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HALIFAX, MONDAY, APRIL 12, 2010
MR. CHAIRMAN: The honourable Minister of Health.
HON. MAUREEN MACDONALD: When we first began to look at the Health Estimates, the honourable member for Halifax Clayton Park had inquired into the breakdown of caregiver allowance by DHA. I have that information and I would like to table a copy of that. Thank you.
MR. CHAIRMAN: The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: Thank you and I'm delighted that we're back at the Health Estimates today and what struck me was that, although we've been here Thursday and Friday, there are so many subjects that we haven't even touched on at all in the work of the Department of Health. I'm hoping today we can have some snappers and maybe less discussion, but still some good discussion, on the different subjects.
I wondered if I could just start with a subject that is important to me on a constituency level. I had just given a note to the minister, a letter and some backup information about a case involving, actually not a constituent, but somebody from Halifax who I know, who had brought me an issue where she had been denied, through MSI, on two or three occasions where she had asked for approval before she looked at a procedure she would need for her child out of province.
My first question is very general and that is, has the minister ever had the opportunity, or ever used the power, to overrule MSI and maybe the deputy minister can give some examples, even, of previous ministers. I don't really know whether or not this avenue is ever apt to be fruitful for Nova Scotians but I know that they certainly have the right to appeal to the minister if they are not happy or don't agree with the ruling of MSI.
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In the case at hand, it is a procedure that can be a much older fashion procedure that is available in Canada but what is really the best procedure is available, and has been for about 30 years, in the United States, and it is to address the issue of a little girl who was born without one ear and there is a name for that syndrome, and I think it is called microtia. I don't have it in front of me, Madam Minister, however, if you could let me know if this is an avenue that is reasonable for Nova Scotians to appeal to the minister?
MS. MAUREEN MACDONALD: Mr. Chairman, just to outline the procedure, generally speaking, people will come to the department with a request that they receive medical treatment outside of Nova Scotia and they ask that that be covered. Their request is often initiated by their family physician, in fact, or perhaps a specialist. There will be, perhaps, accompanying documentation.
The question for the department is whether or not there is a procedure that is similar, that would give you the same outcome, available in Nova Scotia. It may not be the exact same procedure, but can we achieve the same outcome within our existing health care system?
So, this is an assessment that is made by medical people who work on behalf of the department and there have been occasions where I've seen a fair amount of exchange going back and forth, because sometimes it is not a straightforward yes or no answer. I just want to say to the honourable member, she brought this to my attention earlier this afternoon, I will take this to the department and make an inquiry and get additional information, which is generally the practice in the department, as minister, if I require additional information and I think in this case I probably do, particularly as I understand there has been a bit of a history of bringing this forward in the department.
MS. WHALEN: Mr. Chairman, I do want to let the minister know that the mother, in this case Christine Santimaw, had said it was just fine for me to talk directly about her case. I had her permission and she has done a lot of research, she and her husband. It has been three years since their daughter was born with this condition and they have been looking for the answer right along and I know that you will look into it. I don't need to go into the details here today. I just wanted to make sure that there was a procedure in place and that there is an opportunity, especially if there is a grey area around what might be the best way to approach this, that the minister would take an active interest. I appreciate that.
I wanted to go to another subject that is very important to, I think, all Nova Scotians and it has been in the news recently in other provinces and that is pathology. We have noted, and I know everybody has - I'm sure the Department of Health did as well - the controversy and the issue in Newfoundland where there were incorrectly read pathology tests and the same thing has happened in the Miramichi in New Brunswick. I think it is a good time to ask in Nova Scotia whether or not the department has, in light of that, looked at our own circumstance in terms of pathology and lab work and really measured the risk?
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I am looking at this, particularly for the minister, in light of the comments that were made by the minister in the opening remarks about patient safety and quality. I know that those were two of the values that you're really looking at as we go forward, how to better ensure safety and quality of medicine and, of course, the diagnostics are going to be very important there. We have heard even in Ontario of a case where reading the pathology incorrectly led to a mastectomy taking place that wasn't necessary. I think this is a very topical subject and one that I'm very interested in. I just wonder if you could say, in light of this, what the department may be doing, what sort of steps the department has taken?
[5:30 p.m.]
MS. MAUREEN MACDONALD: This reminds me of when I was in Opposition and I actually had an opportunity, as a member of the Opposition, to ask that very question to the Minister of Health. In fact, I raised this question with a couple of different Ministers of Health. We were watching the situation in Newfoundland and Labrador and in New Brunswick. Ontario is a situation that has occurred more recently. There has also been, I think, at least one scenario in Quebec, a little bit different in Quebec.
The first answer with respect to the specific features of what occurred in New Brunswick and what occurred in Newfoundland, the Department of Health did a process, due diligence, when these situations occurred there and determined we did not have the same situation here.
However, having said that, we are always very mindful of the absolute importance of quality and accuracy in our diagnostics and how important it is to ensure that we have quality initiatives in place that will provide protection for patients throughout the system. We, in Nova Scotia, have some amazing pathologists and leaders in this area and I think about Dr. Bruce Wright who is an expert in this area. The department is building on the foundation that we have to ensure that we protect ourselves, and we protect people in the province, with respect to the accuracy of our diagnostic and pathology services.
It's, as you can well appreciate, an area of great complexity, particularly as the science and the technology evolve with respect to the numbers of people for whom - I don't know what you would call - you know, diagnostic testing is becoming a larger feature. It has grown in number, in terms of the number of diagnostic tests that are now part of our health care system of determining what's going on in a person's body and then how they're responding to treatments and all of these kinds of things. Medicine is not like it was 15 years ago, we are becoming much more complicated, much more sophisticated. We're also more technologically dependent in terms of transmitting the results of diagnostic tests.
All of these features of modern-day medicine require great checks and balances in the system so that we are always assured we are getting the right information, that it's being
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properly reviewed and that the checks and balances are in place to protect patients and give us the best outcomes we can get.
MS. WHALEN: To the minister again, I'd like to explore this in a little bit more detail. I didn't hear any strategies that might be in place to give us that assurance that we're not going to have the same difficulty here. I mean it has been suggested to me that in some ways we're just lucky that it hasn't happened here. It could have happened here, the same as it happened in other provinces, and I don't know if it's because you've identified what the shortcoming was - was it a shortage of pathologists? I think it has been said that they were overworked in the areas where this has happened, is that the reason? Do you feel we're well staffed with pathologists or do you think we have better checks and balances in place, because I just heard you say the Department of Health said we didn't have the same situation here. Could you elaborate on what makes us better and how can we be more assured that we are going to be protected from that kind of situation here, because I think the system is pretty busy and I think that the people who work in it are busy and under stress as well?
MS. MAUREEN MACDONALD: We have in the Department of Health in Nova Scotia, and we have had for some time, a division of quality and patient safety. It's actively involved in developing a province-wide system for quality assurance in anatomical pathology and laboratory medicine. I think one of the things that I remember the former deputy minister talking to me about when I raised the question, and certainly the current one has as well, when we have talked about these issues - I mean we are a small province where a great deal of the diagnostic work, particularly in the specialized fields, occurs here at the Queen Elizabeth II, a teaching hospital where there is a concentration of highly specialized personnel who are there to consult with each other and to collaborate with each other.
As I understand it, in the Newfoundland and Labrador situation, this was not the case and you had pathologists who were operating quite a bit in isolation. So this is a problem. In New Brunswick it was a totally different situation from that again, and it was an individual physician whom I don't believe was a specialist, and there was some question about his work over a long period of time identified by the College of Physicians and Surgeons. So, these situations are somewhat different, but that does not mean that we shouldn't be vigilant in terms of the quality of our system. We're always very concerned that in our health care system the personnel who are providing services, that they have the highest qualifications, that they are performing a critical mass of techniques, to be able to maintain a level of accreditation, and you'll see accreditation in many of our DHAs around the province in terms of laboratory work.
So any kind of standards, we adhere to national standards and we're always watching very closely the information that comes out of the various national bodies that do comparative kinds of assessment in terms of the benchmarks that they have established, that will demonstrate whether or not you should have a concern about the quality of your
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diagnostic testing and what have you. We are very vigilant about that and increasingly so. So that's what I would say.
I guess the last thing I would say is that radiation and pathology utilization is growing at a rate of 5 per cent to 7 per cent a year, and that just goes to support the point I was making earlier in terms of how medicine continually is becoming more sophisticated in terms of the diagnostic procedures. We have 35 pathologists at the Queen Elizabeth II and we've recently added four positions over the last year. So we are aware that if you're getting a growth in utilization, it also means that you have to look at the personnel you have to manage that workload and make sure that you're not leaving people in a situation where they're not able to keep up with the demand. So just to give you a few little features of what that looks like.
MS. WHALEN: Thank you, and I do appreciate that. I'm not sure if the minister could just confirm, was that between 5 per cent and 8 per cent a year, that utilization rate? Seven, so it's quite a significant increase from year to year with a stable population, isn't it? That certainly is a concern, again, just because of the volume, but 35 pathologists at the Capital Health District is a good number, and I guess what you're saying is that they can also provide that quality assurance for each other.
My understanding is that they are very busy, and I believe a lot of them are paid on the individual tests that they sign off on, so quality assurance wouldn't be part of their fee schedule in any way. That would be more of a professional courtesy if they're doing that, so I don't know if that has come up in your negotiations with pathologists.
I wanted to ask about the lab itself, because I'm conscious that our time will very quickly be past if we don't get on to some other subjects. The lab itself at the QE II - I guess it's over in the Mackenzie Building on University Avenue, very close as well to the IWK's lab. I'm going back to Corpus Sanchez because I know that the minister will agree with me - we spent a lot of money for 100 recommendations. One of them was very clear, saying "develop a single lab for the academic centres in Halifax." I'm concerned about where we might be in that process.
My understanding of the current lab is, the one for the Capital Health District is a high volume lab which does need to be upgraded. From my understanding, it needs to be either automated or improved in some way. There is going to be a capital cost to bring that up to standard. Again, it's because of the volume and because of the turnaround time for those tests that, unless we look at another way of handling them, we're not turning them around as fast as the IWK does in their lab, which is much smaller and doesn't have the same pressures.
I think there is an urgency and there is also an appetite to talk about shared services and how do we best maximize our utilization of the dollars. If we have two sort of fully-equipped labs very close to each other, I think it does bear looking at with a closer lens.
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I'd like to ask the minister if she could bring me up to date on that recommendation. It was on Page 42 of the Corpus Sanchez Report, and again, I'll just read it: "develop a single lab for the academic centres." Thank you.
MS. MAUREEN MACDONALD: Thank you very much, Mr. Chairman. The honourable member has certainly put her finger on an issue that is important. I would say to the honourable member that the work is ongoing with respect to our review of that recommendation in the Corpus Sanchez Report. I look forward to receiving the final report on that. At this stage I haven't received anything.
MS. WHALEN: I did want to know if the minister had a report, because I understand another consultant had been hired after the Corpus Sanchez recommendation and that has been studied again, and I think in quite a bit of detail. I believe that was done in the Fall. I certainly would be interested.
I had the opportunity today to be over at the IWK on kind of a courtesy call to Anne MacGuire, and asked about, I believe the report is out, but I didn't know if she had a copy. I asked if it was public and she is just back, as you know, from having been off for a little while on some sickness, so she certainly wasn't sure. I hoped today to find out from the minister if you are aware of a further consultant report, and again, if it's not made public yet, when might we be able to see that? I think it is a very important point.
MS. MAUREEN MACDONALD: Mr. Chairman, the report that the member refers to has been referred to the IWK and the Capital District Health Authority, and they are currently working their way through the information in that report and, as well, we will be doing an internal review with respect to the recommendations of that report. So we're working our way through the implications of the Corpus Sanchez recommendation and then the follow-up, to identify what the future might look like.
MS. WHALEN: Thank you very much and to the minister as well, there's talk at the same time about a new VG and the condition of our current Victoria General Hospital, which is a pretty old hospital now. I'm wondering if the lab is going to be part of that discussion or if you could elaborate on the status of a replacement for the Victoria General Hospital. I really don't know how far this has progressed internally but I know the minister, as well, has toured that when she was in Opposition, has seen some of the floors, particularly long-term care, where people are in transition and waiting for long-term care, the fact that the water system there carries Legionnaires' disease and can't be used for bathing and for drinking, certainly.
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[5:45 p.m.]
People who are in that unit, or have loved ones in that unit, are very alarmed. I know that must be on your agenda as a facility that needs to be replaced. I wonder if you could bring me up to date on that as well. Thank you.
MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member is correct, I have been throughout the VG building, as well as the Dixon building over there. First of all, the transitional care unit is on 4B and the key, I think, to being able to move people out of that unit is to have the Northwood facility, Bedford, come on line and that should happen relatively shortly.
I think it is important to let the honourable member know that the water on the unit isn't great but that unit doesn't have Legionnaires' disease. (Interruption) It is in the VG, that's right, but it's not that particular unit, just so that the honourable member is aware of that. That unit really does - I think a former Minister of Health said it should be blown up and I didn't disagree with that member when he said that. One of the first things I talked about to the board at the Capital District Health Authority when I first met with them is my concern that we continue to have elderly people in that unit.
I have toured other parts of the VG. The VG also has a very active unit for surgery. I think 9A or 9B are surgical beds and some cancer care and there is a fair amount of cancer care in parts of that facility. It is on one of the cancer care units, actually, that they've discovered Legionnaires' disease in the water system, so there's a lot of work to be done, capital construction to be done in the Capital District, there's no question about that.
We need, though, to have a plan for all of the capital construction in the province. One of the things that was a surprise to me when I arrived at the department is that unlike the Department of Education, let's say, and school boards in the province - you know how school boards submit their capital priority list to the department, the department then looks at the money they have available and they prioritize and they have a plan that goes out over five or 10 years, well we don't have that in the Department of Health, that was a big shock. Projects tended to be one off, or decisions around doing capital construction. So I asked the deputy, and he and I talked about this - we're developing a structure, a better set of criteria that will help us do some planning for our capital needs which exist throughout the entire province. I think in the end we'll have a much more transparent and open process for capital construction in health care, and we'll be thinking about this system as a province-wide system.
Having said that, getting back to the VG, it's interesting, I had an opportunity to meet with - and the honourable member may have known Dr. Bonjer, who was here for several years. I think he was the head of surgery over at the Queen Elizabeth II. He was leaving and kind of had an exit interview with me. I asked him what his views were about the facilities
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and the master facilities plan and, particularly, the idea of replacing the VG, and he told me not to take it down just yet. He had some very interesting things to say about what he thought that building could still provide in a very adequate way, a more than adequate way. He envisioned that site being used as the site for day surgeries, not necessarily in-patient work, and perhaps it would eliminate some of the concerns around showers, the water system and what have you.
So we're still working our way through what all the capital needs are in the Capital Health District, as well as other parts of the province, and we are looking at how you then set your priorities given the financial ability that you have to pay for new facilities and where the needs are the greatest. I think in the coming year and years in our mandate there will be some action taken to improve the facilities here in this area, which are taxed heavily simply because of the large population that relies on services in the Capital Health District.
