HALIFAX, MONDAY, APRIL 7, 2003
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
5:45 P.M.
CHAIRMAN
Mr. Kevin Deveaux
MR. CHAIRMAN: The honourable Government House Leader.
HON. RONALD RUSSELL: Mr. Chairman, would you please call the estimates of the Minister of Health.
Resolution E9 - Resolved, that a sum not exceeding $2,111,454,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health, pursuant to the Estimate.
MR. CHAIRMAN: The honourable Minister of Health.
HON. JANE PURVES: Mr. Chairman, first I would like to introduce the staff here with me today, and they're going to help me through this slim briefing book here. Cheryl Doiron, our Associate Deputy Minister, and Byron Rafuse, our Chief Financial Officer; I think all members of the House have met them before. Before we get to your questions, I would like to take a few minutes to set some context for this debate. In simple terms our budget is about building on the progress we've made in government and building on our efforts to improve Nova Scotians' access to better, faster, more reliable care.
As members of this House know, I recently released Your Health Matters. Mr. Chairman, this is not the first plan to address Nova Scotia's health needs; in fact over the past 10 to 15 years there have been many others, but there is a big difference between this plan and those that have been released in the past. First, this government, unlike others, has the collective will to ensure our plan doesn't just collect dust; second, our plan will work because it is focused on the needs of people, not the needs of the system - and I can say this with confidence because Your Health Matters isn't just government's plan, it is a plan shaped by the nurses, doctors, and health professionals who know better than anyone how to improve patient care.
1
I want to publicly recognize and thank all of our health professionals for their tremendous commitment and attention to the health and health care needs of Nova Scotians. In fact, many have been planning and working with us since 1999; moreover, this year's budget once again demonstrates we've supported this work with continuing strategic investments. Let me identify the highlights of what we have achieved together and what we plan to do to make sure that Nova Scotians from one end of this province to the other have access to better health care.
Perhaps our greatest success has been in our efforts to train, recruit and retain more nurses. Between 1990 and 1998, the number of nurses graduating each year dropped from 333 to 86. In 1999 this government increased funding to enrol 75 more nursing students each year. As a result of this effort the number of nurses who graduate this year will be more than double what it was in 1998. A good start, Mr. Chairman, that we will continue to build on through this year's budget. Beginning in May, 60 more nurses will be trained in each of the next four years and these nurses will be educated in innovative ways. For example, some will complete their training in a shorter time so they are out of the classroom and at the bedside more quickly.
As the President of St. F.X. said: This funding announcement for nursing has been greeted with much acclaim and pride. This is surely good for Nova Scotia, for the universities and good for nursing. This innovative proposal and government's substantial support of it will serve as a prototype for the rest of the province and universities.
Mr. Chairman, opening up more training seats is just one of the efforts we have undertaken to ensure Nova Scotians have the nurses they need. Through our comprehensive nursing strategy, developed by nurses themselves, we are providing bursaries to nursing students and licensed practical nurses. We also introduced a new pay-for-work co-operative learning program. It began in 2001, available to 60 nursing students; in this budget year we are doubling this number to 120.
Mr. Chairman, our efforts to encourage nurses to make Nova Scotia their permanent or new home are working. In the last year alone, 113 nurses have relocated to Nova Scotia. In fact, I will table Nova Scotia's nursing strategy update, completed by the provincial nursing network and released in March of this year. This update reflects the $10 million commitment we are making this budget year to support the nursing strategy. I know at least one member has a fascination with nursing numbers and I am sure he will want to replace the press releases he uses with the most recent successes reflected in this update.
Our efforts to recruit more doctors are also working. Over the past four years Nova Scotians have benefited from a net gain of 199 doctors. Mr. Chairman, that means Nova Scotians are gaining, on average, a new doctor every two weeks. As outlined in Your Health Matters, an additional eight medical students will begin training this year and we will train 22 more medical laboratory technologists.
Mr. Chairman, let me take a moment to briefly touch on areas where Nova Scotia is not just leading Atlantic Canada, but the entire country. Nova Scotia is the first province in the country to guarantee stable, predictable funding for front-line hospital care. We are providing a seven per cent increase for our district health authorities and the IWK Health Centre in each of the next three years; that's a cumulative increase of $124 million, and this is on top of the additional and substantial spending to cover the DHAs' and the IWK's new wage and salary pressures.
Mr. Chairman, by providing our hospitals with guaranteed multi-year funding increases, we are ending years of roller-coaster decision making and ad hoc planning and patient uncertainty. By providing our hospitals with guaranteed funding, we are guaranteeing patients greater certainty that the services they need and count on will be there for them and their families. In a nutshell, more funding, predictable funding will lead to better planning, better management, reduced wait times, and better patient care. This is just one example of how we are leading the country.
Mr. Chairman, here are a few others: Nova Scotia became the first province in Canada to introduce standards for the diagnosis and treatment of people requiring mental health services; Nova Scotia became the first province in Canada to develop standards and protocols for the diagnosis and treatment of osteoporosis; we are leading the country when it comes to modernizing the collection and sharing of medical information in ways that benefit patients; and we are leading the country when it comes to emergency response services, in fact we have one of North America's most advanced air and ground ambulance services - an often overlooked but critical component of an integrated, well-managed health care system, and I would certainly credit previous governments in the 90s for much of that initiative.
Mr. Chairman, we are a national leader in telehealth services, with a sophisticated video-conferencing system that, with the touch of a few buttons, makes a specialist at the QE II or IWK available to any doctor or any patient in any hospital in Nova Scotia. In the areas of cancer care through Cancer Care Nova Scotia, diabetes care through the Diabetes Care Program of Nova Scotia, and cardiovascular care through Nova Scotia's ICONS program, our province is demonstrating new leadership in helping Nova Scotians better manage and better control disease.
Mr. Chairman, we are also leading the country in another area that may surprise some members opposite. According to data from the Canadian Institute of Health Information, we spend less on administration in Nova Scotia than any other province in Canada - I will table this document for all members that paints this picture. This of course highlights why we have added staff over the past several years, particularly in our seniors' programs and in areas where we are responsible for managing and overseeing our $2 billion health care system. Even with these strategic investments in staff, Nova Scotians want us to be administratively lean and I am pleased that we lead the country in this area.
Mr. Chairman, we are also doing what we can, when we can. This budget includes $33 million to help our seniors live independently, to help them better manage the high cost of prescription drugs and to help ease the financial cost of nursing home care for both seniors and their families. Of the $33 million, $18.1 million has been added to long-term care. Almost half this amount will be used to protect the assets of seniors and to begin reducing their contribution towards nursing home costs. Now, that's the medical cost of nursing home care. This commitment this year will reduce a senior's contribution by approximately $4,600 per year. Just today I shared with seniors and all Nova Scotians our plan to build on this important step.
To recap, Mr. Chairman, seniors will pay less towards their nursing home health care costs every year until they eventually pay only for room and board. When this point is reached, government will consider income only and stop considering assets when assessing a senior's ability to pay. This point will be reached no later than April 1, 2007. We will spend $40 million to make nursing home care the most affordable in Atlantic Canada and as affordable as it is in Ontario and the West. Even more significantly, seniors will be able to keep and pass along to their children and family the assets that they have worked for over their lifetimes.
This year government has balanced its investment in reduced nursing home costs with investments to support other programs that benefit a greater number of seniors. Mr. Chairman, this includes an additional $9.7 million to freeze the Seniors Pharmacare premium and co-pay as well as to cap the co-pay at a maximum of $30 per prescription - a suggestion put forward by the Group of Nine that government was pleased to accept.
Mr. Chairman, in the interest of time, I want to briefly mention a few final budget highlights. An additional $10 million will be invested in ways that will reduce wait times for tests and treatments beginning with cardiac care. Will this budget make a difference in wait times? Every member on this side of the House knows the answer, but if the other side of the House would like a second or third opinion, listen to what Blaise MacNeil, the CEO of the Southwest Nova District Health Authority had to say on Information Morning last week. First, Mr. MacNeil said the district's CAT scanning equipment and support for the new bone densitometer program means that significantly fewer people in his district will have to travel to Bridgewater or Halifax for service. Then Mr. MacNeil said, "The fact that the department has invested in programs like cardiac care, which is of great concern to us, will mean that the queues will be shorter and that people will have more access." His colleague, Don Ford, in the capital district had this to say, "This investment will significantly reduce wait times and have lasting benefits for patients and their families."
So, Mr. Chairman, quite simply, Nova Scotians won't have to wait for our plan to shorten wait lists to kick into action. Approximately $2 million will be provided to train more nurses and doctors and to provide bursaries for paramedics and medical laboratory technologists. This will reinforce our efforts to shorten wait lists. As well, Nova Scotia will
make good use of the federal money provided through the Medical Equipment Trust Fund. Just as we have in the past, every dollar of the $15 million will be used to purchase more and better medical equipment and to provide more specialized training - again an investment that will shorten wait times for test and treatment as well as improve access to services for people no matter where they live in Nova Scotia. In total, the budget to support doctors, nurses, health staff and to improve patient care will increase by more than $119 million.
Mr. Chairman, I would like to wrap things up with a point that surely will be met with universal agreement among all members of this House, namely Ottawa is still a small player when it comes to ensuring Nova Scotians, indeed all Canadians, have access to a universal, affordable and publicly-funded health care system. While we welcomed the new money recently announced through the federal-provincial accord, Ottawa's contribution to national Medicare continues to fall far short of both need and expectation. For example, the $75 million federal signing bonus would maintain our health care system for 13 days - a far cry from what Commissioner Romanow requested and what this government would have expected from a national government that claims it understands the priorities of Canadians. But let there be no mistake - Nova Scotia will use every cent of every dollar provided by Ottawa for its intended purposes and just as we have in each and every year of our mandate, we will, once again, spend more provincial money this year to support a better health care system for Nova Scotians.
Mr. Chairman, we have come a long way since 1999 and, admittedly, we still have a distance to go, but we're getting there in a sure, well-planned stepwise fashion. Our plan is in place. The money to see it take effect is committed in this budget as promised.
[6:00 p.m.]
MR. CHAIRMAN: The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Mr. Chairman, I would like to start by asking the minister if she would table the comments she just made, please, it would be really quite helpful, particularly, I think, with respect to the last portion of those remarks with respect to the increase in provincial funding or the expenditure in provincial funding.
Mr. Chairman, I will table a few documents of my own in a moment which come from the federal government's Web site on federal transfers to Nova Scotia and what's quite interesting about these figures from the federal government is the way they itemize and account for the increased spending in health for the Province of Nova Scotia. My calculation of this is that the Province of Nova Scotia, in fact, has received an additional $141 million from the federal government for health transfers and that amounts to $1 million more than what the provincial government is saying is new health spending.
So, Mr. Chairman, if this is an accurate reflection on what's going on then, in fact, the additional health care spending that's being announced by the Hamm Government is all federal money. Now, I recognize, as do most members of this Legislature, that since 1995 the federal government has starved the provinces for federal dollars for health care spending. Nobody would deny that and that following the Romanow Commission report, we have a health accord now between federal and provincial governments, which I would like to spend more time talking to the minister about, which results in this increase in funding from the federal government, but it's a little disingenuous, I think, to come to the Legislature and to the people of the province and say we are increasing health care spending by $140 million when, in fact, the health dollars that are being spent are federal dollars.
So let me start with laying out, Mr. Chairman, what these documents actually say in terms of federal transfers to Nova Scotia. The documents demonstrate that in 2003-04, CHST cash transferred to the province is $21 million. The CHST supplement is $75 million. It can be over a three-year period although it can be drawn down all in one year which it appears that this government has actually done, which is drawn $30 million that is shown here for 2003, another $30 million for 2004-05 and $15 million for 2005-06, all in one year; the Health Reform Fund of $30 million; the Diagnostic Medical Equipment Fund for $15 million; for a total of $140 million. So I will table this document and I will ask the minister if she would please speak to this issue, perhaps she would like a copy of that, in terms of the expenditures of this government, the new expenditures that have been announced. Is it not the case, Madam Minister, that the expenditures that have been announced are, in fact, the additional federal funding for health care for the province?
MISS PURVES: Mr. Chairman, the numbers do vary a bit, but there are a couple of figures in there that, although the federal government would like us to count them as a new contribution, none of the provinces consider the money from the agreement of 2000 as new federal money. For example, that $21 million of the deal imposed in September 2000, none of the provinces regard that as new money. In fact, that money certainly has already been included and already spent in previous estimates.
The other thing is that in our numbers we're considering the equipment fund, the $15 million this year, for a total of $45 million over three, as a separate item. So we definitely have added provincial money to this year's budget. We do not deny that a large proportion of it is federal money this year, there's no question. But the $160 million or so that we put in last year is still there and that was not a result of any kind of Romanow report or any kind of so-called signing bonus.
Yes, we are very grateful for the federal money, all the provinces are, but we had wanted at the very least to get a federal contribution to health care up to 18 per cent of health care costs and the money that we received this year did not get us there. There were many other citizens of the country, including Commissioner Romanow, who wanted the federal government not only to get us to 25 per cent within a very short time in terms of their
contribution, but to include an escalator clause in the money they were giving to the provinces. They did neither.
So, while I agree that we are able to make progress this year, I don't agree that all the money is federal, some of it is provincial. But certainly if you look at our total budget and what we've spent over the years, the federal contribution is less than 18 per cent of that $2 billion or so.
MS. MAUREEN MACDONALD: Mr. Chairman, I wouldn't dispute for a moment that the federal contribution isn't good enough. I think that if you look at what Romanow was recommending, the federal government's response fell far short in terms of both dollars that were allocated to the provinces and, in terms of some fundamental change in how the federal government is prepared to legislate. For example, to open up the Canada Health Act to make more explicit certain aspects of that Act and to take on the whole issue of for-profit health care versus maintaining a publicly not-for-profit health care system especially in its delivery of health care services. But that's something we can talk about in greater detail at some other point.
It is true that the federal government has not done enough. I think the point I was trying to make is that it's really important - particularly since accountability is one of the things that Romanow recommended - that there be greater transparency and greater accountability for the expenditures of health care dollars, particularly because this is an ongoing battle between federal and provincial governments around funding. The average citizen has a really difficult time trying to understand whether, in fact, the money we're getting for health care from the federal government is not only being spent on health care, but whether or not the provinces are using the flow of federal dollars as a way to shirk their responsibilities and to find ways to, for example, give tax breaks and not carry their fair share of the health care expenditures.
I think that is a very serious concern and it's one that the Minister of Finance in his budget did not bring the clarity to where the increased funding for health care is actually coming from and to demonstrate how the province is either maintaining its financial commitment to health care, increasing and improving the health care system where it can, but rather hiding behind federal money and saying we're doing all these things when, in fact, there could be other things that could be done and other budgetary choices are being made.
Having said that, I want to make a few comments about the health care system, generally. Mr. Chairman, you probably would know and the minister would certainly know, one of this province's strongest health care advocates, Debbie Kelly, who is with the Nova Scotia Citizens' Health Care Network. Debbie is a passionate advocate for a publicly-funded, publicly-delivered health care system. She's possibly home right now watching Legislative TV to observe these debates. Probably today, we'll all get numerous e-mails from Debbie
sending us along studies and media reports on health care across the country and, indeed, in other jurisdictions. I'm sure the minister and her staff have received some of these e-mails.
