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HALIFAX, MONDAY, SEPTEMBER 28, 2009
COMMITTEE OF THE WHOLE HOUSE ON SUPPLY
5:28 P.M.
CHAIRMAN
Mr. Gordie Gosse
MR. CHAIRMAN: The Committee on Supply will now be called to order.
The Acting Government House Leader.
HON. WILLIAM ESTABROOKS: Thank you, Mr. Chairman. It's good to see you in the Chair as we begin estimates. Could you please call the estimates for the Minister of Health and Minister of Health Promotion and Protection, Resolutions E11 and E12.
Resolution E11 - Resolved, that a sum not exceeding $3,422,276,000 be granted to the Lieutenant Governor to defray expenses in respect of the Department of Health, pursuant to the Estimate.
MR. CHAIRMAN: I will now invite the Minister of Health to make some opening comments, if she so wishes, and also suggest that the minister introduce her staff to the members of the committee.
The honourable Minister of Health.
HON. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. Good afternoon. I'm pleased to be here today to discuss the budget for the Department of Health for 2009-2010. Earlier, the Leader of the Progressive Conservatives made some comments that she was looking forward to having an opportunity to ask questions. When she made her comments she said this is the role of our process to examine the financial plans of the government, department by department. She welcomed an opportunity to participate in this process. I, as Minister of Health, welcome an opportunity to respond and to talk about the financial plans of the government with respect to the Department of Health.
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[5:30 p.m.]
I want to first introduce the people who are here with me today to assist me in this process. I'm very pleased to be joined by the Deputy Minister of Health, Mr. Kevin McNamara and by the Chief Financial Officer, Ms. Linda Penny. I want to say that our government's vision for today's families is to ensure that Nova Scotians get the care they need when they need it. That is a goal that we share with our partners in the health care system, the district health authorities and the IWK and the continuing care sector through whom we work to deliver health care treatment and services to the people of Nova Scotia.
The budget for the Department of Health for this year is focused on protecting critical health care services in the midst of challenging economic times. In my short time in this department I have come to appreciate first hand the dedication and the commitment that staff bring to their roles in helping government to set strategic direction, ensure access and quality and provide oversight to the province's health care system. I want to take this opportunity to acknowledge their hard work, their professionalism, their dedication and the quality of their work, Mr. Speaker, which is first rate.
Mr. Speaker, health care demands and costs have been increasing by an average of 8 per cent per year over the past decade. Meanwhile, provincial revenues are now on the decline. Most importantly, Nova Scotians have some of the worst health outcomes in Canada. We have more incidents of chronic disease, of cancer and, indeed, of longer waits.
The world economic downturn and previous poor fiscal health planning makes this a difficult time to manage health systems budgets, yet we remain committed to helping families stay healthy, get healthy and manage chronic conditions. We are committed to doing this while still living within our means.
Now, Mr. Speaker, particularly for members of this Assembly who have been here for a while, we have seen many initiatives over the years, in various governments and particularly in the Department of Health as they've tried to grapple with this difficult problem. Some governments have made choices about freezing wages, some have cut programs.
The extent of the advice on the measures and the options that are available is considerable, Mr. Speaker. When any new government arrives, I think one of the first things they do is assess the work in any of the departments; in Health, this has been no different. In the past few weeks, we've had an opportunity to look at many of the studies that have been done over the years and to come to understand the various working groups that are looking at recommendations for change within the department, and as we make our way forward we have our own working groups looking at this very big issue of the sustainability of the health care system. I'm pleased to say that we have been able to draw on the considerable
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experience of people inside the department, and also people at the DHA level and in various other professional organizations such as Doctors Nova Scotia and, of course, at the IWK.
One of our working groups is, in fact, made up of John Malcom, the CEO of Cape Breton District Health Authority, along with Anne McGuire from the IWK and Dr. Bruce Wright, a very respected physician from the South Shore District Health Authority, as well as Dr. Brendan Carr, who would be well known to people for the work that he does in the Capital District Health Authority but also his contribution with respect to primary health care reform. So we're drawing on the expertise of people such as these to help us in formulating the way forward to deal with the considerable challenges that we have in front of us.
Just as this government has inherited a financial deficit, so have we inherited a health system deficit in the form of wait times. Nova Scotia has some of the longest wait times in the country for some treatments and services. Reducing these wait times is a top priority for our government. Working in partnership with the district health authorities and leveraging funding from the federal government, Nova Scotia is moving ahead with a number of initiatives to increase access and reduce waits in health care.
Last week I was pleased to launch the first phase of the Patient Access Registry project at the Aberdeen Hospital in New Glasgow, Pictou County. The registry will provide a better understanding of where more surgeries can be performed and where additional resources may be needed. As well, patients will know where they are in the queue and when they are likely to receive their surgery.
All district health authorities will be using the registry by July 2010. Nova Scotia is making wise use of our investment in this $11 million project by cost sharing with Health Canada and Canada Health Infoway.
Nowhere are problems with wait times more evident than in our emergency rooms. Over the past 10 years it is clear that there have been growing problems affecting Nova Scotia's emergency rooms. There have been increased numbers of temporary ER closures across the province. People arrive at their local ER looking for help, only to find a closed door. ER closures have become a chronic problem in smaller rural hospitals. At the same time, our larger emergency rooms, especially in the Halifax Regional Municipality and at other regional hospitals, are also under strain. Patients are enduring long waits.
Ensuring patients and families have access to emergency health care when they need it is a priority of this government, and that is why last week I was pleased to announce Dr. John Ross as Nova Scotia's first provincial adviser on emergency patient care. Dr. Ross has the passion, experience, and leadership necessary to help us tackle this challenge. I've heard from many Nova Scotians since we made that announcement applauding the appointment of Dr. Ross.
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The problems in Nova Scotia's emergency rooms are longstanding. They will not be solved overnight, but I am confident that the appointment of Dr. Ross will put Nova Scotia on the road to solving them.
In addition, I look forward to tabling legislation to enhance ministerial and district health authority accountability for emergency rooms. By enabling district health authorities to consult and report on our emergency room system, we can improve our understanding of the issues so that effective solutions can be developed.
My government will establish a fund to assist Nova Scotians who must travel out of the province for medical treatment. In rare cases, patients in Nova Scotia are not able to get the specialized care they need in this province. In the interest of improving access to care, our government will pay for the basic transportation and accommodation costs for Nova Scotians who require out-of-province medical treatment. These treatments must be recommended by the patient's doctor and pre-approved by the Department of Health. This is another way our government is putting patients first.
Another way we will work to reduce wait times is by focusing on increasing access to primary health care services. One of the most recent and significant projects in the area is HealthLink 811. In July, I launched HealthLink 811, Nova Scotia's 24/7 call line where experienced registered nurses are providing advice and information to patients and families to help them make informed decisions on their health care needs. HealthLink 811 will support and encourage Nova Scotians to take an active part in caring for their own health.
In my previous role as a social worker and part of a collaborative health care team, I see the value in offering Nova Scotians a service where they can get answers to questions or the information they need to take care of themselves. Oftentimes it's a lack of information about our health that causes us the most worry. Whether you are a new parent worried about your child's fever or a person caring for an elderly parent who has just fallen, HealthLink 811 will provide you with the peace of mind and the information you need to make informed decisions concerning your health and the health of those we care for.
As we continue to prepare for the upcoming flu season, this service will help provide timely information to callers, informing them of the precautions necessary to minimize the spread of the H1N1 flu. We look forward to enhancing the HealthLink 811 service in the future.
Mental health, too, is another area in need of significant enhancement. Depression is the second most common cause of disability in the developed world and it has been largely ignored by previous governments. Our government will improve support for individuals with mental illness and for their families. This year, community-focused living bungalows will be developed to provide appropriate, respectful care for individuals coping with mental illness.
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Next month the first Mental Health Court will open and will help people who need counselling and treatment instead of holding them in custody or putting them in situations where conflict may arise. We will continue to collaborate with our partners within and outside government to establish and improve our core programs and services, particularly for children and for youth.
Mr. Chairman, another equally important commitment for this government is to make life better for Nova Scotians by helping them access the medications they need to manage illness and stay healthy. We understand the burden that can be placed on today's families when they do not have prescription drug coverage. That is why in this year's budget for the Department of Health we have increased funding to support patients with Fabry's disease. We have chosen to extend funding beyond the expiration of the current agreement because we believe it is the right thing to do to ensure patient care is not interrupted while a new agreement is being negotiated.
Because of poor financial planning over the past number of years, we may be required to make some very difficult decisions where the funding of new drugs is concerned. However, Mr. Chairman, we will improve this situation in future years, in part through the establishment of a drug management policy unit to address utilization, guide decision making, and increase access to medications.
[5:45 p.m.]
Mr. Chairman, another foundation of a solid health care system is infrastructure. In order to provide the modern health care services that Nova Scotians need, we will continue to invest in infrastructure whether that be in the form of equipment, bricks and mortar, or information management systems. This year's budget provides $10 million more to district health authorities and the IWK Health Centre for new and enhanced medical equipment, and an additional $14 million for the emergency replacement and repair of identified needs. We continue to enhance our electronic information systems to advance the quality of health care. This year we will complete a project to standardize financial human resources and material management systems province-wide.
We will continue to increase the number of doctors' offices using electronic patient records, and we will invest in special wait times projects to improve diagnostic imaging services and improve the efficiency of operating rooms.
As I mentioned earlier, our investments will address the mental health needs of Nova Scotians. The development of community-focused living bungalows on the Nova Scotia Hospital site in Dartmouth is an important first step in modernizing care for patients living with mental illness.
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Mr. Chairman, seniors too are another growing population in need of specialized care and services. This government is committed to giving seniors options to stay in their homes and in their communities longer. We will support the continued development of new long-term care beds to give seniors more options closer to home when home is no longer an option, and we will help to make this option more affordable by ending the practice of security deposits in long-term care. We have implemented and expanded the Caregiver Allowance Program to recognize the important role caregivers play in supporting loved ones and friends. That is why we have funded the caregiver program developed by the former government as a starting point, but we know that program is lacking. That is why we are committed to implementing self-managed care allowances and personal alert assistance programs.
Mr. Chairman, retaining and recruiting the right health human resources is a challenge that faces every province and almost every country. It is my belief that Nova Scotia has some of the most experienced, skilled, and passionate health professionals anywhere, and I thank them for the work that they do and for choosing to do it here in Nova Scotia. I would like at this time just to recognize all of those folks who work in diagnostic services throughout the province, who have really stepped up to the plate with the recent developments with respect to medical isotopes. They have demonstrated the kind of professionalism and commitment to providing good quality health care under difficult circumstances by working extended hours and really going beyond the call to make sure that we do not see the wait times for diagnostic services grow, so that they can use the supply of isotopes that we have on hand in the most efficient way possible. They deserve recognition from all members of this House and, indeed, the public in our province.
Mr. Chairman, to maintain and build on this exceptional workforce we will provide an additional $16 million to doctors for increases in services and for more doctors. We will also spend an additional $1.8 million to train, recruit, and retain more nurses across the province.
Seldom is access to medical professionals more critical than in a health care emergency. Since the H1N1 influenza emerged in Nova Scotia in April, our public health acute care and emergency responders have been working extra hard to respond to this new virus. While we do not yet know what the flu will be like for Nova Scotia this Fall, I am confident in the advice and the actions being taken by health officials, and we know we will be able to respond quickly, just as we did when the first outbreak took place this Spring. As part of our planning, we have approved $5 million in funding to allow district health authorities to purchase 90 new ventilators and we have increased our stockpile of many critical pieces of personal protective equipment such as surgical masks and N95 respirators.
We all have a personal responsibility, whether we be parents, citizens, or government officials, to do our part to protect the health and safety of all Nova Scotians. I would
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encourage everyone to get the vaccination for H1N1 when it becomes available. It is the responsible thing to do from a public health perspective.
In closing, I would like to thank you for this opportunity to highlight some of the priorities of the Department of Health, and I look forward to answering the questions of the members opposite.
MR. CHAIRMAN: The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: Mr. Chairman, it's my pleasure to rise this evening and to begin the estimate which will be the start of a long session for the minister and her staff as we look carefully at the estimates from the Department of Health. It's tradition in this House to begin the estimates with Health because it is the largest spending item, the largest department that we have, and in fact, the minister had alluded to the fact of the growth over the last number of years, how quickly the budgets for Health have grown and the demands as well. In fact, the budget for the Department of Health now, if you include Health Promotion, is making up about 43 per cent of our program expenditures. If you take out the amount of money that's in there for debt servicing and some of the pension valuation amounts, with the program expenditures, we're talking 43 per cent. So it's a very large budget that we have in place, and over five years it has gone up by over $1 billion. So it's very significant to see it rise to $3.4 billion this year, I think, just specifically for the Department of Health.
So in terms of context, the time that we spend on this department and the expenditures of Health really is very important, and I know that we give a lot of time to each and every department and that the aims and mandate of each department are important, but certainly this one takes precedence. I know that the minister is very well aware of the importance of the responsibility that rests upon the staff and upon her own shoulders.
With that, again, it is my first year as the Health Critic, so I'm also becoming familiar - I've been the Finance Critic, so I'm quite interested in numbers and in the detail of the estimates, and I had hoped during my discussion to go through some of those line items. One thing that strikes me every year when we receive such a huge stack of financial information is that when you look at a given department it's really quite thin - we don't get a lot of the breakdown, the many expenditures - it's high level, it's rolled up into larger numbers. So even for the Department of the Health, with over $3 billion, I have a fairly small piece of the budget right here in front of me which includes it all.