MS. WHALEN: I would like to ask the minister a little bit more around this plan. I think that what I'm hearing is that it's early days, but there must be some discussion within the Capital Health District about how they could at least build something new that might be better located with the other Halifax Infirmary site, or it might have some efficiencies by being in the same vicinity.
I go back to the lab and just want to absolutely be sure with the minister that the lab would be part of any move to relocate the Victoria General; right now it's sort of an orphan, I think, in terms of any discussions that are going on internally, and I think it would be nice to confirm that they have a place in that new location or new plan. If it's not happening soon, is the minister aware of any plan to automate or improve the current lab at the Mackenzie Building? I understand their turnaround time is not what they would like for testing, largely because of a manpower problem there, and that is that we don't have enough lab technicians.
Any large volume labs in other centres, if we want to look at Toronto or other large volume places - and we do apparently qualify as a large volume lab - they tend to be bar coded, and all the vials come in with their bar code on them. That would tell you whose blood it is, or whose sample it is, and what it is that the doctor is looking to have done, what tests, and that way it can all go almost in a conveyor belt, essentially, to the right station. That would help a lot with the shortage of staff, because I understand a lot of our lab technicians are due to retire - as is a problem throughout our health system, that people are getting close to retirement age. So we need to get ahead of that and have plans on how we can keep up our efficiency and, in fact, improve our efficiency in light of fewer staff.
So I have a couple of questions in there. One is to make sure that the minister hears my plea that the labs be included in all plans whenever the talk is raised of building a new replacement for the VG and, again, if it's staying where it is, it has got to be modernized. I wonder if the minister could just reply to those two questions.
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MS. MAUREEN MACDONALD: First of all, Mr. Chairman, the Capital District Health Authority has developed a master facilities plan and so have a couple of other district health authorities, by the way. Many district health authorities are always looking at their facilities and whether or not they meet modern day standards. It is amazing how rapidly some facilities will become obsolete.
I had an opportunity to tour the Guysborough Hospital in Guysborough, obviously, and even though it is not that old a facility, it has really fallen behind in terms of standards. Just the nursing stations, to give you an example, the nursing stations weren't built to accommodate computers. So you have these working areas for the nurses and you have keyboards sitting on top of a filing kind of area where they have these built-in in and out files.
Obviously when it was built it was a paper system and all of a sudden - I can just imagine a nurse sitting there and trying really hard not to have the computer terminal fall into her lap as she tries to enter stuff into the system. So, it is a nice, small community hospital but it certainly is one that GASHA, in their master facility plan, would like to see some modernization. You don't have to be a health care professional - if you go through that space and observe what it is like - to realize why they're looking for some change.
So the Capital District Health Authority does have a master facilities plan. They're looking out for what their needs are over a period of probably the next 25 to 30 years. It is a very ambitious plan. It is not an inexpensive plan. But I'm not saying that it is not a plan that doesn't have certain elements that we need probably sooner than later.
Certainly, as we look at the final review of the work that is going on with respect to the labs that the honourable member has referred to, we will be making some decisions with respect to the future of pathology in both of those really important facilities.
MS. WHALEN: I would like to say that I am glad to hear that you're looking at a master list for the province, it has always made sense the way it is approached in the Department of Education and I'm agreeing with you in that I'm surprised that it is not here in the Department of Health or for the DHAs. So I'm glad to see that.
I want to ask you briefly, since we're talking about some big capital requirements, about the deficit that we have in equipment, it has been described to me that there is such pressure that we do very little maintenance and we basically just try and hold things together with duct tape for as long as we possibly can. I think in the province - you may have a figure for province-wide, but I believe it is certainly in the hundreds of millions of dollars that are outstanding. I was looking for that figure right now and I can't find it. Having been at the IWK today, they said theirs was not as acute as some other facilities and they have something like $20 million, I think, that they're looking for. I am wondering if you could give me the figure for all the DHAs together, their need for capital replacement of equipment, which is,
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again, like our roads and so many other things that we have a hard time keeping track of. Is there a single figure available for the province in that regard?
I'm not sure if the minister is ready yet, so I'll let her continue to think about that. But what I'm looking at, really, is just the fact, as you were saying, that technology changes and that we need to upgrade it and as well equipment breaks down. It gets to a point where we're just not able to maintain it any longer. So, I would like to know, if we're looking at that, how are we proposing to get a handle on that and maybe have the same kind of plan that will help you prioritize and set out a plan to replace it? We have done it with roads and I think we need to do it with the hospitals too.
MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member is correct, that is exactly what we're doing in the Department of Health as well, is developing a kind of a framework so that we can have a good itemization of what is required and some objective standards to prioritize what is required. That means we're going to be better able to plan for our equipment needs and we haven't had that in the Department of Health.
[6:00 p.m.]
It has been more haphazard, if you will, than that and that leads to a lot of competition among districts and among different kinds of medical specialization and what have you, which has made it, I think, difficult. You only have to look at the competition for MRIs that occurred a number of years ago, not that long ago in Nova Scotia, and the resources that took out of the equipment envelope.
The amount of capital equipment that is required is very large. I don't have the number right here with me, and I will see if I can get that for the honourable member, but we do have a substantial need for capital equipment.
The honourable member would know that the Department of Health is not the only revenue source for capital equipment in the DHAs. At this stage I want to acknowledge the amazing work of the various foundations that are involved in the DHAs across the province that really do a tremendous amount of work in terms of fundraising and, Mr. Chairman, I think about the building trades members in Cape Breton that I had the privilege of meeting when I was in Cape Breton touring the district health authority who made quite a significant contribution from their members to the district health authority for equipment, particularly in the cancer area of cancer treatment - just phenomenal. In our corporate sector, our corporate citizens are often very much involved in capital campaigns around the province for either infrastructure in terms of buildings or in terms of equipment.
But in this year's budget there is money put aside for capital equipment. We're estimating about $20 million. I think we had started to have this discussion when we just adjourned the other day and it has given the officials in my department an opportunity to pull
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together some information for me for the honourable member because I think the honourable member was making reference to the fact that there was a slight decrease between the forecast for 2009-10 and the estimate for this year, a decrease of about $4.3 million. The reduction is pretty much accounted for by the fact that there was a federal medical equipment trust fund and we have been drawing down from that trust fund over a period of five, six, maybe even seven years, and that has allowed us to purchase new medical equipment and to also do some training for staff on new equipment. That fund is now, as of 2010, is fully exhausted, so it is not reflected anymore in the capital equipment.
Just to give you some examples of the medical equipment that was purchased over the past seven years from the trust fund, there were five MRIs purchased at a cost of $8.1 million in Districts 2, 3, 6, 7, and 9. There were a number of other things like a new CAT scanner at the IWK, ultrasound equipment, operating room equipment, incubators at the IWK. These are all pieces of equipment that were purchased. I think about the ventilators - we purchased 140-some ventilators during H1N1, at a cost of about $5 million.
Equipment is very expensive. I was at the Victoria General Hospital for the announcement on the investment of $10 million for radiation therapy equipment to get new linear accelerators and new radiation machines, a simulator. These pieces of equipment - one of the things I want to reassure Nova Scotians about is that we do not take a back seat to anyone when it comes to investing in up-to-date equipment for our specialists and for the patients of the province.
The specialists in this province are very vigilant about making it clear what it is that they need to be able to do their work. They expect to be working on equipment of a high standard with high standard outcomes. I see this over and over in the regional hospitals, and certainly at the QE II when I visit people. The member is right, medical equipment is important. It's a big item in our budget, and we will continue to have a substantial investment in this area.
MS. WHALEN: The figure I found from my meeting earlier today was that it was $200 million in infrastructure needs at the IWK alone. I was quite wrong - I said $20 million, it's $200 million. That's quite a big difference. Maybe about $2 billion in the whole province in terms of equipment needs. I know the minister has said she will look into what the list may be for all the DHAs, but that was perhaps a rounded-up figure that I had to give us a ballpark on what the needs are.
I wanted to ask the minister a couple of quick things around the IWK. My time will be up at 6:19 p.m., Madam Minister, just so you know my time is short. I really want to delve into some mental health questions with you, and I may have to wait until the next round. At the IWK we certainly talked about mental health and their unit, which is a very intense unit - a lot of crises going on at 4 South, where the kids that are brought in there are ones that are
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in crisis at that time, and so are their families. There's lots to be said there, but I wanted to ask you about the age limit at the IWK.
This was something I raised with Anne Maguire, that we have a declining population of young people - our school enrolment is a good indicator of that - and a stable but older population. Therefore, right now the cutoff age at the IWK is 16 years for treatment. I've actually heard some cases that - I realize it's anecdotal, and I don't have any names to bring to the minster's attention, but because there are certain cancers and certain diseases that are prevalent in children, if they're 17 or 18 and they've gone into the adult hospital, wherever they may be, often it isn't recognized as quickly, particularly with cancers that are unique to young people.
There have been a couple of cases when they're referred back to specialists at the IWK, they recognize it right away. Valuable time is lost and sometimes the prognosis is poor, whereas if that young person at 17 or 18 had come into the IWK to begin with, it might have been a different outcome. I just feel that we should have the capacity within the hospital because of the declining number of children.
Now, there may be some complicating factors, and Ms. Maguire mentioned a few of them to me, one being the level of, I guess - I'm trying to think of some of the things - there is more chronic disease like diabetes with young people, there's growing obesity, there are some complications with the cases they have. On the neonatal side, there are older moms and there are often more complications, there are more premature births, she had a number of things. That's more on the women's side though. On the children's side, I think it might be that there's just some more chronic disease.
I really feel that there would be much better care for the young people in Nova Scotia if we got on to expanding the age limit that could stay at the IWK and be cared for by those physicians and specialists who really do understand childhood disease. I'm not sure if that's on the minister's radar screen so I'm raising it today to ask if this is something you've been pushing for or you're aware of.
I'd like you to know that I think it's something that's pretty urgent if we can arrange to deal with whatever objections there may be from other parties. I think we need to do it and I would mention to the minister, I think we have to see that funds follow the children. If we're going to increase the age limit at the IWK, we have to make sure some funds come back from CDHA, or from other district health authorities, because recently the IWK took over some of - I think all of - the breast surgery, but I don't believe dollars followed them to take on that task. As it's a women's health centre as well, I think it's great that they're looking at the cancer surgery for women and particularly breast cancer, but I think they have to be given the budgets to follow that treatment.
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In asking for the age limit to be increased at the IWK, and to perhaps start that discussion, I'm just hoping the minister will not forget the fact that we need to intervene and see that there's a fair sharing of the resources when we do ask one area or another to increase its responsibility and the tasks that it's going to take on. Again, that's around the age, that's particularly what I'm asking about, and the dollars following.
Since my time is short, could the minister also mention about the concept that the IWK has, which I only have learned about very recently, and that is their idea of building what they call the Village, which is just to be adjacent to the IWK. It's got funding from the Mental Health. I think it would include Mental Health. It has funding from the Cancer Society and Ronald McDonald House intended to expand it to have many more beds to accommodate visiting and sick children and their families.
I wondered if you could speak about that. I understand that the funding would be 25 cent dollars for the province. It's an $80 million project but we have funding in place from other sources so that the province would be asked for a quarter of the funding to see that put in place. There's an extra question to throw in so you've got a few there for the IWK, thank you.
MS. MAUREEN MACDONALD: Mr. Chairman, it's no secret that I, like probably everybody else in this province, love the IWK, especially if you've had any personal experience with them. Although I haven't had direct personal experience, in a way I have, and I've talked about this before quite often. I have a nephew who was the youngest kidney transplant child ever done at the IWK and he's 22 or 23 now. I want to say to the honourable member that my nephew continued to be a patient of the IWK long after he turned 16 and he has now been transitioned into the adult system.
I know you should never formulate your opinions on a sample of one, but in a way it's kind of hard not to. If there was ever a reason for the need for greater collaboration between the IWK and CDHA, I have yet to see it. I think that when you have two such excellent facilities side by side, what we all would want to see, and should want to see, is as much collaboration as possible. The people who win through collaboration are the patients, the patients win through collaboration.
My attitude toward these two different entities is that we need to see greater collaboration between them. I bristle a little bit, frankly, if I see an unwillingness for collaboration and a tendency toward competitiveness, because in the end, in a competition, somebody always wins and somebody always loses and I don't really much like that in our health care system.
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[6:15 p.m.]
I'm hoping that all of the work that we do toward health transformation will be informed by our desire to strengthen our health care system, to put patients at the centre of what we're doing and to come out in the end with a better use of our resources to improve health care for patients.
I have a great deal of time for the IWK and I know about their uniqueness and I know about their aspirations as a facility. They also have, I guess what could be called a Master Facilities Plan, which is this village concept - as any other master facilities plan, including the Capital Master Facilities Plan, the small Master Facilities Plan for the Guysborough Memorial Hospital in Guysborough County, the need for capital improvements in the Queens General Hospital, the need for capital improvements in the emergency department and the pharmacy at the Aberdeen Hospital, I think the honourable member is kind of getting the picture here.
What I'm saying is that there is a need for capital improvements across the province. We have been lacking in a kind of formula - I don't know so much a formula - but we've been lacking in a systematic evaluation system that would allow us to prioritize and then invest wisely the limited amount of dollars that we have for capital requirements.
The honourable member indicated that she had been told that it is $200 million alone at the IWK and $2 billion across the province. I think, Mr. Chairman, that that $200 million isn't just for capital, isn't for equipment only, it's for equipment and the Master Facilities Plan. The $2 billion is probably for equipment and master facilities across the province. You know $2 billion is a very significant amount of money, particularly if you're looking at the current fiscal realities.
It's very obvious to me, as Minister of Health, that everybody who comes to see me has a worthy project. All of the projects are worthy projects. They really are motivated by real needs and also by real dreams, in some cases. People recognize what some of the fundamental needs are, but they also have a vision for their DHA or for their particular health issue. In trying to convince me, the Minister of Health, and the people in my department that this is something that needs to be moved forward and invested in - everybody tells me that they can save me money if I give them a lot of money - if I invest in this, they'll save me a ton of money. I bet you that they've told other Health Ministers that if you invest in . . .
MR. CHAIRMAN: Order, please. Thank you. The time allotted for the Liberal Party has now elapsed.
The honourable Leader of the Progressive Conservative Party.
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HON. KAREN CASEY: Thank you, Mr. Chairman, I do want to pick up where we left off last time. I do have what I think might be short snappers. The questions will be short, I'm not sure the answers will be, but I want to speak to some items in the book, so if we could perhaps start with that. It would be on Page 13.8. It has to do with Other Programs.
My attention was drawn to this when I looked at couple of things. Overall there was a decrease from 2009-10 estimates to 2010-11 and a decrease in both the funding and the staff. I am wondering how that will impact on programs with respect to autism. I know there has been a very healthy program within the department. I know from the classroom and education perspective the importance of early intervention. I am just wondering if this will have any impact on the programs for autism.
MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member will know that the province spends about $4 million a year on autism. The vast majority of those funds are actually spent in the district health authorities, however, the Department of Health itself held a certain amount of money in the department for both autism, EIBI, as well as for children with complex care needs. What is reflected in the other programs that the member is making reference to, is a transfer of money from the department for these programs out into the districts, in addition to the money that was already given to the districts.
