged by our recruitment department, with 30 of those who visited being recruited to our province, and there are negotiations ongoing for future recruitment.
Mr. Chairman, there were physicians recruited to Sydney, Shelburne, Windsor, Westville, Springhill, New Glasgow, Stellarton, Berwick, Arichat, Strait Hospital, Cleveland, Yarmouth, Antigonish, Guysborough, Musquodoboit Harbour, Tatamagouche, Bridgewater, Inverness, and Halifax, Bedford, and Dartmouth, as you can see, a large of number of recruitments into what we would consider to be rural Nova Scotia.
In 2002, there have been 14 recruitments so far with physicians who have already begun practice or will be by July. That includes: Spryfield, two in Parrsboro, down in the constituency of the member for Cumberland South, Barrington Passage, and the member for Shelburne read a resolution today about the physician in Barrington Passage; two recruited to Amherst; also to Inverness, Berwick, Kentville, New Glasgow. There were two down in your geographical area, and two in Yarmouth as well as in Annapolis Royal.
We have been fairly successful. Now, in specific reference to the rural incentive package, not all things work in all situations. The package to which the honourable member referred has not been scrapped. What it is is there are certain communities for which this particular package is appropriate; there are other areas where the package is not appropriate. Just let me give you an example of how this works. It was in a part of the province, and I ran into this when I first became Minister of Health, there was a community that had two obstetrician-gynecologists and a third was recruited. The condition of the recruitment is that after a certain period they could either work fee-for-service or they could work on an alternate funding agreement or salary.
The new person was brought in under a recruitment package which included a guaranteed salary for a fixed period of time. The condition of employment was - and of course all three people would have been involved in this - that at the end of a certain period of time all three of these physicians could go to a salary base or they could go to fee-for-service. What happened in that particular case is that the new recruit still in some ways wanted to stay on salary because that's what they preferred. The other two physicians wished to continue on fee-for-service, and because they couldn't get together and decide they would either accept one form of compensation or the other, the person who wished to stay on salary decided they would go someplace else and, as I understand, took a salaried position somewhere else because that's how they preferred to work.
In the case of the rural recruitment, we certainly still have a six-month incentive. It's available, and it's available in Weymouth. The new doctors in Yarmouth who are coming there, that's under the incentive program. One of the things that happened - I guess I could speak specifically of Weymouth with the established doctors there - it was sort of the same situation. You have people in there who are already working very hard in fee-for-service and you have somebody who comes in on a guaranteed salary, and people look around in terms of workloads and things like this. This is why in some communities where there is no fee-for-service there already, it may be appropriate to put somebody on an extended period, on a salaried position. On the other hand, in some communities where there were already fee-for-service physicians, to bring a person in and maintain them as a salaried person for a long period of time may not be fair to those who are already practising.
MR. GAUDET: Mr. Chairman, I want to thank the minister for this information. Those stats are certainly good news, but I can tell you that the gentleman who called the office yesterday who was crying, he certainly will not be overjoyed by hearing all these good
stats. It was kind of interesting to see that the minister indicated that the community of Weymouth is still on the list for some incentives.
My next question to the minister is, does he agree that by not providing incentives, or very little incentive, to try to recruit doctors for some of these rural communities will make it extremely hard for some of these communities to attract doctors and their families to move into these communities?
MR. MUIR: Mr. Chairman, we believe that the incentives that we have in place are good ones, and I think the uptake on our invitations, again I'm not saying that - I sympathize with the person who called the honourable member's office yesterday looking for a physician. I too get those calls in my constituency. Fortunately they are less frequent than they used to be, because . . .
AN HON. MEMBER: They gave up.
MR. MUIR: No, that's not true. We did actually get a couple of physicians in there and it took some load off; we just happen to need more. I want to tell, Mr. Chairman, and this would be something with which you would be familiar, as would some other members out in your neck of the woods, although it's on the other side of the highway so you can't claim it as your constituency, I can remember this time last year there was a group down in the Noel-Kennetcook-Rawdon area - actually more than one group - actively recruiting physicians. Indeed, I know that, Mr. Chairman, as a representative out there, some of your constituents certainly would have been concerned as there were no physicians or very limited physician service out there.
I can distinctly remember being at a family practice society meeting at the IWK one night and speaking via our Nova Scotia television network, the telemedicine network, to physicians from around the province, and happened to mention - I forget how it came up in the conversation - that we were looking, it was actually how you recruited physicians, I guess it was, and I had mentioned that the groups out in that area were trying to come together as communities to get physicians there, and they will work out the distribution of what clinics they were working in. I can remember a physician, actually from down in the western part of the province saying you're out of your mind, you will never ever get a physician to go in that part of the country. I think we have three there now, Mr. Chairman. (Interruptions) We have three. (Interruptions)
Mr. Chairman, some decorum in this House, from a man who had the opportunity to speak positively of the health system. (Interruptions)
MR. CHAIRMAN: Order, please. I apologize. I didn't hear the comment, but I will take you at your word, honourable minister. (Interruptions)
MR. MUIR: Mr. Chairman, the point of that whole thing is we're relatively successful. Again, I want to say most sincerely I know how difficult it is when somebody calls your office looking for a family physician, in distress, and how difficult it is for the person who takes the call, like you or me.
MR. GAUDET: Mr. Chairman, I agree with the minister, there are probably some communities that need no incentive, or very little incentive, in order to attract family doctors in those communities, but there are communities throughout this province that certainly need some help from this minister and from that department.
Mr. Chairman, in Digby there's a group called MEDIC, Medical Emergency Digby In Crisis. This committee was established over a year and a half ago, to try to help recruit doctors for Weymouth and for Digby, for Digby Neck. There are communities who need some help and support more than other communities.
The minister indicated that the community of Weymouth is still on the list for extended salary - I think he indicated - for six months. My question to the minister is, is he prepared to provide additional support to some of these communities that have more difficulties than other communities in attracting doctors?
MR. MUIR: Mr. Chairman, there are differing conditions of physician recruitment for different communities. Clearly, I know firsthand, I have met with the MEDIC group and it is a very good group that works very, very hard. The MEDIC group is quite willing to go beyond the traditional recruitment methods. We talked to them about the situation down on Long Island and Brier Island. They do recognize that it might not be really practical to have a full-time physician down there and they've suggested alternative ways that one could deliver the service.
As the honourable member, I think, is aware, through our emergency medical services, the paramedics are delivering some service down there, not as much as they would like but if they were supplemented by somebody, perhaps like a nurse practitioner, who could be in a collaborative practice with a physician, this is one of the things that the MEDIC group has suggested might be part of an option for them.
I can also say the community health board down in the Digby area has been working with the MEDIC group and has actually provided them some money to prepare a proposal for a submission to the Department of Health. The department has been recruiting people and actually, other people as well have been working closely with representatives from that area and from the MEDIC committee. I'm optimistic that the rewards of the work of the MEDIC committee and its partners down in that part of Nova Scotia will soon be rewarded.
MR. GAUDET: Mr. Chairman, again we have some people in the Province of Nova Scotia who have a family doctor and we have some people in this province . . .
MR. CHAIRMAN: Would the honourable member permit an introduction?
MR. GAUDET: Yes.
MR. CHAIRMAN: The honourable Minister of Justice on an introduction.
HON. MICHAEL BAKER: Mr. Chairman, we have today with us in the Speaker's Gallery of the House a number of staff and residents from LaHave Manor in Dayspring of my riding. They are here today to enjoy the beauty of our House and take the opportunity to listen to the Department of Health estimates, which is always an exciting high point of everyone's day. I would ask those who are able to rise, to do so and we will be glad to acknowledge them. We are very pleased to have them with us today and welcome them to the House of Assembly. (Applause)
MR. CHAIRMAN: We welcome our guests from LaHave Manor in beautiful Dayspring. Yes, indeed, welcome and welcome to all of our guests in the gallery.
[3:30 p.m.]
MR. GAUDET: Mr. Chairman, as I was saying, we have some people in the Province of Nova Scotia who have a family doctor and we have some people who don't have that luxury to say that they have a family doctor. The minister indicated, especially with the situation on Digby Neck, there are currently paramedics offering some level of support to those people. He mentioned something about an LPN maybe assisting those paramedics. Could the minister indicate if that's something that will probably happen in the very near future, that a licensed practitioner nurse will be supporting the paramedics in that community?
MR. MUIR: Mr. Chairman, I would just like to go on a little bit about human resources before I get to the direct question you asked, I believe, if a nurse practitioner was going to be located down in the Digby Neck area. One of the other things we've been successful in doing here in Nova Scotia - and I can say thanks to the efforts of the Deputy Minister of Health - we have been able to get a rather substantial grant from HRDC to study the whole issue of health human resources. I believe the grant was initially close to $1 million and the deputy has been able to supplement that. So in terms of working out a strategy - and this is federal money that he's been able to bring into the province - and we're working on that.
We're also co-operating with our Atlantic Canada partners because as the honourable member well knows, Dalhousie has the medical school for the Maritimes and we do believe in the not too distant future, I think the medical school in St. John's and the school here in Halifax, are going to have to work a little more closely together than they do at the current time.
Also in Nova Scotia we have the national lead in terms of the Canadian federal-provincial territory initiative on health human resources. Dr. Ward has the lead in that so we are, I guess - by virtue of the things we've done - are in some ways the leader in the health human resource field and moving it ahead in Canada. This is, of course, the latter one with the other federal, provincial and territorial partners.
In the case of is there going to be a nurse practitioner down in the Digby Neck area, toward the island, we are certainly looking at all options for that, I know the group down there would like to have one and I think we are going to see if we can accommodate them. I can't make a guarantee because the details are not worked out.
MR. GAUDET: Mr. Chairman, as the minister knows, the people along the communities in Digby Neck have been requesting an LPN for some time now. It has been talked about for quite some time. I have received a number of calls and actually I know of one individual who is currently interested in applying, if that job did ever come up. So I certainly hope that the minister will be able to provide in the near future some direction, especially to the people in those communities, whether or not an LPN will be recruited, in order to help support the service that the paramedics are now providing to those people.
Mr. Chairman, I want to go back to the community of Weymouth. The minister indicated that the community of Weymouth is now listed for six months of extended salary. If the community of Weymouth needs additional benefits or incentives in order to recruit a doctor for the community of Weymouth - but certainly, that doctor will be helping people from surrounding areas - could the minister indicate whether or not the department is ready to provide additional resources, in order to help the MEDIC group to work jointly, in collaboration with his department, to recruit a doctor?
MR. MUIR: We have already done that but the funds flow through the DHA. I just want to make a comment about Weymouth in terms of that. In the six-month incentive contract which is there and, of course, if it's a new grad from a medical school here, they would also be eligible for the physician recruitment strategy, which was the loan repayment incentive or something, I can't remember the details right now, I think it's $5,000 - I'm sorry, $15,000, $5,000 a year for a maximum of three years. They are eligible for that, so that is there as well.
I think the honourable member appreciates this, in the case of the Weymouth area, fee-for-service billings would certainly be greater than the incentive, I shouldn't say would certainly be, I'm presupposing, but clearly there would be an opportunity for fee-for-service billings to greatly exceed the incentive contract on the AFP.
MR. GAUDET: Mr. Chairman, I will be sharing my time with our Health Critic. My last question to the minister is, in this year's budget the Tories are putting $134 million in Health, could the minister indicate to us how much money or how much of this funding is
actually going to be going to help rural communities to help them recruit doctors? Could he provide us with some numbers, please?
MR. MUIR: Mr. Chairman, the rural stabilization fund for physicians contains $9.6 million this year.
