HALIFAX, FRIDAY, APRIL 11, 2003
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
9:58 A.M.
CHAIRMAN
Mr. William Dooks
MR. CHAIRMAN: Good morning. I will call the committee to order, and we will ask the staff of the Department of Health to take their seats. I will then be recognizing the honourable member for Cape Breton The Lakes, who has approximately 18 minutes in turn. Then we will turn to the NDP.
The honourable member for Cape Breton The Lakes.
MR. BRIAN BOUDREAU: Good morning, Madam Minister. I am going to go right to staffing levels at Northside because I know I only have about 18 minutes. Madam Minister, I guess the first thing I want to say is that I am very familiar with the hospital in North Sydney. Many of the services and programs that were offered at this facility prior to 1999 have now evaporated, they're history, they're gone, they've been moved either to the regional facility in Sydney or some people get services outside by private means, but they're limited because people in my riding certainly can't afford to hire private individuals for medical purposes.
Some of the problems I see within your department are in the structure itself. You're changing the structure. You're not providing the same level of service that you did in 1999. One of the major reasons you're not able to deliver that service is the staffing levels at these hospitals. You can't expect a nurse, one nurse to do three people's work. It's impossible. I have had enough jobs in my life, and I'm hopeful to receive another one after I leave here someday. These nurses, it doesn't matter what the job, they need support, they need help. They are stressed out from working long, hard hours. They're dedicated and committed to the profession that they chose in life, but when they go home they are stressed out, they're worn out, they're tired. They have children and families at home.
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For some reason or other the theory in your department is that it's cheaper, you will be able to run your department over there a lot cheaper by paying nurses time and a half instead of paying the benefits. People on the street know and the nurses know why you're not hiring nurses. The Parties are doing a pretty good job in here bringing up the issue with the beds. We experienced bed closures in Northside General Hospital as well, on two floors. Particularly in the area I represent, but the Northside in general, are not receiving the same service outside that facility as they were prior to 1999.
[10:00 a.m.]
Madam Minister, I am familiar with the entire area and I have been outside my boundaries, I've visited Baddeck. In fact, I had the pleasure of travelling throughout Nova Scotia last year visiting all the regional boards and all the administrators, they're all very capable. I agree with your description of Mr. John Malcom and his staff - his support staff and administrative team make John Malcom what he is. The staff make them what they are. More importantly, the front-line health care workers, like the nurses and the health care workers, even the receptionists, they communicate very well, they want a better health care system for the people they serve.
Madam Minister, they tell me that their concerns are falling on deaf ears and that when John Malcom sits down to negotiate, like they're doing today - perhaps not specifically today but there are ongoing negotiations at the Northside Guest Home. My intention here is not to embarrass you or anything, I'm not going to ask you if you know how long these negotiations have been going on. Staff believe and, more importantly, the front-line workers believe that John Malcom is being robbed of the privileges of having the resources at his hand that would be available to provide what is required to support these people in their positions with the service that they're providing.
Addiction services, look at the mess Madam Minister - no, I'm not going to start pointing my finger and saying which facilities you closed, which ones are gone, probably forever, history.
These facilities require people. People in crisis require these facilities. These facilities are a vital part of the health care system. You're changing the structure. You're not providing the same level of service, that's obvious. Madam Minister, my first question to you is in regard to staffing. Yesterday you said there was new money in the budget for staff salaries. I would like you to verify if this increase that you put in the budget is for increases that are already projected this year. The staff at Northside Guest Home who are experiencing some difficulty right negotiating their contract, will this budget line provide people like John Malcom the tools necessary to deal with the issues that they're facing each and every day in the health care system, not only in Cape Breton, I'm not just talking about Cape Breton hospitals, I'm not just talking about the Baddeck hospital - the Baddeck hospital is in dire straits because of staffing levels. The emergency department is at risk. The Buchanan
Memorial Hospital is in similar condition. The Richmond hospital. Those are just the hospitals that I am familiar with. There are many on the mainland, they're all experiencing the same difficulties.
I am asking you, please, don't allow their concerns to fall on deaf ears. Listen to these people, they want to help you. They don't want to be a burden. They're certainly no burden. They want to help, and they want to assist. Ask Mr. Malcom where he gets all of his advice, it's from communicating with that staff that's on the ground delivering the service. That's how, Madam Minister. My first question is, this budget line that you indicated yesterday, will that correct staffing level numbers in these facilities that require help?
MR. CHAIRMAN: The honourable Minister of Health.
HON. JANE PURVES: Mr. Chairman, in regard to the 7 per cent that we discussed yesterday, that 7 per cent increase is for non-staffing increases that the districts face. We have also told the districts that increased staffing costs will be paid for over and above that, so they know that. I wouldn't disagree with the member for Cape Breton The Lakes that front-line health care workers have very stressful jobs, I think we all know that. It is the job of the district health authorities everywhere, including Cape Breton, to decide on the staffing levels they need, at which facility and when.
There has been a tremendous amount of change everywhere in Nova Scotia throughout the 1990s, particularly since 1999 with the start of our new clinical services plan. It is hard to accept, but I can't accept and I'm sure the member doesn't disagree that we do need to change that having many services and many times the same services available in too many places across Nova Scotia is not the way to go in order to sustain a good health care system. In fact, report after report - but I will stick with Mr. Romanow - insisted that new money that went into the health care system should be going in to buy change; that no, we didn't need any private help with a public medical care system, but we did need to force and drive change in the system, not only change in the ways in which governments operate, but changes in the way doctors operate, nurses operate, LPNs operate, everyone in the system.
There has to be more teamwork, individuals have to be more open to changing their scope of practice, and the country, and that includes Nova Scotia, has to be more willing to invest in centres or areas of excellence, instead of trying to duplicate services everywhere. All of this change is happening very fast - not fast enough, perhaps for Commissioner Romanow and maybe too fast for some people in the population, but nevertheless, in order for the system to be able to sustain itself, it wasn't just money that was needed, it was money that was to buy change.
In terms of some of the issues for Cape Breton, we believe a lot has been accomplished in that health authority in the last four years. For one thing, more Cape Bretoners are being treated at home than was ever the case in the past. We're up to about 90
per cent of people who are ill in Cape Breton being able to be treated there. We have added nursing seats to Cape Breton, 75 in 2000 and another 60 this year with the UCCB-St. F. X. collaboration. There are about 50 staff needed in Cape Breton and with more graduates we hope to fill those staffing vacancies.
While I would never say there aren't problems, I would say that the expectation that everything should stay the same is unrealistic and probably not a good expectation to have.
MR. BOUDREAU: Mr. Chairman, I don't disagree with the minister, I agree change is necessary. I'm an elected member of this House and I recognize that we're having financial problems and all that - I understand that. People on the street, I believe, understand that too, Madam Minister. They are looking for change. You're absolutely correct when you say that, but they're looking for positive change. They don't want hospital beds closed down and entire floors in hospitals shut down. They don't want to see services for pregnant teenagers taken outside the community. The success you indicate that your government is enjoying is the result of decisions made by the previous government in Cape Breton. When you speak about the 90 per cent of Cape Bretoners who don't leave home any longer for care here in Halifax, you're correct, but that is not to your credit.
What we in Nova Scotia are requesting is that you become your own hero, Madam Minister. Never mind trying to take credit for other people's efforts - stand up and be counted. You know that the world has changed even since you became the Minister of Health. The world is under different threats, there's chemicals, there's terrorists, there's SARS, there's all kinds of issues here that have grown since you even became Minister of Health. You are the person that Nova Scotians look forward to see what kind of support you're going to provide the people on the ground. That is the support you're going to have to buy; if you're speaking about buying or spending money in a system, put it to good use. That's what I'm suggesting. Put it into the people that provide the inspiration in the system - to the doctors and the other administrators - that you recognized their efforts and their abilities.
What I'm suggesting is that you recognize the true efforts of the people on the front lines in health care. Listen to those people and pay attention. They're not trying to hurt you or your government or the people that they serve. I know you don't believe that for one minute. They can give you sound advice on how to steer the health system in this province, if you're willing to accept it. Madam Minister, you've shown you are your own person in this House, there's no doubt. I agree and I would admit that anywhere. Stand up now and be counted. Your government has more money than ever coming from Ottawa. You have the resources at hand to crack the problems of our system. You're the lady with the authority. I'm a backbencher in here as just an Independent - I don't have the authority you have. Stand up like your predecessor did and put the facilities throughout Nova Scotia where all Nova Scotians don't have to travel like . . .
[10:15 a.m.]
MR. CHAIRMAN: Order, please. The time has expired for the member. I'd like to recognize the member for Halifax Fairview on an introduction.
MR. GRAHAM STEELE: Mr. Chairman, I would like to draw the attention of the House to the west gallery where we're joined today by six students from the Halifax Immigrant Learning Centre, which is located in beautiful, hard-working Halifax Fairview along with their leader, Mr. David Juteau. I wonder if they would rise and receive the welcome of the House. (Applause)
MR. CHAIRMAN: Good morning, it's nice to have you with us here today. I'd like to recognize a member of the NDP caucus, the honourable member for Hants East for one hour in turn. The time being 10:17 a.m.
MR. JOHN MACDONELL: Thank you, Mr. Chairman. Thank you, Madam Minister, I really look forward to an opportunity to get some answers. As a matter of fact, in five years that might be novel, but anyway, my . . .
MR. CHAIRMAN: Honourable member, it's traditional for you to stand up when questioning. They have a better view of you at home.
MR. MACDONELL: Thank you. I'm so used to the Red Room where it's not traditional.
Madam Minister, I'm not sure how familiar you would be with the constituency of Hants East. It has the unique problem that we have a fairly rapidly growing urban area in Hants East from Enfield to Shubenacadie. The larger part of my constituency, what we refer to as Hants North, which would include most of the Minas Basin shore area, Kennetcook, probably from Nine Mile River northward. There have been some really difficult problems for the people in those communities: Upper Rawdon, Maitland and Kennetcook, and they've established three community clinics, but they come under an umbrella of a community organization which tries to look after the needs of all three clinics so that medical services can be co-ordinated a bit.
It's really been a challenge to try to get, number one, in the Upper Rawdon area, they're actually trying to get a clinic. They're working out of the basement of the church hall there, I believe. I really share their frustration that the Department of Health has a strategy around health care issues in rural Nova Scotia. They feel - and I, as well - that community clinics are the best way to go, but not every community has the same needs. Therefore, as much as they can design a clinic for their own use, would be the most appropriate way to go.
I would like to know, because there's still a shortage of doctors in that area for those clinics, the more rapidly growing area in the corridor, this is not a problem. Actually, they expanded the clinic in Elmsdale recently. I just wonder if the minister is aware of any of the issues in that area and I'm really interested to know about physician recruitment for rural communities and if you're aware of any specifics around those communities?
MISS PURVES: Mr. Chairman, I'm told that once we got the clinics in place, that there hadn't been any concerns expressed to the department. What I understand from the member opposite is that there still are concerns, but perhaps not concerns at the boiling point, so to speak. I do know that recruiting physicians and nurse practitioners and other health personnel to rural areas is definitely a priority, and it's not necessarily so easy. I know that 13 nurse practitioner positions have been approved in the province. To my knowledge, only six have been filled to this point. It is a work in progress. We will definitely check into the status of the clinic, as a result of what you've said today.
MR. MACDONELL: Mr. Chairman, I do know that they're anticipating a nurse practitioner there. I'm really kind of eager to find out how that works. I have to say that I would look at that as a positive thing. I think nurse practitioners have a real role in the health care system, and in particular, in areas where it may be difficult to recruit physicians. I'm assuming physicians would agree. I see that there are certain functions that they carry out every day that somebody else could be qualified to do. I'm really looking forward to seeing how that works.
I'm quite positive - I might be wrong - that in Kennetcook, there's not a full-time physician there. One of the things that was brought to me, and I haven't spoken to the people there in some months, but sometimes I find the communities have been able to find physicians, and then they try to work back through the Department of Health to try to get that person licensed or on staff or however the process goes. They indicate that there are, quite often, more problems coming from their end, they find a doctor but can't seem to get the doctor in the community, working through the Department of Health. Does that make any sense, that you could find a doctor but not be able to get them in a community?
MISS PURVES: Yes, Mr. Chairman, that does happen sometimes, and it makes sense why it would happen. Obviously we have a physician recruitment program and a Rural Stabilization Fund to help, but there have been occasions - not too many that I know of - but a couple of occasions where a community is able to attract a physician, and then the physician wants to work under certain conditions that we find very difficult to accept, that aren't within the parameters of what we say we will do to help. Sometimes we are able to work it out, but it isn't as easy as it sounds at the beginning, because, obviously, we try to be generous but you have to be careful with all the me-tooism that goes around. The Medical Society negotiates these things and likes to keep an eye on how agreements work.
MR. MACDONELL: I think I can appreciate where you're going. In your job and I assume in my job, even though I'm not a member of the government, we really have to try to make people know that we're doing the best for their tax dollars. I guess I'm curious, because the demographics and the geography and the needs in particular communities are so different, there's no homogeny throughout the province really. I know people who refer to Truro as rural. I don't refer to Truro as rural. I'm wondering about (Interruptions) Yes, well, I certainly have a high regard for the people there, not necessarily how they voted. (Laughter)
I want to say I'm wondering about how much flexibility the department has in this regard. It would seem that it's not a one-size-fits-all situation, there are those places where doctors would probably readily flock to. I'm curious about the rural stabilization fund, how that fund works or what it is? Also, when it comes to fee for service against salaried positions, I'm looking for how much flexibility the department has in trying to meet the needs of a physician going into an area without opening a Pandora's box that would make you lose ground in other situations?
MISS PURVES: Mr. Chairman, yes, we do try to be flexible. Obviously, one size doesn't fit all. There might be areas - well, there will be areas that are less suited to some kinds of practice than others. We try not to be one size fits all, but we also try to stay within the parameters of agreements that are negotiated with the Medical Society. Before we were doing things this way, we had an awful lot of very weird arrangements in the province, and trying to change them has caused some problems in some communities. The member brought up the best use of the taxpayers' dollars, and that is important. The main thing is the health care but, also, we don't want little mini-systems and mini empires all over the province that make it very hard to keep the system sustainable. That's what we're trying to avoid.
MR. MACDONELL: I would like you to come back and maybe explain the Rural Stabilization Fund, if I heard that right in one of your other answers. Also, I've never gone to, I think it's the Kempt Shore clinic, but it seemed to me this was a clinic set up, I think it was salaried positions, and I'm not sure what other things were done. This was under a previous administration, this certainly wasn't under your government. It seemed to really be something that worked well for the communities there, and this would be in the constituency of the honourable member for Hants West. I'm thinking that there's something that seems to work, the community seems to like it and the physicians seem to find that it works, but it seems like the province has moved away from that model, if I'm reading it correctly.
I'm curious about the role of the Medical Society. When you speak with them, what information is it they bring to you? What models, or do they offer models and say, look, here's what we see would be appropriate or that we can live with? I'm curious about their role, as long as good health care is provided, what types of issues do they raise that enter the mix?
