MR. CHAIRMAN: I call the Committee on Supply to order. We will be dealing with the Health Department budget estimates.
The honourable member for Dartmouth-Cole Harbour.
MR. DARRELL DEXTER: Mr. Chairman, I think when we last were here, I was talking with the minister and examining his estimates for the Department of Health. If I recall, we had spent a fair amount of time on the Seniors' Pharmacare Program. I have a few questions I would like to follow up with the minister on that program; after all, it is a very important program to seniors in this province. First of all, I will ask a very simple question of the minister. Is the minister aware of the regulations around the Seniors' Pharmacare Program?
MR. CHAIRMAN: Order, please. Do other honourable members have difficulty hearing? Should we have the volume turned up a little bit? Is it okay, honourable minister?
The honourable Minister of Health.
HON. JAMES MUIR: It is probably just as well with that honourable member questioning. I need clarification on that please.
MR. DEXTER: It is a very simple question, Mr. Chairman. I am just asking the minister, is he aware of the regulations dealing with the Pharmacare Program?
MR. MUIR: Mr. Chairman, I still need a little bit of clarification. Is he thinking of something done by law, or is he talking about the actual terms and conditions of the Seniors' Pharmacare Program?
MR. CHAIRMAN: Order, please, I wonder if we can have the volume turned up a little bit, perhaps, for greater clarification all around. It would probably assist all members of the House. I know the honourable member is placing his question as best he can, but obviously the honourable Minister of Health is having trouble . . .
AN HON. MEMBER: He can hear, he just doesn't understand.
MR. CHAIRMAN: Oh, he can hear? Okay. The honourable member for Dartmouth-Cole Harbour one more time.
MR. DEXTER: Mr. Chairman, to be specific for the minister, Seniors' Pharmacare Program regulations are made under Section 17 of the Health Services and Insurance Act. Is he aware of the regulations?
AN HON. MEMBER: Send him a copy.
MR. MUIR: . . . the regulations, but I don't have a copy with me . . .
MR. DEXTER: Mr. Chairman, it appears what he is saying is that he thinks there are some regulations, but he doesn't know what they are, which is really quite shocking when you consider that he has gone ahead and made substantial changes to the Seniors' Pharmacare Program in this province by increasing the co-pay, and given that the purpose of these regulations are to provide for these kinds of changes. Perhaps the Minister of Health can tell us whether or not he bothered to meet with the Seniors' Pharmacare Program board of directors?
MR. MUIR: Mr. Chairman, we did meet with a representative group of seniors, but we did not meet with that group this year.
MR. DEXTER: Mr. Chairman, that is certainly the case as far as I understand, and in fact, perhaps the minister would like to confirm for the House, and for everyone else here, isn't it the case that, what you did is disband the Seniors' Pharmacare Program board of directors? You sent them a letter and said, thank you very much, your services are no longer required. Isn't that correct?
MR. MUIR: Yes, it is, Mr. Chairman.
MR. DEXTER: Mr. Chairman, this is shocking because, among other things, what the regulations say is that the minister shall appoint a chairman of this board. Now what I would like to know is if he can explain the decision not to meet with the board of directors, the decision to disband them, and the decision not to appropriately change the regulations as he would be otherwise required to do?
MR. MUIR: Mr. Chairman, there were a number of vacancies on that particular board. As a matter of fact, at the time we were making the decision, I believe there was one member on that board. The intent was that that board would not be continued.
MR. DEXTER: Mr. Chairman, I understand that was the decision. I guess what I want to know is what the justification for the decision is, given this is the government that said they would be consulting with seniors? This was an open and transparent process that was put in place by the government for the express purpose of consulting with seniors. Apparently, one of the first things you did was get rid of it; all I want to know is, why?
MR. MUIR: Mr. Chairman, to be quite frank, as the honourable members across well know, a decision was made by government to move the Senior Citizens' Secretariat from the Department of Community Services over to the Department of Health; in other words we were trying to concentrate the services for seniors. Given the fact that the Senior Citizens' Secretariat is basically an arm's-length agency, with respect to my department, it represents a large number of representative seniors' groups. We felt it would be just as efficient and probably a little bit less costly for government to work through groups of representative seniors who are attached to that Senior Citizens' Secretariat rather than continue with that other agency.
MR. DEXTER: Mr. Chairman, I have to say I am incredulous by that response, because the reality is that the board of directors received no payment, they were a volunteer board. The only thing the government had to pay for was to reimburse them for some travelling expenses. Maybe, since that is the rationale for this kind of a cut, the minister can explain to the House just exactly how much in his budget he is going to save by cutting the board of directors of the Seniors' Pharmacare Program?
MR. MUIR: Mr. Chairman, this government is committing to a smaller and more efficient government. I suppose that information could be generated if we go back through their expenses. I don't think there is a particular line item in the budget which distinguishes between what they spent last year and what they spent this year.
MR. DEXTER: That is not an answer, Mr. Chairman. The minister has offered to us as an explanation for why it is that he is cutting this program, that the reason apparently is for smaller government and it is going to be less costly for them and, if that is indeed the answer that he wants us to accept, then I think it is incumbent on him to at least provide us, and to at least show us that that is the what the real consideration was, by telling us how much his
department is going to save by getting rid of the board of directors of the Seniors' Pharmacare Program. I will ask him one more time, and if he does not have it, will he undertake to get that information because I would like to know. If that is the rationale, I would really like to know how much he is going to save. I don't believe it.
MR. MUIR: Mr. Chairman, we can get that information, but I think it is obvious that we have taken over responsibility for seniors' programs in the Department of Health. It makes good sense to use the services that we have. For example, there are about 60 seniors' councils that are representative, that have some input into the Senior Citizens' Secretariat, including a group of nine seniors groups with whom we have consulted.
MR. DEXTER: Mr. Chairman, what we were talking about was the board of directors of the Seniors' Pharmacare Program. The reality is that this was a board that was set up specifically to deal with this particular item; it was set up to deal with this particular program. One would expect that after a period of time, having dealt with the departmental information, these people would have something specific to offer on the particular program. It was set up to provide advice to the minister on the Pharmacare Program. So it appears that the minister has disregarded the regulations and done away with the board without so much as an announcement of any kind and, I have to say this, I am quite amazed that the minister would do that and still try to tell people that he is consulting with seniors on this program because, clearly, that is not the case. In fact, what he has done is done away with the mechanism for consultation. It is hard to believe.
I would like to tell the minister just a little bit about what is actually happening with the Pharmacare Program out there, Mr. Chairman. I know in many cases people look at the amount that is paid and they say, oh, there is a 20 per cent co-pay and there is such an amount of premium, but what they should really be looking at is how much of the actual drug costs that covers for a particular senior. I know in the example that was given to me, the individual pays, between the premium and the co-pay, 48 per cent of their prescription costs between the two and, when you add them together as a couple, he and his wife pay 76 per cent of the cost of the medication that they use in their family.
What is happening is the actual out-of-pocket costs to seniors are now, in some cases, eating up three-quarters of the prescription costs. So you have gone from zero back when the program was introduced and, every year, or practically every year the amount out of the total that is paid for drug costs continues to go further and further up. It places a much larger burden on the seniors of this province and I have to tell you, Mr. Chairman, I think it is a regrettable situation and we know what the results of it are going to be.
I would like to move on with the minister. I have some questions that I want to talk to him about within the specific lines of his budget. I want to start with the office of the minister and the office of the deputy minister. I note that the office of the deputy minister has gone to $357,000 - is that right, did I read that right? - or that would be $3,575,000. What
I want to know is, given that $180,000 is being paid to Dr. Ward, I wonder, could you tell me what it is in there that has been taken out in order to have that figure come down?
MR. MUIR: Part of it, Mr. Chairman, was for the past couple of years the department had paid for two deputies. The other thing, the position of Physician Adviser, which was attached to the deputy minister's office, we contract for those services should we need them.
MR. DEXTER: Fair enough. I wonder if the minister could tell us, if they are contracted then, do they move over into another line item and, if so, where?
MR. MUIR: No, Mr. Chairman, it has not been moved. The cost would stay in that line.
MR. DEXTER: I wonder if the minister could explain to us the Strategic Direction and Project Coordination line, which is $339,000 and what it is that is going to be done and what projects are going to be coordinated?
MR. MUIR: That, Mr. Chairman, is basically a realignment, but among the projects that the honourable member for Dartmouth-Cole Harbour might be most interested in would be all federal-provincial agreements would be in that line item as well.
MR. DEXTER: I think I heard him say that the Nurse Policy Adviser was also contained in that line item. Are there administrative jobs in that as well, secretarial, those sorts of administrative costs, rolled into that line as well?
MR. MUIR: Mr. Chairman, there are four staff, four FTEs.
MR. DEXTER: I was wondering because, of course, the next line is the Advisory Services, perhaps you could tell us, if the Nurse Policy Adviser is in the Strategic Direction and Project Coordination line, who is in the Advisory Services line?
MR. MUIR: Mr. Chairman, I have been advised - and I apologize to the honourable member - that the Nurse Policy Adviser is in this line, not in the previous one as I had indicated to you and it involves the operational expenses basically of that position.
MR. DEXTER: That makes more sense to me, but then I have to go back to the Strategic Direction and Project Coordination line. There are four FTEs there. You said that it was the coordination of, I believe you said, intergovernmental negotiation. I would like a little more detail on that if you don't mind. Exactly what is it that we expect to accomplish out of this $339,000?
MR. MUIR: Mr. Chairman, looking at that, there are four positions: one is the Executive Director of Health Services and, among other things, he would be a coordinating director for the operations within the department, calling staff meetings and other things like that; the Director of Policy Development, who does a good deal of the intergovernmental affairs work, I suppose, if you are looking for an IGA person in our department, that position would be it; and the fourth person is called the Director of Nutrition, who also does a variety of projects, but also does some intergovernmental affairs work, including when we had the first annual meeting of the Health Ministers last fall, she was among those who provided input to that.
MR. DEXTER: In addition, you have a deputy minister, you have an assistant deputy minister, you have an associate deputy minister, and you have four people in Strategic Direction and Project Coordination, all who seem to be paid for very similar tasks, very similar jobs. I wonder if you could tell us, first of all, who is your assistant deputy minister? I am going to take this one step at a time.
MR. MUIR: It is Bill Lahey.
MR. DEXTER: Would Mr. Lahey's salary not normally appear in the Public Accounts?
MR. MUIR: Are you indicating that it is not there?
MR. DEXTER: It may be somewhere else, it is not covered in the Department of Health. Would it be covered by another department, for last year?
MR. MUIR: We can provide that number. Apparently he was attached to the Department of Human Resources and did transfer to the Department of Health. I have only known him as a member of the Department of Health.
MR. DEXTER: That is why I ask. I only knew him as a member of the Department of Health as well. I wonder if you could just tell us how much he will be paid this year?
MR. MUIR: The projection is approximately $95,000.
MR. DEXTER: Has an associate deputy minister been hired yet?
MR. MUIR: No.
MR. DEXTER: I wonder, could you indicate when you expect to fill that position and what the salary level will be?
MR. MUIR: The competition is still ongoing, and the range of salary - I am kind of going by memory because I am not part of the process - runs somewhere between $80,000 and $120,000, or something like that.
MR. DEXTER: So it is possible that the Associate Deputy Minister of Health will be paid more than deputy ministers in other departments, is that possible?
MR. MUIR: Was your question, was Mr. Lahey paid by some other department? I wouldn't really object, but . . .
MR. CHAIRMAN: Would the honourable member please repeat his question?
MR. DEXTER: Mr. Chairman, the minister has skipped back a few questions. I had asked earlier on whether or not Mr. Lahey's salary appeared in the Public Accounts under the Department of Health, because I was unable to locate it. (Interruptions) The one that I have is the one that was forwarded to us with the other budget documents. So far as I can see, he doesn't appear in the Department of Health. His travel appears there but his salary doesn't appear. I couldn't find it, but if I am wrong, well, then . . .
AN HON. MEMBER: Page 90.
MR. DEXTER: Anyway, I won't take the time to do that now. That was my question at that time.