MR. GAUDET: Mr. Chairman, I want to thank the minister for his answers. I will now yield the floor to my colleague.
MR. CHAIRMAN: The honourable member for Dartmouth East.
DR. JAMES SMITH: Thank you, Mr. Chairman. We have approximately 20 minutes left of this session.
MR. CHAIRMAN: Yes, approximately - almost exactly, until 3:57 p.m.
DR. SMITH: Our watches are in sync. I found the conversation on alternative funding methods quite interesting, quite challenging, because this is a new area that we've looked at here, or relatively new in the province. It's interesting to see the difficulties with that type of a system when you start mixing and matching in those communities. I just want to say that I certainly offer the minister any support that I could to encourage persons to move in that direction, in alternate funding at all levels, whether specialty or family practice - I guess, family practice, you would be more moving from a fee-for-service to a salaried one, but it's still the same regardless of whether it's family physicians or specialists. I don't think there's anything keeping the progress of the accessibility into health care, it's impacting on that more negatively than the fee-for-service at the primary care level.
We've had the pilot projects, and we've had quite a bit of experience with that. I'm not saying that the system would be any cheaper, but if you're going to use the term - we've talked about terms here today, nurse practitioners and others - I would just encourage the minister to do what he can in his term of tenure because, I think until we get that access into the system to facilitate that better than what we're doing. This didn't come with this minister, this has been there for a long period of time. When you have a fee-for-service that's based on if you spend three minutes with a patient you get the same amount of money as if you spend 20 minutes with someone. We know in these rural communities that's one of the issues when you're dealing with elderly people, a lot of diabetes in some communities. They're very complex and you can't solve those problems in three minutes.
I would ask the minister to keep pushing forward with the Medical Society. Sometimes there's support there and sometimes there isn't, but the ones who are against the change are often very vocal. It means that the government has to make some tough decisions some days. I found that very interesting, because I think one of the main problems we have, we have such a good health care system but we're having trouble accessing it, and it's
because of that lack of team approach to the primary care, that we're really falling down right across this country.
Nova Scotia, the federal government during our time, as you know, funded the pilot projects, they were announced under this government, and the information is there. I don't know how the information will turn out, but you can't set up types of facilities that are not going to do the work. There's still a lot of work to be done out there; there's still a lot of sick people. You can't sit around and just have nice conversations, there's work to be done. It can be shared - social workers, nurses, LPNs, RNs and all the other groups, like occupational therapists and others.
I would just like to clean up some of the things we had started the other day. I want to go back, I will just revisit a couple. One is child's dental. I know we can get a copy from the dentist, but there has been a letter that has gone out to the dentist, he said the other day. Would he be prepared to share that with the committee, relative to the Children's Dental Program and the changes that might be taking place and how that would impact on the dentists? If there's a letter that has left his department, would he share that letter?
MR. CHAIRMAN: I wonder if I could beg the indulgence of the committee to make a quick introduction. In the west gallery, I would like to introduce a long-time and certainly a present community activist, a member of the Canso Trawlermen's Co-op, certainly a friend of mine, and I know he's accompanied by a friend of his this afternoon. This gentleman always has the best interests of the Town of Canso at heart, Mr. Patrick Fougere and, of course, his friend, Pat. Please stand and receive applause. (Applause)
The honourable Minister of Health.
MR. MUIR: Mr. Chairman, I'm not sure if I indicated a letter had gone out to the dentists, the insurance company. It had been constructed. I signed those either yesterday or some time not too long ago. I would be pleased to table a copy of that letter, that's no problem.
DR. SMITH: Thank you, because it wasn't clear as to what the role of the dentist might be, and what co-operation one would expect from the offices. It seemed to me that the success of the changes of that program depended on information flowing from the dental offices, where they would indicate who in fact had insurance. We're quite interested in what this program is going to look like; it's projected downsizing of the MSI input on that. Not all dentists are agreed on that. It looks to me likes it has found its way into the budget as a number, but it's still not very clear as to what this program is going to look like and how in fact it will function. We will have to follow that along at another time.
Mr. Chairman, I want to return to the medical equipment fund. It's Page 15.18 in the Supplement. Can the minister take me through that briefly, again. It's there as revenue, I would gather, with brackets around it - there's nothing in this year's. Where is the $15 million sitting as we speak?
MR. MUIR: The $15 million, as we speak, is sitting in the Department of Finance. To go back on that, when the federal government announced that equipment fund two years ago, like everybody else we didn't think it was enough but we were happy to receive it. It was $30.4 million I think was Nova Scotia's share of that. You just don't pick up the phone and say send me a CAT scan or something like that, as honourable members know it takes some period of time.
In that period of time - the honourable member has seen the list - $1.4 million of the money was expended. We were required to draw that money from the federal government. So what happens is, the Auditor General actually always wanted us to take it in one year and, after discussions, it was decided to take it in two years. What happened is that the second $15 million, the list is being compiled at this particular time and the $15 million will be expended this year. I don't really fully understand the accounting principles, but I know that will be expended this year. I know that the money sits in Finance and the equipment will be purchased; $15 million will be purchased this year out of that money that the federal government gave us.
[3:45 p.m.]
DR. SMITH: I guess I will have to pass that over to our Finance Critic to follow it from here. I've tried to nail it down, get a stick to beat it down and hold it for awhile in one spot, but we are sort of running a year behind on that. I can appreciate that some of this equipment maybe has to be on back order for awhile, but it looks to me like the wait times and that could be addressed with this more aggressively adhered to. The anticipated wage settlements that were coming forward, like for paramedics, could the minister indicate where in this budget one would see these delineated here within the estimates?
MR. MUIR: Mr. Chairman, the contracts that have been negotiated or those contracts where salary increases have been determined - and actually we've got one of those out there now that is in the final offer selection process, but I'm told that salary increase was not part of the disagreement at this time. Those things are in the budget and that money has actually been passed out, either to the district health authorities or the agencies, wherever it happens to be in this year's allocation. The paramedics' contract with the NSGEU has expired now. We will soon be beginning negotiations for them, but that is being held centrally, which is the standard practice, Mr. Chairman. It has been the practice since I've been occupying this role.
DR. SMITH: Essentially, I guess, that means not heaven, but in Finance, which is pretty close to there. I gather that's what he means?
MR. MUIR: Again, Mr. Chairman, I'm not sure of the accounting for all this stuff, but it's not in the Department of Health. I guess it is in the Department of Finance. (Interruption) You know, just when it's done, the money becomes - anyway, it comes, but we don't hold it in the Department of Health.
DR. SMITH: Mr. Chairman, I thank the minister for - I think he indicated that the Department of Finance wasn't close to heaven; it was maybe close to the other place. And some days - but returning to primary care, because I really think this is probably - maybe it doesn't get everybody too excited, but to me, it's one of the major areas across this country that we must address.
The minister, I think, was discussing with other members of the House - he indicated his support of clinics and non-urgent, or whatever the term might be, or urgent clinics, and he has talked a bit about walk-in clinics, so to speak. How does the minister visualize - and I don't have much time left. Ours will be done in 10 minutes so I don't want the 10-minute version, but how would you move into community clinics? I know in some communities without facilities it might be easier to do, but what's the government prepared to support and what would you put into a clinic like this? There's a place that I worked, like the Woodlawn Medical Clinic, 22 family doctors, 22 specialists, roughly, when I left in 1993, but what would you do if you - do you forsee clinics throughout the urban and the rural communities, and if so, what would you support? Would you support part of the facility or would you put in, say, social workers or nurse practitioners? By this time you must have some vision of where you would go to address the issues of primary care that are not being addressed now and are really creating the backlog in our community.
I will assure you, Mr. Minister, if you have a few years left in your mandate and if you could address some of those issues in primary care, I think people in Nova Scotia would be very grateful. They may not support some of the initiatives that you had to do, and maybe some of the professionals themselves wouldn't, but I think if you had some concept of an entry system that would facilitate access into the health care system - and you mentioned this first contact person, whether it be a family doctor or nurse or nurse practitioner, which is an extra-trained person beyond an RN. But does the minister want to share what he sees there, and if so, what sort of monies are you prepared to put into that?
MR. MUIR: Mr. Chairman, I guess when the honourable member began with that questioning, he referred to comments I made in response to the member for Halifax Needham two or three days ago, whenever it was. We do have a Primary Care Working Group, which has representatives from many organizations. We are still getting some funding from the federal government, primary care funds - $4.2 million a year - and I think we get it for another two or three years. Models of primary care are being developed by this Primary Care
Working Group and we expect that we will be able to review the good work that group has done in the fall.
The reason I started off where I did was that I want to return to that, and I'm speaking basically, as a Health Minister, where I would like to go with health clinics. You mentioned did I see a variety of workers in there, and the answer to that is yes. I had spoken of the Cobequid Multi-Service Centre as being a good model, in my opinion, of a primary health clinic, and I was also speaking of the North End clinic as being another model of a primary health clinic. Given the input of that and our primary care demonstration projects, like those in Lyons Brook and Caledonia, the Primary Care Working Group will be making a report later on this Fall. Teams are now developing proposals and I expect to be able to make those public in the Fall.
DR. SMITH: We will see in due course because it's always the issue - you know, it's fine to expand. But I would say, in all fairness, one of the reasons that many of the family doctors at this time would want to keep fee-for-service is that their expenses are really running high. I know in the urban community here it's really high; they have to generate income and they do it by turnover of patients.
So I think if we're ever going to address this issue of primary care - because that's what the complaint is from people I hear in my constituency office. Number one is the inability to get someone to see them, a physician, and I think many of those people - not all, but many - would be content to have at least the first contact be a nurse practitioner or RN or LPN, some level of staff who would be professional. But how you move into those areas and set up some sort of a team there on clinics that are already owned by a group or consortium of doctors, whatever, there are various ways that they have shared that, but I don't think the system can really exist much longer in that type of a setup. We have to look at some support at the primary care level on that area.
I'm not here making a plea for physicians because I've severed my ties with the Woodlawn Medical Clinic. Probably it wasn't the right thing to do, but I did it and I guess I will have to . . .
AN HON. MEMBER: They going to take you back?
DR. SMITH: No, Ron Stewart pulled my medical number. The Liberals pulled my medical number. I probably saved more lives - the Minister of Transportation and Public Works in various capacities always said that I cost less as a legislator than I did as a doctor. If I went back, I would break the government.
Anyway, I wanted to maybe finish my line of questioning, or along that line, on the research foundation. I know that it has been cut in half this year. This was a thing of mine that I really always felt was important. I brought in a Private Members' Bill; it didn't get too
far in 1988, but when we got in government we were able to initiate the Nova Scotia Health Research Foundation. Our commitment, although we didn't fund it initially to the top, the goal was to $5 million, this government committed to $5 million; this year it has dropped back to $2.5 million. Is he going to make it up next year or just hold it at $2.5 million?
MR. MUIR: Mr. Chairman, I appreciate the honourable member's question because that's the way it appears in the estimates, that there is $2.5 million to be distributed next year. In actual fact, the Nova Scotia Health Research Foundation will be receiving $5 million. It has to do with the timing of when the institute got up and running the first time. Basically, they got $2.5 million that first year. Then they got the $5 million, but because they were late starting, they only spent $2.5 million. So there has been $2.5 million carried forward. They will have $5 million next year.
MR. CHAIRMAN: The honourable member has about 30 seconds.
DR. SMITH: $5 million in the year that we're currently in now, okay. I just want to go into staffing. I know there has been some criticism of administrative issues in various departments of government. Health overall hasn't increased all that much. It was not one of the high ones, but on Page 15.22 of the Supplement - the deputy minister in the minister's office is not included there, I would gather, unless it's under general administration, but . . .
