HALIFAX, THURSDAY, APRIL 10, 2003
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
2:30 P.M.
CHAIRMAN
Mr. William Dooks
MR. CHAIRMAN: The honourable Government House Leader.
HON. RONALD RUSSELL: Mr. Chairman, would you please call the estimates of the Minister of Health.
MR. CHAIRMAN: We will continue with the Minister of Health.
The honourable member for Richmond. You have 47 minutes left in turn.
MR. MICHEL SAMSON: Mr. Chairman, I am going to take a bit of a different twist from my line of questioning from the last opportunity I had to speak to the minister. In 1999, this government campaigned on a number of different platforms, different commitments that it would make. Individual candidates, in their own ridings, Tory candidates, made different commitments about what they would do if they got elected.
Mr. Chairman, I can tell you that one of the meanest, most crass political campaigns that was undertaken by any Tory candidate in 1999 was by none other than the Tory candidate for Halifax Citadel. I would remind you, at that time - and I can table, for the recollection of any of her colleagues - this infamous postcard that was sent out in the middle of the election campaign. This was a postcard where a candidate stood for public office and said, elect me and I will put people out of work, I will cause hardship to their lives, I will cause stress to their families. In return, I will open up hospital beds, once I put those people out of work and once I close that industry.
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Mr. Chairman, I have been watching politics in this province since I was 14 years old, the last 16 years. I can tell you that I have never seen a more crass, mean-spirited political campaign before in my life, my short life. Therefore, my question today, to that same candidate, the Tory member for Halifax Citadel who is now our Minister of Health, I would ask her to tell this House, after four years of being elected, after having closed Sydney Steel, would she please inform Nova Scotians today how many new hospital beds have been opened by her government in the last four years?
MR. CHAIRMAN: The honourable Minister of Health.
HON. JANE PURVES: Mr. Chairman, on the issue of hospital beds, even the member opposite's own critic was saying that our proportion of hospital beds to population in Nova Scotia was too high, and that he credited the DHA in industrial Cape Breton with doing a wonderful job in trying to put a different emphasis on health, on population health. I think that in our four years in government, we have stabilized our health care system and we have guaranteed multi-year funding. There will still be problems, but we have achieved considerable success. As well, we have been able to take many patients out of hospital beds and put them where they more rightly belonged in terms of being in long-term care and in nursing homes. In that way, we were able to reduce wait lists for nursing homes by 23 per cent.
MR. SAMSON: In 1999, ma'am, you told the people of Halifax Citadel, vote for me and I will open up hospital beds by closing Sydney Steel. You made a commitment to the people of Halifax Citadel that you would open hospital beds. I ask you again, can you please give me the number of hospital beds that have been opened, not the number of patients you have transferred around, not the ratio of beds to patients, how many new beds, ma'am, have you opened since you were elected in 1999, or has your government opened, the exact number of new beds?
MISS PURVES: Mr. Chairman, I certainly realize that estimates is quite free-ranging, and the member can discuss Sysco as much as he likes. I don't intend to. What I will say now is that acute care beds do not translate into health.
MR. SAMSON: Madam Minister, you told the people in 1999 that you would close an industry, and upon closing that industry you would then be able to open up more hospital beds. This is not Question Period and there's no place to hide, there's no place to make your sarcastic comments. We have 47 minutes here today. (Interruptions) Madam Minister, you made a commitment to the people of Halifax Citadel, who are watching your performance here today, I ask you again, how many new hospital beds have you opened or today, tell your electors what you have done on that campaign commitment that you made to them in 1999?
MISS PURVES: Mr. Chairman, health care has been and continues to be a priority for this government.
MR. SAMSON: Mr. Chairman, I am going to ask again, in 1999, you told the people of Halifax Citadel, through this crass postcard that you sent out to them, that you would open new hospital beds. I ask you again, Madam Minister, how many new hospital beds have you or your government opened since you were elected four years ago in 1999?
MISS PURVES: Mr. Chairman, priorities matter and health care is a priority of this government.
MR. SAMSON: Madam Minister, in 1999, your postcard right here says, close/open. I ask you again, since 1999, in four years, how many hospital beds has your government opened, as per the commitment you made to the people of Halifax Citadel back in 1999?
HON. JAMES MUIR: Mr. Chairman, on a point of order. Is there any reason why this man is not talking about the estimates?
MR. CHAIRMAN: That's not a point of order. Order, please. It's up to the Chair to decide if the comments are relevant. I will pass this over to the Minister of Health, although I would like to remind the member for Richmond that he is holding up a prop, and unless he is prepared to read from that or to table that, that's not permitted. (Interruptions) Then I'm going to ask him to table that. He's doing that.
MISS PURVES: Mr. Chairman, certainly, if the member opposite wants to repeat the question, I will repeat the answer, that health care is a priority of our government.
MR. SAMSON: Mr. Chairman, this was a crass, mean-spirited political attempt to get elected. The member then stood as a candidate and said vote for me, I will close an industry, I will cause people hardship, I will put families out of work, and I will open up hospital beds. Madam Minister, today you are the Minister of Health. Your constituents are watching. Four years later, I ask you again, how many new hospital beds has your government opened, as per your promise to the people of Halifax Citadel in this cynical postcard that you got elected on in 1999?
MISS PURVES: Mr. Chairman, we have done a great deal to stabilize health care and health care costs in this province. Our government remains committed to the number one priority of Nova Scotians and Canadians, and that is a sustainable health care system.
MR. SAMSON: Mr. Chairman, four years since this member who was then the candidate for Halifax Citadel went out pitting one end of the province against the other in the most crass, mean-spirited way, saying elect me, I will go in, I will close an industry and I will open up hospital beds. What we have clearly seen after four years is that the minister will not even stand in her place today, with her constituents watching, and say from day one, I never meant to open up any hospital beds, I am now the Minister of Health, I am in charge of a budget of nearly $2 billion, and I haven't opened one new hospital bed either here in the
Halifax region or anywhere in this province since I was elected. Shame on the minister for standing up and trying to say her priority is health care, when her own commitment, mailed out to her constituents said she would open hospital beds and she has failed. Now she gives us nothing more than political spin and political lingo, rather than admitting that she has failed her constituents, that her attempt to get elected with these postcards was just a means of getting votes, that she had absolutely no intention of living up to the commitment she made to the people of Halifax Citadel.
I ask the minister again, will she inform this House, and give us a specific number, rather than hiding behind her shameful political spins, give us the numerical figures of how many new hospital beds your government has opened since you were elected in 1999?
MISS PURVES: Mr. Chairman, health care is a priority for our government. As I mentioned earlier, one of the things we did on coming to government was free up hospital beds for patients needing urgent care and reduced the waiting lists for long-term care by about 23 per cent. For example, just last year there were 70 beds in the QE II occupied by people who should have been in nursing homes, and we managed to free those beds for patients needing critical care by placing those patients in nursing homes. That's one of the examples in which we have been able to make the health system better. We will continue to do that.
MR. SAMSON: Mr. Chairman, in 1999, that minister, then the Tory candidate in Halifax Citadel, along with her Premier, who was then the Leader of the Tory Party, said we have a plan for health care, we can fix health care, and one of those things is let us close Sydney Steel and we will open up hospital beds in this province. We will address the waiting lines that are in the Halifax area with our numerous health institutions and everywhere else in this province, by opening up new hospital beds. Yet today, we all know amongst our own family members, let alone our constituents, that the waiting lines are still there, that the calls to say there's no hospital bed available for you right now, you will have to wait another week, you will have to wait another month, are still the calls we are getting. This is the member who told the people of Halifax Citadel, in her own little postcard, that her solution was to open more beds, have more beds here in metro, have more beds throughout this province and to provide better health care for Nova Scotians.
Madam Minister, you sent out this postcard, which I am assuming you supported, that crass, cynical campaign, I ask you again, will you give us the numerical figure of zero or more as to how many new beds your government has opened since you were elected in 1999, with the personal commitment you made to the people of Halifax Citadel?
MR. CHAIRMAN: Before I recognize the Minister of Health, I would just remind the member for Richmond that we are here doing estimates of 2003-04. Although it has been historic for this committee to allow some reference to the past, it's important for us to ask
questions mostly directed to the budget for 2003-04 (Interruptions) Yes, the budget for 2003-04, with some reference to the past, but let's not be repetitive in bringing up the past.
MISS PURVES: Mr. Chairman, again, we have freed up many hospital beds and improved that situation. Health care remains a priority of our government. (Interruptions)
MR. CHAIRMAN: Order, please. Order, please.
MISS PURVES: Mr. Chairman, of course, I have answered the question many times, and I will answer it again. We have stabilized health care, we continue to put more money into health care, it is a priority of our government to improve the health of Nova Scotians.
MR. SAMSON: Mr. Chairman, with all due respect, when you can get your Premier to stop referencing financial events of 1993, continually repeating the past, then certainly we will be more than interested in talking about that. Madam Minister, could you please tell us, in your budget tabled today, how many new hospital beds will be opened under this budget, or how many other hospital beds have been opened in your previous budgets? More specifically, will the minister confirm that under her government, in her time as a senior minister in this government and in her time in Health, that her government has opened zero new hospital beds in the Province of Nova Scotia? Yes or no.
[2:45 p.m.]
MISS PURVES: Mr. Chairman, as the single-entry access system continues to operate, obviously we do free up more hospital beds that are being used by nursing home patients. I think the member opposite does know that most governments across this country, including the federal government, are aiming to change a lot of things about the way the health care system operates. That includes new models of health care, that is what the Health Reform Fund is all about, it is what the Primary Health Care Transition Fund, initiated in the year 2000, is all about. In all of these measures, in provinces all across the country, we are attempting to change the models of health care and improve the health of all Canadians. Our government will continue to make health care a priority.
MR. SAMSON: Mr. Chairman, what I do know is that this is the candidate, this is the person, this is the Tory candidate who undertook a mean-spirited, cynical and crass political campaign that clearly said, a vote for me is a vote for more hospital beds. Today, Madam Minister, your constituents are watching, four years later they are saying, you said you would open more hospital beds. It's credibility time, Madam Minister, I ask you again, will you confirm, yes or no, that your government has not opened up one single new hospital bed since it was elected?
HON. ANGUS MACISAAC: Mr. Chairman, on a point of order. At my count, this would be the eighth time the honourable member has put the question. There are, in this House - and the Rules of the House apply to the committee as well - rules with respect to repetition. I would ask that you take that matter under consideration with respect to these proceedings.
MR. CHAIRMAN: Order, please. That would be considered a point of order, and I would like to address that. I have advised the member for Richmond that some of the information that he has been supplying has been a bit repetitive, and I've asked him to restructure his questions to the minister. I will monitor that. At the time that I feel it's being repetitive, I will call it to his attention.
MR. SAMSON: Mr. Chairman, I guess we will see just how high our Minister of Education can count, because the people of Nova Scotia expect answers. This is not Question Period. Your little sarcastic answers that you only have to give three times and then move to another question, that's not the case anymore. Now is the time where you are to be held accountable to your electors, to be held accountable to the people of Nova Scotia, and to be held accountable for a $2 billion budget that you are responsible for. The minister has clearly made a personal commitment, through this pamphlet she set out during the campaign, a crass, cynical, political attempt to try to undertake a campaign which she has not upheld. She is now the minister, she has a budget ahead of her.
I ask you again, you have a budget in front of you, could you point out the line item in that budget which shows where you have opened up new hospital beds in this province, either in this budget or any previous budget? Again, Madam Minister, your constituents are watching, we expect a forthright answer, will you tell us whether you have actually opened up any new hospital beds? Yes or no.
MR. CHAIRMAN: I am going to recognize the Minister of Health, and then I am going to ask the member for Richmond to restructure, or to go on with another question. In talking here with the Clerks, we feel that this is starting to be very much repetitive, and we would ask you to carry on with another question. (Interruptions)
Order, please. I recognize the Minister of Health, then we will ask the member for Richmond to go on to another question.
MISS PURVES: Mr. Chairman, I certainly feel that I have answered the question many times, in terms of the matter of priorities and how our government makes health care a priority. I will certainly be prepared to repeat that again in answer to that question and possibly the member for Richmond should take the cotton out of his ears.
MR. SAMSON: Mr. Chairman, a question has simply been put to the minister. The minister has refused to answer that question which is why we must continue to ask her that question. That is why estimates are different from Question Period. We are not limited to just three questions of the minister refusing to answer and then having to move on to another member. That is why in here, Madam Minister, it's not possible to hide, it's where you are to be held accountable for the estimates. You have a budget ahead of you. You have a $2 billion department.
You made a commitment in 1999, as part of your budgetary process, that there would be new hospital beds that would be opened. I have asked the minister and because she refuses to give an answer I put it to her again, show us where in the budget there is funding available to hold up to her personal commitment to the people of Halifax Citadel, to her commitment to the people of Nova Scotia, that if she was elected, in fact, to provide for new hospital beds in this province. There has been four years under this administration. I offer the minister the opportunity again to point out where in her budget there is funding for new hospital beds and what figure can she give us as to how many of those beds have been opened in the last four years?
MISS PURVES: Mr. Chairman, this government has provided many, many millions of dollars more for our health care system since we have come to power. We have reduced waiting lists for nursing home beds and in turn, freed up hospital beds for other kinds of acute care. We have given the district health authorities millions of dollars in new funding and the millions available for this year are certainly outlined in this budget. Some of the funding is for hospitals, some of the funding is for clinics, and all of that is available here in this budget to be examined. Most of the CEOs of the DHAs, with the possible exception of the hospital in Kentville, would agree that they have enough hospital beds for the demand. The DHAs have been given a guarantee of increased funding of 7 per cent for the next three years.