So the EIBI program is not being reduced, neither is the program for children with complex care needs. The money is just no longer being held in the department, it is being transferred to the IWK.
MS. CASEY: Mr. Chairman, does that transfer go as targeted money or will that be at the discretion of the DHA?
MS. MAUREEN MACDONALD: It goes as targeted money.
MS. CASEY: If we could go to Page 13.7, please. I know I've heard the minister speak passionately about mental health needs in the province, both for adults and for youth. I think we recognize that this is an area that we can't afford to underfund. So my question specific to Page 13.7 has to do with mental health programs, again, showing a decrease from $5.9 million to $2.5 million. I guess I would be asking, again, is that a transfer? Maybe I'm answering my own question but perhaps you could explain that to me.
MS. MAUREEN MACDONALD: I thank the honourable member for the question and yes, again this is a transfer and I can give the member some additional information on this. There is a transfer of money for the expansion of the Adolescent Centre for Treatment at the IWK in the amount of $1,966,700; there is a transfer for the expansion of Mental Health Outpatient Services in the Capital District Health Authority, $478,000; an Expansion of the Mobile Crisis Team at the Capital District and the IWK, $293,400; an Expansion of the Methadone Maintenance Clinic, Colchester, with satellites in Cumberland and Pictou,
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$453,900; I don't know if that's an expansion or a new program, it doesn't say expansion on my notes so perhaps it's a new program, but it's $453,900; Proposal from Cape Breton District Health Authority, Adolescent Addiction Service, $200,000.
MS. CASEY: Mr. Chairman, perhaps the minister could table that information. In follow up to that, outside of Capital and IWK there was mention of Cumberland-Colchester and also of Cape Breton and you mentioned a proposal from Cape Breton. I guess my question would be, are these funds available through application, or how is it determined which funds go to which particular DHA?
MS. MAUREEN MACDONALD: Mr. Chairman, these programs were initiated in a previous year, five programs, on a claims basis, but now that they are fully operational, they're being funded and transferred to the DHA and that's why there's a transfer of resources into the DHAs or the IWK, to continue on with the operation of these programs.
MS. CASEY: Mr. Chairman, I appreciate the information. Is there an opportunity for other DHAs to make application and to have programs considered for approval and for funding? If they did not have one and they do want to introduce one, what is the mechanism for that?
MS. MAUREEN MACDONALD: Mr. Chairman, we do accept new program proposals into the department. However, we also encourage DHAs to submit in their business plans the requirements that they have identified for any new programs or any expanded programs and that's part of the process, as the honourable member would know, that we go through as we determine what resources we have and how we're going to be able to assist DHAs to continue programs or expand a program or start a new program.
MS. CASEY: Mr. Chairman, I go back to the three particular areas of the province that were identified here: Cumberland-Colchester, Cape Breton and metro, IWK, Capital. What does that say about services in other parts of rural Nova Scotia? They don't exist? No application has come in? They're funded within their own DHA? Can you give me a bit of an overview of where mental health programs might exist in places other than those three geographic areas?
MS. MAUREEN MACDONALD: Mr. Chairman, there are mental health services throughout all of the province in each of the DHAs. These mental health services are available for adults and in some cases they are available for children. For example, their EIBI is available in all of the DHAs, however, there are parts of our health care system where we have more specialization with respect to children's psychiatry here at the IWK, particularly for children who are experiencing a great deal of difficulty in terms of their behaviour, or psychosis, or sometimes addictions, or multiple problems. In addition to that, we have some specialty services and specialty units.
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[6:30 p.m.]
So the honourable member asks, where does having programs in some of these DHAs leave the other DHAs? The honourable member, as a former Minister of Health, would know that we don't perform orthopaedic surgery in every DHA, for example. So every specialty service is not necessarily provided in every DHA in the province. In fact, we're going to probably see more collaboration between DHAs for shared services to improve the quality of the services that we can provide and to ensure that in the regions around the province there are the kinds of services that people can gain access to, but as you know, Mr. Chairman, we're a small province. We have limited resources, and we have to have specializations in certain areas.
Mental health is no different in that we're not going to be able to provide specialized services for a small number of mental health disorders in every DHA around the province. What we need to do is to ensure that we have general psychiatric services available throughout the province, and then we will have areas of specialization where people will have to travel for programs in some cases. I think the main thing is that we have to make sure that we don't have gaps in our service and we don't have wait times that are so exorbitant that it's almost nonsensical to even have a service. If you can't get access to it, then there's no point in having a service.
So these are the ideas that I have around mental health, that we not try to be everything to all people in every DHA, but that we ensure that we have good entry level and then we have our specialty services with adequate access or access to people that makes it a meaningful service.
MS. CASEY: I know that we spoke the other day about the number of doctors per capita in the province, and we talked about highly specialized and concentration in Halifax, in the Capital Health District. I agree that we need to have a quality service and highly trained professionals available, and the delivery of that service from one central location is probably a better investment than trying to dilute that out across the province. Having said that, perhaps the minister could speak to the demand for that highly specialized service through Capital Health and at IWK for both juvenile and adolescent and adult mental health?
MS. MAUREEN MACDONALD: First off, I want to just add to the last issue that the member raised with respect to proposals for mental health programs. All DHAs across the province were asked to submit proposals with respect to the possibility of developing some new proposals, so a presentation and a proposal had to be made. With respect to the IWK and the Capital District Health Authority specifically. We'll start first with the Capital District Health Authority. The Capital District Health Authority services a population of about 400,000-plus people in the province. It's the largest DHA in the province. The smallest DHA, I think, is Cumberland Health Authority with a population of about 40,000 or so in that DHA and maybe not even that many. So there is great population disparity between the
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DHAs. The pressure on mental health services in the Capital District Health Authority is considerable.
Twenty-five years ago, adults with mental health disorders were not provided with services in our acute care system. If they had psychoses, serious depression, suicidal ideation, schizophrenia, they were shipped to the Nova Scotia Hospital and it was kind of a segregated psychiatric facility. This hasn't been the pattern for treating people with mental health disorders for a number of years and two things have occurred. Deinstitutionalization has occurred meaning people are now treated more often in a GP's office or in a satellite psychiatric mental health clinic in the community and they live in the community in a variety of options, perhaps independently, perhaps in a small options home, or some other supportive environment.
The other thing that has occurred is that psychiatric patients have been reintroduced back into the acute care facility. So if you go around the province, most, you know - St. Martha's in Antigonish has a psychiatric unit, and so on around the province. So in our acute care facilities now, people from those communities, if they have mental health issues, if they have a psychotic break, for example, they can be admitted into an acute care facility. There's no one central place for people with mental health disorders.
The Nova Scotia Hospital is still open. It still has several units of in-patient. They have very hard to treat patients, people who are elderly and hard to integrate into a nursing home perhaps, and people who have very complex care needs. In addition to that they still provide outpatient services and satellite outreach. Throughout the Capital District there are satellite clinics: Spryfield, Cowie Hill, Sackville, the Cobequid Community Health Centre and, of course, more recently, the Bayers Road Mental Health Clinic. In addition, there is a mobile crisis unit. The mobile crisis unit has been expanded and it's a service that operates now, I think, pretty much 24/7 throughout the district and there's money in this budget to expand the mobile crisis unit beyond the urban core here on the peninsula.
I know a wee bit about this particular unit because the initial work to develop a mobile crisis unit came out of the North End Clinic in my constituency under the leadership at the time of a pretty interesting health care activist called Johanna Oosterveld who recognized the importance of having after-hours service for people who were experiencing great difficulty and for whom, perhaps, the emergency department wasn't the most appropriate place to go.
We have built quite a substantial network of mental health clinics across the Capital District Health Authority. What I think we haven't necessarily been able to do is really come to grips with the resources to support people to stay healthy in the community. Access to treatment on some level has expanded and has certainly improved - I say this as somebody who has worked in the system - yet we have not been able to do as much as we need to do
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with respect to the supports to keep people healthy and from having to use the mental health system as a revolving door, so that's the challenge in front of us.
Again, I think the IWK is a facility that has, over the past number of years, developed some really excellent newer programs - the ACT Program, which is an in-house treatment facility for adolescents. As well, they certainly have beds at the IWK for very urgent high-level needs. They also have a program for kids with behavioural problems. I think this is probably the biggest challenge that we face at the children and adolescent level, is the explosion - and I use that word very consciously - the absolute explosion of the number of kids in our province - and it's not unlike any other province - the absolute explosion of kids in our society today with serious behaviour problems, and it is a very big challenge.
There are many parents in our province who are at their wit's end with kids - and little kids, young children, that they have no more control over than I do, and they're their parents - with serious behaviour problems and complex behaviour problems. I'm just not talking about defiant behaviour. I'm talking about anger, anxiety, bullying, and many other very serious behaviours at a very young age. In these situations, the school system, the family doctor, parents, professionals are all very much challenged to get these kids treatment quickly, and that is a very challenging situation to find ourselves in as a province, because there isn't a lot of treatment available and certainly "quickly" is the very difficult part. There has been an explosion in this area, and I believe it's one we have to tackle head on.
MS. CASEY: Mr. Chairman, having been involved in the education system for 30 years - that long, yes - I can certainly attest to the change in the numbers of students who are in your classrooms, and the increasing number of students who do have challenges with their behaviours, and parents who, as you have said, are at their wit's end because they don't know how to deal with that. One of the challenges that I think is before us - I know is before us - is making sure that teacher training institutions in our province give some of the teachers who are going through those programs some insight into some of those behaviours and not expecting that they would be the people to provide the programs and the services, but to be able to identify and to be able to refer.
Many times teachers feel completely at a loss because they don't understand the behaviour, and the strategies that they have used in the past are not effective. They want to do the best that they can for every student but they are at a loss as to what strategies they might use. I would hope that our education system, our teacher training programs will provide some programs that help teachers at least identify, I think that's the role of teachers, and then pass on for treatment.
[6:45 p.m.]
I'm pleased to hear you say that the mobile crisis unit will expand and I think that is a very worthy program and an initiative that is reaching out, literally, beyond the core. I guess
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my question to you is, knowing that most of our specialists, rightly so I would say, are concentrated in metro, providing quality, high-level service, but knowing that there are also mental health clinics around the province, I am wondering what kind of integrated approach or collaboration or consultation exists among those rural health clinics and the specialized unit within the city?
MS. MAUREEN MACDONALD: Mr. Chairman, the government has made a commitment in the Speech from the Throne to develop a mental health strategy. I see a mental health strategy, essentially, helping us identify the gaps and then the action plan to go forward in terms of filling those gaps in priority. Mental health services in rural communities certainly would have to be a piece of that, without any question.
Although, having said everything I've said about mental health services in metro, I've seen some amazing mental health services outside of metro and in the member's own area, not necessarily the member's constituency, but in Truro there are some really interesting examples of really strong mental health services out of the Colchester Hospital and at the community level with the Canadian Mental Health Association.
Joan MacKinnon - for some reason this name comes to mind although I could be wrong - I met this amazing woman in Colchester County, in Truro, who was at one time the executive director of the Canadian Mental Health Association and I don't know if she is still there or not, and maybe that isn't her name. I was just really blown away by the kind of work that organization was doing in Truro and, Mr. Chairman, they, as an organization, don't take a back seat to anyone in terms of being able to be very effective in working with people in that community. They have a very active training program for people with mental health disorders and helping them get into the workforce and once they were in the workforce supporting them, supporting clients who went through their services.
So I think that the idea of having an expanded mobile crisis team, for example, in other areas of the province might be an interesting thing to look at. I know that the mental health system has been dong more training with police officers and, in fact, there are some pilots going on in the education system, more work being done and my colleague, the Minister of Education, and I talk about this all the time, the need to provide better information to teachers, to guidance counsellors and, in fact, to kids themselves. We have teen health centres in so many of our schools now with mental health nurses and various kinds of support groups for young people, it gives us, I think a real opportunity to provide a different kind of outreach all throughout the province that will strengthen our approaches to mental health.
As I think about the kind of things that can be going on in our schools, helping our schools be places not only where the teachers do the fine work they do, but using the physical premises to provide workshops for parents on dealing with children who are anxious, bullying - all of the work around bullying really is in some ways right on the cusp of the
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mental health system, and helping parents learn the proper approach to discipline and the way to reinforce their children's sense of empathy and how to empathize with other children. So I think that the school settings really do give us an opportunity to provide a range of additional supports to families, parents and young people.
I think in the next little while we will be moving forward, we will be coming forward with more information around the development of the mental health strategy. We will be very much looking forward to input from members of this Legislature, as well as people around the province with an interest in seeing a strong mental health strategy developed, and it could be a real exciting time for us here in Nova Scotia, I think, in terms of building a better mental health system.
I'm very much looking forward as well to the Fall, Mr. Chairman, when Nova Scotia will be hosting an Atlantic conference on mental health issues and it will give us an opportunity to bring people from around the Atlantic Region, our region, to share their best practices in terms of the work that is being done elsewhere. There is no point in reinventing the wheel, and there are some very interesting things occurring in New Brunswick, for example. I believe we can learn from them in terms of their approach on a range of issues, as they can learn from us as well.
I have said that this is an area of priority for me because it is a personal interest and it is an interest that I have had for many, many years and I look forward to being able to see some real progress in the mental health field.
MS. CASEY: Mr. Chairman, I commend you for looking for a mental health strategy. I'm encouraged. I hope that the comments today, and working with your colleague, the Minister of Education, will ensure that educators are not only part of the development of the strategy, but also the recipients of some of the benefits from that with respect to early detection.
I will tell this story and - it is not a funny story, but it is a real story and I think it is an indication of the frustration that parents and teachers have, and as a principal, I remember a mother coming in to register her child for Primary and he was a pretty active little fellow and she was challenged to make sure she knew where he was all the time, and when she left, she kind of took him by the hand and she put his hand over to mine and she said, I hope you can do something with him because we can't. Now, he was five years old. I'm thinking if parents are not able to cope with children at that early age, they're turning them over to the education system and to teachers who have not had the proper training either. So we need to make sure that we have a strategy in place that allows the best use of all of the resources that we have to help the students, so I commend you on that, and I look forward to the outcome of the strategy.
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I want to go to one other page within the book, Page 13.4. It has to do with the Executive Administration. I'm looking at the funded FTEs, and although there is a decrease in the estimates from 2009-10 to 2010-11 there is an increase in FTEs, and I'm wondering if you could explain that?
MS. MAUREEN MACDONALD: The decreases, I am advised, were found mainly through expenses in the department rather than through staff.
MS. CASEY: Mr. Chairman, having said that, I would be interested to know how the additional FTEs would be distributed.
MS. MAUREEN MACDONALD: Mr. Chairman, as the member is probably aware, these are not bodies, they're not people, and so if there was a vacancy that was filled three-quarters through the year, it would show up in additional revenue. So this is the case, I am advised - that there are no reductions in full-time equivalents, and we may have provided for a few new bodies, but not substantially.
MS. CASEY: To follow up, are there any vacancies within those positions?
MS. MAUREEN MACDONALD: I'm advised, Mr. Chairman, that there are some vacancies, but we don't know what they are right off the top. We probably could get that information. I know that, as I've said, when I arrived at the department we had quite a number of people in acting positions, and they tended to come into a higher position and then somebody bumped up into that position. So I'm assuming that at some level - because we didn't backfill in terms of hiring people and we still have a number of people acting in positions within the department. We've had a few secondments to Policy Board, and maybe to Treasury as well, but it has been largely a fairly static situation in the department.