MR. SPEAKER: Order, please. The Liberal caucus' time has expired. It's 3:57 p.m., one hour.
The honourable member for Halifax Fairview.
MR. GRAHAM STEELE: I would like to very briefly pursue a topic that my colleague, the member for Dartmouth East, has just left off, and that is the Nova Scotia Health Research Foundation grant. Two years ago the grant was $2.5 million and the government spent $5 million. Then last year the government allocated $2.5 million in the budget and spent $5 million. This year, again, the government has allocated $2.5 million and the minister has said (Interruption) Which is a good thing, that this year the commitment again is $5 million.
Now, the minister explains this as some kind of accounting move based on how the foundation was first set up, but I wonder if the minister could explain how it is that that accounting move happened in more than just one year and, in fact, that year after year the books of the province show $2.5 million allocated and $5 million spent?
MR. MUIR: Mr. Chairman, it's an interesting question. Basically, the first year they received money that wasn't distributed, so it is carried forward.
MR. STEELE: Well, Mr. Chairman, I'm not going to pursue this topic any further, because what I was really after was to find out from the minister whether the actual commitment this year was for $2.5 million or $5 million, but I would have to say I am highly doubtful that this is in keeping with proper accounting practices. Whatever may have happened in the foundation's first year - I could understand something happening in the first year, but not year after year. What it looks like and what we'll have to keep digging into, I guess, is whether this is just a bit of accounting sleight-of-hand that actually makes the government's razor-thin surplus disappear because their commitment from the Department of Health and the obligation expected by the Nova Scotia Health Research Foundation is $2.5 million more than is listed in the books.
[4:00 p.m.]
Mr. Chairman, as everybody in this House knows by now, I'm no accountant, but I can't believe for one second that this is in keeping with Generally Accepted Accounting Principles or that that particular line item has been audited and passed by the auditors. Having said that, I would now like to move on to the subject of the Children's Dental Program, which I understand my colleague, the member for Halifax Needham, was just getting started on. I do apologize; I did not hear that exchange. I'm not sure how far my colleague went with that, but the point that I would like to pursue with the minister now is this idea that the province is no longer the first payer.
So right now, if I understand the - the formal name, I think, is the Children's Oral Health Program, COHP - it essentially provides free dental care for children 10 years and younger - yes, 10 years and younger, free dental care in Nova Scotia. Now, that's changing with this budget. (Interruptions) Okay, I'm just reading from the budget bulletin, Mr. Minister. The minister has just said to me up to 10. That's fine. It's a small point. So children who have not yet reached their 10th birthday are (Interruptions) The minister is explaining. It's a small point.
My son is actually three, so he's well within the limit. So I'm one of the people affected and so are at least 50,000 other Nova Scotia children, because what the government is doing is saying what sounds on the surface to make kind of good sense. It says, well, if you've got private insurance, private insurance will cover it and we won't, and this is going to save. The program used to cost $7.3 million and this change is going to save the province $4.35 million, which they say, well, it's just going to be paid for by private insurance. The problem with that is that private insurance plans don't necessarily pay 100 per cent of the cost of procedures, not to mention the fact that most plans come with a deductible.
Now, I posed this question to an official of the Department of Health and I did get an answer, but for the record in this House I would like to pose the same question to the minister. Will the province pick up the cost of children's health care that is not covered by
private health plans, such as deductibles and any procedure that, for example, is covered at 80 per cent? Will the province pick up the remainder?
MR. MUIR: No.
MR. STEELE: So here we have a situation where the government is backing out of full coverage and saying, well, don't worry, your private insurance covers it. And it's true, private insurance covers a lot of it if you have private insurance, and let's not forget that people who don't have private insurance will continue to be covered at 100 per cent and that's great.
I'm not talking about the one-half of the children's population whose families have now been hit with an unannounced and unexpected increase because if their children need health care that is not fully covered by the plan, that family is on the hook. They didn't know that before. It's not counted anywhere here as a tax; it's not counted anywhere here as a user fee, but it's a very real cost to the families of Nova Scotia. It has just been downloaded on families. Does the Department of Health have any estimate of what the total value is of the amount that has been downloaded on Nova Scotia families as a result of this change?
MR. MUIR: No, I don't have an estimate of that, but I do know the couple of plans that I've been involved in are that children's dental examinations are picked up on a once or twice, or whatever it is - there was a certain 100 per cent payback by insurance plans on some cases of children's dental service. Now, there's a limit to what it is; I know that.
MR. STEELE: So, basically, the minister doesn't know. So what I would like to ask the minister, because we all have to explore what the implications of this change are, is the Department of Health aware of other provinces in Canada that have previously made the same move?
MR. MUIR: Mr. Chairman, I do know that department officials from one province to another are very aware of the benefits or what hurts in Pharmacare or Children's Dental Programs or any other insured service from one province to another.
MR. STEELE: Mr. Chairman, any time any cost is downloaded on families in Nova Scotia, it works as a disincentive to undertake the service for which the family now has to pay. So clearly in one way or another, downloading this cost on Nova Scotia families is going to be a disincentive to children's dental health. I wonder if the minister is aware of any studies anywhere in Canada at any time that indicate what the adverse impact is on children's dental health when this kind of downloading occurs?
MR. MUIR: Mr. Chairman, I'm not sure it's fair to say it's downloading. Like the honourable member, I belong to a dental plan and I know that, although I don't have people in that category any longer, I was paying for the coverage for my children who were not using it.
MR. STEELE: Mr. Chairman, in summary, there is an unannounced downloading of costs onto Nova Scotia families. The minister is not able to cite any other province in Canada that does this although there may be some. The minister is not aware what impact it will have on children's dental health although there will be some, we know that, and this is just another example, just one more example of where the government is hiding the deficit by attacking the wrong problem instead of dealing with the real problem. With that, Mr. Chairman, I would like to pass my time over to the member for Cole Harbour-Eastern Passage.
MR. CHAIRMAN: The honourable member for Cole Harbour-Eastern Passage.
MR. KEVIN DEVEAUX: Mr. Chairman, I just want to add on the Children's Dental Program that my three and one-half year old son had to go to a dental appointment booked last Friday actually, the day after the budget, and when my wife took him to the dentist, they hadn't heard anything about the change and had no idea that the program had been adjusted. So I find it interesting. I remember earlier in some of the debates on the budget that there was some suggestion there had been some consultation, but at least that dental office, which is a fairly large dental office in Dartmouth, had not heard of the changes 24 hours after the budget had come in.
I wanted to talk about a couple of other things with the minister. I wanted to start with something called, and I believe this is under his department, the Choices Program. It is a form of drug dependency rehabilitation for youth. I'm looking at the minister to see whether that comes under his department or not because if drug dependency comes into his department, I'm pretty sure the Choices Program would come under his department as well. This is a program that's based over in Dartmouth either at the Nova Scotia Hospital or at the old Children's Training Centre, the Ray Lee Centre, I believe it's called, next door, and it's a program specifically in place for youth who have issues of drug dependency. I believe there's both outpatient and inpatient services for rehabilitation.
Some of the workers there are constituents of mine and they hear rumours on a constant basis that the program is going to be shut down or that it is going to be cut, and I guess I'm trying to confirm with the minister here, today, on the floor of the House, first of all, if there is a commitment to maintaining the program and exactly how much funding was provided this year and what was that compared to last year?
MR. MUIR: He is right that Choices is a mental health program and it is based in the metro area and actually is currently, I guess, housed, whatever you wish to call it, on the campus of the Nova Scotia Hospital. There is certainly no plan to not continue that program
and I suspect if constituents of yours were hearing something to that regard - there has been some very preliminary discussion about if it's going to remain in that physical site - but that's not the program, the program continues, but where it might be physically located, there's certainly been nothing decided at this particular time.
As the honourable member may know, there is also some discussion by a lot of people about the future of the actual physical facility of the Nova Scotia Hospital and if it's located there, then that would be part of the conversation. There has been no reduction in its budget this year and, indeed, the province, we don't have an actual line item for it because it comes under the broader heading of the Capital Health District's mental health, but I can tell the honourable member, and I'm sure he will endorse this, is that there has been an additional $1.8 million provided for child and adolescent mental health in this year's budget.
MR. DEVEAUX: And I'm hoping that that will particularly be focused on the 15, 16, 17 and 18-year-olds because I've talked to many people who are involved, whether in schools or in mental health, who say that's an area that was dearly lacking in support and I thank the minister for confirming that information here in the Supply debate.
It does lead to another question which is the future of the Nova Scotia Hospital. Again, many of my constituents work there in various capacities. Can the minister confirm - I mean presumably for the next fiscal year it will be open - if there is a long-term plan to close the Nova Scotia Hospital or whether at this point it's status quo and it will remain open?
MR. MUIR: Mr. Chairman, I would just like to go back and clarify something that I said earlier. I said $1.8 million additional dollars for children and adolescent mental health service. It was adolescent and women as opposed to children, okay, and I had correctly stated the other day.
There is a role review of mental health services currently being done and all of the facilities where mental health services are being delivered, you know, would be incorporated in that review. You're absolutely right, there is certainly no plan to do anything in this fiscal year and what that report is going to say and how we would deal with the report, we haven't got it yet, I can't comment on it but, you know, there are some things like the new forensic hospital and the forensic facility used to be located there and it's not there any more and, as you would know very well from being out in that area, the number of beds - in-patient beds - you know, we don't use a whole lot of in-patient mental health beds any more because services are community-based and we have pharmaceuticals that enable people to participate very successfully in the communities so its future is clearly going to be considered.
MR. DEVEAUX: A short question for the Minister of Health, Mr. Chairman, when do you expect that review of mental health services to be completed?
MR. MUIR: Mr. Chairman, the study is actually being led by the Capital Health District. We have some input into it or are participants. It just began. I can't give you a concluding date, but I will try to find out that information for you.
MR. DEVEAUX: But this is a review for the whole province and I'm just looking to get an acknowledgment from the minister with a nod of the head - just the Capital Health, oh, okay, so it is something they're doing, okay.
MR. CHAIRMAN: The nod has been recognized.
MR. DEVEAUX: The nod has been recognized. I want to go on to another issue which is senior respite care. I have had some people in my area who are keen on getting information with regard to this, specifically around, I call it senior daycare. Some people say that that isn't the proper name, but basically it would be respite care during the day for seniors, particularly seniors who are residing with children and may not be able to stay at home by themselves. Can the minister provide me with some information with regard to this, is this something that we currently have in place? Are there such facilities in Nova Scotia? I will start with those questions. Do we have senior day respite care here in Nova Scotia and, if so, how many facilities?
MR. MUIR: Mr. Chairman, the respite is not a provincial program although we did put additional money into it last year. The VON is an agency, for example, they run one down in the Kings West Community Health Centre in Berwick. There is one that operates, I know, in Truro. Then a number of the long-term care facilities have respite beds. You are absolutely right. Those are sometimes crucial to keeping people in their own homes.
[4:15 p.m.]
MR. DEVEAUX: Mr. Chairman, I want to be clear. This would be daytime respite, so it's in the situation where maybe there is an adult child who works and has a parent who's a senior but isn't able to stay at home during the day when the person is working. There's an opportunity then to be able to take them - that's why I called it senior daycare. Some people might not like that term, but it would be an ability to take that senior and have them during the day. So it wouldn't necessarily need to be a "bed" for a person, but space available. I guess my question is, do we have such facilities and does the government provide funding for such facilities?