Mr. Chairman, sustainable health care services is the aim of this government, it's the aim of all governments in Canada, and it is extremely important to the people of this province and the people of Canada. Our plans for spending this year are clearly outlined in our budget estimates and, I repeat, health care remains a priority.
MR. SAMSON: Mr. Chairman, in 1999, as a Tory candidate and her Party as a whole said what the previous government was doing was not good enough. Our solution is a vote for us, is a vote for more hospital beds and, Madam Minister, those are not my words, they are your words here on opening hospital beds - and the name underneath is Jane Purves of Halifax, Progressive Conservative Party. That is not me, I did . . .
HON. JAMES MUIR: Mr. Chairman, on a point of order. I have to support my colleague, the member for Antigonish, on this line of questioning. If he wants to campaign for Danny Graham, or if Danny Graham wants to campaign, if Danny Graham wants to take
on the challenges of Halifax Citadel, Danny Graham should have gone out and got himself elected and he didn't have the courage to do that. For somebody to get up there and do crass political campaigning during estimates, Mr. Chairman, is wrong. (Interruptions)
MR. CHAIRMAN: Order, please. I would like to tell the Attorney General that it's not a point of order. (Interruptions)
Order, please. Order, please. It was not a point of order, yet a comment. I had to ask the member for Richmond to restructure his question. She did at that time move from his form of questioning and moved into the estimates of 2003-04. I acknowledge that and I turn it back to the member for Richmond. I would ask him not to be repetitive in his further comments, but to carry on with estimates. The member for Richmond has the floor.
MR. SAMSON: Mr. Chairman, the people of Halifax Citadel watching today will judge the minister for her actions, will judge the minister for refusing to admit that this was nothing more than a cynical and crass political attempt to say, I will put people out of work, I will cause harm to their families, vote for me, I will open new beds. She has clearly not done that. The people of Halifax Citadel will clearly pass judgment, and they, today, have seen the real face of the person they thought they were electing in 1999.
I would like to ask the minister now, you were in Ottawa as our Minister of Health. You haven't opened up any new hospital beds. Your government continues to criticize the federal government for not being enough of a player in our health care. I ask you then, Madam Minister - maybe you will answer this question, or maybe one of your other colleagues wants to stand up and try to defend you - here is the very simple question, the deal that you agreed to on behalf of the Province of Nova Scotia, did we get enough money from Ottawa, in your view?
MISS PURVES: Mr. Chairman, it was the unanimous view of the First Ministers and myself, representing the Premier, that we did not get enough money. That was one of the reasons the meeting went on much, much longer than had been planned. What we were looking for as a group was the amount of money recommended by Commissioner Romanow in his report. Everyone, of course, welcomed additional money from Ottawa, but it was very important to us to try to get the percentage of funding at least up to 18 per cent of our health care costs which did not happen. That being said, obviously, we welcome any support from the federal government, but no, in direct answer to the question, none of us felt that we got enough money.
MR. SAMSON: Mr. Chairman, in her answers this afternoon the minister has continually said health care is the number one priority, putting health care number one is what she has been doing. She hasn't opened up any hospital beds, as she said she would. Therefore I ask her today, if health care is her number one priority, then why, Madam Minister, on behalf of your government, did you accept a bad deal from Ottawa and not put
the interests of Nova Scotians first when you signed a deal, which today you are saying was not good enough to meet the number one priority of Nova Scotians, which is a fully funded health care system?
MISS PURVES: Mr. Chairman, actually nothing was signed. That was something that the Prime Minister wanted, but no one did. There was no signed deal. The money was accepted because we need the money. There is no question we need the money, but from the beginning of the meeting it was obvious that what was on the table, was on the table, and that number was not going to change. The only number that did change was the Prime Minister agreeing that if there was a federal surplus next year, which it seems likely that there will be, that he would commit additional money for the health care system and he would do that before he left office. That obviously is something that we need, our share of that money, but that was the only change from what was on the table right at the beginning and it was very disappointing to all the representatives of the provinces.
MR. SAMSON: Mr. Chairman, what's disappointing for Nova Scotians is we have a minister who went to Ottawa to represent the people of this province from one coast to another who said, I'm going to Ottawa with health care as my number one priority, the same minister who came back and told the press, I was shocked and awed by the Prime Minister and I was so impressed with the other Leaders that I thought I would sit back and not say a word and just watch the action, not speak up. I didn't think that it was proper for me to speak up, I thought I would let others do the talking for me.
That's what Nova Scotians are disappointed in today, Mr. Chairman, that the minister who said, I will open up new hospital beds, went to Ottawa and wouldn't even put up a fight on behalf of the people here and wouldn't say that this deal wasn't good enough for the people of Nova Scotia, that Nova Scotians would not accept this. Yet, she said that the First Ministers all agreed. We all know that's not true because the northern Leaders said, this is not good enough. They said we're going home and we are not agreeing to this deal. We want better, this is not good enough for the people we represent and what happened? They got a better deal for their constituents. They stood up and fought for them, they didn't sit shocked and awed by the Prime Minister. They did speak up, they walked away from the table and they got a better deal. I ask again, minister, why did you not take the lead of the northern Leaders and walk away and say, I will not accept a bad deal on behalf of the people of Nova Scotia?
[3:00 p.m.]
MISS PURVES: What I did and what the Minister of Finance, who was also there did, was accept a deal that gave more health care money to Nova Scotia. That is what the Premiers of the other provinces did and we did accept that. Everyone said at the time and we were all quoted in the press as saying so, that the money did not close the Romanow gap, that we were grateful for the money, but we were disappointed in the amount and that the accord
would mean that the provinces would all be back to discuss the matter of health care funding with the Prime Minister's successor. Thank you.
MR. SAMSON: The Minister of Health had a choice. She had a choice to walk away. She had a choice to say, this is not good enough. She had the choice to say, I'm putting Nova Scotians first in saying, this is not good enough. She had a choice in saying, I'm going to try to live up to the commitments I made in 1999 of opening new hospital beds and protecting our health care system - I will not accept a bad deal. I will do like the northern Leaders did and I will walk away. In fact, this minister had even more authority there because it is Nova Scotia that chaired the Premiers' council. She could have shown leadership and she could have said, this is not good enough, we will not agree to a bad deal, we will walk away.
Instead, what do we see once again? A minister having to give us political spin rather than admit failure again to live up to the commitments that she made, both to her constituents and that she made to the people of this province. She had a choice. She could have walked away, she chose not to. She gave in and then to have the audacity to come in this House and say, we didn't get enough from Ottawa. You agreed to the deal. You said this is enough. You said, I'm going to forget about Nova Scotians because for me to get a better deal, I'd actually have to speak up and I'd actually have to say something to the Prime Minister rather than sit back and be shocked and awed by his performance and say what a great (Interruptions) Mr. Chairman.
MR. CHAIRMAN: Order, please. Order, please. The member for Richmond has the floor.
MR. SAMSON: I invite my colleagues to read The Chronicle-Herald when the minister was interviewed on her way to the airport, who said, I was awed by the Prime Minister of Canada. I was awed by his presence in the room. I was awed by how he dealt with the Premiers. These are not my words. Read them in the paper. The member for Dartmouth North can read them in the paper. She was shocked and awed by the Prime Minister. Where were Nova Scotians' priorities when you were shocked and awed by the Prime Minister of Canada? Rather than walking away, you accepted a deal which did not meet the needs of Nova Scotians. You did not put health care as our number one priority and I ask you again, you had the option to walk away and say I will stand for the people of Nova Scotia in saying this deal is not good enough. I will follow the example. If she needed something to follow, which apparently she did while she was up there, I will follow the northern Leaders' example and say this is not good enough and we will not agree to something that doesn't meet the needs of our residents.
I ask you again, minister, you still haven't opened up any new hospital beds, you haven't protected our health care system, why did you agree to a deal which was a bad deal for the people of Nova Scotia and did not address our health care needs fully?
MISS PURVES: I think everyone would agree that as the representative of the Premier, and as someone who was constantly in touch with the Premier and who was having discussions with other Premiers, that Nova Scotians are better off because of having more money from the federal government. That doesn't change the fact that it did not meet the expectations of the Premiers and that it did not meet the recommendations of Commissioner Romanow. That has been very clear from the beginning. Thank you.
MR. SAMSON: How interesting it is to see that the Minister of Health hides behind the Premier now in saying she was in touch with the Premier. Maybe it was the Premier's fault for all this. Well, we'll have our day to ask the Premier that question.
You were the one, minister, who went up there to Ottawa. You were the person entrusted by the people of Nova Scotia, by the people of Halifax Citadel, by seniors, by all Nova Scotians, young and old to go up there and get the best health care deal that represented the needs of Nova Scotians. The health care deal that you said Ottawa wasn't providing enough money. You said, I will go to Ottawa and I am going to get the money needed to fix the health care system. The Premier didn't just say I'm going to try to make the health care system in this province a little better - he said in 1999 he would fix it.
Now we have a minister who went to Ottawa who said, I just wanted to get money to make the system maybe a little bit better but not fix it. The northern Leaders walked away and what did they get for walking away? They got more money. They got a chance to fix their health care system because they said this is not good enough. Yet, what do we have here? We have a minister who goes up to Ottawa, a minister who said I will open up hospital beds - hasn't opened one yet and there's not one coming anywhere in the near future. She still won't admit it here today that the commitments she made to her own constituents, she has failed to do. Yet, she gives us the same political spin.
She had an opportunity. She had an opportunity to walk away. She had an opportunity to put the interests of Nova Scotians number one. She had the opportunity to say I will not accept a bad deal from Ottawa. I will not accept a deal . . .
MR. CHAIRMAN: Order, please. The member for Richmond has the floor.
MR. SAMSON: As I was saying, this minister had a chance. She had a choice - she could have said I'm putting the interests of Nova Scotians first, I am not going to sit here and be shocked and awed by the Prime Minister. I'm not going to sit here and say I'm intimidated, I don't really want to speak up because the other ministers and the other Premiers are intimidating. That's not what we elected in 1999, a government that would say it was intimidated by the other provinces and when it goes up to Ottawa. This government has consistently criticized Ottawa day in, day out and said not enough money - when they've got their chance, they've got the Romanow report that clearly says how much money is needed and then when given the opportunity to go up there and get the money necessary not
to make our health care system better, but to fix it - just like the Premier said he would and today what you are again doing is admitting you've broken your promise, you have failed to fix our health care system - you failed to get a deal from Ottawa that would have allowed you to fix our health care system.
I ask you again, why did you not exercise your option to walk away, to lobby for a better deal and to say I'm putting Nova Scotians as my number one priority, not in what the other Premiers want to see, not in what the Prime Minister is saying, but I'm going to make sure that I walk back to Nova Scotia and say I went to Ottawa and I got the money needed to fix this health care system and, watch us, we don't need spin doctors, we're going to show you how we're going to fix that system. I'm going to open up hospital beds like I said I would in 1999. I ask again, why, minister, didn't you walk away from a bad deal for Nova Scotia?
MISS PURVES: Mr. Chairman, what I would say to that is that walking away from federal money was not going to improve the health care of Nova Scotians and walking away from the table would not have improved the health care of Nova Scotians.
MR. SAMSON: Mr. Chairman, the northern Leaders walked away and what did it get them? Did they go home empty-handed? No, they got more money. That's what happened when they walked away. Yet the minister now says, well, if I had walked away, you know, I was intimidated as it was, I was shocked and awed, I was afraid I wouldn't get anything and I would have to come home showing defeat. The northern Leaders walked away, they said this deal is not good enough for our citizens, it won't fix the problems we have in our health care system. As a result of walking away, they got a better deal. That's what walking away did for them, minister. They are proof of what happens when you put your residents as your number one priority rather than sit back and say I was shocked and awed by the Prime Minister and I didn't want to ask any questions, I was afraid that I would be out of line.
Mr. Chairman, the Minister of Finance in his own budget speech again says, well, Ottawa didn't give us enough money. Why did they not give us enough money? Because of the failure of his Minister of Health when she went to Ottawa and that she failed to bring back to Nova Scotians the deal she needed to live up to the commitment she made in 1999. She failed to bring back the commitment which would have allowed her to save face next election and say I did open up the hospital beds I said I would because now she has to go campaigning, giving the political spin she has given us today, saying, well, we've moved this here and we've moved that there, yet at the end of the day, no new hospital beds like she said she would, and I can assure you, for her residents watching today and in the campaign coming, they will be reminded of the words in this crass, cynical, mean-spirited political campaign undertaken by that member because at the end of the day the waiting lines are not reduced. There are still people, I know of my own family members who have been told they have to wait for months for important treatments - why? There are no beds available.
What has happened in the Aberdeen Hospital lately? They're having to put beds in the hallways because there is no place to put them. We have consistently seen emergency room closures in Glace Bay, the Strait-Richmond Hospital, North Sydney, we continue to see them even here on the mainland. Yet the minister went to Ottawa and you had a choice. You could have come home and said I will not accept the bad deal, I will continue to fight Ottawa until we get the money we need to fix the system like we said we would. You could have said no but, minister, you walked away and what's the legacy of your meetings? Your comments about how impressed you were about the Prime Minister and the fact that you chose not to ask any questions, not to stand up for Nova Scotians, shame on you, minister, shame on you for the lost opportunity that we were given. When is the next time that we will have the opportunity as a Canadian province to go to Ottawa and to fight for such an infusion of cash, when will that come up again?