MISS PURVES: Mr. Chairman, the Medical Society, obviously, speaks on behalf of doctors. It will raise issues like quality of life for physicians in certain areas. For example, well this is probably a bad example but I know it to be a real one, a physician husband and wife team who had practised in a part of rural Nova Scotia, not yours, and a number of years ago left to go practice in the U.S. They've stayed in the U.S., not because they didn't like Nova Scotia, but because in the U.S. they got to have a life. They just found the demands so heavy in a rural practice that they weren't able to spend enough time with or attention on their children. So they moved somewhere in the U.S. and they come back every summer for a couple of months, they get vacation and they get to enjoy Nova Scotia at its best.
But they don't want to come back and work here, because they want a life. That is something, 30 years ago no physicians expected to ever have, but times have changed. It's an issue for all doctors, but particularly in rural Nova Scotia where they may not have very much, if any, backup. That being said, that is part of the role of the Medical Society to point these things out and their job is to act as an advocate for the doctors. They also almost act like union reps for doctors. They do a lot of negotiating on benefits, salaries, alternative funding payments, on-call rates, all kinds of things that make a difference not only in urban areas, but obviously more so in the rural areas, where physicians often have to cover emergency wards during the day or night, weekends, or whatever. That is the essence of what they do.
[10:30 a.m.]
MR. MACDONELL: Mr. Chairman, I'm curious, does the Medical Society make recommendations to the department such as, here are the parameters which we can live with and here are the models we could find acceptable, that would meet the needs?
MISS PURVES: Mr. Chairman, yes, they do. They make constant recommendations, they're constantly making the department aware of issues that either have arisen or are going to arise. They meet with people in the department, with the deputy, with other people in the department several times a year to discuss issues of importance to the doctors.
MR. MACDONELL: Mr. Chairman, it's my understanding that the province has had some successes in recruiting doctors, but not necessarily in retaining doctors. I think other jurisdictions - Quebec is one - have done better so I would encourage the minister to look at what other jurisdictions do that may work and see whether or not if fits into the parameters around financing, et cetera. I don't think you have ever told me what the Rural Stabilization Fund is. Can you tell me that?
MISS PURVES: Mr. Chairman, the Rural Stabilization Fund is nearly $10 million.
MR. MACDONELL: Mr. Chairman, I wasn't even thinking about the amount, I was thinking about what the fund is, how it works, parameters around it, is it a one time fund, do you apply for it?
MISS PURVES: Mr. Chairman, I was just asking if there was a signing bonus, too. But no, it's usually a lump sum annually and the lump sum will compensate for some of the on-call issues that they get that urban doctors don't get; the urban doctors just say, go to the emergency rooms. That will also include, I believe, certain fees for emergency room work that they may have to do on top of their regular practice.
MR. MACDONELL: Mr. Chairman, so that fund, does that go to the clinic or to the physician and does it also cover a locum in that area? Would that be out of that fund, as well?
MISS PURVES: Mr. Chairman, the payments go directly to the physician and locums are on top of that. The reason for giving the lump sum is that it may be that if you were just paying per call or per shift, it wouldn't really be enough to compensate for the fact that you have to be on high alert even though one week you may not have to actually do anything extra. So the lump sum is there to cover the "in case".
MR. MACDONELL: Mr. Chairman, I'm assuming if we're talking about on-call, you are paid whether you are called or not. I think it was the Department of Health, actually, that tried to initiate this umbrella organization over the three clinics in the Hants North area, my constituency and I think it was a good idea. Even though people tend to stake their ground and not want to move off it, it has allowed some compromise, I think. People have worked toward compromise and I think the notion originally was that in terms of on-call, at least you had three physicians, even if they were in three communities, that it actually would offer some type of break for somebody. I think that has worked to a point for them. I want to move on to something else.
I have a bit of a bee in my bonnet around a resource centre that is proposed for the Elmsdale area, I guess that's where they are thinking of building it. What this facility is supposed to do is to bring blood collection and a number of other services under one roof and into one facility and these are services already present in Hants East. I guess the thing that is sticking in my craw is that we are part of the Northern Health District and Truro, it's my understanding, looks as though they're getting a hospital, I believe Tatamagouche is getting a new facility as well. I'm not even sure what's happening in Amherst, I think there's a hospital going there (Interruptions) yes, a regional hospital there.
The resource centre in Hants East, the municipality is paying for that, that's a $5 million expenditure and that's coming out of the municipal tax base. In other words, the taxpayers in my area are paying for that, where I don't believe the taxpayers in any of those other areas are paying for those facilities, I think the province is building those. I'm curious as to why the province isn't building this?
MISS PURVES: Mr. Chairman, there have been a number of discussions about that issue and certainly if the municipality builds it we would lease it from the municipality but because of some objections to that, we are also talking about, why not build it ourselves and own it and not lease it. I think for the taxpayer it would be a wash but in trying to make things seem relatively equal, that we may end up building it ourselves.
MR. MACDONELL: Mr. Chairman, I will hold the minister to that and since May is just around the corner, I'll be waiting for an answer. I can't speak for the council there but this certainly is an issue for me and I know for some of the councillors. I'm assuming that if the province was to do that that maybe they could have the ability to enhance it. I think what they're aiming for - it is my understanding - is they would like to, at some point, have something like the Cobequid Multi-Service Centre, that's where they're going. They know they can't get that all at once and I don't think the Cobequid Multi-Service Centre started the way it is at this point. They're looking down the road and even the corridor area from Enfield to Shubenacadie, we're talking 10,000 people. I think it's an issue whose time has come for the people in that area. Actually, it would help take some of the burden off the Cobequid Multi-Service Centre, I know at some point that is slated for another facility to go there. So definitely I want to impress upon the minister that if people in her department would see for the province to do that, I would only encourage them to go along that line. I think first, right off the bat it seems unfair to me that the taxpayers in East Hants would have to foot the bill for that facility.
MISS PURVES: Mr. Chairman, certainly either the province or the district might be building that, the municipality may want to enhance it. We know that the aim is to get something like the Cobequid Multi-Service Centre and we're also discussing whether it would be part of the Colchester project or, you know, separate from the Colchester project in terms of time lines. These multi-service centres and whatever is in them are really convenient for people and they get a really good mix of people in there. I mean maybe you could even put a library in there, I don't know, but it's a good way to have a different kind of a community centre, I suppose.
MR. MACDONELL: Yes, well, I think actually the proposal at this point, because they call it a resource centre, I believe the library is slated to go in there, I think a job search centre is slated to go in there and I think the local community health board, I think their original thought was for this to be a health facility. But, this mix of the municipality there and to try to rent the space, et cetera, et cetera, it has kind of changed a bit. So, yes, I think there certainly are those, you know, even some social services connection to health care, I think a mental health facility and so on, all these things would make a very appropriate facility.
One thing, I just want to give this piece of information to the minister. She can do with it what she may, I suppose like all the information I give to the minister. One of the physicians - and I'm racking my brain to think of his name - who was in Maitland, and I
never thought I could forget it, he has moved away from the area a couple of years ago, but he had a lot of training in emergency medicine and he felt (Interruption) Yes, Rothfels, Peter Rothfels. Dr. Rothfels felt that one of the things that intimidated physicians going to an area where they don't have a lot of support was that they may not have a lot of training in emergency medicine. So it's something that I just leave with the minister, that maybe this is something that the department may want to incorporate into the training of physicians so they may not feel they're hung out on a limb quite so badly.
I have to say, whether it's naive or inexperienced, but I thought if you were a physician, you were a physician. If you're a GP, all GPs were basically the same. It never occurred to me that emergency medicine was a component that was above and beyond your training in emergencies. I thought if you had an emergency and you called the doctor, that would be the person to look after it. So there's obviously more to this than I realized, but it was one of the things that he raised. He felt that his training made him better suited to a rural environment where he didn't have a lot of backup support and that this may be something that would intimidate other physicians from wanting to settle in an area like that. Certainly we will be hoping that if we can get this resource centre up, we could use it actually as a support for the more rural part of our constituency, so that some of those supports that they think they need would not be so far away. It certainly wouldn't be as far away as Halifax. So I don't know, I'm curious if anybody else has ever raised this around the emergency training for a physician?
[10:45 a.m.]
MISS PURVES: Mr. Chairman, yes, that has been raised. It used to be that a doctor was a doctor, was a doctor. That was in my day, but I'm getting on as we all know. There are two things. One is that we're moving to have a P3, although I hate the word, P3 paramedic in every ambulance because they are, while they're not emergency room physicians, they're certainly well qualified to deal with emergency care. The other thing is that we do have a fund administered through the department where physicians can go to Dalhousie University to take training in a component or an area of medicine they may want to learn something about or brush up on techniques, whatever. So if someone wanted to study some component of emergency medicine, there would be funding there for the person to do that. That being said, I'm told emergency room physicians have a very different temperament from other physicians and that's why they go into that kind of a job.
MR. MACDONELL: It must be similar to politicians. (Interruptions) Thank you, Minister, actually it's kind of encouraging to know that there is opportunity, that somebody is looking over the hill to see that something is in place for physicians who want to expand their expertise in an area where they don't have a lot of training with something that actually they may feel meets a specific need in their area.
I want to get down to a little bit of the grassroots of health care and right down to the first responders. In my area it's usually the fire department that are the first responders. These are people who are not really paid, these are all volunteers. Actually we even had someone who was hurt going to help someone and was taken by ambulance and got a $500 bill for that which we thought was above and beyond the call of duty if you were a volunteer to have to pay a bill like that. One of the issues that has been raised by some of the fire chiefs in my area was the fact that they always had a number of oxygen cylinders in their rescue vehicles. So they ran into a situation whereby when the ambulance came, sometimes they would exchange, the ambulance would give the fire department one to replace the ones they used, but then that stopped. Then they had to go and get them somewhere else and they were concerned that this left them quite often without one and so I don't know if that has been fixed, I know I raised it, but I never heard whether or not the situation has actually ever been resolved and I will raise one other issue.
A lot of my constituents actually who are in the northern region, most of us go to the Capital District Health Authority for health care and that would include Windsor. The people in the Hants North area quite often go to Windsor and people in the corridor go to Halifax. There are very few who would head toward Truro. Yet, quite often, when the ambulance would come and pick some of these people up, they would take them to Truro and they would say I don't go to Truro and they would have an argument with the ambulance attendant on this trip which I didn't see enhanced their health at all, putting them in a stressful situation. We raised this a number of times and thought it had been dealt with by people in the department, but every now and then I get these calls that somebody was taken, kicking and screaming, to a destination they didn't want to go to.
So I think, maybe I'm saying two things here. One is that when the department looks at the makeup of the DHAs, maybe they would give some consideration to actually the appropriateness of Hants East being in the northern district compared to the capital district. I think that's where the people would maybe prefer to go. I'm not sure if there's someone interested in an introduction?
MR. CHAIRMAN: Yes, before I recognize the Minister of Health, I would ask the member if he would allow an introduction. So at this time I would like to recognize the member for Inverness who is also the Minister of Tourism and Culture, and Health Promotion, you have the floor.
HON. RODNEY MACDONALD: Thank you very much, Mr. Chairman, and thank you to the member for giving up some of his time. In the Speaker's Gallery, with us here today we have some very distinguished young guests with us and they're here for the Mainland North local committee on drug awareness poster contest which was just held downstairs. I'm going to read off their names and the schools they are with and I was joined down there by the member for Halifax Bedford Basin and many other guests, including
NSTU president Brian Forbes, along with members of law enforcement, parents and members of the committee.
I will ask each individual to stand as I read their name. Angela Cusack from Burton Ettinger, she was the winner from her school; Jennie David from Duc d'Anville; you would never know I was a teacher, I guess. The reading thing is becoming tougher each day. Nadine Keayes-Goguen from Fairview Heights; Elisabeth Giffen from Grosvenor Wentworth; Jessica Grant from Park West; Sarah Belliveau from Springvale; and, last but certainly not least, our grand prize winner today and also winner from her school, Steffany Photopoulos from Rockingham. (Applause) I welcome our guests and I think that they've done an excellent job in being a strong part of reducing our smoking rates here in the province and encouraging other young people with the positive message of a healthy lifestyle, so welcome to all our guests.
MR. CHAIRMAN: Thank you minister. The House welcomes you and congratulates you today. We'd like to recognize the Minister of Health. Do you remember the question?
MISS PURVES: Yes, Mr. Chairman. A couple of points. I believe that situation with the oxygen has been resolved. The first responders or representatives do meet with people on a regular basis now to discuss issues of mutual concern. I'm not positive about that but I believe it's been resolved and we'll check on it.
What the paramedics do when they're taking someone who's been hurt or is ill is to the first emergency ward where they know the treatment is available. We can certainly look at whether that's right or wrong in some cases, but my guess is, a lot of the times you could get faster treatment in some places than others, even though it might not be the preferred site. That has to be balanced against where people want to go.
Recently, when I was down in Bridgewater, they were saying that they were starting to get patients from Halifax going to the Bridgewater emergency ward because they had to wait so long in Halifax that they thought they would just drive for an hour and get seen right away. Lo and behold, that's exactly what happened.
MR. MACDONELL: Thank you, I'll certainly convey your comments when I get an opportunity. I have a couple of other issues and I think they may be connected. One is around lifestyle issues or health choice issues and trying to promote good healthy lifestyles among Nova Scotians. I would say that a lot of what we do brings upon us bad health. So, trying to promote the things that people could do and should do that would limit the possibilities of detrimental health. I know that you can only have so many programs and if people are not going to make some changes, it may not help.
I had a conversation with the honourable member for Dartmouth East and I know we don't usually bring conversations from the lounge into the Chamber, but I thought this was an interesting one. It gave me reason to pause and think about my own constituency and the issue of education among my constituents in terms of health care. One of the things that he raised - and I think he raised it to me because he's a physician and because he saw a value in educating the public. He recognized that in case, actually he was talking about Pap smears for women and the fact that he felt that for a woman to die in this day and age with cervical cancer was something that was so far and above what should be expected. He said this is an area of cancer that we do have the wherewithal to have an impact on as compared to some other cancers. He said that he thought they did better in British Columbia and he didn't relate that necessarily to the previous NDP Government, which I probably would have wanted to jump on and say, yes, you're probably right. What he thought was that the people there seemed to have a different mindset around these health issues and lifestyle choices and that he felt that they probably went above and beyond in trying to ensure their health and that they saw to it that they went to see physicians for testing et cetera.
I'm curious about two things really. One is, the plans of the government in trying to promote good health care among the citizens and also, what is available in terms of Pap smears for women? I'm thinking in very rural communities to try to get the word out to them and then emphasize the need for good community health care facilities for those women to have access to.
MISS PURVES: Dr. Smith and you are absolutely right, it's hard to think why anyone would become ill from cervical cancer in this day and age. We did an ad campaign last year, it's certainly something that the Office of Health Promotion might consider further. In cases where we have alternate payment arrangements with the physicians, that's the kind of deliverable that's tied to those agreements. In terms of the availability of the test, any physician can do that test, it's not a difficult test to do. You don't have to go to a specialist, you don't have to go to a hospital. If you have a family doctor and you're getting it done regularly, that's fine, but even if you don't, it's a very, very simple test to take and detect. I certainly remember it being promoted and quite a common thing when I was 30 years younger. In some parts of the world, it's not common at all actually, but here that is definitely something that we can promote more and should be able to entirely prevent, 100 per cent prevent.