MR. MUIR: Mr. Chairman, it's not a provincial program, but there are a number of these, as he's termed them, adult daycare centres around the province. Here in Halifax, I know there's a large one up at the Northwood site, and I visited that centre. As I said, I mentioned the one run by the VON down there in the health centre in Berwick. There's one in my community that is run there. It is not a five-day operation in my community, but it does provide a very valuable service. A lot of that is done by volunteers. We have made some
money available to help some of these centres. It isn't a provincial program and it would be great if we could have it as one, but we're not in a position to do it right now.
MR. DEVEAUX: Mr. Chairman, so I take it there is no core funding for these programs, adult daycare or senior daycare. Maybe the minister can answer that. Is there actually core funding provided? Is it a program that's funded or is it just something that, on an ad hoc basis, the government will fund if an application comes up?
MR. MUIR: The answer to that, Mr. Chairman, is yes. We do provide some core funding for the Northwood situation and we hope, in the future, that we would be able to provide more core funding. But we, I believe, do provide some discretionary grant monies to some of the others.
MR. DEVEAUX: Mr. Chairman, my next question on this is, are they licensed? Are they regulated in some manner? If so, has there been a freeze on those licences or the ability to fund these?
MR. MUIR: Mr. Chairman, certainly in the case of Northwood, which is a licensed nursing home and also in an "accredited" facility, I expect we would have to say that it does have a licence. The others, the ones which are housed or run by other agencies, no, there is no licence for those that I'm aware of. However, the grant system does make them more accountable.
MR. DEVEAUX: So basically what the minister is telling me is that if you are an accredited manor or nursing home, then there might be core funding provided through long-term care facility funding, and those are licensed, accredited facilities. But if you want to run a volunteer or community-based adult daycare centre, you might be eligible for grant funding, but there would be no program core funding and, on the other hand, it's not licensed either. I'm getting a nod from the minister, so I will take that as a yes.
My other question then is, if someone was interested in starting one up in a community - I think my other part of the question was, has there been a freeze on allowing these? Would your government be open to looking at this sort of thing, and if so, is it Mr. Menzies who they would particularly deal with?
MR. MUIR: Mr. Chairman, certainly we are open for others to get involved in it. Obviously, they would have to apply for funding and this year, I wouldn't be too optimistic. But I can tell the honourable member that one of the things in terms of accountability with this is that last year the government initiated a change in grant applications, and now those agencies are getting, I guess you could say, routine grants or regular grant things. Right across government it changed last year, and they have to submit a valid business plan to do this, which I think was a really good thing, certainly something that was lacking, and hopefully will build in more accountability.
MR. DEVEAUX: This should be my last question and then maybe after responding, the honourable member for Hants East will get up for our Party, Mr. Chairman. If the minister could tell me, is it Mr. Menzies from your department who they would be particularly dealing with? Is it Mr. Menzies who would be in charge of that program if someone was interested in providing community-based adult daycare?
MR. MUIR: Mr. Menzies is our Executive Director of Continuing Care and that would be under his responsibility, part of his responsibility.
MR. CHAIRMAN: The honourable member for Hants East.
MR. JOHN MACDONELL: Mr. Chairman, I want to thank the minister for allowing me to ask him some questions. Mr. Minister, I want to make you aware - if I can find it, make myself aware first - of the East Hants Community Health Board's revised health plan. To my knowledge, this is a plan that has gone before the DHA for my area. I want to say that - actually, I think when I was elected in 1998, and trying to learn about all these issues, it seemed like trial by fire. That fire was being fanned by the Liberals at that time, but it hasn't cooled off any under the Tory administration.
So the East Hants Community Health Board had worked quite diligently to prepare a plan for what they thought would be the health needs for East Hants. Then with the changing of the regional health boards to the district health authorities under the Tory Government, that all seemed to be for naught, yet there were areas that I felt were getting things accomplished that didn't have a plan. But nobody seemed to be particularly keen on paying attention to the East Hants area's health plan.
One of the members on the community health board in East Hants is also a member of the district health authority. They were told they had to revamp their plan for East Hants, which they did. They went to work. They had discussions with people at your department and, actually, what they came up with was a board that would oversee health needs in the communities of Noel, Kennetcook and Rawdon. Now, that co-operative has worked quite hard to maintain doctors or even recruit doctors for that area and I think, from whatever information I've been able to gain, anybody who has come there to practice in that most rural part of my constituency was found either by the community or by one doctor who knew another doctor. There certainly was nobody who came there as a direct intervention of the Department of Health. This was done either by physicians or by the community.
I want to say that I hear the minister quite often when he speaks of the department's initiatives and my impression is that there have been more roadblocks placed in front of these communities than there's been help. Now, this community board put together this plan. I might be wrong on the dates, but something tells me it was last spring that a consulting firm was hired. I think they spent an hour or maybe a couple of hours consulting with the community health board on what they thought their health needs were after they had already
done this. I mean they did this under the Liberals, spent three years doing it, redid it under the Tories, spent a couple years redoing it, and then had a consultant come to ask them what they thought their health care needs were when they had a plan that had already gone to the district health authority and they have had, I think, very little response to it.
I wonder what the overall plan is, or how the department views these plans. I still get complaints from people who are taken by ambulance to the Colchester area hospital who say my doctor is not there, I should be going to Halifax, and you might as well say kicking and screaming that they don't want to go to the Colchester Regional Hospital. My thinking is that the Colchester Regional Hospital area wants to increase their numbers to show that they've got such a high input of patients in that area for whatever their plan may be, but certainly addressing the health care needs of the people in Hants East I don't think is it. So I would like the minister to tell me if he's aware of this plan at all and if his department has some idea of those needs that the community health board in Hants East has put forward for the people in my area?
MR. MUIR: Mr. Chairman, I would like to recognize the tremendous efforts of the community out there in Hants East in articulating their health needs and having put together proposals. I guess the honourable member wasn't in the House the other night, probably in a response to a question perhaps from his colleagues when I was in estimates, and we were talking about a system of health centres. One of the sites that I mentioned was the corridor area and I was particularly spurred onto that because I do know, I had been approached, not this year, but for awhile by the people from Hants East and clearly that's one of the things that they would like to see out there and there's no question about that and, indeed, I support that. Unfortunately, we don't have a whole lot of money right now and I support it in other areas, too, but in that proposal, or whatever you want to call it, that we had articulated to the federal government, certainly that area was included in our thoughts.
They've got a very active community health board out there and in terms of physician recruitment, I will not quarrel with you about who is responsible. For me, the important thing is that the people are there now and before you came in, I was reciting a story of a meeting that I had participated in about a year and a half ago. I happened to talk about the situation out in the Noel-Kennetcook-Rawdon area and one of the people from another part of the province says you'll never, ever recruit a physician to go there. At that time we had one, as you well remember, who was scheduled to come and then didn't arrive on D-Day and I'm really delighted that we now have physicians out there who are full-time practitioners and the residents are getting care.
I would like to acknowledge the work that the community did out there, but also, I think, I have to acknowledge the work of my department, too, in helping the group get together a viable proposal. As you know all too well, initially they were looking for sole practitioners in each community, but the groups did come together and put together a combined proposal and it was successful in getting physicians out there. So, yes, I'm very
much aware of the issues in the Hants East area. I know that area quite well from another life I had once and that used to be part of my territory and beautiful country it is, too.
AN HON. MEMBER: Very beautiful.
MR. MUIR: Very beautiful country, just like the Eastern Shore, Mr. Chairman, and I can remember one night going out in your community and (Interruptions).
MR. CHAIRMAN: Excuse me, one second, please. I would like to keep some order in here. The minister is going to tell us a story and I'm very interested in hearing it. Thank you. The Minister of Health has the floor.
[4:30 p.m.]
MR. MUIR: Anyway, I can remember going out to the meeting one night and having a member of my department actually making the comment this would probably be her first visit to rural Nova Scotia and she remarked how beautiful it was out there, so very, very good. Anyway, quite seriously, Mr. Chairman, they have done work out there, but you're right, it is the district health authority, that is part of the district health authority out there, and the district health authority by legislation is required to consider the plans that come in from community health boards. I feel very confident, I know that you've got strong membership on the DHA from out in that area and I'm sure that the needs and concerns are very well articulated.
MR. MACDONELL: Mr. Chairman, I thank the minister for his response and the minister is right - I don't want to be particularly overly callous - I do recognize that the umbrella organization that was generated to oversee those three communities, that that idea did come from the Department of Health. Actually I thought it was a good idea, just the fact that it was a workable notion, and I think that Mr. Goodick and Mrs. Wotherspoon, who are both on the DHA, are valuable members for us.
I want to know, and I'm going to assume that the member of your staff who found Hants East so beautiful I'm suspecting probably was enough to change him to vote NDP (Interruptions) I would like to know if the minister knows the reason for the DHA to hire a consultant to question about the health needs of the area when they already had a plan?
MR. MUIR: Mr. Chairman, the reason for the consultant was that the DHA, quite correctly, was doing a strategic plan for the whole area. This was part of a strategic planning process and I'm pretty confident that you're going to find that that DHA will have a very good plan that will meet the health needs of all its residents.
MR. MACDONELL: I have two questions, I guess. One is, will the consultant's plan, or comments, or survey, or information, take weight over the plan done by the community? That's what I would like to know and I would also like to know what the cost of the consultant was?
MR. MUIR: Mr. Chairman, the management of the DHA falls under the authority of the DHA board and its administration. It was the DHA that engaged the consultant. I don't know what it cost and, again, it's like the issue of the consultant they had in the Cape Breton District Health Authority about emergency services. That is information that was asked for by the board and they will be the ones responsible for determining how its input will be viewed.
MR. MACDONELL: Have all the DHAs hired consultants?
MR. MUIR: I can't give a specific answer to that, Mr. Chairman, but I do know that a good many of the DHAs have brought people in and asked their advice on particular elements. In that case, I believe that was a little broader than some of the service asked for in other boards, but it's not unusual that they would bring somebody in and ask for their advice about one thing or another.
MR. MACDONELL: I want to know, Mr. Minister, was it your department that wanted the DHA to hire the consultant?
MR. MUIR: In those cases, Mr. Chairman, it was the DHA that hired the consultant.
MR. MACDONELL: But I mean was it at your request, that's what I want to know?
MR. MUIR: No, it was not, Mr. Chairman. As I understand, when they engaged in the strategic planning process, they felt it would be to their advantage to have some outside advice.
MR. MACDONELL: Mr. Chairman, I will leave that issue for now.
MR. MUIR: Just one thing I wanted to clear up, I didn't want to leave the impression that it would be only consultants who would provide this advice. Our staff does work very closely with the DHAs and has provided consultative services, or work-and-focus groups and whatever they have asked us to do. We have also provided, I guess, some consulting service.
MR. MACDONELL: Mr. Chairman, I'm interested in the minister's comments around a multi-service facility or a health clinic, whatever you want to refer to it. I know the community health board is certainly interested in a multi-service facility and certainly not something quite as elaborate as the Cobequid Multi-Service Centre, but I think their goal is that at some point down the road as the population and the needs grow in the corridor area,
that that facility would grow as well, it would develop over time to meet those needs. I'm quite interested in this idea, I see it as a very good idea.
So I would like a more general conceptual view from the minister as to his vision on these multi-service centres or clinics, or if there's a differentiation there between the two. I know that my honourable colleague ahead of me, his community was slated for a new facility, I think (Interruptions) and still is. I'm interested in the demographics and how you see the relationship of that community and mine and those facilities, and what your plan would be for other facilities throughout the province?