Mr. Chairman, now we hear the minister try to put a little bit of cheap politics in there and saying, well, we will go to see the Prime Minister's successor. That is her argument now. I failed with Chretien, I'm going to wait until Chretien is gone and go try a little bit better. I guess we will have to wait and see, wait and see what success the minister then has, but if she goes up to Ottawa again on our behalf, minister, we would ask that you speak up. We would ask that you not sit back and be shocked and awed by the Prime Minister. We would ask that you put the interest of Nova Scotians first and we would ask that you make sure that you come back from Ottawa with a deal that addresses the health care needs of all Nova Scotians once and for all, rather than accepting a bad deal.
Mr. Chairman, how much time do I have left?
MR. CHAIRMAN: Two minutes.
[3:15 p.m.]
MR. SAMSON: Mr. Chairman, in closing, I want to say that what we have seen today is a minister who was continually given the opportunity today to say I wasn't able to live up to the commitment I made in 1999. I undertook a cynical, cheap, mean-spirited campaign to get your vote, yet at the end of the day I have not lived up to my commitment. That is the opportunity the minister had to be able to say I will be honest and forthright with my electors, I will make sure that they know that I may have tried, but I failed in living up to that commitment. She had the opportunity to tell us today why she accepted a bad deal from Ottawa which now her government says at every opportunity that they did not get the money they needed to fix the health care system.
That is the legacy that this minister will leave as history looks back at the one opportunity that she could have said no to Ottawa. She could have said I will put the interests of Nova Scotians first, I will make sure that we get the money from Ottawa needed to fix this health care system. She wasted that opportunity by sitting back and saying I was in awe of
the Prime Minister and I was intimidated by the other Premiers and didn't feel it was my role to speak up for Nova Scotians. That is shameful and now to see this government stand up and say we did not get enough money from Ottawa, this minister must accept responsibility for that. Her constituents will be reminded of that in the next campaign. Nova Scotians are reminded of that today.
At the end of the day, Mr. Chairman, we had an opportunity and that lost opportunity rests on the shoulders of this Minister of Health and I ask her, again, why did you not walk away for a better deal?
MR. CHAIRMAN: Order, please. The time has expired for the Liberal caucus and I would like to recognize the NDP caucus with one hour in turn, the time being 3:17 p.m.
The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Mr. Chairman, it's really interesting, listening to members of the Third Party sometimes. (Interruptions) Hard, difficult, but interesting I would say. I mean, isn't it interesting. The Leader of the Third Party, I think, if my memory serves me right, has spent a lot of time talking about his commitment to building a better working relationship between this province and Ottawa. Doesn't he say that that's what he's going to bring to the arena? Yet the member for Richmond thinks our Health Minister should have walked out of the negotiations with (Interruptions) Well, Mr. Chairman, sometimes some of us in this Chamber need to be able to rise above crass partisan politics and do what's in the interest of the province. (Interruptions) I think also, one of the things . . .
MR. CHAIRMAN: Order, please. Order, please. Order, please. We will just wait until the Chamber is quiet.
Order, please. The member for Halifax Needham has the floor.
MS. MAUREEN MACDONALD: Mr. Chairman, another thing that I found quite interesting is, he spent three-quarters of an hour talking about the loss of hospital beds which, granted, you know, is something we need to be concerned about, but it is a little contradictory again when the Leader of the Third Party has been placing his emphasis on a different kind of health care, on health promotion and wellness, and so I'm really wondering what is it with the Liberal Party? Where are they? Are they co-operators with Ottawa or are they confronters? Are they for hospital beds or are they for health promotion and wellness? Where is this Party? Well, we know where they are. They're in third place. They're over there and that's where they're going to stay.
AN HON. MEMBER: They're in disarray.
MS. MAUREEN MACDONALD: Yes, that's right, in complete disarray. Does the Leader of the Third Party have any idea what the members of his caucus are doing here when they're on the floor in this House? I think not, Mr. Chairman, I think not. Having said that, I would like to use my hour to talk about things in the budget that are of concern to Nova Scotians and not necessarily narrowly of concern to a dwindling Liberal caucus, a dwindling number of Nova Scotians.
Mr. Chairman, I want to talk with the minister a bit about home care which does have a connection to the reduction in hospital beds. I did have an opportunity to raise a few concerns about this the last time I had a chance to question the minister, but not in the detail that I would like. So what I would like to say to the minister is that in the last 10 years there's been a 40 per cent reduction, or close to a 40 per cent reduction in the number of beds per 1,000 population in Nova Scotia. Ten years ago, according to Department of Health figures, there were 5.3 beds per 1,000 population and today it's 3.2 beds. Now, I would like to know exactly how many beds this represents in terms of a reduction that we have lost out of our system and then I would like to talk about the plan to provide more home care to people in their homes who are being discharged out of hospital more quickly as a result of the reduction in hospital beds and the plans for the utilization of the beds we do have. So I will start there. Do we know exactly numerically how many beds this represents that we've lost?
MISS PURVES: Mr. Chairman, that number would be about 2,500 but, obviously, home care services have grown hugely in that time.
MS. MAUREEN MACDONALD: When I look at the estimates in terms of the home care services which are broken down by district, I notice that there are three districts that will see reductions in their home care budgets for next year. The capital district is one, district one and district two are the other two districts, and of the districts that are having increases in their home care budgets, two of them are seeing fairly substantial increases. I think Cape Breton would be having a $3 million increase and there's a $2 million increase in district four, but the amounts of increases in the other districts where there are increases, are relatively small.
Now, I want to tell the minister about a call I got in my office today, an elderly man, 85 years old, his wife has recently had hip replacement, and she was his caregiver before she, herself, became sick and now they receive home care, but a minimal amount of home care. It's something like an hour a day and our office contacted the home care coordinator who said that they need more home care than they're getting, but there isn't staff. Now, we talked about this a bit last week, that there are these shortages of home care providers, but we still are in this situation where people's needs aren't being met. So I guess the question I have is, what is the department's plan to address this very serious situation where the home care resources are stretched very, very thin, where people who have need, who have assessed need, are not seeing the services that they need provided and why is it that in the budget the dollars for home care services in some of the districts is going down and not up?
MISS PURVES: Mr. Chairman, one of the reasons the numbers for districts have been adjusted is because last year was the first year we had quite good standardized information from all the providers about what their services were and what the needs were. So the numbers here have tried to reflect where the greatest need is according to this standardized information and so while we believe it is a more accurate reflection of where the dollars are needed, I don't think there's any pretense that there aren't needs out there that aren't being met as well as they should. I do know that there are staffing vacancies that are preventing the allocation of services in some cases. Some of the money that we're putting into home care this year is going to be used to reduce wait lists for home care, but I wouldn't pretend that there isn't a great deal of work that needs to be done on that system and although we are seeing some improvements, there are still very real issues out there that need to be met and funding that is going to have to be increased even more over time.
MS. MAUREEN MACDONALD: Mr. Chairman, you know when we began to analyze and criticize the financial assessment tools, the forms and the information that was being assessed around long-term care, one of the things that I said when I looked at some of this material that our research people were gathering was that I felt that what I called the social content in the financial assessment tools, the social content had disappeared and that it had become very much just a dollars kind of document that did not take account of the reality of how people live their lives, the community-dwelling spouse, for example.
I say that probably because I come from a social work background and I look at the kinds of things people need to stay well. When I look at home care and the assessment tools and the assessment process that is occurring now, I have to be very candid with the minister that I have some similar concerns in that I've heard the explanation given that we will provide what people need, not what they want, and what people need has been determined in an impersonal and sometimes more removed kind of way from the reality of where people lead their lives. So, for example, the idea is that people don't necessarily need a homemaker to help them change light bulbs in their home, or wash a window that they look out, go outside and sit in their yard for a half hour, however, some people who have been housebound for three months may in fact really need to get outside for half an hour, and that may in fact contribute greatly to the quality of their life and their wellness, their ability to recover and stay well.
So I want to ask the minister whether or not you feel confident that the assessment tools that are being used for the provision of home care do take into account people's needs in a realistic way and that like the financial assessment tools that were being used in long-term care, they haven't been narrowed to try to minimize the amount of care that is provided in a way that's fiscally driven rather than in terms of the health care needs of people who require service?
[3:30 p.m.]
MISS PURVES: Mr. Chairman, I do recognize the issue of unmet needs, particularly in individual situations, where I'm sure, well, I know in fact that the member for Halifax Needham is right, that sometimes little things that aren't covered, you know, are what the doctor ordered so to speak, but I believe that we have improved the care assessment for people needing home care and long-term care. The care assessment tools that we use are used all over the world and we use the same assessment for home care and long-term care to try to get at the right kind of care in terms of what an individual needs, but I can't disagree with the member for Halifax Needham in that we need improved services in many instances in home care but again, even though we have a lot more money in this year's budget, we also have unmet needs in the area, for example, of palliative care. Some areas of the province do better than others and there is a strong need out there. That's just one example of needs that also have to be met. So again I would say that while we have made improvements, we certainly have a long way to go in many areas of health care, including home care.
MS. MAUREEN MACDONALD: Certainly another aspect of this is the pressure that this shift in our health care system, away from the utilization and reliance on acute care beds to a more home care model, has put on family members and I guess people express to me quite often the difficulty they have providing or meeting the expectations that are built into that assessment process, to provide adequate care to people who are left recovering at home. I'm wondering what kind of ongoing assessment does the department do of the impact of caregiving in these situations on the caregivers themselves? I know that there is a slight increase in the caregiver's tax credit, but it's very small in proportion to what many people actually absorb financially, but I'm thinking more around the wellness of people who are caregivers. Many of these people are increasingly an aging group themselves.
As people live longer, you will have people in their 80s and 90s who are being cared for by their children who may be in their 50s and 60s and 70s and certainly I meet many people in my constituency who are exhausted trying to provide care and the impact this has on their own health is quite profound, but in trying to get the assessors to take that into consideration when they're looking at what's required in the household is really difficult. It's very difficult to get that looked at. For example, even if the people are younger, if they're in their 20s, they may be working at jobs where they're in the labour force 40 hours or more a week and they don't have a lot of time left for caregiving in the home. So I'm wondering what the department is doing to try to look at ways to alleviate the stress and the exhaustion that many caregivers themselves face when a member of their family gets sick and is discharged home?
MISS PURVES: Actually that subject is an important one. It's something that is being discussed at the federal-provincial level because it's recognized that it's a growing area of concern. It's also an aspect of a study in geriatrics that's going on out at Mount Saint Vincent University. I believe it's Janice Keefe who's heading up this project and she has
been working quite closely with the department. I think we've supplied her with - I don't think, I know we've supplied her with - a fair bit of information that we have and that is one of the aspects of her research, looking at the effect of this on the caregiver.
I know it is an issue with an aging population. This wasn't home care, but I know when my own mother was dying, I guess it was us, the family, participating in palliative care, that it was impossible for my sister and I to turn my mom over because the tumor was so big and these kinds of things are, you don't think of them beforehand, but they do occur to people all the time and they do put incredible physical and emotional stress on people. So, no, we don't do ongoing monitoring because it's a relatively new area of concern, but certainly we're aware of it and are participating in research on it.
MS. MAUREEN MACDONALD: Thank you, Madam Minister. I want then to ask you some questions about the in-home supports program. My reading of this is that there will be no increase in that program this year and I'm wondering what the minister can tell me about the waiting lists for in-home supports. How many people are waiting for these services and why wasn't there a greater attempt made to provide additional services for in-home supports?
MISS PURVES: Mr. Chairman, the department absolutely recognizes that it needs to move on this program. It's just that we needed to move on other things as well, including long-term care. So that while we have pretty well finished our work on standards for a better in-home support program, we were unable to fund it this year. We have about 600 currently - I think the member probably knows that number - receiving in-home support and we do provide them with monies. I believe I had a question about this the other day in Question Period, or perhaps it was in estimates, that we do have a new program with the Red Cross, an equipment loan program. Well, it's considerably expanded and we do think that this program will help people who need in-home supports in terms of the physical devices they may need, whether it be a wheelchair or a lift, or something like that. So we will be able to effect improvements in that way but, no, we are ready to proceed with a new program, but there is no funding for it in this fiscal year.
MS. MAUREEN MACDONALD: With that I'm wondering, are the self-managed care pilot projects a part of that and have those projects been evaluated? Is there any plan to expand those projects or where does that stand because, as I understand it, these projects have been on the go for about six years. The people themselves, who are able to schedule and organize their own in-home supports, find them extraordinarily useful and they're very satisfied and they would like to see government provide these services to more people. So I would like to know from the minister where that particular program stands?
MISS PURVES: Mr. Chairman, staff inform me that the department isn't actually funding pilot projects. I'm not sure since the program came over from Community Services if there might be an answer there. We are continuing the funding to the clients of the
program, but we are not actually participating that we know of in pilot projects. We have certainly evaluated the program and we have a good idea of how to improve it, but the actual pilot projects themselves, I don't have the answer to that.
MS. MAUREEN MACDONALD: Maybe that's something we could get some clarification on at a later time. I want to ask the minister about the government's plans with respect to assisted living. We're seeing a lot of new facilities opening that characterize themselves as assisted living. So they're not long-term care facilities, they're not nursing home facilities, but they are places where seniors, in particular, who no longer want to, or maybe even are able to remain in their own homes, don't want to be doing maintenance, don't want to be cooking meals even, but want to be in an environment where they have some independence, where they have some privacy, where they can come and go as they please, but they also have people around them to provide services and to take care of some of their basic needs. So we're seeing these places open, they're all private pay, and they tend to be not just private pay, but very expensive forms of residential living.