My question this time. I had asked the minister what the salary of the associate deputy minister was going to be and when he was going to be hired. The answer that I received was that the hiring process was still underway and that he was going to be paid somewhere in the vicinity of between $80,000 and $120,000. My follow-up question to that response was, is it possible that the Associate Deputy Minister of Health will actually be paid more than deputy ministers in other departments? That was the question, where it came off the rails.
MR. MUIR: I don't know exactly how much deputy ministers make, so it would be on a case-by-case basis. I only know the salaries of two of them - one was ours, and one was the Deputy Minister of Education appointed not that long ago. I don't know.
MR. DEXTER: Mr. Chairman, the next line items that I want to talk to the minister about are with respect to the Sector Support Services, the Finance Health Services and, it says, Finance Programs. The Finance Health Services line item has actually increased, and I wanted to know what accounted for that and the subsequent decrease in the Finance Programs line item.
MR. MUIR: That reflects a restructuring of the department.
MR. DEXTER: That may be, but what I want to know is what is included in the line item now that wasn't included before. If there is some fundamental structural change, what is included now that wasn't included before?
MR. MUIR: Mr. Chairman, it would be helpful for me, when I am trying to answer these, if the honourable member could give me specifics so that I can match them up with what you are looking at.
The answer to that is that it is moving in staff from other parts of the department. The actual overall budget for that area has gone down rather than increasing.
MR. CHAIRMAN: The honourable member for Dartmouth-Cole Harbour, could you be more specific?
MR. DEXTER: The problem with that is all I get are the documents that I have here, and they are only as specific as what is provided by the department. I can only refer to the line items that I have, and the minister has to supply any additional information. I wanted to ask a couple of questions about Acute Care. I am on Page 13.9. First of all, if the minister could do the simplest thing for me, could he just explain exactly what he means by Acute Care?
MR. MUIR: In general, Mr. Chairman, it refers to hospital-based services, but it doesn't include public health nor drug dependency.
MR. DEXTER: Thank you, Mr. Chairman, and to the minister. I want to ask this particular question about that. I know the department is undertaking a number of different kinds of programs and they had instituted different kinds of user fees, and there is a suggestion that is circulating out there that one of the things that is going to happen is that where hospitals have beds that are being used for long-term care, and there are no positions for them outside the hospital in long-term care, that the hospital is going to start to charge a daily fee for the bed being used as a long-term care bed. Can the minister tell us if that is, in fact, the case?
MR. MUIR: Mr. Chairman, that was a suggestion from the Association of Health Organizations, to consider that. There has been no decision made on it, but I just think perhaps a little clarification might be in order. What it is, occasionally there are people who are in acute-care facilities of the hospitals who basically refuse to move when there is a space for them, or that for one reason or another, basically by personal choice, they end up staying. If that was the case, they were in a nursing home and they are able to be a private pay patient - this is not talking about people who would be supported by our department if they were in the nursing home - there was a suggestion that might be an additional source of revenue, but nothing has been done on it yet.
MR. DEXTER. Mr. Chairman, the test on whether or not anything has been done on it is to ask the question as to whether or not there has been an allowance made for revenue generated from that source. Can the minister tell us whether or not there has been any allowance made for revenue from that source?
MR. MUIR: In the figure entitled Volume Savings there were a number of things thrown in that, but they weren't particularly broken down as to (a) we will give you x number of dollars; or (b) we will give you x number of dollars. That was sort of an estimate as I guess you can see, and it was proposed primarily by the Association of Health Organizations as opposed to ours.
MR. DEXTER: Mr. Chairman, I think the minister just told me that they did make an allowance for recoveries. Can he point specifically to which line item it is?
MR. MUIR: If the honourable member would just be patient for a minute, we will find that. I thought you had the same detail that I do.
MR. CHAIRMAN: The honourable member for Dartmouth-Cole Harbour is down to the last few seconds.
MR. DEXTER: I just wanted to know which particular line item the recovery is that the minister is pointing to.
MR. MUIR: Page 13.15. Just hang on, I will have it for you. It is incorporated into the Net Program Expenses, Acute Care. The estimates there, $741,197.
MR. CHAIRMAN: The honourable member for Dartmouth East.
DR. JAMES SMITH: Thank you, Mr. Chairman, for the opportunity to join estimates again, following Friday's interventions. I had some time the last few days to think about the budget and what sort of a budget it is, and I still haven't come up with a name. I did on Friday come up with a name for the Minister of Health, I called him Dr. Feelgood, making everybody feel good, but I am still quite puzzled in following some of this. Then, of course, the Premier's comments about the role of the Opposition is to ferret out the information made it all clear to me from that aspect of it as to how there is a lot here that is really not evident and will take some ferreting out.
I thank the honourable member for Dartmouth-Cole Harbour for mentioning going through line by line on some of the administration, because we were told this is where the money was going to come from to fix health care. Yet we see the assistant deputies - or I don't know the exact term that was being used - the assistant assistant deputy, making as much as the other deputy ministers. Now you can argue that within the Civil Service. I know we are losing good people out of the Civil Service. I would like to see these things addressed
across the board. If the government is going to increase the salaries of professional administrators, address this across the board and not pit one department against another. So I thank the honourable member for Dartmouth-Cole Harbour for doing that.
I did want to just mention the board of directors of Pharmacare and just to be clear, they have been advised that their services are no longer required. I know you said there is only one person currently, but they don't necessarily drop off the board. I forget exactly how those rules are, but we know how this government sliced and dismantled the regional health boards without notice, a fact that these people have been advised that they are no longer members of the board. Is the minister bringing forth change of regulations and has this been done to meet the legislative requirements on dismantling this board of directors, the advisory board on the Pharmacare Program? I am not quite clear.
Has the minister again struck in the dark of night and dismantled a community board? We don't buy this, on this side of the House, that it is a great step forward that the Senior Citizens' Secretariat has come into the Department of Health and so now there is no need of that. I think the selection process is different. We have Human Resources here, an all-Party committee, that the minister has obligation to, in most cases, vet these people through, so we are disbanding, the whole British parliamentary system is being sidestepped here. Has the minister dismantled this committee in total? Has he advised the people that he was going to do that and, if so, has he complied, as is his understanding, with the regulations and the legislative requirements governing this committee?
MR. MUIR: There were a number of questions, Mr. Chairman, and I will try to remember them and try to answer them. First of all, I believe the honourable member for Dartmouth East, his first question was, has the board been disbanded? I have written to the members thanking them for their service. The short answer to that is yes; however I should also remind the honourable member for Dartmouth East that at the time I wrote those letters, there was only one person, the board was a board of one at that time because the terms of the other had expired. So when the decision was made as part of, I guess, really the program review, with the seniors moving over to the Department of Health, there was another way we could get appropriate advice. We did that.
The third question is, did I violate the regulation? The answer is no, because the regulation concerning that particular board - and, by the way, Mr. Chairman, I don't want to, in any way, leave the impression that they did not perform a valuable service - is that they were in a position that they could advise and make recommendations, but on the other hand there was nothing in the regulation that required the minister to consult that board.
DR. SMITH: Mr. Chairman, they were vocal on many issues and on an integral part of their premium review, as well. They had members there on that review of the resolution that came out of the House, I think, or the Leader of the Third Party, at that time, of the
Progressive Conservative Party's resolution that was looked at to do away with premiums, and they played an active role in that.
I would say to the minister, is that not the same position that the Group of Nine or whatever the group is, isn't the onus on the minister to consult with them? It looks like he is saying he is going to bring in a new group and that he will be consulting. What is the legislative necessity for the minister to consult with that group and take their advice?
MR. MUIR: Mr. Chairman, that is a representative of groups that represent nine seniors organizations and the Senior Citizen's Secretariat and the honourable member would know that because he, indeed, did meet with the Group of Nine. He meets with that group on somewhat of a regular basis to get their input and to discuss issues of concern with them. I approached them and asked them, when we met with them, as we were in the process of determining the conditions for senior's Pharmacare, this year, if they would provide other advice to us about senior's Pharmacare premiums for the upcoming years and the answer was yes. We will work with them.
DR. SMITH: So the answer is, no. The minister is not really required to consult with them and they really have no official standing relative to Pharmacare. So we shall see then. If that is open consultation and representative, if that is a move in the right direction, so be it. That shall be judged later.
One thing that there has been a bit about in the media, and I just wanted to return to the Budget Address, as well, with the graph on the Budget Address on Page 4 and the debt charges, as a percentage of revenues in Nova Scotia, being the highest. Now I remember, in particular, around the 1998 election, the NDP did a lot on how the per capita in Nova Scotia was some of the lowest. There has been some media lately on that, as well. I noticed that when it first came out and I didn't really think it to be true. I didn't do anything further. I didn't follow that up myself, but then my attention was caught by the media. Is it the understanding of the minister that per capita, or are those weasel words or ferret words, should I say, as to relative, because we are certainly not the leading per capita province putting money into the health system.
The other Party would know that. They had a press conference in front of the VG Hospital in the 1998 election, I think, and they were really chewing us out pretty good. I must say, I took my lumps that day and tried to do it as good as I could. But, certainly, we were low on the totem pole. I think we are a little better now than we were, but we are certainly not number one. So what weasel words? What is the true picture? Is it revenues or is it based on something else? What has your staff told you about that recent media stuff on the Canadian Health Institute, I think it is? Is it CHIP or something or whatever? I forget the exact acronym for it, but it is one of those groups. Why would you put that in the budget? Why would you be part of a government that would have that misrepresentation in the Budget
Address. The Minister of Finance, he can get up and say this sort of thing but, surely, the Minister of Health has more interest than that?
MR. MUIR: Mr. Chairman, the honourable member for Dartmouth East may have been ferreting out information, but he should have had a bloodhound to get on the correct track. The information to which he refers in the budget talks about debt charges as a percentage of revenues. It is not referring to Health.
DR. SMITH: I think he is right. I apologize to the minister. There is another area. I just leafed through this this afternoon and you are right. That is debt charges, percentage of revenues. There is another part. Anyway, this government has said, there is somewhere there and I apologize for using the wrong graph. I just grabbed it. The amount per capita going into health care is the highest in the country. Would the minister stand behind that?
MR. MUIR: I know what the honourable member is referring to. We issued a statement, which we stand behind, and then there was another bit of information that came out. I am told that the information that we received, upon which we made that statement, was the most up-to-date information. It had to do with a fiscal year and a calender year and however you wish to spin it out, Mr. Chairman, Nova Scotia is spending a tremendous amount on a per capita basis on Health and the information that we have is that we are number one in Canada, although the difference between us and Newfoundland would be marginal.
DR. SMITH: I wonder if the minister would agree, before the estimates are over, to table how they came to that conclusion. I would be interested in following it, because I haven't been able to follow that. If you would make that commitment to table that supporting evidence on that.
MR. MUIR: Yes, we have that, Mr. Chairman. As a matter of fact, if I was to stop and dig deep enough, I might even find that I had it with me. But I will defer to staff to give you clean copies or something.
DR. SMITH: We will keep that on our list and if the minister wants to get out for the Spring recess from his budget, then that will be forthcoming, I am sure. The previous speaker or questioner, with his interventions, mentioned about the acute care hospitals. That is the part, I guess, that I meant that I was really having problems with following through the budget with the information that we have been provided. The acute care hospitals, facilities, are being decreased, their budgets. We are getting a lot of this, but it is Y2K. It is not as bad as it looks. I have been trying to sort of sort this out and how this is being used here. I am just not that clear on how that is running. If the figure, in fact, is elevated more than what is actually spent on Y2K, that would mean that, eventually, the cuts will be deeper. We get a lot of this, oh, well, it is just Y2K. I am still not clear because I know, initially, the figures were very high and for obvious reasons, with the facilities having them high. Now it seems
to be to the advantage of the department to be saying that the Y2K is higher and that it makes the cuts look less deep.
So maybe the minister could just be more definite as to how he sees the total Y2K budget and if he will stand by that, that he feels that that is legitimate Y2K costs and what that total cost is?
MR. MUIR: Mr. Chairman, the overall estimate last year for Y2K costs was $40 million. In the acute care section, it was around $32 million and the change in the Estimates Book actually reflects a change of $31.3 million, which simply allows for some odds and ends that have to be cleaned up.
DR. SMITH: So does the minister feel that is solid figure that is going to stand the test of scrutiny over these next few months and that it is an accurate figure?
