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HALIFAX, THURSDAY, JULY 6, 2006
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
1:55 P.M.
CHAIRMAN
Mr. Mark Parent
MR. CHAIRMAN: The honourable Minister of Energy.
HON. WILLIAM DOOKS: Mr. Chairman, at this time I would like to call the Estimates of the Department of Health.
Resolution E9 - Resolved, that a sum not exceeding $2,764,479,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health, pursuant to the Estimate.
MR. CHAIRMAN: The honourable Minister of Health.
HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, I think the previous Minister of Health has confused - no I'm just kidding. It's wonderful to stand here today and start the Estimates for the Department of Health. First of all I feel that over the last number of months, since I've been named Minister of Health, that it has been an interesting challenge to understand the services and the issues related to health care in this province and understanding the budget and those things that we hold so dear to ourselves. I feel that the budget before us and the issues before us are good and shows progress in providing good health care to Nova Scotians.
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Just a few quick comments; I look forward to, as priority over the next number of months as Minister of Health, continuing the work under the continuing care strategy to ensure that we have a true and good plan to protect and take care of folks that took care of us and those are our seniors. I want to make sure that, as we continue the continuing care strategy, all the other supporting pieces flow quickly to connect to it. I also look forward to working with my Canadian counterparts on issues like the National Pharmacare Strategy and working on wait times with our federal government. I think that's an issue that all of us here as MLAs hear on quite a regular basis. A case in point that during Question Period, there was a question on wait times in our emergency rooms and ways to try to alleviate some of that. One of those of course is through nurse practitioners and one that we look forward to working with our DHAs to come to fruition.
I do have a concern as we go along, this year's Department of Health budget shows an increase of about 7 per cent. (Interruption) Is it 8? Okay it's 8 per cent, which under a global piece is unsustainable well into the future, so we need to find new strategies and new ways to deliver health care to make it so that the public purse can pay for it. I have committed myself, and I'm sure other people have committed themselves, to having a publicly funded system. It is the mechanism within it that will allow us to do that.
I do want to say one thing also, that I'm very happy with our DHAs and the relationship we have with them. I want to say here that as we started closing up our books and looking at last year's budget, the DHAs have come within 0.05 of 1 per cent of their assigned budgets which, ladies and gentlemen, is a monumental feat considering they are running a $1.2 billion budget. (Applause) In considering where we've been in the past and where they've come, it was a good minister maybe, but good previous ministers as well to make sure this happened.
I also very happily look forward over the next number of years to continue working with all partners in health care, those are our unions, our DHAs, our associations whose sole purpose is to work with people and make sure that they are healthy and make sure that they thrive in life. I want to thank all those folks for all of the hard work and dedication that they give to health care.
With those few comments I would like to maybe move on quickly to your questions but I do want to introduce a couple of people that are with me. Of course most of you know my Deputy Minister, Cheryl Doiron, she will be sitting here whispering in my ear for the next number of hours - as well as my chief financial officer, Allan Horsburg, and of course the staff who are visiting us in the gallery today.
Mr. Chairman, with those quick comments, I will take my seat and look forward to the questions that will ensue for the next number of hours.
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MR. CHAIRMAN: The honourable Leader of the Opposition.
[2:00 p.m.]
MR. DARRELL DEXTER: Mr. Chairman, I have a number of questions that I want to have the opportunity to address with the minister and his staff, and the way I'd like to go about this - and I know the minister will forthrightly answer all the questions, as he always attempts to do - I'm going to go through a number of them and let you stack them up and deal with them as a whole, if you don't mind.
Over the course of the last election and over the course of the run-up to this session of estimates, and over the course of last year I heard, on the Continuing Care Strategy, time and time again as I went around the province and, no matter who I talked to - whether it was doctors, seniors' advocates, caregivers, any of the political Parties - everybody seemed to be able to identify the problem. Everybody would say that the problem is we have so many people who need to be in long-term care facilities who are now in beds in hospitals that ought to be used for post-surgical recuperation, or for cleaning up the problems in emergency. Everybody seemed to be able to identify this was the problem.
They would, sometimes to me very frustratingly, they would say everybody understands this is the problem. Why is it that the government won't simply ensure there are the number of long-term care beds available so the people who need the service can get it and those doctors and patients who need access to these beds in hospitals are able to get access to those beds?
If everybody knows the problem and everybody knows the answer, why is it the government can't seem to make it happen? That's the first thing.
The second thing is - and I know because I've heard you say this before, and you have sometimes said to me that we just can't open long-term care beds. You've said, and I've heard you say if you and I got a hammer and we went out and started building these facilities maybe they'd be ready sooner. That's a great rhetorical answer. It has that nice feel to it and it sounds great in Question Period, but it doesn't come within a country mile of actually dealing with the problem.
The problem, as you know - and I think most people who have spent any time in this sector know - is that in fact this problem has been identified community by community right across this province for years. You can go to western Shelburne County, Barrington Passage, in Clare talk to the people at Villa Acadienne, go to Cape Breton and talk to people in many, many communities in Cape Breton who identify. There are seniors leaving their communities because they can't get the access to the facilities they
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need. You can go over to Oakwood Terrace in Dartmouth and they can tell you that they have asked for years for expansion, to build more of these beds.
Not only that, the minister would know that many of these communities and many of these facilities have gone so far as to develop proposals that they have made to government. They have had architectural drawings - in some cases the government has actually paid for the architectural drawings because the proposals were put forward and then rejected so they absorbed the cost of the facilities' proposal because that was an unfair thing to happen to the facility and to take up so much of their money.
For example, in my colleague's community, in Barrington Passage down on the South Shore, they of course, as he points out many times, were promised this facility 30 years ago. They have the architectural drawings. In fact, they actually showed up and dug a hole at one point to say that they were going to start the facility, and it just never happened.
Now, in the case of western Shelburne County, the municipalities have actually gone in and they have said that we will donate the land, we will give you the money, we want to be partners in ensuring that this facility gets built. The same is true in many other parts of the province where non-profit committees have been up and been established, they have done the work in their communities.
We only have to go to Middleton to see the dedication of the volunteers in that community asking the government to do the right thing and to provide the number of beds that they need for that community. It's a heart-wrenching story that the former mayor of Middleton tells about one of his residents who was taken out of his home because he needed long-term care and was placed in Bridgetown. He used to go to visit him on a weekly basis and every week when he would go to visit him, the fellow would say can you get me a place up in Middleton, can you take me home? He just wanted to go back to the community where he had worked and lived all his life, where he had raised his family. The mayor said, well, eventually the guy died, and I didn't have to feel guilty about it anymore. That's terrible. That's a terrible way to treat the seniors of this province.
So for the minister, there are so many of these facilities where the actual time frame has been condensed because much of this work has already been done. So my question is, why can't those facilities be fast-tracked so that we can get that work done, get those beds in place, because that's part of the answer to the first question which I just posed. I'm asking this, you know, and I'm not asking for a rhetorical answer, I'm asking so I can understand, so the people of the province can understand.
The third part of this is, let's say that you say, for whatever reason, this can't be done. Then I would like to know what process is going to be in place to ensure that
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people in western Shelburne County, in Lower Sackville and Waverley-Fall River-Beaver Bank, who were promised their facility many years ago, what process is actually going to be in place to incorporate the response of those communities so that they can depend on a process that's going to actually end up with a facility that is going to meet their needs? Those questions are basically where I would like to start on this, and I'm not going to belabour it because I think those are very straightforward questions for the minister.
MR. D'ENTREMONT: Mr. Chairman, I want to go through a number of those issues as well and try to bring a bit of clarification to it. A lot of the question is why have things taken so long, I think is sort of the underlining question that the member brings forward. Sitting in this position, looking at the time that has transpired, and I do believe it has been unacceptable the time that we've had to get things in line, but ultimately that's what has been happening, is that there have been a lot of things being put in line.
Continuing care had been inadequately funded prior to this government coming in. So we had to make an address to bring the continuing care division in line within the department to make sure that they had the funding available for the facilities that we had. As a matter of fact, 30 per cent of the homes in the province were ready to go into receivership. We had to make sure that they had adequate funding there to maintain the beds that we had at that snapshot in time. We also had to work quite diligently and quite a bit on the standardization of pay and benefits for nurses and other professionals within these homes to make sure that they are adequately compensated across the system, so there are very few inadequacies, you know, comparisons from home to home.
We wanted to make sure that the continuing care strategy was done right and, of course it was done in conjunction with the Seniors Citizens' Secretariat while they did their consultations on positive aging, to make sure that we met, through 50 consultations, with 1,400 different individuals, to make sure that what we were trying to embark upon made sense in the short term and in the long term. I think that the continuing care strategy, as you see it today, even though it is a work in progress, will be one that will require a lot more work over the next number of months and years to ensure that we have the correct facilities in the correct areas.
I think that's the challenge. We have everybody asking - and how do you qualify or how do you prioritize those requests as they come to the department? If we take into consideration the Shelburne issue, that's one that I heard a lot about during the last election, one that I heard about basically from day one of assuming the role here as Minister of Health. The back and forth between what the department was saying and what the community was saying really revolved around what kind of services we were willing and able to provide to the community.
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The number one issue that is important to me within this whole continuing care strategy is to ensure that the seniors get their service to stay at home the longest. If we look at the way home care is done and the kind of services they receive at home, the kind of monies that are available for home improvements and upgrading, we want to make sure that all those pieces are in place so our seniors can stay at home where they're more comfortable, where they live out their lives happier and healthier, for the most part, if they have those services in place.
The second piece to the continuing care strategy is, of course, to make sure that we have those beds in the correct area. Mr. Chairman, it's really important to say that we have a number now, we're looking at the 826, we looked at 1,320 over the next 10 years. As this bump of folks are going to increase, the number of people requiring home care will increase. We need to have the beds available. We also need to remember that only about 5 per cent to 6 per cent of our seniors over 75 require long-term care beds. Most of our seniors do live their lives out quite happily within their community, within their homes. Of course our average age is 83.
Ultimately, there's a lot of work that's involved here, you know, creating the base and then finding out where we're going in the future. Going back to Shelburne County for a second, the concern that I had is that I want to make sure that I had the right services in place, adult daycare, maybe the nutrition program, and those kinds of things, before we committed to a full home of 70 beds, is what the community was asking for, and make sure that's the right decision. That's my point there.
The member for Shelburne does underline an issue there, that it dates back to 1976 when the Brass Hill Manor was basically brought forward. Heck, if you would have been able to show them to us in the House the other day, we would have seen a full architectural engineering drawing of a home that was supposed to go into Brass Hill. What happened in that time? Why has it been neglected for such a long time? I don't understand. It's one thing that I'm trying to rectify as Minister of Health, and it's why we committed to the extra 40 beds over and above the 22 beds or 20 beds that are at Bay Side today.
Mr. Chairman, I think we need to have a good plan and a good feeling of where our beds are going to be going in this province to make sure that they service our seniors in the right places. I think it's going to be a challenge. That's why the process will be one that we are opening a project office for the continuing care that will just be dealing with construction timelines, where those people are going, how the RFP processes are going as you put the tenders out. There's a lot of work to be done, but I have to commit that it takes about 18 months to construct a facility if you're building any facility, and it also costs $183,000 per bed. If you're doing a 20-bed facility, or you're doing something, the calculation is $183,000 per bed, from a greenfield site.
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So there's a tremendous amount of money involved, which is why I thank the Municipality of Barrington, and I thank the Town of Clark's Harbour for their offer of property and funding, but it is a very small component of what that home is going to cost in the future.
Mr. Chairman, I will take my seat at this point. I think I answered a few of those questions and I'm sure the member opposite will ask a few more.
MR. DEXTER: Mr. Chairman, there's not a lot that I can take issue with in what the minister has just said. He has kind of laid out, in a kind of common-sense fashion, part of the perspective of the department on this issue. It also underlines one of the key problems in the department in dealing with the issue because they seem to want to confuse the idea that you're going to have home care and all the appropriate supports in place for people who want to stay in their homes, with long-term care.
[2:15 p.m.]
People who have been medically assessed and who the doctors have said need to be in a long-term care facility are not going home, they're not going home. That is part of the frustration in dealing with this. All of those other things are great, I'm very happy that the government has finally got it through its head that you have to have a complete continuum of care that's going to provide people with aging in place supports, are going to allow them to stay in their homes for as long as possible, then potentially move to an assisted living facility, and then eventually into a long-term care facility. All of that is nice to know that that is what is finally on the radar of the government because it wasn't when we first arrived here in 1998, that's for certain. These are people who have been medically assessed by professionals, who require long-term care beds. That's who's in those beds in hospitals, not people who are going home, so let's not confuse those two pieces of this problem.
He talks about $183,000 for a bed constructed in a long-term care facility. Well, the cost of a person in hospital, a hospital day, is about $1,000 a day. Now just my math on that is that if you multiply that by 365, you get $365,000, so the long-term care bed is half as expensive as leaving them languishing in a hospital where they don't have access to the kind of programming that will actually provide them with the quality of life that they deserve. I don't think I'm telling the minister anything he doesn't already know.
It is the same thing that I have heard again from doctors and caregivers - you know, caregiver burnout alone. We have people who are medically assessed who ought to be in long-term care facilities who are actually still at home. There is a real question around whether or not they are getting anywhere near the service that they actually ought to be receiving. I think that is another level of question that the government has to
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address. Let's just set that one aside and deal with those ones who are actually in hospital beds.
Minister, I'm sure you can understand my frustration when you tell me on the one hand that you want to deal with all these issues about people who are going to go home, but what I'm talking about here are those people who aren't going home and who deserve to be in a decent long-term care facility.
MR. D'ENTREMONT: The member opposite is quite correct, you know we have a large number of alternate level of care patients sitting in our hospitals. The point there is that even if we take that person and put that person into a long-term care bed, we're not closing the acute care bed, you know what I mean, we're not taking one and paying for the other. I think that's one clarification that I do want to make here.
We want to offer enhanced community services, things that people can go home. That's why we announced the 50 restorative beds - a place that people, after they've received surgery, after they've recovered to a point where they can go home or whatever, can go and get even better, to go into the service. Without adequate programs to send them to, the doctors will revert to a long-term care bed. If there is no other service for them you can't necessarily go home, you are going to send them to a long-term care facility, or that is how you are going to assess them. So that is why we want to make sure we have some of those programs in place.
If we take the VIP program that DVA has brought out, it has demonstrated absolutely incredible changes in the seniors who receive care from that group. If you look at the members who were going off to the veterans' units- and we do have a few veterans' units that are sitting with a few beds vacant at this point, because they are receiving such good service at home. Those are the kinds of things we want to replicate as well.
Also something to bring to the floor of this House are recent estimates on greenfield construction of homes, I guess it is about $220,000 for new construction per bed. Since 2001-02, we have seen an increase in home care of about 36 per cent of $32 million, and an increase in long-term care since 2001-02 of $188 million, which is a 107 per cent increase. I think we are doing everything we can within the funding envelope to make sure we are making long-term care better. Are we there yet? Absolutely not.
MR. DEXTER: Well, it is not up to me to argue with the minister about these things. I don't think that doctors are purposely misdiagnosing or misidentifying the services that the people in these hospital beds need. I think they do an earnest job of trying to figure out how their patients are going to get the best care, the care that is most appropriate to them. It is really clear that many who are currently in hospital beds are not getting the kind of care that would actually be of most benefit to them.
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I had the privilege and the very eye-opening opportunity to travel around the province and to visit many of the long-term care facilities and also to go to many of the hospitals and speak to the health care workers in these facilities who tell me - let me just give you an example of one of the things I was told. I found this fascinating, in a very sad way, actually, I must say, that you have people in hospital beds who need to be on Alzheimer's wings or wings dealing in a specialty way with people who suffer from an organic brain disease of some kind or severe senility. One facet of that very unfortunate diagnosis is that they tend to become violent and can have violent episodes, mainly out of confusion, just irrational behaviour, because they have a reduced capacity to deal with the stimulation in the environment around them.
How do the hospitals deal with that? How do they deal with the fact that the health care staff who are going into an environment where they may face possible harm as a result of a violent outburst? Well, Mr. Chairman, I didn't know this but what they were doing was hiring security guards to come into the hospital and sit in the rooms, next to the beds of these patients. Now the first thing that must be said is that the poor security guard they hire has no understanding of the medical condition of the person in that bed next to them. My understanding from talking to the workers is that they are sometimes terrified to be there themselves because they don't have - what are they going to do if there is some kind of a violent outburst? It puts that individual in a terrible position. It puts the health care workers in a terrible position and the patient, lying helpless in that bed, does not get the kind of assistance or treatment or quality of service they deserve. That is one of the things that people don't necessarily think about, but it's one of the things I discovered as I went about the province. I just want the minister to know that I'm not alone out here. There are an awful lot of people, who know, who understand the inadequacies of that situation.
The minister says, well, it takes 18 months to build a facility. I just don't understand why it's going to take 18 months to build a facility when I've already told him that many of these facilities have bought the land, have the architectural drawings done. They're sitting there with proposals in front of them - I'm betting that if I were to get on the phone this afternoon and ring them up, I could have half a dozen proposals on your desk tomorrow morning for you to review.
