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MR. CHAIRMAN: Good morning. The Committee of the Whole House on Supply will now be called to order. This morning we will continue with the Minister of Health's estimates. The member for Sackville-Cobequid has 19 minutes left.
The honourable member for Sackville-Cobequid.
MR. DAVID WILSON (Sackville-Cobequid): Here we are, earlier than normal on a Friday morning, but quite interested in pursuing some more questioning around the Health estimates.
I'd like to start this morning around the most important issue, I think, involving health care and health care delivery, and that's the recruitment and retention of health care providers. It's the key component to our whole system here in the province and we know that, in my opinion, and I think in a lot of Nova Scotians' opinions, the government has failed in providing a strategy, a plan to address the needs of Nova Scotians, especially in our rural communities.
We have places like Digby that have been struggling for years to try to ensure their residents have the health care providers in that community to provide services. I attended the rally they had last summer, and it was well attended by all of the members of that community and the surrounding areas. I had the opportunity to speak with the member for that area who was concerned. Unfortunately, government had no representation there or a government member wasn't there.
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I think that sent a strong message; it sent a message of discouragement throughout the residents there to see they were holding such a rally around health care. Usually we see rallies around strikes or issues like that and not around health care. I think the government has to recognize the frustration of rural communities like Digby that have been struggling for years.
I'd like to start - I'll be referring to the Supplementary Detail again. Of course, the minister mentioned the $416,000 that will revolve around the Allied Health - Health Human Resources Strategy. I'd like to ask the minister, will those funds lead to any further training seats or is that money specifically just to create a plan? Will those funds lead to any further training seats in the province?
HON. CHRISTOPHER D'ENTREMONT: The $416,000, I believe, is assistance as far as medical radiology. So basically the allied health professionals, the $416,000 does not refer to dollars for doctor recruitment or added seats to the Medical School.
MR. DAVID WILSON (Sackville-Cobequid): And I assume, to technology seats, is that correct? It's for a strategy and that leads me to, what I talked about yesterday in the couple hours that I had: the relationship of a good health human resources strategy plan, a comprehensive plan; and the importance of retention and recruitment, and how that relates to the workforce, or our workplace satisfaction and the morale of our health care providers in their working environment. We know that with the government's intention with Bill No. 1, I think set out to really put a damper and decrease the morale within that workforce. I have to make mention of the fact that, you know, here we had a piece of legislation that went right at the heart of the democratic process that health care workers have and they were upset.
They rallied, Mr. Chairman. They talked about it and advocated on behalf of their rights as workers and the effects they have. Right now the minister is aware that there are commercials on TV stating that, and the government knows about the opposition by not only our Party, but the Liberal Party as well, to that piece of legislation. What frustrated me the most was the information and the amount of money spent around the media to gain support for that legislation. From what I heard, the NSAHO spent some $350,000 around the media and events, trying to support and bring support for that legislation. So I would like to ask the minister, have there been any health care dollars from your department go toward the media support of Bill No. 1 in that process?
MR. D'ENTREMONT: Mr. Chairman, I can say that no dollars from the Department of Health went to fund any advertising on behalf of NSAHO. I do want to thank NSAHO for their partnership in this issue. You know, as we sit around and talk about the pressures and the issues in health care, for me to sit and watch the work, the anguish, the confusion that is created by a possible strike, puts our system into a lockdown, for lack of any other word to explain.
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Mr. Chairman, I remember speaking with my deputy minister and sitting around a table trying to figure out if we would lose the workers in our health system - I believe that was two Octobers ago when we had the issue of the allied health professionals. I believe it was with the CUPE groups and the NSGEU groups who covered the workers, those kinds of employees within our system. You know, we could not sustain a strike for more than a few hours - for more than a few hours. Every single hospital beyond the ones here in Halifax, I think, because they're covered by a different bargaining unit, would have to have been shut down.
So we sit here quite often talking about the issue of closed ERs, closed ICUs, and the challenges that we have in recruiting professionals. You know, we have to question a bill like Bill No. 1, which I believe is still a very important piece of legislation - one that I believe needs a true debate rather than the closed minds of members of the Opposition today, one that will protect Nova Scotians. Again, Mr. Chairman, I continue to say I need to put the patient number one. It's not about the Department of Health, it's not about the DHAs, and it is not about the unions. It is about the patients and that's what I think about.
MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, the minister talks about the anguish and the stress placed on the system with the possibility of a strike. As I said, and I can't repeat it enough, the key components of our health care system are our workers, are the health care providers. The stress and the anguish and the demands placed on those individuals in this province are great. We're asking so much from our health care workers. I mentioned it early yesterday, around the fact that we have some health care workers working in ORs who work past 1:00 a.m., who have to report back to work within six hours. That's the stress and the burden and the demand placed on those health care workers.
I have statistics and I know we could sit here and debate the positives and negatives around strikes and health care strikes, but we know in provinces across the country that have legislation banning strikes, that they have illegal walkouts. They lose more days in some regions with illegal walkouts, and I think the minister has to realize that.
I wonder what we could have done, what the minister could have done with that $350,000 that they spent on those ads and trying to drum up support. That could have meant nurse practitioners in Digby, or an enhanced package to try to attract nurse practitioners to Digby. So that's the point I wanted to make around that and that's why I wanted to bring that up.
Now, I'd like to move to - and I think I'm going to be in the Nova Scotia Estimates Book now - Page 14.25. We all know the severe crunch that our district health authorities have around capital infrastructure deficits. We know in Capital Health - I know in Capital Health there is, I think, a $90 million deficit in that region, and I know that's throughout the province. So does the minister have on hand, or could he give us the figure of the total capital infrastructure deficit that the DHAs have at this time? Do you have that total number?
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MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Again, just to finish off our discussion around health care strikes and unions and things, of course I have to put in a comment of, I wonder how much money the unions and the coalition of unions spent on advertising against it, of members' dues, members who, I know, did not agree with the stance that the union leadership was taking. So, you know, we can look at this through two different lenses and I know we could spend an awful lot of time speaking about this one as well, so I'll digress as well.
You know, Mr. Chairman, as I believe I had mentioned during my response to the member for Glace Bay - no, I think it was with you as well - we talked about the general issue of capital infrastructure and the deficit that we do have within it. We were talking about the Victoria General Hospital, specifically, during that part of the discussion, but I also mentioned that through the master plan the district health authority here in HRM is putting together - they'll be coming up with a number of what their capital deficiency is. We also have an ongoing project right now with the other district health authorities to give us a better idea of what the capital deficiency is for them and I do hope to report back as soon as I have that all compiled.
[9:15 a.m.]
MR. DAVID WILSON (Sackville-Cobequid): In preparing for estimates, Mr. Chairman, looking through the line items, one thing that really sticks out in my eyes is the figures from last year, the estimates that government put down on the budget or in the books, of what they're going to spend in a certain area. Then we see this year, of course, what they did spend and then of course what they want to spend, or hope to spend, in the coming year.
So under Capital Grants, which the government provides for hospital renovations, construction projects, diagnostic and medical equipment funding, under the line item for Grants and Contributions - Equipment, last year the estimates were approximately $19 million but, in fact, only about $11 million was spent. So I mean we have about $8 million there that was forecast to be spent on equipment, why do we see an $8 million reduction in actually what the government spent last year?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, and to the honourable member - I just saw something at the side of my head and I know it was the Minister of Environment sort of flicking by there, so nice to see you.
The reduction, of course, would have to do with project starts, the availability of on-time completions of certain projects, the availability of equipment, so we were a little under- spent last year because of it.
I also do want to underline the fact that through approvals and ongoing projects in the acute care system, I believe only - there is $290 million worth of work ongoing, I believe,
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spread over approximately five years, as we continue to build and renovate and change hospitals and other facilities across this province.
MR. DAVID WILSON (Sackville-Cobequid): When I hear that response, and I can understand that some projects may lead into this coming year, but that's for equipment. That's something the government says, okay, here we go, we're going to buy this, we're going to put $19 million aside to buy equipment for capital grants for the district health authorities. Then you buy it, you submit the receipts and then you go on to the following year. So there was a reduction of $8 million last year and I notice this year the equipment grants and contributions are about $7 million.
Why are we not even spending what we didn't spend last year in the upcoming year? I mean, we're going to spend $7 million, but we underspent $8 million last year, so why are we not - we know that medical equipment changes and needs upgrading and the new equipment that comes in is so important to have available to our patients and to the residents. So why are we seeing such a difference between this year's forecast or estimates and last year's estimates and then actually what they spent on equipment?
MR. D'ENTREMONT: This is a bit of a conundrum for us as well. The dollars do represent the requests that we have at the department at this time. Maybe it's because we have replaced a fair amount of equipment, maybe it's because the district health authorities have good maintenance programs, maybe it's because the districts feel certain pieces of equipment do not need to be replaced. I really don't know.
If you do a quick survey, you would probably see we would require maybe $20 million, but over the course of the year we only required $7 million. It's a bit of a conundrum for us to understand why the requests don't come in the way we would expect them to. In my estimation, budgeting really has to do with how many requests you get sitting behind you. I can say the numbers representative in this year's budget are the total requests we have from the district health authorities.
The other thing I do want to say to the member opposite is that we do hold some dollars centrally so that we can react in case of a catastrophic equipment breakdown and that kind of thing. So it is representative of the equipment that's being requested today.
MR. DAVID WILSON (Sackville-Cobequid): I think that's why it's such a concern for me when I see that not only under the equipment, but under Grants and Contributions - Infrastructure. Again, last year, the estimates were $38 million and they only spent $25 million. I know for a fact, with the Capital District Health Authority, the infrastructure deficit is $90 million. That area was underspent by $13 million. I have to get some explanation why Capital Health, for example, if they have a $90 million infrastructure deficit, why didn't they get $13 million, or why didn't the Cape Breton District Health Authority get extra money?
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I need the minister to try to explain this a little better to me, why we have an estimate of $38 million and we only spent $25 million. Maybe he can explain a little better, but I just don't understand and I can't understand what the minister is saying around why there's such a difference when it comes to grants and contributions around equipment and infrastructure for health care.
MR. D'ENTREMONT: To the member opposite, I feel within our department, anyway, we have a bit of an issue when it comes to our capital, especially when it comes to construction. Construction, for a whole bunch of reasons, gets more expensive as we go along. A good example is the ER over at the Infirmary site. Not only was it a little late in getting going, so we did not spend this year's allocation, but we also find that it actually requires about $3 million more in order to complete. So at one side that we are not spending all the money in a year's allotment, we're finding that we need more money in the next year's allotment in order to complete some of these facilities. So we find this happens time and time again with a lot of our construction.
We are, sort of, captive to the market. We are captive to the availability of the contractors starting on time or not starting on time. So, Mr. Chairman, I know we try to best organize the dollars that we do have within it but last year, 2007-08, we were basically underspent in our capital grant.
MR. CHAIRMAN: The honourable member's time has expired.
The honourable member for Preston.
MR. KEITH COLWELL: Mr. Chairman, I have a few questions around nurses and I am going to ask some pretty direct questions which probably the minister doesn't have at his fingertips. I would like to know how many nurses graduated from the total nursing programs in the province last year.
MR. D'ENTREMONT: I will get it for you in a second. While he digs, I will stand for a few moments. It is our understanding - and I spoke to this last night as well - there are approximately 296, I believe it was, LPNs graduating this year alone. There are 70 RNs graduating this year. (Interruption) Oh, no, that's added. Sorry, I apologize. I'm mixing up a couple of numbers. I had a little note here. Here we go. I will table this one and you can get a copy for the honourable member.
RNs, there are existing 330 training seats in the province. We are expanding that by 70 seats to bring our total of RN training seats to 400. This also has a breakout - as was requested last night - by site: St. F.X. has 125 seats; Dalhousie has 135, they will be expanding by 25, Dalhousie has some additional seats, I believe that's probably some spare stuff that they are going to be moving around a little bit, which is 24; Cape Breton University
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has 50, they are expanding it by 16 to a total of 66; Yarmouth has 20 seats and they are expanding by five to a total of 25. So, again, that's 400.
In the LPN list, there are currently 90 training seats at the two sites, which is the Dartmouth Waterfront Campus and Cape Breton. There is a bit of a program at Yarmouth that's on a rotating - but anyway, there are some new seats for them in this year. So there's an expansion of 223 seats for LPNs that are going to the NSCC and they will be going to pretty much all the sites. So Strait-Richmond, Dartmouth, Cape Breton, will be getting some added ones, 30 to Pictou, 30 to Annapolis Valley, 30 more to Yarmouth, 30 to Cumberland, 30 to Lunenburg, and I think there are a spare 13 that will be used as maybe depending on what kind of programs the NSCC wants to set up - for a total of 313 training seats for LPNs. I will table this, if I can get a copy of it.
MR. COLWELL: How many graduates in 2007?
MR. D'ENTREMONT: Mr. Chairman, there was very little expansion last year, so if we take the numbers of this year's graduating, there are 296 registered nurses graduating at the end of this year and there are 153 LPNs graduating at the end of this year as well. So it will probably be pretty similar to what it was last year.
MR. COLWELL: The number for 2006?
MR. D'ENTREMONT: About the same. I don't have that number but I can provide it to him in a table form with previous years on it, if he so wishes.
MR. COLWELL: Yes, I would request that and also one for 2005. Is that a yes?
MR. D'ENTREMONT: Agreed.
MR. COLWELL: And let's include 2004 in that as well and 2003 - the number of graduates in each year.
Now, the real question is, with the number of graduates, we have a large number of graduates here, in 2003, of the RNs that graduated and the LPNs that have yet to be supplied that information. How many were hired by the province?
MR. D'ENTREMONT: Mr. Chairman, I know that we hire and retain over 80 per cent. Last year I think we retained 86 per cent of those new graduates. Also, for the member opposite, I will endeavour to have well over 10 years' worth of graduating nurses seats. As a matter of fact, I will probably go back to 1995 when you see that there was basically the shutdown of the two-year programs when we basically had no nurses graduating for a certain period of time. So I will have that available for you too. Again, we hire about 86 per cent through the program.
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MR. COLWELL: Yes, with that information, I would appreciate receiving not only the number of graduates over that 10-year period, but also the number of nurses who were hired in the province by the province to work in the hospitals in Nova Scotia. I think it's a very important statistic. I can recall one year, I have a nephew who graduated from Dalhousie and there were - I can't remember the exact number - 100-some graduates from the RN program and like only 35 of them were hired out of the whole program. The rest couldn't get jobs in Nova Scotia. That was within - I can't remember the year, but it must be four or five years ago.
So when you look at the nurse shortages and the number of RNs who have been hired and LPNs in the area, it comes to mind when you go through this process - and I ran a business for a long time - you see so many nurses in the hospital working extra shifts, overtime. I can tell you, from running a business, after someone works 54 hours a week, that's the limit; if you work over 54 hours a week, you are basically dysfunctional. I know some of these nurses work over that. I don't know how they do what they do. I have the greatest respect for them.
[9:30 a.m.]
My wife was in the hospital three times now in the last three years and the care that she received in the hospital was - I can't say enough good about it. The people were excellent. They are working under adverse conditions lots of times and I can't say enough good about the people who were there. You can tell, when you talk to the nurses, they were tired, they were stressed, because of the hours they have been working. Some of the patients weren't very good to deal with, which was very unfortunate, because the nurses and the staff there are there for one reason, to help people get well.
I really want to see what those numbers are because if we aren't hiring enough nurses here, that means it puts a stress on the nurses who are here. It costs us more money to pay nurses overtime than it does to pay an entry-level nurse who comes into the system who isn't burned out, who really can use the income to pay off their student loans and to build their life. Whereas a nurse who is older really needs more time off and indeed should be spending more time with their family if they so wish. Again, it is up to them to decide that.
I would also like to know, I would like to get a report, for the last 10 years, since you're going to supply me with 10 years, how much overtime you paid to nurses in the system. I think that's going to be a staggering number from what I've seen, the little bit of experience I've had in the hospitals and the working Also, the number of sick days taken by nurses in the hospitals because of the stress they deal with every day and the ongoing long hours that they have to endure. Could you commit to providing both sets of information on that?
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MR. D'ENTREMONT: Mr. Chairman, back in 2000 when this government was new and trying to take hold of a system that was in shambles for the most part, we were hiring approximately 50 per cent of the graduating nurses. I can say that the number of graduating nurses and the number of seats was probably half of what it was in this year's number. Today we are hiring over 86 per cent of those graduating nurses with more and more seats available.
Mr. Chairman, also, you know, in the last year or couple of years, we've been able to repatriate over 100 nurses coming back from the United States, Alberta, and all those places where they went away to, they're coming back to work within our system, to come home. We're also doing a number of retraining for our nurses to give them other opportunities within the system so that they don't get necessarily as burned out as we think they do.