MR. MUIR: I have been advised, Mr. Chairman, that we believe that that figure that we have allocated might be a bit liberal, but it is not way out. It is - we could be right on it, we could be a touch under, we could be a touch over.
DR. SMITH: We will try to keep an eye on that because that seems to be part of the budget that is causing some fog here. I am not quite clear as to how it may eventually spin out. We did speak earlier on the acute care hospitals and the role of the hospitals and I have some specific questions about various institutions. I had mentioned Dartmouth General Hospital on Friday and I wanted to go back to that. Does the minister see the role of that hospital to be an absolute acute care hospital and not moving to some sort of a transition care or a long-term care or chronic care, restorative care - I am trying to use the ferret, weasel words here - is the role of the hospital continuing? He might say, well, that it the capital health authority's jurisdiction but major decisions like that I hope would have the input of the minister. Does he see the role of the Dartmouth General Hospital in any way whatsoever changing, the acute community care hospital?
MR. MUIR: Mr. Chairman, to the honourable member for Dartmouth East, I know that the Dartmouth General occupies a very special place in his heart. I can tell him that if we thought there was going to be a whole lot of change in the role of the Dartmouth General Hospital, we would not be committing significant dollars for the expansion of the Emergency Department this year.
The other thing is, as the honourable member knows, a clinical services footprint is being developed and exactly like every other hospital in the province, it would be premature to make statements while that study is in progress.
DR. SMITH: The answer sounds positive on the surface but it worries me a great deal that there are still the reviews. Sooner or later the government will have to fish or cut bait. I can see the Emergency Department and X-Ray Department being expanded, the equipment is old and it is breaking down and they need more room. It is one of the busier Emergency Departments in metro. There are concerns about the Emergency Department closing down so it is good to hear - I take that to be a commitment that that will stay open, I would hope pending a review of the role of the hospital. There is real concern in that area. These stories do have a way of growing and coming up and down the pipeline but there is real concern that there will be a movement within the programs of that hospital to change to a transition or a restorative type of patient care. I hope that the commitment is there to maintain that hospital in that role, in fact, to improve the services in that particular area.
Would the minister like to comment on the role of the Nova Scotia Hospital? Do you see that continuing as a free-standing institution and under whose jurisdiction? Would that be within the central region or where is the governance for that institution going and will it remain as a free-standing institution or will that be dismantled?
MR. MUIR: Mr. Chairman, the Nova Scotia Hospital, under the legislation of Bill No. 34, will be incorporated into the capital health authority and the board of the capital health authority will become the board of the Nova Scotia Hospital, as it will for the Queen Elizabeth II Health Sciences Centre.
As the honourable member knows as well, we currently have a mental health review ongoing that will soon be completed. He is asking for the specific role and the future directions of the Nova Scotia Hospital, whether it is going to be a free-standing institution or he is looking in the future and, quite frankly, with some of these studies ongoing, the clinical services footprint, the mental health review and whatnot, I cannot be more specific. However, I will say, Mr. Chairman, and he may wish to sniff out some more details in this, we have made a change in Bill No. 34 which does reflect the Nova Scotia Hospital.
DR. SMITH: Yes, and I am glad that the department and the minister did respond to that because our concerns for that bill were real, that a bill would come forward with so little consideration given to people, particularly the people at the Nova Scotia Hospital. I don't know what was in people's minds that brought that forward at that time, a bill that would just let people flounder out there without any guarantee of any benefits and insurability of those rights that are normally associated with that type of change. So whether it was a hurried bill that got lost in the shuffle, but certainly it was a shallow bill on that issue. Now, of course, the amendments are speaking to that.
With long-term care in general, just in a general issue, and the lack of any new money going in, I was not quite clear about the difference between renovations or renovating acute care facilities following the facilities review. Does the minister see additional acute care beds in the next 12 months being started and being built, other than - and I don't mean just converting current beds.
MR. MUIR: There is both a yes and a no answer to that, Mr. Chairman. First of all, as you know, we are proceeding with the new facility for Cumberland County, the Highland View facility or whatever it will be named, and that would imply new beds. Do we have plans beyond that? I think if his answer is to increase the number of beds, the answer is we don't have those plans right now. If he is talking about adding on to existing facilities to put new beds in them, we don't have those plans right now.
DR. SMITH: So the areas like the Glace Bay area and those communities, there are no plans to put new, long-term care beds in there and any renovations on line for that - Seaview, I think, or some such name, I am trying to remember it (Interruption) This is what I was referring to, long-term care. The budget doesn't really provide it so if there are going to be new beds, how would they be paid for? My first question is, will Nova Scotians see new, long-term care beds being started in this current year's budget?
MR. MUIR: Two things, Mr. Chairman; we have a capital infrastructure committee that is looking at how to fund new, long-term care beds. Secondly, we are doing this clinical services footprint, which may have some impact on various facilities around the province. Thirdly, we are moving towards the single-access system and, as the honourable member knows, where that has been implemented fully, it has dramatically decreased the demand for additional long-term care beds.
DR. SMITH: So it doesn't sound like there are going to be any new long-term care beds provided in this current year's budget. I was going down the list in just a general way, in the Supplement to the Public Accounts, at Page 13.4 and primary care remains there as well. I realize the four pilot projects are moving slowly but the minister's understanding of the evaluation of payment schedules for physicians within that primary care model, what is being looked at there is a real test to evaluate, to build a system of rostering or capitation or salary and how the salaried positions would be evaluated. Can the minister be specific on that, and is he happy that this issue of alternate funding for physicians, is that model being used? Will it be evaluated within the primary care models?
MR. MUIR: The physicians in those primary care projects are on salary, Mr. Chairman. Some of the money for those projects, of course, is being generated from the federal government. But, in response to the question which the honourable member asked, the primary care projects have a very extensive evaluation component built in. If these projects go the way we hope, then we will have some data upon which to answer those questions that the honourable member has posed.
DR. SMITH: I accept that for now. I guess the whole issue of looking at the Health budget along with the Education budget, the two together, really the issue of opposition when you hold a government accountable, is really scary. It is really frightening to me, the impact on the Health and the Education budgets together. I say this because in the last few days, I have heard of two physicians who are looking at coming into this province, both specialists I believe, and they now have second thoughts, because, number one, of what is happening around the budget. Maybe they are looking at the deficit and all the other issues but they are also looking at moving their families here. So we have been able, in this last year or so, to bring some order and a plan forward for the health care system. The minister, himself, got up and proudly announced one day that there would be a full component of oncologists. I would like to thank people like Dr. Dan Reid and others who were very instrumental in doing alternative funding and bringing some order to a system that involves orderly and fair payment of clinical practice, research and also health care education. Those three components are so important.
What disturbs me, even in the last few days, I have heard two physicians, one in the Cape Breton area and one in the Halifax area who have either said no or I am looking elsewhere. We are in a global market for physicians. We all know that. What does the minister see when these people say, well, I would like to come? The people of Nova Scotia are fine people. You have a very beautiful province, and the Acadians, as the Minister of Finance knows, are a part of that. I always say some of my favourite patients were Acadian people, so I know it has touched a spot. But, that is no longer enough when we are dismantling a health care system and we are dismantling the education system. These people are in Calgary and Toronto and Vancouver, and looking at Nova Scotia and saying, well, look, we just got things settled down. They went through dramatic changes. They have had reports that say leave the system alone, improve it, but don't dismantle it. Now this word is travelling coast to coast. The word is out again, to those health professionals, nurses and doctors that Nova Scotia is off the list again. That is really disturbing.
The minister announced as I mentioned earlier that they now have a full complement of oncologists. We did that through alternate funding and recruitment. People have come from the United States and Canada and now we outbid, because of the matters I mentioned, having a worthwhile remuneration for physicians so they can do clinical practice, research and education and a nice mix of that in complement with the university and health facilities. Now the word is out across this country, and I believe it to be true, that it is all changing, the whole thing is dismantling again. We are looking at job losses of probably 1,000 people within the health care system. How can you take that number out? So, what does the minister say around the Cabinet when his government is kicking the heck out of education? These professional people are not going to bring their children into this province and depend on the public school system. That is the one they grew up in, generally; largely, that is where they want to stay.
Does the minister have any letters arriving on his desk yet to this effect? What will he tell them when they say, we are not coming to Nova Scotia, they are dismantling the health care system? Not only that, even more importantly, in a lot of their lives, they are dismantling the education system. There is a direct linkage between those two, and we know that. What does the minister tell his colleagues when that sort of letter arrives on his desk?
MR. MUIR: Mr. Chairman, the only comments that I have heard in reference to physicians not wishing to locate in Nova Scotia have come from him. To my knowledge, certainly we have not received that in the department. Notwithstanding, the member mentioned we are in a global market for health care professionals, whether it is nurses, physicians, radiation technologists, or whatever it is. We are competing with everybody else. I think the illustration of the oncologists, the full complement of them and the fact that we will have a full complement this fall indicates that Nova Scotia is a pretty desirable place to work.
If people don't come to Nova Scotia, Mr. Chairman, I think it is probably a reasonable statement to say that it is not because we don't pay pretty well. Our salary scale for physicians, as the honourable member knows well, is among the very best in Canada. We have an excellent university system here which helps with recruitment as well. I certainly have never heard what he is alluding to being mentioned. We have our recruiting difficulties as have New Brunswick, Ontario, Alberta, New York State, New Mexico, Texas, Los Angeles and everybody else. We are doing that, but I think in general, we recruit about as successfully as any province in Canada.
DR. SMITH: Yes, we have, Mr. Chairman, and that is my point. At the very time we were competing for oncologists, they were short of 45 oncologists in southwestern Ontario alone. So, yes, we have done very well. I don't want to be the bearer of bad news, but the minister heard it first here today. If he hasn't heard it, he will be hearing it. It is coming out of Cape Breton and locally here. These are professional people. It is interesting. It may not be the health care environment that is really going to keep those people away. It may well be the education environment, because these people are not going to come into a province with the type of uproar and dismantling of a system that we are seeing.
We are not talking about recruitment only. We are talking about retention. We have many fine physicians in this province that could go anywhere globally, and they stayed here because they like Nova Scotia. There will be a day when that may well change again. I just say that because I think we were making good progress here in Nova Scotia. The statistics would bear us out. I don't mind the honourable member getting the credit for it. He stands up and announces all these oncologists, but just give Dan Reid a little credit some day for that. I know he is not with you any longer, and it is unfortunate.
I did want to look at some of the acute care areas, though. The Eastern Regional Health Board and the acute care budget has been cut from $41.5 million to $38.5 million. I know about the Y2K, but other than the Y2K, where do we see this coming out of the
budget? What is the department saying they will be able to do in this region that will cut over $2.9 million while at the same time reorganizing within the health authorities. Where does the Eastern Regional Health Board find that kind of money?
MR. MUIR: The decrease is about 2.2 per cent, Mr. Chairman, and we would expect the Eastern Regional Health Board to find those savings the same as we are requesting people in the other jurisdictions to find those savings in volume and price, consistency adjustments, in capital changes, drug dependency, public health and administration.
DR. SMITH: Does the minister see any changing of role of hospitals within the eastern regional, downgraded to clinics, or closed? For instance, what about the St. Mary's Memorial Hospital in Sherbrooke? Does he see that changing its role?
MR. MUIR: Mr. Chairman, we have a clinical services footprint which will be established and the determination of services to be offered in the province and where they are to be offered will be considered after we receive that report.
DR. SMITH: The new hospital at Neils Harbour, a very fine facility, telehealth throughout all these hospitals, the Strait-Richmond Hospital in Port Hawkesbury. The Sacred Heart Hospital in Cheticamp, Inverness Consolidated Memorial Hospital, Eastern Memorial Hospital in Canso, Victoria County Memorial Hospital in Baddeck, we don't know yet what that report will have for these hospitals. Would the minister be prepared to assure the people that none of these will be closed or that they will not be downgraded by the new health authorities which really are under the direct control of the minister? The minister will have more control maybe than even now. Will he make the commitment that they will not be closed and that they will remain as hospitals and not as clinics?