So that's why I think it's important when we have the opportunity to question the minister and get answers to just exactly where this spending has gone and learn more about some of the programs and what their actual costs are. Again, this is an area that is very complex. We have an awful lot of the spending of the Department of Health actually directed through the DHAs, and we've got nine different DHAs plus the IWK receiving funding
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directly, and the total for that was again very significant. I think it was over almost $1.5 billion that goes directly through those individual health authorities. That is appropriate, that there is local control and local ability to influence what the priorities are and where the spending is at each level.
I know that the minister's job is to ensure that health right across this province is maintained and that there is a standard level of care, so it requires a great deal of oversight from the Department of Health as well.
Again, Mr. Chairman, we are looking to see what exactly has been done this year. I noted quite a few different subjects that the minister touched on in her opening remarks. It is an enormous area when you think about it, with everything from acute care to the concerns of seniors to some of the preventive things falling under this as well, to some degree.
Wait times were touched on, and that's something we'll want to look at more carefully, and some of the smaller projects like the Patient Access Registry, which was talked about. In fact, information technology is something that doesn't sound all that exciting, and yet it is a huge cost to the department, and it's one of the opportunities we have in this province to actually invest in so that we can have greater efficiencies, a more smooth-flowing system, fewer waits, and better information right across the board. Yet it seems to be an area that has a number of different initiatives that have really plodded along and not had a lot to show for it over the years, and I know that there has been federal money that has been available to the province; sitting on the Public Accounts Committee on a couple of occasions over the last six years, we've had the Department of Health come in and talk about some initiatives on IT that were over budget and behind schedule. So I hope that we can look at some of the projects that are ongoing now and see whether or not that is improving, because I think it is, in fact, a huge opportunity for our province to get a handle on some of the inefficiencies in the system and really try to streamline things. It shouldn't be as difficult as all that to see that actually happen.
We've been pleased as well to see that Dr. John Ross was appointed last week as the emergency patient care adviser, and we know that he will be working for the next year. We feel that it was a promise of the NDP Government in the last election that there would be - and I think more than a year-long study - that there would, in fact, be a promise to keep emergency rooms open on a 24 hour/7 day a week basis right across the province. That's a very compelling thing for people in rural and smaller communities that depend on those emergency rooms. It becomes highly politicized, as we all know. So making that promise, it may be a difficult promise to keep. With Dr. Ross in place - we know that he's outspoken, we know he'll tell us the truth. I have a lot of respect for the people who will speak up and tell us what's what, the people who are knowledgeable in their own area, and it takes courage as well to engage them and to listen to their advice.
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I'm just concerned that after the year is up, and we get a report from Dr. Ross, that there may not be recommendations that will allow that promise to be kept. So I'm concerned that we watch that and see whether or not - I believe I had asked the minister whether that was in Dr. Ross' mandate to begin with. Is his mandate to find ways to meet that commitment or is his mandate to go out and study and, I guess, follow his own instinct in terms of the answer there? So maybe when we get to emergency rooms we can go into that again.
I feel that there is quite a cost associated with engaging him, and there is a year-long wait, which is a significant cost in itself. We will want to see more about that and see whether or not at the end of the day the government's promise to keep those emergency rooms open is, in fact, going to be doable.
[6:00 p.m.]
We did see that money alone is not always the issue, and I started off my remarks by talking about the huge increase in the expenditures in health care. Again, in framing that, it's hard not to point out that over the last number of years we've had some significant increases in revenue in this province which have now dried up. Those days are over, at least temporarily. We had seen hundreds of millions extra in revenue from the offshore, we'd seen good years for revenue coming from the federal government, but beyond that we'd seen a lot of our own source revenues increasing - our own personal taxes, our own corporate taxes were up so this was not a question about us just getting money from Ottawa, it was money we were generating here. But in those years when we had the extra money, I do question whether there was any real significant improvement in our health or in the way people feel about access to health care, given these huge increases in their budgets and going up 8 per cent - sometimes a little less, but roughly 8 per cent a year - and at the end of the day, do we feel we have better access to health care, are people overall - are our outcomes better? I really question that.
I feel like it almost looks like we squandered an opportunity to make some significant headway in a period of time when we had the resources. Now, here we are in a time with much tighter money - really an economic downturn - which we hope won't be long-standing, but nevertheless we do have to weather it. Again, we've got such an increase in our spending and I don't believe a measurable improvement in how people feel or perceive their health care system.
I know that when somebody has an acute issue - or what I hear from my constituents, at least, is if they've gone in with a real emergency they're so grateful and so delighted with the care that they received that they can't say enough about the people who are in the hospitals and caring for them at that point; but it is often the chronic and, I guess, ongoing issues that are not life threatening but are painful and can certainly bring people to a point where they can't be as productive - they can't work sometimes, and they can't enjoy life,
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because they are waiting for procedures that take a long time or that they can't get the help for or see the specialist they need to see. So that's a concern to me, that we start to address those issues as well.
Again, going back to the emergency rooms, I think one of the things it's important to note is that it isn't always about money, because we saw just recently the increase in funds that were made available to the emergency rooms in Cumberland County. They increased the amount they could pay for ER coverage for the doctors, and yet they're still experiencing closures. So that's probably a really good lesson to be learned, that it isn't just about money - it's got to be about something more around the way that we're organized, or maybe it's a human resource issue that we'll be talking about further in these estimates.
One of the things that I appreciate about estimates is that it is - although it is a formal time, it allows for dialogue, certainly between members of the Opposition like myself, in my role as the Critic for Health, and the minister, and through the minister the staff, providing us with answers. I think it is an important time for us to learn more and to get a better insight into some of the stresses that are in each of the departments and, in this case, in the Health Department.
We know that it's probably the most complex department there is. I think I would be safe to say that, because of the many different players and the size of it and the importance to everybody in this province. There is not one person in the province who doesn't have an interest in it and is not a consumer of the services that are provided. If we are fortunate enough to be healthy ourselves, we are often responsible and working and interfacing with the health system, especially as women, we often take care of our children, we take care of our elderly relatives and we tend to be the person who does that navigating for the family. So, I certainly have had some opportunity to interface as well, to be there at the emergency rooms with members of my family and worrying, in those circumstances, as we all do about the care we're receiving.
But I do appreciate that we're going to be able to get into some of these direct questions. Just to start off, some will allow you - I guess you'll have all the answers you need, there's room for you to be more lengthy in your answers, if you like, is what I'm saying. The first one is quite short. I wanted to look specifically around the health care budget, how much of the amount is there for salary and wages? That's one of those items that's hard to drill down on.
You mentioned in your opening remarks about wanting to increase the number of nurses, funds set aside for increasing the number of doctors that we have. I want to know, really, what percentage - even if you could tell us the percentage of the health care budget that is made up of salaries. I know in certain other departments, salaries is a huge and often overwhelming number. Thank you.
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MS. MAUREEN MACDONALD: I'm very pleased the honourable member is the Health Critic for the Liberal Party and I think we'll have an opportunity to work closely together. I welcome your ideas. I've known you in this Chamber for a while and I know you're very constructive and hard-working. I hope you don't feel I'm being patronizing, I mean that sincerely. I look forward to working with you.
You've made a lot of excellent comments, you have good insight into the Department of Health. Your first question really says a lot about the nature of health care. Probably in the vicinity of 70 per cent of the budget of the Department of Health pays for health human resources, pays for salaries and staff. It's a big enterprise when you think about all of the people who make a health care system function.
We tend to euphemistically, sometimes, say doctors and nurses to mean everybody, but there are so many people who are in our health care system - all of the financial people, people who order supplies, put them on the shelves, people who do cleaning, people who prepare meals, people who get meals to the floors, people who deliver supplies, people with computer skills who operate and set up the databases and the little glitches. I think we have care coordinators who are out in the field assessing people for their needs, people who work in the long-term care field - it's a very, very large conglomerate of people who are there making a commitment on a regular basis, a daily basis, to meet the needs of people quite often when they're at their worst, their sickest and their most vulnerable.
It's a very dynamic system. Human resources, then, the managing of those human resources, the training, the continuing education - there are many, many facets of working in this field. Even the insurance, having to provide liability insurance and all of that kind of stuff, no system is without its risks. It's a very, very complicated system.
MS. WHALEN: Thank you very much, Mr. Chairman, that was very interesting. So overall, we get some idea of where those people are working but we do see about 70 per cent of the overall $3.4 billion in this department going to salaries in one form or another. Again, I think many of us know people who work in the health care system, certainly here in Halifax it is one of the largest employers, I'm sure, with the major regional hospitals that we have here and I represent Clayton Park so that's close to home for me.
I wanted to go in the first instance to Page 14.3, which is the program expenses under the category Executive Administration. I had quite a few questions around different items on 14.3, so I'll give the minister and her staff just a moment to go there. In this category, if we look at it and when you find it you'll see under a number of line items, the total amount estimated for this year is roughly $50.1 million and it's up quite a bit from the actual of 2008-09. It's gone up by about $5.6 million in the total, from what actually was spent the year before. If we look at last year, the 2008-09 year which has been wrapped up and we have the actual figures, we see that in fact there was almost $4 million underspent last year. So
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close to 10 per cent underspent the year before and now up $5.6 million and actually above what was estimated last year, so I'm hoping that the minister has that.
I really did want to begin with asking exactly what might be the differences. If in the total sense we can look at why it was under budget last year, question number one, why was it underspent by about $4 million, which as I say is close to 10 per cent underspent and then has gone up now by $5.6 million.
The other thing is it has actually increased slightly over the amount that was budgeted by the Progressive Conservative Government when they were still the government in May of this year, so I'm wondering if we could look at the increase in administration that might be caused by that as well. I'm wondering if that's clear to the minister. Okay, I'll just wait.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chair. I understand that last year there were a number of vacancies in that area that amounted to approximately $2.5 million and those vacancies are being filled. Additionally, there has been an increase of $1.4 million or so in the Medavie contract, so this accounts for those figures.
MS. WHALEN: Thank you very much. I wonder if we could go to the Medavie contract then just to see, that's the Blue Cross contract I believe that the province has to manage the MSI billing. I wonder, looking at that, if that might be in the Physicians and Pharmaceutical Services line item perhaps, which is again, under that Executive Administration. I'm not certain but I think it might be Physician and Pharmaceutical Services. I'm wondering in that one, if we look at it, the amount of almost $18 million this year, again is up $1.8 million from the actual last year in that line item. I wonder if you could confirm that that is where the Medavie Blue Cross is for the management of physician payments and Pharmacare payments.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman and the member is correct, that is where it is.
MS. WHALEN: I wonder if the minister could tell us if, in that contract for Blue Cross, if we pay on the basis of transactions, the number of transactions that are handled, or is it a flat negotiated rate?
MS. MAUREEN MACDONALD: Thank you, Mr. Chairman. To the honourable member, what we do is we have a combination of both transactions and of fixed rate in our contract with Medavie.
MS. WHALEN: Would it be possible to explain that formula, the payment formula, in a little bit more detail?
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MS. MAUREEN MACDONALD: Thank you very much. Yes, as I understand, the fixed costs are for the administrative portions of that contract. However, the variable are the transactions, in terms of the number of services that are provided for the various programs.
MS. WHALEN: Thank you very much. That certainly does show that the number of transactions is very important in determining the cost. Just looking at that line item again, we do see that from the estimate of last year - 2008-09 - to this year, the amount budgeted there is down by about - I've got $428,000, approaching $0.5 million down. I'm wondering what the cause for that would be? What has made that lower than last year?
[6:15 p.m.]
MS. MAUREEN MACDONALD: Would the member indicate which line item she's looking at?
MS. WHALEN: I'm still looking at the Physician and Pharmaceutical Services, which this year is at $17.885 million and last year was budgeted at $18.3 million.
MS. MAUREEN MACDONALD: Mr. Chairman, to the member, there was a reduction in the forecast base adjustment and, in addition, there was a reduction in professional service usage that accounts for that reduction, that difference.
MS. WHALEN: I just wonder again, just for clarification, if the minister could tell me what it means by "professional service usage." Does that mean that Nova Scotians have gone to the doctor less? I'm not sure what that means - "professional service usage," if you could just explain that.
MS. MAUREEN MACDONALD: Mr. Chairman, what that means is the use of consultants. There was a reduction in the use of consultants - physician consultants.
MS. WHALEN: I'm not sure what they were doing to begin with, but I think that's a good thing, I'm sure, if we have fewer of those. Again, to look at that total line item on the Executive Administration - it has gone up, as I mentioned, by $85,000 from where the budget was last May. Now again, to put into context what we're doing with this year's budget as it was presented by the government, by the NDP Finance Minister - the Finance Minister told us that it was largely the same budget that was out in May last year, with just some smaller changes.
Although we want to make it very clear that we see it as the new government's budget, we realize that many of the line items didn't change. So on this one, the one item that changed was General Administration. It has gone up by $85,000. That's the one difference in the bottom line. This is comparing now not last year to this year but the May budget that was defeated to the current budget. I would like to know what the $85,000 difference is.
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MS. MAUREEN MACDONALD: Mr. Chairman, what that is - for a number of years in the Department of Health there had been a senior policy advisor position. It had been removed and it's back in the budget.
MS. WHALEN: Mr. Chairman, while we're talking about staffing as well, I wonder if I can ask the minister if she can provide for us the number of political staff in the department. This is a question that has been asked in the past of governments, especially when governments change, and I would like to know if the minister could provide us with the number of political staff, and if at some point - and I realize I'm asking this just today but if at some point she could agree to provide us with the contracts for those political staff?
