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HALIFAX, THURSDAY, MAY 5, 2005

COMMITTEE OF THE WHOLE HOUSE ON SUPPLY

2:40 P.M.

CHAIRMAN

Ms. Joan Massey

MADAM CHAIRMAN: Order, please. We will resume the estimates for the Department of Health. The Liberals have 26 minutes to finish up. We're waiting for a few people.

The honourable member for Halifax Citadel.

MR. DANNY GRAHAM: I expect to attend to the remaining 26 minutes for our caucus. My opening line of questioning relates to tracking gambling suicides. I have before me a report from the ChronicleHerald dated one year ago today on May 5, 2004. Minister, to you through the Chair, I'd like to quote from that report as it was presented that day.

It starts, "The Hamm government plans to investigate the link between gambling and suicides in the province. The Nova Scotia chief medical examiner's office will collect statistics as part of a study into whether gambling-related deaths are on the rise, as some have claimed. Health Minister Angus MacIsaac said he expects a comprehensive report on gambling and its social and economic consequences will be ready in about a year. 'The people of this province need to have a better handle on the entire field of gambling and gaming.', Mr. MacIsaac said Tuesday at Province House. 'We need to be aware that there are problems that result from this activity and that those problems need to be adequately addressed'." My question for the minister is whether or not he still stands by those words?

MADAM CHAIRMAN: The honourable Minister of Health.

HON. ANGUS MACISAAC: I thank the honourable member for the question. Certainly the statements attributed to me were - a lot of people talking to me, but the gist of them were accurate, to the best of my knowledge. That was certainly what we had hoped to do. I understand there was a great deal of difficulty in being able to pinpoint the cause of those unfortunate incidents to a particular circumstance.

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In some situations, there may be a feeling the connection was obvious. There are circumstances where other factors could have been at play and could have been involved in it. I further understand from my colleague that the Chief Medical Examiner - who comes under the Minister of Justice - did write to the Minister of Justice with respect to this.

At the time, I recall that particular scrum, I was answering the questions. The most appropriate response for me to have given on that particular day would be to speak to the honourable Minister of Health Promotion with respect to the issue because for some reason, the press that day thought it was appropriate for me to answer those questions. I realized afterwards that it probably should have been him. It doesn't in any way cause me to back away from our stated intent at that time, but I do understand the Chief Medical Examiner is having considerable difficulty with respect to being able to clearly identify these issues.

The task is proving to be much more difficult than had been anticipated when I made those statements.

MR. GRAHAM: Madam Chairman, through you to the Minister of Health, it's noteworthy that the Canada Safety Council recently came out with a report that estimated there was a suicide a day due to gambling-related problems. It's noteworthy the Ontario coroner has recently called for the adoption of a report or study on this particular problem. I want to specifically go to a report in the ChronicleHerald again, this time on March 8, 2005. My quote will be extensive just so that you have the full context.

[2:45 p.m.]

In this report it says, "The office of the chief medical examiner stopped tracking suicides linked to gambling last June, saying it was difficult to gauge how accurate the information was." That's consistent with what you've said. "In some cases, Dr. Bowes said, the family didn't know whether the deceased had a gambling problem or relatives were too upset to talk to investigators. When the province did track the number of suicides between January 2001 and September 2002, it determined 10 of 159 suicides recorded, 6.3 per cent, were related to problem gambling. Dr. Bowes, in a written reply to Ms. Mullally, said it would be helpful to have 'reliable information on the many factors contributing to suicides.'" One of the few things Ms. Mullally and I seem to agree on these days.

Dr. Bowes said, ". . . information would need to be gathered as part of a social history developed by people with the appropriate expertise. But he said his office doesn't have the staff or the money to do it. 'If the province or the gaming corporation is really interested in this approach, then we would co-operate in a properly constructed and properly funded prospective study into such an important subject,' he said. 'I would be more than willing to participate in the development and implementation of such a project.'"

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In light of this, and frankly, that is consistent with discussions that I've managed to have with the chief medical examiner as well. There are challenges, he says, associated with tracking this, but properly resourced a study could be done. Given that, my question to you, the minister, is whether or not you are prepared to provide the proper resources to track suicides from gambling in Nova Scotia?

MR. MACISAAC: My response is not intended to be unco-operative to the member, but it's really a question as to whether these are questions that should be directed to the Minister of Health or, given the quotes that he's using which is from the chief medical examiner who is responsible to the Minister of Justice in this province. With respect to the issue of gaming which is under the Office of Health Promotion and the resources that would be related to the request or the question of the honourable member, those resources in fact would come under the Office of Health Promotion.

I would be glad to try to answer the questions, but I would really be answering on behalf of the Minister of Health Promotion because it is his jurisdiction as well as the jurisdiction of the Minister of Justice with respect to the medical examiner.

MR. GRAHAM: Madam Chairman, I appreciate what the minister said in his initial response. He said that I perhaps spoke out of turn and didn't allow the minister responsible for the Office of Health Promotion to comment on this regard. Nonetheless, he is the Minister of Health. This is obviously a health issue. When people are committing suicide, there's not health to promote, it's a health issue. Suicide, I would suggest to the minister, the question and the issue of suicides in this province isn't an issue for Health Promotion, it is a question for Health, and it's why, back a year ago to this day, there was a report in the newspaper that suggested that you said you would track suicides and then we have a report from the coroner who says he'll track suicides if it's properly resourced.

So my question to you is, given your commitment - and you expressed it here in writing that you would like to track this - given the level of resources that you have, a couple of billion dollars, plus, would you be willing, if the coroner were interested in doing this, to simply fund the cost of this through the Department of Health? Because a concern that I have is that when the Minister of Health Promotion is faced with this question he may say something, and I appreciate that he's here today, he may say this isn't a priority, the words came out of the mouth of the Minister of Health, and it's for the Minister of Health, with his $2.4 billion or $2.5 billion budget to be able to say, yes, the nickels and dimes in my big budget, associated with doing something like this, is doable, we're committed to the words that I had before.

The narrow part of my question, Madam Chairman, to the minister, is whether or not, if the coroner were to shape up a costing and a mechanism for doing the study, he would be prepared to fund it?

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MR. MACISAAC: Madam Chairman, the issue that's raised by the honourable member - and in no way do I back away from public statements that I've made with respect to what it is that we want to achieve relative to understanding the connection between suicides and the causes of suicides - the situation referenced by the honourable member refers to a request by the chief medical examiner. To date, to the best of my knowledge, and the deputy is with me and she agrees, we have not received a proposal from the medical examiner.

Obviously having made the commitment, which I made in the past, if we receive a proposal from him, it is one to which we would give very serious consideration. We would obviously look to see whether it is something that is appropriate for the Office of Health Promotion to fund, or whether it is appropriate for my department to fund. The bulk of mental health relates to my department, and I'm quite pleased that we're able to put additional funds in that. If we were to receive a request from the chief medical examiner, then obviously we would have to give it very serious consideration.

I think, as the honourable member suggests, the number of dollars involved, on the surface at least, should not be great numbers. And, assuming that they're not great numbers, what I can commit to the honourable member is that if such a request comes forward, it is one that we will give every consideration to in the spirit of - at any rate, we have not received the request, and whether he has made a request through his own department, which is the Department of Justice, I don't know, but if such a request is forthcoming I'm going to be very supportive of the medical examiner receiving the funds that are required to do the work that he wants to do.

I'm not committing as to which department, whether it's Justice, Health, or Health Promotion, those funds will come from. You might think I have unlimited numbers because the numbers are big - I can assure you I don't. I'm going to make sure that the funding comes from the appropriate department. Will I support such a request? The answer is obviously yes.

MR. GRAHAM: At the risk of sounding overly fussy about the language that we use with respect to this - and I appreciate the minister's commitment in saying that he would look at this seriously if it's reasonable and if it's for an amount that, in particular, is reasonable in the circumstances - I'm linking up his commitment in language last year where he made the commitment that there would be a comprehensive report on gambling and its social and economic consequences, ready in about a year, and I would call that to his attention.

Secondly, that we have from the coroner the remarks that if the province or the Gaming Corporation is really interested in this approach, then we would co-operate in a properly constructed and properly funded prospective study into such an important subject; I would be more than willing to participate in the development and implementation of such a project.

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So, I think, Mr. Minister, while I don't expect you to sign a contract here today, this afternoon, obviously, but I think that we can go right up to the door. Given that you've made this commitment and the chief coroner is saying he's prepared to do it, and you have an interest in it, and assuming, as you've rightly pointed out, that it's not an unreasonable amount, can we take from your comments that not only will you support this, but that this is something that you are prepared to advance as an initiative, that you are proactively going to champion? Given the commitment that you made last year, more than just something that you might support if it came before you, you would be prepared to actively champion the development of this report that you spoke about a year ago?

MR. MACISAAC: Madam Chairman, the quote that the honourable member references in terms of what it is that I said last year, I was speaking with respect to government's intention, and those were things that I believe government stands by. They've certainly been involved in a major socio-economic study. I have indicated the support that I have with respect to mental health issues in this province, and the difficulty the honourable member references is certainly related to that.

I'm not at all afraid of any commitments I'm going to make with respect to the work that's done, but I have to remind the honourable member that I can only respond to specific requests. I have not received, nor has the Minister of Justice, to the best of my knowledge - and perhaps he has, and when his estimates come up, you might want to ask him that question - what I can say clearly is that I have not seen a proposal from the chief medical examiner with respect to this issue. I would want to respond in specific terms to a specific request. What I can say is that inasmuch as this is an issue which is very serious, the issue of suicides in this province, that as a supporter of increased funding for mental health, then that support goes right across the spectrum. The problem referenced by the honourable member is certainly one that is very important, and one which I, as Minister of Health, would want to support.

I can't get out and start talking about what specific requests may come forward, but I can speak in general terms that I stand behind what it was that I said a year ago. We've spoken about the difficulties the chief medical examiner has had in trying to bring together that information. Obviously if he comes forward with a proposal that would assist in that work, then that is something that we would to be as supportive of as we possibly can.

MR. GRAHAM: There is a nuance that appears to be different from what the minister is saying today and what he said a year ago, and I would just like to draw out what I believe to be that nuance, and perhaps the minister could respond and indicate whether or not I get that, or whether he's prepared to take the step that he took last year when he spoke to the media in the media scrum, when he indicated that this is something, essentially, that the government is looking to initiate, that the actions with respect to this were going to start with the government - this wasn't an idea that was asked of you, you were in a scrum and you

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spoke about the preparation of a comprehensive study, and now we see that the coroner says that that's possible, it just needs to be properly resourced.

[3:00 p.m.]

So the square question for the Minister of Health is whether or not he's prepared to actually not respond to what might come from the coroner but to initiate the contact with the coroner, recognizing that he may not have read the March 8, 2005, report and say to the coroner, I see that this might be possible, I made a commitment last year, let's see if we can work it out - and I recognize the Minister of Justice and maybe the Minister responsible for the Office of Health Promotion may have a play in all of this - is this minister prepared to actually do something more than just to respond to a request but in fact initiate it, given the commitment that his government made last year, one year ago to the day?

MR. MACISAAC: Madam Chairman, I have absolutely no difficulty in saying to your committee - and the Minister of Health Promotion is here, the Minister of Justice must be in the other committee - I will certainly take it upon myself to initiate contact through the Minister of Justice with the chief medical examiner and just see where he has been, where he intends to go and, if the honourable member has some comfort with respect to that commitment, I'm quite prepared to make it.

MR. GRAHAM: Madam Chairman, thank you to the minister for indicating that. I have some questions - I'll just pick up on a completely different subject that I had raised with the minister in the past, and it relates to the Cape Breton Wellness Program and the funding for the Cape Breton Wellness Program. The minister might recall that it might be three years ago now that funding to the tune of $150,000 was cut out of a program that addressed primary health care population types of issues. My question for the minister is whether or not that funding has in fact been reinstated or whether or not he would consider funding it, because it is an award-winning program recognized across the Maritimes, and in fact nationally, for providing assistance to a population that is in many respects more challenged than any other population when it comes to health in Canada?

MR. MACISAAC: Madam Chairman, the primary health initiatives that we fund are pretty much all initiatives that come forward to us from the district health authority, and we are involved in a number of those initiatives in Cape Breton through consultation with the district health authority, and we tend to respond to what they bring forward to us with respect to their recommendations.

MR. GRAHAM: Madam Chairman, this was a very specific discussion with respect to the Cape Breton Wellness Centre. It doesn't fall under the umbrella, although it's obviously associated with the Cape Breton Regional Health Authority, it is a separate award-winning agency that is doing breakthrough work in many of the areas that the Deputy Minister of Health references from time to time about priority areas. It's a mere $150,000

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that was originally funded and the question is whether or not - if the minister doesn't know, then a commitment that he will undertake to determine what the status of that funding is would certainly be sufficient in the circumstances.

MR. MACISAAC: Madam Chairman, I do recall the honourable member raising this issue in the past, but certainly in the interests of clarity and time the best thing might be for me to say that we will undertake to give you a report on that issue.

MR. GRAHAM: I know that time is short. I have about 30 seconds - my last question, it relates to an issue that came up in Public Accounts. The Deputy Minister of Health was here when we were talking about alternative funding and what was being suggested is that with the new funding in Health, we need a fundamental shift toward primary health care and not just the tinkering, we need a clear indication that there is going to be rapid dramatic movement toward a population health model. Many of the critics are saying that's simply not happening.

MR. MACISAAC: Madam Chairman, the honourable member, when he uses the words he does to describe what we're doing in primary health care, is not being fair to the district health authorities or those professionals who are involved in a number of fronts relative to launching new initiatives in the areas of primary health care. I can think in my own area there are two major initiatives with respect to literacy and that is something that has moved from GASHA to a province-wide initiative to promote the awareness of literacy as a factor in primary health care. Also, the issue of primary health care with respect to minorities, that is an initiative that came out of GASHA. That also is something that is going to be looked at on a province-wide basis. If we go to Queens County and the DHA I, we have announced the funding for a health clinic that fundamentally reforms the delivery model of primary health care in the Liverpool area, and Queens County generally. That is something now under construction, and that was in response to a community initiative with respect to that particular program.

We have a facility for Tatamagouche that was announced this year. That is a major primary health care initiative, I believe it's $2 million that's earmarked for that. A reference was made earlier in the estimates to the Annapolis project with respect to a new clinic relative to how primary health care is delivered. You can go, Madam Chairman, right across the province and we can find all sorts of initiatives that have been brought forward and what is good about most of these initiatives, indeed if not all of them, is that they have come forward from the community health boards and the initiatives that they have taken with respect to responding to needs in their own areas. We will continue to respond to that.

If we look at the use of nurse practitioners, and we're expanding the use of nurse practitioners, or propose to with the funding in this year's budget and we will continue. But we're not coming forward with a single policy or program that says this is the way to do it,

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we are responding to the needs of communities as identified by community health boards and the district health authorities.

MADAM CHAIRMAN: The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Thank you, Madam Chairman. Mr. Minister, I want to ask you about several areas that are important to people around the province, and certainly you and I will recognize that children's mental health is an area that has a lot of concern throughout our province. Parents and families with children who have mental health disorders or behaviour problems, or activities that appear to be behavioural but may be more than behavioural are in very serious circumstances in terms of having to wait to try to access the kinds of assessment services and then the follow-up and treatment services for these children.