It seems to me that the interest in the community in assisted living residences reflects a need, but meeting that need entirely at this time is based on ability to privately purchase a home or a residence in an assisted living facility. So I'm wondering what the Department of Health is doing with respect to examining assisted living as an option for seniors, you know, as a new sort of development in both housing and care?
MISS PURVES: Mr. Chairman, at the moment the assisted living facilities are strictly private. They're not something that the department licences or finances, but it is an increasingly attractive option for many people. Now, we may provide home care for people in assisted living conditions based on income, but the member is right, since we don't license them, we don't pay per diems and we don't financially support this aspect of a facility, that we're not really involved.
[3:45 p.m.]
However, what we are looking at and will be looking at more closely in the future is whether or not these facilities should be, or not - I'm not prejudging the matter - included in new facilities that get built in Nova Scotia because it may be a good option in many cases that new facilities include assisted living quarters. Certainly we know, in terms of nursing homes, that we have to really look carefully at where they're built and we have looked at models from the U.K. and Denmark, but one of the issues with nursing homes is not just - well, you were bringing up the boarding homes and the so-called small options homes earlier in estimates as part of a solution perhaps, perhaps more so in rural communities than in urban ones, but as part of the mix and we definitely have to look at whether or not facilities include assisted living areas when we're looking at what may be built in the future and where the nursing homes may be built because it could make things a lot easier for the clients and the families if we do that.
MS. MAUREEN MACDONALD: I have a particular interest in this I guess for a variety of reasons, including that I have a lot of senior citizen manors in my constituency and it's interesting, you know, 20 years ago when I first did social work in the North End, people who lived at Sunrise Manor, for example, may have been in their late 50s, early 60s, and today, 20-some years later, they're still there, but as they age, they have a different set of needs. They still want to, when they can, maintain independence and stay there, but sometimes they need a little more support. I'm wondering about whether or not public health nurses, there has been some focus on public health nurses being available to make home visits for new mothers and this program that the Premier talks about, but what about public health nurses doing home visits for seniors? Is there anything to prohibit this from happening now?
What would the process be, for example, for a family, or a neighbour, or someone who felt that a senior in their community, who didn't need adult protection, didn't need any form of institutional care, but maybe needed something beyond just being there by themselves and having a public health nurse come through and take a look at the amount of medication that somebody is on and whether or not there are prescriptions that sort of interact with one another in a negative way, or giving people advice around the kinds of foods that they should or shouldn't eat with particular kinds of prescriptions and all of this kind of stuff.
It seems to me that there is a role for public health in the area of working with seniors and keeping seniors in their own homes, keeping them healthy in their own homes and in their own communities. So the question I have then is, do public health nurses play that role and, if not, why hasn't the department looked at this from a public health perspective to what's happening with respect to seniors?
MISS PURVES: Mr. Chairman, I think the public health nurses play some role now, but it's not a comprehensive system by any means. The department is going to be developing a vision for continuing care within the next fiscal year and there are going to be a lot of consultations with the various stakeholders. This is going to include, obviously, discussions about nursing homes, assisted living, new facilities, the services that are offered, the standards there, new models of services and, actually, that's a very good idea to include the role of public health nurses in that discussion. Whether it's considered health promotion or whether it's health doesn't really matter, it's one of those things that crosses the divide. It's a very good idea to examine that. So I credit the member opposite with some of her good ideas that have come up in the past few days.
MS. MAUREEN MACDONALD: Thank you very much. I would like to take a wee bit of time to talk about mental health services as well. Mental health services are extraordinarily important and, unfortunately, mental health services I think historically get the short shift in many respects in health care expenditures. We have seen the loss of mental health beds in institutional settings and, for many people, this represents progress to a more community-based form of service delivery for people with mental illness but, at the same
time, there are people who feel that we've cut too deeply and that when beds are most needed for someone who has a serious need for hospitalization that the services aren't there. I'm wondering if the minister can tell me how many mental health beds there are in the province right now and whether or not you can give me a breakdown of where they are in the various regions?
MISS PURVES: Mr. Chairman, we don't have that here in the estimates broken down like that, but that is information that is fairly easily obtained and we can get that answer for the member. I wonder while I'm at it, there were some questions asked in the last estimates that I have answers for, if I could table those. Yes, again, I would commit to getting those figures for the member for Halifax Needham.
MS. MAUREEN MACDONALD: I think two Saturdays or two Sundays ago there was a forum on the future of Medicare and Dr. Bob Fredericks was at the forum. I think I mentioned here that he spoke about the difficulty of getting various services but, in particular, he made a statement about mental health services and the needs of children. I know there have been some initiatives that have been announced, which I think we all welcome and embrace knowing how difficult it is to get services for kids, children and adolescents who really require mental health services. There are parts of the province that will be without these services and I'm wondering what the plan is to address those areas where there won't be these programs operating, where certainly there will be children and adolescents who will require mental health services?
MISS PURVES: Mr. Chairman, we actually think that with some of the new money that has been announced for mental health services for children and teens that we will be able to meet a huge portion of the need that is out there now. What we plan to do, and this was a question that came from the media and came up when we made the announcements, that although the teams that we're assembling in metro and in Cape Breton, which would cover about 70 per cent of the young people needing these services, what about the other 30 per cent, what about kids from Yarmouth or Kentville? What we plan to do after we've set up these teams in the bigger areas is evaluate what is most successful about the teams and to try to see how we can set up teams in other areas that aren't served that perhaps may not necessarily be as big but could provide the same kinds of service. You might not need as big a team of professionals, or full-time professionals in a smaller area as you would in an urban area like metro or Sydney, and these people are now being hired.
I agree it seems a bit of a wait, but the plan isn't to just only serve Sydney and metro and let the chips fall where they may elsewhere. It's also true that in some of the cases that will need a bed that the new facility being built here isn't going to be just for people from the metro area. If there is an urgent case that really needs a bed coming from Wedgeport or Digby that that facility would be available. I realize it's not built now, but it is going to be built and it will be available to children from all around the province. So we have a fair bit
of confidence that the money we've allocated for this project will meet an awful lot of the needs that are now being unmet.
MS. MAUREEN MACDONALD: Mr. Chairman, I thank the minister. I've had several cases with kids in my constituency, families in my constituency where there has been a huge crisis around issues that their children had and one of the things in advocating for these families through the system that I encountered was a real reluctance to admit children into hospital. On the one hand, I understood what was going on entirely because the reluctance was that if we got this child in here, how long will we have this child - the fear was that the child would be stuck in the hospital without a plan or a place to discharge the child to, when it was clear that the family, for a variety of reasons, it was not going to be a place where a child could be discharged back to.
So I understand that concern from the institution's point of view, having been an adolescent social worker one time myself in those situations but, at the same time, everybody agreed that the child absolutely needed service and needed it right now. It was a crisis and something needed to be done. What was occurring in a couple of these situations and, coincidentally, I got about four families all in the same weekend with the same sort of problems, the families were being sent back and forth between the Children's Aid Society and the IWK. On the one hand they were saying to talk to the Children's Aid Society and get them to intervene and remove the child from the home, and Children's Aid was saying this isn't a protection case, this isn't a child who is in need of care and protection. In one case it was a parent who was actually in need of care and protection from an out-of-control child. So we had this situation but the hospital wouldn't admit it because their concern was if we get this child in the hospital, we don't know where we're going to send the child to next.
[4:00 p.m.]
It seems to me that there is this kind of, and I don't know what drives that, if part of what drives that are some financial considerations, I know that the families involved felt that it was financial considerations, whose budget was the child's care going to come out of, but I think that there needs to be greater coordination between agencies that look after children so that they don't become in competition with or in conflict with each other about who's going to take care of the children. I know that this is known within the department and I want to know what the department is doing to resolve those kinds of situations that, you know, on Friday night at 7:00 p.m., there's some mother somewhere in the city who is scared to go home from work because she has been beaten up by her son who is 11 years old and bigger than she is.
MISS PURVES: One of the reasons that we are funding the crisis intervention teams is to try to stop the kinds of situations that the member is talking about. I think that I would be foolish to say that moving people around between government departments was going to end, but the idea here is that the overlap would end. We have agreed with Community
Services and talked to them about if a child or an adult or someone needs care, that it has to come to Health for the care. All the people who are working on this project in the department want the best outcomes for the child and the family and are very well aware that sometimes it's a situation with the parents or the caregivers that is causing some of the issues with the child, sometimes it is the other way around, but you can't just work on one part of the problem because it's usually not just one problem.
They've long recognized the issue of needing a hospital bed and we're hoping that this new centre, it may not address every issue, but that it won't mean the IWK has to admit a person to a bed in the hospital and not know what to do afterwards because children will be able to stay in this facility upwards of 12 months, I believe, and the child will not be taken into protection when what they need is essentially health care, but obviously the child who is beating up the mother, or the father, or the aunt, does need health care and has to be assessed as to what that effective health care would be. I know that these situations are not uncommon, mothers particularly being terrified of their own out-of-control children. We had a recent case where a mother was begging that her child be taken away, but had no place to send the child and it's a fairly desperate situation more so if you don't have money, but even if you do, it's very tough to find a place or a way to deal with this situation and we really hope that we will be going a long way to addressing those needs with this new money.
MS. MAUREEN MACDONALD: I want to ask about Addiction Services as well and I don't know if this is something that you will be able to answer at this point or not because I know that these services have been devolved to the districts, but I want to ask about the waiting lists for addiction programs across the province, what are the waiting lists like?
MISS PURVES: Again, we know there are some wait list issues in certain areas, but we can get that information from the districts. We did put nearly $2 million last year into Addiction Services for women and children, but again that is a growing problem in some parts of the province and it's a growing problem with younger and younger children. This may not be news to some members of the House, but the head of Addiction Services at Fishermen's Memorial Hospital was telling me they have a growing problem down there of Ritalin addiction among younger and younger children, you know, they're getting hold of their own pills or kids who have ADD and are taking Ritalin for that are sharing them with their friends, crushing them up and snorting them and so on and so forth, and there's sort of a mini-epidemic down there with some fairly young children. That being said, detox is readily available, but that only takes care of the immediate and, in the long term, people need a treatment for their addictions. Again, we probably fall short, but we have put more money in, and I will get the figures for the member.
MS. MAUREEN MACDONALD: Although I can't remember the particular drug, it's not Dilaudid, that horrible narcotic, there's another drug that is thought to be even more addictive and there has been a fair amount of publicity around Cape Breton, or part of Cape Breton, that has been experiencing this problem and I'm wondering if the department has any
plans? I know in my constituency we have the community-based methadone clinic. Generally speaking, what people tell me is that that clinic has been very effective. They had the potential problem in their funding coming to an end.
The capital district, I believe, is providing funding to keep them going for another year and then hopefully some planning will be done to have them incorporated into the mainstream of the capital's budget, but what about in the Cape Breton area, is there a similar program there? Are there any plans to make a similar program available if there isn't a program there? What can people in that area look forward to and how do you deal with - what's the department's strategy to deal with this highly addictive substance now in that community? Is it a question of monitoring prescriptions and who is prescribing, what's happening around that?
MISS PURVES: Yes, I confirm that the capital district will be helping to administer the methadone program. Here we are funding that for this year because taking away services that are working is just not on. I mean, we can't do that. We would like to expand the program to Cape Breton where obviously, again, you would have a critical mass of people able to take advantage of that program but - no but - we would like to do that and plan to do that in the future although not this year. This year the priority was making sure that the program in Halifax wasn't cut.
In terms of this new drug, part of it is monitoring prescriptions. We do that anyway. I think the member knows that we have a fairly effective system in place - I believe since 1992 or 1993, anyway in the early 1990s - of the narcotic prescriptions having to be done in triplicate and there's a way to keep track of it in that way. If you want to go in and see where something might be going off base, you can do that. This new drug, I can't remember if it was two years ago or three years ago where it became quite public about the Dilaudid problem in Pictou County, for example, and this is a new one to us and we have discovered through looking at the prescription forms that the prescribing of this Oxycontin is much higher in Cape Breton than it is in mainland Nova Scotia to a considerable degree. That doesn't necessarily mean it's an inappropriate form of pain control. It's just that there is more being prescribed in Cape Breton and we don't know why yet, but that can be looked into. I think the member knows that there are cases where doctors may inappropriately prescribe, there are also probably plenty of cases where kids steal from their parents, or their grandmother, or whatever, and get this stuff.
I'm told that one of the big problems with the Oxycontin is that although it's a potent pain medication, it's use again involves crushing it and using it in another form, using it in another way and not the way it was intended for pain control, and I believe there's actually three different brand name drugs that are being prescribed that contain the active ingredient in that. For some reason that has caught on in Cape Breton and we're not letting go of that problem. We have got some statistics on the prescribing and there's something about it that makes it more easily altered than other narcotics and it provides some kind of a high that has
become very popular. The manufacturer of the drug is also working on this problem. So it's not going to end right away, but we are working on it. I don't believe, or haven't been told, if anyone knows whether or not methadone would be suitable for that particular addiction or not. I know it's fairly well-known as a good way to control those who have been addicted to heroin and morphine, but I'm not sure about its effectiveness with this particular drug.
MR. CHAIRMAN: The honourable member for Halifax Needham. You have three minutes left.