MR. MUIR: We actually have a number of facilities that I guess, in general terms, would probably fit some of the things which - and just in articulating this, Mr. Chairman, I would say that I'm speaking as me, not necessarily speaking as the position of the Department of Health although I do recognize it's probably hard to make the distinction - I would like to see out in that area. As you know a lot of the emergency services are delivered either in Hants County, at the Windsor facility, a number of people go down there, or delivered at Cobequid, or they're going into the city, or they're going into Truro. I mean we've got the people there, a good many of them work in the metro area and, you're right, some of them do look that way. There's no question about that.
On the other hand, if you get out into the Noel area, I think they've always looked towards the Truro area, but I would like to see a centre out there that had physician services working with nurse practitioners. We would have some diagnostic imaging equipment out there and, you know, as the technology gets better, I'm not talking about having radiologists or all of these types of people out there, but providing really a primary health clinic and, obviously, I would like to see a fair bit of emphasis on health education as well.
MR. MACDONELL: I will say that if you're thinking along the lines of preventive medicine, education of people, I would like to suggest to the minister that he might want to consider salaried physicians as well, that if they're not working on a fee-for-service basis, then they may actually be able to offer some of that service to the community.
I want to ask the minister, this is a specific issue on a letter you sent back to me and it was around a Mrs. Fagen. I think there was a concern about the funding for flexible lens for cataracts, I believe, if I have that right, that the traditional lens is a hard lens which requires a much larger incision and it's covered by your department, but the flexible lens which is a smaller lens and a smaller incision, which would seem to be more appropriate, is not and you sent me a letter saying that it was covered under the budget of the facility, but wasn't covered under the department and I didn't understand your response. So if you could (Interruption)
MR. MUIR: I would think probably what it was, and I can't refer to the specific case, I wouldn't if I could but, in general, facilities have a standard, you know, there's a standard level of service that is provided and if somebody wishes to go beyond that, then probably some user participation would be required. I guess a more common example of that is that we probably all know people, if you go into a hospital with a broken arm or a leg or something like that, there's the standard cast that can go on, but if you're willing to pay, you can get a little bit more high tech cast if you're willing to pay the additional and I know some medical plans do that. I suppose it's like going into a facility and you opt to have a semi-private or a private room.
MR. MACDONELL: Mr. Chairman, I want to thank the minister and I want to offer time now for my colleague, the member for Sackville-Cobequid.
MR. CHAIRMAN: The honourable member for Sackville-Cobequid. You have approximately 21 minutes, I believe. (Interruption)
MR. JOHN HOLM: That's part, yes. My colleague, the member for Sackville-Beaver Bank, says the annual Sackville Cobequid Multi-Service Centre-type questions and, Mr. Chairman, I have no apologies to make for wanting to raise the issue and to get some things on the public record, not just from private conversations. I say that in my mind I don't think that there's anything that is more important to the residents who are served by the multi-service centre than to get that centre replaced with an adequate facility to provide the level of services.
Mr. Chairman, the staff who work at the Cobequid Multi-Service Centre now and those who have in the past, and I say those in the past because a number of them, because of the frustrations and the working conditions, have moved on to other areas to work because they certainly are working extremely hard under extremely difficult situations and that centre desperately does need to be replaced.
It is a model but, Mr. Chairman, the Cobequid Multi-Service Centre is located on Memory Lane and a lot of people remember it as Memory Lane because originally it was a liquor store and the fence, which the Minister of Transportation and Public Works for a long time refused to really have taken down, had been installed originally to keep the cars from pulling over to the side of the cut-off to run into the liquor store which is a little different from running into the emergency health centre. So I never could understand quite the rationale for the refusal to take down that fence.
That having been said, it is crucially important that the multi-service centre get up and running. We certainly do have within the communities and not only within my area, Mr. Chairman, by any stretch of the imagination, residents who live in Sackville-Beaver Bank, residents who live in the constituency of Bedford and surrounding areas who are working very hard to get the kinds of services that are desperately needed. My first question to the
minister on that and if my memory serves me correctly and I didn't bring my notes, but I believe it was in 2003 that that centre was originally intended to be completed and open. I'm wondering if the minister could now tell us what is the projected date when he anticipates that the new Cobequid Multi-Service Centre, or soon to be called the Cobequid Community Health Centre, will in fact be completed?
[4:45 p.m.]
MR. MUIR: Mr. Chairman, I would hope that the new facility would be up and running in two years. However, I will just give a little progress report for the honourable member. When this program of review and replacement was begun, indeed, it was a replacement program. The functional program is being proposed by the Capital District Health Authority in conjunction with, obviously, community leaders out there or representatives from communities. I should also say that my good colleague, right there, the member for Sackville-Beaver Bank speaks to me of this facility very often, as does the member for Bedford-Fall River. I have actually three people who mention that facility and its need very, very frequently and I can tell you that, as a department, we understand the need and are committed to the facility.
However, the functional program that was drafted, and I'm talking about drafted, it wasn't a final thing, called for extensive additions to the services out there. It started as a replacement facility, to make what was out there working. So the suggested increase, there has to be a meeting of minds on a go-forward and we're proceeding with that now.
MR. HOLM: Sometimes minds take a long time to get together and one of the things that needs to be there in order for the minds to meet in terms of what's going to be in the facility and how it's going to be designed is whether or not the dollars are going to be there to do it.
Now, Mr. Chairman, if you're going to end up having the amounts of money that are needed to buy a used subcompact that is ready, you know, for the stage where you don't bother putting any collision insurance on it any more, are you going to build that kind of a facility or are you going to build a modern one which is going to meet the growing needs of the community for many years to come. What we have to have is a firm commitment from the government. We have to have a firm commitment in terms of the number of dollars, when they are going to be available, if we're going to be moving forward in the planning process, and I would suggest to the minister that when that kind of thing is done, then, of course, it is much easier to come up with a design as to what kind of services will be able to be provided within that facility.
I take the minister at his word, right now the plan is that sometime in the year 2004, so we know that there's at least a one year delay. Maybe the minister could tell us, to begin with, of the monies last year the government, to meet their fiscal budget, they cancelled and
the money wouldn't have been spent last year anyway, I understand that, but withdrew, I believe it was $1.2 million, going by memory, the amount that was withdrawn and basically left $400,000. Are those numbers correct?
MR. MUIR: Mr. Chairman, that was pretty close, yes, but just before sitting down, I guess when you talk about the meeting of minds, sometimes it's hard to make them meet, but rather than fixing a cost on this thing and saying this is the building, I think it would be more appropriate to define the services that are going to be delivered there and then really work the services to the structure rather than work the structure to the services and I don't think you would really disagree with that.
MR. HOLM: We don't disagree with that, but one of the things, of course, you can't design the structure, or what services are going to be delivered there, unless you have a ballpark as to how many dollars are going to be there to design the structure in which you're going to put the services. Mr. Chairman, it would be very easy to stand up here and take a rant at the minister and at this government for the slowness of the process to date. I'm not going to do that.
MR. CHAIRMAN: Thank you, I appreciate that.
MR. HOLM: What I want to see is exactly where we are going and how fast we are going. The monies withdrawn last year were $1.2 million and at that time, Mr. Chairman, I had urged the minister, and he had said no in Oral Question Period, but I urged the minister to allow for the calling of the, what do you call it, the proposal or the invitations to be on the list to do the design work. (Interruption) The architectural kind of design work, but doing the basic proposal work and the government said no, even though the money would not have been spent because nothing would have been done until this fiscal year. So that proposal couldn't be called. I would like to know from the minister how many dollars are in this year's budget for the replacement for the Cobequid Multi-Service Centre and what exactly it is expected will be accomplished this year?
MR. MUIR: There is $1 million. We expect to have the functional plan completed, the site preparation completed and the architectural design either completed or virtually completed.
MR. HOLM: Mr. Chairman, I hope, I don't care who it helps in an election purpose, I couldn't care less, but I hope that the ground has been broken and a tender awarded for the construction of the new facility before we go to the polls again and if that's the government's timetable, fine. If it helps you, fine, but get on with it because the residents desperately need it.
Mr. Chairman, I've got to say this, we have working in the community and under Mr. Farmer there is a fund-raising committee that is working very hard. They're starting what you call the heavy hitting where you're going after corporations, businesses, and they've been receiving, as I understand, I haven't had a recent update, but they've been having some very good success. They're dealing with the middle level and then there is the community fund-raising where they're going to be going to individuals who support the centre who don't have the monies to put in the large amount. Maybe I could just put in this plug that the big oil companies that are getting their money from the offshore and benefitting quite well, they might want to make a donation to the Cobequid Multi-Service Centre Foundation.
MR. CHAIRMAN: Order, please.
MR. HOLM: It's just a suggestion.
MR. CHAIRMAN: I know you're passing a few comments, but this is about questions and answers and I would like for you to go back onto that line of questioning.
MR. HOLM: Mr. Chairman, this is an opportunity, as you know, . . .
MR. CHAIRMAN: And I would appreciate that you withdraw your question.
MR. HOLM: . . . for members to express their opinions and I've been in this Chamber on many occasions where I've seen the questioner stand up and speak for an hour without a question at the end. However, Mr. Chairman, I'm just putting the suggestion forward. I want to ask the minister if he has, and he doesn't have to provide it for me right now, but if he could agree to provide me with the statistics over the last, let's say couple of years, statistics on the number of clients who have been served at the Cobequid Multi-Service Centre and it would be interesting to know, just to see the tracking, and it would also be interesting to know if the department has this, the number of those who are coming to the Cobequid Multi-Service Centre from other areas outside of the catchment area because I know of, and I've heard of people coming from Bridgewater, from the Valley, even from metro, quite a few from metro who will go out to the Cobequid Multi-Service Centre whether it is for X-rays, or blood work done and so on, because they can do it and they can get in there without the lengthy appointments.
So it's not only an issue and it's not only serving the residents right in Lower Sackville where it's located, or neighbouring Bedford, or the Beaver Bank area, it really is a very important centre. The Minister of Environment and Labour, his former deputy minister, was very instrumental in helping to build that centre when he was an executive director out there. In terms of community support, I'm going way back, Mr. Chairman, even to the days before I was elected, and that centre is a model - you know it and I know it - it has been studied around the world. Now they may not want to come and be so impressed by the overcrowded conditions, but it is a kind of model for combining both your social programs
and your health needs. I also put the plug in that when you're doing design work, definitely to make sure that you're planning for it to be 24 hours.
If I could, Mr. Chairman, just before I take my seat - and I've asked the minister for one series of data - I wonder if the minister could also provide me with information on the number of children who are receiving mental health services through the centre? What I'm interested in is not only the total number of children, but the number who are on waiting lists and the average number of visits per child.
One of the things that I found very disturbing is the fact that what seems to happen is that children who are in need of the intervention and help, they may get in, but as a way to spread the services around the number of visits and the number of sessions they are able to receive are cut way back. I see that as a very inefficient way to save money on behalf of the provincial government. I'm not blaming staff because they can only do what they can do, but we have to provide additional staff. If we do not provide that kind of support service in those early years when they're having the difficulty, the problems only magnify and the costs go up. I wonder if the minister could agree to provide all the information . . .
MR. CHAIRMAN: Order, please. Member, your time has elapsed, but I will ask the minister for a quick response to that question. Mr. Minister, please.
MR. MUIR: Mr. Chairman, I do believe we have the stats, certainly on the medical use of the facility. As you know, it also has some community services in there . . .
MR. HOLM: I wasn't . . .