MR. MUIR: Mr. Chairman, we have no intention of closing any of those facilities. Again, I repeat that we are embarking on a process to take a look at clinical services right across the province and all of those facilities that he has mentioned would be included in that review as are the QE II, the Dartmouth General, the Nova Scotia Hospital, the hospital in my constituency and the ones in Amherst, Bridgewater, Yarmouth, Kentville, all of those, and he is asking me for a commitment that I really cannot make at this time. The other thing I can assure him though, as we have said last week, when there are major changes in clinical delivery by the district health authorities, as a department we will review those.
DR. SMITH: Mr. Chairman, he mentioned Highland View, the new hospital in Amherst, is that moving along on track? What is the exact stage that we are at now and have there been any further changes in the role of that hospital or the commitment to what that hospital will look like in that community?
MR. MUIR: There has been a recommendation on that hospital and, as the honourable member knows, the original proposal there was probably one which exceeded the requirements in that facility. As the Auditor General pointed out, when they began the planning for that - and I do believe he may have been involved in the Department of Health when that was going on - it was done without guidelines. What we did was we took a look, in our opinion, at the needs and also the ability of the province to provide the services and there will be a facility. We are going ahead with a new facility up there which will meet the needs of the residents of Cumberland County and it will also be one which we can afford.
DR. SMITH: So certainly the minister is leaving the off-ramps open and the exit hatches just tightly there, yes, because I would not say the people in that area don't trust the minister, but the fact that he happens to live in Truro is an added concern to them. Mr. Minister, what about the Cobequid Multi-Service Centre? Are those plans going forward, what stage are they at and is there a possibility that it will even be upgraded to give them a facility perhaps?
MR. MUIR: There is money allocated this year for the upgrading of the Cobequid Multi-Service Centre. Basically this year we see as a year for intensive planning and it is our hope that construction will begin in 2000 and 2001. I just want to say something about that facility. It is, to me, pretty impressive, the volume of people they put through there and they are able to use the neighbouring acute care beds in Halifax and in Dartmouth to deliver their services, but they do a very high volume of work and it is also sort of a community-based model. As you know, they have social workers, psychologists and everybody else on that site and it is in some ways a good example of a lot of primary services being delivered in a single thing. Also it is an integration of primary and ambulatory care patients.
We have to get to the idea of keeping people out of the acute care facilities, out of the hospital beds. That is what we have to strive for, Mr. Chairman. We cannot afford to be putting people in the hospital all the time. We have to figure out a better way to deliver services and one that will keep them out of the hospital. The Cobequid Multi-Service Centre, I think, is pretty impressive for people who have gone to visit it, what they do there, the volumes they can put through and the cost that it is.
DR. SMITH: I do agree with the minister, that is a very, truly grass-roots clinic and I think it is really complimentary to the area that they have done such a great job there on that facility. Not too far from that particular area is the Environmental Health Centre and the review that is set, is the minister committed to keeping this centre open? It opened its doors in 1997. There is a review. I know that people wanted a review for different reasons. Does the minister think it is a good idea to keep this open? Some people are saying this is a review to make some recommendations. People are purposely put on that who are "against" environmental illnesses being a valid entity. How does the minister answer his critics who are saying this is a step toward closure of this clinic?
MR. MUIR: Mr. Chairman, as the honourable member knows, that facility is basically run for us by Dalhousie University. One of the platform commitments that we made was a review of that and that review, the on-site review, will take place on May 24th and May 25th. We have three very well-reputed, nationally-recognized physicians to take a look at that. There is money committed for the operation of that facility this year. We, again, have no intention of closing it down, but I can say that we look forward to the review to find out. The review will identify the strengths and weaknesses of the Environmental Health Clinic as well as its current mandate and its accountability.
One of the things that has happened, as the honourable member well knows - and he perhaps, indeed, may have been among those who were instrumental in setting it up, I don't know - it is set up as a research facility with the treatment that would take place emanating from the research as opposed to a straight treatment centre. I think that is one of the difficulties of people understanding the Environmental Health Centre, that they don't understand its mandate or the frame of reference that it was begun under and was to operate under. They confuse that with what they would like it to operate under. So we hope to get some information about that and some answers to those questions, indeed, some objective data so we can base our decisions on hard-core evidence.
DR. SMITH: Mr. Chairman, on the AIDS Advisory, moving from the budget of over $101,063, what is going to happen with the AIDS Advisory; what is the long-term goal on that?
MR. MUIR: We have no plans at the present time, Mr. Chairman, to change the role and function of the AIDS Advisory.
DR. SMITH: So the commission will stay the same, the advisory board, but there will be $40,000 less cash in the till? What will be cut out of that $40,000?
MR. MUIR: Mr. Chairman, a vacant position was not funded.
DR. SMITH: Is not funded and not provided for in the budget, so we see a diminished role there for the AIDS Advisory.
On Friday we did touch a bit on Page 13.5 in the Supplement, and Emergency Health Services. I am not clear; the column on Provincial Programs, last year the forecast was $5.5 million and we are looking at Provincial Programs cut to $4.3 million. What is involved with that cutting of Provincial Programs?
MR. MUIR: Well, there are a variety of things that do enter into that. Could I just ask the honourable member again which line he was looking at?
DR. SMITH: It is Page 13.5 in the Supplementary Detail and it is Provincial Programs, under Emergency Health Services. I am trying to treat this as a block because some items have increased but the significant one is Provincial Programs. The question is, what are those provincial programs that will be diminished.
MR. MUIR: There is a decrease of 3 FTEs in that, Mr. Chairman. The professional services have decreased by $1.2 million. This is balanced by $100,000 in increased revenue. If we are looking at it from estimate to estimate, $100,000 in increased revenue and $0.5 million in contractor costs and training, travelling, administrative expenses, that would account for it.
DR. SMITH: The training, is that within the service or are these programs that would be involved with volunteer groups in the community that the paramedics would be involved in. What is that, specifically?
MR. MUIR: It would be a reduction in, I guess, the in-service training of some of the in-service paramedics.
DR. SMITH: Just looking at medical payments and the complement of physicians. How does the minister see the complement of physicians within the budgetary restrictions placed here? Are there any major, outstanding funding commitments that the department has to the medical profession, either legislative or otherwise, or within the agreement, and is there anything outstanding within this budgetary year?
We see an increase, forecast over estimate, of about $5 million to $6 million. Can the minister comment on that? The complement of physicians in the province within the budget? If I could do a second question to save getting up and down, are there other commitments within the agreement with physicians that will be coming due in this debate in this fiscal year, the year we are using for debates here?
MR. MUIR: First of all, Mr. Chairman, there was a contractual increase to physicians effective April 1st, of about 2.7 percent. The number of physicians in total in Nova Scotia increased 34 in 1999 over 1998. The average turnover of physicians, according to the information the department generates, is about 10 percent, or roughly about 200 a year. As the honourable member and other members can see, we actually are gaining. The number of physicians have increased 34 this year and there were something like 47 the year before, an increase in the number of physicians.
There is a detailed list, compiled by the department, of the physician needs of the province. Now, unfortunately, there are some areas where there are specialist needs and some areas where there are general practitioner needs. I just go back and say that we continue to
work at this all the time, Mr. Chairman, and the information that we receive indicates that our physician recruiting efforts are as good as those of any other jurisdiction in Canada.
MR. CHAIRMAN: The honourable member for Dartmouth East, you have just over five minutes left.
DR. SMITH: Mr. Chairman, there are other members on that side of the House who would like to speak but I will probably use this time and come back another time, after the other Party uses their time.
I have been joined by our Leader and I would like to thank him for his support he gave me, as a minister, for this great recruitment program and retention program that seems to be working. I think the minister is being modest. I hope he is not being modest just because he didn't want to give us too much credit for the fine program we put in place but that he will continue that; that was the purpose of my comments earlier. Some of the things are outside the minister's jurisdiction that will impact whether physicians will stay in this province or whether physicians will come back. It has to do with lifestyle and Nova Scotia being a nice place to live. Those are the positives. But, when you are dismantling your education system and you are kicking the heck out of the acute care system and some of the other spinoffs that will trickle down through the whole health system, that is going to put strains on this program.
I hope the program we brought in and had working so well continues to work and overcome all the negatives that this government is doing now to discourage people from either staying in Nova Scotia as a nurse or physician or social worker or physiotherapist, and also those who are looking at Nova Scotia. A lot of these people come on a holiday. They have a look and you don't even know they are in the province, and they are sizing it up. So they meet with Nova Scotians. I just hope they wait a little longer and some of this will settle down, and when they visit this summer looking whether to come or not, they will not run headlong into these large classes and a Minister of Education who says, well it doesn't matter, we can put 50 of your children in.
If someone is going to come from Calgary, two professional people with two or three of their children and when the Minister of Education is up spouting off that it doesn't matter if you have 50 students in a classroom or not, that is not going to bode well. That is why I commiserate today with the Minister of Health, when he has such a backward-looking government behind him, supporting him, he is trying to do a good job, I know. They not only slashed the budget, but they are now slashing all the other parts of that infrastructure that will have people coming to this great Province of Nova Scotia. I made my choice years ago as a physician to stay in this province.
I was tempted to go to British Columbia. I am glad I stayed, but some other people still have choices and are in the process of making those choices. Enough of that, Mr. Chairman, I just want to make that point that I do share the concern of the minister. I hope he spoke up at the Cabinet Table on some of this foolishness within the Education Department and maybe he can get them straightened out over there a little bit. But it is tough sitting around when you have people who don't necessarily share your beliefs and concerns of how important the Department of Education is to the recruitment of physicians and nurses and the retention of them.
Mr. Chairman, I just want to use some of the time briefly on Page 13.7 in the Supplementary and the Children's Dental Program. What specifically is going by the boards with that? I would like to know from the minister.
MR. MUIR: Mr. Chairman, actually in terms of services, nothing is going by the boards. What the province is doing is moving from first insurer to secondary insurer. Most people who do not have the type of insurance that will cover those services, then they continue to be covered by the province. But, in cases where somebody who has an insurance policy, for example, we who are members of the House of Assembly usually have that type of thing, and you, Mr. Chairman, with all respect, you have a child that will probably want to get into the dental business sometime before too long. We would expect that if you were still sitting here and you had that dental plan, we would expect you to cover that cost rather than the general revenues from the Department of Health.
DR. SMITH: Just to keep it simple here in the closing minutes, other insured programs, special drug programs, that is obviously increasing. I suspect it is multiple sclerosis. Are you providing a buffer if the heat gets too heavy to bring Aricept in; as a minister, have you got that padded a little bit that not only the Betaseron group of drugs could be covered, but also you have a little for Aricept? Is that under consideration there, minister?
MR. MUIR: I just would say I am really surprised that given the comments the honourable member has made during these debates on the Health estimates, I guess he asked a question of the House that when he was in office, he didn't make the decision that Aricept would be added to the formulary. But, I would say . . .
MR. CHAIRMAN: The honourable member for Dartmouth-Cole Harbour.
MR. DARRELL DEXTER: Mr. Chairman, I wanted to have an opportunity now to go back to the questioning I had ended with at the expiration of my time. That has to do specifically with respect to revenues generated from charging a fee for those patients in hospitals who are filling a bed, who otherwise would be in a long-term care facility. I think the minister had said it was lumped together in some part of the budget. I don't understand where those revenues are accounted for and would ask him if he could again point that out to me in the budget?
MR. MUIR: Page 13.15 of the Estimates Book.
MR. DEXTER: Okay. Under which, specifically? There are two items here. One of them is for $740,197,000. Surely there is something more on it than that?
MR. MUIR: Where is that? In the figure, the Grants and Contributions under Acute Care on Page 13.15, there is the figure of about $741 million. It would be contained in that because that is basically in that figure.
MR. DEXTER: Somewhere, surely to goodness, the minister has some kind of an estimate of how much revenue he intends to generate by charging people a daily rate for the beds in the hospitals that are being used for long-term care. He must have some idea what it is he hopes to raise in revenue.
MR. MUIR: Mr. Chairman, when this was proposed by the health care providers, they had proposed $10 million in additional revenues. As part of that, they had suggested it might be possible where, in cases that a hospital was acting as a nursing home and this was, again I have to put it in context, for people who were given the option of going to a nursing home or some other place and would not take it or there was space for them and that they had the means to pay and they would have paid if they were in a nursing home, then it was suggested this would be a possible revenue stream. However, inasmuch as these would be people who were effectively medically discharged from the hospital. However, the $10.4 million that was suggested by the health providers when the budget was made up, we took $5 million, and the $2 million which was suggested might be able to be generated revenue there. Because there was no plan, nothing in place really to do that, we didn't take it.