MR. MACDONELL: Thank you minister. I think the thing that raised it for Dr. Smith was he referred to reading something in the newspaper, actually I think when he was minister, so the time frame for that is somewhat apparent. The story he read in the paper was about a young woman, I don't know if it was Antigonish or Pictou that her family took her home around Christmas time for her family to be around her. She was 33 and dying of cervical cancer and he saw a picture of her with her little children. He said he was minister at the time and he felt that this was a real failure with the system that we would lose someone of her age, with young children, to cervical cancer because it's something we should be able
to easily prevent. I'm curious if this test would be something that a nurse practitioner would do in some of these clinics, or would that purely be a physician?
[11:00 a.m.]
MISS PURVES: Mr. Chairman, I would think that that would be something a nurse practitioner could do. I would have to check if that's part of the scope of practice, but it would seem to me it's not difficult.
MR. MACDONELL: I think at this point I'm going to say thank you to the minister.
An opportunity may come back to me to ask some more questions if some arise, but I know some of the most significant issues in my constituency you have addressed, and I will be sure to bring them to you on an ongoing basis if the need arises. I want to say thank you to you and your staff, and I will give the rest of my time to my colleague, the member for Halifax Needham.
MR. CHAIRMAN: The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Mr. Chairman, thank you to my colleague. I have a few questions for the minister in the remaining time for our caucus, continuing on a little bit in the vein of talking about community health clinics. I know that the minister has said that the Romanow money was about buying change in the health care system as much as trying to address and plug some of the holes in our traditional health care system. Certainly one of the things that this caucus has been a strong proponent of is community health care centres. I, myself, have had the opportunity to work in a community health care centre, the North End Clinic in my constituency.
I believe very much in a model that makes use of quite a broad continuum of health care providers. I think, in spite of the fact that we do have a very small number of community health clinics, we haven't really explored the strengths of that model in terms of really building a broad health care team that goes beyond doctors and nurses, and maybe the odd other health care profession, to really expand and look at occupational therapists and physiotherapists, to look at dieticians and nutritionists, psychologists, maybe social workers in this context.
I want to ask what the department's plan is for the expansion of community health clinics and I specifically would like to know what work is being done in the Yarmouth area, because I know that there was a working group looking at establishing a community health clinic in that area. Dr. Rippey from the department and myself were down one evening to speak with people in the Yarmouth community about their needs and helping them build a foundation to establish a community health clinic.
MISS PURVES: Mr. Chairman, part of the money and the planning for expansion of community clinics is coming through the money from the federal government, from the Primary Health Care Transition Fund. This money was made available in 2000, but the negotiations took until last Fall before the money started to come through. Now, there's been money distributed just last month to each of the DHAs to do their consultation and planning for what they're doing in the area of primary care to make change. Now, they call it a transition fund; the fund is not supposed to provide the operational money to operate a clinic necessarily, but it is there to help plan the change. That is going to be the springboard for more of these kinds of clinics across the province.
The $17 million is being distributed over four years, so first the DHAs work through their planning stage and then, as they complete that, next year they can access more money. Some change can be achieved without more operational money; sometimes it just involves moving existing people in services into a different setting, but the money can also be used - correct me if I'm wrong - for physical renovations of a space that might make it more convenient to have a community clinic. So it may seem slow, but it is steady.
That is what that federal money is meant for, and we've signed a contract with the federal government for that $17 million to be used in this way, and there will be an evaluation of that money and the whole project. In terms of the question about the group from Yarmouth, I'm not sure at this stage of any progress there, but I will find out.
MS. MAUREEN MACDONALD: Mr. Chairman, I'm not sure that I heard the number correctly, if it was $70 million . . .
MISS PURVES: It's $17 million.
MS. MAUREEN MACDONALD: . . . $17 million, that's what I thought; $17 million over four years. I'm wondering if the minister can say what would happen in a situation like for example the North End Clinic, where there already is a community clinic. I know that the North End Clinic has struggled with a growing demand for their services with both minimal funds for operating and minimal space. They have a real serious space problem. They were one of the locations for the primary health care project, and that has continued on. Fairly recently, in the last three years, the Metropolitan Immigrant Settlement Association has moved to Gottingen Street and the North End Clinic has an agreement, a relationship with that clinic, and they're providing a lot of health care services to newcomers, for example.
I know from attending their annual general meeting and some strategic planning meetings that they've had that space and the pressure for their services has grown. They've had real difficulty finding resources to meet a growing demand inside a limited space. For a centre that's already established within a district authority, in this case the central region, would there be additional monies to help them address their situation?
MISS PURVES: We don't believe we received a proposal from the clinic under that plan. Certainly for something structural, I think that would be a candidate. The funds are being given to the districts, so it would be a matter of making an application to the district health authority for some funding from that transition fund - again, not operational dollars but it is primary health care transition. It fits with the wording and it fits with the intent, so I'm sure it would be a good candidate for a project if it means changing physical space, expanding physical space.
MS. MAUREEN MACDONALD: That's very good to hear. I will pass that along, if they haven't already gotten that information, so they can look at this.
The other issue I would like to raise around community health clinics is a framework that will help them preserve their autonomy on some level, and their accountability to the community where they reside and to those they provide services to. What I mean by that is using the North End Clinic again as an example, this is an organization that is probably getting close to 30 years old. It's an organization that arose out of the community's need for health care services years ago. That need continues to be there, but in the 30 years that the North End Clinic has been there, they operate with a board of directors that they elect from the community, both of people who use the community clinic but also people who may represent different segments of the community.
The clinic has been a real leader, a real initiator of other services in the community. I can think of any number of other important stand-alone services in the North End that the North End Clinic fostered, because the staff at the clinic would identify a need. They would do the research and they would do the work to get the seed funding to grow a new organization that would respond to that need. So, for example, the Parent Resource Centre in Uniacke Square started as a program of the North End Clinic with young mothers with young children meeting at the North End Clinic with a nurse, probably 15 years or more ago, and identifying that they needed a Parent Resource Centre in the area for young women, young families with young children.
The Methadone Clinic, I think the methadone program in the North End was recognized as a need by physicians and other staff at the clinic. The Creighton-Gerrish housing, all of the housing work that's being done through the Metro Non-Profit Housing Association, a lot of that. The social worker, Paul O'Hara at the North End Clinic had a lot to do with it in terms of identifying the needs of street people and so on.
So the North End Clinic, historically, has had the autonomy to hire its own staff, to monitor the needs of the community and respond to those needs in terms of growing new programs. I know that in the community health clinic sector, and I would say that the methadone program would have the same sort of concerns as funding is channelled to these organizations through the district authorities, these organizations still want to preserve their
autonomy and be able to respond to the needs of the community and be accountable to the community as well as to the funding source, not just for dollars but for actual programs.
There's always this bit of tension there around the governance of these organizations and how they preserve their autonomy in these situations. I'm wondering if the Department of Health has developed guidelines for the district health authorities to make clear what the lines of accountability are and, in those guidelines, if there's been an effort to ensure that the autonomy and the self-determination on some level of these organizations is maintained?
MISS PURVES: Mr. Chairman, I believe the answer is somewhere in between. We do have initial guidelines for these groups, and those guidelines recognize that it's very important that if a clinic is to be a community clinic it has to have representation, whether it's a board of directors, an advisory board or whatever, from the community. We don't want clinics to be absolutely stand-alone, because we want to be able to have some kind of a sensible array of services available in the area; however they won't work without advisory boards and members of the community. Now the Health Authorities Act gives the operation of health services to the DHAs, but the guidelines that we're working on would attempt to get at how this actually works, because we don't want the North End Clinic, or any other clinic that may arise, to lose its community flavour and to lose its roots and just be administered from inside the QE II somewhere, or whatever.
[11:15 a.m.]
MS. MAUREEN MACDONALD: I guess the last point I want to make is there is a concern about the walk-in clinics, the lack of continuity between patients and physicians - you walk in, you never know who you're going to see - and whether or not that model, in fact, is not a model that conforms to the idea of primary health care, where you can develop a relationship, where you can have health care providers who know the whole picture and are able to respond to the real needs, rather than a model that sort of just continues on, this one-off kind of intervention.
MISS PURVES: Mr. Chairman, that is a weakness of that system, and other provinces that have a lot of them find exactly the same thing. It does serve some purpose because a person is going to get seen, but one would think that has gone a little too far the other way. Certainly, you go into some doctors' offices where they have a family practice and you might see another doctor instead of your own physician in an emergency, but you still have your own physician. So there's work to be done there.
MR. CHAIRMAN: We will shift to the Liberal caucus.
The honourable member for Cape Breton West.
MR. RUSSELL MACKINNON: Mr. Chairman, I will try to be very succinct and less convoluted than the previous questioner on the series of lob balls that seem to be going back and forth across the floor. The last two days I asked the minister questions with regard to the air ambulance system. I asked if the minister could inform members of the committee as to the increased cost in the air ambulance system, because when the department took over from the private sector - I wanted the bottom line, what is the cost of the system since the government took over as opposed to, let's say the last year, when the private sector was operating it?
MISS PURVES: Mr. Chairman, staff are still working on that and will supply the answer to that question. The member recognized it wasn't a year-to-year question and there are a lot of figures to go through, but I have undertaken to supply that information to the House and I will.
MR. MACKINNON: Mr. Chairman, I will be honest, I'm a little disappointed because it's something the department officials had boasted about last year going into budgets, that this was going to be a big saving for the department. The minister has already indicated that the costs are over and above what it was when it was in the hands of the private contractor. This is the third day that I've asked for it - do we have any sense at all, other than saying that staff are working on it?
I know the minister wouldn't be doing this, but I'm wondering if somebody in the department is deliberating delaying this information. I think this is a very important issue, because this is an excellent - it's probably one of the best - services operated anywhere in North America, but if we're talking about getting value for dollar, the staff were very dogged in their determination to take over operation of this particular service, and I think, in all fairness, we deserve an answer before we're finished with the minister on this particular estimate.
MISS PURVES: Mr. Chairman, as I said, the year-over-year costs are in the estimates. I did supply an answer yesterday, that was not satisfactory to the member who asked a number of other questions. Staff are working on those other questions. I did mention that in 2001, we did save $160,000 in Star's management fees, but we have increased costs since then, which include wage settlements, 100 additional missions, insurance cost increases and fuel price increases. The member for Cape Breton West had asked for a great many details, and staff are working on that now.
MR. MACKINNON: Mr. Chairman, as I understand, there is a particular division within the Department of Health that deals specifically with this, there is a manager who oversees this particular operation. I would think it would be very simple for that individual - I forget what her name is - who is in charge of this particular program, she could have provided this information. I find it very difficult to accept, I can't accept, the fact that the department - maybe the minister is not aware of this - doesn't have this information. The
minister has said that, so we will have to go with that for the time being. Looking at the insurance costs, how much more are we paying in insurance this year than we did last year?
MISS PURVES: Mr. Chairman, I am told that is embedded in our Canadian helicopter contract and, again, that that is information we will have to get for the member. It is not broken out on a separate budget line here, but we can get that. That was one of the questions that was asked. Given the number of questions asked, what staff are trying to do is to take information that is in a bunch of different places and put it on one piece of paper, the way the member asked, and that is why it is taking some time to get the information.
MR. MACKINNON: Mr. Chairman, can the minister tell us what the total cost of fuel was for the air ambulance system last year?
MISS PURVES: Mr. Chairman, the answer to that question is $279,000.
MR. MACKINNON: Mr. Chairman, the insurance costs are embedded in the contract, I believe the minister indicated, what was the total value of the contract that the minister refers to?
MISS PURVES: For the upcoming year, that is almost $2.4 million, $2.379 million.
MR. MACKINNON: What was the value of the contract last year?
MISS PURVES: It was $1,983,400.
MR. MACKINNON: I think we're getting a little closer. It looks like, assuming that the fuel costs would be relatively the same, let's say $100,000 higher this year than last year, and taking in the difference in the contracts, it looks like the cost of the service has increased by approximately $700,000. Am I in the ballpark?
MISS PURVES: Yes, Mr. Chairman. It has increased over last year. The issue that we're trying to get at, I thought the member was trying to get at, was previous years as well. From year to year, we certainly have the answers to his questions.
MR. MACKINNON: Mr. Chairman, point specific, as I've said before, I wanted to find out and to do a comparative analysis because when this was transferred over into the government's hands, the argument was made by the minister of the day and staff that it was going to save the department money. We're not seeing that. It doesn't seem to be the case. There was considerable evidence at that time to argue against that particular, almost unilateral action against the contractor who was operating it, and it was quite successful, not only because it was a cheaper contract but because this particular company was able to go out and secure endowments from large corporations across Canada to be able to reduce the cost of this service.
Now that's gone. Those types of contributions have evaporated, they're gone. The departmental costs are higher than what the minister said it was going to be, notwithstanding the fact that there's an increased cost for the maintenance of these various pads. There was a lot of volunteerism in that, that's now gone. We could be looking upwards, anywhere from a 50 per cent to a 75 per cent increase in the cost of the air ambulance system. Those are just rough figures.
I'm just curious as to whether the minister has had an opportunity to be briefed by her staff on this particular issue, because $1 million to $1.5 million is a lot of money. It's a lot of money that could have been saved, had the minister of the day and the staff listened to the experts in the industry. That wasn't the case. Has the minister had any discussions with staff because of this rather unusual increase in the cost of the air ambulance service, which could very well have been avoided?
MISS PURVES: Mr. Chairman, we do have wage settlements in sectors, over time, that increase costs, and we have insurance increases, obviously the fuel price increase the member has recognized would take place anyway, and the service has flown 100 additional missions. These all do add to costs. The department still feels that it was the right thing to do, to take over the service.
MR. MACKINNON: Mr. Chairman, I have a couple of other topics I am going to focus on, but just before I go to that, I can't leave it unsaid, the minister has already indicated that she doesn't know whether the insurance costs are up or down because she said it's built into the contract, and she doesn't know the breakdown of the contract. We can't say if the insurance fees are up or down if you don't know the detail of the contract. The minister has already indicated that. As far as the additional trips, perhaps we will focus on that. How many trips were made in the last year?
MISS PURVES: Mr. Chairman, I would like to correct a previous statement. I did not say that the insurance costs had not gone up, it fact it has gone up. The member asked how much it has gone up by, and I said I would get back to him because that's embedded in the contract but I was quite clear that the insurance costs had gone up. The number of flights flown is 600.
[11:30 a.m.]
MR. MACKINNON: Mr. Chairman, what's the average cost of a trip?
MISS PURVES: About $7,500.
MR. MACKINNON: Mr. Chairman, I would like to go back to the other issue, I believe I raised with the minister yesterday, and that's the waiting list. I know she has indicated that the waiting list for acute care - well, maybe no, that's the other issue, the
number of beds. But the waiting list, there was some debate as to whether waiting lists are up or down at the hospitals. The minister wasn't able to give me some detail on that at that point. Has she been able to ascertain any figures on the waiting times for individuals going into hospital?
MISS PURVES: Mr. Chairman, perhaps I wasn't clear yesterday, but there is no such thing as a wait list per se. You have to talk about wait lists for specific procedures, specific treatments. You have to break them down into wait lists for MRIs, wait lists for CAT scans, there is no general wait list that encompasses every single procedure in the system. There isn't such a thing anywhere in the country or the world. You have to break them down into what the wait lists are for. That is precisely the thing that one section of our department is spending all its time on, trying to make sure that before we get into compiling provincial wait lists for other procedures, because we do have them for nursing homes now.
