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HALIFAX, MONDAY, APRIL 26, 2004

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

3:22 P.M.

CHAIRMAN

Mr. James DeWolfe

MR. CHAIRMAN: Order, please.

The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, would you please call the Estimates of the Minister of Health.

Resolution E9 - Resolved, that a sum not exceeding $2,341,690,000 be granted to the Lieutenant Governor to defray expenses in respect to the Department of Health, pursuant to the Estimate.

MR. CHAIRMAN: The honourable Minister of Health.

HON. ANGUS MACISAAC: Mr. Chairman, I am very pleased to rise today to defend the Estimates of the Department of Health. I also should note at the beginning that, this year, the Estimates for the Senior Citizens' Secretariat appear as a separate line item in the budget, so we should not lose sight of that fact, and make sure we call that estimate while we're here.

While we're waiting for my staff to join me and for the benefit of those who are maybe watching the proceedings, perhaps Mr. Chairman you would indulge me if I just for a moment indicate the process we're involved in. For anybody who was watching, they saw a debate that took place on a motion that we go into Supply. That motion and the debates that centred around it has some historical significance with respect to the development of the parliamentary system. The parliamentary system was all about providing approval to the King for the expenditures that the King wanted of parliament in the coming year.

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The tradition developed in parliament was, before they would ever entertain a motion to consider the spending for the sake of the King's government, that members of the House of Commons in Great Britain would have the opportunity to stand and to speak about any subject that may come before the government. It was an opportunity for all members to have their say before any consideration was given as to the amount of money that would be apportioned to the government for spending approval.

So, that debate took place. The rules in this House allow for up to 15 minutes for each Party to state what they consider to be important issues. Those debates can take place at any time that we go into the Committee of the Whole House. We're now in the Committee of the Whole House, the mace is off the table, there's the Chairman rather than the Speaker and that means that the rules are relaxed and members can speak as often as they wish relative to the examination and that, of course, provides an opportunity for a much less formal process where there is a real give and take relative to the information. For the benefit of anybody who might be interested in the proceedings, while we were waiting to get established here I thought I would provide that bit of background.

First of all, I want to introduce staff who are with me this afternoon. We have Byron Rafuse who is our Chief Financial Officer and Janet Knox who is the Executive Director of Acute and Tertiary Care. We also have a number of Department of Health officials who are in the gallery and who are watching the process.

One comment that I make to all of my staff when I'm getting ready for the estimates is that the process itself of having to prepare for estimates is one which provides a tremendous level of accountability relative to the whole process of governing, because not only must I defend the expenditures, but all members and all employees of all departments know that they, on an annual basis, must justify all of the expenditures that are made by their department and under their jurisdiction. It is the evolutionary process that has put us in this situation, has served us very well relative to the issues of accountability with respect to expenditures.

Our government recognizes that health care is, indeed, a top priority for Nova Scotians. This is why this year, despite the many financial pressures the province faces, we have been able to increase our health care spending by $230 million over last year, which is an increase of 11 per cent. The budget for the Department of Health is now $2.3 billion, accounting for nearly 40 per cent of the provincial budget. Program areas in our budget, for example, funding to the district health authorities is larger than the budgets for most government departments. Indeed, when I first defended estimates before this House I was defending estimates to the tune of $100 million. Last year I found myself defending slightly over $1 billion and this year it's $2.3 billion. That gives you a sense of the size of the estimates that we are involved in examining through this process.

AN HON. MEMBER: You're the big spender.

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MR. MACISAAC: Yes, indeed, if only I could give some of it to you to spend on roads, I'd be very happy.

The process for approving the business plans for the district health authorities is underway. The senior leadership team at the Department of Health has recommended that the business plans for the majority of the district health authorities go forward to Executive Council for approval. The district health authorities are finalizing their submissions for that process.

I also want to assure the members that the funding for the district health authorities has increased. You may remember that through the past fiscal year, we have addressed some of their funding pressures by adding $19.2 million for overtime and oncology issues and an additional $9.9 million went to cover benefit costs. We are also continuing our commitment to increase their non-salary funding by 7 per cent for a three-year period.

We have targeted our budget increases to where we believe they will have the best impact. More than $0.5 million will go to expand our public health capacity, allowing us to hire medical officers of health, an epidemiologist, environmental health specialists, a communicable disease nurse and a physician with expertise in disaster planning. This is an important increase in our resources as new diseases, and even terrorism threats, are the realities that we must prepare for in public health care. This year we will increase our immunization budget by $350,000 to expand the chicken pox vaccine and add a new vaccine for 14- to 16-year-olds that will immunize them against tetanus, diphtheria and whooping cough. We will spend a total of $5.8 million on immunization this year.

[3:30 p.m.]

Mr. Chairman, last week we honoured volunteers as part of National Volunteer Week, April 18^th to April 24^th. Volunteers serve an important role in our emergency health services. In rural communities, local volunteer fire departments are often first on the scene of an accident; they are part of the network known as medical first responders and this year we are investing $300,000 to improve training for these volunteers. Children's health needs are a priority for this government and I'm pleased to let you know that we have allocated $300,000 to improve rehabilitation for children at the IWK, enabling them to hire more care providers. This will enable the IWK to address long wait times for rehabilitation for children with disabilities and begin planning with the DHAs on longer-term rehab services for children. In addition, we will be adding $394,000 to expand genetic counselling services at the IWK.

Mr. Chairman, this government is equally concerned about the health care of seniors, and I can speak to this issue as both Minister of Health and the minister responsible for seniors and that's why I was doubly pleased with the cost-of-care initiative. We have listened to and responded to the concerns Nova Scotians have had about the way the province has been funding nursing homes. For too long, too much was asked of seniors themselves. Last

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year we began to address this issue by introducing a $12.75-a-day subsidy to health care costs. Our plan was to set up the subsidies over a three-year period until the full cost of health care was covered by April 1, 2007. With this budget we have moved up the rollout of this initiative by close to two years. Now seniors residing in nursing homes will have their full health care costs covered as of January 1, 2005. This will enable them to retain 15 per cent of their income, a minimum of $150 a month, and will replace the personal use allowance. Until that comes into effect on January 1, 2005, we will remove the restrictions on the personal use allowance.

Health care services also have to be delivered in facilities. This year we will begin construction of the new Cobequid Community Health Centre to help handle the demand for services that comes with a growing population in the Halifax Regional Municipality, and in the Colchester-East Hants District Health Authority planning work will get underway for a new facility there.

It was interesting to hear the federal Health Minister stress the importance of having accurate information on wait times for health care services last week. The Province of Nova Scotia already began to address this issue last year. We made a commitment in Your Health Matters to address wait times and to begin the work to set province-wide standards for wait time information. A committee consisting of physicians and senior health care administrators from across the province and Department of Health staff met throughout the year. Their recommendations to government were released in January of this year. In this budget we are investing $465,000 to begin development of an approach to gather standardized province-wide wait time information.

Mr. Chairman, as a province, we have already recognized wait times as an area that needs to be addressed. We have committed money and work is underway. This example contrasts the difference in the approach of the two levels of government. As a province, Nova Scotia is all ready to commit whatever dollars we have to improve things while the federal government talks a good game, but they have yet to see the sustainable long-term funding to enact real change in the health care system. Nova Scotia is ready at any time to talk to the federal government about improving the health care system - we hope that it is sooner rather than later.

Another area, Mr. Chairman, where Nova Scotia is seen as the leader nationally in addressing health care system challenges is in the area of health human resources. We have already appointed a chief health human resources officer to coordinate health human resources planning. The challenge of staffing the health system across North America will grow significantly in the next decade and Nova Scotia expects government to take action now. While our efforts up to now have done well through individual strategies for nurses and physicians, we need a comprehensive and concrete strategy to meet our future needs for all health care professionals.

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Ensuring we plan for future health human resources needs is critical, because more than 75 per cent of our Health budget is spent employing the health care professionals who provide the health care services. We recognize the need to train and educate more health care professionals and that's why we added eight seats in the first-year class of Dalhousie Medical School last year; we will sustain that increase for this year's first-year class of medical students. We have also invested in spots for 25 Nova Scotians for more medical technologist training in New Brunswick. We have made great progress in the last five years building a well-run health care system. This budget allows us to continue that work by enabling Nova Scotia to maintain its current level of health care services while planning to meet the future demands.

Mr. Chairman, that concludes my opening remarks and I look forward to the examination of the estimates with members of the House.

MR. CHAIRMAN: I will remind honourable members that we're dealing with Resolution E9, for the record.

The honourable Leader of the Opposition.

MR. DARRELL DEXTER: Mr. Chairman, I was engrossed in the Estimates Book as the minister was speaking. Did he have an opportunity to introduce his staff already? Did he do that?

MR. MACISAAC: Yes, I did.

MR. DEXTER: He did, okay. I know who they are, I just wanted to make sure that everybody else knows who they are.

I want to start with just a few comments if I could, Mr. Chairman, because this budget marks an important departure particularly in the area of long-term care, one that many people in this province have been campaigning for for some number of years now - and myself I would include among those numbers - but certainly I think some of this bears reflecting on for the minister so that he understands, and the staff I'm sure understands, how important this initiative is to people.

I remember all too clearly meeting with the support group for family caregivers in the Valley, and a woman by the name of Maxine Barrett who brought to my attention what was going on in long-term care and about the effect that this was having on the families of those who were unfortunate enough to require this care for their loved ones, and I must say that it started out with a number of what I can only describe as heartbreaking stories about the stress and the effects that going through the process of financial assessment and placement was having on the individual caregivers, but of course also on their loved ones, in many cases their parents, or close relatives or neighbours, or people they had some considerable affection for

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who are being essentially - they felt stripped of not only their assets, but also their dignity as they went through this process.

I must say when Ms. Barrett first started telling me about it - it's an issue that was easy to confuse because it dealt a lot with, as life is, the complexities of one's personal relationships because it was sometimes difficult to discern what people were getting in terms of actual health care and what they needed in order to sustain themselves, which everyone would need, like room and board and all those issues so it was not readily apparent to a lot of people exactly what the injustice was that was happening to these people.

I remember walking away from that meeting, not completely certain about the issue and it wasn't until a few days later, as fate would have it, that a women by the name of Jean Heckman, who was a constituent of mine, happened to walk through my constituency office door and she related to me the story of - and she's been, so the minister doesn't think I'm disclosing anything that isn't already known, Ms. Heckman has been very vocal in the press, her story, I think, was on the front page of The ChronicleHerald at one point in time. Her husband had developed Alzheimer's, and she had kept her husband at home for many years, ensured that he didn't go into the system, had cared for him, had provided him with everything he needed in order to continue to live a life of some dignity. Then, of course, eventually, this person needed long-term care. What resulted there was essentially a financial assessment and a stripping away of the assets that she and her husband had accumulated over their lives, to such a point that she felt that she was not able to continue with the lifestyle that she had had before, but not even able to manage to continue to maintain her home and do what I think most of us would consider to be a kind of reasonable expectation of an individual who had essentially dedicated that last number of years of her life to looking after her husband.

I can't help but remember Leamon Demont, who was another constituent of mine, who some weeks later came through my door and, Mr. Minister, I want you to know, what had happened to Leamon was that his mother had been taken, through adult protection, had been taken into long-term care. She lived a considerable way from him and he couldn't look after her - he wasn't close enough to be able to do that, and at some point in time officials decided that she needed to come into care. She had a very modest asset base and she had deeded a couple of pieces of family property that had been in their hands, in the family, since the 1800s. The department decided that they were going to have to sell that property, a very modest assessment, but they were going to have to sell it in order to pay for long-term care costs. Leamon's mother passed away, but the department didn't stop. They went after Mr. Demont.

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[3:45 p.m.]

I remember I went with him to the Social Assistance Appeal Board hearing. I sat there with him and my first question to the Chair of the Social Assistance Appeal Board was how does my constituent even get here? What right do you have to bring him before this board? What is your jurisdiction with respect to this person? I remember the Chairman said, I don't have to deal with questions of jurisdiction, that's for some other court. Well, I objected, as you might imagine, because every tribunal first has to satisfy themselves that they have the jurisdiction to deal with the matter that's before them. Nonetheless, not going to do that, instead went ahead with the proceeding, and I remember helping Mr. Demont state his case so that the Social Assistance Appeal Board Chair could understand it, how unfair and how undignified this all was, but the board went ahead, made its decision and the decision was that he was going to have to sell this property.

I remember all too clearly, Mr. Minister, saying to the officials from your department, how do you think you are going to enforce this decision? How do you think you are going to enforce it? The only chance that you have of enforcing it is taking the decision of the Social Assistance Appeal Board and founding an action on it and suing him, and trying to make that judgment stick. I bet - and I would bet today - that no court would allow that to happen. I remember rather than taking the confrontational view, the officials from the department said what we're going to do is we are going to ask very nicely for him to sell this property and to turn over the money, and I said well, I appreciate that because, in my view, that's all you can do.

I remember, the Denny family in Sydney Mines - you may remember this - when their mother needed nursing care, the inheritance that they had received from their father had to be repaid, in order to pay for her nursing care, even though the father had died some time beforehand.

I remember Gerry Harrop, who was Tommy Douglas' pastor at the First Baptist Church in Regina, and he was in need of nursing home care because of advanced Parkinson's and because he had sold his home and his car and the other assets earlier on rather than distributing them to his children, they were going to take every cent that he ever earned in his life. This was the man who had stood with Mr. Douglas when he was putting in place the Medicare system, of which we so proudly boast, of which you have the responsibility to defend. He thought - I think when this was done, Mr. Douglas thought that this meant that health care, in fact, for people would be free.

We use the word "free" and perhaps it is not the right word, that it would be part of the Medicare system, because we understand that health care is not free. Health care is paid for out of the commonwealth of the people of this province. We have collectively decided that there are some things in life that are too large for us individually to be able to deal with, so we come together as a society to fund a particular service; in this case the service is health

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care. So it's not free and I want to acknowledge that. I'm sure that when Mr. Douglas was arguing for this, he understood that health care was going to always undergo evolution over time.

Mr. Chairman, some of you may know Ernie Taylor and his unrelenting campaign to have these costs covered. Mr. Taylor had a tireless campaign in the Bridgetown community to try and bring awareness to this unfair situation, and I would be remiss if I didn't mention the members of the Northwood Family Council who, over and over again, raise this matter with government and raise the issue with our caucus and I think with many others.

