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HALIFAX, THURSDAY, APRIL 29, 2004
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
2:21 P.M.
CHAIRMAN
Mr. Russell MacKinnon
MR. CHAIRMAN: We will start the clock at 2:21 p.m.
The honourable member for Pictou West.
MR. CHARLES PARKER: Mr. Chairman, I certainly welcome this opportunity to have a few minutes of the minister's time, and his staff's, to ask a few questions in the Health Estimates, particularly as they may impact on my riding of Pictou West. I have looked through the Health Estimates, and there are a number of concerns or questions I have for the minister.
As we know, in the budget there is a resolution around long-term care. It's good to know that before this year is out we will have a solution for seniors. They will no longer be discriminated against, in having to pay for their medical costs. But between now and then, of course, we have eight or nine months, and I suspect that things will be pretty much as normal, and that seniors will continue to have to pay their medical costs, and a total cost, somewhere on average, of $5,000 to $6,000 a month in nursing homes. So in many ways, January 1st can't come soon enough.
I suspect there are probably some families, some seniors who may be holding off until January 1st just to save those additional fees that will be charged. My question to the minister then is, around the period of time between now and January 1st, do you see a backlog or is there going to be people shying away from perhaps applying for long-term care because of the financial savings that will occur after January 1st?
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MR. CHAIRMAN: The honourable Minister of Health.
HON. ANGUS MACISAAC: Mr. Chairman, the honourable member is correct to put his finger on a challenge that does exist between now and January 1st, and that is a challenge that is recognized by the department. It's an important challenge for us because decisions that are delayed with respect to seeking long-term care will wind up putting pressures elsewhere in the health care system. We are very mindful of that situation, and the approach that we intend to take will be as encouraging as possible for people to make their decisions in an appropriate manner with respect to long-term care.
However, the criteria will not change until January 1, 2005, but there is an element of discretion that can be applied in terms of how the situation is enforced. It's not in the department's interest to create problems elsewhere in the system, so there is going to be, I hope, a judicious approach to this that will try to minimize, as much as possible, any backlogs. The encouraging part about it, of course, is as times goes on the period of time that people will be impacted will get shorter and shorter so I think that as we approach the date there will be much less of that pressure, challenge, in the early months leading up to the changeover.
Mr. Chairman, we do recognize it as a challenge, and it's where a considerable amount of common sense will have to be applied with respect to decision making.
MR. PARKER: Thank you, Mr. Minister, for that answer. Certainly, as you mentioned, it will be a challenge, and I'm sure there will be individuals who may want to hold off as the months go by, and they will be waiting until January 1st in order to save dollars. I was going to ask the minister a couple of other specific questions in relation to the long-term care, around the rates. I know every nursing home or long-term care facility is different in the rates that they charge, but once this new system is in place, as of January 1st what will be the rate for room and board? Will it be a uniform rate across the province, or will it fluctuate according to the nursing home?
Secondly, related to that, Mr. Minister, the $150 that each nursing home resident is allowed to keep - is that as it is now, that after three months, if they don't spend it, they lose it? Or will they be able to keep it as long as they wish, to spend as they wish? So those two questions for right now.
MR. MACISAAC: Mr. Chairman, in answer to the first question - it will be a uniform rate across the province; there will be no variance from one part of the province to another, an average rate will be determined. The question of the money that's available, there will be no restrictions relative to that. That will be a portion of income that they are allowed to retain. So they can treat that income in the same manner that they would treat income now. In the interim, we have removed the restrictions relative to how that money is spent, and I believe we have also removed the restriction relative to the accumulation of that money. The concept
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is totally different - it's no longer an allowance; it's their income that they're going to be permitted to keep.
MR. PARKER: Thank you for that clarification, Mr. Minister. You mentioned that room and board will be uniform across the province. Do you have any idea, at this moment, what level will be charged to the nursing home residents?
MR. MACISAAC: Mr. Chairman, the difficulty with providing a number is that people might tend to focus on that number, and we're not in a position where we feel comfortable in giving a definitive number at this point in time. It might be helpful if I could just tell the committee what is different about the two charges. The costs associated with room and board include maintenance, dietary services, housekeeping, management and administration, capital costs, and the return on investment. With respect to the health care costs it will include nursing, personal care, recreation, physiotherapy, and occupational therapy. And 85 per cent of an individual's income will go toward his/her room and board expenses, and that is it.
I could give you a number that is approximate - we're going to cap it at approximately $66 a day, but that's not a number the member should leave here with and say that that's what it would be, but that might help with respect to establishing the range of numbers that we're looking at.
[2:30 p.m.]
MR. PARKER: Mr. Chairman, I guess a ballpark figure, then, in that $66 range is what seniors will be charged for their room and board. It seems to be an approximate figure at this point in time. I have one specific question. I was contacted by a spouse of a nursing home resident, and he's presently paying, I think it's $1,000 a month towards his wife's care in a nursing home. So he's asked me, after January 1st, under the new rules, as a spouse, will he be required to pay anything towards his wife's care in a nursing home? At present, it's $1,000 a month he's paying, and he wants to know whether, under the new regulations, he'll be required to pay any portion of that cost.
MR. MACISAAC: If I can go back to the previous question, we're getting some numbers, and it looks as if it's around $71 a day, not the $66 that I gave you, but, again, the number is not definite. With respect to the question just asked, all residents will be assessed relative to income and will be charged on the basis of their income, after January 1, 2005. It's the income of the individual that will be used.
MR. PARKER: Just for clarification then, Mr. Minister, you mentioned that maybe the room and board costs will be about $71 a day, and the cost to the resident will be based on their income. If their income is less than the $71 a day times 30 days in a month, is there going to be any additional charge to a family member? Or, if they're short and they don't have
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the $71 a day times 30 days in a month, then is that cost picked up by government, not by the spouse of the individual?
MR. MACISAAC: The number that would be charged would be capped at that amount, and the amount of your income that you would be charged would be 85 per cent - that is the most that would be taken from any individual - any shortfall would be compensated for through the department. (Interruption) No, no.
MR. PARKER: Mr. Chairman, I want to switch gears now to a second question, and this revolves around help for individuals with diabetes. I know that in the Throne Speech there was a promise of help for low-income Nova Scotians who are suffering with diabetes. I do believe it was also in your blue book two, last Summer, during the election campaign. Certainly in my riding I have a number of individuals who are suffering with diabetes. In fact there's one young lady who has been to see me two or three times, and I think she actually wrote you a letter asking for consideration, asking for help. She works in a business at the present time where she is receiving medical benefits, but she's sort of locked into that job. She would like to go back to school to take training, but if she does that, of course, she will lose her medical benefits from the job she has at present. So she really feels that with the high cost of the strips, and the needles and the insulin, she just can't get out of the job she's in.
I've looked through the budget estimates to see if anywhere there I could find your promised benefit of help for low-income Nova Scotians who suffer from diabetes - perhaps it's there, but I just have not been able to find it. My question, Mr. Minister, is, when can we expect help for low-income diabetics, or is there something there that I've overlooked in your estimates?
MR. MACISAAC: Mr. Chairman, the answer to the honourable member's question is no, you've not overlooked anything. The commitment that was made, which was contained in the blueprint which we used in the most recent election campaign, was a commitment to cover these costs in year two. We are currently involved with the Canadian Diabetes Association, Nova Scotia Chapter, in terms of formulating the program and the policies and how it would be developed, with the intention of bringing that program forward in the next fiscal year. So we're currently involved in the planning process, and by bringing it forward in the next fiscal year, we will have fulfilled the commitment made in the blueprint.
MR. PARKER: Mr. Minister, thank you for clarifying that. Like I said, there are certainly low-income Nova Scotians out there who would very much like to see this brought forward as soon as possible, and hopefully then next year - I guess is your answer - it will be in the budget.
I want to ask a question around mental health initiatives - it's certainly a very important component of our health care system - and in particular in relation to the Aberdeen Hospital in New Glasgow. We've had a shortage of psychiatrists and mental health specialists
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there from time to time; in fact at one point we were down to just one visiting locum, who was there part-time. It is a concern that we haven't had enough professionals to deal with the situation.
I know one initiative that was undertaken in the New Glasgow area, they've set up a self-help group, the New Hope clubhouse, on the East River Road in New Glasgow. They've suffered some losses of professional staff. They feel they're short on the help that they need. I guess there are a couple of related questions then, Mr. Minister. One is at the Aberdeen Hospital - what is the situation there with our professional staff? Is there enough to handle the workload? Can you just give us an update on that and, secondly, is there additional help for the New Hope clubhouse in that town?
MR. MACISAAC: Mr. Chairman, I thank the honourable member for his patience. The honourable member is speaking about an issue that is indeed a challenge for the department and for the district health authorities, and that is the challenge of recruitment. We have made salary adjustments to the money paid to psychiatrists so that it would become more attractive for them to work in district health authorities throughout the province - we believe that will be helpful in the recruitment effort. We are also, with respect to international accreditation, taking steps - that's one of the targeted areas - to ensure that psychiatrists from offshore or outside the boundaries of this country can receive accreditation.
With respect to the New Hope facility, that is something that would be addressed through the psychiatric services of the district health authority. It is something that they would be making a decision on, with respect to support for that group.
MR. PARKER: Mr. Chairman, I do know the New Hope clubhouse offers invaluable support to those with mental health problems. It's sort of like a self-help group, they go in and they can support one another, but in conjunction with professional staff as well. It sort of replaces an older model, a self-help group that was in the town and is no longer. Just recently they did lose some staff there. My request is if there's any extra money, maybe in a budget line somewhere that's under contingency, perhaps extra services could be offered to that group. That would really help them in Pictou County.
I guess my final question, Mr. Chairman, that I wanted to ask the minister is around the Health Council. I can remember being here in this Legislature in 1998, when it was re-established and it was trumpeted as being of great benefit to Nova Scotians, and that there would some co-ordination or liaison between the government of the day and the community health boards. I think it did serve a role in that regard. One of the former Chairs of the Health Council is from my riding, Vivian Farrell from the Town of Pictou. She certainly considers the decision as unfortunate. The voice of ordinary Nova Scotians is going to be lost in this decision. I guess I wanted to ask the minister, why did you do away with the Health Council, and how will ordinary Nova Scotians now have a voice on health concerns?
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MR. MACISAAC: Mr. Chairman, circumstances change from one period in our history to another as we move forward. As a result of these changed circumstances, it's appropriate to review the status of organizations or programs or policies. We decided to look at the role of the Health Council in this province, because of a number of changes that have occurred. One of those changes relates to the standard of care. That is something that is now being addressed by the National Health Council. We have very effective representation and will continue to have representation on the National Health Council. It will play a role with respect to establishing standards right across the country, and indeed will be instrumental and helpful as we address the challenges of health care going into the future. That's one fundamental change that has occurred.
The other mandate relating to the Health Council was promoting health care of citizens, but we now have an Office of Health Promotion. The Office of Health Promotion has really taken on that particular role, and under the leadership of my colleague has made great progress, in my view. The other element that was being addressed by the provincial Health Council was, as the honourable member suggested, providing an opportunity for Nova Scotians to have input, relative to the provision of health care within the province. What I want to remind the honourable member of is that the budget of the Provincial Health Council, which I believe was $348,000, that entire budget is going to be apportioned to the community health boards throughout the province.
We believe that by providing that money to the community health boards that there will be much more opportunity for citizens to become involved in the process. I would suggest that it will enhance the level of accountability that the person occupying my job will have as the health boards are strengthened and as they get more and more involved, in terms of establishing priorities for provinces. I should correct what I said, it would be the DHAs that would apportion the money to the community health boards. It's not going directly, it's going through the DHAs. I would suggest, with respect to the issue of accountability, there will be even more accountability as a result of this.
[2:45 p.m.]
Secondly, with respect to community involvement in the establishment of priorities relative to health care, we will have even greater community involvement as a result of this move. It's a move that I'm looking forward to, the results of this, and I believe that great progress will be made. So, Mr. Chairman, in summation, circumstances change, and when circumstances change, it's appropriate to take decisions as a result of those changed circumstances.
MR. PARKER: Mr. Chairman, I certainly agree with the minister, we can never have enough consultation between ordinary Nova Scotians and the department in the matter of health care issues. It's very important to Nova Scotians. With that, I'm going to share my time with the member for Sackville-Cobequid, so I will now turn it over to him.
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MR. CHAIRMAN: The honourable member for Sackville-Cobequid.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, it's an honour for me, today, to stand in the Health Estimates to address some questions to the Minister of Health and his staff. It's not just an honour because I come from a community that has been waiting a long time for a new facility, but it's also an honour as a health care professional, as a paramedic, to have the attention of the Minister of Health. I'm sure there's many of my colleagues who would rather exchange positions with me today, so I hope I do some honour to them.
First, I would like to draw some attention to what I just mentioned; our community of Sackville is going to be the new home of the new Cobequid Community Health Centre. As a paramedic and going into that facility, I realized many years ago that there was a need. At the time the community support for a new facility was endorsed by the government. It's been many years, there have been delays and the community has been quite patient and hasn't lost hope. With the new groundbreaking ceremony that took place later last year, the prospect of a new facility is nearer than it was years ago.
Many of the residents in our community who are served by the - I will mention it as - old Cobequid Centre, and many of the members on the government side, many of their residents also use that facility. I know that their community members have supported this much-needed new facility in the area, actually their catchment numbers range up to about 100,000 people. It's an important facility that needs to be opened quickly, and hopefully there will be no more delays.
I'm sure the previous MLA for the area has, in the past, mentioned this facility to the previous Health Minister. I will continue on that legacy. Some of the questions that a lot of my community residents have about the facility would be - one question would be - how much expenditure was put toward the facility last year, in the prep work?
MR. MACISAAC: Last year an amount of about $2.3 million was expended on the facility, and this year an amount of $13.26 million has been budgeted, and the remainder, about $10 million, will be in the next fiscal year. We anticipate construction to get underway shortly with respect to that facility.