If you wanted to fast-track some of the existing proposals that were out there, you could do it. I understand very well that you might say, how are we going to choose among these, there is going to be a filtering process. What will happen, you will go to western Shelburne County, you're going to build the long-term care facility in that community and when you do, a lot of people who are somewhere else in the province are going to start to come home. They're going to come back to their community.
That means they're going to come out of the facility in Villa Acadienne, the facility in the minister's riding, in Yarmouth, in Roseway and as a result, those beds in
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those facilities are going to open. Then people in those communities will have access to those beds. It's going to take some time as you build these facilities to understand how that's all going to shake out. I understand that. But that's not going to be a problem for you on the front end. On the front end you're going to measure how that's going to work out and I would dare say, until you're probably halfway through your strategy if you recognize the under serviced areas first, that shouldn't be a concern for you.
What I like about the fact that we are here today having this debate in estimates is that when I first came into the House in 1998 and I started raising this issue, the minister and I would both know that part of that increase in the envelope in funding on this issue is as a result of the government actually recognizing its responsibility to provide health care for seniors in these facilities. That's something that didn't happen for a very long time, and quite frankly, something that I, as the Leader of the Opposition and as a member of this caucus, am very proud of having had a hand in making it happen.
I'm pleased to this extent that this debate is taking place, that this critical issue with respect to the seniors of this province is actually on the radar of the government in a very significant way. I think all the members of our caucus should be very proud of the fact that we elevated this issue to the point where it is now. I would hope those people who are in that sector are also pleased they are now getting what I think is the attention they deserve.
I want to move on to another thing that is related but separate, which is the second part of the issue that you raised, which is all around the whole question of those supports at homes for seniors.
I forget and I'm sure the minister will remind me just exactly what the commitment of the government was over the last election campaign with respect to the training of new home support workers. I guess what I'd like to hear from the minister is, what is the commitment of the government to train new home support workers? How will they be distributed, how will you decide in what communities those are going to be in and what are the programs you intend to institute in community colleges or with facilities around the province that will yield those home support workers, not only this year but in the years to come?
MR. D'ENTREMONT: I guess I will go with the last question first and work my way backwards a little bit into the home care realm. What we've been bringing forward and what we want to bring forward is, of course, the addition of more continuing care assistants within the system. I forget the total number of continuing care assistants that we require but we do need a fair amount of those folks to get out there and help our seniors and work within our facilities. We also need to work with our community colleges in order to have that kind of training going on with a true recruitment program to make sure that we have the people going into that stream. We also need to look at
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equivalency and experience to look at those people who are basically going around the system or are offering similar services to folks to see how we can integrate them into the system as it stands today.
[2:30 p.m.]
I'll talk a little bit about challenging behavior and how we need to do a lot better job when it comes to working with Alzheimer's and other challenging behaviors. We know we've invested in about $225,000 this year in trying to expand the challenging behavior program. A program that will be included will be an eight-member provincial resource team because we don't have the resources or the people within the system who can work with all the different homes and areas to provide the correct service to these folks.
As we all know, those of us who had the opportunity to visit some of our seniors who do have these challenging behaviors, La Ville Acadien in the Chairman's riding and the Titleview Manor in Yarmouth, I checked out their facility and some of those facilities are not adequate for the kind of care that they are providing. That is why we want to make sure that within the strategy and what we're trying to bring forward this year, is to have at least a standard of care across the province when it comes to challenging behavior. This is why we want to have this provincial resource team that can go around and provide training and those types of things to our areas. We also need to be cognizant that we need to do a lot of upgrades for these units. Titleview is a good example of one that has too many people in it at this point - just doesn't have the facilities that are required. We do also have areas that don't have a facility at all, something that we need to address over the next number of months and years.
If we look at the construction versus RFP process or whatever process we put into place on the construction of long-term care beds in our communities, the 18 months is a realistic time because, not only do we have to get these architectural drawings that some do have, they will happen faster, which is great, if they can get those proposals in and they can be accepted by this provincial coordinator, by the process that will be set forward. That will be brought forward to the members of this House for their interest and their information.
I do want to say that we already have 410 new beds that are already under development in Cape Breton and Colchester in Capital Health. About half of the 826 beds are already in some form of development. I'm going to have to add Shelburne County to that list because we have 40 beds under development in western Shelburne County as well.
Mr. Chairman, I do want to say also that there has to be a strategy in the meantime before we can have these beds constructed. The seniors deserve more than
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sitting in a hospital with all the noise and all the things that go on in a hospital. I don't know how many people in this House had to spend any time in a hospital, I know that's not a great experience and one that we shouldn't ask our seniors to do for any length of time. In the meantime we need to find services and places for these folks. Through the district health authority, in what we call the alternate level of care, they are developing areas within the hospitals that are more home-like settings, places that are a little more comfortable, that are a little less busy.
Last year we provided $3.6 million to the DHAs to either make renovations or changes to wards that are underutilized, and that has been added to the base of this year's budget as well. That will be another $3.6 million to go forward to continue this intern strategy until we have all the beds that we require into the system.
MR. DEXTER: You know, Mr. Speaker, it has been my observation in the last seven years or so that I've been in this House that no department is as good at getting euphemisms out than the Department of Health. These are beds that are under development, these are beds that are not being built, and I don't know what "under development" means but it means, for example, that the beds that were promised in Lower Sackville, in the Bedford area, have been promised for years. They've been under development for years, and what people find so frustrating is that they get these euphemisms for why it is that they're not going to get what it is they need in order to service their loved ones.
In the answer to the home care and home support question, the minister kind of meandered back into the long-term care question so I'm going to follow him on that because I didn't quite address the whole question of what happens when you build a long-term care bed. You don't get rid of the costs with that bed because you're not going to close the bed. Now, that's very true and if that's your reason for not doing it, then you should say so because people do understand that that is the cost. Those beds are going to be open but what that means - I mean I think this is what doctors find so frustrating with that answer, which is that if the answer is we're going to leave them in this bed because if we move them out to a long-term care bed, the cost of that bed is not going to go away.
Well, that is a tremendous misuse of departmental resources. That is using a very expensive bed to try to service a person who, in the end, is not going to even get the kind of service that they require. It's not just doing a disservice to the individual who's actually in the bed, it's doing a disservice to all those other people, those potential patients, the doctors, those people who could be providing an appropriate service, that would use that bed. I know those beds aren't going to go away, but what you would be doing is you would be using those beds for the service for which they were intended instead of for an alternate service for which they were not intended. So let's just try to
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put a close to that particular argument because, you know, if it's one you want to make, then make it clearly, but I don't think it's a very good use of departmental resources.
The minister went back to talk a little bit about challenging behaviours, and he reminded me of something in those facilities, when I went around the province and talked to people, that I should raise here as well because he should know this. There are facilities around the province that are actually not asking you to increase the number of beds. They are asking you to increase the allocation to their particular facility for two reasons. One is because their facility is now inadequate to house the people whom they have in them because they were built back in the 1970s, they have double rooms that are small, and they are now having people in those rooms whose acuity level is far greater than they were in the 1970s, some who suffer, as I have said, from Alzheimer's or from other disabling diseases. What they want to do is expand their complexes so that they can turn those doubles into singles so that the people who are in their facility can actually get the appropriate level of service that they deserve.
I want the minister to think for a second because I know, and I'm sure people have thought of this whatever age you are - let's say you're 70 and you've lived independently all your life and now because of medical conditions that are beyond your control, you need (Interruption) What's that? I'm asking him to project forward - you need this service in a facility. You're a modest, private person, and for the first time in your life you will be taken to a facility and placed in a room with a complete stranger. That's a tremendous strain for some people, and those are the kinds of things that are being dealt with by administrators right across the province in their facilities - not in all. Some of them are new, I know the new facility in Pictou is beautiful, it is well designed, well laid out. As I went through that facility I thought to myself that if I was going to be in a facility, that would be it. I think it is one of the nicest in the province.
What they are asking to do is not to increase the number of beds but to have an appropriate facility for the people they have to serve. That is the first thing. The second thing, and it relates to the first thing, is that the acuity levels in these facilities are so much higher now than they were when the facilities were built, but you know something, the staffing levels have not changed, or they have changed very, very modestly.
I have been in these facilities and I have had the administrators say to me, I wish the Department of Health would come here and audit my facility and see if they think the number of staff in this facility are adequate to provide the service that the people in this facility need. I have had administrators tell me that and I was quite surprised. I thought, in fact, that the administrators would be reluctant to have that evidence come to light but they are not. They want you to know that there is a problem with their staffing. As the administrator in Bridgewater told me, when they built their facility they expected to have 25 per cent of the people in that facility who were going to be what they considered to be heavy care and 75 per cent to be lighter care. Here we are years later and exactly the
[Page 14]
opposite is true - 75 per cent of the people in the facility need heavier care, 25 per cent need a lighter level of care.
I want to be absolutely clear, these are well-managed facilities that have volunteer boards that work extraordinarily hard to support them. Their reality has changed and they are asking the Department of Health for assistance in ensuring that their citizens, the people they are trying to serve, are getting the service they need.
Finally, since we are on that little piece again and I know that there is one more thing I wanted to get through before time runs out or my hour runs out, finally the other thing that is interesting about these facilities is that many of them have a respite bed or maybe two - I don't know if I ran into anybody with two but maybe there are. What that is designed to do is to assist people who are currently caring for someone at home and they want to get a break, to get away. Maybe they are going on vacation and they can't take their loved one with them so they apply to the facility to use that respite bed while they are away. But there are often very confining rules with respect to how long they can use the respite bed, under what conditions that can happen. That is part of that connection to the community that the department should be trying to ensure is there in an appropriate way. I have just covered some of those and I will ask the minister to respond.
MR. D'ENTREMONT: Mr. Chairman, I just want to say that we are going to be focusing on respite beds and families taking care of their loved ones at home. It is something that we want to invest a little more time in, to make sure we have the caregiver strategy that makes sense and will encompass the idea of respite and added home supports. I think if you can stay at home and you have somebody who does want to take care of you, why not take that opportunity, because you know the care they are going to get is going to be absolutely second to none.
Homes that were originally designed back in the 1970s - there were a few in the 1980s, but not so many - had two beds to a room. I can't imagine the traumatic feeling it must be to move into a room and share your life with another person when you had been sharing it with your husband or wife over a very long, extended time and have to get used to the habits of another person. I don't think that's ultimately acceptable. If that's what we have and we have to work with it, that's what we have. But ultimately, as we move on to these new beds, there will be as many as possible of these separate individual units like Pictou. I'm just wondering if maybe we should put you on the list for Pictou, we'll get you on now and we'll try . . .
AN HON. MEMBER: It might take that long. (Laughter)
MR. D'ENTREMONT: It might take that long to get on the list.
[Page 15]
I do want to assure the member that as we talked about adding the 826 beds across the system, we're also talking about 1,659 replacement beds across the system. There are facilities within this province that were constructed maybe in the 1800s, there are some really old homes and there are some homes that are just, of course - a member yesterday brought up the issue of Glades Lodge, the challenge they have there on mechanicals. Quite honestly, that home, again, is a two bed per room type of facility. As we look at replacement, I think that's something that we need to bring forward relatively quickly, within the next few weeks, to make sure the money is in place, the process is in place and get on with the business of construction.
[2:45 p.m.]
I think as we move into construction - you look at the boom that's happening in this city and it happens in a lot of areas around the province and a lot of our construction companies are busy and we need to be able to get on their lists in order to get construction going. With that, Mr. Chairman, I think that covers some of the issues the member brought up.
On palliative care, there's about $3 million - $1 million in this year so $3 million over the next two years, making sure we have a palliative care program that is at least equal across the province. From the southwest - the member for Shelburne could probably attest to that too, that we really didn't have a palliative care program in the southwest and we want to make sure - oh, that's respite? Let's talk about palliative care for a sec.
We want to make sure we have a system that makes sense for those folks who are moving beyond the care that can be given in a home. We have to give some comfort and help to the families and those types of things - we're trying to invest - there's the right number, $832,000 this fiscal year and about $2.2 million over the next fiscal year to enhance the palliative care services in this province, that's really important to me and I apologize for that.
Let's go back to respite for a second where we're investing $3 million over the next two years to improve and expand a wide range of those services in respite to make sure we have the adequate beds and the adequate services there for you.
We'll go back to the issue of recruitment for the CCAs. We're looking at hiring another 230 CCAs over the next two years, which is an investment - oh, past years - of about $72 million. There are $900,000 in the base budget for bursaries for recruitment and retention in continuing care. There are a fair amount of initiatives for continuing care assistants to make sure we have the folks available to take care of our seniors.
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MR. DEXTER: Thank you very much. This question I think is going to be, hopefully, a little easier for you to answer and a little fresher information. I've been intrigued, as I think many people were, at two of the things the government has talked about introducing over this year and next year and that is the expanded Pharmacare Program.
Dealing first with the children's Pharmacare Program, I wonder if the minister could explain to us, how is that going to operate, whether or not there will be a premium paid by families and whether there will be a co-pay on the children's Pharmacare Program? I'll start with that.
MR. D'ENTREMONT: Mr. Chairman, I apologize for not standing up quickly, but I want to make sure I have the information correct.
As we talk about the children's Pharmacare Program that was talked about some time ago which I think was to encompass about 30,000-odd children in the province who don't have that kind of service, and also moving into the families' Pharmacare Program. We are starting work in design with the Department of Community Services on that. A lot of the details are not set yet, or are not available, so it will be hard to comment on that. But if you look at how our Seniors' Pharmacare Program is done and how those needs assessments are done, I think they will be quite similar.
MR. DEXTER: The Pharmacare Program that exists now is within the Department of Health. So, are you saying that the children's Pharmacare Program will not be within the Department of Health? I'm just wondering where in the estimates I'm going to find the money that's associated with the children's Pharmacare Program?
MR. D'ENTREMONT: The children's Pharmacare Program was one initially brought forward by the Department of Community Services, and I think you'll find that in the budget lines of Community Services.
MR. DEXTER: So, then, the Pharmacare Program as it exists today, the current Pharmacare Program that deals with Seniors' Pharmacare is contained within the Department of Health's budget. I think it was called the working families' Pharmacare Plan, will that be within the Department of Health, or will that be within the Department of Community Services? Let me just say, first of all, it strikes me as somewhat odd that that would be in the Department of Community Services if it's meant to be a broad-based program.
MR. D'ENTREMONT: At this point, there are two Pharmacare Programs in this province; one of them being the Seniors' Pharmacare Program, which is housed under the Department of Health, and there is the Community Services plan which is housed in Community Services. As we talked about the children's Pharmacare Program, that was
[Page 17]
an initiative of Community Services, so I think the intention originally was to sort of design something that would probably stay over in Community Services. We were basically just providing an oversight on the formulary and the kind of drugs that were in it - providing just an oversight for them.
I think with the platform promise of the working families' Pharmacare Program that we're looking at an option right now to combine those two ideas to provide a more comprehensive program for everyone, and try to combine those. I would think through the next number of weeks as we sit down with Community Services and we come up with a design of the program, I think you'll see a combination of those. I would think right now, and not to get out ahead, it would make sense to have those programs residing under one roof.
MR. DEXTER: I'm not sure I'm better informed right now than I was when I stood up the first time. I guess then the question I would have would be around implementation dates. Where is the department at in its expectations of when these programs are going to come on-stream?
MR. D'ENTREMONT: I think as we sit down and work on design, the timelines as I understand them right now, it's that the children's Pharmacare Program was originally slated to come into being, I think, sometime late this year. But as we go along, do we put one program in place that is going to end up being encompassed by another program? Do we design them congruently or not?
As the member opposite is very well aware, the working families Pharmacare Program was a platform commitment, and the timeline on that is to try to work on that one and have it in place by sometime next year. As we roll forward on design, I'll be very happy to bring that forward to the member opposite to explain what the program is going to look like, as soon as we have those details.
MR. DEXTER: All of this program design, obviously, is complicated and because the experience with the Seniors' Pharmacare Program is that that program, in terms of its point - well, it has two things that are happening with it. One is, it's becoming exceedingly more expensive to the government, because the cost of drugs continues to go up, and part of that actually has to do, as I think you would agree, with the extension of patent protection which took place at the federal level, and that became a problem that was essentially downloaded onto the provinces. So that's one thing, it has become more expensive to governments, but it has also become more expensive for seniors, as they've seen co-pays go up, as they've seen the premiums go up.
There's a very interesting thing that happens with that particular program. If a senior applies for the program, and if they don't have enough individual income that they have to pay a premium, well, they don't have to pay a premium, and they receive their
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drugs. I think they still have to pay the co-pay. You can have both seniors in a household, both under the threshold, but then what the department does is they add the two incomes together and then the two incomes exceed the threshold and they have to pay a premium. Individually, they're fine, but their combined income exceeds the threshold. Why is it that that is designed in that fashion?