MS. MAUREEN MACDONALD: Mr. Chairman, I would be happy to do that for the honourable member. The current staff that I have - I have an EA and I have the senior policy advisor in the Department of Health. I'm also the Minister of Health Promotion and Protection and that department had an EA, but I do not have an EA in that capacity, so my EA at the Department of Health also assists me in the Department of Health Promotion and Protection.
MS. WHALEN: I would just like to confirm if the senior policy position that is outlined under General Administration, where that is a position that you said has been reinstituted, is that the same person as the political senior policy advisor that you would have?
MS. MAUREEN MACDONALD: Yes, that is the same person.
MS. WHALEN: I want to look at some of the other items, again under General Administration - you know, it has been said in the past that we need to have fewer spin doctors and more real doctors in the system, and I didn't coin that, I think it might have been an NDP statement in the past if I'm not mistaken - there is a line item that is I think the Communications line item on this. Although it doesn't say Communications, I'm not sure which one it would be - perhaps the Chief Information Office? That's the third item down under General Administration; it's called Chief Information Office. I'm not sure if that's IT or Communications, but I'm guessing that one of these administrative line items has Communications and I would like to know if you could identify which one it is and let us know what kind of resources you have for Communications in the department?
MS. MAUREEN MACDONALD: Sure, we'll get that information. I just want to say that the Chief Information Office, in fact, is the IT Division, but we will get you the Communications in one moment.
Mr. Chairman, we have seven Communications Nova Scotia staff in the Department of Health. I would just say they're very, very effective in terms of doing research and, as I said earlier, this is a department that is a $3.4 billion enterprise. It's actually like a small
[Page 15]
corporation, or maybe not that small as a corporation really, it's a fairly significant enterprise and so, yes, we have seven people from the staff of Communications Nova Scotia.
MS. WHALEN: Perhaps in a few minutes, or as you find it, you could let me know where that item might be resting, the office for communications for the department? I know there are lots of reports that come out from different programs in Health and that these are prepared as well, so it's not just the relationship with the press but also other reports and so on that are created and disseminated from that office, but I am interested to know exactly what we have in that regard.
In the meantime I'd like to go to the Health Human Resources Office, and I would ask - that is the fourth line down under Executive Administration. It has a $2.3 million estimate for the cost this coming year, and that has changed substantially, so it's another one I'd like to know a little bit more about what lies within the Health Human Resources Office. It was $3.9 million last year in the estimate, but we only spent $2 million, so it was almost half under-expended, which in itself is quite a question because human resources is, again, one of our key, critical components in the entire operation of our health system. We know that we're facing a shortage in certain areas and, as the minister mentioned, it's not just doctors and nurses, it's also our medical technologists, our lab techs, respiratory techs, and all kinds of medical personnel, and if there's a shortage of them, we certainly need to be addressing it. So I'm very curious, number one, why the department would have underspent by almost half their budget for that last year, and we'll start with that particular avenue of thought - what happened last year?
MS. MAUREEN MACDONALD: Thank you very much. First I want to go back to the Communications Nova Scotia question. Mr. Chairman, the member asked where the budget for CNS staff in the Department of Health can be found and the estimates. It's in General Administration. So that's where the cost of that staff centre is.
With respect to this program here, this is an Internet-based program, which provided information and resources to foreign-educated health professionals. It was a federal initiative and it's winding down, and that accounts for the reduction in the spending.
MS. WHALEN: Mr. Chairman, that would explain why less was spent last year, but this year our budgeting for it is still quite significant, so it's more actually than what was spent last year; if it was winding down, wouldn't it be less again than what was actually expended the year before? Perhaps the minister could tell us, especially if it is a federal agreement, how much money was made available from the federal government for that Internet-based human resource - I guess you said it's particularly directed at internationally-trained medical personnel. I would very much appreciate a fuller explanation of what exactly that program is.
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MS. MAUREEN MACDONALD: Mr. Chairman to the member, last year's budget for that particular initiative was $2,875,000. This year it's $1,183,700, and the member is right, that's not the only thing in this area. There are also some other programs with respect to other costs, other areas of expenditure.
MS. WHALEN: Thank you very much. I think just following that same line of our discussion right now, I'd like to ask where we have our Health Human Resources plan. Where would that rest within that? Is that considered part of Administration as well? I know there are efforts and some programs underway to address and to plan for this shortage of doctors and nurses and technologists so I wonder if you could tell me where the resources are and how much is allocated to really prepare this province for the current shortfall in the number of professionals.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. This particular piece here is with respect to administration. The health human resources planning initiatives, and the costs for supporting those, tend to be in the various areas where they are. For example Continuing Care, you will find expenditures in the Continuing Care Services budget for the health human resource piece. The same is true - we have a nursing strategy and this would be in our nursing strategy piece and the same thing with physician services, so the health human resources is apportioned into those areas where they have the greatest impact and knowledge, in fact, about some of these initiatives.
[6:30 p.m.]
Just so the member would know, we have invested $80 million under the Nova Scotia nursing strategy, which includes recruitment and retention initiatives. The number of doctors in Nova Scotia has steadily increased and we actually are doing better than the national average with respect to the number of physicians in the province, although there obviously is often some concern about the distribution of physicians. Do we have the right numbers in the right places? There are areas that are significantly underserviced or where we see chronic difficulties. The Digby area comes to mind as an area where it has been very difficult to recruit and retain physicians.
As the member said, this is a very important area for the Department of Health, for the government and for the province. We have an aging labour force, not only in a general way, but we certainly have an aging labour force with respect to our health human resources and so we need to constantly look at our recruitment and retention initiatives. Over the years there have been a number of measures taken with respect to the discussions with Doctors Nova Scotia, with the Nova Scotia Nurses' Union, with the Nova Scotia Government and General Employees Union to reflect, in their collective agreements, measures that will help us retain the experienced, older nurses, for example, and make it possible for them to stay in the workforce, mentor younger nurses and pass on their knowledge and their experience.
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It is a challenge but we have a number of programs and of course we do have programs for international physicians. The Clinical Assessment for Practice Program over at Dalhousie, which I'm sure the member is no doubt familiar with, has brought more than 25 physicians to rural Nova Scotia and is a really important piece of our human resources plan to recruit and retain health care professionals.
MS. WHALEN: I wanted to go back to one of the earlier questions that I had, just as a follow-up with the Medavie Blue Cross contract, it was indicated by the minister that that had accounted for a $1.4 million increase in the line item that it related to and I'm wondering if you could tell me, is that a brand new contract or was that an expected increase? If it's a new contract, can you tell me what the term of that contract would be?
MS. MAUREEN MACDONALD: Mr. Chairman, the Medavie contract was a contract that was negotiated in 2005. It has a 10-year term and there are provisions in it for adjustments with respect to the Consumer Price Index, the volume of utilization, economic price adjustments and as well, the additional new programs that may come onstream like, for example, the new Family Pharmacare Program. So it's a very complex contract as you can well imagine and this contract continues to be in place for a few more years.
MS. WHALEN: If I'm correct in saying it's in the line Physician and Pharmaceutical, I'm not sure if I'm correct that's where it rests, but if I am, could you tell me the total cost for the Blue Cross Program or for the Blue Cross contract this past year and how much is in the budget for this year?
MS. MAUREEN MACDONALD: Mr. Chairman, the amount in the budget for last year, well, the actual expenditure for last year was $13,918,871 million. The budget for this year is $14,955,000 million.
MS. WHALEN: And I appreciate that, the only thing I see there is that's about a $1 million difference, not a $1.4 million difference for Blue Cross. So it brings me back to our earlier question about what was fuelling the difference year over year. You told me in the answer to that there were vacancies that would be filled which would account for $2.5 million and this is of the total increase in administration and that, at the same time, the Medavie Blue Cross was going up about $1.4 million. So, you know, I think it's important to just find out what the difference is there on the $400,000?
MS. MAUREEN MACDONALD: Mr. Chairman, I'm told that in this particular area Medavie is not the only expenditure. There's also the administration of pharmaceutical services and physician services. So the variance is from other areas as well.
MS. WHALEN: Just continuing on with administration if I could, the General Administration amount for this year is almost $3.5 million. We determined that it had gone up by an amount for the senior policy advisor but we also were told that all of the
[Page 18]
Communications staff are in that General Administration, top line, the first line in the Executive Administration budget. So I'm wondering if you could tell me, after we take out the Communications people, what else is included under General Administration? So if we take out the senior policy advisor and all the Communications staff, just what else would be lumped into that general category?
MS. MAUREEN MACDONALD: Mr. Chairman, in the area of General Administration, you have the Office of the Minister, the Office of the Deputy Minister, the Assistant Deputy Minister for Financial Services, the Physician Advisory Services, the Nursing Advisory Services, and Social Policy Initiative. In addition there's Communications, Legal Services, Legislative Policy, Labour Relations.
MS. WHALEN: I certainly find that very helpful to see what is in there. I wondered if we could go for a minute to the next page, to the 14.4 line item. In the Medavie Blue Cross that we were talking about earlier, the administration of it, I'm not sure if this is what we see here under the Pharmacare Program as well but perhaps this is something different. All of the Medavie Blue Cross, I guess, is in General Administration, somewhere in administration. I wanted to look at the Pharmacare Program, if we could.
My first question relates to a press release that we had from last January from the department. In this press release, it was January 22nd - I don't expect you to have a copy of that - but it does say and I'll just quote one line - the title is Province Makes Seniors' Pharmacare More Affordable and the line I wanted to quote said, "The total cost to operate the program in 2009-10 is expected to be about $193 million."
That was put out January 2009. Now we're looking at a budget for 2009-10 and the total on this Pharmacare payments is $184 million, so there's a $9 million difference. It's $9 million less. What I'm really looking for is just why that might be or what the department was thinking of in January as opposed to what we see before us in the budget.
MS. MAUREEN MACDONALD: Mr. Chairman, I thank the member for the question. The projection for what drugs would cost has changed. Drugs are not costing as much. There's been a decrease and we don't know this for sure - I suppose perhaps the people who work in Pharmaceutical Services who have a lot of expertise on this could provide a really good explanation to the member.
My speculation is that it's a move to generic drugs, which cost a bit less and I think we're getting into that area now where the patents for the brand-name drugs and the ability to get generic drugs is now improving for people. Remember the federal government, I think under the Mulroney Government, made it difficult for the generics for awhile. They gave patents to the brand names for a certain period of time but I think that there are some changes. The time has passed and it allows the generic manufacturers more opportunity to
[Page 19]
be in the marketplace. So it's not necessarily a decrease in the utilization but it is a question of a decrease in the actual cost.
MS. WHALEN: Thank you very much and I appreciate that answer very much. Through you, I would like to know from the minister if any of the senior's co-pay or premiums are included in that $184 million or is that amount 100 per cent the government's cost? Is it defrayed, is it a net cost, which sometimes happens in the estimates that a cost will be shown net of any recoveries that the government is making and therefore it looks like a smaller investment than, in fact, it is. So I wanted to just absolutely be sure that that amount is entirely what is coming out of the taxpayer portion of our Pharmacare services for seniors.
MS. MAUREEN MACDONALD: It was always my understanding that the Seniors' Pharmacare Program was set up and an attempt is made to have to have the seniors' portion of the program paid for roughly 25 per cent and the government around 75 per cent. Although it is hard to get a formula sometimes that will bring that in precisely at 75/25, we've certainly been more or less able to do that and maintain that arrangement, that division of sharing the cost. So the projection is that the seniors' portion would be about 26.71 per cent for 2008-2009 and this is pretty much in keeping of where it is has been. In 2001, for example, it was 27.68 per cent and all along the way, it's 26, 28, 26, 26. So it has maintained that balance between the government's contribution and seniors' contribution.
[6:45 p.m.]
It's important that the members here understand that each year the Seniors' Pharmacare Program is reviewed and projections will be determined for the upcoming year. In that process, we do take into account the 75/25 per cent cost share ratio between government and seniors and adjust the fees to try to represent that balance. We know that drugs are very expensive and our government is committed to providing affordable and a sustainable program to help seniors in Nova Scotia with their drug costs. We know how valuable this program is for seniors in the province and I think it's also important that we recognize how accessible it is for low-income seniors, particularly those who are in receipt of the Guaranteed Income Supplement and the fact that they don't have to pay the premium to be in this program as a result of that.
So it is a valuable program. It's one that we will be certainly watching very closely in the coming year and we'll be going through the annual review next year; we consult quite widely with seniors' organizations as well when we do that. To the best of our ability, within the parameters of living within our means, we will take into consideration the advice that we get from seniors' organizations.
MS. WHALEN: Just one clarification and one new question on that as well. I just want to clarify on that line item, the Pharmacare Program, which is $184 million, 26 per cent of that is dollars put in by premiums and co-pay? I just want to know if that is, in fact, shown
[Page 20]
that the money that our seniors, and I gather there are about 99,000 - that's what the press release said in January - roughly 99,000 Nova Scotians are registered in the Seniors' Pharmacare Program and it did indicate that roughly 50 per cent received the Guaranteed Income Supplement and are exempt from paying the premiums or they pay a reduced amount. But I just want to know that line item does actually include their funds? In addition to that, because I know my hour is growing shorter, I would like the minister to tell me if there are any plans that would make a major change in the formula that is being used for seniors co-pay? There was a major change made last year, Mr. Chairman, you may remember, where many seniors were finding the co-pay significantly more expensive on higher-priced drugs; although there was a maximum amount for the year, they were going to be charged a percentage of the drug cost and in some instances it was over 30 per cent. Well, I think it was set at 30 per cent - it could be over $100. So I'm wondering if the minister has looked at some of those complaints and is considering any changes?