Mr. Chairman, I was asked last evening to provide the dollars and cents spent on overtime for our nurses, and what I'm going to table here, and I think the member opposite would be interested in seeing, is broken out by district health authorities. This is from September 2006 to September 2007, broken out by just the health authority. This is nursing on the yellow sheet. In the front we can see the overtime listed by DHAs for different jobs within the system, the clericals, the health care services, nurses, Addictions and Public Health, management, non-union, and all other disciplines, and you will see the large number on overtime that we do spend to keep the system going.
MR. COLWELL: I appreciate receiving that information, that's greatly appreciated. When you look at overtime costs, overtime costs have a lot more costs than the dollars and cents shown on your sheet. It typically means people can be off sick longer, it means that their ability to function is diminished somewhat, although I've never seen that ever happen in the hospital, but the ability to do that just because you're tired does take a toll on an individual and then the stress of someone. I know the nurses and the doctors in our health care system take what they do very seriously, they're extremely good professionals and if there's something that they can't manage to get done on a shift because they're tired, it must put a tremendous amount of stress on them when they go home and think why couldn't I have gotten this done, when it was physically impossible to do.
The one thing I did notice in the hospitals though, and I would like to know how this is structured now, and I've heard this complaint over and over again, as the minister knows - and I'm not talking about the floor that was in the media a while ago with one of my constituents - the hospitals aren't clean, not as clean as they should be. Is that contracted work now or is that civil servants doing the work?
MR. D'ENTREMONT: Mr. Chairman, I'll answer the last question first and maybe make a comment on his last comment there. No, the hospital cleaning depends from site to site, in district health authority to district health authority. I know in Yarmouth it's civil servants or staff of the DHA that do the cleaning. I believe here in the Capital District, I think that's a contracted service.
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At the same time, I know going back to the nursing staff and other allied health professionals within our system, we are looking at the model of care change and one of the recommendations of the transformation document of the facilities review was to look at model of care. Model of care means allowing the practitioners within our system to work their full scopes of practice, you know, let clerical do the paperwork, let the cleaning staff do the cleaning on the floor. What we were finding, nurses are trying to do everything for lack of having clerical and those other staff available to them. So we need to invest a little money in some of these other positions so that the nurses can actually work to their full scopes and work within their time allotments rather than working all this overtime.
If you ask a nurse, you know, what is the majority of their time doing, well, the majority would be patient care, but a lot of the time they spend filling out paperwork, getting reports and charts and all that stuff done, you know; in a lot of cases, because there might not be cleaning on the floor, they find themselves doing a bit of cleaning, light housekeeping. They find themselves doing some other things that they really shouldn't be doing and we end up paying as a province for that overtime that they're garnishing because of it.
So, anyway, again the cleaning standards, we're also trying to have the cleaning standards, going back to the cleaning issue again, some are contracted and some work for the DHAs, but we're looking at some cleaning standards that should be monitored by the DHAs. So if there's a specific issue that the member opposite wants to provide me with, I would be more than happy to go back and have a look at that more closely.
MR. COLWELL: The areas that I can talk about from personal experience are the Victoria General Hospital and the Dartmouth General Hospital, both very good hospitals and both have excellent staff, but the cleaning in those two facilities, if you walk into a ward and look on the floor, there are dust bunnies in the corners. The floors have got stains on them that could have been easily wiped up and the list goes on and on. Those are the only ones I personally have seen and I was recently talking to a gentleman who was in the hospital and he said that there was a bloody bandage left in his room for a week - a week. Now, that probably had some infection possibilities, who knows, I'm not a doctor, I wouldn't know that, but it's the sort of thing that standards that should have been in place years ago for cleaning evidently aren't in place and I'm pleased to hear that the department is moving in that direction.
I worked in military contracting for a long part of my life and standards save lives. In my case, if you pushed the button and the thing didn't work, someone's dead, and usually it was the person who pushed the button because someone else is pushing the button and shooting something at them. I can tell you once you put standards in place - it's a long, hard, difficult thing to do, but once you get them in place - they actually save you a fortune, an absolute fortune. Number one, people aren't discouraged because their workplace isn't as clean as it should be. In this case we're talking about cleanliness in a hospital. You have less likelihood of infections and these superbugs that the hospitals are talking about if the cleaning
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is done properly, and just a general atmosphere of an employee coming to work in the day. If they leave their home and their home is spotless and they come into an environment that's not as clean as it should be, they say, why do I have to put up with this?
In a nurse's case or a doctor's case, or even a technician's case, it's not their responsibility to clean the hospital but if these contracts aren't done properly, well, the people who have the contracts should be directed to do it properly and there should be standards put in place. It's all part of our health care system keeping the facilities clean and working well so that they do a proper job. What kind of standards are you talking about putting in place? Are they going to be comprehensive or are they just going to say, well, you've got to clean the floor once a week, or what? What kind of standards are you looking at?
MR. D'ENTREMONT: I know there is a set of policies and guidelines that are done in concert with the district health authorities in their bylaws - I don't know if it's bylaws, but anyway, within their policy manuals on what the cleanliness needs to be in concert with infection control. So what I can try to do, I don't know how available that document might be, I don't know if we can have that today, it will probably be next week sometime before I can get that out of the district health authorities, but there is a set of standards that are nationally accepted that I do believe have a lot to do with the accreditation of those hospitals that they have to meet. So I'll see if I can endeavour to get some of that information for you as well, but I know there is a rigorous set of standards that they have to meet.
MR. COLWELL: Just so I can understand it properly, I understand there are standards nationwide for cleanliness when it comes to sterilizing equipment that's used in the hospital. I'm pleased to see that, as everyone should be. The general cleanliness of the rooms, or the hallways, or the building in general, is that included in that system as well, or is that a separate standard that's used for that? If it's the same standard, I'm very concerned about the sterilizing of equipment, because when you walk in a place and you see it, and it's obvious that the place isn't clean - it doesn't mean that the instrument they're going to operate on you with isn't sterilized properly, I doubt it, I imagine it is.
It really begs to the point if you have someone coming for an interview to work in an office job and they appear in a pair of greasy old trousers, you're not going to hire them. They could be the best person who ever walked into your facility, but if they don't present themselves properly, it sets a bad example. Is the standard for cleanliness in the hospital the same as it is for sterilization - well, what I want to say is, is the same sort of process used or is it two separate things?
MR. D'ENTREMONT: Thank you very much. No, there would be a set of guidelines that would be required, through their accreditation, but also through their infection control divisions or groups within the district health authorities within our groups that would set the kind of cleaning solutions they would have to use, the frequency, the use of those cleaning solutions, the kind of equipment they should be using to clean the hospital, clean the rooms,
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clean different areas of the hospital. So there are a set of standards that they need to meet, that are done in concert with infection control.
I know we've spent a fair amount of time in updating and changing our infection control policies in this province to stop the spread of things like MRSA, VRE and those kinds of hospital-borne diseases. So, Mr. Chairman, I can say to the member opposite, I know there is a real rigorous set of guidelines and if a hospital is not meeting them, I'd really like to know about it to make sure that I can work on it quite quickly to make that change.
MR. CHAIRMAN: The honourable member for Halifax Needham on an introduction.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. I'd like to thank the member for Preston for yielding the floor so that I can do this introduction. I'm doing this introduction on behalf of my colleague, the MLA for Halifax Chebucto.
Today, in our gallery, we have students who are with the Halifax Regional School Board, Adult Education English as Second Language School. They are accompanied by their instructor, Vicky Cullen. These students hail from Korea, Iran, Yemen, Afghanistan, China, Turkey, Uzbekistan and Ethiopia. I would ask them to rise and receive the warm welcome of the Legislature. (Applause)
[9:45 a.m.]
MR. CHAIRMAN: The honourable member for Preston.
MR. COLWELL: Thank you very much and welcome to our gallery today. It's always wonderful to see guests here - enjoy the proceedings.
You addressed part of my question. My question was, when it comes to cleanliness of the rooms - let's make it more specific, I don't really have a concern with the sterilization and the other things, although there are problems and there always will be problems, no matter how careful you are and what you do, because the bugs are so persistent. It's actually in the rooms, I mean if you find things in the garbage that shouldn't be there for extended periods of time, if the floors aren't clean, if the walls aren't clean, if the bed sheets aren't clean, those are issues that really don't give you very much confidence in the hospital, although it may be the best staff, which we do have, doing the best job they possibly can.
It's not an environment that you want to be in, as a patient. You sure don't want to be there as an employee who goes there every day and tries to work and do your job with all the stresses you have with the work. That's really what I'm trying to get at. Could you tell me, what steps are being taken to clean the hospitals up?
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MR. D'ENTREMONT: Mr. Chairman, again to the member opposite, it must truly vary across this province, the cleanliness of our hospitals, because I know during my stay no more than three weeks ago in the hospital, in the ICU unit in Yarmouth, I can tell you that place was absolutely immaculate. You could probably eat off the floor, even though they would advise against it.
Mr. Chairman, I can say that when a patient is moved, the rooms need to be cleaned, the linens need to be changed, the garbages need to be emptied, et cetera. I'm sure there are set guidelines on getting a room ready for the next patient. I don't necessarily know of the procedures or the requirements during the hospital stay, but I know that the linens need to be changed on a certain frequency, that the room needs to be cleaned. There's a very specific use of different disinfectants that would be prescribed in that standard on the cleaning of those rooms.
I can say to the member opposite, as well, that in this budget there are some dollars available for the set-up of an infection control unit. There is another $218,200 in this year's budget alone to set up an infection control unit. That will advise the district health authorities, the hospitals, on infection control, which would really get down to the cleanliness and cleaning and the methods of cleaning the equipment used, the liquids used, et cetera, in those hospitals.
I can say that there's an appreciation for the importance of clean hospitals in this year's budget. I can say I know my home hospital in Yarmouth, and I know the member for Clare, Mr. Chairman, that you can say it is a very clean hospital. But if I compare it to my visit just the other day to the Infirmary site, well, there's a difference in cleanliness, to say the least. So it's an issue I will take under advisement on behalf of the member for Preston and will look closely at that one on his behalf, as well.
MR. COLWELL: I would suggest, and I'm only suggesting this, that there's so much need for beds in the Halifax area that when a new patient is moved in, the cleaning protocol isn't done because there simply isn't enough staff or time to do it, quite frankly.
When you have a ward with two or more beds in it, you'd have to move the - from what I understand talking to cleaning staff, who are very frustrated about this as well, that you have to move the people out. To actually clean the whole room properly it takes two or three hours to do it, and then put them back in. The problem is, there is nowhere to move them, so you can't get the rooms cleaned up and they're behind the eight ball all the time.
I don't know what the solution to this is but if you don't soon find a solution, you're going to have, again, people sick because the staff can't do their work, don't have the resources to do it. It costs our health care system more in the long run, makes longer delays and really makes it more difficult. What can we do to fix this? I mean this has to be fixed right away.
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MR. D'ENTREMONT: Thank you very much, Mr. Chairman. Again, going back to some personal experiences not so long ago, when my mum was in for surgery. I can tell you that what I observed, and it might not be the complete practice across our system, but what I observed at the VG site is that mum came in on her own bed, a bed that had been disinfected and ready and brought in, and then when she was ready to be discharged, that bed actually left that room and the new person came in with their own bed or a new bed. So there's a method in which they take the beds out, clean them, clean the floors, clean the side stands with disinfectants, before they do move patients in.
There is an appreciation for that kind of method. It really doesn't have to do with rooms, it has to do with the availability of equipment. As a new patient is ready to move into their own room or into a shared room, new stuff actually comes in that has been centrally cleaned by the staff. Maybe it could be on the floor of that unit or it could be in a more central location in the hospital. So a lot of that equipment is cleaned and disinfected before they even hit the room.
MR. COLWELL: Well, fortunately I haven't spent a lot of time in hospitals and I hope that nobody has to, but I've never seen that happen, ever. Usually they come in on a gurney, transfer to the bed that is in the room and away you go again. So maybe because you're the Minister of Health, there's a little bit of extra care, not because you insisted on it, because I know you wouldn't do that, but perhaps the staff was trying to impress the minister at that time.
I've never seen that happen and unfortunately, my wife has spent quite a bit of time in hospital and again, with the best care that you could ever imagine. Indeed, they've saved her life on two occasions, in the last three years.
Again, I'm stressing that I think we've got excellent staff but they need the resources. When I say resources, they need the time, they need the space and they need the guidelines to work with, that says this is what we should be doing to ensure that the facility is as clean as we can possibly get it. If you want to go for a walk someday, you and I will go for a walk in a hospital anywhere here in HRM, and I bet you the second or third room we hit, you wouldn't want to have your house look like that. The hospital should be as clean as, or cleaner than, anyone's home.
That's an issue and the more I talk to people who have been in the hospital, they say exactly what I'm saying, the care is incredible, the people they deal with in the hospital are incredible, but the places aren't as clean as they should be. So that's really the issue.
I'd like to know - maybe we can get documents from the health authority to see if they really do change all these beds, because I can tell you, quite frankly, when my wife was in there, on three occasions, that did not happen.
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MR. D'ENTREMONT: Thank you, Mr. Chairman. With all due respect to the member opposite, I do take a fair amount of insult that the member would suggest that a hospital treated my family any better than his family, because of my position. Shame on him for mentioning that during this debate. With all due respect to the member opposite, I would appreciate if he would retract that, because I can't believe he would suggest that.
MR. COLWELL: You didn't listen very carefully to what I was saying. I said at no time would I assume that you, as minister, knowing your reputation, that you would ever request or expect any different treatment than any of the rest of us, and that's what I said, if you check the record, and I stand by that.
Let's talk about the fourth floor in the VG. There was an issue with one of my constituents who was in there, the place is full of flies. I wasn't going to bring this up, but since the minister insisted on talking about issues, I think probably it's a good time to bring this up. That's a place that is not clean, I've seen it first-hand, even the staff who work there say it isn't clean and it's not appropriate for anyone to stay in. I'd just like the minister's views on that before I have any more comments.
MR. D'ENTREMONT: Mr. Chairman, again, I didn't hear a retraction because I heard that these things were done because I was Minister of Health and my mother happened to be on the third floor of the Victoria General Hospital. If that's not what the member said, I apologize for that, but I do take offence to some of the comments that he did make there.
Mr. Chairman, I'm sure that nobody on that floor knew who I was or knew who my mother was until four days later when I went to pick her up in my suit. So I can say that I watched closely, but they did treat us very well, as they treated everybody else well within that unit. I paid attention to the cleanliness of that floor, I paid attention to the cleanliness in the rest of that hospital.
Mr. Chairman, it is an older hospital that was built - in that particular wing, it was the Centennial Building - in 1967. It is an aging building and you know what? I think they're doing the best they can in keeping it as clean as they possibly can.
With respect to the fourth floor, it is an age issue. It really has very little to do with the cleanliness, because I think they're trying to do the best they possibly can with an older building. The member opposite knows, from our discussion last night, that we had a fulsome discussion around the VG sites, with the member for Sackville-Cobequid, on the possible replacement of that facility, of the kinds of services that we're going to be needing for that facility.
Mr. Chairman, I can assure the member opposite that through discussions with the district health authority, with I believe Shannex and the availability of the Sisters of Charity building in Bedford, that there's an opportunity for us to maybe renovate. The Sisters of
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Charity, I believe - they are building their own site and moving out of it. Anyway, there's an availability to maybe finally close the fourth floor of the Centennial Building. In my mind, that's what we need to do, rather than trying to fix it up any more.
I know the member opposite has had the opportunity to visit that floor, I'm taking from his discussion but, Mr. Chairman, I also visited that site unannounced on a couple of occasions. I can see the concern that families would have about that site but the other option, rather than going there, is sending these individuals home. I don't think the member opposite is suggesting that we should be sending people who need this extra care, that we should be sending them home. They need nursing care, they need extra services. The only other option that we would have than utilizing the fourth floor would be to send them home. I really don't think the member opposite is suggesting that.
At the same time, Mr. Chairman, I know, through my discussions with the district health authority, that they are spending time and dollars to ensure that the place is as clean as that building allows it to be.
MR. COLWELL: Well, thank you, I'm very pleased to hear that you're looking at another site for this operation. I'm positive that when you move patients to another site that you'll have it in the best possible condition that you can have before you move anyone in. Because once you get people in, it's a problem you're having with the fourth floor, which I totally agree with. It's very difficult to do anything once you have patients there because you can't have paint and odours that would upset the patients, and probably a lot of them with sensitivities that most of us won't have.
When do you anticipate that you might be able to have this new facility up and going, and how many people will it be able to accommodate?
MR. D'ENTREMONT: If everything goes well, and my fingers are crossed as well, we should be able to have something happen by the Fall. So there are still a few months to go but if we can get something available by the Fall, I think it would be a great day to be there, moving the last patient out of that fourth floor, and get them into a facility that of course would be cleaner and a little newer and renovated. To be able to offer them not only - I mean my issue with the fourth floor, even though it's the age of the building, it's the lack of services that are available to the residents. I know that when a patient goes on to a long-term care facility, not only do they get a room but they get all the services that are available to them - the recreation, the meals and management and those kinds of things, which are very important to the well-being of the patient as well.