We did add, I'm advised, a health economics section, and this is because we felt that in the department it was important to have some capacity to be able to do the difficult econometrics work that they do, crunching the numbers to help us make projections and do some of the analysis in terms of health planning. Most Departments of Health throughout the country and federally have health economic sections, and this was not necessarily something that we had, although we did have at least one health economist in the department.
[7:00 p.m.]
MS. CASEY: Mr. Chairman, could the minister advise the number of staff in the health economics division, and are they in addition to the people who currently are in the Finance Department?
MS. MAUREEN MACDONALD: It will be a staff of three, and one of the three individuals is already in the department in the policy division, so there will be an additional
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two people added. As well, there has been the hiring, or there will be hiring, for one procurement staff in the department. So I think that reflects those increases.
MS. CASEY: Just a couple of questions with respect to services - I noticed in the highlights that there was mention of prehab teams and $1.3 million, and I think the language was to ease stress on the system, and I think preparing patients, pre-surgery kind of work. So perhaps you could explain, is this a pilot? Is this something that will be implemented through the DHAs? Is there a long-term plan? Perhaps we'll take one question at a time. Is this a pilot?
MS. MAUREEN MACDONALD: This is not a pilot. The Capital District Health Authority has a very successful prehab team, and in fact, the honourable members may have heard interviews on the radio in the last couple of weeks around just how successful the prehab team has been in the Capital District Health Authority. So, building on the success of those programs, we have committed an additional $700,000 in this year's budget to set up prehabs in three DHAs. Those are the DHAs where they do orthopaedic surgery in addition to the Capital District, which are Annapolis Valley Health, Cape Breton Health Authority, and Pictou County Health Authority.
MS. CASEY: Mr. Chairman, those prehab teams - is that a model that could be used in other areas of medicine?
MS. MAUREEN MACDONALD: Mr. Chairman, that's a good question. Not being a medical doctor, I'm not really sure. The whole concept of these prehab teams are that they're in the field of orthopaedic surgery, where we know the waits have been really long. People who are waiting for orthopaedic surgery are often in a great deal of pain, and sometimes they are not all that well prepared for surgery when it happens, either.
So as I understand prehab, the way it works is, people who are waiting for surgery, they may see a physiotherapist, they may have exercises given to them to help them improve their situation with respect to pain while they're waiting for their surgery. They may see a dietitian or a nutritionist or whomever to help them lose weight prior to surgery.
The outcome of the prehab program here in the Capital District Health Authority that I've heard has been as follows: people say that their pain decreases incredibly while they're waiting for surgery. They say the recovery time after they have surgery is cut in half because they were so much better physically prepared, as well as mentally prepared, for surgery. The prehab programs are programs that are being used right across the country.
Other provinces have been doing this with a great deal of success and we've learned from that. I think Dr. Michael Rachlis has spent a lot of time looking at the various best practices in health care around the country that will help take resources that we currently have in the system and use them more effectively. This is one of the examples that I've heard him make reference to on a number of occasions.
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We're very much looking forward to seeing these prehab programs established in the other three DHAs where orthopaedics are done. It's a good question whether or not there could be a similar approach to cardiac surgery. I think you'd have to ask a clinician whether or not that would be an effective way to approach other forms of treatment. I would assume in some areas like cancer treatment, it's not a similar situation.
MS. CASEY: If we could continue with the topic of orthopaedics, in particular, Scotia Surgery. I'm wondering if the minister could give me an update as to the contract that has been signed between Capital District Health and Scotia Surgery and the position of the minister on that particular initiative?
MS. MAUREEN MACDONALD: I'd be happy to give the honourable member an update on Scotia Surgery's contract. The Scotia Surgery contract, as the member would know, had been extended for a year. I have written the Capital District Health Authority and given them the go-ahead to extend that contract for another year. The Capital District Health Authority will enter into the process of doing that. The contract is between Capital District Health Authority and Scotia Surgery rather than the Department of Health, but they've been given the go-ahead to extend for one more year.
The surgeries that are being done there are very minor in terms of the kinds of surgeries that are being done. The Capital District Health Authority has submitted, fairly recently, to the department, at my request, a plan to reduce the wait lists for more complex orthopaedic surgery in the Capital District Health Authority and there is money in this budget to operationalize a plan to reduce the more complicated orthopaedic surgeries.
MS. CASEY: It was my understanding that Scotia Surgery is a day surgery. My question is, with the plan for the more complicated, would that be part of Scotia Surgery or will they continue to be the day surgery for minor surgeries?
MS. MAUREEN MACDONALD: No, the complex surgery will remain in the Capital District Health Authority and the Scotia Surgery will continue to do the minor scopes that are being done there. They've been told that they can renew that contract for a year.
MS. CASEY: Mr. Chairman, I believe the original contract was for two days. Scotia Surgery would operate for two - the agreement would be for two days of service, and I believe that was extended. The recommendation from Capital, when I was the minister, was that that would go from two to three days. I guess my question to the minister is, with the extended contract, are they now doing surgeries three days a week?
MS. MAUREEN MACDONALD: Mr. Chairman, the contract has not been signed between the Capital District Health Authority and Scotia Surgery as of this moment. The Capital District Health Authority has proposed a reduction in the maximum hours to Scotia Surgery and they're in the process of working out the details on that. Right now I don't have
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a contract to look at, and I don't know what the outcome will be in terms of the number of days or hours that we will get. Those discussions are underway, and essentially what I've done is I've allowed the Capital District Health Authority to enter into the discussions with Scotia Surgery to carry on for another year with the minor scopes.
MS. CASEY: I understand that the contract is between Capital District Health Authority and Scotia Surgery and that it is under negotiation, and that process has to be allowed to unfold. Did I understand, though, that the minister said that they may be looking at a reduction in the hours in that contract?
MS. MAUREEN MACDONALD: Yes, that's right, a reduction in the maximum hours.
MS. CASEY: One of the things that appeared to make the Scotia Surgery initiative successful, and one that Capital District Health Authority was interested in continuing, was the number of people who were removed from a wait list because they could have access to that minor surgery at Scotia Surgery.
My question to the minister is, what are the most recent numbers that she would have received from Capital with respect to the numbers of surgeries that had been completed at Scotia Surgery?
MS. MAUREEN MACDONALD: Mr. Chairman, about 492 surgeries were completed at Scotia Surgery during April to December 2009. The median wait time for the minor surgical procedures decreased from 297 days to 203 days. About 234 patients were dropped from the wait list for CDHA elective day surgery. Orthoscopic knee scope wait times dropped from 169 in 2008 to 143 in 2009. The overall capacity for in-patient surgeries increased 5 per cent and day surgery volumes increased 12 per cent at CDHA between 2008-09 and 2009-10. I think that pretty much outlines some of the highlights that CDHA have provided us with respect to the impact of Scotia Surgery. I think the honourable member will also know that there were patient satisfaction surveys after surgery and patient satisfaction was fairly high.
[7:15 p.m.]
One of the things that I indicated, I'm very committed, and the department is really very committed, to getting the wait times for orthopaedic surgery down in this province. The CIHI Report that came out not so long ago, maybe six weeks ago or so, has us trailing the pack in terms of provinces across the country. Although I've heard the head of orthopaedics at the Queen Elizabeth II talk about the improvements that they have made, and that they've seen some change, not enough change, but they've seen some positive improvement since the CIHI data was collected. Nevertheless they still have a considerable period to go and we're very committed to bringing those orthopaedic wait times down.
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I, frankly, didn't see it as a useful exercise to take minor procedures that are being done at Scotia Surgery and throw them back into the mix at the Queen Elizabeth II right now when we're trying to get those longer wait times for the more serious surgeries down and that's a priority for us. That's something that I want to see changed in the coming year and, again, the Capital District Health Authority has presented a plan to the department for how they think they are going to be able to make some substantial achievements in that area.
MS. CASEY: Mr. Chairman, I would ask if the minister could table the most recent results on the numbers from Scotia Surgery. My next question, recognizing that the cusp of the satisfaction level is very high, and that the numbers that have been taken off the wait list are significant, I'm still concerned that there may be some negotiations that would reduce the amount of hours. I'm asking the minister what the connection there would be, between satisfaction, reducing the wait lists, and then looking at reducing the number of hours?
MS. MAUREEN MACDONALD: Well, Mr. Chairman, I guess I would say to the honourable member, I would love to have this discussion with you but because there is a discussion going on between the Capital District Health Authority and Scotia Surgery with respect to renegotiating that contract for a year and moving it forward, I think it's probably best that I say as little as possible. I've probably already said too much on this file.
MS. CASEY: Just one quick question, that's all I have time for, but there are some national benchmarks with respect to wait times. The most recent information that I have is the one where we were not meeting or exceeding the national benchmark with the joint replacements. Would those statistics still be true today?
MS. MAUREEN MACDONALD: I'm not entirely sure, but I think it is still the case today, and I think the thing is that there's a continuum of people who are waiting. To get surgery is a long wait but if the wait list is very long, then it's the people who are at that other end of the wait list who really wait a long time. I think there has been some improvement in getting people with a more serious need for surgery in quicker, but people on this end have not moved in that much more quickly and that's the concern. We really have to find a way to both streamline and move people - the flow - and get them through the system much faster.
MR. CHAIRMAN: The honourable member's time has expired on this round.
The committee will recess for a few minutes.
[7:19 p.m. The committee recessed.]
[7:30 p.m. The committee reconvened.]
MR. CHAIRMAN: Order, please. I will now call the Committee of the Whole House on Supply to order.
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The honourable member for Halifax Clayton Park.
MS. DIANA WHALEN: Mr. Chairman, I wanted to go back to the discussion and questions that were coming up around mental health. The minister knows that this is an area that I have a big interest in as well, and I know it has been something that she has followed over her career. You've had quite a lot of time to answer questions for the member for Colchester North, I believe, who had just been asking questions, and I didn't want to go over the same ground. I was listening - I had left the Chamber for a minute, but I was listening to all of the discussion.
What I wanted to ask was around the global budget for mental health. When we were here in the Fall, we said it was about 3.5 per cent out of the entire budget of the Department of Health. Right now I calculate it at about 3.6 per cent. I've added Executive Administration, which is $8.5 million; Provincial Mental Health Programs, $2.5 million; and Mental Health Services to the DHAs is $118.8 million, so roughly $119 million. The total I've got is $129.8 million, and so based on that it would be 3.6 per cent of the overall budget. So I would like to ask the minister if that is indeed correct and if it represents any increase overall from where we were last Fall. If we could just stick to that, I have a number of members of my caucus who would like to ask questions in this hour as well.
MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member is correct. However, there is one area that's not reflected in these numbers that indicates a slight increase in mental health expenditure and mental health services. That is with respect to psychiatrists and an increase in the number of hours - clinical billable - well, not billable, because it's AFP, but the number of clinical hours for psychiatry which is contained in the physician payments piece has also increased. I can't give you a dollar amount right now, but it is an additional couple of million dollars increase.
MS. WHALEN: I wanted to look specifically - and I appreciate that clarification. Perhaps you could give me that number later; I would like to ask for it, if we could get it. I would like to have the total picture, so that piece needs to be added to the puzzle - but what I would like to do is just look at one of the line items which has actually gone down. So what I had there was the DHA mental health budgets increased by $4.4 million, but the provincial mental health programs have decreased by $3.3 million. So I would like to know why the decrease in the provincial mental health programs, if you could explain that? It has gone up in the DHAs but, you know, only by $1.1 million. If that is just a transfer, then we're not up very much.
MS. MAUREEN MACDONALD: Mr. Chairman, that is the transfer that's reflected, and in terms of the amount of money for psychiatry, it's $4.2 million.
MS. WHALEN: The minister has always said that this is a very important area. I know that she has professional experiences while working in mental health, as well as all the work
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she does as an MLA over the years. I just wonder if, as the new Minister of Health, you had issued any directives at all to the DHAs around their mental health budgets or given any specific instructions that might have said this is a priority for this government? I just want to know if you've put your stamp on this, because I don't see it in the numbers. I know that the minister cares about this, but what's important is whether it gets reflected in services throughout the province. So the question to the minister is, can you say what directives you gave?
MS. MAUREEN MACDONALD: Mr. Chairman, two things I would like to say: first of all, the Mental Health Program funding has increased by $2,671,000. The AFP for psychiatrists is an increase of $4.2 million, which also buys additional clinical hours specifically, part of that AFP was a requirement for additional clinical hours.
With respect to the DHA budgets, the capacity of the province in this round of the budget was limited, as we have all acknowledged. We went out to the DHAs and we actually asked the DHAs to do a 1 per cent reduction in funding in their DHA that was non-wage, to come back, and in terms of instructions to DHAs, we expected that there would be no cuts in the mental health area.
We looked inside our own budget in the department to identify where those areas of expenditure might be in our own department, where we could push money out from the mental health budget into the DHAs, which we've talked about in terms of the transfer to the IWK and, additionally, we had those additional dollars for mobile crisis and a few other expansions in mental health. I recognize that it's modest but it is a very important beginning.
We also, Mr. Chairman, want to develop a mental health strategy, so I want to make sure that we're spending the dollars where they're most needed and where the mental health strategy will identify the gaps and the priorities.
MS. WHALEN: I just wanted to make a note that if the overall spending of some of these DHAs for mental health has just increased marginally, it doesn't even seem like they've kept up with the cost of inflation. So I'm saying if you had a 1 per cent or 2 per cent increase on wages and other things in this last year, I guess I would like the minister to explain why the following DHAs received mental health budgets, which would appear to be insufficient to cover inflation?
Just as an example, the South Shore DHA has increased by 0.4 per cent; SouthWest Health, 0.3 per cent; Annapolis, 0.1 per cent; Colchester East Hants was zero; Cumberland is 0.08 per cent; Pictou, 0.05. So those are all less than a 1 per cent increase or no increase and we know we have increases in our wage settlements and just general inflationary increases. So, is there some way to assure us that those areas have not had to cut into mental health?
MS. MAUREEN MACDONALD: I'll get them.
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MS. WHALEN: Mr. Chairman, I know that the minister is searching for that answer right now. I just wanted to clarify that the percentage increase I gave, as far as I could determine, is in the mental health budget. So it's not their global budget I was referring to but those less than 1 per cent increases in their mental health budgets for those DHAs, which was, in fact, the six DHAs that I mentioned that are under a 1 per cent increase in the mental health budget.
I appreciate what the minister was saying that, you know, in fact, these are modest increases. I'm glad to hear there are some but it really is very modest and my concern is that we haven't really put a stamp on this as an urgent area for change. I think, as we go forward, I know the minister is looking for those specific numbers, but maybe she could answer a question around the mental health strategy because you referred to that. I'd like to know the timeline for that and I'd like to know whether or not the multiple organizations that represent families and patients and care providers are going to be included in that, all of the different organizations that do lobby and advocate for the mentally ill.