Debbie isn't only a person who cares passionately about public health care. She's also, unfortunately, a person who is currently dealing with the health care system. Recently she has had a diagnosis of breast cancer and her friends and people who have an enormous respect for her had a gathering on Friday evening to tell her how much we support her and value the work that she's done, but not just the work that she has done - her as a person and as a member of our community. Debbie used that opportunity, Madam Minister, to talk about her experience now in our health care system in terms of the barriers that exist to get in the way of accessing high-quality public health care in a timely fashion. When she finishes her treatment and she beats this thing, she's going to be one heck of an advocate. We haven't seen anything yet because of the experience she's going through.
As well, she talks about the barriers that health care providers face in their quest to provide high-quality health care services in a timely fashion. The picture that the minister has painted of a system that has stabilized and is moving forward is not the same system that Debbie spoke about on Friday night. She spoke about a system where in the quest to wring dollars and cents out of people who need health care, district health authorities have instituted all kinds of ways to generate money to offset their costs. She talked about the payment for parking, for example, as a very real barrier for people gaining access to high-quality public health care in a timely fashion. She talked about a variety of other kinds of barriers that exist.
I know that people like not to focus on these issues, but they are there and we need to focus on them. We need to look at the barriers that exist to people getting access to our health care system and we are a long way from having squared that particular problem in our system. The minister made an announcement today about long-term care. We knew that this announcement has been coming for some time, Mr. Chairman. I want to focus on the long-term care piece for a bit because this is something that this caucus has worked extremely hard at bringing to the attention of this government.
[6:15 p.m.]
Mr. Chairman, when we were first elected we started to look at various aspects of the health care system and how we thought it could be improved. Long-term care is certainly a very important part of our health care system, and it's an important part of the health care system especially for seniors and for other members of our community. Not just seniors, but people who become disabled for whatever reason, who require round-the-clock care, if they require more care than they can receive on the basis of home care in their own homes. They require a level of care, in terms of the amount of hours in the day that they need quality care, and they also require particular kinds of care, people who have some training and the skills to help them bathe, monitor medication, watch their medical conditions on site, skills that
we don't often possess in terms of taking care of people in our own homes and even for many home support workers.
Mr. Chairman, that's what the nursing home system is there for, for people who can no longer stay in their own homes. In this province, we have seen the very sorry state of the long-term care system which had these extremely harsh assessment policies requiring seniors and other members of our community who required long-term care to deplete all of their life savings, all of their assets from the hard work of their lifetimes in order to get the health care they required. We have, with the enormous support of Nova Scotians, hammered away at this issue, pushed the government to adopt a more rational, a more humane, a more caring policy, and in November of last year we had some small success in terms of the government backing away from some features of its assessment for long-term care. But we felt and we continue to feel that that backing away certainly didn't go nearly far enough.
Today, Mr. Chairman, the minister made her announcement that in four years' time this financial assessment for the health care component of long-term care will no longer exist. But really, four years, in our view, is much too long, seniors cannot wait for four years and their families shouldn't have to wait for four years. My understanding is that, on average, there are 200 new admissions to long-term care each month, that at least 50 per cent of all people who go into the long-term care system are people who will have some assets that will be assessed and that they will deplete those assets over the period of time in long-term care. So, literally thousands of seniors between now and 2007 will continue to be subjected to this completely unfair and unacceptable situation where they will have to pay for the health care component of their care.
I cannot understand how this government can plead poor, given the budget that was announced on Thursday. I don't understand how this government can say it does not have the resources to address the health care needs of the most vulnerable members of our community in the last stages of their lives. Generally speaking, that's who we're talking about, we're talking about seniors in the twilight years of their lives who require health care. This government could not find it in their priorities to address the needs of this group until 2007. This, to me, is a situation that I cannot find a rational explanation for. I've listened to what the minister has said about balance, but I also sat in this Chamber last Thursday and listened to the Minister of Finance send $155 cheques to each and every person in the Province of Nova Scotia who has paid one cent of income tax. I ask about the priorities and the choices of the government - frankly, it doesn't make any sense to me.
Madam Minister, I don't need $155 in a rebate. I know some people do, and I'm glad for them that they will receive this rebate. I think that I would like to understand why seniors in the twilight of their life who are unwell are such a low priority that they had to have their needs put off until 2007. Let's not be too maudlin here but let's be honest about this, a lot of these seniors will pass away by 2007. They will never have the benefit of the government's announced intentions today. They will have their life savings depleted,
exhausted, that is happening as we sit here having this debate, as a matter of fact. So I would like the minister, if she would, to explain the choice that has been made by her government and the priority that has been assigned to this group of seniors.
MISS PURVES: Mr. Chairman, before I get to the long-term care issues, I would like to respond a bit, if I may, to some of the remarks at the beginning, concerning accountability. I agree with the member for Halifax Needham that people in this province, in all provinces, want to see more accountability for the spending of health care money, not only health care money but any money that is either raised on our own or given to us by the federal government. That is actually one of the reasons why we produced Your Health Matters, and in the Fall we will be producing a report to patients, not only because we agree but because it is going to be a requirement of the federal government, that for receiving more federal money for health care we show that it was spent on health care.
The other thing that occurred during the meetings on the health care accord was an insistence, by the provinces actually, that the CHST be split into its various components sooner rather than later. The feeling was that accountability worked both ways, and most of us were pretty tired of having various people from the federal government come into the province, whichever province, and talk about everything they were spending on education and then come back a month later and talk about everything they were spending on health and everything they were spending on community services because, of course, they're talking about the same money. So, it's easier for everybody to account for this money when they give it to us in line items, so it can't be double-counted all over the place. That is not an improvement that's going to take place this year, but it is going to take place very soon.
I can certainly point to the accounting of the equipment fund from last year as a way in which Nova Scotia did very well accounting for every cent that was spent on medical equipment, some of which did, obviously, go to nursing homes.
On the long-term issues, Mr. Chairman, I'm sure there is going to be a great deal of discussion about this. At the outset, I would like to credit the New Democratic Party for pushing us faster than we probably would have gone. I realize they put a lot of effort into this, but so have we. Since coming to office, we recognized some of the issues in the long-term care sector as the most pressing needing our attention. It was the lengthy waiting lists to get into nursing homes, causing the use of precious hospital beds for people who would have been better served in nursing homes. It is why the department - obviously, I wasn't the minister at the time - worked so hard in going to single-entry access. We were the last province in Canada to do that. It's the result of having a provincial waiting list and trying to see that those who needed care got it first. We did reduce the waiting lists by about 23 per cent, we did do something for those in need. There were some people in some nursing homes, of course, who didn't like or don't like the system because it's put a stop to the practice of the homes accepting, perhaps the healthier, wealthier patients ahead of those who needed the care the most.
That being said, even repeating what the previous minister said a number of times, that we have added $90 million or so since 1999 to the continuing care sector, both long term care and home care, that we still had a problem. It's my view that four years is not an excessive length of time to wait to fix a problem that took more than 30 years to create. I realize that it would be nice to be able to abolish this problem - well, you couldn't do it overnight, administratively speaking - but sooner than four years, I understand that. However, what seniors and their families will see in the next four years starting this year, is an absolute decrease in their daily costs for medical care in nursing homes and they will see a bigger decrease next year and the year after and the year after. At least by the end of that time, whatever government is in power, we will have a new and fairer system for people needing nursing care in Nova Scotia. I have no doubt that this announcement will spur some decision making in other Atlantic Provinces but we believe it is a necessary decision to make.
Mr. Chairman, I'm not going to talk about our government's decision to keep its election promise about a tax cut, except to say that we felt morally bound to keep that promise because we considered it a major plank in our election platform. Obviously, I and any other minister could have spent that money ten times over, probably, in some of our portfolios if we had it. That being said, we believe that we have a balanced approach towards the needs of seniors and for other age groups in this budget. We do need to work on mental health, we need to help kids, we need to help young families. Seniors in nursing homes need our help, so do other seniors who aren't in nursing homes yet and that is what our Pharmacare announcement was about. It will cost the province $10 million to cap the costs and we are making further investments in home care as well. That is a sector that will also involve considerable work over the coming years in order to provide the kind of care that people expect and, of course, expectations are always rising in health care and other sectors, as the member opposite knows.
MS. MAUREEN MACDONALD: Mr. Chairman, I'm wondering if the minister could tell us a bit about how per diems are actually set in the long-term care sector. I'm sure the minister has members of her constituency or people from outside her constituency who are concerned about what is occurring in Nova Scotia around the per diem costs of continuing care in the long-term care sector. I, certainly, as the Health Critic of my Party - and I know our Leader - get e-mails from people who tell us that the per diem costs in a facility where they may have a family member are taking a substantial jump in cost. Various people have certainly asked us a lot of questions about how in fact per diems are established.
[6:30 p.m.]
Before I was elected I served on various boards of directors of organizations, for example, a women's shelter, where we had per diems and I have a general idea of how those per diems were set in terms of our budgets. We would submit an annual budget that would look at our operating costs, but one of the things that was never included in our operating cost was our capital costs. If we needed to make repairs to our shelter, for example, then that
wasn't something that we could submit to government. We couldn't get our per diems to reflect the fact that we needed a new roof, or we needed to repair a crack in the foundation of our shelter, or if we needed to put some new windows on the building or whatever.
Now, I know that in Nova Scotia we have seen a number of things happen with respect to long-term care. We have seen various nursing homes go through fairly extensive renovations and we've also seen some build new facilities, so I want to ask what is the relationship between the capital expenditures in particular nursing homes and the per diem costs? Is there an ability to pass along the costs of renovations onto the per diem calculations? How exactly does that work?
The other question I would have as well in terms of establishing per diems is, in this sector, because we have a number of for-profit providers of long-term care, how is the calculation - what proportion of the operating budget is allowed for to make a profit? How is that built in and how is that established in respect to the per diem costs?
MISS PURVES: Mr. Chairman, we pay nursing homes the same for patient care regardless of the home, but the variance in the daily rate is due to the fact that we have built capital costs into the per diem costs so that, for example, some of the older nursing homes have 50 year mortgages. You can't get 50 year mortgages anymore. The one caveat there is that the renovations must be approved by the department. There is no question that many facilities need capital improvements but we still need to know we have a bit of a handle on what's being done and why so we know what's going on there. In terms of the profit margin, I believe the profit margin is held to about 5 per cent.
MS. MAUREEN MACDONALD: Mr. Chairman, so what's five per cent of $222 million? I guess all of that $222 million isn't only in for-profit, long-term care. I'm just wondering how much of the expenditures in the long-term care system is actually not spent on health care but is the profit margin for private providers?
MISS PURVES: Mr. Chairman, we don't have that figure with us today, but we can get that for you.
MS. MAUREEN MACDONALD: Okay, thank you very much, Mr. Chairman. I want to talk a bit about home care and I'm pleased to see that there is additional money for home care, however, I notice that there are several boards where home care, in fact, will be lower in terms of the expenditure according to the budget this year than last year. The DHA here in the capital district has less money allocated for home care this year than last year and the same thing with the South Shore and the western part of the province and I'm wondering if the minister can explain why, when home care's budget is being increased, there are some DHAs that are seeing a reduction in home care?
MISS PURVES: Mr. Chairman, the information in the budget documents is based on information that we just started collecting last year. We didn't have these kind of breakouts before and they've been adjusted for demand.
MS. MAUREEN MACDONALD: Well, I mean, I certainly don't have the numbers that the Department of Health is using, or that the district health authorities are using, but from my own experience in my constituency office and talking to people who are on waiting lists, for example, for home care, it seems to me that in the capital district where my constituency is located, there are people who right now have substantial waits to get home care services. So I guess I'm wondering if the minister can quantify in any way what are the waits for the various districts and if there are waiting lists, for example in the capital district, how could it be that less money is needed to provide home care?
MISS PURVES: Mr. Chairman, there are several factors at work here, but the member is right, in the Cape Breton district and capital district, particularly in the capital district, there is a wait-list for certain kinds of home care that is not necessarily a lack of funding. In the capital district there has been a problem filling some of the positions and the demand is higher, obviously, because of the population numbers, but also the job market is a lot more competitive in the metro area and I believe the capital district has begun filling some of the positions that were vacant, but it is somewhat difficult to fill the jobs as quickly as they would like.
MS. MAUREEN MACDONALD: This opens up then a couple of other questions I would have about this. What kind of labour shortages, if you want to use that term I suppose, are there in the home care field here in the metro area? Is it in nursing? Is it in LPNs? Is it in homemakers? Where is the shortage? What is the plan to address that? If, in fact, the problem is with respect to a more competitive environment, for example, you know, home support workers make very low wages. They incur a fair amount of expenses sometimes in just travelling around, getting to their jobs. They tell us sometimes that they don't like not seeing the same client over and over again, they like to be able to do that, and if they're caring for somebody on a regular basis and that person goes into hospital, then they may, in fact, lose money because they're paid on an hourly basis.
There's no incentive to stay in a job like that when they're constantly facing a huge amount of insecurity around their own income and, in fact, they might be able to make a better weekly or monthly wage working at Zellers, Tim Hortons, a call centre. I mean, I hear this all the time. I'm sure this isn't unknown to your department.
So I guess if you could help us understand the real features of that situation, where are the shortages in terms of the kind of person who is providing home care and what is the plan to address it if that is the situation?
MISS PURVES: Mr. Chairman, the shortage had been around nurses. That situation has begun to rectify itself. Then the shortage was with the homemaker or personal care workers and that too we believe has stabilized or it will be stabilized in the coming year. I will endeavour to provide more detailed information from the people we contract those services from, but I wouldn't like to understate the issues that we face as a province in trying to improve home care. That is one of the targeted services the federal government would like to see the Health Reform Fund invested in and their biggest issues seem to be post-hospital home care and that is only one of the areas, obviously, where people need home care and we will have to work very hard to make sure that these labour shortages cease to be so and that we are able to provide the kind of home care that we want to be able to provide.
The member alluded to situations of people having multiple workers and workers having to go to many different places instead of trying to stay with a client and we all know those are very real issues and they're caused by massive scheduling difficulties. I know that we've gone in on a couple of occasions here in the metro area to try to help with this massive effort of coordination, which is what it is, to try to get as many of the right people with the same clients as possible. There's no question, it is an issue and it needs a lot of work.
[6:45 p.m.]
MS. MAUREEN MACDONALD: I want to talk a bit about the situation for nurses, in particular, the retention of nurses in our system. The minister will be aware of a letter - I think that one of my colleagues tabled and read here - from a nursing student in the Dalhousie School of Nursing that appeared in the Herald a few weeks ago. I don't have a copy of it here this evening, but I can certainly get one and table it. This young woman was saying that in fact, the majority of people from her graduating class don't have jobs in Nova Scotia. A few do, but the vast majority are leaving the province. Although the numbers that the minister tables and talks about paint a particular picture and they're very impressive on the one hand, on the other hand we have this kind of information that nursing students continue to leave the province. Some people say, why are we expanding the number of seats to train nurses if we're training nurses for Texas, Florida, Alberta or other provinces?
