[Page 67]
MR. CHAIRMAN: Order, please. Good morning, the Committee on Supply will now be called to order.
The honourable Government House Leader.
HON. MICHAEL BAKER: Mr. Chairman, would you please call the estimates of the Minister of Health.
MR. CHAIRMAN: Yesterday when we adjourned, the honourable member for Glace Bay was on the floor. He has five minutes remaining this morning. (Interruptions)
We're going to recess for a few minutes, until the staff from the Department of Health arrives.
[9:18 a.m. The committee recessed.]
[9:21 a.m. The committee reconvened.]
MR. CHAIRMAN: Good morning, the Committee on Supply will now be called to order.
[Page 68]
The honourable member for Glace Bay.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, I know the minister is short of his staff right now due to a delay. I just have a couple of questions to ask the minister, and hopefully he can answer them without the presence of his staff. I promise we won't continue the private health care versus public health care debate or discussion that we had yesterday, because I'm sure that debate will be continued on in other areas, including the media.
Mr. Minister, earlier this year there was a tender that was posted on the public tenders Web site that indicated that the Department of Health, in partnership with the District Health Authorities and the IWK, would be doing a value-for-money audit of the DHAs' delivery system. I'm wondering, at that time, if you recall, we asked a question in Question Period about that very item. We asked you at that time if the company Corpus Sanchez was the bidder selected to do the audit at that time. I wonder now if you could confirm at this time, Mr. Chairman, could the minister confirm whether or not indeed it was Corpus Sanchez selected as the company that would be doing the audit?
MR. CHAIRMAN: The honourable Minister of Health.
HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, to the member opposite, yes, the successful bidder was Corpus Sanchez.
MR. DAVID WILSON (Glace Bay): Mr. Chairman, could the minister tell us then, please, how much Corpus Sanchez is being paid to conduct that audit?
MR. D'ENTREMONT: If you can bear with me, I am going to have to find my own stuff here. Mr. Chairman, I am going to have to get back to the honourable member because I can't - bear with me just one second here, I have a funny feeling that the number is not in this document. I will have to get back to him on that number.
MR. DAVID WILSON (Glace Bay): I understand that the minister is at somewhat of a disadvantage right now, going through some books and that without his staff.
Corpus Sanchez has been hired before and has conducted audits before. If you review the recommendations provided by Corpus Sanchez in the past - I'm sure the minister knows of these, but let me tell everyone - if you review these you will receive what has happened in the past, that the IWK, for instance, when Corpus Sanchez conducted that review, it was recommended that beds for children with cancer should be closed and wait lists for children's mental health services should be allowed to grow, and acute care beds should be closed at the QE II as soon as patients occupying them are moved to nursing homes, and reducing staff hours at the QE II. Those are some of the recommendations in previous Corpus Sanchez audits.
[Page 69]
I'm just wondering again, now that the minister has the luxury of having his staff with him, if he can answer at least one of those questions. How much is this audit going to cost, exactly what is going to be reviewed, and what should be known about this audit that Corpus Sanchez is going to conduct, Mr. Minister?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, apparently the provincial health services operational review, which is what it is called, and the successful bidder again was Corpus Sanchez, I believe will be somewhere close to $1 million worth of work. It's about taking a snapshot of a time of operations for all the districts, so it will give us an idea where our provincial monies are going and basically give us a number of recommendations to mull over on how to make our system much more efficient.
MR. CHAIRMAN: To the honourable member for Glace Bay, the honourable member's time has expired.
The honourable member for Sackville-Cobequid.
MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman, and welcome back to our second day of Health estimates. I know where I left off yesterday, it was around wait times here in Nova Scotia. I went on for a bit of time there, trying to come to a conclusion of some of the problems seen in the wait times in Nova Scotia and why we have them.
I may get back to that in a little bit, but first I wanted to cover one of the things I stated in my opening remarks yesterday. I went through kind of a list of the subjects I wanted to cover, and one of them that I stated, towards the end, was of great concern to the NDP, of great concern to many Nova Scotians and, for that matter, a great concern for Canadians. It was around the new crop of for-profit health care facilities that we've seen. I know the member for Glace Bay had finished off the day with the minister around a discussion on that, but one of the things that really caught my attention yesterday was a comment from the Minister of Health that had stated, I think during questioning, that everything was on the table when it came to health care and his department's approach on addressing some of the concerns we see in health care.
I want to start off by giving the minister an opportunity to clarify, maybe, or agree or disagree that your government, Mr. Minister, is possibly looking at private health care, and if that is truly on the table for your government.
MR. D'ENTREMONT: Mr. Chairman, to reiterate the discussion of last evening with the honourable member for Glace Bay, the things that we are concerned with in the Department of Health, and one that I hold very important in my list of things I need to be as Minister of Health and the department needs to be, is we have to be concerned
[Page 70]
with, of course, patient safety, making sure that patients are treated with respect and get the services they require, number one.
Number two, we have a publicly funded system. Under the auspices of the Canada Health Act, we need to maintain certain regulations and certain processes in order to meet the auspices of that Act. Number three, we really have to be - not in charge, but at least make sure that we are part of the design of health care in Nova Scotia to ensure that all Nova Scotians receive the correct types of service, funded by the public system.
[9:30 a.m.]
As we get down to how do we maintain our costs, how do we try to find a way that we're not going to eat up more of the budget than we really have to, we have to look at all options. That's where the comment came from yesterday in my debate with the member for Glace Bay. As we look at different delivery models, we really have to keep everything on the table at this point because the things we're doing today are not working to the expectations of Nova Scotians. I think that's probably where we're at right now.
If there are delivery systems - and I don't know what those delivery systems would be - I think it wouldn't be the correct thing to do to say no to them so immediately. We need to have a full review of what our options are in order to deliver services to Nova Scotians. If that means some kind of private delivery, then I think it would be very important to look at those options. That's where the debate went, just to make sure that all delivery models are on the table. If we look at our Emergency Health Services system and our contract with EMC, that is a private company that offers ambulance service to Nova Scotians and making sure that the service is there. It is a publicly funded system and a publicly directed system, for the safety of all Nova Scotians.
I think that comes down to where we're at. We're not throwing anything off the table, because I think Nova Scotians would expect us to make sure that they have the safest and best health system that we possibly can provide for them on taxpayers' dollars.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I guess that was a yes from the minister, that everything is on the table and for-profit health care delivery systems are something that if it crosses his desk, he's seriously going to have a look at it. He mentioned a few different concerns of his. The first one is patient safety. I think that's one of the most important things that we need to do in health care, ensure patient safety. The second one was a public system. I would agree that the public system needs to be protected, needs to get the funds and resources from government to ensure that it continues on providing that service for Nova Scotians.
[Page 71]
I would agree with the minister when he said that we look at the ambulance service in the province. Yes, we have a private company managing the operations, but I have to point out to the minister, with that system in place, there are a lot of rules and regulations and direction from government. They're there to manage it. The trucks, the equipment, the uniforms are all owned by the government. They have control of that system and when we look at what we've seen in the province over the last several years in the private health care clinics and health care facilities, we don't have control. Government does not have control of that. They don't make the rules. They don't tell them what they can do and what they can't do, what equipment they need and what safety measures are in place.
What I'm trying to say is that government is not in control of those facilities opening up in this province and we're seeing them opening up on a daily basis. I have to say, I know the minister is new to the post as Minister of Health, but almost a year ago the former Minister of Health stated publicly that we would see something in the Fall that would help control this, that would hopefully give government more control on what we see in the province, but that didn't come, Mr. Chairman, we never saw that. I know the media has asked the minister again today about this issue and he said we're going to possibly see something coming forward in the Fall.
Well, Mr. Chairman, we've heard that once before from this government. We're hearing it again from this government. I'll give some credit to the minister, being new, but you're still in the same government and it was something that the former Minister of Health said was going to be brought forward in the Fall of 2005 and we haven't seen anything yet. So I'll ask the Minister of Health, through you Mr. Chairman, are we going to see something in the Fall or soon that will give government control of the health care system here in Nova Scotia when it comes to private health care facilities in Nova Scotia?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I do want to remind him of a couple of things. As we talk about a publicly designed and a publicly funded system, there are different delivery models that we should look at. That's what this discussion is and I know we can go on for a really long time talking about this issue, just as this issue has been around for a long time. Every province of Canada has talked about it, some more than others. I've been in this post for four months but, quite honestly, we are not the same government. Quite honestly, it was a John Hamm Government prior, we are now a Rodney MacDonald Government, and I've got to say that we really need to look at things differently. My mandate from my Premier is to come up with some innovative ideas and that's exactly what I want to do to make sure that we protect the health and the safety of all Nova Scotians.
To the member, he talks about these private health care clinics opening up daily. Mr. Chairman, we have three. We have three that are providing different services right
[Page 72]
now that we are monitoring very, very closely. Yes, maybe the correct legislation is not available, but I've got to say, these are doctors who are providing us with non-insured services at this time, things that the publicly funded system does not provide. Also, these are doctors who are managed or overseen by the College of Physicians and Surgeons. These are professionals as well. So I still want to say that even though we don't have that piece of legislation with them, we want to make sure that the safety of Nova Scotians is protected.
When we come forward with a piece of legislation or a piece of regulation for private clinics, I'm sure we'll have a really long debate here in this House. I do commit to try to bring it in as soon as we can, and I'll do it even before that in consultation with the honourable member and also the honourable member for the Liberals, the member for Glace Bay, and we'll talk about private health care to see what kind of pieces of legislation need to be put in. With that, I will continue the discussion with the honourable member.
MR. DAVID WILSON (Sackville-Cobequid): I think that is at the root of why I'm here in the NDP caucus, it's because our caucus believes that a publicly funded health care system not only in our province but across the country, is important to maintain, to fund, and to give resources to. One suggestion that I made to the minister - and I don't know if he has had the opportunity to do this or not - was to go and look at the Romanow Report. This was one of the largest consultations for health care in Canadian history. It went right across this country talking with individuals, talking with professionals, talking with interest groups throughout this province and across the country.
I was fortunate enough to be here in Halifax to take part in some of that. I know that our profession as paramedics made a presentation, a paramedic here in Halifax, Jay Walker, made the presentation to that commission on behalf of the Paramedic Association of Canada. This consultation was large-based, it entailed many thousands, tens of thousands of individuals and I hope the minister has a look at that report and looks at the findings and the recommendations from the Romanow Report. It defines it clearly that Canadians want to keep and value the public system and to ensure that Medicare continues on so that we don't come to the point where what I have in my wallet determines how well my health care is to me. I took pride and cherished the fact that as a paramedic myself I was never asked once when I brought a patient to the hospital what they had in their wallet. I will stand in this House and challenge any government to take that away from Nova Scotians and from Canadians.
I know I could stand at length and debate this and truly provide a lot of information on why we need to continue to protect it. The most important thing is we can't let the erosion of our public system continue and that is truly what is happening
[Page 73]
right now because our governments are not bringing forward stricter guidelines, stricter regulations in Nova Scotia and across the country when it comes to private clinics.
With that I'll move on to something else, I'm sure the Minister of Health will rather talk about other things than this. One last comment which I found interesting that the Minister of Health stated was that it's not the same government - the comment I made about this is the same government - it's not the same government, it's the Rodney MacDonald Government. What that says to me is that Dr. Hamm, who was the Premier of this province for many years, wouldn't allow this to happen but yet he's saying and he's stating in the House today, that the Rodney MacDonald Government, the Progressive Conservative Government of today, will look at private health care in this province. I think that really shows where this province is going and we'll make sure that we stand up to that. Now we definitely will go to something else.
One of the other areas looking through the estimates and it's on Page 11.14 is around addiction services. Addiction services is very important in our province, we look at alcohol, drugs and VLT addictions. When I went through the estimates I looked under Capital Health Authority, number nine, and if you look at addiction services, there's a reduction of nearly $2 million for addiction services for the Capital Health District. I'm wondering if the minister could provide information on why such a large amount has been reduced for the budget of addiction services for Capital Health?
MR. D'ENTREMONT: Thank you, Mr. Chairman, and thank you to the honourable member for Sackville-Cobequid for the question. The honourable member for Glace Bay asked that same question yesterday. It really revolves around the CHOICES program, which is being offered through Capital Health. We felt that since it was an adolescents' program that it would be better served to be with the IWK. So what you are seeing is a transfer of funds from DHA 9, which is the CDHA, to the IWK. You will see a delete of $1.9 million, but you will see an increase for the CHOICES program of $2.6 million with the IWK.
Mr. Chairman, I want to go to some of the comments that he did make about the Romanow Report, and I think I would be remiss if I didn't touch on it for just a second. With the report and the recommendations that were held within it, Romanow admits, as well, that nothing in his recommendations in that report leads to sustainability of the system. They are good recommendations for safety of the patients and those types of things, yet there is no real sustainability piece in it. That is unfortunate, because I do think it is a very good document, it has some very good recommendations in it.
Two things we are taking from that, and there are other things, but mental health, of course, and the increase in funding and the changes we are trying to do in mental health come directly from the Romanow report. Our focus on primary health care comes from recommendations in the Romanow Report. So it is something that is still a
[Page 74]
document that resides on our desk, rather than a shelf. A lot of the recommendations also hold recommendations that are extremely expensive, and if they don't lead to a sustainability of the system, it makes it difficult to take those recommendations in. Like I said, it is something that is still on our desks and there are still things were are trying to implement from that document.
[9:45 a.m.]
MR. DAVID WILSON (Sackville-Cobequid): Thank you, Mr. Chairman. I will definitely be looking through those numbers for addiction services, because it is an important area. It has been well brought out in the public, especially around VLT use and the addiction to them, and the problems in Cape Breton with some of the drugs used there, OxyContin, and now, of course, the pending possibility that we have meth coming to our province. From everything I have read over the last little while stating that this is such a highly addictive drug, we need to look at ensuring that we have the services in place for Nova Scotians who find themselves fighting an addiction. I think we need to continue to build on what we have and actually grow those services.
Now I am going to jump around to a few different areas. One of them is important because it deals with the safety of our residents when they enter a health care facility. I am talking around the infection rates we are seeing for things like MRSA, which is an antibiotic-resistant bug or infection, Mr. Chairman. I remember my first encounter with someone who had MRSA, which I think is methicillin-resistant Staphylococcus aureus - I think is the proper name, I haven't said it in a long time - or VRE, vancomycin-resistant Enterococcus. MRSA and VRE are very potent infections that can't be fought with antibiotics. It is very hard to keep that under control. We have many individuals who go into a hospital because of a certain ailment and then all of a sudden they end up catching one of these super bugs, as they call them. The infection rate has climbed steadily in recent years here in Nova Scotia.
Many front-line health care workers whom I have talked to over the last little while have said that one of the reasons behind this is the chronic vacancy of housekeeping services and other positions in our hospitals that are left unfilled, because one of the best ways to combat these infections, MRSA or VRE, is with proper cleaning. So I wonder what the minister can say about such a high rate of increase in these infections we are seeing in our hospitals, and if he knows one of the reasons why this is happening, and if it's true that it's because of some of the vacancies we're seeing in our hospitals in housekeeping and those areas.
MR. D'ENTREMONT: Mr. Chairman, through you to the member opposite, I have to say that in the last year or so we have added personnel to the Capital District Health Authority to address some of the housekeeping issues. We're not aware of any vacant positions as I stand today.
[Page 75]
I do want to tell you we are concerned in the department about infection rates, as we should be and as are most jurisdictions across Canada. Through this year we have hired an infection control coordinator within the department. That coordinator works with each DHA. Each DHA at this point has an infection control committee to look at these items of infection.
The issues of cleanliness and the correct types of cleaners - it just goes on and on of how to try to mitigate this issue in our hospitals- is very important to us. So I can say to the member opposite, I'm very confident that with this process we'll be able to at least mitigate some of the risks. You can't have it perfect, but at least you can mitigate it as best you can.
MR. DAVID WILSON (Sackville-Cobequid): I think it's important to recognize there have been cuts to housekeeping services in the past. I think the government really needs to look at the number of individuals we have in our hospitals, in our clinics throughout the province and ensure we have the proper number of those individuals to get control of these infections that we're seeing in our hospitals. I hope the minister is committing to ensuring these rates will go down. I know he can't definitely say that would be the case, but I hope he realizes he needs to take additional steps. What we're doing right now isn't working well enough and we have to make sure we have the resources there to ensure we can get those rates down.
Once you have been in contact and are a carrier for some of these infections, you're a carrier for life. It can flare up, you can infect other individuals when you're sick - especially in a hospital setting. Other health care providers come in contact with those individuals. I know a personal example myself, when I first learned about these super bugs was after the fact. I picked up an individual, took them to the hospital and later on we got a call stating that we needed to deep clean our vehicle because we were in contact with an individual who had MRSA. I know there are better programs now that hopefully indicate early on to health care providers that you have a high risk patient or someone who was in contact with MRSA or VRE.
Now, I would like to branch off to one of the reasons why we have such a long wait time, especially around MRIs- having to receive an MRI - especially in Capital Health here. I know the government has purchased new ones for many of the rural communities and I understand they will be up and running soon, but we have an aging MRI at the QE II and this is definitely resulting in an increase in wait times here in the Capital Health Region. The business plan calls for a replacement of the machine this year, so I would like to ask the minister when that will be done?
MR. D'ENTREMONT: To the member opposite with regard to the MRI, we have two MRIs in Capital, those are slated for replacement this year. There are four other
[Page 76]
MRIs that are going to various places throughout the province and those will be, I believe, connected throughout the summer, so hopefully they will be in use by Fall.
This process has taken a little bit longer than we had anticipated simply for the reason the manufacturer was changing their models and we opted to wait a few extra months to get the newest software for those pieces of equipment for the same price. So I am very happy to say that within the next few months those MRIs will be connected and hopefully our wait times for MRIs will be substantially cut.
MR. DAVID WILSON (Sackville-Cobequid): I know the minister doesn't like to give a date, I know he states quite often "this year" or "soon", "very soon" or "in the near future". So can I maybe get a closer date of when this will happen? Will we have the replacement for the MRI in Capital Health by the end of September, maybe?
MR. D'ENTREMONT: Mr. Chairman, I can only use Yarmouth as an instance right now. That machine is being delivered, hopefully, within the next few days. Of course that DHA has been diligent and has the room and the facility ready for it. So we hope to see that one up and running by the end of August.
I can commit the ones in Capital Health to the end of the year. I am hoping to have them quicker but when we look at the installation and the time that is going to be required to remove the existing MRIs and reinstall the new ones, plus the training that is going to be required, I will commit to the end of the year.
MR. DAVID WILSON (Sackville-Cobequid): I just want to reassure the minister that if they are not up by the next session, I will continue to remind him that this is something they announced a long time ago, Mr. Chairman, and we should have the technologists up and trained now. This wasn't something that happened overnight. I am encouraged that most of them should be trained by now and hopefully when they come on line they can start working the day the MRIs are put into the facilities and hooked up.
Now I would like to go to another area. Many Nova Scotians are suffering a great deal of pain and spending a great deal of time waiting to get in to see a specialist. Of course I am talking about the Pain Clinic and the wait times we see with that clinic. Mr. Chairman, I don't know if you know any of your constituents or the Minister of Health knows any of his constituents who have chronic pain and are waiting for the services of the Pain Clinic. The wait is up to three years to get into this facility. This isn't for a minor procedure, this is someone trying to cope, someone who is enduring an enormous amount of pain in their daily lives just functioning, just getting up, just walking out of their house. The waits are three years or more.
I know these wait times are getting worse and worse every day. I know last year the DHAs committed money to look at this issue and now I think they have actually
[Page 77]
struck a committee to look at this. So where are the plans and the resources in this budget to lower the wait times for those Nova Scotians who are waiting to get into the Pain Clinic?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, the pain issue has been one that we have been working on for the last number of months. We have a committee, I believe it is DHA members, chaired by Mr. John Malcom who is the current acting CEO for the Capital District. They are to come to some recommendations to alleviate the wait time for the Pain Clinic, not only to relieve the wait time for the Pain Clinic here, but to come to recommendations to receive pain services throughout the province.
Even at this point we do also have some services in Cape Breton, in the Cape Breton District as well, so hopefully we can have a more encompassing program so that patients are able to receive that kind of service.
In this budget, to react to the recommendations from the Pain Advisory Committee, that is chaired by Mr. Malcom, we have put in the budget about $700,000 to start addressing those recommendations.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I am a little taken aback by the minister's statement that they have been working on it for months. I mean this problem has been around for years and I would have hoped - and I know he is new to it, so maybe that's how he interpreted the question that since he has been in the post only for months he has been working on it for months, but this is an area we need to look at to see what we can do to relieve some the pressures and some of the anguish that these Nova Scotians have in their daily lives. Three years is a long time.
I know a constituent of mine who just received a letter and the letter wasn't stating here is your appointment, come into the pain clinic. The letter stated are you still willing or do you still want to be seen at the pain clinic? I think it was well over three years, Mr. Chairman.
From what I understand, there was a review done and underway and I thought it was supposed to be finished or completed last fall. Through the Chair, is that true, Mr. Minister?
MR. D'ENTREMONT: Thank you, Mr. Chairman, and through you to the member opposite, the process of the committee was only started last Fall. I also want to inform that we had about $300,000 in the budget last year to work on this issue and to work on recommendations. So, quite honestly, at this point we are at about $1 million in trying to address the pain clinic and the pain services for the province.
[Page 78]
I do also want to say that some of these recommendations will be province-wide, so we aren't just going to have a focus on one pain clinic here in the province.
Some of the problems we have also been exasperated by is the lack of anesthesiologists and other people who can offer these services - it's very much a personnel problem and making sure we have the correct professionals, but there are other doctors who provide similar services, and I think that's what recommendations we will start showing and making sure the people get the service they require.
[10:00 a.m.]
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, we will definitely look forward to reviewing the recommendations and ensuring government acts on them, because far too often we see in this province reviews of programs and departments and recommendations made that go undone and are left to collect dust. So I think this is an area, when you look at wait times in excess of three years at times, that government needs to move on those recommendations to start addressing the concerns of those individuals who are inflicted with chronic pain.
Now, as I said, we will keep moving on to another area that has been something that our caucus has been pushing for to increase and expand, and at one point I think we challenged the government on the steps they were taking to address some of the needs of medical laboratory technologists in the province. We are definitely facing a critical shortage in the province and as technology changes, like the MRIs, the need for upgrading and new technologists increases with that, Mr. Chairman.
I know that the new generation of technologists is being trained in New Brunswick; we have seats allocated for Nova Scotians there and that is ongoing until 2008, I believe, that agreement. The first graduates in Nova Scotia from this program won't have completed their studies until 2009. Hopefully, finally that program will be moved back to our province where we should have it, where it should be in-house so that we can ensure that those individuals who are being trained have a better opportunity to stay and remain in Nova Scotia.
Mr. Chairman, when you go away to school and leave the province and get your training in another province, even though you are from Nova Scotia, right there the likelihood of them returning to our province has gone down dramatically. I think we need to ensure that we train Nova Scotians here in the province. We have a great opportunity to do that here with the many technical schools and colleges that we have here in the province - there is no reason why we should be sending this out of the province. Even with the numbers in the class, I believe there's a total of around 24 techs a year that can be graduated through these laboratory technologist programs, we're still going to need more when this new crop of graduates graduate. I'm wondering why the government
[Page 79]
hasn't looked at more seats, and maybe this could tie into economic development and rural economic development. I know the minister is the Minister of Health but maybe this could tie into offering satellite programs in some of our rural communities so that not only are we keeping our students here in the province, but where we need these individuals mostly is in some of these rural communities.
If we can take an individual resident from a rural community and set up a satellite program so they could get trained in their community, who knows what will happen. I think the likelihood of them staying in those rural communities grows because as you get older you start to put ties down and roots into communities that you get trained in and hopefully remain. My question to the minister is, will your government look at possibly increasing the number of seats and the possibility of these satellite schools so that some of our rural communities could take advantage of having economic growth go to their communities by providing a school? You don't even have to build a school, you could utilize what's there now, but maybe even a professor or even what they've talked a lot about is telehealth and tele-education is popular.
I wonder, has the minister thought about those two issues and if we can see some movement on that over the next little while to ensure that we have the proper number of technologists here in the province in the coming years to hopefully sustain the growing changes in technology that we see in health care equipment?
MR. D'ENTREMONT: I'm very happy to stand and talk about our success here. As the member opposite referred to there is an agreement that we have right now on seats in New Brunswick. At this current time we are providing bursaries to 22 of these students, this is a type of bursary that they have to come back and work for us for a set amount of time. I'm very happy to say that the first class graduated this year and 22 of them, I believe, are being employed in Nova Scotia. We're very happy to say that this interim step is working to increase the number of medical lab technologists across the province.
I also want to say that in the design right now, until we have our community college across the harbour complete, that's where our new program will reside where we will have approximately 25 students going through that program every year. It bodes well to making sure we have the medical technologists that we require in our system. The other thing that we are looking at to increase the number and the service in our labs across the province is also looking at the possibility of a medical lab assistant program, which could be offered across the province. It's something that could be done in a satellite method in conjunction with the medical lab technologists program. It would not exactly be a full lab technologist but an assistant that could work within that to take a lot of those tasks and make our labs much more efficient. So there are a number of things we are doing and we're very happy and I congratulate the 24 students who graduated this year who have received placement in our medical system.
[Page 80]
MR. DAVID WILSON (Sackville-Cobequid): I'm encouraged by the numbers that are coming back but it's nowhere near the number that we need to sustain the development and the ongoing issue of the number of technologists we need here in the province, especially now and the next few years. I didn't hear the minister stating anything about looking at the possibility of satellite training for technologists, I did hear about assistant technologists which is a first step but I have to remind the minister that it's not that easy for rural residents who are deciding to go to school, to pack up and come to Halifax, or Dartmouth across the way, to go to school. It's very difficult and that's why I stated the benefit of having these satellite schools is that what we're doing - what I said about taking Nova Scotians out of Nova Scotia to be trained in another province, the same thing can be said about individuals wanting to be trained or educated and taking them out of those rural communities. Once they leave those rural communities and come to the city, come to HRM, I would say, and I don't know if the minister would agree with me, they're most likely to want to stay here in the city. We've seen the out-migration (Interruption)
He said no from across the way, but I don't think he truly believes that because if you just look at the out-migration of our rural communities, which he represents and you, Mr. Chairman, represent, those numbers are stating that is what is happening. I think if we could take steps to ensure that individuals, residents, students, young Nova Scotians who want to be trained, who might not have the funds for one to come to the city - HRM is becoming more and more expensive to live, to rent an apartment, everything is increasing - so whatever the government can do to ensure that we get the services that you can get here around HRM out to the rural communities, will help in rejuvenating, and hopefully increasing the number of young Nova Scotians staying in rural communities. So hopefully he understands my point and that's something, as minister, he'll take back to staff and look at the possibilities we could look at down the road.
The other question that someone had brought up to me actually was around physicians and the seats we have at Dalhousie. I know I've talked to many medical students, introducing a bill on their behalf to help, hopefully ensuring that some of those medical residencies stay here in the province. One of the things that I heard was, again, how difficult it is and how expensive it is for rural students to come to Halifax and to get accepted to medical school. They're competing not only with other Nova Scotians, they're competing with other Canadians and people from other countries.
So one of the questions someone brought up to me, which I said I would mention to the Minister of Health, was, has your government ever looked at designating any seats in medical school for medical doctors for rural communities, for individuals who might come from a rural community, to hopefully give them that extra assistance that they may need to take that step into becoming a doctor in this province? I know one medical student I talked to, who comes from a rural riding, states he's staying here and he's
[Page 81]
actually going back to a rural riding. So I think there's another avenue for government to look at to hopefully ensure that we get those professionals, get those physicians here in the province, trained for one, and get them to remain in the province and remain in rural communities.
So is that something the minister has ever thought about or would be willing to take back to his department to have a look at to see if that's something that might help rural communities obtain the physicians that they need?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, thank you for bringing up that very important issue of the Dalhousie Medical School. Over the last number of years we've increased the seats there from 82 positions to 90. I know it's not a big jump, but it is an increase nonetheless. I think as we do it, we're looking at adding some more residency positions across the province as well as making sure that as that class graduates and moves on, they get their residencies here in Nova Scotia and we have a better chance of retaining those.
At this point in our discussions with Dalhousie and the medical school there, there is no, what I would call, preference for Nova Scotia students or things of that sort yet. I know there are a number of communities across this province now that are providing help to some of our medical graduates and to our students to try to get them to come back to our areas. It's something that I've thought about a lot in the last number of months.
We have a much better chance of retaining our students - if we have a kid from Clare who wants to go and, as a matter of fact, I think there are two or three students right now from Clare who are attending medical school in Sherbrooke. I didn't pull any strings for that. Right now those students are expressing interest in maybe coming back to the province, but we have to provide them maybe with a different way of practice, collaborative practice- types of clinics and those types of things. That has been a very successful program that we have been able to do, having those three seats through Sherbrooke.
New Brunswick just recently announced that they will be doing some medical school through Université de Moncton, in conjunction with Sherbrooke. As well, Dalhousie, I think, is going to be in conjunction with Saint John, or the University of New Brunswick in Saint John, and with 20 to 24 seats. So there are a lot of changes happening in the way that physicians are to be trained, and the seats available to Atlantic Canadians. Like I said, I have thought this on a lot of occasions, but we have a much better chance of having physicians in our rural areas if they originally come from those rural areas. So we need to do a lot more to provide them with the opportunity to attend medical school.
[Page 82]
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I will shift gears again and kind of incorporate definitely something that I have brought up many times over the last three years in this House, in this Chamber, around health care, especially around the Cobequid health region and what we have been promised, and what we see, and what we have, and what we need. I'm definitely proud to represent an area that I believe is the only area that has seen construction of a new health care facility or centre. I don't believe there has been any in recent years. The residents appreciate the new facility and look forward to using that facility, and hopefully using the services that are going to be there.