MS. MAUREEN MACDONALD: Mr. Chairman, the mental health strategy, and how we're going to be moving forward with that, is something we will be announcing in the coming months. With respect to involvement, public involvement and involvement of various stakeholders and interest groups, of course we will be ensuring that there will be an opportunity for stakeholder involvement.
Mr. Chairman, I have to say, and I think I've mentioned this before, there are more than 20 studies that have been done on mental health over the past 10 or so years in Nova Scotia. I think the important thing is that we not try to reinvent the wheel and go through a very repetitive process but we just try to get right to the crux of the issue by looking at what services we currently have, where the gaps are in the services, where the priorities are for services.
It needs to be evidence-based. It needs to be based on good data and good information, like any program that we develop or any approach to treatment of any disease or illness. To some extent that means working with our own data inside the department.
Dr. John Ross, for example, has done a superb job going around and meeting with people out in the community with respect to what their attachment is to their local emergency departments, what their fears are with respect to not having an emergency department or access to timely health care. That is truly very important but it's equally important to have strong data that tell us what the patterns of use are in our system.
We have information and we need to be able to collect information that tells us about bed days for mental health services, that tells us emergency room admissions, that tells us wait times to get into different programs, that tells us what specialty services we have and so on. So we need to have a very good, empirical, facts-based picture of our mental health services
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and the demand on those services and where we're falling down and where we're succeeding as well. From that we'll be able, I think, to start to develop a very good picture.
I'll be very frank, I don't particularly want to go down the road of having every group, who are very valuable and have lots of experience in the mental health area, tell their story, because we've heard the stories, that's what is moving us to develop a mental health strategy. It is time to act in terms of what are the services that we don't have and the services that we need. That's the first thing, I would say.
The second thing is, as somebody who has worked in this field, I will be very careful about being clear that the mental health strategy that we need to develop, from my perspective, while it won't ignore community services and all those ancillary issues, as Minister of Health I do not have the capacity to address all of those issues: housing, employment, training, all of that stuff. I have the ability to address access to mental health care in the health care system. I've thought about this a fair amount, what exactly are my aspirations, as Minister of Health, for mental health strategy and it really is to look at our health care system and determine what we're doing, what we should be doing, what resources are required to do that and over what period of time we can develop a plan to get that in place.
[7:45 p.m.]
In terms of doing the work of developing that strategy, there is conceptual work already going on around that and we will be moving this forward in the coming months. I will look forward to talking more with the honourable member about what that is actually going to practically look like.
MS. WHALEN: I do appreciate that there has been a lot of previous studies and, if anything, I would say that I am anxious for you to make some changes in the system and to start allocating some programs that we know work, and to look and say what is working and what isn't and start moving the system forward.
I'm in favour of that and I think you know best practices and so does the department and the many people who work there. I just also think that we need to listen to the people who have been in the front line and, at the same time, look at the studies - they have been consulted before - then show them that that has been listened to because people do get worn out giving their input as well, when they think that nothing ever changes. I've been a consultant and gone into areas when people did not want to even participate because they said we've been studied 10 times over and nothing gets done. It is true that there's a time for study and there's a time for action.
I wanted to mention to the minister that the IWK this year is spending 11 per cent of their budget on mental health, and you compare that to the Department of Health and I think they are on the right track. They recognize that if we don't intervene soon, if we put children
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who are in crisis and their families in crisis on a long waiting list, we're creating so many other problems in society. We know that children in crisis might be suicidal, they can be violent, there are so many other issues.
MR. CHAIRMAN: Order, please, order. There seems to be a lot of chatter in the Chamber this evening. I would ask the honourable members if they would take their chatter outside the Chamber so we can listen to these important estimates, please. Thank you.
MS. WHALEN: Thank you very much. Just to continue on that vein about the strategy, it's very important for us to see that quickly put into place, based on all the best information you've got from past studies so that we can get moving. I really would say that and I would love a timeline. I understand from your answer that it's just coming in the coming months. I guess you're not able to commit beyond that.
It is important to us and we feel that there's such a crying need, really, across the province. Again, I give kudos to the IWK, they have searched for ways to redirect money. They were introducing some of those lean processes within a couple of their areas, found some savings, redirected it to mental health.
One of my questions would be whether or not the DHAs are free to do that, as the IWK did. I understand from your answer to the previous questioner from the Progressive Conservative Party that, in fact, the dollars are directed that you give for mental health, but can the DHAs also find other savings and put it to mental health, if they see that as a priority?
MS. MAUREEN MACDONALD: Mr. Chairman, I'm glad the honourable member is pleased to see the increase at the IWK. Just to remind the honourable member about the increase in mental health services at the IWK, a fair chunk of that increase is a transfer from the Department of Health to the IWK for that increase. I think I explained the first night we were in estimates, that we financially supported a number of programs that were initiated at the IWK and in the districts and now that they've been established, the money has been transferred to them from our department because they are the people on the front lines who provide the service, we don't provide front-line service, they do. That's as it should be.
In terms of other DHAs and mental health services, I think if you look around the province at the different DHAs you'll find some very interesting work going on. I'm reminded of the Cape Breton District Health Authority, the work they're doing in that district health authority with New Dawn Enterprises, for example. Very interesting partnership to ensure that people with mental health disorders have adequate housing, not only decent, affordable housing, but also supportive. They actually have workers that visit and make sure people are eating and taking their medication, they're getting to doctor's appointments and all these really important elements. The success they're having is very high. It's phenomenal, it's wonderful. So that's a very good model and a very good approach.
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I know that the South Shore District Health Authority in the past was very much a leader with respect to many of the programs they offered to people with mental health disorders in their district. I have met with many boards around the province and I make it a point when I meet with those boards, sometimes it's the first time I've met with the full board, I tell them, as minister, I have essentially five priorities and mental health is definitely one of those priorities. I have an opportunity to talk to them about what I think we need to be doing in the field of mental health and what I hope they will consider as they do their planning.
I know that when a district health authority puts together their budgetary plans, they have a great many pressures. They're pressured with respect to cancer patients, cardiac and general medicine and whatever the specialty services are. It is important that mental health not be left out of that equation. I've made it very clear that this is an area that I'm very interested in seeing us make some gains.
But I don't expect - Rome was not built in a day, as my mother used to say. I don't expect that because this is an interest of mine we're going to transform the mental health system overnight. I haven't been Minister of Health for a full year, we've had to do two budgets, we've had a pandemic in terms of H1N1, we have many other items on our agenda, but my commitment is that mental health will not be allowed to fall off the table. We will see some substantial improvements in mental health services.
It's a very complicated area of medicine and health policy. I anticipate that I will work on this area of health policy for a good many years to come, whether I'm the minister or not.
MS. WHALEN: I would just say to the minister that she and I have both, over the years, seen a lot of ministers come and go from different departments and not leave a mark on that department. I think it's a shame. If we can even make some improvement as we go along and point to something after a period of time that has improved as a result of the leadership that each individual does apply. I'm not suggesting that she would be one of those ministers, or that any of the ministers here are, but I do think that the challenge is there to say, let's leave the system better than we found it. This is certainly an area that needs attention and I hear what you're saying.
I'm glad to see you don't think you can be all things to all people, looking at everything from housing to education, but this is one of those areas with mental health that does have an impact in a lot of different areas and often with our education, for example, that would be your front line for identifying people, identifying children and families that are at risk or are actually in trouble, so they have a role to play. I know you can't do it all and Rome wasn't built in a day, I understand that.
Today, in fact, in this hour, I'm going to share some time with a number of my colleagues, depending on how time lasts and I have a question before I go to my colleagues. I had an issue that's been raised with me.
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First of all, during the election, on the doorstep, when I was knocking on doors in Clayton Park, I met a woman who suffers from aphasia. I have to say that I did not know what aphasia is, and I don't know if the minister does, but I have a description here that says, aphasia is an acquired communication disorder that impairs a person's ability to process language but does not affect intelligence. It's often seen in stroke victims who lose the ability to speak and have to learn again to speak and write and communicate. This woman was a professional woman who was only 50, had a stroke and was learning to speak again and she spoke to me about this issue on the doorstep. To speak on this kind of thing is difficult for her, she has been doing a lot of intensive work to get back her skills but she said the province does not recognize it and doesn't provide help. It's another example of - again, she wouldn't have this unless she had a health plan, which was covering her under disability and it isn't all-encompassing but she's had some help to do the intensive work.
What I'm asking about really is whether the minister is aware of this and I think, if I could just go on a little bit about it, it points to the fact that we're very good in acute care; somebody comes in with a stroke, we're able to save their life. We can look after them and do a little bit of rehab but when we send them home - it's the same thing with brain injury - we don't provide the instruction for their family, we don't give them a program to follow for their continued improvement. It's not unlike EIBI, we know there are programs that require intensive work, and she has to work at this eight hours a day and she has regained a lot of her skills, but she was just saying how hard it is and how little direction there is and how there is no program in place. She has actually started a Web site - I think it's a Web site, I printed some things off on-line - and a blog that she's writing about her struggles and trying to speak for it for others. There is an Aphasia Association in Toronto, there's nothing here.
My main question for the minister is - we have been asking, I've asked the department and she has asked the department just to get an estimated number of people in the province who have aphasia. The answers come back from the Department of Health, we don't know, just no answer. I think we could put an estimate on it and get an idea. I had told her in speaking to her that until we knew who is out there and how many there are, we haven't even defined the problem and the extent of the problem. I had promised her that I would raise this issue and I would be interested to know if the minister knows about that, if she could commit to me that we could get a number from the health information researchers that you have in the department and I'd be happy to give her what I've printed off here.
MS. MAUREEN MACDONALD: Mr. Chairman, I really have no knowledge of this particular disease or ailment, condition, syndrome, I'm not really sure exactly how you would characterize it. My deputy tells me that we do receive correspondence or inquiries from time to time. I'm not sure how we would go about doing an estimate but it's certainly something that I can make some inquiries about in the department.
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Perhaps the Nova Scotia Speech and Hearing Clinic in the School of Communication Disorders might be able to help us in this regard. It's not something that I have any knowledge of but I'd be happy to look into it.
MS. WHALEN: What I will do is e-mail some of this information perhaps to the deputy, would that be best? Then you could endeavour to get back to me. I would like to put it on your radar screen because I think there is a need to talk about this and I know it's just exactly what the minister needs, one more syndrome to create another priority. I realize it is overwhelming but, again, I'm sure you would agree with me that we're so good at the acute side, and then we send people home to rebuild their lives, and they don't have the support and the tools that they need and the help they need to regain their skills - which is possible to do, with what we know now about rebuilding your brain and really retraining yourself. We realized miraculous things can happen.
I am going to turn over the rest of this time to my colleague, the MLA for Richmond. He has some questions for you as well. Thank you.
MR. CHAIRMAN: The honourable member for Richmond.
HON. MICHEL SAMSON: Mr. Chairman, it is a pleasure to have the opportunity to ask a few questions to the minister, especially regarding issues facing the residents of Richmond County. I would be remiss if I didn't first acknowledge our new Deputy Minister of Health, Kevin McNamara, which is a name that's quite familiar in Richmond County. I believe his roots are from there and he still has family in Richmond County, so we're certainly pleased to have someone in such an important position who, I am sure, has a great appreciation for some of the challenges that we face in Richmond County.
[8:00 p.m.]
One of the issues that I wanted to start off with, Mr. Chairman, is that last week I raised the question regarding the proposed new W.B. Kingston Memorial Health Centre in L'Ardoise. This centre is meant to replace an existing facility which is 130 years old; in fact, it is the old convent in L'Ardoise, which was given to the community, and Dr. Kingston at the time moved in there and started his practice. Needless to say, the centre is no longer meeting the needs of the community, so for the last number of years the community, through its board, has developed a proposal for a new health centre, which would be a modern facility for doctor offices and a nurse practitioner, who is now practising in the community, along with other medical services and overall health services for the community.
I do believe that all members of this House have endorsed the idea that these community health centres are the way to go for the future, and that these centres will also not only provide emergency medical care, ongoing medical care, but more importantly, will also
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play a very important role in health promotion and healthy lifestyles through the different clinics and different education programs that are being provided.
Now, Mr. Chairman, as many other communities have undertaken these goals to build these centres, one of the main issues is getting the funding to build them. Right now this centre has commitments from Enterprise Cape Breton Corporation for $500,000; the Richmond Municipal Council has committed $250,000; the community itself, which - Richmond right now has a population under of 10,000 people, and this would be serving about half of the county, so let's say it's a catchment area of about 5,000 people who have committed to raising $250,000, which is an incredible amount of money for a small community. That brings them to $1 million, with the project right now - which I would say is a modest one - pegged at $1.5 million, so there's $500,000 missing. The problem is - and I think the minister is aware, and it is not just an issue of her government, because the previous government, it was the same problem - that the Department of Health has not been providing funding for capital projects that are not Department of Health-owned facilities.
So right now, they're left with $500,000 missing. The business plan which was sent to the minister in October 2009 shows that once it is built, it is anticipated that the revenue from the rentals for the medical professionals who will be there will sustain the facility. So right now it is not a matter of requiring ongoing financial support, which I do believe the Department of Health is doing or has done for other community health centres, once they're up and running.
Right now, we're short $500,000. ECBC has seen this as an economic development tool for the community. That's how they brought their money in. It is under the idea that this will create jobs, it will create employment, and it will stimulate the economy in that area and keep jobs in that area. Right now the Department of Health, as we now stand, is not a potential funding partner. So I know the minister is now the Minister of Health Promotion and Protection, which has been approached as well. We approached Economic and Rural Development. I've approached the Industrial Expansion Fund. We've pretty much exhausted everything. So I guess my question today is, on behalf of the board and on behalf of the residents of Richmond County, is there anything that the minister is doing as Minister of Health to try to identify how the province can become a partner in accessing capital dollars and can she indicate whether there has been any movement there or whether she can give any sort of hope that there might be some role for the province to play in the construction of this facility.
MS. MAUREEN MACDONALD: I welcome the honourable member to the Health Estimates. I'm very glad that the honourable member decided to raise this question with me again because after he raised this matter in Question Period, I went back to my department and I asked about the correspondence because frankly I hadn't seen any correspondence and we couldn't find anything initially. It took a bit of searching and indeed there was correspondence to which I apologize to the community for having misplaced . We get a lot of correspondence
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in the department and that doesn't occur very often but from time to time a piece of correspondence will come in and it will be misplaced but it's back where it belongs right now and it indeed is very much on our radar.
Let me say a couple of things to the honourable member. This government and our department are very committed in terms of primary health care delivery. The fact that we don't have a program for capital construction in the department for primary health care centres is something that we're aware of. We're aware of the shortcomings of that situation. We are thinking our way through a process of working with the district health authorities to identify the extent to which this exists as a problem around the province. The honourable member's constituency is one of many rural constituencies with strong primary health care needs and a good base - obviously if you can raise that kind of money for a new centre - a community base to be able to have primary health care, which is what we want. We want primary health care throughout the province.
At this stage, staff in the department have the proposal, are aware of the situation, there will be some discussions with the DHA to find out where this fits in terms of the DHAs' provision of services and the primary health care assessments that they do. They are closer to the people than the Joseph Howe Building. What I would say is that we will work with the DHA to see what it is they have to say and we will not close the door on good, strong primary health care in that particular community.