MR. D'ENTREMONT: Mr. Chairman, as we look at the Seniors' Pharmacare Program, which does cost a fair amount of money and has an increase year after year of about 10 per cent per year, you know, it does bring a huge benefit, of course, to our seniors. As for design, when we combine the two incomes, is one I'm not too sure of, but I can provide the member opposite with some further details on that, if there is maybe something we're missing here that we can try to alleviate or fix.
Approximately 40,000 seniors pay a full premium on that, approximately 14,000 seniors pay a partial premium, and approximately 40,000 seniors pay no premium at all because they receive either GIS or they're in nursing homes. So it has been a tremendous benefit for seniors, but it is a costly program for Nova Scotians.
I do want to talk quickly, that we look at that kind of cost for seniors, if we take the 132,000 people or so that we feel would benefit from the working families Pharmacare Program - I have to find a silly acronym for that, it would be easier to say - but pretty much it would cost us somewhere in the range of about $90 million. That's just a quick blush calculation on that and one that, hopefully, we'll bring in some more details forward as we work on program design, but that's just extrapolating what we're paying on Pharmacare and work it into that number of people.
Also, as we talk about drug and drug costs, it is one that I had the opportunity yesterday to be at a federal, territorial and provincial meeting. They talked about NPS, which is the National Pharmacare Strategy, which all First Ministers have engaged upon, and asked the Health Ministers to come up with a strategy that talks about a number of things: catastrophic drug coverage, which there are far too many people across Canada who are just unable to pay for the drugs that are prescribed to them so they can have better lives and be in better health; talking about the really expensive drugs for rare diseases. There's getting to be a number of different genetic issues that drug therapies are costing in the hundreds of thousands of dollars. George Smitherman, who is the Minister of Health in Ontario, tells me of one that costs somewhere close to $1 million in his province per year. Do we have the facilities to provide that? Do we have facilities to talk about generics and find some cost-savings in that to try to distribute across the system?
So when we come to pharmaceutical costs and looking at the issues of designing the correct Pharmacare Program for our folks, I think it's going to take some time but we should have some further details for you in the very near future. To my point, I will have
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some more details by either the end of today or tomorrow. They tell me that the staff is very efficient in getting answers back and we don't have them on the floor.
MR. CHAIRMAN: Thank you. The honourable member's time has now expired
The honourable Minister of Health Promotion and Protection on an introduction.
[3:00 p.m.]
HON. BARRY BARNET: Mr. Chairman, I'm pleased to be able to make this introduction during an unusual opportunity here while we are in Committee of the Whole House on Supply. Today we have with us, joining us in the Speaker's Gallery, a number of players who were the subject of a resolution earlier today. We have James Sheppard of Lower Sackville who was chosen ninth round overall by the Minnesota Wild in the NHL Entry Draft; Brad Marchand who was drafted by the Boston Bruins, he is from Hammonds Plains; Ryan Hillier, also from Hammonds Plains who was drafted by the New York Rangers; and Andrew Bodnarchuk from Hammonds Plains was drafted by the Boston Bruins as well. Joining them are a number of very supportive family members and Bill Short, the Player Development Officer with Hockey Nova Scotia. I would ask all members to give them a warm welcome and welcome them to the House. (Applause)
MR. CHAIRMAN: A warm welcome to all our visitors in the gallery this afternoon.
The honourable member for Glace Bay.
MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. I can understand the excitement because if he plays where he is going like he played with the Eagles, then he's going to be a heck of a hockey player. We all love the Cape Breton Screaming Eagles. So it is a great experience and I welcome our visitors as well.
Mr. Chairman, it is a pleasure to be here, as usual, and to take my place during the debate on the estimates, and with the minister and the deputy minister and staff as well. It is always a pleasure to see the deputy minister because I think I can say, without any bias, that perhaps we have one of the more capable deputy ministers in the country who is at the Department of Health right now. Believe me, I don't give out that kind of a compliment too often, let me tell you, so I hope the deputy minister feels rather special at this time.
Mr. Chairman, I would like to take a few moments to address some of the issues contained in the budget. I don't know if there is any subject that perhaps would be more important to talk about at this point in time than that of health. There are always important issues we deal with on a regular basis in the Legislative Assembly but the issue
[Page 20]
of health and the Department of Health is something that at one time or another is going to impact on all of us. It impacts on our loved ones, it impacts on everyone in this province.
Mr. Chairman, as you can see again this fiscal year, the cost of health is going to rise - or it rose already about 8 per cent. So the total budget for the Department of Health now stands at about $2.8 billion. That's about $1.2 billion more than back in 1999. I use the reference to 1999 because that's when the Progressive Conservative Government came into power. I think that actually speaks volumes because first of all, it speaks of the issue of sustainability. Sustainability, I can recall when I stood in this Legislature I talked about how the system was, unfortunately, about to collapse on itself and the issue of sustainability. At that time the budget was just a mere $2.3 billion, so with the increases now, $2.8 billion. So $400 million, a staggering figure for most people to even comprehend, $400 million - and two years later, I would suggest that the same questions that I posed back then would be equally applicable today as well.
I talked about the fact at the time that there was very little investment in the components of health care that would have reduced the burden on the acute care system. I'm seeing the minister nod his head and I know that the minister agrees with that and I know that the Official Opposition agrees with that, that it's something we have to look at in terms of investments in continuing care programs such as home care and long-term care. They were minimal then but we have to change that, we have to change the way we do things.
With that in mind, when you see a continuing care strategy that we see today, the unfortunate reality of that is that the health care system will not see the full benefit of such a strategy for the next 10 years; 10 years, Mr. Chairman, I don't have to tell you or anybody else, that is a very long time. A health care system that needs long-term care beds today won't have access to them. The acute care system that's struggling just to keep up with the needs continues to receive more money, yes, but unfortunately the funding that it receives in many cases just maintains the status quo, that's all it does. We are struggling to do exactly that.
There aren't a lot of new programs, Mr. Chairman, is what I'm saying. There's the maintenance of the old programs which is where the problem occurs. You know I often wonder what has happened since 1999. In 1999 when this government was first elected, they were elected on a premise that health care did not require any more money so to speak; just a dash of investment and some good old-fashioned planning, we were told, was all that was needed.
Where are we today? Well, oftentimes you hear expressions of concern from residents who are not able to access the system. Worse yet you hear from patients who finally do access the system and they're being wheeled into surgery and then told that
[Page 21]
their surgery is cancelled. The likely reason there is lack of hospital beds. I would suggest a perfect example of that is from a correspondence I received - I will table it after I finish reading it, and the minister was copied as well - from Mr. Simon Chiasson in Baddeck, Nova Scotia.
Mr. Chiasson wrote to the minister and he said that in October 2004 his general practitioner recommended that he see an orthopaedic surgeon regarding a knee replacement. He waited for an appointment and in June 2005 in Dartmouth, which was a nine-month wait, he got the appointment and it was decided what he needed was a total knee replacement. He was scheduled for surgery on April 26th, 2006, another nine-month wait for the surgery. He had to be in Dartmouth on Monday, April 24th, at 8:00 a.m. for some pre-op testing and then because the OR time there was scheduled for nine o'clock on Wednesday, April 26th, he and his wife for that time had to find accommodations for three nights.
In his words, after 18 months of pain and limping and a change of lifestyle and three trips to Dartmouth - this is from Baddeck - he thought he was finally going to receive his knee replacement and get on with his active life; this gentleman leads a very active life. At 4 p.m. on that Tuesday, he found out that his surgery had been postponed so you can understand he was frustrated, disappointed and to some extent angry.
He went to the Dartmouth General Hospital, he spoke with the Director of Nursing in charge of OR schedules and also a doctor, the orthopaedic surgeon. The reason that he was given for his postponement was that although there was operating room time available, there would be no bed available for him after the surgery. They couldn't give any definite time frame for another surgery date, so they said it would probably be within another month and they couldn't guarantee that whenever he was rescheduled whether or not that same situation would happen all over again.
He was still in pain, still limping, still suffering, he was about $500 out of his pocket in travel, lodging and meals, and he was frustrated. That's why he would write in his correspondence to the minister that this is an absolutely disgraceful and unacceptable situation - day after day politicians and bureaucrats assure the taxpayer that wait times are being shortened and that health care is being steadily improved by throwing more money into the system.
He's living proof, in his words, that wait times in this province are not improving in his case anyway. As a matter of fact, they've been extended. Mr. Chairman, I'll table that for the House to see. I think that is probably a perfect example of the situations that exist in this province now. It is not, I know for certain and the minister knows and we all know, that is not just a lone case of someone who came to Halifax looking for surgery at some time. That is probably an example of many - he happens to be from Cape Breton, I am sure it would be the case for people from Yarmouth or Digby or from the other end
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of the province as well, that they would be coming to Halifax at the last minute to have that surgery, to have whatever it is cancelled, through no fault of the nurses, through no fault of the doctors, through no fault of the hospitals. It is simply a matter that there are no beds available. So you see the crunch and you can see what can happen.
I would suggest - not to be too political - that back in 1999 when this government came to power, if there was a time to start planning how to take on instances like that and cases like that, it was probably then. That was probably the time to start planning, not today. We, as a Liberal caucus, warned the government a couple of years ago that the system is facing a crunch. It was not a secret and I don't mean to be rude here, I don't think it was a secret to anyone on the government benches that was happening and that that was going to take place. I remember at the time there were some members who said I was being over-reactive. I could not understand anybody saying that to me, to begin with, but it turns out - not to crow about it - but it turns out to be true. Every year we hear the same thing from this government, that they are proud of the investments they are able to make in health care. I know they believe that and I know there are investments made but, unfortunately, sometimes, as I have said, those investments go to maintaining the status quo, instead of making genuine investments in the system, which is why I am saying there need to be some improvements when it comes to that.
I do believe there are a few good initiatives contained within the budget. Sustaining funds to continue with priority primary health care initiatives, that is important. I look forward, later on during this hour, Mr. Chairman, to asking the minister some questions with respect to that initiative as well. I believe that funding provided for programs such as self-managed care is extremely important and again, I am not boasting but that was a Liberal bill that was passed in this Legislature and it is a prime example, I feel, of what you can do spending both effectively and efficiently as well. There is no doubt in my mind that for disabled people in this province, that program has, most importantly, improved their quality of life. It has and it will save the health care system money. I guess that is - I don't like the phrase, "think outside of the box", but I guess if you are going to, that is the kind of thing that has to be done within the health care system in order to make any change.
[3:15 p.m.]
For instance, there's a side benefit of self-managed care - it frees up some resources in the Home Care Program for other clients as well, if you look at it from that aspect. It's an initiative for which I know myself and my colleagues in the Liberal caucus are extremely proud to have been able to support. It was, ironically, a program that was promised by this government back in 1999, and it took until 2005 to get there but, even though it was a long road, I'm pleased to commend the government and the minister for finally listening and bringing forward what is a very important program.
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There are more initiatives within home care that need to be done in order to strengthen and improve our health care system, and some of these initiatives don't really require a lot of money. Probably like most members in the House, I get a lot of calls from individuals who have concerns that their home care workers, for instance, change frequently. It's especially distressing for seniors. They build a trust with the workers over the time they are with them, and when they experience frequent changes, it doesn't really make any sense - to me, anyway - why home care clients are not allowed to see the same workers because, logically, I think it would be easier to schedule the same caseload to the same worker on a daily basis.
But, again, I'm looking at it from the outside in and it doesn't seem to make common sense - anyway, I think it would be easier for the employer, easier on the employee as well. From a health perspective it would make sense for a home care worker to detect some subtle changes in the status of the patient if they're familiar with the client. It's something I get a lot of calls about.
I recognize that's probably not an issue that's the direct responsibility of the minister, but it's certainly an issue that I think he could maybe bring forward to the companies that are providing home care services.
Another area to look at is the reinstatement, in some form or another, of the old in-home support program. It was cancelled in the year 2000 by this government and there hasn't been a replacement announced, but it would be interesting to know - and I will question the minister again at a later time - as to whether there has been a cost-benefit analysis done with regard to that program as well, and how long did it take before clients who were receiving the program in the past ended up with a nursing home bed, and if there's any benefit to reinstating the program - for instance, how many resources in the home care budget could be freed up to expand to other programs and so on.
Sometimes the many people we meet in our communities back home - as Members of the Legislative Assembly you run into certain people who strike a chord and you remember them for different reasons, and I'll never forget, it was only about a year ago, running into Mr. John MacNeil at the Glace Bay Hospital. Mr. MacNeil's a true gentleman, a great person who worked all his life in the coal mines of Cape Breton. He's retired. I don't think Mr. MacNeil has had a complaint about anything in his life. He's just one of those people who was glad to have had the work, he was glad to be in good health, he was glad to be retired. He is a quiet person who really doesn't like to complain but, unfortunately, his wife Blanche got to the stage in her life where she needed to go into a nursing home.
She was hospitalized and, as of a couple of weeks ago anyway - I haven't checked in the last week or so, but I will - she was still on the fourth floor of the Glace Bay
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Hospital. This is the area the hospital uses as - I forget the technical name of it right now . . .
AN HON. MEMBER: Alternate level of care.
MR. DAVID WILSON (GLACE BAY): Alternate level of care. Thank you, Mr. Minister, I'm glad you're up on it. That's what it is, and she was there and Mr. MacNeil stopped me outside of the elevator at the Glace Bay Hospital and as I've said, he never called my office before that time, and he stopped me and wanted to talk to me and asked me if there was anything I could do in perhaps helping his wife be transferred to a facility in Glace Bay. We know that within that structure, I think most of us do anyway, the 100 mile radius rule, that if there are no beds available and so on that perhaps your bed would be located quite a distance from your home.
Mr. MacNeil's only worry in his life at that time, and to come up and approach me out of the blue, was that his wife Blanche would somehow be put in a nursing home that wasn't close enough for him to visit. In other words if it was in Baddeck or whatever the case may be, within that radius but still far enough away, he couldn't afford the gas to travel and go see her. He knew that. He's on a fixed income, his wife is on a fixed income, they simply would not be able to afford the money to purchase gas with gasoline prices rising in order for him to go and see his wife. He was very worried about the fact of what he could do.
As we all know, Mr. Minister and Mr. Chairman, our hands are pretty well tied when it comes to that. We can make the phone calls and we can lobby and we can ask and we can write letters and whatever but the fact of the matter is the numbers don't lie, the beds aren't there. What can you do? Simply hope for the best and hope that things work out. Mr. MacNeil understood that but he wanted me to do what I could and I did. I don't know exactly how it has worked out yet but I'll find out.
I think that is another example of where we are right now in terms of long-term care and in terms of where we're headed. Mr. MacNeil's case is not going to be helped by a strategy that runs over 10 years. It may be that new beds in Cape Breton would help Mr. MacNeil in this case but the numbers just simply aren't there. If you ask anyone involved in working on the front lines, the people who know in long-term care, in that industry, they will tell you that the numbers that are proposed over a 10-year period don't amount to a drop in a bucket. They don't even scratch the surface and that's where the problem lies.
Another area that I think warrants some comment, and again we'll have some questions on that, is the patient health record. I don't know if anyone else feels like I do when it comes to this project but it seems to me that it has been a very long time coming. The benefits when this program is fully operational are going to be immense. When it's
[Page 25]
fully functional I'm hoping that the Capital District will be able to talk to and receive information from all the other DHAs. It would make absolutely no sense if that was not the case, it would just be a waste of time and a waste of a tremendous amount of money. You have to take into consideration doctors' offices and whether or not we're going to see them connected to the system. That to me would sound like another critical link that you'd have to have there, one that would require some planning. I look forward to asking the minister some questions as to where they are in the planning process when it comes to physicians' offices.
Mr. Chairman, there are issues and initiatives that would make the health care system a much better system in the future that have been just waiting patiently - some as long as that magic year of 1999- they've been waiting very patiently to be recognized. There are professions such as midwives and there are dental hygienists who could play a valuable role in our health care system. Their time has come to take their rightful place as professionals in our system. Over the past year, our health care system has seen some changes that occurred as a result of blockages in our acute care system, and I speak of the increased number of private practices, or clinics I should say, private clinics in our province. The government did promise legislation to protect Nova Scotians last year. We've yet to see movement with respect to that legislation that would prevent the problems that it was aimed at preventing, such as queue jumping.
Mr. Chairman, one of the issues not talked about or outlined in this budget, but I again look forward to questioning the ministers on, the issue of health human resource planning. Emergency room closures is an issue that requires more answers and, again, I look forward to asking the minister. We pointed out yesterday in Question Period that it's close to two years now of actual time that emergency rooms throughout this province have been closed. Over 16,000 hours of emergency room closures in Nova Scotia, and I know that it's a frustrating experience for the Minister of Health. It was a frustrating experience for the minister before him, and the minister before him, and before her, whatever, four ministers is what I'm trying to say. Four Health Ministers have had that same problem in this government since 1999 - over seven years.