I've recently become aware of a program that was developed with some research, a fairly substantial amount of research dollars to Dr. Patrick McGrath at the IWK/Dalhousie. Dr. McGrath has expertise in a number of areas. He actually, for a number of years, was sort of considered to have expertise around children in pain. He's a psychologist, and he has developed this program called Family Help that has been piloted in a couple of the DHAs. It is a program where there are a number of coaches, four or five people who are trained as facilitators and as, I suppose, advisors in a way, to provide support to families who have children with a variety of syndromes or difficulties. Attention Deficit Disorder being one, but other kinds of presenting problems, like bedwetting.

The Family Help Program is a series of manuals that family members are actually given. They're very accessible in terms of their clarity and their understandability. They're supplemented by these coaches and a kind of help line service where a family can call in and receive the support and the advice they might require around particular difficulties.

The evaluations of Family Help have been very positive as this being an effective tool to assist families, especially in the early stages of difficulties and in parenting and dealing with children who have problems. However, the research stage and the evaluation stage is over, and this program now is a program that could be used throughout our province, especially for kids, again, in the early stages before their difficulties become so much more severe and costly when it gets into our health care system.

So I want to ask you if you are aware of Family Help, if you are aware of any application that has been made either to the Department of Health or to DHAs to support the continuation of Family Help? Also, what exactly might be done to allocate the financial support to keep a program like Family Help, which has been shown to be effective throughout the research phase, to now make it a part of our support services for families with children with various problems?

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MR. MACISAAC: Madam Chairman, certainly, we're very much aware of the need to provide mental health services to the youth of this province. The additional funding, which we have announced this year, and with an additional $2 million this year and an additional $2 million next year, one of the primary targets of that money will be for children and youth in this province. It's very important, to the extent possible, that we identify problems as early as we can and provide the treatment for those problems as quickly as possible. That is why we developed the standards that we have, and both standards particularly apply to youth in the province, and the money which we are providing will be an attempt to ensure those standards are applied right across the province.

We are aware in the department of the work of Dr. McGrath and, indeed, it is work that he has conducted right across the country, not just in Nova Scotia. What I will undertake to provide the honourable member with is whether or not we or the DHAs that we're aware of have, in fact, received applications from him. I'll attempt to provide you with the status of those applications.

MS. MAUREEN MACDONALD: Thank you, I very much would appreciate that. I have had an opportunity to meet very briefly with Dr. McGrath and I looked at some of the materials, and I was very impressed by the materials. Having done some work in the past in a parent resource centre and also in adolescent mental health with families, I could see why this program could be a very effective program and very useful, particularly with families with young children in the early stages of trying to deal with problems before they've become too chronic, I guess I would say.

Which brings me to another group that I'm concerned about. I hear from families, and I'm sure the minister probably does as well, quite often who have children who are either adolescents or young adults in the early stages of psychosis. I know we have a very small Early Psychosis Program on the grounds of the Nova Scotia Hospital in the former site of the adolescent treatment centre there. I'm wondering if there are provisions in this year's budget to provide any additional financial support to the Early Psychosis Treatment Program and, if so, to what extent will there be additional resources, and what might that program be able to achieve? I understand there are waiting lists for this program.

It's interesting, if you go online and you look at what is happening in other jurisdictions around mental health provisions to people elsewhere, there's increasingly, I think, a recognition that those people with mental health disorders who have family members who stay involved need support and need services themselves. They really need a lot of education and assistance in knowing how to deal with having a person as part of their family network who has a mental health disorder, because it can pose some challenges for families. Is there additional funding allocated to support the Early Psychosis Program and to provide support to families who have family members in that program?

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MR. MACISAAC: Madam Chairman, we have, in providing the additional funding, indicated our areas of priority. I already mentioned children, I mentioned individuals with chronic conditions who need treatment, and the third is community-based treatments. Those are the three areas we've identified. That's not to say that there is a clearly defined line relative to those services. What we will be doing is asking the district health authorities for their priorities relative to the expenditure of this funding, and the programs that are identified by the honourable member are programs which we would look at if they're considered to be priorities of the district health authorities.

It's certainly something we will be aware of. We're aware of the research that has been done in the program referenced by the honourable member and that research indeed is of very high quality. It remains to be seen whether the Capital Health Authority is going to request the funding that is suggested by the honourable member, but we will certainly be doing our best to respond to their priorities.

MS. MAUREEN MACDONALD: I listened to the questioning by the honourable member for Halifax Citadel with interest earlier when he was talking about tracking suicides, the causes of suicide particularly around gambling. I had an opportunity, I think, to ask questions of your predecessor about whether or not the province was prepared to develop a suicide prevention strategy. There are quite a few jurisdictions around the world that have done this. Suicide itself is one of the leading causes of death actually in most countries throughout the world. I think here in Nova Scotia people would be quite surprised to learn that the number of suicides annually in our province actually exceeds quite often the number of deaths, for example, on our highway.

We spend a fair amount of money promoting safe driving and trying to improve the safety of our highways and the supervision of driving practices on our highways, as I think we should, but we do very little, we do almost nothing around suicide prevention as a coherent approach to public policy. I know that at one point the help line here in metro and the mobile crisis unit from the Capital District had organized a symposium on suicide and I think their third symposium is coming up. They had had a working group looking at a provincial suicide prevention strategy and I'm wondering if your government has members of its staff working on a suicide prevention strategy, if there are any resources allocated. I've looked at the Department of Health's business plan and I haven't really noticed. I didn't read it maybe as thoroughly as I could have, but I could not find anything that made reference to a suicide prevention strategy as being part of the plan of the Department of Health. So could you elaborate on that, please?

MR. MACISAAC: Madam Chairman, the honourable member I believe puts her finger on a subject that's very important and indeed our capacity to be able to reach out to people in times of crisis at times is not nearly what we would like it to be. Unfortunately, very often, you know, the time when the crisis arises is as a result of a long buildup to those

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circumstances. So, to have the specifics is what's needed. I'm just being provided with some information here.

We are working in partnership with Capital Health and the Office of Health Promotion's injury prevention strategy on strategies for suicide prevention. So it's a joint effort between Capital Health, the Office of Health Promotion and the Department of Health and we are working on it. I dare say we've not made as much progress as we would like, but it is certainly something that is being addressed and the honourable member, quite rightly, puts her finger on something that's very important because the tragedy of suicide, it's difficult to imagine anything more tragic with respect to the loss of human life. Clearly at some stage the appropriate intervention would make those tragedies avoidable and the challenge is great in terms of identifying that, but it is certainly one that we are currently working with Capital Health on. I'm sure that anything we learn through our work with Capital Health and the Office of Health Promotion will allow us to go province-wide.

MS. MAUREEN MACDONALD: That's good to know. I will maybe have an opportunity to talk to the Minister of Health Promotion about this. I'm going to end because I have many colleagues who want to ask the minister and members of his department questions that pertain often to their own constituency.

I have two final questions I want to ask the minister about. One is around the department's plans or program around persons with brain injuries. This is a question I feel somewhat frustrated in having to ask again because it seems every time we come back to the Legislature and we're in estimates, it's a question that I ask and we don't seem to get much movement from government with respect to a coherent, comprehensive approach to providing appropriate services for people in our province with brain injuries. We all know that brain injuries can have a broad spectrum of effects on people.

There was a working group, quite a number of years ago now I would think, maybe four or five years ago when the honourable member for Truro-Bible Hill was the Minister of Health, and they reported back to government with a number of recommendations. I think that those recommendations have essentially sat on a shelf and it's very frustrating for family members who have a loved one with a brain injury to see them maybe inappropriately institutionalized in a nursing home, or left in an environment where they cannot get the adequate care and services that they require unless the family has an enormous amount of personal and financial resources to draw on.

So one of my final questions is, when are we going to see the recommendations of that working group implemented to have a better basket of services available to persons with brain injuries than we currently have and is that something that's buried somewhere in the budget for this year? The second question I have, and I'm going to bundle these together so that the minister can just answer them and then we can turn the floor over to my colleague, the member for Cape Breton Centre, is about the independent review on public health that's

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going on. I'm aware that there's an independent review on public health that's going on and that a report is being done and I'm wondering when will that report be available publicly and what will the process be after the tabling of the report in terms of implementing and furthering the work of addressing any of the issues in the recommendations that come out of this independent review?

Public health is an area of great importance. It's an area that's often neglected in the health care debate, which tends to focus on bricks and mortar and not enough focus on the population's health and the general good health of the populace, and the need to move beyond an infectious disease framework is also really important. So if you could just share with us what the department is doing with respect to the brain injury report and the public health review?

[3:30 p.m.]

MR. MACISAAC: Madam Chairman, first of all with respect to the review of the public health process in the province, indeed the review is underway. We anticipate a report prior to the end of the June with respect to this. That report will clearly identify some things that we can act on almost in the very short term. Some other recommendations we know will focus on sort of a medium-term thing and some of them might involve some re-organization of the resources that are applied to public health in the province.

Right now we find ourselves in a situation where the Department of Environment and Labour has responsibility for that. Department of Agriculture and Fisheries has some responsibility, the Department of Health has some responsibility. The primary responsibility for public health is with the Office of Health Promotion. Those are all things that need to be addressed. I can tell you that beefing up our capacity with respect to public health, is very much a priority, thus the review that is currently underway and we will be responding as expeditiously as possible to do the things that we can do as it becomes possible. I recall very clearly one of the first things I did after I became Minister of Health was obtain some additional resources for medical officers of health within the province and we've beefed that up and we're going to have to continue to do that.

With respect to the brain injury, the honourable member indeed puts her finger on something that we've not been able to respond as quickly as I would like to see us respond. I know personally, not a number but a few individuals who suffer from brain injury and it is quite disheartening to see them struggle in an attempt to cope with the gap that's been created in their lives as a result of this loss of capacity, and our ability to respond and assist them is not as great as it is in some other areas of health care, and it is clearly something that is yet to be addressed in the manner in which the honourable member suggests it should be addressed. I certainly don't have any issue with her identifying that as a priority. It's certainly one that I would like to see us do.

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If I might, Madam Chairman, I'd like to update your committee on some measures that we have taken in the recent past to address some of this, and they're small steps but nevertheless significant steps with respect to brain injury. The Emergency Health Services Trauma Program's head injury guidelines in 2002-03 have been adopted. Of course once you adopt guidelines then the challenge of funding to meet those comes into play. The Office of Health Promotion injury prevention strategy implemented in 2003-04, and you may want to question the Minister of Health Promotion further with respect to that. Brain trauma outcomes in Nova Scotia is a three-year, $150,000 study with funding from the Nova Scotia Health Research Foundation to identify needs, outcomes and priorities for service, and that is a very important step in terms of identifying the direction that we need to take with respect to addressing this and that is something that is now underway and it will assist in the decision making process as we go forward.

The Department of Health is funding one FTE to the Brain Injury Association of Nova Scotia to conduct a needs assessment on employability of individuals. Now both of the last two measures that I've referenced are measures that have met with favourable response to the Brain Injury Association of Nova Scotia, and when I make that statement, I am in no way suggesting that we have completed everything they want us to do. We certainly haven't, but when the guidelines are set, I think we will have a much better sense of where we need to go and how we can get there.

MADAM CHAIRMAN: The honourable member for Cape Breton Centre.

MR. FRANK CORBETT: Mr. Minister, I have been in and out of the Chamber today so if it's already been said, forgive me, but I hope you're feeling better. It will come as no surprise to you that my questions will concern the New Waterford Consolidated Hospital and indeed around the emergency services provided, or some would say not provided, there.

We've seen closures at that hospital, unprecedented in that hospital's history in the last short while. I appreciate that we realize some of those closures came from a long-standing family physician retiring and leaving a huge gap in coverage for some of the other physicians. Where we see the closures most often happen are the Monday to Friday areas and what we'll refer to as a day shift arrangement, we'll say 8:00 a.m. to 8:00 p.m., that type of closure.

Now, as you are no doubt aware, the New Waterford Consolidated Hospital is a Level 4 hospital and I would assume, and you can correct me on this, Mr. Minister, if you wish, that's determined by the Canadian Triage and Acuity Scale, I think that's what it's called, again, you can correct me if I'm wrong. Mr. Minister, what I want to know is, what relevant factors are taken into consideration when you take a hospital like the New Waterford Consolidated Hospital and put it on a Level 4 basis when you have fairly heavy industrial structures around it and it could be the first stop on a triage system? Why wouldn't a hospital

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like the New Waterford Consolidated Hospital at least be given a designation of a Level 3 hospital?

MR. MACISAAC: Madam Chairman, I can appreciate the honourable member's concern for the facility in the area that he represents, and that's always a challenge for us to try to get the best service that we can for the communities we represent. However, the decisions that are taken with respect to the provision of emergency services throughout a district health authority are decisions that need to employ all of the resources that are available in those districts. The situation in New Waterford is one where the function that's been assigned to it is related to the acuity levels and a very important part of providing enhanced services is the level of back-up that's required in order to provide those services. You can't just say that you're going to increase the services that you provide in a particular area without having all of the additional back-up you need, whether it be related to lab facilities, the capacity of the lab, whether it's related to the capacities of X-ray equipment or anything else.

The district health authorities are in a situation where they have to make these decisions. The function, of course, is to try to get a patient stabilized as much as possible before that patient is moved on to the higher level of service that is more effectively provided in larger centres - that is what goes on. It is a question of limited resources, relative to the capacity that you're able to assign to any particular facility.

The situation in New Waterford isn't any different than the situation in other areas of the province, where we have varying levels of emergency services that are provided. Those decisions are decisions that are taken by the district health authorities as part of their business planning process. I appreciate the concern the honourable member has, and I'm aware of the cancellations every time that they come about because I see the notices with respect to that. That's a situation we would like to see resolved on a more permanent basis.

MR. CORBETT: I partly agree with you and I partly disagree with you. The fact is, it isn't just a human resource factor. As you no doubt are aware, a lot of it is about remuneration for the ER doctors. The fact is there are physicians, I believe, that would cover those shifts, but a fee for service just doesn't cut it.

In North Sydney and Glace Bay the DHA pays the doctors directly, and they take the fee-for-service money and pay the doctors an hourly rate, but they don't necessarily do this during the day shift in New Waterford, they do a fee-for-service schedule. This is the problem, the fact is whatever the hourly rate is in North Sydney or Glace Bay, it certainly is much more advantageous than a doctor sitting around doing a fee-for-service in an emergency room in New Waterford, and that's the problem they are having. The problem isn't like in Richmond, where you don't have a family physician per se, the problem is getting a family physician at the price. What a lot are doing is saying, I'm going to do my

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emergency room hours over in North Sydney or in Glace Bay because I'm going to make some considerable money, as opposed to doing fee for service in New Waterford.

The question has to be, because New Waterford is a Level 4 hospital and not a Level 3 hospital, is that why that type of payment isn't being enacted in New Waterford where it is in Glace Bay and North Sydney?

MR. MACISAAC: The rate of remuneration is part of the negotiation that takes place with Doctors Nova Scotia, it isn't just our decision related to it. I know there are efforts made by the district health authority to try to do things to make it more attractive for doctors to practice emergency medicine in places such as New Waterford. However, they're limited in their capacity to move beyond the provisions of the negotiated agreement between Doctors Nova Scotia and the arrangements that are dealt with in that particular agreement. That is a challenge with respect to the DHA and as I indicated, it's sometimes difficult to address because you get into doing things that are perhaps beyond the capacity of a contract that exists.