Perhaps while the staff is looking at whether or not the money is included, we could talk about whether any changes are expected in the mechanism for the co-pay, because it has put a lot of seniors into distress financially in terms of having to pay not a fixed amount on each prescription, but a percentage of the prescription costs. I am sure that the Health Minister as well has had individual constituents raise that issue with her previously, and perhaps in her current role as minister. So I want to know if that is going to be re-evaluated, and a change made in that program?
MS. MAUREEN MACDONALD: Mr. Chairman, I thank the honourable member for the question. First of all, I just want to go back and tell the honourable member that, yes, the seniors' portion of the payments are reflected in that line item that you referred to and it is under $48 million.
With respect to future formulas, as I was saying, this is an annual process of review and we will be looking at utilization and cost and need. You have to look at the need that people have as well as you make your plans. Part of determining what need is, is to have the consultations and the discussions with seniors' organizations and work with them. The seniors in this province, the Group of Nine, have demonstrated their keen willingness to work with government in terms of having a program that meets the needs of as many as seniors as possible. Many of the changes that we have seen in the seniors' program that have strengthened it over the years, including removing the premium for lower-income seniors, are the result of the advocacy and the representations that have been made by seniors' organizations.
I was here 10 years ago when seniors' groups made those representations. I know those folks and I'm sure they'll continue to do the work that they've been doing.
MS. WHALEN: Just in the same vein with the pharmaceuticals, I would like to ask if there is a different line item for the pharmaceuticals that fall under the catastrophic drug
[Page 21]
category. I know the minister mentioned that the government will now be funding the Fabry's disease drugs, and I know that Nova Scotia is an area of the country that has a larger number of people with that disease, and it does have genetic roots, so that's the reason for that.
I'm just wondering if you could tell me where in our Health Budget we would find the funding for that and the increase that would go along with the promise to now fund the drugs for those suffering from Fabry's, and also any other catastrophic drug coverage?
MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, those estimates are found under Other Insured Programs in the estimates. The member is quite correct - there are a variety of drugs that are covered in those estimates. The Fabry's drug is only one. Over the years there have been other drugs that the government has agreed to fund - MS drugs come to mind. I don't know if Avastin is there or not, but there are a number of drugs there that are covered.
MR. CHAIRMAN: Thank you. The honourable member's time has expired for this round. The honourable Interim Leader of the Progressive Conservatives. Pardon me? The honourable Minister of Health.
MS. MAUREEN MACDONALD: I'm wondering, I'm just having a little trouble with my voice, I'd like to have a two minute break. Would that be agreeable?
MR. CHAIRMAN: Thank you. We will recess for a couple of minutes.
[6:53 p.m. CWH on Supply recessed.]
[7:06 p.m. CWH on Supply resumed.]
MR. CHAIRMAN: Order, please. I will now call the Committee on Supply to order.
The honourable Leader of the Progressive Conservative Party.
HON. KAREN CASEY: Thank you, Mr. Chairman. I am pleased to stand in my capacity as Leader of the Progressive Conservative Party to begin questions in estimates on Health. As you know, our Health Critic is Christopher d'Entremont, MLA. He will here at another point in time. I am the person responsible for asking the questions tonight.
I would like to say congratulations to the minister for having been given the responsibility as Minister of Health. It is a huge portfolio, I can say that from having had a bit of experience there. I know the responsibility that goes with that and I do believe that the minister will take that responsibility seriously and will work on behalf of all Nova Scotians to try to deliver health care in a timely manner.
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One of the commitments that I made personally when I was there was to make sure that we provided quality health care to all Nova Scotians, within the resources that we had. I don't think that position has changed any. I do know, and it has been said here tonight, that there are increasing costs for health care year over year. We know that in this province we are experiencing declining revenue, so the challenge to meet the increasing demands with few dollars is indeed one that is not easy to meet.
I want to begin by saying that I do understand a bit, the position that the minister is in because she has been in that portfolio for about four months, I guess. I remember when I was elected in June of 2006, the budget had been tabled at that particular time, and I went into Cabinet at the end of June and we were in this House, I was defending an education budget that I had never seen, in the first week of July. So you have had a little more lead time than I did but I do understand that you will rely on your staff and I want to acknowledge the staff who are here with you. I understand that it's not uncommon for staff to have to provide answers to the minister during estimates, so I appreciate where you are.
As I had said, and we've talked a fair bit about this, about the budget that was presented, and my comments about the budget that was presented by the minister were that it certainly contained a lot of programs that any government would want to introduce or maintain for their population. Some of those were certainly part of the budget that we had prepared in May. There are some changes to some of those, some cuts to some of those, some increases to some of those, but it has taken on a new flavour. So I think we can easily say that it is an NDP budget and I will be asking the questions of the minister in that light, that it is their budget with a lot of good programs that we supported.
I also recognize that within the structure of the Department of Health, there are responsibilities that belong to the district health authorities. I expect that the minister and staff may respond to some of the questions by saying that it is a responsibility of the district health authority. However, we do recognize that the funding for those DHAs does come from the department. So directly or indirectly, the department is responsible to ensure that those DHAs have the funding that they need in order to deliver the programs for which they have responsibility. I will accept an answer that says this is a DHA responsibility. I will follow that up with another question.
The questions that I have are in no particular order. They simply focus on some of the changes that are there between what was presented in the budget of May and the budget of September. I will be asking for clarification. I said in my introductory comments that I believe our responsibility is to ask the questions that Nova Scotians are asking. We have an opportunity as their representatives to be here and ask those questions on their behalf and so I do believe that many of the things that I will be seeking clarification on will be things that will be of interest to all Nova Scotians.
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It has been said by the minister in her opening comments, and I think everyone is well aware of the fact, that costs for health care have been increasing by about 8 per cent. It's always a challenge to try to get control of those increasing costs and I guess my first question to the minister would be understanding and accepting and knowing that those health care costs are on the increase. I'm wondering if the investments that are made in health care through this budget reflect that 8 per cent increase in health care costs?
MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, the increase of 8 per cent is over - the actual increase in the budget over last year is 6.75 per cent, not 8 per cent. It's 6.75 per cent, but in fact, the department was underspent by $40 million in terms of what was estimated to be the expenditures for last year. So, yes, the actual expenditures were $40 million less than what had been projected in the estimates when the budget had been tabled the year before.
MS. CASEY: Just for clarification on that if I could, it has been stated that the health care costs in this province are increasing by 8 per cent. The budget is increasing by 6.75 per cent. Is that correct?
MS. MAUREEN MACDONALD: The actual spending increase was 8 per cent over the previous year. The actual spending increase - 8 per cent over the previous year but it was $40 million less than what was estimated. The budget that was brought forward in the previous year projected a significant increase in spending, an 8 per cent increase. In fact, at the end of the day, $40 million less was spent than anticipated, which represents a 6.75 per cent increase.
[7:15 p.m.]
MS. CASEY: If I may, it's my understanding that the May budget that was presented had an expenditure of $3,454,729,000 and the one that was presented in September had $3,422,000,000 - so this is a difference of $32.4 million. Does this translate into $32.4 million in cuts to programs?
MS. MAUREEN MACDONALD: The honourable member is correct. The estimate in the May budget was for $3,454,729,000 and this estimate is for $3,422,276,000 for a variance of $32,453,000. However, the variance was not arrived at by cutting any program or service. The variance was arrived at because of various things.
For example, there was a reduction - a delay in the opening of long-term beds, estimated to be $5.269 million. These delays, as the former minister would know, are the kind of construction delays that would occur in the normal process of getting construction of various facilities - maybe tenders weren't called quickly enough or awarded quickly enough. So, that's one example of where savings were found. Those payments obviously didn't have to be made.
[Page 24]
There were some other areas as well where reductions were found around capital construction projects. I believe changes in amortization based on projects being delayed, so as interest rates changed over a period of time, some savings would be realized, these kinds of things. Let me say again, no programs were cut and no services were discontinued to achieve the $32 million in savings between the former government's budget last May and this budget.
MS. CASEY: Thank you, Madam Minister. I will go into the long-term care facilities and the Continuing Care Strategy, but perhaps I could just clarify here - there appears to be a $4.2 million difference in the two budgets in the long-term care budget line. Would you confirm that?
MS. MAUREEN MACDONALD: Thank you very much. Yes, the honourable member is correct. That $4.248 million decrease is because of a delay in long-term care beds, estimated to be $5.269 million. However, that was offset by earlier openings, due to construction ahead of schedule of $1.021 million. So the result is a $4.248 million decrease.
MS. CASEY: Thank you. So if we can go back again to the $32.4 million difference, and we've just now accounted for the $4.2 in the long-term care - can you tell me where the other $28.2 million savings might have been found?
MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, there is an additional decrease between the May and September budget and other capital grants in the amount of $25.797 million. The items that contribute to that decrease are some capital projects that, once again, could not be completed in this fiscal framework. For example, the reduction in new funding for the radiation therapy, the bunkers - that was a $10 million project that cannot be started.
Now I believe, though, that there is money allocated in this budget to do the planning that is required to have those radiation therapy bunkers go forward. As the former Minister of Health would know, these bunkers are required as part of the commitment of the former government with the federal government, to see a reduction in wait times for radiation treatment. However the actual construction of those bunkers, which had been calculated at $10 million by the former government and reflected in that budget in May, is no longer possible, so that was corrected in this budget.
Additionally, the member would know that the Colchester Regional Hospital under construction is also somewhat delayed. Due to that, the capital construction project there, $21.5 million was able to be removed from this budget. There are a couple of other smaller items in that amount as well of capital grants, but again, Mr. Chairman, these items were removed for the same basic reason - they couldn't be completed in the time frame. Energy retrofits, for example, originally presented under - that's an offset, actually that's added in, so ignore that last part.
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MS. CASEY: So would we be able to have the minister tell the House that the savings that were achieved, because some of the capital projects could not be completed, will be available in the next budget year so that those projects would be completed as planned?
MS. MAUREEN MACDONALD: Yes, the answer to that question is yes.
MS. CASEY: Thank you, I do feel a bit better. Let's look at long-term care facilities and I know you mentioned that there was a savings of about $4.2 million there because of the delays in some of those. As you know, the long-term care facilities was part of the Continuing Care Strategy which was announced in two phases by the previous government. It was announced because it was recognized that whether it was crowding in an emergency room or crowding in hospitals with patients who needed to be in a more appropriate setting, there was a commitment to the long-term care beds and that commitment was 1,320 beds by the year 2015.
The first phase of that would have been for 804 beds. RFPs went out for those. Many of those have been completed, many of those are in various stages of construction and I believe that RFPs have been called for perhaps the last few of those facilities. My question to the minister is this - are any of those facilities yet to be constructed and if so, what are the projected opening dates for those that have not yet been constructed?
MS. MAUREEN MACDONALD: Mr. Chairman, this program to either add long-term care capacity or replace existing beds in facilities that were quite outdated is a really important initiative of government.
Mr. Chairman, you would know that there are facilities around the province where the existing facilities, the beds, were built quite a long time ago, maybe in the 1950s or 1960s, and the kind of standards that we have today are significantly different. So the former government had announced its strategy to add, I think, a total of 812 beds into the system and, as the honourable member knows, some of those beds have opened but many of those beds are still under construction and some have yet to have the sod turned. So they're at various stages, I would say.
Let me itemize a bit of what has occurred so far. There are 10 facilities being replaced in some parts of the province: Tideview Terrace, 90 beds in the Digby area, expected occupancy in 2004 - 11; Tidal View Manor, 105 beds in Yarmouth, expected occupancy 2009 - 11; Northhills Nursing Home Limited, 50 beds in Middleton, expected occupancy 2006 - 10; Shiretown Nursing Home, 53 beds in Pictou, expected occupancy 2008 - 10. I think that might be wrong. I think it might be 2009 -10 actually, but I will check with the department on that.
From time to time, as the member knows, you'll see a second briefing note that will correct just a date. The Shiretown Nursing Home in Trenton with 36 beds, the expected
[Page 26]
occupancy 08/10; Alderwood Rest Home, 70 beds in Baddeck, expected occupancy 04/10; Inverary Manor, 71 beds in Inverness, expected occupancy in 11/10; Glades Lodge, 66 beds in Dartmouth, expected occupancy 09/10; Glades Lodge, 58 beds in Hammonds Plains, expected occupancy in 09/10; Windsor Elms, 108 beds in Windsor, expected occupancy 01/11; Duncan MacMillan, 26 beds in Sheet Harbour, expected occupancy 02/11; and Ville Saint Joseph-Du-Lac, 76 beds in Dayton, expected occupancy 03/12. So this is - I don't know that it's complete information for the honourable member, but it is some of the information I have and I will insure that it is complete and, if it's not, we'll provide complete information.
[7:30 p.m.]
So the Continuing Care Strategy is to add 1,320 new long-term care beds into the system by 2015 and 840 new beds were committed to be opened by March 2010; 722 beds were awarded and are currently under construction. The remaining 480 beds were committed to open by March 2015. Mr. Chairman, as you probably know, and I would think the honourable member would know - the former Minister of Health - this is a long-term strategy to provide more capacity into the continuing care system and there are replacement beds coming onstream and have come onstream. There are some new beds that have come in, and there's a fair amount of activity and construction in this sector around the province and there will be much more to be done.
MS. CASEY: I would like to thank the minister for that list and I would certainly appreciate when you can, Madam Minister, provide a status report on all of those facilities and a projected opening date for those. One in particular that I would like to ask about, and that was the RFP that was called for a facility in the western part of South Cumberland - can you give me the status of that RFP?
MS. MAUREEN MACDONALD: Mr. Chairman, to the best of my knowledge that RFP closed today.
MS. CASEY: Madam Minister, I believe, if I recall, that was the last RFP to be called for that block of beds that were announced in that first phase - would that be correct?