That's the reason why I want to see some changes when it comes to that fourth floor and a transitional unit.
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[10:00 a.m.]
To a previous issue, and I apologize that I'm reading from a Blackberry on this one but I will read it into the record. This is a note on hospital cleaning: in CDHA the VG and the IWK are cleaned by an outside contractor, which is Crothall Services. All other sites are cleaned by Capital Health employees, so Dartmouth would be cleaned by Capital Health employees. There is a seven-day cleaning course that employees must take to be employed. Beds are changed each day and all floors are cleaned daily.
MR. COLWELL: I didn't see that happen, quite frankly. The beds weren't changed daily and the rooms weren't cleaned daily. I would say it's more likely probably the people working on that floor, or the inability to get in to do the work. I would think that's probably what has happened and I will discuss that afterwards.
There's one question that maybe you can't answer yet, how many beds are you going to put in the new facility for long-term care?
MR. D'ENTREMONT: Thank you. Parkstone, I think, is the one that we're looking at, would be able to accommodate approximately fifty patients, so that would well take care of the patients who are in the transitional unit today, which I think is thirty or so, and of course be able to take on some other people who are probably here and there within the hospital system here in HRM.
MR. COLWELL: After the people are moved out, are you going to renovate, as much as you can with the age of the building, the fourth floor and use that for general hospital beds again?
MR. D'ENTREMONT: No, I think we probably would just close that off until we have a better idea of what we're doing with the building as a whole. I think the availability right now - that was a closed floor to begin with, and was reopened in order to take on this transitional role. I think we'll probably close it up again for the interim, until we have the master plan from the Capital District on what the future is going to be for the VG site as a whole.
MR. COLWELL: Mr. Chairman, I'm going to turn over some of my time to the Leader of our Party for some questions, and I'll resume if he doesn't take all the time.
MR. CHAIRMAN: Thank you. The honourable Leader of the Liberal Party.
MR. STEPHEN MCNEIL: Thank you, Mr. Chairman. I'm pleased to join the discussion today. I want to thank the minister beforehand for his co-operation over the past year, from my constituents' perspective, in terms of maybe not always getting the answer I
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want or the answer that they want to hear, but for his co-operation in trying to at least provide them with an answer.
I was very pleased listening to the Budget Speech when we talked about the coverage of the drug Avastin, as well as the colorectal screening. My first thought, of course, went to the Connors family and the tremendous work that they had been doing, and that Jim Connors had done, on behalf of Nova Scotians fighting for this drug coverage. As everyone in this House knows, Mr. Connors himself had coverage, but he was fighting for Nova Scotians who did not, and this really was I hope - I am sure it was - a proud day for his family when they heard that this drug was being covered, for the tremendous work that he had done.
As I was looking through the budget, I'm looking, trying to find out - where in the budget have you put in the costs for the colorectal screening program that's going to be implemented?
MR. D'ENTREMONT: I'll go to the screening program first and then I'll talk about Avastin. There is approximately $2.7 million in this year's budget to basically turn on the colorectal screening program, to get it incorporated into the districts across the province - so it will be a stepped approach, available in different parts at different times. Also, there will be some training going on for the health care providers who will be working on the colorectal screening program, as well as maybe some more general training for the public so they understand what the program is and how it's going to work.
Mr. Chairman, within the budget documents, the cost of pharmaceuticals is probably held within a bunch of different places. With the district health authorities, they would have their own pharmaceutical listing - and I'll probably grab some of those pieces for you as soon as we can find them - as well as there's a general pharmaceutical number that we pay for, the other cancer drugs that are in.
Approximately - depending on what the guidelines are going to be, and we don't necessarily have a clear set of guidelines on usage of Avastin at this point, which will have to be done in concert with our oncologists, with Roche, the company that provides Avastin, hopefully we'll have it available as soon as we possibly can.
The estimate this year in exception drugs - these are the things that we don't either see coming up as a new drug or some things that maybe we approved at the last minute and we couldn't necessarily get a line item for it within the budget - exception drugs are $29,439,100 that we are going to be estimating to be paying for this year. There is an increase in that budget line from last year of about $449,000, so it waxes and wanes on the usage of drugs and the kinds of drugs that are covered by that list.
MR. MCNEIL: Today it was reported, and you were quoted in the paper telling Nova Scotians that your best guess is that the cost of Avastin will about $3.6 million. When we go
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through the Budget Estimates there is a special drug budget program that has increased by about $1.6 million. We are still short - if you look in the Cancer Care Nova Scotia budget, there has been an increase, but I assume that is where part of the $2.7 million that is for the colorectal screening program is located, so there seems to be some discrepancy between the number that you are quoting, being attributed today in the paper, and what is actually budgeted in the estimates here.
I am wondering - this program, will this be available to all Nova Scotians? Are you capping it? Who will determine which Nova Scotian, who requires the drug, will get it? What are the parameters that your department is putting around this program?
MR. D'ENTREMONT: The colorectal screening program is listed under Cancer Care Nova Scotia, which is a total estimate of $7.6 million and there is a line item for the $2.7 million that the colorectal screening program will be costing us. In reference to Avastin, it is approximately $3,500 per month, so therefore about $35,000 per patient per year, and we guess there would be somewhere around 100 patients who would require it. The nature of Avastin is that it is a late treatment drug, so it is probably a third run, and it would require that the oncologist would have tried to treat the cancer with one and two before you go to three, which is how this is being used in other provinces. So it would be a guideline, I think, that we set up through Cancer Care Nova Scotia on the usage of any of these drugs and how they are used in the treatment.
So hopefully we will have some of that done as quickly as we can to have basically both things roll out at the same time, because my concern was, as we roll out the colorectal screening program that we will be finding more incidents of colorectal cancer. Some of them would be early stage - not thankfully, but at least treatable by a certain number of methods - in some cases we would have late- level cancer and we would have to treat it with a drug like Avastin. So we want to make sure we have the full slate of drugs available.
MR. MCNEIL: Mr. Chairman, I hope, as we roll out the colorectal screening program that we do discover the cancer at a much earlier stage. That's the purpose of rolling out the program - it's to identify that cancer early on, treat it, and make sure that Nova Scotians have an opportunity to recover and live a full and healthy life.
You mentioned the increase in your budget for Cancer Care Nova Scotia. When you take away the $2.7 million that it is going to cost to implement colorectal screening, that nowhere near leaves enough money to cover the drug Avastin, so I am wondering where else in this budget - so Nova Scotians can feel comfortable that this program will be there and available, and I think it's important to tell Nova Scotians whether or not it is the intention of government to cap this program, whether this program will be based on the ability of one to pay, whether it is an income-based program, what are the parameters around this drug coverage that Nova Scotians are going to have to adhere to?
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It's important that we lay this out, because when this was introduced on Budget Day, Nova Scotians believed that the drug Avastin would be available to them without any parameters - as long as their medical professional believed that they required that drug, it would be available for them and it would be covered by the Province of Nova Scotia. So I think it's important that we identify where in this budget that money is located.
MR. D'ENTREMONT: Mr. Chairman, I can again say to the member opposite that this was a late addition, therefore you will not see a line item that specifically says "funding Avastin." What I can say to the member opposite, if he wants to refer to the Supplementary Detail, Section 14.5, exception drugs, there is an estimate of $29,439,100 - we will be funding Avastin through that fund and, of course, through some of the funding with Cancer Care Nova Scotia. So the dollars are available there.
The other issue is that by funding Avastin and the utilization of Avastin, there are other drugs that will not be used. A lot of times the third- run cancer treatment was covered by another drug, so you can take the cost of what that drug would have cost you, you can delete that and sort of plug in Avastin. So even though I don't necessarily have that line, because it was a late addition, I can say that the dollars and cents are there, within our Pharmacare Program, to cover the cost of Avastin.
The clinical guidelines will be set on the usage of Avastin by clinicians, by oncologists and again I can say to the member opposite that in all other jurisdictions this is a late- run cancer drug, a third run, so it is available at that time.
Mr. Chairman, those people who has come to us as MLAs, who have come to us as government members or Opposition members, are in third-stage cancer for the most part, which is not a great place to be. Again, we're talking about Avastin that does not cure cancer, but it does extend life, and I'm sure for those who are suffering from cancer, every month that we can add to their lives is a precious month.
MR. MCNEIL: Mr. Chairman, I appreciate the openness of the minister around the addition of the drug Avastin to the budget, but regardless of the fact that it was a late addition, it still has to be budgeted - we have to have confidence, Nova Scotians have to have confidence that the government has put in place enough dollars to cover this.
Today you were quoted as saying you believe it is going to cost about - your best guess is $3.6 million. The line item that you refer to in that budget is increased by $400,000. Each line item in this has increased by $300,000 or $400,000 - that's a far cry from that $3.6 million that is required.
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[10:15 a.m.]
Nova Scotians need to know whether or not this drug will be funded completely. If their medical professional believes they require that drug, where in this budget have you funded for it? It's one thing for us in this House to say that we're going to cover this medication, but Nova Scotians have to have confidence that the money is in the budget to make sure we can do that.
So we need to have some clarification. Where in this budget is that $3.6 million located for this coming fiscal year, to make sure that those Nova Scotians who have been fighting for this coverage and Nova Scotians who require this drug, are going to be able to receive it and have all the confidence that they're not going to be forced into financial ruin because we haven't taken the due diligence to make sure that the funding is in our budget?
MR. D'ENTREMONT: Again, I explained that this was a late addition and therefore it does not have a line item. I can also say that there are a number of places within this budget that underline the cost of drugs. Mr. Chairman, this is a budget that guesses - these line items guess the cost and utilization of cancer drugs throughout the course of a year and if you take a new drug, which supplants another drug, the costs tend to even themselves out.
Mr. Chairman, I can say that the dollars we have available for pharmaceutical services, the dollars that we have available for Cancer Care Nova Scotia, the dollars that we have in other parts of the budget, I can assure the member opposite and I can assure all Nova Scotians that the dollars are here in place to fund the drug Avastin for this year, and we will have a true line item for this drug in next year's budget.
MR. MCNEIL: Mr. Chairman, let me first of all say that we, as a Party, are pleased to see this drug coverage; we're pleased to see the colorectal screening program - as you know, our Health Critic has been talking about, speaking to you and your predecessor about a colorectal screening program in this province, and we are pleased to see it being mentioned.
It is not good enough to say that the money is there and this drug will be replaced and we will find the money here or there. Nova Scotians have to look at this and we, as legislators, have to see in this budget - there has to be some level of confidence that we can meet that commitment. It's one thing for all of us to say we're going to do it, and then when it comes time to pay, it's not there.
You've been quoted in the paper putting out this figure of $3.6 million. You mentioned earlier that it's approximately $35,000 that it will cost per year per Nova Scotian, roughly 100 of them. So you have that figure already somewhere cemented in the logic that you used when this was put into the budget. You have a great idea of what your estimate should be, but nowhere in the budget do we see that estimate being reflected in the numbers.
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There are a lot of assumptions happening here - you're assuming that when this drug is prescribed to someone else, another drug will be removed, this will take the place of it, the cost of it. We should not be assuming all of this. You identified yesterday to a reporter that it was $3.6 million it was going to cost. When you added that to the budget at the late stages, we should have been able to identify quite readily somewhere in the line, and it doesn't have to be a line item that specifically says for the drug Avastin, you could have added the money to the special drug program or you could have added to the cancer care budget item, but those budgets have only minimally increased - they probably reflect inflation in some cases.
So I think it's important over the next number of days that as a department we can identify where that money is and be able to tell Nova Scotians with some confidence that it's there - I would encourage you and your deputy and your department to be able to say here's where that money is.
I also want to talk for a minute, if I can, Mr. Chairman, about an idea that we brought to the floor of this House around making sure that we were covering - making sure that medical students had an opportunity to practice here in Nova Scotia. We had said to you, Mr. Minister, that when those twenty seats that were coming available because New Brunswick students were going back to Fredericton, that we wanted you to enter into an arrangement with Nova Scotian students that you would pay for their full tuition at medical school providing they signed a contract with you that they would work in the Province of Nova Scotia in under-serviced areas.
To be quite honest, I was disappointed not to see that in the budget. It was one of the things that I believed we would see in this budget, but it wasn't there. I would like to know - either you've dismissed that idea out of hand as a government, or are we moving forward and Nova Scotians can see a program similar to that, a program that is like that in the near future? Let me tell you, Mr. Minister, as you're well aware and your department is well aware, there are many Nova Scotians who do not have access to a family physician.
We can talk about the ratio per capita and where we fit nationally, but there are many Nova Scotians, the only number they know is that they don't have a family physician, they don't have a number to call. So I'm wondering if you could talk about whether or not your department actually seriously looked at that option and where we are with that.
MR. D'ENTREMONT: Mr. Chairman, I will go back just to finish off the Avastin issue and then we'll talk about medical seats there for a quick second. The dollars - again I can assure the member opposite - are available; they are in three or four different spots within our budget. I can talk about other programs - the high-end drugs approved by the provincial committee; claims-based funding to districts, which is another $6.9 million that is available. Again, the coverage and the utilization waxes and wanes, so sometimes there's a high use of one drug and no use of another drug, and I can say that there is up to $3.6 million available within those three different funds to cover a drug like Avastin.
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The other thing that I can say, Mr. Chairman, is that $3.6 million represents the maximum use of this drug per year, if that patient would be receiving the drug for the full year. Our experience and the information that we have, the patients do not receive the drug for the full year. Mr. Chairman, again as I've said before, the average extension of life that this drug offers is approximately five months - 4.7 months. So most patients do not receive it for the full year.
So, again, I know the member opposite is looking for a specific area and to see a true addition of $3.6 million. But I can say within the budgeting process, within the space that we leave ourselves because of the other drugs that would have been coming down the pipe during the year anyway, we make budgetary decisions to include certain extra dollars within that funding envelope to fund drugs as they come down. Oxyliplatin, for example, that was approved last year - it did not have a number in there and if you look at it, we're funding ten new drugs and there has been no change to our item. So it is funded within that envelope because utilization changes, drugs change, and we really have to sort of roll with the requirements of those funds.
The medical training seats - and I thank the member opposite for his interest in this, for his leadership in this. I want to talk a little bit about the difficulty that I have been having when it comes to the medical school in trying to negotiate - and again this negotiation is not only through our department but it's in concert with the Department of Education as well, who has the responsibility for universities. When I first came to the Department of Health and had my tour of Dal Med, there was basically a sales pitch at that time to increase the number of seats to its maximum, without infrastructure change. The maximum that I think that school can take at the time - if I remember in my conversation with the Dean of Medicine, Dr. Harold Cook - is about ninety-six. So we can put approximately another six students into that facility, we understand. I mean it could be up to 10, we're aiming for 10 but they're saying they could do about six because we've got ninety undergraduate students, I believe, going through there now - in order to train more.
It always has been my intention on this one to have those to be designated seats for Nova Scotians, more specifically students who have an interest in family medicine, and more specifically to have a return for service built into those seats. There has been agreement in our conversations with Dalhousie University to allow this to happen, but I don't have a number that has come back from them that can tell us how much this is going to cost us. It's about $56,000 per student per year, so if we're going to add ten, you can do the math on that. It's still my intention to go forward with this for September and I feel that within our training envelopes that we have the dollars available to do that on behalf of Nova Scotians and on behalf of your leadership on this one as well.
MR. CHAIRMAN: The honourable member for Sackville-Cobequid.
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MR. DAVID WILSON (Sackville-Cobequid): Mr. Chairman, I want to pick up where I left off because I don't think I received the clarification around an issue where I'm trying to get some clarification. I'm not an accountant and a lot of Nova Scotians are not accountants, but when I read through the budget estimates, which I've done for several years now, I still can't grasp the idea that if government is estimated to spend $19 million and they only spend $11 million, where does that $8 million go? I would like to ask the minister again - and that figure I mentioned was on the grants and contribution for equipment within health.
That $8 million that we did not spend last year, and we know this year we are going to spend $7 million so my trying to figure that out in my mind - we are actually underspending about $1 million. So really, in my mind, there is a cut to the money available for equipment within Health of $1 million, so again maybe I will give the minister one more chance to try to clarify - if the government was going to spend $19 million and they only spent $11 million, where does that $8 million go and why are we only spending $7 million this year?
MR. D'ENTREMONT: Mr. Chairman, neither am I an accountant. I really just don't have that ability. I do have a lot of respect for those who are CAs, my CFO here, for the work he does for our department because he does spend an awful lot of time with numbers. Of course, my brother-in-law is one as well, so I do get to hear a lot about accounting on a regular basis and I really have no details to fight with my brother-in-law when it comes to some of these issues.
But anyway, basically what happens here - due to late starts, whatever - the cash flow cannot happen, so if we budget $19 million for the construction of X building and we had envisioned it to spend $19 million from September to March and the cash flow is available so we can write the cheques out for that $19 million, but the project itself really only starts in December, let's say, so it only runs for the four months remaining, we can only kick out $11 million in paying that directly. So what happens is that I can't take that extra $8 million and pay it forward; that $8 million, due to the accounting rules of the province, has to be sent back centrally. So as much as we try, within our department, to find other homes for those dollars, dollars do end up going back to the Department of Finance to be used centrally for other issues of government.