We know that we're comparing apples and oranges when we say the wait lists for CAT scans in Sydney is so many weeks or months, that we're talking about exactly the same thing in Halifax or wherever. Then that information, when we know we're working from the same standards, gets put into a provincial system. Once it's province-wide, you're much better able to advise patients to go to a particular hospital or clinic for a certain procedure. It may not be the one they want to go to, but it may be a better one for them.
Even in emergency wards, the emergency wards across the province don't necessarily measure their wait times the same way. Some may measure from the time you come in the door until the time you see a physician. Some may measure from the time you're triaged to the time you see a physician. What we have to do - and this is a big people enterprise - is get the standards the same, so that we know, when we're putting out wait list times, they're accurate. Right now, for some procedures, for example, some specialists have their own wait lists. So a patient may be told, you can't have a CAT scan or - I'm trying to think of another procedure - an operative procedure for six months, but what they're referring to is you can't have it done by that particular doctor for six months. They aren't necessarily referring to a hospital wait list.
I know the member for Cape Breton West may think that I'm trying to keep figures from him, that is not the case. It's just that the question that he asked has a very complex answer that we don't know all the answers to.
MR. MACKINNON: Mr. Chairman, I would like to refer to a recent article - well, not too recent - 2002 done by the Fraser Institute, a little bit of a right-wing think-tank. It's entitled, CRITICAL ISSUES Waiting Your Turn: Hospital Waiting Lists in Canada (10th Edition). Essentially it's an evaluation of health services in every provincial jurisdiction, the territories and nationally. One of the issues that I found rather interesting was that for Nova Scotia, in terms of waiting times, actual versus reasonable waits, between appointment with specialists and treatment, from the period of 1998, 1999 actually, about halfway in between,
it went from approximately six days up to, no, six weeks up to 9.4 weeks, which seems to be a rather significant increase in time. I do have to apologize, I will go back to the first page to find out if that's days or weeks. Anyway, I think it's weeks.
That seems to be a rather significant increase in the time someone has to wait to get to see a specialist. Is the minister aware of that, and what action has the minister taken to mitigate that increased waiting time for a patient to be able to go from their practitioner to the specialist?
MR. CHAIRMAN: Just before I recognize the minister, I wonder if the member for Cape Breton West would, perhaps, have a photocopy of that page that he referred to from the Fraser Institute, some may want to peruse it a little bit.
The honourable Minister of Health.
MISS PURVES: Mr. Chairman, I certainly would like to have a look at that. Also, I would like to find out where they got the particular information, because depending upon the disease and depending upon the specialist, that might or might not be a significant increase. Certainly, my own experience and that of friends is that you can wait to see a specialist anywhere from a month to six months to a year, depending upon what the condition is, who the specialist is and where he or she is located. Without access to that information, I'm afraid I'm not able to answer the question of whether it's a significant increase or not. It could be, but it might not be, as well, because I don't know the details.
MR. CHAIRMAN: The member did indicate he would provide us with a photocopy of at least the page from the Fraser Institute article. I might just say, with all respect, it seems a bit ironic that the Liberal member for Cape Breton West would be providing the government with a page relevant to the topic and out of the Fraser Institute. We certainly appreciate his generosity. (Interruptions)
MR. MACKINNON: Mr. Chairman, I would hope that the minister and the government would be equally as kind to have this waiting list reduced, so that patients would be able to see their specialists in a timely fashion. I have no problem perusing and reviewing right-wing think-tank data, even if it fits in with the neo-conservative dogma that sometimes comes from across the floor, from the government. I would be only too pleased to provide the government with some of its own information.
In this particular issue as well, there is a lot of fascinating stuff here. I'm going to point out a few other sets of statistics and then I'll pass the book over to the minister and then I'll get to the focus of really where I want to go with this issue. On Page 62 of this particular edition from 2002, I'm not sure what date exactly, the estimated - according to Table 14 - number of procedures for which patients are waiting after appointments with specialists, Nova Scotia - for example, gynecology - has one of the highest per capita in the country,
which I thought was a little concerning. For general surgery, I'll read out the figures: for British Columbia for procedures per 100,000, it's 304; Alberta, 226; Saskatchewan, 729; Manitoba, 226; Ontario, 210; Quebec, 311; New Brunswick, 184; Nova Scotia, 236; and so on. When you figure out on a per capita basis, that's fairly high.
I asked the minister about her information systems yesterday. For example, my question was with regard to the waiting times at the outpatient units of different hospitals across the province. The minister indicated that she wasn't able to provide that information. I would think that it wouldn't be all that difficult to check with the regional hospital authorities or the community hospital boards - they keep changing the names and the structure around so much that it's hard to follow. It would appear to me that it wouldn't be that difficult to find out how long a patient would have to wait, on average, at the QE II as opposed to the Colchester Regional or a hospital in New Glasgow or the Cape Breton Regional or whatever. Is the minister telling us that they just don't have that data whatsoever to be able to give some indication to members of the committee whether access to health care is getting better or the waiting times are getting longer, especially at outpatients.
MISS PURVES: I'd just like to clarify if the member, when he says outpatients, means emergency wards? That was one of the questions that was asked yesterday and we are getting that information. It's not information that we have at the department. The district health authorities do have that information for all the hospitals and that's what we've asked them to collect. Bearing in mind, that still they may not measure wait times exactly the same way, but we can get the information. I would add - I've said it before but I would add again - that if someone sees you and judges that your condition is far less critical than others in the room, you may have a wait time of five to six hours. That is judged as a reasonable wait time in context with the other injuries or illnesses that the emergency ward may be dealing with on any given day.
MR. MACKINNON: I'm going to shift the focus just slightly, but it's on information systems in a different fashion. The minister indicated that the department has a waiting list for seniors going into nursing homes. Would the minister give us the figure as to how many seniors are on the waiting list waiting to go into nursing homes province-wide?
[11:45 a.m.]
MISS PURVES: We don't have that with us, but we can get that very quickly. We can get that this morning.
MR. MACKINNON: Perhaps the minister would also apprise members of the committee as to how many seniors are presently in hospitals waiting to go into nursing homes as well. With that information, you can give me an actual figure or just give me an average figure, the approximate time that they stay in the hospital while they're waiting to get into a nursing home. Is it, on average, 25 days, a month, two months or what have you?
MISS PURVES: On average, it is a couple of months wait between being medically discharged and going into a nursing home. It may not always be a couple of months, but that would probably be the average. Meanwhile, we will also get the information on the numbers of seniors in beds awaiting placement in nursing homes.
MR. MACKINNON: How much do the seniors have to pay while they stay in the hospital waiting to go into a nursing home?
MISS PURVES: Mr. Chairman, that rate is about $50 a day.
MR. MACKINNON: Does it ever go higher?
MISS PURVES: Yes, it goes up if the patient refuses a placement in a nursing home, then it goes up to about $200 a day, I believe is the figure.
MR. MACKINNON: Do we have many cases of seniors who don't want to go to the nursing home, who would rather stay in the hospital? I know myself, I've had at least one case in the last year where a terminal patient, when he first went into the hospital, I believe before the first week was over that the staff from the Department of Health had rushed in and insisted that his wife fill all the papers out to start the process to have him sent into a nursing home. Lo and behold, I think he was in the hospital for almost 11 months for a whole variety of health reasons and he eventually died in the hospital. But the Department of Health went to great pains to try to have him transferred into the nursing home despite the fact that his health didn't warrant going into a nursing home. So, are there many cases that are in dispute now within the department that are similar in nature to what I've just described?
MISS PURVES: Mr. Chairman, no, there are very few cases like that. Obviously, the earlier the assessment process is started the less wait there may be. It's also a case where it could be hospital staff rather than the Department of Health. There aren't so many Department of Health people running around the countryside performing those duties. Regardless, it certainly is easier and quicker to get into a nursing home if both the care assessment and the financial assessment are done earlier rather than later.
MR. MACKINNON: I'm going to take a moment to focus on that because it seems as though the left arm and the right arm within the department don't seem to know what they're doing. I believe when the minister was first appointed to that department, I think she referred to the frustration, I think she reflected the frustration by many people across Nova Scotia with the way the Department of Health officials were handling that. I believe she used the term, Gestapo-like tactics. (Interruption) That was the quote in the paper, and I believe the minister will concur. I always was told, something my dad told me one time, he said, no matter what you do in life, at the end of the day you're the captain of your ship - if it sails, you sail, if it sinks, you sink too. So the minister is now captain of the ship. What specific action has she taken to dispose of those Gestapo-like tactics out of the department?
MISS PURVES: Mr. Chairman, just for clarification, I did say department staff were looking like Gestapo, I didn't say they were using Gestapo-like tactics. It may seem a fine distinction, but it is a distinction. We've changed our processes considerably and we continue to meet to refine those processes. We consulted with the Group of Nine. We've had meetings with the Fire Marshal's Office; people in my department, and the Fire Marshal's Office and Community Services, to try to work out more - and succeeding - humane ways to deal with situations in which elderly people had been moved abruptly from one location to another. We have also taken great pains to begin involving the families right at the beginning instead of dealing primarily with either the boarding home or small options home, whatever you choose to call them, the operators, who, themselves, are in a difficult situation sometimes.
There are situations where they know they can't care properly for people but the hospital sends them back and the elderly person has nowhere to go, but the operator of the establishment may know very well they're not equipped to deal with the needs of that person. So we do not have a perfect system by any means, but the specific actions that we've taken are beginning to work, and we will continue in that vein to try to make sure that if a person has to be moved that it is done in the gentlest, most humane way possible and that the family is aware of all the options. Given the problems that can result when elderly people are moved, even under the best of circumstances, we feel this is a better way to proceed. It does not mean that we are going to be ignoring the fire marshal's recommendations, or trying to endanger seniors, that's obviously not what our objective is. Our objective is to try to deal with people more compassionately.
MR. MACKINNON: Mr. Chairman, I sense a little backpedalling on behalf of the minister there. She's now saying it was a perceived Gestapo-like tactic, as opposed to real. We have to be very careful because the message that was sent out to the people of Nova Scotia - at least I think that's what the minister was trying to convey - was that staff in the department were using Gestapo-like tactics and she was going to stop that. Now she's saying it was only a perception and when she got in there she then found that that's all it was, it was just a perception and they made some housekeeping changes.
She made reference to the Fire Marshal's Office and I have to say, personally, Mr. Chairman, I'm suspect, because it seems when one government department wants some dirty work done they will call the Fire Marshal's Office. I've seen that happen with the Department of Education. I've seen that happen in this department and that's not to diminish in any way, shape, or form the importance of fire safety and protecting seniors. Look, I was the Minister of Labour who was responsible for that, I know the importance of it. I could never give the staff enough credit for all the good work they do but it seems to me that any time the government wants to achieve a certain objective, well, let's call in the Fire Marshal's Office and that sends up a red flag and everybody goes for cover and uses the Fire Marshal's Office as a smokescreen to achieve whatever they really want to achieve.
Maybe it's a way to really centralize these nursing home services, I don't know. I mean maybe that's just "a perception". Maybe they like to rehouse seniors in these large commercial-type institutions. Maybe that's just a perception, but the minister knows full well, she's an expert at public relations and she knows very well how to use the right punch words to get the message across. My concern is - with regard to the Fire Marshal's Office, point specific - how many calls have been made by the Department of Health to the Fire Marshal's Office in the last year to investigate issues such as what has been occurring in the last few months, or altogether for that matter?
MISS PURVES: Mr. Chairman, I don't have the answer to that question. I have no way of finding the answer to that question and I think the member opposite knows that.
MR. MACKINNON: Mr. Chairman, I find that totally unacceptable. The Department of Health has called in the fire marshal on different occasions and now the minister is standing here today and saying she doesn't know how many times he has been contacted. As I've said before, you're the captain of the ship. The buck stops at the top. You have to know how many times your officials are calling the Fire Marshal's Office with what are supposed to be legitimate complaints. Certainly there has to be some record of how many times the Department of Health has contacted the Fire Marshal's Office, to show some validity to the concerns by the Department of Health vis-à-vis the concerns that are being expressed by the operators of these small nursing homes in rural Nova Scotia?
MISS PURVES: Mr. Chairman, if someone in the department called the Fire Marshal's Office with a complaint about a particular location, that call would be noted and logged, and in that case we're talking five or six calls last year. We work with the Fire Marshal's Office on a number of issues and staff are calling the Fire Marshal's Office regularly on a lot of matters where the calls would not be logged and that's what I'm referring to. To get every single call to the Fire Marshal's Office, that would not be an attainable figure because there is such regular communication. If he's talking about specific complaints about some of the unlicenced homes, then the answer would be five or six and I can get back to him whether it was five or six.
MR. MACKINNON: Of the five or six that have been contacted by the Department of Health, how many have been shut down?
MISS PURVES: To my knowledge, Mr. Chairman, none have been shut down.
[12:00 noon]
MR. MACKINNON: What issues were resolved to make it such that they weren't shut down, or what was it that precipitated the Department of Health to call the Fire Marshal's Office?
MISS PURVES: Mr. Chairman, there are a number of issues here, but we will only call the Fire Marshal's Office if we receive a complaint - sometimes it is a complaint from a family member, sometimes it's a complaint from a neighbour and occasionally it's a complaint from a competitor. The issue that the department is interested in is essentially the mobility of the seniors, the ability of the senior to get out in the event of a fire. There was a recent incident where it wasn't a mobility issue, but it was an understanding issue because . . .
MR. CHAIRMAN: Order, please. There are some conversations that are taking place in the Chamber that are out-loud conversations. I guess the Chair wouldn't mind if there were some whispered conversations, but the Chair would prefer no conversations - other than the one between the members - taking place at this moment. So I would appreciate it if the members would take their conversations outside the Chamber.
The honourable Minister of Health has the floor.
MISS PURVES: So, that's our concern and that has to do with the level of care that may be appropriate for that person. If the person is bedridden and can't move, it's a real issue for us because we know that that person would not be able to get out in the event of a fire, but the fire marshal doesn't make that decision. That decision is made based upon an assessment by a care coordinator on the senior, but the other issue, which you know is obviously not undertaken by the Health Department, is inspections of nursing homes, boarding homes, small options homes, which occur regularly as part of the job of the Fire Marshal's Office, as the member would know.
These inspections take place unannounced and various aspects of the nursing home, whether it's a large institution or a very small home, are looked at. Usually, well, perhaps not usually, but at any time, the Fire Marshal official may order certain remedial action be taken in the homes, whether doors open the right way, whether the fire alarms are in the right place, the size of the stairways, you know, the width of the doorways, and in the bigger homes, whether or not the sprinkler systems work and so on, and whether the fire doors are kept closed. All of these things are things that he would look for and if he or perhaps she, finds that something needs to be changed structurally, then orders will be given for those things to be accomplished within a certain period of time.
MR. MACKINNON: Mr. Chairman, very helpful information, but it didn't answer the question that I asked. So we will just move on to the next issue. On Page 64 of that same report - I just sent a copy over to the minister - I noticed Table 15 does a comparison of estimated number of procedures for which patients are waiting after an appointment with a specialist, and they did a comparative analysis between two years ago and last year.