MR. DEXTER: That is all very interesting. So what the minister has said is that they estimated that they could get maybe $10.4 million out of the system, but since there was no plan in place that what they would actually account for was $5 million in additional revenues. Now, this is a service that is being provided, for which a fee is being charged. That fits the classic definition of a user fee, Mr. Chairman. I wonder if the minister could tell me if that is one of the user fees that was included in the cost recovery measures bulletin that was distributed to all members of the House and to the press and to the people of Nova Scotia.
MR. MUIR: It wasn't included as a fee to the province. That would have accumulated to the facilities, not to the province.
MR. DEXTER: That is an interesting explanation because, of course, if that money does not accumulate to the institution, then who would have to otherwise pay it? I will tell you who - the province. So, it is the province who gains on its books the $5 million from the recovery of these fees. I guess, the point to be made about this is if you are not going to undertake a new long-term care program, if you are not going to put in place more beds, and what you are going to do is turn your hospitals into long-term care facilities, then all of a
sudden, what develops is a conflict because the hospitals, which in the acute care section of this budget, are taking one heck of a whack - I did add it up at one point in time and I think it is somewhere in the vicinity of $70 million in cuts under the acute care line of this budget - what is going to happen is that the tendency is going to be to want to have ways in which you can generate revenue and if long-term care beds become a revenue generator, then the hospital is in the position of needing the revenue, then moving those people out is not going to be high on the priority list of the hospital.
Essentially, what they are doing is supporting the hospital and cutting their own costs by turning it into a long-term care facility which I would assume is contrary to what you want to do if you are seeking to provide an acute care service. Perhaps, Mr. Chairman, you, like many other members of this House, have heard the examples, especially the ones with respect to the Valley region, where they have had to cancel surgeries because the institution is full. Can the minister justify, or provide us with the rationale for allowing that to happen.
MR. MUIR: The honourable member for Dartmouth-Cole Harbour has come out with a number of points. First of all, I would like to go back to something - although I don't run a long-term care facility - that he implies that these long-term care facilities would prefer to keep people in them as a revenue generator had that particular proposal gone ahead.
I can tell you right now that if you were to ask any of these administrators, they would sooner that they didn't have these folks in there for some of the reasons that the honourable member has mentioned. However, the fact that some of them are medically discharged, yet for a variety of reasons, remain in the hospital, the reasoning for the hospital people I assume was that if you were not here and you could be someplace else because there is a spot for you, and if you were able to pay, if you were in that spot, why shouldn't you pay me if I am providing your room and board. I guess that, to me, would be a reasonable question.
Second, the other portion of the honourable member's question was clearly the issue of long-term care beds and he mentioned the Valley Regional Hospital. He is right, there was some elective surgery that was cancelled there. The important thing of that, and I know it is an aggravation to those people who go or have elective surgery scheduled and it gets cancelled on them, and it is not just the Valley Regional, there are lots of reasons and sometimes they aren't just because there are no beds, I think it is a somewhat comforting thing to know that if a person has a need for an emergency service in Nova Scotia, then that service is available.
Getting back, just briefly to the Valley Regional, and I haven't heard any reports in I guess 10 days, and the honourable member has a pipeline down to there, he could be part of that public relations firm in a former life, that is spinning this stuff all out, but (Interruptions) anyway, there were some beds that were vacant in Soldiers Memorial in Middleton; a dozen people who were basically in that long-term care category were moved down there and I take
it, because I have not heard the honourable member suggesting this for a few days now, that the problem is solved and I am pleased that it is.
MR. DEXTER: I guess the point is that there hasn't been a Question Period for a couple of days and that is probably what the minister is taking some comfort in, but I will tell you the truth, if I were the Minister of Health I wouldn't be relying on the fact that I hadn't heard anything about it from an Opposition member for a few days. I would actually be going down to the institution, checking with those people and finding out for myself. As good a source as I am, I wouldn't be relying just on Opposition members.
I am going to go back to the whole question of the long-term care beds, but I think we need to do a little exploring in this first because I would like to draw the minister's attention if I can to the long-term care program. The four regions are listed there. I am using the Supplementary Detail. They are broken out by region and, as an example, the central region went up by $350,000 in the long-term care program. I guess what I would like to establish from the minister if I can, is, what is the cost in running the long-term care program? If we take the central region, it is $47.602 million. What is it that you are paying for when that money is expended?
MR. MUIR: That basically is our portion of the costs of the patients who are in long-term care facilities and I think I should explain is that it is patients, really. Funding goes with patients, as opposed with facilities.
MR. DEXTER: What we are paying for there is to support the patients who are in those facilities. If you create more spaces in long-term care facilities, the cost to the government increases, is that not correct? I just want to make sure I have the relationship correct.
MR. MUIR: It would depend, Mr. Chairman, whether they were private pay, as they are known, or government pay. Actually, we have had a number of proposals to the department for people who would like to deal only with private-pay patients as opposed to, if they were private pay, I guess technically the additional cost to the government, at least in the short period of time would be nil. However, if they got in there when they really didn't need to be in there and they ran out of money quicker because we are in there then the province would have to pick it up on the other end.
MR. DEXTER: It is fair to say, is it not, that any number of long-term care beds that are licensed are going to carry costs to the government, will they not?
MR. MUIR: I don't think that you can be that absolute categorically. The reason is that there are some people whose financial resources would enable them to live in one of these facilities and they could pay their own way, presumably, if they lived twice as long as they are going to live. They have that type of resources.
MR. DEXTER: Right now, the government is paying out $47.602 million to support people who are in long-term care facilities in the central region. Apparently there is a cost associated with having them there. (Interruption) So, I understand that. What I am asking you now is a very simple question, if you increase the number of long-term care beds and you put more patients in them, is it not the case that the cost to the government is going to increase?
MR. MUIR: Mr. Chairman, I think we are having some difficulty in making the distinction between private pay, those who pay their own and public pay, those who are funded either wholly or partially under the government. So in general, I would agree that if there are more beds there is a good chance there will be more cost to the government, notwithstanding that if they were all private-pay patients, then even the honourable member in the New Democratic Party can understand that.
MR. DEXTER: I think that is bingo, Mr. Chairman. The point I am trying to make to the minister is simply this; if you don't increase the number of long-term care beds but you turn the beds in hospitals into long-term care beds that you generate revenue on, it is in your interest not to increase the number of long-term care beds because what you have done now is you have created a revenue generator in your hospitals. That is the point I was trying to make to you. That is essentially what you have done in this budget and that is a bad choice. You have raised $5 million in revenue by turning hospital beds into long-term care beds. You didn't tell anybody, you didn't put it in the budget bulletin. If the ferret had not struck here today, nobody would have known, to use the Premier's words.
Mr. Chairman, I am surprised that as we continue to dig around in these budget items that we continue to find these kinds of hidden user fees. I think it is a disservice and I think it is shocking that Ministers of the Crown, that a government, would participate in this kind of a charade. What it amounts to is essentially intentionally trying to massage the numbers so that people don't know what the real picture of the province is. This is coming from a government that said they absolutely want to see the books of the province given an accurate portrayal. That is not what has happened in this budget already.
I have a few other questions I want to raise. One of them has to do with the whole question of hospital construction. Under Page 13.12 again - I am in the Supplementary Detail - there appears to be $29 million in the hospital construction budget. Now my understanding is that the building, for example, of Cumberland County's new regional acute care hospital is supposed to be $45 million. Perhaps the explanation is that that is not all going to be expended this year. I am just wondering where does Cumberland County's new regional hospital fit in with this budget item?
MR. MUIR: Mr. Chairman, I thank the honourable member for that question. He may not know this but when you get into these capital projects, the community contributes as well. So technically the contribution was supposed to be on a 75/25 basis; in some cases there has been some allowance where the community couldn't do it. So in the case you asked
specifically about, the Highland View Hospital, that, indeed, is as you said, about a $45 million project - actually $45 million and change. The community contributed to that $6.8 million, roughly $7 million, which knocks that down to around $40 million - you know we are talking about the whole thing. So really what we have allocated this year in the capital expenses is $8 million. So it is about five times eight, so it will be over a five year period.
MR. DEXTER: Okay, so when is the hospital actually slated to be operational?
MR. MUIR: In probably the 2002-03 budget year. When the decision was made, the plans had to be modified, to come down to a figure; it delayed the process about four months. I should also explain that the community's share is part of the up-front money; it doesn't kick in over the five year period, it would be part. So the actual expenses probably this year would be closer to $12 million for the Highland View Hospital rather than $8 million, but that includes what the community has put in. This refers to the government's contribution.
MR. DEXTER: Okay, I guess I understand that. What I wanted to know is, why is it that it is being booked over an extended period of time? The only example I can think of is Sysco, where you booked all the debt immediately, in fact, I think he put it in last year's budget to drive up the deficit.
What I am wondering is why it is the hospital construction costs are being budgeted out over a number of years?
MR. MUIR: I am reluctant, Mr. Chairman, to try to explain the accounting details to the honourable member across the floor. I don't want to see him more confused. Basically the assets are on the book of, in this case, still the regional health boards and the regional health boards get their capital funding over a period of time.
MR. DEXTER: Well, I think it was the minister who said that the books of the regional health boards are the books of the government and that was the whole point in consolidating the balance sheets.
Perhaps you could tell us, if about $8 million of it, from what I took from what you said in there, is what is being attributed to that particular hospital, what are the other construction costs that are contained in that figure?
MR. MUIR: This year, Mr. Chairman, there are six major projects for which funds have been put aside. The Yarmouth redevelopment, $4.1 million; the - I don't know about this one, Mr. Chairman - Dartmouth General, $3.5 million, and that is for the Emergency Room renovations; I don't know about that one anymore either; the Cobequid Multi-Service Centre, $2.5 million, that is for start-up, planning and all the types of things that you do there
and to help you; the Cape Breton Regional Health Care Complex, about $1.6 million for Emergency Room renovations there; and the Highland View Hospital, the new facility, about $8 million for that; and for Phase II down in Yarmouth, about $5.5 million. Then there has been about $3.9 million allocated for small projects which includes such things as Fire Marshal's directive, safety emergency issues and so on, and sort of an emergency capital fund.
MR. DEXTER: I have another unrelated question and it has to do with the line item with respect to the AIDS Advisory. I don't know if this question was asked (Interruption) I understood that but I am going to ask it again. I understand that that budget item has been cut by $38,000. The reason I ask is because I was of the understanding that HIV cases are increasing at an alarming rate. That is what we read in the papers. So I wonder if you can explain to me what happened as a result of this cut? Was it simply a salary? If so, what was the rationale for it?
MR. MUIR: The rationale was this, Mr. Chairman, basically it was a research position that was vacant. The feeling during our preparation was that that type of research could either be picked up by other places in the department or, as the honourable member knows, we now have a health research fund and it could be funded from that if it was good, legitimate research.
MR. DEXTER: I will continue with my little tour through the various other issues, Mr. Chairman. I wanted to bring the minister's attention to the Ground Ambulance Program. I notice - and this is, again, on Page 13.5, for the minister's reference - that it is $123,000 less than the previous year. Now I assume that this is the funding to EHS; is that a correct understanding of that?
MR. MUIR: Could you ask the honourable member to repeat? He said $123,000 and I am trying to find the line item to which he is referring.
MR. DEXTER: On Page 13.5 it says Ground Ambulance Program and you will see the forecast for 2000 (Interruption) I have, yes, $123,800 less and I am just wondering, the $37 million listed there, that is a payment to EHS, is that correct?
MR. MUIR: Mr. Chairman, the answer is yes.
MR. DEXTER: Now I am sure all members of the House will remember the debate that went on in this House around the paramedics and the ultimate compromise that was reached with respect to that situation. I am sure all of us have read something about the wage settlements that were instituted as a result of the compromise that was reached. I guess, given all that, I am wondering why it is there is $123,000 less in this year's budget. Perhaps the minister could explain that.