The campaign to change the way in which we do long-term care doesn't belong to any one person in this room - it belongs to the many people across the province who took it upon themselves to make their voices heard. I would like to acknowledge early on after we started to raise this issue and the implications of it became clear, that the then Leader of the Liberal Party came forward to support the initiative and I believe that it formed part of their election platform in the last campaign as well. We may have disagreed about timing, but the one thing that we did agree with was that the old system and the way that it operated had to come once and for all to an end.

I believe that the first of the next calendar year when this comes to an end, that people across this province will be thankful and will be indebted to the many people out there who took it upon themselves to raise their voices, who had the courage, Mr. Minister, to go out under the glare of the media to talk about the experiences that they had, and in many cases, very personal recollections. You may know, as I do, that just recently, Mr. Sid Coutts has been sitting up in the gallery to talk about what happened to him and his wife, who is in need of long-term care. Very personal stories, and they were prepared to come forward because they saw this as something that had to change

I believe that the change here, we think of it, of course, in terms of our citizenry and, of course, in terms of the parents of loved ones, the people we know. I believe that this will set the course, not only in this province, but probably in the rest of Atlantic Canada. It has always amazed me that Atlantic Canada, including New Brunswick, Prince Edward Island and Newfoundland and Labrador continue to have the kind of system that they had, in the face of what happened in the rest of Canada, which was much more equitable. It is true, as it is true with Medicare, that in the years to come there are many people who will benefit from this change.

There may be people sitting right in this room, right at this moment, who will benefit from this change. There are, undoubtedly thousands upon thousands of Nova Scotians who will benefit as a result of this change in public policy that's made in this budget. The reality is, Mr. Chairman, that many of those people will never know, they won't know the stress, they won't know the campaign that took place, they won't know the fight that took place in the political arena in order to make this happen. But they will benefit from it. That is, I believe

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one of the great strengths of our system, that we can make change and understand that in the far reaches of time, beyond perhaps even our lifespan, that people will benefit because we had the foresight to change the way we do business in government. I think it speaks well that all of the people in this House could stand up and applaud the Minister of Finance as he spoke about this particular piece of the budget.

I wanted to start with that, because I think it's important that the minister understands that this is a moment in the evolution of our health care system that will be very important to many people as the years go by. Having had the opportunity to do that, I just have a few brief questions with respect to what this is going to mean to people, and whether or not the minister has thought about this. This is the first one. Because the new system will kick in on the first of next year, one can imagine that people who are thinking about moving into the system would delay moving in, knowing that they would have to put their parents or their loved ones through this financial assessment process.

Is the minister concerned that what will happen is that there will be a kind of reservoir of people who will wait until the first of January before coming into the long-term care system, and what that will mean to the actual resources to have them placed in long-term care facilities, and in the meantime, the resources of home care may well be called upon to respond to the needs of those people while they are being kept at home?

MR. MACISAAC: Thank you very much, Mr. Chairman, and I want to thank the Leader of the Official Opposition for his comments. I can assure the honourable member that indeed I have a great appreciation of how significant a step this is, relative to the development of our Medicare system. As the honourable member points out, it is not something that any one individual can stand up and claim credit for, it is a situation where many people have been very effective in bringing the issue forward, and the honourable member certainly deserves credit for that.

He made reference to Tommy Douglas. Tommy Douglas had the great foresight to bring forward a system of Medicare in the Province of Saskatchewan and it was a very tough battle for him because there were work stoppages associated with that. There was great resistance in terms of bringing that system forward, but it was indeed brought forward. Then you can look at the development of Medicare nationally and the former political minister in the Trudeau Government from Nova Scotia, Mr. MacEachern, played a very significant role in that government, in terms of bringing it forward - it would have been in the Pearson Government in those days, bringing that forward.

When it was implemented in this province, it was a Progressive Conservative Government, and it was brought in under the leadership of the former Minister of Health, the late Senator Dick Donahoe, who was very instrumental in developing Medicare in this province, and indeed brought the system in with very few hiccups, probably one of the smoothest transitions with respect to the development of Medicare that occurred anywhere

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in the country. I always maintain that part of the reason he did that as effectively as he did is because in the initial stages of the debate, he was not what you would describe as a full-fledged supporter of Medicare, and not being what you could describe as a full-fledged supporter of it, he was extremely familiar with what he would have described as many of the pitfalls of the system.

That perspective, I believe, allowed him to address the implementation of medicare in this province in a way that allowed it to come forward. He embraced the concept, defended the concept. Indeed one of the most effective speeches I have ever heard in this House was the late Dick Donahoe defending medicare - I believe it was the anniversary of its implementation in this House. It was a great discourse and I was just amazed at how he had that capacity to embrace this system which clearly improved the lives of Nova Scotians in a very significant way, even though in the initial stages it was not something that he had embraced.

I think that of course speaks to our whole system of collective and Cabinet solidarity and the need to get behind government initiatives. The point that the honourable member makes is a very valid point that indeed, significant reforms that come about, very often come about as a result of being implemented and being embraced by people of all political stripes and people of varying backgrounds. This clearly is an example of that, and I think he is quite correct to draw that analogy. I'm also pleased that he has drawn the distinction with respect to medicare and the costs associated with medicare. For us to describe it in the use of the word free is very, very misleading, I think, and does not do the program a real service. All citizens must place a value on the services that they receive from that program, because without placing a value the system becomes ripe for people to use it in an inappropriate manner. The expectations that arise from the attitude of it being free and the attitude of it not having a cost, we all pay a great price for that.

[4:00 p.m.]

I think it's appropriate that all us avoid the use of the word "free". The honourable member is not alone in having used that - I must say I had a bit of a hiccup in the middle of the Minister of Finance's speech when he used the word free in relation to this service. It's a very important distinction to make, that indeed it is not free and that all Nova Scotians and all Canadians pay a price for the delivery of Medicare and health care in this province.

To the specific question of the Leader of the Official Opposition. Indeed, he points to a challenge that we have as a department relative to the implementation of this program over the period of the next number of months, and that does present us with a very significant challenge because, as he points out, if people decide to back away from seeking the services of a nursing home, then the services they require need to be provided in some manner or another.

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So it is appropriate for us to behave and act in a way that we minimize the fears that people have relative to providing these services. While we cannot wipe the slate clean - we simply can't afford to do that - I believe that we can behave in a manner that will entice people to behave as close to normal as possible during this transition period. The staff in the department are very much aware of that; they're very much aware of the fact that if we're not successful in doing that there is a price to be paid elsewhere. Indeed, it is a challenge.

We're confident that we're going to work toward minimizing the dislocation relative to this challenge as much as possible. I would not be entirely forthright with the committee if I were to say there isn't a problem and there isn't going to be one. I can assure the committee that we're very much aware of this, and we're going to work in a manner that will minimize any disruption relative to the normal flow of people seeking the services of a nursing home during this transition period.

MR. CHAIRMAN: The honourable member for Halifax Needham, on an introduction.

MS. MAUREEN MACDONALD: Mr. Chairman, I would to draw the members' attention to the west gallery, where we're joined tonight by Mr. Maurice Hickey, who is a resident in Halifax Needham, the North End of Halifax. He's a crossing guard in our community, looking after little kids and their safety. I would like Mr. Hickey to stand and receive the warm welcome of the House. (Applause)

I was just going to say it's too bad that Bill Estabrooks, my colleague, the member for Timberlea-Prospect, isn't here to see the lovely Montreal Canadiens sweater that Mr. Hickey has on.

MR. CHAIRMAN: Welcome to all our visitors today in the Legislature.

MR. DEXTER: Mr. Chairman, it doesn't matter if Mr. Estabrooks is here or not, I appreciate it. (Laughter) Especially after last night.

I'm going to move along a little bit, because there are a number of things that I wanted to cover and I'm not sure that I'm going to have a chance to get back to some other things, but one of the things I wanted to talk about was that there's a graph in the Budget Speech that talks about the health care administration. I was just curious about it, because it says - in fact I don't think it would be overstating it to say it brags that Nova Scotia has the smallest health care bureaucracy in the country. I was just wondering - it says 57.85, and I assume that's dollars per person, is that right?

MR. MACISAAC: Mr. Chairman, yes, that is the figure. It's not our figure, it comes from CIHI, and it is a per capita figure, the cost of administration on a per capita basis.

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MR. DEXTER: That's interesting, because I was wondering whether or not the Department of Health had a figure for its administration.

MR. MACISAAC: It's a line item in the budget. We'll find it for you. The estimate for 2004-05, total administration for the Department of Health is $30.9 million - or $31 million to round it off.

MR. DEXTER: Can I ask whether or not that would include the administration of the district health authorities?

MR. MACISAAC: No, it does not. The district health authorities are a separate administrative item.

MR. DEXTER: I wonder if I could just have you point out to me the page with the general line item with respect to the Department of Health?

MR. MACISAAC: In the Estimates Book - I will find it in a second. Mr. Chairman, in the Estimates Book itself, Page 12.2, there is a presentation of the administrative costs, however, you will need a calculator to get a total. We're looking elsewhere to find just what that total is relative to those. While we're looking for it, if you want to look at those, you can.

MR. DEXTER: I would encourage you to continue to look. One of the great difficulties with trying to examine the estimates of the Department of Health has always been around the question of what are the administrative costs associated with the department. Of course, the fact that we can't find out what the administrative burden is in the district health authorities continues to exacerbate that problem and perhaps the minister has - I see him getting advice - a comment to make on that.

MR. MACISAAC: Mr. Chairman, the honourable member is correct, the figure I gave him, $31 million, is for the administration of the department itself. I don't have a precise number for him relative to the DHAs, but approximately 7 per cent of the DHAs' budget is administration. If you do the arithmetic on that, it comes out to about $70 million.

MR. DEXTER: So that would put the overall administrative budget somewhere around $100 million? Again, I find that every year I try to look at these things and every year I find it frustrating. I just want to explore, if we can, a little bit about this.

When I go to the doctor's office and they ask me for my health card, how does that get charged to the system? How does that actually happen?

MR. MACISAAC: The payment to doctors comes under the category of Medical Payments. It would be part of that budgetary item.

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MR. DEXTER: I certainly understand that much of it. What I was wondering is exactly the route of the money from the Department of Health through to the doctor. You have an administrative capacity within the department, but the reality is that you don't actually handle that money, I mean they're not sending you an invoice and you're not writing a cheque and sending it back - isn't that the case?

MR. MACISAAC: I'm not sure if this is what the honourable member is looking for or not, but when you go to the doctor's office each procedure or service that is provided by the doctor has a specific claim number to it. The doctor would submit that to Atlantic Blue Cross Corporation and Atlantic Blue Cross would then submit a payment back to the doctor. We, through the Department of Health, through medical payments, provide Atlantic Blue Cross with that money that's used to pay the doctor.

MR. DEXTER: Now we're getting somewhere. That's exactly what I was wondering about. What I wondered was how do the administrative costs of Atlantic Blue Cross get reflected in your budget or in your calculation of administrative costs? The money that you pay Atlantic Blue Cross to administer the medical payments, are they accounted for - I'll start this first - as administrative costs in the Department of Health.

MR. MACISAAC: It is a number that's included in the $31 million and it's approximately $8.7 million.

MR. DEXTER: Is that broken out somewhere in the estimates?

MR. MACISAAC: I'm told that it's included in the Chief Finance Office on the line item in the Supplementary Detail.

MR. DEXTER: So it would be included in the $12 million line item under the CFOs?

I noticed, curiously, that at the end of the estimates there is something called Funded Staff, and there's a whole list of funded staff which include people in the CFO and in the Chief Information Office and all of that - is there a reason that's broken out? These numbers appear to be broken out separately, so I assume they're not included in the other line items. Is that a fair assumption to make?

[4:15 p.m.]

MR. MACISAAC: The item to which you refer is provided for information, so you have an understanding of how many people there are working in various parts. The money that's used to pay for them is included within the budget items. They're full-time equivalents.

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MR. DEXTER: So 16.1, for example, in General Administration is the number of FTEs that are assigned to the Department of Health General Administration is the way I understand that, and I see that the minister is nodding so he's in agreement. Now at least I understand why that was broken out separately.

As has already been raised with the minister outside the House, there was considerable interest in the fact that one of the line items in the General Administration that was increasing - and I assume this would be included in the overall administrative budget - was the whole question of Communications which went from $494,000 last year to some $622,000 being forecast next year. I know that the minister was asked how many people there are in the Communications Department of the Department of Health, and I didn't have the benefit of that answer, so perhaps he could tell us, and tell us why it is that the Communications Department continues to grow quite significantly at a time when that money could be used in the Office of Health Promotion or could be used in other initiatives within the department?

MR. MACISAAC: The question relative to the increase in that budget, which is just over $100,000, one part of that is to make provisions for the report to Nova Scotians that we've committed to putting out as a follow-up to Your Health Matters on an annual basis. For the information of the House, I just want to point out that that particular report was done completely by the staff. They did all of the writing, editing, layout, getting it ready for the printer and everything - that was all done in-house. The staff did all of that work; we didn't contract any of that out. We would plan to do that in the same way next year. The costs associated with the publication then are for the printing costs and for the distribution costs relative to it.

We also have a maternity leave which is reflected in those numbers. The breakdown of employees - many of the employees are employees of Communications Nova Scotia, even though they are charged against our department. So, in terms of that breakdown, there are four Communications Nova Scotia employees and three employees of the Department of Health.

MR. DEXTER: When you talk about those employees, are they directly Communications staff or are they administrative staff?

MR. MACISAAC: One position is a secretarial position and the other two are Communications staff.

MR. DEXTER: Mr. Chairman. I want to move along because, again, I don't have a lot of time to deal with this, but I wanted to go Page 12.6 in the Supplementary Detail. There is Net Program Expenses, Acute and Tertiary Care, and there are two line items there - Acute and Tertiary Care Administration, which I assume goes into the general calculation of administration of the Department of Health, and the next line item which is Acute and Tertiary Care Management, and I was wondering if you could explain what the difference between

[Page 15]

those two line items is and whether or not the management side is calculated as part of the general administration budget or rather as part of the administration budget of the Department of Health?

MR. MACISAAC: I have the Estimates Book out and you're at the Supplementary Detail, so just give me a minute.

Mr. Chairman, the two items really relate to the fact that there is one that is purely administrative in nature and that's the Acute and Tertiary Care Administration; the other is the management who actually carry out and deliver the programs of the department - I see I've not answered the question fully.

MR. DEXTER: So you're saying that these are doctors who actually do the delivery? I don't think that's what you're saying. I just want to know why it is that they're distinguished - well, I guess the first question is are these included in your calculation of administrative costs and, secondly, if not, what it is that you use as the defining line between administration and management?