For plastic surgery in Nova Scotia there was a 59 per cent increase in waiting times, or in in patient backlog. There was a 27 per cent increase in that backlog on the issue of gynecology and there was a 54 per cent increase for - and I can't even pronounce the word to be honest, I would have to get a doctor to pronounce that word - ophthalmology, I believe it is. Then there are several other issues but one that seems to really catch my attention is on the issue of general surgery. There seems to be a growing concern there - a 20 per cent increase. Now that, to me, is a very telling issue. Has that been the case in the last fiscal year, 2002-03, has there been an additional increase? Has that trend continued in that direction or has it reversed?
MISS PURVES: Mr. Chairman, we would have to go back and get that to look at those numbers to see whether wait lists for general surgery are going up or going down. I do know that in the health authorities that they have been reorganizing their operating rooms and their operating room times and it may have made a difference. I should also point out that general surgery is one of the areas that will probably become more difficult as time goes on, as fewer and fewer medical students wish to go into general surgery, and that is going to be a real issue which is actually starting to be felt right across the country.
MR. MACKINNON: Mr. Chairman, not only in general surgery is the backlog growing, but in neurosurgery there's a 52 per cent increase. In orthopaedic surgery there's a 60 per cent increase. In cardiovascular, it went down 22 per cent, as with urology. Internal medicine went up 28 per cent, radiation oncology, 91 per cent. I can't see how the minister can say that health care in Nova Scotia is getting better. Maybe the quality of service, a person receives is getting better but access to health care is not getting better and these numbers speak to that. So I would ask the minister if she could quantify or give some explanation as to how her words don't seem to match with the evidence that's here before us?
MISS PURVES: Mr. Chairman, health care in our systems are being stabilized. We are getting better information and we have to prioritize, as everybody does. Where we have identified problems and been able to measure them properly, we have been able to reduce wait times. But two of the issues that we're going to be tackling next are the areas of oncology and orthopaedic surgery. I know the member opposite understands this and it's very frustrating for the people waiting, for orthopaedics in particular, well it's no less frustrating for people waiting for oncology, it's just that there are fewer of them. The advances in orthopaedic surgery and the abilities of the surgeons to replace hips and knees and so on, is so good, the demand is higher. When you know you have that kind of service, your wait list gets bigger, the better you get at it. You know there's at least one surgeon, for example, at the QE II that has a clinic down in Lunenburg, so he can do his orthopaedic surgery down in Lunenburg and not have to postpone patients in Halifax. That's one way of helping patients there but again, what we have to look at with that kind of surgery is perhaps increased use of operating rooms and that is certainly possible, but it's something we have
to talk a lot about, with the people at the QE II and the district health authority. We do have an additional neurosurgeon coming to the QE II which should reduce the wait list there.
MR. MACKINNON: Mr. Chairman, I'm not going to belabour the point too much other than to make the point that the evidence that's here in this report points quite clearly that we're getting a buildup. It's like water building up on a dam and the pressure is building and sooner or later it's going to let go. We're not able to keep up with the demand for health service, particularly for radiation oncology. Now, we're talking cancer. People should not have to wait a longer period of time for treatment of cancer, you get that done ASAP because every day is that much worse for the patient. I know that every member in this Legislature can relate to it, I know that, so this is serious stuff. We can come in and do our political thing in here, make our statements and so on, but things are not getting better and the evidence points to it and that's the issue I wanted to make.
There are some areas where things are getting better, I know that, because of information and science technology and improved systems and so on. I'm not an expert in medicine, I know very little about it other than to say, well, I can get some Tylenol or go get a prescription from a doctor for a certain ailment, or something. But I'm afraid, if what these experts are saying is correct, things are not getting better, they're getting worse. Perhaps the minister could give us the figures for the fiscal year we're just finishing to do a comparative analysis on those. Also I wanted to raise another issue. Today it was reported in the local media in industrial Cape Breton that parking fees for the hospitals in Cape Breton are increasing by 100 per cent. They're going from $1 to $2 effective the beginning of this fiscal year, or it could be today. No, I'm sorry, effective April 28th. Was the minister aware of this and does she have any idea of the impact that this is going to have? Is this going to be part of their operating budget and is this just confined to the Cape Breton health complexes?
MISS PURVES: Mr. Chairman, yes, we were aware of this. Again, the fee is not mandated by the department. Each district makes its own decision on parking fees and, as I've said on previous occasions, waivers can be obtained by persons in need if they wish to do so.
Earlier the member asked a question about seniors on waiting lists and I wonder if I might answer that question now. There are 108 seniors fully eligible in communities, and fully eligible means the assessments have all been done in communities waiting for placement, and in hospitals there are 35 fully eligible patients waiting for placement in nursing homes.
MR. MACKINNON: Mr. Chairman, I realize the decision on parking fees is at the hospital level, but what the minister is saying to these hospital boards is we're only going to give you so much, the rest you go and get somewhere else, and the cost of operating health care in Cape Breton is now going to be done through parking fees. Is Cape Breton the only
area that the minister knows of where these parking fees will be increasing? Are there other areas of the province where parking fees will increase?
MISS PURVES: Mr. Chairman, I haven't been told of any others increasing this year, but I do know that some other areas already had their parking charge at $2. (Interruption) Cumberland is increasing also. I believe the announcement that the rate would be going up was actually made last year.
[12:15 p.m.]
MR. CHAIRMAN: Order, please. The member's time has expired.
The honourable member for Halifax Fairview.
MR. GRAHAM STEELE: Mr. Chairman, in the main Estimates Book on Page 12.33, there's a figure of $30 million for Grants and Contributions for Infrastructure. Well, that's kind of a high level so I thought I would look in the Supplementary Detail for more information. On Page 12.21, it says under Hospital Infrastructure, $30 million. So there's not one line of extra detail in the Supplementary Detail. Sometimes I wonder why we have the Supplementary Detail because so much of what's in here is simply repeating what's in the main book and there's not actually any supplementary detail. So my first question today is to ask the minister, in detail and preferably in writing, how exactly that $30 million breaks down and how it's going to be allocated. The minister may choose to answer that question verbally if she wishes, but I expect the list of capital grants is long enough that perhaps if she were to table the breakdown it would be much more enlightening to all members of the House.
MISS PURVES: Mr. Chairman, I can give the member opposite a list of the projects in general. We know the amount that we have for capital grants, we know the demands we have for capital and so we have prioritized these and we do have a list of projects, but we don't have the amounts - we have not broken down the amounts ourselves. So I will say included in that number for the $30 million will be the Yarmouth Hospital, Phase II, planning for Colchester, some renovations for the IWK, construction money for the Cobequid Multi-Service Centre, a study for the Valley Regional. There will be also work done at the Dartmouth General, the dialysis unit in the Cape Breton Health Authority and various small infrastructure projects. But, at this time, the department has not allocated all the funding exactly, to many of the projects, but those are the areas that will be receiving capital money this year.
MR. STEELE: Just to make sure that I understand, Madam Minister, are you saying that the budgetary envelope, as it were, is $30 million, and not all of that $30 million has been allocated at this point? Is that a correct understanding?
MISS PURVES: That's essentially right, Mr. Chairman. We are prioritizing the projects; there are some small projects that we may yet consider. Obviously, the demand is greater than the supply in terms of what we're doing, but there are some things we know we absolutely have to do, but that will be coming, that information will be coming.
MR. STEELE: Mr. Chairman, will the minister table a list of the approved projects and the amount associated with each project?
MISS PURVES: Certainly, Mr. Chairman, I will do that when we have it. I did explain that the districts have not yet been told the exact amounts that are going to their project and, when we have determined that, I definitely will table a list of the projects and the exact amount going to each.
MR. STEELE: Now, I just want to make sure I understand this again. The minister is telling us, if I understand her correctly, that not only can she not give us the list, but the district health authorities haven't themselves been told what has been approved, yet the Legislature is being asked to approve an allocation of $30 million? There seems to be a disconnect here with what we're being asked to approve and what's actually happening out there in the real world. I'm not sure that I see the logic of doing it quite that way. Nevertheless, with specific reference to the Capital District Health Authority, has funding been approved for renovations, major or otherwise, to the Nova Scotia Hospital and/or the Dartmouth General Hospital to be funded out of this $30 million?
MISS PURVES: Mr. Chairman, yes, in terms of the Dartmouth General, funding for their dialysis unit will come out of this allocation. I know the member opposite knows this, but from the point of view of information for other members, most of these projects are multi-year projects, not all, but most of them are, and a continuation of some from last year and the year before and there will be more work done next year.
MR. STEELE: Does the $30 million include approval for renovations to provide for a mental health in-patient unit at the Nova Scotia Hospital?
MISS PURVES: Mr. Chairman, neither official here with me today has seen that request, so it is not on the list, to be direct.
MR. STEELE: Mr. Chairman, I would now like to talk to a different topic entirely, a topic that is dear to my heart and has been for some time, that's the topic of ambulance fees. Just to start us off, just to get us started on this topic on which I intend to take the next little while, I wonder if the minister could let the House know how much revenue is expected to be taken in from ambulance fees this year as opposed to last year?
MISS PURVES: This year our share would be $6.9 million in ambulance fee recovery.
MR. STEELE: That's interesting, but not entirely my question. How much money is being taken from Nova Scotians in ambulance fees, in total, this year - and this is also an important part of the question - as compared to last year?
MISS PURVES: This year and last year the amount expected to be recovered is the same.
MR. STEELE: Mr. Chairman, I'm not going to ask any more of those questions because the answers are taking a surprisingly long amount of time and I only have so much time to get into this topic. The minister will be aware that starting early last year, over a year ago, I started raising the topic of unfair ambulance fees in Nova Scotia. For a whole list of reasons the fees, as they operate on the ground in the real world, can be unfair. I raised this issue repeatedly with the former Minister of Health and to say that I got no satisfaction would be understating it, or overstating it, because that minister seemed to be intent on misrepresenting the issues that I was raising on refusing to do anything about it, refusing even to acknowledge that there was a problem and what the minister said was that, oh, you're saying this, oh, you're saying that and, of course, these things, these misrepresentations about what I was saying had nothing to do with the on-the-ground reality, but the net result was that more than a year later, absolutely nothing has changed.
So now that we have a new Minister of Health, I have renewed hope that somebody in the Department of Health is going to acknowledge that we have a problem, and before the minister reads the same briefing notes which the former minister had - and let me hope the briefing notes have been changed since then, I really hope they have - let me say what I'm not saying - I am not saying that we should do away with ambulance fees. We need ambulance fees. That's okay. I'm not saying ambulance fees are too high. In most cases, ambulance fees are fair and reasonable. What I am saying is that the policy operates in such a way that in some circumstances it can be dreadfully unfair and the person on whom the burden falls is not the person on whom the burden ought to fall.
So I'm even not talking about giving away any provincial revenue, I'm just talking about putting the burden of ambulance fees where it belongs and not on Nova Scotia families who can't afford these fees when they work their magic of unfairness. So I'm not going to ask the minister about individual cases, it's not fair. I know she can't answer on individual cases and it's not fair to raise them, but I am going to ask about policy aspects. When two or three people get into the same ambulance, each one of them gets a bill. So the province's take is much, much more than the cost of service. Why is that fair and what is the minister going to do about it?
MISS PURVES: Mr. Chairman, the simple answer to that question is that we believe the policy is fair because the costs charged per trip are based on average costs of the whole system and the cost of the personnel as well. So if two people, for example, are in an ambulance and they're both being treated, they will both get a bill.
MR. STEELE: But you see, the problem is that the costs are calculated per patient, whereas the actual costs are per trip. If you have one ambulance making one trip, then the fixed costs of the ambulance are the same, the fuel costs are the same, the costs of the personnel are the same. In fact, there is no additional costs except marginal costs; there is no additional costs associated with carrying more than one person and yet each person receives a full bill as if they were alone in the ambulance. So I want to ask the minister again, why is that fair and what is the minister going to do about it?
MISS PURVES: Mr. Chairman, the fees are not based on the costs per trip. They are based on the cost of the system as a whole and even though we do charge a fee, it still doesn't cover the whole cost; the costs are still subsidized. That is how the policy operates. I know the member opposite does not think that it is right, that the costs should be based per trip, but the fees only represent about 10 per cent of the cost of the system.
[12:30 p.m.]
MR. STEELE: The minister knows very well that's completely beside the point. I'm disappointed to hear her read from the same briefing notes that the previous minister was reading from. Talking to the previous minister about this issue was like talking to a very thick concrete wall, and I was really hoping for something better out of this minister. I'm disappointed that her initial answers to this are exactly the same as the previous minister's answers.
One of the other situations where the policy can be unfair is in some motor vehicle cases where the bill is the full amount, now $600, whereas if a motor vehicle is not involved it's $105. The theory of this is that it gets passed on through the insurance company and it's not really the individual who pays. What the government refused to understand and what the previous minister refused to acknowledge, even though the Insurance Bureau of Canada acknowledges it, is that the theory is wrong, because when you submit one of these ambulance bills to your insurer, your premium can go up does go up. Now, it doesn't go up for everybody, it only goes up for the very best drivers. We're not talking about uninsured or under-insured drivers as the previous minister tried to mislead people into believing one day - we're talking about Nova Scotia's very best drivers. The IBC tries to split hairs and say it's not really the premium that's going up, what you're losing is your good driver discount, although to the person who receives the bill, it's all the same thing - all they see is the price going up. For some people, if they submit the ambulance bill to their insurer, the amount they pay to their insurance company will go up by more; that is a fact. It is a fact; it can't be denied; it happens; it's real. I don't care what the minister's briefing note says, that is the way it really works out there in the real world.
So my question to the minister is, why is that fair that somebody should get a $600 bill and what is the minister going to do about it?
MISS PURVES: The reason the previous minister and I are sounding the same on this is because the department feels very strongly that the system it has in place is fair. What may seem like splitting hairs in terms of insurance premiums possibly going up would be precisely what the member alluded to and that is it's not the ambulance bill itself that is causing a premium to perhaps go up, it would be the fact that the person was in a car accident, perhaps causing the premium to go up.
MR. STEELE: Maybe the crowd on that side won't really understand how the ambulance fee system works until it affects somebody they know. The minister's version of how the system works is simply detached from reality - it is simply detached from reality.
Let me ask about another situation. In the workers' compensation system, if a worker is hurt on the job the province bills $600 because they believe, incorrectly, that the bill is picked up by the Workers' Compensation Board, and it is not. Under the Workers' Compensation Act, the ambulance that takes an injured worker from the workplace to the hospital is the responsibility of the employer. It's right there in the Workers' Compensation Act and yet they still get the $600 bill, which is the bill that the province sends out on the assumption that it's being picked up by an insurer. Now, a $600 bill to a small employer is a big deal. They know and they'll acknowledge and they'll accept that they have to pay the lower fee - the $105 - that's fine, they'll pick that up, but they do not understand why they have to pay the $600 bill when there is no insurer to pick it up. So my question to the minister is, why is that fair and what is the minister going to do about it?
MISS PURVES: I'll have to get back to the honourable member on that particular aspect of ambulance fees, that is not something that I have at my fingertips.
MR. STEELE: Another way in which the ambulance fee policy can be unfair is to people who are not Canadian citizens but are here awaiting the receipt of their permanent resident status. These people have come to Nova Scotia and Nova Scotia is their home. They're not going anywhere else, they don't have a home anywhere else. Their home and their families are here, particularly in the cases where an aged parent has come to join a family member who's already here.