MS. MAUREEN MACDONALD: Well, I guess I would like to use the last few minutes then talking about drug coverage for Remicade and for the Alzheimer's patients. You know most provinces, I think, now have moved to adopting the drugs that are being used to sort of hold off the advancement of Alzheimer's disease. They have been found to be effective in doing that. People who are afflicted with this illness, and particularly their family members, I think are very anxious to have a decision from this government on that and they've waited a long time. So I want to ask the minister when we might hear that your government in fact will be including Alzheimer's drugs, these drugs for Alzheimer's patients?
[4:15 p.m.]
MISS PURVES: Mr. Chairman, the Committee of the Atlantic Formulary looking at this issue has made a recommendation that is going to be discussed by the Atlantic deputies. It's either next week or the week after. In this particular case we do want to work together and come to a common decision. The provinces can, of course, decide on their own to go ahead, but I believe, and I've said before, that we're all very concerned that if we go ahead and okay these drugs for use, that there be protocols around their use and that we undertake some physician education before we allow them to be prescribed willy-nilly. There is the medical issue that a particular drug may not work for a particular kind of dementia or it may work, but it may only work for a certain length of time and a person may not need to be on it forever. They are very expensive and we would like to make sure that they're used in situations that are most appropriate.
You know this isn't in the briefing notes, but there is another issue and that is we don't want to create false hope in people that, okay, we've got these great new Alzheimer's drugs and all of a sudden, you know, things are going to be a lot better for everybody because that won't be the case. They will work for some people in some situations but, if you watch a lot of American television and drug advertising, you would think that some of these things are going to solve all your problems and, yes, it will help sometimes, but it isn't going to be a cure-all for everyone with Alzheimer's disease.
MR. CHAIRMAN: Order, please.
The honourable member for Cape Breton Nova. (Applause)
MR. PAUL MACEWAN: Thank you, Mr. Chairman, and thanks for the applause, colleagues. I don't really propose to ask the Minister of Health any great series of questions. I think I shall deliver a lecture to her. (Interruptions) This might be a little easier perhaps than having to answer a series of rhetorical questions. I have two exhibits here in front of me and I can table them. Let me table, first of all, this nice election pamphlet from Jane Purves of Halifax, Progressive Conservative Party, about what she would do and what the John Hamm Government would do if they get into office and, secondly, this fine production today of which I am not the author. I think you are, Mr. Chairman, but I'm not sure, I'm not sure.
It compares new money from Ottawa for health spending in Nova Scotia from the province and comes to the conclusion that Tory arrogance equals priceless and it has a fine photo of the Minister of Finance with his head having grown this way and the Premier also having grown, as I think Pinnochio's nose did. So I will table those two pieces of evidence as I proceed with my speech and I will pick out two more of those flyers from my collection here and honourable members whose libraries are not very big can perhaps add those two flyers to their libraries so they may grow. (Interruption) A book, well, he wants the full size. Well, he will have to wait awhile because it takes time to put a book together.
Now, what have we here? Well, we have a pamphlet from the last election and we have a pamphlet from the next election. That's what we have I think and the last election was the famous Purves postcard. It was deposited, I've always said, into every mailbox in the province, but that's not true. It was put into every mailbox in the constituency where she was running which I believe was Halifax Chebucto, was it? (Interruption) Halifax Citadel, all right, I don't always get those ridings straight in Halifax because I'm not that familiar with them, not having campaigned them door by door. I see Dr. Smith looking at me with glistening eyes as if he needs me for the next campaign, but I think he runs in Dartmouth, not in Halifax. (Interruptions) Well, we will get on to that, let's deal right now with the estimates of the Department of Health.
Now, she told the voters of the riding where she was running that if a Conservative Government got in, it would do two things. It would close the Sydney Steel plant, put the lock right on the gate, close it once and for all, and in place of the Sydney Steel plant, with all the millions of dollars that closing it would save, we're going to invest those dollars into new hospital beds. So you had the caption here of "Closed" over Sysco and "Open" over the hospital beds. Now, that was side one of the Purves postcard and the other side said Progressive Conservatives of Nova Scotia, a John Hamm Government will close Sysco once and for all, Priorities Matter. That was their election slogan last time - Priorities Matter. It says to stop pouring dollar signs into Sysco, protect our health care system. Vote Jane Purves of Halifax, Progressive Conservative Party, and it even had a nice little x on the ballot to show how to do that. So that was the message. I don't think they will deny it. It's a piece of evidence and I will table it in any event to demonstrate the case.
Now, let us put the case to the test. Was this done? Well, that has been the question of the day here to date, was it done? I know that other chairmen have ruled that it was - well, I wouldn't say unparliamentary, but it was out of order to keep asking that question over and over. So I won't ask that question. I will make the statement, was it done, because you can make a statement in the same form as a question and put a period at the end instead of a question mark and that makes it an assertion rather than an interrogatory. (Interruption) The voice inflection, he wants me to get into voice inflection. You know in studying Chinese, they have all monosyllabic words, but they have four tones of voice in which you can express them, rising, level, falling, and falling a great deal. So by doing that, you can give every word four meanings. (Interruption)
I'm not going to give you an example right now because, well, if you were to say hello, (Interruption) Well, I haven't gotten into Cantonese yet, that's another. They're all written the same, but they're said differently. You will find the same thing is true in Arabic where people often say, well, I speak Lebanese, or I speak Egyptian, but they all speak the same language in writing it, but the way you say it is different and you have to learn each one separately. That's like English. I won't get into English because I want to speak on the Health estimates of this government, but in any event the question is how many beds, that's what I was starting out from, how many beds did they open on account of having closed Sydney Steel.
Well, there are two propositions here - closure and opening. Did they close? Yes, they did. How do I know? Because it's in my constituency, Mr. Chairman. It's sort of the focal mid-point of my constituency, my constituency consisting of that site and everything around it on all sides. How's that for a good description of where my riding is? Did they close it? Yes. What are they doing with it now? They're tearing it down. They sold the operational part to an Indian development company. (Interruption) By the name of Zoom, exactly, the minister over there knows the name of Zoom Developments and what is Zoom Developments going to do with the Sydney Steel plant? Well, I will tell you what they're going to do.
Mr. Chairman, it reminds me much of the restoration of Fortress Louisbourg where all the portions that they could excavate were picked up and identified, labeled, and each one was given a letter and a number to identify what it was and then they were all reassembled, like a jigsaw puzzle where you put all the pieces together to get the big picture. That's what they did with Louisbourg and that's what Zoom Developments proposes to do with the Sydney Steel plant. They're going to number all the parts, cut them apart, take them down, ship them to India, reassemble them, make steel and guess who's going to be at the top of the customer list of Zoom Developments when they make steel? It will be Canadian railways and other utilities that need rails and other steel products of that type to continue to operate.
Why will the Sydney Steel plant be in Hyderabad or some such place? The answer is wage costs because you (Interruption) And environment, the minister over there is absolutely right, you don't have the environmental standards in India that you have here and you don't have to pay the number of rupees per hour that you have to pay over here to work, to get all the benefits that people get over here, pensions, and workers' compensation and all those types of things. You could hire people there to work for relatively little, with relatively little safety gear, with relatively little environmental protection, et cetera, and thereby cut costs and thereby cut the price of the finished product, and thereby flood the market with cheap steel. So that's what's going on.
That is part of the Conservative economic development strategy for Nova Scotia, Mr. Chairman, and to illustrate that point, just look how the minister just coached me through the last five minutes of my speech. He knew everything I was about to say because he has been the man who was in charge of doing it. I'm just telling you about what he did. So did they close the Sydney Steel plant? The answer is, yes, they did. (Interruptions) And they're proud of it, good.
Let's examine what they did from an economic point of view. We had in Sydney a brand new blast furnace, never produced a drop of iron, never produced a single - I don't know what unit of measurement was used, I guess it might be the number of litres because it was a liquid, of liquid iron. It cost $81 million new. It sat there, first of all, shiny and nice and after awhile rusty and old, but it sat there from the times of the John Buchanan Government until very recently. Under this government that facility was taken apart for scrap. What did they get for the scrap of the value of an $81 million blast furnace?
I don't know, I don't know, but I know that in shipping scrap steel out of Sydney by the boatload, the scrap steel is, first of all, weighed because you can't pick a ship up out of the water to weigh it to see how much is aboard, you have to weigh the product first and then put it on the ship. So they weigh the scrap steel and then when the total amount of weight is calculated, you multiply that by the price per ton and then you get the value. (Interruption) Less shipping, he's right, you see, he knows all of this stuff. I don't need to tell him, he can tell us. It's the first time I've gotten this minister to open up so much since we've been sitting here in the House, Mr. Chairman. You've got to give him a chance. All right, I will give him every chance, not to do these bad things, but to explain how he did them. I will give him every chance.
Anyway, they sold the operational part of Sydney Steel to Zoom Developments for I believe $4 million and some, about $4.5 million they sold the steel plant for. It makes steel, it could have been operated right here, but instead they would rather see it operating in India so it zoomed away. Was the steel plant worth more than $4.5 million? I think so, Mr. Chairman, I think that the assessed value of that steel-making facility, as it was in Sydney, I don't have the assessed values here, I know there were assessments done, there was a price put on it. If my honourable friend, the member for Cape Breton South, was here today, he
would know the numbers right off the top of his head because he was the minister for that department where this minister formerly sat. (Interruptions) And he will be back, I have no fear of that, but he's the man who knows the value of the Sydney Steel plant and it's a lot more than Zoom got it for. Maybe I can rest my case on that note. (Interruption) Well, I shall, but in a different direction.
So I will say that they did close Sydney Steel, they did not sell it for what it was worth. They therefore took a loss as compared to what it could have been sold for. They did not find a local developer who was prepared to run it on the site in Sydney. Johnny Abbass, for some reason, they turned away. I can't understand that one, but in any event, did they find some other developer or entrepreneur who would operate the plant in Sydney? The answer is, no, they did not.
[4:30 p.m.]
Our government, knowing we had - I wouldn't say we had suitors, that doesn't sound like the right word - we had expressions of interest. Our government was all ready to go forward and keep the Sydney Steel plant in operation and the Sydney Steel plant would be in operation to this day if the Liberal Government was still in power. (Interruptions) That's right. Yes. But there was a crew called the NDP and they could not allow the Liberal Government to remain in power. We had proposed free licence plates for volunteer firemen and that was what got the NDP so steamed up, I'm told. When they saw that in our budget, they said we've got to vote against this budget and bring that government down.
On doing further research of the matter, I find that they had already reached that conclusion to vote against the budget before they had seen the budget and knew what was in it, if you can imagine such a thing. This was called NDP logic in action and it was formulated by the honourable law professor from Halifax Chebucto. See, they know the ridings, they're just like the minister over across my way for Digby - they know everything, they can tell us how they did it. But they pulled the rug from under our feet. I remember there was a vote taken right here in this Chamber and they and the Tories voted together to bring our government down, precipitating a mid-summer election when we had just had an election 14 months before. They said, oh no, we need another election. If the NDP had their way, I'd say they would have an election every day of the week. That would make them happy.
So they had the election and what happened? The NDP went down, they didn't go up at all, they had 19 seats and they got down to 10. We had 19 seats and we went down to about the same. And we weren't counting on Hinrich Bitter-Suermann to bail us out.
AN HON. MEMBER: How many were you down?
MR. MACEWAN: Well, we're growing daily. Mr. Chairman, you should be at some of the Liberal nominating conventions that I've attended. Maybe I shouldn't get too far into that one, but I'll say that they have been very well attended, demonstrating widespread interest in the project of getting rid of this government and their allies and replacing it with the kind of government we had prior to 1999. That's what I see in my travels about the countryside.
I was answering the question, did they close Sydney Steel? The answer is yes. I was explaining how they got the mandate to do that and the answer is because of the actions of the NDP. I rest my case.
Now, moving on. Did they open the new hospital beds? Where are they? Well, I'll tell you, in the area that I come from, the area is served by two hospitals, the Cape Breton Regional Hospital in Sydney and the New Waterford Consolidated Hospital in New Waterford. I haven't had too many . . .
MR. FRANK CORBETT: Forty years old this month, Paul.
MR. MACEWAN: New Waterford hospital is, yes. Not the regional.
MR. CORBETT: Opened April 3rd.
MR. MACEWAN: There, he has it right to the day. See, the NDP knows what they're doing. Oh, yes, they know exactly what they're doing - that's why they pulled our government down and put that Sysco-closing Tory Government opposite in power - that's why they did it.
The point is that the New Waterford hospital and the one in Glace Bay and the one on the Northside, all three of them, are in a constant state of turmoil. They do not know from day to day whether they will continue to exist or not. That's the climate of opinion that this government has generated.
Some may say it was just as bad under the Liberals. No, it wasn't. It wasn't at all. When our government came to power in 1993, there was a secret plan that had been formulated by Donald Cameron and company providing for massive hospital closures and cuts all across Nova Scotia, a secret plan that was never made public by the Conservative Party, but I've tabled it here in this Legislature several times. It is genuine, it did come from the Department of Health and I got it from the new Liberal Minister of Health at the time, Dr. Ron Stewart, who came to me with this big pile of papers and said, what's this? I said let me see it and I'll tell you.
I got it and I read it and it said, closure plan, top secret. Hospitals of Nova Scotia - 29 or 30 pages, all the cuts. They were even going to close the All Saints Hospital in Springhill because they were against All Saints. Don't know why, but that's a Conservative mentality, you see. So they had all these plans and one was certainly to close the New Waterford Consolidated Hospital, not just in part, but totally and to bulldoze the site. Just like the Conservatives did to Sydney Steel. They've done exactly the same thing there, they've closed the steel plant and they're bulldozing the site right now with their friends from Zoom. Zoom will be at it, they'll wait until after the election to allow the Zoom people to get to work, I know.