MR. MACISAAC: First of all, both items are under the administration budget of the department. The first item would be the executive director and her staff, but the other are those who establish the standards and monitor the standards of care as they're being implemented - that is more or less how it works. They report to the administrators as such, but they develop the standards and ensure and monitor the implementation of those standards.

MR. DEXTER: I'm just going to go through and check these off and you can stop and tell me if any of these are not included in the administration of the Department of Health and I'm going to just start on Page 12.3 of the Supplementary Details of the Estimates. I'm just going to read off some of these and if there's something in these after I finish that is not included in administration, maybe you can tell me.

Obviously, General Administration, which is the first one; the Chief Finance Office, which is the second one, and all of the services supporting the chief financial officer's office; the Chief Information Office, and the support for that office; the Chief Health Human Resources Office, which we've had some discussion about; the Chief Policy, Planning and Legislative Office; the Associate Deputy Minister; the Acute and Tertiary Care; the Continuing Care; Population Health doesn't have anything in it any more; the Quality, Emergency Health Services and Health Protection items; Primary Care; the Mental Health Program - and we're going to just stop there for now and see if there are items in here up to Page 12.8, that don't fall in the category of administration and what they would be.

MR. MACISAAC: I understand, Mr. Chairman, that if you were to take the total of all of those sums and put them together you would get $31 million, so they're all part of administration.

[Page 16]

MR. DEXTER: So that's what makes up that $31 million cost. In Medical Payments, which is the next item, there is nothing in there that would be considered of administrative nature, so this is a straightforward payment directly to physicians - is that right?

MR. MACISAAC: That's correct, Mr. Chairman.

MR. DEXTER: Now, I wonder about this, and I wonder, when we made the payments to physicians - physicians, of course, are in the business of running their own offices, and they would pay their own administration out of those payments, is that correct, or am I misunderstanding how that works?

MR. MACISAAC: Yes, that cost for the office of the physicians is embedded within the tariffs that are paid, that's correct.

MR. DEXTER: I assume when you're doing your overall planning that you would have a look at that. Do you know what percentage of those payments go to support the administration of that program?

MR. MACISAAC: The overall answer to the question, Mr. Chairman, is yes, but each tariff item has a separate administrative element associated with it, and it's going to be different for each one of those. I don't have all of them available here, but we could certainly attempt to make that information available to the honourable member.

MR. DEXTER: Well, if the minister would make that undertaking to provide me with that, I would be interested to see it. See if I have this right - now overall, the medical payments, they represent the overall cost of the delivery of a number of different kinds of procedures that might be done in the office of a physician, and I think what the minister was saying is that depending on what service the physician is actually supplying, the administrative allowance that goes along with that charge is different. One assumes that they use more of the resources of the individual physicians, but I mean this is a day and age when we have computers, we have complicated accounting software.

I know, in fact, the Auditor General has said that they need to hire and contract out specialized staff sometimes in order to be able to review and audit books, but I'm assuming that when these items are sent out and determined, that that actual breakout takes place at the Department of Health level, like you actually know when you're sending the money out how much of it is allocated. I mean maybe the physician spends more on administration, but only so much of it can actually be allocated for administrative costs, is that right and is that what the minister is undertaking to provide us?

[Page 17]

MR. MACISAAC: Mr. Chairman, the amount of money that's at question here is something that is predetermined as a result of the negotiating process. So once the agreement is in place and the money begins to flow, then each service has an administrative element to it, and that is what we would undertake to make available to you.

[4:30 p.m.]

MR. DEXTER: Okay, just so the minister and I are on the same wave length - what I want to know, in cold hard cash, is how much of the $511 million that's allocated goes to administration at the physician's office level. I'm understanding that this is from the perspective of the Department of Health; in other words, there's a tariff and you pay on the basis of the tariff. Whether or not the doctor in his office pays more or not is up to him. What I want to know is what the dollar figure is that the Department of Health feels it's paying in administration for that line item.

MR. MACISAAC: Mr. Chairman, what we will do is - and the honourable member is correct to point out that it is a predetermined fee that flows to the doctor, and how he or she decides to spend it is up to them - what we will provide you with is that element of the fee that this presumably identified as being an administrative charge.

MR. DEXTER: I want to move on now to the Pharmacare Program and what we will see here allocated is about $103 million in the Pharmacare Program. The Pharmacare Payments, is this purely the cost of the drugs or is there, as there is with Medical Payments, an administrative cost associated with the way in which those drugs are delivered to the patients. I mean, who administers the program and how is that accounted for within the $103 million?

MR. MACISAAC: Included in that number is the dispensing fee to the pharmacists. That's how they are paid, so it's part of that cost.

MR. DEXTER: Does the minister know, in dollars, how much of that $103 million is in that dispensing fee category?

MR. MACISAAC: Mr. Chairman, the amount is determined as a per cent of the value of the prescription that is dispensed. I don't have the exact number with me, but we'll take note of that and make it available to you.

MR. DEXTER: I'm going to continue on with this. I guess my point is that in each one of these services, buried within them is an administrative component, which I'm betting, as an observer, but I'm betting that that's not included in the $57.85 per capita. Now, as you say, you didn't manufacture this number, it came from CIHI, and no doubt we'll have to have a closer look at exactly what they count and what they don't count, if we want to find out the answer on health costs. Just simply because it seems so incredibly out of whack with what's

[Page 18]

going on in administrations of similar size. I'm sure that's something that we'll be able to track down and I don't mean to ask the minister to explain that.

Under other Net Program Expenses, on Page 12.10, there's a whole list of payments that are made including, for example, the Children's Dental Program. Should I assume that there are also administrative costs reflected in each one of those items as well?

MR. MACISAAC: Mr. Chairman, under the item referred to by the honourable member, all of the administrative charges to those programs are covered under the fund we discussed earlier, the Finance Administration, except for the Children's Dental Program and there is an administrative fee paid for that; that is separate.

MR. DEXTER: I just have, on an unrelated subject, but I only have a couple of minutes here so I want to get this in because it has been a question that's asked of me, and it has to do with those individuals who are currently at Sunrise Manor and who were previously in the rehab centre who, I believe, when they were sent to that facility they were told they were going to be there on a temporary basis for a year, and I think it has been something in the order of two and a half years. There has been some considerable objection with respect to that program by a lot of different people with interest in caring for those individuals. I wonder, could the minister explain to us the state of play there now and what, if anything, is going to change?

MR. MACISAAC: Mr. Chairman, with the indulgence of the honourable member, in the interests of providing as accurate information as I could, I'd appreciate it if he'd allow me to come back to the committee at a later date with the update on that information.

MR. CHAIRMAN: Thank you, Mr. Minister, and the time has been used up for the NDP.

The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I will say at the outset that I intend to make more than a few comments, so the minister can relax for a little while, and then I'll get to some line-by-line items later on if we have the time and, if not, we'll save them up for another time.

It's been interesting the way things have started during the Budget Debate on Health. First we had a rather thoughtful and educated lesson on procedure here in the House of Assembly by the minister who - I'm impressed - knew most of the rules regarding when we go into the Committee of the Whole House of Supply. He even knew where the Mace goes, so I was impressed by that at the beginning, and certainly I'm impressed with the knowledge of the Leader of the Official Opposition and the minister on the history of Medicare in

[Page 19]

Canada. So it's been a lesson, just sitting back and learning about some of those things, for me.

I thank both the minister and the Leader of the Official Opposition for enlightening me on those matters right now. I mean that in all seriousness, because sometimes it's good to hear from veterans of the Legislature, such as the Minister of Health - they've been around for a very long time - and occasionally it's even good to hear from of the Official Leader of the Opposition, Mr. Chairman.

I'm pleased to rise in place on behalf of the Liberal caucus and to begin our debate on the estimates in the Department of Health but, before I begin a certain line of questioning, it would be rather remiss of me if I didn't take this opportunity to perhaps get out some general thoughts, concerns and opinions about the health care system and what was contained and what was not contained between the lines of the Health budget, a budget as we now know, a Health budget that is to the tune of $2.3 billion, or 40 per cent of the total budget of the Province of Nova Scotia, which is worrisome in itself, Mr. Chairman. Certainly I would say at the outset that my comments are in no way directed towards Department of Health staff at any time. I hope that they're not slighted or offended by anything that I might say. I certainly am quite aware of the hard work of the Department of Health staff that goes into estimates and budgets and planning on a year-round basis.

Mr. Chairman, in all fairness, what has gone into this health care budget on behalf of this government is a lack of planning that exists within health care in this province, it immediately comes to mind when one looks at the Health estimates. In 1999 it was this government that said health care did not need any more money. Those were the words of Premier John Hamm, that in Nova Scotia, health care did not need any more money, it just needed better planning. That's the words of then and still Premier John Hamm. Five years later we find that the figure is over $574 million. No indication that the system is or will be better. Ask the people that are working in the system, ask the people on the front lines, ask your front-line health care workers who are working in a system that is clogged and at the end of its wits on a daily basis, whether or not the system is better.

Most importantly, we don't know if it will be accessible to Nova Scotians when and where they need it. Now that, Mr. Chairman, has to be one of our biggest concerns - whether or not Nova Scotians can access their health care system. But yet, the government seems to be very proud of itself, and they're able to boast and brag and come up with a figure of $231 million more that they are pouring into health care in Nova Scotia. I would suggest that this is a very disturbing public relations exercise on behalf of the government.

A lack of planning on the part of this government is severely threatening what is the sustainability of our health care system in this province. Mr. Chairman, through you to the minister, I cannot stress - and yes, to the government as well, to the government in general

[Page 20]

and to the members of the New Democratic Party - and I will remind them as well, that the sustainability of our health care system is in deep trouble in this province.

Mr. Chairman, you may or may not be aware, I hope you are, that we had a round table in the Liberal caucus, two members, of which I was one. The other one was the member for Kings West. We travelled around the province, meeting with health care professionals, and we met with administrators, we met with the general public, on our round table on wait times. We went from one end of this province to the other. I was particularly struck by the comment made at one public meeting that went something like this, pretty soon in this province, the person said, you will have a Minister of Health, and you will have a minister responsible for what's left over in this province if we keep going the way that we're going.

[4:45 p.m.]

It was the first message, Mr. Chairman, that flashed through my mind when the estimates for the Department of Health were tabled. We're not far from that right now when you start looking at the Department of Health taking up 40 per cent of the overall budget. You start looking at just over $2.3 billion with only an 11 per cent increase, we are not far from that now. Sadly, thanks to poor planning on the part of this government, then perhaps the day of collapse - although I hope we never get there - is coming sooner than we all think. Without what would have to be fundamental investments in certain key components of our health care system, the entire system is indeed in danger of collapsing on itself.

Mr. Chairman, it is not acceptable for government to say that they are spending more money on health. As a matter of fact if you take a look at the most recent report in this country, what everyone is looking at now in the Romanow report - indeed, Mr. Romanow recommended that there be a plan in place, a concrete action plan in place before any more money was thrown at Health, as it continuously is. It's not acceptable for a government to say they're spending more money on Health. They now have to demonstrate that they are investing in the right areas of health care in this province. That's irrespective of where they live, or the type of health care that people need, or if they are able to access it in a timely fashion.

Mr. Chairman, I've said in this Legislature before and I will say it again and I'll probably repeat it in the not too distant future, that, as I mentioned, the round table sessions that we had on health care wait times throughout this province have been for me, and I'm sure for my colleague for Kings West, an invaluable lesson and an invaluable learning experience. The lessons that we've learned on the road have led me to the conclusion that indeed this budget and this health care budget, are a long way from being a cure for the health care system.

[Page 21]

Mr. Chairman, the budget tabled, in no way shape or form begins to address the challenges and gaps that we heard about as we travelled from one end of this province to the other. Let me start for instance in the Annapolis Valley. We met with an organization there that is attempting to bridge a gap in service by trying to establish a hospice for palliative care patients. This group has made its way through the bureaucracy. They were asked by the department, they've been asked to develop a financial and administrative structure, and they have yet to receive a response. The day that we visited Valley Regional, there were 12 palliative care patients at the hospital. A 10-bed hospice, that was being proposed would reduce the burden on the Valley Regional Hospital, and would ensure better quality care for those who were looking for palliative care.

Mr. Chairman, let's not forget that when you talk about health care, and how expensive health care is, you are talking about a per diem cost of about $1,100-plus at the Valley Regional compared to a $400 per diem at a hospice. Better care at a reduced price and you decrease the burden on the Valley Regional Hospital. If you just take a look at that one equation, I suggest it sounds rather logical. It did to me. I'm sure it would to the Minister of Health as well.

Mr. Chairman, let me give you another example. We have the emergency department where on the day that we visited, there were seven or eight patients, in a 15-bed emergency department. They were waiting for a hospital bed. The challenge for the hospital there, like virtually every other hospital across this province is a flow of patients. One must be reminded that the problems that we hear so much about, for instance at the Queen Elizabeth II Emergency Department, in the Capital District, is just not unique to the Queen Elizabeth II. Those problems are being experienced perhaps on a smaller scale, but just as big in terms of the effect that it has on hospitals across our province. And we found that to be the case in hospitals and emergency rooms that we visited across the province.

Mr. Chairman, we hear the government say that there will be 85 long-term care beds, but with this government you have no idea whether that is going to incorporate what has already been announced or whether there are 85 brand new beds that are going to be in the system. If we look at the budget, you would gather that a large number of those nursing home beds have already been announced and will be re-announced again sometime soon. So, again, at the Valley Regional, the ability at that hospital, and at the other hospitals that we toured throughout this province, to improve the flow of patients in their facilities, may or may not be addressed in this budget.

Mr. Chairman, the day that we visited the Valley Regional, the facility was forced, at that time, to use mandatory overtime for the second time that week. The only other option would have been for them to call all of the referring hospitals and to tell them, would you please stop transferring patients at this time. That type of decision is not an easy one - do you force nurses to work overtime to open up more beds, or do you tell other hospitals that you're unable to deal with the health care needs of a patient that is being referred? Certainly,

[Page 22]

for the health care professionals, that's the type of stressful environment that they certainly don't need. It's an extremely poor work environment, and it certainly would do nothing, for instance, if you were looking for an assist in recruiting efforts for specialists and so on.

Mr. Chairman, the inability of this government to appropriately plan for and then address the needs of long-term care is actually paralyzing our acute care system in this province. It is most welcome to see the government cover the health care costs of long-term care. The inability of this government over the past years to adequately meet the needs of long-term care patients - and let's not forget that we see no mention of a plan to deal with our aging population, as well, that's another segment that's missing. To adequately meet the needs of the long-term care patients will put a significant strain on this system, a strain without a plan from this government.