MR. DAVID WILSON (Sackville-Cobequid): That's very encouraging, not only to me but to the 100,000 people who use the facility, or who will potentially use the facility. That's very promising. I look forward to the construction of the site, and I know that the groundwork has been laid. They're getting read to do some foundation work, I believe, or
putting the footings in soon.
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During the last election, being my first attempt at talking and canvassing and trying to see what the people of the community really want, the number-one question that a lot of these people were asking me - because they had been very patient, Mr. Minister, over the years for this facility to be finished - when is it going to be finished? Really, just a simple question of when does the department or yourself, Mr. Minister, foresee the completion of this much-needed facility in our community?
MR. MACISAAC: The facility will be completed in fiscal 2005-06. I probably shouldn't get to the point of identifying months at this stage, but once the construction is underway we can provide a more definitive timetable. I very much appreciate the comments of the honourable member with respect to that facility. What's of interest in terms of that facility is that it will be focusing on the provision of service to citizens and that, I think, will help and it will become, I believe, a focal point. Mind you, it's unique in terms of the catchment area that it serves. The honourable member indicated about 100,000 people. It is a facility that will provide services without the necessity of beds associated with it, so it's one that's dedicated to service and medical services in its entirety. That, I believe, will be a very positive contribution to the total provision of medical services within the province, and we definitely look forward to its completion and getting under full operation.
MR. DAVID WILSON (Sackville-Cobequid): I'll have to agree with you, Mr. Minister, the focal point of the services provided is going to be amazing, and over the last several years we've had plans and floor plans for the different services that are going to be provided out there. One, I'll make mention of, I think is the chemotherapy area. I believe that patients now won't have to travel so far, or come to the city when they're receiving treatments such as chemotherapy for their illnesses. I think that's very important when dealing with residents who are going through such a hard health emergency, or health condition. They like being in their own home as much as they can and really dread going to the hospital. Sometimes those treatments are drawn out and it is a long part of their day when they have to go and seek those treatments.
I think when the new facility does open it will draw the community together a little more and we realize that this facility can play an important part in the health care system, especially in HRM here, and in the province because we do have residents from all over who may find themselves in the new Cobequid Community Health Centre - if it's from people flying into the international airport or travelling along the roads, as it's an easy access off the highway.
I think what I was trying to get to is that this facility can be a major player in the services and the condition of our system here, especially in HRM, because as you're aware, Mr. Minister, and I'm sure many people here in the province are aware, there has been what we call a crisis going on over the last little while. Some people say it's been months, maybe a year, but being involved in providing a service in Nova Scotia, in health care, it's been years in the making, and it's been years that we've needed to address some of the issues, especially
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when it comes to emergency rooms. Just as of Christmastime when it seemed like the crisis boiled over and we had health care professionals like the ER staff at the QE II come out publically and state that something needs to be done. I was quite amazed when I saw that transpire because, with dealing with a lot of these health care professionals over the last eight or nine years, I didn't think they were ones to step out into the limelight, if you want to call it, and go in front of the cameras and the public and really denounce what was going on or the problems that existed in the ER. It really took a lot for these employees to stand up and say that there is a crisis going on in the ER.
I have to tell you, Mr. Chairman, and, Mr. Minister, it has not gone away. I talk to a lot of health care professionals on a regular basis, a lot of my colleagues who are still working in the provinces, paramedics, and it's still there, the conditions in the ERs. They are not in the limelight, they are not in the papers every day but there is still a crisis going on and there are still long waits. People are waiting hours, if not days, in the ER.
I know the minister had mentioned earlier - I'm not sure if it was yesterday or the day before - about beds really aren't the issue. I agree somewhat with him, but beds are a big issue when you need a bed in the ER. When you're in the waiting room and there are no beds in the ER, and there are people who are admitted to the hospital and need a bed to go to, then it is a bed issue. When you have ambulances, sometimes up to eleven ambulances, sitting outside the department waiting for a bed to transfer their patient over, it's a bed issue.
Coming from a paramedic background, when I heard a lot of these ambulances were waiting hours on end, Mr. Minister, and it seems it's just getting worse over the last year, since I've taken a leave from that profession, I've talked to many colleagues who have said over the last couple months it's unbelievable the difference in the wait times that they have now, compared to, say, nine months ago.
Even I have noticed over the last, I'd say, two years the increase in the time that we wait when we transfer a patient over to the ER staff. Under policy and protocols, when an ambulance in this province brings someone to an ER, they don't transfer care immediately - you don't just arrive and that's the end of story, you have to wait to transfer care to the proper people, and if there are no beds, then the paramedics stay with that patient, or those patients, and treat them. I've heard the term earlier in media releases about hallway medicine, and that's what is going on. Many times over the last couple of years, I have been waiting in the ER and had to treat patients with either increased pain from a fracture, or other medications have to be given to them and the paramedics are treating them. I think what is happening, the communities in our province are being left unserviced by paramedics. The day the 11 ambulances were outside the area, that's 11 communities in this province that had nobody covering them.
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Yes, the paramedics do a great job, and dispatch does a great job in trying to place ambulances throughout the province when we're low, but it's just fortunate that we haven't had any major instances that needed a large number of ambulances at once, when there was such a backlog in ER. We've been really fortunate and lucky, I think, with the deployment of ambulances.
So getting back to a few question on the Cobequid Centre again and the role it can play in the future, when it does open. A lot of our residents have asked me, like I said in the previous question through the campaign and still contact my office, and they're under the assumption that when a new hospital is built, it's going to be 24-hour service. As you're well aware, Mr. Minister, after 10:00 p.m., they close their doors. They don't just kick the patients out, but they treat the patients who are inside, then open back up at seven in the morning. But as a paramedic, I know emergencies happen at all times, at any time of the night.
I don't know where this misconception came and I try to let as many people in my community know that this new facility is not going 24 hours. What I want to ask you is do you have any funds or are you looking at diverting any funds to extending the hours of the new hospital when it opens, or even extending it to 24-hour service?
[3:00 p.m.]
MR. MACISAAC: Mr. Chairman, in response to the honourable member's question, the decision taken with respect to the hours of operations, that decision was based on an analysis of the demand that would exist for that facility. Between the hours of 10:00 p.m. and 7:00 a.m., the demand is very light, and that demand is light not just in that catchment area but it's lighter throughout the region. It's anticipated that it would not be an appropriate use of resources to have it operate on a 24-hour basis. But I should point out to the honourable member that should the demand prove to be there, that it would indeed have the capacity to be able to operate on a 24-hour basis.
As the facility opens and begins operation, and the analysis of the demand relative to its operation is carried out, there will be very careful monitoring and if it is necessary to look at another arrangement then I'm sure that it would be looked at, because it would be in-appropriate to simply shift an overload and demand from one place to another. Based on the studies which have been done, it is anticipated that it can handle most of the volumes between the hours of 7:00 a.m. and 10:00 p.m., and because the demand between 10:00 p.m. and 7:00 a.m. is less all over, other facilities that are operating 24 hours could do the job of looking after people who would need emergency service in that time frame. However, just to repeat, the facility would have the capacity to operate 24 hours if necessary.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I'm encouraged somewhat from the comments, but there has been a demand. Even as early as through the Christmas holiday there was an incident where the facility had to stay open, or had to commit
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to servicing patients who were in the facility at the time. That reason for having to keep those patients there and keep staff and doctors there was because the QE II, which at the time was overloaded, wouldn't accept the patients. After 10:00 p.m., the agreement is that the Cobequid Centre would transfer patients into the QE II, but on this night, which I believe was around December 30th, the QE II refused those patients.
I understand the point of the emergencies and the studies that have gone on through the community and throughout the province warrants not to open it 24 hours, but there have been times, many times over the last several years that even extended hours, or even a trial, would probably have alleviated some of the problems we've seen here at the QE II. There have been some times in the past - I think that was the first time ever that the Cobequid had to actually keep five or six patients throughout the night.
I'll change things here - I want to cover a little bit about the Emergency Health Services line here in the Estimates at Page 12.20, and I see under the line for Emergency Health Services and that it "Provides funding for ambulance services in the province, as well as air medical transport, centralized communications and dispatch, and other related services." I see that at $81.5 million, I take it. Is that number right there? Is that correct?
MR. MACISAAC: Mr. Chairman, yes, the operating costs, the estimate for 2004-05 is $81.5 million.
I want to go back to the previous discussion, if I might. There obviously may be times when it would be appropriate in times of high demand, whether it's related to an infection or an outbreak - I don't like to use the word fluid in relation to emergency room - if some such event were to occur, then indeed it would be appropriate to be in a position to be able to operate a facility like that for 24 hours. I don't believe that we would want to keep it operating 24 hours just in case, if the demand is not appropriate for that. I understand also that there is a recognition of the need on the part of the Capital Health to be able to accept patients from ambulances in a more rapid fashion than has been the case previously, and there continues to be work done to address that, and I understand that there has been some improvement in the period of the last couple of months relative to that. It is recognized as a problem and efforts are being made to address it.
MR. DAVID WILSON (Sackville-Cobequid) : Mr. Chairman, the figure here on Page 12.20, the total budget for Emergency Health Services is $81.5 million. That's a huge number. I'm wondering if you could break it down - do you have the breakdown of that total cost with, I'll say, probably the three biggest users of the funds, which I would take it to be, emergency medical care, the air medical transport, and communications and dispatch - or is communications and dispatch all linked in together with their emergency medical care, since they're taking care of both?
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MR. MACISAAC: Mr. Chairman, perhaps I could recommend to the honourable member if he would go to Page 12.11, in the Supplementary Detail and you will see a breakdown of the net numbers that are there. Do you have it? You can see there that the Ambulance Subsidy - payments are $58.6 million, the Ground Ambulance Operations are $745,000, Medical Quality Control $512,000, and Provincial Programs $7.58 million, Communications and Dispatch $3 million, and the EHS Amortization figures are $3.5 million. Is that the breakdown you were looking for?
MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Minister. That probably brings me to one of my questions around the Ambulance Subsidy Payments. Can you clarify what that line indicates or where that source comes from?
MR. MACISAAC: Mr. Chairman, that's the amount of money that's paid to EMC for the services that they provide.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, looking back I guess through the Supplement to Public Accounts, under Emergency Medical Care I notice last year's expenditure was about $60.7 million, the previous year was $56 million. I see that from last year to this year they're about the same. Do you foresee any great increase or decrease in the next forecast, a year, for that payment?
MR. MACISAAC: Mr. Chairman, the increase in that budget was just over $8 million and I understand just over $6 million of that was for an increase in paramedic's wages.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, great, I hope that increase is in there next year when negotiations start. I'm sure my colleagues would appreciate that. (Laughter) I hope not. That brings us to a couple more questions, one would be user fees. Over the years, as a paramedic, I think when I started user fees were $60 or $65, there have been several increases. I'm wondering - and forgive me if I've missed this anywhere here in the lines - when we do get those user fees for the ambulances, how much was taken in last year on user fees?
MR. MACISAAC: Mr. Chairman, the amount of revenue that we've received was $6.9 million and that was based on the current rate. With the increase we anticipate receiving $7.5 million. That, of course, is based on a rate of $120. It's important to point out that the actual cost of providing that service is over $600, if you do the cost, it's over $600. Our fees in this province compare reasonably well, we're about the same as New Brunswick, P.E.I. is $130, in Manitoba they charge $190 and Saskatchewan charges $275, plus a kilometre charge beyond that.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, from the answers I'm receiving I'm creating more questions so I have two more questions on the user fees. One is, I can't understand why in the province when you use the ambulance and you then get charged
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a user fee that if you were to call an ambulance for an emergency at home for instance, MSI covers a large portion of that and the user fee kicks in at $120, but yet if you're a passenger you get a bill for $600, the full amount for the price that the government had put on that one call. I don't understand the reason why we are trying to download that on the insurance companies and maybe that could alleviate some of the problems we've seen in insurance rates. I don't understand why there's a discrepancy in where you're sitting, when you do have an emergency or an accident when you call the ambulance. I'm just wondering if you have any comments on that?
MR. MACISAAC: Mr. Chairman, the communication we have with the insurance companies is that the minimal volume they have relative to ambulance charges is not a factor with respect to the rates. The pressure on rates comes from perhaps the treatment of the injuries that occur, but the ambulance charge itself in relation to their total bills is not a contributing factor to the increases. All Nova Scotians are required to have insurance and the insurance companies are in fact the payers with respect to this fee. If we were to somehow start subsidizing them relative to this thing then Nova Scotians are going to pay in another way and I would suggest that the increase in the costs would impact more directly on Nova Scotians than it would in the manner in which it is now set up.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, many times over the last several years, even though that statement is told to the people who use the service, a lot of them are scared to even attempt to put a claim in for $600, because of their fear of increased insurance rates and over the last two or three years insurance rates have skyrocketed so they're hesitant to put that claim in. We have I would say thousands of Nova Scotians who pay it out of their own pocket just because they know that if they put a claim in for $500 or $600, if it was a car accident, their insurance rates are going to skyrocket, so they are paying it out of their own pocket. The insurance companies with the atmosphere of rate increases are contributing to them being scared to claim that.
I'm just wondering, is it in your view or your department's view are you trying to recoup the cost of the service with these user fees? Are we going to see a $600 user fee in the near future for ambulances? Is the intention of the department to is try to recoup the cost of the service that we provide to Nova Scotians?
[3:15 p.m.]
MR. MACISAAC: Mr. Chairman, I'm sure the honourable member is not engaging in a level of speculation that would cause fear among the people of this province. The fee structure that we have is one that is consistent with past practices and the amount of money that we are dealing with here is $1.9 million, the insurance industry relative to automobiles - the Minister of Transportation and Public Works can correct me - but it's an amount that's in billions of dollars and in relative terms there's quite a spread here and I don't at all think it to be inappropriate for us to continue to have insurance pay these costs.