MR. CORBETT: I guess what I'm looking for from you, Mr. Minister, is would your department be willing to do an undertaking involving the DHA to look at the New Waterford hospital with respect to moving it from a Level 4 to a Level 3 care, something that could be shown to the public that we can move forward, and if the need is there then we could also do the same financial arrangements or, indeed, if the DHA could get into the same financial arrangements with the attending physicians in New Waterford that you have in Glace Bay and in North Sydney? I should say that this line of questioning is not saying that the need in Glace Bay and North Sydney isn't real and shouldn't be paid at that remuneration, I fully support those two locations. This is not about bringing somebody down, it's about bringing somebody up. (Interruption) You have a real global view on some of these things, Mr. Minister, you never know when it will come back and bite you. But it is about bringing people up, it's levelling on the high side.

I can't impress enough on you, Mr. Minister, around that piece of it. I know people who work in that hospital and citizens, their anger is when they see a release come out that says, the closure is due to a doctor shortage. They will say, it's not really a shortage of doctors, the closure is caused by a lack of fair remuneration that they would see. Fair is a debatable term, I realize that, but their idea would be that they would be paid at or very near to what those other two Level 3 hospitals are paid.

To come back to my point, I guess I'm asking you, is it worthwhile for you to initiate it, or do you have the power to initiate it, or should the DHA initiate a reassessment of that facility in New Waterford, in view of bringing it up to a Level 3, so that they can pay the ER doctors that same remuneration?

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MR. MACISAAC: I've listened very carefully to the honourable member and I know it is a concern to him, as I've noticed the large number of notifications that have come forward with respect to the situation in New Waterford, it certainly gets my interest, in terms of that particular situation. I would be quite happy to take his concerns under advisement to look at what the DHA's rationale is and see when was the last time it has been looked at, with respect to decision making and get back to the honourable member with what I find and what recommendations are made. I will certainly make sure that the DHA is made fully aware of the concerns that you have raised here today.

MR. CORBETT: That, indeed, is a fair answer. With that in mind and realizing that our province for this month will probably see continued closures in that ER in the time frames that I talked about, one of the problems put forward by the public back a few years ago, around the possible closure of that emergency room at that point, and subsequent information that came out of the Murray report - the Murray report was a report done for emergency rooms. I think your predecessor from Truro-Bible Hill may have been the minister at the time - at that point, one of the positions put forward by the DHA was that if that emergency room was to be closed, they would have an EHS vehicle with personnel aboard parked in that parking lot ready to go. It appears that that EHS can't fulfill that need on a full-time basis. Has the DHA spoken to you about this or have you heard anything from EHS why they can't fulfill that obligation?

MR. MACISAAC: The honourable member was probably engaged in the other committee when I had this discussion previously, not related to New Waterford but other situations. One of the things that those who provide the ambulance service in this province need to be able to do is to have the flexibility of moving the resources around within the province, so that they're best able to meet the commitment with respect to a nine minute contractual response to emergencies that exist. What would happen, if a unit was sited at a particular point without the capacity of being able to move they, in a sense, would lose the ability to move the resources around.

If I could give you an example, the bus tragedy that happened in Antigonish. Thankfully, there wasn't a big loss of life in that but it did require the use of a large number of emergency vehicles to be able to respond to that situation. The only way that you can get that to happen is through the dispatching of those ambulances, that you need to have an immediate redeployment of ambulances throughout the province, in order to be able to compensate for the loss of the resources that go to the particular incident in question.

So the whole system is based on the ambulances having the capacity to be able to move and fill in areas when an ambulance has to take a call to move to another area. Their whole mode of operation is centered around this capacity of being able to move and provide the services elsewhere.

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I extended the invitation to the honourable member for Kings West, I believe, in response to a similar question, of taking him to the centre where the ambulances are controlled, and the dispatch centre where all of this redeployment occurs. I extended the invitation to him to take him to that centre and I would be more than happy to extend that invitation to the honourable member for Cape Breton Centre and you perhaps would better understand what I'm attempting to explain here today.

MR. CORBETT: I'll certainly try to take you up on that. What you laid out, Mr. Minister, I agree with, but then we kind of separate company. We understand - as most people do - that ambulances can't be parked there no matter what. I think we agree in emergencies or "disasters" that the whole system better be mobile, because that's the idea behind having it. What we're saying is that within reasonable bounds. EHS from time to time has said no, we're not going to do that tonight and that's the problem. The problem is that the residents were told during the study of the Murray report that that would be done and now they don't seem to have the wherewithal to back that up - that is what is causing the consternation with the residents.

I don't take any great disagreement with you, Mr. Minister, when you say this is how it operates. I certainly take your word for it, I'm sure you're being forthright and honest, that's not the problem. The problem is that the folks in the area were given a guarantee, and it's apparently a guarantee that the DHA can't live up to, so we need some clarity on that, on saying it is a problem.

Another problem is that EHS has come up with an edict that they're going to take certain levels of acute care around heart attacks and so on - I'm using laymen's terms - that they will bypass the hospital altogether. This is now something not from the DHA's perspective but it's something EHS has decided. Is this a common mode of work for EHS to decide to do an acuity test and then bypass certain facilities and just send a letter to the DHA and say, this is what we're doing?

MR. MACISAAC: The decisions of that nature are decisions that are taken by the professionals at the scene. I don't really know enough - and hope I'll never know any more than I know now - about what goes on with a heart attack. I guess all of us hope to remain ignorant with respect to that. But when the professionals are making decisions with respect to how best to provide for that individual in those circumstances, and they make the call in terms of whether they're going to go to this facility or whether they go directly to another.

I know, for instance, of circumstances in the area where I live, where somebody suffers an incident of some kind and the ambulance and medical providers will make the call as to whether that ambulance is going to stop at Guysborough, whether it's going to go directly to St. Martha's Hospital, that's not an uncommon decision to take. It very much depends upon the circumstances that the professionals find themselves in.

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MR. CORBETT: Mr. Minister, I would like to change course a little - our time is just about up here for now - but I want to talk a bit about the DHA's primary care initiative and basically, that would include community health centres for the New Waterford-Glace Bay area. The question is, I realize that Doctors Nova Scotia and your department are discussing the deliverables - and maybe you need an AFP around that - but I just want to know - and I think community health centres get a bad rap because they see what happensed and it was poorly portrayed in New Brunswick and people see that as a loss of service not a gain of service, in some respects - the whole idea of primary health care as it relates to community health centres. The initiative, I know, is talked seriously about in New Waterford and Glace Bay, where is your department at in relation to this and I suspect in talking to Doctors Nova Scotia about their position, that they want to see some kind of AFP in place or something where they would not lose money? Could you enlighten us on that?

MR. MACISAAC: Madam Chairman, first of all I want to say to the honourable member that our experience in Nova Scotia to date - and I don't see anything that's causing that experience to change - is in communities where they have had community health centres as suggested by the honourable member, that is collaborative practices between a physician and nurse practitioners and others who may be part of that collaborative practice, the reaction has been extremely positive to those. As a matter of fact, in some areas of the province, the reaction that the DHA gets is, when can we get our nurse practitioner, because they really find that it's very positive. One of the positive aspects of the alternative funding program, for instance, is that the physicians themselves when they are with a patient find that they have much more time to spend with that patient, but also one of the reactions of patients when they are with the nurse practitioner, then the same experience is true, that they find themselves in a situation that there is much more time to provide.

With respect to the specific questions you've asked, if you don't mind I will take those as notice and get back to you so that I can provide you with a more complete answer than I can provide here this afternoon, but certainly in this province, we've had a positive reaction to community health delivery vehicles and our challenge is going to be to be able to respond as rapidly as communities want these facilities.

MR. CORBETT: Madam Chairman, thank you, Mr. Minister. I guess I tend to agree with your position on it and my only fear is that if you look at where some of these models were initiated, they were initiated in places that I believe, and correct me if I'm wrong, that didn't have existing facilities like a hospital and how these are introduced to the community may seem - I may try to be a bit clairvoyant, but say in areas I know this is going to replace our emergency department. This is what this is doing, and this is why I would hope that we would be out in front of it because I see it as you see it, as a very positive component to primary health care and I would hope that any initiatives that are done in both the Glace Bay and New Waterford areas are on primary health care and community health centres, that they're giving the proper public perspective that people can rest assured that it's not about

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shutting down somebody's emergency room, it's about, in real terms, freeing up the health care providers to do what they're supposed to do and allow that to grow.

I take what you said about the information, you'll take it under advisement and get back to me and I appreciate that, but I guess the question about the sensitivity of bringing that into areas where emergency rooms now exist, they exist in a fairly close proximity. I'm thinking like in areas where it's provided now in the Digby area, when you're looking out on the islands and the transportation hurdles that will have to be attached there. I guess I want to feel some level of comfort that when this is spread out that it's spread out in such a positive way that people are seeing that this is what it is. It's an augmentation of the health care services provided by your department and by the DHA.

MR. MACISAAC: Madam Chairman, thank you very much and I appreciate the concern identified by the honourable member. It's not all in areas like Digby or remote areas of Cumberland County that we've had this experience. We've had it in other areas where there are better medical facilities or more readily available facilities than elsewhere, and our experience is that all of these facilities tend to sell themselves, and once we get them up and running, they become the focus and people are quite content to go ahead and get their services from these facilities rather than the so-called traditional model that's out there. So, I appreciate the concern that you have and you're quite right to say that we need to have people embrace these facilities on their own value and not to judge them in relation to some previous service, and whenever that happens, our experience has been that the new model is the one that's the most preferred by people.

MR. CORBETT: Madam Chairman, I realize time is getting short and this question is not to give short shrift to this very serious dilemma, but I'll try to make it very succinct, Mr. Minister, so it will give you time to answer. The question around people with disabilities and community living, if you will, where we find people who are really in no person's land. They have disabilities. They need some help living in their home or need some kind of care and the only option open to them is long-term care homes.

I have a young woman, I think I've written to you about her, Mr. Minister, who lives in the community, she needs assistance in the morning, getting out of bed. She needs assistance for a few meals, and she needs assistance going back to bed. Now some kind of community living space would be the best for her but all the Department of Health says that they can mandate to offer her, and this is the same we hear from Community Services, is long-term care. What are you seeing in the future that would be there for these people, because there's a real need today?

MR. MACISAAC: Madam Chairman, thank you very much, and I want to say to the honourable member and members of the committee that you correctly identify a situation which, from our perspective, we want to see a better alternative for individuals in that circumstance. I guess our emphasis is going to be on trying to ensure that individuals are able

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to remain in their home as long as possible and that's what our province-wide consultation is all about, is to get people focused in that direction. Now, it may be that the circumstances you're referring to are circumstances where the home care may not be enough and the individual might need something beyond that, but not a long-term care facility, and that is part of the spectrum that we hope to identify through the consultation. What we're doing is trying to make sure that we explore all possibilities within the spectrum itself and situations described by yourself will be ones that I would hope would get a very good airing in this consultation process and that we would get recommendations that may provide a better alternative than those described by yourself.

MADAM CHAIRMAN: The time allotted for the Official Opposition has ended.

The honourable member for Preston.

MR. KEITH COLWELL: Madam Chairman, I have just a few questions for the minister and hopefully they'll be easy questions. You put in the budget approximately $300,000 for chronic pain and wait times. Could you explain to me exactly what that money is for?

MR. MACISAAC: Madam Chairman, I want to thank the honourable member for the question because this is an item in the budget that is very important to me because I believe that one of the things we need to do is to try to do as much as we possibly can to assist those who are suffering chronic pain and currently the situation is not acceptable. We have a wait time that approaches two years with respect to being able to get to a pain clinic. We are not organized in a way where if we were to provide the full infusion of funds, which we estimate to be in the vicinity of $1 million, to be able to suddenly shrink that wait time. There needs to be an element of planning and preparation in order to address that, as well as some resources being applied throughout the course of the year to start reducing the wait times.

So while the number that's identified within this budget is $300,000, and a portion of that will go to planning and preparation with respect to addressing the longer wait time, it is part and parcel of a larger commitment to ensure that we get appropriate wait times in place with respect to the pain clinic. Certainly, we're a long way from that now, but we do believe that with about $1 million, we can adequately address that and bring that wait time period to a much smaller number than is currently the case. You have to think in terms of the $300,000 as being part of a phased commitment with respect to addressing the pain clinic wait time.

MR. COLWELL: I appreciate your answer. I'm going to ask a couple of small questions, maybe you can answer them all at the same time, if you can. The $1 million you're talking about, would that be annually or would that be (Interruptions) Annually. Would this be connected at all to the problem that we're having in the province now with chronic pain and the Workers' Compensation Board? Are those two things tied together in any way?

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MR. MACISAAC: Madam Chairman, as I understand the situation with the Workers' Compensation Board, it has to do with the processing of the claims as opposed to the situation I'm talking about, which relates to anyone who is awaiting treatment for chronic pain, to try to provide some relief to that pain that they are suffering, whether they're workers' compensation cases or other citizens who experience chronic pain.

MR. COLWELL: Maybe I didn't make myself clear enough, and I do appreciate the answer he gave me. Maybe what I should ask is, with the problem we've had with chronic pain and workers' compensation, people having to wait a couple of years to get diagnoses or treatment or whatever the case may be, it may prolong that situation for new cases, in this case, probably, rather than the older cases that have already gone to the chronic pain clinic. Would that have a bearing on the outcome of that? Do you think some of the people might be able to be helped? I'm not asking a medical question here, just the philosophy of it and what the overall philosophy of the process would be.

MR. MACISAAC: That is related to the issue of the planning that we need to do to get a good handle on precisely what it is that we're dealing with in terms of these questions. That's why we want some of this money to be spent in that way as opposed to flowing directly into the clinic in the first instance. We want to do that planning and get it underway so that we can move forward, understanding all of the complexities that are out there with respect to the issue of pain and pain management.

MR. COLWELL: I appreciate that answer. I know it's a very difficult situation with chronic pain. I deal with a lot of people who have chronic pain with Canada Pension disability claims. It's a very complicated question, so I do appreciate your answer. I have another question, and some of these answers you may not be able to give me today, and that's fine, you can forward them later. Again, there was some discussion earlier about head injuries. I don't know if you gave the answers at that time, and if you did, that's fine, you can just indicate that you did and I'll look them up.

I'd like to know the typical cost, the average cost of treating a head injury, and I don't mean someone whacked me on the head, but a serious head injury, if you have that information. What are the potential outcomes of head injuries? If someone gets a serious head injury, is it usually reversible or usually not the case? Whatever the percentages are, I'm just looking for percentages here. I'd also like to know the stats on the causes of head injuries by age group, children, young adults, older adults and seniors. That's a lot of questions at once.

[4:15 p.m.]

MR. MACISAAC: Madam Chairman, the honourable member correctly anticipated my response. I would be glad to take those questions on notice and get back to you with the detail that they require.

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MR. COLWELL: I just might ask one other thing about this, as well. What preventive steps - when you maybe bring the information back, if you don't know the answer right away - are undertaken - I don't know if this a fair question to ask you or not, and if it's not a fair question, just tell me and that's fine - in the process?

MR. MACISAAC: There is an Injury Prevention Strategy that is led by the Office of Health Promotion. A very important element of that strategy relates to the prevention of brain injuries. I know that the Department of Transportation and Public Works is also very much involved in safety initiatives with respect to preventing injuries. Very important in the injury prevention field is the area of preventing brain injuries. There are initiatives underway, and the honourable member might want to question the Minister of Health Promotion further with respect to the initiatives that his department is leading.