MR. MUIR: Mr. Chairman, again it is sort of, I guess you would say, a net figure. What it reflects is, as we said, some increased user fees for 2000-01. It reflected the increase in ground ambulance cost due to the wage settlement and some other administrative expenditures were decreased.
MR. DEXTER: So what the government was able to do was not only cover off all of the wage cuts but to actually decrease the cost of the program through user fees. Did I get that right?
MR. MUIR: The increase in salaries, Mr. Chairman, due to that settlement last spring was a little less than $10 million. I am not going to get into the immigrant investment fund, which was another source of revenue there. That is one I have trouble with, I do admit that. The other thing, we are projecting an additional $4 million in user fees.
MR. DEXTER: I wonder if the minister could tell me where in the budget would the funding for the Environmental Health Clinic be? Under what line item would it be?
MR. MUIR: It is divided between shared program and Other Programs, Mr. Chairman.
MR. DEXTER: I wonder if the minister could tell us what it costs to run the Environmental Health Centre on a yearly basis?
MR. MUIR: $1.2 million - it is $600,000 in one spot and $600,000 in another.
MR. DEXTER: Now I had specifically asked what it did cost. Has that same amount of money been allocated for running the Environmental Health Clinic this year?
MR. MUIR: Yes, it has, Mr. Chairman.
MR. DEXTER: Can the minister tell us what the cost of the external review that is taking place on May 24th and May 25th is going to be?
MR. MUIR: We have set aside $70,000 for that, Mr. Chairman.
MR. DEXTER: I wonder if the minister could take us through the line item with respect to recoveries - Revenue Recovery Under Insured Programs, and break it down for us and tell us just exactly what is in the Revenue Recovery line item?
MR. MUIR: Excuse me, Mr. Chairman, would you clarify that or repeat that? Some of the words that are used in the Estimates Books are . . .
MR. DEXTER: Mr. Chairman, on Page 13.5 of the Supplementary Detail, under Insured Programs, there is a line item called Revenue Recovery. I am trying to understand what is contained in that. It appears to me that that is a cost item and I am trying to understand how revenue recovery is a cost item.
MR. MUIR: That is the cost for administering Revenue Recovery and you are absolutely correct. It provides for the development, implementation and maintenance of revenue recovery, policy and procedures, responsible for out-of-province recoveries according to inter-provincial billing agreements, third party liability, vocational rehabilitation, shared recoveries, and Veterans Affairs. All of those things would be in this item.
MR. DEXTER: Mr. Chairman, I have agreed to share this time with the member for Dartmouth North. He has a few questions he would like to ask the Minister of Health. I have a lot more to discuss with the minister but perhaps at another time.
MR. CHAIRMAN: The honourable member for Dartmouth North.
MR. JERRY PYE: Mr. Chairman, it gives me pleasure to rise on the Health estimates. I do know that the minister is quite prepared for the kind of questions I will pose to him, knowing the generosity of the minister when he was serving as a member in Opposition, in a previous time, and how adamant the minister was with respect to health issues and particularly how open and consultative his government was going to be with respect to the delivery of governmental services to Nova Scotians.
Mr. Chairman, I want to go directly to the Minister of Health. I want to ask the minister if, in fact, some of the information I heard from him is correct. He indicated earlier that when he imposed the fees to increase the Pharmacare premiums that he had consultation with the Group of Nine. I am wondering if the minister will tell me if there was a full Group of Nine present at that meeting.
MR. MUIR: Mr. Chairman, I will have to check on that. There were certainly nine people representing seniors in the room. Now whether the Chair of the Senior Citizens Secretariat - I counted her as well.
MR. PYE: I hope the minister will provide that information to me.
Also, I am wondering if there was any agreement by his government, and while he was in conversation with the Group of Nine, did they have any opportunity to go back and consult with their respective groups with respect to the increase in the Pharmacare Program?
MR. MUIR: Mr. Chairman, there were options presented, we asked them for their opinion and if they wished to go back, I guess, effectively, and dealt with it that afternoon.
MR. PYE: Mr. Chairman, I take it from the minister that he is open and prepared to tell this committee today that there was no forcefulness by his government to deliver an ultimatum to them, they either had to accept this or lose Pharmacare?
MR. MUIR: In the connotation that the honourable member for Dartmouth North is putting that, I certainly would have to say he is obviously subject to misinformation. Now if he is talking about comments and part of the conversation where we described the state that we found the Seniors' Pharmacare Program in, that if it was to be sustainable over the long term, then there had to be greater participation, to say an ultimatum, no, I wouldn't. That is probably the wrong connotation for that, I would suggest.
MR. PYE: Mr. Chairman, so I guess the minister is implying that no, there was not. I guess maybe I should not have used the term, delivered an ultimatum to the Group of Nine or those people who were present at that meeting. Maybe I should have said, here are the severe consequences that if the increases do not go up, and that you must make a decision here now. So the minister, hopefully, will take that into consideration, that there was some urgency for those individuals to come forward rather quickly with respect to a position that was made just prior to the budget deliberations.
Mr. Chairman, I want to go directly into the Estimates Book if I can. I want to talk about the Senior Citizens' Secretariat. I am going to the Estimates Book, Page 13.16. I believe there are Grants and Contributions of some $12.917 million. That is down from the previous year of $28.564 million. My question to the minister is, can he tell me if there is a commitment by his government now that the Department of Health has taken over seniors' issues. and that the Seniors' Secretariat is a part of that - and I do know that when this government was in Opposition they continuously supported a full-fledged Senior Citizens' Secretariat. As I understand it, the Senior Citizens' Secretariat, at present has one coordinator, by the name of Valerie White. I believe the very first executive director was F. R. MacKinnon, who was then replaced by Brian Vandervaart, I do believe. Since Brian Vandervaart's time there has been no executive director.
I am wondering if there is money put in the fund for an executive director of the Senior Citizens' Secretariat, and if this government is prepared to incorporate the Senior Citizens' Secretariat as a body it once was? I do believe that it had approximately 10 to 13 seniors volunteering. It had a representative from the Department of Community Services, I do believe it had a nurse-nutritionist on that board, as well as a drug advisor from the now-disbanded Nova Scotia Pharmacare board. So I am wondering if the minister can give me clarity. Is there allocation in this budget that addresses the Senior Citizens' Secretariat and puts the Senior Citizens' Secretariat back to its full complement, which many seniors and seniors' groups have been asking for?
MR. MUIR: Mr. Chairman, as the honourable member knows, that budget line and the whole thing came over from Community Services and I will have to find that information for you. I can say that there are something like 60 seniors' advisory groups that have some contact with that secretariat. The Group of Nine, of course, represents roughly about 70 per cent of the seniors in the province.
I would suggest, Mr. Chairman, the functions he is giving are those which it has been doing on a volunteer basis. I am trying to think, and I have sat on that committee as one of the ministers meeting with them, and I would not say that anything the honourable member has mentioned was not still being done there.
MR. PYE: Mr. Chairman, through you to the Minister of Health. Are you implying there will be funding set aside to hire an executive director of the Senior Citizens' Secretariat?
MR. MUIR: I haven't got the budget detail on that right now, Mr. Chairman. I will have to provide that to you.
MR. PYE: Mr. Chairman, as you know and as the minister is very aware, out of the Senior Citizens' Secretariat budget allotment comes some funding for the Seniors' Expo. I am wondering, through you to the Minister of Health, since his budget is now responsible for the secretariat, if there is funding set aside for the government's contribution or portion to the Seniors' Expo. I believe it is coming up very soon.
MR. MUIR: I would have to get that detail for that. Again, Mr. Chairman, in their budget there is a $92,600 line item entitled, Other, and it may be incorporated in that. I should explain this information was transmitted to us very late in the budget process and I don't have the detail that I would like to have for him, I apologize for that.
MR. PYE: Mr. Chairman, it makes it difficult for me to understand because this is the ferreting-out system and I am wondering if, in fact, there is additional funding for the Seniors' Secretariat, over the previous year? I also wonder if there is additional funding or if, in fact, the funding has been reduced to the Seniors' Expo. Again, I don't know because I am unable to get that information. I am wondering if the minister is prepared to - I guess since he is unable to get that information. I can understand in the haste of the shift coming over from Community Services, seniors and seniors' responsibilities now falling into the Department of Health and because that happened so quickly, just a month prior to, I do believe, or three weeks prior to the announcement of the budget, that there is some difficulty in getting those figures.
I am wondering, Mr. Chairman, through you to the minister, when can I expect that information?
MR. MUIR: I believe, Mr. Chairman, we can have that information available for him tomorrow. Just one other thing, he mentioned the Seniors' Expo. One of the reasons I believe that money may be in there, although I stand to be corrected, is that we have not received any specific requests since I have been there to get more money for it. We have not heard anything so I assume that they . . .
MR. PYE: Mr. Chairman, I want to go to the blue book. I am not fully aware of all the contents in this blue book but I do know some of the contents. I recognize that in year one of the Tory mandate it had indicated on Page 9 that it was going to ensure that there was adequate funding for addiction recovery programs and introduce funding to provide in-patient support for gaming addicts.
Now, if I go to Page 13.3, and I see that in fact there is approximately $11.1 million budgeted for the year 2000-01 and I see that there was $11.991 million for the previous year, that is a reduction of some $800,000. I am wondering where the commitment is to the rehabilitation program in this Health budget?
MR. MUIR: Mr. Chairman, I really hate to ask the honourable member to repeat his question but he talked about the blue book promise and something else and I was trying to find it here.
MR. PYE: Mr. Chairman, I am pleased to oblige. First, I took the contents out of the blue book. He is absolutely right with respect to Page 9 of year one in which the government was to make a commitment. Then I went to the Estimates Book, Page 13.3, and it indicates Addiction Services. As you can see, there is $11.111 million. That is down from the previous year of $11.991 million. My question to the minister, where have these cuts been made? Is there, in fact, additional funding for those addiction programs?
MR. MUIR: Mr. Chairman, I thank the honourable member for that question. Program re-allocations to the regional health boards accounted for $600,000 and then the overall 2 per cent adjustment, which we asked everybody to make, accounted for another $200,000.
MR. PYE: I don't think I received clarity on that. I am asking the Minister of Health, is there additional funding for addiction program services to those individuals in need in the Province of Nova Scotia? That is what I am asking. I want to know if the minister is prepared to tell me if there is additional funding for those addiction program services.
MR. MUIR: Mr. Chairman, there have been additional monies into the districts for outpatient Mental Health Services. It is expected that under some of those things, for example, in the northern region there would be some addiction concerns I guess if you were looking for something particularly called addictions but it is incorporated in there.
MR. PYE: Mr. Chairman, as a lay person, that is not clear enough for me. I want to understand this budget. As the government has told us, we have to ferret out the information that is here. What I want to know from the Minister of Health, as I understand it, the gaming foundation now is part of the Health budget and, as a result, there is money coming out of the gaming foundation that is delivered to Addiction Services. Now I want to know if, in fact, there is an increase, if there is money out of the gaming foundation into this Health budget to provide increased funding, as the government has said in its blue book, to people who have gambling addiction problems?
MR. MUIR: The gaming foundation, Mr. Chairman, is a separate fund and it is not included in this budget.
MR. PYE: Thank you, Mr. Chairman, for clarity. So we can say that the gaming foundation does not pass any money over to the Department of Health, which then distributes it to agencies that are in need of a gambling addiction problems?
MR. MUIR: Mr. Chairman, the answer is no. Now the money for that is passed directly to the foundation and the foundation has, indeed, been moved over to the Department of Health. What the future of the foundation is, we are looking at all aspects. It doesn't mean that that money would disappear, that is not the intent.
There has been some suggestion that if we are talking about administering this money, if we need two agencies to administer it or just one might do it.
MR. PYE: Since it is now part of the Department of Health, although a separate agency, if I can get a clear picture, and if, in fact, it is under the auspices of the Department of Health and the minister is responsible for where that money will go, can the minister tell me how much money is in the gaming foundation that has been set aside for the treatment of gambling addiction in the Province of Nova Scotia?
MR. MUIR: Mr. Chairman, the primary function of the gaming foundation was for research, as opposed to treatment. I believe the total amount in that foundation right now is about $2.8 million. It is not included in our estimates. That is from my memory, not because it is in here.