I know the government announced several services that will be offered at the new Cobequid Health Centre. One is cancer care, the ability to receive some of your cancer treatment at the facility. To my knowledge, as of today, that unit hasn't been opened yet. So I would to ask the minister, when does he foresee that service being provided at the new Cobequid Health Centre?
[10:15 a.m.]
MR. D'ENTREMONT: Mr. Chairman, as you know, most services that are held within districts are basically under the purview of the DHA, so we have to sort of work in conjunction with them when it comes to services. I'm very happy that the Bedford-Sackville area has been in receipt of a $34 million facility, and it is quite a facility to behold. I'm very happy that our government was able to provide that to those residents.
Insofar as the oncology piece and a cancer centre, Capital Health has been in the process of hiring three new oncologists. I think two of them have been offered and hired, and there is one offer still outstanding, to try to have that. I do believe, at this point, they are looking at providing those services, once that full complement is up, to offer those services at the Cobequid Health Centre.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I think it's important that government follows through on the announcements. They take great pride in announcing things very early. The new Cobequid Health Centre is a prime example. I don't know how many years it has gone back, how many times they have announced the opening and re-announced it, and now the services that they announced at the time still have not been up and running. I think it's important they realize they have to live up to those commitments to get them out, because it's an important issue.
Cancer care and treatment of cancer is important to all Nova Scotians. As a paramedic, I know what it takes out of an individual coming from outside the city into Halifax to receive the treatment and care of chemotherapy or radiation, and all they want to do is get back home. So I hope that service and the ambulatory care clinic comes on-line very soon so that the residents in the Cobequid health region - as I said many times
[Page 83]
in this House, it services well over 100,000 residents, or can potentially service 100,000 residents.
I know the minister has stated several times, especially when I bring it up in Question Period, Capital Health, and that they are in control of what services, and their budget. I understand that, but ultimately the Minister of Health is put in the position to ensure that the services get delivered to Nova Scotians so hopefully, he might be able to give me a little more of an answer on the next question around the use of nurse practitioners, especially in the emergency room.
Mr. Chairman, we are so underutilizing our nurse practitioners now. I have read studies that stated nurse practitioners can dramatically drop the number of patients needing to see a doctor. I think one report I read said that a nurse practitioner was able to divert 80 per cent of the patients that came into a clinic from having to see a physician.
I'd like to ask the minister - I know he has talked about nurse practitioners and the use - when can we see, or are you working at, getting nurse practitioners utilized, especially in our emergency rooms? It could benefit not only the Cobequid Health Centre but areas in the rural communities that see closures of emergency rooms. I'm wondering if that's an area you've looked at, talked about and are pushing to have that accomplished?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I very much appreciate his interest in nurse practitioners and the benefit they can give the current health care system. I believe it's very important. I've seen some of these professionals at work and the service they provide is, of course, second to none, which is why I was very happy to introduce a bill to this House in the last sitting and again this sitting, which again expands the scope of the nurse practitioner and what kind of services they can offer.
As it stands today, there are 19 nurse practitioner positions in the province. Unfortunately we have a couple of vacancies we are still trying to fill to make sure we have the full complement. At this point, each DHA holds it within their business plan to request nurse practitioners. I can say there are a number of requests to us right now, but, of course, due to funding, we have to make sure they're in the right place and we're better using our funding.
We also have to pre-define the use of the nurse practitioner in an emergency setting. We want to make sure they work as collaboratively as possible and that their roles are very well defined within that emergency setting as to who sees what, when, what kinds of levels and what they are allowed to do, which has been a bit of a challenge.
[Page 84]
Nurse practitioners had a bit of a shaky start when the idea was first brought to this province. Nurse practitioners have been around for 20, 30, 40 years or more - the old outports used to have nurse practitioners. It's not new, but we have to bring the physicians on line. More and more as we go along here, the physicians are very happy to work with nurse practitioners. It's kind of funny now that in a lot of places as we set up new clinics, it is definitely the physicians that ask to have those nurse practitioners in their practice.
So, hopefully in the next number of months as we go along through this budget process, I'll be very happy to announce some more nurse practitioners throughout this province.
MR. DAVID WILSON (Sackville-Cobequid): I appreciate those comments, but I just want to give one example of how we're not utilizing them to their full potential. At the Cobequid Health Centre, for example, we have a nurse who was trained, took the program, trained as a nurse practitioner and was unable to work to that level of training. In my mind, that's just such an underutilization of such an important health professional.
I also request that we need another physician at the Cobequid Health Centre, which is probably about a $200,000 cost for just one a year, but in the meantime, I think the use of nurse practitioners is a very feasible way to address some of those concerns. A nurse practitioner's cost for one year may be $20,000, so, yes, we need another physician at the Cobequid Health Centre but I think we need to seriously look - I know the minister has stated he takes directions from the health authorities, but maybe the minister should jump in first and maybe save some money by saying, well let's get the nurse practitioners there quickly. I know that many of them have done their training through the Cobequid Health Centre and I would think they would be well received there and throughout the province when it comes to their ability to work in that setting.
To the story of the nurse practitioner at the Cobequid Centre, unfortunately we are losing her. I know she has taken a job outside the province and probably is gone now and that is a great loss to the province. I think the minister should really look at speeding that up and ensuring that Capital Health and other health authorities have a serious look at that because I think nurse practitioners could be a good way to start addressing some of the wait times that we see in the province.
I know I have only a couple more minutes. The last issue in health that I want to talk about in my area is, of course, the long-term care facility. I have talked to the minister several times inside this House, outside this House. I know other ministers have concerns on long-term care facilities for the Cobequid Health Region. That area has been recognized as in need for, I think, well over 15 years, if not more. We are on the verge of having a facility built through Northwood, gaining the contract to build and put in place and, all of a sudden, we hear the rumours of a different site selection. I must say,
[Page 85]
the former Minister of Finance from your own government was promoting the area around Rocky Lake. Your past member from Waverley-Fall River-Beaver Bank was promoting Rocky Lake and, all of a sudden, now we are hearing of this alternate site.
I have to emphasize the fact that many of the resources that seniors who will reside in the long-term care facility will need and utilize will be available at the Cobequid Health Centre. With the Rocky Lake site - I believe the Cobequid Health Centre is less than a kilometre away. Also, that is where the advanced care paramedic ambulance is, so that is less than a kilometre away, within minutes of responding.
So I encourage the Minister of Health to do what he can and do the right thing for the people, not only of Sackville, but of Bedford, of Fall River-Waverley-Beaver Bank. I mean, this long-term care facility is supposed to help the whole region. If you look at where that proposed site on Rocky Lake is, it is right next to Highway No. 102 where it is quick access to Fall River. It is in the community of Bedford which is on a road linking Bedford and Sackville. So I hope the minister recognizes the importance.
We have seniors sitting in malls getting petitions now - 4000 signatures - to ensure that that's the site where this new facility should go. So with that, I know I have only about 30 seconds but I think I am more or less just leaving that to the minister. He knows my feelings on this issue and I hope (Interruption) You can commit on the other time, no problem, but I hope that is resolved in the near future. Thank you, Mr. Chairman.
MR. D'ENTREMONT: Mr. Chairman, the Northwood site for the Cobequid Health Centre area has concerned me over the last number of months. The recommendation that is now currently on my desk - and I have to say I was still uncomfortable with it because of the communities' requests and interest in the issue. I just want to make sure of that before the final selection comes out.
As the member opposite knows, there were nine different sites reviewed during this process. It has been brought down, of course, to one and I just want to make sure that that is the right one for the community, as well as the right place to build this facility for Northwood.
I am going to commit to something today, so you write it down; I will have this announced by August 4th. I am going to look at the staff, they are probably going to freak out. So there you go, by August 4th we will know where it is going.
MR. CHAIRMAN: The honourable member for Sackville-Cobequid's time has expired.
[Page 86]
The honourable member for Kings West.
MR. LEO GLAVINE: Thank you very much, Mr. Chairman. I am certainly pleased today to rise and ask a few questions and make a little bit of inquiry from the minister and his staff. This is an area, of course, health, that is a top priority, I think, for all MLAs here in the House and certainly Nova Scotians.
Having had the opportunity two years ago to do a wait times round table across Nova Scotia, it certainly provided me with a number of insights and certainly a good factual base to be able to speak about a number of the topics that have already been referenced here in the House. I do apologize for not having been able to be in the Chamber for all of the discussion. So there may be a little bit of redundancy on some of the questions that I do ask as I also had to sit in on Agriculture.
The first and primary area that came to my attention as a candidate back in the year 2003, and it's one that certainly has not diminished in this province. Maybe one that's not as hot-button a topic as it was perhaps in 2003, but certainly one that is ever relevant and ever critical in the delivery of good health and having timely health delivery in Nova Scotia and that's, of course, around the area of wait times. So I'll have two questions here, one in reference to the QE II because as the major provincial hospital in our province, what is happening there certainly has that ripple effect right across Nova Scotia.
On the day when I had a tour of the QE II, about 15 or 16 months ago, perhaps there was no more striking piece of information that came up than the fact that there were about 150 patients who had been in hospital for three months or more waiting for placement. We know the kind of impact that that has when those patients cannot be moved out to either the regional hospitals or smaller community hospitals, or obviously to long-term care beds. I'm just wondering, what is that statistic today in terms of the number of patients and a baseline for around the three-month period and beyond for patients waiting at the QE II for placement?
[10:30 a.m.]
MR. D'ENTREMONT: Mr. Chairman, the member opposite, thank you for taking some time to question the estimates of the Department of Health, I thank you for your interest in it, and I kind of missed your questioning on Agriculture because, of course, we had some good conversations over there. You are referencing Unit 4B which is, of course, over at the CDHA. Currently it ranges between 150 and 180 residents, in that area. This year the new funding, in order to do more work to continue the operation of that facility, we are looking at another $745,000.
[Page 87]
MR. GLAVINE: Thank you very much, Mr. Minister, for that little synopsis. Certainly it still remains a startling statistic and one that certainly impacts again on the delivery, I think, of timely health right across Nova Scotia that we haven't seemed to be able to make strong headway. The same picture is much in evidence in the Annapolis Valley, in the Annapolis Valley Health Authority, where we have anywhere from 15 to 20 at any given time who are awaiting placement at the Valley Regional. Once again, I'll just ask that basic question, in terms of the planning that is currently going on to make more acute care beds available at the Valley Regional, I'm wondering, what is the timeline for an increase in beds at Valley Regional and what are the expectations when those beds become available for actually reducing some of the wait times in our area?
MR. D'ENTREMONT: Just to the previous question from the member in reference to the LTC facility, or wing, at Capital Health. As we talk about the Sackville-Cobequid site for Northwood, that's 150 seats, we're also talking about a joint facility between Community Services and Health which will be another 150 beds, and of course there are even more challenging behaviours as well. There are some initiatives that are going on that hopefully within the short term will alleviate some of the problems that we're having on sending people there. Ultimately, once we're done this construction of beds and continuing along with the continuing care strategy, we will no longer need those kinds of facilities at all.
In regard to the acute care beds that are being constructed at the Valley Regional, of course there was about another $3.9 million in this year's budget for the completion of those beds. My deputy tells me that we should be somewhere in the next three months or so before those beds can be occupied, so hopefully sometime in the early Fall we can see the usage of those beds. Of course that opens up a whole bunch of options for Valley Regional when it comes to their orthopaedic program and those types of things in order to provide more services to Valley residents.
MR. GLAVINE: In regard to the planning for the Valley Regional, which is the centrepiece of health care delivery in the Annapolis Valley, it brings me to a more underlying kind of question, and I'd like to hear from the minister in terms of what is the construct, the basis of providing the current amount of funding to the Valley District Health Authority, because I'll come around to another question which I think is perhaps critically relevant to the delivery of health in our region - I'm just wondering, is it based on the total population it serves, is it based on the size of Valley Regional, the other facilities we do have, the number of professionals delivering; what are some of those bases on which the Valley District Health Authority receive their funding for a fiscal year? I think the kind of service, the timeliness of the service and the very nature itself is tied into that, and I'm just wondering about a little general framework for that please.
[Page 88]
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, I'm getting the hang of listening to two conversations at the same time, making sure that we have the correct information as we stand up and answer these questions.
When it comes to the funding of our DHAs, in particular the Valley Regional, it is most definitely service-based, the type of services that are being offered in each facility and each area. The business plan and the programs that are proposed and continued within those business plans, as well as historical pieces of how the funding has happened over the last number of years, Mr. Speaker, we have committed and continue to commit an increase of 7 per cent to the DHAs for the near term so they can have the best planning possible. The challenge has been in the past, for every DHA, is to make sure they can plan on a yearly basis, because a lot of these programs are over three or four years and they continue. So it's very difficult when you don't know your budget from one year to the other, so we have committed that their budgets would be the same, plus 7 per cent, in order for the continuation of the expansion of some of those programs.
Also as the member for Glace Bay had mentioned during his questioning, he had asked about the facilities review and basically working in each DHA to do a snapshot in time of operations of a DHA so that we have a clearer picture of where Nova Scotia taxpayers' money is going and how it's being transferred into services so that we can make better assessment of those business plans and give more evidence, of course, to the DHAs when they come and ask for funding from us.
I've got to say as well, from my visits with the DHA in the Valley, they do a phenomenal job and again to the point, I congratulate all DHAs for coming so close to their budget target, being within one-twentieth of 1 per cent of their target for this year. So I think things bode well on having even ground and I look forward to some of the new services and expansion at Valley Regional Hospital.
MR. GLAVINE: Thank you, Mr. Minister, and certainly I'm pleased to hear that there are now annual increases because it's one of the areas that I'm not sure is being taken account of to the extent that it should. I feel the Annapolis Valley Health Authority in our area is certainly already at the very beginning stage of what we're going to see across Nova Scotia when we talk about an aging population.
Within the Annapolis Valley Health Authority, we include of course Digby, we have three communities now that have a population where 25 per cent is 65 years of age and over. We have eight communities in Nova Scotia where 20 per cent of their population is 65 and over, and in the Annapolis Valley we have five of those communities. So the aging strategy piece has pointed out some directions that we need to be going. I'm wondering if the Department of Health now has that kind of long-term planning that is going to allow for the other critical pieces - the long-term care beds, continuing care, home care - which are some of the pieces of the plan that will enable the
[Page 89]
district health authority, the Annapolis Valley District Health Authority, to deal with what I see as the beginnings of a very significant, very large senior population?
I certainly see signs in my community and in my riding where some of the seniors' issues are not getting the kind of attention in their health care system that we need to be delivering. While we do have one outstanding facility in the Grand View Manor, there are still many other services that our seniors can be receiving in terms of health care. So I would just like a little bit of an overview of where the plan is going to be looking after the geriatric patient and certainly the long-term care requirements that we do have.
MR. D'ENTREMONT: Mr. Chairman, through you to the member opposite, when it comes to the Annapolis Valley, I think we've been very cognizant that is an under-serviced area when it comes to the availability of long-term care beds. As a matter of fact, when we did our review, we looked at trend analyses, looked at the demographics of the area, and basically made the calculation of 10 beds for people over 75 who must access a bed because of varying reasons.
As we looked across the province, in order to come up to our calculation of the 826 beds or so because, of course, as needs are presented to us, as proposals are brought to us, that number may fluctuate a little bit, but ultimately the Annapolis Valley would be receiving well in excess of 150 beds throughout that calculation. I know the member for Annapolis has been asking quite honestly for services in his riding and for Middleton. I know that would be about 40. So as we make those calculations of a true distribution across the Valley, I think we're looking at 150 or more beds for the area.
I look forward to getting some requests for proposals out there and seeing which communities would be willing to have that kind of facility. Ultimately, at this point, we haven't had a true discussion on what kind of facilities we're looking for, whether it's expansion or new facilities, and that information and that kind of consult can come from members just like you.
MR. GLAVINE: Many of the topics that I'll cover this morning are definitely integrated into the whole medical delivery. One of the areas that I still hear some local concerns about - I just heard recently that at the health centre in Berwick, which has blood collection services, they went to a new electronic means of gathering information and putting it into a system that would be available long term. It brings up the whole area that I certainly have had some wonderment about. It was raised a number of times when we went around the province a couple of years ago, and perhaps you already may have had some address of this particular issue in the earlier part of the estimates, it's around our electronic medical record system.
[Page 90]
The larger kind of global question here is that at the end of the day are we going to end up with a fully integrated system? I know it has been very costly. I know there have certainly been a number of delays. I know there is still duplication that is going on. Again, I would just like to have an update as to where we are with the implementation, and what is the timeline? And since we are doing budget estimates, what has it cost Nova Scotians to date to put this system into place?
[10:45 a.m.]
MR. D'ENTREMONT: Mr. Chairman, I thank the member for Kings West for those questions. Basically they revolve around the program called the NSHIS, Nova Scotia Health Information System, and what we're trying to do is to make sure that all parts of the province are connected with the same type of programming so that there can be sharing of information from one district health authority to the other, from one clinic to another, from one hospital to another.
I can say we are currently working on completing the client registry component of it. We're still expanding the primary health care component of it, which is the interconnection of clinics and doctors' offices. We are currently only at about 30 per cent there, so we're still trying to expand that to a place where all doctors' offices and those types of facilities have access to it. We continue to work on the financial reporting systems for DHAs to make sure they have the correct payroll systems and HR systems and those types of things within their accounting, things so that they can share information back and forth with the Department of Health as well.
We also want to expand to a Pharmacare Program, which is a component of this. As well, we could talk about PACS and the information sharing of diagnostics, X-rays, MRIs, CT scans, and those types of products. That is complete to about 91 per cent of the whole province, there are only two or three machines that can't be connected, apparently. So we've made some strides largely in part to the sharing and the contribution of Canada Health Infoway, which has been a funding partner with us through the auspices of the federal government. Many of these programs and systems are extremely expensive, due to our connectability and the wiring and technology that is required for them.
Things that I do want to see in the near future are, of course, the expansion of that primary health care capacity, making sure that our clinics and areas are duly served by it, and also to make sure that the patient health record is clearly available to all sections of the province. So if you have a person from Yarmouth who gets sick in Kentville, that patient's information is available to the doctors for treatment.
We also have the health surveillance system that is under design which is a great component of the system. We also have a couple of things like the OR scheduling
[Page 91]
program which would help us out with our wait times. The unfortunate part there is that it's a complicated piece that all district health authorities must sign on and ultimately another expensive program, but we continue to work with it. But all districts at this point are all inter-operable, they are all able to share their information from one district to another and we'll continue to expand that system in the near term.
MR. GLAVINE: Kind of brings me back again to the round table on wait times. Again, I'm familiar with a couple of the doctors at the Annapolis Valley Regional Hospital where they have seen very little change over the past two years, for example, in orthopaedics. It is still a nine- or 10-month wait. We also have patients that come from the South Shore up to Annapolis Valley Regional Hospital for their surgeries, for joint replacement.
In terms of the availability in other parts of the province, and that being on-line, is it up to doctors to post their list when you say it's probably not as up to speed as you would like? Perhaps there can be more movement of patients from one part of the province to the other - Valley Regional and the doctors performing surgeries, they certainly have a lot of pressure on them to try to reduce that nine- or 10-month wait time for a hip or a knee or other joint replacement. If that list is available to a patient in the Valley, on the South Shore, in Truro, or New Glasgow where similar surgeries are done, if it's posted and available, then the family doctor can help them in terms of making a decision about another location where they could go.
I know that may not always be preferable for a family, but we know it's a much shorter time in hospital now before these patients do get back home, so long hospital stays and having family around is not as critical a piece. I'm just wondering where that list is, its availability, its on-the-ground significance for patients making those kinds of decisions - where is this at this particular stage?
I remember the day of the announcement. I was at the Annapolis Valley Regional Hospital, there was a lot of fanfare around this particular announcement. I'm just wondering in reality, how is it working? Is it making a difference to patients in Nova Scotia?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Kings West, the information he refers to is our wait time Web site. It is available to all Nova Scotians off our main Web site where people can go and look at different regions. I believe it's broken down by regions, by hospital, also by the type of surgery and the type of service they are requiring. On there we can find a whole list of different services that can be done from orthopaedics to diagnostic testing to cancer - I believe there are probably 10 or 20 different lists you can pull down. So a patient, in conjunction with their family physician, can make a decision on where to put their name in for any type of surgery.
[Page 92]
Going back to the primary health care service, we were talking about the inter-operability, or the connection of doctors' offices to this main health system. Of course, not all doctors' offices are connected yet. As we are setting up new primary care clinics, we're making sure that information is there. For instance, the one we have in Yarmouth, the new IMG clinic we have there, they have the newest technology, wireless tablet PCs; it's quite interesting that when they do their diagnosis and do a request for pharmaceutical, they can bring down and have the best information available to them right there on the machine of what kind of dosages and the kinds of pharmaceuticals that should be prescribed for those patients.
Also, that information can be sent quickly to the pharmacy. I was actually speaking with one of the pharmacists, a friend of mine, and she said she was more than excited when she got the first print-out from the system that she could actually read it. So as we are talking about safety in pharmaceuticals and the correct dosages, I think this is a leap ahead.
The main piece you are referring to is the wait times Web site that is held, just click off on the right-hand side of the Department of Health Web site.
MR. GLAVINE: Before I leave the area of electronic medical records and so on, the important piece here is the provincial system that in time will be in place. I was wondering if we could have at least a ballpark figure on what it has cost to date to put this into place. I know that we roared ahead at first and then we had some problems with the system. I'm just wondering, what is it costing and has cost Nova Scotians to put this system in place?
MR. D'ENTREMONT: Mr. Chairman, I don't have that number with me but I will endeavour to have that listing to the member and I will try to have a bit of listing with the program or what IT solution it is and maybe what kind of costing went along with it. This has been happening over the last number of years as we go on, so it will be over a number of budget years and, of course, we will show this year what kind of funding is available to implement these kinds of systems.
MR. GLAVINE: In my remaining time, just to get to look a little bit more at some of the local questions, or maybe I still have quite a bit of time, I'm not sure. Anyway, currently in my riding we certainly have, as in other parts of the province, doctor shortages. The community of Berwick, of course, lost two doctors as we know by now, in just a very short time, in a one-month span. They had almost recruited one doctor who was certainly going to be sponsored, had a local doctor to act as a mentor, had passed their clinical assessment program, but for some reason the district health authority lost this doctor from coming to the area. I'm just wondering again, where is the department with assisting small communities like Berwick, to get their complement of doctors up to speed?
[Page 93]
MR. D'ENTREMONT: Mr. Chairman, recruitment, of course, has been a challenge over the last number of years, to make sure that we have the physicians in the areas where we needed them. The ironic part in the province is that we have probably the second highest physician-to-population ratio in Canada, yet they are mostly focused here in HRM and in some other centres. So we talk about Berwick and other rural areas where we're having a little more of a challenge to get the physicians to locate there.
Of course we have a recruitment officer in the Department of Health whose sole purpose is to continue to work with areas that are looking for physicians, to make sure they are aware of the availability. We are also working with Physician and Pharmaceutical Services within the department to make sure that the correct remuneration packages are available to them, depending on whether they want to collaborate or work alone, fee-for-service, those types of things. We also try to treat every part of the province fairly and as equitably as possible so there is no one area over another.
We also find that within each district at this point each council, through the municipalities, through the district health authorities, through different organizations have different types of incentive packages, as well, that we try to work with and deal with when physicians are interested in coming to this province.
It is still a challenge to make sure that we have physicians coming to our province, yet I think the trick here will be to continue to work with the School of Medicine at Dalhousie to make sure that we can take students who are interested in medicine from our areas, provide them with the mechanisms to go through school, and hopefully entice them to come back to their home communities. I know a lot of us through this Chamber had the opportunity to attend university, in a lot of cases we had to go away to university, yet something brought us back home. We hope that kind of rural feeling will bring a lot of our students back to our area. So we need to have better mechanisms and continue to work on that to make sure that we have physicians in our rural areas.
MR. GLAVINE: Mr. Chairman, I thank the minister for that response. Also, reiterating for the second time not just the importance of getting doctors into rural areas of Nova Scotia but certainly pointing to one of the more successful areas of recruitment, and that is actually having students from rural areas who are in med school and who would go back to rural areas. He's absolutely correct on that.
In fact, just recently, I was handed a research paper done by a medical student at Dalhousie. He looked at other provinces and what they deem to be the most successful means to get people to come to rural areas. One of the most successful areas that he had documented, in fact, was northern Ontario. If we think of northern Ontario, with its isolated communities, its distant communities, and certainly remoteness in the Canadian
[Page 94]
Shield does exemplify great distances and small communities. What they did was look at students who had applied to med school from some of these small mining and logging communities and actually assisted with their education and put in place a five-year plan for them to come back to their communities.
[11:00 a.m.]
I think it's great for us to talk about this. I know we're going to see in rural communities - we have Berwick that just lost two doctors. Next year, at this time of the year, in June, two doctors in Middleton have announced their retirement, a year ahead of time, obviously, to give their patients an opportunity to look elsewhere. Looking at the age of the doctors in some of the small communities of the Valley, and I'm sure it's similar along our coastal communities, I'm just wondering, what are some of the concrete pieces that the department is looking at in getting doctors to come in and be the next generation of primary health care deliverers, our family doctor?
MR. D'ENTREMONT: Of course each district, Mr. Chairman, has a physician recruitment plan, and basically a family practice physician practice plan to make sure that we have the types of professionals, such as a family practitioner, in each area. You reference a challenge that we're facing in health care, especially when it comes to physician recruitment, and that is as some of our older doctors are retiring we're finding that it requires more doctors to replace a single doctor. Their patient loads are different. The new breed of doctor wants to have a certain lifestyle, wants to have a family, wants to have time to do things correctly. So we are finding it more of a challenge to find these family practitioners to come to our area.
I do want to say that in the last year, 2005-06, in our communities the DHA 3 has received some recruited doctors: Middleton received one, Annapolis Royal received one, Kentville saw an increase of at least four doctors recruited, Wolfville had two and New Minas was able to recruit one. So I think by looking at the other districts, the Valley district is doing quite well on recruitment compared to other regions in the province. As the plan continues, we continue to look at the remuneration of doctors and making sure they have the correct fee-for-service plans, making sure they have due remuneration and are comfortable in those communities.
It's also important for our communities to make our new doctors comfortable, to make them a part of our communities and I think this has been a challenge for a time and I think it's very important for our municipalities and towns to do their best to help us keep those doctors as they come in, because retention, in my estimation, has been just as much a challenge as recruitment has been.
MR. GLAVINE: I thank the minister for that overview. There's no question that when I do meet with the CEO of District 3, the Annapolis Valley Regional Health
[Page 95]
Authority - one of the references that is often given for a model that is working extremely well is what we currently see in Annapolis Royal. There's no question that we're seeing it from the point of view of the doctors, the other medical practitioners, the patients and from the community - we see a very, very strong approval of that model.
Looking at two little offshoots here, first of all I know that I live close to an area that's such a collaborative practice and I don't mind using estimates to both promote and to ask the minister, are there other areas of the province being looked at? When I take a look at the Kingston-Greenwood area, in my view it's one of the population growth centres of the Annapolis Valley, it also has a transient population. When I went door to door - and it is now less than four weeks since we've gone door to door - in the Greenwood-Kingston area I had a lot of questions and a lot of asks about what is government doing, what are you prepared to do to support more doctors in our area?
I certainly think that the Kingston-Greenwood area, possibly in collaboration with some of the doctors that provide the service personnel on the base with their service, may in fact be able to be incorporated into a collaborative practice for that area. I'm just wondering, is that the model that's going to be expanded if we're taking a look at - there are five counties now of the 18 in the province that still have some population growth going on and I certainly think that Kings County in general and District Health Authority 3 has to look at the provision of expanded medical services and I'm just wondering if this is one of the models that can be applied to an area that is under extreme pressure for family doctors.
Certainly, in my view, having a family doctor is still one of the great and important pieces that we all need in terms of our health and I think in promoting good health and having that history of the patient is a critical piece for good care. I was just wondering, could the minister provide some insight on that area and if in fact there are budgeted dollars to start to look at that kind of model?
MR. D'ENTREMONT: To the member opposite, we're talking about primary health care collaborative practices which is not much of an acronym but a good explanation of what we're talking about as we talk about doctors and other practitioners in the same setting.
Annapolis Royal, of course, is a very good example of what can work, and how we can alleviate some of the problems that we've had in other areas. Other areas that we've seen some of the same type of set-up, of course, in Tatamagouche, we're looking at the North End Clinic, the Duffus Street clinic, and then a couple of other places in Advocate where they basically have a central node for the physicians. The physicians will travel to some of the other communities held within it. I think more and more, especially as the new doctors are graduating and coming into our system they're finding, that these
[Page 96]
collaborative practices work much better for them because they are trained in more team settings and require a little bit of work together.
I think what we're also seeing within these collaborative practices, we're also seeing that they have a little bit better quality of life, that they're able to depend on one another to fill shifts when someone is not feeling so well or has other responsibilities in the community or at home.
So we will continue to try to expand these as different communities come forward and propose these to us. I think that's the key right now to rural family medicine, is definitely to try to incent and make sure that we have more of these collaborative practices across the province.
MR. GLAVINE: I'm not sure, Mr. Minister, if that was a yes to the Kingston-Greenwood area, but the overall tenor of your direction is appreciated, and certainly hope to work with you in this area of shortage.
One of the areas I do happen to be critical of government on is the implementation of nurse practitioners in the system. I know we do have a few who are working, but when I take a look today and I talk - and I have talked to a couple of the doctors in the Berwick area where they have just recently lost two doctors, they feel that a nurse practitioner in their system where they have, in fact, at least a couple of the doctors who have their offices right in the medical centre, if we had a little bit more flexibility in that program, I think it's one that could certainly alleviate a lot of pressure on the doctors in an area where we are feeling the pinch of shortages.