Yes, Mr. Chairman, I'm as glad, and my caucus is as glad, as any other member in this Legislature to see a combined effort by Opposition Parties to put enough pressure on this government to move up the timetable to 2005. Perhaps that is a prime example, a shining example of how a minority government should work, and how Opposition should work, regardless of who gets credit for coming up with the idea in the first place. I must say that it was the government that did move and say, we're going to make this plan effective in 2007. And if that's what it took, the combined Opposition effort, to say, move it up to 2005, maybe we fell short of doing our job when it should have been moved up to 2004, and maybe we should have pushed a little bit harder, but not going there and giving the appropriate credit where it should be, to the minister and to the government, to finally move that up to the year 2005 and do exactly what should have been done, and cover the health care costs of long-term care patients in this province.

Mr. Chairman, let's go to the issue of home care. It was interesting, when we asked the professionals, again at the Valley Regional Hospital, we asked the role of home care when it came to actually discharging patients. Do you want to know what we heard? I'm sure you do. We heard that it sometimes takes the hospital up to two days to discharge a patient, because that's the amount of time that it takes for home care to get straightened away, and that's two days that that particular patient will be occupying a hospital bed. That's two days when a patient could be in the comfort of his or her own home, but they're not because of the challenges that are being experienced in home care.

It's one of the keys, in our opinion, to where health care should be going in this province, but we're not there. We're not even close in terms of what should be done in home care. Mr. Chairman, it remains to be seen whether that $231 million increase in health care spending will provide support for a better resourced, more enhanced, home care program. I doubt it, because, in all honesty, that would require a plan. Again, it's not something that we've seen from this government.

[Page 23]

Mr. Chairman, there is the issue - again in the Valley, and I know I'm using the Valley for a lot of examples. We had some great meetings there in that region, and we heard from a lot of people. There's the issue of women's health, for instance, in the Valley region. There is an 18-month wait for gynecological surgery, with 110 women with serious health conditions in the Valley area who are on a waiting list. I would suggest to you that that kind of a wait list for that kind of health care in this province, in any area of this province, is totally unacceptable.

We also heard from a person by the name of Shawn Trahan, a young man from Aylesford. We told his story here before, in the Legislature. Two years, he was told, he would have to wait for surgery. It would take two years for him to get surgery on his foot. Unfortunately, Mr. Trahan's disability benefits were running out, and with his five children - five children, that's correct - he was faced with what he would consider a decision that surely no one should ever have to make. The decision was whether he should actually go ahead and have his foot amputated, so that he could go back to work to feed his family.

Mr. Chairman, what we learned is that people who are waiting are numbers on a chart or on a graph or on a list someone is looking at. What we seldom hear is what that wait process does to people. We seldom hear about deteriorating health, about the mental anguish and the pain, all of those things that this government, if they ever get around to producing an actual wait list, would be able to quantify. We know that the issue of wait lists is being studied, it's been studied for years now. We knew the problem existed.

With the exception of the former, now-departing Deputy Minister of Health, who has never admitted, in this province, that there was a problem with wait lists, on about the same level of acceptance as saying that there's no problem with prescription drug abuse in Cape Breton - but that's another story for another day and I will eventually get there, during estimates or whatever the case may be, but it was the departing Deputy Minister of Health who said that he didn't see a problem with wait lists in this province, but we know there is. Every Nova Scotian knows that there is. Every Nova Scotian or their relatives or friends or children who have ever waited in an emergency department or who have ever waited to have surgery done, who have ever waited to even get a family doctor knows that there is a real problem with wait lists and wait times in Nova Scotia.

Now, what we see in this budget is $465,000 on a budget line item to monitor wait time lists, but where are the lists that are going to be monitored? Why isn't government sharing those lists with the general public, with us, as an Opposition Party? What are the action plans that are there to deal with these lists?

[Page 24]

[5:00 p.m.]

Mr. Chairman, what this government has failed to realize is that to deal with wait lists first of all, you have to deal with the health care system. You just can't keep shovelling loads of money into acute care when the system can't sustain what it has now because there is either insufficient support for home care or long-term care and again, there is no plan. That has been identified by many experts. It has been identified by just some of the anecdotal evidence that we gathered in our round table trip across the province. Every day, Nova Scotians would tell us it doesn't have to be hundreds of millions of dollars to solve the problem. There are common sense solutions to some of the problems that are facing health care, but time and time again we were told, no one is listening to us, no one is paying attention. If they did, those people were telling us, there would be an appropriate plan in place and we'd be able to solve problems like what we see happening at the QE II Emergency Department and at other emergency departments across the province.

MR. CHAIRMAN: Order, please. The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, I was wondering if the honourable member for Glace Bay would adjourn the debate momentarily so we can return to the House to introduce a bill?

MR. CHAIRMAN: Would the member agree to that?

MR. DAVID WILSON (Glace Bay): Mr. Chairman, I so move to adjourn debate.

[5:02 p.m. The committee recessed.]

[5:03 p.m. The committee reconvened.]

MR. CHAIRMAN: The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): I remember exactly where I was so I'll just continue from where I was, Mr. Chairman. As I said, it's easy because the whole concept of what I'm trying to get across here is that there's no plan. If you refer back to the fact that there is no plan, then that's exactly where we pick up from where we left off.

Mr. Chairman, I was talking about wait lists and, in particular, I also mentioned long-term care and home care. In the Capital District, during our tour of the province on wait times, we made a stop in the Capital District, in particular, at the QE II. There were 142 patients the day that we were there, waiting for long-term care beds, 15 per cent of the beds were occupied with patients who can be cared for in other facilities.

[Page 25]

Wait times, Mr. Chairman, in this province for the elective CT or CAT scan are increasing. The emergent radiotherapy treatment wait times are increasing. Surgical cancellations were up because of no beds, yet at that time 142 beds were occupied with long-term care patients.

In every facility that we visited across the province, long-term care beds were identified, not by us, Mr. Chairman, they were identified by the health care professionals, the administrators, the nursing professionals, the doctors, the chiefs of staff, whatever the case may be, whoever we talked to at those facilities. At every facility across the province, long-term care beds were identified as one of the major problems facing those facilities.

We travelled to the Cobequid Multi-Service Centre; we made a stop there as well. The centre, to my surprise, serves a catchment area of about 100,000 patients. I was absolutely amazed. An absolutely wonderful facility, excellent staff that were there, the only problem, it closes at 10:00 p.m. One of the other problems that they tell us there, they'll put patients into an ambulance to transfer to the QE II, whatever the case may be, and when they get to the QE II they are in a lineup of ambulances trying to access services at the QE II. Mr. Chairman, the minister perhaps could be asked, does your budget provide for 24/7 emergency service at the Cobequid centre? Is that going to be there?

Let me give you another example, there's the case of Mrs. Edith Power, who has been waiting since the year 2001 for a hip replacement. Her pain has been, as she describes, just constant pain. The wait is totally unacceptable in this province, if you are waiting since 2001 to have a hip replacement.

Then, Mr. Chairman, came the news from a general surgeon in Halifax that last year at the QE II, 25 per cent of surgeries were cancelled. Not done. In 2001, there were two operating rooms that were closed as a result of budgetary constraints and they remain closed today. Does this budget address that situation?

We heard from an employee at the Nova Scotia Hospital. This particular employee spends 50 per cent of her time trying to find a hospital bed for a mental health patient. Not uncommon, to find a patient from Halifax end up in Cape Breton, in this province. Far away from the one source of support that they need most, in the time of that sort of crisis, that being their family.

We found in every centre that we visited across this province, that mental health concerns were at the top of the list of concerns, whether it be accessing emergency departments or just accessing the mental health care that was required by patients. We found mental health care patients who were triaged medically, within a certain amount of time, but then waited 8 hours, 10 hours or 12 hours in emergency rooms to access any kind of mental health care whatsoever, psychologist or psychiatrist which is unheard of in some areas. Mental health, which is the forgotten health care component, I would suggest, Mr. Chairman, was

[Page 26]

mentioned in every round table discussion that we had in this province, is once again, totally, absolutely and wrongfully forgotten by this government.

There are some communities, Mr. Chairman, in this province, where it is not uncommon to wait three weeks to see, for instance, a family physician. There are caseloads, if you're lucky enough to have a family physician, for instance in Yarmouth, that can number from 5,000 to 6,000 people per doctor.

Mr. Chairman, let me raise the subject of community health clinics and the question of whether or not there are any resources allocated for community health clinics in this province. What about resources for doctors' offices that would enable them to stay open on weekends and evenings? Resources have been allocated - just not this year. For emergency rooms that are coping with an influx of patients who are unable to gain access to either an office or a doctor, the budget is saying carry on operating as you are, there are no resources in the medical agreement to deal with the level fours and fives that visit ERs until the year 2006-07.

Let me give you a personal experience. Unfortunately, about two or three weeks ago, I think everybody so far in this province has contracted this viral infection that's going around that leaves you with coughing fits. You know? Anybody had it? It's not pleasant. It's not life-threatening and you certainly don't require - and I hope the member for Dartmouth North doesn't get it. It's not pleasant and it's not life-threatening, as I said, but let me give you my personal experience. Here I am in Halifax one night and it's about 4:45 a.m. and I can't stop coughing.

HON. JAMES MUIR: Do you smoke?

MR. DAVID WILSON (Glace Bay): No, I don't smoke, but it's a nice try from the Minister of Education. I'm coughing and coughing and I can't sleep, I can't do anything and eventually I'm growing short of breath. I'm not from this area, my family doctor's back in Cape Breton, I have no idea, unfortunately, although I've researched it since, where the community clinics are. I'm desperate so I'm going to make a trip to the emergency department at the Queen Elizabeth II Health Sciences Centre at 4:45 a.m.

I get there and I go into a triage room and there are three paramedics there. I'm triaged right away - blood pressure taken, temperature taken and so on and I'm put over to the sign-in area, the registry area, I'm taken care of and I'm put out in the waiting area. Good day, have a nice day. Eight and one-half hours later, I've finally seen a doctor, I've had an X-ray and I'm told, Mr. Wilson, go home, you have a viral infection and there's nothing we can do for you. Which, certainly, is not anyone's fault at the QE II. It's a viral infection and there is no medicine available for a viral infection - you pretty well have to let it work its way through. I did get an X-ray and I was comforted that I hadn't contracted pneumonia or whatever the case may be, but for myself and the others that were there in the waiting room -

[Page 27]

and there were others there who would have probably been diagnosed with the same level of treatment that I was diagnosed - I would have been at the bottom of that triage system. The 1- 5 scale that they use, I would have been a 5.

It has become the norm in this province that you will wait anywhere from eight to 10 to 12-plus hours in an emergency department because really, what the health care system has said right now is that you shouldn't be here in this emergency department. You have no place in this emergency department, you're not sick enough to be in this emergency department. Heaven knows, and they did that day at the QE II, every booth, every bed, every stall was full at the QE II that day. Doctors and nurses were running off their feet. Certainly, because of my illness, which was on a very, very low scale, I'm not even suggesting that they should have been running off their feet to look after me. They had much sicker people there. What I'm asking is that in this province, in our health care system, where else do those people go? Not just me, where does the mother with a child with an ear infection who can't get to sleep in the middle of the night, who has no community clinic, who has no doctors' offices open - where does that mother take her child? To an emergency room.

[5:15 p.m.]

We have nothing else in this province to offer them whatsoever except, come to an emergency department and wait for hours on end and maybe you'll be lucky enough to see a doctor. That day that I spent eight and one-half hours - believe me, through no choice of my own, I would rather have been at 100 different other places, although the staff and the doctors were excellent - believe me, on that day I saw people leave that emergency department because they were so frustrated and exasperated with what was going on, they just couldn't cope any more. These are sick people - maybe not at the top of a triage scale, but they are sick people who left this hospital without getting any treatment whatsoever because of the system that we now find ourselves in.

That same day, there was what I assume to be a volunteer who is in charge who came in around 7:00 a.m. - I think I had a waking moment at about 7:00 a.m. as I was sitting in the very comfortable chairs in the QE II - well, maybe not that comfortable, I wasn't in the comfort room, I was just in the emergency room. But, as there was a volunteer that day who was actually going around checking names to see whether or not you were in next or whatever, I was getting a little bit tired at about maybe 8:45 a.m. or so, a little frustrated. I asked this gentleman and he said, don't go yet, you're next. So I sat down and waited about another hour or so before I got in. Next in the emergency department is measured not in minutes, it's measured in hours. Not in minutes, unfortunately.

That's my personal experience and I tell the minister about that because I think it's indicative and I think it's an example of what is happening many, many hundreds and thousands of times across this province - people who are trying to access a health care system which is totally inaccessible to them right now under the circumstances that we find ourselves

[Page 28]

right now in Nova Scotia. It doesn't matter whether it's in Halifax, Glace Bay, Digby or Yarmouth - it doesn't matter. What we have found is that if you are using an emergency room as your prime source of health care in this province, then you are in trouble.

You're not in trouble because of the staff that works there or the resources that are there or the doctors that work there, you're in trouble because it may just not be accessible to you right now in this province because of the numbers of people who are trying to use it or because it may or may not even be open. I've raised that now in this Legislature for the last five years. In some areas, including my own, it's still not a certainty if you go to the emergency department in the first place whether or not that emergency department is going to be open. You could run into the problem of doctor shortages, which still exist in this day and age in Nova Scotia. Mr. Chairman, that's an example of how emergency rooms are coping with an influx of patients who are unable to gain access to an office or a doctor and so on.

Let me change my train of thought for a minute and go to the subject of information technology and the need to be able to access information pertaining to diagnostic testing and patient history so that we can avoid duplication and, hopefully, we'll avoid error in the system as well. This was an issue that came up at every site visit that we had with our round table on wait times as well. The power this system would have to address the issue of wait times is enormous. The resources and support needed to make it a reality, however, by this government is somewhat dubious. Past information technology budgets have been overspent, the project has been delayed and we'll need to hear from the minister when we get into the detail and get into the meat of the budget estimates, we'll need to hear from the minister why the project has been delayed, when are we going to see some progress here, how do you plan to train nurses and other health care professionals in the system, when do you plan to do so? All of those I would suggest are legitimate questions, Mr. Minister, which hopefully you'll get a chance to answer at a later time.

Mr. Chairman, then came the overwhelming support that we heard in every community that we visited and every community meeting that we attended to provide resources for health promotion programs. Everywhere that we visited, we've heard first-hand of their support and I would again be remiss if I didn't tell the minister that this is an issue where in this case the people are ahead of the government. Never since the issue of smoking in public places, have I seen a component of health care where the desire of people to see more support in a health promotion program actually outweighs that of the government.