I haven't verified it, but I have been told that the nurses that are graduating from the nurse practitioner program also are not able to secure full-time nursing positions in the province. I guess my question is to ask the minister to look at this situation from the other end of the spectrum. To what extent is the department aware of the young women and men who are training to be nurses, who do not have full-time jobs in Nova Scotia, and who are leaving? Are we keeping track of that aspect of what's going on? Are we looking at whether or not we are training health care professionals, specifically nurses, for jobs in other parts of our country or on the continent? Are we looking at that and if we're not, do you not think that it might be prudent for us to take a look at that so that we can address it in some way?
MISS PURVES: Again, there are a number of issues here, but it is true that of our nursing graduates last year, 80 per cent of them stayed in the province. This is better than in previous years. It is also true that we have vacancies around the province waiting to be filled. The member for Dartmouth East brought up the Valley issue while members of the Opposition have also brought up the Valley issue. There are also some vacancies in Colchester. They're not necessarily all vacancies for new graduates. We know that there are vacancies in critical care, which requires a bit more experience.
One of the issues that we have specifically with graduates, more so with graduates of the Dalhousie Nursing School, is that while there are jobs in the Capital District, for example, I think so far this year about 45 new graduates have been hired, the vacancies aren't all in the same location. There may be vacancies at the Dartmouth General Hospital, there may be vacancies at Cobequid, there may be vacancies at the QE II. Sometimes graduates can't get a job where they want, but it's not that the job isn't necessarily available. That is obviously not true of all - many are prepared to go wherever the job is.
The government, or the department, wants to see the nurse get to the patient and if we can't do that in a way that meets the planning needs of the districts, then yes, we're going to lose some nurses. Although, not most, not the majority. The vast majority are staying now and we want to keep it that way.
The trend for people wanting to stay in Halifax is great, but that's not the only place we have needs. One of the reasons that we were so glad to accept the proposals that have to do with St. F.X. and UCCB is because we tend to retain more of these nurses who train in those areas of Nova Scotia. There's no problem with retention of the nurses graduating from UCCB, for example. We would like to see more programs like that.
If, for example - this is just an idea that's being explored at the present time - if we ended up seeing a program between Dalhousie Nursing School and the Nova Scotia Agricultural College, for example, to use some of the facilities and rooms in training on that campus, we might see young people or even not so young people wanting to stay in the Truro or Colchester area because that's where they're from if we could make it easier for them to train there. Certainly Dalhousie and the Agricultural College co-operate in many other ways and there are many people there with a science background.
The other thing that we are happy about the St. F.X. proposal is it would see some people graduating at different times of year than the normal graduation time. That makes it easier to fill jobs. When everybody graduates at once, it's a little bit harder because the needs don't necessarily happen like that. It's an attempt to get a not year-round, but at least twice a year graduation time, that's very helpful for the system.
No, obviously, we don't have a perfect system, but we do think we're doing better and that's really a credit to the nurses themselves. Since they've been involved with Barb Oke and developed the nursing network, they come together and they propose solutions which I have found to be immensely practical.
MS. MAUREEN MACDONALD: Mr. Chairman, I don't have a lot of time left so I will just finish off, I guess, by talking a bit more about health care human resources. I think that, rightly so in many respects, nurses and doctors who make up the majority of health care providers in our health care system, certainly in our acute care and tertiary kind of systems, are really extremely important. I know that the government has made a commitment around medical lab technologists where impending shortages are very worrisome and require attention.
I think that there are other health care human resources that have been under a fair amount of pressure. I'm just speaking as a social worker who knows social workers who work in the health care system. I know that this is an area where a lot of people who have worked in the system for a number of years are retiring. Social work, as a profession, as one of the health care professions in fact, is facing a situation of having greater difficulty finding people to go into that field. I know that pharmacists have been confronted by the same situations. It may be part of the demographic situation that we have now, where a lot of the baby boomers are heading into early retirement and retirement, and we're seeing a greater pressure on a variety of professions within the health care system.
I think I will end by asking the minister if she could speak to what assessment the department has done around the breadth of health care professionals beyond those core professions of nurses and doctors and medical lab technicians, for example, to look at all of those other people in our health care system who provide really important services. It's probably true that no one in a hospital will die if a social worker, for example, isn't available, but those services are sure important to families and to patients. What analysis has been done of the breadth of the health care professions, and what planning or strategies has the department developed to address impending shortages in a variety of health professions?
MISS PURVES: Mr. Chairman, the member opposite is quite right, social workers and pharmacists - pharmacists, we know from national studies are going to be in huge demand and there's going to be a shortage. Obviously this year we know we have to do something about lab technologists and certain classes of paramedics, and we are moving on that. For the last two years, the department has commissioned a study of all its health care professions to get a baseline example of who we have, where we have them, when we're going to need them, and this is actually information that I'm sure most people assume that the government has but in fact we never did have it. That document will be ready for publication fairly soon. That should give us a much better idea of the kinds of issues the member for Halifax Needham is raising.
Certainly, we know that across Canada, we're going to be facing, to varying degrees, the same kinds of shortages. The same thing will happen across North America, but that's not so much our concern. Our concern is Canada and how we're going to deal with, on a national level, the competition for workers who are in short supply.
MS. MAUREEN MACDONALD: I want to thank the minister. I know these are important issues for people who are in the field. Quite often they worry about, not just themselves, but their profession's ability to meet changing circumstances and demands. I think that the idea of having people from those professions involved in the planning, the planning for the best way to train, recruit, retain, integrate into the health care system and plan for the future of the health care system is really very important.
I'm wondering - just quickly here, because I think I'm almost out of time, well, I probably don't have enough time to make my last question, so I will save it and turn it over to the other Party.
MR. CHAIRMAN: The honourable member for Dartmouth East.
DR. JAMES SMITH: Mr. Chairman, thank you for the opportunity to address the estimates. Health tends to often be the first one, particularly in the Legislative Chamber, because it is an important matter of discussion, where the minister is called to defend the budget of her government relative to her responsibilities, in this case Health. It should be Health Promotion as well, but I will have to work my way through that somehow, to see if we have a chance to speak to that minister or if the Minister of Health is prepared to address some of the important issues of health promotion and wellness, because it is certainly such an integral part.
[7:00 p.m.]
The estimate debates, Mr. Chairman - it's sort of interesting how when you roll out the various programs within a department such as Health, it seems to be so all-encompassing and so important for the day, but you realize it's really a snapshot in time. So many of the programs have been in place for long periods of time. Some are, in a way, declining. We look at the public health initiatives that were so much in the forefront, and now we see something that was so much a part of our communities just not there. A lot of these changes have come through various governments, through various Parties that were represented by those governments, but times have changed.
All of a sudden, we're brought back to what is really important. A few weeks ago we were discussing matters of bio-terrorism and small pox and all those other initiatives, and then all of a sudden, bingo, nature raises its head again and we have an epidemic almost circling the globe, I suppose, and maybe if we knew more about it, would be identified as
SARS. This always gets my attention, because my grandfather on my father's side died in 1919 coming up Halifax Harbour with what was then referred to as the Spanish flu.
Just when we think we're getting very sophisticated and getting a lot of these initiatives, these challenges to health, particularly in the area of infectious diseases, all of a sudden, if it wasn't for the war on Iraq overtaking most of the electronic and print media, I'm sure SARS would be filling a lot of those pages, more than what it already is. We are trying to follow those issues as well, in context, as we follow the issues at home, the more bread-and-butter issues of everyday living that Nova Scotians call on their health system to provide and meet their basic needs.
The minister starts by speaking in terms of her plan, Your Health Matters. It's a nice brochure, a nice press conference, much participation. I particularly enjoyed the participation of the deputy minister. I had never seen a deputy minister - I wish I had a couple of them. I had three deputy ministers when I was there, over a period of time, but I never had one who was so supportive during a press conference. He would even hold up his hand when the minister was asked a question, and he answered the question. I really want to just comment on the quality of her choice - I don't know, I guess she didn't play a part in the choice - of the deputy minister, certainly he spoke very well.
I did want to make another comment a little later on - in fact I will mention it now because I really do think that the deputy and all the other staff are really doing a great job in that department. It's very challenging for staff. I tried to say a nice thing one day about the deputy minister in a press release. It had to do with the physician training at the Dalhousie Medical School, and there were some discussions, obviously ongoing, between the Department of Health and the medical school. These are always very interesting. They're not really talked about often in public, which is just as well, I would think. I supported the deputy minister and thought it was a good initiative. He was speaking out about the importance of this but also the importance of being responsible, and the cost of doing this. I don't think anybody ever knew or could figure out how much it costs to train a medical student to become a doctor. There are all kinds of figures around. I'm not sure that is known.
However, I was chastised by an editorial piece, how silly Smith would be that he would really pay a compliment to the deputy like that, and doesn't he know what the job of Opposition is. So if I seem a bit critical sometimes, I'm just following directions. (Interruption) No, no, but this was not anybody in the House criticizing. I mean certainly the minister probably enjoyed that her deputy was being supported like that, but I was chastised - didn't I know my place and it was written in an editorial in The Halifax Chronicle-Herald and it was on the front page, or under the fold there.
So, anyway, I will try not to be too critical. I do believe, in other words, the point being that the role of Opposition, while it is to be critical, I think that we try to offer some constructive and positive comments from time to time, but I don't seem to get in as much trouble when I criticize as when I try to be constructive so maybe that says something about my constructive advice.
The minister also spoke earlier of the nursing strategy and this is so important that this is unfolding. She made some allusion to a member during her press release on the nurses' number, and I don't think I want to get into much of an argument about the nurses' number. We know that in the early 1990s there were cutbacks, in the beds really, in the acute care. We were way, way the highest per capita beds in Canada when we formed government in 1993 and even with, I think about a third of the beds were taken out of service within the health care system, we still remained top of the heap for hospital beds per capita. I'm not quite sure, I haven't followed it lately, but I expect we're still holding our own. So you can argue that, but we know that we lost 1,200 nurses following Bill No. 68. Now, whether they disappeared or they left the province or they just didn't register, I expect it was a mix of all of those.
Now, we had a release today on long-term care; the minister referred to long-term care and I would just have a question before I sit down. I would ask her if we can look forward to any more announcements, maybe tomorrow, on long-term care. The rumor mill is grinding out there that you're going to have a release tomorrow on something. I can't believe that although there was some criticism today perhaps on the long-term care announcement, that it was drawn out - the honourable member for the NDP had mentioned earlier that she thought perhaps there would be so many of them that many may not even be alive by the time, the effect of the program where the health component of long-term care would be funded by this government.
I was a little more jaded than her perhaps. I sort of thought that the government quickly had to control their agenda and they had to do something positive for seniors because the $155 cheque really was coming out pretty negative, particularly with seniors. I spoke to one of our nominating candidates in southwestern Nova Scotia today and he said he was getting a lot of calls in his office relative to seniors really being ticked off that this money would be going out and they didn't qualify for it and they just thought it was not fair. I know the weekend has gone by after the budget and there is some feedback, so it will be interesting to see how that goes. Is this really an earnest program and if so - and I will come to some of the federal monies that are coming into the province - why that could not have been used for that now and address the needs? That's the commitment that our Party has made in forming government, that we would address that issue to pick up the health component of long-term care, and that is the commitment that has been made by our Leader.
Pharmacare is an interesting issue where they ran out of things to increase, Mr. Chairman. One year they put up the premium, the next year they put up the co-pay, and then the next year they said we're going to freeze it, aren't we good? They will probably find something in Pharmacare to jiggle around next year, but I do want to also comment about the catastrophic drug funds and where that is going within the federal monies. We speak in terms of wait times and I think within the estimates we see increased monies going to address the wait times. I think that's important, but I really don't believe that there are many Nova Scotians who really believe that the health care system, that the access into the system is addressing their needs much better than it has over the last several years. There are some indications that there are some improvements in certain areas, but I think that is not the opinion of Nova Scotians.
We follow this in the estimates this afternoon, and we had some discussion about how much money has actually come in from Ottawa under the federal health reform fund. I didn't follow all of it; I couldn't follow all the numbers, but our feeling is it may not be as much - our information from Ottawa isn't as much as the NDP have said, at least in that particular area. But I think whatever it is, I notice the minister did not get into speaking percentages relative to how much the federal government is putting into health care, and I think that's interesting. I was always quite amazed over the last while that the federal government often stays silent when it is said that the federal government is now putting in 12 per cent, or something like that, and we know that there's a tax point issue. I don't know how much you can add it up to be, but it could be really around 40 per cent, or even a little more that they're contributing, but they seem to be content to let the provincial government keep picking away at them, and they have not really counteracted in a way that I think they could.
One thing that I know, and I must say I envy the minister to be a Minister of Health at a time when there is increased funding from the federal government and it's substantive. There is an awful lot of difference when the funding is increasing, as opposed to when it's decreasing. It seems like the times in government that we spent, it took the first couple of years to really find out what the previous Progressive Conservative Government had left us and trying to do some good things and address some of the needs within that, and then all of a sudden, a few years later, the federal government start having cutbacks. So that was very substantive from our point of view and really made it a challenge; it made exciting times.
I mentioned the public health initiatives in primary care and access into the system. We look forward to the development of a team approach to primary care - and we will touch on that another day - and the $17 million relative to that amount. I think the mental health issues have been appropriate, at least it has been on the agenda. I am concerned that whether it's Community Services offering the service, or it's Health, that we actually have the personnel within those programs to actually deliver the service, and I'm not convinced that they're there yet and we haven't seen those programs rolled out, but we're watching. At least it's on the agenda and I think the main thing with any Minister of Health is to keep mental
health on the agenda, to keep it on the table as it sometimes tends to slide off or it tends to be chipped away at and not enjoy the priority of acute care, particularly.
We're looking forward to following the negotiations with physicians. There hasn't been too much reaction to that. I think there's 7 per cent put in the budget to address the physician. Some of that is for recruitment but we know that there is a budget or negotiations coming forward and they're on the go. So it looks like the minister will have some leeway to at least keep physicians happy a little longer. The nurse practitioners are a concern, we don't seem to see the initiatives that we were hoping to see in this province and we would like to maybe have a little more information on that. But Health Promotion I mentioned and I guess I could just maybe ask - I know it's under another minister and it's in another area and if the minister sees Health Promotion matters as that, or will we have to wait to see if the other minister stands up - does she consider that to be part of her responsibility as well or should I wait for the other minister and try to get a crack at him down the road somewhere?
[7:15 p.m.]
MISS PURVES: I wonder if I might make a brief introduction - you could push the time off to the end?
MR. CHAIRMAN: Go ahead, Madam Minister.
MISS PURVES: Thank you. There are a couple of members of my constituency association who are friends, in the gallery: Paul Fitzgibbons, Drew Campbell and Mary Lou Leroux and I wonder if they would stand and receive the warm welcome of the House, please. (Applause)
First, I would like to assure the member for Dartmouth East that the Minister of Health Promotion will be available to answer his questions. I'm not sure what time has been selected for the estimates of the Minister of Tourism and Culture, but he will be doing Health Promotion at that time. I'm not able to answer questions involving his portfolio; it wouldn't be quite proper for me to do that.