Again, I'm wondering what the plan is. Are we going to be able to get nurse practitioners in that clinic-type setting where you already have an array of services being offered? I feel diverting 20 per cent - I'm not sure what the goal is with a nurse practitioner, but if we could divert 20 per cent of patients coming into the medical centre in Berwick or outpatients at Soldiers Memorial or any of the health centres, I think it's one of the real saving areas that we can approach. Again, probably like you, Mr. Minister, perhaps you know one, two or three of these people who are trained as nurse practitioners. Certainly when I look at the background and I look at two or three in our area - in fact, we have one from our area who is actually doing some practicum here in the city now in the nurse practitioner role - I absolutely think it's a piece that is worth the initial investment for the enormous long-term savings that we can start to generate in our health care system. I would just like your comment there. Is there a one-, two-, three-step kind of program that will see more nurse practitioners on the ground in Nova Scotia?
MR. D'ENTREMONT: Mr. Chairman, I can commit to the member opposite that we will continue to expand the nurse practitioner services across this province. We do
[Page 97]
talk about the 19 that we do have in the province. We still have a couple of vacancies to fill at this point. We do want to continue to expand those.
Mr. Chairman, also within the district health authorities they do have a lot of leeway on the kind of professionals that they hire within their systems as well, and we do urge the DHAs to use a nurse practitioner in their complement of professionals at the clinic level, at the hospital level, and whatever they feel they can use the services of a nurse practitioner for.
I can say to the member opposite that we will continue to expand the positions for nurse practitioners. The challenge really is how they collaborate with a physician, where the medical oversight comes up and also the billing piece, where is where we had to make a decision to flow the funding from the department and through the DHAs for the time being on the payment of nurse practitioners, but I will continue to commit on the expansion of nurse practitioners in this province.
MR. GLAVINE: Mr. Chairman, I thank the minister for that certainly positive response. It's one that I think whose time has come.
Just a couple of other areas. Recently on a visit to Valley Regional and speaking with the chief of staff there, one of the concerns raised was the pay differential for anesthesiologists - and I know that the cases you would find in Capital Health or at the QE II certainly are ones that are more complex, perhaps much longer operations than some that are performed at Valley Regional. Again, that could be one of the deterrents from attracting and maintaining the appropriate level of anesthesiologists at Valley Regional. It is one that, again, I'm wondering if the Department of Health and the minister is aware of and again I'm wondering how that will be addressed, if it has not already been addressed.
[11:15 a.m.]
We know that for Valley Regional and our regional hospitals to perform their functions, if not tertiary level care but certainly secondary level care, they have to be able to have anesthesiologists, so I was wondering, could the minister make some comments in that regard?
MR. D'ENTREMONT: Mr. Chairman, the anesthesiologist issue has been one that those professionals had been underpaid for some time, which we started a couple of years ago to bring their levels of pay back to a Canadian standard. Basically they have been stabilized and competitive and the chief of anesthesiologists at Capital Health, who at the current time is trying to recruit some, feels that he will be successful in doing that with the current pay scale for those professionals.
[Page 98]
We also have been able, through Physician Services, to be able to come up with an alternate funding plan for anesthesiologists, which is now available in Capital Health, Dartmouth General, those areas. I do believe those will be rolled out across the province, so that all our anesthesiologists will receive their due remuneration, depending on where they are in the province. I think with those changes and stabilization and making sure they are competitive, it will bode well. The "also" part that we have talked about, leading a development of anesthesia assistants, as well, to make sure we have some supports for these anesthesiologists, that they have an assistant or those types of people who can do some extra monitoring, and hopefully expand the service we are offering for surgery and other uses at this point in time.
MR. GLAVINE: Mr. Chairman, I thank the minister again for that direction in which there can certainly be some measure of assurance to the anesthesiologists working at Valley Regional, perhaps at other regional hospitals, that fairness in compensation certainly will be the order of the day.
One of the other areas that I certainly keep hearing about in my riding office and as I talk to health professionals. We know that home care is certainly a critical piece in the delivery of good health and in allowing patients to come out of hospital much quicker than in the past.
However, once again, there are difficulties that are often there. We hear, for example, my most recent case was a stroke victim who is now home and had no help for five weeks. It was in those first five weeks that her family was trying to help her cope without any kind of support. What they were looking for, as much as anything, was to have home care come in and help them deal with basic cleaning and hygiene and so forth for their parent.
One of the things that keeps getting suggested to me - and I'm not sure if in fact there is strong documentation and good research and so on to support it in Nova Scotia, but while we do adapt and take from other jurisdictions, I like made-in-Nova Scotia solutions. I'm wondering if, in fact, downloading the home care to the DHAs and allowing for more localized versus centralized administration for something like home care, may be a good way to go. I'm just wondering if District 3, or one of our districts, would be willing to pilot and take a look to see if there can be greater efficiencies, a more timely delivery of services. Certainly in regard to the efficiency piece, the geography of areas sometimes is not always accounted for in the delivery of home care.
I'm just wondering, again, if the minister and deputy are looking at this piece and are able to offer Nova Scotians some small tangible improvement. We know there are some great strengths in this program. I know some of the people in our area who work in home care, and I know that it's a matter of some fine-tuning, some extra resources, and I would just like to know where the department is going in this critical area.
[Page 99]
MR. D'ENTREMONT: Mr. Chairman, through the continuing care strategy, we talk a lot about home care and different programs that we can bring forward to help the care of our seniors in their communities. It has been exceptionally tough for the Valley. It seems that we definitely have a personnel problem, we just cannot get the continuing care assistants and the home care workers we require to provide the service. Many of the people offering the service tend to be married to some of the personnel at the base in Greenwood, and of course those tend to be transients. They come in to do services and their spouses end up getting transferred to other bases.
It has created quite a bit of a challenge for us in the Valley region, to the point where we're continuing to work with the Nova Scotia Community College in the training of continuing care assistants and people who should be able to offer those services in their area. We're currently investing about $900,000 in the recruitment of continuing care assistants, we are working on a marketing campaign to offer this as a profession to Nova Scotia students and other people looking at changes in their professions. We're also offering bursaries to those types of professionals. I think we're doing a fair amount to try to bring up that pool of workers to alleviate the problem that we're having in the Annapolis Valley.
I also want to underline a couple of other programs and expansions that we're talking about that we do have some funding for. Of course, there's the self-managed care program, which is one that has had good uptake and allows patients with some complicated illnesses to get the professionals that they need for home care and other pieces; increased home support that we are investing another $2 million to try to expand programs in areas and, of course, community initiatives that we're trying to do to alleviate some of those ALC pressures of the $3.6 million. So we are trying our best to keep that system alive, but we do have the longest wait time for home care services in the Valley at this time.
Some of the other things we're trying is to add portable home oxygen, more respite care, more palliative care, to help out the families to take care of their loved ones because I think it is very important that there are a lot of people out there who would really want to take care of their parents, yet sometimes don't have the financial means. I think it is very important that as part of the continuing care strategy, we move into what we call the caregiver strategy to make sure that we have the points available to families to take care of their own as well. So I think we're well on our way, but the concern for Annapolis Valley will continue to be one of personnel, to make sure that we have people available to fill those positions.
MR. CHAIRMAN: The honourable member for Kings West has approximately two minutes.
[Page 100]
MR. GLAVINE: Thank you. With just two minutes left, I guess I'll depart from that area of home care which the minister has outlined and he recognized some of the unique problems that we do have in District 3. He didn't commit to a pilot program of decentralization, but maybe that's one that in time we will be taking a look at. Just very quickly, I'm wondering with the EHS service, does that come under his ministry directly and, if so, is there a need to look at fine-tuning and so on in an area? I'm just wondering if that's his area of responsibility.
MR. D'ENTREMONT: Mr. Chairman, the answer is yes, EHS is a part of our department, as is the ground ambulance system, the LifeFlight system, and all the components that go with that. We're very happy with the system as it stands today. We are very happy with response times and the service that they provide to Nova Scotians. This system, in my estimation, is the best emergency health system in Canada, if not in North America, and we will continue to monitor to make sure that the service is available to all Nova Scotians at all times.
MR. GLAVINE: With perhaps not enough time to do a follow-up on that question, I will see the minister about a specific question. I want to thank him and his staff for providing me with some of the background and solid pieces of information to continue to work with the department. Thank you.
MR. CHAIRMAN: Before the Chair recognizes the next speaker, we will take a comfort break for the minister, his staff and others. So the committee stands recessed for a few minutes.
[11:26 a.m. The committee recessed.]
[11:41 a.m. The committee reconvened.]
MR. CHAIRMAN: Order, please.
The Committee on Supply will now reconvene.
The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I welcome the opportunity to ask a few questions to the minister and his staff. I want to focus in the beginning on mental health services.
Mental health services often don't get their due. They have some pretty heavy hitters to be in competition with when it comes to health care services, things like cardiac and cancer. Often, because there is so much stigma associated with having a mental health disorder, I think that maybe sometimes the public will, to make this a high priority
[Page 101]
and see the kinds of services and resources that are required isn't always as strong as it is in terms of some of these other, also very serious areas of need in terms of health care.
Here in the Province of Nova Scotia, we have seen on the front pages of our paper the concerns around various individuals who are stuck in forensic units, who are inappropriately in front of the courts. I want to ask the minister - specifically around seniors with mental health disorders who are in need of 24-hour care but who are aggressive and known to have the occasion to have violent outbursts, it would be inappropriate to place them in a general population of seniors - what does the Government of Nova Scotia have available, right now, for these seniors? How will this government address the gaps in the services that are available for these seniors in the short term, in the very immediate term?
MR. D'ENTREMONT: I thank the member opposite for taking her time here at estimates and asking questions about a very important issue of mental health and more specifically regarding the safe keeping, the care of some of our seniors with challenging behaviour.
I will admit right now that the current system is a little lax and not quite available to these types of individuals, quite sadly. As we talk about expanding in the near term and short term, there has already been a commitment from the Minister of Community Services for a five-bed unit as an interim step to try to take care of some people with challenging behaviour; also, a joint facility, as we have been discussing over the last number of months between the Department of Health and the Department of Community Services, to take on the role for those folks who don't belong in a forensics hospital or another type of facility. We still have a lot of work to do insofar as that, but at the time being we are trying to place these folks in the best facility possible, some of these being long-term care facilities with challenged behaviour units and other types of facilities across Nova Scotia.
[11:45 a.m.]
MS. MAUREEN MACDONALD: I want to thank the minister. I can't begin to tell you how frustrated I am with this government's response to a problem that we have known about for probably one and a half to two years. It doesn't seem to be improving, it seems to be getting worse while these discussions are going on.
I don't know what the problem is in terms of the ability to act, but there is no action. With all due respect to the Minister of Community Services, a five bed transitional unit will not even begin to address the problem. I'm talking specifically about seniors, a growing senior population to begin with, but in that population, people who have mental health disorders and who, as a feature of those mental health disorders, will be aggressive, agitated and will expose staff in situations to violence in the workplace
[Page 102]
which is, in itself, a problem. Also other frail seniors can't be placed in a long-term care facility with other seniors who are frail and vulnerable, and the patient-staff ratio such that there isn't that constant supervision standing over those people.
I want to come back to that specific question about that specific population and the question is where now in the Province of Nova Scotia are there beds for seniors who have mental health disorders, who are aggressive and, if there are none, when will we see some in the short term to deal with a very serious and growing problem? That is my question.
MR. D'ENTREMONT: To the member opposite, there are a number of facilities now - and I'm assuming that she's talking about people who have been assessed that require long-term care, so these are the ones that are moving into long-term care facilities. There are a number of facilities across this province that have challenging behaviour units - Alzheimer's units as some people identify them to be - and they are in various places around the province, which is a concern. As these folks move into populations, the busier it is, the more agitated they are in most cases. They do require a different type of care and it's one that we will continue to expand upon.
I have to say that in this budget there is an extra $670,000 for challenging behaviour, so the expansion of some of these facilities, extra care by professionals, as well as another $225,000 in the continuing care strategy, so this year alone we're focusing about $895,000 towards challenging behaviours and making sure that these seniors are protected and taken care of in the proper manner.
MS. MAUREEN MACDONALD: I want to thank the minister. Mr. Chairman, I want to ask the minister about a specific proposal that was in front of his department, as well as the Department of Community Services, from an organization that's based here in metro, that's well known to me for the very excellent work they do with homeless people and hard- to-house people. This is an organization called the Metro Non-Profit Housing Association and they had a proposal in front of your government regarding supportive housing for people who have both addictions and mental health disorders, who are very hard to house, who are overrepresented in the homeless population on the streets, overrepresented in the emergency shelters throughout HRM and who are often exploited, I guess you would have to say, by a class of landlord that offers less than desirable living conditions for people who have serious health problems.
This organization has been trying desperately to get the government to recognize the need for supportive housing. This is housing that will have staff available to ensure that people are eating properly, getting medications - and it's precisely as it says: it's supportive housing, which means that there's a staff component, which means there's a cost component, and it's not just throwing these people into the community and having
[Page 103]
a friendly visitor drop in once in awhile, it's having people right there who can really monitor and support people on a very regular basis.
It's a model that has worked in other areas - there was an excellent presentation from a group from Toronto that the Canadian Mental Health Association brought in for one of their annual working educational public conferences, and they did this phenomenal presentation on what that has been able to achieve in the City of Toronto. I want to ask the minister whether or not his government, his department, will be providing financial support to Metro Non-Profit Housing Association for the supportive housing initiative and, if support is forthcoming, when will we see that?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I am unaware of a proposal from the Metro Non-Profit Housing Association, nor is my deputy minister aware of it. What we are aware of is that there are discussions ongoing right now with Capital Health with that group. I can commit to the member opposite that we will continue to have those discussions and look at the proposal that is being brought forward, and I'm sure with other partners that would be required on this, namely Community Services. I do believe at this point that there are just discussions ongoing with Capital Health, that we are aware of at this point.
MS. MAUREEN MACDONALD: Mr. Chairman, I'm confused that the minister and the deputy minister are unaware of the proposal. I had this proposal probably a year and a half, two years ago. I know - is it Mr. Campbell? - Mr. Jim Campbell, perhaps, in your office, has been in regular contact and involved in discussions with Metro Non-Profit Housing Association, as well as representatives from the Department of Community Services. I've seen some correspondence with staff from the minister's department. So it's not solely in the purview of the Capital District Health Authority where this is happening, although it may have been kicked back to Capital District. The point remains, this is a population that is crying out for the appropriate living conditions in the community and just not receiving the kind of support and attention that's required to make what would be a very important service a reality.
I want to ask the minister at what stage is the department in providing patient advisers to people with mental health disorders who are now in hospital under the Involuntary Psychiatric Treatment Act? I don't know that the regulations have all been finished around the Involuntary Psychiatric Treatment Act, perhaps they aren't, but I would like to know, what stage are we at of implementing the Involuntary Psychiatric Treatment Act and putting in place patient advisers?
MR. D'ENTREMONT: Mr. Chairman, the funding is before you within this budget for the funding for the patient rights advisers. It is our understanding of the process, from my understanding of the process, that as soon as we get approval for the funding here, we will complete the selection process as it has been undergoing at this
[Page 104]
point. Once the patient rights advisers are in service, then we can complete the regulations for the Involuntary Psychiatric Treatment Act. So I think that's the process. So as soon as we can get approval - hiring, Act.
MS. MAUREEN MACDONALD: Mr. Chairman, there are so many things I could ask and I have to limit my time and share it with my colleagues. I'm going to move from mental health and ask the minister about a concern that we've had here in the NDP caucus for quite some time, and that's a concern around ambulance fees. I want to tell the minister of a situation that I had in my constituency with a constituent who's over 80 years old, who has a life-threatening blood disorder, who lives in a senior citizens' manor independently, not in a nursing home, who loses consciousness because the oxygen count in her system, her blood, is such that she doesn't get oxygen and she passes out.
She had to be taken to the Queen Elizabeth II Health Sciences Centre because of one of these fainting spells. She was admitted, she was in hospital for a number of days. She subsequently received an ambulance bill in the vicinity of $500 or so and eventually that account was placed with a collection agency in Newfoundland and Labrador. This is a woman who lives in a low income seniors' residence and has very limited income. She was called and harassed, I think is the only way to put it, to pay these ambulance fees to this collection agency in Newfoundland and Labrador.
In the course of that attempt to collect on these outstanding fees, the collection agency in Newfoundland and Labrador was under the impression that she was a person who was gainfully employed and had absolutely no good reason not to be paying those fees. I can't tell you how upset and agitated this lady was when she called me. She is 81 years old, she is very frail, she is not in good health, her use of the ambulance was not frivolous, it was because of a life-threatening situation.
I use this as - perhaps it may be one of the more extreme examples of what we see, but the former Minister of Health made a commitment to the members of this caucus that there would be a review of ambulance fees. I'm wondering, where is that review at? Has the review been conducted? Is there a report? What is the department's position with respect to the outsourcing of the collection of ambulance fees to collection agencies in another province and these kinds of incidents? I'm sure the one I had with my constituent isn't unique.
[12:00 noon]
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and through you to the member opposite, of course I can talk at length to our EHS system and the program and the service that it has provided to all Nova Scotians. It is unfortunate that your constituent had to go through such harassment from the Newfoundland and Labrador company in trying to get that fee back. I can commit to the member opposite that if it has
[Page 105]
not been resolved, to make sure that she does get that information to me so that can be resolved. I'm sure that we do pay for almost 92 per cent for all transfers and fees in the province to date.
As far as the independent review has been taken, the review has been provided to the department at this point and it is currently being reviewed by staff, so I'm hoping to have some of those recommendations brought forward for public dissemination and see what their thoughts are on it. It does show some very interesting things, but it does put us very much in line with other Canadian provinces in how the fee service is being charged to Nova Scotians and to patients in Nova Scotia.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I want to thank the minister. I very much look forward to seeing the result of the independent review. This caucus has some concerns about the growing amount of public-private partnerships in the health care delivery. It's not all a rosy picture - the kinds of things that result for the citizens of Nova Scotia when they need health care. Certainly the positive part of EHS is the outstanding service that people receive, which I have witnessed first-hand and have heard so many positive stories from one end of this province to another. The staff are professional, they are efficient, they are caring and they do an outstanding job.
But when you look at the placing of accounts with collection agencies that first of all aren't in the province, secondly have no idea who they're dealing with and the kinds of fairly strong-arm tactics that get used in the field of collections generally, that's what it's all about, it's collecting money. The fact that you're dealing with people who are frail, elderly, sick, poor, all of those kinds of things, really don't make a hill of beans of difference to the person, that faceless person, who is on the other end of the phone. It's one of the really negative downsizes of public-private partnership and it's the people of the Province of Nova Scotia who pay for that in more ways than one.
I recently had a situation where a constituent contacted me to talk about a serious health care problem. It was a situation where somebody needed to get to the emergency department and because they were so concerned about the fee that they would face if they were taken there with EHS, they weren't prepared to call EHS. This was a cardiac situation and you have to ask yourself - this is exactly what the studies have shown around letting fee-for-service come into our health care system.
The impact is that people who don't think they can pay will in fact not use health care services when they most need them either for the kinds of preliminary intervention that can actually save us money down the road because the more critical levels of care won't be required when things hit a crisis. I look forward to reading the review and seeing how ambulance fees have been assessed and their impact and what have you. I
[Page 106]
assure the minister that if we don't see that review soon we will be coming after it over and over again until we do.
I have two more things I want to ask. I want to ask why on earth the government of Nova Scotia hasn't done anything to intervene in the disgraceful situation of Dr. Michael Goodyear and Gabrielle Horne. This has gone on now for three years and I understand all of the stuff around litigation, you don't want to get involved when there's litigation going on, but you know, this is not acceptable. It's not acceptable to me, as an individual in this House, to see that an organization like Dalhousie University has to play a leadership role in asking the Government of Nova Scotia and urging Capital Health to deal with this. If government has any power at all, then they certainly have the power to do something in this case.
It's unacceptable that anybody, any individual, and particularly our health care experts and providers who we desperately need - we want to create a positive business community and we should also want to create a health care environment that is a really strong health care environment for our professionals and for people who do research, oncologists like Dr. Goodyear, for heaven's sake. I want to ask the minister, are you prepared to allow this to go on or do you have any intention of trying to facilitate a settlement and bring this disgraceful situation to an end?
MR. D'ENTREMONT: There is no real legal framework for us to interject, yet we can be the sober second thought and urge certain parties to sit down and discuss this situation that is unacceptable and has been going on for far too long.
We have already had Capital Health sit down and come up with a number of recommendations that are being reviewed currently by the board of Capital Health. We're also urging Doctors Nova Scotia to change some of their guidelines that would allow these two physicians to practise. We've been very active in the last number of months to make sure that we have the parties talking and making sure that these two physicians continue to offer service to Nova Scotia. We definitely have not been sitting idle on this issue.
Just to a previous question, to the member opposite, the proposal from the Metro Non-Profit Housing Association, the proposal did go to Community Services. So while it's not necessarily with our office, it is with Community Services.
MS. MAUREEN MACDONALD: Mr. Chairman, I thank the minister for his clarification.
Mr. Minister, on the Horne/Goodyear situation, I recognize you don't have the legislative framework, but this Legislature has the ability, the government has the power to put in place a legislative framework to deal with this situation. That's my point. We
[Page 107]
cannot allow this to go on and on and on and on and on without - I mean, frankly, we've got the hammer and we're not prepared to use it. That's what I'm saying to the minister. Ten years? How long are we going to let this go on? How long are we going to allow two highly-trained, highly-skilled medical professionals who deserve a little bit of justice as the people of Nova Scotia deserve to have them working at their capacity in our health care system? Frankly, it leaves me speechless that we allow this to continue. I'm not going to really ask the minister to stand up and respond to that, that's my point to you.
Perhaps you can answer in this next question. I want to ask about the assessment, if there has been any assessment done of the low-income Diabetic Assistance Program that was introduced. It is a program we were all really looking forward to, we were really glad when it was introduced, but there have been some criticisms of the program and the fact that people have to have the money in their pocket to get the supplies and the things they need up front, and then they recover it. That's the whole point of a having a low-income Diabetic Assistance Program, is to help people who don't have the money get these things. Has it been reviewed? Is there a report? Is there a plan to do a review? Is there a plan to address, specifically, that problem?
MR. D'ENTREMONT: Mr. Chairman, just to finalize the discussion in regard to the two doctors who are currently under review at Capital District. We've asked the DHA to come back with changes to their bylaws. I have approved those revisions to their bylaws to allow this dispute to finally be finalized, hopefully in the very near term, so we will not prolong any longer. We didn't have to bring down the big hammer of legislation, but it would have been next should this not have been resolved.
When it comes to the low-income Diabetic Assistance Program, which is a program that I think has been phenomenal and is going to be helping lots of Nova Scotians, the conundrum we were sort of in on the rollout of the program, because we did not have the IT solution to administer a Pharmacare Program in contact with the pharmacies, we felt it was probably just as important to roll the program out, get the medications to the diabetics who required them. I'm very happy to announce, or to re-announce that the recipients/patients can now get their medications with only the co-pay, except for one retailer that is still having problems with the IT solution and making the connection. So low-income diabetics can now go into pharmacies and get their supplies, as anyone would with any Pharmacare Program.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I want to thank the minister and the minister's staff. I would like to pass the remainder of the time to the honourable member for Shelburne.
MR. CHAIRMAN: The honourable member for Shelburne.
[Page 108]
MR. STERLING BELLIVEAU: Thank you very much, Mr. Chairman. I do appreciate the time to talk on this important topic, especially from Shelburne County, and I know that my colleagues from across this beautiful province share this valuable time.
I think we can talk for a number of hours, and we will on this particular issue, about all the improvements we can do, or suggest to do, under the health care system. It comes down to one basic, simple solution. I suggest that it is all about finding money to do this.
My question to the minister and his staff is, will his government and the minister fight for an amendment under the Canada Health Act? My understanding is that the funding now is based on per capita to each province. I suggest to you that we have an aging population, that this giant iceberg is moving through our system and that I encourage the minister and his staff to follow this approach to get more federal dollars so we can address these issues, especially dealing with health care. We have an aging population that is different compared to other provinces. So that is my first question, Mr. Chairman.
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. The solution to all problems apparently is, of course, finding more money. Unfortunately it is not always the case, we can't grow a bigger budget than we have. The honourable member does talk about working with the federal government and this was something that we would continue to do and continue to have discussions around CHST, the Canadian health services tax, and how that number is distributed across Canada.
In the news, the Premiers have been talking about the equalization gap of Canada, where we have provinces that are doing extremely well and other provinces are not doing quite as well. So we do have to have a better distribution of funds for all programs within our province, within Canada. It's one that I'm very proud that our Premier as well as our Minister of Finance, and all ministers who sit at federal-provincial tables, that we continue to make sure we have our fair share of funding from the federal government.
[12:15 p.m.]
I can commit to the member opposite that I will continue working with the federal minister, Tony Clement, on programs to make sure that we have money for wait time guarantees or wait time benchmarks, that we continue to have money for the expansion and replacement of medical equipment, that we have extra funding for other programs that come along that should be shared.
I also have to say to the member opposite that the purview of health, as laid out within the Canada Health Act, that it is the purview of the provinces. So that has been
[Page 109]
our challenge up to now, but we will continue to do our best to make sure that we have our fair share from the Canadian Government towards health care.
MR. BELLIVEAU: Mr. Chairman, again, if you are familiar with Shelburne County, our incentive packages to attract professional doctors to our community has been addressed, I believe through a Private Member's Bill a few years back. Our community and county have struggled for a number of years to attract these professionals to our community.
If you look at the long term, and it's interesting - I note a personal story within Shelburne County of parents who cannot get their child in medical school. It's interesting to note their story because to me here is a good example of that individual getting their education and eventually coming back to our community.
My question to the minister and his staff again is that these rural communities across Nova Scotia are struggling to find long-term approaches to their professional health care needs. To me there is a simple, logical explanation to this. The Minister of Health and his staff should be suggesting to the medical schools in our province that they should be designating seats for rural students to educate themselves and, hopefully, our community will support these students and these students will commit to coming back to these communities. Again, my question is that these seats have to be designated because these students who are coming from our communities are competing with international students and again I ask you, this is a common sense approach of trying to address an issue that is going to help us down the road.
MR. D'ENTREMONT: Mr. Chairman, through you to the member for Shelburne, I just want to commend that community. It has done fairly well over the last number of years in recruiting different positions but it, like other parts of the province, has had some difficulties in retention. I think that's sort of our trick, and why the member opposite brings up the issue of taking students from our communities, helping them get through medical school, because we have a much better of chance of getting them to resettle back at home.
Dalhousie School of Medicine does sit with our recruitment committee and does play a large part in the recruitment of doctors in Nova Scotia. There are discussions ongoing of how to better that situation and I, too, agree with the member opposite that it would probably roll down to the designation of a few seats to try, maybe even as a pilot to try this out, just to prove it, because I know and you know that this probably should work. So I look forward to the discussions with Dalhousie, but we also have an opportunity here, it's not just with the Dalhousie School of Medicine, but we also have to look at the availability of doctors doing their residencies in our local communities as well because we only have a certain amount of good residency seats that are sprinkled around Nova Scotia, the Capital Health District and a few other facilities across the
[Page 110]
province. It would be nice to see them in places like Yarmouth or Shelburne where we could be able to do some residencies there because as they get comfortable in a community, hopefully, they can stay in those communities.
MR. BELLIVEAU: Mr. Chairman, I'm going to ask the minister, after I sit down, for clarification on what I thought I heard. I thought there may be an opportunity for a pilot project on this. I will ask him for his clarification on that but, anyway, I think that the questions I brought forward here are a common sense approach to addressing a major issue in our province. I suggest again that we have this major iceberg of aging population, which I'm part of, the baby boomers' generation. If these issues aren't addressed, we're going to continue to hear stories and I'll tell you a few from my community, of residents in my community, their wife is in an establishment 50 kilometres away in one direction and their sister is 50 kilometres away in the other direction. I ask the chairperson to make that decision for that individual, what direction do you go each day to accommodate your loved one. We have veterans who are going to our hospitals now and there is simply not a bed for them. These veterans did not turn away from us when it was his or her duty, but our health care is turning away from our seniors and our ill.
We have personal stories. I can tell you personal stories of people who are patiently waiting for heart transplants. They are patiently waiting to go in to have a bed to do the preliminary tests so they can be in line for these operations. We have people who are waiting for knee and hip operations and their schedules have been cancelled. They travel a great distance not only to Halifax, to Kentville, people from Shelburne County. So I go back to the minister and ask for clarification on the question about the pilot project first of all, but until we find more money and until we do common sense approaches to these, we will not have solutions. So, hopefully, the minister can address some of these questions.
MR. D'ENTREMONT: Mr. Chairman, through you to the member for Shelburne, as I talk about pilot projects and discussions with Dalhousie School of Medicine - you know, we want them to be a part of the total solution for Nova Scotia. At this point our discussions with them have been good, yet they are very reluctant to designate a seat for one student or another. They feel that they should allow all people to apply for those seats, but if you look at other jurisdictions like New Brunswick, Quebec, Ontario, there are certain schools that have designated seats for those local students. So I look forward to continuing my discussion with the school, through the deputy and through the departmental staff to look at an option of maybe a pilot project, to find a few students and run them through the system to see how well that works, but also the expansion, I believe, of the residency program, will help out a whole bunch too.
Case in point, I have an acquaintance who had to go away to medical school because she could not get accepted here in Nova Scotia, so she went away to Hungary
[Page 111]
for the first year. She's in the Isle of Saba right now, which is somewhere down in the Carribean, which I'm sure is even hotter than here, which is hard to believe on a day like today, but she's now having a challenge of finding a residency spot in North America. To find a residency here in Nova Scotia would be phenomenal because we have a Nova Scotian who would go through her residency here in Nova Scotia, so the chances of having her stay would be phenomenal.
The medical students that we talk about come from Dalhousie, in Nova Scotia and New Brunswick. Without designating seats, within the medical school - we can talk that over 1100 are being placed in communities right across Nova Scotia. We see them still stay within a certain radius of their medical school. Mr. Chairman, again, on the retention of these, I think it's very incumbent upon all communities in Nova Scotia to try to make the best life possible for those medical students, those medical graduates who are coming to our communities, whether they be from Nova Scotia or from all points of the globe.