[10:30 a.m.]
MR. DAVID WILSON (Sackville-Cobequid): Which leads me to believe that the spending spree that the government had toward the end of the year, the $220-some million, plus $75 million to the fund, that is where that money is coming from - that is my understanding. So the money you spent at the end of the year, the spending spree you spent just at the end of the year without approval from this House, part of it ultimately came from grants and contributions that were supposed to be or were meant to be spent on equipment in health care.
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Anyway, I am going to go on to another area - Program Expenses for Capital District Health Authority. We look at the line items and the forecast of last year, what we spent for Capital Health - in the Estimates Book, Page 14.2 - was $620 million. So this year, under the estimates, it's recorded at $605 million. So that is a difference of $15 million. I wonder, could the minister explain why their budget for Program Expenses for Capital Health is $15 million less than what we spent last year?
MR. D'ENTREMONT: As Allan is trying to find those numbers, I will sort of rebut the issue of the dollars going centrally and maybe ask the member opposite to tell me whether he doesn't think that student relief was important, that he didn't think that the MOU with the universities was important, which all have to do with making it more economical for nurses to go through the system, that makes it more . . .
HON. MARK PARENT: Protected areas.
MR. D'ENTREMONT: Protected areas. Well, I'm talking about health care, with all due respect to the Minister of Environment. I know he's very passionate about environment.
Mr. Chairman, I can say that you know there were some direct benefits to health care, and especially from the other line of questioning that we've gone through over the last number of hours on the recruitment and the retention of nurses and other HHR staff, that it's very important to have competitive tuitions, competitive bursaries, and competitive pieces that are available to the university system. So, you know, there is a direct correlation between those two. (Interruption) Thank you very much, Mr. Premier, at least I don't feel so alone answering all these questions.
I need to get the explanation here of those dollars, so if you want to wait a second or you can go on and ask another question and we'll only be one-off for now.
MR. DAVID WILSON (Sackville-Cobequid): Actually it's first a comment - no question those expenditures are important, but what's most important is the fact that I supported a budget last year that was supposed to spend $19 million on equipment in health care and only $11 million was spent. That's the most important thing, Mr. Chairman. I didn't support any budget that spent $300 million just leading into the end of the year. I supported a budget last year that was supposed to spend $19 million on equipment in health care. That's the important thing and that's why we have such an issue when we see $8 million where I don't know where it went. It went in, I guess, to the spending spree of the government - that's my issue and that's what's important.
So I would like to go to now around some more questions and I know the minister will get the question around the $15 million reduction that I see in Program Expenses for Capital Health. One of the things I noticed here in the line item - and maybe he can get his support to get it - it's on Page 14.16 of the Supplementary Detail, and it's the line item that states
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under Program Expenses for Long-Term Care programs and it was Strategic Framework. Last year it was $1.1 million, this year it's $8.5 million. I just want some clarification on what that line item entails, why is that expense there, and I believe it's up maybe $7.4 million, in Strategic Framework, it's the last line item under Long-Term Care, Program Expenses.
MR. D'ENTREMONT: Mr. Chairman, let's talk about the strategic framework. Basically it has to do with the HHR strategy and other strategic frameworks when it comes to, of course, the training and the recruitment of CCAs and other health professionals in the long-term care sector. So those are the dollars directly to the additions of CCAs and those types of people within our long-term care system. So that's what that line item is.
The Capital Health issue, the $15 million issue, has to do with the reallocation of wage settlements. Last year what we ended up having to do because we didn't have the true allocations of all the dollars and cents due to - I forget which wage settlement it was - that we just sort of lumped it into Capital Health. What we see this year is we actually had time to place it into the correct district health authorities, so that's why you see the difference of $15 million. The $15 million would actually be shown in other parts of our budget in the other district health authorities.
MR. DAVID WILSON (Sackville-Cobequid): So under that Strategic Framework, that $7.5 million - I think the minister mentioned that part of that's the recruitment and retention aspect, or some has been involved in that. So I wonder if the minister or his department keeps track of the spending amounts for each discipline - say physicians, nurses, technologists, on what you're spending in recruitment, in trying to recruit and retain those health care providers. Do you actually keep records of how much you're spending to attract those health care providers to our system and hopefully retain them also?
MR. D'ENTREMONT: I don't specifically have it maybe for physicians and maybe some of the other pieces, but I can quickly list some of the issues that are within the nursing strategy and the additions to the nursing strategy this year, as I spoke to last evening. In recruitment and retention, advertising and promotion, there is about $500,000 that is listed there; RN recruitment incentives, strategies, is still to be determined - there is still some work to be done around that one but we were allocating about $250,000 to that; the third year co-operative experience, which we were finding some very good benefits to that and apparently the students are enjoying that quite a bit, that is $240,000 and we are trying to expand that to 40 students, I think, this year at about $6,000 a pop. So that brings it to 100 per cent of the students. So that forty brings it to 100 per cent of the students who will receive that third year co-op experience.
Facility-based recruitment and retention initiatives fund which is about $239,000; facilities-based placement premium, which is an incentive, $84,000; and upgrade for food handlers and medication management modules and those kinds of learning initiatives is $80,000; prior learning assessments, assessors, RNs provide on-site assessment to transfer
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credits for outside students to do work with those students who have been trained in other jurisdictions that have come to Nova Scotia, and we will put some dollars in place for a coordinator to coordinate the transfer of credits program. We are finding some nurses are going off for some of the training and want to come back to Nova Scotia or are taking their master's degree and we are trying to find ways to incorporate that outside learning into the programs - again, this is all in addition to the $5 million that we have in the nursing strategy, that we have had in our budget for the past number of years.
MR. DAVID WILSON (Sackville-Cobequid): I wrote most of them down. Hopefully I have some support from the gallery to keep track of some of those numbers. I would appreciate it if that is something you could share with me, a list of that. I would appreciate that. I think it's important to have that information and have that with us.
So now I want to move on to - I'm going to use the Supplementary Detail book, Page 14.4. I want to talk about, again, what we approved last year through the budgetary process, a budget that was supported by this House and what was actually spent again. I know I'm concentrating a lot of time on this, but I think it is an important issue that we need to try to get some answers of why certain areas and certain line items and certain departments and certain programs you didn't spend as much money as the budget had indicated last year.
So under the Pharmacare Program and the Pharmacare Payments, first question, what does that line item entail? What exactly or what is covered under that $178 million for Pharmacare Payments?
MR. D'ENTREMONT: Mr. Chairman, to the member, again - as I was sort of answering questions from the Leader of the Liberal Party - the medication, pharmaceutical side waxes and wanes and changes every year. Quite to our surprise this year, there is basically a decrease in the cost of our pharmaceuticals due to the availability of generics in this year's round, a change, the decrease in tariffs, in the tariff agreement. Even when that happens, that gave us a considerable savings but utilization has gone up 8 per cent. As I said, things change within that module, so this year is representative of the new generics that are on and the tariff agreements that have been signed.
MR. DAVID WILSON (Sackville-Cobequid): So what we could take from that, then, is the saving of last year, which was about $7 million, ultimately the Avastin portion of pharmaceuticals which I think the tentative number on that is around $3.7 million, maybe even $4 million. So really the savings from last year will cover the cost of Avastin this year - and we noted here in the budget that we are actually budgeting less for Pharmacare than we actually budgeted last year by some $1.5 million, maybe even $2 million. So at least there I can see that if we didn't spend $7 million, or we saved $7 million, why shouldn't you spend that on a pharmaceutical like the drug Avastin. I'll get into that a little later with some comments about that issue.
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Now, I'd like to move down to, again, kind of on the same theme around what we passed in the budget last year and what we spent and maybe some clarification on some programs that I think are so important here in the province. They're used by Nova Scotians who are vulnerable, who need the help of government and apply for these programs.
The first one is the low-income residents with diabetes, or the low-income diabetes program. It was budgeted last year at $2.6 million, we only spent $1.4 million. I'm wondering why such a difference again in that program? We're looking at over $1 million saved in the low-income diabetic program and I'm wondering why. Is it because the uptake - people weren't applying for the program? If that's the case, maybe we should spend some of that $1 million in ensuring those people are aware of this program, or expand what is covered in that program. Why such a discrepancy from last year in that low-income diabetes program?
MR. D'ENTREMONT: Just a general comment - this has to be maybe one of the first times we've had a discussion around decreases in health care costs on the floor of this Legislature. We do have some programs, as they've started rolling up, they're not spending the dollars we had thought they might. In this particular case, it really has to do with take up. Maybe we need to do a little better job in advertising and working with physicians and pharmacists to make sure that diabetics know this program is available to them.
We do know that in the course of setting up a program that it really takes about five years for a program to become fully subscribed. I think this is just representative of that. Again, we would hope more Nova Scotians would take part in the diabetic program, because it does provide such a good help on the cost of insulin and other components of treating and caring for diabetes. So, Mr. Chairman, again, it is a strictly utilization on this one as well.
MR. DAVID WILSON (Sackville-Cobequid): So if that's the case with this program, a program that we supported and advocated for for many years, the minister stated that maybe we should look at the advertising of this. So have you had the discussion with the staff of the department to say, are there people we're missing with this program who we could help? Have you had those discussions, and when will we see an increase in awareness around this important program?
[10:45 a.m.]
MR. D'ENTREMONT: Mr. Chairman, yes, I've had that discussion. I have regular discussions with my pharmaceutical staff on the usage of these programs - this one and the Family Pharmacare Program, as well - to make sure we're meeting the needs. As far as we understand, the take-up on the diabetic assistance program is good - it is not fully subscribed and we would hope it would be fully subscribed within the time frame that we set. We really don't know exactly the reason they're not picking it up as much as they should. Again, I think we have to do a better job in advertising and making it available in doctors' offices and
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pharmacies so that Nova Scotians are aware this program is available for the treatment of their diabetes.
MR. DAVID WILSON (Sackville-Cobequid): I look forward to seeing an increase in the awareness campaign around this program.
The line item right beneath that one is also an important one here in the province, one that many of our children here in the province take advantage of - the children's dental program. That too has seen a reduction in what the actual cost was at the end of the year, a difference of just over a half million dollars.
Recently I had a call from a constituent who was in the situation where I believe the cut off time for this program, or for children, is the age of 12. This individual started the process with her family to have some oral health care problems addressed and found themselves with a huge bill at the end of it. When they asked and applied to have that covered under the government's program, they were denied. On appeal, they told us and told me in a letter that I believe the minister or a member of his staff sent me that, well, no, we're not covering her because she's over the age, but those procedures weren't going to be covered anyway even if she was six months younger at the start of that process. So with $0.5 million savings, why would we see, you know, a child in Nova Scotia who is on that borderline of the cutoff, why wouldn't we see maybe exceptions in maybe expanding what they do cover for procedures under the dental program for kids in the province?
MR. D'ENTREMONT: Mr. Chairman, the children's dental program is one that I think is important for the dental care of children, to make them aware and treat them through their infancy so that they can continue on in adulthood taking care of their teeth. Of course, you know, dental care is very important to the overall well-being in health of a person - again something that's very important to us.
Just to speak of the program quickly, it's a two-component program providing diagnostic and treatment services, prevention activities, through the application of a Public Health initiative to eligible residents of Nova Scotia up to their 10th birthday. The program has two components - the insured services treatment component and the Public Health services component. I just wanted to - I'm just trying to read the rest of this here so it's not so much, OICs and numbers like that provide that in most cases where private insurance coverage has left an outstanding amount due, the government will accept responsibility for those costs - so either to pay for the full costs or whatever the private insurance does not cover.
What we find this year is that there was a tariff increase this year of about 5 per cent. That's an increase of approximately $211,800 but there was a huge utilization decrease within that age group of about $345,700 so it does show that total decrease of $133,900. So to the member opposite, you know, we're unsure of why the decrease went down because it does cover an awful lot, but maybe it is representative of the availability of private insurance for
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families with children now, either through this program or maybe through private programs. So we are going to watch that one a little closely because I remember when I was in that age group, I believe it almost covered us to 14, I think, at a time. So, you know, we need to monitor that one and if we do have some extra dollars left over next year, maybe we should be increasing the age on it.
MR. DAVID WILSON (Sackville-Cobequid): And that's why earlier this week or maybe it was last week - today is Friday - earlier this week the member for Halifax Atlantic talked about a piece of legislation that she introduced and it was about that portability of a private health care program. I mean that piece of legislation if it was seriously looked at by the government - hopefully it will be - I would think could help reduce that cost, maybe even eliminate that line item there, or at least reduce it because of additional third party coverage. So I know we're not supposed to talk about other bills but I thought I would put a plug in for that piece of legislation.
So now I want to go to the couple pages past that one, Page 14.7, and the line item is Cancer Care Nova Scotia. We had $4.5 million last year and there's a definite increase to $7.6 million. So is that the money allocated towards the colorectal screening program or could you advise me why that increase is there?
MR. D'ENTREMONT: Mr. Chairman, Cancer Care Nova Scotia, of course being a very important program for us.I do also want, I don't know if I, I did announce it at a statistics briefing that we had over at the Holiday Inn not so long ago, that we do have a new chairman for the Cancer Care Nova Scotia. I do want to thank and wish well Réal Samson who will be taking over the chair of Cancer Care Nova Scotia and wish him well.
Yes, quickly put, the biggest increase is the colorectal screening program - $2.7 million. Some other pieces are pretty much just wage increases, staff increments, funding for staff increments, clerical support for cancer drugs, health record technician, adjustment prior years, internal wage transfers and those kinds of things, to bring us to the total of $2,908,100.
MR. DAVID WILSON (Sackville-Cobequid): So the $2.7 million is in that figure? Okay, just for my record. One of the things that I read - and I read pretty much all my mail - back at the end of last year was the media piece that the government was criticized on that they sent out, promoting what the government is doing. In that, from my recollections, there was a piece on colorectal screening. I believe, and maybe the minister can correct me, but I believe they said they are going to spend in the upcoming year, $3 million on a colorectal screening program. So why are we at $2.7 million when not even a year ago, in the media release and in the newsletters that you sent out to all Nova Scotians, you said you would spend $3 million. There is $300,000, so why the difference between $3 million to what we see today in this budget of $2.7 million.
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MR. D'ENTREMONT: Mr. Chairman, the $3 million number is really representative of some of the other dollars that would be spent on treatment and some diagnostic pieces that are happening within the districts. As much as we try to budget centrally for this program, there are some other expenses that the district health authorities would be spending so we basically rounded the number to an even $3 million for that document.
MR. DAVID WILSON ( Sackville-Cobequid): As I said, Mr. Chairman, that is not what the mail out said to Nova Scotians. It said $3 million. It's just another example, I think, of here the government is saying we are going to spend some money, we are going to spend $3 million but really we are going to spend $2.7 million. Or we are going to spend $19 million on equipment but no, we are only going to spend $11 million. So I hope the minister understands our frustration when we try to go through the line items here and we see what the government says they are going to do and what the government does.
Maybe the minister will comment on that later but I want to move on to another line item. We all know, I know and I think the Chairman knows the importance of health research in our country and in our province. In order for us to ensure that we can best service our residents with new initiatives in health care, with drugs, in any aspect of health care delivery, health research is needed. We need to make sure that if there is an investment made by government, that the research is there to back it up. We've seen cuts on the federal level to health research throughout this country, which is a shame.
I know Prime Minister Harper is not, in my opinion, very favourable toward the health research programs throughout this country. That is why I am bit concerned here when in this line item underneath Cancer Care, we have Health Research Foundation Grant where they received $6.4 million last year and now we see that in the upcoming year they will receive $4.9 million - a difference of $1.6 million, Mr. Chairman. So with that reduction of money going toward health research which is so important in this province, why has that reduced? Is it because they asked for less money? I don't think that is probably what happened. Why is there a reduction of $1.6 million toward the Health Research Foundation Grant this year.
MR. D'ENTREMONT: Mr. Chairman, if you look at estimate to estimate, there is only a $13,000 increase in that budget. What we saw last year, there were a couple of one-time funding initiatives that were given to the health research foundation. There was $1 million in grants and projects that it was increased by. During the year, there were a health policy research centre dollars that were available to them at $500,000 and there were some office renovations that we undertook during the year of $17,000, I believe, for a total of $1.5 million or so, over and above the existing budget of $4.9 million. So that's sort of why we see some extra dollars in last year's but if you probably went back a year beyond that, you would see a pretty similar number from our grant to help research.
MR. DAVID WILSON (Sackville-Cobequid): And I do note that but what I'm trying to emphasize is that we have a federal government that is backing away from health research.
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I know last year they've gotten a bump on money towards their program and their initiatives. I just want to lastly emphasize the fact that they received additional money last year. It would be just as beneficial to Nova Scotians and to the government to ensure that they have available additional funds like they had last year, if not matching last year's.