I can understand why, and it would be very easy for the minister to stand and throw his hands in the air and say, tell me what I'm going to do about ER closures, go ahead, let me know, I don't know what to do, and I'm not quoting him, Mr. Chairman. I'm just saying that it would be very easy for him to do that. I'm sure the department staff has struggled with this issue as well, I don't know, but the other day, and I'm sure it may have been just one of those moments in Question Period, but I know the answer is not to call 911. That's not even close to the answer.
Mr. Chairman, I know that the Health Department is a department with a number of pressures on it. I know that. We all realize that in Nova Scotia. It's a department that also has, in my opinion, some great potential as well. It will require leadership, it will
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require dedication, and I look forward for the next approximately half hour anyway of questioning the minister for some specific budgetary issues as well as some general concepts.
Mr. Chairman, let me address the minister. The province has increased funding for primary care programs by $3.3 million over last year's budget. According to budget documents, this money was to sustain funds to continue with priority primary health care initiatives previously funded through the federal primary health care transition fund. This province received a total, I believe, of just over $17 million from the federal primary health care transition fund. Nova Scotia was also to benefit in a multi-jurisdictional funding envelope that saw New Brunswick take the lead in a self-care, telecare program for Atlantic Canada and that was an additional $6.9 million. So could the minister perhaps indicate where the additional $3.3 million is going to be spent over the next year?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his lead up to his question. I think I would rather - I will answer his question, of course - but maybe make a few comments on some of the comments that he made. I do want to thank him for recognizing my deputy and put her in such high regard because it's definitely a job that requires a lot of time and a lot of dedication. I, myself, want to thank her for her work in the Department of Health because it does take a fair amount of time and concentration to try to pull this off on a day-to-day basis.
The member opposite talked at fair length on a lot of issues and the one, as we go along, that's very important is, of course, the growth in health care and looking at an increase of close to 8 per cent in this year's budget alone. There was an 8 per cent increase last year and there was 8 per cent the year before. Not only is this happening here in Nova Scotia, this is happening nationally and it is happening internationally, the escalating costs of health care.
Why is it happening? For a whole bunch of reasons. It had everything to do with making sure that we have the correct remuneration for our health professionals, the recruitment of those professionals, making sure that we are paying the same for one in an area and one in another area.
[3:30 p.m.]
Cancer costs and cancer drugs have been increasing exponentially over the last number of years, I think 25 per cent this year, which is absolutely crazy if you look at it. I think our residents deserve to have the best cancer care they possibly can have and to have the pharmaceuticals, the drugs that are required to make them better, or at least to make their lives as comfortable as possible.
[Page 27]
We talk about closures and lack of professionals. Really, if you look at Nova Scotia, if we take a true physician/specialist versus population, we do have the second highest rate in Canada, which was a revelation to me as I moved into this portfolio. I think we may have a problem in distribution of where those professionals are. As we talk about closures, I know this is frustrating to me and it is frustrating to the member opposite to see ERs close down for a weekend. The Strait Regional Hospital will probably, over a month's time, be without its doctor as she moves off to India to do a month's service there, before she comes back. So I think there needs to be a little better strategy and communication between the district health authority and the hospital and the Department of Health, to make sure we have the correct type of personnel in that area so that doesn't happen.
We talked a little bit there about wait times. The wait time strategy is something that we have had undergoing for the last year or two years now. I think the biggest challenge for us was really to grab the data, to find out where those wait times were, what kinds of surgeries those folks were waiting for. I think it has moved on to the wait care strategy of putting certain technological pieces in place in order to monitor. This has been a challenge because a lot of these orthopods would have their own list of patients waiting for knee hip replacements. The eye doctor would have his list and the cancer doctor would have his list and we need to find a way to centralize this list, and at least give people a choice of who they are going to and making sure that the doctors are busy providing the care they want to provide.
As we look at the wait time strategy across the country, we are working with the federal government right now trying to distinguish through the First Ministers' meeting, as they have asked us, to go forward and discuss this and try to come up with a strategy. We are taking orthopaedics, which I think is probably the most concerning one across Canada right now, by far the most concerning one here in Nova Scotia, as well as cancer wait times, cardiac wait times, eyes, which is cataract surgery, and, of course, diagnostics. I think we have gone a long way in diagnostics and making sure we have the correct pieces, CT scanners and, of course, MRIs as we move along. I think we are making leaps and bounds there but it costs a tremendous amount of money to purchase those pieces of equipment.
The member opposite talked about his patient in Cape Breton and the issues he was having on that wait time. I think, as we look at it, we provided a wait times Web site. The information is available to know how long each centre is waiting. So if a patient can look at that and the doctor can look at that and maybe realize that out of the four or five centres that provide orthopaedics in the province, you would pick the one that has the shortest times. So you are redistributing the folks who are going into those surgeries.
Mr. Chairman, it is known that the wait time in the Capital Region right now is somewhere near 18 months, which to me is unacceptable. Why is that happening? It has
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a lot to do with scheduling, availability of ORs, availability of anaesthesiologists. But, the wait time is less in Kentville, it's less in New Glasgow, it's less in Sydney, so if we can find a better way to make sure we flow these patients from one area to another, I'm sure a gentleman from Cape Breton would save some money to be able to get the surgery in Cape Breton which is something I want to see happen. Personally I think it would be a wonderful thing to have somebody from the Valley go to Kentville or possibly go to Yarmouth would be wonderful. But as we go along, we have to make sure we have the professionals in the right areas and the availability of OR.
I want to thank the member opposite for bringing up the issue of self-managed care and just say that we are doubling that pot of money this year so a lot more people can grab hold of that self-managed care program. These are people who are sick or infirm and can't receive, or feel that they can't receive, the type of care they require. They can take this money and hire the people they require.
I think in the instances we have been able to fund right now those patients are very, very happy. I hope to move that program along as we go.
Of course, we talked about long-term care and continuing care and the issue of the 100-kilometre rule, which is a very unfortunate one. To the member opposite, you have your first request, here's the home you want to go to, here's your second home you possibly want to go to. In the absence of that, do you want to be in a home or do you want to stay in the ALC? Ultimately, I think, it is better serving that some of these folks do go off to a true home, a long-term care facility, to get the service they deserve and they require. Then, as soon as a bed frees up in their first choice, they can move back closer to home. Sometimes it takes time because of the unfortunate reason of beds freeing up or some of our seniors passing away. It is something that takes time and it's unfortunate and sad.
But, it's something that as we move along with the construction of new beds in the province, that is something that hopefully we'll be able to dispose of - the 100-kilometre rule - as we have homes and facilities closer to home communities.
Let's make sure that we know that two-thirds of the beds that we're committing to over the next continuing care strategy are going to be constructed in the first four years. There are 125 beds that are either constructed or about to be constructed or in a certain level of construction in the Cape Breton region.
Also, the member opposite talked about the people who say we're only touching the tip of the iceberg in constructing the 1,300 new beds. But the ratio we try to use to come up with some kind of formula really boils down to the percentage of folks over 75 who require long-term care. The study we have here in Nova Scotia and other jurisdictions across Canada sits in at about 5 per cent. So, do we want to build too many
[Page 29]
beds? I don't think so because it's not sustainable. Do we want to have the right amount of beds? Absolutely.
I talked a little about the NSHIS, which is firstly the health record or trying to move towards an electronic patient record and making sure that patient information is shared across the province. If you have an injury in Yarmouth and you're from Glace Bay, when you go in the hospital there, there's your patient information. These are the things you've had done here, the medications you're on, et cetera so there can be better flow and better care for people right across the province.
The member opposite brought up the issue of other professionals. You know, midwives, the midwives issue is being dealt with from the department. They are trying to design a process to set up a college of midwives, or something similar to a college of midwives. The issue and the problem we have been having up to this point is that normally in a college, in a self-regulating profession, you basically have a number of other people watching over and making sure that things are done correctly.
With midwives, we don't have enough of them in the province yet to constitute a college. We had to come up with another option to provide oversight in a short period of time so I'm hoping to have a piece of legislation to come forward, we believe in the Fall, as all stakeholders are consulting, we have the correct piece in place. Dental hygienists is another sticky issue at this point as we try to make sure that both sides of this story sit down and try to figure out their way through, because we have the dentists on this side who feel that it should be dealt with this way and we have the dental hygienists who feel it should be dealt with this way.
I truly believe, Mr. Chairman, that there is a solution there and one that should be forthcoming in a short period of time. I do look forward to also bringing some of that information forward and it's not by chance, but it's also by lots of phone calls in my own home riding of dental hygienists who do want to see their profession recognized and treated as a true profession in its right of being able to provide care and service to Nova Scotians.
Mr. Chairman, I might surprise my deputy minister here but, you know, there are so many other professionals within health care that we don't recognize who do require maybe a second look to make sure to see how they fit into primary health care. These are talking about the other professionals such as naturopaths, chiropractors, and those types of people. She didn't fall off her chair, that's good, but ultimately as we deal with making our community safe or making people safer, and making people healthier, I think we need to have the primary health care programs and primary health care systems in place.
[Page 30]
The member opposite talked about making our communities and our society healthier which I think is what the dedication is and what the commitment from the Premier has been in the creation of Health Promotion and Protection, of working with healthy benefits, working with recreation, working with all those things within communities that are going to make people healthier that will take off the strain from the acute care system.
I think we got pretty much almost all the way down. Of course, publicly funded, which is one I think we'll find we talk about a couple of times throughout this debate, you know, publicly funded versus private, but the water on the beans tends to continually change on this one. As we had the Chaoulli case in Quebec and how care is supposed to be administered, that if you wait over a certain time, that you can go somewhere else and get it funded and how the integration between a private system and a public system works. There's a tremendous amount of work to be done there and a tremendous amount of searching and research to be continued to be done there.
I personally think that we still require a publicly funded system. That I believe in totally. The question of if there's a place for a private system, I don't know and, in the absence of not knowing, I feel that there should be some more research done, but the intention is still to bring into this House at some point, hopefully in the Fall - and I keep saying the Fall - a private Health Care Act that (a) protects patients; and that (b) protects those workers who will be required and to make sure that we're not draining professionals away from our already taxed public system.
To the question on primary health care transition money, obviously I think it was the true question at the end of the story. It really is what we use our money for, is to sustain coordinators in each DHA, number one, and to sustain a primary health care information system. So we have used that funding towards that, NSHIS. No? (Interruption) Oh, compatible. So really I guess we're talking to the pieces within the clinic level and the private practice with information systems on that and to add additional nurse practitioners and collaborative practice groups in communities and, of course, the long-term care private pilot that we put into place just a few months ago at Northwood where we have a nurse practitioner working in that facility. Of course, we are planning and continue to plan the tele-health, tele-triage program that will be very similar to the one in New Brunswick, and we're talking about that planning implementation sometime in 2007.
So with those quick comments, Mr. Chairman, I will look forward to further questioning from the member for Glace Bay.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, if that's the definition of the minister's version of quick comments, I don't know if I want to ask him another question. I know he's a former radio guy and so am I, we used to speak in just short
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sentences there, a friendly reminder for the minister, and I thank him for his comments. What I was asking is, as we did get to the point about the additional $3.3 million that was spent, the additional $3 million over the next year, some of the federal primary health care transition fund, as the minister just mentioned, was used to establish nurse practitioners. I would like to know, could the minister outline how much of the total of $17 million was used to establish nurse practitioners?
[3:45 p.m.]
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Let me give you a quick rundown of where that $3.36 million went: two nurse practitioners in Cumberland County who will be working a collaborator practice arrangement, which was about $180,000; primary health care transition, which the funds were used to sustain and continue activities that began as a result of the primary health care transition fund; leadership infrastructure; managers, coordinators and clerical support, which is about $2.2 million. The Electronic Patient Record sustainable funding and the IT support and consulting fees also belong in there.
We also did a bit of diversity and social inclusion pieces which focused on race, ethnicity, language and culture. It is a program within the Department of Health or within primary health care that will be brought through the system, which was an investment of about $140,000. I think that pretty much runs it - no, wait, there's more.
Expand community-based multi-professional teams which includes the family practice nurses, dietitians, social workers and others, which is a project of about $400,000; SPI sites, which is nurse practitioners working in collaboration with GPs. There is one on the South Shore, one in Cumberland County, one in Pictou County, one in the Capital District. This funding is for salary and benefit increases, due to the contractual agreements, which is about $84,000. Nurse practitioners' salaries and benefits increased due to contractual agreements, as of May 2005, which is about $247,000, and finally the nurse practitioner on Brier Island, to continue that program there as it was transferred from EHS to the district health authority, which was $184,000 or so, so that does add up to $3.3 million.
MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. I am a little confused. My question was, how much of that $17 million was spent on nurse practitioners? I didn't hear a figure but if you just wanted to confer with the deputy there for about 30 seconds, maybe you could give us that exact figure. Also, if you would, could you answer how many nurse practitioners we have working under the direct auspices of the Department of Health who are being paid by the Department of Health, how many of them are actually being paid by the Department of Health?
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MR. D'ENTREMONT: Mr. Chairman, I think probably the simplest thing to do here would be to commit to the member opposite that we will provide a list to him with basically a listing of where that funding has gone within primary health care and how it has benefited our nurse practitioners across the province.
MR. DAVID WILSON: (Glace Bay): Mr. Chairman, perhaps the minister didn't hear the second part of that question. How many nurse practitioners do we have who are working directly under the Department of Health and are they being paid by the Department of Health?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his clarification on that question. What it boils down to right now is that we have 17 nurse practitioners practising in the province. The funding flows through the DHAs. We are holding the money centrally to make sure they are protected, but we do also want to make sure we have a really good program of nurse practitioners to move into the future. Through the DHAs, the funds are being held centrally.
MR. DAVID WILSON (Glace Bay): Just to clarify, Mr. Minister, what you're saying is that the nurse practitioners are now the responsibility of the district health authorities? Are they paid from the district health authorities' respective budgets, or are you saying they're paid by a central budget from the Department of Health? Would the minister please clarify that?
MR. D'ENTREMONT: Mr. Chairman, no, the funding for the nurse practitioners, they get paid by the DHAs, and the DHAs make the recommendations to us on where the nurse practitioners will be placed. So we look forward to their suggestions on where they feel within their systems that they require the nurse practitioners. We do hold the funding for the nurse practitioners centrally in the Department of Health, but we flow it through the DHAs for their remuneration.
MR. DAVID WILSON (Glace Bay): So there's no funding for nurse practitioners that comes from district health authority budgets? That's what you're telling me. Would the minister like to clarify that please?
MR. D'ENTREMONT: Again, the DHAs are the funder, the employers of the nurse practitioners. The money is flowed through from the Department of Health through the DHAs to the nurse practitioner. So they are employees of the DHA, and we provide them money accordingly to pay for those professionals.
MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman, thank you, Mr. Minister. In June 2005, the federal government issued a funding report on initiatives that were undertaken using the primary health care transition funding money. According to that document, one of the expected results was the enhancement of information systems
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within primary health care models in preparation for electronic health records. Could the minister indicate where there have been enhancements made to the information systems in primary health care settings?
MR. D'ENTREMONT: Mr. Chairman, to outline a little bit of where that funding went, to make sure, is that all districts have received some funding on electronic patient records and the Nova Scotia Health Information System. Quite specifically, about 30 per cent of all physician offices now have access to, or have computers in them that have access to the system, and all collaborative practices at this point have the computer systems and that access in them. That's where the funding was targeted.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, in addition to the $70 million that was provided to this province directly for primary health care initiatives, another approximately $6.9 million, as I mentioned previously, was allocated to develop a multi-jurisdictional project relating to self-care telecare for Atlantic Canada. New Brunswick was the lead province in this initiative.
Under New Initiatives on Page 11.1 of the Supplementary Detail, it indicates that one of the new initiatives would be the establishment of a province-wide telehealth system. I'm curious, since we already have a province-wide telehealth system in our hospitals, am I to assume this priority is a result of that $6.9 million that's spent on the self-care telecare system? I'm looking for a clarification.
MR. D'ENTREMONT: They are two programs that are similar in name, but different in scope. The telecare program that we have now is basically connection of hospital to hospital so that doctors can see patients in remote areas.
The telehealth, telecare program that we're talking about in this budget that was underlined, I think, in the Speech from the Throne and we talked about it a little bit during the last election, is basically a tele-triage program, which is similar to New Brunswick. Nova Scotians can call in with their health issues and would be talking directly to RNs to receive care. What they'll be able to tell them is do this, do that, take this, take that, but also tell the patient that maybe you should go visit the ER. What shows is it does bring down the number of visits to an ER by a dramatic number. I think it's somewhere close to 20 per cent to 30 per cent of visits for those minor things - upset stomach, fever and those types of things. It is a tele-triage system versus the in-hospital remote access to specialists and physicians that exists today.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, perhaps the minister then can tell us what the status of that self-care telecare system is in this province right now, where does it stand?
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MR. D'ENTREMONT: Basically there are two costs associated with this that we're bringing forward that speaks of it within this year's budget; basically the set-up fee which is about $2.5 million, the operational per year is about $5 million. We'll see the implementation and the start of that hopefully in January 2007.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, maybe the minister could indicate if there is money allocated in this budget for this initiative and, if there is, how much?