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I'm a bit surprised that any accident that would require the use of an ambulance - I know that any slight bumps that I've had in my vehicles in recent years, I don't get away with a $600 bill, it costs an awful lot more than that to fix any of them up, even if it's a slight dent in the door when you're trying to get out of the apartment building parking lot. That can run you over $600. In relative terms, if you're involved in an accident that's going to require the use of an ambulance then I would suggest that most of time your insurance claim, that part that would involve an ambulance itself, would be a small portion relative to the total claim. There would be exceptions to that but in most cases I think the portion of the claim that would be related to the ambulance bill would be a relatively small portion relative to the entire damage that would take place in the vehicle involved in an accident that would result in somebody needing an ambulance.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, the last thing I would want to do would put fear into any Nova Scotians to call for an ambulance, it contradicts what I've done for almost the last 10 years. I have to tell the minister that many times since I started in this career I've had to convince people to go to the hospital when they really needed to go and the biggest issue wasn't that they didn't want to go to the hospital, it was user fees and they didn't have the money, they didn't have the job that had insurance that would cover these user fees, they were low-income people. They were scared that if they went with us and they had received a bill or user fee and they didn't pay it, then they wouldn't get an ambulance. I always assured people, I don't care about the bill, don't pay it, maybe I shouldn't say that but I said no one will not send an ambulance to your residence, but that is the fear that a lot of Nova Scotians have when they don't have the luxury of having special insurance or coverage through their work.
I want to change gears again, in the opening comments from the minister, he had mentioned first responders and $300,000 that was going to be allotted to them. I'm just wondering, is that a one-time grant or do you foresee infusing that kind of money to the first responders in this province on a continuing basis?
MR. MACISAAC: Mr. Chairman, they are very important parts and becoming a much more important part of emergency medical services in this province. We definitely see that as something that would be on an ongoing basis. There's a recognition here of the important role that they play and we want to continue to do that and hopefully achieve a much better integration of services as we move forward.
MR. CHAIRMAN: The time for the NDP caucus has now elapsed.
The honourable member for Kings West.
MR. LEO GLAVINE: Mr. Chairman, first of all just a few general comments. I had the opportunity during December, January and part of February, to get around the province with our medical wait times team, not a very big team, but certainly one that was very well received. We did gain some, I think, very strong insights about what is going on in the
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province. I know on a personal level it indeed was a great education to find out what, in fact, was happening in different regions.
As a general remark, I would have to say that people when they accessed the system had a good degree of contentment, satisfaction with the services. However, maybe because we were identified as the wait times team, we certainly heard a lot of stories from people who didn't have that timely access and we know that is a key problem that is with us now, and that certainly will be with us for some time to come.
One of the areas that certainly was addressed in many of the communities, and we did get out to a fair amount of rural Nova Scotia, was the fact that there were many communities that are under serviced by rural doctors - doctors in small towns, small communities. I personally believe, again, the family doctor is the critical component in the health care system. Even in my own area of Kingston-Greenwood, where we have a mobile population at 14 Wing Greenwood, when my family doctor and I knocked on quite a number of doors last Summer in the campaign, I was actually amazed at the (Interruption) Well, my family doctor works 80 hours a week, so he would take two hours out of the 80 and do a little door to door. I was amazed at the number of times that he was actually asked, will you take me on? Will you take me as a patient? We have many in our area, probably about 1,000 families now without a family doctor.
As I was starting to say, you know, it's a critical component, the family doctor, in terms of having that history and that longitudinal picture of what's going on with a patient and many without. I'm wondering what steps are directly being taken to improve the number of doctors available in rural Nova Scotia?
MR. MACISAAC: Mr. Chairman, we of course have a recruitment office within the Department of Health and they have achieved considerable success in recent years with respect to the recruitment of doctors. We have a rural incentive program that is designed to encourage doctors to establish in rural parts of Nova Scotia. There are other things that we want to do and one of those is to find a way of streamlining the process and the time that it takes for internationally-trained medicine graduates to have their qualifications accepted here in this country. That is a challenge that we're working on and we want to address.
The other thing that I can say, we have about 800 family physicians in this province and we are, as I said, actively recruiting and increasing the numbers. I know that this service is available in your DHA - and I don't have the numbers with me now or the e-mail address - but there is an information service in the Valley that will identify family practitioners who are taking on new patients and people can contact that.
We continue to have the challenge of recruitment. It's something that we work vigorously on all of the time. We'll continue to do that. We're operating in an international marketplace. As I said, we need to improve our capacity at being able to have doctors recognized who would come from offshore, but we also have the challenge of retaining
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graduates here and we have enticements for them to do that with respect to debt reduction, moving expenses, and we're also looking at alternate funding programs and seeing ways of assisting them to establish.
As we go forward, we also need to recognize the family doctor who was kind enough to take time out of an 80-hour week to help you get to this place. The number of people that we're going to have who are prepared to do that in the future is diminishing and people have their families and their responsibilities to families. We also need to be addressing how we provide services, especially in rural parts of the province so that we can, in fact, have medical practitioners who can get a life, to put it bluntly and be able to practise. That involves the team concept and it also involves the necessity to have other health care practitioners work with the family doctors in providing services.
The model of service delivery is something that has to be addressed as we move forward, if we're going to effectively address the concern that the honourable member articulates, and that is an adequate supply of medical professionals in rural Nova Scotia.
MR. GLAVINE: Mr. Chairman, certainly you pointed out an area that is going to be a major concern. I know in my colleague's area of Bridgetown, a family physician left there, and it literally, truly did take two physicians to replace his normal 16-hour-a-day workload. That certainly is a major concern, when I look at the age profile of doctors in our area, and it's probably typical in rural Nova Scotia.
[3:30 p.m.]
Recently - I believe, you received a copy and I know the NDP received a copy - I had a letter from Dr. Robertson, Chief of Staff at Valley Regional, and I believe you had the same letter, Mr. Minister. In terms of recruitment he was outlining what I saw as a very grim picture for Valley Regional and yet I would consider its location, its services and so on that are provided there, the professional community, near to a university and so on as a very attractive area to have a practice.
He was outlining the case of where they had recruited a urologist. As soon as he finished he was going to be coming to Valley Regional. However, on closer examination of what was taking place at Valley Regional and that is, of course, the lack of operating time and the low number of beds available for a practice, he has decided not to come to the area. He finds this very alarming, again when he looks at the age of the current urology staff there, and certainly he started in his letter to go through a few other departments where he sees the same kind of concern being raised by his surgeons at Valley Regional.
Therefore, it leads me to the pressures that are on Valley Regional. I would say that outside of the QE II, not just from our tour but living close to that area, I would see it again as one of the real trouble spots. I was wondering, Mr. Minister, what plans do you have in terms of dealing with that pressure situation in a hospital where ideally, according to the Chief
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of Staff, you should have about 85 per cent of the beds occupied at a given time, for good turn-around and so on, and is currently operating at 100-110 per cent capacity.
There's a situation that I think really needs attention. I wonder how this budget, with its increases, may possibly start to address the Valley Regional situation?
MR. MACISAAC: Mr. Chairman, indeed I do not in any way take issue with the honourable member with respect to the pressures that are being experienced by that facility. I did have the opportunity of meeting with the district health authority and I believe Dr. Robertson was in attendance at that meeting. Because we recognize the pressures that are there, we've made available to the district health authority an amount of $1 million for them to do appropriate preparation and planning to address the circumstances described by the honourable member, and it is our intention to respond to that planning process in an appropriate manner, to assist them in addressing those circumstances.
In the course of our conversation at the meeting with the DHA, I was able to explain to Dr. Robertson, because he was of the view that we were looking at something in the vicinity of 10 years to be able to address this, and I assured him on that occasion that we're looking at a period of less than five years to have the issue fully addressed. However, the planning is essential to being able to do it and of course once the work gets underway it just takes time to be able to do the design, get the tenders called and get construction that's necessary done and underway. We're very much aware of that situation. We're very determined to address it in the long-run.
I have been encouraged in recent months by the numbers that I see relative to that facility with respect to the recruitment and retention of nurses, which of course is a very important element of being able to attract doctors. They want to know that they have adequate nurses and other medical professionals to be able to do their work. There has been a major shift and some reason for encouragement with respect to that particular issue. The honourable member raised an issue, we are very much aware of it. We're working with the DHA to address that, but short-term solutions, while we'll work with them to assist them in their recruitment and retention, we do have a longer-term process that we have to go through to fix that on a permanent basis, and that is our objective.
MR. GLAVINE: Mr. Chairman, the other area that touches upon Valley Regional is in fact the emergency room and the very difficult overflow situation that takes place on a daily basis at the hospital. Again, we see that emergency room is not operating perhaps quite like it should. Certainly in all of the communities that we visited, it was of course here in Halifax with the QE II and also being on-site during the nurses dilemma, in particular, aggravated through the Christmas period, that brought to light very critical and wondersome situations for the long term. Certainly the message that we received when we went to the 10-15 different communities that our tour went around, how emergency rooms currently operate is of huge concern.
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At the QE II in particular which is the province's trauma centre and really embraces P.E.I. as well, it certainly does not operate as a trauma centre to the extent that it should. In fact, it operates more sometimes as an outpatient, as a general emergency room and we all know that there are many cases that probably should not even enter the doors to create the backlog and true emergencies are not being handled perhaps as timely and so on as they should.
What I'm really wondering here, is there a true plan to allow the good professionals we do have to operate in the trauma centre as they should? Is it going to take a structural change? Is there going to have to be the equivalent of a Cobequid medical centre for Halifax? How in the long term are we going to give some assurance to the professionals and to really the people of Halifax and indeed the province, that it can operate? I think in particular when we were Kentville, of the emergency room doctor there, he told us that it is very common for him to go to Halifax with a critical patient and be in the ambulance for up to two hours. There's almost, because of his level of competence - he encumbers the burden of having to remain in the ambulance. In other words, if things deteriorate a little bit, he's able to look after them. Meanwhile, you now have a GP who is the backup at Valley Regional.
This is not what we would call the best delivery. It all seems to be contingent on that bottleneck at the QE II. I'd just like to know if you have some longer term view on how that issue is going to find a satisfactory result for Nova Scotians?
MR. MACISAAC: Mr. Chairman, first of all, I want to point out that we do have trauma teams working and they're working effectively. The question is can we improve the circumstances under which they're working, and that will certainly be part of the results that we will achieve as we improve the delivery of the emergency medicine at the QE II facility. We are taking steps to do that.
There was a comment that the honourable member may have missed that I made earlier and that is with respect to the amount of time that ambulances spend at the QE II. That is recognized as being a problem and the QE II and EHS have been working on that problem and finding ways of resolving it. I understand that real progress has been made over the past two months. There is still more work to be done, but it is something that is being addressed.
The 10-point plan which we have brought forward - and I want to point out that it was never our intent when we brought that forward to say that this was going to cure the thing overnight. There were short-term initiatives that we could take that would improve the delivery of emergency care in that facility, but the longer term, of course, is that we had to provide - or the medium term I should say - additional nursing care beds within the metro area, and we have made a significant announcement with respect to that this week. The 33 beds, by the end of this Summer, should be in place, and with that we're opening up some of the bottleneck.
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Obviously the longer-term solution centres around the expansion of the facility itself, and the design work for that is currently underway and we would anticipate that moving forward on schedule. The provision of these longer-term care beds does help somewhat. If I could go back to the situation that he described in the Valley Regional, the backlog of emergency patients that was occurring there, again that points for the need for additional long-term care beds and those beds, as the honourable member would know, we have opened a number of those - 16 in April and 14 will be opened in June, and that will be a total of 30 additional long-term care beds there. The extent to which long-term care patients are occupying acute care beds is part of the difficulty that is moving toward resolution, and it should assist in the flow-through of patients with respect to the Valley Regional facility.
We're taking steps. We're making progress and I feel confident that as we move forward these problems can be addressed. One of the major problems with respect to the QE II facility, of course, is a structural problem in that the original planning which called for two emergency rooms was not implemented, and by increasing the capacity we will address that shortfall.
MR. GLAVINE: Mr. Chairman, one of the terms that we kept hearing a lot, especially from the CEOs - and we met quite a number of them as we went to the different health districts - is the burden of disease. We know that in Nova Scotia, and we do have statistics in terms of cancer rates and cardiovascular circulatory, diabetes and so on, we are well above the national average.
[3:45 p.m.]
Having taught some geography I know the demographics fairly well in the province and when I look at that age group 35 to 55, where one in almost three Nova Scotians are in that age cohort, that is certainly the age bracket where the sedentary lifestyle, the obesity, the adult onset diabetes and so on all come into play. I absolutely believe that some of the health promotion areas - and I've been involved, for example, with a kickoff program in Kingston with kids, with the Active Kids, Healthy Kids program - what kind of educational model and thrust is going to be upon that particular age group, 35 to 55, where almost one in three Nova Scotians are now situated, and knowing how the increases are likely to occur if we continue with the same type of trends and patterns that our health is going? If we don't dramatically alter it, we're going to place an even greater burden on the health care system.
I'm just wondering, what are a few of the initiatives that are going on to try to take some action now to prevent an even greater crush on the system as we move into the next 20 to 25 year period, when those people will then be 55 to 75? I think it's absolutely critical that we do something now, and I would like to know what is the Department of Health doing along those particular lines?
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MR. MACISAAC: Mr. Chairman, when we come to this age group or any other age group, there are two responsibilities here: one is the responsibility that I have as Minister of Health; and the other is the responsibility of the Minister of Health Promotion in the province. Our great challenge, of course, is chronic disease management and the treatment of that disease, and that is why I look to the Minister of Health Promotion and wish him great success in his endeavours, because it's only through his success that our burden of management will in fact be reduced. I do know that through his efforts we have had some success with respect to reducing the use of tobacco in this province, and we continue to address that mostly through the Office of Health Promotion. Healthy eating is also extremely important, and I know that there are initiatives with respect to reaching the overall population relative to the importance of healthy eating.
It's interesting, as we have to eat a lot of our meals in restaurants when we're here in the city doing our work, one of the thing that I'm noticing is that in restaurants you have choices now. It used to be that fries came with a sandwich and that was it, but now they offer you a salad or they offer you a soup, or something. I can honestly say, Mr. Chairman, I probably have had a handful of french fries since the new year, simply because I'm becoming aware of the fact that I can substitute other things. I think the fact that that is happening is an element that some progress is being made relative to the issue of healthy eating, and obviously the challenge is to get everybody to move in the direction of having the soup or the salad as opposed to the fries.