So the family is well established and maybe the parent has come from the country of origin to live here and everybody knows they're going to get their permanent resident status, they just don't have it yet, and what happens is instead of being billed the $105 like everybody else, they get billed $750 - or is it even $800 now? - the bills have gone up and I've lost track, they used to be $750, and they're probably, if I know and love this government the way I do, $900 by now since their bill was typically 150 per cent of what a Nova Scotian would pay. So my question to the minister is, for those people who are awaiting their citizenship or their residency and yet they're billed like any other tourist coming from another country, why is that fair and what is the minister going to do about it?
MISS PURVES: My understanding is that with an ambulance fee or a hospital charge for a person in that situation, once they get their immigration card or their hospital card, the fee would be waived or returned, once the proof is there that they are in fact going to be staying.
MR. STEELE: If that's the policy, the department does an awfully bad job of telling people that's their policy. To say here's the bill, but if you do this, this, and this, and show us this, this, and that, then we'll waive it is all very well, but the only thing that comes through the mailbox is the bill. So the least of the department's issues here in dealing with ambulance fees is the way they communicate with the public about what their options are. If that's the department's policy, maybe - just maybe - they might want to think about revising it so that the person never gets the $750 bill in the first place.
The same thing happens to people who move to Nova Scotia from other provinces. This particularly happens with students. Heck, I was a student, that's why I came to Nova Scotia. I came here and I stayed and there are lots of other people who do that, there are lots of other people who move to Nova Scotia for all kinds of reasons, but they have to live here a certain length of time before they qualify for the Nova Scotia health card. They can be here and this can be their home and it can be where they intend to stay, but if they don't have that magic Nova Scotia health card, then they get billed the out-of-province rate even if their home province or their former home province refuses to pay, which happens quite often.
My understanding is that the department sends these bills on the theory that the other province will pay, and the problem is they don't, not always - I would say even frequently the other province won't pay. Or, at the very least, there's a dispute over whether they will or they won't, and yet these are Nova Scotians living in Nova Scotia, intending to stay in Nova Scotia, and yet they get billed as if they were strangers; they get the same bill as if they were a tourist. So my question to the minister is, why is that fair and what is the minister going to do about it?
MISS PURVES: Certainly the system is set up to be fair, the system is set up presuming we honour other provinces' health cards, that they will pay fees for their residents here in Nova Scotia. There may be situations - I'm sure there are situations perhaps where there's a dispute over whether or not another province will pay, but anyone who objects to an ambulance bill can avail him or herself of the appeal process and appeal that bill.
MR. STEELE: What the minister is saying is simply divorced from reality. It's simply divorced from reality, and I don't know who's in charge over in that department, but I will say this about the ambulance fee policy - that whoever is administering that policy does not understand how it works in the real world.
What the province has done is put Nova Scotians in between themselves and other provinces. What should be happening is there should be an interprovincial agreement on paying ambulance fees for each other's residents. But, because the government isn't doing that, they put their citizens in the middle and it's the citizens who get the high bills, it's the citizens who have to fight with the other provinces. Let me tell the minister something - there are many cases where the other province won't pay, refuses to pay, won't pay the full amount, but it's the citizen of Nova Scotia who is fighting with that other province. That should be a matter between health officials in the different departments, they should not have the citizen in the middle. That's a good example of what I was talking about. The burden of this issue falling on the wrong people.
Another category, and the last one I'm going to raise with the minister, is people who simply don't have the money; they simply don't have the money. The typical case that I've heard of will be somebody who has a disability, who has no income other than their disability income, but they have an illness that requires them, as a medical necessity, to take an ambulance. I was talking to a young woman from Antigonish who, I think, is probably well known to the member for Antigonish, if not to the minister, and she has epilepsy and her epilepsy requires her to take the ambulance frequently.
She's very well known to the paramedics in town. They know her, they know her situation and they treat her very well. The problem is that she gets bills that she can't afford, even though when she has one of her seizures she has no choice but to take an ambulance. It's the only option available to her - it's part of her life, it's part of who she is, that she has this medical condition that requires her to call on paramedics frequently. She showed me a list of her bills and in a two-year period she had taken the ambulance 10 times. Ten times in two years - it's part of who she is and part of the condition that she has.
She's on a disability income and the only reason that she can afford to live is that she lives in a heavily subsidized housing unit. Needless to say, she doesn't have the money to pay for an ambulance - she doesn't have the money to pay $5, never mind $105 every time she has to take an ambulance. Yet, there is no provision in the ambulance fee policy for her and people like her who need an ambulance as a medical necessity but can't afford to pay. The bills will not be forgiven; they owe the money and it goes on their credit record that they owe the money and it's with them forever, so not only does epilepsy become part of their life, but so does having a bad credit rating. They have all these outstanding bills that they can't possibly pay and every so often they get a collection letter and a collection call asking when they're going to pay. The answer, of course, is never because my income hasn't gone up.
[12:45 p.m.]
So for those people who, out of medical necessity because of a permanent medical condition, regularly need to take ambulances, those people are getting billed and there's no provision in the policy for forgiveness for people who don't have the money. My question to the minister is, why is that fair and what is the minister going to do about it?
MISS PURVES: I know that in some cases of hardship, arrangements are made to pay over time. I know there are incidents where bills have been forgiven because of hardship cases, but the member is right - there is no provision per se for people who simply can't afford to pay except through the appeal process, when sometimes it does happen, and that is possibly something that we could look at altering.
In terms of the hospital bills being paid by students or people from other provinces, what we can do - what we haven't done because ambulances aren't covered under the Canada Health Act, but there is an interprovincial committee on hospital bills that looks at those kinds of issues as far as hospitals go - we can undertake to talk to this committee about ambulance fees and how other provinces treat us, how we should treat people from other provinces to see if we can get something worked out there that perhaps would end all the disputes that apparently take place over these kinds of ambulance issues for out-of-province people.
MR. STEELE: Whenever I hear the minister talk about the appeal process, I have to say there's a problem with that. The appeal process is designed to determine whether the policy has been properly applied or not, and occasionally it isn't and that's life, no big deal, people can appeal and win, but it doesn't do one solitary thing for people who get an unfair bill because the policy is unfair. The appeal system is not empowered to change the policy, and that's why I keep raising it here in the Legislature. This is a policy issue. The issues I've raised today are not amenable to appeal because the policy has been properly applied. So of course they're going to lose their appeal. Many of them have appealed and they lost because the policy was properly applied. The problem is the policy itself, and I'm going to keep going after this issue until the government changes the policy, because in some cases it can be dramatically unfair.
As the minister knows, with my assistance, seven Nova Scotia families have refused to pay their bills. They announced in March of last year, and they announced publicly - no, actually six of them announced publicly, and a new one last week, but that's another story for another day, and I'd love to tell that story. That was a Glace Bay case, as a matter of fact, Mr. Chairman. A case from Glace Bay, I should tell you about it some day - but the government, on those six cases that announced publicly last year that they were going to refuse to pay their bills have had the government essentially give up on collection.
Apparently that's all it takes, and I have resisted the urge to say publicly that all anyone has to do if they don't think their ambulance bill is fair is refuse to pay it. After a call or two and a letter or two, the collection effort will just evaporate. I've resisted that call because I don't think it's fair to those people, I don't think it's fair to the Department of Health, and I don't think it's fair to the system, but if that's what it's going to take to get the department to change its policy, that's what I'll do.
It will wreak havoc in the system if I say to people if you don't want to pay your bill just don't pay it. Because what's happened in those seven cases I brought to the department's attention is they have given up collection efforts, and yet they can't bring themselves to admit the policy is unfair, they just haven't done anything to collect the money. Now we've got a problem here and I'm going to keep after this issue until the government recognizes that and with that I'm going to turn my time over to the member for Sackville-Cobequid, who has just come back from an announcement of some importance in his constituency.
MR. CHAIRMAN: The honourable member for Sackville-Cobequid.
MR. JOHN HOLM: I thank my colleague, the member for Halifax Fairview who was raising some extremely important questions with the minister, for sharing some of his time with me. As my colleague pointed out, I just came back from the constituency of Sackville-Cobequid, which I'm very honoured to have had the opportunity to represent, where the Premier was out making an announcement. I would have to say through you, Mr. Chairman, to the minister, the Premier looked quite well; he looked fine. He had a lovely election platform drop behind him, it was all very nice and it looked tickety-boo. The would-be Tory candidates were there in full force and I have to say that I quite enjoyed myself. I always love hearing good news, no matter how many times I hear the same good news.
My question through you, Mr. Chairman, because I had spoken to the minister about this topic a little bit earlier, did the minister, herself, and her department have any real direct involvement in the crafting of the announcement, or was that all done by the propaganda ministry?
MISS PURVES: Mr. Chairman, I'm not sure which propaganda ministry the member is referring to. We certainly supplied costs and details but, to the best of my knowledge we didn't design the press release and the backdrop or whatever else went along with the announcement.
MR. HOLM: Mr. Chairman, the minister said she didn't know which of the propaganda ministries I was referring to, and that, of course, is one of the other problems of the government, that they've got so many - and that issue was already raised by my colleagues in Question Period, pointing out how the various government departments, the minister herself, of course, the Premier, and other ministers have substantially increased the amount of money that is being put on the positive PR flacks that have been hired, rather than
putting that money into programs and services, but as I said, and I said this to the media, I very much welcomed hearing the announcement today. I enjoyed hearing it before, in fact, I will say in all honesty I enjoyed hearing it the first time, made by the member for Dartmouth East when he was Minister of Health and came out and announced that we were going to be getting a new Cobequid Multi-Service Centre.
Mr. Chairman, I know that the member for Bedford-Fall River was out there, too, smiling, smiling and wanting to be caught in the camera lens, I am sure, being associated with an announcement and, as I say, it's a great announcement as far as it went. I have the announcement. The Minister of Health said that she hadn't, you know that they provided certain information to the Premier and the Premier's - I won't call it a propaganda team, I will just simply say information people, those who craft the words, and I'm just wondering, had it ever been announced before that the number of beds in the emergency department would increase from the current level of 12 to a higher level of 24? Had that ever been announced before?
MISS PURVES: Mr. Chairman, staff tell me that functional planning has just been recently completed and that that announcement had not been made before.
MR. HOLM: Mr. Chairman, the functional assessment may have just been completed, but it was actually completed before, you had to have your functional design work completed before you could send it out to the architects, because the architects have to do their design based on what the functions are going to be. Could I ask the minister, before I go into a few of the other things that I seem to remember having heard before, I wonder if the minister could tell us if the architects have concluded their work?
MISS PURVES: Mr. Chairman, no, the architects have not completed their work. The functional plan will allow them to complete their work.
MR. HOLM: That's interesting, Mr. Chairman, because of course one of the things - and this is what I saw new for the first time, this is the first thing that I saw out there that seemed to be new - we have a nice conceptual plan of what the building is going to look like and we have architectural drawings of the floor plan, so you know what the floor plans are like, obviously you must have some idea what that floor space is going to be used for in terms of services.
MISS PURVES: Mr. Chairman, yes, we do know in general, but in terms of architectural plans, functional plans for all the details, for all the details of the wiring and so on and so forth, those have not been done, but yes we obviously have an idea of the program space and the floor plan and so on, but the very detailed drawings have not been done.
MR. HOLM: Mr. Chairman, where I'm coming from on this - and I'm sorry if I'm a little bit cynical . . .
AN HON. MEMBER: You are.
MR. HOLM: I'm told by an equal cynic from another caucus that I am. That having been said, what I find and what I honestly - and I've said this to people out there and I've actually said it to the media as well - what I find extremely disappointing will be the term I will use, and I could have used a stronger term, but which I find extremely disappointing, the things that I see in here, the things that are being promised for the Cobequid community health centre are things that were basically announced before, not where in the physical structure they're going to sit. We knew that the architects have been appointed and that the architectural drawings should be completed by now. What I find extremely disappointing is that here we are on the eve of an election, on the very eve of an election, and all we seem to get today - and I'm encouraged, I'm pleased that it was said, I'm pleased that there is a recommitment, a reaffirmation that this centre is going to be built - I would have expected, at least on the eve of the election when the government has had so much time, that the government and that the Premier would have brought forward even more positive news, not just that we're going to still do what we said before that we were going to do, so that we can have my picture taken in front of a backdrop saying that, and hopefully get some positive media coverage tomorrow and hopefully gain a few more votes. I would have expected that the Premier would have made an announcement as to the actual call or a date when the tenders for the construction were to be issued.
AN HON. MEMBER: Did he do that?
MR. HOLM: We didn't hear that, Mr. Chairman. Now, I'm sure that your predecessor was forced by the Minister of Finance to have withdrawn over $1 million from the centre a few years ago, the planning process. Had that, of course, not been done, the architectural work and design work could have been completed before now and the ground could have been broken, the concrete poured and steel being erected. It wouldn't be completed - not likely - but it could have been started.
[1:00 p.m.]
Now, I'm sorry if I'm sounding a little bit cynical, but now yet again it looks like we're being told this is coming. The new thing is, in a brochure you can put in a conceptual picture. Staff in the gallery who are no longer in the gallery saw it as well. Big billboards or posters were unveiled showing these things. But there was no announcement as to the date when tenders would be called. (Interruption) The member for Cape Breton West said you'd have to wait and see who the member's going to be maybe. Well, if they think that it's only going to benefit or affect them one way or the other in Cobequid, they're sadly mistaken.
The member for Bedford-Fall River, his residents deserve a new facility out there as do mine. The residents from his constituency - the residents from the Beaver Bank area, Mount Uniacke, Timberlea - have been receiving excellent service from the staff at the
Cobequid Multi-Service Centre for years, under extremely difficult conditions. They deserve to be congratulated. That centre provides such excellent service and things like blood work and X-rays in such a timely manner, people not only from the immediate surrounding area use that facility, people from the Valley, the South Shore and elsewhere come there to get those services done because they can get them often in a more timely fashion. The staff there are incredible. What they have been able to do, they deserve the accolades of all of us.
As I said, if the previous Minister of Health hadn't had that money withdrawn or maybe he volunteered to have it withdrawn, we'd be further along. I want to know from the minister, will there be something more tangible than the Premier standing for a photo op in front of a backdrop to re-announce what has been announced before? The former Minister of Health has made announcements on this too. Will there be something more concrete before the election is called? Will there be a selection - a short listing even of those who are going to be asked to bid to construct this badly-needed facility that is a model that others, as one of the speakers today correctly pointed out, New Brunswick, has followed. Other places have studied that facility. It would be nice if they had a more modern facility that could meet the needs to actually come and study, mind you. I'm wondering if the minister could tell us, will there be something more concrete, something tangible, tenders being called, even if not awarded, before the gentleman who stands out there to get the photo op, drops the writ? Do you have any kind of assurances, any kind of encouragement, to give to the people who work in that facility and have received the services through that facility?
MISS PURVES: Of course, I don't know when the election is going to be called, but the capital district will be issuing a tender on the architectural drawings and that - if it hasn't been done already - is going to be done any day now. Once those are evaluated, then we'll look for someone to build the project. So those detailed drawings will be coming very soon.
MR. HOLM: So, is the minister saying really it's all in the hands of the Capital District Health Authority to get that process, the timing and everything done?
MISS PURVES: Not exactly. Capital health does take care of the processes, i.e. putting an ad in the newspaper for a facility in their district. In terms of funding, we have a certain amount of funding set aside this year - our share being nearly $4 million to accomplish a great deal of work this year on that project. So the money is there.