MR. D'ENTREMONT: Pretty much we'll be talking about that in next year's budget because basically there is nothing in this year's budget for that implementation. So we'll be looking at next year's budget to implement the telehealth, tele-triage, telecare system.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, as I understand it, this project is a multi-jurisdictional project. So I'm wondering, does that mean Nova Scotia will undertake this initiative with the other Atlantic Provinces or are we going to implement our own system? Is this our own system that's going to be implemented?
MR. D'ENTREMONT: Mr. Chairman, we did go down the road during this process of finding ways to partner with the other provinces in the set-up of the program but what it is, even at that point, we would have our own units in each province. So you would have your own RNs dealing with your issues in each province. So this represents the set-up fee in our province but still using the expertise and the background from the other provinces as well.
MR. DAVID WILSON (Glace Bay): I'm left wondering as well, Mr. Minister, who's going to be responsible for actually addressing the needs to care for Nova Scotians through this system. Are you going to have, once the system is up and running - and, I'm sorry, you said 2007 sometime - are we dealing with trained professionals who are going to be sitting there, or are we dealing with workers who are hired to input symptoms into a system and then read the information from a screen? What are we dealing with in that situation?
MR. D'ENTREMONT: Mr. Chairman, I think from my knowledge of the system and how it's going to work there will be, of course, medical oversight from physicians, but all the people who will be working in the system will be trained professionals. They will be RNs for the most part, and I think the opportunity is why we wanted to have it in each of our own areas where New Brunswick would have its own and we would have our own, is that we have an opportunity for some of our more experienced, and experienced by age, nurses who are looking for different opportunities. As some of these RNs get on in their careers, they're looking for something different to do and maybe they're looking for options. This is a great opportunity for them as well. So you know, even for retiring
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nurses who want to do something different, this is a great facility for them; nurses who became handicapped, maybe have a bad back, or whatever, so they're looking for options to still use the skills they have. So that's the kind of professional we'll be using within that facility.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, I know my time is just about to run out.
MR. CHAIRMAN: You have approximately one minute and 15 seconds.
[4:00 p.m.]
MR. DAVID WILSON (Glace Bay): I'll take that time, Mr. Chairman. Just a reminder to the minister that when we're talking about such a system and who's going to staff it, in terms of professionals, whatever the case may be, I'm hoping the minister just isn't relying on that perhaps some retired nurses will be there, maybe they will and maybe they won't, I hope there's more of a plan in place to provide for staffing levels of such a system. It's the same as when the minister made reference to having a Web site for wait times. It's great to have the Web site, but the Web site simply provides you with how long the wait times are and how many people are waiting. The actual Web site doesn't do anything to remedy the situation of wait times in Nova Scotia.
With that, Mr. Chairman, I'll take my place and allow for the next speaker.
MR. CHAIRMAN: We will take a short recess.
[4:01 p.m. The committee recessed.]
[4:04 p.m. The committee reconvened.]
MR. CHAIRMAN: I call the committee to order please.
The honourable Minister of Health.
HON. CHRISTOPHER D'ENTREMONT: Thank you, Mr. Chairman, and I want to thank the members for their indulgence and I look forward to the questions from the Official Opposition.
MR. CHAIRMAN: The honourable member for Sackville-Cobequid.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I want to first begin by welcoming the Minister of Health, hour three I guess, to his first set of estimates as minister. I don't know if the 10 or 12 hours of Health estimates is what he expected, but
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I'm sure when the Premier asked him to take over Health or was told to take over Health, he knew that this was going to be part of it.
What I will do for the Minister of Health is actually go over a quick overview of some of the things I'm going to talk about and question him on, and then actually go into detail, so I'd appreciate him not answering everything I was going to talk about but I will get into questions. I just want to give him a bit of overview of some of the concerns I have as the Critic for Health for our caucus, some of the problems and issues that myself as the member for Sackville-Cobequid and Health Critic, to hopefully get some of these issues out in the open and get some answers from the minister.
Of course, everybody knows just coming off the election that health care is the number one issue for many Nova Scotians. They have a lot of concerns and those concerns increase when themselves or a loved one has to enter or is involved in the health care system in the province. I want to begin by stating that I believe we have some of the best health care providers in the country, if not in the world, here in Nova Scotia. By no means do I take away from the delivery that these health care professionals give to the patients and residents of Nova Scotia by the questioning and the concerns we have of different departments. It doesn't reflect the job they do, it just reflects the issues and concerns that I think not only our province is dealing with when it comes to health care issues, but what the country is dealing with around health care and the delivery of health care in what people, I think, perceive should be a timely manner. Those are a lot of the issues I'll talk about in the next hour and then probably over the hour I get tomorrow.
A lot of the issues around the low-income diabetic program that we're very proud of advocating for many years. I know the member for Halifax Needham had been pushing for a program to exist here in Nova Scotia and we were happy to support that last year in this province, but there are still a lot of questions and a lot of issues around the delivery of that program and how it's supposed to target those low-income Nova Scotians in hopes to improve their lives when they're suffering with the terrible disease of diabetes. I'm also going to talk a little bit and ask some questions around Emergency Health Services, definitely a passion of mine being a paramedic and coming through a system that has evolved over the last six or seven years to what I think is one of the best services in North America. There are issues in there, there are several areas that we do need to improve and need to get some questions and answers from government on.
The other area that I will talk a bit at length about will be around the wait times and that's to deal with every aspect of wait times, if it's elective surgery to emergency wait times and so on.
Also, a lot has been said around long-term care, especially during the last election. I think all three Parties have tried to address what we see as the proper way and the better approach, or the best approach, to hopefully address some of the concerns we
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see in long-term care, concerns of those Nova Scotians who are waiting to go into a long-term care facility or those Nova Scotians who know that in a few years they may need to go into it, or have a loved one who may need to go into it. There are a lot of issues around long-term care.
Infection control and rates with some of the diseases here in Nova Scotia is on the rise, Mr. Chairman. I'll have a few questions around that and, of course, around continuing care. It's definitely another issue I think we need to address, we need to put resources in, government needs to recognize the importance of investing in continuing care in hopes of reducing such a huge burden on taxpayers and the government spending of health care dollars. I think by addressing some of the concerns and issues in continuing care, we can, hopefully, someday, reduce what we see as a never-ending increase in health care spending in our province and, for that matter, across the country.
Most importantly, I want to talk today or maybe even tomorrow a little bit around an issue that is important and dear to my Party, not only here in Nova Scotia but across the country, and that's the issue around a for-profit health care system. We've seen that Nova Scotia has been an area where these for-profit health care clinics or facilities have come in to try to set up and test the waters, I believe, in how not only the Nova Scotia Government will react but how the federal government will react to a for-profit health care system or for-profit health care facilities, not only here in Nova Scotia but in the country. That's an area where I think government hasn't done enough. They've said they would address this issue on a number of occasions, and I'll get into that in detail a little bit later.
Mr. Chairman, another area is around emergency rooms, especially around the closure of many of them for some reason or another, mostly around the personnel, the human resources, the inability to have a physician man those ERs throughout the province. Many of them that close are in rural parts of the community here in Nova Scotia. It's a stressful time for the community members to know that the emergency room that's maybe in the centre of town is not available to them on long weekends and holidays.
I'll also talk a little bit around the use - and I know I questioned the minister today on it, briefly - the use or underutilization of nurse practitioners in this province. I know the government has invested funds to increase the number of nurse practitioners and the training of them, but the government needs to continue that to ensure that we have these professionals who I think can offer so much and be utilized to address so many of the issues that we have in the province at a smaller cost than most people think.
I think that's an area where government needs to work quickly, because not only are we going to see these nurse practitioners leave, but we're going to see some of them unable to maintain their licences and continue to practice. We have nurse practitioners
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now who are working in the province and who are unable to work to their full potential, to the potential that they are trained. I think that's a shame, and I think government needs to act quickly on that one.
With those few comments, I will get into breaking down the questions I have in each of those areas. The first one, definitely, is around the assistance for low-income residents with the diabetic program that the government initiated last year. As I said, I know the member for Halifax Needham has pushed and advocated for this for many years, as I have since taking over the Health Critic portfolio for the caucus. It's an important area because not only does it, hopefully, I think, reduce health care costs in the end, it provides a service to those Nova Scotians who are suffering a terrible disease and who can't afford to maintain and hopefully provide the instruments they need to hopefully maintain a good level of glucose, and I think the program needs to be looked at to ensure that what the program was meant to do, and the people the program was supposed to help, actually does that. So my question to the Minister of Health is, why are these residents who are struggling to make ends meet required to pay for the products up front - doesn't that defeat the purpose of this program? So why was that part of the program there, to have an up-front cost to people in Nova Scotia who, in the first place, couldn't afford those products to hopefully maintain and keep a tight lid on their disease, with fighting diabetes?
[4:15 p.m.]
MR. D'ENTREMONT: Mr. Chairman, thank you to the member opposite for his introduction and now for the question on the low-income diabetes assistance program. Quite honestly, as we went into this program we did not have the system in place to provide the pay so we could set it up like a true Pharmacare Program, and we worked quite diligently, and I know my group has worked quite diligently, on making sure that that system was in place as soon as possible. I'm very happy to announce today that I think we have one more retailer to bring on-line to this system. So I'm hoping within the next few weeks that the people accessing this program won't have to pay their up-front costs for the diabetes supplies. (Interruption) Oh, we're on, I'm sorry . . .
MR. DAVID WILSON (Sackville-Cobequid ): We are on, the minister is stating that they have started to pay for that up-front cost which . . .
MR. D'ENTREMONT: Sorry about that. Just for further clarification on that, claims are now adjudicated electronically. So I think we just have one retailer right now that we cannot use because of a computer glitch, but hopefully they'll be on-line as well, so low-income diabetes people can get their assistance and just basically pay the co-pay, as other Pharmacare Programs would.
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MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I know the residents who are trying to gain access to those products appreciate that, but it still leaves the fact that here we are, a number of months later, when I think this part of the program should have been the first thing to be looked at by government - I mean, here's a program that was deemed to target those low-income individuals who can't afford to get proper product to hopefully fight their disease. So I'm glad to hear that, and I'm sure the residents who are accessing that program are glad to hear that, and I look forward to, hopefully, that program expanding. So I ask the minister through you, Mr. Chairman, do you have the number of how many residents in Nova Scotia are taking advantage of this program, as of today?
MR. D'ENTREMONT: Mr. Chairman, I just want to comment quickly that the question was with this program because it was a very important program for this government and one that we wanted to get going as soon as possible, so we had to make a decision of whether we wanted to wait until the electronic systems were in place or get the medications to the patients as soon as possible. I think we made the determination that we wanted to get the therapies and the equipment, and all of the other things that it pays for, to the patients as quick as possible.
When it comes to how many people are accessing the program right now, I don't have that number, but I will endeavour to have that information to you by tomorrow.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, thank you, I appreciate that. I will definitely look forward to getting that information because I think it's important as an Opposition member that Nova Scotians know how many individuals are gaining access to government programs, especially an important program like this. That brings me to the estimates and some of the lines in the estimates under the detail - it's Page 11.6 in the Supplementary Detail for the minister's information - and under it we see the line for the Assistance for Low Income Residents with Diabetes, and last year's estimate was a $2.5 million investment and, of course, the forecast was there of $280,000. I'm just wondering, could the minister comment on why such a difference in the estimates of 2005-06 of $2.5 million and a forecast or an expenditure of only the $280,000?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Quite honestly, the original budget of $2.5 million had a different start date. We figured we could get it in place sooner than anticipated, sooner than we did, so the $280,000 represents a late start to the program.
MR. DAVID WILSON (Sackville-Cobequid): I kind of figured that might have been it, but I wanted to hear it from the minister. I definitely think that is one of the things we have seen from your government, you announce things but it takes a while for
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you to implement them. An important program like this, I think should have started pretty quickly after the announcement of this program.
So that leaves, I think, about $1.2 million that wasn't used last year, so of course we can take that off this year's $2.5 million - so realistically I think government is investing about $1.8 million for this year's program.
Now I see that the estimate for this year was the same as the estimate for last year's start-up of this. What do you anticipate the use of that fund this year? Did you take into account potential growth in residents taking advantage of this program and possibly going over budget, or have you estimated a high ceiling on the cost of this program over a year?
MR. D'ENTREMONT: Mr. Chairman, the $2.5 million represents the annualized cost. As we set up a program, we would of course do some research to find out what uptake would be - uptake means over a number of years - and that research showed us that this would have an annualized cost for the first year of about $2.5 million. Of course, the expenditure of $280,000 basically represents a bit of start-up and the utilization.
We do estimate though, over a 10-year period with the extra uptake as it would go along, that we would probably see a total program cost of somewhere near $9 million.
MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. I know the minister said he would get me the information on how many residents are using or taking advantage of the program now. When the start-up of this program was initiated you must have used a figure of what you thought or guesstimated how many residents would use this program. So does the minister know, when they did the estimates for this year, what they projected would be the number of individuals in Nova Scotia taking advantage of this program?
MR. D'ENTREMONT: We are still trying to get that information, but I know when the research is done you look and see what the uptake is, see how many low-income diabetics we do have in the system, what the projection of new cases will be and what the projection of the cost of drugs will be. We will get the final information for you to make sure you have it correct, but it does represent, as I said, over the next 10 years, in about 10 years' time it will be about a $9 million program.
Also, Mr. Chairman, as people apply and they qualify, they will belong to the program.
MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. It is my understanding, and maybe the minister could correct me, that there was some kind of a review done of the program, is that correct?
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MR. D'ENTREMONT: There was a fairly extensive review done by Pharmacare people within the department. Looking at other jurisdictions to see what the uptake was in those areas too that have similar populations and similar programs.
Like I said, we will try to get that information to you on the uptake, maybe what the projection of that uptake will be this year, next year and into the future. Again, Mr. Chairman, as we estimate what the number is, I can assure all members in this House that should people apply, they will be covered.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I look forward to receiving that information, and hopefully a copy of what the findings were in that review. I hope and I encourage the government, the minister, to promote the fact that we have this program. These low-income individuals in our province aren't sitting in front of computers and don't have access to papers and stuff, they're struggling with their daily lives. I hope that all effort is made to make sure you reach those individuals through community groups or through community services, or any other groups in the province to ensure they know about this program, and they can take advantage of it.
What I'll go to now, Mr. Chairman, is around Emergency Health Services, EHS, a few questions around there. On the next page in the Estimates Book, I'll use some of the lines under Emergency Health Services on Page 11.7. I had a question around the Ambulance Subsidy - Payments. Last year the forecast was $61 million, and this year the estimate is around $63 million. So it's an increase of about $2 million. What is that $2 million increase for? Can the minister give some information on the $2 million increase from this year over last?
MR. D'ENTREMONT: Mr. Chairman, most of what you see there in the increase would be contractual obligations for increases. We look at the 2005-06 paramedic wage settlement; the contractual increase in the ground ambulance - also within that you can talk about the fixed-wing contract, some backup costs that were required there - some contract increases for LifeFlight; of course, aviation fuel increases, because they are a global piece in there as well; set-up costs for the paramedic college; as well as some additional pieces, Trauma, EMT program, and other things held within that program. So they do talk about mostly contractual items within that system.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, why I ask that, because it doesn't seem like it's a huge increase, especially around the fact that - and I don't know if the minister is aware of this, but the paramedic contract actually expired last year. So I know in the coming months, hopefully, we'll see some evolution of that contract being signed. So has the minister taken that into account? Has EHS come to the minister and his department and stated that we have the paramedic contract due to be signed, hopefully, and ratified over the coming months?
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MR. D'ENTREMONT: Mr. Chairman, to the member opposite, assure him that funding has been put aside for that contract talk, to be making sure the amount of funding is there. All labour negotiations, as they go forward, are held centrally through, I think, the Treasury and Policy Board for movement within each department as those contracts come available. It's very difficult to say how any one piece of negotiation will come out so it's held centrally and not directly within the budget of the Department of Health.
MR. DAVID WILSON (Sackville-Cobequid): Hopefully, the minister recognizes the importance to continue to recognize the paramedic profession in the province, especially after one of his answers to the question, I think yesterday, around the closure of emergency rooms and the lack of emergency room physicians in areas of this province. The minister stated that one of the directions that the community uses is to call 911 and that, of course, is the paramedics who are on standby throughout this province. They play an important role and I think we need to continue to recognize the service they provide on a daily basis, but also the additional service like being dispatched to an emergency room that is closed. It has been going on for many years and they're more than pleased to provide that service for the residents of their community.
[4:30 p.m.]
Under the next line it caught my attention, around the Communications and Dispatch. The forecast last year of $2.8 million and this year $1.6 million, which is a reduction of about $1.2 million - and I know the member for Hants West, I believe, may be interested in this where he is newly elected and it comes from the communication and dispatch portion of EHS - so I'm wondering, why such a reduction in that line this year in the estimates for that Communications and Dispatch?