There are a number of issues raised by the Health Critic for the Liberal Party and I'd like to briefly address some of them although, obviously, I won't be fully addressing all of them at this point.
One of the first issues, or perhaps the first issue he brought up was that most important area, particularly it seems right now, of public health. I noticed a recent column by Mary-Jane Hampton which talked about cutbacks in public health. That was something that the Medical Officer of Health for Toronto was talking about on Cross Country Checkup yesterday as well - about how, in times of relative calm in public health, somehow the money
seems to go to other things, particularly acute care and other areas of the system where the demands seem to be more pressing.
Obviously with the coming of SARS to the world, as well with the increased problems we're going to see with West Nile Virus, which is sure to make its appearance in human beings in Nova Scotia this summer, the profile of public health has become much higher.
There have been no cuts to public health in the mandate of our government; in fact, we reinstated the home visiting program for public health nurses which, this year, we'll be spending about $2 million on - when fully implemented it will cost about $3.1 million. But, depending upon what crises we may see, and we cannot know about them all in advance, it is certainly possible that we will have to spend more money in this area. I can assure the House and all Nova Scotians that we're keeping a very close eye on this situation.
One of the areas, too, where we may be able to do some work in public health areas is in the area of primary care, because there is a separate federal fund that the provinces are able to access for primary health care initiatives. We are acutely aware of the importance of public health information, education, and of the immense body of knowledge that is needed by public health officials to help us cope with things like West Nile and SARS, and who knows what it will be in six months' time or even a year's time.
The member for Dartmouth East raises the issue of the past and the prominence that public health took in past years, and certainly as not a young person I remember very well polio and the visiting school nurses who gave you your little tablets or sugar cubes, and all the attention that was paid in those times to public health issues such as polio. Well, polio has almost disappeared, of course - but not quite, but it's unlikely we will ever see the end of new public health issues that we have to deal with. (Interruption) Another announcement tomorrow on long-term care? No. No, there is not another announcement tomorrow on long-term care.
The issue of the catastrophic drug fund is again one that has raised expectations in the public across the country. In fact, there will be more money in the health reform fund for catastrophic drug coverage, but it's estimated by the federal government and provincial governments that it's going to take at least two years for deputies and officials across the country to set up the standards for what this catastrophic drug fund will cover. Obviously there are going to have to be some moving targets in there because, at the rate of which new drugs are being developed, there's going to have to be protocols for how they're used and when they're used, and that's not just for the existing ones.
I know there are many people out there who are looking forward to this additional money and certainly this government is one of them. But I do see there being a need to temper expectations because it will take time to work out what is in fact "catastrophic". The
member spoke of how well-spoken the deputy is - and he certainly is - and he has pointed out several times what is a catastrophic cost to someone earning $18,000 a year is not catastrophic necessarily to someone earning $80,000 a year. To most people catastrophic is what they can't afford, and there have to be very good guidelines and, hopefully, compassionate guidelines around what this money will be used for.
Given the cost of some of the drugs available these days, it wouldn't be long before the whole catastrophic drug fund was consumed, so that's an issue where we're going to try to lower expectations. Even though we know there will be some relief, I'm very much afraid that it won't be as much as people expect.
Another issue that the member raised is that of nurse practitioners and how we perhaps don't have as many as we would like. I can tell the House that we are making progress, that there are 13 approved positions, that six have been filled and we have seven yet to go. We would like that progress to be faster, obviously, but it is taking place.
That being said, I believe I have addressed at least some of the issues raised by the Health Critic for the Liberal Party.
MR. CHAIRMAN: I wonder if the member for Dartmouth East will allow for an introduction.
The honourable member for Halifax Fairview.
MR. GRAHAM STEELE: On behalf of my colleague, the member for Timberlea-Prospect, I would like to draw the attention of the members of the House to the west gallery where we are being visited by the 1st Five Island Cubs with their leaders, Christine Madill - and I understand that, yes, it is that Madill - Doug Marshall and Elizabeth Anthony. I would like to ask the cubs of the 1st Five Island group to rise and receive the welcome of the House. (Applause)
MR. CHAIRMAN: Thank you, member, and certainly welcome to all of our guests.
DR. SMITH: I was sort of hoping that we'd get a pre-empt on the senior and long-term care announcement tomorrow, that it would be addressing some of the drug issues, certainly Aricept and others. I think this minister finds herself with that particular issue very much where we found ourselves with multiple sclerosis and Betaseron. I will just say to the minster that this working together with other provinces on these formularies, it's interesting, but I'll tell you they'll sometimes sort of drag you back a little bit, or not encourage you to move forward in areas where you should move forward. That was the way with us when we, through Dr. Jock Murray and the multiple sclerosis clinic, set up criteria for Betaseron and the other drugs that followed. For those who qualified for that care, it was expensive and so is Aricept.
The research is in, I hope that this government will not be so crass as to just do it as an election ploy, although I must say I was quite interested in the $155 cheque. I really didn't think that this government had the guts to do that, the crassness of that, that they would do that. I hadn't seen things like that, I was in British Columbia in my earlier days, at university, and that's where once a year - I confess that while I was in British Columbia I voted NDP.
AN HON. MEMBER: Oh, my God.
DR. SMITH: I did, I know. There's hardly a day goes by that I don't recall that, particularly when the Legislature is in session, but the reason I did is because of those sort of things that were being done on a regular basis by "Wacky" Bennett's Government there, so I thought my alternatives really were not great.
I think if they can do that type of initiative, Mr. Chairman, there is no question to me. Why are they so stubborn? What is the problem with not covering Aricept and drugs for Alzheimer's disease? Again, the research is in. I spoke to a gentleman the other day on the phone relative to his wife, and later called the daughter as well to confirm what he had said and there is a marked improvement, clear cut, but the people are hurting. It's costly, it's not as catastrophic as some other drugs but the minister said it well - what is catastrophic to some is not catastrophic necessarily to others. I'll tell you, there are many people in this province that an extra $60 or $100 a month is catastrophic.
We look at the programs - and this was sent out by the Cancer Society and group - the programs that are available. The same nominated candidate who called me today called me back in February, I think it was, relative to a gentleman who was travelling who had cancer and he approached a caseworker and it sort of keeps going around and around in circles. It just so happened to tie in with the programs that are available to people on extreme limited incomes who could possibly qualify for travel costs. The Department of Community Services has a program there and also the Department of Health has the Drug Assistance for Cancer Patients (DACP) and that deals with various criteria for there. I think it's all well enough to say, it's catastrophic for some and not for others, but I'll tell you that in the part of the world where I grew up, they're still hurting down there and transportation for cancer patients is a big issue.
I think maybe something like that would make a nice announcement and maybe if you've got time - I notice you signed very quickly the quarantine issue relative to SARS - when I asked the question in the House the other day, the minister had signed it off the night before. I thought maybe it might have to go to Order in Council before Cabinet, but obviously it did not, so she responded there. So she's able to make those types of decisions. I think, and maybe I can even make a promise tonight that I will not say that it's crass politics if this government, leading up to this next election, brings in coverage for the Alzheimer's drugs. I can't speak for what other members of my caucus might say, but I will make a pledge that I will not criticize the government as being crass and playing politics if they bring
in a plan to cover Alzheimer's disease for those persons who are unable to afford it within the program as we know it.
It is working, the research is in, we're finding many different factors that are involved in Alzheimer's. I guess like all other diseases, many diseases they break down into different types and different causes and some factors are more predominant in the expression of the disease than others, but we know one thing, that the medications are working for some people very well. These people, many of them have very modest incomes and they cannot afford the cost. You know what happens after that, various things happen. I don't want to dwell on that particular issue, but I think if the minister were moved to make an announcement tomorrow, that would make a good announcement.
Just going back a bit to the monies relative to the federal government, and it is nice to be in government at a time when the money is flowing a bit freely - never as much as you need, never as much as you could use, but it is there and with some management could really be focusing on the pressure points within the health care system. According to the 2003 and 2004, the federal health accord, the Health Reform Fund was to be used in three areas: home care, catastrophic drug program and primary care. Home Care, to the budget on Page 12.19, has increased by approximately $7 million in these estimates. The Special Drug Programs has increased by $2.3 million - that's on Page 12.9 in the Supplementary Detail to the estimates, and Primary Care is only noted in the estimates as having a budget of $441,000. Those total $9.7 million approximately, and given that there's been $30 million drawn down, we've only spent $9 million to $10 million - say round figures of $10 million. Where has the other $20 million gone, Madam Minister, in that particular program?
[7:30 p.m.]
MISS PURVES: Mr. Chairman, yes, that would be a good announcement, but I won't be making that announcement tomorrow though. If you don't mind, I'll go to the last question first and then talk about the Alzheimer's drugs a bit after that.
Mr. Chairman, the health reform fund, which is $30 million this year, is one of the areas of funding that will increase in the out years. In fact, almost all the funding increases are in the out years and that is because, as I said, we're not expected to have the protocols in place, for about two years, of what a catastrophic drug fund would cover. The other point - and probably the most important point on this health reform money - as discussed by the First Ministers is that the Health Reform Fund is flexible and has to be flexible, even though the federal government wants the concentration of money to be spent in those areas.
Different provinces have different levels of development in these areas and the Premiers insisted that they be allowed to have credit for that. For example, Saskatchewan has a very well-developed and well-recognized, excellent home care system. It's something that they've been working on for longer, and perhaps better than other provinces, and they did not
want to be forced to spend a big proportion of their health reform fund on something that already existed in their system. They wanted the flexibility to be able to take the health reform money and put it to an area that they really needed work on. This was agreed among the ministers and health ministers previously - the health ministers actually had produced a basket of services that they thought people should be able to use the health reform money for.
We are making progress in areas that others haven't. Some of our information technology is a good example. Some of the other initiatives that we've taken do fit the criteria of the health reform fund but that you may not find it in an increased budget this year in an area, even though we have increased spending on home care and primary care. A lot of our primary care initiatives are going to be coming out of the primary care fund, that separate fund, that transition fund that we've been able to access.
If you consider home care, any service available to people in the community, then you might well be able to consider long-term care a form of home care. That may be stretching it a bit, but there are a couple of provinces who felt strongly, Quebec being one, that the issue of needing to spend money in long-term care, or as they call it - in Alberta they have a different name for various things, it was important, but it wasn't on most provinces' radar so it wasn't included in the directions for the Health Reform Fund. So, as I say, the $75 million signing bonus and part of the Health Reform Fund are accounted for in what we're already doing and that is fair game, as Saskatchewan will be recognized for already doing considerable work in home care.
Mr. Chairman, I'm sure the former minister knows this as one of the issues that comes across the Health Minister's desk, whether it's MS or Alzheimer's or other drugs that have been found to be of use elsewhere, these are among the most stirring letters that you get about the inability to pay for drugs or the inability to access a certain drug. The Atlantic group has developed a set of protocols for the use of Alzheimer's drugs and is going to be sitting down to discuss this issue next week.
The Atlantic Provinces do want to move in concert in this area. We are all getting similar demands. There has been developed a set of protocols that includes physician education and original research that would allow us to approve these drugs, but we would like doctors to follow the protocols because the member for Dartmouth East is right, some drugs work in certain situations, but not in other situations. There will be some physician education required, perhaps not for all physicians but for some, for example, on how to differentiate dementia, because we're estimating that even if the protocols were strictly followed, it would cost the province about $3.7 million a year to cover these drugs. So it would be a really good thing for some people if we could do that, but we're trying to find a way to do the right thing and manage costs as well.
DR. SMITH: Mr. Chairman, I thank the minister for her comments. I think the only thing is, I would caution her being involved with the other provinces. I know I had the same feeling when I saw Minister Rock and other provincial ministers coming out of a meeting and noting great progress had been made at the meetings and they were doing the joint formularies and all this. I also see it as - my concern from the consumer point of view and the people point of view - that that's fine, but it gives them a group that joins together, whether it's the Atlantic or across this country in one group, it gives them a stronger voice to say no and that's the problem. That was my experience with Betaseron. In fact, one of the Health Ministers, or the Premier, somebody called our province, pretty mad at us from the Atlantic Region, when we told them we were going to go our way and we had no choice and the time had come, even though times were tough, budgets were tight, we were going to do it. So I just share that and I don't see that as a great positive step. I think there are many things that can be shared, but I never saw that as a great enlightenment that they join forces with others to say no, when things should be done on fairness.
We talked about SARS. I just want to touch on that a bit, on the public health issue. I know we had addressed that a little bit the other day. I did want to say that my question relative to exchange students coming back, and since then I've heard others have come back into Halifax, I assume Dalhousie, and others, and I know some of the physicians who were working with them advised them to go home. I still think the province could have given more leadership there, and I would like to see why the minister chose not to.
At Acadia, where there were 14 students coming back from Asia - I'm not sure exactly of the location - but I know they would be considered generally high risk, the administration and Mr. Kelvin Ogilvie, the President and others, I think showed leadership that our Department of Health should have, the minister should have. It is my understanding, unless they've changed it since then that their intention at the time was to have these students in quarantine. I think this is a serious matter.
I know the minister said - I didn't quite know what she meant and I still don't - we're not going to do what Prince Edward Island has done and I think Hansard would reflect that you said that, Madam Minister. I don't know what you meant, but I think Prince Edward Island - other than the way they approached the sale of gasoline - basically, I think, as far as the SARS issue, I didn't see that they were overreacting. Maybe she could explain her comments on that, but also why you would have young people coming back from a high-risk area into a university with no direction.
I'm not sure, maybe they were screened at Pearson, whether we are accepting the screening at Pearson as adequate, but we're not sure yet how this is folding out and I don't want to be fearmongering in any way, but this hasn't completely unfolded yet, the whole SARS epidemic, and we have a lot of international students here. If 14 are coming back to Acadia, I can only assume there are more coming back to other universities. I know some came back to the Halifax area and were not quarantined with any authority, but just with
their precept or, their teacher, or whoever the physician would be, considered recommending to this person to stay home - for I gather the 10 days - and they worked out assignments and various things that could be done.
So can the minister explain her attitude toward Prince Edward Island and what they did or didn't do that she didn't approve of and also, did she feel comfortable that the university had to take the initiative to do what they thought was right? In retrospect, every day more information is gained, but yet, I would think, it would still be considered by most fair-minded people the decision that Mr. Ogilvie and those people at Acadia University made was the right decision under the circumstances. Where was the provincial government, the Minister of Health, on that issue and what was signed and when? The minister said - when I asked about the quarantine issue and the powers that would flow, whether that can be changed by regulation - she signed something the night before, I think that would make it a Tuesday night. What actually did she sign and did it have to go to Cabinet before it was approved?
MISS PURVES: Mr. Chairman, I understand the member opposite's concern about SARS. I share that. Our department was in touch with the administration and doctors at all the universities because of the number of students and potential families that will be coming in from away. As members of the House know, the universities can always come to us to help them, but they felt that they could handle their own situations with the knowledge that they had and we had to give them. If that would be insufficient, then we would do what we can to help them.