The issue of alcohol consumption is an important issue; it's one that we need to address and are working at addressing it. I'm sure the Minister of Health Promotion, when doing his estimates, will in fact be addressing that, as well as the need for physical activity. I believe the two important elements - and I'm a little late in life coming to this conclusion, but better now than never - relative to this are healthy eating and physical exercise. I believe that if those two were emphasized in lifestyles, I think tobacco would be less of a priority in people's lives and alcohol consumption would be less of a priority in people's lives.
The last point I want to make in all of this - and the honourable member references that age group of 30 to 50. One of the age groups we are focusing on relative to the issue of healthy living is the children of our population. We're doing that because we have a serious problem relative to children in this province and their lifestyles. If we can reach the children, then we'll get the adults, because I believe that the children will have a great influence on the parents in terms of lifestyle.
I say that as a person with some experience relative to the use of tobacco. If it were not for my youngest son being persistent, at age three, emptying our - my wife and I both smoked - he would get our packages of cigarettes whenever he found them, and he would find them, and he would take the cigarettes and break them in two, or put them in toilet and he'd leave them there for us to see, and after awhile we got the message and we quit. Hardest thing I ever did in my life, and I don't want to bore members who were here in the last session with the story about how I quit smoking, I won't do that, but it was the most difficult thing
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that I ever did in my life. Both of us were very positively influenced by the activity of our son who didn't like the exposure to smoke, and he was influenced by what he was seeing by way of television ads and things of that nature.
I think it's very important that we address this issue with our youth and I believe that the age group to which you're referring can be significantly influenced if we can get the job done with our youth.
MR. GLAVINE: Mr. Chairman, I am very, very pleased to see that the minister is taking all those good initiatives to heart that we have out there, especially if we get out to health seminars or any kind of educational model, we know that's very big on the agenda.
I did have a second question here but I think I will wait until the Minister of Health Promotion has his day, and I'll go back to him.
I wanted to share this time today, so therefore just a couple more questions. One of the areas that we saw and experienced on our tour was in Cape Breton. Dr. Rod MacCormick at the Cape Breton Cancer Centre at the Cape Breton Regional Hospital. I was very taken by not just the new equipment and the new surroundings and the work that he is doing there, but how he is doing his practice, and that is by having the cancer treatments offered, directed by him, I guess, through telemedicine to two or three of the other sites, smaller hospitals in Cape Breton. I thought it is a great model for a greater utilization. One of the things that struck me there, and as we went to some of the other health districts, is that not all health districts are, I wouldn't say created equal, but certainly they're not operating, I don't think, in an equal fashion, even though they do offer different services and so on.
I would have to say that there is better utilization, there is better practices and I am wondering why some of our smaller hospitals, our rural hospitals, can't adapt some of those kinds of practices and take some of the pressure off of our regional hospitals. I would have to observe that over the past five years, rightly or wrongly, either, again, with strong direct initiatives or maybe through indirect processes, I would have to think that the current deputy minister has put greater emphasis on the regional hospitals as opposed to rural medicine, here in the province, which certainly needs that kind of attention.
I reference that particular model that I saw there because it took pressure off the Cape Breton Regional Hospital and it made the other smaller hospitals, I thought, work more effectively and it kept those patients in their communities. I'm just wondering why we don't have more measures and means going on in our smaller hospitals across the province - is that the decision of the CEO and the DHAs, or should we be having stronger directives on a provincial basis as part of a plan emanating from the Minister of Health, or Ministry of Health, for the province?
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MR. MACISAAC: Mr. Chairman, the situation described by the honourable member indeed is one which is growing in its capacity and application throughout the province. I can say to the honourable member that it is a function not only administratively, but it's also a function relative to the capacity and motivation of practitioners to be able to employ the technologies that exist. There is more and more of an inclination for people to do that then ever before. Just to perhaps illustrate the example of the fact that it is not just one district, it moves from district to district, that the same Dr. MacIntosh you referenced also provides that kind of service to Saint Martha's Hospital, in Antigonish, for cancer patients there.
So there is a recognition of the value of employing this technology and we are encouraging the use of that technology throughout the province, and as I say there is more and more education taking place relative to its employment, there are more and more practitioners who are in tune with technology and prepared to use it. I think that eventually we will see a much greater use of this level of technology in our province, but it is definitely something that we encourage and want to see a lot more of in this province because it's a very, very effective use of human resources to be able to do that.
MR. GLAVINE: Mr. Chairman, two questions to finish up. First of all, at Valley Regional, I know they have been requesting and asking the CEO there - and probably the minister - about an oncologist for Valley Regional Hospital. In that area of medicine in the Valley, certainly we are at a decided disadvantage, especially with elderly patients who have to come to Halifax for this kind of treatment. I know there is a desire to certainly have that area covered in a strong fashion at Valley Regional. So, I was wondering, do you have any kind of timeline, a possibility, to offer Valley residents in terms of that medical service?
[4:00 p.m.]
MR. MACISAAC: Mr. Chairman, in the provision of the services of oncologists, the challenge is to reach as many people as we can in a manner that does not require them to travel great distances; however the challenge is to provide the service in a way we are able to meet the demand, even though that demand may not require full-time services of an oncologist. We are attempting to have clinics provided - I just reference the use of Dr. MacIntosh's operation in Antigonish, and that is done on a part-time basis to meets the demands that exists there, and that model is being employed through the province.
The specific reference to Valley Regional will be a question of analysing the demand for that particular area, and seeing whether it's appropriate for part-time clinics to be there, or indeed whether - I can't say at this time, I don't have enough information before me to provide a question as to what the demand there is relative to full-time employment of an individual. However, the province wide objective is to ensure that through satellite clinics we are providing service to as many people as close to their homes as we possibly can. That is the process that is evolving as we develop and find resources to address it.
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MR. CHAIRMAN: The honourable member is going to pass his time?
The honourable member for Preston. You have approximately 20 minutes - well, about 19.
MR. KEITH COLWELL: I have a few questions for the minister regarding home care. Some unusual things have happened in the last while in home care. It seems that the care, when people come home from the hospital, doesn't seem to be there anymore. I have constituents who have had brain surgery within the last year and had been sent home from the hospital in good condition. They had very good service at the hospital, not a question about that at all, but when they applied and qualified for home care to help them get through some of the basic things they had to do to make sure they would stay out of the hospital, it wasn't there.
The story they were told was that there weren't enough home care workers. I know several home care workers, and I checked with them, and they weren't getting a full week's work, and some weeks they were working very little, so there seems to be some kind of a disconnect between the home care contractor - in this case I believe it was Northwood Home - Care probably, but I am not sure on that - and the workers who work with them and the home care people that indeed there wasn't that service there when the individual needed it. In both cases, the individual went back in the hospital for an extended period of time, because they didn't have the care they should.
That is poor economics in any way you look at it, but it's even worse than that, because if someone is ill and they do come home, and they have the opportunity to be at home and recover at home, from what I understand the recoveries are much faster, and indeed it costs our health care system - which is stressed to say the least - a lot less money so you can spend money in other areas and do other things that you have to do. Could you give me some general comments on that to start? How that's structured and what might have gone wrong in these two cases - and these are just two that I know about, and I am sure there are a lot more. This is in this area, not out in the rural area where there is not the expertise to do it.
MR. MACISAAC: The honourable member speaks about a situation that indeed is a challenge for us, and that is the shortage of home care workers in some areas of the province, and so the recruitment of home care workers is a challenge for us. We put a bursary program in place last year, which pays the full tuition of students attending the Continuing Care Assistant course at the community college in the province, in order to try and provide an incentive for people to enter that particular profession. It is something that we need to continue addressing.
With respect to the specifics that the honourable member mentions - if the member would care to provide the specifics outside the Chamber, or by way of letter to me, I would be glad to try and track down what might have gone wrong in the circumstances that he has described.
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The member is correct, there are challenges with respect to this and we are addressing those through the bursary program and through recruitment. Hopefully we can diminish that shortage and the problem will be addressed. I believe we are making some progress on it, but the fact that we found it necessary to put the bursaries in place suggests that there is a shortage there that needs to be addressed, and we are working to that end.
MR. COLWELL: I am glad to hear of the bursaries, I think that's a very positive step, and one that we have to do. The problem is, from what I understand in these cases - and I will forward the detailed information and I won't talk about them here of course - just in general terms the problem seems to be some kind of a disconnect with Northwood Homecare that says it didn't have enough funding to supply the people, or enough staff, and the staff on the other hand were not even getting 35 hours per work, they are getting a lot less than 35 hours a week, and maybe working 2 days a week instead of a full week. So there seems to be some kind of disconnect there.
I would ask - and you probably can't answer this question right now, because I know it's sort of more detail than we should be going into here - would you look into that and see what the disconnect there is? I can give you more information as well on particular cases that will help that. There seems to be a disconnect, how can you rectify that? People are definitely there in home care, I know that for a fact. I know several home care workers who are not getting the time every week, and at the same time the constituent was telling me that they were told - now this is second and third hand information, so it may not be accurate - that they weren't getting sufficient funding to the Northwood Homecare program to actually do all the work that they are supposed to do.
MR. MACISAAC: I'd be quite pleased to respond to the specifics, when the honourable member provides them, and see what information we can provide relative to this. We look forward to receiving the specifics and will give you as much information as we can relative to the situation, and learn whatever we can from the investigation into it.
MR. COLWELL: Pursuing this a bit further - again, this is some information you probably should have today, or your staff should have there - if someone goes back in the hospital because of this kind of difficulty - and I'll I appreciate your response when I give you all the information so you can do that. If you take someone out of their home, and they have to go back into hospital again, in the QE II, what's the daily cost in the QE II as compared to having the cost of a home care worker come into the home and doing even the maximum amount of work they would have to do in a day in this sort of situation, what is the cost comparison?
MR. MACISAAC: Mr. Chairman, I want to make certain that we are not aware of any funding issues relative to home care that are preventing people from getting treatment. As I said, once we receive the specifics of the situation, we will be very pleased to look into that and, obviously, the reason we have the Home Care Program is because of the cost differential that exists between patients being treated in hospital as opposed to patients being
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treated and cared for at home. I can tell you the only figure I know for certain is the figure at the QE II. The average cost of care is $1,000 a day in that particular facility. So the quicker we can get people at home and keep them at home, obviously, is the most efficient use of funds for the health care system in this province and that is our objective. As I indicated, we're not aware of any funding issue that would exist relative to this, but will be quite pleased to investigate and get back to the honourable member.
MR. COLWELL: Going on about home care a bit, how many home support workers are provided in the contract with the Capital District Health Board?
MR. MACISAAC: Mr. Chairman, I don't have that detail with me. I'm very pleased to provide the honourable member with that detail as soon as we're able to obtain it.
MR. COLWELL: Have there been any discussions between the department and the organizations that provide the in-home support programs to fill up the gaps in these programs between where they are and where they really should be? Are there any ongoing negotiations with that or any discussions about that within the department and, if there were, how recently had there been?
MR. MACISAAC: Mr. Chairman, one of the things the honourable member will see upon an examination of the estimates is that because of the challenges of hiring home support workers, we have been underbudget with respect to that figure because of the inability or the lack of supply of home care workers. So I'm not sure if that's the gap to which the honourable member refers or not, but certainly we are, as I indicated previously, working very hard at recruitment and increasing the number of students who would decide to enter into home care work as a profession through the bursaries that we're offering. So we hope as we increase the supply of home care workers, that we can come closer and closer to spending all the money that's in the budget for it and certainly that amount of money reflects the need that is out there and it's our objective to meet that need.
MR. COLWELL: You didn't answer my question about how many home care workers there are in the central region, but hopefully (Interruption) Okay, I appreciate that. How many home care workers are you looking for now? How many are you short?
MR. MACISAAC: That work is contracted out and it would be, I will make the response to the previous question about the number of workers, I will make that answer, to the best that we can get it, part of the information that I provide to the honourable member because we need to communicate with those who are providing the service in terms of getting numbers which are reasonably accurate for the honourable member.
MR. COLWELL: Back to the full work week that we talked about with the home care workers, are you aware of that situation, the people who actually are trained aren't getting their full week's work that may help fill some of the gap? Now, I don't know if that's a problem with funding, or if it's just the way that the contracted companies that do this are
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managing their time and, if that's the case, would the minister give an undertaking to review those contracts and make sure those people are fully utilized so people can get the services they need?
[4:15 p.m.]
MR. MACISAAC: Mr. Chairman, I can assure the honourable member that the thoughts that went through my mind as he described a situation of there being underutilized workers, when we're in a situation where there is a shortage of workers, I had made a determination in my own mind that if, indeed, we find a situation where there are people who are underutilized, we're going to find a way of fixing that because if they're underutilized, they need to be fully utilized because the funds are there. As I indicated in previous budgets, we've not been able to spend all the money.
So I look forward to getting the details and I look forward to learning as much as we can about the member's suggestion that there are people who are underutilized because it does not fit with the facts that we're facing which is the fact that we don't have sufficient supply of workers to provide this service and we're trying to do our best to increase the supply of those workers. So the answer to the honourable member's question is yes and I had come to that answer long before he had asked the question.
MR. COLWELL: I appreciate that answer and I'm sure Nova Scotians will be very pleased to hear that you're going to pursue that and it will be good for all of them. Now, if indeed you can make some improvements there, and then probably there always are some improvements when you look in detail and with the commitments you're giving, I'm sure you will find some improvements.
If indeed after those improvements are in place and you do have enough trained people, are you willing to put more resources into home care when the time comes that you have to do that, to make sure that people get the proper home care and they stay out of the hospital so they're not paying $1,000 a day, that if they have to go back to hospital, or stay in longer than they really should and free the beds up?