MR. COLWELL: Thank you very much. Those are all my questions. I'm going to turn it over to my honourable colleague.

MADAM CHAIRMAN: The honourable member for Richmond.

MR. MICHEL SAMSON: Madam Chairman, it's a pleasure to have the opportunity to ask a few questions of the Minister of Health, and the Department of Health, on behalf of the residents of Richmond County. As I'm sure you'll be aware, health care continues to be one of the top priorities for residents in Richmond County. We have an aging population, but at the same time I'm also pleased to report that we have a number of young families that have relocated back to Richmond County, which is something we're extremely proud of. So we do have a variety of health care needs, as would many other communities, and with those needs come a variety of challenges, challenges that I'm sure the minister and his department are well aware of. It's with some of those challenges that I wish to have some discussion with the minister today.

Mr. Minister, if I could I'll start with the issue of the Richmond Villa. I'm sure the minister is well aware of this one, I don't think he needs a briefing note on this subject. I know it's one that's of particular interest to him, and we're certainly appreciative of that. As the minister knows, a number of years ago environmental studies were done which indicated that the current 75-bed facility located in St. Peter's had numerous problems, to the point that it was not feasible for that facility to continue to operate. Based on that, the Department of Health indicated that they would fund the construction of a new Richmond Villa. At the time, the original construction time frame that was provided to the residents of Richmond County and to myself indicated that construction would begin in November 2002.

We all know now, Madam Chairman, that we're in May 2005, and I regret to report that construction has not started. Needless to say, the residents whom I've had the opportunity to visit with are very sincere in asking, when are we going to get our new facility, and why have we been waiting so long? The staff have certainly expressed concerns about

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the state of the current facility, and family members of residents are also very concerned about the length of time it has taken and their patience has certainly been stretched on this issue.

Madam Chairman, last Fall the community of St. Peter's and the entire County of Richmond celebrated the official announcement of a site for the Richmond Villa. We have a commitment, we have a site, we have a sign - the sign's up - we have the plans for the new facility, so my first question today is, can the Minister of Health confirm if the tender for the construction of the new Richmond Villa has been awarded, and can he indicate who was the successful bidder?

MR. MACISAAC: Madam Chairman, what I can report to the honourable member is that the tender documents did go out, and that when they closed there was only one bidder who responded to the tender offering. That bid came in considerably beyond the anticipated budget for the project. I can tell you that discussions are taking place between the single bidder and the department with respect to the bid. Any more than that would be difficult for me to speak to because it is a negotiation situation. Once there is either a successful resolution of that or some other outcome, which I do not want to anticipate, then - I think the less I say about it, the better it is because of the nature of the discussions that are taking place. I will certainly undertake to provide the honourable member with as complete a briefing as I can after the process has been completed with respect to the information.

MR. MICHEL SAMSON: Madam Chairman, I want to thank the minister. Certainly I don't want to raise any concerns that are going to delay this in any way, but I know that a number of people in the community and others who have been watching this - I believe the facility is going to be in the range of $11 million to $14 million, if I'm not mistaken, it's somewhere in that range. What many of them have asked is, considering that's quite an expensive facility, why was there only one bidder? Is this common practice?

Many people have been puzzled as to why, considering the nature of this project - it's quite significant - there would only be one bidder. I'm just curious if the minister's department has concerns over this, or if it just happened that there was just one interested in this particular project, and can he provide any information that would put concerns at ease on that specific matter?

MR. MACISAAC: Madam Chairman, it's difficult to answer with any degree of certainty, as to why there was only one bidder in this particular circumstance. But it is unusual, normally you do get more than one bidder. There has been some discussion - and this is not scientific in any way - that we're a little bit a victim of some of our own successes, in terms of the amount of construction that we have going on in the province relative to schools and renovations, hospitals and hospital renovation, and all of these things, that we have a limited pool of contractors, and their capacity to be able to respond is perhaps not as

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great as it would be in a period where there might be less of this activity taking place. That's not a scientific answer, it's speculation to that effect.

MR. MICHEL SAMSON: Madam Chairman, it's an interesting spin on things, I guess. I'll let the people of Richmond decide if they believe that things are so busy right now in the Strait area that only one company was interested in bidding. We've got one. My understanding is that approximately over 30 tender packages had gone out on that specific project, and there is one bidder. So be it, we have one bidder.

My understanding, in the most recent phone call I made about 20 minutes ago, is that there appears to be a verbal agreement that has been reached between the department and the bidder, which is wonderful news. I'm wondering, with the minister not being able to give specific dates, can the minister indicate to us if that is the case, there is a verbal agreement and the documents will hopefully be signed in the future, can we expect a sod-turning ceremony soon, along with the beginning of construction of this facility? Can you give us any sort of a sample of what kind of time you expect the residents should be targeting as to when they can expect work to start on this facility?

MR. MACISAAC: Madam Chairman, I do know that discussions were underway between the department and the contractor. I have not had a conversation with folks in the Continuing Care department today, so if, indeed, the situation is as suggested by the honourable member, it has not been brought to my attention. My deputy and my chief financial person are here with me, so this afternoon, at least, we've not had an opportunity to be brought up to date on that.

I think I said last year during estimates that there's nothing that would please me more than to be able to go to Richmond and do a sod-turning ceremony. I can tell you, Madam Chairman, if, indeed, an agreement presents itself in the relatively near future, we will have a ceremony not too many days after the House rises.

MR. MICHEL SAMSON: Madam Chairman, I certainly look forward to that sod-turning ceremony. I'm sure we'll be able to find the appropriate shovels and whatever else might be necessary for the minister. In fact I spoke to a gentleman today who even asked me to pass on to the minister that the sooner the better, especially because lobster season is starting next week in Richmond County, and we're certainly hoping he'll be able to join us in the very near future for such an important announcement in light of that. (Interruptions) That might be possible.

One of the issues, Mr. Minister, dealing with the Richmond Villa, as you know, it's going to have the same number of beds as the current facility, 75 beds. The difference is that a number of those beds are being set aside for some of the new programs that are being offered in long-term care, respite care beds and I think there are assisted living-type beds, which is wonderful news and we certainly look forward to those additional services. The

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concern that has been raised, though, is that you are reducing the number of long-term care beds that will be available for people who would be residing at the new villa on a long-term basis.

Based on the fact that you just recently put out a call for expressions of interest for new long-term care beds under the Cape Breton District Health Authority, based on the fact that the population is aging in the Richmond area and in the surrounding areas, I'm wondering, what information or on what bases or criteria did your department conclude that a reduction in the number of what is traditionally known as long-term care beds was warranted for this new facility, or whatever information you can provide that would put residents' minds at ease that there actually is a logic and vision here that's being applied as a result of this reduction?

MR. MACISAAC: Mr. Chairman, the beds that were identified for the Cape Breton Health District, 25 beds were part of a major consultation that took place in that area. Indeed, if you read all of the references in the budget documents, an additional 100 beds for the Cape Breton area were identified. Now, these are beds that are required to do two things: one is to provide relief in the acute care sector in the Cape Breton District Health Authority; and the other, of course, is to meet the needs of the long-term care population in that area.

Now, specifically to Richmond Villa, what is anticipated there - and I understand this is based on an analysis of the population in Richmond - is that widening the spectrum of the types of beds that will be available there will meet the needs of the population as anticipated in the future.

[4:30 p.m.]

We're also going to be placing a greater emphasis on keeping individuals in their homes for a longer period of time. That's part and parcel of the province-wide consultation that is taking place. That's part of the reason we have, for instance, made permanent the self-directed home care program. That's part of the reason we've put more dollars into the home care.

We in no way anticipate those funds are going to look after everything. We fully anticipate that the consultation that is taking place will assist us in determining how to widen the spectrum of home care options so that people will stay in their homes for a longer period of time. So it is part and parcel of that wider consultation as well as the long-term care beds that would be required as well.

MR. MICHEL SAMSON: I appreciate the minister's response. I'm wondering, as I indicated earlier, if he could present me or the House with any sort of a study or review that would have been done by the Department of Health in drawing the final conclusion of how many beds would be required. I guess my concern is that I'm aware of specific situations

[Page 204]

where individuals have had to be kept at the Strait Richmond Hospital, for example, for extended periods of time because of the fact there was no bed available for them.

So I guess the big concern - don't get me wrong, we're extremely happy to have a new Richmond Villa - the issue is, are we losing an opportunity to build it with the right amount of beds now or down the road are we going to be faced with the situation where again people are being kept at the Strait Richmond Hospital or at St. Martha's Regional Hospital or the Cape Breton Regional Hospital for extended periods of time because there's no long-term care bed available for them in Richmond County, either at St. Anne's Nursing Care Centre or the Richmond Villa? I appreciate the answer the minister has given and I hope he's right that this does strike the right balance, but I'm just curious, does he have any sort of study or report internally that was done that he could provide to me or to this House that would give some sense of comfort that the right amount of beds are being constructed?

MR. MACISAAC: First of all, I will undertake to provide to the honourable member the information that we have available, but I want to outline how that information was gathered for the benefit of members of the committee.

A complete analysis was done of home care for the seniors and daycare for the children in the area. We took into account the respite and that consultation took place with the folks at Richmond Villa itself, with the district health authority, with the municipality and they were focused on the needs for a new Richmond Villa. So it was based on that consultative process that the design that is going to be brought to fruition in St. Peter's is one that reflects that consultation that took place.

As I said, I would be glad to share the information we have.

MR. MICHEL SAMSON: I look forward to receiving that information.

Now, we've got the Richmond Villa out of the way, I know the minister mentioned last year and he said again this year, that's probably the one top thing he was looking forward to was the construction of the Richmond Villa. The number two item might be getting a long-term, permanent doctor at the Strait Richmond Hospital.

I don't know how to put in words the personal frustration that I have had in my seven years as a member, the frustration of the staff and the volunteers of that institution and the frustration of the surrounding communities - Richmond, Inverness, Port Hawkesbury, Mulgrave - that are serviced by that institution. Once again, the emergency room of the Strait Richmond Hospital is closed during the weekdays, 8:00 a.m. to 6:00 p.m. Monday to Friday and this has been so since January of this year. This has been so even though the doctor who was there gave a month's notice that he would be leaving. You can almost say the Department of Health has had at least four months now, going on five months, to try to

[Page 205]

address the situation. Unfortunately we find ourselves again without a doctor during the daytime.

There have been some valiant efforts by some of the surrounding physicians to try to come in one day a week, two days a week - we were left with a situation where the local radio station would announce, the Strait Richmond is open on Thursday, it's closed on Friday, open again on Monday, but closed Tuesday, Wednesday - it was just mass confusion. I've mentioned before, our greatest fear is that we are going to have a significant emergency where someone is going to land at the door of that institution between Monday and Friday, 8:00 a.m. to 6:00 p.m., and something drastic is going to occur because there is no available physician there.

I have to tell you, we almost had a real life example of that when we had the unfortunate bus crash that took place in Monastery. Students were returning to Newfoundland, most of them were brought to St. Martha's, four were brought to the Strait Richmond. Fortunately, it was a Sunday evening and there was a doctor there at the emergency room. How much longer can we continue before we roll the dice too long on the health of the residents in our community? So I ask the minister, can he explain his government's inaction in getting this vital emergency room reopened since it was closed in January of this year?

MR. MACISAAC: I'm not trying to be picky over a very serious situation. The word "inaction" is not appropriate with respect to the efforts that have been expended on the part of the DHA, the Department of Health. The degree of success of that action is what is legitimate to speak about. That has been a huge challenge, continues to be a huge challenge. I will say that all of the EHS services are fully aware of the times when service is available at Strait Richmond and when it's not. They will respond accordingly with respect to their destination on the emergency calls.

I hear the announcements the honourable member hears; more than that, I read the announcements whenever they're being made in terms of when the facility is going to be operational or not operational. That is a huge challenge for us in the department, for the DHA, for the community. I know my office has been in conversation with representatives of the community on almost a weekly basis with respect to leads that are identified and trying to track down the leads. The challenges that we have of dealing with the College of Physicians and Surgeons when somebody who might be available is looking for an immediate okay from the College of Physicians and Surgeons, they, in turn, feel that it's appropriate for them to conduct due diligence with respect to prospective candidates that might come forward. I'm sure that as they view these, it would appear to the community as failed attempts, and it must cause them to wonder what is taking place.

[Page 206]

We can't just accept anybody. We need to be certain the appropriate licensing authority, which is the College of Physicians and Surgeons, is satisfied that when they give their okay that it is an appropriate decision on their part. We do our very best to bring to their attention the need to act as expeditiously as possible with respect to these situations.

I know this is not an immediate response to the honourable member, but it is something that I know the College of Physicians and Surgeons and Doctors Nova Scotia are working on with respect to finding methods to expedite the involvement of IMG personnel, international medical graduates who are currently in the province, and getting them appropriately licensed. The process currently in place is cumbersome. I do know that they're working diligently at trying to expedite that particular process and if they are successful, there will certainly be some improvement there. From what they tell me, I'm encouraged but I don't want to speak on their behalf at this juncture.

It is a challenge. We continue to work very hard at it. It's not the only challenge that we have. We certainly have a very significant challenge currently before us with respect to Eastern Memorial Hospital in Guysborough County, Canso. We have similar challenges in other parts of the province, and we need to continue working at these things. I can just tell the honourable member that he knows the success we've had, but I can tell you that it's not for a lack of effort.

MR. MICHEL SAMSON: Well, I guess the question becomes, how long can you sit in the mud spinning your tires until you eventually say, okay, something else needs to be done or we're never going to get out of here? Six years and I don't even dare try to guess how many times I have either through Question Period, through resolutions or through estimates, raised the issue of chronic closures at the Strait Richmond.

The minister knows that concerns have been raised about the level of remuneration provided to this facility because of its unique location and because of the challenge associated with it, is that many doctors are frustrated by the fact that where they're practising out of Strait Richmond, doctors surrounding them are earning significantly higher incomes than they are. That issue is there and the community's asking, well, at what point will the Department of Health look at addressing the remuneration, to see if that could possibly provide a long-term solution and get a doctor who is willing to stay for the long term, and we haven't heard anything about whether remuneration is being looked at.

Maybe the minister can express that and indicate whether they are looking at that and whether there is a possibility that because of its uniqueness, if not geographically, in that I can't think of any other institution in this province that has had the chronic closures of the emergency room department that this one has. That's not a distinction that I'm proud to say we have in Richmond, but I'd say the minister would be hard-pressed to point out any other hospital in this province, in the last six years, that has seen the problems in the emergency room that the Strait Richmond has. So I'd like him to address that.

[Page 207]

The other frustrating issue is - and it may be time that we have a better look at the College of Physicians and Surgeons and maybe it's not this government that should be accepting responsibility for some of these actions and maybe it's time that we had a serious look at their own actions - we had a doctor express an interest in coming to that hospital in January. He was in the U.S. There was an issue about his credentials. He received a phone call yesterday indicating that his credentials were not sufficient to operate that facility. It took from January to May to get a decision. That's just not acceptable in this day and age, three or four months to get a decision while an emergency room stays closed. Now I appreciate the minister saying they're looking to get some efficiencies, well, they have a long way to go and if it is strictly within the College of Physicians and Surgeons, then let's call a spade a spade, and let's try to deal with that problem and call them to task for what's taking place here.