MR. D'ENTREMONT: Mr. Chairman, to show the change in that and why there's a decrease, it basically represents that we had the opportunity to purchase some equipment at the end of last year to bring forward, so it just represents that throughout the year we will be spending less because it has already been purchased in a prior year.
MR. DAVID WILSON (Sackville-Cobequid): Thank you. I guess that's why we're here so we can jog not only your memory, but my memory of what happened - I do remember talking about that.
A couple lines underneath is an area which is very important in the province around Emergency Health Services and that's Medical Quality Control. They play an important role in ensuring that residents are protected from the people who are providing services to them. As a result of quality control we can improve not only the paramedic profession but it's the same in all professions such as the technologists, nurses and even the physicians. We notice last year that the estimate was almost $0.5 million but ended up costing $740,000 and then this year it's back down to just under $600,000. First
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question I guess is, what was the indicator or what happened that had such an increase in the estimate to the forecast of last year's budget?
MR. D'ENTREMONT: The variance between the 2006-07 estimate and the 2005-06 forecast is what I think you're referring to that shows a decrease of $140,000. The decrease was due to a purchase of medical drugs and supplies, so again a prepay from the year prior and an increase of $80,000 for the set-up of the paramedic college. If we're looking at the difference from this year, again the governing body for paramedics, there's about a $100,000 or so increase in order for the operation and the technology and the project manager and those kinds of things for the set-up of that paramedic college.
MR. DAVID WILSON (Sackville-Cobequid): I don't know if I can really figure out what caused that, because I think the minister mentioned the paramedic college in another line item but I'll go on with that.
I want to talk about something that I've talked about in the past around LifeFlight and that operation. It's an important aspect and component to Emergency Health Services here in the province, especially for our rural residents who depend on getting to the tertiary care hospital here at the QE II - not only do our own residents depend on it, but residents in Atlantic Canada. We have a great hospital and it's important in some aspects and some times in medical emergencies to get to the QE II Emergency, and LifeFlight has filled that hole and I would love to see, hopefully down the road, an expansion of that.
We recently had a move that was a bit controversial around the pediatric crew moving from their base out at the airport - which is right next to where the aircraft sits - back to the IWK. I know that falls under the IWK budget line, but I would like to ask the minister if there was ever a review or an audit done since the pediatric team moved from the airport back to the IWK, has there been a review of response times with that move?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman and to the member. In reference to the LifeFlight and the pediatrics team at the IWK, since the move, and there are a various number of reasons why that team was relocated back to the IWK, and it really has a lot to do with maintaining their licences and making sure that they have the clinical time in order to do their jobs and maybe to keep up their skills. I wanted to assure the member opposite that there is a full review happening right now of the air ambulance system, but not only looking at response times, the response times and the quality of service, and a whole plethora of different things.
You know, Mr. Chairman, if you look at the combination of the two programs, the ground ambulance system and the air ambulance system, and I'm going to say it in
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this thing and he came close to saying it, but we do have the best EHS system in Canada, if not in North America.
MR. DAVID WILSON (Sackville-Cobequid): Definitely, I'll say it now, I think we do have the best EHS service in our country, definitely. I hope that when this review is done, it will be made public so that not only yourself can evaluate it but Opposition members can evaluate it to make sure that was the right move. I'm still left wondering if it was. I know that the minister mentioned that it was due to competency and ensuring that the members of that team are fully trained and get the exposure they need to continue on to provide a great service. But to be totally honest, Mr. Chairman, the agreement that was set up originally when LifeFlight started, we wouldn't have to worry about that because the agreement had these members of this pediatric team putting a portion of their time at the airport and a portion of their time at the hospital.
But that was never happening, Mr. Chairman, because of course they didn't have the numbers to put out at the airport to fill all the shifts. I don't know who's truly at fault at that. I think government should have ensured that the original agreement that was set up was followed, and I don't think we would be here today discussing the movement of a pediatric team from being stationed next to an aircraft into the IWK.
So I would like to ask the minister, you know, I do have concerns. I know a review is ongoing, I believe he stated, but I do have concerns that we don't see the same thing happening with our adult crew that is maintained out at the airport right now who are presently on call waiting for an emergency somewhere in Nova Scotia. So I would like maybe some assurance from the minister that the adult crew isn't being looked at as possibly being moved to maybe the QE II or Dartmouth General to maintain their credentials when they hopefully will provide great service at the airport and give good response times.
MR. D'ENTREMONT: Mr. Chairman, I would have to check on the status of the adult team and the responsibility on that because I'm not quite certain at this point. Let me also tell the member opposite that the EHS medical directors are still tracking the missions and since the move there has been no change in LifeFlight's ability to respond and has had no impact on patient safety as of yet. So we are monitoring still quite closely from those medical directors at EHS. Also to bring to the attention of the member opposite from a previous question in regard to the low income diabetes program, there are 1,308 people receiving service from the low income diabetes program as of June 16th.
MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. I will emphasize the fact that the adult team for LifeFlight actually is quite busy, and I think the minister has to do everything he can to ensure they are there, ready to respond to an emergency in our province. As I said before, the majority of their calls are to rural
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communities but, also, the adult team provides service around HRM with scene landings. They frequently, if there is a bad accident, say, on the way to Windsor, on the highway, will actually respond to there where it could take you, say, from St. Croix to Halifax, 40 minutes with your lights and sirens on, where the LifeFlight crew could do that in, I think, a tenth of the time. So, it is an important service that I think I need to emphasize that should remain at the airport, and I look forward to the report.
Now I will turn to an area that we hear about a lot, that I bring up a lot in Question Period, and one that I know the minister and all government members hear about, and that is around wait times in Nova Scotia. I provided the minister with a copy of the operational measures indicators, because I will refer to that for a few minutes, around some of the issues and the benchmarks and the targets that are in place to hopefully be a guide to provinces to be able to meet those requirements and those targets, Mr. Chairman. When you read through it, I don't know if Nova Scotians have seen this, but it is very scary when we look at wait times, in general, for all aspects of health, it is very scary.
I would like to touch a little bit on some of them now. The first one is around the percentage of emergency patients leaving without being seen, Mr. Chairman. The benchmark for this is around 2 per cent. So 2 per cent of the population who go into an emergency room and walk away, that is the benchmark. I have talked about this before. I will mention some of the numbers for Capital Health. I don't have the numbers for all regions, but I know these are the most significant ones that are quite high, actually. With this, we can look back to February 2006. I know there is a new report coming out, I believe, this month, any day now, and maybe we will get it before the end of estimates and I can reflect on those.
For the month ending February 2006, we look at the Dartmouth General, that has 7.6 per cent of their patients who go into the emergency room to be seen, walk away. At the Dartmouth General we have slightly lower, 4.7 per cent. So they are a little closer to the benchmark - people who go to the Dartmouth General to seek some assistance from the Emergency Room end up walking away.
The most interesting numbers, which I have great concern with, are the numbers at the Cobequid Health Centre, the community health centre that is in my riding, that services well over 100,000 people here in HRM, had a percentage of 12 per cent in February, and the target is 2 per cent.
If we look back a year ago, that has doubled at the Cobequid Health Centre. It was 6.7 per cent last February 2005, and now it is 12 per cent. This is an emergency department that is only open from 7:00 in the morning until 10:00 at night. So my question is, when you look at these figures and you hear time and time again from government that we are going to increase spending in health and try to address some of
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the wait times, what is the minister going to do, or what is he doing to try to address these wait times, especially at the Cobequid Health Centre, when there is a 12 per cent walk away, when the target is 2 per cent?
MR. D'ENTREMONT: Mr. Chairman, it is interesting to quote that kind of report and that kind of wait time. It is really not an indicator of wait time. It is a concerning issue to have people walk away when they require care. The indication, when we talk about that, is these are very much so less acute. You really have to also take in what people's expectations are and what they feel they should be waiting for certain things. It is something that concerns us and it requires a lot more oversight in the next bit.
The Cobequid issue being so high, I think, is really attributed to a new facility. You know, being unfamiliar with the facility, being unfamiliar with the services and the actual utilization as it went up, and we need to make some adjustments there but, Mr. Chairman, I can assure all members that this is an indicator of CDHA, it's not necessarily an indicator of all other ERs as well. There are different utilizations across the province and the 2 per cent is something we strive for but, of course, it depends on the day, the acuteness of the items and, of course, expectations of those patients. If we look at true wait times and how long they're staying in the ER, I think that's something that we should be trying to address.
[4:45 p.m.]
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I appreciate the comments from the minister but, you know, we don't have to look back too far around the Cobequid Health Centre, if we just look back in October 2005 when the new facility wasn't open yet, the walkaway numbers or percentage was 11.7 per cent. So it was almost the same and, to tell you the truth, it probably is even higher now with the new facility because, yes, I've talked to many of the staff there who have seen an increase in residents who have normally gone to the other two areas, the Dartmouth General Hospital and the QE II, who are now trying to go to the Cobequid Health Centre because they maybe assume that with the new facility that things will be quicker but, I tell you, that's not the case.
I know the minister had mentioned the acuity level or they may not be as severe or as high as, you know, the people who go in there may not need the full service of an emergency physician or an ERP, but that takes me to another chart in this report around the average emergency wait times for Acuity Level 3 patients. These are patients who need urgent medical attention. They have a serious issue or serious problem that needs to be addressed and the target for that is within, I think, 30 minutes by a physician. So if you come into an emergency room here in the province, they give you an acuity level and one is the most severe where, you know, you need medical attention immediately or
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the possibility of death is very likely and, of course, Acuity Level 5 is those less urgent, someone who might need some stitches or have a sprain.
So Acuity Level 3, they are in need of medical attention and they have targets they have set up that they need to see a physician within 30 minutes. Those wait times are astonishing also, Mr. Chairman. We look at the Cobequid Health Centre which fortunately is one of the lower of the three that I'll mention, is about 101 minutes that an acuity level patient waits in the emergency room after been triaged, to the time where they see a physician. The Dartmouth General Hospital is about 114 minutes. So they're a little bit higher than the Cobequid Health Centre where they wait 114 minutes before being seen by a physician after being triaged by the nurses at Dartmouth General Hospital, but the QE II is 144 minutes and they go in, that's after you've been triaged by the paramedics at the QE II, to the point where you see an emergency room physician and the target is 30 minutes.
So there's another indication of a problem we're continuing to see when you look at Acuity Level 3 wait times, when we look at patients leaving without being seen. So when it comes to that, I wonder if the minister could elaborate why he thinks those numbers are so high and is it really realistic for this government to expect to meet the targets of 30 minutes for when we're dealing with patients who have Acuity Level 3 who are trying to be seen by a physician in the emergency rooms here - I know I said three local hospitals, but in Nova Scotia?
MR. D'ENTREMONT: Mr. Chairman, you know, the reasons for long wait times, especially in an emergency situation, can revolve around a whole bunch of issues of why. Time of day, the actual amount of people who are sitting in the waiting room and, you know, how busy it is, whether or not there are some people waiting to get bumped up into a bed and maybe the unavailability of that at that time because of either ALC or other issues happening in the at that time.
Mr. Chairman, I can say that this is a challenge for us to (a) find the root causes, and (b) to have solutions for them. Sometimes they revolve around, of course, what we have been talking about in continuing care and finding places to move some of these alternate level care people on to facilities where they require having more physicians and nursing staff. Also to the point, as I said in one of the questions earlier, we have the second highest physician-surgeon ratio in the country yet we seem to have a discrepancy in the amount of time people are waiting for minor procedures, and ER visits.
Level three, of course, revolves around bleeding, some respiratory, and those types of semi-serious ailments. So it does concern us that it is 133 minutes, I think, for Capital Health. The unfortunate part is that it's not a bad wait time compared to some other facilities around the province. So we have a true challenge right across the province to make sure we have those wait times down to a place that is acceptable, and I have to
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say medically acceptable. We need to find what that time is. I think the benchmark reflects a medically- acceptable time.
I'm sure that even when I have to visit an ER at some time that I would like to be seen immediately, but we know full well that it can't happen, depending on the acuity of your ailment as you visit there. Which brings us to the point that we need to have a better analysis, I think, of primary health care within the province and having opportunities for patients to visit places other than ER's. In some cases you can get your stitches and treat whatever your minor ailment might be in other facilities, whether they be some kind of primary health care, it might be a community clinic. I think those are the things that we have to be continuing to focus on to take some of that load off of our true emergencies and let them be true emergency centres to deal with the one, twos and sometimes threes, but to have those fours and fives dealt with outside the system, which does create lots of blockage at those facilities.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I appreciate those words, and I was anticipating the minister to come up with a few more reasons why we see such times or waits in our emergency room. He did say one important word is beds - waiting for a bed, and I was hoping that he would continue on with that. I think a large portion of this, and I've said it in the past, I know the previous Minister of Health and the one before him had often stated that the crisis we see, especially in the emergency rooms, isn't a bed issue. I get so frustrated when I hear that, because that's the case - it's a bed issue.
Many of the problems we see - and I could still go on and talk about diagnostic procedures, the wait times for those, we're nowhere near the benchmark. I could go on and talk about elective CTs, the wait times are nowhere near the benchmark, I could go on to elective MRIs, we're nowhere near the benchmark. A lot of these stem from the fact that we can't do them because we have nowhere to put these patients if they need to stay in the hospital.
It's a domino effect, and it brings me to the long-term care issue that we see in this province. It has been neglected for far too long, and we're seeing the repercussions of this right now in the wait times, in our emergency rooms, in elective surgeries. We're seeing the problems because that area of health care - long-term care and continuing care - has been neglected not only by this government, I believe, but by the previous governments before that. They didn't have a vision of realizing what we're going to need in the future, and we need long-term care beds now.
I know the government has a 10-year plan, Mr. Chairman, but in 10 years, God knows what we're going to need at that time. There's no way you can tell me, there's no way the Premier of this province can tell me that they know what they're going to need in 10 years. I just don't believe it, I don't think many of the members in my caucus would
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believe it, and I don't think many of the residents of the province would believe that they can predict and try to manage what we're going to need for long-term care 10 years from now - we need them now. That domino effect goes right back into the communities, it starts with those individuals, those Nova Scotians who are in the hospital for some reason or other, had a fall, maybe an increase in a dementia that they may have, and they realize they can't take care of themselves now and there is nowhere for them to be placed. They are put on a waiting list for a long-term care facility.
Well, a hospital is not a place for an individual who needs other services. It's great when you need emergency services, you need a medical service, that's great, we have great hospitals in the province. We have great physicians, surgeons, technologists - health care professionals will provide that - but a hospital is not the environment that these individuals need the care from now. They need to get into a long-term care facility or a small options home, where maybe they can have interactions with other residents. That's what's missing when you have these individuals laying in hospital beds on floors throughout this province.
It's deemed a hospital for medical treatment, not for treatment of our seniors or our aging population. They are missing a huge ability to hopefully improve where they are in their lives, and I think that improvement comes from that association with other residents, with their family members coming in and visiting with them, taking them out of, say, a long-term care facility to somewhere around the community, or even just outside into a garden. That's where we need to realize that we need to work quickly, not in 10 years.
I know that the minister has stated that in four years the majority of these beds will be built, or the new facilities will be built, but we are in dire need of them right now. I don't have to point too far, I point to my own riding and my surrounding riding, Mr. Chairman, at a long-term care facility that was deemed necessary, I would say 15 years ago, before this government. I remember them talking about certain locations in Sackville that were going to be looked at as a long-term care facility. Here we are now, 15 years later, still waiting in that community for a long-term care facility.
We have patients or residents in my own community who are living quite a distance - it may not be the 100 kilometres that some of the rural residents have to endure. But I tell you, when you have someone, an elderly person living in Sackville and their loved one is in Cole Harbour at a nursing home, or in Eastern Passage in a nursing home, they can't get there if they don't have a vehicle or other members of their family, they can't get there enough to see their loved ones. So it is an issue here in HRM, it's an issue in the rural parts of our province and I think we need to encourage government to step this up. I think the residents will let the government members know, let the Minister of Health know that yes, it's good to see that you have a plan now, but I think you need to make that plan roll out a little quicker and that we need to start addressing those needs.
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As I say, that domino effect, we have that patient who is now lying in a hospital bed and now you have someone who may have been in the emergency room who now needs to be admitted to the hospital, who can't be admitted because there are no beds upstairs to go to. What does that do? There is a patient lying in an emergency room bed, which was deemed to provide emergency services, emergency care - and they are meant to see many patients. So that one bed in the emergency department now is tied up by individuals for hours on end and even for days on end.
I know the member for Pictou East was telling us earlier in the week about somebody in his riding - actually, I think it was a family member - who was in the emergency room for three days. That is just not the place to be when you're ill and you need other services other than those in an emergency room. Mr. Chairman, I have been in the emergency rooms thousands of times and you don't get any rest there, you don't get any interaction with staff on a level that you would have on a floor in a hospital. It is a fast-paced environment where you have people dying in the next bed. People die in the emergency rooms in Nova Scotia, and here you have a patient who, days prior, should have been up on a floor to try to get well and hopefully get out of the hospital.