MR. HOLM: The thing is, I remember money having been there before and some of that money then - oh, the commitment wasn't broken, we're still committed to things, the money was just delayed. That happened. This government delayed the actions. Here we have the Premier out there - I'm sure the next election had absolutely nothing to do with his decision, just like the Premier when he said that giving this $155 cheque to those Nova Scotians who make enough money to pay provincial income tax has nothing to do with the next election. Nothing whatsoever. I've spoken to one or two Tories who actually believed him. Not many others.
The services that are needed in that community need and deserve to be met. The minister knows and knows very well that centre delivers them and it's a wellness type of model and the system is designed not to hospitalize people but to provide the services within the community. It is a more cost-effective way of delivering those services. What bothers me - I'll accept if there are some delays for legitimate reasons, reasonable people do - what I object to is politicizing. I'm not accusing the minister of politicizing it, but I object to politicizing essential delivery of services and the development of that centre. Quite honestly, today's announcement - although if somebody comes along and gives somebody a compliment, most people don't get tired of hearing that compliment, no matter how many times it's given, by different people. If somebody is going to be given a commitment or promise good news, you always like to hear the good news, no matter how many times it's told. But you also want to see when there are things that are supposedly good news, you want to see the concrete commitments and actions that show that good news is actually moving a step forward beyond political statements.
In today's announcement, quite honestly, that's a nice picture. I don't know if the minister had seen it before or not, do you want me to send over a copy so you can see what it looks like? This is the only copy I have, but I imagine the gentleman in the gallery has a few as well, so I'll let you have a look, Mr. Chairman, and give it to the Minister of Health, at what the concept for the new centre is going to look like.
MR. CHAIRMAN: Order. Are you tabling that document?
MR. HOLM: No, I just sent it over to the minister. I don't have another copy, she can get another copy from somebody else. Very attractive building.
AN HON. MEMBER: Blue and white?
MR. HOLM: No, it's a silver colour. I haven't seen - well, I have seen a bluish-tinged glass before, I haven't seen blue concrete yet, although it can be painted. It's a very impressive-looking facility. Before I leave that topic and go onto something else briefly, I'm
wondering if the minister can tell us, you already told me in here before that there was going to be about $5 million going towards that project and now we hear about $4 million because as it turns out, one of those millions of dollars is actually from the foundation. So $4 million of provincial money this year and that's up to, it doesn't say it's all going to be used this year, we had money up to before that doesn't get expended and then that money can make its way back into the system for the next year's announcements. Can you tell me anything concrete, what additionally is going to happen other than announcements, to assure the people that the facility will be going ahead before the Premier decides to go out, to see what fate it's going to be or see what kind of verdict the voters in Nova Scotia are going to have on him and his government?
MISS PURVES: Mr. Chairman, what we will see this year is the completion of the detailed architectural drawings, a tender called for construction and the beginning of construction.
MR. CHAIRMAN: The member for Sackville-Cobequid, you have five minutes remaining.
MR. HOLM: And that's what we're going to see, but you didn't say which of those items we will see before the election is called. So if we don't see anything before the election call - I will tell you, Mr. Chairman, and I think I'm very fair to make this commitment, that if after the next election, Mr. Dexter, the Leader of the Official Opposition, should happen to be Premier, I think you can say without any hesitation that those commitments will be followed. (Interruptions) They would be followed but we have had some experience with other political Parties, the red and the blue team, who then go back into the bunker. They pull down their veil of secrecy. Sometimes it was a red curtain that got pulled down, sometimes it's a blue haze that covers them and when they go into their secret abode, then things change. Then things can change. (Interruption)
The member for Cape Breton West is hoping that the Liberals form government and that it's a minority government because then he thinks he might have a shot at getting into Cabinet if they form government under those kind of conditions. Mr. Chairman, the reality is we have seen commitments made and then those commitments end up either getting broken or dropped after an election. We saw that with what was once to be a vocational school and I firmly believe, I know this is desperately needed and the only way that you can pay proper respect to all those who have worked for so many years to bring this about is to ensure that it does. I urge the minister to urge the Premier to put some of the effort that he and his staff put into their propaganda pieces into actually getting the tenders called because it is extremely important that something tangible be seen if somebody is to believe in it.
I'm wondering, Mr. Chairman, just one other question before I leave the Cobequid, it said in terms of the total amount of money, and it is going to be a very substantial facility if all this is done, I don't deny that, but in that there is $26.5 million of government money, the $4 million which the foundation under the capable leadership of Mr. Farmer and the generosity of businesses and citizens and their group of volunteers who are working for him, committed to raise and they're already at about $2.5 million. That's nothing to be sneezed at and they're all to be commended for their service and tireless efforts, but the remaining $3.5 million will come from community partnerships. I'm wondering if the minister could explain a little bit more about what those community partnerships really mean and where's that money coming from exactly?
[1:15 p.m.]
MR. CHAIRMAN: The honourable Minister of Health, there's one minute remaining in the NDP's time.
MISS PURVES: Mr. Chairman, I believe the foundation has been having a bit of trouble finding some local partners, but I don't imagine that situation is going to stay that way for long. I think they will be successful and I would like to assure the member for Sackville-Cobequid that this project will be completed. I know it's proceeding slowly, but when we came to government we had a list of schools the previous government had left and with the exception of one which didn't need to be built, we committed to completing those schools and building those schools on that list. It was not, it seemed to us, a particularly political list. It seemed that it was a needed list and that's what we did and that's what we intend to do with the Cobequid centre, we intend to proceed with that. (Applause)
MR. CHAIRMAN: Order, please. Your time is up. (Interruption) No. Order, please.
The honourable member for Richmond.
MR. MICHEL SAMSON: Mr. Chairman, it's a pleasure to have the opportunity again to ask a few questions to the Minister of Health regarding her Health budget and some of her previous commitments made in getting to this House. What we did see yesterday was the minister refusing to acknowledge the fact that although she made a campaign commitment that shutting down an industry would result in more hospital beds, yesterday, in fact she said, no, no, I didn't mean more hospitals, I said I would keep the hospital beds that we had open. Then we find out, lo and behold, she has actually seen, under her administration, 179 beds closed since 1999. So on two fronts, whichever way she wishes to spin it, she has failed to keep her commitment to the people of Halifax Citadel and the people throughout the rest of this province. I'm sure they will remind her of that when she goes knocking on their doors in the next election
Mr. Chairman, one of the other statements that was made by the Leader of the Tory Party of the day was that it was his belief that the health care system could be fixed with $46 million and that the health care system, what it really needed, was a good dose of cutting administrative fat because there was way too much administrative fat in the Department of Health. So I would like to ask a few questions to the minister regarding her own office now that she is the Minister of Health. I'm curious, minister, if you have these figures, of what the cost of the minister's office, along with your deputy, associate deputy and whoever else you have now, what the cost of that was before you came to power in 1999 and what the cost of that office is today?
MISS PURVES: Mr. Chairman, I do have the figures of what that office costs today obviously, but I think the member opposite knows full well that the Estimates Book does not contain four-year-running totals. So I would have to go back and get the information for him on the costs of 1999.
MR. SAMSON: Mr. Chairman, I'm wondering if the minister could ask her finance person who is here with her if he could give us just an indication as to whether the cost in 1999 as compared to today, whether it is lower today or higher than what it was in 1999, without getting into specific figures, and I honestly believe there's a very simple answer to that question. (Interruption)
MISS PURVES: Mr. Chairman, the financial officer says there have been no significant changes in the minister's office that he knows of, but obviously we can go back and get those figures.
MR. SAMSON: Mr. Chairman, I guess let's start off with a few easy questions then. Madam Minister, I'm wondering if you could tell me at what point the position of associate deputy minister was created?
MISS PURVES: Mr. Chairman, it was the end of May in the year 2000.
MR. SAMSON: So we have an associate deputy minister we've never had before in the minister's office, and yet the costs of the administration of the minister's office has not changed from 1999 to today. I will give the minister an opportunity again to indicate whether, as that is one example, if the cost has increased from 1999 to 2003 of the administration of her office?
MISS PURVES: Mr. Chairman, there is a separate listing for the associate deputy's office on Page 12.10. I would point out that the department did have an assistant deputy minister before, which we no longer have, although we do have an associate deputy minister. I would argue that the stability of having one deputy had been a considerable cost and stress saving compared to the numbers of deputies that came and went under former administrations.
MR. SAMSON: Well, there goes the point again, Mr. Chairman. You had a Leader of the Tory Party who said in 1999 that he was going to cut administrative fat in the Department of Health. Now we have a Health Minister who says, well, no, we actually needed more people in administration in the Department of Health. She's saying that one deputy minister wasn't enough, we've actually had to add more people on the administration side because there wasn't enough.
Once again, Mr. Chairman, but one more broken commitment by this government. They said that they could cut administrative fat and they said that's where the real savings were in the Department of Health. Now we know that they have actually increased the amount of staff. Now that we've gotten that acknowledgment from the minister, the other point is that we have said all along, consistently, that this government does not have a realistic outcome-based plan for the Department of Health. They have continued to pour money into the department year after year. Spending has increased in the department, this under an administration which said in 1999 that health care has enough money, it just needs to be better spent and better allocated; cut the administrative fat and we have enough, $1.5 billion is all you need to run the health care system in Nova Scotia.
Well, here we are, under this budget we're going to surpass the $2 billion mark. So I ask the minister, if you do have a plan - which your government continues to show this glossy brochure with feel-good messages that you call a plan - if that plan is viable, then I simply ask you, Madam Minister, can you tell me today, under your plan, whether your department will need any additional money in next year's budget or will it be able to continue operating with the money it has under the plan you're telling us that you have?
MISS PURVES: Mr. Chairman, the member opposite well knows that there are always wage adjustments that need to be made. I'm sure he's also aware of the chart that I tabled earlier that shows that our Health Department administration is by far the lowest of any province in the country, and that is not our information, that is information from CIHI, a very respected national agency. I would also add that our department's administration accounts for 1 per cent of the budget and that would compare very favourably with most administrative costs, for example, school boards or anywhere else, of 3 per cent.
So, Mr. Chairman, there have been staff let go in the department. We try very hard to be administratively lean, and the bulk of the spending in health care goes on programs and services to people, not paying endless numbers of more people here in the city, but systems do need people to run them. The bulk of the new spending in Health is going to things like doctors, nurses, cardiac care, DHA services, mental health services, all the things that the Department of Health and the taxpayer fund in order to improve the health of Nova Scotians.
MR. SAMSON: Mr. Chairman, if this government has a plan, any sort of reasonable facsimile of a plan, it should be able to tell Nova Scotians today, this is how much it will cost next year and the year after and the year after that, to run the Department of Health. If it's just wage adjustments, you must have some sort of projections as to what you can expect for wage adjustments to deal with that. Everyone else does. So I ask the minister again, under your plan, how much will it cost the Department of Health to be able to provide the services next year under the plan that you claim that you have? Could you please give us a figure for next year and the year after under the plan that you supposedly have for the cost of administrating our health care system?
MISS PURVES: Mr. Chairman, the plan we have for health care was outlined in the document called Your Health Matters, which all members are familiar with. The plan we have for departmental spending for the next year is contained in the estimates that every member of the House has. Our plans for spending in the department the year after will be tabled with next year's budget estimates, as is the case, and we will not depart from that. We have a plan for health care in Nova Scotia. Obviously, it requires administration. We are giving multi-year funding to the district health authorities. We do not consider it necessary to give multi-year funding to ourselves.
MR. SAMSON: So we have a plan, yet it doesn't deal with finances, Mr. Chairman, it only deals with administration and providing programs, but finances, no. You have to wait for the budget next year because under our plan, we don't look at how much it's going to cost to run the system and next year. If you want to find out how much it will cost for health, well, you've got to wait until next year's budget and if you want to find out what it will cost in two years, well, you're going to have to wait two years, until that budget. If you want to find out what it's going to cost for three years, you're going to have to wait for the third next budget.
Mr. Chairman, what is that? It is an admission that this government does not have a plan. It cannot tell Nova Scotians today how much the health care system is going to cost next year, the year after, or the year after that. This is a government that said they had a plan. This is a government that said health care doesn't need more money, it needs a plan. It needs better management. What have they done? Year after year, what do we see? A couple of million dollars more - and they say we're investing in health care.
They said to the Liberals, back in 1999, you don't need to invest in health care, there's enough money. The system can work. You need to better manage it. What we see today is an admission that this government, in four years, its number one commitment made to Nova Scotians has failed. This minister and her predecessor year after year stand up and say we have a plan, yet budget after budget they ask for more money and more money and more money because there is no plan. The spending continues. The lineups are still there for surgeries. People are in beds in hallways in emergency rooms because there isn't enough room and there are still doctor shortages throughout the province, especially in my own riding, as I think the minister should be well aware of and the rest of the members of this House. (Interruption)
Well, Mr. Chairman, the former minister says that has something to do with the MLA. Well, I can tell him when this MLA sat in a minority government for 18 months, we brought five new doctors to Richmond County, something that has not been done under this government, because they've cancelled the incentive programs that were in place and they've failed on that.
[1:30 p.m.]
Mr. Chairman, I ask the minister again, under your plan, the plan you say you have, how much will it cost the health care system next year and the year after under the plan you say you have for health care?
MISS PURVES: We have already announced 7 per cent increases year over year for non-wage costs for the DHAs. That is part of our plan. In terms of care, Your Health Matters outlines our plan. In terms of departmental spending this year, our plan is here in the Estimates Books. In terms of long-term care, we have outlined our four-year plan. In terms of the funding that's going to be available for health care in Nova Scotia, we have a good idea of what those needs are going to be.
However, what we have no plans to do - and I presume this is part of the new Liberal election platform that's going to be announced this weekend - is to do budget estimates for all departments for three years in one year. That seems to be what the member opposite is suggesting that we should be doing.
MR. SAMSON: The minister says it is unreasonable to ask her to be able to tell us what it's going to cost her department for the next three years and to give us an idea of what her vision is, what her plan is. That, right there, is a true admission of what sort of Tory Administration we have in this province. To say it is unreasonable to ask how much it will cost the taxpayers next year and the year after for a health care system, this coming from a minister who stands in the House and says we have a plan, we know where the plan's going to bring us, we know what the outcomes are going to be. Yet, when you ask her about the plan, she can't give us any answers. Then, when she doesn't give an answer, the Minister of Tourism and the rest of them chirp out little things, trying to distract from the fact that their Minister of Health can't answer the questions.
I ask you, Madam Minister, you said that you have a plan in this book you referred to, you waved it, your glossy brochure, I think it's Your Health Matters, here's a very simple question, under the plan outlined in Your Health Matters, how much is it going to cost to be able to deliver the plan outlined in that brochure?
MISS PURVES: The plan, as outlined, will cost what we have spent over the last several years, plus what we were spending this year, plus monies that will be invested that we have announced over the next several years; then other things will crop up which we cannot plan for, but which we will have the money for. There is a difference between not having a plan and having a member of the Opposition not like the plan. There is a difference between having a plan of how to spend very carefully the money that we know we have, then having a plan to borrow $600 million for operating costs without a plan.