MR. MACISAAC: Mr. Chairman, that as we look forward is where we want to be moving. Obviously, the longer we can keep people in their homes, the more treatment they receive in-home as opposed to an institution, then the more cost effective it is and the better the lifestyle for the individuals involved and that is very much part of the discussions that we will be having with the Government of Canada and it has already been, I believe, agreed to as part of the health reform initiative. So the answer, high level, is yes. We have more work to do relative to identifying funding with the Government of Canada with respect to addressing this, but that definitely is the direction that we plan to go and, you know, that's a national objective that the people of this country want to achieve and look forward to working with the Government of Canada in terms of achieving that objective.
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MR. CHAIRMAN: The honourable member for Preston with approximately two minutes remaining.
MR. COLWELL: The other question I have is about in-home hospital care. To what extent is the province doing that now? Are they doing it at all? Is there any effort or has that just gone by the wayside?
MR. MACISAAC: I'm not entirely certain as to what the honourable member was referring, however, I can say that in the area that I have the honour to represent in this House, they, as far back as the 1980s established a hospital-in-the home program. That started out first as a program called Martha Home Care because it was an initiative of the Sisters of St. Martha in Antigonish. What it did was provide hospital treatment to patients in their homes.
Subsequently, that got taken over by the district health authority and was provided by them. It is currently provided by Home Care Nova Scotia in that region. They were very much ahead in their thinking, relative to reform of the provision of health care. There are a lot of lessons to be learned from them and indeed, we will be doing our very best to ensure that programs like that are enhanced throughout the province.
MR. CHAIRMAN: Order. The time allotment for the Liberal caucus has expired.
The honourable member for Sackville-Cobequid.
MR. DAVID WILSON (Sackville-Cobequid): I want to continue on with where we left off and the minister was answering a question about the $300,000 towards first responders. I'm encouraged with their commitment to supplying funds to this group. It seems as though it will be continued in the years ahead. That's important because as in their title, first responders, they are a group of individuals that usually are on the scene of an emergency before anybody else. The training and the equipment they have is vital for them to do the best job they can and by improving their training and equipment, I foresee a cost savings down the road - especially in health - with the emergency situation.
As you're aware, the treatment you get in the initial stage of an emergency or a health emergency is important. If you get proper and up-to-date treatment, then the end results are better and hopefully less time in a hospital if that's where they're going. So the need to train people who are on the scene first is very important.
Along with the first responders who are responding to many emergencies throughout the province, especially in rural Nova Scotia, paramedics are usually alongside with them. We have many bases throughout this province in remote areas where the first responders and paramedics work together when an emergency situation occurs. One of my final questions - I'll be sharing my time with the member for Hants East - I know I asked this to the minster before in Question Period so I thought maybe today would be a better avenue to get an answer. I see that it's important that the training for the paramedics is up to date. In the blue
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book the government put out during the election we noticed there was a bursary for advanced care paramedics in return for a service agreement. It's important to, hopefully, live up to that and it's not just a commitment they made prior to an election. My question to the minister, because we are losing paramedics in this province that can get training elsewhere and get jobs elsewhere and this is affecting the coverage in rural Nova Scotia, is there money allotted for these bursaries and can you tell me how much and when are you going to implement this? The school year is coming for many of these advanced care paramedic programs in September.
MR. MACISAAC: I'm pleased to be able to provide information to the honourable member with respect to the bursary program. Going back before 2003-04, we had provided 25 bursaries, before 2003-04. In fiscal 2003-04, we provided 15 additional bursaries - that's over and above the initial number. In 2004-05, we budgeted for an additional 15 - that would be a total of 55 bursaries that are being provided. They are $7,000 bursaries so that would be a total of 55 paramedics will have been funded to receive this training by the end of 2004-05.
MR. DAVID WILSON (Sackville-Cobequid): If I understand this right and the figure you gave was $7,000 - that was, I believe, a bursary that EMC is giving to the employees. This was in place before, that Emergency Medical Care were giving bursaries to go to school. Is it my understanding that the bursaries announced in the blue book are those that Emergency Medical Care were already offering and you're just continuing that and you placed that in the blue book?
MR. MACISAAC: The money, EMC does provide the bursary, but the money flows from the Department of Health to EMC for this specific purpose of that bursary. So it is a dollar amount that is paid by the Department of Health for these bursaries.
MR. DAVID WILSON (Sackville-Cobequid): From that answer, Mr. Minister, the paramedics of the province are going to be quite discouraged with that. It was their understanding, especially during the election, there was going to be additional bursaries provided and I guess that answered that. For now, I'll pass the questions over to the member for Hants East for the remaining time.
MR. CHAIRMAN: The honourable member for Hants East.
MR. JOHN MACDONELL: I want to thank the minister and his staff. I recognize that not only did the member for Sackville-Cobequid inherit the constituency of the previous member, but he also inherited his talent for brevity.
Mr. Minister, I kind of thought from your conversation there as you sat down that maybe you wanted to make a comment in response to that member's last comment. If you wanted to do that when you respond to my first question, you could do that.
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[4:30 p.m.]
I'm going to say something that might catch you off guard. I think I've been in this House six years and have never said it and I'd like to go on the record to say, no privatization of health care in this province. Not that I have a clear indication that this is a direction that the government is going, but it's a worry that I have in a national sense. I certainly hear Mr. Klein, and he talks more and more in this regard. We hear more about flexibility in the system, flexibility in the Canada Health Act, and I want to tell the minister that I worry. I worry about privatization of health care in this country, and since I know Mr. Klein is of the same philosophical political view as this government that it may not be today, it may not be tomorrow, but my gut tells me and I worry that someday down the road we're going to look at that and I think it won't come in a rush, it'll come by stealth. I want to say, I want to be on the record to say, that if it takes the last remaining breath that I have to oppose privatization of health care, then I'm going to use that last breath to do that. I want my constituents and Nova Scotians and my family to at least recognize some point in the future if necessary that I stood in this House and said that.
I have a number of concerns, Mr. Minister, on health care issues. I have a rural constituency - actually a constituency that is made up of urban and rural. The urban area, what we call the corridor of the area from Enfield to Shubenacadie, doesn't seem to run into the same problems around trying to attract a doctor and so on, but certainly if we look at Rawdon, Kennetcook, Noel, and that area, what we refer to as the Hants North area, it's definitely a different situation. I want to say to the minister that I think the department has tried to help us out there. Those three communities for the Rawdon Health Clinic and the Kennetcook clinic and the Noel clinic, they have come under an envelope there or an umbrella I should say, of one body and I'm not sure that everything works as fluidly as they would like, but certainly my impression is that the department hasn't really worked against them. I think the department has tried to be helpful, so I would encourage that.
One thing that I would like the minister to consider and I'd like to know if he has considered it and that is, although we have three doctors in Rawdon, Kennetcook and Noel, one works exclusively I think in the Rawdon area and one works exclusively in Noel, but there is one doctor who actually works partly in Rawdon and partly in Kennetcook, so the fit obviously would be better if we had one in each one of those clinics, but none of them live in those communities. Those doctors certainly, I think one lives in Truro, the one for the Noel area; one lives on Quinpool Road, that does Rawdon and Kennetcook, or at least lives in the city I'll say; I think one lives in Brooklyn in Hants West, for the Rawdon clinic. That's not a terribly long distance away for that community, but it hasn't made the most perfect fit.
Without knowing a lot about the histories of those doctors of where they were raised, an idea that has come to me sometime ago was that we should be offering incentives to students who are from rural communities, because I think they would have a greater appreciation for the rural lifestyle and be more willing to live in those communities. I'd like to get the minister's thoughts on that, whether or not actually you might say well, look, the
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department's already doing that but I'm not aware of it, so if you could fill me in on what your thoughts are in that area.
MR. MACISAAC: Mr. Chairman, as the honourable member was reciting the communities, some memories I had of the first time that I've ever been through those communities is when I had the opportunity of working with what was then Maritime Telegraph and Telephone Company Limited. We were replacing lines up through Tennycape, through Noel. It was one of the coldest Januaries that I can recall and I can tell you the wind blew in a pretty bitter fashion. I was very pleased a number of years later to be able to return to that area for a Summer visit and enjoy the very pleasant surroundings. I can recall one of the things that stands out in my mind is as I traveled through on a Saturday afternoon, the number of outdoor gatherings in people's backyards with guitars and singing, I felt like I wanted to stop and join them, but I didn't.
AN HON. MEMBER: Were you wearing a kilt?
MR. MACISAAC: I wasn't wearing the kilt, no. However, that's not what the honourable member was asking me about, but I was just sharing that memory. It's a beautiful part of the province and it certainly has those characteristics - in many respects a very pleasant remoteness, but the challenges of remoteness that go with it relative to health care.
The honourable member may be interested to know that one of the things that the medical schools in this country are coming to recognize is that in recent years they have placed far too much emphasis on the training relative to acute care and because of that, many of the graduates were people who were perhaps not motivated in a way that would lead them to think about a rural practice. But they are changing their approach with respect to training and placing more emphasis on a training that would have a broader perspective to it so that hopefully as more graduates come out of our medical schools - and I'll remind the honourable member that we've added eight additional seats in the last two years, so there are eight more students now in the second year and eight more in the first year of study - that will assist somewhat.
We have, of course, as the honourable member would know, been helpful in providing a nurse practitioner to the area and that has resulted in making the job of recruitment of physicians easier so that we're able to get people there. Perhaps the circumstances as described by the honourable member are not ideal, but the fact is the people are in fact being serviced by general practitioners in that area.
Again, members of the House will tire of hearing me say this but it's part and parcel of how we need to think in terms of changing the delivery model and the impact of the nurse practitioner in those communities is something that has been of some significance relative to that and we need to continue working in that direction.
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MR. MACDONELL: Mr. Chairman, I didn't necessarily hear you say you agreed with my idea about the rural students but I recognize some initiatives that the department has taken on, or the government has, but I would like you to consider actually making a dedicated target of students from rural Nova Scotia to see if it's possible to get some uptake from them in terms of studying medicine.
I'm curious about who monitors the role of a nurse practitioner or actually doctors in a community to ensure that the fit is right or that what we had hoped in terms of health delivery in those communities is being met?
MR. MACISAAC: The relationship that exists between the general practitioner and the nurse practitioner is a relationship that is defined by way of a practice agreement that is entered into before they actually start practising and that agreement is one which is signed off on by the College of Nurses in the province. Now, the nurse practitioners are employees of the DHAs, but the arrangement of a practice is an arrangement between the medical practitioner, who by the way is a private practitioner of health and not public, paid by the public dollar but is a private practitioner. So that is that.
One of the things I neglected to mention in my comments earlier about attracting students to consider rural postings in this province, in my meeting with the Cumberland Health Authority, I was very pleased to learn of an initiative that's taking place there, I believe through the community health boards, and they have recognized there that they have challenges in terms of serving the rural population and what they are doing is they are organizing themselves to fundraise in their communities with the idea of putting together bursaries that would be paid to students who might become qualified as laboratory technologists, or qualified as a nurse, or indeed qualified as a medical practitioner.
Their objective is they feel that if they can get an agreement from people who grow up in the area and become qualified as medical practitioners, that when coming back to the area, they would sign an agreement to practise for a certain period of time, but they feel very confident that once they get somebody who has grown up in the area to come back and re-establish, that they in fact will stay in the area. So that is an initiative which we want to follow very closely to see what success they have and I've shared that particular story with others because I think it's something that will pay dividends for them.
MR. MACDONELL: Mr. Chairman, I want to say that if you think it will pay dividends, I wish you would take it on and do the funding because I can see that the community health boards, depending on your community, the ability to fundraise is going to be limited and so I would see that certainly there will be community health boards that may more easily than others be able to fundraise in a fashion suitable enough to do this and others that would not be able to and certainly the more rural communities, you know, which are lower population, we know all the statistics about depopulation in rural Nova Scotia, aging communities, fixed incomes, et cetera. So I see problems in rural Nova Scotia of trying to promote this on the basis of communities doing the fundraising.
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[4:45 p.m.]
If it's something that the minister sees as a good idea, then I encourage the minister to take it on and do a couple of pilots in a couple of communities and I can suggest a couple of them in Hants East if you wanted to test a trial balloon there and see what might happen because I see it as a problem. It's almost downloading to the communities and they have enough to consider. The community of Rawdon actually has the hope to build a health clinic and they're trying to fundraise and they're having a pretty tough time of it. I can see that if you were to add something else to their list of things they're trying to do, it would be practically impossible and actually, certainly in terms of small communities, I think the province has a role to help fund those clinics.
I think the province has shown a fair bit of flexibility. I think the doctors in that area are on an alternate funding strategy and I don't think it's fee for service, which I have to say I think the province made a good move in doing that. So if you're looking at ways that really help bring health care to communities, I certainly would hope they'll think about, well, you know, if we were actually to put some money into a clinic, that would keep people from winding up in a place that's more expensive to address their health care needs. So I will get you to respond to both those comments, one around the fact about the health boards doing the fundraising and also funding for clinics.
MR. MACISAAC: Mr. Chairman, I used the example of Cumberland and the idea came from the community health board, but the initiative itself is something the community took on and what that reflects is that for the communities involved, they have made this a very real priority and that is what they want to be able to do. Now, you know, it's the question of when the role of community ends and the role of government takes over. The honourable member referenced that we are on an alternate funding program with respect to the physicians in that area. That's an appropriate response of government relative to trying to find ways of being innovative and to improve the delivery of health care and to find ways of recruitment and make it more attractive for people to go to an area. I think it's not the role of government to go ahead and supplant the initiatives of local communities relative to things.
The issue of service delivery, of course, is something that rests with the district health authorities and so relative to the clinic situation, that's a question I think that should be pursued with the district health authority relative to their planning and their initiatives. So, again, and perhaps it's the reason that I sit with this group and you sit with that group, you know, my philosophy is that we should not be doing things that stifle community initiatives and I think there's lots of room for communities to respond to their own needs and I simply put that forward as an example of what's done in one area. We do not have the capacity to do it all and communities can take responsibility for their own priorities when they deem it to be appropriate. With respect to the service delivery, however, it is a question that the DHA may very well want to respond to for that community.