MR. PYE: It is not included in your estimates. Would I be correct in saying that it should be included in the budget estimates of the Health Department if, in fact, it is going to be administered by the Health Department in one way or another?
MR. MUIR: I guess, Mr. Chairman, and the devil will get me for saying this, but I would love to have the money that is in the gaming foundation and be able to distribute it through the Department of Health. The fact is that it does have its own board, which is responsible for the distribution of that money.
MR. PYE: I guess I want to go back on this just once more because there are a number of Nova Scotians who are facing gambling addiction. The former Minister of Health, who now sits in Opposition, I asked him this question on the budget, did he consider gambling was a health issue similar to alcoholism and tobacco and so on? He indicated yes, he had considered that was an addiction and a health issue.
If I can ask the minister, Mr. Chairman, how much money - he has already implied that a lot of this money is set aside for research - how much of those dollars from the gaming foundation will go into gambling addiction problems and the rehabilitation of gamblers in the Province of Nova Scotia.
MR. MUIR: Mr. Chairman, there are rather specific conditions surrounding the access of those monies from the foundation. As I said, the intent of the foundation, going from reading the documents, had more to do with research than with treatment. In any event, the money from the foundation has been used in the past, and the honourable member well knows, perhaps better than me, about where some of that money has been used. It is not intended to be used for ongoing operational purposes. Indeed there was considerable press about the role of the gaming foundation and how the monies can be used.
What has happened is that people were given some seed monies to set up programs and, because they had been given seed monies, when they applied for the money and their application was successful, there were very specific instructions or guidelines given to them. This was not to be seen as an ongoing source of funding. It was for seed money. They could use it from a research perspective. They get it up and running, and then they had to generate their own operational revenue.
MR. CHAIRMAN: The honourable member for Dartmouth North has approximately two minutes left.
MR. PYE: Mr. Chairman, I would like to pursue that a bit further, but I think I will step off that track since I only have two minutes. I want to go back to the Conservative blue book once again. I want to see if, in fact, the Minister of Health, during the PC's first mandate has lived up to this commitment as well. On Page 9, the fourth bullet down, it indicates that in the first mandate of this Conservative Government, they will, "Dedicate a portion of the
tobacco tax to fund new health promotion and disease prevention initiatives, including programs designed to discourage tobacco and other substance abuse among youth." I am wondering if, in fact, that is within your Health budget and where can I find it in that Health budget?
MR. MUIR: Mr. Chairman, I thank the honourable member for that question. The government will be rolling out a comprehensive tobacco use strategy before too long and, as he knows very well, the tobacco taxes go into general revenues, and the clear answer to that is yes, there is a certain portion of the tobacco tax that is going back into the programs to which he refers. However, I don't really think that is the question he is asking. I think what he really means is are we going to take the tobacco tax and say that 10 cents or 2 cents or whatever it is from each tobacco product sold is going to go into public health promotion. Our intent is still to fulfil this promise, but it is not done right yet.
MR. CHAIRMAN: Order, please. The honourable member's time has expired.
The honourable Leader of the Liberal Party.
MR. RUSSELL MACLELLAN: Mr. Minister, I just want to follow up where we left off on Friday. We talked about the beds closing in these various hospitals, as has been predicted by Mr. Smith, the CEO of the QE II, and you mentioned that if beds, indeed, did close, then certainly as many nurses would not be needed and there would be a reduction in the number of nurses. I want to use that to go on to what the member for Dartmouth-Cole Harbour was talking about, and that is the use of these beds that have been closed. Does the government have any plan for using acute care beds that have been closed?
MR. MUIR: Mr. Chairman, there have been no acute care closures announced, and the clinical footprint when it comes out will talk about appropriate bed use, among other things.
MR. MACLELLAN: All the footprints in the world are not going to tell us what we need to know right now. I am not worried about the government seeing footprints, I am worrying about them hearing footsteps and not coming forward with the information we need to have.
It is very convenient to have this government talk about further documentation regarding health care and economic development. To me, all that does is tell me, and the people of Nova Scotia, this government hasn't got the faintest idea what it is going to do in these areas, and they are waiting until they can put together an answer. The minister reminds me - and he is a teacher - of one of his students who, in a math problem, would look up the answer in the back of the book and then do the question to match the answer. I want him to tell me, now that he has the answer, how is he going to meet the problem? There are going
to be, presumably, I think there is no question, acute care beds closed. Does the minister envision another use for those acute care beds in hospitals?
MR. MUIR: Mr. Chairman, there are no plans to close acute care beds at the present time. I would suggest if, in the future, that does materialize, I guess it would be great if it could, which would mean that we didn't have the number of people, the demand on the service we have today. But if we go back to the member for Dartmouth-Cole Harbour and some of his questions about that and my home community, and I am sure his home community and anybody else's home community, the Premier's home community, that when we hear waiting lists are longer than we would like, quite often a part of that is that waiting periods are not all bad; a reasonable waiting time. But it generally implies the beds are not available as quickly as we would like to have them. Closing acute care beds, the absolute number of them, I don't see that, particularly when we are talking about the regional facilities and whatnot that deliver a fairly broad range of acute care services. We are not at that stage now, although I wish we were.
MR. MACLELLAN: So, there is no plan, no intention, no possibility at all of using acute care beds that have been closed for long-term care purposes? Is that what the minister is saying?
MR. MUIR: Mr. Chairman, I didn't say that. However, it is a type of question, if you answer it one way, you are darned if you do and darned if you don't. He is talking about beds that are currently in service, acute care beds, and that is notwithstanding the ones that were temporarily closed in the Yarmouth hospital or in the QE II. I am not talking about those. We have no plans at the present time to close additional acute care beds and turn them into long-term care beds. Although we do know there are facilities that are not being used to full capacity, that do have empty beds in them, they are not being used for acute care beds at the present time. So, as a result of our deliberations, the studies that are ongoing, if it made economic sense for communities and made sense for the overall picture of health care in the province, I suppose it is something we would look at.
MR. MACLELLAN: I would suggest to the minister that, whether he intends it or not with this budget, and what he is going to be allowing, the QE II and some of these other acute care facilities are not going to be able to maintain the present number of beds they have. It is either the minister doesn't visualize the closure of acute care beds, or he sees there is a possibility of acute care beds closing, if there are not enough funds and provides more funds. I think that is not something that a footprint document or any kind of follow-up is going to be necessary to do. It is a very real choice that the minister and his government should be facing right now. If they are not, the outcry that is going to follow this shouldn't be any surprise to this government. This government should be condemned for not anticipating that this is exactly what is going to happen.
To go on to the use of and the need - and the minister said waiting it not always bad - I want to just ask the minister, when we were in government, we promised two mobile bone densitometer units. Are they still going to be provided, or has the government cut those back?
MR. MUIR: Mr. Chairman, we are establishing a clinical footprint which will deal with such things as bone densitometers. As the honourable member knows, indeed his government did promise two mobile machines.
I did meet very early in my tenure in this position with representatives from the radiologists' group, and their opinion is that mobile machines are not as good as fixed machines. The capacity of the fixed machine is far greater than having two of these rolling machines around the province. I didn't get into that, because I don't want to get into an argument with my friends, the radiologists, who are experts about this. The fact is, it has been reported that the jury is still out on the efficacy of an extensive program of bone densitometry - not only here, this has been questioned right across the country - and we are trying to make a reasonable decision on this. Now, perhaps I can give you an example of what I am talking about, what I have been told.
The honourable members on the other side know as well as I do that, in general, if the service is there and it has to do with health care, it is going to be subscribed. You don't have too much that is available in health care that is not 100 per cent subscribed. Unfortunately, sometimes programs that are set up become used for things other than what they were intended, simply because they are available. Again, the one which is quite often cited has to do with basically mammography, and the screening program here in Nova Scotia, I believe, was set up for people 50 years and older.
We have a fair degree of backlog on mammography screening. I know they do it over in Dartmouth and here in Halifax and Sydney and other places. Quite often with that program, notwithstanding there are exceptions, but in general the significant portion of that backlog was created because some people in that program are not what the program was really initially intended. I think one of the reasons with the reluctance to go full bore on the bone densitometry is to try to get agreement that the program - and your colleague sitting next to you would know more about this from the clinical portion than I - would be used as it was intended, which obviously, requires some education of general practitioners and people like this.
I will tell you, I do know a little about bone densitometry because I am sure the honourable member is well aware I have been questioned in my own community, because the auxiliary of the Truro hospital wished to put one in there. Our feeling was we were not ready to put it there at that time. I want to tell you, that auxiliary is responsible for getting a satellite dialysis unit in the hospital, which to me is not a bad trade-off.
MR. MACLELLAN: I am perplexed by the honourable minister's statement. What he seems to be saying is that he doesn't think two additional densitometers would be 100 per cent subscribed to. We have two densitometers in the Province of Nova Scotia, and it would be funny if it wasn't so sad. There should be more.
The minister is questioning the effectiveness of mobile densitometers, which I think will be subscribed to because of the fact that we have the mobile mammograms. Once you get people using the mobile system and expecting it to be there, it will be there. Now, I don't want to get into a debate on whether the mobile units are better than the fixed units, that is not the point. What I am saying to the honourable minister, Mr. Chairman, is you have to make a decision on this. Is he saying that densitometers don't serve a purpose? Is he saying, as well, that there is not going to be 100 per cent uptake in subscription of two additional densitometers? Is that what he is saying?
MR. MUIR: No, I expect, when this clinical footprint is established, that somebody will probably say there should be another bone densitometer in Nova Scotia. What I am saying is entirely to the contrary, Mr. Chairman. What I am saying is that, in general, if there are medical services available, not only in Nova Scotia, but anywhere else - it is like, do you know of any GP that is looking for patients? Do you know of any hospital bed that is not filled in Nova Scotia? In general, if the services are there, they will be 100 per cent subscribed to.
Let me give you an illustration why I think the clinical footprint is important. We will talk about bone densitometry. I can tell you, with bone densitometry, I have been criticized in my own community because they are saying, if you want to get a bone scan, you have to wait a long time because you have to come to Halifax. But, you know, there is a machine down in Lunenburg, Mr. Chairman. The waiting list for that machine in Lunenburg was less than one week. So, people in my community, rather than waiting for whatever period of time it was to get it done in Halifax, if they were willing to go down to Lunenburg, which is really not a whole lot of difference in distance, they could have cut their waiting period in time by a tremendous amount.
I want to give you another example from in his home community in Sydney. They had a tremendous waiting time for CAT scans, I think about a six month - something like that - waiting period to get a CAT scan. Now, that is routine CAT scans, not for people who have an acute need. So, the people in your community funded 25 per cent of a new CAT scan unit, which should clean up that backlog. But, you know, at the same time that they were waiting six months to get a CAT scan in the Sydney area, they were waiting one or two days in New Glasgow, the same CAT scan.
We are a fairly mobile population right now, and it might be they need one up there, but what I am saying is that if people had gotten in their cars - and they might come to Halifax to go shopping or to go to a hockey game or come down to go to university or something like
that - if somebody had loaded up a bus and said, while we are waiting for that machine in Sydney, let's go to New Glasgow and get a bunch of these cleaned up. It sounds bad, but a little bit of ingenuity, when the capacity in the system was not quite as good, and I am not saying in any way that they don't need that machine up there, don't misunderstand me, what I am saying is that there were some options, perhaps not as desirable, but when we are talking about the allocation of rather scarce health care dollars, we have to look at everything.
MR. MACLELLAN: What the minister is saying is that the next time there is a midget AAA play-off in New Glasgow, they should fill up the bus first with people who want CAT scans so that they can get up there and get their CAT scans? That is the most archaic expression of health care that I have ever heard. There are two densitometers, one in Halifax and one in Lunenburg, and unless there is a hockey game in Lunenburg, unless the bus is going, these people are not going to be able to get their densitometer appointments. Since there were other areas not serviced by densitometers, we thought that this would be a good way of making sure that people had access.
The minister knows from the very statistics that he used that people are not getting in their cars and driving up there for a CAT scan or a densitometer. You need them positioned within reason where people can go within one day and get back. That is not happening, that is not the case right now. I really have a problem with that. Now in the minister's own riding of Truro, if he feels the densitometer is too close to the one in Halifax or Lunenburg, I could understand that, but if he is saying that they haven't made a study yet and so he is not going to approve anything, the minister knows that there is a shortage of densitometers and they should be there.