Now, where were we? We were talking about the hospital in New Waterford and its being in a constant state of uncertainty, but the Liberal Government, when it came to power in 1993, stopped these Conservative plans to close all these hospitals around Nova Scotia and instead demonstrated leadership in trying to reform our health care system here in Nova Scotia in a very massive way.
I know I've often talked about the ambulance service under that heading because it struck me as so strange that because my good friend, the member for Timberlea-Prospect, happened to own a 45-yard-long Cadillac limousine and a bucket of paint, if he painted it white and put a red cross on each side, he would then come out as Bill's Ambulance Service Ltd. It was legal. It was the practice in those times.
When we came to power, we set up the Emergency Health Services ambulance program with trained operators, proper vehicles, licensed, inspected, they even have their safety inspection stickers up to date on their windshields. We're running an ambulance service of a professional type here in Nova Scotia now. Who did that? It was done by Dr. John Savage and Dr. Ron Stewart - that's who did it. It wasn't done by Donald Cameron, Roger Bacon or any of their illustrious predecessors. Now, that's one thing we did in health.
Another thing we did was to keep the New Waterford hospital open. I'll tell you, Russell MacNeil represented that area during most of those years together with myself and we worked very hard to try gradually to get that hospital brought back to full capacity, full operational capacity. There was a time when with a three-storey building, one of the three floors was completely empty. They had to heat it and insure it against damage by fire, but there wasn't anybody in it, one of the three storeys. Through the work of Russell MacNeil and myself - that I don't want to speak on at great length - we persuaded the government of the day, the Liberal Government of the day, to put hospital beds into that floor and so make the hospital fully operational for the first time in many, many years. That's what the Liberals did for New Waterford and area.
I trust that we did the same thing for Glace Bay, Mr. Chairman. You, perhaps, can decide on that more than I can, but I thought, viewing it from afar, that the record looked pretty good. It looks a lot better than it did under the Conservatives.
The Conservatives got back in thanks to the NDP in 1999. Since that time, I've heard (Interruption) Explain what?
AN HON. MEMBER: Explain how that happened.
MR. MACEWAN: I just did. If you were asleep during that time, I can't help it. (Interruption) He can read Hansard, exactly. If he can't read Hansard, you teach him to read and then he'll be able to read Hansard. Let's get back to the estimates.
Now, where was I? I was talking about what the Conservatives have done since 1999 when they got into power, thanks to the NDP. What they have done has been to reverse things, just as with a car when you change the gears from going forward to reverse, it backs up. The Tories have done the same thing to the health care system - they've slammed the whole system into reverse and now it's backing up when it should be going ahead. In New Waterford, Northside and Glace Bay, the prevailing sentiment is that the people are not sure, that as long as that crowd remains in power, they will be able to have their hospital. They think it may be closed the day after the election. Maybe Zoom Developments will be sent out to Glace Bay after they're through with Sydney Steel and they could do the same thing out there they did to the steel plant and take it apart piece by piece and put it on the next boat to India and set it up in Madras or Calcutta, you know, and they will have a new hospital there thanks to this government. I don't know. How could I know based on their past record, it ain't reassuring. It's not reassuring.
The question is have they carried out the intent of this message and the answer is, yes, in part, they have done A, but not B. That's the verdict. So what more can I say? I could say the $155 cheque is supposed to obliterate all that and just vote for the people who gave you the cheque, don't bite the hand that feeds you.
I have another piece of literature in my mailbox today above and beyond - well, I didn't get this one, somebody else got that one, but they passed a copy of it on to me. That's how I . . .
AN HON. MEMBER: Sharing the good news.
MR. MACEWAN: Sharing the good news he says. See how proud they are with what they've done, how they closed that steel plant in Sydney. This flyer here refers to the new money for Health from Ottawa, $140.3 million and it's broken down by category - $75 million CHST supplement, $30 million health reform fund, $15 million for medical equipment and $20 million in additional CHST 2000 health award. That money, that new money for Health, was matched by a corresponding contribution of $300,000 from the Province of Nova Scotia. Ottawa gives $140.3 million, Nova Scotia gives $300,000. Now, that's the difference between the federal Liberal Government and the provincial Tory
Government and maybe I can rest my case again on that point, that they are not doing what they ought to be doing.
These numbers prove it and I know that these numbers are very well researched, Mr. Chairman, so I shall say no more on that, but the concluding bottom line here is that the total price tag of Tory arrogance is priceless and, just to illustrate that point, there is a magnified photo of the Premier and the Minister of Finance showing the Minister of Finance, in particular, suffering from somewhat of a swollen head. That's just what the photo says, I'm not saying that he has that, I'm saying the photo shows that. So we can see from this short lesson, oration, something of the hollow nature of the Conservatives' claims of having done a good job in government.
Now, I know they're just about to get out to the hustings and they're getting all their signs cleaned off from last time and their stakes sharpened, resharpened, so that they're ready to go to work once again. They had a version of this last time and they're planning version two in a couple of weeks. As soon as you get your $155 cheque, the next day you're going to get a free book in the mail - Strong Leadership . . . . a clear course, Volume II.
[4:45 p.m.]
AN HON. MEMBER: Another best seller.
MR. MACEWAN: Another best seller they think. I don't think that the record, as I've explained it in this short speech, illustrates something worthy of support, Mr. Chairman, and I won't say that we in the Liberal Party, and we've had our ups and downs, there's no denial of that, we would be a government right now if we hadn't had our downs, but we are ready and willing to provide a team to Nova Scotia for their endorsement at the polls that will do a better job than the crowd across the way and what more could I say? That's a question, I'm here to ask questions, but I think the answer is self-evident and I hope it will be shown on election day.
MR. CHAIRMAN: The honourable member for Cape Breton West.
MR. RUSSELL MACKINNON: Mr. Chairman, the other day I asked the minister with regard to the air ambulance program and the fact that the Department of Health took over that service, and at that time she indicated, contrary to what the department had contemplated, a reduction in the cost of service, that actually it increased. I'm asking if in fact the minister has had an opportunity to secure those figures and could she provide them to the committee?
MISS PURVES: Mr. Chairman, I did table the answer to that question earlier, but I will read from, when EHS took over operations from the private operator in March 2001, we did not expand administration and saved $160,000 of Starr's management fees. That being
said, costs have increased since that time because of wage settlements, 100 additional missions, insurance cost increases, fuel price increases and also Canadian Helicopters Limited now functions as the employer of the flight crew. That's one person to manage roughly $60,000, but there are no new Department of Health employees.
MR. MACKINNON: Mr. Chairman, would the minister simplify all that and please tell us what's the bottom line? How much more are we paying than we did before it was taken over by the Department of Health?
MISS PURVES: In terms of the actual operations, we're paying less. In terms of the increased costs and increased missions, we're paying more. Obviously, if you're flying 100 more missions, that's going to cost more than a 100 fewer.
MR. MACKINNON: Mr. Chairman, the minister still hasn't answered the question. What's the bottom line? At the end of the day, how much more money have we expended than previously?
MISS PURVES: I will have that for the member in a few minutes when I get the right page.
MR. MACKINNON: Mr. Chairman, I was looking at the Supplement to the Public Accounts for the last two years. I know for the Supplement to the Public Accounts for the year 2001, the total expenditure by the Department of Health through Communications Nova Scotia was approximately $100,000 and for the 2002 Supplement, it was well over $700,000, more like about $720,000. Why the substantive increase in Communications' expenditure?
MISS PURVES: Mr. Chairman, the reason for that addition largely, except for 3 per cent wage increases for people there, is an additional person.
MR. MACKINNON: Well, heavens, Mr. Chairman, an increase of $600,000, I hope we didn't hire somebody at the cost of about $600,000 and excepting the 3 per cent increase in wages. Could the minister clarify with more detail as to why, you know, the expenditure was over $600,000 more than the previous year?
MISS PURVES: Excuse me, Mr. Chairman, I must have missed the original question. I thought the question had to do with Communications and the increase in Communications over last year and that increase is $100,000, not $600,000 or $700,000.
MR. MACKINNON: Yes, that's within the Department of Health, that's for staffing, but the amount of money that was expended and paid out to Communications Nova Scotia as demonstrated in the Supplement, there was an increase of $620,000 there. Why the substantive increase?
MISS PURVES: Mr. Chairman, there was a change in the way that Communications Nova Scotia and the various departments did the billing. It used to be that certain Communications staff were counted as department employees. Now they're counted as Communications staff employees. So we account for paying Communications Nova Scotia for the staff and that's why the increase. It's not $600,000 worth of new people. It's a change in how the system works.
MR. MACKINNON: Mr. Chairman, if we were to make the average pay, of let's say $40,000 per Communications officer, which I think is a reasonable figure, you're looking at about 15 Communications personnel who would be transferred from the Department of Health over to Communications Nova Scotia. Is the minister telling the members of the committee that we have transferred approximately 15 employees, the equivalent of 15 employees, over to Communications Nova Scotia?
MISS PURVES: Mr. Chairman, I don't believe that at any point in the last year or two that we've had 15 Communications persons in the Health Department. I will endeavour to get more detail, but I will say that the change in the way that they are paid now as billed is accurate. That has happened within the last year, I believe, perhaps the last year and a half.
MR. MACKINNON: Mr. Chairman, the minister still hasn't answered the question. She can't account for the increase of $600,000-some, $620,000. First she was saying that it was because those employees were transferred over to Communications Nova Scotia and the change in the billing process and then with the 3 per cent increase in wages, but we haven't been able to quantify where that $620,000 has been expended or why it has been charged back to the department from Communications Nova Scotia?
MISS PURVES: Mr. Chairman, there were in that year other expenses besides people. For example, creative services, publications, media monitoring, printing and stationery costs, and other support services. There would be some advertising included in that and these also are part of the expenses of what we would pay to Communications Nova Scotia. I mean just for printing documents and so on, it would be around $400,000 on its own.
MR. MACKINNON: Mr. Chairman, would the minister be kind enough to table what documents were supposed to have been printed for the $400,000. Initially she was saying it was for wages and cost of living and the transfer of employees from one department to the other and now she's saying that the lion's share of that is for the printing of pamphlets. So we would like to know, is it some kind of a health promotion situation here, or what's the situation?
MISS PURVES: Mr. Chairman, the member has asked for a humongous task which we will try to do, but the printing of documents for the Health Department in any year, first of all, doesn't include anything we did this year because Public Accounts reflect a previous
year, but it's everything that you would print to do with public health. For example, all the public health information that goes out to doctors' offices, drug stores, and so on and so forth from the Department of Health about diseases or procedures, or whatever, is included in the publications that we have printed for us and done by Communications Nova Scotia. So, you know, there is nothing underhanded going on here in terms of the publication of documents.
MR. MACKINNON: Mr. Chairman, I didn't suggest that anything was underhanded about the process at all. If the minister is feeling a little chippy about it, you know, I don't know what the rationale would be, but all I wanted was just some explanation and why the rather excessive expenditure from the previous year. So I will take that on notice for a provision, at least an outline of what that $620,000 additional dollars would mean. Would the minister be kind enough to indicate - obviously with a department of this size, there are always individuals and situations that arise within the Department of Health that would lend to litigation against the Department of Health or various district health authorities. Would the minister be able to apprise members of the committee as to how many cases are now pending against the department and/or the various health authorities?
MISS PURVES: Mr. Chairman, again, we can supply that information. We don't have it with us. There are some cases pending against us but we can get that information from Legal Services. The number, you know, may change from day to day.
MR. MACKINNON: Would the minister be able to give us some indication, on an annual basis, how many lawsuits would be generally pending before the department? I'm sure her staff would have some general idea of how many cases would be pending before the department.
MISS PURVES: Mr. Chairman, we do not have that information. Our Legal Services would have that, it may be available at the Department of Justice, but we can get the information in very short order.
MR. MACKINNON: Mr. Chairman, could the minister apprise members of the committee as to how many cases have been settled in the last year?
MISS PURVES: Mr. Chairman, we do have our chief financial officer here and he would be made aware of cases that had a financial implication and he is not aware of any cases settled in the last year that have a financial implication for the department but, again, we will get back to you with that information.
MR. MACKINNON: Yes, Mr. Chairman, I notice there's a considerable expenditure of dollars for legal services, I would presume, because they're for different law firms across Nova Scotia, well into the hundreds of thousands of dollars. I would ask perhaps if we could get a thumbnail sketch of what that represents? I mean we don't seem to know how many
lawsuits are pending, what cases have been settled or what. It seems that it would be justified to have an explanation as to what all these legal expenses are for.
MISS PURVES: Mr. Chairman, no, not all the legal services required for the department would have to do with lawsuits or pending lawsuits although that would be part of it. We use legal advice for rewriting Acts, rewriting regulations. We use them for advice on labour negotiations considerably. Those are among the services that we purchase. We have our own people and we use outside services as well.
[5:00 p.m.]
MR. MACKINNON: Mr. Chairman, perhaps I could take it on notice if the minister would be kind enough to give us some more detail on the total legal expenditure by the department for legal services and, if possible, a breakdown on that detail. I know it's outlined in the Supplement as to the law firms and the amounts, but it doesn't give any detail as to what - I don't want to get into micro-management, but at the same time, periodically we hear through media reports about different individuals who have considerable concern about the way they feel they have been treated in a particular case or what have you. I'd be absolutely surprised to think that there weren't some legal matters that were pending that would cause some consternation for the department. We don't hear too often about how they're settled and I think it would be refreshing for the taxpayers to know exactly whether there's a growing trend towards litigation on health-related matters. Or if, in fact, it's the same as it always was for the last 10 to 20 years.