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MR. MACDONELL: Mr. Chairman, I want to say that I disagree. I think communities can do a lot, I think communities do do a lot, and I think there are communities that can't do a lot. Some can't do very much. When the minister says, there's a point where communities end and government takes over, well I think government takes over when communities can't do it. When they recognize a possible solution to a problem, I would like to think that the government is visionary enough to say, gee they've come up with something that might work.
I think this is something that can be applied across the province and I think that we are the ones, when it comes to health delivery, who really should ensure that it's a common delivery as much as possible across the province and not a mishmash of whatever any particular community health board or community group can do. That is definitely the role that I see and I want to say to the minister, certainly that may be partly connected to why he's over there and we're over here, but I want to tell the minister the over here is getting bigger all the time, and at some point it will topple over to the point that it will be over there and we can have this conversation backwards across the floor, at least I hope we will get the opportunity. I'm hoping we'll be able to say, well it is possible to do that.
I want to touch a little bit, since you raised the DHAs as a possibility for the clinics, well the DHAs are not super in their ability either. To my knowledge, their funding comes from the province. I looked at initiatives. Presently there's a plan to build a new hospital in Truro, and, I think, an addition or some changes to the hospital in Tatamagouche. I think there are 7,000 people roughly in the Tatamagouche area. There are 10,000 people in the Enfield, Shubenacadie, Nine Mile River area, and we were unable to get funding for our multi-service centre which is planned for Elmsdale - the municipality is building that. I want to thank the province for putting some health services in there which will actually help pay the mortgage for it.
When I look at what's being done by the DHA in other parts, the Hants East area didn't get the funding that some other areas did get. I think it's a benefit to the people of Hants East that the Municipality of East Hants was willing to try to pick that up. I appreciate at least that the government was willing to take space there and offer services there and help with those payments, but you can see where I'm coming from, that there was definitely a difference in the way dollars were allocated in my area, compared to other areas of that DHA.
One point I want to make regarding the DHA, is I don't think that we are exactly in the right place in my constituency. Mount Uniacke is in the Capital District. The rest of Hants East is in the Central District. I think it would be a much more appropriate fit if the shore area, at least South Maitland to Walton in particular, probably from what I understand from those people, a lot of those people would travel towards Truro for their health needs. The biggest part of my constituency travels towards Halifax. So, I think it would be a much more appropriate fit if most of that constituency was in the Capital District.
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I'm not sure whether this has been a numbers game, to try to get the numbers up for the Truro area, to make it look viable enough to make a case for the hospital or what, but I can assure you that most of the people, certainly in the corridor area of Hants East and Nine Mile River, which is a big part of that population, if you take that population, plus Mount Uniacke, which is already in the Capital District, the Capital District would be the proper, more appropriate area for most of my constituents with a smaller group, that would maybe more appropriately be in the Central District. As far as the funding from the DHAs for clinics, well they can't do any more than what the province is willing to give them in terms of funding for the DHA.
My colleague, who spoke prior, brought up first responders. I want to mention that as well. Local fire departments are a valuable part of health care in my constituency, and the one in particular that I want to raise is Maitland. I think the tax base there, municipally, is about 600 homes, so it's a very small funding ability for that fire department. They spend a lot of time fundraising. They are trying to fundraise for a new truck, and 40 to 60 per cent of the calls are not fires, they are first responder health issues, and I think this is something the department should be looking at, as to whether or not these groups are actually able to carry out that role, and should be offering some help in that regard. I will listen for your response.
MR. MACISAAC: Mr. Chairman, I'm not sure if the honourable member was aware or not, but in fact there is an amount in this year's budget to provide assistance for first responders, it's an amount of $300,000. There are, I believe, 158 fire department that would be assisted in this, through training and equipment. As I indicated in response to a previous question, this is not a one time injection of funding, it is something that we intend to include annually in our budget, and we, of course, will do an analysis of how the money winds up being used and the demand relative to that money. We do recognize the very important role that's played by first responders in this province, and it's our intention to do our utmost to ensure that they are adequately trained and the level of equipment that they have is appropriate for them to play and continue to play an effective role in that capacity.
MR. MACDONNELL: I was raised on a farm so the expression, don't look a gift horse in the mouth, does have some meaning for me, I have to say. You kind of know that the gift is losing value over time. In terms, the $300,000 sounds very good; if there are 158 departments, that is less than $2,000 per. This is my next suggestion, something that may not come under your envelope of authority, but certainly would be under some minister. I've been curious to know why the province charges fire departments - I think they have to have radio permits, and even if you consider registration vehicle permits or whatever - why we force fire departments to pay those fees.
It would seem that if they're doing this job on a volunteer basis, number one, for most of them, that they are fundraising to pay the province these fees, when they are actually saving the province money. It's kind of to the ridiculous point actually. I had a case, I think it was the Shubenacadie Volunteer Fire Department, where one of the firefighters was hurt. The ambulance took the firefighter to the hospital, then they got the bill for taking him. I had to
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shake my head and say there's something wrong with this picture. To my knowledge, we intervened, and I think the province did give them a break on that. I have to say, sometimes the right hand doesn't know what the left hand is doing.
[5:00 p.m.]
It certainly would seem appropriate to me, that any fees charged by the province, for whatever fire departments need, it would seem like an inappropriate thing for them to do, considering I can't see that those fees would amount to an awful lot. The less than $2,000 that the departments are going to get, out of the $300,000, well they could probably top it up a little bit by not charging them for whatever fees. If they still need the permits, that's fine, but I don't think it's in the best interests of the province to be charging them for that. Do you have a comment about that?
MR. MACISAAC: The actual fees and the setting of the fees themselves are not something that comes under this department. Indeed I'm told that some of those fees are fees that we have to pay as a department. However, the balance is always there. If you exempt the fees, then there's less money to provide the services. The fact is that first responders are getting $300,000 this fiscal year that was not available to them last year. The fact is that we recognize that this is an appropriate expenditure of money, and have made the decision to make it part of the budgetary base. It is something that will be analyzed on a continuous basis relative to the provision of that service.
The honourable member made reference to a firefighter having to be billed for an ambulance fee. There is a procedure in place where the members of a volunteer fire department can be reimbursed for those fees. It is there, it's, I suppose, a bit of an inconvenience when you have to apply to get reimbursed, but again, you have to have some control over expenditures and there has to be a way of determining that indeed the person was a legitimate member of a volunteer fire department and is entitled to be reimbursed.
MR. MACDONELL: I think that would be pretty simple to do at the site, when you pick the individual up, that could be determined. I am going to move fairly quickly. I was asked by a constituent to find out if it's possible to determine how many people, and this will be difficult, I think, but how many people in a particular area of my constituency would be on dialysis. Is there a computerized way to get that information, or is that a pretty far . . .
MR. MACISAAC: We will do our best, if that is satisfactory for now.
MR. MACDONELL: Well, that's pretty satisfactory. (Interruption) I'll give the pertinent information after - if you could even try to do that, that would be great. I guess I want to throw a hypothetical at you. In this province, if I were taking my child to a medical clinic and I didn't have a health card, do you think that that child should be turned away from care, because they don't have a health card?
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MR. MACISAAC: Madam Chairman, I appreciate where the honourable member wants to go with this, and there is a provision in the budget that if a medical card is in fact outdated, that it should be renewed, and unfortunately, people abuse the system. You have to take steps to ensure that there isn't an abuse of the system, and that is why it is necessary for us to take the step to have the cards renewed. In the event that a patient presents themselves to a medical practitioner there is an obligation by oath of the practitioner to provide treatment for that person in the case of emergencies. If it were that sort of a situation, then treatment would be provided. However, if medical cards are in fact outdated, then we have an obligation to make sure ours are updated.
MR. MACDONELL: I won't pursue this anymore, but I just want to say that the hypothetical situation that I'm thinking of, if it was destroyed, or some sudden circumstance, that it was lost, not that it had expired.
Last year, maybe my timing is off, but when Honourable Jane Purves was Minister of Health, I had raised the issue of a moratorium on the licensing of residential care facilities, and the minister at that time said that actually there is no moratorium, we're not keen to issue licences in places where we seem to have lots of placement in facilities, but in areas that don't have them, there basically is no moratorium.
I told the people, actually, Serenity Lodge, in Enfield, to contact the person that the minister had given me the name of during the Budget Debate and that went absolutely nowhere. The staff said they don't even understand why the minister even said that. I have talked to the people at Serenity Lodge, at this point your department has said to them to fill out an application and they would look at it, and if there are people who are calling and looking for a placement, that their application would seriously be considered. I guess what I'm really saying to the minister is, it looks as though from your department, that they would look at new applications, and I am really here to speak for this facility, to encourage your department at the time when they do apply, that this will get serious consideration, but if you have a general comment around the moratorium, I would be pleased to hear it.
MR. MACISAAC: What I can tell the honourable member is that in fact, as applications are received, do an evaluation of them. Aside from that, there is a complete analysis being done departmentally with respect to the wider issue throughout the province. What I will do is make sure that officials in the department are made aware of the honourable member's concerns relative to this application.
MR. MACDONELL: Minister, I'm glad to know that you're actually accepting applications because it seemed like last year that wasn't even possible. Just one other, can you tell me, it's one of these questions that you may or your staff may shake their heads at, I think we've pretty much figured out, at least it's my understanding, that we kind of know what the cost of smoking is to the health care system, or at least within ballpark figures. If my memory is right, it's around $175 million and if anybody wants to correct me, I would appreciate that, but do we have numbers in terms of alcohol-related health issues?
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MR. MACISAAC: Yes, I was trying to listen to two people at the same time.
MR. MACDONELL: I wonder if we have a number, first of all, if my number around smoking is right, but if we have a number on alcohol-related illnesses, if we have a dollar figure on the cost to the system?
MR. MACISAAC: Madam Chairman, your number is close to being correct. It's closer to about $180 million a year and that just about matches the amount of revenue that we get from tobacco products. So if we could eliminate the use of tobacco, then we could wipe $180 million out of the health care costs and it would be a wash, but we would have a much healthier society. I don't have the numbers with respect to alcohol because it's a much more difficult impact to get an accurate assessment on, you know, relative to the costs associated with it and that's a more challenging figure to find. I don't know if my colleague has (Interruption) But at any rate I know that there are, in the past is what I'm talking about, the past, a long time ago, that I've seen figures relative to what the cost is, but they're only estimates and I haven't seen anything more recently.
If I could share these numbers with the committee, it might be of interest. The cost to the Nova Scotia health care system, an estimated $180 million a year, that's 9 per cent of the annual cost of health care and tobacco, but second-hand smoke costs an additional $21.5 million a year. So it costs us more to treat the effects of tobacco use then we get revenue which I believe is the statement I made here the other day in the House.
MR. MACDONELL: Madam Chairman, with that I will wind up my comments. I want to thank the minister and I want to thank the minister's staff. I appreciate your efforts and I want to hand it over to my colleague, the member for Dartmouth South-Portland Valley.
MS. MARILYN MORE: Madam Chairman, I really appreciate this opportunity to raise a few issues and because time is short, I think I'll put my question first and then give a little bit of preamble or background to it. I'm basically asking what money might be in the Health budget that would provide some sustainability or strategy around the volunteer sector? Just as background to that, you and I both know how many provincial agencies, organizations, community groups and others are involved in direct health care in this province. It includes everything from the health charities, to organizations that support volunteers who are raising money for hospital equipment and renovations, to the volunteers in nursing homes, the first responders, the volunteers who help out with family caregiving situations and on and on and on, so I'm looking for some support from the department for the volunteer sector. I'm just wondering if there's anything in there to relieve some of the pressures that those organizations are under because, quite frankly, you can't do your work without them. So it's in everyone's best interest to support those community groups and organizations.
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[5:15 p.m.]
MR. MACISAAC: Madam Chairman, the honourable member indeed describes a situation which we in this province are extremely fortunate to have and that is the large number of volunteers in the health sector. If you go to any health care facility in this province, you see, you know, just a large number of people who are volunteers, from people who would greet you at the door, to people who are prepared to give you directions on where to go, to people who are there spending time with patients on their own, people who are out fundraising, the people who are running the canteens in order to raise money for them. We do have a fund of - I'm looking for the numbers here - but we have a fund of approximately $2 million that is used to assist various volunteer-type organizations and I believe the honourable member is familiar with Community Links which received some funding from that particular program.
The honourable member does describe a situation that we're very fortunate to have in this province and the encouragement of our volunteer sector is something that we all need to be aware of and I think the fact of just taking the time to thank people who give of their time is one of the most important things that we could all do to encourage that level of activity.
MS. MORE: Mr. Minister, I just want to mention some of the pressures and challenges on that sector for the record. First of all, the lack of stable funding is a big problem and I'm going to be talking about this when the Health Promotion budget and the Community Services budget comes up as well. Staff and volunteers are spending more and more of the time that they were spending on programs and services on fundraising and this is such an important issue that I think the provincial government, across all departments, needs to be looking at a provincial strategy to help with this particular situation.
Statistics Canada information is suggesting that fewer volunteers are putting in more hours and donating more money and while that is worthy in itself, it does make the volunteer sector a bit vulnerable in that any major impact on the core volunteers in this province could have a ripple effect across the level of programs and services that might be able to be delivered. So, for example, when the Health Department develops policies around early discharge from hospitals, making the families the first charge on looking after people requiring care at home and services in the community the second charge before home care services are provided, such policy changes as having more surgery done on a day surgery basis rather than staying overnight, while these may save money for the Department of Health, they do put significant pressure on the volunteer sector - families and communities. What I'm suggesting is that there needs to be more consultation before some of these major initiatives are undertaken, so that you understand there is this impact, that these things don't happen in isolation and that it's not going to have a severe impact on the expectations of the community and the government for the volunteer sector.
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The insurance issue is another one that's hitting a lot of the volunteer sector groups. There's a lot of concern among a number of boards of directors in that the insurance companies are asking, in many cases, when you renew your home insurance, whether the individuals, the policy holders, actually serve on any boards of directors. They see that as a high-risk activity. This, we think, we have to keep a close eye on because it's going to have an impact on the people who are willing to serve on boards who run many of these organizations. There's also the general liability issues facing many of these organizations that they're finding it more difficult to handle the premiums. It's adding to their fundraising pressures.