[7:45 p.m.]
I don't think the member opposite would question the knowledge and expertise of our public health people in the department, which is very good. We are doing, and have done, everything we think that is prudent and reasonable to keep the public informed about SARS. To date, we have no suspect or probable cases. That does not mean we will not, but it means that we do not at this time. We were luckier than Toronto because they had no time to adjust to the crisis because they were part of the original wave.
What I meant in the P.E.I. case, was a case of where a family came home from China and a school or a school board decided that just because the family had come from China that the kids could not go to school. That was what happened there and there was no reason, according to our public health officials. I specifically asked this question, should we be doing that, and they said no, healthy children should be in school. To the best of anyone's knowledge, and I've heard this repeated again, and again, a person is not infectious unless exhibiting some of the symptoms of SARS. What I meant in referring to what happened in that particular case was that I didn't think we should be prejudging people, according to race or travel, if a number of conditions were not met for what was suspect in a SARS case - for example, contact with a SARS patient exhibiting symptoms and/or travel from a foreign
country. Certainly I wouldn't like to see healthy children kept out of school for no reason unless there was some new public health reason to do such a thing. It was nothing about P.E.I. in general, it was just that particular incident.
What we signed on that evening before the member asked the question was an Order in Council, which requires a certain number of signatures in order to make certain diseases notifiable and certain diseases able to be forcibly quarantined if necessary. It was an Order in Council that was necessary, and we got the signatures here in the House of Assembly rather than wait for the Thursday Cabinet meeting.
DR. SMITH: I thank the minister for explaining more fully what was signed that evening and I think she's clarified that. I'm still not sure what direction to a university, such as Acadia, was although she mentioned that the department had been in communication with that.
I think there are two ways you can look at that. I know that someone returning from parts of China, maybe Beijing, it's not an issue, but it's certainly on the minds of people. I think if I had anything to say relative to the behaviour of a child going back into a classroom and the classroom knew they had just come back from China - I know some people from Halifax came from Hong Kong, Australia and other areas, it's happening every day - but I would think that almost with the discrimination a child would suffer, it may be worthwhile to withdraw that child, with the consent of the family. I think that's a matter of choice.
I was just on the phone today with a physician from Miami, a Chinese person, and he had an interesting experience on an airplane. He was flying first class, business class, whatever it was, anyway, to make a long story short, a person decided to ask him some questions because of his race. Had he been to China lately? He said no, it had been quite a period of time since he had been in China. To make a long story short, the gentleman moved away from him, but also got a mask from someone on the airplane and put it on, whereupon my friend started to cough loudly - he said he didn't have to cough - he coughed so loud that the gentleman left the area and he had two first class seats to himself for the flight. I think that is what you would call racial profiling. I don't mean that we sort of look suspiciously at anyone who may have come from that area but I think there are some well-documented situations, I think we've covered that.
I commend the staff for recommending to the minister that those orders be in place. I hope you don't need them, but if you do, most people, I think, will comply. Some choose not to and that would concern me, as the behaviour of those people might be the very ones that would be infectious. I'm not so sure that you can tell when somebody's contagious or not with that, I don't think we know enough about that illness yet. I think there would be asymptomatic people who would not show signs, in the early stages of that illness, until we find more about that.
I did want to compliment Acadia for taking that initiative. The fact that our daughter goes there has nothing to do with it. I was concerned about it and I know she will take care of herself. I thought they had shown an initiative and were being very responsible. How they will work with families that are coming over for graduation in a couple of weeks' time, that's another issue that they're dealing with, and I'm sure they've been in consultation with your department, minister, and will do the right thing. They're certainly not fearmongering or over-reacting, in my opinion.
Relative to long-term care, I know that the minister has mentioned the flexibility within the program of monies available. I know it was always a joy to sit at the table as a Minister of Health, with Quebec. They're certainly original and you never know where they are coming from exactly, other than they were going to be fighting for flexibility par excellence. I always enjoyed them because I always felt there was a lot in common between Nova Scotia and Quebec. I think both provinces have struggled with rural poverty, particularly, and I think that has presented determinants of health being such, relative to that rural poverty, that they were very much on side with us on many issues.
I know relative to home care, that we started off behind and it has really concerned me that we've not made the progress in home care that we should have. Manitoba has probably set the standard years ago, with Saskatchewan following and those provinces have really done well. They have a technical aids program and others that other provinces are still trying to catch up with.
I think you can understand, Madam Minister, when you're here our job is to hold you accountable, either in a critical role or in a constructive manner, I hope the latter. There is still the matter of accountability and if you can't follow money - then we have the history of the Hepatitis C money and how your department has handled that. Whether you were there as minister or not at that time, doesn't matter, it was your government and you were at the table. So, we have to really try to follow this money. The money should be following the patient, but also we should be able to follow the money through, as it follows the patient.
So, with long-term care - and this is why the difference of opinion on the amount of monies - we're erring on the lower numbers coming in through the health accord monies, and probably more in the range of $96 million is the information that we had. The point is if you do it that way, with the $30 million on the Health Reform Fund, $15 million for medical equipment - I sure wish I'd been minister when that sort of money was flowing. I wouldn't have had it in a bank account at the Bank of Montreal drawing interest, I don't think. But anyway we finally got that money wrung out and got it accountable to some extent - I never was quite sure about the forensic unit furniture, but I think that went through the Capital Health Region somehow. But we were pretty satisfied that we accounted for the $30 million, $15 million over two years, and now another $15 million, that's $45 million for medical equipment coming into this province, which is a pretty nice chunk of change to address some of the wait times and diagnostic services.
Having said that, the CHST we feel would be $51 million at least, and I'm sure probably more according to the NDP, perhaps they may have more accurate figures, but we will give the benefit of the doubt. So my question on long-term care and the announcement you made today, I'm sure there are people in their 80s and that age group, who are looking at 2007 as being quite a time off. I mean I'm sure everybody here intends to be here - I know the minister, the member for Hants West, has announced that he will be running again and I offer him encouragement. (Interruption) No, we just look alike, we're not the same age and that gives me great consternation.
But, seriously, I don't know what the minister's - the Deputy Premier, the member for Hants West - plans for 2007 are, but I suppose it will be time for him, he will be able to dispose of all his assets by that time. I suppose if you wanted to make an appointment with him, you would still have to come to the Legislature. I certainly hope he just doesn't run to win the seat and then resign and gets somebody to do a
AN HON. MEMBER: Shame. Shame.
DR. SMITH: No, no. I'm just saying I don't think he will because I think in this change of government you're going to have to make a commitment for about eight years at least. So that's about the time the government's health program will be kicking in, unless there's a Liberal Government following this next election, where immediately the health component of long-term care will be covered by Danny Graham and a Liberal Government.
So my question to the Minister of Health is, why won't the minister move forward with covering the health costs in long-term care? This minister, this year, with the additional, at least $51 million in CHST - and this might be the last time this evening - I see the former Minister of Health here and I just want to share with him what a joy it is to deal with this minister, Mr. Minister, when she stands up and actually answers a couple of questions; she actually answers some questions.
MISS PURVES: Mr. Chairman, as said before, yes, 2007 is a long time to wait for some elderly people; however, they will see immediate results this year. The rates are going down this year by $12.75 a day, $4,600 a year. They will go down further the next year and the next year and the next year. So it's not a matter of waiting for four years for everything, there will be a gradual plan.
MR. CHAIRMAN: The honourable member for Dartmouth East, you have 1 minute and 20 seconds.
DR. SMITH: One minute and 20 seconds, well, I think that's what I inherited from the NDP. So should I donate it back to them? I don't know if she would like to use that now, but I think it's an appropriate time. We have other issues I would like to return to another day. I understand that we've allotted by agreement some period of 10 hours or so. I know
there are a lot of local issues, I know you, Mr. Chairman, have always been very much a proponent of in-home support care in your area where it has been challenged - and challenged across the province by this government. So I will just say I would like to, in closing, thank the minister for the glossy brochure that is a band-aid - the Rumsfeld directions, he followed that well when preparing this. You take every little thing you've done and put it together as a band-aid and call it a plan. So I leave you with that tonight - we're not pleased with it; we would like to see more of a plan; and we think you can do better than this.
[8:00 p.m.]
MR. CHAIRMAN: I will now recognize the honourable member for Halifax Needham. It's 8:00 p.m. You have up to one hour, should you choose to use the full hour.
MS. MAUREEN MACDONALD: Mr. Chairman, I would like to go back and talk a bit about seniors again in need of continuing care. I would like to talk a bit about the situation in the small, unregulated places where seniors are around the province. I think this is a really important issue to spend some time looking at because the public certainly has been concerned about what they saw in the news around how frail, elderly people in these homes were dealt with, and certainly there was either a strong perception, if you followed the letters to the editor, that seniors were being treated badly, and the minister herself made some fairly strong comments about the approach that had been adopted by the authorities who were involved in transferring and moving people from these situations.
I know that the minister has been to at least one of these homes, the Happy Haven unlicensed facility in Lunenburg County and you know I'm still trying to sort this out myself. Having been here for five years, this isn't the first time this issue arose - it certainly was an issue that was on the floor of this Legislature when there was a minority government in 1998. I remember members who are now on that side of the House who took a very firm position in support of the operators of small, unlicensed facilities and in favour of the family members who were certainly advocating for some flexibility from government around having a continuum of care that would, in fact, include these smaller homes.
I know myself, in terms of speaking with some of these operators, that although on the one hand it would appear that the fire marshal made decisions about the moving of people, that certainly the Department of Health was quite intimately involved in this process, in assessing and advising the Fire Marshal's Office, I suppose on some level of what was happening and where the department stood with respect to these places. The minister will know that there are people who work in the field of gerontology and on the care of seniors who have expressed concern about the impact of transferring frail, elderly people in these circumstances without the necessary care or planning, or some period of adjustment, or whatever.
So there are a lot of questions I think that need to be answered that have never adequately been answered by government about these small, unregulated places, not the least of which is a question around the standards of care, whether or not the department thinks it's appropriate to separate couples, for example, frail, elderly couples who need care, who are in situations like this, the whole question of moving people to the extent that they can't see their family members on a regular basis. I would like to ask the minister whether or not these small, currently unlicenced places have any place in this government's plan for continuing care - and maybe we will start with that question, do these small places have any place in your plan, your government's plan, for continuing care? There is a real desire, I would suggest, on the part of people in this province for small, personalized, home-like settings rather than large institutional, very expensive, very costly settings.
MISS PURVES: Mr. Chairman, the member opposite raises a very important and big issue. It's a big issue that, except for the occasional appearance on the front page, largely doesn't make the news. In point of fact, we don't actually even know how many of these homes there are in the province, because there's no requirement even for registration. We don't pay the per diems for the people in them, they're private pay and they're run by private owners. We do have an idea, but we don't even have a handle on that information. It is something that we probably should know.
Right now we have a committee of some members from our department and the Department of Community Services looking at this issue, because these homes have to operate under at least two different Acts, the Homes for Special Care Act, and then there's the issue under fire regulations. Sometimes I know it seems to some of the people involved that the Department of Health uses the fire marshal as a shield to go out and do what it wants because it has an agenda to put everybody into nursing homes. This isn't the case. Naturally, people in the Department of Health and the Fire Marshal's Office are very concerned about safety.
One of the issues, though, is in some areas they may come across a home where there are really unsafe conditions and there was a situation like that that I've gotten a letter about. The family was really glad the department had gone in and made the people move, because the conditions were so bad; she just wished we had done it sooner. On the other hand, you have the Happy Havens of the world, where they felt that they were providing good care, that they had complied with every request from the fire marshal in the past, and that people were being moved because the department had an agenda. Then you have a slightly bigger facility, like Cookville, also down in Lunenburg County, where the pre-Christmas incident took place. Again, those owners felt they were complying with every rule, they didn't know what they were doing wrong, and they still don't know what they're doing wrong.
That's a bit of a long answer to a good question, but they do have a place. How we're going to, if we're going to, move to register these facilities to try to get a better handle on what they can and can't do, because it would seem from the issue of the public interest that we should because in point of fact there is a place in the system for homes like this, there's a place for people to go before they need heavy nursing care, and most responsible owners recognize when they can't care for a person any longer. The complicating factor there is sometimes the hospital sends them right back because they don't have a bed. Another complicating factor is, of course, families, because as a department we need our people to be more family-oriented because there are situations that happen when the family doesn't even know their relative is being reassessed, they don't know of the move. We've left communications to the operators at the home and sometimes they don't understand what's going on, so all of it gets very mixed up.
I did go down to Happy Haven after meeting with some of the people involved, just to see what the place was like. It was one of those places where you go in the kitchen and they feed you peanut butter cookies and squares, and you want to stay there all day drinking tea and chatting. It was very friendly. The real issue there was a certain gentleman who did have Alzheimer's disease, but was very physically strong. He was certainly able to get in and out of a place, no problem, if there was a fire. The issue was would he understand that he had to get out or would he understand enough not to go back in. His son and daughter-in-law felt very strongly that he would. In our assessment in this particular case, it was borderline and we got the advice of a non-departmental gerontologist and Dr. Donaldson was allowed to stay, but his family does recognize that if his care needs change a lot he will have to be moved to a nursing home.
Yes, it's another area that needs a lot of work, because we can't say there's no place, there definitely is a place for - what they consider themselves to be - small options homes in a certain stage of an elderly person's aging process. We must make it clearer to families that our interest really is the level of care. It's just that it's hard. I'm sure the member, all members of this House know that it's very hard to think about moving a family member from a home-like atmosphere, if that's what you wanted in the first place, that would be close to your home, into what's seen as an impersonal institution. At some point, for many people, that step still has to be taken.
To go back to what I was saying at the beginning, yes there is a place for these homes, but we have a lot of work to do in getting a better handle on how many and what kinds of rules and regulations we should have, without being too onerous about the rules and regulations in order to ensure the safety of the people who are staying there.
MS. MAUREEN MACDONALD: I want to thank the minister for the answer. I would like to say that it seems to me, on some level - well, Northwood Manor is an example. Northwood is a very large organization. Because it's large it doesn't mean it's impersonal. I'm not suggesting the minister was saying that, and I wasn't saying that either, but you will
never have a Northwood Manor in a small rural community, for example. So it seems to me, because the province is so different from place to place, maybe the smaller places may also have some greater need in rural communities than in the metropolitan area, although I recognize that what Northwood is doing is quite different than what some of these small places are doing.
Having said that, my perception is that there's been a bit of a bias in our health care system, in our planning for health care, perhaps in favour of big operators. I think that that's something that needs to be addressed if we're going to look at including bringing these smaller places under the umbrella of public services on some level. The minister has indicated that there is a joint committee between the Department of Health and the Department of Community Services, and I'm wondering if she could indicate what the mandate of that committee is and when the committee will be reporting, when we can look forward to a report from the committee, and where in that process will some of the people who have been affected have a place to participate, because certainly in the area of continuing care the larger operators have been very much a part of working with government in planning the single-entry system and the need for capital investment in continuing care, and it seems to me that a similar kind of process and the same kinds of courtesies and involvement should apply to this other group as well in this process.