I haven't read the proposal myself since it has been located but I would very much welcome an opportunity to do that and to talk with the honourable member further about it.
MR. SAMSON: Mr. Chairman, I'm pleased to hear the minister say that because when I did check with the Chair prior to asking the question, I was at a loss that it had not been replied to and I certainly, having been elected the same time as the member, I certainly expected when she entered the department, she would want to make sure, as most of us do when we're ministers, that that kind of correspondence gets addressed immediately. I have no doubt that there's a lot of correspondence going to the Department of Health and I'm pleased that it has been identified because I believe there was a copy sent to the Premier's office as well. I know that the board will be very anxious to hear from the minister and I'd be happy to arrange for a meeting with the board and the minister, along with her staff, to discuss this.
As I said, I know there are pressures in the Department of Health and that's why I think in this case, it might be a matter of looking outside the box, outside of the Department of Health because Enterprise Cape Breton Corporation has looked at this as an economic development model and as well as an important factor in the economy of the community. So it might be time for the minister to have discussions, with the Minister of Finance and her colleagues to see if there is a way to look at other funding tools within the provincial government to make the investments in this capital construction. I think it is one of those
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investments that clearly will pay off and bring money back, and maybe it's time that we start looking outside the Department of Health for this kind of funding for these clinics. But I will certainly follow up on correspondence to the minister and hope that we can meet and have the board give her more details on the plan.
One of the other facilities in Richmond County that I wanted to talk about is St. Anne Centre in Arichat, which services the communities of Isle Madame, Louisdale and surrounding area. A very important facility and at the same time I can say a very unique facility because of the fact that it is the only health care centre in Nova Scotia that is not under a DHA.
Now, that has worked very well for the community, it has worked very well for St. Anne's, it has recognized its unique nature and the incredible amount of services that they're able to provide as well as maintaining a Level 4, I believe, emergency room, which basically has been done, thanks to Dr. Laurie MacNeil who has been carrying an incredible work load and case load for quite some time, as well as keeping the emergency room open.
Now, as the minister is probably aware, the famous Corpus Sanchez Report finished with the final two clauses talking about St. Anne's Centre and the recommendation that St. Anne's Centre no longer be permitted to remain as a stand-alone facility but that it be forced to merge with the Guysborough Antigonish Strait Health Authority. So my first question on this subject is, does the minister intend to implement that aspect of the Corpus Sanchez Report as it currently stands?
MS. MAUREEN MACDONALD: Mr. Chairman, to the honourable member, I haven't decided yet whether that recommendation will be implemented or not. But it is something that I will assess very carefully.
MR. SAMSON: Mr. Chairman, I am quite pleased to hear that and I am sure that the board itself and the community will be pleased to hear that there might still be an opportunity. It is not a criticism of GASHA. We still all rely on GASHA, especially. St. Martha's Regional Hospital, which serves our communities, the work that GASHA does with the Strait Richmond Hospital, which well serves Richmond County. But St. Anne's has worked and I guess the message that they're saying is why play around with something that is working. The other concern is that by being included with GASHA, all of a sudden, they are part of the mix when it comes to having to make funding decisions and possible funding reductions and there is extreme concern about the elimination of the emergency room funding for that facility.
So, again, I know that the board has sent correspondence recently, in fact, to the minister, I think in the last few weeks, basically just outlining the many services that they provide and their desire to remain as an autonomous facility.
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I just want to tell the minister, I did have a bit of fear when I first saw Dr. Ross' interim report because a few pages in it provides a map and I noticed that St. Anne's Centre wasn't on his map and I was afraid that that was an indication for St. Anne's, but I was happy to see at the end of the report that it does list St. Anne's as one of the health centres that does have emergency room service in the province. So, hopefully, any future reports will put St. Anne's back on the map on Isle Madame in Richmond County, but I'm certainly pleased to see that is under consideration and look forward to hearing from the minister because I know that the board is quite anxious as there has not been a formal agreement yet to join GASHA, although some discussions have taken place.
One of the issues which I have raised in the House with the previous government, and I'm curious to hear where the current minister's thinking is, is the issue of dialysis services in rural Nova Scotia. Richmond County, especially Isle Madame, has been identified as having one of the highest rates of diabetes in Nova Scotia, in fact, more specifically, one of the specialists in Sydney has actually identified that the Acadian community tends to have a higher rate of diabetes than many other cultures. So, as a result of that, that doctor has been working with the Department of Health to try to identify better services for Richmond County. Because right now, while the Strait Richmond has started to provide some dialysis services, I believe the best way to describe it is that they provide needle dialysis but the line dialysis, which is a more complicated one, it's currently only available either at St. Martha's in Antigonish or at the Cape Breton Regional Hospital. If you live in Richmond County, that's pretty much an hour and a half in either direction.
[8:15 p.m.]
So you're an hour to an hour and a half to get dialysis services. So if you live in Richmond County, having to travel two to three to four days a week, an hour to an hour and a half one way, it's putting a tremendous amount of strain not only on the patients but their caregivers who have to take so much time out of their schedule to provide that.
We did meet with the Department of Health not long ago, prior to the last election, and we did speak with some of the staff. Warden John Boudreau, who is very sensitive to this topic, joined me for that meeting and so we did have some discussion but, I'm curious, could the minister advise us when can we expect to see line dialysis services at institutions such as the Strait Richmond Hospital?
MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member raises a very important program issue. We do have a provincial dialysis program, we have clinics and we have satellite sites, but it is true that a number of people are travelling from various parts of the province. The honourable member for Shelburne is often speaking to me about this issue for people from his community who have to travel to Yarmouth. The honourable member for Guysborough-Sheet Harbour is often speaking to me about people from the Canso area, for example, who have really long distances to travel.
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So this is a growing pressure on our health care system without any question and we have in the department an initiative that is looking at where dialysis patients are around the province and where the services are around the province. As we have an ability to address those pressures, we need to make sure that we get services particularly where we're seeing critical masses of people in communities.
Now, there's an additional possibility here, I think, that I'm actually somewhat familiar with because I mentioned earlier that my nephew had a kidney transplant, and he's actually a young adult today, and he has been on home dialysis for three years. It's quite an amazing thing that can happen in terms of people's ability to be able to take care of that aspect of their health. Not everybody can do this, I recognize this, but for people who are able to do this, it is - not liberating because they still have to follow that regime - but, boy, does it ever make a difference in terms of not having to be on the road to get dialysis all the time, the time you spend in the car, the time you spend, and you can be in your home, you can watch television, you know, you can sleep at night, you can do a lot of things. I don't know where the future will bring us in terms of technology and medical procedures but I have a hope and I have a belief that we're going to see dialysis for a lot of our population change quite dramatically in the not too distant future.
When my nephew was a teenager and much younger, this would have been unthought of as an option, home dialysis. Today it's very much an option and it has an added bonus and the financial end of things shouldn't be our motivating operandus here if the quality of life wasn't better, but it improves people's quality of life dramatically.
So I just want the honourable member to know that the dialysis program in the department, the funding is holding steady. We spent our forecast last year - $615,000 - and we've budgeted $794,400 for the upcoming year. It's a modest increase, an increase of more than $100,000. It will give us, I think, an ability to certainly maintain the services we have and perhaps add a bit. I don't know if the honourable member has been to the dialysis unit in St. Martha's. It has just recently been renovated. It's phenomenal. It's really a very - lots of natural light, very airy. If you have to travel and have dialysis, it has to be, probably, one of the better settings that you could have it in.
MR. SAMSON: Mr. Chairman, I certainly have heard some great comments about it, but I'm sure the minister being from that area, would join me in saying that in mid-December one would not want to make the commute three to four times a week from St. Martha's to Isle Madame, because you would probably go through four different weather patterns and none of those weather patterns is pleasant at that time of the year, and that's the frustration.
We have a situation I've advocated for a number of families, where we actually had support from the Department of Community Services, that were providing some mileage support because of the frequency of the trips that were being made down to Sydney. The problem is that particular family, they're now both over 65 and they no longer qualify for any
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support from Community Services, so they're left on their own to pick up the mileage. So I'm curious in that regard, has the minister given any consideration to the possibility of putting together a program that would provide some form of mileage support for low-income families who are required to travel on a regular basis from significant distances to access dialysis support in the province?
MS. MAUREEN MACDONALD: Mr. Chairman, I'm advised that the Department of Community Services does have such a program to assist low-income families who receive dialysis to travel.
MR. SAMSON: And the only challenge with that is that the Department of Community Services won't assist after you turn 65. So the situation I was referring to is, they are low income, but now that they're 65, the Department of Community Services - unless the minister wants to make an amendment to that policy, currently at 65 you no longer qualify and there are reasons for that. So my question would be, if the Department of Community Services is still willing to help low-income earners under 65, will the Department of Health at least entertain looking at assisting low-income families who are above 65 years of age and would no longer be eligible for any support from Community Services, because right now once you're over 65 you're on a fixed income, you're on your pensions, and travelling three to four days a week to either St. Martha's or the Cape Breton Regional Hospital is a significant cost - wear and tear on the vehicles, meals and everything else, so I'm curious whether the minister would be prepared to at least explore the idea with her department, and at least, maybe, even try to identify the numbers of Nova Scotians who would be over 65 and requiring this type of dialysis support?
MS. MAUREEN MACDONALD: Mr. Chairman, certainly it's a good suggestion that we at least crunch the numbers and take a look at how many people are in this situation, and what the financial impact might be. Certainly if people need access to health care, we have a duty to provide it, and to try to figure out how best provide it.
MR. SAMSON: I'm pleased to hear that the minister is prepared to look at that, and I will certainly be happy to follow that up with some correspondence. I think that's a debate we should have, because at the end of the day we're doing budget estimates, and we're looking at whether this is a reasonable budget and what are the best ways to spend money, so I make the suggestion knowing that I don't have all the numbers. I'm not sure how many of the people this applies to but I can certainly tell you I know of a few instances where individuals chose not to take treatments because they were not prepared to travel three or four days a week to either Cape Breton Regional Hospital or St. Martha's Hospital. We all know how those ended, they ended in death. There were options but they just weren't prepared to have to go through the turmoil and the financial impact that would have.
I think the minister is correct, we do have a duty in assisting people. At the same time, we have some financial realities to try to keep in mind as well.
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I would be remiss if I did not ask the minister if she could provide us with a bit more detail on the Self Managed Care program. The minister will probably recall that I have risen in my place on a number of occasions to talk about the need to provide support for families who are caring for loved ones at home. We realize that the program that was announced in the last budget has had significant shortcomings, to say the least. I'd be curious as to whether the minister would be able to provide us with a bit of a recap on that program, as far as how many people either made inquiries or applied to the different DHAs and how many were approved for that program and if the minister could provide those numbers.
I guess more specifically, maybe she already has, that's great. I guess my question is, is the minister prepared to date to tell us when the details of that program, this new program that she has put together, are going to be made available? I'm sure many families in Richmond County would want me to ask when are the applications going to be ready?
MS. MAUREEN MACDONALD: Mr. Chairman, the honourable member for Halifax Clayton Park asked a number of questions the other evening about the Caregiver Allowance Program and wanted to know how many people qualified by DHA. I have tabled that information and I see she has provided it to the honourable member.
We have in the budget for this year a substantial increase in the amount of money we have allotted for caregivers but, as well on that line item, is the self-managed care program, as well as some monitoring aids for people who need them.
We have undertaken a process of review of the existing caregiver allowance, which has included some consultation with groups like Caregivers Nova Scotia, for example, to get from them a more complete picture of what they think of the existing program, how they would improve on that program and what other programs might look at. Caregivers are just one of the groups we have consulted with.
We have gathered information from other jurisdictions as well. We are in the process of sorting through the information we have received back from our consultation and reviewing what options we might have available to us. I have yet to make a decision with respect to the preferred options. Then the member would know that the process is, once we've arrived at some decision in the department I will move it forward to my Cabinet colleagues for decision. At that point we will make an announcement on what the future of these programs will look like. I do not have those details yet. We're very much involved in a process of building on the existing programs.
Let me say that we do understand the importance of self-managed care. This has been an area that I know the honourable member has had a keen interest in over the years. I would have been . . .
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MR. CHAIRMAN: Order, please. The time allotted for the Opposition Party has expired.
The honourable member for Argyle.
HON. CHRISTOPHER D'ENTREMONT: Mr. Chairman, it's my pleasure to stand once again and maybe ask a bunch more questions on the budget of the Department of Health and, more specifically, some of the programs as we see them and maybe some more questions referred to our own constituencies. I know I'll be sharing my time with the member for Cumberland South.
While we're talking about caregiver allowance and maybe to get a better feeling, if I remember correctly in some of the questioning that we had of you back in the Fall, when we were bringing the issues of the Caregiver Allowance Program and the people who weren't able to get into it, you had made a statement that you were looking at creating a new program and maybe phasing this one out. Now we seem to be into a phase of, well, let's see if we can make this one better and make it work for Nova Scotians, which is what I think the Liberal Party and the Progressive Conservative Party were advocating for in the Fall. I'm just wondering where that change happened between the Fall and the Spring.
[8:30 p.m.]
MS. MAUREEN MACDONALD: Well, I think first of all I would say that there has really been no change. We have a Caregiver Allowance Program, and we have - it's getting closer to 700 people who are enrolled in the program, 650-plus, I guess, at last count - 661 clients have been approved for the Caregiver Allowance Program. It was initially targeted at about 750.
This program, as the member will no doubt remember, had a very - I suppose in a way it had a bit of a controversial test assessment on who would gain eligibility. There's something called a MAPLE assessment tool and it has different levels, in terms of the level of care that is required. Only the people with the most severe needs on the assessment tool, MAPLE 5, were eligible for the caregiver allowance. Those people tended to be people who had a lot of behavioural features of their situation, in addition to maybe mobility and some other things.
This program was a new program. It gave $400 a month to a caregiver. There was an income test - there is an income test, you had to have an income that didn't go above a certain level and so forth. Initially there was quite a lot of interest in the program. There were many people who thought they would be eligible, who didn't realize there was an income test, for example, and were very concerned. They didn't feel it was fair that there was an income test.
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Other people were caring - a very high level of care - but no aggressive or violent or difficult behaviour. So they would be a MAPLE 4 on the assessment and not a MAPLE 5, and not be able to qualify.
The program was designed for a MAPLE 5, and a certain amount of money was allocated in the budget for a small group - 750 applicants. It has been a program that isn't a year old. It was implemented in August, as a matter of fact, so we're still a bit away from the first year. Nevertheless, we have taken this program and we have embarked on a consultation around the program with a number of interested parties, such as Caregivers Nova Scotia; Dr. Janice Keefe, who holds the chair in Healthy Aging at Mount Saint Vincent, who is a very strong proponent for supports for caregivers; and a number of other organizations - the Alzheimer's organization and so forth.
So we've gone out to talk to these folks about what they think about the caregiver allowance and while people see its limitations, they like the ideas of the caregiver allowance. We're still looking at the information that we've received from various groups and crunching the numbers in terms of the information we now know around the level of interest in the province just because of the applications that we've processed, you know, even people who aren't eligible. In this year we will make some decision about this program and how this program will either conclude or be expanded, or continue on the same. I mean you essentially have two or three options.