So I would like to move down the page a little bit. Last year under the line item on pandemic planning, last year we spent $610,000 on that line item but this year there is no money allocated. I wonder why maybe that line item has no funds allocated towards pandemic planning in the upcoming budget?
MR. D'ENTREMONT: Mr. Chairman, just to go back to the health and research issue - I mean health and research is very important to me. You know, I thoroughly enjoyed meeting the researchers, very interested in the projects that they undertake and the benefits that it gives to Nova Scotians. I find clinicians and researchers, you know - they're one and the same. If we can have a physician or a specialist come into the province who can see patients on one side and do research on the other side and have a more wholesome life, why not offer that here in Nova Scotia.
What I can also say to the member opposite, even though the dollars for the Health and Research Foundation have seemed to be pretty steady over the last number of years, there are a number of other funds that directly fund health research in this province. The Premier's Innovation Fund; brain research; the Brain Repair Centre, which is really a research organization, it's funded directly or funded through the Department of Economic Development. Of course, each DHA has its own research fund that they use more locally for research that's happening with their staffing.
The pandemic issue, there was an amount of money last year that was one time spent for, I believe it was either antivirals and equipment. I'm just looking here, right, and there was intensive work last year on the pandemic plan, the document that people will refer to if we do find ourselves in a situation. So there were some dollars spent last year on antivirals and those items that are, of course, still good this year that we didn't have to spend money on again. Of course, all those costs are shared with HPP. So there are some dollars over in the honourable Minister of HPP's budget that talks to pandemic as well.
[11:00 a.m.]
MR. DAVID WILSON (Sackville-Cobequid): And I would hope, and I know the minister can't comment on line items under Health Promotion and Protection, but I hope that there are funds there to start the work around a comprehensive strategic plan, especially around the accountability and the management structure of pandemic planning. It was criticized in the Auditor General's Report most recent report, around the fact that there are no clear lines of communications because of the crossover between the Health Department and Health Promotion and Protection Department. We have, for example, our nurses who
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work under Public Health, work for the Capital Health region or the District Health Authorities' which falls under your mandate. Yet their goals and policies and regulations come from another department and that was a criticism from the Auditor General. So maybe a quick comment from the minister on where we are and is there money allocated to ensure that there's a plan that overlaps departments like the Department of Health, and Health Promotion and Protection? To ensure that the government doesn't have another audit finding like we had in the last Auditor General's Report and that we can ensure that the safety of the public here in Nova Scotia is best served by departments working together.
MR. D'ENTREMONT: Mr. Chairman, our pandemic plan had been developed over a number of - a couple of years to put it together, which was done in concert with our department, with the Department of Health Promotion and Protection, with all DHAs, with the federal government and, of course, with EMO, to organize that. It is a document that will continue to be groomed, one that will have to change and react depending on the possible threats that are out there, the difference in technologies that will be available to protect our citizens, et cetera, et cetera.
Mr. Chairman, I can also say that even though I do relish my time here in the House, I was scheduled to be at the Exercise Staunch Maple, which is going on today over in Shearwater. Exercise Staunch Maple is a combined initiative of, I believe, EMO, HPP, ourselves and the federal government on really exercising what happens if a cruise ship, for example, comes into our harbour with injured patients, with injured individuals on board, or with some kind of illness that we cannot identify.
Mr. Chairman, over on the waterfront today - and I hope that the media will be reporting on it tomorrow, on the success, or the experience of Exercise Staunch Maple. Again, I know the Armed Forces I think is - I can't remember which ship we have over there, but I know DND is participating with this as well, the cruise ship, they're pretending they're a cruise ship, but ultimately we'll be setting up a field hospital to treat these patients or these ship-goers in an appropriate manner.
So it's basically a very good learning exercise to see how our procedures are working, to see how our policies are working, and to see how our workers, our specialists, are working to contain and treat the patients who are sick over there.
So even though, again, I'm glad to be here to be discussing the estimates, I was really looking forward to seeing the progress at Exercise Staunch Maple. Had I known, I would have invited you over.
MR. DAVID WILSON (Sackville-Cobequid): I would have taken a break from all this if you wanted to go. There are a lot of criticisms around the lack of plans and are we really ready for emergencies, but I know the good people who work in emergency services, like the paramedics, firefighters and police, will do the best job even without maybe the government
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doing its best job to have the plans and policies in place. So I wish them well today in their exercise.
The reason I talked about the public health aspect of it, because during the next few pages in all the district health authorities under their program expenses, last year there were line items under Public Health Services for each of those DHAs. So, for example, district one, the South Shore District had $1.1 million; Southwest District had $1.7 million; Annapolis Valley, $1.7 million; Colchester, $1.7 million; and so on. Roughly $12 million last year, that I can point out, was spent or was under the umbrella of the Department of Health. This year those are all zero. Why the change from last year to this year?
MR. D'ENTREMONT: Mr. Chairman, to that, there were $22 million worth of programs and dollars transferred from the Department of Health to the Department of HPP, and those line items represent those transferred programs that are now over under the bailiwick of HPP.
Also back to the issue of pandemic planning, emergency preparedness, there has been a health emergency management centre established by DOH and HPP. It was set up last year. We have a retired navy commander, Russell Stewart, heading up the unit to better organize the operations of our departments if we would ever find ourselves in a medical emergency such as a pandemic.
MR. DAVID WILSON(Sackville-Cobequid): Did you say Dr. Stewart? Is that who (Interruption) I thought he was mentioning Dr. Stewart who was instrumental in changes to the paramedic service throughout the province.
You said that there's a transfer of $22 million and I know you can't answer this question and hopefully our Critic for Health Promotion and Protection - I know the government often states that the Office of Health Promotion and Protection were increasing the funds to promote healthy living, that whatever increase they have this year, $22 million of that was under your umbrella. I'm sure our critic will keep an eye on that and I'm not sure if that's how much that department's budget had risen this year or not, we'll have to look at that.
So now under addiction services of course in all of those district health authorities, they have line items for that and I've highlighted them all. But there's only one, Colchester East Hants District Health Authority, that had seen a reduction - maybe a small one but still a reduction of nearly close to $70,000. In addiction services I think every penny counts, every dollar counts, so $70,000 would go a long way in helping those Nova Scotians who find themselves fighting an addiction and needing the help of their health authority and those professionals in it. Even though it's a relatively small number of a reduction when we look at the overall budget in health, I think for that important service - which I think in my own opinion is underfunded - why is there a reduction of close to $70,000 or maybe $68,000?
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MR. D'ENTREMONT: I don't have the necessary details on that one so I'll have that available to you hopefully early next week maybe even by the end of this one, but I doubt I'll have that line item available to us.
MR. DAVID WILSON (Sackville-Cobequid): We'll make sure we look at that and hopefully receive that. Now I have kinds of questions on a few things. I know I have about 20 or not even 20 minutes. I'm going to look into the Assumptions and Schedules book that we have that we were given. Under it, on Page 1.15, is listed money that we've received on the federal sources and that would be revenue coming into the province. It goes back to 2004-2005 and then the years leading up to 2008-09. So in 2004-2005, we received $44 million under Health Reform Fund. Could the minister maybe say how much of that money is left, if any, and maybe quickly where did that money go?
MR. D'ENTREMONT: I believe that number is representative of the primary care fund. Pretty much we were getting dollars directly from the Federal Government to fund our primary health care initiatives in the province. As far as I understand, at this point, all dollars from that fund have been spent or pretty much all spent up last year so there are no more dollars in that fund.
MR. DAVID WILSON (Sackvile-Cobequid): So all spent up to last year, so this year that money is gone. That $44 million, I know there's no new money in there, but that $44 million would have been spent up to this date? Just for clarification maybe.
MR. D'ENTREMONT: About 25 per cent of physicians have EMRs, and EMRs were paid for through that - the electronic medical records, or the computerized programs for them were paid under that fund; the district health authorities set up primary health care plans, and that was funded out of that fund; there were primary care coordinators in each district that were paid for from that fund - so there were a number of initiatives that basically we continued to pick up after the expiry of that fund.
MR. DAVID WILSON (Sackville-Cobequid): I know the minister might not have all those details, but is it possible to get a breakdown of that money? The biggest criticism we have and Nova Scotians have, and that I have, is that we receive $44 million from the federal government, it goes into the bank account of the Government of Nova Scotia and then you bring out your estimates, you bring out your budget every year saying we are going to increase spending in this area in health care but, yet, $44 million of that spending over the last four or five years came from a fund that the federal government gave us.
I hope the minister can provide me with a breakdown and maybe it will keep me quiet over the next six months - if I get that breakdown of where exactly that money went. I mean, if you spent it you must know where you spent it, and if you can give that to me I would appreciate it.
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I don't have much time and I'll be close to wrapping up my portion - I know in the next time allotted for this, the member for Halifax Needham will speak so I am going to talk about a few quick things and hopefully get some clarification. One is the recent changes to the Pharmacare Program, and I asked the minister in Question Period this week about it. The minister mentioned that there may have been an error about sending an invoice out to seniors, and that's really a lot of the confusion that I have received calls on. Here we have changes to the program, so seniors who have been in the Pharmacare Program for whatever length of time, some of them for years, receive a package from the government saying we are changing the way the payment plans are and how you are going to pay for this - so they had questions.
The government set up a 1-800 number and, of course, they were inundated with calls, and I think that number crashed, and since many of them had concerns they turned to their MLAs to try to find out - well, I was unaware of those changes pretty much right up until the time I started to receive calls. So those seniors actually filled out their information, sent it in, saying here is how I am going to pay the premium. Some of them paid it upfront, some of them went on monthly billing, like they always have been, and then within days, some of them received an invoice saying they owed the premiums in full.
[11:15 a.m.]
With that confusion, with the crash of the phone line, can the minister say today that no senior who might have missed the deadline for the Seniors' Pharmacare Program will incur a penalty - because you have some severe penalties placed on you if you don't enter that Pharmacare Program by that date and you're stuck with those penalties for, I believe, five years - so can the minister state that no senior will be penalized because of that confusion, because of the inability for them, at that time, to get the question that they had answered?
MR. D'ENTREMONT: Mr. Chairman, I think if we had a chance to go back and do it differently we would. There was some added confusion with two programs at the same time, of course, the new Family Pharmacare Program and the Seniors' Pharmacare Program and how those two programs interact.
Of course, there were a number of changes, the major one being the opportunity for seniors to pay their deductible, co-pay, over a more spread-out way, through a payment plan, which was asked for, again, by the Group of Nine. Anyway, there were a number of changes that were there that may have been a little more confusing than they should have been, but there was a bill that was sent out in error to individuals that caused the majority of that confusion. There were immediate steps taken to address that situation and to provide that solution to ensure that seniors could leave a message and have their calls returned.
There was just no way that we could take the volume of calls that were coming in, so we did set up an answer system, which I know was difficult because, in my experience anyway, it's very difficult for a senior to leave a message. They want to talk to a real person
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and I do not blame them. So, anyway, we did set up that program, we were able to take those messages and get back to those seniors as soon as possible. I can say that no seniors were penalized as a consequence of the delay in contacting the program - and even if we heard of one today they will not be penalized because of the glitches that were in that system.
MR. DAVID WILSON (Sackville-Cobequid): I have to wonder why you didn't just say that in Question Period. I know this is a different atmosphere than Question Period - as everybody says, it's not answer period. So I'm glad for that answer and I hope you've learned a lesson - don't mess with our elders, they get upset, and they don't like changes. They want to know exactly where their money is going and how they're going to pay for it - and those changes affect them in a negative way.
One of the things about the Pharmacare Program that I did notice - there was a big change - was the fact that if they do pay their premium fully, they're not going to get any refund if for some reason they don't meet those requirements, right? So I believe that's different from the program last year. Is that a change that took place - even though they've paid in full, there won't be any refunds if they don't use their premium and their total co-pay that is required by them?
MR. D'ENTREMONT: Mr. Chairman, you know, this is a quasi-insurance program, so the dollars that do go into it do get used in paying for drugs maybe for other people if certain individuals don't use their total amounts. This was a bit different when it came to having to decide at the beginning of the year, you know, looking at your drug utilization over the last year, and if you spent over that amount, your total co-pay, which of course it was capped at $300-odd, $390 or $380, whatever that number was, you could make a decision and say I want to pay that monthly as well - but you had to guess, and if it turned out you made that decision and you didn't use up to that co-pay amount, those dollars would not be refunded to you and they would go into the larger pot for that program.
But, Mr. Chairman, I can also assure the member opposite that those changes were not done without a lot of consultation with organizations, seniors' organizations - the Group of Nine to be more specific - and I can say that I took a lot of heat when I came into this department two years ago, when we didn't put the co-payment option in. I thought the Group of Nine were going to come after me and beat me to a pulp, but anyway it took a year, you know, it was a missed opportunity but ultimately it took us a year and some major planning and some discussions with our service provider to make that monthly co-payment option available. So I know it was difficult during that time, but I can assure, again, that no seniors were penalized because of that technicality or that glitch.
MR. DAVID WILSON (Sackville-Cobequid): I'm glad to hear that, Mr. Chairman, and Mr. Minister. Now, quickly, to an issue across the harbour here - Dartmouth General, fifth floor, vacant. How is this? I think they have boxes in there and stuff, and one of the suggestions I've heard, and I hope the minister heard, was why not use that as a day surgery
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clinic where we could utilize an OR that's not being used over there, I believe - have a day surgery unit there and invest funds into a public system instead of, I think, taking the easy way out and signing a contract with a private clinic. Is that an option you're going to look at, Mr. Minister, in the near future, and hopefully we might see that?
MR. D'ENTREMONT: Mr. Chairman, I can say to the member opposite that it is hard to believe, it is hard to believe that we had a piece of infrastructure like that sit there since 1986 - I don't know, where's Darrell? Darrell was on the original board of directors, or the member for Cole Harbour was on the original board of directors that built that hospital - how a piece of infrastructure like that went unused for such a long period of time is absolutely incredible to me.
Anyway, what that really says is that - again we're talking about the master plan the Capital District will be providing to us, I'm hoping towards the end of summer, will incorporate what we want to do with that. The ideas that I'm hearing for that site would be - I think there are three options that are before us, and I like the surgical idea better, having patient rooms for maybe orthopaedic surgery, or what have you, available on that fifth floor.
But there have been some other discussions of just a basic in-patient wing to maybe even another addition of transitional care, or something like that, that you could utilize that floor for - and none of those options are cheap. The renovation or the set-up - I can't say renovation because there's really nothing there, but the set-up of that floor, I've heard numbers of about $4 million to $5 million in order to do that. So that would have to be addressed in the broader capital infrastructure requirement of Capital Health.
MR. DAVID WILSON (Sackville-Cobequid): I think we need to definitely move on that. It's such a waste of an opportunity to have a facility like the Dartmouth General where we can expand and provide more services, and provide services that we need to look at changing and moving from the old VG building.
I know I only have a few minutes, so I want to end my time here today - and, as I said, the member for Halifax Needham will pick up in our next allotment - around an issue that I have mixed feelings about, and that's the decision of the government to fund Avastin. The reason I have mixed feelings about it is I think it's great for the people who have been struggling with cancer here in this province, who have been prescribed Avastin and had to make that difficult choice to either pay out of their own pocket or go without, and the reason I want to bring this up at the end is because we had people come forward who are in those difficult situations. Blair George and his wife, Marlene, who is fighting cancer, and they have spent a large portion of their life savings to fund that drug, came forward after, I think, they realized a couple of other advocates, who put a face on this issue, passed away in the last couple of months.
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One, of course, is Jim Connors, who passed away last month, who was a strong advocate, not only for Avastin, but for cancer care, sitting on the board for the Canadian Cancer Society. Here's a gentleman who didn't need to worry about the choice of paying for Avastin, he had the means. He said that: "I can afford it." He paid for it. It extended his life, I have no doubt, talking with him over the last while, and I know our Leader had talked to him so much over the last year, two years, about this issue. He was able to pay for that, but he advocated on behalf of those Nova Scotians who couldn't pay. People like Judee Young who was a nurse here in our province, was a health care provider and she made the difficult choice not to bankrupt her family to pay for Avastin. She lost her life just over two months ago.
And that's why I have mixed feelings about this. I think it's so important we recognize people like Judee Young and Jim Connors and Marlene Blair who were fighting every day. All we got from this government for the last two years was that we can't do it, we won't do it, we're not going to do it. Now, today, we see that this budget has that in it and I'm glad to see that. We will never know if Judee Young had received that drug, if she would still be here today for her family, especially her nine-year-old son. (Applause)
MR. D'ENTREMONT: You know, this issue has not been easy for me either. It's one that - we try to make the right decision on behalf of everyone. We talked earlier today of the complexities of health care. There are a whole bunch of different treatments that come before us on a regular basis that have hope, that have some kind of benefit to patients, and it is really hard for a minister, for a department, to try to look at some of these things objectively when we know that we are trying to do the best that we can with the dollars we have and the services and information that we have.