I also want to mention, while we are pleased to see the focus on health promotion, this sort of artificial divide between your department and the Office of Health Promotion does add to the workload of the volunteer sector in that sometimes they have to deal with both departments.
MADAM CHAIRMAN: Order, please. The honourable member for Annapolis.
MR. STEPHEN MCNEIL: Madam Chairman, I want to thank the minister and his staff for coming today and giving me the opportunity to ask a few questions. I'm sure the minister is well aware that my riding is in the western tip of the Valley District Health Authority. I have the very good fortune of having a community health centre in Annapolis Royal which I believe could be used as a model for much of the province. I'm sure you've heard plenty about the Valley Regional Hospital and the challenges that are being faced by it. I'll be quite up front - the sole reason that I am here is because of Soldiers' Memorial Hospital and the challenges that are being faced by it and the downsizing of it.
I've been searching throughout our own district as well as asking anyone who might have an opinion on where a hospital the size of Soldiers' Memorial Hospital fits into the plan of the Health Department. Everyone can describe to me where the community health centres fit, where the regional facilities fit. Where does the medium-sized hospital fit in the plan of the Health Department?
MR. MACISAAC: The facility to which the honourable member refers is a community hospital. It has a capacity of providing a variety of services, but it has some beds to provide acute care which are served by the family doctors in the area. There are emergency services provided through that particular facility. As I indicated, the acute care sector, there are some diagnostic services that are provided in addition to that. But it is an example of what we describe as a community hospital. The services it provides are a very good service for those people who need that level of service and it serves as an extremely good supplement to the regional hospital that is in the area.
MR. MCNEIL: The minister is describing the hospital - one of the challenges faced by Soldiers' Memorial Hospital is, and he mentioned the acute care beds quite accurately. We also have a transitional unit which is completely full. More often than not, the four beds that
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are in our outpatient's area are full on the weekends. People are not being transferred into an acute care facility. We're operating at - they like to boast - a 98 per cent capacity. We heard earlier that 85 per cent is the capacity we should be shooting for. So what do we tell the constituents surrounding the Middleton, Kingston, Wilmot, Lawrencetown area when they're looking for a hospital to have an acute care bed?
MR. MACISAAC: Perhaps I can be even more specific with respect to the services provided at Soldiers' Memorial Hospital. It's a level 3 and there's 24/7 services provided there relative to emergency department, there are 37 inpatient beds distributed among acute medical care and transitional care, that is those requiring the longer convalescence while they await transfer to long-term care. There is a diagnostic service, there's general radiology and ultrasound, laboratory services are provided in that facility, ambulatory care. There are a variety of outpatient services including, diabetic and nutrition counselling and visiting specialty clinics. There is a day surgery for opthamology and, a 25-bed veteran's unit is housed in that facility. There's an 18-bed addictions withdrawal management unit and there is a mental health centre located in that particular facility. That's quite a wide variety of services that are provided there.
MR. MCNEIL: No one is questioning the variety of services provided at Soldiers' Memorial Hospital. What I asked and what I would prefer to get an answer to is what do I tell the patients that are located in that community who are looking for and requiring acute care services and are being sent home because there's no bed? The Valley Regional Hospital can't take them and they can't be transferred here. What do we tell that patient?
MR. MACISAAC: Madam Chairman, earlier in answer to questions from the honourable member's colleague, I made reference to the provision of long-term care beds. I believe we identified a number - 30 - additional long-term care beds. That will assist considerably, not just in reducing pressure at the Valley Regional, but also at Soldiers' Memorial Hospital.
The honourable member is correct, when you look at the capacity numbers, they are quite high. But, as those beds come on stream, there should be some relief provided as a result of those beds, allowing people to leave those areas more quickly.
MR. MCNEIL: You hit on a point that I was going to ask you about and that is long-term care patients in acute care beds. What's been before your department has been a community group in Middleton who are looking to build a long-term care facility - I believe that's been in front of your department for at least the last two years. They're looking for some direction and whether or not there is any hope at the end of the day that something will take place for them in Middleton or whether this is all for naught. I'd like to have some direction on that.
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MR. MACISAAC: Madam Chairman, I did have an opportunity to meet with the group the honourable member refers to, but in the shorter term, what we will be watching very carefully is the impact the additional long-term care beds that we've identified will have on Annapolis County because what was happening previously is that there was a greater shortage of beds in Kings County, as a result of that many residents of Kings County were being cared for in Annapolis. As these beds are opened these residents will be moving back home, those who wish to move back home, and hopefully that will free up some of the capacity within Annapolis County.
[5:30 p.m.]
We will want to look at the impact that the additional beds are going to have relative to the longer term, and see just how that plays out.
MR. MCNEIL: As the minister knows, the western tip of Kings County borders on Middleton; there's a high density population in that general area. Can I get a commitment from the department that if further long-term beds are required, that the progress that has been put in place by Middleton will be first on the docket?
MR. MACISAAC: Madam Chairman, I'm not, today, in a situation where I'm going to say who is first, second, or third. What I am in a position to say is that the proposed facility in Middleton, to which the honourable member refers, will be part of a broader analysis that's being done throughout the province relative to planning, so it will be taken into consideration in terms of the planning that we do relative to the future. We have received that proposal, and I've had an opportunity to meet with the people in the area. As we address the long-term planning, that proposed facility is certainly one that will receive very careful consideration.
MR. MCNEIL: Madam Chairman, you mentioned earlier about the surgical suite at the Soldiers' Memorial Hospital, I'm sure you're well aware that suite was just done over two years ago prior to the surgeon leaving and going to Kentville. There are presently three days of opthamology surgery going on there now, and there are two days where the surgery unit is left vacant. Considering the problem that they are having in the Valley with getting surgical room time, would it not make sense that the surgeon and supporting staff do some of that day surgery in the two vacant days that are in Soldiers' Memorial Hospital?
MR. MACISAAC: Madam Chairman, It would appear that the suggestion of the honourable member is one of those situations that's far easier to articulate then it is to put in practice. I believe that the honourable member can translate what I'm saying with respect to that - the idea is a sound one; the capacity to be able to put it into effect is more challenging.
MR. MCNEIL: Madam Chairman, I appreciate that. I guess what I would like to hear from the minister is that that is one of the challenges that his department is willing to take on. I recognize the challenges faced around that scenario; unfortunately that's what being in government is about - there are tough challenges and tough decisions that have to be made.
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I'm wondering, is your department is looking at that, or actually discussing that with the DHA and seeing if that is an option?
MR. MACISAAC: Madam Chairman, the honourable member has correctly identified the people who ultimately need to address this and those are the folks at the DHA. Will we have discussions with them? We've had many, and we will continue to have them. There is, however, a need to persuade others as to the value of that suggestion, and persuading others is the real challenge. We will not give up on that, however it is something that everyone needs to continue to work toward.
MR. MCNEIL: Madam Chairman, my colleague from Kings West brought up the issue of doctor recruitment for all of rural Nova Scotia, but in particular I wanted to speak to you about the riding of Annapolis.
We're going to be faced in the next five years with a critical problem in that many of our doctors are going to be getting to the point where they're ready to retire or certainly downsize their practices. A few years ago we had one doctor leave Bridgetown, leaving 4,000 patients without a doctor. Two doctors had to come in to deal with that. There are a number of issues surrounding this problem in terms of younger doctors not wanting to work the same hours that their forefathers have done because they have different lifestyles. I'm just wondering if you could give some direction on where your department is going in recruiting doctors, particularly to rural areas?
MR. MACISAAC: Madam Chairman, we do have a rural incentive program with respect to doctors in rural parts of the province, and that is something that we continue to work on. Another challenge relative to attracting doctors to rural settings relates to the training that is provided in the medical schools. It is the medical schools themselves that have done some analysis of the work they're doing relative to training students, and they have found that perhaps there's a much greater emphasis on acute care training in the medical schools as opposed to a broader training that would allow students to give more consideration to rural settings relative to their practices than is currently the case. As a result of the training that has taken place up until now they tended to be focused on acute care settings and wanted to set up practice in areas where acute care medicine would be the focus of their practice.
As a result of the change in attitude taken by the medical schools and the change in the emphasis of the practice, it's hoped that more and more students will be inclined to give consideration to establishing in rural parts of the province.
Alternatively, as the honourable member points out, or in addition to a measure such as that as the honourable member points out, there are other challenges that have to be met and that is to find delivery models that incorporate not just the doctor, but nurse practitioners and others who can provide services in a clinical setting that would be able to serve residents in rural Nova Scotia. That's really part and parcel of primary health care reform that is being worked on and it's something that we need to do more of.
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In addition to the items that I have mentioned here, I would again draw the honourable member's attention to the million dollars that we provided to the DHA to do an analysis of the services that they provide. Of course, part of that is to look at not just services in the regional hospital, but services that are provided throughout the entire region. We look forward to hearing from them relative to their plan and addressing that with them so that part of the concern that would be addressed of course is the capacity to attract rural doctors.
MR. MCNEIL: Madam Chairman, I'll ask a couple of questions at once. You brought up the idea of the clinics, in providing services in a clinic setting. I'm wondering from a rural perspective if that's part of what you might see as a future plan for rural Nova Scotia? Annapolis Royal is presently in the process of putting together a clinic, and if you have not been in the Annapolis Community Health Centre, Mr. Minister, I would encourage you - I'd be more than happy to take you, but if you wanted to go on your own I would encourage you to go there. They're a forward-thinking organization.
The other issue around that has been the nurse practitioner. There was a nurse practitioner in Annapolis Royal, but she left in December. She left because her services were being underutilized. One of the flaws that she saw in the system was that she had to be associated with a particular physician, where in the Province of New Brunswick she can be associated with a clinic, and whichever physician is working that day, she can collaborate with that physician who is on duty.
There are two questions there: one is if the clinic setting is something that we can look forward to seeing and expand in rural Nova Scotia; and the other is whether or not we are looking at the requirements around nurse practitioners to see if we can bring them more online to what is working in other parts of Canada, to make sure that the nurse practitioners we have stay.
MR. MACISAAC: Madam Chairman, to the honourable member. The situation he describes, clinics will be part of the future and an important element of clinics is the role of nurse practitioners and other people qualified to provide part of the medical service. In the event that the models that we are using relative to agreements between nurse practitioners and physicians is not appropriate, then it's something we obviously would want everyone to consider relative to reviewing those arrangements. I view it is a work in progress, with respect to that. We have, for instance, nurse practitioners currently practising in a collaborative arrangement with paramedics and a family physician as part of the Long Island and Brier Island research project. So we will learn a great deal from that particular project which will assist us in further formulating our approaches.
The honourable member puts his finger on something that does need to be addressed. Certainly if somebody with those skills is underutilized, that points to a need to focus attention on that and see what improvements can be made.
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MR. MCNEIL: I will extend the offer again that I'll take you to the health centre in Annapolis. It's a facility that you should visit and it certainly does give a different perspective on the way health care is being provided.
The other question is, as you may remember, in the Fall I raised the issue of self-managed care, and I'm just wondering, where is that on the radar?
MR. MACISAAC: Madam Chairman, the short answer to the honourable member's question is that the situation that I described to him in the Fall, there isn't any change relative to that.
[5:45 p.m.]
MR. MCNEIL: Madam Chairman, the person I spoke to you about in the Fall, Rick Laird, once, when the House was adjourned, spent in excess of two months in the hospital, all because of a situation where he was not getting the care - and here's a person with disabilities who is capable of making his own decisions around his care being provided. This program is being set in place, it probably will not save the Department of Health any money up front, but in the long term it will save the Department of Health money because people like Rick will not be spending their time in acute care beds. The interesting aspect around this is that if Rick was able to provide his own care, he would be much healthier, and in the long term, we, as a society, would be better off. What's really interesting is that it won't cost your department any more money because you're already paying the money. So, I'm wondering, what is taking so long, and can we see any movement on this in the next year?
MR. MACISAAC: Madam Chairman, I have said this before in the considerations of the committee - one of the very negative aspects of the job that I have is the fact that I'm always faced with situations where I know that if I had some additional resources then we could do things that in the long term would improve the lives of people. If we had additional resources we could make investments that would result in efficiencies being achieved within the department; however, the reality is that we have limited resources to bring to the demands that are placed before us and we need to make our decisions relative to that. That fact does not preclude the reality of the situation, that all honourable members could get in their places and make good and valid arguments as to why we should be spending additional monies in other programs and elsewhere, and when they all sat down I could probably get up and give an equally long list of things that they had not addressed with respect to it.
It's not my intention to put the needle on the federal record again, however, just to say it this way - if we were moving in a realistic manner toward the objectives of Romanow, which is 25 per cent federal funding, there are many of the things that the honourable member refers to that we could do such as providing physio services, home care, self-directed care. We' re not there and, unfortunately we have to rationalize the resources that we have relative to priorities.
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MR. MCNEIL: Madam Chairman, considering the fact that there's a pilot project on the go right now that we know is actually working and proving it, considering we know the federal minister is on record as saying the province will receive federal money this Summer, does that mean we'll get a commitment from you that the self-directed care will be put in place this Summer?
MR. MACISAAC: Madam Chairman, the only decisions that I can take are based on the budget numbers that I have before the committee. Those budget numbers reflect the realities of the revenues that this province has. When we reach a stage where additional dollars flow to the province or are committed in such a way that we know they will flow to the province and it will meet the test of the Auditor General, then obviously we would need to begin addressing different priorities relative to our expenditures. At the time that that happens, we will begin that particular process. I can say that the program to which the honourable member refers is certainly one of the programs that would receive consideration.
MR. MCNEIL: Madam Chairman, this is an opportunity for me to ask a few questions on behalf of some constituents. One of my constituents needs access to the sleep disorder clinic for some medication adjustment. I'm just wondering, would you know what the actual wait time for her is to have access to that clinic?
MR. MACISAAC: Madam Chairman, we have one sleep lab in the province and we do know that there is a wait list for that. I don't have the numbers with me, but perhaps the honourable member could drop a line and we'll do our best to find that number.