MR. MUIR: You weren't referring to that? I don't think I can provide that. In terms of the mental health statistics, I believe that would probably be available. I think we have the first information, that would be included in the functional plans. It may very well be there.
MR. CHAIRMAN: Mr. Minister, you want a bit of a break? Then we'll take a three-minute break.
[4:57 p.m. The committee recessed.]
[5:02 p.m. The committee reconvened.]
MR. CHAIRMAN: The honourable member for Lunenburg West.
MR. DONALD DOWNE: Mr. Chairman, it is my pleasure to have a chance to ask the Minister of Health some questions pertinent to the concerns of the people of the South Shore, more particularly the area I live in, Lunenburg West, and questions surrounding the issue of the South Shore Regional Hospital.
The minister will recall the issue of mental health, as I've brought that matter to the forefront, and I will be talking about that later in my questioning. What I wanted to talk about today is the issue of the pediatric unit. Mr. Minister, as you are aware, the district health authority in our area has decided to cancel the pediatric unit, and you indicated in this House upon questioning that the pediatric unit as we know it will not be there but, in fact, they will try to find some way to put sick children in the hospital. I know you've had a chance to review it. I understood you were going to check with the district health authority in the area. Can you inform the House and inform me as to whether or not we're going to have a stand-alone pediatric unit for the South Shore Regional Hospital?
MR. MUIR: Mr. Chairman, as I believe I indicated to the honourable member the other day, the business plan that was approved by the Department of Health did call for that initiative to take place. I have not had any further communication from the district health authority, or my staff, that that wasn't going to occur.
MR. DOWNE: Mr. Minister, I want to table a letter that was sent to your deputy - I assume you have read it - back on March 22nd. It came from the Medical Society in our area, signed by probably close to 25 doctors. In that letter it goes into detail about the issue of the importance of the pediatric unit for the South Shore. These are all professionals in our community who have signed this letter indicating to you that not only is it wrong to close the pediatric unit, the board themselves were not even fully aware of the impact of the pediatric unit within the hospital and the number of children who are utilizing that facility.
I want to table this letter, and I want to ask my first question of you, Mr. Minister. Why have you not responded to that letter that has been signed by in excess of 20 doctors in the South Shore requesting answers to specific questions?
MR. MUIR: Mr. Chairman, I did read the letter, that I can tell you. He's absolutely correct, I thought there were actually more than that who had signed the letter. Certainly they have concerns, and there is a process in that DHA for them to articulate their concerns. I can tell you as well there was an op-ed piece in yesterday's paper - I think it was written by the representatives of the nurses who staff that unit. It's not unusual, and hospitals are no different than anyplace else, when there are changes being contemplated quite often anything that is different does create a discomfort, and I was not surprised to receive a letter about those things. I can say there was an integration of a pediatric unit and obstetrical unit in the
Colchester Regional Hospital, I guess a year and a half ago, and it also generated some concern being expressed by the medical people.
MR. DOWNE: Mr. Minister, there are 48 doctors who have signed this petition, this letter, and we're not talking about tying in pediatrics and obstetrics together, what we're hearing is that we have no idea what's going to happen to the pediatric ward. It's going to be shut down, and those beds are going to be put somewhere in the hospital. Quite frankly, the doctors who are in charge of different aspects of the hospital are saying this could cause infectious disease problems within the hospital. The board has informed them that they don't know where those children are going to go, if anywhere. They are going to try to send them to Halifax if possible, but as it is right now they could very well be in a surgical ward, they could be on any one of the floors in the South Shore Regional Hospital, and nobody is saying where those children are going to go. Those sick children could, in fact, be put in with mature adults.
Anyway, we have no answer to that question. Why would you allow sick children in the South Shore to have no idea where in fact they will end up being within the hospital itself, within the South Shore Regional Hospital? They could very well be in an area that would be wrong for a child to be.
MR. MUIR: Mr. Chairman, the district health authority made that proposal. It's not an unusual proposal I'm told, by people who know that. Obviously working with the physicians is going to be part of the solution. I'm a little disturbed that the honourable member is trying to paint worst-case scenarios rather than looking positive and moving ahead for that facility. Just because the "pediatric", what is called the pediatric unit has been proposed that it be closed doesn't necessarily mean that the children will not be grouped in some other section of the hospital.
MR. DOWNE: Mr. Minister, the reason I'm bringing this to your attention is because I brought it to your attention before, it's not a matter of change, it's a matter of uncertainty, it's a matter of poor delivery of health for the people in my riding and the children in my riding. I will stand in this House any day of the week and ask the questions that are being posed by doctors who are in that hospital, and by nurses who are in that hospital, who have come to my office and have said to me that this is not right, what's going on in regard to the health and safety of the hospital and the children who are going to be in it. Don't say that I'm fearmongering when doctors and nurses in fact, in my riding - you might laugh about it - are concerned about it.
In fact, a number of doctors have gone to the board and talked about the demographics of what's happening in the pediatric unit. I understood that the board themselves were not aware of the amount of use the pediatric ward has in the South Shore Regional Hospital. Last year alone they had 190 days of day-surgery patients in the hospital. I hope your deputy takes these notes down and double-checks them, because her staff didn't
have that information, or somebody in the district health authority didn't have that information, the board didn't have this information. I understand there were 150 observation patients in the hospital last year. The year before that there were about 190; the year before that it was around that same figure. That wasn't part of the overall study or the information that the board even had. In fact, over the last five years, there's been somewhere close to 3,000 people in the pediatric ward.
So the concern is that the board themselves were not privy to that information. The meeting that took place with doctors, with the board and the CEO were not aware of those numbers, were not aware of that statistical data. What they were using was input or information that was not current and not totally up to date. The doctors provided that information, Dr. Cote and others have brought that information to the attention of the staff.
Mr. Minister, I know that one of the ways this government is trying to shed its responsibility is saying the district health authorities are the ones that are making the decision. Well, Mr. Minister, you are ultimately the minister responsible for health delivery in the Province of Nova Scotia. The buck stops at you, whether you like it or you don't. Ultimately you are responsible; ultimately you are the minister who has to deal with the fact that I have a riding that has sick children in it and they don't know where they're going to end up going. It is my responsibility to ask you the questions and it's ultimately your responsibility, as you know, to make sure that health delivery is provided in a fair way. Right now the doctors and the nurses are saying it isn't under the system that the DHA is proposing to go forward with. If they do go forward with it, ultimately it's your responsibility. You can hide behind your staff, but ultimately it's your responsibility and I believe you realize that very well.
Mr. Minister, there's been a study done, a study that was done for the district health board or our area, District 1, that cost somewhere between $25,000 and $60,000, an external audit or an external study to deal with this issue. As I understand it the report has come back, wasn't liked by the people who read it and has gone back somewhere else. I ask the minister if he is aware of an external study that was done for the South Shore Regional Hospital with regard to pediatrics that cost somewhere between $25,000 and $60,000 - are you aware of that study or are any of your staff who are here today aware of that study?
MR. MUIR: I'd like to begin in response to that question, the honourable member is implying that pediatric services will not continue to be delivered at the South Shore Regional Hospital and that's not necessarily the case. They may be delivered in a little bit different way than they are now, but to stand up and say that children and other young people who would normally be categorized as receiving pediatric service will not get it there, that is not my understanding of the situation at all. Again, it's the issue of the physical location apparently or the special status given to the pediatric unit - it doesn't imply that those services will not continue to be delivered there.
In the case of the study, my understanding is - I don't have any details of it, I guess it was commissioned by the DHA - I've been informed by staff that the study that was commissioned certainly included things other than pediatrics and I'm also told that it was never completed.
MR. DOWNE: The study, I understand, was completed and was rejected because you didn't like the findings in that particular study and was asked to go back and do it again. Now my question to you, Mr. Minister, the study was commissioned by the DHA - where is that study and, if it's not done, there was a draft done I'm aware of that, where is that draft?
[5:15 p.m.]
MR. MUIR: That study wasn't done for the Department of Health. To be quite frank, the study to which I'm referring, the department actually invited itself to be a part in it and the invitation was turned down, so whatever happened to the study he would have to get that information from the DHA. It certainly hasn't come to us and I really can't answer that specific question.
MR. DOWNE: Mr. Minister, you're responsible for the almost $2 billion budget in Health and you mean to say that a DHA can spend money on whatever they want on a study dealing with the fact that whether or not the decisions they make are going to be good or bad on the health delivery in the community that I happen to live in and you're not concerned about that? You're not worried about that? You don't care about that? That is your responsibility as minister to be aware of that, and I would think that any study that's being done with regard to looking at the restructuring of the health delivery system in any riding would be of interest to the Minister of Health - good, bad or indifferent. I ask the minister would he undertake to provide that information to me and would he contact the CEO of the DHA 1 to find out what the status of that report is, where is it and when will it be completed, and will he undertake to provide that to myself and members of this House?
MR. MUIR: Obviously we will have communication with DHA 3 officials. That study wasn't done for us - I'm sorry, DHA 1 - we don't have a copy of it, therefore I can't provide it to him. I understand that the study is, whatever it was, it is not fully completed. He indicated there was a draft document that was submitted. He probably knows that better than me. One of the things that we have tried to do with our new structure is return decision making to the communities. They have medical advisory committees or medical management committees, and clearly the board in DHA 1 is doing what it believes is best for the residents in that area. I don't have the results of it. If somebody gives me a copy and it's not marked confidential, then I suppose I could make it available, but inasmuch as it's not a document of the Department of Health I'm not really sure that I should be making it available.
MR. DOWNE: Thank you very much, Mr. Minister, and maybe we can find another way of getting the information from the department. I would hope that you would have wanted to share information concerning health delivery in District 1, and as it impacts on children and health delivery for children, I would think that you would be interested in that. I will make sure that the good people in Lunenburg County realize that you really don't care what the study says, you're not going to go after it, and you have the authority to go after it, you have the responsibility to ask for it. It's not a big deal, I'm sure they wouldn't want to hide it from you. I mean you're the one who's giving them the cheque.
The issue of plans - we talked about strategic plans and in the letter that has been sent to you by the some 48 or 50 doctors in my area, they ask very clearly for - it's quite clear in the letter, ". . . from a recent meeting with them, . . ." - being the board - ". . . that the Board of DHA 1 does not have a Strategic Plan for delivery of Health Care in this District. We do not know yet whether they support a strong Regional/District Hospital with two Community Hospitals or alternatively endorse three Community Hospitals. To cut a unique service such as Pediatrics in this fashion leads us to believe they do not support a strong Regional/District Hospital model." Do you agree with that aspect of the letter or not?
MR. MUIR: Mr. Chairman, he might be good enough to table a copy of that letter. I did see it some time ago, I can't remember what it was. I think you are saying it is quite clear that the board of DHA 1 does not have a strategic plan and whether they support a strong regional district hospital with two community hospitals or, alternatively, endorse three community hospitals.
Mr. Chairman, there is, obviously, apparently some disagreement of the doctors who signed this letter and I suppose it was the doctors at the South Shore Regional Hospital. I think that those who are associated with that, who signed the letter, that is a district which goes beyond the South Shore Regional Hospital. There are at least two other facilities and clearly I think that is probably something that is, we certainly, I suspect when we released the clinical services document, gave some indication of the position of the department.
MR. CHAIRMAN: Order, please. Could we make sure that document is tabled, perhaps provide the minister with a copy and make sure it is tabled. Again, the member for Lunenburg West.
MR. DOWNE: It goes on to say, "It is our fear that as a result there will be a gradual erosion of Speciality and Subspeciality services to the detriment of the entire population of Lunenburg and Queens Counties (and with ramifications to the Capital Health District)."