Unlike smoke-free places, Mr. Chairman, where this government failed to meet the expectations of the public, this is an area where people are demanding that the government pay some attention but, sadly, with an increase, as the Minister of Health Promotion knows, of $25 million being collected in tobacco taxes, the public sees a $3.6 million investment towards health promotion. It seems, I would suggest to anybody who would take a look at that and keep an open mind, that that would seem like a bit out of balance. If this government

[Page 29]

does not begin to address in a meaningful way the area of health promotion, we will always see unsustainable increases in acute care, we will always see a sicker population and there will always be nothing but a crisis looming ahead.

Mr. Chairman, we are happy to see an increase in Health Promotion of that $231 million extra for health care which was a mere 1.5 per cent of it that went to Health Promotion. The figure was, am I correct in saying $500,000? (Interruption) No, sorry, $3.6 million, off track, $3.6 million, but as long as we see a spending allocation that out of a total budget is that small, we'll always see acute care budgets increase and a system that's unable to meet the needs of Nova Scotians. I've been told, and I can't recall the exact person who told me this, but I'm told that in this province it costs approximately $250,000 an hour - is that correct - to run the health care system? (Interruption) Pardon me? I think that's approximately right. That's a staggering number when you think about it. How can we continue to keep feeding that kind of voracious beast that's going to eat $250,000 an hour?

We have to find other ways, Mr. Chairman. The minister, I think, would like the people of Nova Scotia to believe that the Health budget has increased and because of that everything is going to get better. Again, it can't get better without a plan and that plan has to encompass the entire health care system. This budget is not going to lead to better health care in this province. It can't happen without a plan.

Mr. Chairman, before I continue, can I ask you just exactly how much time I have left, please?

MR. CHAIRMAN: You have until 5:51 p.m.

MR. DAVID WILSON (Glace Bay): Thank you very much. Mr. Chairman, this budget, as I said, won't improve health care in this province and certainly won't improve the flow of patients in this province. This budget continues to put money into hospitals without providing resources for those components of the health care system that keep people out of hospitals in the first place and that enables patients to leave hospitals for other levels of care which I've mentioned already, or even allows patients to be treated in their own homes which, again, we stress should be, it's not, but should be a key component in any kind of budget, in any kind of plan, that of home care.

So, Mr. Chairman, this budget amounts to nothing more than a public relations budget and the government is sitting back and hoping that the people will say, well, isn't this government great, they're putting more money into health care, putting more money into health care all the time, it's approaching $600 million more that will have gone into health care. But remember the Premier who said health care doesn't need any more money in Nova Scotia, everything will be fine, it just needs better management.

[Page 30]

Mr. Chairman, mark my words, we'll be back here next year with a large infusion for Health, no plan that will enable government to shift the burden of costs from one component of the health care system to another. We'll be back here with the health care system this time next year. The health care system will be no better. The health care system will be no more accessible as a result of this government's investment for wait times and we'll be back here, or whoever is back here, year after year after year, no matter who it is. It may not be me and it may not be the member for Dartmouth North and it may not be any member in this House, but whatever members come back, they're going to be faced with the same kinds of problems, only worse, because it gets out of control. It's like a raging brush fire that no one is putting water on, and it will spread and eventually it will bounce from the brush into the homes and homes will be destroyed and eventually people's lives will be lost. I suggest all of that's happening already in our health care system.

Mr. Chairman, you know, what we've learned is that there are people who are still waiting unacceptably long periods of time for surgeries, or for emergency departments, for family physicians, all of the things that I've mentioned, but what we learned here on our travel across the province, in a round table on wait times that is, was pretty simple and it was a message that came very strong, as I mentioned, from everyday Nova Scotians, people that you and I represent. The message was strong that you absolutely cannot continue to pour money into an acute care system and fool yourself into thinking that things are going to get better. The system is complex. I don't pretend to have all the solutions or all of the answers to health care. The system is interrelated, something that I suggest the government has yet to figure out, I will suggest that part, and I hope that the learning experience of the minister in his tenure in his department has been as valuable as my learning experience here as a critic for health care.

I hope, Mr. Chairman, that the minister understands that those closest to the system right now, the professionals, the administrators and the public, they are all saying that without investments in other segments of the health care system, that you, Mr. Minister, or the next minister, the two previous ministers who were here under your government, you will never fix health care. You will never find the cure for what ails the health care system in this province unless you are willing to admit that there has to be a plan. The failure to plan has led this government, unfortunately, to just pouring good money over bad. That's all you're doing.

Nova Scotians with $231 million are not going to be any healthier and they are not going to be any better off with the health care system that this government is now offering. It will be quite the opposite, Mr. Chairman. So I would ask the minister why he would continue, you know, what it amounts to is you're fooling with the people of Nova Scotia.

[Page 31]

[5:30 p.m.]

This is a public relations exercise. This is day after day of news stories, of people telling us, and people telling the Official Opposition, as well, of all the horror stories that have been in the newspapers over the past five years, over the past year or so, of people who can't access the health care system, of people who are not treated in a timely fashion in this day and age in this country. The Leader of the Official Opposition talked of the great Tommy Douglas, of Medicare and what it meant to this country. The minister warned, let's not think that it's free. Medicare, health care is not free. I don't think anybody who is in dire need of health care, who walks into an emergency department, I don't think the first thought in their mind, when they walk in and say, I need to see a doctor or a nurse, is, by the way, how much is this going to cost?

In Canada, that's not the way that we think. In this country, the country of Medicare, that's not how we were brought up to think. We were brought up to think that Medicare, that access to health care is going to be there when you need it, without any hesitation, without any thought of how much it's going to cost. That's not, for everyday Nova Scotians, a problem to grapple with. That's a problem that governments and Health Ministers and staff, unfortunately, at Health Departments have to deal with on a daily basis, and no one is looking at them saying, you must come up with all the answers, you have to find the solution.

What people are saying, and again, at the risk of repeating myself, is that you cannot continue to pour money into this problem. You cannot, for instance, as the Minister of Finance is doing, and the Minister of Health and the Premier, say, Ottawa, we need more money, please, what's wrong with Ottawa, give us more money, we need more money for health care. And then, on top of the fact that that's perhaps the wrong solution, turn around and say to Ottawa, we won't give you any guarantee that those dollars you give us are going to be spent on health care. You can't do that.

Nova Scotians, as every Canadian, have an absolute right in this country to have access to the best medical care that they can possibly get. Nova Scotia has a tremendous facility in the QE II, a tremendous facility that offers not only Nova Scotians but people in Prince Edward Island, in New Brunswick and other areas in the Atlantic Provinces, the health care that has become known as only being available at the QE II and only available in this province. That health care system is in danger right now, Mr. Chairman.

The health care system is in danger of a total collapse, unless we finally admit that first, before we throw that good money over bad, before we make the mistake of doing that again, we have to come up with a sustainable plan, an action plan that is going to make it possible in this province to walk into an ER and be treated properly, in terms of how long it takes to get that treatment. As I said, not to be treated properly - because the care is there, in most cases the resources are there, with the exception that we have a serious nursing shortage in a lot of facilities in this province, and I think the minister is aware of that.

[Page 32]

It's another common thread that we found throughout our travels across the province in our round table on wait times. Among those common threads: nursing shortages, doctor shortages, wait times that are unacceptable, and in some places there's no service available whatsoever. In some places in this province, you cannot get the service of a psychiatrist. It's not right, but it exists.

In other places in this province you can get excellent care, in terms of orthopaedic surgery. In Cape Breton, the orthopaedic wait time right now is probably a couple of weeks. That's pretty darn good in this province. But if you take a trip in a car for four and a half hours and find yourself in Halifax, you will find yourself on an elective wait time list of 5,000 people at the QE II. You will never catch up to that wait list. Never. That amounts to years of surgical time in an operating room, and by doctors. I would suggest to anybody of any reasoned thought that having 5,000-plus on a wait list is totally unacceptable in the year 2004 in the Province of Nova Scotia.

Mr. Chairman, I know there has been somewhat of a correction in my time, that I now have about four or five minutes left. Again, there are a number of areas within the budget that I certainly intend to, when we come back, during the next hour or whenever the case may be, ask the minister. There are a number of areas in there. There are some grey areas there where we can get some details from the minister, and I will be asking him about the fact that administrative costs seem to be on the rise, and we still have a problem with district health authorities. Although the minister made reference to the fact that most of them do have budgets, there are still district health authorities without a budget in this province. District health authorities, in the past, have waited over a year before they even got a budget.

Mr. Chairman, how can you plan? How can you plan to financially run a district health authority, when you don't have a budget for over a year? There are many more areas that we will be bringing up during our time. But again, I think - and by no means did I mean to stand here for close to an hour now, and I hope it wasn't taken by anyone, in particular by the minister and his staff, that I'm standing here preaching what should or shouldn't be done.

Mr. Chairman, it's always a long shot for a politician to say this is a matter that we should not play politics with. This is a matter that goes far beyond politics, far beyond political lines. This is a matter of an individual's right to access medical care in this province. When we see the problems, and we all know the problems that exist, we don't need surveys to tell us that there are long wait lists, we know they're there. Agreed - we need to measure those wait lists in a fashion that we can use to put together a formula to take care of them, to put together to get rid of those wait lists. That, agreed, is being done, and we needed to do it a long time ago, but at least there's been a start.

What we have to, as I said, admit is that there is a problem in health care. It will exist year after year unless we finally admit that it's out of control. We have to stop, we have to put a plan together that before we put another cent into it calls for action on taking care of

[Page 33]

the problem itself. Again, and I think it's been widely accepted, that the Romanow report was a pretty good report, in terms of what should and should not be done in health care, and to accept that report and to say that's exactly what Mr. Romanow was saying, come up with a plan first, because you can't cure this problem by just throwing money at it, you cannot, absolutely, do that, it is not the answer.

We have to find out, Mr. Chairman, why this government has taken the road that it is now taking with health care, why it has ignored such things as home care, why it has not come up with a plan. Those are all, I would suggest, very logical questions that have to be answered by the minister during his time in Estimates. Those are questions that are being asked right across this province, from one emergency department to another, from one stressed-out nurse to another, from one stressed-out lab technician, or whatever the case may be.

Every health care professional across this province is now looking at this government and at the Minister of Health and saying, what are you going to do to solve this problem? Please pay attention to what we're saying; put together a common sense approach to health care, and make it work in this province, once and for all, so that we can be guaranteed, one year from now, 10 years from now, that our health care system will remain in place.

MR. CHAIRMAN: The time for the Liberal caucus has elapsed.

The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Mr. Chairman, I welcome the Department of Health staff here to help us understand the budget in the Department of Health a bit better. The honourable member for Glace Bay paints a fairly grim picture. Parts of his dissertation I agree with and I accept, but there are parts that I don't agree with and there are things I probably need some time to think about. Nevertheless, I think it's an important debate, and this is an opportunity, not just to look at the actual dollars and cents, but the assumptions that are made in making choices about how to spend the resources we have in the health care system.

Mr. Chairman, I've had the privilege of being here in this place for a little more than six years now, and if the honourable member for Glace Bay thinks that there is no health plan today, he should have been here six years ago when I came here under the MacLellan Government. (Applause) He sure as heck would have seen what a lack of planning looks like.

At any rate, here in the political arena where health care is probably one of the most important and hottest political issues, we spend a lot of time debating health care issues and having discussions about health care issues (Interruptions)

[Page 34]

MR. CHAIRMAN: Order, please. The honourable member for Halifax Needham has the floor.

MS. MAUREEN MACDONALD: Mr. Chairman, as politicians, there isn't anybody who isn't aware that health care is the issue that governments can rise and fall on, for sure. I think it's when we, as human beings, here in this Legislature, are touched personally, like so many Nova Scotians, it's when you're touched personally by the issues in health care, that it really hits home why this is the number one issue that Canadians and Nova Scotians care about. I had the occasion this year to be in that situation where a member of my family needed the health care system. At that time, there were things that I learned about the health care system, because of having a family member in the health care system, in a way that really brought home the strengths and the weaknesses of our health care system.

[5:45 p.m.]

I want to start first in the debate tonight by speaking to the strengths, because where I differ with the honourable member for Glace Bay in what he had to say with the grim picture he painted, is that I don't believe our health care system is about to collapse. I don't believe that our health care system is unsustainable, and I don't believe that we are about to lose our system. I think that our health care system is an excellent health care system. It has a remarkable number of people who are absolutely dedicated to making this system the system of excellence that it is. This doesn't mean that there aren't problems, it doesn't mean there aren't serious problems at times, it doesn't mean that all of the decisions that get made are great decisions, and it doesn't mean that you can justify where expenditures are and aren't on every occasion.

I think we have to be very careful in the public debate around our health care system that we don't take a course where we speak so poorly about the system all the time that we hamper the morale of people who work in the system, that we discourage and undermine the confidence in people who are ill and require health care, and that, in fact, we create cracks in the system by our hammering of the system in a way that interests - for example, private interests - that would like to argue that they can provide health care for profit in a more efficient and a more effective way - will come forward and embrace the opportunity to take over a system that we have created, around the perception that it's broken.

I'm always very clear about the responsibility that we have as public figures and as elected people, that we try to enter into this debate about our health care system with some sense of balance, so that, in fact, at the end of the day, we have a better health care system, a better publicly-funded and publicly-delivered health care system. That is the objective that I have, and the objective of members of the NDP caucus. I wanted to say that.

[Page 35]

I wanted to say that when the situation occurred in my family this year where a family member needed the health care system - it was a very serious, life-threatening situation for this member of my family - there was excellent medical care at St. Martha's Hospital in Antigonish, however, the care and competence of the personnel in the hospital was what really made that experience such a positive experience for that member of my family.

However, the problems that existed in emergency departments that we saw here in the Capital Region were fairly similar to the situation in the emergency room in Antigonish. That is that there weren't beds in the facility itself, on the floors, on the wards. Many people who were coming in with severe illnesses had to spend several days in the emergency department, and in those situations they had a lack of privacy, they had no place to have regular bathing and that kind of stuff. Emergency rooms are not equipped to provide the same level of supports that you would get if you were admitted to one of the wards in the hospital.

I think this is a very serious problem. A person I know, who worked for the Department of Health for a number of years, at a fairly senior level in our bureaucracy here in Nova Scotia, who continues to work in the health care field providing consulting services, once said to me, what goes on in emergency departments is like the canary in the coal mine - if your emergency department is in crisis and there are problems in the emergency rooms, then, certainly, this signifies that there are problems in the system as a whole.