Communities are without emergency room service while it's taking three to four months to determine whether a specific doctor has gotten an interest. And the frustrating part is, if we get a doctor who calls tomorrow and says I'm interested, and there's an issue about his credentials, are we looking at another three to four months before we even find out if this doctor is someone who might be able to serve in this emergency room? Two questions. Are you willing to look at remuneration? Have we finally gone far enough that it's time to look at the remuneration for the doctor at the facility and number two, how can we possibly justify the delay that took place by the College of Physicians and Surgeons to make a determination as to whether this particular doctor was qualified to work at this facility?

[4:45 p.m.]

MR. MACISAAC: Mr. Chairman, I thank the honourable member for articulating his concerns as he has, and I will say that they are concerns that I share. The issue of remuneration, I'm informed by my deputy, has, in fact, been tried in the past. I don't have all of the details with respect to that. (Interruption) At that facility, yes, during the day shift, to try to encourage some attendance for the provision of emergency services. The responsiveness of the College of Physicians and Surgeons is something that frustrates the honourable member, and I share that frustration in terms of being able to get answers. I'm not going to say to the College of Physicians and Surgeons that they should short-circuit their process in any way that might cause them to be less diligent than they should be. We have tried, and will continue to try, to impress upon them the situation that people are facing in parts of the province with respect to getting timely answers.

What I will undertake is to share with the College of Physicians and Surgeons a transcript of your comments here today, so they can have a better appreciation of the frustration that you and the people of Richmond experience as they await decisions with respect to prospective candidates. Indeed, when you wait that long for a decision, you live in the hope that perhaps you have a solution to your problem and it causes you to perhaps ease off a little bit in terms of going after somebody else, and you develop a relationship with the person you're recruiting, and you feel a sense of loyalty to that individual in the hope that

[Page 208]

they're going to become the answer to your problems, so you don't put yourself in a situation where that person is in conflict or in competition with some other individual. That creates all kinds of problems for communities.

We're all human and when you are dealing with a hopeful solution to a problem, you don't want to do anything to cause that person to become disinterested and as a result you behave accordingly. So the longer that a person has to live awaiting an answer as to the qualifications, then it's really time that water has passed under the bridge and a lot of it in terms of being able to address that. So I will certainly share the honourable member's concerns with the College of Physicians and Surgeons and I will indicate to them that I will share my comments that I've delivered in response to your comments here. In terms of being able to do more than that, we'll have to monitor the situation very carefully.

MR. MICHEL SAMSON: Well, I appreciate what the minister is saying and no one would ask your physicians to cut any corners, but in this day and age, 2005, in the age of technology and the age of communication, to suggest that checking someone's credentials would take three to four months, is just ridiculous. Let's call it for what it is. It is ridiculous. A four-month wait to check someone's credentials is ridiculous in 2005. Back years ago when communication was difficult and sending a letter to the States took a couple of weeks, maybe, but not today. That's just unacceptable, and I would challenge anyone to come and tell me that a four-month wait to check someone's credentials is legitimate in this day and age.

The College of Physicians and Surgeons has to start answering for this and I'd be frustrated, if I was minister, having to hear me express the frustration at the government, when the whole time you need to wait for them to make a decision. So it's time, the people of Richmond want to know who is responsible here and who is holding this up and if that's the case, then let's deal with issue right there.

As far as I know right now, there is no doctor in sight. The question is, what do we do? How much longer do we wait? We're on five months now. How much longer can we go until we say, something different needs to be done? I appreciate the deputy minister indicating that there was some change in remuneration. I remember being part of that change in remuneration, there was some increase with relocation money and it was creative ways of trying to increase it without changing the classification. So the classification has never been changed, it has never been upgraded.

I would ask the minister if he would ask his staff to provide him with the salaries of the doctors in Isle Madame, St. Peter's, L'Ardoise, Port Hawkesbury and Inverness and compare the billable hours that they billed MSI compared to what was billed or what was paid to the doctor at the Strait Richmond Hospital. You will see that there is a significant difference. So I can't accept the statement that remuneration has been tried and it didn't work. There were attempts to improve it, I agree with that, but it was nowhere near to

[Page 209]

moving it to the new classification and I'm not going to get into the A, B, C, D and that. It's quite complicated and hospitals fall under different categories, being the services they offer - whether they have an OR or whether it's just a simple ER and how it is.

The message is, you have to try something different at the Strait Richmond Hospital so at least we can say, do you know what, this minister has at least tried to address the remuneration. He's changed the classification. Hopefully, now, this will bring the salary in line with doctors in the surrounding communities and that may help. What we are asking is for at least some sort of movement on this, Mr. Minister, that would show you've taken this seriously. A four-month closure is unacceptable and this is at least an attempt to make it more attractive for a doctor to locate to this area. That is something you can control that is within your jurisdiction and I would ask that you consider that.

Is the minister prepared to undertake a review of the salaries, or however you want to put it, basically the take-home pay that doctors in the surrounding areas around this institution are bringing as compared to the doctor at the Strait Richmond Hospital in the hopes that that will be enough to justify it's time to change the classification of that institution so that the remuneration provided to any new doctor would be comparable to the surrounding communities?

MR. MACISAAC: Mr. Chairman, the request the honourable member made, for me to review salaries paid to doctors in the areas that he identified, is something that we can look at and see what conclusions might be drawn from that analysis.

MR. MICHEL SAMSON: I appreciate that the minister has indicated he would do that. I am wondering, would the minister commit to sharing that information without giving names because I know that's very important. There are some concerns around privacy and that's not an issue, but would it be possible that when that review is done that the results of that would be shared with me for discussions with your staff based on what outcomes come from that?

MR. MACISAAC: Mr. Chairman, I will certainly be prepared to share whatever information the lawyers tell me I can share. (Interruptions)

MR. MICHEL SAMSON: Hopefully you don't get in a situation where lawyers are arguing with lawyers about what information you should be sharing. We will do our best to avoid that, but I appreciate the minister is willing to look at that. Based on the information we have been provided, I think the results will clearly show that something needs to be done to change the remuneration at that facility because no matter what doctor is going to come, the minute they start talking to the doctors around them and they see the amount of work they are doing compared to what others are doing and the difference in the remuneration, it certainly is an issue. Will it be a solution? Maybe not but I can certainly tell you, Mr. Minister, I would be more than prepared to go back to the people of Richmond and say at

[Page 210]

least this minister has made a concrete change in the hopes of trying to address that problem, and I hope that review can be done relatively quickly.

One of the issues, unfortunately, I have to raise with the minister again this year, that he certainly would be familiar, he and his predecessors, that I have raised before and it was interesting when we talked about the Richmond Villa and the amount of long-term care beds - and I'm sure the Minister of Education would be familiar with this - is the In Home Support Program, the program your government froze in 2000 to undertake a review. It has been a five-year review and that is probably about one of the longest reviews that I've ever seen. The program used to give $400 a month to caregivers who stayed at home to care for loved ones, loved ones who technically may have been entitled to be put in a long-term care facility, instead were kept at home, the idea being to provide some sort of financial compensation to families where a loved one may have not gone to work, may have incurred additional expenses because they were caring for a family member. It was a means, it was an incentive. More importantly, it was not an expense, I would submit to you, it was an investment, that $400 a month to a family. I know there are still families in Richmond County who are receiving it; I was pleased to help them back in 1998-99 to get on the program.

The problem is that when the government froze the program, they said no new applicants, but those who are receiving it can continue to receive it. The frustration is that I have people call me and say, well hold on now. My next door neighbour tells me you got them the In Home Support Program to care for their mom. I'm caring for mom and dad next door and I can't get it, why? Why should I continue not going to work, to have the expense of having loved ones at home rather than put them in a long-term care facility where we all know that the cost per day is - I'm not even going to try to guess the numbers - but $400 per month compared to what it would cost you per month to put someone in the long-term care facility? The savings are incredible.

So I ask the minister again, knowing the success that the In Home Support Program had and the fact that this program fits clearly into its goal of allowing people to stay at home longer rather than going into long-term care facilities, why, in good conscience, has your government not yet brought forward either a new In Home Support Program or lifted the freeze on the old In Home Support Program?

MR. MACISAAC: Mr. Chairman, I just want to make sure I have something clear. I understand, just a little bit of the history of this program, it is one that came from Community Services to Health and then that wound up being frozen in that circumstance. I understand that Community Services is articulating a new In Home Support Program for individuals of this nature and I understand there is funding available for them.

[Page 211]

I further understand that the clients who are being assisted in the program that we have now, that there is a complete analysis being done of their circumstance to see whether they would fit with the program Community Services is having, or is implementing, and if they don't fit there then clearly we need to find a vehicle that delivers services to them. So while the program doesn't have additional funds identified for it in this budget, there is activity relative to the program and what needs to be done to assist the clients in that program who are not going to be accommodated with other programs being provided by Community Services or ourselves.

MR. MICHEL SAMSON: I know there is some confusion around this because there used to be the old In Home Support Program, those frozen in 2000, and it used to be with Community Services. I think the worst thing this government could have done is take it away from Community Services, because I think Community Services were the hands-on people who knew exactly what the situation was and I can't speak well enough about the staff in St. Peter's in Richmond County and how well they administered the program and they were there to help families. No offence to the Department of Health, but that program should have never left Community Services. They were the ideal people to deal with this and it should have stayed there.

[5:00 p.m.]

Not to be argumentative with the minister and maybe he can correct me, but my understanding is that the program Community Services is now offering is meant for children or young adults to stay at home, basically meant for families that have an income under $40,000 a year, I believe, that have a child with special needs. I think it goes up to a certain age. So it's a great program and maybe we could look at that income cap moving down.

My understanding is that program is not available for seniors and what I'm talking about is exactly what you were referring to earlier, trying to keep Nova Scotians at home longer so they are not on the health care system, they are not in a long-term care bed, and that's exactly what this program was doing. I can tell you the successes and I know families, where the dad should be in a long-term care facility - I shouldn't say should be but he would qualify for that, there's no doubt - but he's being kept at home. He wakes up in the morning surrounded by family, he goes to bed at night surrounded by family. One of his daughters is staying at home with him, she cannot go to work as a result, and she receives that $400 a month as compensation from the government for keeping her father at home where he wishes to be.

The amount of money your government has saved just in that one example is incredible and that's why I tell you this program shouldn't be looked at as an expense, it should be looked at as an investment. I know a family where both the mother and father are elderly and would qualify for long-term care, but are being kept at home. Four hundred

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dollars a month is what it's costing your government, imagine, and you know the numbers, what it would cost per month for those two individuals to be in a long-term care facility.

We've got to find ways to make savings in health care and that program was the way to do it. I saw the successes when we were in office, I saw the successes during the short period between when your government came into office and then the program got frozen, because we even got more people that were in it at that time. I remember when your government came to power and one of the first things you said - I remember the property tax rebate for seniors that had been frozen and your government had indicated that you thought it was unconscionable to freeze a program where you had seniors who were getting the property rebate and yet new seniors couldn't qualify for it, you thought that was terrible. So be it, you made the change and you said, now it's available to all seniors.

Here you have a program where, as I said, the neighbour next door is getting it, the other neighbour cannot get it and has been on a waiting list since 2000 when your government said it would undertake a review. I have to say, that while I said that the College of Physicians and Surgeons taking four months to decide on a doctor's qualifications was ridiculous and wasn't acceptable, your government is taking five years; five years these families have been waiting for your government to tell them whether they can get what their next door neighbour has been getting for years.

Will the minister commit today to looking at reinstating the In-Home Support Program, the program that is available for families that keep loved ones at home - for the most part it was seniors - that was providing them with $400, maybe more per month under the new program, whatever is available? Will your government commit, after five long years, to finally taking concrete action on this matter so that we can start allowing Nova Scotians to stay at home, which is what you've suggested, and we can start seeing real savings to our health care system, which you will surely agree, badly needs it?

MR. MACISAAC: We are in fact in the process of re-evaluating, not just this program, but the whole spectrum of needs of individuals such as those described by the honourable member. Not just seniors, the spectrum of age relative to keeping people in their homes for a longer period of time. My deputy is working very closely with the Deputy Minister of Community Services to ensure that we are taking a joint approach to this problem and that the policies that we will bring forward will in fact reflect the needs of clients, whether they be clients of Community Services or Health, that the program we provide is indeed a program that provides the resources that will assist individuals, regardless of age, with remaining in their homes for a longer period of time. I anticipate bringing forward recommendations with respect to that consultative process and there's a policy development process that's currently underway.

[Page 213]

MR. MICHEL SAMSON: I am pleased to see there is some action going on and I have great faith in your deputy minister and I am familiar with the Deputy Minister of Community Services. I know that they are both relatively, for the most part, new deputies in their current positions, which begs me to question, what were you doing for the past four years or the past five years in regard to this program?

I am pleased to see that you're having those discussions and it just begs the question out of pure frustration because as the Minister of Education can tell you, I have the letters from him, I have the letters from the current chief of staff for the government, Jane Purves, when she was minister, and it's just a history of: it's under review, we think it's going to come soon, and I think at one point I had the Minister of Education actually indicate that he expected there to be money in the budget. When was he Minister of Health, back in 2002? It was a long time ago, unfortunately, and I wish that he would have been correct in saying the money was coming, but it didn't come.

This is just one of those situations, Mr. Minister, where I don't know what else to do. I've tried hollering, I've tried writing, I've tried questions, resolutions, reason, please, I don't know what else it's going to take to convince your government, and too often we're told that the Opposition Parties simply criticize and they simply want to spend more. Well, this is an example, where for the last five years, I've been trying to get it clear to your government that this is a means of saving you money, this is a means of helping Nova Scotia families, this is a means of allowing our loved ones in Nova Scotia to remain at home for as long as they can, a means for your government to recognize that caregivers do need some support and that home care is not a 24-hour a day service.

When someone needs 24-hour service, Home Care can only provide so many hours, somebody needs to be staying with them. That person should be recognized for the financial sacrifice they are making, they're not working, they're not contributing to Canada Pension, they're not contributing to any other sort of personal pension because they're caring for a loved one. It is wonderful, a great show of love and respect for their family member or their loved one and at the end of the day when we look at the economics, it saves the government money, it saves the Department of Health money, and if there's one department that needs to save money, it is your department. An 11 per cent increase last year, a 9 per cent increase this year, how much is it going to be next year? We've got to try to put in systems of support to keep people at home and we can't just say it, we've got to have programs there to do it.

I know Community Services has started some steps to work with families - again, it was my understanding it was younger children with special needs or even young adults, keeping them at home rather than having to put them in some sort of institution or long-term care facility. That's a wonderful program and my only objection to it is that the income cap is a bit too high.

[Page 214]

Let me just finish my time by saying I hope in my time elected that I can see the day where the government will bring forward this type of program again so we are able to work with Nova Scotia families, keep loved ones at home and see the success this program should achieve.

MR. CHAIRMAN: The honourable member for Dartmouth South-Portland Valley.

MS. MARILYN MORE: I too am going to have some questions about long-term care and I'd like to talk a little bit and get some information about the long-term care capacity in Dartmouth. I want to start by telling you a little bit about Oakwood Terrace, which I'm sure you're all familiar with anyhow, but it is a top-quality home for special care in my constituency situated across the street from the Dartmouth General Hospital. It's a non-profit organization, it has 111 beds and it has an excellent reputation to the point where it is pretty much the first choice of nursing home care for Dartmouthians.