MISS PURVES: Again, we will supply that information, but in terms of a growing trend towards litigation in all of our society and certainly against medical professionals, that is absolutely true. But there are many cases launched against, for example, doctors or a hospital or even a nurse that would not be against the Department of Health. Therefore, they would not be cases that we would be dealing with. They might be, but they may not be - not all litigation would see its way into something that the Department of Health would have to deal with per se.
MR. MACKINNON: The question I asked on a previous day to the Deputy Minister of Health when he appeared before the Public Accounts Committee was the average age of doctors in Nova Scotia and if he could give us some breakdown in periods of 10-year segments, age-wise, let's say from 25 to 35, 35 to 45, 45 to 55 and so on, so we can get an idea of that detail. I haven't been able to secure that information and that's well over a year ago. I would think that the Department of Health should be able to provide that information. Would the minister give an undertaking that she will provide that information?
MISS PURVES: I know there was an HRDC study being done and I believe that study is completed now. It probably will not be difficult to get that information, but it's obviously not something that we have here in the Estimates Books.
MR. MACKINNON: I can appreciate it not being there with her Estimates Books, but in dealing with a broad range of health-related matters, I think it would be a matter of considerable importance that we know that information. From time to time we hear doctors saying that they're overworked and they get to a certain age, they're like any other professional - they like to cut back on their workload. I'm asking the minister if she will provide that detail within a reasonable period of time.
MISS PURVES: Yes, I believe I already said that I would provide that information.
MR. MACKINNON: One of the complaints that I have in my constituency is the number of acute care beds versus tertiary beds. Could the minister give us some indication as to the status of acute care beds in Nova Scotia? Do we have more acute care beds today than we did, let's say, five years ago when the government came to power, or do we have less and perhaps if you could give us some indication of that in relation to the total bed count?
MISS PURVES: I know that we have more critical care beds than we did three years ago, but again, I would have to get back to the member with the details of how many beds in what category we have in each of the DHAs. It is not a number that I have memorized.
MR. MACKINNON: Mr. Chairman, I thank the minister for her response. Not being a health care professional myself, I don't understand all the technical jargon or the lingo, so to speak, and sometimes I find it a little difficult to differentiate between acute care and tertiary care and that sort of thing. The bottom line is, can you give me, for the Cape Breton district in particular, the total number of beds, including the regional hospital, the community hospitals - like Glace Bay General, New Waterford, Northside and so on - give me the total number of beds that we have today as opposed to four years ago? Perhaps, if that number is available province-wide, I would appreciate that as well. I suspect the minister's budgets will be on again tomorrow and I'm not sure if that's too short a notice, but if we could have that information by tomorrow, I would certainly appreciate it.
MISS PURVES: Mr. Chairman, we will try to have it by tomorrow and if not tomorrow, by Monday. We've been relatively swift with responses so far. We'll get the beds for each DHA and divide it by category. That's, I take it, what the member would like to see, particularly for his district but then, as well for all the other districts. It may take until Monday to do that, but we will try to have it by tomorrow.
MR. MACKINNON: Mr. Chairman, another issue of concern in a number of the hospital settings in the district that I represent is the waiting time. The waiting time seems to be going up, not down. I don't know if it's a scheduling issue or a staffing issue at the hospital or what. I'll take a moment just to clarify. It's no way any reflection about the quality of service that is being provided because the staff is second to none, whether it be the cleaning staff, the nursing staff, the kitchen staff, the doctors, the lab technicians or administration, they all do an excellent, professional job with the resources that they have
to work with. I wanted to put that on the table and it doesn't matter which facility - that's my experience - it seems that the waiting time seems to be increasing.
I know a constituent of mine had to attend one of the regional facilities here in Halifax, again with excellent service, but unexpectedly had to go over for outpatients and I believe the waiting period was five or six hours. It was late in the evening, but to me that seems like a long period of time - maybe I'm wrong on that, but if the minister could give us some indication of what the average waiting period is for each hospital? I'm sure the local . . .
MR. CHAIRMAN: Order, please. Thank you. The member for Cape Breton West has the floor.
MR. MACKINNON: If it's possible - it may be a question of securing that information from the regional districts - if we could have some indication or some detail as to what the waiting time is for each of these jurisdictions, each of these hospitals, so we can determine as to whether there's an imbalance in certain regions of the province that we may have to deal with.
MISS PURVES: The issue of wait times is something the department's been working on for a while now. It is a lot more complex than just what are the wait times. There are different wait times for different procedures. There are any number of different kinds of wait times, whether it's for an MRI or CT Scan, or bone densitometry, or whether it's for elective surgery, heart surgery, or some other kind of surgery. So the question is one, the answer for which would fill several volumes of material and in point of fact, we don't even have all that information in a standard way in order to be able to measure it. That is one of the pieces in the information puzzle that still needs a huge amount of work. The different hospitals and districts don't even measure wait times the same way.
So in some cases you're comparing apples and oranges and we can certainly supply information on wait times that we know are accurate that compare apples to apples, that we actually know. For example, we know quite a bit about the wait lists for various kinds of cardiac surgery at the QE II and we know why they have grown so long, and that is partly because of improved procedures that allow more people to have the procedures. So it's a case where, in that particular case and in many other cases, an improvement in health care actually creates a longer wait list. It's not a concept that's necessarily well understood but, for example, to give an extreme example, if 20 years ago you were waiting for cataract surgery, you might or might not have had a very long wait because only certain people were given cataract surgery and it wasn't possible to do on other people. It was a very long and complex process that people were hospitalized some length of time for. Now it is routinely done on an outpatient basis on thousands and thousands of people who 20 years ago the operation wouldn't even have been done on them.
So, again, there may or may not be a wait list depending on where the service is offered, but is it reasonable and is it a result of bad management or lack of money, or is it a result of improved service as in the case of the cardiac care. So we will give you what information we have, but I can tell all members of the House that this is a very, very complex project and we're only partway there.
MR. MACKINNON: Mr. Chairman, I have to say one thing. I'm a little disappointed, and not that the minister hasn't been giving me the best information that she can possibly provide, but what she's saying is different than what her predecessor said and what the Premier has said publicly, and that is that waiting times are down. She's saying here, today, in some cases because of improved service and improved technologies, that waiting times may be longer. So it begs one to wonder how can the Premier and her predecessor come up with the conclusion that health care is better because the waiting times are less. I agree that it's far more complex than just simply saying right across the board, you know, whether it be an MRI, or eye surgery, or an organ transplant, or whatever, I understand all that, but we spent a lot of money, and it was started under the previous Liberal Administration, over the last four years improving our information systems and the deputy minister appeared before the Public Accounts Committee and went to great lengths to expand on that.
[5:15 p.m.]
The minister now is telling me that she doesn't have sufficient information systems to be able to determine how we can measure these waiting times, so I'm quite concerned. What's the status of our information systems and how much has been spent on it in the last four years, and how would she rate where we are on the scale of our information systems? The Conservative caucus, when they were in Opposition, day in and day out - I remember the Health Critic at the time, the member for Kings West, the honourable George Moody who was a Minister of Health in his previous life - that was their biggest concern and now the minister is saying we're back to square one. So how much money has been spent on these information systems and when can we expect to be able to measure improvements in our health care system and ultimately improved cost-efficiency? That's what I'm getting at, value for dollar.
MISS PURVES: Mr. Chairman, there was no standardized information, and there isn't yet, enough standardized information on wait lists to be able to give an informed, comprehensive answer to the member's question the way he wants it. Information systems in themselves are not going to get to the basics of how wait lists are measured. That is a human function that has to be recorded in an information system. Again, I will have to get back to the member about how much has been spent on information systems in general in the last four years because we don't have the four-year rolling figure here.
We have just the year-to-year, but we can get back on that, but there are many kinds of different information systems, including a major one that is being rolled out in the Guysborough-Cape Breton area this year and the information systems will be about many things, not just about wait lists. Patient information is not about wait lists, but it's one of the things that we want to be able to provide for people; complete patient records that would be available to all health care providers across the province are one of the major aims of this information system and we are doing fairly well in Nova Scotia relative to the rest of the country, but it is a huge project. I mean it's a $4 billion project nationwide and the systems are very, very expensive.
MR. CHAIRMAN: The time has expired for that member.
The honourable member for Cape Breton The Lakes. The time is 5:18 p.m.
MR. BRIAN BOUDREAU: Mr. Chairman, my first question I guess to the minister, I don't have a preamble and I'm not much of a camera person so I will get right to the point. My first question is, I've had many calls from seniors in my constituency in regard to a $6 fee for a blood test in other parts of the province. I guess my question, I would ask the minister whether she intends to make this a universal fee on blood services at local hospitals throughout Nova Scotia?
MISS PURVES: Mr. Chairman, no, the fee for blood collection that is being charged at various clinics, or in some cases mobile clinics around the province, is really a fee for convenience. There is no charge if you go to the hospital to get your blood taken and that is as true in your area as it is in mine. If you have the $6 and you prefer the convenience of having the service done at a clinic, then there is a fee for that, but if you can't afford that, or you choose not to, you simply go to the hospital and have your blood taken there and it doesn't cost anything. It was not a service that was mandated by the Department of Health. It's done in various districts because some people prefer the convenience, but it is not mandated and it won't be mandated. The fee for blood collection in any hospital is zero.
MR. BOUDREAU: Mr. Chairman, my next question is, I'm wondering on hepatitis C and teenage pregnancy, those sort of statistics, does your department keep a record of communities that have statistics in regard to teenage pregnancy and that sort of thing, does your department keep a record of this, compile a record?
MISS PURVES: Mr. Chairman, figures for teen pregnancies, those figures are not kept at the department, they would be at the local district level. The issue of patients with a disease such as hepatitis C, which is what they call a notifiable disease, we would have those statistics at the department. We do have those statistics at the department through the Public Health Division.
MR. BOUDREAU: Mr. Chairman, I guess my question now is, are these files reviewed before you make any major decisions when you cut programs from hospitals?
MISS PURVES: Mr. Chairman, there are two parts to the answer to that question. One is that anything that we decided as a department that we would cut, or not increase funding to, sometimes a lack of increase is called a cut, is based on the best evidence available and usually it's very good evidence of whether or not a program is working or needed, or can be offered in some alternative way.
The second part of the answer to that question is at the district level or, yes, at the district level there may be a decision to cut a program or a service and that may be something that the district has the best information on, but that is not usually done. I don't know if it's ever done, but it's certainly not usually done without us being advised in the department, or the decision having gone through the business-planning process, whereby the districts say what they're going to do with their money and how. Oftentimes, if a proposal would come forward for cutting a service, or a program somewhere, that the department doesn't believe should be cut, then we would take that back to the district and say, no, you can't do that, let's look somewhere else. If there's no alternative, then there have been times when the department has provided funding, but sometimes there are programs at an individual hospital that a district may very well want to cut and do not see as very important to their mandate, but the department does. So there are some fairly good checks and balances in the system.
MR. BOUDREAU: Mr. Chairman, I'm going to ask my next question in regard to supplies at hospitals. Do you regularly review supplies or do you leave that up to the district authorities? I guess, while I'm on my feet could you explain just what the process is that you allot money to departments in regard to supplies. I will tell you why I'm questioning. I visited a hospital on the mainland, I don't want to say which hospital, but an emergency happened in that particular community, it was an eye injury, and when the young gentleman got to the hospital, they had to cut the bottom of a Styrofoam cup and put it on the gentleman's eye and send him on here to Halifax, they had to tape it on with black tape, and that story came directly from the gentleman's father. So, my concern is, why don't nurses and health care professionals have the tools to do their work and why do some hospitals seem to have supplies and in other districts they don't have any supplies? Could the minister explain, please?
MISS PURVES: Mr. Chairman, the decision on allocating supplies would be made at the district level and not be made at the level of the Health Department. I mean they have a better idea of what might be needed in individual hospitals. They would have figures on that, you know, they would generally know how many syringes they usually use at a hospital in a given day or week or month. So, generally speaking, we know hospitals have to have supplies like schools have to have supplies. Everybody has to have supplies and part of the 7 per cent increase that we are giving to the DHAs is to support inflation on basic supplies. I mean we know that they're going to need that absolutely.
MR. BOUDREAU: Mr. Chairman, could the minister explain if there has been an inventory taken in the various districts in regard to supplies for hospitals in particular?
MISS PURVES: Mr. Chairman, that would be strictly a function at the district level. They have purchasing departments in the hospitals and the DHAs and they know what they need and that is something that there's no need for the department to get involved in such a basic business function. We want to make sure they follow the purchasing policies of the department and we have been pushing and succeeding in many cases in getting group purchasing to try to make the cost of supplies as reasonable as it can be, but that's our function in that area, is simply trying to help them with bulk buying and purchasing and they make the actual decisions at that level.
MR. BOUDREAU: Mr. Chairman, I'm getting a little baffled here. There has been no inventory taken, Madam Minister, if you could, could you please explain how you came to the 7 per cent figure, how did you arrive at that figure for an increase in supplies to medical facilities? Where did that 7 per cent figure come from?