MS. MAUREEN MACDONALD: To the honourable member, I believe that is accurate.
MS. CASEY: Still along the lines of RFPs and awarding of contract and construction of a new facility, there is a service agreement that must be signed prior to the construction - are you able to give me the status of service agreements for facilities that currently have not begun construction?
[Page 27]
MS. MAUREEN MACDONALD: To the honourable member, the department has been working through a process of developing service agreements with the various long-term care providers around the province, as the former Minister of Health would be very well aware.
The background to this, Mr. Chairman, is that we are now devolving the responsibility for long-term care to the DHAs around the province - this is something that has been discussed for as long as I have been here in this Chamber, which soon will be for 12 years. When I was first elected, we had four regions. The government of the day had gone to an organizational governance structure for our health care system, which was referred to as regionalization - there were four regions and certain services were provided by those regions. Then a subsequent government, under Premier Hamm, rearranged the health care system again - there was a lot of dissatisfaction with the four regions. So we arrived at the configuration we have today, which is one where we have nine district health authorities and the IWK.
However the provision of continuing care services, including long-term care facilities, was never devolved into the district health authorities - it remained a program that was administered by the Department of Health. What that meant was that the Department of Health and the folks who work in the Health Department were the ones who negotiated and worked with the various long-term care providers around the province. We have quite a few providers of long-term care in our province, as the former minister knows. We have not-for-profit providers, we have municipalities that are very active in providing long-term care facilities in their area, and we also have a for-profit sector providing long-term care facilities. The relationship has been between the Department of Health and the long-term care sector.
However, the former government made a decision to devolve continuing care into the district health authorities. This has been something that the district health authorities have been asking for for many years, and it makes a certain amount of sense certainly to do that and to have done that, simply because there is such a strong relationship between the provision of acute- care services and long-term care services. It's hard to plan for your bed utilization in hospitals sometimes when you have no ability to plan for your utilization in the long-term care sector. It's important to harmonize policies and procedures between the long-term care system and the acute- care system and your health human resources and a whole variety of things.
We've had many ups and downs in the past number of years because of inequity, I would say, between the long-term care sector and the acute-care sector. We've seen a time when people essentially doing very similar work but doing it in different sectors had very, very significant wage differences that could not be accounted for simply on the basis of where they worked, Mr. Chairman. So it has been a long time getting to the place where there is movement to devolve the continuing care sector into the district health authorities.
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It won't simply be long-term care, Mr. Chairman. It will also be home care and it will be some other programs as well that will go into the district health authorities. In fact, the care coordinators for continuing care have already left the Department of Health and are now working in the various DHAs around the province.
It has been a transition that has been very smooth, probably not without its little bumps, but essentially very smooth, and it is the beginning of a greater devolution.
Once you do that though, the Department of Health still very much has an interest in seeing some policy objectives through this process and certainly one of the policy objectives that we have in the Department of Health is the very important objective of having accountability, transparency and equity in the relationships between the DHAs and long-term care providers.
We're all partners in the delivery of health care to people in Nova Scotia and the people in the province expect us to conduct ourselves with professionalism, to be open, transparent and to really get the best results, not only in terms of high quality care but they also expect a fair return for the health care dollars that are spent, which after all aren't our dollars - they don't come out of my pocket personally. They come out of the people of the Province of Nova Scotia, many hardworking people, and they have a right to know that their government is looking for a measure of accountability and transparency in the process.
So that is a long explanation for why we are entering into a process of developing service agreements. The intention is to have service agreements, which will be standardized across the province for various providers. As well, we'll lay out the terms of the relationship, the expectations with respect to accountability and transparency. I want to assure the honourable member that the process she was involved in when she was the minister and - perhaps didn't initiate it, perhaps one of her colleagues initiated, but no doubt she was involved in this - that we're continuing on with that process.
In the course of doing this, we are consulting with the long-term care sector. This is not a process that's being imposed on people without a lot of discussion, a lot of meeting, a lot of collaboration and involving them, because they are in fact our partners in the delivery of care. But we're very clear in the department about the absolute importance and the public value of having a written set of parameters with respect to the governance of these facilities and the accountability that we expect in the operation of facilities around the province. I think the public expect nothing more than that from us.
MS. CASEY: Thank you, through you to the minister - yes, I'm very familiar with that process. My question was really the status of those service agreements, which of those facilities would have a service agreement already signed and which ones do not?
[Page 29]
MS. MAUREEN MACDONALD: I don't have that information here on my desk but I will undertake to provide it to the member before the health estimates are completed.
MS. CASEY: Thank you and to the minister - if that could also be accompanied by the complete list of facilities, their projected opening dates and also the status of the service agreements.
I do have one follow-up question with respect to that, though. Will the devolution, which has taken place or is in the process of taking place, change the partners in that agreement? As you have outlined, prior to the devolution out to the DHAs, those agreements were with the department. Now that's been devolved to the DHAs, will that agreement with the long-term care provider be between them and the DHA or between them and the department, or will there be all three signing to that?
MS. MAUREEN MACDONALD: I thank the honourable member for the question. The service agreements actually stay with the Department of Health, but we have a Memorandum of Agreement between the department and the DHAs with respect to what the arrangements are going to be.
(7:45 p.m.)
MS. CASEY: I will move on to another topic, if I may. It has to do again with the hospitals in the DHAs and their funding. It would appear that Capital Grants for hospital and renovations projects have been cut back to $87.8 million from the Spring budget of $113.6 million. I'm wondering if we could have some explanation as to the detail around that $25.7 million difference?
MS. MAUREEN MACDONALD: Just to make reference back to the honourable member from earlier when we were discussing the changes between May and September, there is a $25.797 million decrease in the budget for Capital Grants. That reflects a reduction in new funding for radiation therapy bunkers, which could not be started in 2009-10; that was $10 million. Cash flow adjustments for capital construction projects reflecting the Colchester hospital, $21.5 million for a total of $31.5 million.
Then there were additional expenditures - $3.5 million for energy retrofits, so subtract that from the $31.5 million and $2.2 million, subtract that from the remainder as well because funding was provided to assist DHAs with equipment and emergency medical equipment needs. That's how we arrive at that difference.
MS. CASEY: Thank you. My next question speaks to a line that shows an increase. We know that our Emergency Health Services in this particular province are second to none and so I'm pleased to see that there is an acknowledgment of that in the budget. I would ask if you could perhaps outline the additional $5 million. My numbers are looking at going from
[Page 30]
$93.2 to $98.5 million and wondering where that additional $5 million might be used? In Emergency Health Services, what I'm seeing is that last year the EHS budget was $93.2 million, this year it's $98.5 million, an increase of $5 million. My question is how is that additional $5 million is going to be spent?
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. To the honourable member, that increase reflects wage settlements in the contract with EHS personnel and that's how that money will be spent to fulfill the wage settlements in the contract.
MS. CASEY: Thank you for that information, minister. With respect to Emergency Health Services, would there be any indication that the Emergency Health Services that are currently provided should be expanded in this province and, if so, how are you responding to that need for additional services?
MS. MAUREEN MACDONALD: Just for clarification, is the honourable member talking about EHS services specifically? Yes?
MS. CASEY: Yes, it would be specific to EHS services.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. We have no plans for an expansion of EHS services at this time. However, we are looking at the need for possibly a fixed-wing aircraft of some kind. I think this is due to the unavailability sometimes of what we currently have, in terms of the helicopter. I think we've seen a little bit of discussion of that recently in the media.
MS. CASEY: Thank you, Mr. Chairman. Under the line "other health care initiatives," there appears to be a decrease in spending of $2.9 million. It is my understanding that "other health care initiatives" includes such things as Cancer Care Nova Scotia, Nova Scotia Hearing and Speech, and mental health programs. My question to the minister is, first of all, what other health care initiatives are included on that line? Perhaps we can go with that question first.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. The honourable member has a good memory. There are lots of things in this area and if you bear with me, I'll go through it and give you a flavour of what's in here.
Allied Health, HHR strategy is in here, Canadian Blood Services is in here, Health Research Foundation grants are in here, information products development, access strategy, information technology initiatives, medical lab tech training program, mental health programs, nursing initiatives, Nova Scotia Health Ethics Network, pain management, pandemic planning, physician training seats, primary care programs, provincial health services, operational review, provincial programs, stroke strategy, Nova Scotia Family
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Pharmacare, health care capital amortization, recoveries for Hep-C, and recoveries for LMAPD, which - I'm sorry, I'm not too sure what that is. These are the other health care initiatives that make up that line in the estimates.
MS. CASEY: Thank you, Mr. Chairman. Well, I guess my memory can't be very good. I only remembered three of those on that list. However, my question is, with that particular line and those very important programs, can the minister tell us from where the $2.9 million would be cut from that particular line.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. There are quite a few things that contribute to this but the two big ones are Family Pharmacare, lower utilization than projected. Family Pharmacare was projected to be a $30 million line item - was the budget base - and in fact it has been reduced to $26 million. That reflects a reduction of $4 million, but at the same time there are increases in some of these areas as well, so it's a complex picture of where these changes all come from.
MS. CASEY: Thank you, and thank you to the minister for that answer. So the net difference would be $2.9 million, would that be correct, the net difference on that line would be $2.9 million?
MS. MAUREEN MACDONALD: I believe that's the case and again, through you, Mr. Chairman, to the honourable member, no programs were cut or reduced to remove services. When we looked at utilization, we realized - and for example, with the Family Pharmacare Program, it was a new program, as the honourable member would know, it was a new program that was established and as with all new programs, you quite often bring forward an estimate of what you think the utilization will be and you plan for that and sometimes you don't have it bang on. The utilization can be more than you anticipated or less than. In this case, for example, it was less than and we've adjusted the budget accordingly, more realistically.
MS. CASEY: Mr. Chairman, if I could then follow up on the Pharmacare with some specific questions. It certainly was a program that was introduced and it was designed for those families that did not have a drug plan. I believe our estimates were, at that time, we were looking at - I think it was 118 families, perhaps, or 180. I'm not sure what the number was, but a number of families did not have a drug plan and this was to give them some assistance.
My question to the minister is, understanding what we've just been told is that the uptake on that was not as great as anticipated, how many Nova Scotia families have registered in the Family Pharmacare plan?
MS. MAUREEN MACDONALD: Mr. Chairman, in 2008-09, families actively participating were 12,778 and individuals actively participating, 16,766.
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MS. CASEY: Mr. Chairman, through you to the minister, are we looking at an uptake of less than 30,000 people for that particular program?
MS. MAUREEN MACDONALD: Mr. Chairman, there is a higher enrolment in the plan than there is actively participating. As the former minister would know, there's kind of a requirement that you spend so much money on drugs yourself based on your income. There's no set amount but it's kind of a sliding scale, as I understand it, and then at that point you can actually take advantage of the program. So there are more families, there are 18,094 families enrolled and 32,173 individuals enrolled but as the member can see from the prior figures that I've provided, many of those folks aren't actively participating. They haven't been able, and for whatever reason I really don't know, if it's because their drug needs aren't great enough or because they've decided not to pursue the program or whatever, but those are the numbers.
[8:00 p.m.]
MS. CASEY: Mr. Chairman, it's my understanding from that program that it was designed for families who had no drug program, no drug coverage. It was also designed for people who experienced unusual financial burden at certain times and maybe not all of the time would they have to be recipients of this. Are you able to tell us how many of those families that you have identified as being enrolled are people who had no program, no drug plan, and how many are people who have taken advantage of it when the financial burden was too great for them to bear?
MS. MAUREEN MACDONALD: I would say to the honourable member through you, Mr. Chairman, that based on the information I have I can't really answer that question at this stage. I will again undertake to see if we have that information in the department and if so, we'll provide it to the honourable member. You know, everybody who's a member here, particularly people who have been here for a while, we all know of the challenges that families have around getting access quite often to prescription drugs. Particularly if they are people who have low and modest incomes and work in an environment where there is no drug plan as part of their employment. We all know as well that the costs of prescription drugs have escalated considerably, particularly as you see more and more new drugs come on the market.
I think that every member of this Assembly recognizes the limitations of the Pharmacare Programs in the Atlantic Region. I think that, you know, from time to time we'll see accounts in the newspaper, Mr. Chairman, that talk about the accessibility of pharmaceutical health care across the country. We will see that other provinces have very, very robust Pharmacare plans for their citizens but Atlantic Canada has lagged considerably behind the rest of the country in the provision of any kind of plan for their citizens. This plan, this attempt to make a prescription drug program available to families and individuals is, I think, an important one but we can see from the numbers that there are still people out there
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who probably don't have access because of the limitations, and we all recognize that the limitations in our plans are often due to our financial capacity to provide more robust plans for people. I think that one of the things that I feel fairly strong about, Mr. Chairman, is that we have now in our province a number of drug plans - we have a Pharmacare plan for people who are in receipt of social assistance; we have programs for diabetics, the diabetic program; we talked earlier about the exceptional drug programs, MS, and Fabry's and some other drug plans; and then we have the Family Plan.
It would be, I think, desirable to be able to look at whether or not there is any benefit to, I wouldn't say amalgamating plans but a greater degree of harmonization, coordination, a central administration, whatever, to see if we could realize some efficiencies and then reinvest those, any savings that you could realize from having all these different plans, into providing better coverage for people in the province, so that we would actually see more people having access to the prescription drugs they need. This is something in the coming year I would certainly look to the folks in the department to consider and to do some work on. Thank you.
MS. CASEY: Thank you, and I know that the clock is ticking on us here, but I do want to suggest to the minister that I think it's important to keep that program in your sight. We recognize that there has not been the uptake that was initially projected and there may be a number of reasons why - sometimes it's communication and sometimes people aren't aware of it, but I thank you for keeping it in the budget at this point in time.