I think our goal is to not be in a hospital. It costs this government and taxpayers hundreds and hundreds of millions of dollars to occupy a bed in a hospital. So, as I said, it's a domino effect. Then you look at the emergency room. Why do we have patients leaving the emergency room because they can't get in to get the care they need and the care they expect? I've heard a lot of people say if you're an acuity level 5 or 4, you probably shouldn't be in an emergency room.
[5:00 p. m.]
Mr. Chairman, we can't cast judgment on an individual who, in their own life at that time, their own environment, believes that they're going through an emergency and they need the assistance of a doctor and they end up at the emergency room. We can't have that mentality, and we need to give them every opportunity to seek that help they need, or seek the assistance of a physician that they need, in a timely manner. That domino effect goes right out the door into our communities because not only if there's a wait in the emergency room, you have paramedics, ambulances that go to an emergency call in the community somewhere in the province and end up in our emergency rooms.
I'll use an example of the QE II. Many times as a paramedic I would end up there with a patient and we were unable to transfer that care over to the emergency room staff. Policy states that the paramedics treat that patient; that patient is under the care of the paramedics until that transfer is done and complete. So we have paramedics now - and myself, taking a leave three years ago, the wait for me on average was half an hour to 45 minutes, an hour would be excessive, but I can tell you, Mr. Chairman, to the Minister of Health, right now we have paramedics going to the QE II, for example, and they are
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waiting four hours with a patient on their stretcher to do that transfer because there are no beds. Why are there no beds? Because I believe that domino effect, if you look right up through the system, is that we have too many people in the hospital and not enough beds.
So you look at some community somewhere in the province that is now without an emergency vehicle - what happens if it happens on a night where the emergency room is closed in one part of our province? We have one paramedic or one ambulance crew covering that emergency room, we have more ambulances being delayed at emergency rooms in others. So we have a systemic problem throughout, where people aren't getting the service that I think they deserve and need.
I know I've gone on a little bit longer, but it's important that we recognize that it's a bed issue and, you know, one of the main things we've all heard during the campaign, and we all campaigned on, was long-term care. That's an area we need to start addressing. We need to look at supporting continuing care and long-term care, and I know the government has a plan but, as I said earlier, Mr. Chairman, it's over 10 years and we needed a plan probably 10 or 15 years ago. That's what has been lacking in this province, is a plan and an avenue, a road to go down, to start addressing the needs of our aging population.
I don't know the figures, but in the next several years the number of our population over the age of 65 is increasing by large amounts. I think when that happens we're going to see ourselves in a tough situation, and I hope I'm still here representing my area, fighting hopefully - maybe by then we'll be on that side of the Chamber - but I can tell you, through you, Mr. Chairman, to the Minister of Health, if they don't start addressing this issue soon about beds and long-term care in Community Services, their numbers are going to continue to drop. We will more than welcome more members to our caucus so that we can provide what we believe is a good plan to address continuing care and long-term care in Nova Scotia. So with that, I'll give my time to . . .
MR. CHAIRMAN: The honourable member's time has expired.
The honourable member for Glace Bay.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, again I welcome the opportunity to continue asking some questions of the Minister of Health and his department. If he could look at Page 11.4 of the Supplementary Detail, under the heading of General Administration, the department has grouped together all of the executive administration under one heading. In previous budgets each of the offices and general administration was provided in greater detail. So, I'm asking the question, why has that been done?
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For instance, in the 2005-06 budget, the estimate amount for General Administration was about $2.3 million; in the 2006-07 budget, the estimate amount provided for 2005-06 is just over $3 million, which is about $71,000 higher. My question is, what has been added to the estimate amount presented in this year's budget to make the 2005-06 estimate figures completely different? Just a clarification.
MR. D'ENTREMONT: Mr. Speaker, just to clarify, could you say which page you are referring to?
MR. DAVID WILSON (Glace Bay): Page 11.4.
MR. D'ENTREMONT: If we look at Page 11.4, I know he's referring to General Administration, which is the top line which shows the estimate of $2.939 million - is that what you're referring to there? Then underneath, you can see Chief Finance Office, Chief Information Office, Chief Health Human Resource Office, Chief Policy and all those separate offices as they were laid out - Acute and Tertiary Care, Mental Health Program, Continuing Care - are all separately listed below it. You wanted clarification for General Administration?
MR. DAVID WILSON (Glace Bay): The 2005-06 budget, the estimate amount for General Administration was about $2.3 million - correct? The estimate amount provided went up to $3 million which is just over $71,000 higher. So, I'm asking, what has been added to make the two figures different?
MR. D'ENTREMONT: Okay, we're getting there. If you look at the estimates 2005-06, you're looking actually at a decrease there of tens of thousands of dollars. The estimate of 2005-06 was $3.047-whatever million and this year we're looking at $2.9 million so we're looking at a decrease from last year.
There was a decrease in the communications officer positions, executive director, education renewal, I believe. There was a transfer of Secretary III, some miscellaneous expenses of about $40,000. So, the transfer of Secretary III would show about $49,000 and the communications executive director, education renewal was deleted, I believe, a position we didn't require from last year to this year.
MR. DAVID WILSON (Glace Bay): Maybe I'm not being clear enough. An estimate is a figure that should remain identical so that government is able to determine how much under or over budget it is in one particular office or budget area at the end of the fiscal year. So, when you estimate the amount at $2.3 million and the forecasted amount is $2.8 million, that would appear that you're over budget by about $500,000. Am I right? Again, from changing the estimate number for 2005-06 in this year's documents, you're actually giving the appearance that you underspent by about $200,000. But I want to know why the two estimate numbers for 2005-06 fiscal year are not
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identical in the 2006-07 budget documents. So has your General Administration budget increased by $0.5 million over last year? If it has, then in what areas of general administration was the increase? Any clearer?
Mr. Chairman, in the interests of not wasting too much time, perhaps the minister can get back to me at a later time. It is just a clarification matter of some figures there. I am not accusing the minister of hiding any money or anything, well, you can never tell.
Mr. Chairman, let me turn your attention then, please, to the estimate amount for communications. In the 2005-06 budget under Communications, it increased by about 29 per cent to almost $800,000. The entire communications budget for the Department of Health has increased by 116 per cent since the year 2000. This year the amount that is budgeted for communications is not being provided. So could the minister please indicate how much is budgeted for communications in the 2006-07 budget?
MR. D'ENTREMONT: Mr. Chairman, I am going to be quite honest with the member opposite, we are having a tough time trying to find the lines that you are speaking of, so if you would just bear with us here for a second. On communications, could you reference the page and line?
MR. DAVID WILSON (Glace Bay): Mr. Chairman, again, it is an item and if the minister wants to get back to me, that is fine. I have it noted in my notes the exact line item but it is under Communications. There is nothing there. This year the amount budgeted for communications is not provided but if the minister has found that information now, then perhaps we could hear from him now.
MR. D'ENTREMONT: One thing, now that we are trying to get ourselves in line here, and I apologize to the member, we were carrying one communications officer for the Seniors' Secretariat for some time and I think we still hold that one. I will endeavour to get that information to you, to give you an outline of the communications requirements and why the numbers are not quite in line.
MR. DAVID WILSON (Glace Bay): Just to give the minister a general idea of what I am looking for here, how do you increase the budget for communications by 116 per cent since the year 2000? Surely one employee isn't making that much money. I don't think within the Department of Health, not even the deputy minister gets paid that much. So if you could give me that information.
Let's change the focus a little bit, then, if you would please, to Addiction Services, Mr. Minister. This one is on Page 11.2 of the budget. You indicate that you are providing additional funding to maintain the Capital District Health Authority's methadone treatment program. Direction 180, I think, is the name of that program. The overall budget though for Addiction Services in the Capital District has decreased by just
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over $1.8 million. Almost a $2 million decrease. So even though you provided increased funding for Direction 180, the funding has decreased. So I'm asking the minister, what has been cut because of that decrease in funding?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, the decrease which shows is the transfer of the CHOICES Program to the IWK. So it went from one district to another district. So it doesn't represent an overall decrease in the program, just simply one program got shifted to where it belonged, to the IWK.
MR. DAVID WILSON (Glace Bay): What's the reason for that? I need a little bit further explanation, Mr. Chairman, if I could, from the minister, and the reason why. Why that reduction and where did it go again, please? I didn't quite follow that.
MR. D'ENTREMONT: Mr. Chairman, we had the program, the program for mental health. I think that's what you're referring to there, and showing the decrease in the program. If you look at, I believe, the transfer of the CHOICES Program, which is an adolescents program that got transferred to the IWK. So you'll see an increase of the same amount in the IWK Health Centre budget of about, I'm not too sure of the total amount. We're just trying to get those numbers. Anyway it's the transfer of that CHOICES Program, which is an adolescent mental health program, from Capital District to the IWK under the mental health programs.
[5:15 p.m.]
MR. DAVID WILSON (Glace Bay): Mr. Chairman, Mr. Minister, in every other district throughout the province, you've seen a very small increase, in the vicinity of maybe between $8,000 and $14,000 increase. Cape Breton District had an increase of $38,900, and I'm wondering, does that enable the Cape Breton District to continue with an adequate methadone treatment program, especially given the challenges that they've had in that area, in that district with the abuse of OxyContin?
MR. D'ENTREMONT: From the deputy minister, I'm fairly confident that the $38,000 does represent the regular increase that was asked for by the facility to administer the methadone program, plus I know there are some ancillary costs that were required for that program.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, Mr. Minister, until very recently, this province did not have an abstinence-based treatment program for addictions, but recently after years of hard work by a group of dedicated volunteers, the Crosby Centre has opened its doors. Prior to the Crosby Centre reopening, some residents of this province were being sent to Ontario, or British Columbia. My question to the minister then is, how much will this centre save the province, in terms of enabling Nova Scotians to get treatment here at home?
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MR. D'ENTREMONT: Mr. Chairman, I think the numbers that the member opposite is asking for would be very difficult to ascertain. Because of course it's the choice of the patient whether they go to a private system as the Middleton one provided and those kind of treatments, to what's being offered today through the district health authority in that facility that the member refers to. Simply, we're trying to increase the financial dimensions of that budget and I think we've seen an increase right now of mental health and addiction services a fair amount - a total of about $4.7 million, to try to catch up to where we belong.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, the minister is saying that's a difficult figure to come up with. So, if you can't tell me how much that centre is going to save the province in terms of letting Nova Scotians get treatment here, then how much did your department spend last year sending Nova Scotians out of province for abstinence-based treatment?
MR. D'ENTREMONT: We did not pay to send patients out of province for that kind of treatment, so we wouldn't have tracked those kinds of numbers.
MR. DAVID WILSON (Glace Bay): I'll ask the minister, who paid for it, then, Mr. Minister?
MR. D'ENTREMONT: That would have either been paid for by the individuals or through their insurance programs, if they were lucky enough to have one. That was done by the patients themselves.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, let's take a look, if we might, at other insured programs. Page 11.6 of the Supplementary Detail. Last year, when the Low Income Diabetic Assistance Program was announced, the department indicated it would be an $8 million to $9 million program when fully functioning. Last year $2.5 million was budgeted, and $280,000 was spent. My question for the minister would be, patients buying their supplies before they actually get a reimbursement, would that be a reason why there's been such a low take-up on this program?
MR. D'ENTREMONT: Mr. Chairman, that would represent a late start, number one, for the program. Of course we started it in January of this year, which is a few months later than we had anticipated when we created that estimate. It would also represent a lack of knowledge in the community of the program and the actual up-take of it. As we boil it down, through the next year we expect to spend that $2.5 million. I think that once it's fully subscribed to the demographic that we feel is representative of that, it would be somewhere close to $9 million per year.
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MR. DAVID WILSON (Glace Bay): Mr. Chairman, to the minister, is that still the case? Do people who are eligible for that program still have to pay up front and then get reimbursed?
MR. D'ENTREMONT: Mr. Chairman, I'm very happy to report that that is no longer the case. Of course the reasons were we didn't have an actual IT program to use to interact with the pharmacies when it came to paying for this, as in a normal Pharmacare Program. I'm very happy to report to this House that that is no longer the case, except, I think, for one retailer. We're still having some problems in sharing the data back and forth. As it stands today, these folks will be able to get access to that program as they would a normal Pharmacare Program with a small co-pay.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, I'm pleased to hear that. I would also like to know, though, just how many participants are in the program right now, and what you plan to do about marketing that program so as many Nova Scotians as possible can know that that has now changed in the program and that the program is available, to begin with. That's an important change in that program because we could never understand why, in the first place, that program was established under a pay up front and then get reimbursed method. It just didn't make any sense to us. I'm glad to hear it, but how many people are involved in the program right now? And what is the department going to do about marketing that program to tell everyone that it's available?
MR. D'ENTREMONT: I'd like to make three points to answer the question on how many people. Right now there are 1,308 people as of June 16th who are on the system. Secondly, I want to say that we're working with the pharmacies and the physicians themselves to make them aware of the program so they can make their in-patients aware. I do believe there is some information being handed out by the Department of Community Services as well on this aid and it's available across the system.
To the point of why the patients were paying up front, it really boiled down to our contractor or our service provider who was changing systems at the time and did not have the ability to take on the new load. We felt it was important to get the program out there and get the products available to these diabetics so they can keep themselves well. It wasn't the best way to do things, yet I feel it was incumbent upon us to get the program out and get those medications to the people who needed them.
MR. DAVID WILSON (Glace Bay): Under the title of Special Dental Plans, Mr. Minister, according to Page 11.6 of the Supplementary Detail, Special Dental Plans have about a $157, 900 reduction in their budget, why that reduction?
MR. D'ENTREMONT: Basically it represents a utilization decrease of about $173,000. If you look at the way it's laid out, if you look at an estimate last year of about
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$1 million and the utilization of about $798,000, we just suggested that by the right amount because of that utilization decrease.
MR. DAVID WILSON (Glace Bay): Could the minister tell us what's included in those Special Dental Plans?
MR. D'ENTREMONT: That program represents some challenging dental problems that children under the age of 10 would be experiencing. It would include some orthodontic work, braces, those kinds of things and some surgeries required, but it does represent the lowered utilization in that program from this year over last year.
MR. DAVID WILSON (Glace Bay): So the minister is saying that's not actually a reduction, is that what you're saying Mr. Minister, there's no reduction in that program?
MR. D'ENTREMONT: It's not a forced reduction, it's just representative of lower utilization for the program, less people asking for it and less people requiring it. It just represents the utilization that was experienced over the last number of years.
MR. DAVID WILSON (Glace Bay): Okay, Mr. Minister, let me draw your attention to a line item called special programs and let's deal with another reduction you can explain for us as well. There's a budget for $300,000 for Special Programs, that's a $50,000 reduction from last year's budget. What specific programs are included in Special Programs - two questions if you might, what programs are included and why the reduction in Special Programs?
MR. D'ENTREMONT: Special Programs represent annual payments to hemophiliacs. Again, it would be the same issue, the utilization is down on that so it's representative of that utilization.
MR. DAVID WILSON (Glace Bay): You're batting a thousand so far, Mr. Minister. Let's continue under other health care initiatives with another reduction so to speak, until I hear your explanation. If I can direct your attention to Page 11.8 of the Supplementary Detail, it would appear that the biological budget, it appears anyway, has been reduced to zero. Is this the case, Mr. Minister, or has that maybe just moved to another department?
MR. D'ENTREMONT: Mr. Chairman, that would be representative of a transfer to the Department of Health Promotion and Protection. I think you will see that repeat itself a few times throughout our budget, a transfer of programming from the Department of Health to the Department of Health Promotion and Protection.
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MR. DAVID WILSON: (Glace Bay): Just for my clarification, Mr. Minister, as well, is that not the budget from which flu vaccinations and the children's vaccination program, is that the budget that takes care of that?
MR. D'ENTREMONT: If I had a perfect world I would just say yes, but sure, it is the publicly-funded vaccine to children and adults, according to Nova Scotia's immunization schedule in order to prevent vaccine-preventable diseases and improve the health and population through funding provided. It is used to purchase vaccines required to deliver that immunization program. That is exactly what it is, and it has been transferred to HP&P.
[5:30 p.m.]
MR. DAVID WILSON (Glace Bay): On Page 11.9 of the Supplementary Detail, under Other Programs - Grants and Assistance, it has decreased by $884,000. Why the decrease on that item, please?
MR. D'ENTREMONT: Mr. Chairman, I think it is representative of a whole bunch of changes that would probably represent programs that are no longer required and to programs that are being transferred to HP&P. I will endeavour to have that information to you hopefully by tomorrow.
MR. DAVID WILSON (Glace Bay): Thank you, Mr. Chairman. I don't mean to be flippant, but "whole bunch" just doesn't cut it, okay. So maybe I will take that commitment to provide it tomorrow. There are a lot of questions there, whether there are any specific grants or assistance that have been decreased. A list would be good, Mr. Minister, let's put it that way, a list would be helpful.