MISS PURVES: Mr. Chairman, the committee that we have between the department and the Department of Community Services - well there are probably 10,000 committees, but there are two that are relevant here. One is the group looking at updating the Acts under which a lot of these homes operate under the legislation. The other group, which is composed of people from Health, Community Services and Environment and Labour, which includes the Fire Marshal's Office, are looking at precisely the kinds of protocols and issues that we're dealing with when we look at some of these smaller unregistered or unlicensed facilities, and how we can do a better job communicating with the families, with the operators, with the patients and with each other, because sometimes we work together and sometimes we don't.
[8:15 p.m.]
We don't want this perception to persist, that the fire marshal is doing one thing and the Department of Health is using the fire marshal as a cover, or they're not working together, or they don't know what they're doing together. We want to improve communications, obviously get more verbal communication, oral communication, written communication, so that more people are educated about what we expect and what we can do for them. Then, perhaps, fewer of these situations would arise in which a person has to be moved very quickly - that is very disturbing, and it's not just a matter of whether it occurs before Christmas or whether it's a husband and wife.
Those things are important, but the whole issue that the member opposite raised, about moving elderly people, is a huge issue. Even if the move is not unwilling or not overtly disruptive, it can still cause a deterioration in a patient. I read an article recently, it was about nursing home renovations in a small town in England. They had absolutely planned their renovations out, they planned where they were going to move the patients to, everybody knew about it, the family knew about it, and in spite of all that there was still a deterioration in the ability of the patient to recover from that kind of a move, because that is the kind of thing that really bothers us more as we get older.
MS. MAUREEN MACDONALD: Mr. Chairman, yes, I read a bit of the literature as well on the impact of moving people in these situations. One of the things that I've been told is that the single-entry access system - which we in this caucus certainly support as a form of having a single-entry point for assessment for a variety of services that people might need - one of the things about the actual implementation of single-entry here in Nova Scotia has resulted in a substantial increase in the number of times that seniors are being transferred from more than one facility.
As I understand it, there's a reason for this, that a senior or a person may go into hospital, they may be moved from the hospital bed to a bed in the transitional unit while they're waiting for the assessment process to occur, they may go through the assessment process and a bed comes open in a facility that's not their first choice, and they may be moved to that facility, and then when a bed comes open in a facility where they want to be, which is closer to their family, they may be moved again.
I know, for example, of at least one long-term care facility where I'm told that the number of admissions that they are getting now in this facility, 50 per cent of the admissions are transfers, an elderly person who's been someplace else first; this is a significant increase in what they have seen in the past. I would like to ask whether or not the department is paying attention to this situation, are you monitoring this situation? If so, what are you finding, and what's your plan to minimize the numbers of times and the proportion of people who are in that situation?
MISS PURVES: I'm not sure if that 50 per cent figure is typical for all homes, but I will check on it. We can get access to that information. I do know that about 40 per cent of the admissions to nursing homes are from hospitals. I would have to go back and do some digging on what percentage of that 40 per cent get moved again. It is quite true that we would prefer patients to leave hospital if they don't need to be in hospital, but often there isn't a bed available in the home of their choice. So the member opposite is quite right, they will be moved nearby to where there's an opening and then, when one becomes available where they want to go, they get moved there.
I am sure that we could dig up those figures for the member opposite, to find out in what percentage of cases they get moved too often. Obviously the ideal would be to go from the hospital to the nursing home of their choice, and then stay there.
MS. MAUREEN MACDONALD: I would very much appreciate knowing more about what information can be provided on that, because certainly one nursing home administrator has expressed to me a concern that the drive for efficiency, to make the system more efficient, has in some ways left behind some of the care and quality and caregiving that is really necessary in providing care to this group.
I want to move away from this particular focus. Again, I had touched briefly in the beginning on some of the barriers to getting access to health care, and I would like to spend a bit of time looking at this. One of the things, as you know, is the DHAs all around the province have been looking for ways to generate revenue, and they have a little phrase for it - I can't remember it, it's alternative something something, which is really health care code these days for fees for different things, like fees for blood collection in satellite areas or fees for parking and different kinds of fees.
One of the things, a recent case actually, not in my constituency but in the constituency of one of my colleagues that I've been asked to sort of participate in doing some problem solving around has been a situation where an elderly couple at different periods of time in the last six months have both been hospitalized in the Capital District at the QE II. In the first case it was the elderly man in the household who was admitted to hospital. At the time of his admission there was no ward, I guess you would say, available, and he was placed in a semi-private room. He had insurance but his health care insurance did not cover a semi-private room. He has been billed for being in a semi-private room, even though a ward wasn't available. The amount of money is actually quite substantial, especially given that this household, this elderly couple simply do not have very much income.
Shortly after he was discharged home, the woman in the household had to be hospitalized. This was before any bill arrived for the semi-private room, so she was completely unaware of the situation. In the intake process of going into hospital, it was never explained to her. She was asked if she had private insurance and she said yes. She was placed in a semi-private room. They're now dealing with a bill of more than $1,000 and they have been receiving letters. In their case, they haven't yet been told that their bill will be placed with a collection agency, but I've had members of my own constituency who have dealt with the accounts department in the district, with people who tell them that if they don't pay the bill it will be placed with a collection agency, and that they run the risk of ruining their credit ratings, et cetera. A fairly aggressive kind of bill collecting is going on.
I guess what I'm wondering is, to what extent does the department monitor the practices in the district health authorities for generating alternative sources of revenue, including the credit and collections practices of the DHAs? Do you provide guidelines? Are
people given any kind of training with respect to the legal parameters, if you will, which you can legitimately go out and attempt to collect on a debt? I know that most other credit and collection departments have some legal parameters in which they operate. So my question is, what do you do about those kinds of situations? Are you aware of them?
MISS PURVES: Mr. Chairman, I think we're all aware of the pressure on government institutions to raise revenues wherever they can without, obviously, trying to harm quality of care. Charging for parking, for example, any revenue generation, including charging for parking, would have to be approved by the department in the DHA's business plan. I can recall seeing a few things that weren't approved.
Just to stick with the parking for a second, it's my understanding that if a patient has a reasonable case to be made, why he or she has to be in the hospital and cannot afford to pay for parking, I believe that person can apply to the hospital for an exemption in order to get a pass. Certainly, for most people, the nominal charges for parking are not a hardship, but there's always going to be a case where it is a hardship. There is an out in terms of being able to ask for a special pass.
On the issue of charging for the semi-private rooms, I would like to have a look at that case, if the member would advise me of it. Perhaps she already has and I haven't seen the correspondence, but it certainly does not seem right that a person would be put in a semi-private room because it was the only choice the hospital had, and then that person would be charged for it. It certainly does not seem that that should occur if that is, in fact, what occurred. Perhaps there should be better information given to patients about the fact that they will have to pay, that their insurance won't pay for certain things when it will. That seems a communication issue. But it does not sound like a particularly good situation. We'd really like to have a look at that particular case. Obviously, for those who can afford a semi-private room, it's not a problem.
MR. CHAIRMAN: The honourable member for Halifax Needham, just to advise you, you have 30 minutes left in turn.
MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the minister and I will make sure the minister does get that information. I believe it's my colleague, the member for Halifax Chebucto, I'm not sure if he's written you or not, but I can save him the price of a stamp and we can get you that information.
[8:30 p.m.]
I want to ask a bit more about the fees. I guess that we know that user fees exist now in our health care system in a number of ways. Not just the parking fees, there are user fees around the ambulance services and children's dental services. My question is, what is being done to assess the impact of these charges, what plans might be in place to reduce and even
phase them out altogether? If they are barriers to health care, this is a problem. I know that while it may be true that a patient can ask to have fees waived, some people don't feel comfortable doing that, and because of that, they won't access services.
So, first of all, is there any assessment that's done on what impact these charges have had on people in various parts of the province?
MISS PURVES: Mr. Chairman, we don't have any assessment plans or a system in place now certainly, but each hospital, each district, would be aware of the numbers of complaints. Whether they actually have scientific data that demonstrates a consistent barriers to access, that would be interesting information. As I say, yes, some people are not comfortable asking for a special pass, then they may not even have the knowledge to know they should do such a thing.
There really aren't a lot of user fees in the health system. I know that we do have ambulance fees that some people object to, or the size of them, and we do have small fees for satellite blood collection or clinics in some of the buildings in Halifax. If you want to go to the hospital and have your blood taken, there are no fees. It is still a free service and really, for the satellite clinics and the ones scattered around metro, it is a fee for convenience. It is not something that you have to pay, you definitely do not. You can go to any hospital and have your blood taken and have the blood work read by exactly the same people.
I don't know why I thought of this, and it may not be the appropriate place, but for those who are familiar with the American humourist, P. J. O'Rourke, he said, "If you think health care is expensive now, just wait 'til it's free!"
MS. MAUREEN MACDONALD: As a strong conservative in the American system, I would understand what he's saying given that their for-profit system is considerably more expensive than our not-for-profit system and considering that a lot less people are covered by their system. Anyway, I won't make any comment because it might be judged as being anti-American and, gosh, I wouldn't want to go there.
I want to ask some questions about equipment. I think the discussion coming from fee-for-service or fees in our system and talking about this new investment - $45 million I think the member for Dartmouth East had indicated, is a substantial investment. Given that we have a substantial amount of money now to invest in medical equipment, I want to ask you what is the position of the government with respect to the private MRI. I want to ask why no action has been taken with respect to a private MRI operating in the province. I'd like to know, as well, when the MRIs at the IWK and in Cape Breton will go into operation. Maybe we will start there.
MISS PURVES: This government does believe in a publicly-funded system, and staying that way. I think that's clear from our submission to the Romanow Commission. We have made the point again and again, and will continue to make to the federal government as other provinces have, that in order to maintain that publicly-funded accessible system that we are going to need more and more money; we need the percentage from the feds and we need the escalator clause.
In terms of the private MRI clinic that's operating here in Halifax, we were awaiting a firm position from Mr. Romanow. He did discuss the issue of workers' compensation clients jumping the queue, and he did address various issues but didn't come out as strongly as he might have. Frankly, it's a difficult one because the private operators are operating within the Canada Health Act as it exists now. They're not doing anything illegal in terms of the Canada Health Act. We will be taking a position, but I think the member can appreciate that it is one thing to take a position for ideological reasons or whatever, but we aren't that interested in just putting someone out of business or taking an operation that isn't illegal and somehow making it illegal.
The issue will probably be whether this clinic is publicly administered. That's one of the key aspects of the Canada Health Act, because we have institutions in our system that are private. For example, some food services, laundry services and so on, they're not direct medical services, but that is again different from medical equipment, per se. A service can be privately delivered but I think that it probably has to be publicly administered. You can learn a lot from the private sector, but in order to be true to our standards - and she's right, our system doesn't spend as much as the American system and delivers better service to more people. We will be coming out with a position on that in the next six months.
MS. MAUREEN MACDONALD: Well, this is very interesting. I'd like to explore it a little bit further, although I'm not sure how far I'll get. I'd like to know what that means, that it will be publicly administered. Does that mean that the province will buy the operator out and run it? Or, does it simply mean that patients will be sent to the private clinic, paid for out of the public purse, and that somehow there will be some kind of a regulatory framework and set of guidelines established to govern the practice of the clinic? Which of those is it, or is there something else I've missed entirely?
MISS PURVES: We have an option to require it be accredited at the time the clinic is set up. We felt we had no legal ability to stop the clinic so we're looking - obviously we're a Conservative Government, we're not against private business - for a way in which this clinic and any other clinic that may want to set up could operate, but still operate within the public administration domain, consistent with the Canada Health Act.
We do have private operators in the health care system; nursing homes are a good example. We have many private operators, but they still have to operate according to certain rules and there has to be considerable amount of accountability to the Department of Health and the government.
MS. MAUREEN MACDONALD: I probably recognize as well as anyone that you are a Conservative Government. What I'd like to know is, why on earth would a government of any stripe want - especially in the context of constantly talking about not having enough money to provide the services that people need - to take our scarce financial resources and not apply all of them to the provision of health care? Why would you accept that some portion of those scarce dollars can be used for private profit? That's the question. We don't have a lot of resources. We hear this constantly from government and in some areas then certainly you want to preserve as many of those dollars as you possibly can for front-line health care delivery, not for siphoning any of it into areas that are not direct investments in people. We have $45 million now for diagnostic equipment and other forms of equipment. What possible justification can there be for not putting every cent into our public health care system? I don't get it. Regardless of ideology, it doesn't make any common sense to me.
MISS PURVES: That $45 million from the federal government, which we will use in segments of $15 million over three years, will all be going to diagnostic equipment and other equipment for hospitals and nursing homes in Nova Scotia. Absolutely. That includes MRIs, CAT scanners, lifts in nursing homes, and some of the same things that we spent the previous $15 million on. Now, the list hasn't been finalized, but it will all go to improving services in the public health care system, whether it's in Sydney or Dartmouth or Kentville or Liverpool, or wherever it is. It won't be going in any way to subsidize a private operation, it will be going to our public institutions.
[8:45 p.m.]
MS. MAUREEN MACDONALD: This is a debate we actually really do need in this province. There's a ton of money to be made in our public health care system if we were entrepreneurs. Health care is something that people are always going to need, it's sort of like food and water and air. When you think about diagnostic services, then diagnostic services are sort of like - they're it, they're the core; increasingly, they're an expanding core of health care. You have to be able to get that diagnosis. So it seems to me that once you open up one area of diagnostic services, then you certainly open up the possibility of all diagnostic services. Then once you open that up, then you open it and surely this is what is the biggest fear of people who believe in a publicly-funded and a publicly-operated health care system, the ultimate beginning of the end of our public health care system.
I would remind the minister that your government looked at the P3 schools and did an assessment on whether or not that was a good financial deal for this province, using common sense and forgetting about everything we ever heard from the former government
who dreamed up this approach to building schools in the province, and found that money that could be available for education and for schools, money that we really needed was used for private ends, that was unacceptable. It seems to me that this is the same idea, this is unacceptable in our health care system, where we need this money. We know, we look at budgets. Let's look at budgets in Nova Scotia, health care, every year, increases. Our expenditures in health care increase, and it's going to continue to increase. Health care expenditures will increase because of the increasing cost of technology, the drugs - you know all of the arguments, the aging population, all of these things.
I'm not worried about hurting the feelings of one guy who's an entrepreneur who saw a good opportunity. I'm sorry, but there are bigger considerations than some guy's entrepreneurial spirit around setting up a private MRI - it's probably more than one guy, actually several guys, I suspect all guys. Anyway, I think this is very problematic, and I think we really do need to have the debate. I think we need to have it before your government decides to accredit the private MRI, and has a press conference in front of a shiny blue backdrop that says, this is now part of our health care plan for Nova Scotians.
MISS PURVES: Mr. Chairman, I know there are other Conservatives in governments in Canada that have really gotten on the private health care bandwagon, and this province is not one of them; we have not been promoting this in any way. In the case of the clinic that exists now, we just felt we did not have the legislation to stop it. That being said, I agree with the member's point on diagnostic services being very important; that's why we're looking at establishing provincial wait lists. It's why we want to get new equipment as quickly as possible, so we can help reduce some of these wait times.