MR. CHAIRMAN: Thank you, the time has expired for the honourable member.
The honourable member for Dartmouth East.
MR. ANDREW YOUNGER: Thank you, Mr. Chairman, and I'll share my time with the honourable member for Halifax Clayton Park.
MR. CHAIRMAN: That's very kind of you.
MR. YOUNGER: Mr. Chairman, my first question for the minister, and I'm not sure if she is aware of some of the issues, particularly around the Dartmouth General Hospital and specifically of late around the blood collection services which are backing up into the emergency room as people try and make use of those - well, frankly, get blood collected, which is forcing people to move to private service providers to get that done. I'm wondering whether there are any plans in this budget or what plans your department has with respect to improving access to the publicly funded blood collection services?
MS. MAUREEN MACDONALD: I'm not sure exactly what the honourable member is referring to, but let me just first, in a very general way, say that I am, and the members of this caucus are very committed to a public system. We, I think, in terms of our tradition, our
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values as the Party that the greatest Canadian led in the Province of Saskatchewan, Tommy Douglas, when Medicare was introduced, are very aware of that tradition and we're very proud of that tradition not only for ideological reasons, which we sometimes are accused of, but for very practical reasons. The practical reason is that in our view it is important that every possible dollar of health care funding that we can wring to provide service and good quality, high-quality service, to the citizens of our province is really important, and sometimes the best way to do that is certainly to ensure that it is publicly delivered, that you don't have large multi-national corporations, with interests in attaining high corporate profits to redistribute to a small number of shareholders, driving the health care decisions of our province.
We only have to look at what is occurring today in the United States to see the interests of the for-profit sector there, particularly the insurance industry, which I don't think there is any question they are very much involved in the attempt to shape what will occur finally for American citizens who have no health coverage. This is something that we're very thankful here in this country that we don't have to deal with in that way.
This is not to say that we don't interface all the time with the for-profit industry. There are a lot of for-profit companies operating in the health care sector - we buy our supplies from companies, it's a very big business. We have great partners, but we really like the fact that they have to compete to get contracts and that gives us an opportunity to try to get the best deal we can, but there are certain aspects of our system that we very much want to keep under public control.
MR. YOUNGER: Mr. Chairman, I may not have explained it well enough, but I certainly got one half of the question, and I think the minister and I might agree that as things go on in the U.S., for all Canada's flaws in the health care field, I certainly hope they will come to choose something similar to our model for the U.S.
The issue, particularly as it relates to the Dartmouth General, the Dartmouth General has been in a situation for a number of years where people are unsure whether it is slowly being abandoned by the Health Department, but then suddenly they'll get some sort of expansion - the Dialysis Centre was something a couple of years ago that I attended the opening - the fear is, and blood collection is the latest one, if you are a citizen of Dartmouth or Eastern Shore or one of the areas that feeds into the Dartmouth General and you want to go there for blood collection services, your wait time is substantially longer than just going across the bridge and going to the Infirmary. There seems to be something fundamentally wrong with that when we want people to be able to access the Dartmouth General and if we see the Dartmouth General as an important part of the Capital Health system.
So I guess what I would like to know from the minister is what are the plans, what is her vision for the future of the Dartmouth General Hospital - how does her department
[Page 35]
plan to tackle some of these issues? Today it's blood collection, and maybe they need more staff, but these are all going to cost money - so what are the plans in that respect? Thank you.
MS. MAUREEN MACDONALD: I thank the honourable member for the question, now that I understand it a little better.
Let me start by saying to the honourable member that the Premier sat on the board of the Dartmouth General - I've heard him stand in his place in this Assembly more than once and talk about that experience and talk about his commitment not only to the Dartmouth General but his commitment to the Dartmouth General because he's committed to the people of Dartmouth. He understands that the people of your community had a great deal invested in the building of that centre and the ongoing operating of that health facility. So I just want to start by acknowledging that.
In terms of the future of the Dartmouth General Hospital, the Dartmouth General is part of the Capital District Health Authority, a very, very large DHA, a critical DHA not only to the metro area and the people who live in the Capital District Health Authority, but all across the province people come to our DHA for tertiary care and from outside the province from this region. The Dartmouth General is an extremely important piece of infrastructure in terms of the capacity of this DHA to meet the huge amount of demand that's on it.
The Capital District Health Authority has gone through a process of looking at their facility needs right now and into the future. I think we all recognize the very great challenges that the current fiscal situation places on government to address all of the facility requirements of DHAs around the province, but we also recognize that we have facilities that need more investment. They have great potential to provide maybe more services or different kinds of services than they're providing now. In the process of looking to the future needs of the Capital District Health Authority, very much a part of that discussion - I want to assure the honourable member it will be a discussion that will occur with the community, not between the government and the Capital District Health Authority. All facility planning is really a process that needs to include the community. That will be a process of consultation and discussion, and the importance of that particular facility will be very much a critical piece of any ongoing discussion and planning.
[8:15 p.m.]
It's something this government recognizes, and will be looking forward in the future to seeing what the people of Dartmouth envision for that facility and how we can work toward realizing those aspirations.
MR. YOUNGER: Thank you, Madam Minister. I look forward to those public consultations. I think the fear in Dartmouth and the surrounding areas is - as the minister said, the Capital District Health Authority is enormous, and frankly one can understand why
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their focus might be on the cardiology department or one of the transplant departments. That's very understandable because they're servicing the entire Atlantic Provinces, in some cases. The fear is that a smaller hospital - and the Dartmouth General certainly isn't small by the standards of some others in the province, but it's small by the standards of Capital District Health - that it doesn't get lost in that shuffle, as sometimes seems to be the case.
It's very important to the region, and if we ever had a situation where there was a reason why you couldn't cross the bridges and there was a region-wide emergency, then obviously, that would be all anybody on that side of the bridge would be left with.
I'd like to move on and follow up one of my first questions - it sort of alluded to the public-private health care debate. Not too far from the Dartmouth General is the Scotia Surgery Clinic. I would be interested to know - obviously the minister's Party was very critical of that in Opposition and I'd be interested to know what the plans are for the government with respect to the Scotia Surgery contract.
MS. MAUREEN MACDONALD: I want to thank the honourable member for the question. Mr. Chairman, through you to the member, on June 3rd the former Minister of Health signed an extension to the Scotia Surgery project for another year. The project has been extended for a year; it also has been expanded from two days to three days.
The Scotia Surgery project is a project that sees minor orthoscopic procedures done in that private facility. For the people who require those procedures, the response of the patients - because they have been asked what their experience of having procedures done in that facility were - their response was very positive. They had a very positive response and, you know, that's a good thing. We want people in our health care system to have a positive response.
However, having said that, the wait times for orthopaedic surgery at the Capital District Health Authority have not been reduced by one iota having this agreement with Scotia Surgery. The wait times in the Capital District Health Authority for orthopaedic surgery continues to be pretty much what they were prior to the Scotia Surgery project. So, you know, this is the situation that we find. We will, I will as Minister of Health and people in our department, continue to work with the Capital District Health Authority to identify what is required to reduce orthopaedic wait times.
In the area of wait times we have seen significant improvements in some areas but the fact that we have seen no improvements in orthopaedic waits is something that is of considerable concern to me as minister and to this government. We would like to find a way to change that and we have some ideas about how that may occur. We made some commitments in the election campaign with respect to pre-op kinds of programs. We are planning to fulfill those commitments in the year in which we said we would fulfill them in our mandate, which isn't right now but we're looking at doing something. It's not unusual
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to find people in our province waiting for close to two years to have orthopaedic surgery, to have a hip replacement, a knee replacement, or what have you. It's just not acceptable, really, to have those kinds of waits. So notwithstanding the introduction of Scotia Surgery, this contract remains in place for another year and what I would say to the honourable member is that we will continue to evaluate what the impact is.
MR. YOUNGER: I wonder with the orthopaedic wait times not changing, does the minister know whether that's simply a matter of more people coming into the system seeking those? Therefore, a wait time that may have otherwise increased is just staying the same or is it roughly the same number of people going in? That would be the first question I would ask, relating to that and the second follow-up to that would be, do I understand then from the minister that they, in fact, have not decided to not renew the Scotia Surgery? I guess that's a double negative and I'll make that more clear. Have they decided, do I understand that the government has not decided yet whether it will renew the Scotia Surgery or similar contracts at the end of this period?
MS. MAUREEN MACDONALD: Mr. Chairman, to put it as plainly as I can, that decision was taken out of our hands for one year on June 3rd when the contract was renewed for that period of time but I would like to say to the honourable member, through you, that in this budget we have added $1.7 million to fund an increased volume for orthopaedics at the Capital District Health Authority. So while Scotia Surgery continues to operate and, you know, provide the orthoscopic work. We're not resting on our laurels with respect to CDHA and the work that needs to be done there. We're in constant conversation with them about developing a plan to reduce the waits.
MR. YOUNGER: Thank you, Mr. Chairman, and to the minister, I would appreciate maybe if at some point - I don't expect you to have these numbers or that staff would have this now, but if we could see what sort of numbers were in the system waiting for orthopaedic procedures before and what the numbers are now, because I am interested to know whether the wait time issue - whether they've picked up some additional numbers and that's why the wait time is there, or whether in fact there has been no difference.
I personally don't actually have a real strong view one way or the other. The second element to that was, of course, the use of the Stadacona hospital and the military hospitals, which is intriguing to me in that it's a publicly funded hospital, of course, so it's obviously a very different situation in that respect, in the respect of Scotia Surgery, which is private. So I would be interested to know whether the minister plans to look at expanding that opportunity or taking advantage of that underutilized operating space and even potentially doctor time.
MS. MAUREEN MACDONALD: Mr. Chairman, I think if I'm reading the material correctly, there has been an increase in the number of procedures at the Capital District Health Authority by 283 in orthopaedics; for certain types of orthopaedic surgery, we have
[Page 38]
seen some increase. However, the wait times continue. Now what that means, are there - I don't know. One of the things that we're very pleased about is the announcement that I was able to make at the Aberdeen Hospital in New Glasgow with respect to the building of the data collection system to really start looking at this issue province-wide. We hope to have this data collection system in place by July 2010.
One of the things that the surgeons and other people will tell you is that it's not absolutely clear, when we count people on waiting lists, if some people are being counted more than once because they get on more than one list. You know, Mr. Chairman, this was certainly the case before there was a single entry point for long-term care. The wait lists for long-term care facilities ten years ago in Nova Scotia were horrendous. There were thousands of people waiting for long-term care beds and the Health Critic says there are thousands - well, there are actually probably under 300 now waiting for long-term care. It's still 300 too many, I acknowledge that. We don't want to have people having long waits to get into a long-term care facility, but the thing about that was that families would go to several facilities - they might be on a wait list at Northwood, they might be on a wait list at St. Vincent's, they might be on a wait list at Glades, and so when you start accumulating the numbers from all of those facilities, the wait lists look very high.
Every facility managed their own wait list. Well, with surgeries - with orthopaedic surgeries it's somewhat similar. Every surgeon manages their own wait list and so it is conceivable that there are some people who have seen and been referred to, perhaps, more than one orthopaedic surgeon. So it is possible that the wait lists are higher, that they appear to be higher than the reality, but we don't know that. We don't know that until we're able to construct a single database of some sort, a way to gather information accurately and know that people aren't being duplicated on different lists.
So the system, the database that we announced on Friday, is a kind of significant development in terms of moving us towards better data collection. It's a partnership between the Department of Health and a network of surgeons from all over the province who have been participating in the planning of this, and the implementation, and we're very happy for this partnership with surgeons. It will make a very big difference in allowing us then, once we know the accurate wait list, to be able to put resources where they are most needed and where they will be most effective. The end results will be shorter wait times for people who need surgery.
[8:30 p.m.]
MR. YOUNGER: Mr. Chairman, before I yield the floor to my honourable colleague, I will just say that's very good news, but in hearing that I hope that the government will fairly represent the wait time changes. If it does turn out that there are people on multiple lists, I hope that the government - when they show their before and after numbers - will be taking all the duplicates out, otherwise it might show quite a success where maybe there isn't as
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much of a success as we hoped for, although I certainly do hope that they are successful. With that, Mr. Chairman, I will yield the floor to the member for Halifax Clayton Park.
MR. CHAIRMAN: The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: Mr. Chairman, it's my pleasure to continue with questions here in the Estimates for Health. I was going to start in another spot, but since we're talking information technology and the announcement that the minister made - I think just within this week, that was made from the New Glasgow area, I think the Pictou Health Authority - I wanted to ask just a couple of questions around that.
I'm not sure first of all where it would appear in the line items, I'm wondering if there is a line item called Information Technology Initiatives, if that's where it is. I had one indicated which has gone down by $2.5 million, so I'm a little bit concerned actually. That is on Page 14.7 and I must say that I'm in the Supplementary Detail rather than in the main Estimates Book, you may have had difficulty when I was providing the numbers last time. In the Supplementary Detail there is a line item called Information Technology Initiatives on Page 14.7 and it's down $2.5 million. It is down to $38 million.
Actually, when I say it's down $2.5 million, it's down from the May Budget, I should point that out, not down from last year's estimates, it is significantly up from last year. But I would like to know if that's it and if you could explain if that is where we would find this particular initiative which you just described as a partnership with the surgeons in the province. I'm assuming that the department is definitely paying for it and the surgeons have lots of good ideas that will, hopefully, make a much stronger and much more effective way of tracking our wait list. So I'll just wait for an answer on that from the minister.