I would also like to know, is this the budget item that provides grants to community health boards, and have their grants been decreased? Is that the budget item that provides to those boards, Mr. Minister?
MR. D'ENTREMONT: Mr. Chairman, that is not representative of that. The community health boards receive their funding as grants through the Department of Health Promotion and Protection.
MR. DAVID WILSON (Glace Bay): Thank you, Mr. Minister. Under the district health authority budgets, when you look at the DHA budgets, obviously the lion's share of the increases there is going into acute care. In fact, the increases total well over $71 million. Do those increases allow the district health authorities to maintain the status quo or are there some new programs there in those budgeted amounts?
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MR. D'ENTREMONT: Mr. Chairman, the numbers for DHAs, for the most part, are based on their business plans as they bring them forward every year, and their requirements. The number would be representative of contract negotiations and normal increases in operation, fuel charges and those types of things. Also, there are a few new programs that that would represent, and rather than try to dig out each one of those, I would also endeavour to have a listing for the member opposite. As I am reading some writing as we go, things like mental health, primary health care, NSAHO pension, oncology increases. Things like the switchboard for the Roseway, DHA 2, the clinic in district two, wait time funding for DHA 4. There is a list of those and I will endeavour to have those for you tomorrow.
MR. DAVID WILSON (Glace Bay): Mr. Minister, have any of the district health authority budgets been approved this year?
MR. D'ENTREMONT: We cannot approve district health authority business plans without the approval of this budget. So, the answer is no.
MR. DAVID WILSON (Glace Bay): I understand that, but I'd like to know when you anticipate approving these budgets. It's July and we're five months into the fiscal year and I'd like to know, then, does it make sense to you that the DHA budgets should become part of the package that we debate here on the floor of the House?
MR. D'ENTREMONT: Each district health authority, as you see it here, is broken up for that very reason, to be able to discuss them and look at them. Of course, we have to wait for the approval of the total budget before we can say a yea or a nay to any district health authority's budget.
I also want to comment, one of my opening comments was that each district health authority knows they pretty much can go and look at a 7 per cent increase as we have basically said to them year after year. We know they have a tremendous challenge - whether it be wage or other issues. The second point I want to commend them for this year, they're coming in at one-twentieth of 1 per cent of their total budget. Again, I want to congratulate them on that monumental effort.
MR. DAVID WILSON (Glace Bay): While we're on the subject of acute care budgets, it was announced today that surgical and obstetrical services at the Colchester Regional Hospital will be unavailable between July 7th and 10th, tomorrow, due to a lack of anaesthesiologist coverage. Was the minister aware of that specific cancellation?
MR. D'ENTREMONT: Yes, I was aware of that. The department continues to work with Colchester Regional District Health Authority to see if there's something we can do, either a locum to provide those services to the Colchester Regional Hospital.
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MR. DAVID WILSON (Glace Bay): I'm sure the minister will agree this type of cancellation and the shortage in general of anaesthesiologists has been a problem. It certainly hasn't resolved itself and I do recognize the shortage of these specialists is not just a Nova Scotian problem, it is a nation-wide problem. But, I'm wondering if the minister and the department have developed a province-wide action plan that we can use to deal with this issue?
MR. D'ENTREMONT: Some of the things that we have done as a strategy, of course, is to provide the best remuneration that we can. We have come up with certain sharing arrangements in our alternate payment plans to correctly remunerate the anaesthesiologists. I can say to the member opposite, it's a tremendous issue across Canada, if not all of North America. Things that I want to look at over the next bit is trying to find some way to extend them, if there is some collaboration that they can have with other health professionals to provide anaesthesiologist services to offer that to our patients.
We're also looking at anaesthesiologist assistants. Basically it's - I don't know if the professional would be a doctor or a nurse - oh, a two-year respirologist, have some kind of technologist training to be able to assist at different types of surgeries.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, I might ask the minister, as well, while we're on the subject, have you had any discussion with your provincial counterparts regarding this problem, and if so are there any unique programs or initiatives that are being undertaken by other provinces that perhaps would warrant looking into, from a Nova Scotia perspective?
MR. D'ENTREMONT: Mr. Chairman, quite regularly, the people from the Department of Health, the deputy ministers and all those folks, often do meet with their provincial counterparts, as I do with my counterparts, and have this discussion. Like I said, this is a national problem that we have. It's something that we need to get our head around, because what's happening really is that jurisdictions are basically outbidding themselves for these types of professionals. It's something that we have to find a way to stop in order to make sure that we have the correct distribution across the country.
It's going to be very difficult to do that when you have such great remuneration programs, like they do in places like Alberta. Ultimately, we are leading Ontario in looking at our system and trying to have those extenders, to try to find ways to offer better service, and to try to stop some of these closures. Ultimately, it's not acceptable to the patients to cancel their surgeries, especially when some of them have waited so long to get them in the first place.
MR. DAVID WILSON (Glace Bay): Mr. Minister, this is an area that ties in with the overall subject that we've been talking about today. The member for Sackville-
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Cobequid went on at great length about the fact that it ties into ER closures, wait times, some of the big issues that are facing health care these days. We know that these problems are there, we know they are national problems as well, and we know that they exist. What I'm asking, I guess, in general and perhaps even in detail, is what the Department of Health, what you and your department are doing to try to prepare for those problems. How do we tackle them? If you want to be generalized, how do we tackle the problems of ER closures? In this case, the specific detail is for anesthesiologists, again this is not a new problem.
As I made reference in my opening remarks, the whole issue here is one of sustainability. If those problems exist out there and they have existed for a period of time, or years in this case, then what's being done? What are the specific plans to try to tackle these problems?
MR. D'ENTREMONT: To the member opposite, we've been working over a number of years to prepare and to put certain actions in place, with our Wait Times Advisory Committee, the committee has provided us with a number of recommendations. Some of them revolve around certain information technology solutions, such as the NSHIS, to make sure that we have the information that can flow from district to district; also the PAC system, which allowed us to share diagnostic information from one district to another so that the professionals required can see them; and to move on to things like OR scheduling programs, so we can have a better feel for the ORs that are available, the professionals who can provide services in them, and allow our surgeons to travel from one OR to another, so they can provide services on a more regular basis.
MR. DAVID WILSON (Glace Bay): I'm interested, as well, Mr. Chairman, in the minister's comments, when I was listening to his dialogue in debating the estimates with the member for Sackville-Cobequid. The topic of private clinics will always come up in any conversation about health care no matter what area of the country you live in, but in particular here in Nova Scotia recently. I'm wondering where the minister stands exactly. I'm not saying that it was - I'm trying to be kind here, Mr. Minister - a wishy-washy kind of answer that you gave, but it wasn't really something that you could sink your teeth into.
I'm wondering where the minister stands. You did indicate, I think, anyway, that private clinics do have some sort of role to play in health care in Nova Scotia. Am I correct in saying that?
MR. D'ENTREMONT: Mr. Chairman, that's exactly not what I said at all. What I did say is that as we're looking at the total system - and this is not just a Nova Scotia issue, this is an issue right across the country, you know - do we take all options and do we look at them all? I mean I'm not at a point where I want to take any option off the
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table and if it requires analyzing certain public or privately administered programs, I'm not going to throw them off yet.
[5:45 p.m.]
Mr. Chairman, it is something that Brian Postl - the report that just came out on wait times takes a glance at the public and private systems to see if there's an integration of the two, but I have committed and will continue to commit that Nova Scotia, to my point in Canada, will have a public-funded system.
MR. DAVID WILSON (Glace Bay): Although the minister, Mr. Chairman, would indicate that what I said was exactly not what he said, what he said was exactly not what I said at this point in time. What the minister is saying is that private clinics, private health care in this province is an option. That's what the minister is saying. If you're willing to take a look at it, that means you're willing to entertain private health care in Nova Scotia. You've as much as said that, Mr. Minister, that you would be willing to take a look at it. So I think Nova Scotians have a right to know right now and this is the time during any legislative debate, it's over the debate of estimates, that we get a chance to talk to ministers face to face and have them answer in detail exactly what's happening within their departments.
So I would be interested in knowing, and I'm sure a lot of other Nova Scotians would be interested in knowing, is that what you're saying is you're going to take a look at private health care in Nova Scotia as perhaps a means of providing health care to the residents of this province.
MR. D'ENTREMONT: Mr. Chairman, quite honestly, you know, as we look at wait times, as we look at the health care system in this country, I don't think it's fair to Canadians or Nova Scotians to take anything off the table as it stands today. So if there are options there that (a) make it sustainable, (b) make sure that patients receive the care that they require and (c) is funded by you and me, the taxpayer, then I think it is incumbent upon us to look at all those options.
MR. DAVID WILSON (Glace Bay): Well, Mr. Chairman, exactly as estimates work and they're designed to do, you ferret out the truth eventually. That's what estimates are all about and the truth is here, now, that you have a government that is admitting through it's Health Minister that they are willing to establish a private health care system in this province. That's exactly what the minister just said. The minister said anything is on the table and private health care is there as anything. So the private clinics that all the furor came up about over the last number of years, and all the concerns that were there about queue jumping and about human resources going over to private clinics instead of being in the public health care system, the minister is now saying, well, that really doesn't matter. All the minister is saying is that if we have to look at private health
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care, we will because that perhaps is a good way of spending tax dollars in this province and is the minister going against just about everything that this country stands for in terms of public health care?
Now the minister is saying that that's no longer the ethic of this government, of this province, but you're looking at private health care now and eventually Nova Scotians will be forced to pay for their health care, Mr. Minister?
MR. D'ENTREMONT: Man, I think I should try to find a better way to explain this one because I think I'm going to continue doing it for the rest of the evening by the looks of it. What we're trying to explain is that we want a publicly defined system, a publicly funded system. If there are private issues in there to deliver the service, then I think it would be incumbent upon us to look at all those options.
Ladies and gentlemen, Mr. Chairman, I think as we look at the rise in cost of health care, the challenges in providing services, that I think it would be kind of silly not to throw things off the table. So I will continue to say we are looking at a publicly defined and a publicly funded system that all Nova Scotians can access health care. There might be some tweaks that we might have to do with the delivery system and I know that I'm in peril of more questions on this one, but that's fine. I believe that in order to address the system, we might have to change the system and I'm not going to throw anything off the table at this point but I'm going to say once again, publicly defined, publicly funded. I'm not saying anything about private pay.
MR. DAVID WILSON(Glace Bay): It's a great debate, it's one that is held across this province at many times, but when you say that you're not talking about a private health care clinic, then you are talking about private health care clinics because you're saying you'll look at anything. What I think Nova Scotians would be looking at from you and your government would be that they can have access, they can have public health care that will be there guaranteed no matter what. I don't draw that from what you're saying. What I draw from what you're saying right now is that you've got a system that's in dire straits, you've got a system that eats up more and more money every year - 8 per cent this year, it's $2.8 billion.
Mr. Minister, you know how much, we all know how much of a drain that is on the public purse. We all know that it's approaching 50 per cent of our entire budget in this province and we all know the challenges that face the health care system on a daily basis. At the same time, Mr. Minister, don't stand in this House and say that you're not thinking about private health care. You are thinking about private health care and you've just said it because you're prepared to take those questions, as you just said, and many more that will come, based on that alone, that there's going to be some form of a private health care system in this province, some form of a health care system that will deny treatment to those who can't afford it. That's what I'm worried about.
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I think that's what a lot of people are worried about in this province, whether or not they'll have access to health care in this province and that it won't cost them a cent regardless of their income, that they will have access to public health care. That's a major worry of anybody in this province and I'm looking for a guarantee from you right now, since we brought up the subject, a guarantee from you and your department that there will never be that kind of a system in Nova Scotia. There will never be a system where you have to pay to get treated in this province, that health care will be free and accessible to each and every Nova Scotian in this province from this day and thereon. Mr. Chairman, I would like that guarantee from the minister today.
MR. D'ENTREMONT: I'm glad I have the opportunity to have this discussion - let's put things on the table. The Opposition seems to be here criticizing the growth in health care and the critical point that it's in and the problems that we're having, yet they seem to feel you can't put anything on the table. Mr. Chairman, I'm going to say that we're going to continue to be consistent, continue to be consistent with the Canada Health Act, we're going to be consistent with publicly defined and publicly funded health care for all Nova Scotians. I will commit to that, I can't commit forever because I won't be here forever. While I'm here I will protect Nova Scotians and I will protect patients and everyone in Nova Scotia that I possibly can under a publicly funded system.
MR. DAVID WILSON (Glace Bay): Mr. Minister, if you bring in private health care in this province, you won't be here forever, you won't be here much longer, I can guarantee you that. You know that as well as I do, because you know what people think, you know what people say at the doorsteps during elections, you know what some of the main topics are and you know that health care is always number one. It's always a number one concern of Nova Scotians that people who wouldn't be able to afford treatment, in that kind of a system, get treatment in this country and in this province. Mr. Minister, you know that as well as I do. You can shake your head all you want, but what you're talking about right now is introducing a two-tiered system in this province: one for people who can afford to pay it and one for people who can't. Mr. Minister, you know that, you've said that here today. I think that's an absolutely shameful statement, Mr. Chairman, an absolutely shameful statement.
MR. D'ENTREMONT: It's funny how this discussion has sort of degenerated to the point of cat calls and accusations, and those types of things. What I am saying here again, and I'll say it one more time, is we will have a publicly funded system for all Nova Scotians. So no matter who you are, where you live, what your educational background is, whatever it may be, you will have access to the health care that you need, when you need it. How that is delivered, is the one that I say that we need to be looking at because of the costs and the escalation. The member opposite can stand there and say, you know, it's not sustainable to grow by 8 per cent a year. It is not sustainable to continue to do it the way he does, yet he can't consider any options. How can you possibly do that?
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MR. DAVID WILSON (Glace Bay): Mr. Chairman, it's not that we're not considering any options. The whole purpose of the last couple of hours that the minister has been questioned, over the last three hours, has been going over estimates and what you can do and different programs that can be provided to try to make the existing system better. That's our purpose and that has always been our purpose here in this House, Mr. Minister. But what you've said, and you're not denying it, you said that you're willing to put anything on the table. Anything. As long as you say that you're willing to put anything on the table, then I'll say again, to you, you're willing to entertain any kind of system, which would include a two-tier system, which would include more private health clinics in this province, and as you said it, maybe a different way of delivering it, but you can be guaranteed that Nova Scotians will be charged for that delivery, and that's where my argument is coming from.
That's my argument because I'll say to you that that's not the system that most Nova Scotians want, and I'll be quite glad to - it's a great debate. I agree with you, but you've said what you said, and what you've said is that you're willing to entertain private health care in this province. You'll take a look at it and, Mr. Minister, you'll live or die by those words, but they'll be there. They'll be there in the future.
Mr. Chairman, may I ask just how much time I have left, please.
MR. CHAIRMAN: The honourable member has member has approximately two minutes and a half.
MR. DAVID WILSON (Glace Bay): Thank you very much. Let me ask, I have no reason to continue, but I'd like to give the minister an opportunity, I was going to ask before we got into that debate, just exactly what his exact plan was, and I've asked for it already, today and yesterday. I'd like to know his exact plan, how he intends to deal with the problem that we have in this province over emergency room closures. What's going to be done about it? This is the summertime. This is when it occurs every year because of the doctor shortage that occurs at this time of the year, and I'd like to know if the minister has an exact plan on how to tackle this problem, because it's a serious one and the minister knows that. I'd like to know, what is his department going to do?
MR. D'ENTREMONT: Mr. Speaker, thank you to the member opposite for that question. It's quite a challenging one and as he's well aware, as the professionals who are in our hospitals and provide service in our emergency rooms go off on vacation and do have families and people to attend to, it is a challenge for us. I can say to the member opposite that it is something that we want to continue to work with the doctors because the doctors do hold a lot of the cards in this one, that we do want to continue to work with funding programs, we do want to continue to work with them to find ways to find replacements. Again, we have one of the second highest ratios of physicians and surgeons, to population, in all of Canada and it is something that we should be able to
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address with some oversight. We need to know, in the department, when somebody is going off, so that we can help provide and find some local service for them.
I'm not going to let this private health care thing go without the last comment there. We have a Canada Health Act that we must abide to, and it is an Act that I believe in and it is something that I believe as Canadians that we need to have Medicare. We need to have a system that is available to all Canadians. What I am saying is that as we look into service delivery, within the system, there may be opportunities that I'm not willing to throw off the table just yet. We need to be looking at all options, to make sure that we have the best possible health care for all Nova Scotians. I will not be throwing out the Canada Health Act. I will not be throwing things out like that, but I will be looking at all options, as they pertain under the Canada Health Act.
MR. CHAIRMAN: Order, please. The time allotted for debate on the estimates in Committee of the Whole House on Supply has expired.
The honourable Government House Leader.
HON. MICHAEL BAKER: I would move that the committee do now rise and report progress.
MR. CHAIRMAN: The motion is carried.
[The committee rose at 5:59 p.m.]