MISS PURVES: Mr. Chairman, I'm sorry if I wasn't clear. The 7 per cent increase is not just for supplies, but supplies would be included in that 7 per cent increase. The 7 per cent was arrived at largely through taking a four-year average of what the increased costs were, at least that's the essence of it, and their increased costs, these are all non-staff costs. The 7 per cent increase, we have guaranteed them that, plus we have said the negotiated salary increases would be on top of that. So, you know, supplies obviously would be included in that, but there are other costs included in non-staff costs and supplies would be one of them.
[5:30 p.m.]
MR. BOUDREAU: Mr. Chairman, I'm still a little baffled. I know I'm probably beginning to confuse the question, but I'm still confused. You came up with a 7 per cent increase in a budget that had no inventory. I have a hard time understanding how you, as the minister, could be aware of the need of supplies in hospitals if you didn't look at the file, or you didn't have the information in front of you, to know what these facilities require. So perhaps to save more confusion, I will ask the minister very clearly, and I will say this first before I ask her - many facilities in this province in the last two years have asked for extra supplies and were denied because there was no money to buy these supplies. So I guess my question to the minister is, will she make the undertaking that if the 7 per cent is not enough for some reason, will it be increased to 10 per cent, or 9 per cent, or 8 per cent, whatever is required to ensure that these medical facilities do in fact have medical supplies for when they're required?
MISS PURVES: Mr. Chairman, we came up with the 7 per cent on non-staff costs through looking at financial statements from the DHAs and the hospitals, not through doing an actual inventory ourselves. We don't micro-manage to the extent that we're sending out inspectors to do inventories of supplies in all the hospitals in Nova Scotia. There are financial statements, there's external accreditation. You take those financial statements and you look at average increases, say, in fuel costs. That would be another example of a non-staff cost and you can see that, on average, fuel costs are going up by whatever and that is factored into the 7 per cent and so are supply costs. You also have to anticipate a certain amount of new supplies to go with perhaps procedures that are becoming more common that weren't before, but there's a lot of financial information that is gathered together by the department and people went over that and came up with the 7 per cent figure that would, you know, guarantee the DHAs that much in non-staff costs each year and then we left the salary component out of it.
MR. BOUDREAU: Mr. Chairman, that's fine, I can understand, I never suggested that we send out auditors or someone in to check supplies in every hospital, this is a modern world, it's 2003. We do have technology in this province and I think, you know, for the most part you're aware of that because you do put some of it to good work. In regard to the 7 per cent - I want to leave the 7 per cent if I can - is the 7 per cent locked in and are you prepared to increase it if health care facilities request more money for supplies, for this item, the 7 per cent, are you prepared to put more than 7 per cent if it is required?
MISS PURVES: Mr. Chairman, obviously if you're planning for three years and you've got good data to begin with, which we do, we think the 7 per cent is adequate and the DHAs think it is adequate, too, for those things. That's not to say that more money wouldn't be allocated for other things. For example, the mental health programming that we just announced, that is money that comes out of the Department of Health's budget even though the work being done is going to be done in the DHAs. When those are successful, that money will be rolled into their budgets and it won't be held centrally. So if something happens in a particular area that for some reason more money is required, we're always prepared to look at that. I mean if we had an outbreak of SARS, for example, somewhere in the province, which we haven't had and hopefully won't have, it's pretty obvious that some hospitals or a DHA might incur a lot more costs than another DHA for that reason and, of course, you know, we would have to look at providing the funding for that. So we are open to reviewing it, but in terms of feeling that 7 per cent is adequate, except for emergencies, we do feel it is exactly.
MR. BOUDREAU: Does the minister realize that there are hospital foundations in this province that are actually paying and supporting oil bills, heating bills for hospitals, is the minister aware of that?
MISS PURVES: Mr. Chairman, no, that would be unusual for a hospital foundation and I was not aware that any hospital foundation was paying regular oil costs. That's part of what the 7 per cent was meant to cover.
MR. BOUDREAU: Mr. Chairman, I might as well move along I guess. Travel is always an issue for my residents, particularly for medical appointments and commitments up here in Halifax but the wait times are exorbitant. I know of one lady who waited 16 months to come up here for heart surgery and actually it was only testing and she waited 16 months. I have a resident who lives in my area who had back surgery last fall, similar surgery to what the Premier had, and she waited close to two years to get up here. So this is a major issue for the people I represent and I want to make that very clear and I want to ask, what can you do? Do you have any resources that are available to you that would help people who live in stress and this creates stress within families and people are concerned, particularly when it's a major illness. So you know, I don't know if you have the resources at hand, but would you commit to at least reviewing the process and improving the wait times?
MISS PURVES: Mr. Chairman, there are some wait times that we're able to do something about right away, cardiac surgery being one. The next one that we're going to be looking at is orthopaedic surgery. It is an issue in Nova Scotia and is also an issue across the country and there are different ways to deal with it, but we do recognize, particularly with orthopaedics, the waiting list is too long. We're dealing with cardiac care first. It will involve money, obviously everything does, but there are ways that perhaps we can do it more efficiently, using operating rooms at night for example, having a provincial wait list that would be able to prioritize the urgent care better. We don't have a provincial wait list right now for orthopaedic surgery. There are wait lists around in each area, each hospital, and if we had a provincial wait list, we would certainly be able to prioritize the more urgent cases much better than we can right now.
MR. BOUDREAU: Mr. Chairman, I thank the minister for the reply and I appreciate her attention to this subject because it is a major issue, particularly for people who live outside of Halifax. This year there has been no increase for in-home support. In-home support programs in Cape Breton have now a waiting list from here to the street. Do you have any plans to deal with this issue?
MISS PURVES: Yes, the issue of in-home support came up earlier. Although we're in favour of the program, we are unable to provide more funding to it this year. With a couple of exceptions, the people who are on it will continue to receive it. Young people who are receiving service from Community Services now who have reached the age of 19, will come to us and they will be included in it. We have an expanded equipment program with the Red Cross which is going to be able to help out some of these people with the actual equipment supports they may need. In terms of having the funds this year to expand the program, no, it's going to have to stay the way it is.
MR. BOUDREAU: I'm disappointed to hear that, Mr. Chairman. I guess my next question to the minister, you came back a month ago or three weeks ago from Ottawa and there was a new pact and you have new money for health from Ottawa, an increase. I guess my question to you is, is every red nickel you are receiving under this new arrangement that you and the Premier negotiated with Ottawa, every red nickel, is it going to be spent in the Department of Health this year?
MISS PURVES: Yes, it will be spent on health care; that will be spent and more. That was never an issue, that was something that the Premier committed to, I committed to and the Finance Minister committed to.
MR. BOUDREAU: The previous government in 1999 approved projects in Sydney Mines, the Miners Memorial Manor and in North Sydney at the Northside Guest Home. This riding is now Cape Breton North and both of those facilities are located within Cape Breton North. However, the residents that I represent are also served by those facilities. We've seen two floors in the hospital changed around - there's a lot of vacant space in that hospital now. We're using the hospital - the community is being told - as a temporary respite area, most people call it, but it is a nursing home, the floor has been changed in the Northside General Hospital. My question is, do you intend to build any nursing homes or put any additions on the nursing homes? Is that part of your plan for health for Nova Scotia?
MISS PURVES: We do know that the demand for nursing care beds in the Cape Breton district is the most urgent in the province. We did authorize the use of that space for that purpose. In terms of new nursing home beds, Cape Breton is the priority area.
MR. BOUDREAU: Mr. Chairman, this is what I would suggest is an urgent concern in the community so I would ask if the minister has a timetable when she feels she will be secure enough in her position or stabilized in the department - it doesn't matter how you put it. I just want to know - you've obviously recognized the problem - when will you be dealing with this issue? When can the residents, who require nursing homes in my area, expect to see this development?
MISS PURVES: Mr. Chairman, we have a joint team composed of members of the department and the DHA working on that right now. We haven't received a recommendation from them yet but we expect to in the next couple of months. That recommendation would involve the numbers and kinds of beds that they see as needed and where. Once we get those recommendations we would have to look at them. As I say, there's a fair bit of pressure from other areas for nursing home beds, including Halifax, but we do know that the most urgent need is in Cape Breton.
[5:45 p.m.]
MR. BOUDREAU: Mr. Chairman, I do appreciate the reply the minister provided.
Ambulance bills, Madam Minister, have you signed a new contract with EMO since your government took over the Department of Health? Since 1999 when your government was elected, is there a new EMO contract in place since then?
MISS PURVES: I believe the member means EMC - Emergency Medical Care. The contract has been extended. To the best of my knowledge we haven't signed a new contract since we came to government, but we have extended the existing contract.
MR. BOUDREAU: I want to be clear - the contract has not been altered, there's been nothing added, there have been no clauses put in, it is the exact same agreement today that was in place in 1999. Is that correct?
MISS PURVES: The contract with EMC is performance based. They have met the criteria that way. Obviously, there have been negotiated salary increases since then so those items have changed. We're not aware of any substantive changes to the contract, but I will certainly go back and have a look. Perhaps there have been a few, but nothing substantial.
MR. BOUDREAU: Mr. Chairman, I deal regularly with bills for ambulances. These are the students and the seniors and the people on fixed or low income that can't afford to pay these bills. They get in an accident, one student was involved in an accident as a passenger, she was asked to sit in the ambulance. When she sat in the ambulance, and stepped out, three days later she got a $500 bill. These bills were not being sent to Nova Scotians prior to 1999. Where was this theory created?
MISS PURVES: Ambulance fees are based on the actual cost. They're still heavily subsidized. Usually if it's a case where the charge can be billed to an insurance company, then we try to recover that cost. If a person doesn't have insurance, then a charge can be based on the personal rate and the bill can also be appealed if there are extenuating circumstances for some reason. But, we are looking at trying to recover our costs and if we can recover our costs from insurance companies, then we don't have to recover the costs from the Nova Scotia taxpayer. That's the bottom line. We're not trying to cause difficulties for people who are in real difficulty, we're trying to make sure that we can recover as many costs as possible so that we can provide the services that people need.
MR. BOUDREAU: Madam Minister, I don't know if you understand it, but I'm from an area where unemployment is high and people can't afford to pay extra bills. These bills are causing stress and probably other medical expenses for the taxpayer because people are getting counselling over this. You have to realize the impact this is having on our health care system. Most people I talk to are baffled over where this fee comes from. Everybody
recognizes that it's important to have those ambulances on the road and somebody has to pay for them, but people feel they're paying their taxes and that health care should be universal.
I don't imagine too many people would have sympathy for the insurance companies, particularly with the market out there today, however, the poor little old lady down the road who's on a fixed income, a senior who is 72 years old, who gets a bill for $500 in the mail, who can't afford to pay her oil bill this month, it has a very stressful impact on that individual. Madam Minister, I guess I would ask if you have any plans to review this policy, to, perhaps, seek out the impact that this is really having on Nova Scotians?
MISS PURVES: Mr. Chairman, the short answer to that is no. As I said, people can always appeal. We're always willing to look at cases where the person really objects, for some reason, to paying the bill. The Auditor General has looked at how we structured these fees, and he has said that it is sound. We do have one of the best ambulance services in the country and that comes at a cost. As well, the cost of ambulances is not covered under the Canada Health Act. It is a service we are providing, above and beyond the Canada Health Act. For the most part, we have to be able to pay, where we can, due cost recoveries. That means that other money in the system is used for services that are equally needed. It's a fact of life that these ambulance services are very expensive, and we have to find a way to pay for them because they're not funded by Ottawa. That's the answer to the question.
MR. BOUDREAU: Could the minister explain the criteria, when you get a billing? For instance, from what I understand, what you're telling me is that it's the length of travel, that's how you get billed. I want to ask, if somebody is involved in a car accident tonight, and there's a mother and a daughter in the car, they're both rushed to the same hospital, how many bills come out of that vehicle?
MISS PURVES: Mr. Chairman, the fee structure is based on a per person cost. It is averaged out over all the costs, the costs of the ambulances, the costs of the paramedics, so that if that mother and daughter were rushed to the hospital or wherever, there would be two bills. You're only billed if there is care provided, in other words, if someone is attending to you, doing something for you in that ambulance. For example, if the daughter was injured and the paramedics were performing whatever procedure on her, and the mother was just there accompanying her or watching, then there would only be one bill. The bill would be for the injured person, not someone who was going along as a concerned parent or vice versa.
MR. BOUDREAU: Mr. Chairman, I want to stick with this ambulance fee. I guess my question to the minister is, is the minister confident that she is aware of all of the details of the fee structure, is she aware of the structure in regard to billing for ambulances? Are you very well educated on that issue?
MISS PURVES: Mr. Chairman, staff are very well aware of the structure, the details of all of the structure of the ambulance billing, and that is what we have staff for. No, I have not memorized the fee structures of the ambulance billing. I am aware, in general, of how the ambulance billing works. For detailed information, I can get that from staff and I can certainly get it for you.
MR. BOUDREAU: I just have a short snapper. I'm wondering if the minister receives calls from her riding in regard to this issue? Does this issue affect residents in your riding?
MISS PURVES: Mr. Chairman, ambulance fees are not based on distance, they're based on care. There are plenty of people in my riding who talk to me about ambulance fees. A lot of them have to be taken from the seniors' residence to the hospital, for example. It happens all the time, yes.
MR. CHAIRMAN: The time has now expired for today's budget estimates.
The honourable Acting Government House Leader.
MR. WILLIAM DOOKS: Mr. Chairman, I ask that the committee now rise and report progress.
MR. CHAIRMAN: The motion is carried.
[5:58 p.m. The committee rose.]