Also, before I forget, I would say that there are no public funds going to support this MRI clinic, and we have no plans to do that. Perhaps when we get our equipment numbers up to par with some other parts of the country we will find the atmosphere less attractive for those who want to go into the private diagnostic business, or any other business. I know the member opposite knows this, but one of our concerns - it's obvious but it should be stated - is that improvement in diagnostic services and reduction of wait times is going to have to also be accompanied by a reduction in wait times for treatment because it's obvious, but sometimes people forget, that knowing you have a certain condition or disease, or need a certain operation, six months sooner is going to be great, but not if you can't get access to the treatment six months sooner - otherwise it just adds to the anxiety and it doesn't do any good.
We want to make fairly sure, through our work with the DHAs, that whatever we do to increase access and the timeliness of diagnostic procedures, that the treatments can keep pace with that; otherwise we've just gone from one bad situation into perhaps a worse situation. That's something we can't allow to happen. Again, I know that the Health Critic recognizes this, because she's been around this business longer than I have, way longer, but we have to be very aware that some of the wait lists and some of the treatments - everything
improves so fast that you can have everything under control in the health field, like cardiovascular surgery, and all of a sudden a new method or a new protocol for treating heart disease will come along, as was what happened at the QE II, their waiting list and their working time doubled overnight because they were using new protocols.
All of a sudden you had a wait list for procedures that weren't even being done six months previously. So every success has a financial cost - it has a human return, but it has a financial cost. I know she knows that, but I just wanted to make the point.
MS. MAUREEN MACDONALD: I want to thank the minister for those points. I'm not a member of the medical profession. I've been here for five years and have very little time, some days, to know what really goes on in the real world, I feel. Reading the account in The Chronicle-Herald about what actually occurred was very interesting, because it was well laid out in their editorial, the detail was there that gave you a sense, and you know just how fast the medications are changing. It's incredible how fast the drug situation is changing. So it's a challenge, there's no doubt about it. It's a very real challenge.
I'm wondering, the minister did make reference to the possibility or the probability that there will be an accreditation of some kind around, maybe, the private MRI. I'm also wondering about other issues that have certainly been discussed with me about the need to look at protocols - I don't know if protocols is the right word - some kind of measures that government puts in place to prohibit or to make sure that there isn't conflict of interest occurring between people who work in our public health care system, who are providing and delivering services inside the system, but also investing or participating directly in private health care delivery.
I'm wondering if that is an area that the department is looking at, if you've adopted
or you're developing any guidelines for members of the health care professions and, if so, what we can expect around that whole area of the real possibility of a conflict of interest.
MISS PURVES: Mr. Chairman, I believe the concerns raised by the member for Halifax Needham are going to be addressed in a position paper that the department is going to be presenting to me all around the provision of diagnostic services and other issues to do with privately or so-called privately-funded health care. We are not taking the position that anything other than a publicly administered public health care system is one that we want for Nova Scotia. But there are a number of issues, including that one - a quite important one actually, that the member raised - that are going to have to be addressed in this position paper.
MS. MAUREEN MACDONALD: I know I don't have a great deal of time left, but I want to ask a question about the number of hospital beds in the province. I believe that during the last 10 years there has been a substantial reduction in the number of beds per thousand of our population; I believe that the reduction is something like 40 per cent. I want
to know if there has been any assessment of the impact of that reduction, and whether or not such an assessment might be available for public scrutiny to look at what the impact of the reduction of beds has been since 1992-93.
MISS PURVES: Mr. Chairman, the reduction in the number of beds is about 2,500, or roughly 40 per cent, the honourable member is correct. We have not done a formal assessment of that, although the rationale for doing it was contained in Phase I of the Clinical Services Plan - or the clinical services footprint as the former minister used to call it. There may come a time for that to be assessed, but right now we believe that even though we're not as ahead as some provinces on home care, that some of the advances in home care and the single-entry access for long-term care and so on have mitigated that situation; in other words a lot of the beds were being used for long-term-care purposes and a lot of people were in hospital - some might call them social admissions, but were in hospital when they really didn't need to be in hospital.
There may come a point where we do an actual paper trail of that, but we don't see any indication right now of that formal assessment being necessary, given the provision of alternative services.
MR. CHAIRMAN: At this time I would like to thank the member for Halifax Needham from the NDP caucus for her questions. The time has expired this evening.
The honourable member for Glace Bay, with 46 minutes in turn.
MR. DAVID WILSON: Mr. Chairman, I would like to take this opportunity to tell the minister a tale which has become a rather familiar tale in this Legislature, and it's the tale of the Glace Bay hospital. It's a tale that the former Minister of Health is very familiar with, but has done absolutely nothing about. It's a tale that, unfortunately, the people of Glace Bay are all too familiar with and are rather disappointed, to say the least, that this government has failed to address the needs, in particular their needs, the people of Glace Bay and surrounding area, and that of an emergency department in Glace Bay.
An emergency department that I will remind the minister was closed at least 32 times last year; an emergency department that if someone arrived at the emergency department at the Glace Bay hospital it was just not there, it didn't exist - 32 times last year and at least half a dozen times so far this year. I may be way off on that figure, it's probably more. I would suggest that under the former Minister of Health and indeed under this government that there have been more emergency departments closed in this province than under any previous government before in the history of this province.
[9:00 p.m.]
Mr. Chairman, that's not a record that I would be proud of, and I'm sure it's not a record that this Minister of Health is proud of, but nonetheless it's her problem, it's a problem that she now has on her shoulders and a problem that I eventually, sometime tonight, would like to hear an answer to, as to what's going to be done to alleviate the problem that exists in Glace Bay. As I said, it's a situation now which finds in an area that, I've been told by the officials from the Cape Breton Health Care Complex, there are 30,000-some visits to the Glace Bay hospital on a yearly basis, to the emergency department of the Glace Bay hospital on a yearly basis.
Based on that - and as John Malcom, the CAO of the Cape Breton Health Care Complex, will tell you - you just can't take those 30,000-some visits that are made on a yearly basis and say, let's close the emergency department of the Glace Bay hospital and transfer them to Sydney, or let's transfer them to New Waterford, which is another story altogether, Madam Minister, as you well know, because of what's been discussed for the future of the New Waterford Consolidated Hospital and its emergency department there itself, under the Murray report. I am sure the minister has made herself familiar with the Murray report and the recommendations contained within that report.
Now these are all situations which, again - I hate to keep harping on this - were in the hands of the former Minister of Health. They were all situations that the former Minister of Health knew about and did absolutely nothing about during his tenure as the Minister of Health. This government, during its time in office, has done absolutely nothing about these situations. Now we're approaching four years, as the minister well knows, and we're in the midst of what I think everybody in this province knows now is a campaign that will soon be launched by this government.
So far there have been no promises to never close the emergency department at the Glace Bay hospital again. That's one campaign promise I have not heard this government say, and there's been no money spilling out from the Department of Health saying, here's the money to keep the Glace Bay emergency room and the New Waterford Consolidated Hospital emergency room open for the next seven years, which seems to be a figure that the government likes to use these days, that they will fund programs over a four-year period or a five-year period or a seven-year period, whatever the case may be. The Minister of Transportation and Public Works, I think, at one time said, we will deal with Sunday shopping in five years' time. He remembers making that statement, but it may not be a statement that he will remember now leading up to election time, because they will have to eventually make a promise about Sunday shopping - another story for another day.
I'm dealing with emergency rooms right now and what's being done to treat the people of Glace Bay and surrounding area. One time - Madam Minister, you may not be aware of this - there actually was a plan to put a sign at the bottom of South Street in Glace
Bay. The minister may not be familiar with Glace Bay but it's the only street leading to the Glace Bay hospital, the bottom of South Street. There actually was a plan, and maybe the former minister would remember this, by the Cape Breton Health Care Complex to put a flashing neon sign at the bottom of South Street to tell people whether or not their emergency room was open or closed - something like the Englishtown Ferry, is it running or not operating? That was the same kind of plan that they had for the hospital in Glace Bay.
Just forward thinking, as far as I'm concerned for health care in this province, to come up with a neon sign that will tell you whether or not you can get the proper acute care that you deserve at an emergency department that is closed. The bottom line is doctor shortage, we know that. There are some who will say scheduling is a problem, local doctors are a problem, but the bottom line we know is that people in that area certainly don't have enough doctors to staff their emergency department. That we know, the former minister knows, and this government has known for some time now.
Now I'm going to let the minister answer a general question eventually, but I'm not finished yet. I'm going to let the minister answer a general question on what the situation is in Glace Bay and area, in New Waterford and area, and the Cape Breton Health Care Complex, in terms of emergency room staffing and emergency room, just the fact as to whether or not those departments eventually stay open, but I want to remind the minister as well that when you talk about such things as MRIs and you talk about such things as bone densitometers being added to hospitals, in a lot of cases, Madam Minister, the people of this province are putting that equipment in their hospitals; it's not 100 per cent this government.
Correct me if I'm wrong, but it's not 100 per cent the funding that comes from this government. It is money that is raised by the community and by the general public. They also contribute a major portion of the cost of that equipment going into hospitals and it's also, in a lot of cases of new equipment that has been added to hospitals in this province, whether it be in Cumberland County, or Richmond County, or Cape Breton County, a matter that the federal government has given this province a lot of money to contribute towards new equipment.
Now, Mr. Chairman, this is money that the province takes, and when they make the big announcement about whatever new piece of equipment is going into a hospital they don't say God bless the federal government for giving us this money. They say we are putting it here as your provincial government, aren't we great? In truth, in reality, the federal government has contributed this money, but the province is under no obligation to say that it's federal funds that are being used for this equipment. As I said, the new money comes from the federal government, or the money that is coming from the community in general - and this is from people who go out and raise money in the community, and I will give you an example. There's a house that's for raffle, I guess you could say, in Baddeck and they're raising money; they hope to raise, I think, $1 million, or whatever the case may be and probably a lot of people here have purchased tickets, so on behalf of the Cape Breton Health
Care Complex, thank you very much. It goes towards a good cause, but again it makes my point that this government is not necessarily coming up with the money for all new equipment, not coming up with the money for health care, but they are taking the credit. They take the credit and that's all.
Now, having said that, Mr. Chairman, I would like to just ask this one question and, again, it goes back to - well, it's one question for now. I may have to confer with my colleague for more questions or he may want to take up some of the time remaining to ask some more questions, but just on one question, and again in general, and I hope the minister will reply to the best of her knowledge and I'm hoping that she will give me the answer that I'm looking for, but I would like some kind of a commitment from the minister, from this government, that the emergency department at the Glace Bay hospital will not have to undergo at least 32 closures as it did last year, and that the emergency department at the Glace Bay hospital will be staffed and will remain open on a daily basis in conjunction with all the other facilities at the hospital, including the intensive care unit at the Glace Bay hospital, that that emergency room will stay open on a daily basis and provide the proper care for the residents of that area that they deserve.
MR. CHAIRMAN: Before I recognize the Minister of Health, I would ask the members in the House this evening to quiet their conversations. It's getting rather noisy. So we will see how that goes before I ask them to take their conversations outside. So we would like at this time to recognize the Minister of Health and we certainly enjoy listening to you, Madam Minister. I'm sure everyone wants to hear you, so please, you have the floor.
MISS PURVES: I can assure the member for Glace Bay that the intent of the government is to ensure exactly what he asked, but he did acknowledge, Mr. Chairman, that the problem from time to time is not having enough physicians and that is something that we know and that we work with the DHA on. It's not a matter of funding because there is funding for the doctors. There is no plan to have the Glace Bay emergency closed half the time, any of the time. That emergency ward should be open 24 hours a day, seven days a week, but it is a matter of physician recruitment and turnover and some of these physicians, as he knows, are staffing more than one emergency ward as part of their duties and it is a problem that we would all like to resolve, but the intent is to do precisely what the member for Glace Bay says.
I would like to just make a note about the equipment funding. I certainly recognize that hospital foundations and fundraising events across this province provide a great deal of the money for the equipment going in. We also know perfectly well that the federal government, particularly last year and this year and for the next two years, will be providing much-needed funding for equipment in our hospitals. We always acknowledge foundations and the federal government when their monies are involved, and we can't claim the credit for what other people have done. However, one of the issues that is often neglected is the equipment needs to be operated, and the operating funding from the equipment has to come
from somewhere and, no, it's not an up-front cost but it is an ongoing cost and you always have to build it into the business plans and operating expenses for the district health authorities and the hospitals. That is a cost that the province has to pick up and has to plan to pick up and so we are part of the solution, along with the feds and the hospital foundations.
MR. WILSON: Mr. Chairman, I'm hoping that I heard the minister correctly and I know the minister told me that it's her intent to do everything I say exactly. If I can paraphrase the minister a little bit on what she said, she said her intent is to do exactly what I say and what I said was keep the Glace Bay emergency department open 24 hours a day, seven days a week. That's what I'm saying. If the minister is committing to that, I'm astounded. I'm openly astounded and probably finished what I intended to do here, and I can go home for the rest of the night, but I can't and I won't. I won't sit down because I want to hear it again.
Mr. Chairman, I want to make sure that the minister is telling me that she is committed here, now, and her government is committed too. Not once this year, not once for the rest of this year will the Glace Bay emergency department be closed - I want to hear the minister say that.
MISS PURVES: Mr. Chairman, what I said is our intent is that the Glace Bay emergency department will be open seven days a week, 24 hours a day. That is what the DHA and administration want, and that's what we believe to be the right thing, but there are physician issues that make a guarantee of that always being the case impossible, because you need the right number of physicians to make sure that these repeated closures do not happen and, until you get the right number of physicians, no one is in a position to absolutely guarantee that, but that is absolutely the intent. We agree with the intent; we agree with that hospital emergency ward being open 24 hours a day, seven days a week.
MR. WILSON: Mr. Chairman, that clarifies, that's more along the line of what I was thinking. I'm not getting a guarantee, I'm just getting someone who's saying that's the intent.
Well, it's everyone's intent to keep it open, it's everyone's wish to keep it open, it's everyone's wish that there were enough doctors there. So let me ask the minister, if that's her intent, then what is she doing? What have been her actions to date to ensure that the Glace Bay hospital will stay open, the emergency room, seven days a week, 24 hours a day and what has she been doing recently to address the doctor shortage in the area?
[9:15 p.m.]
MISS PURVES: Mr. Chairman, I'm certain that we can get exact details on ways in which we've tried to work with the DHA to attract physicians. We do have a physician recruitment program. In general, it is working very well in Nova Scotia and I'm told that the Cape Breton DHA, people find it very attractive to work there. I'm not sure what the problem
is right now, I will endeavour to find that out, but I'm sure the member actually knows more about that than I do, given that it's his area. I will provide the information of how many meetings and what attempts have been made to attract physicians to Glace Bay because I'm certain I can get that information for him.