MR. BELLIVEAU: Mr. Chairman, I'd like to turn my time over to my colleague here and I want to thank the minister for responding to my questions. Thank you very much.
MR. CHAIRMAN: The honourable member for Pictou East.
MR. CLARRIE MACKINNON: Mr. Chairman, through you to the minister, are you aware, Mr. Minister, of the release in Ottawa today of the Final Report of the Federal Advisor on Wait Times, Dr. Brian Postl? He's the CEO of the Winnipeg Regional Health Authority. I'm getting right into my questions. I have a series of them.
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Pictou East, I thank him for his question. The Brian Postl report has been one that we have been able to be briefed on, one that the Province of Nova Scotia totally supports. It is also one that talks about some of the costs and where the funding should come from to address the critical wait times in Canada and we're hoping the discussions will continue with the federal minister and the federal Department of Health in trying to make services better for all Canadians.
MR. MACKINNON: Mr. Chairman, I understand that Dr. Postl is looking at some of the systemic problems that exist and he's pointing out, at least in some of the leaks that have come out, about the fact that increasing funding doesn't necessarily translate into better service, and I understand that this 76-page report is a must read for all Canadian politicians and I hope that we at least get 52 copies of that.
Having been briefed on the report, I'm wondering if the minister is willing to look at some of the content, particularly some of the things that relate to protection of
[Page 112]
turf, and perhaps even to look at an accountability audit. An accountability audit, I believe, is perhaps the key to this whole thing, because the money going in sometimes doesn't translate into better services. For example, if a piece of equipment looks a little bit better but is the same as something that's worth $10,000 and you payed $40,000 for it because it looks better or whatever, that doesn't do anything for the system. What I'm saying is, will there be any consideration to accountability auditing within our hospitals?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Pictou East, just to give you a quick rundown of some of the information held within the Postl report and the things that we actually support, some of the processes are already undergoing here in this province. Ultimately the biggest one we've been working on is, of course, information systems and making sure we have the IT solutions there to know what our wait times are, and to find the solutions to remedy them. Looking at centralizing management of wait times - far too often wait times are handled by particular surgeons or particular doctors. We need to find a better way to bring those wait times into a central area.
The other thing, Mr. Chairman, is a lot of times some people are on two or three different wait lists, so we need to get a better feel of that data that is required. Mr. Postl also talks about research for looking to connect between wait times and health outcomes. Right now when we look at a wait time, we basically pull someone to see if they're on the wait time and how long they have to wait, or we do an exit survey to see where they are. We want to be able to find that integration and find out what the outcome is, as well.
Mr. Postl recommends having patient navigators to work with patients on wait times, so somebody who is on a list knows where to call and has that one person to call on a semi-regular basis to find out how they're doing, where they are, and if there's any change in their process. Right now, you go on a wait list and you have no idea where you are for the most part. So it's a better use of time. Also, to revise a re-engineering process, they're looking at the Calgary orthopaedic pilot. There are a whole bunch of places - we don't need to re-invent the wheel - we can look at what's happening in other jurisdictions in Canada to help our wait times.
[12:30 p.m.]
As far as the audit that the honourable member talks about, we are currently in the process of an audit, PHSOR - and I don't know who came up with that acronym, but it's great, it sounds like a phaser. Ultimately it's to look at a snapshot in time of where Nova Scotia's tax dollars are going with the system and analyzing the outcomes to see if we're doing it right or doing it wrong, or what those recommendations to change it would be.
[Page 113]
MR. MACKINNON: Mr. Chairman, to the minister, to what degree have housekeeping services been cut in our hospitals, and what are the possible impacts of less soap and water or cleaning or whatever you want to call it? What I'm referring to is post-surgical infection. The post-surgical infection rates, perhaps in comparison to other jurisdictions - I don't know if anything has ever been done in that respect. However, other jurisdictions have also cut the cleaning potential within the hospitals and so on. This is becoming a concern that is being expressed by a number of people, that sometimes it's safer to be home than to be in our hospitals. There is a whole series of items that could be listed as instances of very poor cleaning that is done in some institutions. In some areas there has in fact been privatization of services, in many jurisdictions today. This is a concern that a lot of people are expressing. I'm wondering, is the government looking at that?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, I thank him for the question. I know we had a little discussion about that yesterday, in reference to a gentleman we were chatting with. The Department of Health has not directed the health authorities to make cuts in housekeeping. As far as we're concerned, we haven't seen cuts in housekeeping in any facility under our purview.
Infection control rates, or infection rates here in Nova Scotia are very much on par with other jurisdictions. We're no worse off, but then again we're probably not much better. We need to find a balance. As we had the discussion earlier this morning with the member for Sackville-Cobequid, we have implemented an infection control coordinator within the province who can work with the DHAs. Each DHA now has an infection control committee to make sure we can keep up the standards.
Don't forget that accreditation is a very important part of our hospital system and a large part of the accreditation of hospitals has to do with the management of their infection control and the cleanliness of those facilities.
MR. MACKINNON: Mr. Chairman, I would like to thank the minister for the response to both of those questions. It seems that some things are being done that are concrete.
However, another concern is, are there improvements in the hospital staffing ratios, i.e., the numbers in middle management, some of who are much like us - they spend perhaps entire days at meetings and so on? One example is a committee on fragrance in hospitals - I mean, what I believe and others believe may be part of the problem is that we could perhaps get along with some fewer administrative positions and have more front-line caregivers.
[Page 114]
I know this isn't new, this has surfaced a number of times in the past, but is this something that's being looked at - the ratio of middle management and management to the number of people who are on the front line in caregiving?
MR. D'ENTREMONT: With regard to staffing levels, it has been a challenge over the last number of years to make sure we have the correct number of front-line staff, yet making sure we have the correct type of administration making sure the checks and balances are also in place.
I can say to the member opposite, the Nova Scotia Department of Health in particular, not necessarily the DHAs, has always staffed the Department of Health in the country. We're pretty thin for the amount of work we do. I can say that through the 1990s, there was a large cut in middle management and I wonder sometimes whether some of those folks are doing more work than they should be and things are getting missed.
So, I can say to the member opposite, it is not our indication that we are too top heavy, but I do say our focus now is making sure we have the correct number of front-line health care workers, whether it be technologists, nurses, doctors, what have you.
MR. MACKINNON: Mr. Chair, to the minister, what are the factors behind discontinuance of a pain clinic wait list after it reached five years or more? Is it recruitment, retention, financial? It's a very serious problem in this province.
MR. D'ENTREMONT: The pain clinic has been particularly troubling to me, to see such a long wait list for a service that is so life enhancing for some of the patients that require it, which is why last Fall we had the creation of the pain advisory committee that is being chaired by the acting chair today of the Capital Health District, Mr. John Malcom and we are making sure we look at all the services in the province. I think it's not just an issue of the pain clinic here, but in the absence of other services in the province, we're seeing an undue focus on the one here.
We have invested a fair amount of money to implement those recommendations as they come forward to us, and we are looking at, as I said, other parts of the province that we can offer those kinds of pain services. We are also hopeful that with the increase of anesthesiologists or anesthetists in the province that that will alleviate where those patients can get the service. So I think we are well in hand of making a dramatic change there.
MR. MACKINNON: Mr. Chairman, to the minister, I have run into a number of circumstances in the very short time that I have been an MLA. These are situations where people require services that can't be given within the province. So my question is, if services have to be provided in another jurisdiction and the people do not have the
[Page 115]
resources to look after travel and accommodations, travel and accommodations are always passed on, it seems, to these people, are there avenues of providing the necessary funding other than through Community Services?
MR. D'ENTREMONT: Mr. Chairman, and to the member opposite, if a service is not available in Nova Scotia and the patient has been referred by a physician and approved by the physician, we do cover the health care cost, for the most part, within Canada. To date, I have not had discussions or thought on the accommodation or travel costs associated with this type, but we do make sure that we do cover the health care cost, itself, for these patients.
MR. CHAIRMAN: Thank you. The honourable member has approximately a minute and a half.
MR. MACKINNON: Mr. Chairman, I certainly hope that the minister will look at the accommodation and travel situation, it is a grave one.
Recruitment and retention are very important factors. From a personal experience last Fall, needing an oncologist, and the fact that we were faced with a situation where there were 6.75 positions available in Halifax, compared to seven positions that existed back in 2000, I hope that efforts are being made to make this a better situation, because it is a deplorable thing when someone has to wait for 13 weeks, 13 weeks for the appointment with an oncologist.
Now I understand that things are, in fact, improving, but maybe at the expense of another hospital. I understand that an oncologist from Sydney has recently come to Halifax. Well, that makes the situation better in Halifax, but it certainly makes the situation worse in Sydney. So I hope that real efforts are being made.
Very quickly, I understand that an oncologist was trained in the system, and lost.
MR. CHAIRMAN: Order, please. The member's time has expired.
The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: Thank you very much, Mr. Chairman. It is a pleasure for me today to rise with just a few questions. I won't be taking a lot of time today, but a few questions that relate to health care. It is always a privilege to have the opportunity, as a member of the Legislature, to speak directly to the minister, and to have with you your staff who are so competent in helping to advise, as well. So it is an opportunity for us, which I think is very important to everyone to be able to raise our local issues and also issues of a broader concern.
[Page 116]
I had a couple of areas I wanted to examine. As many of you know, the Clayton Park riding is home to a large number of newcomers to Nova Scotia. It is also very important for the trend that we have where we are trying very hard to increase our number of immigrants to Nova Scotia. I am very interested in the services we provide that help make their transition here that much easier and better.
One of the questions I wanted to raise with you was the difficulty - we often talk here in the Legislature about education and English as a second language for the young families or the children of the families that are moving here, but another very serious concern is how we provide health care to those new Canadians, and whether or not language barriers are, and I believe they are, a concern to new Canadians as they come here. It's a very different system. It's very intimidating often and the lack of language ability makes, as you know, even for Canadians, for English and French-speaking Canadians, a difficulty often in understanding medical treatments. So my question is to the minister, if you could address some of the initiatives that you know of that are being offered, what you know of where the need is greatest and how we might be able to respond? I'll let you just give me your general overview, if you would.
MR. D'ENTREMONT: Mr. Chairman, you know, this has been one of interest to me and interest to the Chair when it comes to access to health care services in your own language. Especially with the French-speaking population we have in this province, you know, I think we've made some improvements and we'll continue to do so for that population.
The population that you refer to, of course, are our immigrants from countries far and wide and in a whole full range of different languages. Most of them being newcomers would probably have difficulty talking to our physicians in English. What we've done is approved a position within Capital District, basically we call it a diversity coordinator who can work with people within the system who require translation services, cultural discussions, helping those patients have the best experience possible to make sure that their outcomes are as good as possible within that system.
Let's say even through teletriage, as we're talking about the program that we're going to be implementing early next year, there is an option there that they can actually call in and receive service in over 100 languages through, I think it's a call centre in Winnipeg, I believe, is where they receive that service. So we are making the best of what we can on implementing new programs to make sure that there is service in a whole range of different languages so that service can be available.
[12:45 p.m.]
MS. WHALEN: Mr. Chairman, I wonder if the minister could tell me a little bit more about this triage program, perhaps you've mentioned it earlier in estimates, and it
[Page 117]
sounds very interesting. You mentioned that it would provide services in 100 languages and I assume it is a distance form of health care, or health advisory. Could you give me a little more information on that and how that might help people who live in my constituency and here in Nova Scotia?
MR. D'ENTREMONT: Mr. Chairman, the program that I'm referring to was held within the - I think it was from the Speech from the Throne, as well as the platform of the Conservative Party during the last election and talking about it - basically a telehealth, teletriage program which would be a phone number that our citizens can call to get base advice on health conditions. The idea basically is to have the services of RNs answering the phone, helping them through their ailments, making suggestions on treatment as well as suggestions to see an ER if they require.
The program, as it stands right now, is basically a copy of that one that's in New Brunswick. You do have your local RN service here, but when you do fall into a problem of not being able to understand language and being able to understand a caller's needs, well, through this implementation across the country of other service from a Winnipeg telecentre that would offer those services in 100 different languages. So that is basically the premise of that system.
Also to the members interested in this, we're looking to design a program to educate immigrants on how to access our health system, and no differently than maybe ESL. As people come in and have to learn English or another one of our official languages, we should be able to provide them with an idea on what our health system is because our health system in Canada is even a fair amount different than that one in the U.S., that's even different than that one in different places around the world. So we need to do more work to help our immigrants that way.
MS. WHALEN: There's at least one organization that I know of that does offer translation services where there are volunteers who will be matched. I wonder if you could tell me how they are utilized within the system and whether there's any support for that non-profit organization to just support - I know that the translators are volunteers, but I'm wondering if there is any support for the organization. I believe it has been around quite a number of years, perhaps 10 or 20 years, and I wanted to know, how are we helping to keep that organization viable?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Halifax Clayton Park. As far as I understand right now on the way that service is offered through the DHA, in particular the Capital District Health Authority, is that they basically contract that service from this organization. I'm unaware of how much that costs or if it does cost at all, or if there are any supports there, but I could endeavour to find out some information for you as, again, it's under the purview of that health authority.
[Page 118]
MS. WHALEN: Mr. Chairman, again for the minister, I would appreciate that information if you could. Often the fine level of detail is not available or it would be in budgets from the district health authorities, so we would appreciate it if you could find that and just give me a little more background on it, because certainly I do worry about the access to health care where people are intimidated to go forward or they are unable to access it.
I think it's worth noting that the second most prominent or prolific language in HRM is now Arabic. In Clayton Park that's very visible in the community and in our schools. We had a discussion at Community Services, I believe it was, not long ago around MISA and some of the services offered to new immigrants, and one of the things that came out is that often, particularly the women at home do not acquire the language, that their children are learning English in the schools and often the husband is working and acquiring English, but the mother who's home and a caregiver, there's a risk that they will fall between the cracks and not get the language training they need. They're usually, as the deputy minister and minister will know, it's very often the woman in the family who accesses health care on behalf of the whole family, and that's true in our own culture as well, that the women are the most familiar with how you go about accessing and getting the services you need.
So I think that as the caregiver in that case, it's very important that we reach women and that we know they have the services they need, and that we find a way to demystify the system. I think your idea of educating, providing some kind of education through either ESL, through the schools, or some other social non-profit group, would be very helpful as well because it is a very important part of life in Canada.
Leaving that one aside, I would like to talk a little bit about self-managed care - and I know it has come up a couple of times. I had lobbied strongly on behalf of one of my constituents with the previous Minister of Health and his staff to get the kind of health care needed for a person in my riding who is confined to a wheelchair, but does work. There's a difference that was quite noticeable to me in that his concerns around the home care he was receiving was the dependability, the hours of service because he had a job to go to. His is actually a job that had different hours. He often works night shifts and has to be picked up by the accessible transportation at a certain time in order to reach his job and work the shift through the night and, because his care is quite intensive, he requires at least two or three hours of care to get ready and be up and ready for that transportation to work.
Home care doesn't always guarantee the time at which they come and there's a certain amount of flexibility around that and often with his afternoon shifts it might interfere with the way the shifts ended - it was the VON in this case that does it here in Halifax. The shifts would often not be conducive to the time that he needed. It was a big problem and my hope at the time, Mr. Chairman, to the minister, was that this new self-
[Page 119]
managed care, that we would allow individuals, by putting their care back in their own hands for those who are able to manage the arrangements of the administration of that, that we give people more control over their day and their care so that they could pursue the other things that are important in life.
I don't want to see people who are severely disabled being unable to access the work that they can find. We've talked here on a number of occasions about people who are disabled and their high rate of poverty and their inability to find work, and when we have somebody who has a good job and is able to perform that work we need to work very hard to make sure they can maintain that. So home care was an issue with this individual and, in fact, had been cut off because of various disputes, let's say, around how things were going. My advocacy on his behalf was to see this individual could get the control he needed so that the money could be put in his hands and he could access care.
My hope was that self-managed care would provide that for him. During the election, when I had spoken to his family at the doorstep, I was told they were very happy that self-managed care is here, but it doesn't serve their needs. They said - I don't think this is entirely correct, but I'm hoping the minister can correct my understanding - that nursing care was not available. This individual needs medical nursing care, not just housekeeping or that kind of care, and he can't access it through self-managed care.
I'm wondering, are there restrictions? If you could explain to me a little bit more because my hopes were very high, my expectations were high, that this would be a real God send to certain people who have need of daily home care services. The fact is, it hasn't met or measured up to the expectations of this particular family in the Clayton Park riding. So I'm anxious to know if there are some restrictions - is it a financial restriction or is it a restriction on certain services that might preclude a person who is confined to a wheelchair - that's the situation here - he needs medical help each day to get up, to do the exercises he needs and other physical care. I'm wondering, could you address whether or not there is a shortcoming or perhaps a misunderstanding?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, the self-managed care program, which started last year, is a fair step forward in an option for care for many disabled and some of our seniors.
When it comes to that, it's basically a program to allow people to remain independent in the community as long as possible. The limit really is $3,500 per month, so it's up to you, depending on your requirements and your assessment. Just reading through the requirements, it says registered professional health services like nursing, continue to be provided through the home care service. So I'm just wondering if that might be a bit of a shortcoming here to the true system of home care.
[Page 120]
For the honourable member's information, as of June 15th, there were 15 individuals who have become self-managed care clients and signed those contracts with the Department of Health. I'm interested in maybe researching the issue around nursing or health professional care within this package. I think I would get back to the honourable member just to see whether that is a shortcoming or a project program design, but also to say that we've increased self-managed care this year, basically doubling it, and adding another $1.75 million to it this year alone.
MS. WHALEN: I'm interested that the amount has been doubled. I do think this is a program that needs to be extended. I think the evidence of almost 10 years - I believe it was a full 10 years - of the pilot program that was initiated under the Liberal Government in the 1990s, showed the people who were on that program were extremely happy. In fact, the attrition rate had been very small, I think only one or two that had moved away had stopped accessing the pilot project. We had a lot of evidence that this is very good and it helps people have control over their lives, as well as accessing the care they need. It takes some of the bureaucracy out of their lives, which I think is important.
My concern might have been that the $3,500 perhaps - I mentioned this to our Health Critic who said perhaps that isn't enough to access daily nursing care. I'm not really sure, but that might be something I could bring the individual case to your attention and we could look at why they feel they're not eligible to even apply or be part of it. My understanding was that this would really improve their lives to some degree.
I wanted to go back for a minute to the credential recognition. I guess in a sense we're looking at immigration again. One of the biggest issues I've run into when we're talking about immigration and talking to newcomers is that it either affects them directly or they have friends it's affecting. Many newcomers arrive in Nova Scotia and cannot practise the professions for which they've actually been selected to come. We set very high standards in Canada for the level of education and skills and financial resources a family has when they arrive here in the country. A lot of that is related to the profession they bring with them and then, of course, they run into roadblocks. The medical professions are no exception.
This last year, you introduced a program called the CAP program which was to help, as I understand it, those trained doctors - maybe other medical people as well, but I understood it was doctors - get their certification and be recognized here in Canada. There are some shortcomings in that program, as I understand it, it is very difficult to qualify.
I wonder if you could give us a little bit of an update of where you are because this is a tremendously important problem. I'm sure the Minister of Immigration is here at the moment, so she will recognize this too. If you talk to newcomers, this is a huge
[Page 121]
problem for them. We have a lot of people who are qualified and I'm sure could be mentored into the system properly, but they aren't being used at all. At the same time, we have, on the other hand, huge needs in our medical system. More doctors are needed and more nurses, and we are not using those people who have the skills. So could you give me an update, please, on the department's response to those issues?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and through you to the honourable member for Halifax Clayton Park. In the reference to the CAP program - the Clinical Assessment for Practice program, it has been one that has worked relatively well. Of course when we come to the requirements for physicians, especially international medical graduates, we have to basically leave that oversight to the College of Physicians and Surgeons in what they feel are adequate practice levels, adequate practice training.
What we have been able to do is that, during this CAP assessment, we hired, I believe it is, 11 in the first group, which is October 2005 to January 2006. In the second group there were 10 physicians available through the CAP program. Six were hired in May-June, two are going to be starting in late July-September, and then we have two who are kind of unsure of at this point. So there is a mechanism now that is far simpler than what we have in the past. Quite honestly, and I'm sure you heard a lot more than I did, that there were a lot of people coming to this country who did have some adequate training, who were just completely unable because there was no mechanism to allow them to be assessed or to practise in this province. What we did see is that a lot of them ended up moving to other jurisdictions where they did have that kind of assessment and plans for integration into particular medical systems.
[1:00 p.m.]
We have been working with a lot of the proponents in this one and I can say that for my own community and seeing how our international medical graduate clinic is doing in Yarmouth, where we have three of those folks working in a hospital setting in Yarmouth, I think it's going to be working phenomenally well. Basically, within that clinical assessment, there are guidelines that they can set out of extra practice time for training under the supervision of a doctor, that can happen before they roll out to work on their own within our system. So I think we are making strides and we still need to continue the upper progression of making sure that those folks have the opportunity to work here in Canada.
MS. WHALEN: Mr. Chairman, the minister mentions the first class of 10 doctors who went through that program. I'm wondering, could he fill us in on how frequently this is going to be offered and whether or not there is a waiting list now of applicants to continue that program?
[Page 122]
MR. D'ENTREMONT: Mr. Chairman, definitely this is going to be something that is going to happen annually. Currently in the third group, we are doing assessments, or the CAP program is doing their assessments and hopefully we will have a recommendation come forward very soon of how those folks are and find them with their clinical placements somewhere in this province.
Just to give you an idea, the first group, whether we looked at the remuneration, moving expenses, the mentor honorarium because, of course, we have to pay a mentor to basically give oversight to those doctors and a whole bunch of other issues. The first group cost us somewhere near $1.9 million; the second group of 10 physicians is costing us somewhere near $1.6 million; and the third group, we do have an estimate right in here that we are going to be coming to a similar cost. As we assess that, we are just making sure we have the tools in place to bring more of those medical graduates in.
MS. WHALEN: I appreciate that level of detail. I'm glad it's continuing. I'm somewhat surprised at the investment required to mentor and set up a program like that. Again, we have said the need is acute here in Nova Scotia to have more physicians. It only makes sense that we help in the integration of newcomers who have been brought here because of their skills. It would be interesting to go through the breakdown of those costs at another time because I think that's a surprisingly high cost for, let's say, 10 people to be integrated.
I wanted to ask you about the needs sometimes for extraordinary drug costs. Again, it is a constituency issue that, Mr. Chairman, I would like the minister to just perhaps be aware of. I'm sure it happens on a routine basis with all constituencies and all MLAs. I had a case where a gentleman came to see me who had been diagnosed with hepatitis C. The treatment for that is something called interferon, I think. It's something that is injected, it's like a chemotherapy kind of treatment. Basically the patient is fairly incapacitated for upwards of a year or more. In fact, in my own family my sister had that treatment. It's known to eliminate the disease and you can be well at the end of it, but it's a really difficult treatment to go through because you cannot work, you have to stay home and be cared for by somebody in your family because you're just so ill during that time.
There is also a huge cost to this drug and that's really my issue today, the cost of the drug and that it's not covered routinely. It's not available because you're not in hospital, you're at home, so you need to have a drug plan or you need to be covered because you're on social assistance. There has to be some extenuating reason why you would be able to get that paid for. In the case of my constituent, it was not possible through social assistance and the person does not have the means whatsoever to pay for this themselves. It is thousands of dollars, although I don't know the full cost.
What I'm asking of the minister is, in cases like this, an MLA will write a letter directly to the Minister of Health and say, would you please look at serving or helping
[Page 123]
this person. I don't know how frequent it is, but my question to the minister would be, what guidelines are there for cases like this, how frequently does it come up and what do we have available for a case like this?
I have written a letter and, as I understand it, we're still waiting to see what might be done in this particular case. It's not an isolated case either. It is, as you know, Mr. Chairman, something that is across the board, I'm sure, in every riding. So I wonder if you could talk somewhat to this program and what might be available.
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and I thank the member opposite for bringing up this very important issue. In reference to pharmaceuticals and the basic Pharmacare Programs, there are so many different therapies out there for so many different ailments that it is absolutely incredible. Some of them are, of course, of huge costs, as the member is aware.
There are basically two things going on when it comes to pharmaceuticals. One of them, of course, is as announced in the Speech from the Throne and, of course, throughout the election, of the working families Pharmacare Program, which is one to grab hold of about 200,000 Nova Scotians who, at this point, do not have access to a Pharmacare Program. Whether they aren't in the Community Services realm so they aren't able to access that program, or their employment doesn't allow them to have access to a drug plan, so we are trying to grab hold of those folks and provide them with a Pharmacare Program that they can get the pharmaceuticals they require, from one drug to another.
When it comes to some of these - I don't know what the right term for them is, but very expensive drugs. Through the national pharmaceutical program or the National Pharmacare Strategy, which I had the opportunity to sit with my federal-provincial colleagues, or mostly my provincial colleagues, on Wednesday in Fredericton, we were talking about that particular thing at length for quite some time.
Basically when we look at the expensive drugs, Fabry's is a good example of enzyme therapy which costs about $300,000 per year. How do common folks access that kind of program? So we're looking at strategies and ways to get them those kinds of pharmaceuticals within a catastrophic drug program.
The other thing that we've been trying to do in pharmaceuticals, as well, within that strategy is look at those generic drugs, looking at trying to bring our costs down, maybe try to find some strategies to work together with the different provinces on bulk buying. There's just a whole bunch of great ideas there to try to bring the costs of pharmaceuticals down. The study talks about how we're paying about 30 per cent more on drugs than some other jurisdictions in the world, so we need to have a good strategy that is Canada-wide, to help out. Through the working families Pharmacare Program and
[Page 124]
through the work they were doing on catastrophic drug coverage and expensive drugs for rare diseases, I think will give some consolation to those people who require that kind of pharmaceutical.
MS. WHALEN: Mr. Chairman, just to wrap on that, I'm wondering, are there guidelines for the minister when you receive these requests that come through either directly - I don't know if they come directly ever from physicians - but directly from MLAs, are there some guidelines that you would have to go through that would say, yes, we will cover this or no, we won't? Thank you very much.
MR. D'ENTREMONT: Mr. Chairman, of course with any documentation or any letter that is sent to the minister, it does cross my desk, we look at it and we send it to the correct department that will look at that request. But as for guidelines on whether a drug is covered or not, of course we have our decision that will look at that when it pertains to our program, such as the Seniors' Pharmacare Program, and what is available under that formula or not.
In some cases, depending on if you've tried a drug or not, a really good one is Nexium - "the little purple pill" I think it's called - and it helps out, I think, gastrointestinal problems, but it wasn't covered under our program. So we do ask that the physician try a couple of the ones that are under the program and if you don't react to them, then you can make the request to us to be covered for that. So there is a process available for some of these different drugs, as it stands, but I think it's really to try to get that Pharmacare coverage for those folks who don't have it to date.
MS. WHALEN: Mr. Chairman, just a final question on that. If the minister could tell me, when would we be able to see this program then operating for low-income families, the working families Pharmacare Program, so that constituents like this particular one will know that there is some relief in sight?
MR. D'ENTREMONT: Mr. Chairman, I think the commitment has been to this point, to start working on a program designed to have rollout sometime late into 2007, but by the time we do the work - the other issue that we had is that there was the Children's Pharmacare Program that has been under design from Community Services. We have the program for seniors, so I think that the opportunity here is to try to put them together and offer a good plan for all.
MS. WHALEN: Mr. Chairman, what I'd like to ask about now is community health care again, and I know that members who represent rural ridings have talked about the need for clinics and that sort of thing in their areas, but I have to point out that even an area like Clayton Park, which has probably in its catchment area around 100,000 people, could really benefit by having a centre, perhaps not unlike the Cobequid Centre, but maybe not as big. I really have come to this realization talking to people and their
[Page 125]
concerns again about emergency room waits, particularly about people going down there because they have no other option but to go and line up and join the queue at either the IWK or the Queen Elizabeth II Health Sciences Centre, in order to get service or get some help. They often wait hours and hours for something that may not be all that serious an emergency, but they have nowhere else to turn.
As a neighboring community, I looked with some envy at the old Cobequid Centre, I thought it was good and my own physician had directed me from the Clayton Park area in the past, to go to the Cobequid Centre, it would be quicker when taking my children for X-rays or for, hopefully, a quick visit to emergency, which I think may be an oxymoron right now so we won't use that term. But they had told me it would be faster if you went to Sackville rather than going downtown, and Clayton Park is just about an equal distance to either one.
The idea of having a community centre where you could go and have just as was talked about in the election - I think a number of parties talked about it, we certainly did - having a sort of team of professionals where you could go and get stitches or get an X-ray or have a nurse or doctor, have a quick examination to tell you what needs to be done, that would really filter out or screen out a lot of people who shouldn't be sitting in those emergency rooms downtown in the big hospitals. We've done such a lot of concentration of our services, that even in HRM there are communities like Clayton Park that would be far better served by having a community centre where that service could be offered, and I would say at a much cheaper price than lining us up in the emergency rooms of our major regional hospitals. I'd like you to speak a little bit about any of your department's plans - I'm hoping there are plans - to extend that kind of service within HRM.
MR. D'ENTREMONT: Mr. Chairman, the honourable member does bring up a very, very important issue and one that I feel needs a lot more thought and a real strategy in how to get these facilities in communities around the province; communities include HRM and Clayton Park and, heck, even Pubnico would be a good place to put one, heck, maybe Tusket. How about a new one? I have to get my points in here too, sometimes.
Ultimately, if we look at the two facilities we have in the city right now with Duffus Street and the North End Clinic - they've been two wonderful collaborative practices, and ultimately a clinic setting people can go to to receive the services for their minor ailments and get the kind of health care I think all Nova Scotians deserve.
As we look at it, we have no mechanism, at this point, to say this is where one is going. We hope that proposals come from the community. So I would say to the honourable member should a proposal come from the community, we would review it and look at it favourably.