Currently, I believe there are about 29 residents who are suffering at various levels of dementia and that nursing home has been trying to get agreement from the department to expand the capacity for several years. I understand last year they actually put in a very detailed plan that would create a third unit for their Alzheimer's patients and this would allow the home to actually provide three separate units to accommodate people at different levels of functioning and would certainly improve not only their capacity to take in more Dartmouthians, but it also would improve the quality of programming and life for the people who would be there in those residences. So I'm just wondering, what is the status of that proposal to expand from Oakwood Terrace?

MR. MACISAAC: Mr. Chairman, the proposal that we have received from Oakwood Terrace is indeed a proposal that is under consideration. In the budget we've made reference to about an additional 125 to 150 beds in the metro area and we do know that a large number of those beds are going to go in the Bedford-Sackville area. However, the allocation or distribution of all those beds has not been finally determined and certainly the application from Oakwood is one that would be given very serious consideration as we take under advisement and make our decisions relative to the distribution of beds throughout the metro area.

MS. MORE: I'm pleased to hear at least there's some openness to the possibility of an extra 30 beds going to Oakwood Terrace. I'm curious though to know why the department would be seriously considering placing up to 150 beds in the Bedford area when we've already heard from my esteemed colleague, the member for Sackville-Cobequid, that there's not a 24-hour emergency service, in fact, neither now at the Cobequid Multi-Service Centre nor at the new centre. Wouldn't it make much more sense to place additional capacity close to one of the present hospitals?

[Page 215]

MR. MACISAAC: Mr. Chairman, really the decision that we take with respect to the location of beds is very much related to trying to keep people as close to their home communities as possible in terms of the location of long-term care beds. Otherwise, you know, from the metro area, we could just build one great big facility and be done with it. Our objective is to ensure that people can maintain as easily as possible the connect with their home communities. We have one of the finest ambulance services in North America and that service is capable of responding to emergency services regardless of where they occur in the province.

MS. MORE: Well, that really puzzles me, Mr. Chairman, because I vaguely remember the controversy about getting nursing home capacity at the Mount Saint Vincent Sisters of Charity Motherhouse and here we had the opportunity to actually keep not only a number - I'm not sure, perhaps it was 50 or 60 sisters - actually in their own home, in a facility that had been renovated at considerable cost to the Sisters of Charity, but would also have the capacity to take in some other people. Instead, they didn't get a licence and those sisters had to be moved to a for-profit - I believe it was the Shannex facility - and the stress of actually moving some of those women resulted in their death. So I'm just wondering why that same principle wasn't being followed when the application from the Sisters of Charity was being considered?

[5:15 p.m.]

MR. MACISAAC: Mr. Chairman, the honourable member's reference is not providing the complete story of the situation, the reference with respect to Mount Saint Vincent. It wasn't a matter of approving nursing home beds in the facility that was there, it was the question of whether we were going to okay the building of a new facility to accommodate the sisters and that was not in the cards and, indeed, before a new facility was ever completed, you know, the numbers of sisters involved would probably have changed quite considerably. So it wasn't a matter of approving the facility that existed at Mount Saint Vincent, it was a question of whether we were going to approve new beds at that location.

MS. MORE: Mr. Chairman, you know, sometimes I find my memory isn't as good as it used to be, but actually I had a work connection with the Motherhouse during those years and I'm pretty sure that several millions of dollars were spent to bring that facility up to code and that the unit that was prepared as a potential nursing home was fully equipped and operating for their own sisters and certainly would have met the standards that the department required, but let me get back to Dartmouth.

As you know, Oakwood Terrace is a non-profit facility. So it has a community board of directors. It has well over 100 volunteers who complement the services of the staff. Any investment in that facility would go directly to salaries, programming and services, all to benefit the residents who live there. Is it your intention if you go ahead with your plans to put

[Page 216]

up to 150 beds in the Bedford area, will that be going to a for-profit or a non-profit organization?

MR. MACISAAC: Mr. Chairman, just to go back to the Mount Saint Vincent situation again, I think it's worthy to note the history of that particular facility. The application that was before the Department of Health was for a new nursing home facility and indeed it was the intention of the Sisters of Charity to sell the convent, which they have subsequently done. So the application we had was an application for new nursing home beds. Now, the situation with respect to the Bedford area, these are replacement beds that were taken from Northwood. They were beds that had been approved for Northwood and they wound up being - I forget the details or the circumstance around (Interruption)

Yes, there were changes in the standards of the building and as a result of those changes, 100 beds were eliminated from the building itself and the commitment was made to Northwood that they would be able to obtain replacement beds as a result of that decision. So if Northwood decides that they want to proceed with the facility in the Bedford-Sackville area, the replacement bed commitment will be applied to them in that circumstance and if that goes forward, then of course it would be Northwood that would provide the service.

In the event that that does not happen, then it would be appropriate for us to put out a request for a proposal and based on that request, a decision would be made with respect to providing the beds. (Interruption) All right, I'm informed that indeed Northwood has decided that this is what they want to do and they're proceeding with the planning with respect to providing those 100 beds in that area.

MS. MORE: I'm wondering, I realize you've set up a continuing care committee to assess capacity right around the province to help in some decision making within the department, but do you even have any preliminary idea or indication of what the capacity needs are on the Dartmouth side of the harbour?

MR. MACISAAC: Yes, there is a planning group that is providing, to the consultative process, the information that is referenced by the honourable member. With that information, obviously, we'll formulate part of the recommendations that we will get from the consultation process.

MS. MORE: Mr. Chairman, when do you think that committee will be reporting, and if it shows that there is great need in Dartmouth, would you consider reallocating some of those 150 beds to that side of the harbour?

MR. MACISAAC: Mr. Chairman, what we do know with certainty is that the bed requirement for the metro area is in excess of 150 beds. So it would not be necessary for us to make a decision to move beds from the Bedford-Sackville area to some other location. We do know that the requirement for beds is sufficiently beyond that 150 number that other

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decisions beyond that will have to be taken. I anticipate receiving a preliminary report from the consultation process in the Fall, with a final report coming in the Spring.

MS. MORE: Mr. Chairman, I assume, then, that the application from Oakwood Terrace would be on hold until at least those preliminary reports come in? Am I hearing two possibilities: one, that some of the 150 seats allocated for Bedford could possibly come to Oakwood Terrace - I believe you said that earlier - and, secondly, the government has the choice of increasing the number of beds in the metro area beyond the 150 that you're proposing in this year's budget?

MR. MACISAAC: Mr. Chairman, I've just been given an indication here, just to give some insight as to what's required in the future over the next 20 years. If we don't change how we provide services - and this is the reason that we're doing the consultation - the province would need an additional 3,600 long-term care beds over the next 20 years. Clearly, we need to get into providing alternate care with respect to individuals, because that is a huge requirement. We do, indeed, need other ways of doing it.

I do recall having said things that would cause the member to think that some of the 150 beds might wind up in Dartmouth. What the information tells us is that there is capacity for 125 to 150 long-term care beds in the Bedford-Sackville area. So, in all likelihood, a decision will be taken to move with those numbers. When the consultation is completed and, indeed, we receive an interim report, we may well garner enough information from that interim report to make decisions with respect to the allocation of beds elsewhere in the metro area, as well as right around the province.

MS. MORE: Mr. Chairman, it's interesting. I've been working with seniors in this province for probably the last 20 years. I can't tell you how many consultations and meetings and forums and advisory committee meetings I've attended over that period of time. The outcome of all of them has been very similar to what the minister's suggesting now, knowing that we have to develop a continuum of housing options and care options for older residents, especially that whole area of enriched housing.

I guess my only advice would be we have to stop studying it, we have to start moving on it. People are getting older, and I'm sure you know only too well that the residents going into nursing homes and homes for special care currently are older and much more frail than they were five to 10 years ago. Often they are those members of our society who just can't stay home any longer. So I'd encourage the minister to take very quick action on this issue. It's a long-standing one, and it's not going to go away. It's just going to get worse, and the catch-up period is actually going to cause a crisis.

I would like to move on to another line of questioning. There's a lot of concern and confusion over what's going to happen to both the programs and the facilities at the Nova Scotia Hospital. I'm wondering if you can give me any information that I can share with my

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constituents to help them understand where in the decision-making process those programs and those buildings are now?

MR. MACISAAC: Mr. Chairman, I appreciate the patience of the committee. The choices program that is on that site is a program that will be relocated in the near future. That's a firm decision. There are dollars in the capital budget this year to address the planning issues related to the other renovation projects that need to take place on that site. That money will flow this year, and it will provide us with the direction and guidance that we need with respect to further decisions, in terms of the investment of capital on those renovations.

MS. MORE: Mr. Chairman, I'm wondering, are you planning any sort of communications program to stay in touch with people who both live and work in that area, so that they can feel involved? They have a definite stake in what happens to those programs and that property. You may be aware that there are a number of small options homes and boarding houses and care-in-apartment programs in that area. They're very much related and focused on the day programs, the out-patient programs that are available at the Nova Scotia Hospital. So any change to that program delivery is going to have a dramatic effect or impact upon these people's lives. So I'm just wondering, what can your department do to reassure people and make them feel that they're both knowledgeable about what's going to happen and have some kind of control over their futures?

[5:30 p.m.]

MR. MACISAAC: Mr. Chairman, I thank the honourable member for that question. Indeed, it is a very relevant question with respect to the community that's there, because there is a considerable interdependence between the facilities on that site and facilities that exist within the community. I'm aware of that from having my visits to the site, and conversations with those who are involved in the provision of services there. It is something that we will need to do an effective job on, with respect to communicating intentions relative to that site.

Because of the sort of community that's built up around the Nova Scotia Hospital site and the services that are provided there, that's one of the reasons that we want to look at doing as much renovation there as we possibly can. There clearly is a support system that's out there, that's interdependent upon the facilities and the services that are provided on that site. That particular site, and those renovations are a priority of Capital Health, as well as ourselves, and we will be working very closely with them. I will certainly make the point made by the honourable member here, the need for us to communicate effectively. I know the head of the Communications division in my department is in the gallery, and she's making similar notes with respect to the need to do that.

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MS. MORE: Mr. Chairman, I appreciate hearing that, and I'm quite encouraged by the suggestion that there may, even if those programs are regionalized or whatever, still be a role for that community in terms of delivering programs to people who are living there. As you know, there's the hospital across the road, the Dartmouth General Hospital, the professional building, there are other supports in the community. I see the minister smiling, have I read too much into his answer? I certainly thought, in the mention of renovations and whatnot, that there seemed to be a continuing role for some part of that facility and that land.

MR. MACISAAC: Certainly, Mr. Chairman, what we do want to do is complete an assessment to ensure that, to use the honourable member's words, some parts of the programs that are there would remain there. As I indicated, we will be working very closely with Capital Health with respect to making those decisions. There is an awareness of the service infrastructure that has developed around that site. Where appropriate, we would want to continue that relationship.

MS. MORE: Mr. Chairman, I don't have a lot of time left, and I just want to mention that I frequently get calls and visits from constituents who are very concerned about the wait times. I'm not going to go into all the different stories, but certainly the wait times for orthopaedic operations, mental health services and the emergency room, I would say, are at the top of the list, and you're very familiar with those issues. The other concern that seems to come into my office a lot is home care, especially the need for an expanded self-managed care program, but also all kinds of concerns about the adequacy and the thoroughness of the Home Care Program.

I'm wondering, has the department ever considered the possibility of taking someone familiar with that program and sort of putting them at arm's-length from the department as sort of an ombudsperson to help people who have legitimate concerns, help them sort of resolve those, help them navigate through the system, help connect them with the people who they need to get their particular situation in front of? It's becoming more and more of a role of the MLA's office, and I'm not sure that's appropriate. I'm just wondering, have you ever considered setting up something like that?

I know some of the major hospitals, I'm not sure what they're called, have sort of a patient adviser or whatever, so that if you have a problem, you can call this person and they usually can get it resolved fairly quickly. It's someone who can take the layperson's concern, be able to transmit it to the professional and get the answer back in a way that people understand. It really accommodates people's different levels of need and understanding of the health care system. I think of all the programs, this would be most relevant to the Home Care Program, because a lot of stressed-out family members and seniors are really struggling with knowing how to navigate that.

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MR. MACISAAC: Mr. Chairman, I want to thank the honourable member for bringing that situation forward. Her suggestion is one that we will certainly take into consideration. I want to explain some of my own reactions and what I have initiated within the department, relative to similar issues that you're referencing. I soon realized that we had a very serious weakness in the department with respect to our capacity to conduct an appeal of a decision. It became very apparent to me that people who were considering the appeals were the people who made the decision in the first place, which is not a very appropriate method of gaining what we would - and I'm not casting any aspersions with respect to the professionals who are involved, but one who is receiving the decisions of an appeal would want to feel that that appeal process was conducted in a very objective manner. So you have to ensure that the impression that is created is the reality. The impression should be that there is objectivity.

So I have asked the department, and they're currently in the process of doing a complete analysis of our appeals procedures. I'm going to ask - and they understand this - that we put in place a more objective method of considering appeals to decisions that are taken. So the first steps would obviously be to appeal, have a reconsideration of evidence that is brought into a decision. If there is not satisfaction with that decision, then we need to have another level to go to with respect to considering it.

I don't know if that fits completely with what the honourable member is suggesting, but whether we have one individual or a single office that sort of does this, I'm going to await the recommendations of the department with respect to how we do this. I do know that there was absolutely no resistance on the part of the department in getting on with this project, because they understood, as did I, that we had to have a better system. I will certainly pass on the suggestions as you articulated them this evening and have those suggestions considered by the department as they formulate their recommendations to me.

MS. MORE: Mr. Chairman, I want to thank the minister. That's exactly the kind of thing that my office has been dealing with, and I neglected to mention appeals but that has been a big part of it. As you're familiar, I spent a year trying to help one particular patient with MS receiving home care, sort of navigating and going through the appeal process. By the end of it, I fully understood her level of frustration. I can understand the frustration of the people we were dealing with, the officials in the department, as well. I'm sure this is very time-consuming and I suspect they would be very pleased to have it segregated off into a sort of arm's-length group of people looking at that. I'm very pleased to hear that you're pursuing that, I certainly encourage you to set up something like that unit.

MR. CHAIRMAN: The honourable member for Hants East.

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MR. JOHN MACDONELL: Mr. Chairman, I want to thank the minister and his staff for some time. I'm not sure there's a whole lot of snap, crackle and pop in the estimates, so I can see how four hours may seem like an eternity, not that I'm going to try to be any more entertaining than anybody else.

First of all, I want to thank your deputy minister and staff. I've had two occasions recently, one on a long-term care issue, where the deputy met with people from my constituency and actually, I would say, was very gracious. Even if the response had been more negative, they were well received and that issue actually, the last information I had is that I think they've got something that works and I want to say thanks on behalf of those people. It's a very important issue in my area and I know that they really appreciate it, I appreciate it, and I appreciate the way your staff handled that.

The other area I want to address, and this was also an issue when I was in with the Rawdon Hills Health Clinic people. We met with Mr. Miller and Ms. Payne in your department and actually had a very good meeting with them. The basis of their request, the Rawdon Hills Health Clinic basically has been formed since I've been elected, since 1998, and I remember being at the very early ground level of this community trying to get something going there. When I think back to how green I was on so many of these issues and my learning curve going straight up, but I'm amazed at what this community has done.

As a matter of fact, I'm amazed at what communities do, you know, by and large by volunteers and so they're operating out of the basement of a manse in Upper Rawdon and, you know, that's just not going to work. They do have a piece of land for a site. They have the well, they have the disposal field in. They've got $55,000, or some such thing, in the bank. Part of that was money I think from the municipality. One family has done sleigh rides, you know, donating the money to the health clinic. Somebody else would make a quilt. They have auctions, you name it, I mean if there's a way to generate funds for this project, they've been doing it, but I've got to say, Mr. Minister, that not only are they trying to do that, but they're also trying to run the clinic that they have.