MR. WILSON: Mr. Chairman, I was hoping that the minister would know more about the subject than what she's just delivered to me. Certainly, she could have been brought up to speed from the former Health Minister who was trying to deal with it for almost a four-year period and did absolutely nothing about it. Perhaps the former Health Minister wouldn't have too much to tell her because of that fact, that he didn't do anything about it. I was hoping that one of the priorities of the new Health Minister in this province would be to try to solve the doctor shortage in this province. As a prime example, Glace Bay stands out; Richmond County is another area that would stand out and there are other areas in this province who have severe problems with their emergency departments and with doctor shortages. So I'm hoping that a doctor shortage in this province would be one of the priorities that the minister would be tackling right now and I'm hoping that she knows more about this than she's just let on.
Let me give her another chance. Let's say, on a provincial basis, what is being done to try to solve this problem which has been an acute problem over four years? It's not like the government hasn't had time to try to find a solution to the doctor shortage problem in this province. This has been a government that's been sitting there for four years. Surely somebody has been doing something to try to solve a problem of a doctor shortage in this province. Let me ask the minister what it is they've been doing and not an answer that says, well, I'll get back to you at a later date. The minister should be well aware of what's happening with this problem in this province as of right now.
MISS PURVES: Mr. Chairman, what I do know is that we're adding, not recruiting, adding two doctors a month - one doctor every two weeks in this province. They are not all in the right place at all times, but we are certainly succeeding with physician recruitment. Our pay is well in line with other provinces, there are people who want to work in Nova Scotia because they like it here and because we have a beautiful province. We are adding doctors. Is the plan perfect and are they all being added exactly where they're needed all the time? No, of course not.
MR. WILSON: I'm going to turn soon to my colleague for the remainder of the time, but just in closing, I know that certainly the plan isn't perfect. No plan is. What we're dealing with here, Madam Minister is, as I said, an acute problem which has been there and has been extreme in some cases. It's only a matter of time, may I suggest to you, that though all the precautions are taken, that there's an ambulance situated outside the doors of the emergency room at the Glace Bay hospital, when it's closed, it's only a matter of time, Madam Minister, before someone arrives at that hospital and decides for whatever reason not to go through the doors, not to get treated there, to maybe wait out in a car, not go in for treatment because
there's no doctor there. It's only a matter of time before someone's life is at stake in this situation.
It is not a matter that I take lightly. Having been in the position of going to that department myself and seeking emergency care, I shudder to think what would have happened if that department had been closed at that time. I know first hand what the people at that hospital can do and I know first-hand how talented they are and how good they are at what they do. I'm asking the minister and I'm pleading with the minister on behalf of the people of Glace Bay and surrounding area - as the minister well knows this is not just Glace Bay, this is the surrounding area, it takes in a larger area and a lot more people - but I'm asking the minister to give it a top priority in her department, to work with the Cape Breton Health Care Complex officials, to take the provincial recruitment program and to apply it in all its power it may have to Glace Bay, in particular, to solve a problem that has been there for some time and needs to be remedied.
That department, as you said and I agree with you, needs to remain open on a seven day, 24-hour a day basis. It's the only way that it can respectfully treat the people of Glace Bay and surrounding area. I'm asking the minister to make that one of her top priorities. With that, I will turn over the remainder of my time to my colleague, the member for Dartmouth East.
MR. CHAIRMAN: Thank you, member, for your time. I would like to recognize the member for Dartmouth East with 25 minutes in turn.
DR. JAMES SMITH: Mr. Chairman, I thank my colleague, the member for Glace Bay, for a very important issue. The Cape Breton health care community has been, I think, an extremely interesting one, that to me has been a great success story in so many ways - the building and coordinating of an area that was fragmented and working against each other, not transferring patients appropriately, all those initiatives and the work that's gone in by many people, both administrative and other professions. Just in the Department of Health working there we've seen the growth of the cancer care centre - those initiatives.
When you look at the specialties that are now being provided in certain hospitals there, new physicians and perhaps the new emphasis on preventative medicine and wellness - I know smoking is a major issue in those communities in that area - it's been a very positive development I think over the last several years in that community. When you hear things like this, this is disturbing. The people deserve better, they deserve a quality of care that is better than that.
I spoke earlier about the high ratio beds per capita, how Nova Scotia led the country by a very wide margin. If you look at those communities that we're speaking of here tonight, those ones were extremely high, extremely high. You only had to talk to people who were being admitted and those who had family members being admitted and you would see what
was happening in that community. It wasn't a good way to practice medicine. I think a lot of things had to change and have changed.
We can't let it deteriorate and we have to maintain it. Those communities have made great sacrifices - New Waterford and those places particularly have been really concerned about losing their hospital. The role of the hospital has changed. I think the people in that area, they were so taken with their family doctor, some of them are legends of their time. They would go around at 1:00 a.m. and if they saw a light on in somebody's bedroom they would knock on the door to see if everybody was well and those are the stories that come out of there. But, however, it was a health medical model, not a wellness model.
I think the transition has changed and the people have adapted, within a decade, very dramatically in that area. Some of the doctors are still practising there at 80 years of age. They were bought off once. He didn't want to tell people that the doc was leaving, so he said the government made him quit his practice. Anyway, it worked out that he gave his money back from the buy-out at 72 years old, or whatever the time frame was. That's how attached the people were to their one physician and now I think they've adapted. The whole health care system has changed in that area, to the team approach and all the various services have changed in that area.
So, they have made sacrifices. They had a long way to go, you might say, but it was a cultural change. They had the check-off system, very much of a socialist medicine type program there early on and they had become dependent on a system that had changed and was not adapting to the time. But there were many strengths in the Glace Bay area, particularly their home care, homemaker services that were the model for Canada really and remain in some way even today. There was nothing comparable, unless you look at something, maybe without a St. Martha's in Antigonish, which would be more of the home care thing.
The reason that we gave the priority to the issue here today is because we think it's symptomatic of a system that needs support and they have made dramatic changes and they deserve better than some of the emergency services that are there. Someday, it's better probably we take the sign down altogether than to have a sign that says emergency department and not have it open, the unpredictability of it.
I want to thank my colleague for that tonight. I know it's a bit of a ramble, but I think we have to call a spade a spade some days and it took some dramatic changes. I know I was certainly beat up as a minister on occasion down there. I remember one of the protestors was there waiting to get at me so long she got tired so we offered her a bed in the hospital and she went to sleep and slept the night and I snuck out and didn't have to enjoy her wrath on the way out. (Laughter) I just share that with you minister, when all else fails, and they've got you locked in a room, there's many uses of hospital beds, don't forget that one. Very few
people can avoid just testing a bed to see how it actually works. For me, that night, it worked very well.
Moving to the long-term care issue, perhaps I could finish sometime this evening with this. Madam Minister, it's Page 12.20 of the Supplement. As was mentioned earlier tonight, the increase was $22.952 million. I know it was $8.5 million in the press release today, so that would leave approximately $14 million. Where do you see that being targeted within the long-term care system?
We know some of the stresses and strains. In fact, you were kind enough to meet former MLA Don Downe and myself and discuss various issues relative to long-term care. What general area and what can we expect there? We know that there's been some moving of beds around, there's been renovations and shifting beds around, but there's been no actual increase in the long-term care beds in this province. We speak about the Cape Breton area particularly and you know that it's hurting there. I have in my briefcase a letter from a constituent of mine living in Dartmouth East but has a parent in the Cape Breton area and some of this correspondence goes back to 2002. She has dementia, she's falling, she's in a residential centre and yet she's told there's no nursing care.
These are people who have been very independent and have lived under very difficult circumstances at home and now in a home that is not adequate for care in the opinion of the family. There are areas like Cape Breton that are - it's well documented - in great need of more long-term care beds or facilities. What is the general $14 million - if we are factoring in the $8.5 million announced today - where will the remaining $14 million be designated?
[9:30 a.m.]
MISS PURVES: Yes, I was made aware soon after assuming this portfolio that the most urgent need for long-term care beds was in Cape Breton. We're working with the DHA on that, although the funding that the member refers to does not include money for new facilities.
It does include, of course, the $3 million announced in November and the $5.5 million towards long-term care funding that we announced the detail of today. There are also salaries in there. We have an increase in benefit funding to the nursing homes in order to help them and an increase in operating funding, the benefit funding, that's almost $1.5 million. We have an increase in Pharmacare costs. We have some money set aside for our challenging behaviour strategy, or some of the patients in nursing homes need a different kind of care. We are also including some funding for some of the new facilities that have been built. Those incrementally put on top of the other money that the member mentioned pretty well gets us to the $18 million.
DR. SMITH: Certainly the per diems in some of the nursing homes are jumping pretty high, pretty rapidly. I've been quite surprised by some of them. I know it's great to see new facilities, perhaps, but some of the increases have been very dramatic and I'm sure they've come to the attention of the minister.
Looking at Page 12.18, Single Entry Access decreased by 62.7 per cent, or $1.5 million. This was heralded as the great pride and joy and was mentioned every day it came to discussing long-term care - the great saviour, the single-entry access. Where we learned of it was in our constituencies when people started calling and what quickly became a forensic audit of family resources when application was made for long-term care.
Out of this came many, many problems. Some things seemed to go along reasonably well, but other families were dramatically challenged. This seemed to be such a great thing that was going to - the answer, the previous minister would give to the single-entry access, it became a cure-all and now we see it being cut by almost 63 per cent.
So what challenges will the people experience? What can one expect for these changes? We know we wouldn't want to see them waiting any longer for the assessment. I think I've shared with the House one of the calls I had from a person whose sister-in-law was in the intensive care unit in Dartmouth with a mobility disability problem plus in intensive care with coronary artery disease. She had been living with her husband, but he was in the hospital as well. What precipitated the call, he had been deemed to be ready for a nursing home or at least medically discharged from the hospital - I think it had gone from $50 to $100 that day the family member had contacted me. So you have two seniors, elderly, both with major medical disabilities, living alone, find themselves both in the hospital. The woman in a wheelchair with a disability, a mobility disability, intensive care unit and her spouse in the other part of the hospital and those people, with a very modest income, are being billed $50 - and I think it went up to $100. It was either $25 up to $50 or $50, I think, to $100, but $100 sounded a lot, but I think that was the information that I had. Anyway, your staff will know if I am in the ballpark.
It was a substantive amount of money that was being imposed. That's the sort of calls that we get in our constituency and I really find it difficult to explain to people that the health care system is better now than it was in 1999. I mean that, to me, is a grave deterioration of the whole support system.
You can call it community services or health, whatever, and some day they will all get together, but it seems to be a long time coming. All that type of thing, if this is a single-entry system and charging those people, that couple that I mentioned, under those circumstances, just to me doesn't make sense. It's not fair and it doesn't make sense and we're supposed to compliment you and your government when their flashy brochure says your health matters. Well, I wouldn't really have taken that glossy brochure down to the Dartmouth General Hospital and showed those people who brought that situation before me.
Anyway, I haven't heard the outcome recently, but I hope something has come to their senses.
So my question would be, what will be the impact of the single-entry access system? Is it being funded another way or cut under the Supplementary Detail and that's what we have to go on, are the estimates. Would the minister comment on the status of the single- entry system and what changes one might look forward to that might, hopefully, have a happier ending than the situation I've just brought before the House this evening from the Dartmouth General Hospital.
MISS PURVES: Mr. Chairman, in this section the bottom line shows estimate to estimate, that the amount being spent is going up, and that's because of additional positions, but the member for Dartmouth East is right, where it just says single-entry access, it looks like it's going down and that's because some of the costs have been reallocated notionally to different districts because we're preparing at some point, and all the details aren't finalized yet, that home care and long-term care, when we think we can do it most seamlessly, will be devolved with districts. So we are accounting for the monies in the way we believe they will be spent, but the total amount being spent on a system is still greater than it was last year estimate to estimate because we will be adding positions.
DR. SMITH: Mr. Chairman, I think I followed that and I guess that will become evident in the business plans then of the DHAs when we find the status of those. I think that was the thing that was difficult for people to understand who had relatives in some parts of the province who were being treated differently, so I think as long as the standard is maintained throughout as the assessment evaluation is done for placement.
On Communications, relative to the Communications' budget, there's an increase of 26 per cent and it would be interesting to break it down. That's an actual dollar increase of $107,000, if the minister could break down that amount. We've seen some glossy brochures and coming into an election campaign, the Opposition gets a bit suspicious of the motives of the government. We have some examples of what we deem to be government advertising for political purposes. I think the member who spoke earlier, the member for Glace Bay, has brought that concern forward. So the increase is significant and certainly amounts to a nurse and a nurse practitioner in a rural community for a year or more.
Government is about choices and you have to make choices. So we have the need of those types of services; they have used as an example a nurse and a nurse practitioner in a rural community for a year. This money, instead of going into Communications, is there that much need in Communications that the government needs help in its message? Can we be assured that this is not a lead-up to an election and a feel-good type of communications exercise. So if we do appear cynical, yes, we are. It's a major increase in communications. This government does not have a good record in using taxpayers' money to get the political message out. It sometimes even puts it on government stationery. Can the Minister of Health
assure the committee here tonight, Mr. Chairman, that this in fact is not the case and can she explain the breakdown of this major increase of 26 per cent in Communications in the Department of Health?
MISS PURVES: Mr. Chairman, this particular increase is due to the general 3 per cent increases in wages that you will see throughout the budgets in various government departments, plus the addition of a Communications person who was seconded from Education. So in terms of the taxpayers' dollar, it is a secondment and is money that was being paid anyway.
MR. CHAIRMAN: I would like to advise the member for Dartmouth East that he has three minutes.
DR. SMITH: So it wasn't a straight trade then the minister is saying because one of the Communications people went to Education and how does that work? Does that save you money there? I don't quite follow that. Is there an extra person in Communications in Health now?
MISS PURVES: Mr. Chairman, we have another person in Communications who came from the Department of Education, but I believe the member for Dartmouth East is referring to a person who went from Health to Education. She went to fill the spot of a person who left government to go to Emera.
DR. SMITH: Maybe I won't ask that question again, I think we've gone there. (Interruption)
MR. CHAIRMAN: Order, please. The member for Dartmouth East has the floor.
DR. SMITH: Just to shift slightly, Mr. Chairman, and thanks very much for your patience, I would just like to spend a bit of time on the business planning process currently and where this stands, the status of the business planning with the district health authorities. What's the current status of the business planning process?
MISS PURVES: Mr. Chairman, the DHAs have their initial numbers and they will be getting back to us by the end of the month, if not sooner, on their work-through of those numbers.
MR. CHAIRMAN: The honourable member for Dartmouth East, one minute, it's a long minute and a half, but one minute. (Interruptions)
DR. SMITH: I'm being encouraged by my socialist friends to give it my best shot, but I know, having said that, I would totally bomb out. (Interruptions)
MR. CHAIRMAN: Honourable member, maybe you could wait for tomorrow to ask your question. The time has expired for the estimates this evening. (Interruption)
The honourable Government House Leader.
HON. RONALD RUSSELL: Mr. Chairman, I move that the committee do now rise to report considerable progress and beg leave to sit again on a future day.
MR. CHAIRMAN: The motion is carried.
[9:45 p.m. The committee rose.]