[Page 126]
[1:15 p.m.]
MS. WHALEN: Thank you, I appreciate the advice from the minister, and perhaps I'll start something rolling.
What I'd like to go to now is a different subject, and that's mammograms and breast screening. I had a specific concern around our current practice, and that is at the age of 50, women go from an annual mammogram - which I guess is allowed from the age of 40 to 50 - and it becomes an every two year service that's available. In my own reading of different material that I've picked up in doctors' offices and here and there, it suggests that women over 50 are at greater risk than younger women of developing breast cancer. So my question to the minister is, why in Nova Scotia do we decrease the level of screening when women, in fact, are entering a period in their lives when they're at greater risk of developing breast cancer?
I'll tell you that I do think it's wrong. I think there's a lot of anxiety in women about breast cancer, and that they want to do the right thing and get the right amount of screening and prevention. It gives women a greater sense of comfort knowing that you've been screened, that you're doing the right things and that this is being taken care of. If you're told by the Breast Screening Clinic that you're not eligible for another full year, which happened in my case, I was not happy. I think it should be an annual examination that's paid for by the government. So I would like to have your answer please.
MR. D'ENTREMONT: Mr. Chairman, in the guidelines for the Nova Scotia Breast Screening Program is, of course, set by that program ,with oversight from Dr. Judy Caines, I'm sure it's completely evidence-based on why they suggest that. I can also say to the member opposite that through the normal practice of self-examination and should someone have to go see their doctor, they would receive that diagnostic even if it is within the two years. Even though the examination is urging Nova Scotia women to get their breast screening done every two years after the age of 50, should something arise, they will get as many as they require, as this cancer and this ailment is one that touches so many of us, and to make sure that they are treated in a correct fashion.
MS. WHALEN: Mr. Chairman, I appreciate the answer but I don't think it has quite addressed the question yet. The fact is that the likelihood of developing breast cancer increases with age for women and we are decreasing by 50 per cent the availability of mammograms at that age. So I fail to understand why we are providing an annual mammogram from 40 to 50 and that it decreases to half that frequency when we get beyond 50. As I say, it's a time when women become more likely to develop cancer. So I think that it is a bit of a concern.
I should say at the same time that a self-examination is obviously a good practice and so on. However, a mammogram will detect a cancer a lot sooner than anybody could
[Page 127]
detect it, a doctor or otherwise, by a self-examination. So, again, there's a much greater comfort in knowing that you've had a mammogram and that it has come back clear. So if the minister could address again why it would decrease at the age of 50 when the incidence of cancer increases?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, the breast cancer screening program is one that is run by that group with Medical Oversight. Medical Oversight makes the recommendations. So I would commit to the member opposite that I will provide her with some information from the program to try to explain why there is this discrepancy in screening times.
I'm sure, you know, for the members in this House that there is definitely a reason and definitely medically proven of why this is done, but I can also say to the member opposite that we are making improvements to our mammography program, also increasing, or digitizing the program so it does increase the amount of mammograms that it can take, so utilization can go up so more people can receive that service, but I will commit to providing information of why there is this change in the amount of time screening is required.
MS. WHALEN: Mr. Chairman, I'll let that one go, I would like to have the information when it becomes available, if you could ask for a little bit more explanation. I'm sure that that will help me to better understand why. I would just be very hopeful that it is not for a financial reason that we want to decrease the amount of mammograms that we're providing. I'm sure that the evidence if it comes from that, the guidelines that are set will help me. So that would be good.
Just as a final question, I would like to look at nurse practitioners again. I understand the minister has had a couple of questions on this during estimates. I just would like to, you know, again for my own experience, to hear it directly. I had very recently, on Canada Day in fact, had a discussion with a constituent who had travelled widely. He had been in Florida where he had been treated by a nurse practitioner. He had gone to an emergency clinic and been treated by a nurse rather than a doctor. He thought it was tremendously effective and he even wondered out loud why we weren't doing more and, in fact, he sent me an e-mail which I'm going to forward to the minister. He wanted me to send it to the minister and ask what are we doing in terms of extending the use of nurse practitioners.
The other day in Question Period, I heard a number given of how many nurse practitioners we have, but we're not giving them the full authority, I believe, Mr. Chairman, that the minister would confirm this, that we have licenced nurse practitioners but we're not utilizing them in the full extent of their capabilities. I would wonder if, in particular, you could refer to the use of nurse practitioners in emergency rooms. I think it's important that in New Brunswick they have looked at the backlog of patients in the
[Page 128]
emergency rooms and recognized that nurse practitioners could again probably help many of those people and move them through the emergency room quicker. So I think that's one very practical answer for our own emergency room situation and I wish you would offer some insight into the use or what we can do to give them greater licence.
MR. D'ENTREMONT: Mr. Chairman, I'm very pleased to continue standing and talking about nurse practitioners because I think they're definitely a valuable option for services in our facilities to make sure that they bring down wait times and people can see the correct professional for the correct ailment.
Currently, as we said, there are 19 nurse practitioners in various locations around the province and yes, we are trying to expand that number, making sure we have them in other locations. We are leaving it up to the DHAs to make suggestions on where they want to see nurse practitioners. The department is currently developing guidelines with the College of Nurses and the College of Physicians and Surgeons, in order to find that scope of practice within an emergency setting. So we are looking forward to using those professionals to their utmost and trying to expand that throughout but we are looking for those guidelines in working with them. Also, the bill that is before the House, for the nursing profession, does talk a little more about the scope of practice and requirements for nurse practitioners as well.
MS. WHALEN: Mr. Chairman, I would just like to thank the minister and his staff for their help this afternoon in answering my questions. I am going to turn over the questioning to my colleague for Digby-Annapolis. Thank you very much.
MR. CHAIRMAN: The honourable member for Digby-Annapolis.
MR. HAROLD THERIAULT: Thank you, Mr. Chairman. I won't be quite as long as my colleague was. Just a few local questions for myself and it is on Digby. We have a wonderful little hospital in Digby. It has been there for a few years and in the past seven or eight years it was pretty much closed down to just a clinic with a few beds open in it.
During the last election, or going through the last election campaign, there was an announcement of a 13-bed restorative care unit, which will supposedly open up in the Digby hospital. I understand that is a joint initiative with the South West Nova and the Annapolis Valley DHAs. It is certainly welcome news, if it is all going to happen.
I understand these are supposed to be opened in the Fall of 2006, these 13 beds. I was just wondering if the minister could confirm whether this project is still on target to be opened in the Fall of 2006 and also, will there be other announcements about restorative beds in this province?
[Page 129]
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and I thank the member for Digby-Annapolis for the question. It is quite true that during the election the South West Nova District Health Authority made the announcement of 13 restorative beds for the area, which is in conjunction with the Annapolis Valley Regional Health Authority as well. That comes out of the 50 restorative beds that we announced for the province and I am unaware just yet if there were other announcements done in the province on those 50. I can assure the member opposite that those restorative beds will continue to be available or will be available in the Fall, as previously announced.
MR. CHAIRMAN: The honourable member for Timberlea-Prospect on an introduction.
MR. WILLIAM ESTABROOKS: Thank you, Mr. Chairman, and I thank the member for Digby-Annapolis. Today in our gallery we have the opportunity to meet the youth group from the historic, famous community of Beechville. They are here with their leaders today. I had the opportunity to meet them for a few moments downstairs. They are a very well behaved group, a compliment to the leaders. I would ask that the Beechville Youth Camp stand with their leaders and receive our recognition. (Applause)
MR. CHAIRMAN: Welcome to all our special guests.
The honourable member for Digby-Annapolis.
MR. THERIAULT: Thank you, Mr. Chairman. Yesterday I questioned the minister on the issue of the physician situation in Digby. In response the minister indicated that they were busy recruiting physicians in the Digby area.
Mr. Chairman, I have before me a list of openings posted on the minister's Web site and Digby doesn't seem to be on this list. I believe for some reason, whether it is a misprint - I don't believe it's misprinted but, anyway, will Digby appear on these lists that the minister has on his Web site or is this a misprint?
MR. D'ENTREMONT: If I could ask for just a little bit of clarification - which list is he referring to?
MR. THERIAULT: It's a list on the Nova Scotia Web site of Nova Scotia Health, the minister's Web site. I have this right here in my hand.
MR. CHAIRMAN: Could the honourable member specify what the list is for?
MR. THERIAULT: It's for all the districts, wherever, Antigonish, Barrington, Bridgewater, Chester, Dartmouth, Halifax, Lunenburg, Mahone Bay - Digby is not listed
[Page 130]
- how many physicians are needed in each of these communities. Digby is not on this list, why not?
MR. CHAIRMAN: Now we understand. Thank you.
MR. D'ENTREMONT: I thank the honourable member for that clarification. I'm uncertain exactly why Digby would not be on that list, but I can say to the member that physician requirements are basically outlined by the district health authority where they feel they need extra service. I really don't have the information to respond to that question, but I will try to get the information to him of why Digby may not be on it - or Bear River, or another community within his riding.
[1:30 p.m.]
MR. THERIAULT: We keep hearing about recruitments and how the Department of Health is recruiting doctors from all over the world, and from our own country. Just how do the recruiting people go about recruiting doctors in this province - is there a mechanism in place and can you explain to us how that works?
MR. D'ENTREMONT: Mr. Chairman, I am just getting some clarification on the different types of programs that we have for physician recruitment in this province.
We have a physician recruiter situated within the Department of Health who provides oversight for the other DHAs; the DHAs themselves have physician recruiters and people responsible for recruiting; we also have programs through the Web; through some funding to visit different graduations - I don't know exactly what they're called, but they go to different places where there are graduates, to try to entice them to come to our province; plus the programs that we're doing with the medical school, the IMGs, as well as the CAP assessment. So there are a number of initiatives going on for the recruitment of physicians in the province.
MR. THERIAULT: Mr. Chairman, I'm just wondering if it's done - we talk about foreign doctors coming here to this country to practice, and I want to give you a little example of something about Cuba and Venezuela. Cuba has more doctors per capita than any other country in this world. Right now they have 66,567 doctors in that country, and Venezuela just took 20,000 of these doctors off their hands by trading them oil. The Cuban people, I believe, are the smartest people in this world. I've been to Cuba many times and they just keep rolling the doctors out down there, rolling the teachers out, and there's nothing for them to do. So you've got countries like Venezuela coming in to trade oil with them; 90,000-some barrels of oil a day for their 20,000 doctors. I don't think Venezuela's hurting for doctors right now.
[Page 131]
Has Nova Scotia or this country ever looked at doing something similar to what Venezuela did with Cuba?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Digby-Annapolis, it's difficult to figure out exactly how they do their works and how they get so many doctors trained. There has to be an interesting way to get some of those physicians maybe to relocate and come to a jurisdiction like Nova Scotia.
Just to give you an idea on our complement at this point, Nova Scotia has 800 GPs, or general practitioners. At this current time we have about 30 openings for different areas in the province. As far as specialists go, we have 1,300 specialists and about 35 openings at this point in time. So our complement is actually quite good, it's just the distribution I think is what I talked about in the past, how to incent some of these physicians and doctors to provide service to our other areas.
Of the physicians we have in this province right now, 25 per cent are foreign trained. I think we have relatively good success in getting international graduates to come and practice here in Nova Scotia.
MR. THERIAULT: Mr. Chairman, I'll share the rest of my time with my colleague for Annapolis. Thank you.
MR. CHAIRMAN: The honourable member for Annapolis.
MR. STEPHEN MCNEIL: Mr. Chairman, I want to thank my colleague as well as thank the minister and his staff for coming in and giving me an opportunity to speak to him today. Any time in the past that I have had to deal with the minister and his staff, I very much appreciated the way they have opened up their office to my constituency and have always dealt with those concerns, and wanted to deal with the best interests of the constituents.
The riding of Annapolis is quite fortunate. We have Soldiers Memorial Hospital as well as the Annapolis Health Clinic which I heard mentioned earlier today, which I think is a model across - should be a model across - Nova Scotia. It is as much because of the hospital auxiliary and the co-operation that is happening amongst the health professionals in that area.
But we are reaching a crisis in another part of my constituency, which is around Soldiers Memorial Hospital, and it has to do with doctor recruitment. I spoke to the minister prior to the election - and I'm pleased to see and congratulate him being back in the same post after the election - around alternate payment plans for physicians coming into rural areas. I was pleased to be able to say to the community that we had acquired two of those from your department, with your support. It is one way for us to help recruit
[Page 132]
physicians to rural areas. I'm wondering if you could explain to me, through the Chair, on other initiatives in your department and how we're going to disperse the doctors across rural Nova Scotia?
MR. D'ENTREMONT: I do want to thank the member for Annapolis for bringing up that issue of payment plans, the issue of APP versus FFS, or fee for service. Too many acronyms in this business, I think.
When it boils down to it, when we try to incent a new doctor, a new physician to come to a rural area, of course, they have to get their complement of patients and try to build themselves up to a point that they are paying for their overhead and paying themselves a wage.
In the previous fee-for-service program, it really didn't allow them to do that, it took awhile to get up to speed and to get the patients and to get enough fee for service going. I think the alternative of the APP was allowing them to have a base salary and taking into consideration the expenses, and then provide them with a fee for service over top to make sure the flow of patients is still going.
What we're doing in the rural areas is incenting physicians to move into different areas. There are a number of different programs - guaranteeing income for a period or what is called an AFP, physician student loan repayment program to get them to go to places where we feel there is larger need. So, there are a number of different incentives going on on the provincial level, but of course there are a number of different initiatives happening at a municipal level or a community level to try to bring doctors to different parts of the province.
MR. STEPHEN MCNEIL: Mr. Chairman, from an area in Nova Scotia that cannot afford to get into a bidding war and put up an incentive for doctors to come to our area, one of the challenging things and one of the things I want to challenge you and your department in doing is making sure that the incentives are blanketed across Nova Scotia. You cannot have one community offering $100,000 for a new physician to arrive when there are other communities that just simply cannot afford to get into a bidding war.
Many of the things that happened in the community I live in - we can provide quality of life issues for people who want to come here. The question is how do we get them and attract them in the first place? Part of that is around the clinic in Annapolis Royal when you look at how they have come in under the collaborative practice. We are trying a similar model in Middleton, which would be tweaked a bit to respond to the needs of that particular community. One of the issues is around nurse practitioners, which has been talked about an awful lot here and I think the issues are similar in every riding. We have one in Annapolis Royal.
[Page 133]
There is actually a nurse in the process of being trained who lives in the Middleton area, in the catchment area of Soldiers Memorial Hospital. I want to know what initiatives or what incentives are presently in place from your department that could be offered to that student to make sure that she stays in the Annapolis Valley, or stays in Nova Scotia first of all, let's say stays in Nova Scotia and then stays in the Annapolis Valley, to ensure that the people of that area are given the kind of quality health care that they deserve.
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and through you to the honourable member. There has been no real incentive program for nurse practitioners as it stands, but we do pay for a large amount of their training and really the focus is going to be through the nursing program or through the Nova Scotia's Nursing Strategy to make sure that we train more of these professionals and have them available within our communities. As you are aware, this training is, I think, a two-year program on top of the regular Bachelor of Nursing. So trying to find nurses - and there are lots of people out there ready to take the training, but the strategy is part of that money, to move beyond into nurse practitioners. So there are a number of initiatives there that are across Nova Scotia. There is not one area that is really being targeted more than another.
Just to go to the issue of fairness for different places in Nova Scotia. I mean, we try to make sure that our incentives are pretty much equal across the province. I think it is unfortunate that we do have these bidding wars from one municipality to another, and quite honestly, I would like to hear his comments on that to see how he might want to change that. I think it is unfair to communities that really can't afford it and that deserve a physician just as much as another area in the province.
MR. CHAIRMAN: The honourable member's time has expired.
The honourable member for Queens.
MS. VICKI CONRAD: Thank you. First I would like to address a couple of questions around mental health. Rather than belabour a lot of preamble around these particular questions, because certainly the last couple of days in the House there were many questions around mental health, one of the specific questions I would like to ask of the minister is the wait time to be assessed for those people in crisis situations, with those urgent mental health situations, should be three days, but the assessment process actually can take several weeks. So I would like to ask the minister what specific measures and/or programs are planned to address the assessment needs?
MR. D'ENTREMONT: Mr. Chairman, I think what we have done in the last number of months and throughout this year is that we are making sure we have crisis intervention teams and we have those in place and, in some cases they are mobile teams that can go and do assessments on some of these individuals and make sure they are
[Page 134]
directed to the correct treatment or care that is required. So I think we have done a fair amount in changing the strategy, because I think before it was really an assessment through sort of one set place and our psychiatrist or not. We have tried to make this a little more fluid so that people can get that service.
MR. CHAIRMAN: Thank you. Before I recognize the honourable member, we will take a comfort break for the minister and his staff. We will recess for a few minutes.
[ 1:43 p.m. The committee recessed.]
[ 1:51 p.m. The committee reconvened.]
MR. CHAIRMAN: Order, please. We will return back to the estimates of the Minister of Health.
The honourable member for Queens.
MS. VICKI CONRAD: My second question around mental health issues - and I suppose I should have asked this before the break so that I could move on to other questions in other areas - my question is dealing with the shortage of short-term mental health beds, and again I recognize that this was discussed through Question Period over the last couple of days. It certainly is recognized that there will be a move toward five beds for the HRM region. Unfortunately, that number of beds is far from the beds needed to address the serious shortage. So my question for the minister is, after these five beds are put in place, when will other adequate beds be moved forward to address the real serious issue?
MR. D'ENTREMONT: Mr. Chairman, I thank the member for Queens for the question. As we talk about mental health services and short-term and long-term beds, we have to make the determination between which region we're talking about, because if you look across the province when it comes to short-term, long-term mental health beds, we are not necessarily in a shortage position. If we're talking about Capital Health then, yes, we are in a shortage position, and we need to find ways in the meantime to make sure we redistribute those folks to make sure they get the care they require.
I guess it would be an intermediate program through the Department of Community Services that we're talking about to provide a number of beds for those transition people who are coming from the forensics centre back into the community. I also want to tell the member opposite that I'm very happy to have made the announcement prior to the election of the renovation of the Nova Scotia Hospital, and basically the redirection of how that is being administered. We're talking about putting in a more residential facility, a more home-like atmosphere, smaller groups, so that people can feel a little more at home. I don't know if you've ever visited the Nova Scotia
[Page 135]
Hospital, but it is very sterile and very hospital-like, and definitely not conducive to treating these folks to return through their home communities.
So I'm very happy to make that transition for the Capital Health area. We do look forward to another transitional unit, a combined unit, which is a 150-bed unit to be built somewhere in the HRM for some more of these transitional people, in the longer term.
MS. CONRAD: I thank the minister for that answer and, yes, I have had the opportunity to visit the Cole Harbour facility several years back, and actually worked for a couple of years as a residential counsellor in a group-home environment in a small options home. I do know that they too are experiencing bed shortages, and it is very important that the department move fairly quickly to ensure that there is not a shortage of beds for people in crisis, and too the differentiation between the types of beds, whether they be long-term care beds for some clients and small options residential facilities, more home-like environment for other clients. So it's going to be very important to look at the needs of all of the clients needing to be served. My question was more about a time frame issue in terms of after those five beds are up and running, the next phase of beds, when will we be looking at that?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Queens, we really don't have a timeline yet. We're still in discussions with the Department of Community Services, because they are our partner for this type of facility. I would hazard a guess that it will probably be a couple years out before we can have that type of facility designed, sited, constructed, which is unfortunate that it is that far out, which I feel that we need to find and continue to work with those mental health providers to make sure that we have services there for an interim basis.
MS. CONRAD: Thank you. I would like to move on to a different set of questioning around home care, and more importantly when home care services to clients get disrupted. There are various reasons that clients find themselves without home care. One example that I just want to bring to the minister's attention, there is an elderly woman whose family actually lives in the Sackville area, this particular elderly woman had to go into hospital. She was previously in the home care system, receiving home care, and found herself needing hospital care for a short term. Once she was in the hospital for more than three days, her home care services were cut off because of her stay in the hospital. Because she is unable to stay in her own home and is without home care and because of the wait times to get back in the queue, this woman has had to stay in the transitional care unit until her home care was reinstated.
What happened was that this woman, who was already receiving services, finds herself in a situation where, for a short-term period, she is no longer needing the services but then finds herself back on a waiting list. We also know that the waiting list for home care is queuing up. So my question to this particular woman's situation, is this an
[Page 136]
effective use of health care dollars and what percentage of seniors in transitional, alternative level of care units in the hospital are there because they can't get home care or other services besides nursing home beds?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for the question. I don't have the specific guidelines in reference to receiving home care when you are away from your residence for an extended period of time. I don't know how long your constituent was away from home when that was discontinued, I'm not exactly sure of that.
Home care around the province, if you're looking at the South Shore waiting list, is basically - and I'm just going to quote you some numbers as of June 2006 - that there is nobody sitting on the wait list for the South Shore that we are aware of. There is nobody on the list for South West, nobody on the list for Colchester-Hants East, nobody for Cumberland. There are a few people in Pictou, a few people in Guysborough-Antigonish Strait and, of course, Capital Health has a large number of people waiting, as well as the Annapolis Valley, and of course that's for the reasons about the challenges they have in personnel that we discussed a little earlier.
[2:00 p.m.]
I will endeavour to get you a little further information on why that happens, once you go into hospital, why do you have to get back on the wait list, but from the indication here, really there is nobody on the wait list, so it is an interesting discrepancy here.
MS. CONRAD: Thank you. Certainly I would appreciate that sharing of information. I think because time is of the essence here, I would like to jump to another question revolving around home care but speaking to home care workers or home care providers specifically. The range of services that home care workers are allowed to provide in a client's home has been drastically reduced. There is no common-sense flexibility to allow for care that will best help that client and provide relief for the caregiver at the same time.
For example, one woman may not be allowed to go anywhere while the home care worker visits if her spouse is receiving home care. What tends to happen is when the home care worker arrives and the family caregiver is looking for a bit of respite to either go out and do a bit of shopping or banking or just some relief time for herself, if the client in question is receiving any kinds of medications or is being transferred with a Hoya lift or another type of device, that caregiver is not allowed to leave the home while the home support worker is in the home because they are not allowed to pass medication to the client receiving home care or they are not allowed to use some transferring devices on their own without another person in the home, even though perhaps they might be trained in that area, so that is a concern.
[Page 137]
I can tell you that does happen quite frequently, where caregivers are requested to stay in the home while the home support worker is there to provide services because there are some services that have been cut and the home support worker is not able to provide those services. This is a shame because most of these home care providers, home support workers, caregivers, they are trained in these skill sets. So I guess my question around that would be, there is a serious need to review some of the policies around home care delivery and also a serious need to look at flexibility within the system. I can tell you, as an eight year front-line worker in home care, I have seen a lot of changes to the system and it really is flawed in a lot of cases.
Also, another question I want to address around home care itself, is the travelling that workers end up enduring in their geographical areas. For example, I was a front-line worker in Queens and, of course, the geographical area is vast. The scheduling of home support workers to clients sometimes would take you from one end of the riding to the next. Unfortunately, it results in a rotation of home care workers in a client's home so that clients receiving home care workers in their home are seeing strangers almost on a fairly regular basis. So I would like to ask the minister if there is any plan in place to look at perhaps having hubs of geographic areas where home support workers are actually working in their immediate area and servicing the clients who are in certain hubs within their geographical areas, rather than being spread out. Perhaps it is a scheduling issue, but I think if you look all across the province that this type of issue is a problem with home care delivery all across the province.
I am sharing this hour with three colleagues, so I will pass my time along to the member for Pictou West, after the minister briefly responds. Thank you.
MR. CHAIRMAN: Just before we proceed, I have an introduction that has been requested.
The honourable Minister of Tourism, Culture and Heritage.
HON. LEONARD GOUCHER: Thank you very much, Mr. Speaker, and thank you for allowing me a moment here. I just wanted to take a moment. I am very proud to introduce to the members of the Legislature my family; my wife Lucy, in the east gallery; my grandson Noah, my political advisor, and my daughter Kimberley. Welcome today and I am very proud to have you here. Thank you very much and enjoy your stay. Thank you.
MR. CHAIRMAN: The honourable Minister of Health.
MR. D'ENTREMONT: Thank you very much. I, too, welcome our guests to the gallery. It is always great to actually have your family visit and see the hard work you do and actually have them recognized by this very auspicious group.
[Page 138]
I want to say a few remarks, and I do want to thank the member opposite for her comments and actually thank her for her work as a home care worker because sometimes it is not a task that is easy, yet it is a very valuable service that we have to offer to Nova Scotians and to seniors and to other people around the province.
I, too, get calls on a regular basis on - I guess you would call it the management or scheduling of home care services and how different members or home care workers have to travel and sometimes to me, it does not make a whole lot of sense. It is something that through the continuing care strategy and through the caregivers strategy that we are going to have a real close look at how home care services are offered to Nova Scotians.
I can say that we don't deal directly with the scheduling of those services, we just make sure that the funding is available for the patient and it is up to that contracted association or group to provide that service.
I do want to say, though, that it seems like a lot of issues are happening over the last number of years - I am sure you have seen it - when it comes to labour standards, when it comes to liability issues, when it comes to a whole bunch of worker protection issues, too, of what a home care worker is allowed to do or not allowed to do. I can commit to the member opposite that we will be still monitoring the home care services in this province closely, because we do believe it is a key to keeping seniors in their home and keeping them comfortable and definitely a large part of our continuing care strategy.
MR. CHAIRMAN: The honourable member for Pictou West.
MR. CHARLES PARKER: Thank you, Mr. Chairman, I almost find it hard to see you but at least you're around the corner there somewhere. Mr. Minister and staff, you're probably getting tired and worn here in the heat of July, but you're ready to just keep on rolling are you? Okay. I've got some long-term care questions I want to ask you about. First of all, around the cost of ambulance fees for residents who live in a long-term care facility, as we know it's $120 per call when they go from a seniors home to a hospital. Sometimes it's right next door and certainly some feel the fee may not be justified in every case. I wonder if it might be possible to give me - and maybe you don't have it right at your fingertips - the amount of money that has been paid out by seniors in long-term care facilities for these ambulance transfers to hospitals over the last fiscal year and perhaps even over the last three fiscal years. Would that be possible? I know you don't have it right there but is that something you could provide to me?
MR. D'ENTREMONT: Mr. Chairman, we're trying to discuss this and whether or not we can actually get that information from our contractor, because we would have to survey the nursing homes themselves in order to find out how many transfers have
[Page 139]
happened, who they are and maybe try and put it together that way. I will commit to the member opposite for an answer, it might not be the total listing of what he's asking but we'll try to see if we can come close to that.
MR. PARKER: I'd appreciate, Mr. Minister, if that's available and as I said, for the last three fiscal years, if those figures would be available to me. Another issue around long-term care is a mental health issue. Certainly it seems there are more and more people going into long-term care, some at a much younger age because of mental health issues, some people in their 40s or 50s or 60s, certainly long before it would be expected. In Pictou County, where I am from, we have mental health facilities in the IOF home in Pictou and also the Glen Haven Manor in New Glasgow, but still there are not enough beds, especially beds designed for those with mental health problems and especially secure facilities in case there are people with violence or behaviour problems.
It's a real issue, a real concern and one of our long-term care facilities, the Valley View Villa located in Riverton in Pictou County, is undertaking a project where they want to build a 33-bed unit, a secure Alzheimer's unit and they've actually put a proposal in to the department I believe within the last year, perhaps a little longer ago than that, 18 months ago, and they're very interested in getting that facility built. They feel there is a strong need for it and I'd just like to get an update from the minister's staff on where that proposal is for that 33-bed unit at Valley View Villa.
MR. D'ENTREMONT: Thank you Mr. Chairman, and through you to the honourable member. When we talk about beds, especially long-term care beds for people who are under age, especially for mental health patients, some of them would be dealt with through Community Services, through residential care facilities, through community-based option homes and those types of things. As we move into the golden years, when we look at long-term care facilities and are asking about challenging behaviours, we have allocated a number of dollars to continue our expansion of the Challenging Behaviour Program and will continue to work through the Continuing Care Strategy on the development of beds across the province. As we look at the under-serviced areas, we first have to make sure that they have a comparable service. Pictou, for example, is a very well serviced county compared to let's say Colchester, so we need to make sure there are checks and balances to make sure that the correct communities are getting their beds.
I'm not aware of the proposal from the facility that you're asking for but I would suggest that it's something that would be given due consideration after the sitting of the House as we move along the creation of the 826 new beds for long-term care in the province.
MR. PARKER: Well again, in relation to that 33-bed unit proposal, we do have some people in Pictou County - who are going to other counties - who need a secure
[Page 140]
treatment facility, a lock-down facility at times because of violent behaviour problems. I can think of at least two that are in a facility in Truro - I forget the exact name of that long-term care facility. They are from Pictou County and there just aren't enough secure beds in our county, so I think there is a need for it. Obviously the board of directors at Valley View Villa feel there is a need for it and it's at least over a year now since they put their proposal together to the department. I'm just wondering, if you don't have it right at your fingertips, could you give me an update when it's available, where their application is or what the status of that 33-bed facility might be? I will leave that with you and hope you are able to give me some answers .
I want to move on to another long-term care issue, around a single-entry system where people go into a facility and have a financial assessment. Their income is taken into consideration but obviously their debts are not taken into consideration. We have some spouses who are left at home with quite a lot of debts, a mortgage payment or car payment, VISA bills, on and on. I realize while there is a minimum amount that the spouse gets left over, it's $1,200 and some for the spouse, but oftentimes that's not enough. When you have a mortgage of $400 or $500, you have a truck payment, you have a large VISA bill, how does that spouse survive when they have to pay for all those past debts on half the income that the household would have because the other half is now going to pay for the care of the individual in the long-term care facility?