Now, in addition to that, our Party in the provincial election made a commitment to introduce a self-managed care allowance and as well as some technical aids. I can't remember, they have a specific name, but it's kind of that medical - not medical alert, but you know the alert kinds of devices where if a senior falls at home, they've got the panic button - so these kind of programs for seniors. In the budget you will see an increase over the caregiver allowance that was allocated. In both estimate and forecast there is an increase and that increase is - the Personal Alert Assistance Program, is what it's called.
So the increase in the budget line is, I can't remember exactly how much, but I think it's about $3 million, and it reflects the commitment we made for self-managed care allowances as well as the Personal Alert Assistance Program. These programs are to be developed and as we have those developed, we will certainly be letting all honourable members in this House know about that. The line item has increased by $1.9 million.
MR. D'ENTREMONT: Thank you very much, Mr. Chairman, Madam Minister, thank you very much for those answers. I think a lot of provincial programs, when you look at them, all are based on maybe somebody else's program and it's not necessary to have to go and recreate a wheel in order to fit a niche or a requirement in our society. We always felt that when it came to the services of long-term care, there were many individuals in this province who were saving our treasury millions and millions of dollars by keeping loved ones at home.
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Any little bit that we could have provided them to help with some of the bills, some of the time required, you know, a lot of people leaving jobs and leaving certain businesses, that it was worth a few million if not more. So it was good to hear that there has been some serious consideration given to the caregiver's allowance and I can say that I would offer, you know, myself or I know the member for Richmond, who has been an advocate for this program for many years, to help out in any way we could to help make this program better for Nova Scotians. So I thank the minister for that.
I'll move on to a couple of other things. I'm wondering, and it's good that you have your deputy with you here because he was the CEO there for awhile and I'm going to ask some questions around the South Shore, and maybe where, you know, this has been a longstanding project which is, of course, the Queens General, the master plan for the South Shore. We can go on and on about a lot of the different ideas that have been floating around. So I'm just wondering maybe where the whole master plan for the South Shore is and where is the Queens project fitting within that master plan?
MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the honourable member for the question. I'm sure the honourable member for Queens would like to thank the honourable member for the question as well.
We have received the master plan from the South Shore DHA and we're reviewing it in the department. There has been a budget suggested to the board and we're waiting for a proposal from the board on that.
MR. D'ENTREMONT: Mr. Chairman, if I remember correctly, it's always funny how this one sort of worked, where you had the community group and the hospital foundation that were looking at renovations to Queens General at the time. In some places I think their eyes were larger than what they could bite or what they could chew. As a part of that, before they could make that first step, you had to look at the infrastructure that was held because we can't forget that within 20 minutes driving distance you have three hospitals, 20, 25 minutes so you've got Queens, you've got South Shore and you've got Lunenburg that are all bang, bang, bang. I believe there's also a clinic up in, not New Ross, but New Germany so there's a lot of infrastructure having to be watched out for.
Of course the challenge that you always heard - and we'll talk about dialysis a little bit but you get dialysis coming from all directions from within your caucus and from outside your caucus. Ultimately the idea was renovation and work on Queens General because it needed it and then at the same time you had the South Shore that really would like to have some dialysis work done there.
I'm just wondering if some of those plans are being incorporated in. I know the fundraising has been going on within Liverpool and the Queens area but just wondering
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maybe some more timelines, if the DHA has it and they're looking at the proposed budget, when might we hear back from them?
MS. MAUREEN MACDONALD: Mr. Chairman, our understanding is that we'll hear back from them probably within a month or so but it's really hard to say how soon we will actually hear back but in that ballpark I would think.
MR. D'ENTREMONT: Ultimately that's good to hear because this is one of those projects that has been going on for a very long time that you want to hear some kind of movement on. There have been a lot of discussions, there has been a lot of heartache, there has been a lot of work. If you're asking for a fundraising committee to be doing that work, they need to know what their target is in some cases. I think that's what has been happening in Queens and it has been happening for a long time. Not to say that the renovations to the regional hospital aren't needed. I think for some time, as anyone who has visited the emergency room there knows, it's quite small, anyone who has visited there knows that there is no dialysis, that individuals either have to make a choice whether to go to Queens or actually drive into Halifax if you're sort of from the other side of that district.
It is a challenge, I think, in many cases of having the right infrastructure in the right place and I know they deserve to have a clear mandate of what they should be doing on an infrastructure standpoint. I believe the hospital was built in 1984 or something like that. It's not an old hospital considering the age of some of the infrastructure we do have but they are at a point where they need to actually do some work.
I'm just wondering, in the master plan, does it talk to a dialysis unit at the regional hospital or is it more ER based? I'm just wondering what the proposal really brings in for infrastructure renewal.
MS. MAUREEN MACDONALD: Mr. Chairman, my understanding is that the greatest bulk of the proposal is ER based. Earlier I had a chance to talk a bit with the honourable member for Halifax Clayton Park who was asking about capital projects, and she was saying that her understanding was that there was about $2 billion in outstanding capital needs identified in the province. Sometimes I think it would be more accurate to say "capital wants" throughout the province, although there are some definite needs.
I think about the Pictou area, New Glasgow, the Aberdeen Hospital, the emergency department there is not all that dissimilar to Queens General. We face very big challenges in terms of trying to update our facilities and make sure they're of a good standard in terms of the pressures on them. I was talking about the little community hospital in Guysborough, I had a chance to tour that facility. It's a lovely little hospital, but really, you have the nursing stations built before computerization, you have terminals and keyboards that are stacked on top of areas that were built for paper filing cabinets. It's a Workers' Compensation case waiting to happen.
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When you're in places like this you can see how tremendously out of date the working environment has become for just the kinds of - stretchers, ambulances, hospital beds and other technology that now is commonplace in a modern health care facility.
MR. D'ENTREMONT: If I remember correctly, you always had two infrastructure lists in the department. You had the ones you wanted to do, and you had the ones that really needed to be done but you didn't have the money for. It was always a struggle to really find those dollars for those little things. Having the right articulating desk for your keyboard or having room to store a couple of extra stretchers is huge in a lot of these hospitals because they weren't built for that kind of usage. Even though they're only 20 or 30 years old in some cases, they really weren't built for today's environment. It always baffled me because you had really good people, good architects providing you with the best information and best designs, and yet you're out of date in 30 years. It's not just in one place, it's in many, many places amongst our 38 or 39 hospitals in the province.
I know that I'm going to be sharing my time with the member for Cumberland South, and I know he'll probably ask some questions around Springhill, the Amherst hospital, Pugwash, and those areas. I wasn't sitting here when we talked about the Truro hospital, the Colchester Regional. I remember being a part of this one and being in a meeting and being lobbied for more money. I remember saying, okay, if I find you the money, will you promise me that there will be no more? I had assurances and promises that it would not go over and above the $155 million, I think that was the number that was finally agreed upon.
The challenge was always, the government will pick up the rest. The community can only raise a certain amount. I agree with that. If a community is of a certain size and the fundraising capability within that area is a certain amount, I think the number was $25 million at the time, I'm just wondering what exactly happened to that $155 million number which was told to me - this was two years ago now - this is the maximum number, we promise you we won't go over. Here we are again, you're having to find more dollars to provide to that fund. I'm just wondering where that project is at this point?
MS. MAUREEN MACDONALD: Well, as I like to say in the department, I've never built a hospital before. I'll tell you, when I looked at the financial history of this hospital, I was, to say the least, just totally outraged, to be honest with you. This hospital has almost doubled in cost since the initial approval of Cabinet - $104,000 and an additional, I think, $56 million and now an additional $24.5 million, and the ask was for an additional $36 million or maybe $38 million.
I wish I could tell the honourable member what went on here. I cannot do that today, but I hope that before I leave this place I am able to answer that question. I don't mind telling the honourable member that I have had quite a lengthy discussion with the Auditor General about it. We're still trying to sort out the details of a very, very good review. There will be a review of this. I don't know if it will be by the Auditor General, but it will be by some auditor,
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and at the end of the day, I hope we're actually able to learn what occurred so that we can be sure that we don't repeat this in the future. We don't have this kind of dollars, and if you can't plan your health care dollars in an effective way, then we might as well all give up and go home. This is a very bad example of health care spending run amok.
The other thing I would say, and the honourable member said this, there is this kind of idea - I now call the Department of Health "the Bank of the Department of Health." There is this kind of an idea in some circles - not in every circle, but in some circles there is this view that the Department of Health has a big money tree out back and we can just cover everything and nobody has to worry about being fiscally responsible, because they can just trot down to the Department of Health and we can look under the cushions and magically find money for whatever. It is not exactly like that. There is no money tree. There aren't even any cushions for the most part - there probably should be, but there aren't any cushions.
We have to change the culture of all our partners who are providing health care. People need to know that they need to treat that money like it's their own. They need to be very vigilant, and there isn't an unlimited supply of money in the Department of Health to cover bad management practices. It is not going to happen.
MR. D'ENTREMONT: Even to the point - and I welcome a review of that project, because it is one that, if you look at it quickly, doesn't make sense. How you can take a hospital - let's say the one that was built in Amherst or just outside in Nappan, Cumberland County - which should have been the right size. That was built for $56 million. It is a beautiful hospital. You walk into it, it is a modern new hospital - $56 million. Then you have this one, okay, you can say that maybe over the construction phase, you can add another $20 million to it, let's say. Okay, well, you're at $76 million, $80 million at an outside number. It became $106 million and then it became $155 million and now you're saying it is about $25 million or $30 million more than that.
Here's what my thought is, and God bless anybody who wants to do it: we continually worry about community share. You know, when we go to build a hospital, we say we want the community to provide 25 per cent of the cost or whatever the number is, what the ratio is. Do you know what? If we had foregone the $25 million from that area and said, okay, listen, we're going to build you a $80 million hospital, but here's what you're getting, probably everything would have been fine. You would have had your hospital for $80 million and it would have been done. But no, because we expect to listen to the community and we listened to the doctors and we listened to everybody that's got an opinion on what a regional hospital needs to have, you end up having, I wouldn't call it a Taj Mahal but, one heck of a hospital. When it's finally done, this is going to be one hell of a nice hospital and it's going to have everything in it, everything you ever want, but is it what we needed? Would we be better off to say, here is the box, here's the design, go build it and the decision would be whether it needs 75 beds versus 60 beds, you just size it appropriately. In these cases, in my experience and you're going to find this too, there just seems to be no limit to the extravagance of these
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hospitals, of what they need to be when they really just need to be a square box with beds in it and good health care and a place that people can work in.
As much as I wish the community well in their new hospital, I believe maybe some of their extravagance has really put the project in jeopardy, has put it behind schedule now because we're there waiting. If I remember correctly, the original design was supposed to use natural gas as the heating and all of a sudden, well, we can't get natural gas so we're going to have to use something else and that's added to the cost of the facility. There just seems to be bad planning and whatever review that can come out of it I think would be appreciated by some previous Health Ministers as well because it just frustrated the hell out of us too. I hope you do solve it and I wish you well.
I don't know if maybe you have a comment on that, maybe have one more thing to say and then I'm going to share my time with the member for Cumberland South.
MS. MAUREEN MACDONALD: Mr. Chairman, I would anticipate that in the not-too-distant future we'll be able to say what the review will look like and, who knows, the honourable member might have an opportunity to speak with the auditor or whoever is doing the review and that would be very much appreciated as well. I mean, we really do have to learn from this. We have limited resources and we need to use them wisely and I understand when a community has aspirations for the very best for their citizens and what have you but I think that we have to be realistic about what we can afford as well.
MR. D'ENTREMONT: Mr. Chairman, that will conclude my questioning for this evening. I would like to come back maybe tomorrow, I think there's a little bit more time, and maybe talk about mental health issues. I'm just wondering if some of those projects are in place but for the time being I'll give the rest of my time to the member for Cumberland South.
MR. CHAIRMAN: The honourable member's time will expire at 9:29 p.m. The honourable member for Cumberland South.
HON. MURRAY SCOTT: Mr. Chairman, I want to begin by thanking the minister for being here this evening with her staff to answer questions around health-related - it's a very important issue, I know, for all of the members here on both sides of the House and I do, again, appreciate the opportunity to ask some questions of the minister.
I know it's not your department, minister, but I heard you just say that you hope before you left the Department of Health you'd be able to find out why a project such as the one you mentioned in Colchester was so far beyond budget. I know the government has already made a decision about this issue, but that was one of the very reasons why - if you look back at some of the projects over the last five years, there were projects that ran way over budget for all kinds of reasons. One was that there was a lot of construction in the province going on so there weren't a lot of contractors coming forward so we're kind of left to the mercy of the very
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few tenders that would actually come in, which would come in maybe a bit higher than what we had hoped.
The other thing was steel prices of course went through the roof, there were all kinds of reasons. That was one of the reasons why - and again, I know this government has already made a decision against it - we as a government were partnering with the private industry. I know there has been a lot of discussion and a lot of strong feelings around the private partnerships in the past in regard to schools. I really felt, and I know the government felt at the time - we visited B.C., the Deputy Minister of Transportation and Infrastructure Renewal and myself and some other staff and one thing we heard loud and clear in B.C., at a hospital we visited out there, which had the cancer centre for the whole Province of British Columbia under the roof of this building, was that this building was - at that time, about a year ago - due to open in May. There were two things that we heard loud and clear, it was ready to be finished on budget and on time.
[9:00 p.m.]
I have no idea, I don't know what has happened in the last year since that happened but I do know that I felt at the time, as well, that we had to look at another way of building buildings in this province other than just the traditional way and if there's some way to involve the private partnership that was good value for the taxpayer, provide a good service for, in this case it would be health services, then really it was a win-win all the way around for the people who were paying the bills and as well for government that was delivering the service.
There are probably other ways and the circumstances - I don't know what has happened here in Colchester, but certainly we all should be concerned when you see a project that is overrun by the amount that you just mentioned.
Anyway, I just want to get back for a moment, if we could, to the Self Managed Care Program. I heard the minister explain in the Fall about the MAPLE process and about MAPLE 5, I think, being the highest level. I'm wondering if the minister, since the Fall, has taken the opportunity, or if staff has, to review those who were denied through the program to see if there's any way - and if I understood you right, I think you said you're over the number now that you had actually thought at first you would accept in the program. I'm wondering about the numbers in the program now, what was anticipated at first but the other thing is, if you've had an opportunity to review some of those who have been denied, to see if there was any way to help these folks.
MS. MAUREEN MACDONALD: Mr. Chairman, just before I go to the caregiver allowance, I'd say to the honourable member that the Colchester Hospital project is being built by the private sector so in a way it is a private-public partnership. It's public dollars, private sector building and managing the hospital as all hospitals always are. The only
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difference is that at the end of the construction period, we'll own it rather than having it owned by a private proponent and of course we'll operate it.
The Caregiver Allowance Program was designed to - it was anticipated about 750 people would be eligible for this program. As of the end of March, 707 people qualified for the program, so staff in the department who crunched the numbers and made the projections weren't far off. Today I think there are about 614 people enrolled in the program and some people have gone into long-term care or have passed away and at least in one case a caregiver has passed away and so that accounts for the discrepancy between the 707 and the 614.