I know that back in early January when the health care workers in the Capital District at the QE II held their press conference and they talked about their frustration and the kind of crisis that was occurring in the Capital District, I know that there was a tendency, first of all, not to accept what they had to say as signifying a reality and the other thing is that there may be a perception today that that situation has been completely addressed.

I want to start with this because I don't think that situation has, in fact, righted itself, not by a long shot. I continue and, in fact, in the last two days I've had two different calls in my constituency office from family members who have had an elderly parent in the emergency department. In one case an elderly parent had been in the emergency department for three, almost four days by the time they contacted my office and was waiting for a bed and today, I believe, the call was about a person who actually had been in the emergency room for a considerable period of time, had in fact gotten a bed, and now has been moved into a transitional unit, I guess, waiting for a long-term care bed and you can see how these things connect as those cases come forward in my constituency room.

So I want to start by talking to the Minister of Health around the acute care sector and the measures in this budget that his government is taking to address what are very serious problems in acute care and in emergency departments. I know that when I go through the Health Estimates, the Supplementary Detail books, and I look in each DHA, I see what is forecast for the end of the year from the estimate. Each DHA indicates that there is a deficit

[Page 36]

and as you add the deficits up across the DHAs and if you put the IWK in there as well, there is a considerable accumulation of deficit.

Today the Department of Health provided some information to the media about how the DHAs will break even at the end of this fiscal year and how much money the Department of Health has brought forward to make that happen. It's about $57 million, I believe. Yet when I look in the column of the department's estimates for the DHAs for the coming year, when I calculate whether or not in the coming year there has been an adjustment that will take into the account the fact that the DHAs this year were unable to fall within their existing approved budgets, whether there was an increase that will accommodate the problems in this year's budget, I don't find it. I find that the DHAs are short a considerable amount of money.

So I want to ask the minister, how will it be possible to avoid the kinds of situations that we have seen in the emergency rooms around the province? How will it be possible to ensure that the DHAs and the IWK will have adequate operating funds so they won't have to cut programs or go looking for ways to raise fees for parking and all of those other things that are being done inside the acute care facilities. Can the minister tell us what his plan is, how this will in any way, the estimates for the DHAs and the IWK, give us the stability in the acute care sector that we really quite desperately need?

MR. MACISAAC: Mr. Chairman, I'm very pleased to have an opportunity to get to my feet again and no doubt will be up a lot more often from now on. First of all, I want to thank the honourable member for Halifax Needham for providing me with the cushion of time that she did relative to the comments from the honourable member for Glace Bay. I also appreciate the fact that she does, while I'm sure she will find many areas that she feels are inappropriate relative to the budget, have confidence in the health care system, I think is a very good premise upon which to base an analysis of where we're going, and it's in that attitude. There's not everything that will be brought forward that I will necessarily agree with. However, it is I believe appropriate for us to be fair in our analysis with respect to what is good and what is wanting relative to the perspective that we all take to the process.

In particular to the honourable member's question, I want to point out that in the last year, relative to the DHAs budgets, we added an amount of $19.2 million and this was added to the base and that was to cover oncology and overtime figures, pressures that the DHAs were experiencing. So that $19.2 million is now added to the base of the DHAs. In addition to that, there is $15 million which was transferred from the Department of Health to the DHAs and, for example, biomedical waste, mental health, Veterans Affairs Canada, additional therapists for early identification and intervention services for children with autism and operating dollars for the bone densitometer for DHAs No. 2 and No. 4. So that additional money is also now part of the base.

[Page 37]

There was $9.9 million that was transferred to the DHAs and the IWK for wage increments and benefits for health care workers and that amount of money has also been added to the base. The funding that the DHAs will receive in the year under examination now will be 7 per cent over and above the additional monies that I've just referenced that were added to last year's approved budget and, of course, those monies were to reflect the pressures that the DHAs were experiencing and it was deemed appropriate for those numbers to be added to the base for the DHAs so that the 7 per cent is, in fact, a number that is added to those numbers I did mention. There was also an amount of $12.9 million that was added and it's related to the classification costs for Capital Health. That number has not yet been incorporated. It's being held centrally because there are issues to be resolved around that particular amount of money.

MS. MAUREEN MACDONALD: Mr. Chairman, my next question is a question about the fact that there seemed to be so little excess capacity in the acute care system around the Christmas period, the holiday period when, first of all, you had people taking some Christmas break, there was an outbreak of flu, and then you had the ongoing pressures on the emergency departments generally. I want to ask the minister what analysis the department has done with respect to the capacity of emergency rooms around the province to be able to cope with a flu outbreak, some kind of scenario that places additional pressures on the emergency rooms.

[6:00 p.m.]

I have heard many people say that what we've done in our health care system, what we've done in our emergency rooms, for example, is we've adopted those just-in-time kinds of managerial practices where you squeeze every bit of excess capacity out of the system so that you staff it with certain assumptions that people are always going to be busy based on a kind of flow of people through that department, but if in fact you have a bottleneck at one end, or you have a greater inflow from another end, then you don't have the capacity to be able to deal with that. So I wonder has the department looked at whether or not we have left so little excess capacity inside our emergency departments that this will be an ongoing kind of problem that we'll see every so often in a cyclical kind of way?

MR. MACISAAC: Mr. Chairman, the situation to which the honourable member refers is indeed one of the great challenges that faces the health care delivery system and that is the capacity to be able to operate your emergency services, where you have a situation that is extremely difficult to predict the input or, you know, the people who show up and look for emergency services and your capacity to be able to respond to them.

There are some patterns that do emerge that assist in the planning process. There are times of the year that wind up historically appearing to be busier than others and the DHAs, and we work with them, in terms of attempting to address those things that become identified through the process and try to incorporate some of that into the planning. I'm not suggesting

[Page 38]

that that's done easily. It is very difficult to be able to provide any sort of accurate predictions and, obviously, Mr. Chairman, I'm extremely reluctant to use the term flu in relation to emergency rooms based on what I went through in January when we talked about this, but indeed the flu did play some part. In the final analysis, curing the flu was not the solution to the emergency room situation in Halifax, if I can say it that way, but an outbreak of the flu does put pressure on emergency rooms throughout the province and there is a great challenge in trying to organize yourselves to be able to meet that.

What I can say to the honourable member is that we work with the DHAs to try to learn from every experience to see if there are things that we can do that will assist us in the future in terms of being organized to respond to sudden increases in demand. Now, obviously, part of what we had to do in the Capital District was recognize that there were bottlenecks at the end of the process that needed to be freed up to allow us to move things through more quickly and we're addressing that. There are some temporary beds that have been opened. I will be having more to say about that in the very near future relative to a longer-term solution to that particular problem.

The honourable member puts her finger, Mr. Chairman, on a very real challenge that the health care system has. We do work with the DHAs in trying to learn as much as we can from every situation that presents itself and to become better organized. I'm not going to stand here today and say that we have the situation totally under control. Hopefully, every experience will allow us to improve and better deliver emergency health services as we move forward.

Perhaps while I have the floor, Mr. Chairman, I can relate that while I agree with the honourable member that the solution with respect to the Capital District emergency situation is not in hand, we are making very real progress relative to that. As I just indicated, we have done something in a very significant way to remove the bottleneck at the end of the process. We are proceeding with the plans to increase the size of the emergency room facility and the honourable member would appreciate that that problem is one that really dates back to the opening of that facility when it was anticipated that there would, in fact, be two emergency facilities that would accommodate the demand in this area and the second was never opened.

To the credit of the planners at the time, they did set aside space in that building where we're now able to move into in order to increase the capacity of the emergency facilities. Those steps are happening and they're not things that you can do overnight, but there are some shorter-term measures, mostly under the control of the district health authority, that have been taken that are easing some of the pressure and I'm not in any way suggesting that very significant progress has been made, but some progress is being made. We have taken a step that will result in the bottleneck at the end of the process being alleviated and once the construction is completed, then we should be in a much better position to facilitate and meet the demand that presents itself in that facility.

[Page 39]

MS. MAUREEN MACDONALD: I would like to thank the minister. I'm going to ask the minister two things, one is just a minor follow-up question which I probably should already know the answer to, but I don't, and that is the planned expansion of the emergency room, where is that at right now and when is it anticipated that the expanded emergency room will actually be completed? So that's one thing I would like to know.

The other thing I would like to know is - and this is back to my concern about whether or not the DHAs are adequately funded now so that they're stable in terms of the pressures on them - back sometime this Winter there was a report, I think in The Daily News, that talked about some hospital beds in the province that were under utilized, beds that were utilized at maybe a rate of 50 per cent or 60 per cent, 40 per cent, I can't remember the exact figure, but I remember at the time, and I think the Premier spoke to this afterwards, they were in Guysborough, Canso, really small locations, possibly Tatamagouche, maybe the Fishermen's Memorial Hospital, possibly Annapolis. I don't have the actual article in front of me, but I know that for these communities, for people who live in these communities, there is grave concern that that information appearing in the paper and the comments that were made by government members were a signal that those beds were being examined and they were being looked at for the potential of whether or not they would be left in those areas.

I think people would rightly want to know whether or not the government will guarantee that those hospital beds won't be closed and that the DHAs, as they continue to look at ways to manage within the envelope they're being given, won't go looking in that direction. I would like to put that to you - I would like to know whether those small numbers of beds that were identified in some of those smaller facilities, whether the residents in those communities can feel secure that those beds will not close in this fiscal year?

MR. MACISAAC: Mr. Chairman, first of all, to the first question relative to the expansion of the facilities - we're now in the planning process and we anticipate completion of construction, not in this fiscal year but in the fiscal year that would follow this year. So there is a significant period of time when that construction will be underway and, of course, then to outfit and gear up the facility, we anticipate that it will be operational in 2005-06.

The other issue that's raised by the honourable member is one that came about as a result of a FOIPOP by one of the daily newspapers - they asked for the occupancy rates of hospitals throughout the province. The ones that made it to the press were obviously those that had low occupancy rates. The questions that flowed out of that was does that mean that because the bed occupancy rate is only 30 per cent that you're going to decide to close that facility? I want to come back and address this, but if the honourable member would permit me, I would like to relate some experiences I've had in meetings with the district health authorities as I went around the province.

[Page 40]

I noted with interest that some of them, in describing their roles, would begin with a description of a facility, and then it would have a number of beds in that facility, and under that would be a list - and many of them very impressive lists - of what services are provided in conjunction with each of those facilities. The question that I started to ask the folks in the DHAs was is the description of the facility and the number of beds what is important, or is the description of the services that are provided by the DHA in those communities what should be important?

As the discussion evolved, it very clearly focused on the services that are provided in those communities. But it pointed out to me that if we are going to fundamentally deal with the funding issue that confronts us with respect to health care, and that is that this escalating cost, year after year, the increases, that one of the things we better start focusing on is the service that we provide and how we provide the service, because if we continue to measure health care solely on the basis of the number of beds that are there, I'm afraid that we're not really doing a good job of communicating to our citizens that which is important about health care.

[6:15 p.m.]

I felt that that particular FOIPOP and the story that flowed from it was not helpful to promoting the need for us to focus on services relative to health care rather than focusing on the issue of beds. The hospital in Antigonish - the honourable member would be familiar with that - when that was built, around 1986 I think it opened, it was built as a 175-bed facility. There are now, I believe, somewhere in the vicinity of 77 or 78 beds in that facility, a 100-bed difference. The community does not feel that difference relative to health care, because how we deliver that health care has changed dramatically over the period of the past 20 years and, as a result, we don't need the same number of beds. But the services that we provide are enhanced, in my view, compared to what they were 20 years ago.

I believe it would be helpful if all of us - not just government or people within the Department of Health - if our society really started to focus on services that are being provided within our communities rather than on the number of beds. Clearly, the number of beds, if there's an occupancy rate of 30 per cent relative to beds, is not a clear indication of the health care that's being provided within those communities.

To come back to answer your question, the commitment that I want to make is that the services that our citizens are receiving through these facilities - and in some instances those services are not necessarily housed in a facility, they can be in rented space downtown or rented space in the community or the village or wherever - the service that's provided will be maintained and hopefully enhanced.

[Page 41]

In order to do that - and this is part of some of the fundamental reform that needs to take place relative to the delivery of health care - we need to be prepared to accept that perhaps our doctors need to think in terms, and we as a society need to think in terms of our doctors doing less and others in the health care delivery system doing more, so that we get better use of our physicians than currently is the case, and that those who have skills fully employ the skills that they have in order to provide the services. So that requires some changes.

I think the challenge that faces a lot of us in terms of achieving those objectives is significant, because as long as our citizens respond to headlines about beds, then we're not leading the way relative to the fundamental changes that have to take place in the delivery of health care. Indeed, I welcome the opportunity to go to Ottawa and talk about this, because it's not just a Nova Scotia challenge, it's a challenge that exists right across the country. We need, all of us, to impress upon our citizens because, let's face it, most citizens don't significantly think about health care until they reach the point where they actually need it.

The honourable Minister of Transportation and Public Works is a long time from ever really being in a position where he will need that service of our health care system, at least if the way he moves around here is any evidence of that.

We have a very significant challenge, and I think the honourable member and her question points to that challenge, points to the need for us to be engaged in the discussions relative to reform, but it also points to the need for even the DHAs, when I had my discussions with them, to change their slides so that they put the services first in their communities, and the institution is really a secondary item relative to that in terms of importance and in terms of the health of the people of those communities.

MS. MAUREEN MACDONALD: I did not hear a commitment to keep those beds in those communities; however, your point is taken. I do understand the distinction between services and beds, and the debate that has been around in the health care system for awhile. It is an important one, but I think sometimes a bed is a service that is required, or it goes with the important service that is required. I think the other thing that is a real challenge in terms of having this discussion is that hospital beds have closed and the services didn't necessarily follow. For a lot of communities, that's a real concern. If they see services that were once available in their local area, and now they have to travel long periods of time for that, or in fact they get no services at all, so this will continue to be a debate, no doubt, tied to the question of beds and services, and what comes first and where.

I want to ask the minister some questions about wait times for diagnostic services. In the Health Estimates, one of the things that I've noticed is - this is in the Supplementary Detail, on Page 12.21 under Capital Grants - the Diagnostic and Medical Equipment line item states that there was an estimate of $15 million for Diagnostic and Medical Equipment for this year, yet less than $4.5 million has been spent. This is puzzling, to say the least. I couldn't

[Page 42]

quite understand how it could be, particularly when we know that the wait times for diagnostic services are extensive in many areas. So there are a number of questions I have with respect to diagnostic wait times, but I'd like to start first by asking the minister why there is such a large discrepancy between what was estimated for Diagnostic and Medical Equipment and what it forecast to be spent.