Are there some exceptions? Are there some possibilities of looking at individuals, the spouse left behind with a lot of debt?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Pictou West, I just want to thank him for the question. It's one that I personally have come in contact with as MLA and it definitely concerns me. My example is, of course, of a younger couple, one who has suffered a stroke and does require long-term care and, of course, she is stuck back in the community taking care of a house and some children and those types of things. For example, only 15 per cent of long-term care residents actually still have a spouse. So when this calculation was originally designed, most times there wasn't a spouse and when there was, they were of similar age, let's say, or similar competencies.
[2:15 p.m.]
What I have asked the department, from the couple of examples I have already come in contact with, I have asked them to review that policy and come up with an exception for those folks who are of a younger age, for the most part, have very dissimilar ailments and those kinds of things, so that more money can stay in the community with that spouse, to take care of the bills and the houses and those types of things that are required.
[Page 141]
MR. PARKER: Mr. Chairman, I have a couple of examples too. One where there is 20 years difference in the age and the lady who is left back home, the spouse, is only 52 years old and still working but still has a whole lot of debts, a mortgage and children and car payments and so on. I can think of another example of a lady 74 years old. Her husband is around the same age but they still have a mortgage on their house. It creates quite a burden, even if the minimum amount of $1,200 and some stays with the spouse, it's still very tough.
Another related case I want to ask about is around GIS, when an individual goes into a long-term care facility their income is maximized so that it includes their GIS as part of that income, and it is suggested to the spouse that you apply for benefits or get the extra GIS if you're living apart - I think it's called involuntary separation. I ran across a case just the other day where there is a spouse who was told she is supposed to apply for the GIS and somehow through the red tape she did not and she was being charged a daily rate as if she was getting the maximum income, including the GIS. In actual fact she never applied for it, she didn't realize the red tape involved to get the GIS extra. So I wonder, is there follow-up from the department or from the single-entry system to make sure that the individual who is eligible for the GIS is actually getting it? In this case she was not.
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, it is my understanding that through the single-entry system the residents or the citizens are being told of their options and being told that as one of the spouses go into a long-term care facility and one has been left behind that they can apply for GIS and other programs that are available to them.
MR. PARKER: As I said in this particular case there's at least one individual out there who didn't realize she had to apply again for this GIS supplement and she's being charged the daily rate as if she's getting it so she's penalizing herself unaware that she should have applied for it. Certainly now it's looked after, but I'm just wondering if there are others out there in the same boat. It might be an idea for the department just to double-check to make sure they actually have the GIS they are supposed to be getting.
I want to briefly touch on the distance that seniors are travelling to live in a long-term care facility. I know there are people in Pictou County who are residing in homes in Colchester, Hants and Musquodoboit Valley and other areas all within the 100-kilometre policy. Vice versa, there are people from Colchester who are living in Pictou County because that's where they were put when they applied to go into long-term care. Is it possible to make a trade? There are families that would love to have their loved ones much closer to home.
I just want to know, what's the update on the department's policy about getting people closer to home -100 kilometres is too far. We had one case recently of a
[Page 142]
gentleman who was living in the Sheet Harbour area and he ended up in New Glasgow and it was 99 kilometres. The loved ones really wanted him back in the Duncan MacMillan facility in Sheet Harbour, and eventually after a year that did happen. There are too many people living far, far away from their families, how can we better change that?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, this is the crux of the issue when it comes to making sure that we have the right number of beds in the right areas around the province. You are quite correct in saying that there are people living in communities where they shouldn't be or where they've been placed because that was their first option or second option and there is a mechanism to trade these residents to get them closer to home. Yet, it has to be done in a way that is accepted by the residents, sometimes the residents are very comfortable where they are and they don't really want to move, so you can't do that against their will.
Ultimately as we look at Colchester, a great example, unfortunately, of an under serviced area, we want to make sure that we have the correct facilities built in that area and what you'll see - I see the member for Truro-Bible Hill shaking his head, that as you have those facilities constructed there or some of those beds opened up for those residents, you're going to see people moving out of Pictou into those residences opened up for Pictonians and hopefully other areas of the province where they're held. As we move on in the continuing care strategy and getting those 826 beds in place, we'll see a dramatic change to where residents are able to go and we might likely be able to completely dispose of that 100-kilometre rule.
MR. PARKER: My time is rapidly winding up here and I'll just ask one quick question, if I could; perhaps there's a quick answer too. All around the wait times for operations, for diagnostic testing - I could give you numerous examples of people who have waited for weeks, months, years for hip operations, knee operations. I had one lady who was right on the operating table, had been prepped, and she was all set to go. At 3:30 in the afternoon she was told, no, sorry, we can't do it, we're going to have to send you home, the anaesthetist was not available and we don't know when we can take you back in because we're not sure when the beds are available; there have just been all kinds of problems. Quickly, can you give me any update on what the department's policy is on shortening wait times?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, I'll try to be as quick as possible in my response, but simply we do have the wait time committee suggesting and recommending ways to shorten those lists, working with the district health authorities making sure we have the correct types of professionals in those areas so that we can continue the surgeries on time, to continue to work with our federal counterparts as we talk about wait time benchmarks and making sure that we have the facilities and the IT solutions on O.R. scheduling and those types of things to make sure
[Page 143]
that people get their surgeries on time. This is a very challenging issue, as I am sure you are well aware.
MR. CHAIRMAN: The honourable member for Halifax Citadel.
MR. LEONARD PREYRA: Thank you, Mr. Chairman. Halifax Citadel, as you know, is home to most of the largest hospitals in Nova Scotia and most of the health care facilities in Nova Scotia and it also has the largest concentration of health care workers, doctors, nurses and other practitioners.
During the campaign I had lots of time to consult with them and talk with them about issues. It seems to me - and certainly in talking with them - money is not the main issue for most of them. The biggest issue for them relates to working conditions.
What I would like to do is ask a quick general question and use three small examples revolving around this question of working conditions and how important working conditions are for the recruitment and retention of health care professionals.
My first question is really a more general one, what steps is the minister taking or has the minister taken to deal with what appears to be a really antiquated, authoritarian, decision-making system? Health care workers are frustrated. There appears to be more of a 1950's management style where working conditions are changed at a moment's notice and without any meaningful consultation. I wonder if you are taking steps and what steps you have taken to address those problems?
MR. D'ENTREMONT: Mr. Chairman, as the member opposite I am sure is well aware, we have had some challenges when it pertains to the Capital District Health Authority because it is so large that it is very difficult for management, I think, to get their head around how to run these, I think it is about 12,000 employees within that system. What we have seen are some changes with the management style. As you are aware, we now have an acting CEO by the name of John Malcom, and I am very confident in his work of trying to change some of the systems that are there. We just approved some bylaw changes on how the district health authority operates and how the board reacts to front-line workers and how they react to the actual management of those facilities.
I am very well aware of some of the issues as they flow down. I am confident there are changes being made and we will continue to work hard to make sure we have a very efficient system and one that is amenable to the workers there because we do want to make sure that when it comes to retention and safety of our workers, we want to make sure they have the best work environment possible.
[Page 144]
MR. PREYRA: A specific example, during the course of the campaign I had the privilege of working and meeting with some of the nurses, former and current nurses in the Orthopaedic Unit. The Orthopaedic Unit was touted as one of the flagship units, it was supposed to be the unit that was showing the way, in terms of dealing with the wait times. Now it is extraordinary the turnover in that unit. Most of the turnover relates to the management of that unit itself, the hours of work and the days of work are changed on very short notice. They are very young nurses with families and they are finding they just can't keep up with management there. They can't organize their lives in the way that the management would like them to do it. Most of the decisions are made without consultation. They seem to have lots of ideas on how to do it and nothing seems to happen.
The problem there generally seems to revolve around poor planning, and especially planning around lining up the professional staff needed to deal with the necessary operations handled there. I wonder if you can comment specifically on the Orthopaedic Unit and why there seems to be such a real challenge in keeping nurses in that unit?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I am sure the member opposite, in asking the question he is doing it in a full knowledge of trying to help but unfortunately, I can't speak specifically on any one unit or bargaining unit or anything like that. I can talk quite generally about the culture within that organization, which has been one of some very different management, one that we'll continue to work with the CEO of the Capital District to provide them the tools and also to continue to work with the Nurses' Union and to continue to work on our efforts of workplace violence. We feel that any workplace violence is unacceptable especially the type of violence which is more mental - the ones that you can't see by the true word "violence" but there are some things that are being done that are unacceptable that we've been made aware of. We'll continue to work on it, and try to rectify and make a better workplace for all those professionals.
MR. PREYRA: I understand the minister's need to protect confidentiality but we're not talking about particular nurses here and we're not talking about particular patients, we're talking about a problem in a unit that falls in the minister's area of responsibility and as the final authority on this, I think he does have a responsibility to look into what's happening at that orthopaedic unit and what needs to be done to correct it.
I do want to move on to another example and that relates to pensions. As you know four unions representing more than 80 per cent of the health care workers have filed a grievance over their employers' use of pension surpluses - over $53 million has been used essentially to take a form of pension holiday. As you know in other cases and other situations employers have taken pension holidays and then found that there's a
[Page 145]
shortfall and made the employees pay for it. In a way it's a transfer of risk to the employees and as a former president of the faculty union, we always had issues with that because these arrangements are part of the collective bargaining process and they should be respected as such and dealt with as a partnership issue.
My question is whether or not the minister is going to use his good offices to get the employers to at least bargain in good faith with these unions. They've indicated that they have a strike vote and that they will go out and strike over this issue and whether or not you're going to ask them to expand benefits or cut premiums or share the surplus in some way because this money is coming off the backs of health care workers.
[2:30 p.m.]
MR. D'ENTREMONT: That definitely is a situation that concerns me and I was very happy to have met with the union leadership here at the House on Wednesday. Mr. Chairman, there are a few things here that I'm going to just make a quick comment on. We can't forget that the pension plan is one of the Nova Scotia Association of Health Organizations, of NSAHO, it has a board of trustees that manages the investments and the day-to-day pieces of that plan. There are four members of each union who sit on that board of trustees so I'm just wondering, has there been a lack of communication? Has there been a breakdown in direction? I'm not too sure and really my jurisdiction on this is very limited except for trying to get people to sit down and at least chat about it.
The other piece, I can't call it unfortunate but it does change the water on the beans just a little bit, is that since they put the grievance process in place, since there were a number of grievances that were put in place on Tuesday or Wednesday, there is now a legislative process to look at the issue. Once that's done I sort of have to step back and wait until that grievance process is run through, yet I will continue to work to make sure that the correct pieces of communications are happening.
MR. PREYRA: I must have misunderstood the minister because usually in a collective bargaining process when four or five unions sort of file grievances and say that they are going to have a strike vote and they're going to go out on strike over that issue, it doesn't mean that the process is working very well and I'm sure he had no intention of saying that.
If I can move on to a third example, we have a problem at Simpson Hall at the Nova Scotia Hospital. For example, we know that unit needs much more work, it needs replacement, it needs better handling, and the department is essentially just using plaster and whitewash to deal with what is essentially a larger problem. Even the plaster and whitewash is posing a problem there. Construction is underway during working hours, there is chalk dust and sanding dust, and people are working there. Work is conducted without any warning, with no mask and no ventilation. It seems like the health and safety
[Page 146]
of these workers has been compromised. They are worried about it, they have complained about it in the past, and they don't seem to get a response from the department.
I'm wondering, do you have any plans for looking into working conditions of people who are having to face this kind of thing day to day, apart from the general problem of what you are going to do with Simpson Hall?
MR. D'ENTREMONT: Mr. Chairman, quickly going back to the last issue in regard to pension, the NSAHO health care pension. At every bargaining session each unit has the opportunity to bargain for its benefits, including its pensions. So I think there are many opportunities here for those unions to settle the dispute through normal processes. Anyway, it's one that we will continue to monitor and make sure there is a good outcome for all Nova Scotians, including those unions and the people held within them.
In reference to Simpson Hall, as we've come and talked about the new construction at the Nova Scotia Hospital and making sure that we have a good resident area and actually changing the type of service we are providing to them, Capital Health is also looking at Simpson Hall and looking at the services there and looking at, well, the deplorable state of that building. I know there has been some safety work that has been done just recently. I know that Capital Health is looking at its options right now, which does include moving that into some rental property or the like, because most of this is ambulatory, outpatient-type services that are offered at Simpson Hall, at this point.
MR. PREYRA: Thank you, Mr. Minister. I want to use the 30 seconds I have left to just summarize and say that working conditions are really important, that most of these, especially the young nurses, are very, very frustrated with what's going on there in the management in their individual units, in terms of the respect they get in their jobs, in terms of issues like pensions, in terms of working conditions, their physical working conditions and the way in which they relate to their supervisors. If we really do want to deal with the recruitment and retention problem we have to look first to the front-line workers as partners in this process, as people who have good ideas. We have people bearing the brunt of what is going on in whatever restructuring and review that takes place.
I would certainly encourage the minister to - these are just examples - look into these types of problems, because it is these types of problems that are driving nurses away. I don't need an answer to that, it's just a general comment. Thank you. I will hand over the rest of my time to the member for Waverley-Fall River-Beaver Bank.
MR. CHAIRMAN: The honourable member for Waverley-Fall River-Beaver Bank.
[Page 147]
MR. PERCY PARIS: Thank you, Mr. Chairman. What I would like to do is just have a little preamble here, to give the chairman a bit of a demographic view of the Waverley-Fall River-Beaver Bank riding.
What we have in the riding is what we call the traditional families, who have been there for generation after generation. There is a cluster of them. Many, many years ago, certainly before my time, those so-called traditional families had a large land mass, they owned acres and acres of land. What has happened in more recent years, and over the years, what those so-called traditional families did was, they sold off their lands, and their lands were purchased for the reason of future development. That future development is taking place now. As a result of that future development, now you have new families, younger families, and you have transient families who are moving into the riding.
What happens when this occurs is that the homes that are going up today are not the single-family dwellings, they are not the bungalow-style homes, now they are usually on oversize lots, many of them an acre in size, some an acre and a half. The dwellings are two storeys, very uptown-types of homes, very high-priced homes. We all know the impact, the result of that sort of activity, the ones who get left behind are the so-called families that I referred to as the traditional families. As these traditional families - and we all know, and we've heard in this House over the last number of days, we've talked about the aging population in Nova Scotia.
Certainly in the riding of Waverley-Fall River-Beaver Bank, those traditional families, even now, their children are in that category of an aging population. The end result being that those families, with the increase in taxes, the increase in real estate, are having a hard time making ends meet. As they become older, what we don't have in the riding are those facilities and those amenities that could accommodate the needs of that aging population.
I'll give you a good example. In 2003, after the election of 2003, there was an elderly woman who called me. One of the things I do as sort of a sidebar is, I write a column for our local newspaper, and I've been doing that for a number of years. I've always talked about an aging population, and the lack of amenities and facilities for that group of the population. This elderly lady called me after the election - I want to emphasize it was after the election, so I really didn't have any political clout at that time, not that I have a whole lot now - and she had a lakefront property. What she was willing to do at that time was, she wanted me to facilitate the takeover of her property on the condition that we could turn that home into a seniors' facility. She had lost her husband a couple of years before that. She was living by herself. She had a disability. She was in her 80s. She wasn't able or capable of keeping up the maintenance of her home. It was her family dwelling, where she raised her family.
[Page 148]
She had considered going into a nursing home. The problem with that has been well documented here over the last 24 hours. She didn't want to take the risk of putting her name on a list and ending up who knows where. For the sake of wanting to stay there, where all of her relationships were, where her social life was, she wanted to spend her remaining years in the area she knew best. She wanted to spend it with some dignity and some comfort, staying home. So she offered her house. She said, look, if you can help facilitate turning this into a nursing home, I'll give you my house on the condition that I can stay here until I pass.
That didn't come to pass. As things would have it, she did put her name on a list. She was one of the lucky ones, she considers herself lucky in one respect, because it's still somewhat in driving distance for her kids. She ended up in the Valley, at a home in the Valley, to much heartbreak for her. Thank goodness she's living with us today, and we will never know the anxiety and stress that caused in her life. We all know one of the biggest factors in health is stress. Stress can take years off your life, depending on the makeup of the individual. She ended up in the Valley, and we'll never know the distress that immediately caused her.
I bring that up because since the 2003 election, it's now at the point where, after this most recent election, I've had a number of individuals call me, and even during the campaign, approach me about the lack of facilities within the riding itself. I know, during Question Period a couple of days ago, we talked about Northwood Care, Rocky Lake. That's not the purpose of why I stand in front of you today. One of the things is that Northwood Care, Rocky Lake - I don't want to enter that debate. The debate that I want to enter is the lack of amenities within the riding of Waverley-Fall River-Beaver Bank. I will emphasize that the lack of beds, whether it be long-term care, assisted living or independent living, there's just not enough of them. My question today, is there any sort of plan, whether it be short term or long term, that can accommodate the needs of an aging population within the Waverley-Fall River-Beaver Bank riding?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his interest in this issue and bringing forward the story of that resident. I'm sure there are a lot of us around this House who have very similar stories about people. Ultimately, as we look at underserviced areas, and we know that within Capital Region - and we have to really look at the region as it stands right now, as we're looking at the allocation of beds - that in order to meet our ratio of seniors over 75, we're looking at a ratio of at least having 100 beds per 1,000. That's the ratio of people requiring long-term care beds.
From the proposal that Northwood has provided us that would see the construction of 150 long-term care beds, it doesn't really stop there. They talk about assisted living opportunities and some other opportunities within a campus-style facility, which I think is the right way to go. In a growing area, like Sackville-Cobequid, Beaver Bank, Bedford - it's such a large, growing area.
[Page 149]
As we look at the global number of 826, we still have to do a little bit of work to find out exactly where those beds are. As we go through the RFP process, and saying that we want beds in a certain area, any option would be considered. So, if it would be a small home with 10 beds in it, or something like that, you know, I think everything would be considered.
MR. PARIS: Mr. Chairman, so I don't misinterpret anything that has been said, I just want a point of clarification that I heard this correctly. What I think I heard is that the department is willing to explore additional beds, regardless of where they are in the Capital Region, but specifically for Waverley-Fall River-Beaver Bank.
MR. D'ENTREMONT: Mr. Chairman, just to the point of clarification, a little bit, we want to see facilities in the right place, quite honestly. So we really need to look at the population, and the population of seniors over 75, because those are the folks we really have to target when we go to long-term care.
[2:45 p.m.]
Just a quick comment on stress levels and taking time off your life, I think we're in a great place for taking lots of time off our lives. Anyway, that's just a little funny that I had to enjoy.
Ultimately, as we look at an area, and right now our global number is looking at HRM, as we look at the distribution of those beds, smaller communities, I think, it would be in their interest to make proposals for some small homes, somewhere in Fall River, Beaver Bank. It would be nice to see a facility, as well as the big facility that will be going somewhere in the catchment area of the Cobequid Health Centre. I think we're going to be seeing a fair amount of change in your area, as well as other members' areas, in the addition of beds for long-term care.
MR. PARIS: Mr. Chairman, my final question for the minister, through you, is a simple question, is there a timeline?
MR. D'ENTREMONT: Mr. Chairman, through you, to the member opposite, our commitment is there for the 826 beds in this province, and we will distribute those to where the need is required. It will be done through an RFP process, so we will say we need x amount of beds in this general area and we will look for those proposals to come forward to the department.
MR. PARIS: With all due respect, I just want to reiterate the question with respect to RFPs, what I am looking for, when can we expect this? Are we looking at a year, two years or four years?
[Page 150]
MR. D'ENTREMONT: Mr. Chairman, the plan is to have about 250 within the first two years or so, and to see the balance of those 826 beds to be in place within the first four years.
MR. CHAIRMAN: The honourable member for Annapolis.
MR. STEPHEN MCNEIL: Thank you very much, Mr. Chairman. I want to continue asking the minister around the issue of doctor recruitment in rural areas. Earlier in your presentation, Mr. Minister, you mentioned, I think it was 800 GPs in Nova Scotia, 1,300 specialists, was I correct? I wonder if you could give us a breakdown of how many of those 800 GPs are actually outside in rural areas and how many are here in metro, and how many of them are practising full time, as opposed to part-time?
MR. D'ENTREMONT: Mr. Chairman, that is information I don't have with me. So I will endeavour to have this on Monday, some information on the distribution of those GPs in the province.
MR. MCNEIL: Thank you very much. Earlier, we were also talking around the medical school and the number of seats that are there. It was suggested by the member for Shelburne that some of those seats should be set aside for rural Nova Scotians. How many of the existing seats there now are set aside for Nova Scotian students?
MR. D'ENTREMONT: At the Dalhousie Medical School there are no seats designated for Nova Scotians. What it shows is that two-thirds - or 50 per cent - are from Nova Scotia.
MR. MCNEIL: Presently, at Dalhousie Medical School, there are no seats designated for Nova Scotians. I wonder if the department has a handle on how many Nova Scotian students are attending medical school elsewhere in the country. One of the interesting things that happened in my riding was, there was a young lady attending university in Ontario who came back to Annapolis Royal, came back to do six weeks of practicum with the Annapolis Health Centre, as we were talking about earlier, and when she came home she came to see me and said she has been recruited by every other province but her own. I am wondering what is happening, where we are falling down on that? Do we have a number of how many other Nova Scotian students who we could be, right now, encouraging to come back here to work when they finally graduate?
MR. D'ENTREMONT: Mr. Chairman, it is a situation that would be unfortunate to miss out, but we have no real mechanism to know where students are taking their courses. I don't know if there would be a process there for it, but then again, as we look at trying to make sure they get the residencies, we are trying to expand residencies so other people in other schools can be here in Nova Scotia, but I don't think we have a mechanism that can really identify students who are taking it from outside. We do attend
[Page 151]
recruitment fairs in various parts of the country and offer incentive packages to many physicians and medical graduates.
MR. MCNEIL: I wonder if it is possible, on your Web site, to make a spot, to make a port for students who may be interested in coming back to Nova Scotia who are now being educated elsewhere in Canada, to leave with you or your department their e-mail address, so then you can continue to forward them things that are happening around here in Nova Scotia.
It seems strange to me that New Brunswick can chase a Nova Scotian student to Ontario, and we have trouble following that student. Somewhere in the system, whether it's in your department or whether it is in the Department of Education, whether it is a student loan, we know those students are going somewhere. I think there needs to be some co-operation among the departments to help solve what is becoming quite a critical situation in many of our rural communities. The answer might be there, quite frankly; some of the answers might be right there in front of us and we're just not seeing them or we're not reaching out quickly enough to bring them back.
I want to move on to another issue. It's interesting, as I've listened in the House and everyone starts talking about health care, all of the problems in each of our ridings seem to be very similar. I don't want to let this time go by without speaking about long-term care beds. Of course, the Middleton area and the area that has been chasing two previous health ministers for long-term beds and now will be chasing you for them. During the most recent election campaign it was widely distributed throughout the constituency of Annapolis that the former Minister of Health, who actually is the current Minister of Health, had committed to 40 long-term care beds, and the Premier of the province, who is now still the Premier of the province, committed to the people of Middleton and surrounding areas to 40 long-term care beds. There seems to be a lot of confusion out there, and I'm hoping that in our little conversation here today that we will clear some of that up and where maybe this may have gone awry.
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member for Annapolis, we have researched this just a little bit to figure out who said what, and when. I still am unable to find a true commitment. There seemed to be a lot of talk about 40 beds for Middleton, and to do a long-term care facility there. I can commit to the member opposite that there will be new beds in the Annapolis Valley, and, through the RFP process, I am pretty certain that any proposal for a 40-bed facility would be looked upon quite favourably.
MR. MCNEIL: Mr. Chairman, through you to the minister, the Annapolis Valley is quite large. Mr. Minister, during the election campaign, the riding of Annapolis was very narrow, and the community of Middleton is very distinct. Actually, I know we're not supposed to have props in the House, so I wouldn't bring one, but I can actually give
[Page 152]
you the literature that was sanctioned by your candidate and the Party that those beds were coming and that you had committed to them and that the Premier was in agreement with them. As a matter of fact, the Premier spoke to the Middleton nursing home group and said, if the minister supports these beds, I will be supporting the beds. Your candidate was going around telling the people of my riding that you were there. They have demonstrated the need, there has been no question about that. I want to say to you, it's one thing to say that to me. I want to invite you to the riding of Annapolis, I want to invite you to the community of Middleton, and we can have a meeting with the Middleton nursing home society and explain to them how a candidate, during a political campaign, can say one thing, and commit it to a candidate and the former Minister of Health and their Leader and, yet, days after an election, we've conveniently forgotten about that promise. So I will sit and wait for you to respond.
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, when it comes to the placement of long-term care beds in this province, we've been very clear that we wanted to make sure that we had a clear strategy in place, which is why we introduced the Continuing Care Strategy a few months ago which identifies the need for long-term care beds from one end of this province to the other. So far, we've committed, over the next four years, we will be building and providing 826 long-term care beds across this province. The specific issue of Middleton is one that I am aware of, one that the honourable member has made me aware of on many occasions. He's a darn good member. He's a darn good member. Make sure it's in there twice in Hansard, now. I can commit to the honourable member that once we have a certain budget approved, or hopefully approved, that we will move down the road of identifying specific locations for those bed expansions. When that time comes, I am sure that this department and the Continuing Care Branch, and the project manager who will be working on this file, will be looking at the Middleton proposal very favourably.
MR. MCNEIL: Mr. Chairman, I want to thank the minister. I will allow the community members to bring this up to him again, as I'm sure it will happen, and I may be the next candidate in Annapolis quoting the Minister of Health on campaign literature, except I will have it in writing and it's on the record. So that will be good.
One of the other issues that I want to talk about is the bill that was passed in the last sitting, the Self-managed Support-care Act, which was introduced by my colleague, the member for Glace Bay, and supported by all members of this House. I know it was an issue that was brought up originally by the former member for Dartmouth North, Mr. Pye, who was championing this along with our caucus.
In my view, it has given a new lease on life for people with disabilities. I am very pleased that program has been able to be used in my constituency and in other parts of the Valley. One of the things, as I look at that program, I'm wondering if the Department of Health is looking at that as a way to provide long-term care or a version of home care
[Page 153]
for our aging population. It does an amazing job right now with people with disabilities, allowing them to go back to work, allowing them to have some control, some dignity over their own lives, live in the environment they want to live in. I believe, whether the program can be massaged a bit, we can use that same program in terms of long-term care and how we provide that at home, or a version of home care. So I'm wondering if the department is looking at that, whether or not that is something that Nova Scotia seniors can expect to see in the near future?
MR. D'ENTREMONT: Mr. Chairman, through you, to the honourable member for Annapolis, as we look at different ways and different mechanisms in which to provide service to our communities, I think every program must be looked at, and there's no point in reinventing wheels if this program is at work already. What I can say, in the development of the Continuing Care Strategy, when we met with different seniors' groups, different service providers, there were a lot of ideas that were floated. I can say that within the caregiver strategy, as we move forward, we'll provide a lot of the programming and services that the member speaks of.
MR. MCNEIL: I wonder if the minister could tell me how many service providers there are across Nova Scotia now, providing the home care services, that the government actually contracts with?
MR. D'ENTREMONT: Mr. Chairman, as you are aware, these are contracted services, for the most part, and we don't have the information directly available to us. So what I will do is, I will commit to having that information to you at our earliest convenience, which will probably be Monday.
[3:00 p.m.]
MR. MCNEIL: The reason I ask, Mr. Chairman, to the minister, how many people are contracted out to provide home care services across Nova Scotia, is that there seems to be a different level of service across the board, depending on where you live in the province. One of the issues I hear about an awful lot in my constituency is the fact that people who are acquiring the service are upset a bit at the fact that their caregiver is changing so rapidly. Some of the home care services being provided is very intimate care, and for some of these people it takes a long time to develop a relationship with their caregiver. What's happening is that caregiver is changing so rapidly that they're unable to find any type of relationship. So what I'm wondering, if we have a number of companies out there providing home care services, are we reviewing it, are we reviewing it in a way to ensure that the service is being applied equally across Nova Scotia, regardless of where you live?
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, through the Continuing Care Strategy we have identified that we do want to look closely
[Page 154]
at home care services across the province and how they are administered. For a number of years now, even the district health authorities have said they want to sort of take charge of home care services and provide those kinds of services. So there are many things going on to ensure that home care services are similar across the province. The concern, I think, you bring forward is really from the issue that we have a number of vacancies in the Valley for home support workers. We are having a challenge making sure we have a full complement of home care workers and, therefore, the wait list is getting a little longer. As far as the particular programs, I think when it comes to respite care, when it comes to housekeeping services or the other services that are provided, I think they are all very similar.
MR. MCNEIL: The issue is perhaps, Mr. Minister, the services may be the same, the question is accessing those services, it varies right across the province, and in the constituency of Annapolis there is a long wait. The other issue around that is the fact that when someone is receiving home care, there is not the consistency with the person providing that care. In some cases, I've had constituents tell me, in the run of a month, they've had as many as 15 different people in their home providing very intimate care. If it's truly trying to provide care of service for the individual client, then that is what we should be focusing on. I'm wondering, under the present system, the way it is now, you identified one need in the Valley, is your department now looking at that need in terms of ensuring the consistency of care workers with the individual client?
MR. D'ENTREMONT: To the member opposite, yes, we are looking at the whole delivery model of home care in this province. I have the same instance, the same stories that I hear from residents and home care workers in my riding, where it really sometimes doesn't make sense on the scheduling, the clients they are seeing, the different clients they're seeing. I think that there should be a better flow, that these home care workers get to know their clients and can provide a better sense of service.
The other issue of getting home care in the first place, I think, is a challenge, as well. I want to make sure there is a centralized way to access this somehow as we did it with access to long-term care, some kind of single-entry-type process that would make it easier for seniors to get home care, also giving them a mechanism in which to ask questions. I know most seniors have difficulty. They end up either calling their MLA, or just bearing the problems they're having or the concerns they are having on the care they are receiving. So we do have to really look closely at the system and how that service is being delivered.