MS. MAUREEN MACDONALD: Mr. Chairman, I'm not sure that we're looking at what the member is looking at. Is it a decrease? Did the member say it was a decrease of $2.358 million?
MS. WHALEN: $2.5 million.
MS. MAUREEN MACDONALD: $2.5 million. This reflects a reduction in the operating costs of the electronic medical records rapid expansion program. It's not a cut in a program that was being introduced, it is just a reduction in the operating costs associated with that. (Interruption)
MS. WHALEN: I wonder if the minister would tell us more about this Information Technology Initiatives line. I hope you've got the right line item as well because if you look just from year to year, 2007-08 to the next year 2008-09, it went from an estimate of $20 million to $26 million and this year it's $38 million. So there have been some significant jumps in this line item.
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I mentioned in my opening comments that IT has been an area that we've been hearing about here at the Legislature for at least the six years that I've been a member and a lot of times those programs end up over budget and behind schedule. There's a number of them that we can point to. I don't know what's going on here with the great increases from year to year or if this is completely on track for a number of major initiatives that are rolling out. So my question would be, you know, I've highlighted that item and I would just like to know what the huge increases are year to year and if you can explain whether it's one major initiative or is this a combination of initiatives?
MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, there are a number of significant increases in various operating areas. The member I think probably would know about the HASP system which is human resources, it's a financial package and it has to do with the payroll and benefits area in the DHAs and in the IWK. To implement this system, this is a system that the department has been working on implementing and has implemented in a number of areas and it's estimated that that cost will grow by $3 million this year, for example.
Another program that will result in increased costs of $5.695 million is an EHR Program. It's entering its final year and it's shifting costs from capital as the project enters implementation and training. The project will be on budget over the three years but that represents another almost $6 million in that line item. Additionally there are increased operational costs associated with supporting new IT initiatives including an EHR program and a surgery program and that's $3.366 million.
I want to say to the honourable member, I understand where she's coming from when she talks about having seen these technological initiatives over a long period of time and wondering what benefit we get from them. It's a very valid question. There are a couple of things that I'm learning as minister in the early days in the department. You know our health care system is amazingly behind the times when it comes to computerization compared to industry, the financial industry, the retail sector, the service sector, insurance, transportation, the airlines.
I mean, Mr. Chairman, we have a $3.4 billion health care system and we're just starting to get technology in the last eight years, 10 years, in Nova Scotia, if that. It's shocking, we still have physicians' offices in Nova Scotia with no computers and hand written records.
We still have long-term care facilities where the only computers might be in the office with the administrator, so this is a problem. We live in a highly computerized, technologically advanced society now, a knowledge-based society, yet our health care system, a big enterprise like our health care system, has significantly lagged behind the introduction and the implementation of technology and being able to take advantage of the benefits that technology could provide us - in our big hospitals, for example, being able to
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restock your supplies and not have people walk up and down the aisles and count boxes and write it down on a clipboard. It's that basic. So that's one thing I've learned.
The other thing I want to say to the member is that - and we all know this as MLAs and in our homes - once you have a piece of technology, it becomes obsolete very quickly. It's the nature of the beast to constantly be upgrading, to constantly be looking at what piece you need to add on to do what it is that you really want to do. We've all experienced that probably in our daily work lives, in our offices or even in our homes.
Imagine in the health care system, where things are constantly evolving and changing, new sets of issues emerge, new questions need to be answered and new things need to be planned for. I think this is the challenge when we get into the area of technology. I'm sorry to be so long-winded but these are things that I've learned that are really fascinating.
MS. WHALEN: I appreciate the minister's comments and letting us know what she has learned as she has taken on this responsibility. You hit the nail on the head when I said what are the benefits. I do believe we need to be using technology and there are some direct patient benefits. It's kind of amazing to think that we haven't had payroll and employee benefits already computerized somehow. Certainly the rest of the Public Service is all computerized. We're using SAP, I believe it was, and I would say that was a Cadillac system, at least my understanding is that it was like a Cadillac system we ordered up when we went with that program.
For health care spending that doesn't seem like a direct benefit to anybody, certainly not to patients queued up or wait times or long-term bed shortages, somehow it pales when you are looking at something like payroll and benefits that have now been computerized. That should have been done, as you said, years ago. I'm not sure why it hasn't and whether or not - or should we not see some savings somewhere else. If somebody was doing this manually, are there not legions of clerks or something who will now be reassigned somewhere else or perhaps no longer on the payroll? There has to be some corresponding saving somewhere, so I do wonder about that.
I had written down the question about what are the IT priorities of the government because I know there are a number of different programs and you've alluded to them. You've talked about an EHR one, I believe a surgery program. I'd like to know where we are seeing the priorities that are going to give us the best improvement to the system, the improvement that's going to help patients who are waiting and people who have health needs that have to be addressed. I can think of some that we've heard of and read about, things like again, computerizing doctors' offices and patient records, and patient records in hospitals which aren't all computerized as well, digital imaging so that we can have immediate access to digital imaging and records that are kept. That would be a priority, I would think, so people don't wait for X-rays or wait for mammogram information to be transferred to the hospitals.
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I just want to know, where would you say are the key areas where we can improve patient outcomes and improve the system, rather than getting bogged down in a lot of separate projects? I'd like to know that the minister has a priority and an idea about what needs to be done now in terms of introducing information technology and just technology in general to our system.
I think that she did a really good job explaining to us that the system has been slow to adopt change in technology, and really is so far behind that it's going to be a big job to now get us on that footing, but surely there's some best practices in other provinces and places that we can look at that we can say, that's the priority we need to do today, or yesterday, the ones that we really need to get going on. I think that that's very important, that we identify them and that we know that the government is looking for the priorities with the best savings to the system or improvement to patient outcomes.
[8:45 p.m.]
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman, and it's a fair question. I would say without any hesitation that the electronic health record is certainly one of the priorities. It has to be a priority. So many members of our community, their interaction with the health care system is in their family doctor's office, and to be able to have the family doctor communicate with specialists, with diagnostic services, to have specialists be able to communicate with each other - this is so critical. I don't think there's any question about that, so we place a great deal of priority on the electronic health record.
Unfortunately, we don't have the luxury of just having a priority, where that's what we're going to do and nothing else. We really need to invest in and transform many pieces of the system electronically. As I explained to the member, it's a huge enterprise, it's like a large corporation, and you don't have the luxury of just doing one thing and doing it well. You have respond to many, many needs and you have to attempt to do more than one thing and one thing well, but the electronic health record is certainly something that's really important and is a priority.
I want to also say to the member - and I'm not going to take too much more of your time - but I want to say that part of what this province attempts to take advantage of and will continue to take advantage of is federal dollars. It has been a priority for the federal government in the past, through a couple of initiatives - the Canada Health Infoway, in particular - to put federal dollars toward information technology initiatives in the provinces. The extent to which we can take advantage of federal dollars coming to the province is very important, and we actually end up with a number of the projects that we have underway - we end up recovering a fair amount of the costs of those projects through the realization of federal dollars. So I want to say that to the member as well, we take that into consideration as we look at the menu of initiatives that we really need to do and we say, okay, how can we
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get the greatest financial impact to do what needs to be done here? That's a piece of how we set priorities.
MS. WHALEN: Still speaking on information technology, the minister has stated a priority item would be the electronic health record, which I certainly know we've talked about and has been touted - that individuals could actually carry their record on basically a credit card. That's what you hear the people speaking about, the vision of being able to have all of your information at hand, and I think that is important as people travel and access health services, but I wanted to ask the minister if she could give us some idea of where that project really is? Are we at the infancy stages of an electronic health record or are we underway, are we starting to make headway? I think that's important to know. I also began my questioning by asking what the total budget was for salaries. Roughly speaking, you said 70 per cent of the budget for Health is in the salary range. Could you give me some idea, a dollar figure for how much we have identified in the annual budget - this year's budget - for information technology? Again, I recognize they're in different budgets and they're here and there. It makes it hard for a critic to piece it together, and I'm hoping that you would be able to give me, you know, a fairly accurate ballpark figure that takes us to the realm that we're talking about. The one line item I had pointed out is $38 million, but I know that's not the only line item that would be in the budget and that may be a question that requires some piecing together by the financial officers. So if you need to provide it later, that would be fine.
MS. MAUREEN MACDONALD: Yes, I would say to the honourable member that because IT appears in more than one area, we would have to look at that and do the calculations, but we would be happy to do the best we can to figure that out and get the information to the honourable member.
With respect to the electronic health record, currently 1,171 health care providers are participating in this initiative. This includes 249 family physicians at 83 primary health care clinics; 88 per cent of the province's nurse practitioners are also on the provincial EMR, along with 34 hearing and speech clinics and the provincial Hepatitis C Program; and 72 additional clinics have expressed interest in joining the provincial EMR Program.
Without a doubt, Mr. Chairman, there is a great appetite in the health care providers, particularly in the primary care area, to participate in this program and, you know, I remember when the pilot projects were announced, the North End Clinic, which is in my constituency, was one of the primary sites, and I have to tell the member it has made an enormous difference. This is where I get primary health care, and it's fantastic to go there and to now have an electronic patient record. It has made a great deal of difference for the physicians, for the nurse practitioner, for the nurses, for the nutritionists, the social worker, and the other health care providers in that facility, and for patients - you know, you don't see a difference in the kind of health care you get. It's seamless. I had the privilege of being in
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Yarmouth at the DHA there and there is a wonderful family doctor - I think her name is Dr. Lahey - it's terrible, I should know this, but it's gone.
AN HON. MEMBER: Sheila Lahey.
MS. MAUREEN MACDONALD: Yes, Sheila Lahey, who works there. I was taking note of the way that she utilizes technology in her office, not only in terms of keeping records but as a teaching tool as well. It's phenomenal. So there's a lot we can do with technology that will transform the way medicine is practised and health care is delivered and will result, I believe, in many, many improvements in the quality of working life for the health care provider and the outcomes for the people who need health care.
MS. WHALEN: I wanted to change gears, but I have one last question on this one that maybe the minister could give us a quick answer to. That is, given that we have 1,171 providers you said are using it now, is the government doing anything that encourages other practices and other doctors who are, you know, on our billing number system and so on to come on board and do this? Is there any incentive or program or encouragement that says, come on, guys, you have until this length of time to get on board, because we may have all the earlier doctors already on board, how do we get the others to come and make it more extensive?
MS. MAUREEN MACDONALD: I want to thank the honourable member, Mr. Chairman, it is a great question. There are provisions in the master contract that have been negotiated with Doctors Nova Scotia to incent the conversion and the participation in the electronic patient record.
MS. WHALEN: Good, I'm glad to hear that. I don't think where I go has that system in place, so I'll check on that in Clayton Park, because we have a number of doctor offices and group practices there.
I wanted to quickly go - I have about 12 minutes left in my hour and wanted to ask you something about medication reviews, going over to the pharmaceutical area. I have a bulletin that was from the pharmacist, it's a pharmacist's bulletin, it says Pharmacare on it, it says that it is from the Nova Scotia Department of Community Services. I'm wondering if that will relate to yours as well, but it says that there was a pilot project for a medication review that would be undertaken by pharmacists, not by doctors.
The minister may remember, Mr. Chairman, that there was a bill the Liberals had brought forward some time ago asking that there be a senior medication review. It's an idea that is well entrenched in other places, particularly Australia as I recall, where doctors themselves do a medication review annually for seniors and it saves a lot of money to their system. They found it to be a tremendously positive thing.
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Too many seniors are on multiple drugs that they have been on or perhaps they were prescribed one drug some years ago and they stayed on that and then other drugs were entered into the situation. Often one is no longer needed, or they counteract each other, or there is a lot of negative or adverse reactions because of these drugs all being prescribed to the same person. Nobody sat back and looked at what made sense and whether they should come off that one and be on something different. So it just becomes a growing problem and a very expensive problem and seniors, as a result, often have an adverse effect. It may affect their coordination, it may affect their mind, they can become sort of foggy because of the drugs they're on. It is not good for anyone, so it's a perfectly wonderful idea to review their medication.
I was referring - and I don't know if you are aware of this program that said it was a pilot program that was begun in Truro and Glace Bay, it was in March 2008 and pharmacists themselves were going to do a drug review. It is my understanding that they would choose the customers or the patients who they would review, that they would get their permission first, that there would be a charge then for that review to take place. So, first of all, I'm wondering if the minister is aware of it and if she could tell me how it's going, it's been more than a year since it's been in operation now.
MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the honourable member and I want to say, no, I'm not aware of the pilot project. I don't know if it is a pilot project of our department or if it is a project of the Department of Community Services, but it is something that I (a) will check into and (b) I'm really glad that she has brought this to my attention. I know well the phenomenon that she speaks of in terms of seniors being on multiple prescriptions and sometimes the lack of, for want of a better word, harmonization between the prescriptions and the difficulties that this can present to seniors.
I know that, for example, the pilot project at Northwood with the nurse practitioners who have been there, part of the concern was to ensure that attention was paid in a very rigorous way to the adverse effect of prescription medication that many seniors in that facility experienced from time to time. I know that this is a question that many gerontologists have and there is quite a large amount of literature on this. I know that pharmacists, in terms of their scope of practice, have great capacity that sometimes is not necessarily well utilized in our health care system, which brings me to another initiative that is going on in the department. This is with respect to models of care and really looking at having the right health care provider providing health care services to people, putting the patient first, the patient at the centre of our health care system and saying what the needs of patients are and who is best able to provide care for those needs based on their expertise.
I think pharmacists are, in many respects, very capable of doing things that we haven't necessarily had them doing in the system. I would be interested if the honourable member has more information, not only that but with respect to the bill that you made reference to and the information on which it was modelled from Australia. We say that all
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ideas that are good ideas are worth examining, looking at and studying and who knows where it will go. So, to the member, provide that information and we will have a look at it.