What they are saying there is they don't have the facilities, from what they understand from the discussions with the board, to be able to look after sick children so they are going to have to send them to the QE II, or send them to Halifax to be looked after, which causes again more costs to the system. These are doctors - and I know that your boss is a doctor and
generally they're perceived to be people who care and understand what's going on - these people are saying to you, and you haven't responded yet, or talk to Mr. Ward - the deputy minister hasn't responded yet. These are very legitimate issues that are not being addressed and have not been addressed by the board.
They go on to say, "We feel that the current Business Plan for DHA 1 contains serious flaws and presents a very real threat to the future delivery of sustainable, quality Health Care to the people of this District. We strongly urge you to halt this process immediately . . ." These are the specialists and doctors in my area writing to your deputy - and I assume that your deputy has informed you of that - they are saying, "We strongly urge you to halt this process immediately and instruct the Board to come up with a rational Service Delivery Plan for our District and then match the funding to this Plan."
They are saying that what we've got right now is not going to work in the South Shore. They go on to say, "We physicians are extremely distressed with what we see taking place and request your urgent response to this letter." This letter, again, was sent on March 22nd, almost a month ago, and no response to date. Why has this letter not been responded to, Mr. Minister, by your staff?
MR. MUIR: It may indeed have been responded to and not be down there yet. I don't know when you received the letter. I can certainly check with the deputy. The letter was addressed to him and if he has replied, I haven't seen a copy of his reply, not necessarily that I would. I think the thing is that I think this is difficult for that DHA 1, there's no question. It was difficult for DHA 2 and difficult for DHA 3 and difficult for DHA 4 and DHA 5 and difficult for DHA 6 and DHA 7 and DHA 8 and DHA 9 and the IWK.
Mr. Chairman, I know that there are difficult decisions to make and you aren't going to keep everybody happy. We are aware that there are a number of issues in DHA 1 and unfortunately a lot of them don't really have a whole lot to do with medicine. We are working with the board chair and the CEO and hopefully they can be resolved in an appropriate way. Again, I want to say that in the case of the pediatric issue where it began, we certainly haven't been given any indication that services would not continue to be delivered.
MR. DOWNE: As of today, this letter had not been responded to. As of 11 o'clock this morning they have not received a reply - as of 11 o'clock this morning and that's almost a month ago. This is a letter that is signed by almost 50 doctors and specialists in my riding and in the South Shore Regional Hospital urging the deputy minister to deal with this immediately. Now, a month is a long time. (Interruptions)
MR. CHAIRMAN: Order. Order, please. Nothing is going on record here. The member for Lunenburg West has the floor.
MR. DOWNE: There is a concern - to the minister - with regard to the lack of response. I believe that the medical profession have been more than patient waiting for this response. They have heard not a thing from Dr. Ward and/or your department, and the letter was sent on March 22nd. You might have read it just recently and that could be because the deputy just gave it to you recently. I don't know, but I know one thing, the letter is there, it is an urgent issue and it has not been responded to, and I would ask you to undertake to this House that you will get a response to this letter. Ask the deputy to respond to this letter this week.
MR. MUIR: Mr. Chairman, I will endeavour. The honourable member knows, having been a minister at one time, that mail comes in and every letter that comes in is important. We do endeavour to see that correspondence is answered as quickly as it can be. I will certainly talk to the deputy and say that you have raised the matter and would encourage him, if he has not answered the letter already, to answer it as soon as he can.
MR. DOWNE: Mr. Minister, this letter has been signed by the President of the Medical Society of Nova Scotia. This has been signed by almost 50 doctors in the area. This is not a matter of somebody sending a letter in and it's in the system. This is a serious letter and for you to imply that well it is just one of many letters is not acceptable to this member sitting on this side of the House and it shouldn't be acceptable to you as minister. The fact that I have even brought it to your attention before and the fact that this letter has not been responded to has those doctors very upset - not even a phone call to explain this.
Mr. Minister, the net loss, as I understand, of the pediatric ward will be somewhere between five and eight beds, and depending on where you put the children at, there is no clear understanding at this point that there is going to be a joining with any other sector of the hospital except the indications are they're going to find some beds somewhere somehow for children who are sick. Can you explain to me, is there a specific plan that I am not aware of that the children will be dealt with in a stand-alone type of facility or in a facility that would be compatible with sick children?
MR. MUIR: I haven't received a plan. Again I go back, this is an issue of management of the facility. I don't manage the South Shore Regional Hospital and I don't manage the QE II, nor the Colchester Regional Hospital or any other. I'm sure that if I did that honourable member would be the first one up on his feet hollering that I was interfering with the good folks in his constituency and their decision-making. I'm very confident that the administration will work with the physician population there and find a solution. Mr. Chairman, I guess that when people don't like something, they come and change it. That is a system they have to work out. It is a relatively new system. That's something they have to work through, and I'm quite confident that they can.
[5:30 p.m.]
MR. DOWNE: It is not a matter of simply working through a system; it's a matter of trying to have some answers for the parents with children who are sick, and what they are going to do with them. It's a matter of answering a question about the doctors and the professional nurses that are there. What's going to happen with them? Where are they going to go? One of the issues, Mr. Chairman, that we have asked the minister about before is a full-time specialist in pediatrics. How are you going to recruit a pediatric specialist to the area when they don't even have a ward to go to? How are you going to do that, Mr. Minister? Or is that just another one of these smoke-and-mirror approaches to recruitment on the South Shore?
MR. MUIR: Mr. Chairman, I know that the honourable member put that question out of context. He's trying to stick up for his constituents, but he knows perfectly well that most of the work of any pediatrician, unless they are stationed at the IWK, would be done in the community, not in the South Shore Regional Hospital.
MR. DOWNE: What I understand, Mr. Chairman, is that there's been a position vacant in pediatrics in my area for some time. It hasn't been filled and indications are - from your staff, Mr. Minister - that they have been trying to get somebody. Now, with the fact that the ward is going to be shut down, how are you going to bring a doctor who deals in pediatrics to our area when they don't even have a ward? That is a pretty basic question. I think you should be able to answer that.
MR. MUIR: Mr. Chairman, I thought I'd made some progress with the members on the opposite side. One of the things - and his colleague, the honourable member for Dartmouth East, can tell him this; I'm sure they had the discussion - is that he is equating a health delivery system to beds, and that is an outdated and inadequate perception of it now. The question - and I hope that there will soon be a pediatrician in that area to serve the needs of the children. I'm very confident that when a pediatrician is there, the beds that the pediatrician needs to serve the children of that area will be there.
MR. DOWNE: It is interesting hearing a member of the Progressive Conservative Party that built a hospital in every community, depending on what mood the Premier was in on that day, that talks about equating hospitals and beds - what we're talking about here is the fact that a pediatrician is required in our area because of the workload. It hasn't been filled, and this minister appears not to care whether it is filled or not. That's the issue.
Another issue in our area, Mr. Chairman, to the minister, is an ENT specialist, an ear, nose and throat specialist. I understand that the board itself has somebody who is prepared to go and work at the South Shore Regional Hospital. I understand that this ear, nose and throat specialist wants to move there, but with the announcement that they're closing the pediatric unit, that individual is now saying they probably won't go. The board has until
tomorrow to inform that specialist whether or not there is going to be an opportunity for him to practice in our hospital with a pediatric ward. Now that's how serious this problem is. You can dance around this issue all you want. You can fool around this issue all you want. You can blame anybody you want. You can go with all sorts of rhetoric all you want. The bottom line is that that specialist will not be there after tomorrow unless the board is going to tell him that there will be a pediatric section.
You know a lot more about health than I do, and you probably don't know that much compared to some of these specialists, but you know more than I do. I know one thing; these ear, nose and throat specialists deal a lot with young people, and those young people need to have a ward to deal with. That specialist is saying he will not be here unless there are at least five or six beds in a ward for pediatrics. Now what do you have to say about that, Mr. Minister - the minister who brags about the recruitment programs by this government - when we've got somebody who's prepared to come and come for what? They don't even have a ward to deal with. How are you going to deal with that, Mr. Minister? How do you answer that question?
MR. MUIR: Mr. Chairman, I don't know about the accuracy of the story that the honourable member has just related. It sounds to me like it could be an urban myth or rural myth, or some type of myth, and I suppose it could be true. He's reciting second-, third- or fourth-hand information as factual, and that's never a good thing. What I can say is that the issue is, are there going to be beds to serve the needs of the children in that area? The answer is yes. Again, to relate health service delivery to beds, I think, is inappropriate. I know that the honourable member really knows better.
MR. DOWNE: Mr. Minister, I will challenge you here today. Dr. Chris Naugler, a doctor in my area, talked to me specifically about this today. Dr. Naugler is not afraid to use his name, and I will give you his phone number. It's 543-4700, and you can phone him because he would like to tell you the facts of what I just told you with regard to the ENT. If you don't believe me, phone Dr. Cote at 543-6659, if you want to try him out. Now that's the kind of information I have. Those are the facts I have, and that's how ill-informed you are as Minister of Health in regard to this issue. That's how cynical and sarcastic you are about the pediatric ward for the South Shore Regional Hospital. You made one statement, that it's not a matter of what's going on in our zone as being not all medical. Maybe it's something else. Maybe you're referring to it being political. Maybe you're saying that your government is playing politics with that particular area. I don't know, but if that's the case, shame on you if that's true.
Mr. Chairman, I asked the minister if he will undertake to make those calls and make the call to Dr. Chris Naugler. I have his private number and his cell number, which I will share with you after this debate. I ask you today, will you undertake to call him today or tomorrow and report back whether or not the information I gave you was accurate? Will you do that?
MR. MUIR: No, that's a matter for the local DHA.
MR. DOWNE: This minister is a coward when it comes to dealing with the issue of trying to find the truth about the pediatric unit in the South Shore Regional Hospital. You're hiding behind people you have put there to do your dirty work and you should be ashamed.
MR. CHAIRMAN: Order, please. That sounds very unparliamentary. Would the honourable member for Lunenburg West please withdraw that comment.
MR. DOWNE: No, I won't withdraw that comment. I never said anything wrong, Mr. Chairman.
MR. CHAIRMAN: Perhaps in the context of Beauchesne, using that terminology may be permitted, but it has certainly caused interventions by Chairmen on previous occasions. I'm asking the honourable member if he would withdraw the comment whereby he called the honourable Minister of Health a coward?
MR. DOWNE: The Minister of Health indicated to me in this House that I was not telling the whole truth with regard to an issue in my riding. He said it could be this; it could be that, indicating that I'm not here asking a legitimate, fair question of that minister as he smirks over there. I brought back to him who he can call to back up what I'm saying and I asked him if he would have the courtesy and the respect for the members of this House to do exactly what he said, to clarify for his own mind what's factual, and he refused to do that. Now how else would you refer to him, Mr. Chairman? Would you refer to him as a minister who doesn't care, a minister who is not interested in what's going on? I'm not asking him to run every DHA in the province, but I do expect him to show some compassion and concern for a problem in an area that is real.
MR. CHAIRMAN: Order, please. The honourable member should know, when he's speaking of respect, that Beauchesne and the green Members' Manual do speak to personal attacks on members in the House. I'm asking the member to refrain from that type of language. I've asked him to withdraw the comment. In committee, perhaps he's not under any obligation, but I do think that in the interest of decorum in the House he would oblige with the Chairman's request.