MR. MCNEIL: It's 22 to 24 months for her to wait to get access to have that adjustment done. So I'm wondering, anywhere in the budget is there any funding that's going to address this situation?
MR. MACISAAC: Madam Chairman, we are addressing wait times; that is however not one of the items that will be addressed in this year's budget.
MR. MCNEIL: Madam Chairman, I'm sure all MLAs are constantly having brought to their attention, medical issues that each of their constituents may have, but one of the things that I found interesting in looking at your budget number was that the Dental Surgical program was underspent this year by some $200,000, and I have a constituent who is being denied having surgery for $7,200 because it's deemed not to be a medical thing, it's believed to be a cosmetic issue, when she has doctors, letters being written that it's the sole cause of headaches and so on. I'm just wondering what direction the minister could give me that I could give to my constituent - where are we going to go with it?
MR. MACISAAC: Madam Chairman, this is a question of being able to meet criteria established relative to the provision of such a service. That criterion needs to be met. I understand there is an appeal process relative to this and I don't know if that appeal has been pursued or not, but if it hasn't then the patient might want to look at the criteria and
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determine as to whether or not an appropriate ruling has been made and, if there is some doubt, perhaps the appeal would be of value.
MR. MCNEIL: I appreciate that. I was wondering if there is somebody within in the department that I could forward some information to, and who specifically would I talk to to deal with this situation?
MR. MACISAAC: Madam Chairman, if the honourable member would forward the material to me, I would have an appropriate person within the department address that situation.
MR. MCNEIL: I will do that. I've noticed here on Page 12.3 of the Estimates, for Chief Finance Office administration there's an increase of approximately $840,000, yet when I looked through the DHAs and I look at the total increases for addiction services it's less than $500,000. I'm trying to equate those two numbers and why there would be such a difference.
MR. MACISAAC: Madam Chairman, I believe the honourable member is referencing the increase of about $755,000 for the Chief Finance Office line item, is that correct? In other words, it is an increase in the estimate from 2003-04 of $11.4 million, to $12.1 million, and $564,000 of that is related to the service level agreement of the Atlantic Blue Cross contract and the wage increases and everything in that contract they're assigned to the line item of the Chief Finance Office.
MR. MCNEIL: Is it under the upper heading of Administration that those articles fall under? Yes. Great. One of the other things that has been much talked about in the news has been the information system for Nova Scotia. I'm wondering, how far behind schedule are we on delivering that service to ensure that we have an up-to-date information system?
MR. MACISAAC: Madam Chairman, we are currently on schedule. We did announce a revised schedule with respect to the implementation of that program, but we remain on schedule with respect to its implementation. If the member is interested in the detail: District 7 will be fully implemented at November 2004; District 8, October 2004; District 1, December 2004; District 4 will be April 2005; District 6 will be April 2005; District 5 will be June 2005; District 3, October 2005; and District 2 will be in March 2006. Those are the expected completion dates.
MR. MCNEIL: How much has been spent on that system to date?
MR. MACISAAC: I thought I had the answer, but what I have is a breakdown of where the money is going that I can share with the honourable member. (Interruption) Okay, I do have the numbers here. The year 2001, there was a budget of $2.2 and an actual expenditure of $2.2; in the year 2001-02, a budget of $6.8, an actual of $5.4; in 2002-03, a
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budget of $13.2, an actual of $12.4; and 2003-04, a budget of $22.1, an actual of $21.6. That is the amount of money that's spent to date.
MR. MCNEIL: Who is putting together that information system for the province? Where have we bought our technology?
MR. MACISAAC: The software that we're using for that service is a Meditech software which is employed extensively throughout North America.
MR. MCNEIL: Thank you. One of the things I guess maybe you can answer is, in my riding there is a company called, Britech . . .
MADAM CHAIRMAN: Order, please. It is the moment of interruption.
[5:59 p.m. The committee adjourned.]
[6:30 p.m. The committee reconvened.]
MADAM CHAIRMAN: The honourable Leader of the Liberal Party.
MR. WAYNE GAUDET: Madam Chairman, looking in the Budget Speech, on Page 14, it talks about 94 per cent of Nova Scotians having doctors, therefore 6 per cent - and that 6 per cent is 56,000 Nova Scotians - don't have doctors. I know in my riding of Clare there are many people who don't have doctors and when you look at many communities throughout rural Nova Scotia, you see there are a number of communities looking for family doctors. I know in Clare, about five years ago, Dr. Leslie Griffen who was practising in Clare at the time decided to further his studies. A position then became available and I think the position has been open now for five years, yet in those five years we haven't heard much during that time, except when Dr. Barbara O'Neil late last Summer was in Digby County looking at starting a practice. At the time there was an opening in Weymouth, which is a neighbouring community of Clare and she was also looking at Clare.
Looking back at those last five years, there was very little said or done by the provincial government to try to help recruit a doctor for the people of Clare. In the end, she decided to open a practice in Weymouth, where Dr. Felix Doucette had retired and later passed away. The fact that she went to Weymouth, many people in the Clare area were very pleased because right now in Clare there are a number of residents going to the community of Weymouth to see their family doctor. In the community of Weymouth, we have two doctors, Dr. Don Westby and Dr. Barbara O'Neil.
I guess my first question to the minister is, looking at those last five years when there was an opening for a family physician for the Clare area, I'm just curious, what did the department do in that five-year period to try to fill that position for the people of Clare?
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MR. MACISAAC: I thank the honourable member for the question. I haven't, obviously, been here for the last five years, but perhaps I can speak in some general terms that may address some of the concerns of the honourable member. We are actively pursuing incentives with respect to attracting doctors to rural locations through moving expenses, some alternate funding programs that are in place, and debt reduction programs as part of the incentive package.
I have, on previous occasions, spoken about some of the change in the approach of the medical schools with respect to how they're training physicians. The medical schools have realized, or come to a realization, that they place a great deal of emphasis on acute care and, as a result, people graduating from those medical schools sort of have an orientation toward a practice that focuses around acute care as opposed to the traditional rural GP attitude. I understand that the curriculum is being adjusted so that there is a broader approach relative to the training of physicians, and that should have an impact on people graduating from medical school who are not so focused in a particular direction, so hopefully some of those people would look at rural practice as being an opportunity for them. That's a cultural thing that will have an impact as a result of the adjustment in the training practices.
I understand also that we provide incentives for the training of one doctor in Quebec at a French-speaking medical school, and that amount is going to be increased, so it will go from one to two. Again, I recognize that's not addressing the honourable member's immediate concern, but it is part of what is out there in terms of trying to address this whole question of rural practices being more attractive to practitioners throughout the province.
MR. GAUDET: In the Budget Speech the government talked about a renewed effort to recruit doctors, particularly for rural Nova Scotia. I'm just wondering, could the minister explain if the government is proposing to do something differently with recruiting doctors for many rural communities?
MR. MACISAAC: The major focus will be centred around some of the change in practice that we would employ in rural Nova Scotia with the increased emphasis on nurse practitioners and the role that they play in enhancing recruitment in rural Nova Scotia. We're also aggressively pursuing attracting people through alternate funding programs as a means of attracting physicians to rural Nova Scotia, so that if they come under an alternate funding program, they do not have to think in terms of establishing the practice or moving into an area where they would have some doubt as to whether there's sufficient population to be able to support their practice. If they can look at a guaranteed level of income, then it is something that works to their advantage. So that is the tool that we're employing, and we want to expand the use of that particular tool to attract doctors to rural Nova Scotia.
MR. GAUDET: I want to focus a little bit on the medical graduates. Could the minister indicate how many medical students graduate every year, and how many of those decide to remain and work in Nova Scotia? I don't know if the minister has that information.
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MR. MACISAAC: The capacity of the medical school is that it graduated 82 physicians last year. We have, of course, in the last two years, increased that by 8 - that is those going into the medical school, so in four years, when they work their way through, then it will go up to 90 graduates from the medical school. But you have to appreciate that the medical school serves all of Atlantic Canada and students from beyond the borders of Atlantic Canada. So I can tell you that we have, I believe, 50-plus, 51 additional physicians working in Nova Scotia this year as opposed to last year. Now, what I can't tell you is how that breaks out relative to the 82 physicians - how many of them are Nova Scotians. We will try to get that detail and provide it for you though.
MR. GAUDET: Madam Chairman, I've been told according to the Canadian Medical Association, the acceptable number of patients for a rural doctor is between 1,600 and 2,000 patients and I will come back to why I'm asking this question, I want to find out if this is correct or if it is within that range. Many of the doctors in Clare and in the neighbouring community of Weymouth have large practices. I know of one doctor who has over 4,000 patients; I know of two doctors who have over 3,000 patients. So I know the fact that we currently have two physicians available in our area right now, doctors are trying to provide a service especially to the people who don't have doctors and what I'm hearing practically every day is that there are a lot of concerns from the residents that if the government does not hurry up with recruiting, many people believe they're going to actually lose their doctor.
These doctors have heavy loads, long hours, are burnt out. Many residents are expressing concerns for the well-being of these family physicians. So I'm trying to find out if there is such a scale for a rural practice, if the number of patients technically allowed, I guess, is between 1,600 and 2,000 patients for a rural physician. Is that the case? I'm just curious.
MR. MACISAAC: Madam Chairman, the numbers that the honourable member was referring to would be higher than the average number and the average number is approximately one to 1,200 in the province, but that number is lower in urban areas and tends to be higher in rural areas. Now, that would account for some of the increased numbers that he has, but it would appear that those numbers are larger than the norm and because, you know, it's part of the situation where we heard stories earlier today of one doctor retiring and requiring two to replace the doctor because the patient load was so heavy and people who are setting up a modern practice are choosing to place more emphasis on family and lifestyle and not take on so many patients and for that reason we require two physicians to be able to replace those doctors.
That is why we accept that there needs to be aggressive policies with respect to attracting doctors to rural parts of the province and that is why we need to change the model of practice. We need to employ nurse practitioners. We need to employ the concept of clinics so that we can have doctors make a decision to move to rural parts of this province and not feel that they're going to be subjected to a large, you know, seven-day-a-week practice without any relief and that is what needs to be addressed as we move forward and it's with
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that in mind that we are employing the recruiting strategies that we are and using the concept of nurse practitioners in order to be able to achieve that, but it is a challenge and we're continuing to make it a priority.
[6:45 p.m.]
MR. GAUDET: Madam Chairman, that completes my questions to the minister. I want to thank the minister for answering those questions and I want to yield the floor to my colleague, the member for Annapolis. I understand there still may be a little bit of time for one more question.
MADAM CHAIRMAN: The honourable member for Annapolis.
MR. STEPHEN MCNEIL: I just wanted to go back to the last question that I asked you, Mr. Minister, regarding the Nova Scotia health information system. I'm curious about the company that is providing this service, why we would be looking out of province for a company to provide a health information system when there's one in my riding in Lawrencetown which has been providing a health information system around the world to governments, why its own government would not be using it to provide that service?
MR. MACISAAC: Madam Chairman, there was a request for proposals with respect to that competition. It was an open competition and the company that won received the contract based on the results of that competition. I can point out that they have extensive experience in providing this type of service internationally and especially in North America.
MR. MCNEIL: Madam Chairman, I think government at all times should be recognizing, when you're looking at businesses in Nova Scotia, that we should be recognizing them. There's something wrong with that system - they're here to put in place, plus you're employing Nova Scotians, but at that I would like to end the comments from our caucus and thank the minister and his staff for allowing us the opportunity to question him.
MR. MACISAAC: Madam Chairman, I understand that I now have an opportunity for concluding comments. What time frame, five minutes. Those who know me know that it's a great challenge for me to speak for five minutes, but I will do my best. First of all, I want to extend my appreciation to all members of the committee for their questions and for the very legitimate concerns that they have brought forward on behalf of all Nova Scotians. I hope that we have been able to provide as much information as we could with respect to answering those questions. That is what this process is all about. It's part of the accountability of government to the people of the province. There were some specific questions that were asked of us. We will undertake to get the answers to those and I will table them in the course of the session so that that information will be available to members who asked.
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I also want to express my appreciation to the staff of the Department of Health in the great amount of work that goes into preparing estimates and, again, the fact that they have to do that on an annual basis points to the fact that there is an accountability process, but when you look at the work that goes into the preparation of a document such as this, you have some appreciation of the fact that there is a great deal of work that went into it, but also the fact that there's a great deal of accountability associated with the operation of the department and we were very pleased to be able to come forward and defend these estimates.
Madam Chairman, we should not lose sight of the fact that if I'm winding up here, when we're dealing with my estimates, it is not just the estimate for the Department of Health, but also for the Nova Scotia Senior Citizens' Secretariat. So we want to make certain that that estimate gets called. I don't want to lose sight of that. I'm sorry. (Interruption) Well, I guess I'm getting to that stage where I might be starting to be considered an expert based on experience rather than just responsibility. As I said, we'll undertake to provide the answers that are required and, again, I want to thank the members of the committee for their perusal of these estimates. (Interruption)
Well, this is the stage in the process where it's appropriate to be kind, Madam Chairman, especially when you're looking at the clock winding down to the last of the time frame. I've enjoyed the experience. It certainly is, as members who have had ministerial responsibilities know, a time when you really get to judge or an assessment of how well you know your own department and I was rather pleased with what I was able to do here today, but I also know that there's more work to be done in that regard and I look forward to doing it.
So if that is the time, Madam Chairman, I want to thank members for their participation.
Resolution E29 - Resolved, that a sum not exceeding $772,000 be granted to the Lieutenant Governor to defray expenses in respect of the Senior Citizens' Secretariat, pursuant to the Estimate.
MADAM CHAIRMAN: Shall Resolution E9 and Resolution E29 stand?
The resolutions are stood.
The honourable Government House Leader.
HON. RONALD RUSSELL: Yes, Madam Chairman, I move that your committee do now rise and report considerable progress and beg leave to sit again on a future day.
MADAM CHAIRMAN: The motion is carried.
[6:51 p.m. The committee rose.]