Our department has looked at the people who have not qualified so we have a very good breakdown in terms of how many people applied for the program, how many people were assessed for the program. Not quite a thousand people were assessed for the program,900-some-odd people were assessed, and there were a number of people who didn't qualify for the program and we know why that is. We know that X-number of cases didn't qualify for the program because they didn't meet the income test, for example, because there is a ceiling on the level of income.
So many people were ineligible, they didn't fall into that MAPLE 5 on the assessment and we know exactly how many people fell into the next level of care on the assessment tool, the MAPLE 4, and we know some of the characteristics of those people. For example, people with MS, there were a number of people who had multiple sclerosis who have very high level needs in terms of care needs but they had MS that wasn't aggressive. This is the difference, I'm told by the care coordinators, in the assessment of what would make you a Level 4 or a Level 5.
MR. SCOTT: Thank you, Madam Minister, for that. I guess you started to go into what I was going to ask. My next question was, has your department determined - you've looked at people who didn't qualify and you've done a review of why and the categories they may fit in - have you done a review or has the staff done a review in regard to, first of all are there people who qualify for long-term care but wouldn't qualify at home through the MAPLE process?
MS. MAUREEN MACDONALD: Yes, we're able to say whether or not any of these folks would qualify for long-term care placement if they didn't have a caregiver to care for them at home.
MR. SCOTT: Thank you, Madam Minister. I guess my question was, so if there were people who would qualify for long-term care but would not necessarily qualify for the Self Managed Care program through the MAPLE process, would it be cheaper to keep them at home and change the program, rather than have them go into long-term care?
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MS. MAUREEN MACDONALD: In a way, yes, that is true, but I guess the thing is that not everybody is seeking long-term care. There are people who are averse to going into long-term care. I try to explain this to people from time to time. I'll use not this situation, but I'll use another situation. I might have somebody come to me and say, Ms. Minister of Health, there's a home in our area that if you gave this home a licence and they were able to take people because they have a licence, they could take people who are in hospital beds, and think of all the money you could save by giving them a licence so that we could free up hospital beds because it is a lot cheaper - it would be a lot cheaper to have somebody in these beds than in hospital beds.
The problem with that analogy is that you don't just give a licence, you also pay for the health care costs of those beds and, at the same time, when you move people from those beds in the hospital into the cheaper beds, then other people move into the expensive beds, so you end up with the expensive beds filled and the cheaper beds filled.
In terms of the economic issues, it doesn't necessarily follow that you save money because you're implementing that policy. The same thing, in a way, is true for caregivers. I don't think that we should look at the Caregiver Allowance Program - this is my own, personal view - as a way to save the system money, it doesn't really save the system money because in most cases those families aren't going to place their family member in long-term care anyway.
We have a caregiver allowance to give those caregivers some opportunity for a bit of a respite. We give them those allowances so that they can make some small, little changes in their lives, in their routines, so that they don't become the sick person who needs hospital or health care. I think that's really the basis for which we should provide a caregiver allowance. That's my own, personal view.
MR. SCOTT: Thank you, Madam Minister, for that. I think I heard the minister say earlier to my colleague that the department is looking now at what the future of the Self Managed Care program will be, whether it will continue, change, or be stopped. I think that's what I heard you say earlier.
I had a question around Addiction Services. Addiction Services in Cumberland County, as you're probably aware, there's a very good program of addiction services being offered in Cumberland County, throughout the county. It is based between Amherst and All Saints Springhill Hospital. There is some suggestion that that service may move from Cumberland County, and I'm just wondering if the minister could elaborate on that, please.
MS. MAUREEN MACDONALD: I don't have any information here for the member right now. I'm not aware of that, but I will look into it and let the member know.
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MR. SCOTT: Thank you, Madam Minister, I would appreciate it if you could get the information for me. It could be a rumour, and I hope it is just a rumour, but I wanted to try to find out if in fact there's any substance to the discussion being held in the community.
The other - as the minister would know, I had written to the minister back in the Fall and I had also asked a question during Question Period - there had been a request for proposals put out for a long-term care facility in the western portion of Cumberland South - somewhere in between the River Hebert/Parrsboro/Advocate area. My understanding was the timelines around that RFP have been extended, I believe it was to November, I think, in the correspondence I had back at the time. I wonder, could the minister just give me an update on that RFP?
MS. MAUREEN MACDONALD: Can I go back to the addictions question for a moment?
To the honourable member - HPP, Health Promotion and Protection, also provides some resources for addiction services. So our numbers in Health aren't indicating any decrease to your DHA for addiction services but we'll have to check at HPP. (Interruption) Isn't, yes, the numbers here don't indicate in that DHA any decrease, but that doesn't mean the HPP piece. So we'll have to check - HPP will be on tomorrow in estimates as well.
With respect to the long-term care facility that the honourable member has just raised, Mr. Chairman, I don't know for certain, but the deputy and I seem to think that there has been a request for a proposal and no response. Is that possible? Is that the one the member is referring to? I don't know.
MR. SCOTT: Mr. Chairman, I was under the understanding there was at least one response to the RFP, but I think it was to close, and I don't remember the dates, Madam Minister, I think it was September or October, and I think there was an extension towards the end of November. I think in the correspondence that I received back from you was that there was an extension and that further detail would be coming later. But I do believe there was at least one response - probably from a provider and a facility owner in the county now. They probably responded to the same RFP.
MS. MAUREEN MACDONALD: Mr. Chairman, is this a nursing home in south Cumberland? Is that the area you're looking at - 22 beds, okay. So there was a closing date of the RFP on November 29, 2009, and there were respondents. The proponents that submitted responses submitted per diems that were significantly over the allowed amount and the advice that we have received from TIR procurement staff is that negotiations will commence with the lowest bidder.
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MR. SCOTT: Thank you, Madam Minister, for that. So the department would continue to negotiate with the lowest bidder to try to bring it in line, I guess, with what would be acceptable within your department for per diems - is that right?
MS. MAUREEN MACDONALD: Mr. Chairman, absolutely. We continue to have a number of small projects around the province that we are working really hard to move forward. I told the honourable member for Argyle that we're going to throw a little party in the department when we're able to close off these beds - it has been a long process and the staff have worked really hard, but we haven't given up on any of the projects and we won't give up on this project either.
Going to the points, I think, that were made by the honourable member for Argyle earlier, many of these organizations have come to the table with great energy and aspirations for new homes in their communities. Their primary concern and consideration is to build a facility that will benefit the community and will result in great care for the residents of their community. That's what motivates them and I understand that, and it has been very nice to meet some of these people who are working from one end of the province to the other on new facilities.
[9:15 p.m.]
We in the department have to support those efforts, but we have to do it within an envelope, and it has been challenging at times - sometimes projects have aspirations for their home that go beyond our ability to financially support those aspirations, shall we say? So we have to work with the community organization and ensure we get really good value for our dollar. It can be a difficult process at times, but it has, in any of the cases that I've had any involvement in - and I've met with the odd group around the province who have thought that maybe I could find a little more money under the couch to help out - I've been very impressed with how they have continued to work with the department staff, and department staff do not give up on these projects. We want these beds, because we can bring them in on budget, but it's a process.
MR. SCOTT: Thank you, Madam Minister, for that. I think you'd find - I don't know about the rest of the province and other areas, but I know my own area they're certainly looking very anxiously towards the future. They would appreciate the fact that you have a budget to work with, and whether it's per diems or capital costs, that it has to come in within budget. They would know that you work diligently to make sure that happens. They're just as concerned, as I know a lot of communities are concerned, about seeing loved ones moved to other areas of the province.
I remember one lady, her husband was actually moved to the South Shore somewhere, separating those people - as you've heard, I'm sure, many, many times. I think you would find the people in my area would be very understanding of the fact that you have a budget to
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work with, you know the per diems and so on, so I appreciate your answer and I appreciate the fact the department is still working on that facility for that area.
I want to change now to a different area - same kind of an issue, but a different area - my constituents in Advocate. I had written to the minister back in the Fall - and I haven't all the details here in front of me, or the numbers, but some time ago there was an announcement that the care centre in Advocate, originally there was going to be a bit of reallocation of space, I believe, within the facility. Then, as folks got involved, the project seemed to grow a bit and became even more than what the community had originally asked for.
What we were attempting to do at the time, or I was attempting to do - Advocate, Madam Minister, as you may or may not know, is probably 40 to 45 minutes from Parrsboro on a good day, but in the middle of winter it's a real challenge to get there in a shorter time than that - originally there was going to be some allocation of space with two additional beds. That seemed to be a small community and with the distance they are from larger communities with these types of facilities that are required, there was an agreement that the medical folks needed some additional space for different services, and there was a requirement of probably of two additional beds, which doesn't seem like a lot to many people, but in Advocate it would make a huge difference.
Somehow it grew and became an addition - anyway, at the end of the day what was agreed upon was that this community, being the small community it is, but very supportive of their school and their health care system, they agreed to raise their portion for the project; in fact as part of that agreement - in meetings that we had with the district health authority and with the Department of Health - they owned a property in the community that they actually kept for when they had a doctor living full-time in the community, they had a facility that they owned, and the local foundation agreed that they would sell this property and that would become part of their commitment.
So they have raised their portion, they have indeed sold the property, and now they have a nurse practitioner and a small building that is right on-site at the care facility. They have sold that property, they have cut their portion so the community has their commitment met and have had for quite some time now. Again, I know the project, I know we have to stay within budget and I know this project over time has kind of taken on legs of its own, that it has changed several times when really all the community was asking for from day one was two additional beds and it seems to have grown into a $1 million-plus project. Anyway, the community does have its commitment in place. They have sold the property that they owned to pay part of their commitment and now they are wondering, could you update them?
MS. MAUREEN MACDONALD: Mr. Chairman, is the honourable member referring to Bayview Memorial? Is that it?
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Bayview Memorial - I am advised that due to delays in planning and design the project could not be completed in 2009-10 and that the redevelopment of the space is expected to occur in the fiscal year of 2010-11. The estimate in 2009-10 was that this would cost $623,000, and the estimate for this year is $1.5 million. Because I see so many small homes, it is hard to keep track of them all, but if I remember correctly I saw a piece of correspondence dated June 3, 2009, to the honourable member from the deputy minister indicating that those two beds had been allocated, but I am also advised that there might not be an Order in Council approval on that yet. So that's all of the information I have and we will have to track it down and see what else I can find out.
MR. SCOTT: Mr. Chairman, to the minister, thank you. That was kind of the point I was making, that this project went from the community asking for two additional beds, a reallocation of space within the facility, and as folks got involved - and to their credit, I know they are trying to improve upon the health care delivery - the project grew from two additional beds to some reallocation of space to then becoming an expansion of the facility and it grew and grew.
But the community was asked at the time to come up with, I believe it would be a third if I understand right, which they did, so the community sold some property they had in the foundation, they raised this extra money they had sitting aside and then the project again seemed to grow, for reasons no one really seems to know - and no disrespect to anyone, I think some engineers got involved and they looked at the building and said maybe you need to do this, you should do something else, and then first thing you know it becomes a $1.5 million project.
Anyway, I know the minister was faced with some tough decisions around budgeting, and I know that this was a hospital which was changed to a care centre. I am told as the building was built a number of years ago, and the community really came on board, like all small communities do, and came up with their share long before the government was able to find theirs, and if somehow your department could take a look at this again and just let me know - really, it has actually been two or three years and, again, the community has their portion sitting there and they're wondering what the next step is and, Madam Minister, with all due respect, this number will only grow. If you don't do what the facility just actually needs and the community needs, as more people look at it the price will just continue to grow and what will happen is that pretty soon the community won't have their share any longer, and pretty soon you won't be able to afford it through your budget because you won't have the necessary dollars to do it.
So I'm just asking on behalf of the community if the department could take a realistic look - is there money in the budget this year for that and, if there is, how much?
MS. MAUREEN MACDONALD: The department is still working with the DHA to determine the best use of the space there. I believe there is some money in this year's budget
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for that particular project, $1.58 million, but as I said I'm not sure if it has had the appropriate approvals in some ways. I will look into that.
MR. SCOTT: Thank you, Madam Minister, I look forward to that. As the minister would know, because of our geographic location in proximity to New Brunswick, there are a lot of cancer patients from Cumberland County, a lot of patients in general - I understand there are people from New Brunswick who come across and come into the health care system of Nova Scotia, but there are a tremendous amount of people in Cumberland County who go to Moncton. Their doctors refer them there for cancer treatments; in fact, I've had contact with a lady just this past week over that very thing.
Two things always seem to come up - one is the cost of medications, particularly for people who are going for dialysis. It seems that if you are on dialysis in Nova Scotia and there are certain medications you need, the patient pays for them, but if you go to Moncton for dialysis, it's all provided to those patients free of charge. Free of charge to the patient - somebody's paying for it.
If you're a Nova Scotian getting service in Nova Scotia, you pay for the medications. If you're a Nova Scotian who goes to Moncton for dialysis, you get the services free of charge. A lot of patients in our area don't want to come to Halifax, they don't want to stay in the province, they want to be sent to Moncton, New Brunswick, because they're not paying for the medications. Is the minister aware of this and is there any information? I'm sure someone's paying; I'm sure it ends up being the Province of Nova Scotia, I would think.
MS. MAUREEN MACDONALD: Not only am I aware of this, but I'm aware there are differences inside Nova Scotia between DHAs. Sometimes it's said that we have ten different health care systems in Canada when you look at the provinces, and sometimes I think we have nine, plus the IWK, different health care systems inside Nova Scotia.
There's a certain amount of autonomy at the DHA level to purchase supplies and what have you. For example, I just recently learned that if you're having cataract surgery in some DHAs in Nova Scotia, you pay a different amount for the lenses they use than if you're in another DHA. It's all based on probably the DHAs ordering individually, and the bulk in which they order and so on.
This is a situation that we have because we have a certain degree of autonomy in our health care system, so that provinces, for example, can make their own decisions about what they'll cover and what they won't cover. Those decisions get made based on a wide range of opinions. Ambulance fees vary dramatically from province to province. There are people who come to Nova Scotia in the summer as visitors and they're in a situation where they require an ambulance and they get a bill from the ambulance and they go, oh my gosh, that would never happen in our province, the ambulance fees aren't anything like this. So you will find a great deal of variation from province to province.
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I can imagine that, particularly because we have all of these border issues, in your part of our province I can see that people have an attachment to the health care system in New Brunswick for example, for a whole variety of reasons - convenience, location, and probably people who work in New Brunswick use health services in Amherst and vice versa. I certainly became aware of the interconnection during H1N1 when people at the hospital in Amherst, who work in Amherst but were from New Brunswick, were getting vaccinated and some questions were raised about whether or not that was an appropriate use of our vaccine. So, you know, it's complicated when you have a border area.
One of the things that our department, our government and the Department of Health, will be attempting to do in terms of better utilization of Health dollars in the coming year - and I don't know if you were here when I had a chance to talk about this earlier - is we've learned from Prince Edward Island. Prince Edward Island has a nurse hired in New Brunswick who works to repatriate (Interruption) She's from Cumberland County? - to repatriate patients from P.E.I.
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: I move that you do now rise and report progress.
MR. CHAIRMAN: Is it agreed?
It is agreed.
The motion is carried.
[The committee adjourned at 9:31 p.m.]