MR. MACISAAC: I thank the honourable member for her question and, indeed, what she is speaking about is there is a process relative to the expenditure of this money. The first step in the process is for the request from the DHAs to receive approval, and once approval is received they're in a position to go out and purchase the equipment that they need. It is not possible all of the time to be able to complete those purchases prior to the end of the fiscal year in question and, when that happens, that approved amount that remains unspent gets carried over into the next year. The estimate for 2004-05 for that fund, for instance, is an amount of $25.757 million. That is where that additional money would go and how it would show up.

MS. MAUREEN MACDONALD: Then that brings me to some questions about wait times and the government's plan to decrease or shorten wait times, particularly. I'll start with just getting diagnostic services. I know that there is the working group on reducing wait times; however, I'm not aware that there is an actual plan. I want to ask the minister whether the department is keeping records, an accurate account of what the waiting times are for diagnostic services around the province in the various DHAs, whether that's an area that the DHAs report to you? If it isn't, is it part of your plan to make that something that needs to be developed in order to develop a timely plan to decrease wait times? I would like if the minister would speak to the whole question of what the plan is to reduce wait times for diagnostic services, and how much in resources are being allocated in this fiscal year to decreasing wait times.

MR. MACISAAC: The issue of wait times involves activity on a number of fronts, and it is all related to planning that is in place. I might use as an example the situation with respect to the emergency room in Capital Health. The fact that in a matter of less than 10 days the Capital District Health Authority and the Department of Health were able to come forward with a 10-point plan is not something that was cobbled together in a 10-day period. There in fact was in effect a planning process. One of the lessons that might be learned from that is that perhaps a better job could have been done relative to sharing the planning process with people involved in the front line, so that they might have had the assurance that all of this was being addressed.

With respect to wait times, we have invested in the previous year the $5 million with respect to the cath lab at the QE II, and that has resulted in wait times coming down to normal numbers with respect to cardiac procedures. We have, this year, announced an additional amount of money to address wait times with respect to orthopaedic surgery both at Capital Health, the opening of an OR facility and additional beds at capital health, plus an

[Page 43]

additional orthopaedic surgeon at New Glasgow and that of course will go a long way to bringing us in line with national standards - that's not to say that that is going to happen overnight, but it will start to relieve pressure in that regard.

One of the real challenges with respect to the issue of wait times is for everyone to understand what is meant by a wait time of a given period of time, so that there is a consistency and everyone understands what we mean when we say there is a wait time of four months or there is a wait time of five months. That is not achieved easily, but it is part of what we are attempting to do in the coming year with respect to the investment we've made of $465,000 on the wait time initiative. While we are developing long-range processes and plans to address wait times, we are not waiting to implement it all at the end of the process, we are implementing as we can, and as we obviously can recognize pressures that have to be addressed in the shorter term. So it is a process that brings us to a much better understanding.

[6:30 p.m.]

As I said in my opening remarks, I believe that when we go and meet with the federal government later this Summer, in this province we'll be able to present ourselves as leaders relative to this process and that is as a result of the planning, the understanding that exists within the department and with the DHAs for us to develop a consistency and for us to address priorities relative to the planning process. I look forward to that discussion on a national basis, because I believe we'll be able to make a very significant contribution to it.

MS. MAUREEN MACDONALD: I know that I had seen some of the research that Dr. Dunbar and his colleagues have been doing around orthopaedic wait times, and I had an opportunity to be at a presentation that he and his colleagues did. I also had an opportunity to talk with them and they have a lot of expertise in terms of setting up the research to track and gather the information, so it doesn't surprise me, I suppose, on one level that there are some areas where we have a real advantage because of the expertise that exists in our medical school and in our medical research community.

I'm wondering if the minister could detail for us how the $465,000 for the wait time initiative will be spent? What specifically will those resources be allocated to and where will it get us at the end of the expenditure of these particular resources?

MR. MACISAAC: I thank the honourable member and I appreciate her patience. Sometimes when you're in this process you receive information that's designed to be helpful to you - usually it arrives after you've sat down. However, I was content with the fact that I did cover most of the points I should have in the previous question.

At any rate, the objective of the wait times initiative is, first of all, to get a standardized measure that's clearly understood by all participants in the process - from the specialist to the family doctor, to the patient, to those involved in the diagnostic procedures -

[Page 44]

so that everyone understands what we're dealing with. We need to establish a database with that information, so with that database then people can get a clearer picture of what's going on in the province. Then people can see where wait times are perhaps longer than they are in some situations and shorter in others, so there is some choice that people would have relative to that.

It would also give us the opportunity of having performance measures relative to how we're doing so that we can measure it on a consistent basis, and the measure will mean something to everybody who is involved rather than the measure meaning one thing to the family doctor, something else to the specialist, meaning something else to the diagnostician, and being just nothing but a big question mark sometimes to the patient. So we need to get those performance measures underway.

Now, obviously what we want to achieve are in the following key areas: surgical services, and we've made a beginning with that with respect to orthopaedics and it's not just a start, it's a very significant step forward; diagnostics with MRI and CT and genetic testing, those are matters that are going to be addressed in this process; and there's the question of the general practitioner's referral to gastroenterologists, plastic surgery and medical oncology.

These are the areas that they will be focusing their attention on and, once they have completed those areas, then they will move to others, but these are the areas that are considered to be priorities and there is a need for standardized measures so that there can be a performance analysis done and people will understand, when they see a number, precisely what that number means - all participants would understand the meaning of that. It's a significant initiative to be able to put all of that together but, without doing that, we're really not in a position to plan properly where we should be going as we move forward.

MS. MAUREEN MACDONALD: I'd like to thank the minister, that is helpful to have that level of detail.

I'm wondering if the minister could give us some information about wait times for MRIs - is that something that the department already has some knowledge of? I ask this specifically because this is probably the technology or diagnostic service you hear the most about. I know that the Capital District had released a bit of a report card of some kind where they indicated that the wait times for MRIs had actually decreased, because they had added additional staff and were running the MRI for a longer period of time, and that meant they had the ability to reduce wait times. So I'm wondering if the department has looked at that, looked at the wait lists for MRIs and whether we have a sense that we are making some progress even though it is part of this larger wait time initiative. Probably the outcome still, province-wide, is probably not known, but what about here in the Capital District Health Authority?

[Page 45]

MR. MACISAAC: I want to thank the honourable member for the question. Perhaps some specific numbers relative to her question will show up while I'm on my feet - and maybe they won't. In the event that they don't, I'll make sure that they're made available to her. I can tell you it's a number that we're very pleased with and I'm surprised at myself that I'm not able to spout if off, because it's not often that you get those opportunities.

We have moved and it's because we now have four pieces of equipment around the province and we're getting a much better use in sharing of the facilities between Capital Health and the IWK, in terms of the use of the facilities there and, of course, with the opening of Sydney, that has made a huge difference. There's upwards of, I believe, 100 patients a week that used to come in this direction, who no longer - and we're out of time on this element.

MADAM CHAIRMAN: The honourable member for Cape Breton West, on an introduction.

MR. RUSSELL MACKINNON: Madam Chairman, I take great pleasure in introducing to you, and through you to all members of the committee, two very distinguished Nova Scotians, Ms. Betty Boudreau who, by the way, is Treasurer of the Nova Scotia Womens' Liberal Commission and Greta Murtagh who is a retired school teacher. Greta is well-known throughout the Halifax region. She was very active in political life, as well, but also very active in Acadian Affairs and promoting the French culture during her teaching profession and I think, given the fact that this is a rather special year for the Acadian culture, it's quite appropriate that we introduce such very distinguished Nova Scotians as Ms. Murtagh and, of course, Ms. Boudreau. So I'd ask if both individuals would rise and receive the warm welcome of the committee. (Applause)

MADAM CHAIRMAN: The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): Madam Chairman, I must say, before I ask the minister some questions, that I found it absolutely amazing that after an hour of talking on the health care system that the member for Halifax Needham would agree with the Minister of Health that there's no problem in health care in Nova Scotia. We have no real concerns, everything is rosy. Everything is great according to the member for Halifax Needham and the Minister of Health, who say the only problem with the health care system is the member for Glace Bay. I found that absolutely amazing when the member for Halifax Needham was asking about wait times, elective surgeries, wait lists and so on. If there's no problem, how do those lists even exit? How do they even exist if there are no problems in health care in this province?

Why not just take our heads out of the sand, as the minister should be doing, and admit that there's a problem with no plan, and get around to finally solving the problems that face health care, instead of trying to play some silly little political game with the members of

[Page 46]

the NDP, Madam Chairman? Why not get down to the real task at hand and face up to the problems and try and find some solutions? That would be my suggestion for the minister.

Madam Chairman, I would suggest that. I'm going to skip around in our Estimates Book here and try and get to the bottom of a few things. Let's start out on Page 12.12, of the Supplementary Detail book. The Cancer Care Nova Scotia budget, which you will see on line 3, has been basically flatlined. There's no increase in the Cancer Care budget and I'd like to give the Minister of Health an opportunity to explain to us why there has not been an increase in the Cancer Care budget.

[6:45 p.m.]

MR. MACISAAC: I want to thank the honourable member for the question, Madam Chairman. It's important that all members of the committee understand the role of Cancer Care in Nova Scotia. Its role is, as a body, to set standards relative to the provision of care for the treatment of cancer in the province. As such, while in every facet of health care we would like to be able to provide additional dollars, we're not always able to do that. We should understand that Cancer Care Nova Scotia and its budget is not indicative of the amount of money that is being spent on the treatment of cancer within this province.

If we look at some of the results of the past period of time - you can look at the urgent Cancer Care wait times in Capital Health decrease from 14 days to 9 days, Madam Chairman. The next urgent cases wait time decreased from 26 days to 18 days, and less urgent cases, wait times decreased from 55 days to 28 days. That's not to suggest that we, in any way, are satisfied with the fact that there are wait times of 9 days, or wait times of 18 days or, indeed, wait times of 28 days. We would like to be with a system where, in fact, people could receive treatment almost immediately. We're not going to be there. We will be able to reduce wait times and get them down even further.

It's quite interesting that that honourable member makes the suggestion that perhaps not enough money is being spent. He also, on a previous occasion during this examination of the Health Estimates, suggested that somehow we should not have been urging Ottawa to put more money toward health care in this province without there being a detailed plan.

I don't take any issue, and I said just recently that, indeed we look forward to the planning process relative to the provision of health care, and we look forward to the planning process with respect to how we would organize ourselves to provide health care into the future, but to suggest that there aren't current needs that require additional expenditures of money is not an accurate reflection of the situation that confronts us.

Madam Chairman, if you were to look at an expenditure by the Government of Canada on a per capita basis relative to health care, from the period of 1993 to the period of 2002-03, you would see that is a flat line. There has been no increase on a per capita basis

[Page 47]

of the Government of Canada with respect to the delivery of health care. On the other hand, if you look at the per capita expenditure of Nova Scotia money and the per capita expenditure on health care within this province, it goes from a figure of just under $1,500 in 1993-94 to a figure of approximately $2,300 in 2002-03. While that huge increase is taking place with respect to the expenditure of health care in this province, the federal government's amount of money has remained flatlined.

The other bit of evidence that I could point to, with respect to the issue of whether it is reasonable for us to expect Ottawa to make additional contributions to health care in this province, is to consider where we have been just from last year to this year relative to Ottawa's expenditure on health care. The amount that they provided has not changed from last year to this year - there has been a shuffling of the chairs in the deck, but the amount of money that's coming is the same last year as it was this year. Even with the $60 million that they supposedly injected into the system in this fiscal year. All that did was bring it back up to $105 million that we received additionally last year. So that amount of money is flatlined - it remains the same, it doesn't change.

The honourable member asks me for a commitment that any money that we receive from Ottawa will in fact go to health care. When you consider that we haven't received any additional money from Ottawa, from last year to this year, and we have increased the expenditure of health care in this budget by an amount of $230 million, then I would suggest, Madam Chairman, that Ottawa would have to increase its contribution by as much as $230 million to health care in this province before we would have to deal with the issue as to whether all of the money that came from Ottawa went to health care, because they gave us nothing extra this year and we injected an additional $230 million into health care this year.

That's really the issue that's at play here, the fact that there isn't additional money from Ottawa, and there is additional money from this province, in an amount of $230 million, for health care for the citizens of this province.

MR. DAVID WILSON (Glace Bay): Madam Chairman, it's the same one-note song that we're hearing from the minister all the time: Ottawa, Ottawa, Ottawa. What I asked the minister was why there's no increase in the Cancer Care budget. It clearly shows, if you look at line 3, again on Page 12.12, Supplementary Detail, that what you actually spent in 2003 and what you're forecasting in this year remains exactly the same. In the meantime, 5,200 people will be newly diagnosed with cancer in Nova Scotia, and 2,500 of them will die as a result of cancer this year alone, yet what happens if don't reduce wait times for cancer care because you flatlined the budget?

Now if the minister has had any representations made to him on behalf of Cancer Care Nova Scotia, then I'm certain that those representations did not include a suggestion that you flatline the budget. I'm sure Cancer Care Nova Scotia didn't say to the minister, if he met with them, we don't want any more money. Look at the statistics regarding cancer. Given that

[Page 48]

you would have presumably had the benefit of a meeting with Cancer Care Nova Scotia, I'm asking you what initiatives are on hold as a result, then, of this budget flatlining? I'm asking that because the minister did not answer why there was no increase. If there is no increase - and it's quite obvious, it's in black and white, the figures are there - then what initiatives are on hold because there is no increase?

MR. MACISAAC: Madam Chairman, perhaps I will try to explain it a little more, the distinction that I was making with respect to the setting of standards, which is the responsibility of Cancer Care Nova Scotia and the treatment of cancer, which is something that is funded through the district health authorities in this province. So there are no initiatives that are on hold, as such, with respect to Cancer Care Nova Scotia. The standards that they are implementing are standards that are having an impact right across the province. They will continue to implement those standards. There has been very real progress with respect to the cancer patient navigation programs that are being implemented throughout the province.

Madam Chairman, to suggest that because the budget for Cancer Care Nova Scotia has been flatlined translates into some sort of lack of funding with respect to the care of cancer is not accurate, and I want to draw that distinction, because the district health authorities in fact have the money that's dedicated to the treatment of cancer in this province.

MR. DAVID WILSON (Glace Bay): Madam Chairman, I'm sure the minister knows Cancer Care Nova Scotia is a program of the Department of Health. It was created to reduce the burden of cancer on individuals, on families and the health care system through prevention, screening, education and research. Now, again, I will ask the minister, what additional work can be done on, let's say for instance, the screening front by Cancer Care Nova Scotia if the budget, as it is, is flatlined? What about prevention? Can Cancer Care Nova Scotia do any more work on prevention if there hasn't been an increase in their budget?