I would have liked nothing better than to have said yes to Avastin two years ago, but the expert panel that I have to trust, that provides the information to us - which was made up of public members, it was made up of oncologists, it was made up of a specialist - had said that this drug does not provide the benefit that people are saying it did. One of the toughest decisions I think I have ever had to make as a member of government, as a human being, was to say no to that drug. My heart breaks every day when somebody brings up the name Judee Young or brings up the name of Jim Connors. I hope today that at least this fixes that issue - it doesn't fix it for them, but it will fix it for generations of people to come. I hope that we do have a better appreciation for trying to get some of these drugs through.
I thank the committee, because they had to make a tough decision as well. They knew what the public pressure was, they saw the human face that was on this one and I just want to say that I'm glad we were able to bring it forward here. I would have been much gladder, much happier, and much more able to mend that broken heart that I had by saying no to it, to be able to provide that a couple of years ago. I want to thank the member opposite for his intervention on that one.
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MR. CHAIRMAN: Order, please. The time has expired for the NDP caucus. We will take a short recess for two or three minutes.
[11:29 a.m. The committee recessed.]
[11:32 a.m. The committee reconvened.]
MR. CHAIRMAN: Order, please.
The honourable member for Preston.
MR. KEITH COLWELL: Mr. Chairman, I am going to share my time with my colleague, so I will just be quite brief on my questioning.
I have a couple of questions about doctor recruitment. I know it has been a real big issue in the rural areas for some time and I know that the minister has been working to try to alleviate that problem and it is very complex. Unfortunately, the problem is starting to spread to HRM. We have a medical clinic in Mineville that now has experienced difficulty getting a doctor. Now this was unheard of until just now. The patient load is increasing every day as the population increases in the area and we are having a real big problem getting doctors in the area. What programs are in place to assist someone in the area here, where there hasn't been a problem before for doctors recruitment?
MR. D'ENTREMONT: Mr. Chairman, I thank the member opposite for his question. What we are finding is that we don't necessarily have that doctor recruitment issue in the urban cores. Mineville, even though it is not so far away, would still be qualified by those in the urban core as being rural, you know, kind of. I know it is only five miles away but it is not in the core. What we are finding is that because of the availability and the proximity of a trained hospital, the availability of the university nearby, that some of the new physicians don't want to wander so far away from that kind of expertise to help them in their clinical decisions.
I think it really, in some respects, has a direct relation to the way doctors are being trained today. They need to have everything fancy around them. They work in a team, they work in a group. The thought of going to work as a private practitioner, a family practitioner, in a rural-ish area - we will call Mineville rural-ish - so we need to really focus on doctor recruitment as a whole. That's why I think we have this challenge in the more rural areas that we continue to talk about, why don't you spend more time and more effort on recruiting for places like Digby or spend more time on recruiting for places like Tatamagouche. What we are trying to say is, we are trying to be fair and even across the board in our recruitment strategies.
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Just to give you an idea on our physician recruitment lately, DHA, and we will talk about CDHA, there were eight family practitioners recruited in 2007-08, so you would hope that maybe one of those eight would end up in a community like Mineville. You can't necessarily force them to go there but maybe we need to find some kind of incentive locally for that area. There were 25 specialists recruited to the CDHA for a total of 33 physicians in last year alone. Out of those, there was one CAP physician, so one international medical graduate who came to the area.
So, again, it is just trying to be general for us and then you will have the district health authorities themselves trying to make that decision on where they would like to place those physicians. Maybe we should have a discussion with Capital District to see what their plans are for a community like Mineville.
MR. COLWELL: Yes, and I appreciate the answer on that. It's a serious issue and it's to the point that the community may be in trouble with not having enough doctors in that clinic down the road - hopefully that isn't the case - and the recruitment has been quite a problem. Fortunately for the area, the area is an incredible place to live and you're only a few minutes from the hospital so that is a bonus, but if we're having that kind of trouble in that community, we're going to have a huge problem in the really rural areas where it's not so close to things because a doctor today wants to not only be tied in close to the hospital, which is important, but also when they're not working, it's nice to be able to go to the theatre or do whatever else you want to do in your recreational time, and have everything available in a community like Mineville.
So it's a real and serious concern and one that hopefully doesn't become a long-term concern but just a short-term thing. So anything that we can do to help resolve that, I would appreciate it and I wouldn't mind talking to the minister about that at a future time when we're done this to see what we can do to help in that community. I can give you more details which I don't want to really discuss here.
MR. D'ENTREMONT: Again, thank you very much for that intervention and, as well, the other thing that we are seeing is that a lot of physicians who are coming to Nova Scotia to practice, of course, come with a family or come with a spouse and that spouse tends to be a professional as well, whether it be an accountant, whether it be an engineer, and sometimes it's very difficult for that spouse to find employment in a rural area. So maybe, you know, not necessarily specific to your instance, but maybe it's an opportunity in your instance as well that there are other options for that spouse as they come to practice here in Nova Scotia. So, thank you, and I look forward to that information and that chat.
MR. CHAIRMAN: The honourable member for Kings West.
MR. LEO GLAVINE: Mr. Chairman, I know we're moving along through estimates and I was in the Red Chamber when my colleague, the Health Critic for our Party was asking
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his questions. So I hope I don't engage in too much redundancy but there are some questions that I would like to put to the minister. First of all, I want to thank the deputy minister for the occasions through the past year, both at the Public Accounts Committee and also in correspondence and calls, for her promptness and frankness in the issues that I've raised with her and, as well, I welcome staff here today.
To start off with, probably the issue that is most pronounced in my own community of Kingston-Greenwood-Middleton and surrounding area, we know that the beds at Valley Regional and those that support them at Middleton and Annapolis have really experienced an enormous period of 100 per cent occupancy for some time. So in the last few weeks, to lose four beds on the medical ward at Soldiers Memorial has definitely caused some alarm in the community and among the staff at the hospitals, particularly the nurses whom I've spoken with. At this point in time, it definitely looks like a shortage of nurses, nurse fatigue and so on, that brought these beds to a closure. So I'm wondering if the minister could speak to that in the hope of returning those beds to active service.
MR. D'ENTREMONT: Mr. Chairman, welcome to the discussion on the estimates of the Department of Health to the member for Kings West. There are a couple of things going on in the Valley, of course, the redevelopment project at the Valley Regional I think will help with some of the pressures that we have been seeing across the Valley with the hospitals that we do have in there. More specifically, I'm trying to find, do I have it over here, I'm just trying to find the initiatives that we have in nursing that we talked about in the province.
We are adding new seats to our specific programs across the province so one issue, of course, is the availability of nurses to begin with, to staff the different hospitals and wards around our province. So we are working on an expansion of hospital seats specifically within this budget and I can't remember, I know we had a document with some numbers here, but anyway (Interruption) Yes, the nursing seats again. (Interruption) Okay, 70, there are 70 new nursing seats in the province. Oh, yes, right there, you should always look down below your nose, 70 new seats.
So just to give you a quick rundown of the schools and the nursing program that they have and the number of seats that they have, St. F.X., of course, has 125 existing seats. They will not be getting an increase this year. Dalhousie has 135 seats and they'll be getting 25 new ones, to be training 25 new nurses, for a total of 160. Additional negotiations- apparently we're just holding some spares over there of 24 for Dalhousie as well. Cape Breton will be getting an expansion of 16 nursing positions over and above the 50 seats that they already have today. Yarmouth will be getting an extra five, bringing their total complement up to 25. So we will be training, after this year, over 400 new nurses for work in our system. So I think that's a very important piece to maintaining these units in the province to make sure that they stay open.
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MR. GLAVINE: Mr. Chairman, I'll just try this perhaps another way. I'm wondering how long the minister and the Department of Health see these four beds as not being able to be in service, not to be able to be utilized, especially since they're also very, very connected to the daily operations at the Valley Regional in order to keep that facility operating as closely as possible to the regional requirements and the advanced level of care, mostly around secondary level of care that goes on there, because if you can't move patients back to Middleton, then it does curtail some of the work that can go on there. So I'm just wondering, is there a date when at least it's hoped to have these beds back in service?
[11:45 a.m.]
MR. D'ENTREMONT: Mr. Chairman, as much as I would like to have that detail for the member, I don't have it with me today, but what I'll do is I'll endeavour to either have it by the end of this sitting, today's sitting, or have it ready for him on Monday, to have an idea of what the planning is going around to replace either the nurses or supplement the nursing staff at Soldiers Memorial so that the unit can open because I can say that with the challenges that we've had with Soldiers, they're actually running at about 98 per cent occupancy. So they are a very busy hospital for the size. It's a great hospital within the Valley offering some great services. So we will try to get some information to the minister from the DHA about what the recruitment is doing and what they're planning on staffing in order to have those four beds available.
MR. GLAVINE: Mr. Chairman, knowing a good number of the staff at Soldiers Memorial and on that ward in particular, one of the things that comes to light in our smaller, perhaps more demographically-stable communities, you know, in our towns of 2,000, 3,000, 4,000, 5,000, we don't see tremendous amounts of in and out-migration of people. So what seems to be taking place there is that we have now, on a couple of the wards, many of the staff in their mid years or perhaps even older. I'm wondering if there's any connection with staff wanting to retire early, reduce the number of days and hours and the connection to the 12-hour shift. We all know, as people advance in years, having the kind of stamina, having the kind of mental acuteness that is required of a nurse - are there any studies to reference nurses working a 12-hour shift and whether or not termination of career becomes a factor?
I know that in many of our communities comparable to Middleton, we seem to have those who entered the profession 25, 30 years ago, are on the latter edge of the baby boom generation and now seem to all at once be there in their 40s, 50s and getting close to retirement and perhaps the wear out and the demand of the change to 12-hour shifts - if the minister and the department see whether or not, in some hospital settings, this may be an area that he would possibly have to visit and review.
MR. D'ENTREMONT: We did have a conversation around - especially when we talked about model of care, we talked about the issue of 12-hour shifts versus 8-hour shifts. I know a number of years ago when the government had tried to change that time and it was
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pushed back on quite a bit that the nursing staff did like working those 12-hour shifts. But I think that was a day when you worked maybe two 12s in a row and then you would get a couple of days off. That's really not happening today, so maybe there's an impetus for changing that model during our discussions.
To the member opposite, one that has really been enthusiastically received by nursing staff is the model of care change that we're proposing. We're proposing working with a group of clinicians, nurses, other HHR staff to look at how we're staffing units to begin with. How are we staffing the ORs? How are we staffing the emergency rooms? How are we staffing the wards?
Too often we find that nurses are sort of the catch-all on the floors. They're doing everything. They're filling out all the charts, filling out all the documents, doing some light housekeeping, doing everything on that floor. I think that's what's really contributing to the burnout. What we need to have is an investment of dollars in changing the model of care to make sure we have the ward clerks, make sure we have the cleaning staff and those pieces into this.
Just as we set up the project team for the model of care initiative, there are two nurses from Kentville who are delaying their retirement because they're so enthused about the idea of changing that model of care. I think in the end, by having nurses be nurses and ward clerks be ward clerks and making physicians be physicians, I think it will give the opportunity, on the recruitment side, that people will be generally happier and therefore it will be a much more attractive occupation to sign up for.
So, there are a number of things going on that I think will directly impact the operation of hospitals, just like Soldiers Memorial.
MR. GLAVINE: Yes, Mr. Minister, that does sound like a positive initiative. Hopefully, we can see some implementation and pilot programs, at least, move forward and at a time where, as you rightly said, if we can hold on to those people with the expertise and knowledge and who have made a wonderful contribution to the profession.
I probably will move back to that in a moment, around nurse retention. But the other glaring area, the media piece in our area, and it is not, I wouldn't say, a super-serious situation, but one that when it does take place, people ask questions, is with the X-ray machine down at Eastern Kings. We know that trying to reduce wait times in as many of our areas as possible is always the goal. Is this part of an ongoing look at equipment in terms of its function, a bit of an overhaul of the equipment? Is there a plan? Is it due to the age of this piece of equipment? Is this particular service, you know, well in view to be continued at Eastern Kings? If you could just give me a little bit of a status report on that, please.
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MR. D'ENTREMONT: Mr. Chairman, there has been a project ongoing, basically a recap of all infrastructure within the province - buildings, X-ray machines, the whole gamut - to have an idea of what the age of this equipments is, what kind of life expectancy is left in them and give us an idea to really, truly, plan a replacement of equipment on a priority basis. So that information is still being compiled right now, that we will have available to us. Ultimately, I think even just X-ray itself, we have a pretty good inventory of what we have, an idea of what we have that will be replaced. It's not insurmountable but it is still a large mountain to climb to get at that. We did talk about the capital deficiencies within the Department of Health, the pieces that are within our purview. We are up and above the $1 billion mark kind of thing when it comes to some of that equipment.
But, Mr. Chairman, I think with the Eastern Kings issue, I think it is something that we can look a little more closely at, for the residents of the Valley.
MR. GLAVINE: Obviously, since returning to the House, doctor recruitment, doctor retention, nurse recruitment and nurse retention have already been considerable topics here for us and probably will continue to be while we are in the Spring session.
The Valley area, and in particular I would say the western part of Kings County, when we look at current need in Berwick, there used to be two doctors serving the community of Aylesford, now there is one. We have had a collaborative practice set up in Middleton which seems to be being well received by the community but also, of course, a husband and wife team of doctors retired at the same time. So around recruitment, when you have in Berwick, for example, really a turnkey office and medical clinic available to a doctor, I'm wondering where that sits in terms of the provincial priority list and has your department worked with the committee that has been set up? I know that the site manager of Eastern Kings is on that committee and I know they have had a few people interviewed but, at this stage, again, Berwick is not at its complement of family physicians and I will reference the Greenwood-Kingston area a little later.
MR. D'ENTREMONT: Mr. Chairman, my chief financial officer assures me that Berwick is not up to its full complement of physicians as he hears that from his father quite regularly. I want to say that there has been a tremendous amount of work done to try to understand where our vacancies are and where we need to be focusing our time. There are, within the department, people who would be assigned to specific areas, so there is a dedicated staff member - not dedicated staff member but a staff member - within our department of physician services who would be working with the committee in the Valley, in Berwick and Aylesford, on that.
What we're finding now is that the collaborative practice idea, or at least working in a group, is much more attractive to some of our newer physicians. So I think we're finding difficulty in areas where there was sort of one doctor and trying to find another one doctor to fill that position is difficult because we don't want to take over somebody's practice and sort
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of work alone. So the success that we have seen is with people who have set up those primary health care clinics where there are, you know, two doctors or three doctors, and maybe a family practice nurse, maybe a physiotherapist could be showing up there, you know, to be a little more wholesome.
A really good example is the member for Digby-Annapolis and the success that they've had in Bear River and even not so far down the road in Annapolis with what used to be the Annapolis Hospital, it has turned into a wonderful example of a primary care clinic that maintains an emergency room, that maintains diagnostic equipment, but a number of professionals work together. I think we need to really continue to replicate those kind of models to make it more attractive to some of the newer physicians who are trained in more of those team environments. I think that might be the success that you guys might be seeking.
MR. GLAVINE: Mr. Chairman, one of the areas that we see a community, and a particular, I guess establishment within the community, taking somewhat of the issue in their own hands is at Greenwood. I've spoken several times here in the House, especially on estimates and also I think through Question Period, at least on one occasion if not two, on the number of military families - because they are transient - who come into the Kingston-Greenwood area and environs a little further afield as well, and find it very, very difficult to get a family doctor and so they're going to establish a clinic off base. I'm wondering at this stage if you are aware if - the DHA I would think would have to grant approval for that while it's linked very strongly to the military community.
The base commander at a recent event made this announcement which, again, is a hopeful piece and that is that they would be, perhaps maybe even involved in their own recruitment, but that they would be looking at setting up a clinic and it would, first of all, be for the families of military personnel. Any ex-military families who lost the family doctor in recent times due to retirements would have access to it and they would look at, you know, a profile of around serving 2,000 patients, which I guess is probably an average for a family physician or a little bit larger. So I'm wondering if DHA approval has been given for that, is the province involved in recruitment or is it going to be the military community that will do the recruitment?
MR. D'ENTREMONT: Mr. Chairman, to the member for Kings West, I'm not really sure if, well, I know that approval from the district health authority is not required, but I would suggest that there is probably some collaboration going on there because even with the clinic on base, there would be a relationship with the district health authority for minor diagnostics and those kinds of things that cannot be done at the clinic on the base. So I would welcome the opportunity to have that kind of relationship continue to expand.
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[12:00 Noon]
Do you know what? We've seen, over the last year, a much better appreciation and better openness from our Armed Forces to look at the communities that they're in and the communities that they serve in the provinces that they're in. Just recently, we talked about the opportunity to use the Stadacona Hospital to do some minor procedures where we had a great opportunity there. I again thank the rear admiral for his foresight on this one to let us try that. I look forward to an agreement where more Nova Scotians can actually use the facilities.