MR. SAMSON: Well, $600 million later is where you're at Madam Minister, since 1999. (Interruption) Not borrowed, $521 million is borrowed. Ask your Minister of Finance. That's the legacy that you will have, $521 million is what you've borrowed. You're spending over $100 million again this year, most of it from Ottawa. You are saying you have a plan, Madam Minister, and a plan must have a price tag on it, it must have a vision as to what the costs will be. Under your government, we are now to the point that 44 per cent of the total revenues of this province are going into the Health Department and there is no end in sight. I ask the minister again, what is the total cost to deliver a sustainable health care system in Nova Scotia under the plan you claim you have? Tell us what will it cost year in, year out, to deliver the plan you say you have for health care.
MISS PURVES: Mr. Chairman, 44 per cent of a provincial budget is a very high percentage in program spending, it is less than the percentage in some other provinces and higher than some. Health care is very expensive, but it's a priority of Nova Scotians. The answer to the member opposite's question is that if you take a budget, the total program delivery Health budget in any one year and add 7 to 8 per cent, that is very likely what it's going to cost each year going on. That is what all provinces predict, the demand for health care will continue to rise and the costs of providing that health care will continue to rise.
MR. SAMSON: Madam Minister, is it your commitment today that next year when you come to the budgetary process, the Department of Health, under your plan, will not ask for any more than a 7 per cent increase as to what you've outlined right there, and there won't be a need for any funding other than that 7 per cent under your plan? Will you make that commitment here today?
MISS PURVES: What we're talking about today is our plan and this year's plan. What I said is that likely health care increases in future years will be around 7 per cent to 8 per cent and that is what I'm prepared to say.
MR. SAMSON: Is the minister saying that under her plan next year she will be asking for another 17 per cent increase in her current budget?
MISS PURVES: One of the challenges - not to the Health Department but to the health and well-being of Nova Scotians - is to keep that increase to between 7 and 8 per cent, not 17 per cent. That is what we will attempt to do.
MR. SAMSON: She's the one who uses the 17 per cent figure so that (Interruption) Yes, you did, you can check through Hansard. That's why I was confused why you were going from 7 per cent to 17 per cent.
Anyway, is the minister prepared to commit today that under her plan, which she says is working, that she will not require any more than 7 per cent additional funding for the Department of Health next year under her plan? Will she make that commitment today, or
is it going to be similar to the commitment she made to the people of Halifax Citadel with her postcard in 1999 which she hasn't come a country mile close to keeping?
MISS PURVES: Mr. Chairman, I'm glad to see the member opposite is assuming that I'll be doing this budget next year. I will commit to helping to provide the best health care possible to Nova Scotians within a limit of 7 to 8 per cent. Obviously, we have no idea of what might happen in Nova Scotia between now and then. We could have a SARS outbreak, we could have something else happen that we don't know about, so obviously I cannot make that kind of firm commitment the member opposite asks.
MR. SAMSON: Madam Minister, I will tell you why I made that statement, it is because your own Deputy Premier informed us earlier in the day that it was his belief that the election would only be next year in 2004. It was certainly no vote of confidence in your chances in the next election. Why I made that statement, I was instead relying upon the sage advice of your Deputy Premier and his statement that he made earlier in the day.
Madam Minister, in 1999, your Leader, today's Premier, said he would fix the health care system in his first mandate. I ask you today, four years later, is our health care system fixed, in your view?
MISS PURVES: In my opinion, the health care system has come a long way. It is much more stable. The relationships between the providers and the districts and the department are much better. The department itself has been stabilized with the leadership of a deputy and associate deputy. In those areas, I believe we are much better off.
MR. SAMSON: Your Premier, in 1999, your Leader said, in my first mandate, I, John Hamm, will fix the health care system. I ask you again, Madam Minister, four years later, is the health care system in Nova Scotia fixed?
MISS PURVES: Mr. Chairman, I will repeat, in fewer words, what I said before. Our health care system is in much better shape than it was. A lot remains to be done.
MR. SAMSON: Mr. Chairman, on the first page of the blue book, it says - I know the member for Guysborough-Port Hawkesbury may have difficulty with this, but I will read it for him, "As your premier, my first priority will be to fix the health care system. We will make sure that when individual Nova Scotians need health care, it will be there for them." I ask you again, Madam Minister, is the health care system fixed, and is health care, when individual Nova Scotians need it, now there for them under your government?
MISS PURVES: Mr. Chairman, the health care system is in much better shape, and yes, health care is there for Nova Scotians when they need it. It is not always exactly what they want, it may not be in exactly the time frame it should be, but it is certainly there for them. We have an excellent health care system.
MR. SAMSON: Madam Minister, it's not there when the Glace Bay emergency room is closed, it's not there when the Strait Richmond emergency room is closed, and it's not there today when the Parrsboro emergency room is closed. These are all things the Premier said he would fix. It's not there for the people of L'Ardoise, who have a doctor shortage, it's not there for the people of Isle Madame and the Louisdale area, who have a doctor shortage, and every other community that is experiencing doctor shortages. The Premier said he would fix health care.
We now have a minister who won't commit to saying that she doesn't need any additional funding in Health other than administrative increases in costs. She now says, well, no, we might have a SARS outbreak. Everyone knows there are some outside forces that any business plan could be affected by, yet the minister cannot provide us with an accurate statement, saying, this business plan is going to cost x number of dollars, barring any outside influences that were unpredicted.
The fact that she cannot stand here and say, this is what my plan is going to cost and this is how much money I will need to deliver it, is a clear admission that this government does not have a plan. What do they do? They put out a glossy brochure, they take public taxpayers' money and they do advertising on the radio, in papers, and they hire more spin doctors rather than medical doctors, to try to convince Nova Scotians that they have a plan for health care. Nova Scotians are not being fooled. This is the number one priority that the Premier staked his credibility on. This is the number one issue that even the Minister of Health, as a candidate in 1999 - close an industry, open hospital beds. The facts now show that she has not lived up to that commitment. We don't know if she ever had any intentions of doing that. Yesterday she wouldn't tell us or admit that she has failed to live up to that commitment.
The facts clearly are that she hasn't lived up to her commitment to her constituents, and the Premier certainly hasn't lived up to his commitment to Nova Scotians. What he thought was such a simple task, to fix health care in 1999, hundreds of millions of dollars later, four years later, the minister cannot stand and say, we fixed the health care system. That is the overall assessment of this government. That is the message that we will be bringing to the people. I can tell you, in my own communities, we had programs in place, the Rural Physician Incentive Program, that was working. It was working well. Was it perfect? No, but it was working. It brought physicians in.
[1:45 p.m.]
What did this government do? It made cuts to that program. It started reducing the guarantee, it started reducing the amount of time, and where do we find ourselves today? Another doctor shortage in Richmond County, other doctor shortages throughout the province, surprise, surprise. Yet, this Premier said that wouldn't happen under this government. The Strait Richmond emergency room, under John Hamm, has been closed for
longer than it has been open, under this government. That is the legacy for Richmond County. That is the legacy of health care. Someone who said they will fix health care, someone who said, trust me, I am a family physician, I will make sure - he stood in here and he said - under my administration, the Strait Richmond will have a doctor and the emergency room will not be closed. The facts show it has been closed longer than it has been open in the four years of this Tory Administration. That is the legacy that will be left.
Mr. Chairman, I want to take this opportunity to start talking about a few issues which are near and dear to me in Richmond County. The first issue I raised with the minister in Question Period last week, it was painfully obvious that the number one file for the people of Richmond County, the minister had absolutely no idea what I was talking about. That was very disappointing, I must say. I would say it's disappointing even from her staff's perspective, with all the work that has been done by her staff, that their own minister had no idea of this very important file for the people of Richmond County and surrounding ideas.
That file, Madam Minister, is the Richmond Villa, which you clearly had absolutely no idea about when I raised it in Question Period last week. Hansard will clearly reflect that. Any independent source who reads it will clearly know the minister had no idea. Here is a long-term care facility that is of extreme importance, both to the health and the economy of Richmond County, and yet the Minister of Health had no idea what I was referring to. I don't even know if she knew what the Richmond Villa was. I ask today for the minister to explain. Her own department said they would negotiate with the Department of Housing to build a new villa. They prepared a timeline.
Before I continue, I want to say, as the MLA for Richmond and having talked to a number of people involved in the process, that I know the associate deputy minister, I know some of the names I'm familiar with, Mr. Lampier, Mr. Menzies, the associate deputy minister, Madame Logue-Burley, I know these people have worked hard on this file, and I thank them for that, because it's an extremely important matter for the people of Richmond County, for the residents who are in that facility, who know they're in a facility which has already failed an assessment. They know they should no longer be in that facility. There are family members who are very anxious, who have been calling, who are worried that their loved ones are in a facility which is not a healthy environment for them. And there's the staff who must work in this facility, day in, day out, who know themselves that this facility has failed the assessment.
I ask the minister, it is her government that told the people of Richmond County that under their plan, along with the Department of Housing, that site selection was set to begin in June of last year, construction was supposed to start in the Fall of 2002, construction was to continue throughout 2003, with a target of the Fall as the date when residents would move into the new facility.
Mr. Chairman, the fact is, there has been no site selection done, there is no facility under construction. Right now, there is none in sight. I ask the minister, can you please explain to the people of Richmond County and to me, what happened between your department and the Department of Housing that has resulted in the fact that there is not a Richmond Villa anywhere in sight?
MISS PURVES: Mr. Chairman, this was and is a pilot, and it has taken longer than we thought it would. However, the Department of Transportation and Public Works has evaluated a couple of sites, and I can assure the member for Richmond that we will begin construction of the villa sometime this year.
MR. SAMSON: Mr. Chairman, June of last year is when the site selection process was supposed to be completed. We are now in April, a year later. We are soon approaching one full year since your site selection was supposed to be completed. I ask the minister again, what happened, what happened in your own department that has caused such a delay to the construction of the new Richmond Villa?
MISS PURVES: Mr. Chairman, staff say they had not heard those dates but, regardless of that, some sites have been evaluated, and although the project has been delayed, it will proceed.
MR. SAMSON: I would be more than happy, Madam Minister, to provide you with the timetables set out by your own department, if you don't have them. I can make a phone call and have them faxed up to me fairly quickly, although it is Friday. It might take me until Monday. This is the timetable that came from your department, it's not something we've made up. It actually has a nice little table, and it's very professionally set out, specific dates, site selection, start construction, construction going on, when the residents are going to move in. It alarms me that you're not aware of this, and you say that your staff is not aware of this. Needless to say, that causes me a little bit of concern when you say the villa is a priority for you.
Is it the minister's statement today - she keeps referring to the site selection process, now that's news to me - that the site selection process is why we have encountered the delays to date? Is that what the minister is saying?
MISS PURVES: Mr. Chairman, no, it's not. The site selection process has not been the only issue, it's one issue. Another issue was dealing with the Department of Housing and the municipality and trying to get certain conditions in place to meet the objectives of the pilot. It was a number of factors.
MR. SAMSON: Mr. Chairman, the reason this causes such alarm is that the municipality was more than prepared to go in, build a new facility, operate it and do that, since the 2000 report. I know the department had good intentions and we are pleased that the
Richmond Villa will be a pilot, make no mistake, we are looking forward to that. I think it's going to be an example. I certainly agree with the concept. I think it's going to be an example to be followed for communities from here on forward, of long-term care facilities. Yet, when you find out that the Department of Health is negotiating with the Department of Housing, only to be told later that those negotiations have broken off, and now the department almost wants to return to the initial suggestion from the municipality, it is a little bit disheartening.
Madam Minister, I am not making up these concerns. I have family members who are calling me, who are very concerned and who have said, look, you told me last year that you had a chart from the Department of Health, you gave me the dates of June for site selection, you gave me the dates for this, what went wrong? I am the one who has to tell them, well, I have to try to find out what went wrong, because this is the Department of Health's own time frame. The former minister said, we're on target, we're moving forward. He made the commitment last year that those dates would be met, that all was well. All of a sudden, it's gone off the rails. The minister made a statement earlier, and I want to ask her today, will she commit today that site selection of the new Richmond Villa will be underway and the construction will actually begin before the end of this calendar year?
MISS PURVES: Certainly, Mr. Chairman. This will occur before the end of the fiscal year. We don't have an exact date or dates, but before the end of the fiscal year, yes.
MR. SAMSON: Well, the minister will know that the fiscal year ends March 31st, so that's almost a year away from now. Are you saying that you cannot commit that a new facility will begin earlier than one year from now? I ask you again, Madam Minister, you have seen the delays that have taken place here, you are aware of the anxieties of the family members, of the staff and of the residents who are there, will you commit that site selection and construction of the new Richmond Villa will begin this calendar year?
MISS PURVES: Mr. Chairman, I will re-commit to having these things take place before the end of the fiscal year, knowing that, very likely, construction would not be starting mid-winter.
MR. SAMSON: Mr. Chairman, in this day and age, construction can start any time of the year, and the minister well knows that. To say that because it's winter there won't be construction, that's why she won't commit is disappointing to say the least, and I know it will be disappointing for the people of Richmond County. I know my time is very short, Madam Minister, and I may have the opportunity to come back to this.
One of the elements that they're looking at phasing in with this pilot project - there is a daycare centre run by the Isle Madame Daycare Centre that is in St. Peter's - is they would like to have, as part of this new villa, the daycare be a permanent part of this. I think the concept is great, the idea that children would be interacting with the clients at the villa. A learning process would be shared there. The whole healthy environment for the clients
would be there. Will the minister commit today that her department will continue to work with the Isle Madame Daycare Centre to ensure that the daycare does become part of the new Richmond Villa complex?
MISS PURVES: Yes, Mr. Chairman, I will commit to that. That's still part of the planning process. It is one of the aspects of the pilot that makes it the most interesting.
MR. SAMSON: Mr. Chairman, I had received some information that there was some concern that the talks along the line with the daycare were not going as smoothly as we had hoped, and that because deadlines are being reached, there had been some sort of communication from the department saying that unless clear financial commitments were going to be made by the daycare that they may be phased out of this project. I would urge the minister to keep that as part of it. I am pleased to see even the minister thinks it is an interesting concept. I fully agree.
Again, in my short time that I have, Madam Minister, you have a very hard-working villa board there, led by Chairman Steve Sampson and the board members who are there, CAO Louis Digout, Councillor Steve MacNeil, and some community members who are on that board. They are very committed to seeing a new facility, they have been so since the year 2000. You have a staff that is under a great deal of anxiety there because of the facility. You have the residents who are concerned and you have the family members of those residents who want to see a new facility. At the same time, this is an important economic generator for Richmond. I urge you to continue to push on this, and to take it . . .
MR. CHAIRMAN: Order. Order. The time allotted for the four hours of estimates has ended for the day.
The honourable member for Richmond on an introduction.
MR. MICHEL SAMSON: Mr. Chairman, in the west gallery, I have the pleasure of introducing a couple of visitors to our city. They managed to get across the causeway. Obviously security is lacking at our good causeway. Pay no attention to the fact that the Liberal AGM is taking place this weekend, as to why they might be in our good city. I have the pleasure of introducing Mr. Aubrey Cameron, who is the President of the Glace Bay Liberal Association, and Mr. Francis Gillis, who has been a long-time campaign worker. Both are tremendous supporters of my good colleague, the member for Glace Bay. I would ask them both to rise and receive the warm welcome of the House. (Applause)
MR. CHAIRMAN: The honourable Deputy Government House Leader.
MR. WILLIAM DOOKS: Mr. Chairman, I ask that the committee now rise and report progress.
MR. CHAIRMAN: The motion is carried.
[1:59 p.m. The committee rose.]