What type of message is this government sending to cancer patients and their families in this province if the Cancer Care Nova Scotia program that has done so much to help patients has not seen one more red cent in terms of a budget increase? I would like the minister to answer. What kind of message is that sending to Nova Scotia's cancer patients and their families when they haven't seen one cent of increase in their budget, Mr. Minister?

MR. MACISAAC: Madam Chairman, the program to which the honourable member refers is a program that Cancer Care Nova Scotia is working on with the Office of Health Promotion, and the honourable member may wish to pursue this further with the Minister of Health Promotion when his estimates are brought forward. What needs to be understood is that with the additional resources that are being put in place for the Office of Health Promotion, and the Office of Health Promotion working together with Cancer Care Nova Scotia, that indeed there is the capacity to do additional work relative to the mandate of Cancer Care Nova Scotia and the Office of Health Promotion.

[Page 49]

MR. DAVID WILSON (Glace Bay): Madam Chairman, I will change subjects, number one, because I haven't received an answer yet, and certainly I will pursue it with the Minister of Health Promotion, but again it leaves a lot of questions unanswered for cancer patients and their families in this province.

Let me switch to the topic of Continuing Care on Page 12.6 of the Supplementary Detail, Continuing Care Administration, which has increased by over $1.6 million. I would like to ask the minister, why such a large increase?

MR. MACISAAC: Madam Chairman, the number the member is referring to reflects a transfer of money from the program side to the administration side of home care. It's simply being accounted for in a different place, compared to where it had been previously.

MR. DAVID WILSON (Glace Bay): Madam Chairman, if you look at Page 12.12 of the Estimates Book, it states that the Salaries and Benefits for Continuing Care are increasing by about $475,000, which accounts for a lion's share of the increase there. When you look at Page 12.22, Supplementary Detail, you see there an increase Funded Staff, the budget says there will be an increase of four staff people, and when you divide - if I'm doing my calculations correctly - four staff people into $475,000, and assuming that it's going towards their salaries, then you get an average of salary per new staff person of just over $118,000, about $750, which would amount to a lot of pretty high paid help. I'll ask the minister what exactly are those staff people going to be doing and, indeed, is that their salary?

[7:00 p.m.]

MR. MACISAAC: The actual number of employees involved is six and not four, and that number includes not just the salary but the benefits that go with it and the expenses related to the activities of those employees as well. You can't do a straight division and come up with a number - it's a combination of salaries, benefits, and expenses related to those positions.

MR. DAVID WILSON (Glace Bay): I thank the minister for that clarification. At the same time that the salaries and benefits are increased, the grants and contributions are reduced to zero. You completely eliminate grants and contributions, so my question to the minister would be what grants and what contributions are being eliminated?

MR. MACISAAC: Again, it's a situation not of something being eliminated, but of being transferred. Again, they're transferred to the program delivery as opposed to where it existed previously.

MR. DAVID WILSON (Glace Bay): Madam Chairman, I'd like to change topics now and talk about the Children's Dental Program. If you look at Page 12.10, the Children's Dental Program, one can see that the budget last year, according to my calculations, was

[Page 50]

underspent by some $900,000. I'd like to know from the minister why was that program underspent?

MR. MACISAAC: The member is quite correct to take note of a figure like that because it does make an impression when you look at it at first glance. Actually, the situation that's reflected in that number is related to the take-up on the program itself. That has decreased and, as a result, the amount of money that was actually expended was less than that which was estimated.

MR. DAVID WILSON (Glace Bay): As I recall, in the 2002 budget, there were some changes made by government to the Children's Dental Program - as a cost-saving measure, they said at the time. Then, in October of that same year, they were retracted, so when the retraction took place the Children's Dental Program went from $2.9 million to $4.6 million, which is overbudget by about $1.7 million. So this year as the minister said, the budget is underspent - in fact, less is expected to be spent in 2003-04 than 2002-03. So I'll ask again for a clarification from the minister. Could he explain what changes have been made that would allow such a drastic reduction there?

MR. MACISAAC: There are no changes to the program. What has changed are the number of people taking advantage of the program - that has decreased.

MR. DAVID WILSON (Glace Bay): Madam Chairman, again let me switch topics here and go to the question of district health authority funding. I'll refer the minister to the Supplementary Detail, Pages 12.13 and 12.18. On Budget Day the government was boasting about $78.5 million extra going into district health authority funding, and in reality the increase amounts to about $21 million, I would suggest. When you take the estimate for 2004-05 and compare those numbers with the forecast, which is where the DHAs expect to be by the end of the year, then you end up with an increase of only $21 million and not $78 million as the minister and this government keeps saying. My question for the minister is, is this $21 million enough additional funding for district health authorities?

MR. MACISAAC: I need to point out - and I hope staff will listen carefully to make sure that what I'm saying is completely accurate - that there was a transfer of $15 million that previously had been charged to the Capital District Health Authority for the services of physicians who were employed in the medical school and at Capital Health in the teaching program. That money was transferred out of the Capital Health to the medical payments file. As a result, it would appear to have reduced the funding for Capital Health by an amount of $15 million, but in effect they have the benefit of that $15 million as a result of not being responsible for its expenditure. So it's a net effect of $37 million positive for the DHAs.

MR. DAVID WILSON (Glace Bay): I'm going to ask the minister for some more clarification if he doesn't mind. I think last year we indicated that there was no way that the amount budgeted would be enough for the district health authorities, and when the numbers

[Page 51]

were all said and done, and you compare the estimate to the forecast figures for 2003-04, it looks like the DHAs will actually be overbudget by some $57 million. So, I'll ask the minster how is it possible that with an increase of $21 million - what you're providing to district health authorities this year - how is it possible that will be enough?

MR. MACISAAC: Madam Chairman, I don't think it's a question of anybody being wrong - it's a question of understanding where the dollars are. The health authorities on the budget will be to the benefit of about $37 million as a result of the transfer to medical payments out of the Capital District. The honourable member in referencing the apparent overexpenditure of the DHAs will recall that in the early Fall the DHAs identified areas of concern that they had with respect to their funding which government examined and responded to in a positive way.

The honourable member will recall that as a result of oncology costs and overtime expenditures, there was a pressure of an additional $19.2 million for the DHAs. In addition to that, there was an amount of $15 million which is transferred from the Department of Health to the DHAs and the IWK and some of those items, Madam Chairman, biomedical waste, mental health, Veterans Affairs Canada, additional therapists for early identification and intervention, services for children with autism, and operating dollars for the bone densitometer for DHAs 2 and 4. So that $15 million figure was there.

In addition to that, there is the increase in benefits for health care workers which were transferred to the DHAs and the IWK and we allowed for a $9.9 million figure for that amount of money. So when the honourable member notes that they will appear as being overexpended, it's because of those adjustments that were made to assist the DHAs in meeting those pressures. In addition to that, that money was not just added on a one-time basis, it was added to the base, so the 7 per cent increase that the DHAs receive this year is based on that money being added to the base. So that's the explanation for that change.

MR. DAVID WILSON (Glace Bay): Madam Chairman, let me ask the minister what business plans, have the business plans been approved to date right now? Could he outline exactly what business plans have been approved?

MR. MACISAAC: Madam Chairman, we're dealing with a situation that is in process. I can say that I believe eight business plans are that far from being released and said that they are approved. But there are still two final steps in the process before we can say that they are approved definitely, and I'm going to wait until those steps have been completed before we get into the process of identification. I can tell you that that is very close and I would anticipate eight of those business plans will probably come forward before - well certainly before the budget comes forward for final approval, much before that, I would anticipate, but I don't want to allow room for any catch that might come along in the process, and I don't anticipate any. But I would expect it will be very soon when we'll be able to make those announcements.

[Page 52]

MR. DAVID WILSON (Glace Bay): Madam Chairman, when I asked the minister how many business plans had been approved and the minister says that X number of business plans are this close to being approved, then I would suggest that the answer is that there are no business plans that are approved as of right now, not officially. There are no business plans approved. (Interruption) Yes, well, right now as we speak, no business plans have been approved for DHAs.

Part of the problem with this year's forecasted amounts for the district health authorities, which in the case of all DHAs are more than what was budgeted for last year, is because of how long it took for this government to approve the business plans last year, and I'm sure the minister will admit that it took a very long time last year to approve the district health authorities' business plans. In some cases they were over a year before they actually got their business plans approved. So let me ask the minister, do you believe that the additional $21 million will cause some problems in that business planning process for DHAs? Do you see any problems there? (Interruption) I will just say the additional $21 million - we have an ongoing dispute here of whether it's $21 million, or $76 million as you're saying, will cause some problems in the business planning process for DHAs and at the same time you're telling me that perhaps by the time that we vote on the budget here, district health authorities will have their business plans approved?

[7:15 p.m.]

MR. MACISAAC: Madam Chairman, just to be as clear as I can be, the department has provided its approval, or at the executive director level, senior staff have provided their approval for eight of the DHA budgets. Two of the budgets are still under more detailed discussion at this stage and when I made reference to the time we get to voting, I was referencing the eight DHAs that have been approved departmentally will come forward. While we'll do our very best to ensure that the approval process moves along as quickly as possible, I would not want the member to feel that I was talking about the remaining two that are currently under discussion when I said that. I was talking about the eight and it's really, in my view, at this stage simply a matter of procedure to get from departmental approval to the final approval process.

I can tell the honourable member that the DHAs are back refining the documents themselves to ensure that they reflect everything that's going on, and if the honourable member had difficulty hearing that I don't mind repeating it at all. But at any rate, the process is much advanced in relation to last year. Well, anyway, I will leave it at that - it's much advanced in relation to last year.

MR. DAVID WILSON (Glace Bay): Madam Chairman, on September 19, 2003, the government issued a press release that stated that district health authorities are going to receive an additional $19.2 million for costs associated with nursing. I would conclude from that commitment that the extra funding would be allocated towards acute care, and I'm

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assuming that the minister will agree with that assumption. So when you compare the estimate from last year to the forecast, then district health authorities in the acute care area are overbudget by over $51 million, and if that's the case, I would suggest that something has gone drastically wrong. Either district health authorities did not have enough funding to start with, or the plan for health care is so out of whack that the entire acute care sector is on the verge of collapse.

So, Madam Chairman, if you don't have appropriate home care services, what happens is acute care gets stretched to the limit, and if long-term care patients are staying in acute care beds your system gets backlogged and acute care budgets of district health authorities go out of control. So despite what the government is saying - and the minister can answer this question - perhaps there are not enough nurses in the system, perhaps the acute care budget and the tremendous overrun can be attributed to overtime costs, or what is it? So let me ask, Madam Chairman, what exactly seems to be the problem there, Mr. Minister?

MR. MACISAAC: For clarity's sake, Madam Chairman, there is in fact an additional $42 million going into the DHAs as a result of last year. I would point out to the honourable member and to members of the House that with respect to the business planning process of DHAs, last year we were into our third year of that business planning process. Now, to suggest that we would embark upon a new relationship with respect to the delivery of health care in the province as administered by the district health authorities, that we could overcome all and every possible difficulty in a two-year period, I would suggest it's perhaps not realistic.

I think what's important is that in the course of last year when the district health authorities identified shortcomings in the business plans that were presented, as a result of circumstances that came to the fore throughout the course of their year, then the government's response to providing additional money in the sum of $47 million is something that is to the credit not just of the DHAs but of the government itself and of the relationship that exists between the Department of Health and the district health authorities, that there is such a strong working relationship between the district health authorities and the Department of Health, with the support of government, that they were able to address and resolve these problems that arose in the course of the year.

So, it is a major step forward, in my view, with respect to the maturing of the district health authorities. The capacity of the Department of Health to work with them, to recognize real problems and address those real problems by convincing government of the need to do so, I would contend that we have made great progress in the relationship between the district health authorities and the Department of Health and government over the course of the past year, and we look forward to the coming business plans being even more reflective of the reality that exists in the health care delivery sphere, and that we would, in a very significant way, diminish and anticipate any future problems that may be encountered.

[Page 54]

So we have confidence that the numbers that we are presenting in the budget are numbers that will, based on our anticipation of the needs of the district health authorities, be sufficient to meet those needs. That does not mean that it is simply a sit down and stamp of approval with respect to the business plans, there is a process. There needs to be, first of all, an understanding of what it is that is being funded through the district health authorities and there needs to be a very real justification of that funding, and there also needs to be an opportunity for the district health authorities to state their case relative to the government's anticipated funding needs related to the District Health Authorities.

So the short answer to the question is we're confident with the numbers we have presented; the longer answer is in order to explain that there is a maturing process that is taking place in the relationship between the DHAs, the Department of Health and government. Thank you, Madam Chairman.

MR. DAVID WILSON (Glace Bay): Madam Chairman, let me say this, even with an extra $19.2 million that was allocated last Fall, acute care for DHAs is still overbudget by some $32 million. In that press release last Fall it was indicated by the minister that $19.2 million came with strings attached, and one of the strings was that DHAs would end the year without a deficit.

Mr. Minister, I draw your attention to what appears to be deficits for the District Health Authorities. For South Shore DHA, $2.3 million; for Southwest Nova DHA, close to $2.9 million; for Annapolis Valley DHA, close to $4.5 million; Colchester East Hants DHA, about $2.8 million; Cumberland Health Authority, $1.68 million; Pictou County DHA, $2.46 million; Guysborough Antigonish Strait DHA, $2.2 million; Cape Breton DHA, $7.5 million; Capital District, over $22 million; and the IWK, just over $8.7 million.

DHAs are expected to pick up the deficit and what you provide them in terms of extra funding for the fiscal year, it won't even cover their deficits. What you've provided, Madam Chairman, is in no way, shape, or form - whatever kind of thinking you come up with would not reduce wait times. What you have provided won't even begin to cover about $57 million in deficits, and what you've provided is a negative growth health budget. How can district health authorities be expected to manage? How is it possible that the minister and his government can claim that they have a balanced budget when district health authorities in this province are some $57 million overbudget? How is that possible?

What we have found again is a minister who is, basically, trying to justify no plan. We have absolutely no plan whatsoever for health care, and we have no plan for district health authorities either.

MADAM CHAIRMAN: The time allotted has expired.

The honourable Government House Leader.

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HON. RONALD RUSSELL: Madam Chairman, I move that the committee do now rise to report considerable progress and beg leave to sit again on a future day.

MADAM CHAIRMAN: The motion is carried.

[The committee rose at 7:26 p.m.]