MR. MCNEIL: The Self-Managed Attendant Care Program could solve some of these issues, in my view. I think it's something that your department should seriously look at. I think there's a huge potential to make this happen. What we are faced with, many people are requiring health services because of physical needs, not their inability to think, not their inability to act or hire or be their own boss. I think this program would
[Page 155]
allow them to take charge of their own care and I think it's something that we as a province and, particularly you, as Minister of Health, should be looking at and trying to move forward with.
One of the other things that is happening, one of the good news stories in my riding is telemedicine. At Soldiers Memorial Hospital we have a link, and it has provided an opportunity for the constituents of Annapolis and, really, the western end of the Valley to have access to health care professionals who are here, in a way that's responsive to their own lifestyles. They don't have to give up a day at work, they can go into Soldiers Memorial Hospital for their time, spend an hour, or 15 minutes, have the specialists interact with them through modern technology, along with a support worker there at Soldiers Memorial Hospital. I'm wondering if this part of the health care system is being expanded, whether or not we'll see that spread throughout other parts of my riding, and where we are heading with that.
MR. D'ENTREMONT: Mr. Chairman, I can commit to the member opposite that we will continue to expand that program, making sure that we have more and more services available through the telehealth program. Also, to say to the member opposite, we will continue our process to make sure we have a telehealth/tele-triage system in the province that will be available to all Nova Scotians, with their ailments, as they require medical attention. They can call in to a number and receive some baseline health information and some treatment options. To the current telehealth/tele-triage - we are going to have to change the names because they are very similar programs - the actual program, it's wonderful to provide clinics and allow certain specialists to see patients who are unable to go to the centres where those specialists are. It's something that this government and this department is moving forward and expanding as much as we can within the confines of our budget.
MR. MCNEIL: Mr. Chairman, I want to encourage the minister to continue to expand that program, as it is truly in the best interests of all Nova Scotians. It allows them some normalcy in what is otherwise some difficult times for them as they are requiring the services of health care professionals who do not reside in their physical location.
During the last sitting of the Legislature, the Community Services Committee - all three Parties - participated in a number of things that took place. One of the things was dealing with the issue of autism. The government committed, under the former minister, $4 million for a pilot project to move forward to help children, and help those families who need those supports. I wonder if the minister could explain how far along they are with rolling out that program, and could he explain any additional funding that Nova Scotians can expect for that program?
[Page 156]
MR. D'ENTREMONT: Mr. Chairman, I'm going to have to apologize to the honourable member for Annapolis, but could I get him to recap his question?
MR. MCNEIL: I'll see if I can remember this. One of the great works that the Committee on Community Services did last time, and there were many , but one of them was around the issue of autism. The department took up the lead from that committee and instituted a program around autism. They committed $4 million to that program, under the former Minister of Health. I wonder if you could tell us, tell me, where are we in rolling out that program and what initiatives is your department going to be doing to increase funding to that program?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for rephrasing, we were writing things down from a previous question. Ultimately, the autism program, as was discussed in the Committee on Community Services, one that the previous minister committed to making sure was implemented, has been fully implemented, which is a program of $4 million per year. It is the autism spectrum disorder program, which at this point has been working very well and receiving some good reports on its effectiveness and usage.
MR. MCNEIL: One of the issues, when the program was being rolled out, was around having the professionals here to actually provide the kind of care that we were looking for. There were people who brought in - they were calling it Train-the-Trainer, it was that model. I'm wondering, has that been fully completed and do we now have the specialists who are here in Nova Scotia, the professionals who are here, to provide the actual training so we could have more people in place to help increase this service?
MR. D'ENTREMONT: Mr. Chairman, the member opposite is quite correct in saying that part of the program was basically training the trainer and training the specialists who would be working with these children with this disease, with this illness. Basically, everybody will be trained and the program will be fully implemented by September. So everybody will be trained and it will be in full use by that point.
Before I sit down, I do want to fill in some blanks from a previous question on home care. From the 20 home care providers in the province - there are 20 home care providers and they provide somewhere close to 1.7 million hours of home support, and there are about 450,000 nursing visits being held across the province through our home care system.
MR. MCNEIL: Mr. Chairman, I appreciate the information around the home care providers, and I'll go back to my initial part of that and that is to ensure that there is a level playing field across the province, that there is the same level of service in every part of Nova Scotia, regardless of where you live.
[Page 157]
To stay on the autism issue for a minute though, Mr. Minister, as you know this is an early intervention, this is to help those children at the very early years when we can identify and move forward. We have another problem and that is the fact that we've failed a generation of young children who have autism syndrome. They are presently in the school system and I'm wondering, has your department been exploring any way that we can provide them the kind of health care that they need to ensure that their life looks brighter as they continue to move through the school system and out into the working field?
MR. D'ENTREMONT: Mr. Chairman, to the member opposite, it revolves around autism for those children who are now in school. There had been $2 million spent on working with those children. There is programming within the school system now and you probably could ask that question of the Minister of Education when her turn comes up.
[3:15 p.m.]
The concern I have really when it comes to autism is not necessarily the supports, I believe the supports are now there within the community and within the school system. The spectrum disorder program is there for the early years. My problem that I'm seeing that we need to start addressing is really the caregivers, the parents of these children. In my riding alone there are a number of children with autism, and one of the homes that I was able to visit had two children with autism and the frustration - you know, to the mother's frustration as she was unable really to work because she's required at home when the children are home to provide them with the extra care that they require. So we do need to find some programming there that is going to help some of these children and families at home, but I believe that we are doing a fair job of making sure that those supports are there in the school system and, of course, during the early years.
MR. MCNEIL: That in some ways, Mr. Minister, shows the frustration and leads into the frustration that many Nova Scotians are feeling. It's when you become five, then you don't become a health issue, you become an education issue, when their concern is they're just wondering what's in the best interests of their children, and the Education Department is trying to deal with the educational issue, but there's still the health issue that has been left for them. For us to be able to say, well, now that you've moved into the age of five and are going into the education system, that's not our problem anymore - well, quite frankly, that's just not good enough.
From a family's perspective - and you're so right, there is this respite care for parents, but there's still the issue of dealing with the health of these children and how do we provide them with the kind of care, even the kind of treatment that they deserve, as we are doing now, and I think your government and all Parties in this House should be proud of the role that we've played in terms of the early intervention, but we still have
[Page 158]
to deal with the issue of the kids who are going into their teens whom we have let down and have not treated.
So I want to say to you, as the Minister of Health, you still have a responsibility. I will ask the Minister of Education on what they're doing in terms of other supports, but there's a health issue and you need to deal with that. We need to be upfront and deal with that in the best interests of those students or, more importantly, Mr. Minister, in the best health of our province, because the healthier those children are when they go into the workforce, the better off all of us will be, and that's what we need to recognize and continue to push and move forward on.
I want to talk a little bit about addiction services in the Valley. I know you're aware, Crosbie Centre has reopened its doors. I want to know what your department's relationship is with the Crosbie Centre at this particular time.
MR. D'ENTREMONT: We're very happy to hear that Crosbie Centre has reopened its doors. At this point, there is no interaction nor funding that goes between the Department of Health and the Crosbie Centre.
MR. MCNEIL: I'm wondering if there are ongoing negotiations, if there's the possibility that will be happening, or does your department basically believe that addiction services have one model, one way to provide that service and that is on an out-patient model? Are you prepared to enter in with the Crosbie Centre to find out if there is a relationship that you can help support?
MR. D'ENTREMONT: There are a number of different treatment processes that are brought forward and that are actually looked upon on a regular basis. Crosbie House is one which really focuses on one type of treatment. The district authority really focuses around inpatient, out-patient and other types of supports as well. So I think there is room for all models in this province, but at this point there is no relationship with Crosbie House and the department.
MR. MCNEIL: Mr. Chairman, to the minister, just as every person suffering from an addiction is different, so could be their treatment. The idea that one model will solve all of the addiction problems we have in the province is just short-sighted. We know that will not work. I guess what I would say to you, I would encourage you - in our case in the Valley there's a proven model that works for a large number of people, which would be the Crosbie Centre - I would encourage you to reach out to them and your department to reach out to them and find out what supports you can provide.
There are a lot of families, quite frankly, suffering from the way the government believes they can deliver addiction services, it is not functioning for them. Other models
[Page 159]
may provide that and it is our responsibility to help those families find the model of care that will help them get over their addiction.
If I could just draw your attention to the Estimates Book on Page 11.2 and it's the Pharmacare Program. I notice there is an increase and I see there's one in the previous years as well. I wonder if that's just what you budgeted as an annual increase, or is there something else happening there?
MR. D'ENTREMONT: The increase in the Pharmacare Program, which is the provincial drug program that offers Pharmacare for those folks over 65 years of age, is due to utilization, which would increase about $12.9 million; tariff increase, which is about $950,000; and the increase in seniors' premium co-payment of about $950,000.
MR. MCNEIL: I'm wondering if the scope of the drugs that Pharmacare is actually covering, is that changing? Are there new ones being added to that scope or will there be some dropped off? Has there been any change at all in that plan?
MR. D'ENTREMONT: There is the formulary committee, the committee that reviews drugs for use in the Pharmacare Program. I can say they do meet on a regular basis to review the scientific data on adding or deleting drugs from that formulary. They also utilize the information from the Canadian drug review, so a lot of the drugs you will see on that list have good scientific data to make sure that they are as safe for usage as they possibly can be.
MR. MCNEIL: Around the Pharmacare issue, you had mentioned earlier - I guess it was in your campaign - about covering children of low-income families for Pharmacare, as well I'm sure you're well aware, you can get early Pharmacare through Community Services for some Nova Scotians, and then you also talked about the working families Pharmacare. Under the ones that you are presently delivering right now, do they fit in that bottle? Is that being budgeted there or are they being budgeted somewhere else?
MR. D'ENTREMONT: What you'll find is the Department of Community Services manages their own Pharmacare Program, the low-income Pharmacare Program and the Children's Pharmacare Program is dealt with there. We deal with the Seniors' Pharmacare Program, yet the formulary in the listing of drugs and those types of things are supported by our staff at the Department of Health.
MR. MCNEIL: In November, your department released an Elder Abuse Strategy and I'm wondering where we are within that program, has it become more than a strategy, and when will it be implemented?
[Page 160]
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable member, the Elder Abuse Strategy was developed under the Senior Citizens' Secretariat and I think we see the implementation pieces held within that budget, so I would say that you should reserve your questioning for the Minister responsible for the Senior Citizens' Secretariat, which is not me.
MR. MCNEIL: I will take you up on that. There is also a Strategy for Positive Aging and I'm wondering if that is also falling under the Senior Citizens' Secretariat because I believe the Minister of Health was the one who was doing the announcement of them. I'm just curious, I believe you made the announcements as the Minister of Health, is someone else going to do the implementation?
MR. D'ENTREMONT: The Strategy for Positive Aging would have been done by the Minister of Health at the time when that gentleman was responsible for the Senior Citizens' Secretariat. I believe it was done by the Honourable Angus MacIsaac at the time. Ultimately those two strategies are held within the Senior Citizens' Secretariat, which is now under the purview of another minister.
MR. MCNEIL: I thank the minister for engaging me today and answering my questions. I guess perhaps the Premier thought your workload was too heavy and didn't think the others' were heavy enough. I want to thank you and I look forward to working with you over the next number of months as we move forward to ensure that the citizens of Middleton and surrounding area have those 40 beds that they've been looking for now and actually have been promised by your government, so I'm really looking forward to you being there when you turn the sod and are ready to go. Thanks again and I will turn the rest of my time over to the Leader of the Liberal Party, Mr. Samson.
MR. CHAIRMAN: The honourable Leader of the Liberal Party.
MR. MICHEL SAMSON: Merçi, M. le président, il me fait plaisir d'avoir quelques minutes pour posé des questions au ministre de la Santé. Premièrement c'était encore son poste comme ministre responsable du ministère de la Santé et aussi comme ministre responsable des Affaires Acadiennes. Je suis bien content d'être un Acadian mais vous-même, M. le président, d'avoir que c'est lui qui est encore dans se poste comme un Acadian qui maintien ce poste. J'espère que j'aurais l'occasion dans quelques minutes de lui posé plusieurs questions et plus important je m'attend que j'aurais plusieurs réponses du ministre en même temps à mes questions.
Mr. Chairman, allow me to start my questioning first with a subject I've raised a couple of times here in this House during the past number of years to both the current minister and his numerous predecessors in that department. It's the situation at the Strait Richmond Hospital. We've probably had more chronic doctor shortages at that one
[Page 161]
facility than any other facility in this province and I assure you that it's not a distinction that the people of Richmond County are pleased to have.
It is a wonderful facility, and unfortunately for a number of issues we've had difficulty having a long-term physician at that facility. Currently we do have a doctor who's there, my understanding though is, unfortunately, like so many doctors she would like to have a bit of vacation time this summer, which I'm sure she is most deserving of and entitled to. The problem is we have already been given indications that her taking a vacation will result in daytime closures of that facility again.
My question to the minister is, what steps are you taking to ensure that a doctor will be located to serve the emergency room of the Strait Richmond Hospital during the daytime hours on weekdays if and when the current physician at the facility decides to take vacation this summer?
MR. D'ENTREMONT: Merçi, M. le président, je remercie le question et pour commencer ses commentaires en français en ouvrant son ligne de questions. J'aimerais beaucoup même de répondre les questions toutes en français si je pouvais mais je sais que tous les autres membres au législature ne sont pas chanceux assez de comprendre le français. So I will answer my questions in English.
Richmond and region has been definitely a challenge for the department, some of it revolves around the actual location of the hospital and the difficulty that some of the local physicians have in travelling from their practices in Port Hawkesbury to the hospital. Ultimately I think what we've been trying to do there is making sure that through locum coverage that we would have some of these doctors travel to Strait Richmond to do the fill- in. I think what we'll commit to today is that we will do our best to make sure that there will be part-time coverage of that facility, to ensure that there is full-time coverage at the emergency.
I think really this has to be done in conjunction with the DHA and making sure that we are aware, the Department of Health, of upcoming vacations and types of work stoppages that are going to close that ER, because ultimately it is unacceptable that those services are not available to those residents.
[3:30 p.m.]
MR. SAMSON: Mr. Chairman, I respect the minister's answer, but I'm wondering if he could be so helpful as to tell us when the last time his government was successful in obtaining a locum doctor for the Strait Richmond Hospital - I'd be most curious to find that out.
[Page 162]
MR. D'ENTREMONT: Mr. Chairman, through you to the honourable Leader of the Liberal Party, I'd have to go back and find out when the last time was, but I'm sure he already knows and he'll inform us when his opportunity comes. I can say that there is 24-hour coverage at the Strait Richmond right now and there will continue to be 24-hour coverage at the Strait Richmond. We have made some changes to try to entice doctors to come there, making sure there's an alternate funding plan and there's more sustainability for coverage. Hopefully this is a discussion that we probably won't have for awhile.
MR. SAMSON: Well, the answer to the minister's question which I posed to him is that it has been years since his department has managed to find a locum doctor for that hospital.
Now, what's a locum doctor? Locum doctors are doctors who make themselves available to travel to different areas, different clinics, different parts of the province for short periods of time to replace doctors who may be on vacation, may be on sick leave - and it's something that's a regular occurrence. I know that in the community of Arichat, for example, we've been very successful in getting some doctors come in on what's known as a locum basis and that is for short periods of time. The Strait Richmond Hospital on the other hand is not so successful - it has been years and what's happening when the doctor goes on vacation, or happens to be sick, is the emergency room closes.
My question to you today is, will you give a guarantee that when the doctor at the Strait Richmond Hospital this summer chooses to take vacation that there will be a replacement doctor there and that emergency room will continue to be, as the minister said, a 24-hour emergency room?
MR. D'ENTREMONT: I know the member opposite would really like to see a guarantee but, of course, in this type of business, there are no true guarantees because of certain issues and things that may arise at the last minute. I can assure the member opposite that we are working diligently with the district health authority to make sure that we have correct remuneration, making sure that we have as many provisions in there to ensure that there is 24-hour care at the Strait Richmond Hospital.
MR. SAMSON: With all due respect, Mr. Minister, I've heard those commitments from you, I've heard them from your predecessor, the one before him, the lady before him, unfortunately, with all due respect, it hasn't worked. So let me ask you again, if you take the Strait Richmond Hospital situation seriously, will you give your personal guarantee, as minister, that your department will find a doctor to replace the current physician when she goes on vacation which, I'm understanding, may be for a month's time? Will you, today, give your commitment to the people of that area - which also serves the Premier's own riding, in case you weren't aware of that, and also the riding of the member for Guysborough-Sheet Harbour and even the member for
[Page 163]
Antigonish - will you give your guarantee that your department will send in a physician to replace the current physician's holidays at the Strait Richmond Hospital?
MR. D'ENTREMONT: Mr. Chairman, I'm really glad that the member opposite has so much faith in me that he feels that my guarantee could make sure that happens. I'm saying today that we will do our best in working with the Strait Richmond Hospital and the district health authority there to make sure that not only do we have locum coverage, but we would also have the time of a doctor there on a full-time basis. I think that is probably the best solution to make sure that we have the doctor complement at a point when that doctor feels it's time to go off on vacation. Actually, by the sound of it, she doesn't necessary go off on vacation, she goes and provides service in another country, for some time to do that. So a very valuable type of physician. I will commit today to do my best to ensure that there is coverage at the Strait Regional Hospital.
MR. SAMSON: Well, Mr. Speaker, as the old adage goes, actions speak louder than words. So, Mr. Minister, you are now being given the opportunity, it is your actions that will determine exactly your success. I believe you are sincere. I would like to think you are sincere on this. I thought your predecessors were sincere, as well. Unfortunately, they did not have success. Time will tell in the next few months.
I will be more than happy to issue a press release, and your actions will determine what that press release will say. It will either be to commend the Minister of Health for being able to find a doctor during that time, a locum doctor to come in, or the regular press releases that I've sent for your predecessor, the now Minister of Service Nova Scotia and Municipal Relations, also the Minister of Transportation and Public Works, also the former, former member for Halifax Citadel who, unfortunately, were unsuccessful in that regard. I'm sure the minister and his deputy and staff understand the frustration at that facility.
Let me end with telling you that each day, each hour, each minute that emergency room is closed, you're rolling the dice. You are rolling the dice hoping there is never an emergency, that nobody shows up at that door with an emergency that's life threatening only to be told, I'm sorry we're closed right now because we don't have a doctor. That cannot continue. For years now your government has rolled that dice, and I just hope and pray that I don't have to stand up here in this House and inform Nova Scotians of the disastrous consequences of that.
To another issue which I've raised again, Mr. Minster - I don't know if I even had the chance to raise it with you but I've certainly raised it with the now Minister of Service Nova Scotia and Municipal Relations who told me the program is coming back, the previous Minister of Health, from Halifax Citadel, who promised me the program was coming back, and your most recent predecessor, the now Minister of Transportation and Public Works, who also promised me this program was coming back.
[Page 164]
The In Home Support Program. This program that was put in place by the previous Liberal Government was meant to assist caregivers who stayed at home to care for loved ones who, in many cases, left their employment in order to stay at home. This program, way back then, was providing caregivers approximately $400 per month, a small amount of financial compensation for the fact that they were keeping loved ones at home which, at the end of the day, it was saving the government thousands of dollars by having loved ones remain at home and getting the proper care, rather than having to be put in a long-term care facility.
To give the minister a bit of history, your government, after being elected in 1999, decided to review this program in 2000. Now, I'm not sure if I'm aware of any longer reviews than the review of this program, because in 2000 one of the most unfair things you did was not allow any new applications. There was a freeze, but anyone who was on the system kept getting paid for it. So you had a situation where you had neighbours taking care of loved ones, one was getting paid and the other one was not getting paid.
This clearly cannot continue. The minister needs to know right now, the long lineups of people waiting for long-term care is as a direct result, in many ways, of the cancellation of this program, and that caregivers can no longer financially afford to keep loved ones at home, they just can't. The In Home Support Program was assisting in allowing them to be able to keep loved ones at home. It has now been six long years. Three of your predecessors promised me, in writing, that this program was going to be re-introduced. Six years later, still no program, families are waiting, loved ones have been forced into long-term care, added costs to the government, added costs to this province.
My question to the minister is, will you commit today to re-introducing the In Home Support Program in our province?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and through you to the honourable member for Richmond. I have to say there are a number of issues we tried to address here. I do want to go back to a previous question, quickly though, to our Emergency Health Services. I know he talks about disaster and waiting at the emergency room door, but I have to say, from a previous member from a government that set up one of the best emergency health systems in Canada, these are the types of things that we need. When people need help they have 911, they have an ambulance service, they have a helicopter flight service that can help Nova Scotians when they need it the most. When we talk about the In Home Support Program, currently in the Department of Health we are still supporting the people who ran the program before us, so there is still $5.5 million within our budget that is maintaining the people who already had it.
[Page 165]
Number two, there has basically been a transfer of this program to the Department of Community Services. There is the Direct Family Support Program, which provides in-home support for individuals caring for family members by providing respite funding. Approximately 1,600 clients are in that program. There is the Alternative Family Support, which provides nurturing, community setting for adults by placing them in approved care-giving family homes; there is the Independent Living Support Program, which provides support to individuals who have the ability to live in their own community with minimal supports. There are a number of programs, most of them are with the Department of Community Services that basically took over the In Home Support Program from the Department of Health.
The Department of Community Services, of course, and the Department of Health have an excellent partnership, which results in looking at that continuum of service between both departments. Mr. Chairman, we want to make sure there is less duplication and make sure that we have a standardization of programs and policies in making sure that those benefits are available to all Nova Scotians.
MR. SAMSON: Mr. Chairman, that is the answer given when there is no answer at all, that is to say it has been shuffled off to another department. The sad part is that it should have been left with Department of Community Services, to start off with. It is your government that took it from the Department of Community Services and put it into the Department of Health. It was working when it was with the Department of Community Services because they were able to stay in touch with the people and with the families and be able to provide. But you sent it to the Department of Community Services and you didn't give them a bigger budget. So they are now left with only taking care of the people who were approved prior to 2000.
Right now, today, there are no programs available from your government to give direct financial assistance to caregivers. Do you acknowledge that, that there are no government programs giving direct financial assistance to caregivers who stay at home to care for loved ones. Do you acknowledge that here today, yes or no?
MR. D'ENTREMONT: I just listed off a number of programs held within the Department of Community Services that take on new people. I want to say that we are still supporting the people who were in the In Home Support Program when it was with the Department of Health.
I think the member opposite may have a bit of confusion about what those programs are. The Department of Health is still supporting those In Home Support Program people with the $5.5 million that I spoke of. The program that I'm speaking of is with the Department of Community Services, I'm sure he'll question the Minister of Community Services. We are talking about new clientele. So, yes, we are providing money to people who are taking care of people at home.
[Page 166]
MR. SAMSON: I find it disappointing because the minister knows that no one prior to 2000, no one after 2000 has been allowed in on this program. For six years now, no one has been allowed in on this program, nor through Community Services - I don't think they are allowing anyone in either, they don't have a budget for that. Direct financial assistance is not being provided to caregivers who leave their jobs to be able to care for mom, dad, aunt, uncle or a next door neighbour. Now you're wondering why so many people are trying to get in nursing homes.
Look at the big picture. People can no longer afford to keep loved ones at home when they're losing financially and your government has turned their back on them since 2000. The end result is, they call me to say we'd love to keep mom and dad here in the house, but we can't financially afford to do so. We have no choice but to put them in a nursing home and now you're stuck with the problem that, since you've been in government, you've actually closed beds rather than open any new beds.
Now you have this waiting list and a 10-year plan - 10 years. Fortunately for you and I, hopefully we won't need that in 10 years, but imagine telling people to wait 10 more years before this problem is going to be addressed. That's the situation we find ourselves in.
It's no wonder we're in the crisis we're in in health care, when the government can't even look at the success these programs have had. Just look at how many people are still on the In Home Support Program. You can count how many people would be on the waiting list for long-term care if you didn't have that program. It's very simple math, figure out, of those who are on the program, how much it's costing you per month and then look at how much it would cost you if those people were all in nursing homes. It's not rocket science. It's a tremendous saving. It's a matter of investing money to save money.
[3:45 p.m.]
The previous minister said, yes, I understand. We have a new program. A former minister, now with Service Nova Scotia and Municipal Relations, he understood as well, he was bringing in a new program, yet there is no new program.
It's discrimination, because for the past six years, on one side one neighbour can get paid, but the next neighbour can't get paid. To talk about the programs of Community Services - they're trying, but it's nowhere near what the In Home Support Program was doing and it offers some different services. Yes, it offers a bit of respite care, gives some break for the family and everything. But at the end of the day, these caregivers, many of them are women, are no longer working, they are not contributing to any pension plan, not contributing to Canada Pension Plan. This is going to have a long-term impact on them in the future.
[Page 167]
These are sacrifices they're making and the In Home Support Program was a means of giving them a bit of income - $400. It may be more today, yet your government in 2000 said we're going to review this program and we're going to see if we can't strengthen the program. Well, you found a way to strengthen it, you cancelled it, in effect. For the past six years you allowed the charade of giving these families, through the different ministers before you, with the letters they sent me, commitments that this program was coming back. Wait a little bit longer, there's a new program coming.
There is still no new program coming. I'm sad to see that basically from your comments here today, from your department's perspective, you have no intentions of bringing back the In Home Support Program to allow new clients to be able to get in on this program. So I submit to you, minister, you're now in charge of the department that's in a crisis. You realize that. You have to openly talk about private health care because you can't take anything off the table, in your own words, because you don't know what to do.
You've allowed this to happen for years. Not just you, your government. Your predecessor, the Premier, when I asked him in this House - I don't know on how many occasions - what was he going to do to deal with the crisis in health care, he continued to say there was no crisis. Then when he passed his very last budget, when the media asked him, what's your next priority now your budget is passed, he said I want to be able to deal with the crisis in health care.
Well, how hollow it was back then and how hollow it is today, because for almost a year after that, he did absolutely nothing to talk about health care. Unfortunately my colleagues over here to my right have not been very helpful whenever we've tried to talk about looking at health care, because they've always shouted back that it's a matter of doing cuts and closing hospitals. That's not what it is. When is the last time we looked at health care and said can we do things differently? What business has not done financial analyses over the years, or had companies come in and say can we do things a little bit better? Only the Department of Health. That is probably the only government department that has never done that. The question is why?
By not doing that, that is why you still have programs like the In Home Support Program that could be saving you money that you're still freezing. Since 2000, you still haven't allowed people in, yet each year your budget has increased 9 per cent, 11 per cent, and if I'm not mistaken 9 per cent again this year. (Interruption) Eight per cent. Our province is growing at a rate of 2 per cent to 3 per cent. It doesn't take rocket science. It's not sustainable, it hasn't been sustainable, and it's not getting any better. Until you start investing in programs that allow people to remain in their own homes where they want to remain, and help families and caregivers who are there out of the goodness of their heart trying to keep them in their own homes, we're going to continue to have the problems that we are going to have.
[Page 168]
Those waiting lists are going to grow. Your 10-year plan of I don't know how many beds - you said, 800 beds, or something, over 10 years - you better start increasing more beds because the lists are going to grow longer. Families are going to grow more frustrated. There is a solution. There was a program that was working. For six years I've been trying to convince your government to bring it back and, until you do, you're going to continue to have the headaches that you have.
MR. CHAIRMAN: Order, please, the member's time has expired. Before we recognize the next speaker, we will take a short break.
[3:49 p.m. The committee recessed.]
[3:54 p.m. The committee reconvened.]
MR. CHAIRMAN: Order, please. We'll call this meeting back to order.
The honourable member for Dartmouth East.
MS. JOAN MASSEY: Mr. Chairman, I'm pleased to stand here late this afternoon to talk about an issue that certainly is important to all Nova Scotians, and certainly is an issue that I heard a lot about on the doorsteps - "stories from the streets", I guess, is what we could call it.
Health care definitely was the number one issue that I heard on the doorsteps. When I campaigned and I asked folks - if I said to people on the doorstep, hello, introduced myself, I'm here today, before you go to the polls to vote, to ask you if there are any issues you would like to talk about today, anything that is concerning you or your family, a lot of times people don't really have something to say at the very beginning, but if you throw out a few topics, the one they seem to always want to interact with you on is health care. It's something that as soon as you jog someone's memory, they have a loved one, a relative, somebody who has been impacted by their health and what they faced in the health care system in Nova Scotia.
It does bother me a fair amount to stand here and hear the Liberal Party talk about all the bad things that the Progressive Conservative Government has done, when in fact they were in power from, I believe, 1993 to 1998.
What I heard at the door from people is they were really hoping that the NDP could do something to help them. A lot of people don't know, exactly, the details of what needs to be done because it is a complicated issue - and I'm not going to stand here and pretend I know the ins or outs of it. I think the honourable minister's staff know a lot more about health care than I will ever know in my lifetime, and I thank them for coming here, and for the hard work they do for the people of Nova Scotia in trying to dig through
[Page 169]
what is a huge issue to all of us. I would bet that it's probably the number one issue that most of the candidates, successful and otherwise, faced on the doorsteps.
I'm just going to list some of the issues that I did hear about on the doorsteps - I know I won't get through all of them in any amount of great detail because there are 20 of us as the Official Opposition and we are all only going to be able to get so many minutes in here - wait times, long-term care issues, home care issues, emergency room issues, hospital stay time issues, assessment wait time issues, Pharmacare, food and security issues, self-managed care issues and mental health care issues. I'm sure I haven't hit on half of them. So if anybody is out there listening, they know I have been trying to listen to what they've been telling me on the doorsteps and I don't want anyone to feel that I haven't heard them or want to try to help them.
So there are a couple of examples that I'd like to talk about. In fact, someone came to me prior to the election, with an issue of wait time, actually to get in to see a cardiologist. There are a couple kinds of wait times in Nova Scotia, and I'm sure in other parts of Canada. You go to your doctor, the doctor says, I want to send you to a specialist. So, first of all, you wait to see your doctor. You get into your doctor's office, then it's well, you need to see this specialist so I will contact the specialist. Now you have to wait to hear back from the specialist.