[9:00 p.m.]
MS. WHALEN: Mr. Chairman, I appreciate the minister's comments because it really is a compelling argument to look at, that and the difficulty we have in our current system - where in Australia it is doctors who are doing the seniors medication review - the difficulty we have here is that doctors are not paid for that service, it is not something they would be doing. Some of the doctors, in fact, say they do it on a fairly regular basis themselves but it is really hit and miss.
If you make it a standard program that targets seniors in particular, because as we know, the cost of health care climbs as you get older and people then tend to be on a lot more, a myriad of drugs, a lot of different drugs that they have, over time, been put on. I would happy to give you the information on the actual savings that were documented in Australia by making that a service that doctors would be paid for.
The one that I was referring to where pharmacists were doing the review, the two names on the bulletin that I have are the Community Services Department and the Seniors' Pharmacare Program. I will give you that as well. Perhaps you can look into it and maybe before estimates are done we can talk about that again, because it is something we think is very sensible to do and I think pharmacists may, indeed, be the right people to do it in some degree, perhaps they can do it just as effectively as doctors themselves.
We think it is very good and I would like to bring the bill in again and discuss the bill with you because perhaps it could find its way into practice in Nova Scotia and we would be happy to be involved in bringing up good ideas.
The other point that I wanted to raise, because you had mentioned geriatrics yourself, is that this program that was started as a pilot was not available to people living in nursing homes. It said very clearly it was for people not residing in nursing homes or homes for special care, it couldn't be somebody who was receiving medicine or medication in compliance packaging. I don't know what that means, but those are three categories not allowed. I would suggest that people in nursing homes would be primary candidates for this kind of a review, one reason being a discussion that I had with one of our most renowned geriatric doctors, and that is Dr. Ken Rockwood, who practices here in Halifax and, in fact, has attracted a great group of researchers around him. I understand that young researchers come from across North America, because of his reputation, to work here at Dalhousie on some of his studies and I had a chance to discuss with him at one of the health research gatherings.
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He had said that in most nursing homes you will find many, many patients who are taking cholesterol reducing drugs and those are the kind of drugs that are given to people my age, or the minister's age, for long-term benefit, that keeps your cholesterol level low and helps with your overall heart health and so on. But when you're already elderly, it doesn't have any particular good effect because it is intended for the long term, for years and years of high cholesterol. So it is an example of a drug and we could very easily look at people in the nursing homes and say, it doesn't make sense that they be on it.
I don't want to take any drug away that improves the lifestyle of seniors, but if it has no real benefit because it is intended to be for a 10- or 20-year time frame, then really why are we prescribing it? It's just one more drug that they really don't need to take and isn't going to have any real outcome that's positive. So that's a very simple example of something that he just threw out there in conversation and said that there are many other examples like that if we sat down with the experts and looked at drugs. So I go back to the idea of a medication review and I wonder maybe just in the couple of minutes left the minister might like to respond to that and I will again go back to the bill that we brought forward and bring to her attention the information that we had that led us to suggest that in the first place.
MS. MAUREEN MACDONALD: Thank you very much and I too am a fan of Dr. Rockwood and there are a number of very excellent gerontologists and it's a field that is extraordinarily important. It may be difficult sometimes for people to get access as well. I recognize that and I've seen people who really require that kind of specialization, someone who really understands many of the features of old age and some of the specific diseases that are associated, dementia, Alzheimer's and these diseases that seem to be more prevalent now than they had been.
We have a unique, I think, group of researchers in the province in various areas including Dr. Janice Keefe, who is a specialist on aging out at Mount St. Vincent as well. So I think we have a number of people who we can draw on for a whole array of not only direct services but really policy ideas that can lead to significantly better health care and, as they like to say, aging in place, so that people have the best quality of life that they can have at any particular time in the stages that we go through throughout our lives. Thank you.
MR. CHAIRMAN: The honourable member's time has expired for this round.
The honourable Interim Leader of the Progressive Conservative Party.
HON. KAREN CASEY: Thank you, Mr. Chairman and to the minister, just a few more minutes and a few more questions.
I want to speak a little bit about a program that was introduced in the Spring, which was well received. I want a little bit of an update on that, it's a colorectal cancer screening program and as the deputy would know, he was there when we launched that, actually in the
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Bridgewater Hospital. It was something that the government had given $300,000 to Cancer Care Nova Scotia in 2007 and it was a plan to implement a population-based screening program, a self-screening program, I might add. It was to focus directly on colorectal cancer. The research shows that this particular cancer, when it is detected early, has about 90 per cent chance of being cured, so it's critical that there be early detection and early treatment. One of the ways that we believe that early detection could occur was with a self-screening program and it was introduced in two district health authorities at that time, early in 2009.
The question that I have for the minister is, can she provide for all of us in the House and for all of Nova Scotians a status report on that particular self-screening initiative in those particular two DHAs?
MS. MAUREEN MACDONALD: I'm not entirely sure if this is correct but it's my perception that the colorectal screening project was implemented as a pilot and it is taking time to evaluate the implementation in the three participating DHAs, which are South Shore Health, GASHA, and Cape Breton, to learn where improvements to the program can be made.
To date the response from citizens of these three DHAs has been good, but to build capacity in the program there is a need to incorporate some electronic interfaces with information systems that will allow timely access to information as it moves to other DHAs. This will happen in January 2010, and it is expected that the program will roll out to the next group of DHAs in March or April 2010. So I think it's important to say through you, Mr. Chairman, to the honourable member and to the people of the province, that the pace of this project has not intentionally slowed, but it is proceeding at a pace that allows a manageable, methodical rollout.
MS. CASEY: Thank you, Madam Minister, and I stand corrected: it's three, not two. My question, how is the response being received? How are people who are participating in this particular self-screening assessment - how are they sharing that information so that you at the Department of Health have some of knowledge of the participation and the success rate with people using this kit?
MS. MAUREEN MACDONALD: The details of this would be with Cancer Care Nova Scotia and with our acute care branch. I don't have that information at my fingertips, but I will undertake to get it and provide it to the member. However, I would indicate again that I've been advised, in a general way, that to date the response rate from the citizens of the three DHAs where this program has been rolled out has been good. What that actually means, I can't tell the member, but I will attempt to find out.
MS. CASEY: Thank you. That information would be of interest to me, and I'm sure to others. When we introduced that as a pilot into the three DHAs, the dollar amount that the government gave Cancer Care Nova Scotia was $300,000. I guess my question to the
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minister is, is there any information at the department that would tell you whether that was adequate dollars, and if it was not, how much additional cost has there been in those three DHAs? That would be my first question. Was $300,000 adequate? If not, how much would be required?
MS. MAUREEN MACDONALD: Mr. Chairman, it is my understanding that in this fiscal year we anticipate that we will spend $2 million on this program - that the original program had an allocation of $2.7 million plus $300,000, but the $300,000 was not spent. We anticipate that what we will require to run the program this year is $2 million.
MS. CASEY: Just so I'm clear, to run the program in three DHAs for one year, you're looking at approximately $2 million?
MS. MAUREEN MACDONALD: Yes, I believe that is the case.
MS. CASEY: If I could go back and ask for clarification on something that the minister said, and perhaps she has answered the question already, but if the decision is made at the Department of Health to do a universal implementation of this, has that been estimated as to what the cost would be, and would that be the January 2010 date that you mentioned?
MS. MAUREEN MACDONALD: Yes, I believe that is the case, that it is anticipated that the program will roll out to the next group of DHAs in March or April 2010. Now, I would need to get clarification in the department of what that means in terms of the next group of DHAs. I don't know if that means all the other DHAs or if there is another grouping of the DHAs that remained. There are six DHAs left and I'm not really sure, so I will look into that for the member.
[9:15 p.m.]
MS. CASEY: To the minister, if that's possible, if you could let us know if that January 2010 is another extension of that or if it would be to all the DHAs. That information would be helpful and thank you very much for that.
I want to ask another question if I could, with respect to another new program that has been introduced and has started with implementation, and that's the HealthLink 811 program. As we know, that is one attempt to provide some health care information - personal health care information to individuals on a 24/7 basis. We know that we have many folks in rural Nova Scotia who don't have access to health care, to physicians in their communities, or who may - because of their age or other circumstances - may not be able to take advantage of health care that may be close to home but not in their home. So the intent of this 811 line was to provide those folks with an opportunity to at least talk to a health care provider, and that health care provider would be able to give them some advice, some direction, and at
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least help them navigate through to a more appropriate health care service if that was what was required.
We recognize that one of the ways to do that, of course, was to follow up a practice that had been in existence in other provinces and, again, allowing individuals to seek that advice and direction, perhaps without ever having to leave their own home. We know that some people would find it difficult to make a drive in the middle of winter - two seniors on a snowy night in February not being able to get out. So I believe the intent here is good and I will be watching, of course, with interest to see what the participation is with that.
One of the side benefits of that, although it wasn't the purpose for which it was designed, was to see if that would relieve any of the pressure or reduce the number of visits to emergency departments - people who, again, at 2:00 o'clock in the morning their doctor's office is not open, they need some advice and care, and perhaps an emergency department trip is not where they should be but they have no other choice. So this gives them a choice and I'm very pleased with that.
I guess my question to the minister is, do you have a date for full implementation for that particular 811 initiative?
MS. MAUREEN MACDONALD: Mr. Chairman, HealthLink 811 was implemented fully and in accordance with the contract at the end of July - July 29th - and since that time, it on average receives about 200 calls a day, which means literally thousands of residents in our province have used this service. As the honourable member would know, we were the last province, pretty much in the country, to go with such a service. I have to say that I was really delighted to meet the staff who are working in this service. I met a number of the nurses from all parts of Nova Scotia, from Glace Bay, from Timberlea, from the Amherst area; I met a woman who was bilingual, who's originally from the Province of Quebec and who came to Nova Scotia, is a nurse, and was absolutely delighted that she would be able to use her French in assisting francophone members of our community who would call the line and want to be able to speak with someone in their own language. That was just a very heartwarming event, the day that we launched 811. The nurses, the managers, and other people who will answer that line were so enthusiastic about what it was that they were going to be doing.
So the program has been implemented. It's fully operational in most respects, I would say. Certainly, we will look at the service over a period of time with a view to what, if anything, we can add into the service. One of the things that I found particularly interesting, speaking to the representative for McKesson Canada, which is the administrator of this service, is that in some areas, some jurisdictions, this 811 is used as a kind of a mental health counselling and referral line, to take people who are very distressed and who need to reach out for an empathetic and professional ear, and it has been incorporated into some of the services that are provided.
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Our service is not geared to do this. It is an information service with respect to your health care concerns that are primarily physical in nature, but there is no reason why, if we could see good evidence and information that it would be useful in the field of mental health - as something that we would certainly be able to consider in the future, Mr. Chairman.
MS. CASEY: Mr. Chairman, I understand when we were talking about this particular initiative that it did have the potential to expand into other sources of information in other ways in which to help all Nova Scotians deal with their health care issues.
I do have a question to the minister. One of the parts of the design of this particular initiative was that it would allow nurses who were available through the 811 to provide that service from their own home. That would mean, or could mean, that we had services being provided in many rural communities across the province or in metro. I guess my question to the minister is, is she able to tell us what communities would have a nurse who is participating in this HealthLink 811 initiative?
MS. MAUREEN MACDONALD: I don't have an itemized list of the communities in which each of the nurses are resident, Mr. Chairman, but I do know that the nurses were recruited from throughout all of the districts and that one of the things that, again, the administrators of the 811 program were really pleased about was that they were able to get what they felt to be a very representative distribution of nurses from around the province. I have to tell you why that was a great comfort to me as Minister of Health.
When you introduce a service like this, you do not want all of your nurses from one DHA leaving the DHA and becoming the labour force for a new service, leaving a particular DHA short. Because of the distribution of nurses from across the districts, this has meant that no one DHA was left in a scenario where they had lost their two emergency room nurses, or their one ICU nurse, or their senior ICU nurse, or whatever. So the distribution actually was quite excellent in terms of being drawn from the various DHAs and not concentrated in any particular DHA.
The other thing I would say to the honourable member, and she would know this, know what the operator's objective was in terms of recruitment - because concerns were expressed about taking nurses out of the public system and having them work this line. There was a commitment, an idea, to look at nurses who had left the regular health care system labour force due to occupational injury kinds of situations - maybe a nurse who had sustained a back injury or other kinds of injuries which can be common to the profession. So the proprietor did attempt to find nurses who had left the sector but who still had a lot of skills and a lot of talent and expertise to offer. So they did follow through on that commitment of attempting to recruit from an injured nurse, and they had some success, but it was limited in terms of who they were able to recruit.
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My perception, just based on - I didn't meet all of the nurses, obviously, that will be working on the 811 line, but I think I met probably 16 or 18 because they had a very good turnout at the launch - my perception was that a lot of the nurses who have signed up for this program are women who have relatively young children, and a very big consideration for them was that they would be able to spend time with their children. Many of them were looking at leaving nursing for a period of time, particularly if their kids were of elementary school age, to get their kids through the elementary years. This gave them an opportunity to continue to work as a nurse, use their knowledge, and be in the labour force. So this actually worked out very well for many of them and for us.
MR. CHAIRMAN: Order, please. The time allotted for debate in Committee of the Whole House on Supply has now expired.
The honourable Government House Leader.
HON. FRANK CORBETT: Mr. Chairman, I move that the committee do now rise and report progress.
MR. CHAIRMAN: The motion is carried.
[The committee adjourned at 9:28 p.m.]