MR. DOWNE: Mr. Chairman, I will move on to some other questions and try not to be as caring about my community, as the minister doesn't want people to be concerned about the reality of what's happening in health care in Nova Scotia. I feel that is a little disappointing, when he doesn't even want to pick up the phone and phone the people who are under his watch to find out what's going on. That's all I asked him to do, and I thought that was a reasonable request. I didn't think I was asking the minister to do too much.
He's not interfering; he's merely finding out for himself. The fact that he questioned my integrity and my knowledge - to find out the information for himself, and what he does with that information is entirely up to him. But at least then he has the facts. That's what he was questioning, whether or not what I was saying was factual. I would ask the minister again, Mr. Minister, would you make those calls to find out if the information I'm providing here today is factual?
MR. MUIR: No.
MR. DOWNE: You mentioned earlier in debate on Health a health equipment trust fund. It shows that under the estimates - this is on Page 15.18 - the Medical Equipment Trust Fund is zero. Can you restate to the House that this, I believe, $15 million that was referred to by my colleague, the member for Dartmouth East - where that money is? And is $15 million accurate?
MR. MUIR: The $15 million is accurate. That money was given to us by the federal government, and I'm told - I will let the finance experts speak specifically about it, but when you get it you have to claim it. We had to claim it, and we didn't spend it; therefore, the money now resides in the Department of Finance, and there's $15 million there for us to draw down for medical equipment.
MR. DOWNE: So then somewhere in the estimates for the Minister of Finance, he will have $15 million in a fund specifically set aside for medical technologies and equipment for the Department of Health?
MR. MUIR: Mr. Chairman, again, you will have to speak to the Minister of Finance about that. I just know that the money is there. It's not covered in our resolution simply because the money has already been booked. That money is available to purchase medical equipment this year. I wish I could speak more clearly about the accounting process; I can't, but the important thing to me is that we have that money to expend.
MR. DOWNE: I will check with the Minister of Finance when we do estimates on that particular point, and we will find out where the $15 million is - if in fact that's the amount it is - and how it is going to be allocated from an accounting point of view. The minister knows this is a very serious issue to me; this is one that I feel very compassionate about and I'm very frustrated. I tabled some 1,300 signed petitions in this House not that long ago; over 1,300 signed that petition with regard to the pediatric unit for the South Shore Regional Hospital.
There appears to be no specific plan at this point for the pediatric unit in the South Shore Regional Hospital. I think the minister would agree that that's probably true. Would the minister put a temporary stay on that unit until a plan is developed, or is he going to let the DHA simply disband the pediatric unit and hopefully somehow, somewhere, sometime,
somebody will come up with some sort of plan, whether it works or not? Would you intercede to have a temporary stay, at least until a plan has been developed, because there's no plan as of now?
[5:45 p.m.]
MR. MUIR: Mr. Chairman, one of the things that the DHA has been asked to keep us updated on is how they are going to operationalize their business plan. We have offered our staff to assist them in their go-forward positions. I'm pretty confident that there will be an adequate substitute made for what currently exists when and if the change is put into effect.
MR. CHAIRMAN: I should once again caution the honourable member for Lunenburg West that, in fact, the Chairman was right regarding using the terminology, coward. No member shall use offensive words against any member of the House. It's considered to be improper language. Again, I will appeal to the honourable member to either remove that statement or apologize for making that statement or take his seat.
MR. DOWNE: I will retract that statement, and I will just say that he just didn't want to do it.
MR. CHAIRMAN: Thank you.
MR. DOWNE: Mr. Minister, this issue is not one that is going to go away, and it's not one that the good people of the South Shore are very happy with at this point in time. I want to say to you that the 49 doctors and the ear, nose and throat specialists who will probably be deciding not to stay tomorrow because of the fact that you will not deal with it will be resting with you. I've asked for the proceedings of this to be sent out to the people of my area so they understand all too well exactly how you and your government feel about the pediatric unit and the concerns of the parents of children in my area, who are phoning me scared about the fact that they don't know what's going to happen for their children. You can laugh about it, cry about it, make fun of it, or hide behind whoever you want; you are the minister and ultimately I understood that a minister is responsible, full stop. If you know there's a problem, it's your responsibility to make sure that serious problems don't happen.
I've asked you simply to look into the matter to try to find a solution. They want to work with you to find a solution. The way you have it set up now, you're going to add to the cost of health care by doing that. I have other colleagues who have some questions. I hope that maybe I will have time later on to bring up three other issues that I would like to discuss, but I will now step down and ask my colleague, the member for Richmond, to continue debate.
MR. CHAIRMAN: The honourable member for Richmond.
MR. MICHEL SAMSON: Mr. Minister, as you are well aware, once again the Strait-Richmond Hospital is without a daytime doctor to cover the emergency room. As you are aware, this has been a challenge for quite some time. I am sure your staff is well aware. In fact, prior to the most recent doctor's arrival, the community had gone 10 months without being able to locate a doctor for this area.
Mr. Chairman, the doctors in the surrounding area servicing the Strait-Richmond Hospital have now come out publicly and stated that it is the current funding formula offered at the Strait-Richmond Hospital that is impairing the ability to find a doctor to stay at that institution for the long term. Will the minister, today, admit and recognize that the funding currently offered at the Strait-Richmond Hospital is not competitive with the salaries that are being made by doctors in the surrounding communities or at other similar institutions?
MR. MUIR: Just before answering the honourable member's question, to the honourable member for Lunenburg West - I didn't say it during the discussions. I did meet with a medical representative from the South Shore Regional Hospital, and we discussed not only the issue of the pediatric unit but many other issues concerning the delivery of service in DHA 1. I did have a good meeting.
Secondly, to refer to the member for Richmond, as he knows, the fee structure for that was negotiated with the Medical Society. I can tell the honourable member, as was in the case of DHA 8, we're quite willing to sit down with those responsible. Obviously the Medical Society has to be part of that, to see if there can be some reallocation of resources, if there is.
The other thing the honourable member has implied is that money was the reason that that physician left the Strait-Richmond Hospital (Interruptions) You did today. I would say you did imply that today. The other day you carefully, and I appreciated the fact that you didn't say that, but the fact is that physician left, I'm now told, because his spouse was admitted to medical school in some other part of the country. That was the reason for leaving, it had nothing to do with remuneration.
MR. SAMSON: Mr. Chairman, we're aware, and I'm sure the minister is aware, of why he left. The problem was before he got to the Strait-Richmond Hospital, it was with Dr. Thomas, with the doctors before. The salary being offered is not competitive because of the unique situation in the hospital. I believe the minister is aware of that. I'm pleased that the minister is willing, with his staff, to entertain negotiations with the Medical Society. I certainly will be in contact with them, asking them to review what is currently being offered at the Strait-Richmond Hospital, and certainly hope that the minister will be willing to be part of those negotiations through the district health authority, whichever one it is. The fact
is that we have a serious problem, and it needs to be addressed. Simply bringing in a new physician is not going to change the problem.
Mr. Chairman, one of the issues which has certainly been near and dear to me, and that the minister is certainly aware of, is the rural incentive program which is used to entice doctors into areas in rural Nova Scotia that are under-serviced. Recently, without public notice, the Department of Health has started to change the incentive program. Rather than having a five-year guaranteed salary, in certain circumstances, I might add, the department has gone to a six-month incentive. Certain communities will still have five years, yet a number of other communities have been downgraded, what I would call a downgrade, to a six-month incentive.
Now, when I raised this concern, the spokesperson for the Department of Health said that this was done under the recommendation of the district health authorities who had requested the Department of Health to put that incentive program in certain communities from five years to six months. That is what your spokesman said, contradicting what I had said in the local media. Is it your position now, Mr. Minister, that the decision to move some of those incentives in certain communities from five years to six months was done by the district health authorities, or was it a decision made by your department here in Halifax?
MR. MUIR: Mr. Chairman, I can't comment, really, on the conversation he had. I didn't know that he did have one with representatives of the Department of Health. In response, somebody brought this up a little bit earlier this afternoon, and in some places the five year incentive program works, in other communities it doesn't. To use the word downgrade, I think that's an inappropriate connotation. What happened is, where there were changes made, it was felt that the changes were made in the best interests of the delivery of services to a particular community.
MR. SAMSON: Mr. Minister, specifically, who made the decision, and who makes the decision, finally, whether an incentive program in certain communities should be five years or six months? Is it the DHA or is it your office here in Halifax?
MR. MUIR: The Department of Health does provide those incentives, so clearly it is the Department of Health that does make the final decision.
MR. SAMSON: Mr. Minister, I would encourage you to speak with your spokesperson, Morris Green and maybe inform him of that so that next time he will not go out and publicly contradict MLAs and blame it on the DHAs for making these decisions. I certainly hope that you will inform him of that, so that the next time, rather than trying to contradict us and being proven wrong, he will have the correct information.
Mr. Minister, again, on your decision to move from five years to six months, do you have any sort of study or any sort of report or anything which your department relied upon in moving that from five years to six months, which would give us a sense of confidence that you have some information which shows that a six month incentive is going to have just as much success as a five year incentive? What did you rely upon in making that change?
MR. MUIR: Let me give you an example, and this is hypothetical, just an example to illustrate why some of these changes might be made in particular communities. We do recruit people, and I can remember discussions last year with a physician who wished to come in and work in a community where there was a fee-for-service physician. This person came in and had asked for a very big incentive and wanted the incentive extended beyond what would normally be done there. What happened was the person was not, for one reason or another, personal lifestyle, you can call it anything you want, the fee-for-service physician was working, let's say, 60 hours a week and really seeing a lot of patients. The person who came in on salary was making roughly the same amount of money for seeing one-third the amount of patients.
That's part of the reason for that in individual communities. If you're going in as a sole practitioner, then a salaried position might be. If you're going in in a literally fee-for-service situation where everybody else is working fee-for-service, the six-month incentive is there, probably to encourage a person to really work to build up their practice. Obviously, if that's the case, it's felt that there is sufficient opportunity in fee-for-service to generate revenue in excess of what you would get on a contract position.
MR. SAMSON: Mr. Speaker, it's quite clear from the minister's answer that he has absolutely no report or any information on which to rely, and only time will tell. I can tell you that certainly from the experiences that we've had and the challenges we've had in the Strait area and in Richmond, moving that from a five-year guarantee to a six-month guarantee is going to have a negative effect. In fact, physicians in our area, long-term physicians, have publicly stated this. So, obviously, the consultation process on this change was just as good as some of the other changes the Minister of Health has made. To point to one example where there was abuse and to use that as justification for an across-the-board change, I think it is sad to say the least.
Mr. Chairman, one of the other important issues in my riding, as the minister is well aware, is the situation with the Richmond Villa. I'm curious, could the minister indicate to us if he's prepared to make a guarantee today that the funding has been put in place and that we will see the construction of a new Richmond villa this year?
MR. CHAIRMAN: I would ask the minister to be quite concise, if he could be, please.
MR. MUIR: Mr. Chairman, the honourable member implied that there was a blanket change in terms of the rural incentive programs, and that was not the case. I thought I made that very clear. I just wanted to make that clear. Those communities that had the original incentive in place, unless there have been extenuating circumstances, it's still there. Yes, there is still a go-ahead commitment for the Richmond villa.
MR. CHAIRMAN: Seeing as how we are approaching the moment of interruption, I would advise the committee because there have been some questions, approximately 10.5 hours have been expended in the Health estimates in the Chamber here. We will be going to the NDP caucus tomorrow, probably, if the Government House Leader calls that.
The honourable Government House Leader.
HON. RONALD RUSSELL: Mr. Chairman, I move that the committee do now rise, report considerable progress and beg leave to sit again.
[5:59 p.m. The committee adjourned.]