Mr. Chairman, regardless if it's a DND hospital or if it's a provincial hospital it really doesn't matter because at the end of the day the taxpayers are seeing the dollars come from the same place. It is all our infrastructure anyway so there's got to be better ways to do things. Really, the crunch in doctors and services and those kinds of things really make us look in different ways. If there's something that I can do to help that clinic along for that area I would be more than willing to visit with the member opposite and see what kind of helping hand we could give to open up a primary clinic like that.
MR. GLAVINE: I appreciate that response and offer of support as it moves forward. On the nursing retention area I'm wondering if I could have a little bit of an overview of any statistics that have been gathered in terms of when a nurse graduates from Dal or St. F.X. or CBU and they come to one of our hospitals in the province, do we have a picture of how long they'll remain in that first posting? I know that one of the suggestions or one of the areas that has been brought to my attention is that Valley Regional seems to have a turnover of 20 nurses or so each Spring. I'm just wondering if there's something more that the province can be doing in terms of retention of nurses.
At this point I haven't spoken with the Nurses' Union on this particular issue but young graduates, and especially those that are recruited from out of province, it's like they try on the hospital, they try on the community, and again having to recruit on an annual basis fairly heavily to fill the required positions. We know that the daily demands in our regional hospitals are pretty extensive. We've heard from the South Shore recently that they are running into a real crunch around having sufficient nurses. So I'm just wondering if there is anything being developed or in place to try to retain nurses that we do recruit from our province or inter-provincially?
MR. D'ENTREMONT: Mr. Chairman, speaking quickly to the issue of trying out a hospital, the member opposite is quite right. What happens a lot of the time especially from individuals who come from outside, in this specific cases nurses, they come to Valley Regional for instance because of its rural nature, but I think they find out that it's probably our third most complex hospital in the province. It is a very busy hospital, they are seeing some very sick people, they are providing some very complex health care. If that's not what you thought it was then people tend to go somewhere that they can find a slower pace or what have you.
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So that's the challenge we have getting people from outside or a different area to work in a facility like that. What we're also seeing though, especially the experience in Kentville at the Valley Regional, is that those nurses that had time to train there, that have done their clinical experience at that hospital, stay at that hospital. So we need to do more than that and I think by the expansion of the seats for the nursing program that we'll have a better opportunity to have that co-op experience happen and get them to all hospitals. I think at that point when they're still students you can start putting your fingers in and try to grab them and get them to stay in those kinds of facilities.
To speak to more specifically the current nurses' settlement, the Nurses' Union settlement has a number of initiatives in it for the recruitment and retention of nurses.
Just to talk about some of the retention, long-service increments after 25 years of service, they get another 3.5 per cent; retention of potential retirees, a 2 per cent bonus payment for fulfillment of a 12-month commitment after retirement eligibility; retired nurses incentive; nursing leadership in our practice practicums, up to a $600 premium for each program; an 80/20 trial that the NSNU is doing, sort of changing that temporary, regular, full-time positions of 80 per cent in clinical practice and 20 per cent mentoring; innovative shifts, so we are trying to look at that shift composition to see if there is a better way to staff the floors.
There is like cost-sharing of health benefits for retired nurses and for voluntary reduction of appointment status from full-time to part-time, re-entry of retired nurses, creation of receptor pools for mentoring, job sharing. These are things that we really didn't necessarily have in our hospitals for our nurses. I think there was a lot of thought and a lot of work that went in on behalf of the Nurses' Union and was accepted by government during this last round. I want to thank the Nurses' Union for their dedication, for their membership in getting some of these things that are very important to all Nova Scotians.
MR. GLAVINE: That gives an overview of some of the areas that hopefully will be implemented and we will perhaps retain nurses longer who come to the Valley Regional and any of our hospitals across Nova Scotia.
Before I forget this thought - because I had brought this particular issue to estimates and also here, through Question Period and through press releases, as the minister well knows, along with my colleague, the member for Digby-Annapolis - and that is the issue of the emergency ward in Middleton. I am very pleased to say how well that issue has been addressed. It was a very difficult one for us because lots of times people had to find out by way of the radio, because some occurred within a relatively short period of time, without a long advance notice. I don't know whether it is a model that can be used in other hospitals, but the assignment of a doctor who has been going through training as an emergency room doctor, or has some in his background but is continuing to upgrade but responsible for the scheduling, the filling in, and I'm just wondering, was this a little bit by design or did it just
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happen in terms of a doctor in the area, in relation to the military, or whether or not it is something that you have looked at where, in our small or rural hospitals, where the emergency ward, again, without a lot of family doctors, remains a very busy place and a very high rate of service on a daily basis.
So I wanted to acknowledge that. If the minister wanted to make any comment to that, fine, but I just wanted to acknowledge that the service has substantially improved. I know I had to write the CEO in the area and the hospital board about a couple of cases that were very disconcerting when patients arrived at Soldiers Memorial Hospital and, of course, the emergency room was closed. If you have come from the east to the west and then had to go back to Kentville, you have lost a lot of time. We had a couple of difficult cases outside of an ambulance transport. So I just wanted to say, that is part of a good news story. I don't know if it is a model that you are actually looking at or was it more by circumstance that it happened?
MR. D'ENTREMONT: It's good to hear of successes in emergency care in this province. I think in Middleton there was an appreciation for trying a different model.
What I've said in the past is there's no cookie cutter solution for any of these emergency rooms and trying to keep them open. I think what happened there is that there was an appreciation from the community, an appreciation from the DHA to sort of open it up a little bit. I think that we need to look at the successes of places like Middleton but, at the same time, I don't know if that kind of solution would work in a place like Digby. I don't think it would. So we need to find that true solution for Digby.
Anyway, it's good to hear that it worked. I think there's probably a little bit of luck involved in it but I think it also has to do with the perseverance of the community, of its MLAs, of its district health authority, to make a solution work.
MR. GLAVINE: Thank you, Mr. Chairman, and thank you, minister. One of the areas, of course, that remains a troublesome one, not only in this area but across the province, is the long-term bed conundrum. We know in relation to that this year, Code Purple was in order at Valley Regional for several weeks in succession.
We're reaching now, perhaps, even a point at the manor, the Berwick Manor which is, again, an outstanding facility that is going to be looking at some renewal.
In our area there are 50 long-term care beds planned for Middleton but we may actually see, then, the closure of one of the current facilities in Annapolis. So therefore, there may be no net gain for beds. I know that the department has been doing some inventory of the Valley region and, as I've mentioned on a couple of occasions in this House, the demographic in our area - we're in, I guess, an advance area of what's going to happen to a similar degree across the province when we have the number of communities that have a high percentage of
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65-plus and we know that demographic is, in fact, accelerating its impact on the heath care and the need for long-term care beds.
So as going forward to try and deal with that need and also one of the elements in reducing the number of beds at Valley Regional that are occupied by those awaiting long-term care placement, can we see some possible alleviating of that critical situation in our area?
[12:15 p.m.]
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. As the member opposite alludes to, and I think he's quite right in his assumption, that this first round of 840 beds really revolves around equalization, making sure that all districts in all areas of the province are represented with long-term care facilities or beds equally.
If we look at the deficiencies that we had in Colchester-East Hants, it was phenomenal. There were really no long-term care facilities in that area, and that was sort of repeated here and there across the province. So even though the Valley itself did not necessarily have a big introduction of beds, Kentville did get a 62-bed facility so that will sort of spill over into the different areas of the Valley. At the same time, different areas will be looked at during the second round, which will be increasing that number to make sure that we have the available beds for 10 per cent of the population over the age of 75. That's sort of the overarching ratio that we've been trying to adhere to across the province.
Just to be a little more specific to the member, currently in the Annapolis Valley District Health Authority, there were 58 people, as of March 7th ,waiting in hospital for long-term care placement. In September 2007, there were 88 people sitting and waiting and as of March 5th this year there were 72. So we have been able to drop that number down and we hope to continue to drop that down even further.
The other issue, of course, is the beds, the actual acute care beds in Kentville. Apparently, as far as I understand, 14 of those 21 new beds that they are constructing, 14 of those 21 beds are in service today. We'll look at those extra seven beds which will come on line, I believe, in September. So again, there are some real incremental changes that will continue to happen, so Code Purples and really being too tight will stop happening in places like the Valley.
MR. GLAVINE: Thank you, Mr. Chairman. Obviously, related to this whole issue is home care. It's one of the pieces that again I've talked about during estimates and here in the House on a number of occasions. I'm pleased to say that, again, we've had some improvement in our area and I don't mind going on the record to say that the new supervisor or CEO in our area, John Dow, has done a very credible job with trying to improve home care on a number of fronts and, in particular, making schedules work a lot smoother.
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However, one of the areas that has been talked about at our board and MLA meetings and when we have all the MLAs from the Valley get together with the CEO, they seem to be comfortable with the idea of devolution to the DHA and I'm wondering if the Department of Health is looking at preparing or agreeing to at least pilot one of the areas that has been very troublesome for, I think, the delivery of home care in the province. Kings County has had many challenges. There have been recent improvements and I'm pleased to say that because the beneficiaries are the seniors who are getting more timely care.
It's an issue that I would prefer I didn't have to bring to the House and bring to the Minister and Janet Knox in our area, but I'm wondering if there's still some thinking and if that's a logistical change that the department is still considering,
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I'm very happy to tell the member opposite that we will be devolving home care services, long-term care services, to the districts as soon as we can. That has been an announcement that we made when we talked about the recommendations of the facilities review of the transformation document. So that is ongoing.
There is a team that has been set up to help that transition happen. Of course there are some ongoing discussions right now with the unions, those individuals sit in and discuss how that transfer is going to happen and how those benefits are going to transfer and all those questions. So that is something that will be ongoing, which I think, from the discussions that I have with my district and I'm sure you had with your district, the talk about that continuity of care through these systems would be better managed if everybody sat in the same room rather than one DHA, one Department of Health, somebody doesn't work on the weekend - anyway, it was a bit of a mess. I think, if we can make things a little more efficient, a little more understanding, I think we'll go a long way.
Another thing that I think is going to benefit seniors and their waits and being able to keep them at home longer is the addition of 400 daycare seats, basically 400 adult daycare seats that if you are taking on the task of taking care of mom, or dad, or an aunt, or what have you, that you'll be able to bring them to one of these adult daycare centres. They'll be able to get the recreation and the type of engagement that seniors would need in order to keep them healthy and be able to give the caregiver some time to do other things rather than spend all that time with their parents or loved ones. So I think that's a big issue that's going to be very well received in the communities. There's 400 for the province and I forget what exactly the breakdown would be for Valley but I know Valley has a proposal before us for this as well.
I can say that we've been making some steady improvements in home care wait lists in this province. There are two really bad ones. Valley, I think, would probably be the worst one for a time to get service but the biggest number, of course, is for us here in Capital but that's I think a function of the population base. Just to give you an example, waiting for home care services in the Valley was 180 as of February 2007. In October 2007, that number had
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been brought down to 164 and the number of clients waiting today, or as of March 2008, is 116. There's partial service being delivered to 89 of these wait-listed clients in the district. So there are some steady improvements being made.
The best example that I have is really in the Colchester-East Hants area where they had a wait list of 68. It went up in October 2007 to 88 and today they have no wait list. So, you know, I think it can be done, to get the professionals trained up, get them working, get them out in those communities and provide home care services to our seniors, and that is, I think, way better than the services of a long-term care facility. There are people who don't need to be in a long-term care facility and they would rather be at home and we need to have and continue to expand on those kind of services. Hopefully, we can make those steady decreases in wait times for the residents of the Valley.
MR. GLAVINE: Perhaps, Mr. Chairman, if you could inform me as to the time remaining?
MR. CHAIRMAN: The member's time will expire at 12:33 p.m.
MR. GLAVINE: Thank you. One of the areas recently brought to my attention was that of mental health delivery at the community level. It was brought to my attention by a Department of Justice worker, obviously a case worker who would have clients who are in need of mental health counselling, mental health professionals, and the issue that was brought to my attention was that many of the providers in the community level of mental health are also in private practice.
So they're in private practice, they also serve in the public domain as well. They are finding that having a client who needs some help, who's going through the public service - in fact, people who in October, November, wanted to get those services, have not yet been supported and have not had their cases brought forward, but knowing that people who were going through the private delivery were much, much quicker and I'm just wondering if this is an area that is problematic across the province and what kinds of ways is this going to be addressed by the Department of Health?
MR. D'ENTREMONT: Mr. Chairman, there are two things that we're trying to do when it comes to this issue. Of course, the increase that we're seeing this year of $2.8 million for Mental Health Services, which will increase the services for the ACT program - the ACT program, I believe, is the one down at the train station that is seeing youth at risk. The other component of that $2.8 million will be going directly to the community mental health clinics which, I think, will mostly go for staffing so that we can actually see the individuals as they need help.
The other piece that we are investing in, of course, is the addictions' realm, we are adding dollars to the addictions programs across the province. I forget exactly the dollars
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attached to that. There are $26 million that are going to that, which is an increase of about $3 million. They are small steps, still, but I think they are steps in the right direction.
MR. GLAVINE: Mr. Chairman, just a couple of other areas to touch on as my time is winding down here. One of the issues that I brought to the House was the question relating to breast reduction surgery. I know that the department has made some changes in the criteria. However, it continues to be an issue for women across the province. I don't like to bring individual cases here, but, again, I have had a couple of others, recently, come to my office with this.
One of the related issues, and I know that currently there are still studies that are going on, research around this area, but, again, the linkage of body tissue, the amount of breast tissue mass and its relationship to cancers is now being well established. Across the country, we have lower criteria in place in eight other provinces, one other is similar to Nova Scotia and there is one province that does not place criteria on getting breast reduction surgery. I am wondering, how often are the criteria reviewed? Also, in the most recent case that I have approached the deputy minister with, her doctor had appealed twice for breast reduction surgery and my awareness of her need is extreme and I'm just wondering, now, with the health linkages, is there room for, again, an appeal to a body that can give perhaps more objective analysis as to the need that may arise?
[12:30 p..m.]
MR. D'ENTREMONT: Mr. Chairman, maybe I will talk a little bit about mental health and addictions just to finish off that train of thought and then we will talk about breast reduction afterwards.
Just basically for the member's interest, DHA3, which, of course, is Annapolis Valley, will be getting an increase in mental health of about 5.9 per cent, which is another $365,000 to their budget. So there is going to be, I would say, some significant improvements in mental health services for the Valley. The other piece - there are outpatient clinic expansions for CDHA and IWK which will have impact for residents around the province, of about $550,000 to address those community wait lists that we are having today.
The issue of breast reductions is one that is difficult because there is such a varying list of the reasons why or why not to fund or not fund. If we look across the country, the specifics are all different. If you could say that it was just an issue of grams, so the removal of X amount of grams constitutes funding and less than that, it does not, or if it has to do with back pain, shoulder pain, et cetera. I think it is a very difficult one. I know when we reviewed it from your discussion, your urging, we were able to drop the requirement from 500 grams to 400 grams, yet it still left a lot of the other pieces in place.
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Quite honestly, we could take restrictions completely off and really all it would end up doing is just make the wait list longer because we have only a certain amount of surgeons who can offer this type of surgery. So it is, do we or do we not do it.
I don't think there would be a huge cost impact but I know that individuals who are waiting for breast surgery today do wait an awful long time. I don't know exactly what that wait list is, but some people that I've talked to wait for up to four years to get through that whole system, to finally get their breasts reduced.
So, I think we'll continue to review it as it goes along but again, there's such a discrepancy amongst provinces on what is funded and what is not funded, that it's a difficult one to really grasp.
MR. GLAVINE: I think I'm just down to a matter of seconds so rather than get into a question today, I'll wait until the next opportunity and I wish to thank the minister, the deputy and the staff for being here today. Thank you.
MR. CHAIRMAN: The honourable member for Halifax Needham.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman, and welcome to the deputy minister and the staff from the Department of Health. I'm pleased to have an opportunity to raise a few issues with you. This is always a great opportunity to talk in greater detail about concerns that are on the minds of the people of Nova Scotia and health care is always top of mind. I think we would all agree on that, no matter what disagreements we might have about other aspects of health care provision, that it's the most important area for most people.
In the news in the last little while, we've all, I think, observed with a fair amount of shock and concern the situation in Newfoundland and Labrador, the public inquiry that is occurring there with respect to the accuracy of diagnostic testing. It's not peculiar to Newfoundland that these problems are occurring. The question of the accuracy of pathologists' testing is now a topic in several other provinces as well.
I want to ask the minister if there have been any concerns here with the accuracy of our testing in the Province of Nova Scotia, in any of the DHAs or the IWK and I also want to ask what quality assurance controls are in place to assure that we are getting the most accurate diagnostic services and also what protocols does the Department of Health have in place, that if there are inaccuracies identified, that patients will be informed of this in a timely manner and that the public will have that information?