So the basis of our meeting was to see whether or not there was any possibility of funding from the department. At this meeting we had it became clear that there was indeed a very real possibility of some help through federal transition funding. Mr. Miller and Ms. Payne were very helpful, I have to say, and they suggested that this group make a presentation to the DHA. They wanted to feel secure in the thought, I guess, that the DHA supported the Rawdon Hills Health Clinic in this endeavour to build this facility. So that's what we did, we met with staff at the DHA, that was Mr. MacKinnon and Dr. Shaun MacCormick, and Tracy Martin, who was involved with the primary care side and actually working under Eleanor MacDougall. The chairman, Karen Casey, was at that meeting.

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That was a much more difficult meeting I want to say and I'm not sure that the minister could ever believe from my demeanour that I could leave in a frustrated manner, but I want to tell you it wasn't just the trip home from Truro to Enfield that I needed to cool me off because even weeks later it still goes through my head, but the impression I got from that meeting was they didn't really support the Rawdon Hills Health Clinic, number one, that was the first message that I got. I think the message finally boiled down that they wanted to be sure that the other members of the Hants North Area Health Cooperative - and the Minister of Education would remember that because we took a delegation into him and I think at that time he and your present deputy, who was I think the assistant deputy perhaps at that time, they were very helpful at that time to come up with this notion of this Hants North Area Health Cooperative, which was kind of an umbrella for Noel, Kennetcook and Upper Rawdon and I was impressed, I have to say, because they tried.

[5:45 p.m.]

Anyway, the East Hants Community Health Board had put together their health plan. As a matter of fact, they had a health plan very early in this whole process. As a matter of fact, their health plan was together pretty much before the government changed, when it was the health districts, and so they were up and ready to roll. They submitted their plan to the DHA. The DHA approved their plan and the Rawdon Hills Health Clinic is part of that plan. So when we went to this meeting with the DHA and got this message - I did - that indicated to me that they weren't all that supportive of this notion, I was quite taken aback and told them you've already approved it, you know, you've already approved three clinics for this area or plan for three clinics.

I also tried to make the case that the dollars that we were coming after were not really their dollars, they were federal dollars. I think when I left the meeting, because I had to leave a little early of it ending, they wanted some assurance from the other clinics - Kennetcook and Noel - that they were in agreement with the direction the Hants North Area Health Cooperative was going. I have to tell you, Mr. Minister, and I'm not sure, you know, I'm not going to assume that you micromanage the DHAs, but about a week after that there was an announcement in the paper that the DHA was spending $2 million in Tatamagouche to renovate the Lillian Fraser. Now, that was their money.

We have a new resource centre just about completed in Elmsdale that the DHA didn't build, wouldn't build. As a matter of fact, when we tried to get them to build something in East Hants, they said we don't build bricks and mortar, but yet that's exactly what they're doing for Lillian Fraser, is they're spending money on bricks and mortar and they're renovating that facility. So the taxpayers of East Hants have picked up the tab for the resource centre which is $4.5 million to $4.7 million.

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I guess I would like to hear your comments. I would like to know if you can tell me if there is a way to know how much of the DHA's budget goes from the people of Hants East. I'm assuming it's not a per capita basis, but if it is, I would like to know that. Is there a way to know how much money goes from the people of Hants East toward the DHA that covers their area? And you can comment on my other comments because they weren't questions.

MR. MACISAAC: Mr. Chairman, with respect to the last question that the honourable member raised, off the top of my head, I'm not sure what vehicle we would use to try to put that information together because it's not something that we normally think of with respect to expenditures. I am certainly familiar with the facility that the municipality is building. I had the opportunity of touring that facility with the warden, the past warden, with the members of the DHA and with the project manager, and that facility is far greater than just a health care facility. It's quite a credit to the community really to be able to go ahead with a facility of that nature.

I think it's one of the steps in terms of recognizing that what is coming together in that area is, if you like, a new focal point, and this is a major piece of the infrastructure of that new focal point. You certainly have, in that area, the commerce centres that are required to support and sustain a community. The facility that the municipality is building is a facility that provides the service element, related to what a community needs to sustain itself and survive.

We sometimes think of these as being services that are traditionally provided within towns, but this is one that is being provided by the municipality, recognizing what the citizens in that area need. I consider it to be a major step forward for that municipality and for the community in particular. I'm pleased that the district health authority is part of that.

If you look at that situation in hindsight, you may be the beneficiary of what you consider to be a bad decision by the DHA, that they did take the decision they did because it provided an opportunity for a much broader facility to serve the interests of the community. I'm pleased that the health care services are an integral part of that. I'm not sure you share my view in that regard, but I think in hindsight the community is going to be well served by what's happening there.

With respect to the other project, obviously I'm not up to date in the details relative to that. I guess the question I want to satisfy myself about, relative to all of that, is the degree of co-operation that does exist in all of those centres that you referenced. I want to find out about that, because I'm certainly very curious to know what the relationships are there. I will do my utmost to get some information on that and see where it takes us.

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MR. MACDONELL: I want to say to the minister, I was raised on a farm, so I know about looking a gift horse in the mouth. The resource centre - and the comparison I'll make to other places funded by the DHA, solely, there were health services that went into those places, as well, paid for by the department, yet the department built the structure, or whatever. That didn't happen here, and that's the point that I want to make. We appreciate those services. They were in Hants East, a number of them, and we just collected them into that one facility. I think if the province wanted to put $2 million back to the municipality on that, they would probably consider that great. We do appreciate that help from the department and the DHA.

I want to say I've tabled a petition here on a request for dialysis in that facility. I would like the department to think about that. People would also like to have X-ray services there, as well. It is a focal point. It is a good initiative. I don't want to see the people of Hants East doing things with their municipal tax dollars that other people are getting done through their other tax dollars, and seem to be paying twice.

With that, I'm going to have to take my place because my colleague is expecting some time, and I have to be fair. But my final comment, I would like you to give whatever consideration to the Rawdon Hills Health Clinic and their initiative, and I want to say thanks again to your staff for their help. I really appreciate it, and I know the people there do.

MR. CHAIRMAN: The honourable member for Pictou West with about five minutes left.

MR. CHARLES PARKER: Mr. Chairman, I know my time's going to be interrupted by the late debate, so I'm going to ask you some short snappers, Mr. Minister, before the adjournment, and then we'll have some other issues for you afterwards. I want to come around, first of all, to the initiatives in the budget around diabetic, low-income coverage. I certainly welcome that initiative. We had hoped that it would actually be here last year. It was in your Throne Speech, and there it wasn't, but I'm very glad to see it this year.

Can you give us some details on how the program is going to work, who's going to be covered, will strips and needles and insulin, all supplies, be covered, when will it start, and what's the income level for coverage?

MR. MACISAAC: Mr. Chairman, first of all, I want to comment about the commitment that was referenced in the blueprint and the amount of money that we've identified this year. The money that was identified in the blueprint was for a much narrower program than the program that we're going to offer. The program we're going to offer will include - I don't have the list in front of me - sticks, insulin, syringes, the needles, oral medications that would be required, all of those medications or test devices that individuals would need in order to be able to control their disease effectively will be provided by this

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program. So the program that was committed to in the blueprint was a much narrower program that focused on test strips only.

Now, the reason that the number is lower than the $3 million identified in the blueprint is because we're really beginning what's going to be an $8 million to $9 million program. The take-up on programs of this nature - and we were quite surprised to learn this - in other jurisdictions is much slower than one would anticipate. This is certainly sufficient money for us to begin the program this year.

The income levels have not yet been determined. They will be, and we're working within the Department of Health with the Canadian Diabetes Association with respect to coming to those income levels. The program, we hope, will be operational in the Fall, maybe late Fall. By the way, I've asked the department to provide a complete briefing note that I will make available to all members of the House with respect to the details around this.

MR. PARKER: I certainly welcome the initiative. There are a lot of diabetics throughout the province, and certainly in my riding of Pictou West. I've had a number of contacts from people who are looking for answers and are very much looking forward to the help that will be provided. I assume that it's available to all low-income Nova Scotians who qualify, it's not just people on social assistance but all people with an income below a certain threshold. Do we have any idea of where that threshold might be? Is it $15,000 or $20,000 or what?

MR. MACISAAC: Mr. Chairman, currently, all of the services that I referenced are provided to Community Services clients. So we're talking about low-income Nova Scotians over and above that income threshold, not insured, people who do not have insurance. That's the group that we're talking about. (Interruptions) Now, we haven't set the income threshold yet, but it would be those individuals who are not now being serviced by Community Services, who have low incomes and do not have an insurance policy that would assist in covering these items.

MR. CHAIRMAN: This brings us to the moment of interruption.

[6:00 p.m. The committee recessed.]

[6:30 p.m. The committee reconvened.]

MADAM CHAIRMAN: The honourable Government House Leader.

HON. RONALD RUSSELL: Madam Chairman, would you please call the estimates of the Department of Health.

MADAM CHAIRMAN: The honourable member for Pictou West.

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MR. PARKER: Madam Chairman, back to the minister I guess on Health estimates. While your staff is waiting to come in, I want to, in the few minutes I have remaining, come around to the question of long-term care. In particular, in relation to a particular concern that a resident of mine has brought to my attention on several occasions. This concerns the system and how it changed on January 1^st. Certainly we applaud the system that no longer are people's assets being seized and rather it is based on an income level. Certainly people under the old system, many of them paid hundreds of thousands of dollars until their assets were depleted and nothing was left.

I'm particularly concerned about these people who maybe have given all they have to give, they have spent $0.25 million or $300,000, sometimes even more than that over several years, until they have nothing left to give. This happened with a couple from the Town of Pictou in that their assets were depleted and then because of the spousal income rule, they were assessed at $1,071, I think, that the husband had to pay for the wife's care in the nursing home. After January 1^st, it was sort of contemplated that that would end, that would be the end of it. In fact, Mr. Minister, I recall asking you here a year ago in Health estimates if the spousal contribution required would discontinue and you told me yes, it would. It would no longer be a factor.

So I want to ask in particular on behalf of the people who are under the old system, who still have the $105 comfort allowance, why is it that they are still being asked, in some cases, to continue paying for the care of their partner who is in a nursing home?

MADAM CHAIRMAN: The honourable Minister of Health.

MR. MACISAAC: Madam Chairman, the honourable member raises a question which has affected a few families that we have been made aware of with respect to their circumstances. The decision that was taken was that there indeed would be a recognition of household income relative to the financing of nursing home costs. The threshold was established based on the splitting of the income. I've seen enough cases to date to cause me to believe that it is appropriate for us to do a review of this situation which, as I indicated when we rolled the program out, that we said that for the first year we would monitor it very carefully and look at circumstances that need to be altered. I can say that that is one of the circumstances that we are looking at. We have not come to any conclusions with respect to our position on it, but it is something that we are taking a very keen interest in and will be analyzing it very carefully.

MR. PARKER: Mr. Chairman, I will come back to this same issue. In your Continuing Care briefing document, it says that there is a recognition of special situations faced by residents whose assets have already been depleted and that is exactly the case with this particular gentleman in that they have given up a lifetime of savings. It is all gone and now not only is it all gone, he has to pay an additional amount every month for his wife's care, $1,071. It just seems unfair because I'm sure there are not too many in the province who

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are in this situation. Most nursing home residents are singles, I would think, but there are a few who still have a spouse left in the community. In addition, under the old system, they paid all they had and now they are paying again over and above what she is being charged. There is just an unfairness to the system.

I guess, Mr. Minister, I would ask that you might consider what's in the document, where there would be special situations - I think this is a special situation - for review and finally I think it mentions in that same document that changes can be considered. It is, as you mentioned, a policy in flux and you are reviewing your information as you go along and I would hope that you can consider special circumstances and review policies that are unfair so that it is fair to even those who have lost everything already. Maybe again, I would just ask you to comment on this situation and ask, can there be some review of special circumstances, especially for those who have already lost everything?

MR. MACISAAC: Mr. Chairman, the honourable member would appreciate that I won't involve myself in discussions about specific cases on the floor of the House, but I would encourage the honourable member to write to me with the specifics of the situation he is referencing and we will certainly take a good look at it.

MR. PARKER: How much time do I have left, Mr. Chairman?

MR. CHAIRMAN: About two minutes.

MR. PARKER: Okay, I want to switch gears here to another topic and that's ambulance fees that residents in this province pay. I think the fee that is charged to residents between nursing homes and hospitals is approximately $120 but if people are involved in an accident, the fee that is charged is $600. I have a case of a constituent in my riding where there was a vehicle accident and one ambulance came out and took two people to the hospital and they were each charged $600; so there was a $1,200 ambulance fee bill for one accident. It just seems exorbitant, $1,200 for one ambulance to take victims to a hospital. So, Mr. Minister, if I could ask about ambulance fees and the $1,200 that was charged to two people from one accident. It seems too much. Is it possible that our fees could be reviewed, that a more reasonable level could be exercised on people?

MR. CHAIRMAN: The minister has approximately one minute for his answer.

MR. MACISAAC: Mr. Chairman, the fee that is charged is well below what it costs to provide this service. You have to think of it in terms of the cost of providing the service, not in the ambulance trip because you are not paying for a trip. You are paying for an overall service and the number of calls that are answered in a given year, divided by the total cost of providing the service, gives us a per person charge relative to the provision of the service. Indeed, if people are appropriately insured in this province, all trips related to automobile accidents are items that are covered under the insurance policies that are in play in those

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circumstances. That's how it goes; $816 is the cost of single ambulance services per person. So you are not paying for the cost of sending the ambulance back and forth, it's all of the backup services that are related to the provision of that service.

MR. CHAIRMAN: The honourable member for Glace Bay.

MR. DAVID WILSON (Glace Bay): I'm not laughing at you, Mr. Minister, it was a private joke over here in the Liberal caucus and it wasn't connected with the Department of Health in any way, shape or form, I want you to know. (Interruptions) Well, the clock is ticking, Mr. Minister, I can tell you that.

I wanted to just finish off our time talking about the estimates of the Department of Health with a few questions, first of all, about long-term care. I also wanted to enter onto the record, concerning home care. I must admit that I couldn't agree more with my colleague, the member for Richmond, on the issues that he raised about home care and it was an issue that came up time after time when we toured the province on our cross-province tour last year with the Liberal roundtable on wait times. It was continually identified as the number one issue that we were told about as an idea whose perhaps time has come and something that would indeed help the health care system.

Just before I get onto that topic, Mr. Minister, if I could, Mr. Chairman, through you, I understand from the Business Plan for the Department of Health that on Page 27, to be exact, that the Department of Health will begin evaluating the impact of the new long-term care policies and their impact on residents and families. I would like to know what complaints the department has heard from seniors with respect to those changes and what specific policies you will be evaluating.

MR. MACISAAC: Mr. Chairman, the most significant concern that has been expressed to us centres around the income splitting of families and some of the hardships that that has created in some circumstances. We are certainly looking at that very carefully with a view of addressing it. There were some other issues that came about through the Nova Scotia Association of Health Organizations and they have identified some concerns related to the challenges that face the long-term care facilities relative to the new policies and we are committed to working those out. There was also a concern centred around the recreation services and we addressed that particular concern as well.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, the personal use allowance that was once known as the comfort allowance that now co-pays for prescriptions and ambulance trips and eyeglasses and dental work, now all the responsibility of the resident, have there been any number of complaints concerning that and I also wanted to know, Mr. Minister, do you consider those health costs?