So what some people have asked me on the doorstep was, when I do finally get an appointment with the said specialist, is that when my wait time actually starts, or does my wait time start when I go to see my doctor? Sometimes, when they do get an appointment to see a specialist, they may be waiting six months or seven months, I don't know how long, to get some kind of health care that they're looking for. A gentleman actually contacted me and was very concerned that he had not heard back from the specialist. Apparently, a normal wait time for an appointment booked by your doctor should be about three weeks, presuming your doctor calls and says, here's your appointment and off you go. Then you still have to wait for the appointment and that can be cancelled or what have you. That was one of the examples that seemed to crop up, the confusion around, when does your wait time start, when does it stop?
[4:00 p.m.]
Another issue was around the wait times in the emergency rooms and people going to the emergency department and actually being admitted to what I call, you're still in the emergency department but you're in some kind of cubbyhole, cubicle, curtain kind of no-man's land. People are really in pain. They're stressed out. If they don't have family, they're really in dire straits.
Even though I know the staff in our hospitals deserve a huge amount of credit, they are overworked, I think, right now, with what's going on in the system. They put out
[Page 170]
110 per cent, plus. They are phenomenal people. If anybody has ever spent any time even volunteering in any of our hospitals, you know what I'm talking about, it's just something that these people give of themselves. They are the last people who will ever complain. You have to drag a complaint out of somebody that you know who works in the health care system. I don't care what you say, you have to drag a complaint out of somebody who works there. These are phenomenal people.
We do have people who are down in those little emergency cubbyholes, who might be there for - I personally have encountered this - a couple of days, where you're not getting hot meals. You're there 24 hours a day, you might have somebody in the bed next to you who is in a lot of pain, crying out in pain. There are people coming in who are having drug abuse problems, and there are mental health issue patients coming in. It's just not a really comfortable position to be in for a couple of days. These people really should be moved, as quickly as possible, to a room where they can have their stress levels brought down and this sort of thing.
Another example that I found was somebody talking about having a loved one at one of our hospitals who is an Alzheimer's patient, and is trying to get an assessment done to find out, really, where this patient should be in the system. They're just left sort of stressed out at home, waiting for this assessment to be done, so that either the patient can be moved to an appropriate facility, hopefully close to home. Those are just three of the examples of some things I did run across in my door-to-door campaigning.
If there's a question in there, I guess it's not a question that's easily answered. If you read through the Nova Scotia Government Business Plan for 2006-07, there's a priority wait time section that talks about collecting wait time data, on a voluntary basis, monitoring the wait time project, that there's going to be a Web site or there is a Web site to help people decide if, indeed, they want to travel outside of their own community to a location where maybe the wait time is shorter. There seems to be some kind of a 10-year plan there.
I think people are really feeling the frustration level, and I think wait times is one of the things that they're feeling it on the most, because you're left at home wondering, again, am I ever going to get into the hospital, is something going to happen to me before I get into the hospital? Is it an emergency, is it non-emergency? Well, if somebody has an aneurysm, really, it's an emergency. You could die at any moment at home. So if you're sitting at home waiting for six months, scared to death - you're still going to go to work every day, you're going to do all things, just waiting for this thing to pop, and off you go. Most people don't survive it, to make it to the hospital. So there's that whole sort of grey area of what's an emergency situation and what isn't an emergency situation, right across Canada, I believe.
[Page 171]
What I'm wondering then, if, indeed, the Minister of Health can actually give me more of a definite definition on the wait times and the question of when does a wait time begin. So I go to the doctor and then I go to the specialist. Once that appointment is made, am I off the wait list? That's the question. If I get an appointment with my specialist and I'm still waiting to actually go see the specialist, am I still on the wait list? Maybe you could sort of talk about some of the issues around wait times, I'd really appreciate it.
MR. D'ENTREMONT: As we talk about wait times, wait times have dominated our thoughts for a very long time, to look at the different types of surgeries out there and people waiting far too long to receive those services. To answer the specific question, and I'll talk about it a little more too, the specific question of when a wait time starts is pretty much from the referral of your family physician. When your family physician sends you off for hip replacement surgery, the clock ticks. When you finally receive the surgery, the clock stops ticking. That is the general wait time.
What we're trying to do, as well, is we would like to have a better appreciation of the referral time. We're going to try to break those wait times down for referral to specialist and then from specialist to surgery. We want to have a better feel of where that length of time is too. I do hear a lot about, my doctor says I need to do this and he has referred me off to a specialist and yet I haven't heard, in forever, from the specialist. It's something that we need to break down and find a little more data on, to see if there are ways to rectify that part of the wait time.
To the point of emergency-type ailments, when you go to an emergency room or you go to a doctor who identifies you as being an emergency patient, whether it be an aneurysm, whether it be whatever, you receive immediate surgery or immediate care. There are five levels of acuity, depending on your assessment. I would say that it may sound bad, but your doctor may have only assessed you at a three or four, maybe you have time. It's all bad, it's depending on how the system works. But I can say that a person requiring immediate surgery receives immediate surgery. We are trying to focus down on five different types of wait times and see if we can focus in on one or two of them and see if we can bring them down. Orthopaedics is the one that I would like to see some real work done on, making sure that people needing hip and knee replacements get those things in a regular time.
I have a friend who has been waiting far too long. He has been waiting somewhere close to 18 months, but 18 months is about the average, right now, for hip or a knee replacement, here in the Capital District Health Authority. It's a little less in Kentville, a little longer Capital District. So we want to be able to see those wait times come down. I've seen him walk around with a cane and I've seen him having to retire early because he just can't function anymore. I do wish him well in making sure that he
[Page 172]
does get that surgery in an average wait time. Ultimately, it's not acceptable to have to wait 18 months to have something like a knee or hip replacement done.
The other one, of course, is cardiac, making sure that our wait times in cardiac - those ones aren't so bad because we do have some really good professionals and a system that works very well here within Capital District, and I think also in Cape Breton they have a cardiac program there too. If we look at cataract surgery - we actually have one of the lowest cataract surgery wait times in the country.
Cancer care waits and oncologist waits are not so bad. And the fifth one is diagnostics. So we're looking at MRIs, CT scan, different types of labs, and of course the work that we've done in trying to expand MRI services and making sure that we have those types of things in place. Hopefully, as they come on line, we'll bring those wait times down.
There are a lot of places to focus in on. I'm looking at orthopaedics at this point, to see if we can make a difference there, and hopefully we can take what we find out there and move it into those other levels of wait times in other types of services.
Just for the House, for this committee, I just wanted to - a question that was asked by the member for Annapolis wanting the distribution of urban and rural GPs. Out of the 1,665 GPs, 844 of those are urban, 821 of them are rural. At this point I don't have a breakdown between full-time and part-time. I would also like to table some of the further questions from yesterday's session.
MR. CHAIRMAN: The honourable member for Dartmouth South-Portland Valley.
MS. MARILYN MORE: Mr. Chairman, I certainly appreciate this opportunity to raise a few concerns from my constituency. I realize it's late in the day and it has been a long day. The first three I'm just going to mention quickly and then I have a couple of questions on the last two.
There are five particular health care system concerns I want to bring up today that have been brought to my attention. The first thing - we've heard a lot about it - is wait times. All I want to say is that it's very frustrating for the patient, the family, MLA, neighbours and everyone, particularly when people are waiting in fear because they don't know the outcome, when they're waiting in pain and when it severely impacts on their quality of life - you know, their ability to look after their children, their ability to work. So those are particular concerns.
The next one I want to mention is home care. I have a number of clients in my constituency who qualify for home care services but are not able to receive it in a timely
[Page 173]
adequate fashion. For example, someone may be released from hospital after having serious back surgery, has no one living with them and is told that they won't be able to get a home care worker for two weeks. Now, how is that person, particularly a senior, expected to cope? Also, someone with a chronic health condition who qualifies, for example, for 14 hours of home care a week, but is only able to receive it for four hours, and family members have to take time off work in order to help out. These are not only unsatisfactory, they're unacceptable, and we have to do something to bring our home care services up to par.
As you probably realize, the Nova Scotia Hospital is in my constituency and so I have a much larger proportion of population of mental health consumers who live near the hospital for a number of reasons, but partly to take advantage of the out-patient services. It's very frustrating to see them trying to cope in terms of living independently, but not getting the support services on a day-by-day basis. Some of them actually need help with their medication, and not receiving that just makes their situation all that much worse. A number have been actually placed into continuing care situations for seniors, and without the adequate sort of daily support there's a lot of friction between the senior population and the mental health consumer population within the facility, and it just creates a very unhappy situation, unsatisfactory for both groups. I think there are efficient ways of looking after some of that situation.
Getting to my two questions. The Dartmouth General Hospital does not have a bone density scanner. For the population the size of Nova Scotia, we should have 10 scanners. We only have five. I'm just wondering, I know a number of years ago, I heard that for a hospital to be able to buy some capital equipment, the community was expected to raise 30 per cent of the cost of that piece of equipment. Is there such a formula that is actually considered by the district health authorities and the Department of Health, before major capital equipment is added to regional and community hospitals?
[4:15 p.m.]
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for her comments pertaining to her riding of Dartmouth South-Portland Valley. In regard to the purchase of medical equipment, it's one that normally, on the higher price - and higher price means in the millions - is cost shared at about 25/75; 75 per cent from the Department of Health, 25 per cent from the community. A bone densitometer, I'm just taking a ball park guess there of $200,000, $300,000. We don't normally cost share on that type of equipment. It's really up to DHA, within their business plan, to purchase these things through their regular operating funds.
Ultimately, I don't know within the Capital District - and I look at this as the Capital District, knowing services are done in Dartmouth and services are done on the Halifax side and other services in other parts of the HRM - I'm just not aware of how
[Page 174]
many bone densitometers we have in the Capital District. (Interruption) There are two and their wait list is high, okay.
MS. MORE: Through you, Mr. Chairman, to the minister, thank you for that information. Certainly the Capital District is under serviced and the wait list for bone density scans is well over a year. Again, I think that's unacceptable.
The last point I wanted to raise is the freeze on continuing care beds. I've mentioned this a number of times, but I have an excellent facility called Oakwood Terrace in my constituency. It's across the road from the Dartmouth General Hospital. It has an excellent reputation and it has been trying to expand and add other levels of service for seniors in our community for a number of years.
I'm just curious, because I see in other parts of the province that the approvals have been given for expansions and upgrades and renovations, and I'm just wondering if perhaps the facility in my area for some reason, because it's a non-profit, is somehow being penalized. I'm just wondering, do you have a breakdown of the percentage of additions or renovations for continuing care rooms and beds in the province, as it breaks down in terms of the number that have gone to the non-profit sector and the number that have gone for the private for-profit sector?
MR. D'ENTREMONT: Mr. Chairman, I want to assure the member opposite that there is no freeze on long-term care beds; as a matter of fact, as we move along in the continuing care strategy and making sure that we have the correct distribution of those 826 beds in the first four years, each community will have their opportunity now to respond to the RFP, the request for proposals. I hope that your facility would resubmit through this new process. Also, about 30 per cent of our homes are non-profit. What would be the percentage private for-profit? About one-third, one-third - we have private for-profit and then we have private not-for-profit, so it's about one-third, one-third, one-third.
MS. MORE: Mr. Chairman, through you to the minister, what I was actually looking for was the breakdown in terms of approvals, let's say for the last five or six years in terms of additions or renovations. I'd like to know the breakdown in approvals that have gone to the various sectors.
MR. D'ENTREMONT: Mr. Chairman, a lot of the construction that you've seen up until now has been responding to certain health issues, whether they be mould and those types of things, in these long-term care facilities. Some of them have been trying to focus on extremely under-serviced areas, because there are those areas in the province that really didn't have any facilities whatsoever. I will commit to the member opposite that through the normal process now, as we move on from this budget and hopefully into a true RFP process where people can bring their proposals forward, that there will be a
[Page 175]
good increase in the beds in the province, as well as some replacements and renovations, as a lot of these facilities are due.
MS. MORE: Mr. Chairman, just one last quick question. Can you give me some idea of when the window of opportunity will be for the Dartmouth area to send in those applications, those requests?
MR. D'ENTREMONT: Mr. Chairman, I can assure the honourable member opposite that as we go along we still have some work to do in the prioritizing of where we should be focusing first in the province, and I would commit to the member opposite to make her aware of that list as soon as we have that one prepared. We are working on the strategy and we're going to be hiring a project manager for the total project in the very near future. This is going to take some time to get in place, but I will inform the member opposite when that time comes.
MS. MORE: Thank you. I'll pass over my time to the member for Hants East.
MR. CHAIRMAN: The honourable member for Hants East.
MR. JOHN MACDONELL: Mr. Chairman, I want to thank my colleagues. I was hoping for 45 minutes with your department, but in this world that's not possible.
I'm not going to sit down without at least educating the member for Richmond when he said that the NDP was talking of closing hospital beds - I wish he would come into the world of Nova Scotia and the work that this Party has done - I will remind him that under the last Liberal Administration they laid off 1,000 nurses in this province, which started the backlog in health care in this province. They imposed a moratorium on long-term care beds I will say, which we're still trying to live through, and it was the Liberal Party that actually forced seniors to pay for the health care in nursing homes, for those who were able to get into nursing homes, something that the New Democratic Party was able to correct. So if he has other delusions that he would like to have impacted, I would be glad to do that for him.
I want to say right off the bat, Mr. Minister, I appreciate the help of your staff and your deputy to issues of concern that have been in my constituency, but I do want to take some of my time to say that I think that East Hants is being somewhat left out when it comes to issues around health care delivery in this province. I put the blame at the feet of the DHA and it's either them or it's you - it's one or the other. If it's them and it's not you, then I see that as something you can correct; if it's you and not them, I see that as something you can correct, but it's probably less likely that you're going to correct it.
Look, services delivered in Hants East, basically paid for by the department, are the services that were delivered in Hants East and paid for by the department for some
[Page 176]
time, but there really has been nothing additional in years in that area, I want to tell you that - I think I should say with the exception of the group options homes, both Serenity Lodge and Mitchell's, we really appreciate what the department did in that regard.
I just want to make you think a little bit about my constituency and where we are. I have one of the fastest growing areas east of Montreal - the corridor area from Enfield to Shubenacadie, Nine Mile River, we have over 10,000 people in that area alone. Our DHA didn't build our resource centre that we have there that we put these services in - it didn't do that, the municipality did that - but the DHA gave $1.5 million for renovations to Lillian Fraser. Now, there are about 6,000 people in the Tatamagouche area and they have a hospital - we don't have a hospital in Hants East.
Now, maybe in the summertime with the cottagers, et cetera, that population probably balloons quite a little, probably up to the 10,000-people range, but that would be for two or three months of the year, and we have those people 12 months of the year. I haven't found that the DHA has been particularly great at asking, what are your needs? I know the process - the community health boards make up a plan, they put their priorities to the DHA, the DHA puts its priorities to the department - I know it, but something just doesn't seem to be right to me in the delivery of service to my area.
One of the things that my community health board had looked at was they were trying to get the ambulance service in conjunction, as part of that resource centre. They wanted that housed there - gee, that was an impossibility, but it wasn't an impossibility to do it in Tatamagouche. So it seems to me that the people in my area work really hard and they get very little, I think, for it. I'm amazed and I'm impressed by their work ethic, their commitment and their determination.
The Rawdon Hills Health Centre has been an issue. I met with your staff over a year ago, Mr. Miller and Ms. Payne. They indicated to us that there was funding there. They wanted us to go through the DHA and I'm telling you, we hit a roadblock, a stone wall. If ever anybody gave you the impression that wasn't going to be built, it was that DHA. Don't point fingers at the former chairman because I thought she was a good chairman for that DHA, I want to tell you that.
With that said, we met with the DHA on this because we were advised that they wanted the DHA onside and they said well, you should partner with somebody. They were not really opposed to the health clinic being built, they were just opposed to funding it with money that I thought they should have found to fund it in the first place, which they didn't. They didn't take up that cause. So now they have thrown it back to the community health board for them to make a decision and the community health board says, we don't approve bricks and mortar. That was their position long ago.
[Page 177]
Now they're worried. If they say yes, spend $250,000 or $300,000 on this facility, does that mean that in the years to come they are always going to be told no, you can't have this capital cost or you can't have that capital cost because we did this for you, so you are getting nothing for the next few years? So the community health board now seems to be at odds between the members who are from Rawdon and the rest of the constituency. It seems blatantly unfair to lay this on them. I tried to get correspondence from Brenda Payne - can you clarify this for them so they won't feel so jeopardized? She did send me a good letter but not quite good enough. It didn't allay the fears of the community health board for them to agree.
Now, I was to a meeting in February where the DHA was going to hire a consultant not just to look at this situation but to look at the overall situation for Hants East. That was going to be done and that work was going to be done by the end of March. I was to a meeting the other night - Tuesday night I believe - and they just figured out who they are going to hire. There is no timeline, it might be November, it could be whenever. I just can't believe that for a meeting we had a year ago in March, where the department said yes, there are funds for this, that we are going down the road of almost two years before we even get anywhere.
[4:30 p.m.]
I want to tell you, if somebody can take a plane and fly over the HRM or my constituency to give this message: we are being stonewalled either by the DHA in my area or we are being stonewalled by the Department of Health in this province. Those people do not deserve it. I would like someone to take the bull by the horns and give somebody a really good shake and say enough messing around on this, let's get down to work and do something, because they have given all they should have to give to try to do this.
I know that the deputy is pretty close to this, she is well-informed, so I would like some response before I run out of time, if you could. I have some other issues but I don't know whether I'm going to get to them, but that's a biggie for me.
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and I thank the member for Hants East for standing and bringing concerns from his constituency. I have to say that we have a lot of areas in this province with a lot of requests before us, but I think we need to focus in on the issue of primary health care. We continually talk about primary health care and providing better service to our citizens. Some of those revolve around having the correct type of clinics and the correct type of facilities.
I will commit to the member to provide him with some more information on this one, we just don't have the full details with us, and also commit to him to have a meeting some time next week to discuss the issue and maybe find where the roadblocks are,
[Page 178]
whether they are with our department or with the district health authority. I do want to thank the Colchester and Hants East District Health Authority for the work that they do in the community, but it's questionable why things are transpiring the way they are.
I can also commit to the member opposite that as we look at long-term care within his riding - if you look at the Colchester-Hants East area, it is by far the most under-serviced area in the province where we are going to try to focus. So hopefully there will be some proposals and things that come forward from your community that would look at helping out our seniors and maybe even have some kind of health care setting that could work on a number of areas.
MR. MACDONELL: Thank you, minister, I appreciate that. On the issue of long-term care, that is one that hasn't gone away and we are an under-serviced area, so any help there would be appreciated.
I just want to say for my community, especially the more rural part, the Hants North part of my community, it's serviced basically by three clinics: Noel, Kennetcook and Rawdon. They're in the basement of a manse, and those are the ones that have a piece of land, they've spent some money there and the department indicated that would be your contribution for this. We can do this.
I can tell you that if this survey or this study, or whatever is going to happen with this consultant, if it says - I can pretty near write what I think this is going to say - that Kennetcook will be the area that will build this and will put all those under one roof, you are going to get a firestorm of protest for that. We've been down this road, and they have indicated they want three facilities in those areas.
From Walton to Noel is 23 kilometres, it's 14 kilometres from Noel to Kennetcook, 14 kilometres from Kennetcook to Rawdon, so we cover a big area there. I want the minister to know that's what the community wants, that's what the community health board has indicated for years. When the Honourable Jamie Muir was minister, we met with him and kind of lined this up under this umbrella. It seems to have worked well, and I'm quite sure the people are not willing to move off that track to have that as one facility there in Kennetcook. They'll be looking to maintain the three that they have and for Rawdon to get some assistance to build their own.
I want to talk for a minute - I'll table this for the minister and the deputy because I'm going to read from it. I have to tell you, I'm not sure where it's from. I think it's from a Doctors Nova Scotia publication, but I'm not positive because the facts I have don't indicate that. It says: President's Message, Dr. Romesh Shukla, I've been in frequent contact with the Deputy Minister of Health, Cheryl Doiron, over the past month or so as we work to resolve a number of outstanding issues. The most pressing issue of the time of writing this message was the orphan patient problem where physicians are
[Page 179]
looking for a long-term plan to address the growing demand for caring for orphan and unattached patients in hospitals.
It goes on to identify Truro as one of those areas, but it says in this that if a resolution isn't found by the end of November, the Department of Health will provide a solution. So I'm curious, this is an issue for my constituents who go to the Truro hospital and I'm wondering, have you resolved it, has something been done by the department?
MR. D'ENTREMONT: I can assure the member opposite that we do have a program for the orphan patient program. You'll find it in the budget, I believe you'll see $1.1 million to address the issue that has been underlined by the president of Doctors Nova Scotia, which really was a funding program that doctors were unwilling to take the time away from their practice with those who were being paid a fee for service to go to the hospital or go to a long-term care facility.
MR. MACDONELL: I want to also say that one issue that does seem to be an ongoing problem in my area, very little of my constituency actually go to Truro. A very small amount. I mean, Mount Uniacke is in the Capital District, so almost all of my constituency, I say, should be in the Capital District. There's a little bit along Route 215 - South Maitland, Maitland, perhaps that area - that would go to Truro, maybe some towards Shubenacadie, and there are people who are picked up by the ambulance who go kicking and screaming to Truro saying, no, I don't go to Truro, I go to Halifax. My doctor is in Halifax, I don't want to go to Truro, and they go.
I'm not sure if they're trying to make the numbers look good in this DHA by dragging people to Truro so that they can say we want some funding. They requested funding from the municipality for the new hospital in Truro and I think they have to base it on whatever numbers they think go to Truro, but I will tell you this is an ongoing problem and people are not all that impressed when they're having a health concern and being taken in a direction that they don't want to go.
I think, Mr. Chairman, I'm out of time. So I'll thank the minister.
MR. D'ENTREMONT: I thank the member opposite for giving me a few moments to respond. Ultimately when the district health authorities were set up, I'm sure there were a number of boundaries put in place. It has never been brought to our attention to make a change for your area, but I can understand the concern of your constituents that they do flow towards the HRM.
MR. CHAIRMAN: The honourable member for Cole Harbour-Eastern Passage.
[Page 180]
MR. KEVIN DEVEAUX: Mr. Speaker, I believe I have just a little over 10 minutes before our time is up for the day, is that correct,?
MR. CHAIRMAN: You have approximately 11 minutes.
MR. DEVEAUX: There are a couple of questions I specifically want to ask, one that came in the budget, and maybe the minister can verify. It's the Capital District Health Authority that I know has been discussing the issue of expanding its teen health clinics to the junior high level. I know they have one now at Beechville-Lakeside-Timberlea Junior High School, Ridgecliff I think it's called, maybe I'm getting those mixed up, but I know that in my community there's a strong interest in having a teen health clinic at the Eastern Passage Education Centre. In fact, the community has raised money to partner with Public Health. Obviously, to have the nurse there, it would take funding from the government. Can the minister verify that this is actually his department I should be talking to about this; if so, can he give us some details?
MR. D'ENTREMONT: Mr. Chairman, I'm very happy to answer in the negative to this question, that it is the responsibility of HPP. So if you could take that up with that minister when his time comes up.
MR. DEVEAUX: Mr. Chairman, it's actually an interesting point because Capital District Health Authority comes under your jurisdiction. So I guess what I'm hearing is that Public Health within the Capital District Health Authority reports to a different department. Well, if that isn't a bureaucratically interesting situation to have, I don't know what is. It must be a very interesting way in which they have the reporting structured within Capital District Health, but I'll bring it up with the Minister of Health Promotion and Protection when he comes up in the Red Room.
My other issue is with regard to dental hygienists and this is an issue that I know the minister is familiar with and one that I want to take a couple of minutes for, to put some issues on the record. I'm hoping that he may be able to respond before our time lapses. The issue is that the dental hygienists in Nova Scotia have been eager to be able to be a self-regulated profession. They are a profession that I will note is dominated by women, a profession that at this point is still very much under the control of the dentists and the Provincial Dental Board. In fact, I believe there is not a separate regulatory board for the dental hygienists, it's the Provincial Dental Board and, in fact, I think they have a couple members on the Provincial Dental Board, but it is itself dominated by dentists.
So where you have - and I think it's fair to say - a very fraternalistic approach to dental hygiene where a male-dominated profession, in the case of dentists, is telling a female-dominated profession, in dental hygienists, that we don't want you to be self-regulated and able to run your own business. Well, let's be clear, this is not about whether or not dental hygienists should be self-regulated, this is about the fact that
[Page 181]
dentists are afraid they're going to lose the dental hygienist from their office. They're worried that I'm going to go to a hygienist to get my teeth cleaned or for that preliminary checkup and if a dentist isn't in the same office, that somehow that means I'm not going to necessarily go to the dentist and, of course, they're going to lose money.
So let's get down to brass tacks and say that this is about the dentists trying to stop dental hygienists from being self-regulated so that they can have more control over how much money they can make and, to me, that's unfair. Dental hygienists in this province are long overdue to be self-regulated and not under the thumb of dentists. I'm wondering, can the minister tell us when we can see legislation that will ensure that dental hygienists will be self-regulated and it will not require a visit to a dentist once every 12 months if I want to go see a dental hygienist?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his question. This has been one that I, as MLA, have had in my office and one, as now Minister of Health, to have under my purview. We have asked that the dental hygienists and the Provincial Dental Board get together and try to build a path to allow for the self-regulation and self-management of dental hygienists. We don't disagree with the idea, not whatsoever. We feel that dental hygienists should be a self-regulated profession, as they truly are when it comes to the dental health of Nova Scotians.
There is a debate right now and I think there needs to be clarification amongst those two of how many visits you need to have to the dentist. So I can be concerned a little bit, to make sure that the dental health of Nova Scotians is protected, yet I understand the needs of the dental hygienists to be a self-regulated profession. Hopefully it's something that we can move on relatively quickly and have a piece of legislation in the very near future.
MR. DEVEAUX: One of the dilemmas, and this is a scenario that is presented often, is that in many cases there are people who are incapable of traveling to a dentist. They are in long-term care facilities, maybe they are bedridden at home, and a dental hygienist - in fact, I believe Public Health actually funds certain dental hygienists, but beyond that it could be private sector as well - they actually provide certain dental hygiene and dental health services to those people.
If we have legislation that says they must see a dentist every year, it's going to require them to be transported to a dental office or, in turn, dentists would have to come - but my understanding is that that is fairly rare - in order to ensure that they can also have dental hygiene services.
As a government, I understand that your desire is to find a consensus between dentists and dental hygienists. I would say to you that if one of those groups becomes intransigent and unwilling to bend on the issue, I would like to hear from you on the
[Page 182]
record, if your government is prepared to move forward with self-regulation in order to ensure that dental hygienists get that self-regulation, even if the dentists seem to be balking at that.
MR. D'ENTREMONT: You know this is an issue that has been ongoing for I believe almost three years now, maybe even longer, and one that I would like to see come to fruition just so everybody can get on with it. Maybe there are suggestions that have not been researched yet. Maybe if there is a concern of the dental hygienists working outside of a practice, maybe there is a way to say that they all have to work in a collaborative practice so at least everybody is nearby, I don't know. Maybe there are some things that haven't been discussed yet, but I would be on the record in saying that I would like to push for a solution for the Fall and if there is something that I need to do to put my foot down per se, I would be willing to do that just to get it over with.
[4:45 p.m.]
MR. DEVEAUX: I guess the other component of this is - I look at the other health care professionals, physiotherapists are a good example. It was two or three or four years ago, prior to that time you couldn't see a physiotherapist in this province unless a doctor referred you and we got rid of that. Again, you had a male-dominated profession paternalistically trying to control a female-dominated profession, in the sense of physiotherapists, and we addressed that issue. I believe that if it can be addressed on the side of physiotherapists versus doctors, it makes no sense for me now to understand why we should have a very different approach, except again for the fact that you have dentists who seem to be unwilling to bend on this issue.
I guess I ask you, based on the model we have with physiotherapists, and we haven't seen a wholesale change in - I don't think we have seen doctors' salaries go down because we now allow people to refer directly to physiotherapists. I guess I'm asking you, is that a model that your government has studied and is willing to look at with regard to dental hygienists versus dentists as well?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his questions. I thank him for that comment. It's quite true that there was that decoupling of physiotherapy services from the regular referral service and it is a system that has worked quite well.
I can say to the member opposite, I know there are options to make sure we have an independent profession, a self-regulated profession for dental hygienists and I look forward to working with them to find that solution. I'm one of those people who not only believes there is a consensus, but maybe there are a couple of steps that were missing to prove to the dentists that this can happen and it can protect them and their practices.
[Page 183]
MR. DEVEAUX: Thank you, I appreciate the minister's comments. So I'll say on the record that our caucus supports the dental hygienists, and in the purpose of moving this legislation forward I hope your Cabinet can find a solution that we can all meet up with.
Quickly, one last question. I had a constituent recently call me who was told, when she left the Dartmouth General Hospital and came home - she wanted other transportation - she was told by her doctor that she had to take the ambulance. Then she receives a bill for that. At the time, she said, look, I can't afford a bill. She was told at the time that if the doctor ordered her to take an ambulance home that she wouldn't have to pay a bill. I guess I'm wondering, can you clarify what the rules are with regard to ambulance fees as to if the doctor orders someone to go home in an ambulance, compared to a taxi or a friend driving them, whether or not they can then be billed for that?
MR. D'ENTREMONT: Mr. Chairman, through you to the minister, to the member - I have to stop using that word, I'm going to create expectation there. I'm not too sure of the regulations there and how a doctor referral would do that. I will endeavour to have that information for you, hopefully Monday, during the next sitting.
MR. CHAIRMAN: Order, please. The time allotted for debate on the estimates before the Committee on Supply has expired.
The Deputy Government House Leader.
MR. PATRICK DUNN: Mr. Chairman, I move that the committee rise and report progress.
MR. CHAIRMAN: The motion is carried.
[The committee rose at 4:49 p.m.]