MR. D'ENTREMONT: Thank you very much, Mr. Chairman. I welcome the member for Halifax Needham to the estimates of the Department of Health and I look forward to the next hour or so of discussion of health care in this province and more specifically to the HRM.
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I know that she'll probably be talking about some mental health issues and, of course, some clinic issues that do affect her riding.
When it comes to pathology in this province, after the nightmare, I guess you could call it, in Newfoundland and Labrador, we did ask a number of questions about our pathology program here in the province and we have been assured by the College of Physicians and Surgeons, we've been assured by our pathologists - we do have a larger group of professionals, very well-trained professionals, who do work collaboratively - that we would not see the impacts of Newfoundland because of the way they do practice.
I think really the reason is in Newfoundland and Labrador they really worked alone, there was no quality control put on their work. Here in the province, again, they work collaboratively, they do check each other's work and do those kinds of things. So I'm very comfortable in saying that our program is probably one of the better ones in the country and we will not be seeing the kind of incident that happened in Newfoundland and Labrador.
MS. MAUREEN MACDONALD: That certainly I think is an important reassurance for all of us. I remember, I think it's quite a few years ago now, Mr. Chairman, and it was a very different issue, there was an individual at the IWK who got into a bit of trouble. I think it was identified after he had left the country but nevertheless I think it is very important that we have these reassurances.
I want to turn my attention to another matter that I'm sure the minister and his staff are aware of and I would like to explore what, if anything, the department will be doing with respect to this situation. On March 19th - and I will table this - a cardiology resident at the Queen Elizabeth Hospital wrote an opinion piece in The ChronicleHerald with respect to the concerns that he and his colleagues had around the serving of fast food in the facility at the Queen Elizabeth II Hospital.
As the minister would be aware, young people from Citadel High were leaving the high school and coming over to the hospital to get fries and Timbits, and what have you, and he and his colleagues had staged a bit of a demonstration at the end of February. They had left the hospital and gone to the cafeteria over at the high school to get a healthy lunch. He and his colleagues, and since he wrote the op-ed piece, his name by the way is Dr. Rob Stevenson, and his colleagues, two nurses, have written letters to the editor, Gillina Yates, a nurse practitioner, and Jacklynn Humphrey, a dietitian, encouraging the Capital Health Authority and the hospital to practice what they preach, to deal with this issue, to have more healthy food in their facility.
It's interesting that they brought this forward. It's an issue that certainly other people have raised as we've seen a more commercialized element in our hospitals and the pressure on these facilities really that has been generated by government itself to get DHAs into the business of cost recovery, looking for alternate funding arrangements, looking for ways to
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generate revenue. One of the ways that our health care facilities have looked to generate revenue has been charging fees for parking in the parking lots. They have eliminated quite a few of the cafeteria services that they had in the past and they've replaced them with franchises, you know, Tim Hortons, Robin's Donuts, or what have you.
So the end result is that you have these cost centres now in our hospitals but the dietary choices at these cost centres are really quite a strong contradiction to what most of the medical professions who are trying to deal with disease and illness have to cope with. So given that there is this contradiction that these young medical professionals have made so visible, what is the Department of Health intending to do to address that issue and hopefully it's not more study? I don't think this is something that really needs to be studied.
MR. D'ENTREMONT: No, if I had to say "study"one more time, I tell you. This is an issue that even though I have been to the hospitals and I have actually gone and grabbed a pizza, when you really think about it, you don't think of the overarching issue. When we built the new high school, I don't think we realized students would probably hop on over and go serve themselves of the unhealthier foods there.
So we do need to address that and what we have done, through the committee of CEOs, is bring in of course the individual who is responsible for healthy eating, to have some discussions with the district health authorities so that they do make better food choices. I think, in respect to the Capital District Health Authority, I believe they have a number of contracts that they need to get out of in order to get them off site. I know they are looking seriously at getting rid of those unhealthy foods so that we can offer the more healthy pieces from their cafeterias. So there is work going on right now and I will report back to the member and to this House when that change has happened.
MS. MAUREEN MACDONALD: Does the minister have any idea how long it will take to get out of any of these contracts, and are we looking at this occurring in the IWK as well as at the Capital District and will it apply to DHAs perhaps in other parts of the province that have similar arrangements?
MR. D'ENTREMONT: No, this discussion happened with all CEOs of all districts. More specifically, I don't know the specific contracts that the district health authority would have with the service providers or these food suppliers, though I know there probably would be some kind of demonstration that would happen on behalf of Tim Hortons drinkers if we ever pulled the Tim Hortons out of there. So there has to be some kind of discussion. I know I was there the other day, and I think I drank two coffees from Tim Hortons. So we need to find a balance there, too. I think if we have, in the food-court-type setting, those healthy choices there, and only the healthy choices, I think we would go a long way in helping the families and the individuals who are in those hospitals.
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MS. MAUREEN MACDONALD: Mr. Chairman, I certainly, being a Tim Hortons connoisseur at times myself, would hate to see Tim Hortons entirely disappear - but, absolutely, I think you do need those choices.
I want to ask a few questions around the issue of wait times and information about wait times. I note that in February of this year, the province received additional money for two pilot projects in Nova Scotia with respect to patient wait times guarantees, and I know that one is with respect to building a strong province-wide information network with respect to orthopaedic surgical services.
[12:45 p.m.]
Now I want to ask questions about this particular pilot project and the stage at which it is operational right now. I want to offer to the minister and staff several experiences that I have had in my constituency office where individuals have contacted me, as their MLA, because they have a family member in a great deal of pain, lengthy waits, and they are beside themselves. They are looking for advocacy or they are looking for advice from me, as their MLA. It is difficult in terms of we are all very clear that queue jumping, for example, is not an acceptable practice or part of our system, yet we want to offer people who feel quite desperate - by the time they get to my office, if they are looking for help with their medical situation, they are desperate. That's how I look at it.
So I want to offer some good information about how they may advance their own health care. I tend to say well, perhaps your surgeon is a surgeon who has an extraordinarily large clientele and there may be a surgeon somewhere else in the province who has not as great a wait list. Yet there is no possible way that I, or any layperson, can get access to that information. You end up having - I have had constituents, they have had to go back to their family doctor, and their family doctor has to attempt to do the research and find out, make referrals, and it's an extraordinarily cumbersome process. The information isn't there and I think that for people who persevere, and by luck or by contact and good connections - if they have a family doctor who is really well connected, he was in med school or she was in med school with somebody else who is married to an orthopaedic surgeon in New Glasgow, then they can maybe get them in quicker.
This is not right. It's just not acceptable that people aren't able to find out what the wait times are, what they are for the different surgeons in different parts of the province, and they can go to a Web site, get the information, ask for a referral and be referred.
So I am wondering, is this what is anticipated? What exactly is this pilot project going to do to facilitate the fair access to information for people who are attempting to improve their own health care situation as they wait for unacceptably long periods of time on lists, quite often here in the Capital District?
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MR. D'ENTREMONT: Mr. Chairman, if I may just take a second to do a quick introduction of a couple of people who are in our gallery?
MR. CHAIRMAN: Please do.
MR. D'ENTREMONT: I want to welcome Leslie Porter. Leslie is, of course, the much better half of our member for Hants West. I want to say hi to her. (Applause) I also want to welcome my better half, Anne, who is up in the east gallery as well. (Applause)
So, going to my answer - wait times is a complex issue because the system is designed in such a way to be complex. There are so many practitioners, so many diagnostics and it is very difficult to navigate through that melee of services.
What the $8 million that we received from the federal government - and I thank the Honourable Tony Clement for his input and his help along the way on this one - we have two pilot projects or two basic projects that are in that $8 million. In that $8 million is the diagnostic imaging project, which will help family physicians order tests. That program, which has been designed by radiologists and actually by the Canadian Radiological Society, will look at the specific test, the specific ailment and actually suggest the kind of test that the patient might need, and by correctly identifying the type of test that person might need will stop just basically blanketing all of the tests and thereby cutting down costs and speeding up the service for patients. So that's the first $4 million.
The second $4 million is basically the development of an orthopaedic portal. The orthopaedic portal really has to come after the assessment clinic. So let me step it through a little bit here - through a partnership with Bone and Joint Canada and looking at a project from Calgary, there is basically an assessment clinic that is being created here that physicians will end up referring a person requiring orthopaedic surgery or some kind of orthopaedic question - you know, they might not need surgery after assessment. Send that person to that clinic, they will be assessed by maybe an orthopaedic specialist, maybe a nurse, maybe a physiotherapist, and then they can identify the correct type of treatment that this patient might need.
The examples that we're hearing from the Calgary experience is that that has almost knocked down the wait list - not only knocked down the wait list, but the requests for surgery are by about half because it's speeding it up. I mean, right now if you're waiting two years and maybe all you needed was a knee scope at the start, you will need the full knee replacement by the time the two years gets around. So, you know, if we can do this more speedily we can get the more appropriate service for them. So by investing in that wait time or within that orthopaedic assessment clinic, I think it will make a big difference for the patients because that's something you can understand. You can understand that you're being referred to the clinic and the clinic will give you those directives and treatments for the next step, but right
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now the family physician is basically referring you off into the grey area and you have to wait until you get that phone call some day by the specialist - and that's not acceptable.
Also - yes, just a note from my deputy here that that clinic is for pre and post - so after your knee replacement, after your knee scope, after physiotherapy, you continue to contact and work with that clinic on your joint problems that you might be having. Anyway, after that step, once you get referred on, then you would be able to sign on to the orthopaedic portal and that would give you up-to-date information on where you are in the wait, and that way you can start planning - all right, my wait is eight months and then you know where it's going.
Depending on emergency surgeries, whatever it may be, you know it could be a little longer, it could be a little shorter, but at least you would have an idea. Right now there's no appreciation for that, it's all of a sudden you get a call out of the blue and you're scheduled for three weeks down the road or something like that. That's not fair because you can't plan for that because if you get a knee replacement, or get a hip replaced, it's a number of weeks of physiotherapy and getting training and getting ready to go back into your community. I know my deputy has had that opportunity twice now - I think two hips? Yes. So it's quite an operation and quite a recuperation that goes with it.
The other thing that we're doing for wait times is we're putting in, in each district, a wait time coordinator, a person who can help patients navigate through this maze of services, and hopefully they won't be coming to our MLA offices and saying, well, I don't know where I am, and then we have to sort of call through to ten people to try to figure out where the heck they are - these wait time coordinators will have that information available to them.
So there are basically three initiatives going there on orthopaedics alone.
MS. MAUREEN MACDONALD: That's very helpful. How will patients get to a navigator - what is the referral process for that?
MR. D'ENTREMONT: Once we get them deployed to all the districts, we'll advertise the availability of these coordinators and then you as public can contact these wait time coordinators and they can work with your file. So it would not require the referral of your doctor to a wait time coordinator - those wait time coordinators are there for all people within our system.
MS. MAUREEN MACDONALD: Thank you very much, that's very helpful. It's interesting that you give the example of people needing some time to prepare. I had an individual in my constituency that I wanted to use as an example, not specifically to get any intervention for him because it's now long past what's required, but it was a very good example I think of where we have a need to do something. I'm not entirely sure what, but this individual is a person with a disability and he's in a wheelchair, and has been for quite a long time, he still has upper body strength and he moves himself in and out of his chair mostly with
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his arms and he has developed carpal tunnel syndrome quite badly in is wrists. He was for some time now - quite a long time - waiting on wait lists, waiting for surgery on his wrists and he was contacted on a Thursday and told that his surgery was going to occur the following Tuesday, as day surgery.
He was very happy about that, but then he ran up against two problems. Number one, of course as a person with a disability he needs to get transportation through Access-A-Bus and they need a two-week period to schedule an appointment; and the more difficult problem was that he would require home care after he came home, because after having the surgery he wouldn't be able to get himself in and out of the bathroom, prepare for bed - any of these kinds of things that he normally would be able to do.
Because there was no home care arranged - and home care isn't arranged in advance of going into hospital, and my office was informed that there was probably a minimum wait of two months to get him home care - he had to cancel a surgery that he had waited for, for 14 or 16 months, and start all over again, and with no assurance that anything would change.
When he contacted our office, we knew the Access-A-Bus problem was going to be there, and I said look, we will make funds available for you to get a private taxi - there is a service for people with disabilities here in the city - but around home care, there wasn't a thing that we could do. We spoke with his family doctor who said it was not their responsibility to make these arrangements, and we spoke with the Capital District Health Authority and they told us that they can't do these things either.
So it was very frustrating. You know he hasn't had his surgery, he's on a list and it may be a bit of a unique situation in that he is a person with a disability, but nevertheless it just seems to me to be unacceptable that somebody would find themselves in this situation. So would this be a "navigator" kind of situation?
MR. D'ENTREMONT; Mr. Chairman, I think some of that could be helped out with the addition of a wait time coordinator, to try to coordinate these other services that need to be available for a patient. It also really underlines the issue of transformation in primary health care - everybody should know what's going on.
[1:00 p.m.]
The person scheduling the surgery should have known that this individual needed home care - so knowing full well that home care is not available in four days, they should have been able to work out their lists and made it more appropriate for this patient. And that's why we need to change. Even to a physician who says well, that's really not my responsibility - well it's everybody's responsibility because we need to be there for the patient. So I think the wait time coordinator will be a big addition, a good help to the system.
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Ultimately we need to transform, and that's why devolution of home care, I think, is important, so that schedulers for surgeries know in advance what the home care wait is going to be, and try to put them together. I think that would make a huge difference in helping our patients like yours.
MS. MAUREEN MACDONALD: Mr. Chairman, that brings me to my next point, my next question, which is about scheduling of home care. I think if there's one complaint that we hear as MLAs with respect to home care - beyond the long waits for home care - it's how it's scheduled and the unpredictability of scheduling, I guess.
It's frequent for some recipients of home care services that they see quite significant changes in any kind of routine scheduling so that some days they may get a home care worker, generally I am talking about nursing, nursing home care, coming in the morning but sometimes in the afternoon, sometimes not until late in the evenings. I am wondering what arrangements the department has with the various home care providers, the VON and what have you, to support them with technology and training with respect to scheduling and then quality control over the actual services that are provided.
MR. D'ENTREMONT: Mr. Chairman, this is one that we have been dealing with for a number of months now. In specific, really building around the home care services of Northwood, Northwood home care services. Not so long ago, we were in contract negotiations with the workers for home care. Basically, the Northwood contract, we had an issue around guaranteed hours for the workers. This is a service that is very difficult because you have a group of employees, of service providers, who doesn't match the number of need. We are trying to spread these individuals out across a city and across a number of different patients. We need to try to have the best system that we can put in place.
The Northwood contract, I think, has taken some appreciation for this to try to be consistent with patients. If you are going to be 9:00 o'clock, show up at 9:00 o'clock and try to be at 9:00 o'clock every time rather than giving the call and being there.
Some of our service providers, though, don't have any necessary policies that help patients out this way. It's a service and we show up when we show up and that's not acceptable. We need to make changes to that and I think there is an appreciation now that these policies are being developed.
MR. CHAIRMAN: I understand there is an introduction.
The honourable member for Dartmouth South-Portland Valley.
MS. MARILYN MORE: Mr. Chairman, on behalf of my colleague, the MLA for Dartmouth North, I am very pleased to welcome the law class from Dartmouth High School
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and their teacher, John Nimmo. I would ask fellow colleagues in the Committee of the Whole House on Supply to give them a warm welcome. So, yes, please rise. (Applause)
MS. MAUREEN MACDONALD: Welcome to our guests in the gallery.
Mr. Chairman, that is really reassuring. I think that for people who rely on these services they, too, sometimes have other things going on in their lives, other appointments and things. So the scheduling and having some predictability around scheduling is very important, especially when these services are delivered in somebody's home because there is an element of privacy and what have you there. We all sort of view our homes as our domain where we are the top dog and it's hard to have people just popping in and out at will sometimes, even if they are providing us with a service that we really need and we appreciate.
I know many people in my constituency appreciate their home care services and providers but they are wanting to have some regularity in the scheduling. I know they very much appreciate when they have the same care provider over a period of time, too, because that person gets to know their condition and their needs. Like a family physician who has known you for a period of time, you develop some trust in their ability to care for you and their knowledge of your condition and your needs.
I know my time is about at an end here. I wanted to take an opportunity to thank the department - I'm assuming the department has provided funds for the recent campaign around transplantation and the need for Nova Scotians to sign their organ donor cards. There are several hundred individuals in this province waiting for various kinds of transplants and it's very important that we continue to encourage people to be organ donors. There's no greater gift than the gift of life, so I did want to thank the Department of Health and I'd like to see that continue. It has been a concern of mine that resources hadn't been allocated maybe in this way for some time.
MR. CHAIRMAN: The time allotted for debate in Committee of the Whole House on Supply has now expired.
The honourable deputy Government House Leader.
MR. CHUCK PORTER: Mr. Chairman, I move that the committee rise and report progress.
MR. CHAIRMAN: Is it agreed?
It is agreed.
[The committee adjourned at 1:07 p.m.]