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[6:45 p.m.]

MR. MACISAAC: Mr. Chairman, the costs that are referenced by the honourable member are costs that all Nova Scotian citizens have to pay, whether you are in a long-term care facility or whether you are in your own home, those are charges that apply to you. The policy with respect to the personal use allowance for these individuals is consistent with what is charged to individuals outside. The other aspect related to this is that all of the assets that individuals had prior to coming to the long-term care facility now remain with those individuals so the circumstances are quite different for new people coming to the facilities than they were for those who were covered under the old policy where assets were depleted in order for payment to be made for the service of health care. So the individuals currently in the long-term care facility are treated no differently than individuals who are remaining in their own homes.

MR. DAVID WILSON (Glace Bay): Mr Chairman, could the minister indicate why there is currently no appeal process for decisions that are made with respect to the amount of income that is left for the resident who remains in the community and once I hear that explanation - well, let me give you what I'm thinking before you give me that explanation. The amount of income, for instance, that is required to live in Halifax Regional Municipality is greater than what is required to live in other parts of the province, I would expect. So indicate to us why there is no appeal process for those decisions that have to be made, please.

MR. MACISAAC: Mr. Chairman, there is, with respect to all decisions taken by the department, the capacity to be able to appeal. As I made reference to earlier in some comments to the honourable member for Dartmouth South, I believe, we are looking at our entire appeal process within the Department of Health to try to come forward with a process that is separated from the departments in its day-to-day operations so that there can be a greater acceptance of the impartiality of the appeal process. That is something that we are considering.

We have, in fact, responded to inquiries from individuals and families as the program has rolled out and we have looked at each situation separately. We have addressed particular situations. The experience is telling us that indeed it is appropriate for us to look at the whole issue of family incomes and how they are assessed relative to that charge that is made to the household with respect to one member of the household being in a long-term care facility. So that is the process that is under review currently.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, could the minister please tell us when he expects that review to be completed and if the findings of that review will be made public?

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MR. MACISAAC: Mr. Chairman, I anticipate in the reasonably near future, bringing forward recommendations to Cabinet with respect to appropriate changes that would be required in order to address the shortcomings that are apparent.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, as I mentioned, I wanted to touch on the topic of home care and the comments that were so eloquently made by my colleague, the member for Richmond, regarding home care, what it could mean to this province. Again, on Page 27 of the Business Plan, it is mentioned that direct funding is an alternative way to deliver home care services as mentioned. I would like to ask the minister, could he indicate whether the direct funding program policies currently being finalized in the department will include a return to the In Home Support Program that the government froze five years ago?

MR. MACISAAC: Mr. Chairman, the self-directed Home Care Program is a program that we are proceeding with. The In Home Support Program is a program that we are currently reviewing with the Department of Community Services. The honourable member would know the history of that program, that it was with the Department of Community Services, then came to the Department of Health. The freeze was placed on it. There is money in this year's budget within the Department of Community Services to provide in-home support for an element of the population. We are reviewing the other spectrum of the population to see what programs are appropriate and to decide whether it is appropriate for those programs to be delivered by the Department of Community Services or by the Department of Health and that process is underway.

MR. DAVID WILSON (Glace Bay): Mr. Chairman, it's strange how things seem to come to you at an appropriate time but I wanted to take this opportunity with the time that is left to enter a letter into the record during these estimates. It talks about home care. It's a letter that I just received on May 1^st from Elva Vassalo. I talked with Elva today and I asked her permission and she was absolutely thrilled that this was going to be read in the Legislature because she wanted to make sure that her message was getting out there and I know the minister and his staff will give me their undivided attention perhaps just for a couple of minutes if I read this letter.

Mrs. Vassalo lives on 168 Crestdale Drive in Sydney Forks and she writes:

"Dear Dave:

It is too late to help us, but since you are doing so good as Health Critic . . ."

Well, I didn't want to read that part but, anyway, that's what Mrs. Vassalo wrote:

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". . . maybe my story could help someone else. My husband Frank had been sick for over thirty years and we managed and I could work to support our family. About two years ago he really started to go down fast and this past summer [the doctor] suggested I go away for a rest. Our daughter came from Middle Sackville to look after her father while I was gone. I called Homecare and they came out to evaluate Frank. I asked for help on Wednesday and Saturday or two other days which ever (sic) was best for them. She asked to be left alone with Frank and she decided he needed homecare everyday (sic) which was fine.

I went away on September 13, 2004 and returned on September 29. The morning of October 4, 2004, Frank became very sick and had to be taken to the hospital by ambulance, he had congestive heart failure and pneumonia (sic), he was in hospital until Christmas Eve. We had a hospital bed and all the necessary equipment to make him comfortable. I was able to look after him alone and somtimes our daugher would come from Middle Sackville to help. Homecare came every morning, then they started coming at night for a tuck in, there was no need of this so we stopped the tuck in care. Then they started coming in the afternoon to get him up to walk and he wasn't happy with this, so we stopped them coming.

I had repite (sic)for two hours on Sunday morning so I could go to church and four hours each on Tuesday and Friday all of this was great. Now the problem came for me the latter part of February. Frank got what they call 'Sundowners' where he became strong in the evenings and could sit up in the hospital bed and through (sic) his leg out of bed and I was afraid he would fall out and kill himself.

I called [Home Care] to see if I could get some help from midnight until eight in the morning, this way I could get some sleep and could carry on until midnight again. We had to put Frank back in hospital On (sic) March 8^th and [Home Care] came to see me on March 9^th and told em 'no' this could not be done. I asked if they could start to prepare Frank for the day at 6:30 am (sic) and again the answer was 'no'. I asked if they came at midnight they could combine the two, then I would'nt (sic) need home care through the day and she said no.

When [Home Care] came to see me on March 9^th she had papers to be filled out to put Frank in a Respit (sic) Home SOMEWHERE IN THE PROVINCE. We didn't make enough money to pay homecare or to have someone come in on our own. They would keep him in a Respit (sic) Home for thirty days and then he would go in a permanent home. This is not what I wanted. I needed help for six or eight hours a night and they would not help.

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What would the difference in the cost be? Besides Frank would have been so much more content to be home, where we wanted him and where he wanted to be."

Mrs. Vassalo goes on to write:

"To me this is so foolish and I only needed help at night so I could carry on through the day. As it turned out, I went to the hospital that afternoon to see Frank and got a prescription from the Dr. for him to sleep at night. I left the hospital at 3:15 p.m. and asked for one and ahalf (sic) hours to get the prescription and get home. At 4:40 p.m. the nurse called and gave me a list of Frank's medicine to give him at suppertime, they gave him his same medicine, only less in the morning and more at supper time and she was sorry they had'nt (sic) given him his supper. I said that was fine, he arrived home at 5:55 coughing terrible. I put the mist machine on him and rubbed his chest and back with campfore (sic) but to no avail. I called the hospital and they told me to take him back. I called the ambulance and he was on his way back to the hospital at 6:15 P.M.

Shortly after arriving back at the hospital [the doctor] told me he did'nt (sic) expect him to live through the night. He passed away on March 15.

He had congestive heart failure again. You feel so terrible, asking yourself was there something else you could have done.

I am sorry this is so long, but I felt I should fill you in on the whole story.

I hope there is something that can be done to help someone else in the position that I was in. As I mentioned before they would not pay eight hours a day but would pay twenty four. It doesn't make sense to me.

Sincerely

Elva Vassalo"

I want to table that letter, Mr. Chairman, for the minister and everyone to see and I think it brought home very poignantly some points concerning home care in this province, Mr. Minister. I know it's a struggle. I understand that health care is perhaps the most difficult thing that we deal with in this province, that health care is certainly the most expensive thing that we deal with in this province. Health care professionals are telling us that they are frustrated, that they are worn out. Doctors are telling us the same issues about ER closures. We heard today of ER closures in New Waterford. I face them on a regular basis in my constituency of Glace Bay. You don't know when the ER is going to be open or closed. Now

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we face them throughout the province in some instances. They are becoming more and more of a problem. Private clinics, doctor shortages, ER closures.

I understand, Mr. Minister, for you and your staff that this would be a struggle every day just to get up and deal with these enormous problems that are facing us but we have to find a way to try to make things change. We can't continually pour money into health care with expenditures now totalling almost $1 billion more than they were in 1999, and is health care any better in this province? If you ask an individual such as Mrs. Vassalo, or if you asked an individual who is waiting for orthopaedic surgery, their answer certainly would be no.

Those who live in communities without access to family physicians, which is the first point of contact in our health care system, the entry point that prevents people from having to access the other levels of health care, they don't think that we - and I mean we as legislators - are doing a very good job of managing health care. A gentleman called me up the other day and he told me that he wanted to get in to see his family doctor. His family doctor's receptionist told him that he would be able to get in to see his family doctor toward the end of June. The man is suffering in excruciating pain from a broken back, basically.

Mr. Minister, the pressure points, the wait times, the ER closures, the frustration with doctor shortages and so on, if you have no direction, or no plan - and I'm including in that a plan that I think would be the first step toward perhaps solving some of the money problems, some of the big problems that we have in health care in this province, and that would be home care - for long-term care, then we are just going to continue to pour money after more money into acute care but we have not improved the system. The most telling signal that our acute care system is blocked and not functioning right now, in my opinion, is what is turning out to be the proliferation of private clinics and private centres and diagnostic centres and private hospitals.

[7:00 p.m.]

Those initiatives, Mr. Minister, I would suggest to you, respectively, are born out of frustration, frustration that specialists are not able to help their patients and help them in a timely manner. I don't think that it is acceptable in this day and age that we had to pump another $70-plus million into acute care, not even knowing whether or not there is a plan and in this budget, which is why we are talking about health care estimates for the last number of days, we see a smattering here and there and a smattering in the pressure point areas. We see a bucket load of money into acute care but at the same time we see absolutely nothing for catastrophic drugs. For instance, we've mentioned during estimates the issue of Fabry's disease, cancer patients. All of these amount to what I think are missed opportunities in our province. From a health care perspective, we will pay for it in the long term. We will pay for it down the road. It's a missed opportunity. The budget is a missed opportunity.

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In 1999 this government, under the direction of the Premier, said that health care did not need any more money. Now at the same time, he stated that health care professionals told him that $1.5 billion was more than enough for health care. What we need is a plan. It's what we have yet to receive, a plan. You just don't need the money. The money continues to pour in so we need a plan and those expenditures that continue to mount up, they aren't going to go anywhere. They won't go anywhere at all.

We talked about some possibilities and I know that the minister, and I know that his staff, in particular, I know from the various sessions of the Public Accounts Committee, your deputy minister has been there, I think, more than I have attended Public Accounts Committee meetings and she has faced the music time after time of MLAs looking across the floor at her and saying, deputy, what are you going to do about this? There is only so much that any deputy minister, that any minister, that any member, that any staff can do about problems that have become chronic and problems that are now running rampant and out of control.

We have a duty, we have a responsibility as elected members to question ministers, to question estimates and to try, I would think at the same time, to come up with some ideas or at least to put forward some ideas that maybe they should be considered that they would be a help. As Opposition members, it's not just our responsibility or our job to criticize for the sake of criticism. One can easily fall into that trap of criticizing. It's the easiest thing to do but to criticize, I think, with a purpose and my purpose here, at this moment, and over the past several hours that we have been debating the estimates, is to try to get to the bottom of what is becoming a bottomless pit and that's health care. We all know we can't continue to go on the way we are. A 9.3 per cent increase this year and we don't know what it's going to be next year. It was 11 per cent the year before. We know that we can't continue down that road. We understand that.

So when we suggest something that I think makes sense, and it deserves the consideration, I think, of an entire department, of an entire Cabinet and executive committee, when we talk about home care, this is a theme, as I said time after time, that has been put forward as possibly one of the missing pieces of the jigsaw puzzle, in-home support as well. The minister himself referenced an excellent program which I had the opportunity to have explained to me in his home constituency of Antigonish and the hospital program that is run by St. Martha's - it's going to slip my memory - Hospital In The Home program. It's a tremendous program, one that I think deserves the attention of perhaps being tried on a province-wide basis. I don't know if that is possible or not, all I know is that when I think I hear a good idea, I think it is something that you should take a look at.

I understand that the minister and his department are taking a look at it. It makes me very happy to hear that sort of forward-thinking, Mr. Minister, that if we look down the road, and we are all in it together, this is an aging population in our province, an aging population that I don't, as others think, is going to lead to more problems but I hope that it would also

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lead to more solutions. But the end run, the end of the line is going to be that we will be there someday, hopefully, not all of us but unfortunately, a great deal of us are going to require some form of medical care down the road in this province. We know how good it can be and we know we have the capability of making it better. I think what we should be looking at right now is taking those possibilities, taking those ideas that are suggested to us, whether they come from the Official Opposition of the NDP or whether they come from the Liberal caucus Opposition, I don't think it really matters. I think we have gone by the stage where partisan politics should be playing a role any longer in health care in Nova Scotia.

I think we finally reached the point where a three-Party system, a minority government, whatever it takes to make the changes to health care and if that means we have to be vigilant on issues such as private clinics or private hospitals, and I do personally consider them somewhat of a slippery slope on the way down to eventually leading to a health care system that you would have one health care system for people with money and another health care system for people without money. I don't personally think that that is the way we want to go but at the same time, having said that, Mr. Minister, I agree with your comments that there is some room for private clinics to help publicly-funded health care and if that's the case, then fine, but we have to make sure that that happens.

Having said all of that, Mr. Minister, I wanted to again thank your staff. I know that it's extremely difficult to sit over there and listen to us ramble on sometimes and not being able to speak, except into the ear of the minister but we know . . .

AN HON. MEMBER: Speak for yourself.

MR. DAVID WILSON (Glace Bay): Well I didn't mean rambling in a negative way, I meant very positive ramblings with very positive and constructive suggestions, I should add, and I wanted to thank you, Mr. Minister, and your staff for allowing us this time. As you know, it's the issue in our province right now. It is the biggest one that faces people, no matter what anybody else in the back row over there says - they are shaking their heads. It takes the most money to run health care. It's the biggest budget. It continues to gobble up money and if we're not careful, I've said it once, I've said it a thousand times, what's going to be left after the Department of Health budget is the department of everything else and we don't want to go there.

So on a non-partisan ground that I stand at this moment, Mr. Minister, I encourage you and your staff to leave no stone unturned to find ways to make health care work in this province. Mr. Chairman, I thank you very much for your time.

MR. MACISAAC: Mr. Chairman, I want to thank all members of the committee for their contribution to the discussion surrounding my estimates. I understand that we've reached the stage where it is appropriate for me to call my remaining resolution. Is that how the procedure works? So I would call Resolution E-29.

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Resolution E29 - Resolved, that a sum not exceeding $979,000 be granted to the Lieutenant Governor to defray expenses in respect of the Senior Citizens' Secretariat, pursuant to the Estimate.

MR. CHAIRMAN: Shall Resolution E9 stand?

Resolution E9 stands.

Shall Resolution E29 carry?

Resolution E29 is carried.

The honourable Government House Leader.

HON. RONALD RUSSELL: I move that your committee do now rise, report considerable progress and beg leave to sit again.

MR. CHAIRMAN: The motion is carried.

[7:10 p.m. The committee rose.]