The minister talks about the footprint, well, I am telling you where you are going to find that footprint is right in the middle of a cow patty, if the minister does not do something beforehand to alleviate the need that exists. I am amazed that something we promised would happen - if the minister wants to have that fixed, then fine, but what he is doing is stalling. He is stalling so that these aren't going to be commissioned at all and that is unforgivable because there is a definite need. I don't know, I think that the status of women would have to be awfully concerned about the minister's attitude towards this tremendously serious problem about bone density disease and osteoporosis in Nova Scotia, and would take a very dim view of the callous attitude of this minister.
Another area. We had pictured and hoped that we could get away from some of the archaic ways of transmitting X-rays and doing X-rays in the Province of Nova Scotia. One of the ways of doing it is the picture achieving and communication system. I want to know where that stands. Is the minister, and this government, prepared to move on a PAC system, a picture achieving and communication system, or have they completely discounted that as they have discounted the two densitometers?
MR. MUIR: The Leader of the Liberal Party is absolutely correct. That is something that is a priority for this province, digitalization. These pictures they are sending around, it is part of the information technology allocation that we have made this year, and it will be really great to have that thing set up province-wide, hopefully by next year. We certainly recognize it.
I guess what I am trying to emphasize is that we want to do things correctly. We want to make our decisions based on evidence and I think the honourable member would recognize that too often decisions have been made here in Nova Scotia, not only in health care, but in everything else - and I said this the other day, they were good decisions, but they were made for bad reasons. We want to make good decisions for the right reasons and we would really like to make decisions in health care based on evidence, and I go back to the bone densitometer.
This is all it is. It is not to dispraise anything on the efficacy or the good things, but we want to make decisions that are based on evidence above all else. If we make them on evidence and they don't turn out to be good, at least we have something reasonable to fall back on. Good evidence does sometimes lead to bad decisions, I don't dispute that.
MR. MACLELLAN: It reminds me of a story about when a friend of mine, a prominent member of the Progressive Conservative Party federally, David Crombie was visiting Sydney. He was talking to one of the aldermen, as they were called then. The alderman was telling him about the work he was doing and he wanted to get traffic lights at Ashby Corner, there was a study that was going on. David Crombie made the remark, did the alderman think that traffic lights were viable, that they had proven themselves or not? Is this what the problem was? I ask the minister, does he think that the PAC system is something that hasn't been proven? Does he think that densitometers are something that haven't been proven and he is waiting to see if they fulfil the anticipated need or support? I have a problem with this. These are things that are needed right away. I don't know, he talks about wanting to have this PAC system in place by next year, so I would ask the minister, what amount is he contributing this year so that this system will be in place by next year?
MR. MUIR: There is a group that is still trying to work all of those things out in terms of that. I guess the honourable member has his feelings about a number of things that in some cases I would question whether they are evidence based. One of the interesting things, and the honourable member sitting next to him can tell him in going to these meetings of Ministers of Health and hearing some of their expressions about some of the generally accepted medical practices that have gone on in the country, which are accepted as being the way to go, there are some real questions about some of these things that are tossed out.
MR. MACLELLAN: I am becoming more incredulous all the time, listening to the honourable minister. Really what he is saying is that densitometers and the picture achieving and communication systems have not been proven, they are not state of the art, they are still iffy, and those technologies have not really been accepted yet. I just can't believe that the honourable minister or anybody in health care in this country would actually believe that; not even the Premier would believe that. I can't imagine that this is the feeling.
I want to ask too, on the subject of X-ray suites at the Dartmouth General, it is my information that three of the nine suites are not being utilized because there is not the money to operate them. Is that the case? I would ask the honourable minister that.
MR. MUIR: It has not been drawn to my attention that they aren't.
MR. MACLELLAN: I would say it is fair if he doesn't know about that, but I am surprised if it turns out they are not being used and he hasn't heard about it; it would be surprising, quite frankly, if that information has not reached him.
I want to talk to him about a couple of things in the book, The Course Ahead, and a couple of things that I found in there that I would question the minister on, I just want clarification because I could not understand what they were driving at. One is on Page 22, and it says, "We are working with the Cancer Commissioner to create a regional centre of excellence." What does that mean, on Page 22?
MR. MUIR: Mr. Chairman, he referred to Page 22; Page 22 of what particular document?
MR. MACLELLAN: The Course Ahead.
MR. MUIR: I guess, Mr. Chairman, I would respond to that in two ways because he knows that there is a cancer centre up at the Cape Breton Regional Health Care Complex and the other is here in Halifax. So I would assume that the two centres of excellence to which he is referring would be those two.
MR. MACLELLAN: I have the document here. Someone kindly handed it to me and I will just read a little more of it. It says, "At the same time, we must make certain that when our citizens become seriously ill they have access to the best care and treatments available. We are working with the Cancer Commissioner to create a regional centre of excellence. We expect that in collaboration with the Provincial Health Council, we will be able to develop the first-ever standards of care for Nova Scotia."
Like the honourable minister, I know there are the two cancer units in Nova Scotia. I just wonder what they mean by one centre of excellence. I am perplexed by that and I cannot understand what is meant by that.
MR. MUIR: It would be, Mr. Chairman, one centre of excellence, two sites and, obviously, the Cancer Care Program in Nova Scotia would be providing the direction for both of those sites. So it is really one centre of excellence, two sites for that, and certain functions would be provided in Cape Breton, certain functions would be provided in the metro area. The largest component of oncologists is located here in Halifax so the centre would be more in-depth here in Halifax than it would be in Cape Breton, but the other thing is, too, and it is not only the two centres, but we do provide some treatment in the Yarmouth Hospital. Oncologists, too, visit there and as Cancer Care in Nova Scotia gets their centre up and running, and providing the service here in Halifax and Cape Breton, that centre of excellence will also provide some service down in Yarmouth which it does right now.
It may provide services at the Aberdeen Hospital in New Glasgow, perhaps St. Martha's, perhaps Colchester, perhaps the Valley, perhaps the Highland View. So the centre of excellence would have a number of sites. There are two primary sites, one at the Cape Breton Regional Health Care Complex and at the V.G. site.
MR. MACLELLAN: That is a strange explanation because it would refer to two centres, I would think, if that is what was intended, or three centres. I just find the terminology unfortunate, or the way it has been expressed unfortunate, and it concerns me.
With respect to his own office, the deputy minister's office, and the advertisements for an assistant deputy minister, an associate deputy minister and an information technology head, is he aware of the advertising for those three positions?
MR. MUIR: We are advertising, Mr. Chairman, for an associate deputy minister. We have an assistant deputy minister. We are not advertising for a further one.
MR. MACLELLAN: Is it the associate you are advertising for? Is that what you are telling me?
MR. MUIR: That is correct, Mr. Chairman.
MR. MACLELLAN: What about the information technology head?
MR. MUIR: Yes, we are advertising for that position.
MR. MACLELLAN: What is the associate deputy minister going to do? What is going to be his or her role as compared to the assistant deputy minister?
MR. MUIR: The new structure of the Department of Health had four program areas and the four program areas would report to the associate deputy position.
MR. MACLELLAN: I am really having a difficult time understanding that a government which says they are going to cut administration is only cutting the lower levels while at the same time in the deputy minister's office, is putting in new positions, new salaries that I, and I am sure most Nova Scotians, don't understand as being necessary. Why is there this double standard that exists in the Department of Health?
MR. MUIR: There is no double standard, Mr. Chairman. Unfortunately, or whatever you want to call it, the health services that are being delivered in this province, there has been a lot of criticism of them and including those that were promoted by his government and I am not saying rightly or wrongly. The recommendation, as we changed towards a more community-based system, is that we need a certain administrative structure to make that work. The recommendations that have been given to us to make this work is that we need three very experienced individuals. The structure that we proposed allows for that.
Unfortunately, if you are going to get senior people, there is going to be very strong demands on these individuals who come in, and you have to compete. You are competing with the private sector. You are competing with other provinces. One of the criticisms - and I know this honourable member has seen this - levelled at governments in the provincial press and national press, is that if you are going to run a $1.65 billion corporation, then you have to have people who are able to run $1.65 billion corporations.
I can tell the honourable member, and I know he understands this, that the advice that I was given, and this is talking to people in the health care field when they get into the regional health boards, one of the things, the advice given to me by people who I respected, actually I am including those who have been involved in leadership roles in that regional health board structure which his government set up, is that when you are getting into the business of trying to deal with health care, don't short-change yourself by trying to get bargain-basement people. The associate deputy minister is going to focus on programs whereas the deputy is going to be able to focus on strategic direction.
MR. MACLELLAN: I cannot say whether the deputy minister is above a bargain-basement person, but he certainly isn't getting a bargain-basement salary. So if you are going to judge a person by their salary, then certainly he would be somewhere on top of the flagpole outside.
I want to just say to the honourable minister that he talks about a community-based health care system. I think he made the point that if, in fact, it is a community-based health care system, you don't need these people. It is because it isn't a community-based health care system, it is a system that is focused here in Halifax, at the Department of Health, that they are building this pyramid of people and they are taking the responsibilities away from the regions and bringing them to Halifax. All the communities are going to be doing is making some suggestions that the district authorities have to accept or tell the people in Halifax why they didn't. Then the people in Halifax, when they get these suggestions, will decide whether
or not they like these suggestions. The amount of community-based input is far reduced. That is why he has these advertisements for these high level people. He is taking the responsibility away from the regions of the province and putting them in Halifax.
Now, I want to ask the minister, on another area; what increases have been put in the budget for children's mental health?
MR. MUIR: The Leader of the Liberal Party did say some things but let me answer his last question first. The answer to that is $900,000. Secondly, if we are successful and we can get the health care basically delivered in the communities, then in my view, basically we who are trying to get us to that system will be doing ourselves out of a job. It is not our intent to build up a structure to have a bureaucracy. What we are trying to do - we have a task, we have a plan set out in front of us and when that task is completed, then there will obviously have to be a different direction taken. We will be into maintenance, rather than initiation and leadership and those things.
MR. MACLELLAN: Mr. Chairman, I just want to say to the minister that I think that the area of health care which is really most in need of further funding and attention is children's mental health. I say with all due respect that the additional $900,000 is not going to do what needs to be done.
I want to say, too, to the honourable minister on the question of administration, where the four regional health boards are now becoming nine district authorities, what is going to be the saving going from four to nine in these agencies - the saving in administration?
MR. MUIR: Let me go back. The honourable member asked a couple of questions there, or at least he made a couple of comments in responding. In addition to the $900,000 which is specifically targetted for children's mental health services, he is aware, too, I am sure that he has seen in the budget there is an additional $2 million there for the treatment of children who have some sort of developmental delay and autism. So there is actually more money than just that $900,000 that has gone in.
The other question he asked, the cost of going from the regional health boards into the district health authorities, everybody, and I know he knows this and it is not a deliberate attempt to - he and his colleagues or the colleagues in the New Democratic Party to indicate that they don't really know what was happening in the province, but in addition to the four regional health boards that existed, we had the QE II as a stand-alone institution, we had the IWK as a stand-alone institution, we have the Nova Scotia Hospital as a stand-alone institution and we have the Cape Breton Regional Health Care Complex as a stand-alone institution. So really, when we are talking about four boards, that is not true; we were really working with eight boards.
The difference is that right now we are going from eight boards to 10 boards. So rather than really looking at a 225 per cent increase in so-called administrative structures, the Cape Breton Regional Health Care Complex and the Eastern Regional Health Board are going to be folded together as one unit. We are incorporating the Nova Scotia Hospital and the Queen Elizabeth II Health Sciences Centre, I guess it is called - it was so simple when you had to say the VG and everybody knew what you were talking about - those two are being folded into the Capital Health District. So the number of administrative units is really not increasing the way it is.
Now we do believe, particularly here in the Capital Health Care District, once we get into that common business plan and starting to talk about shared services in the Capital Health Care District, that you were going to find, alone in administrative savings, we were talking about a significant amount of savings. In the others, we are talking about going from the regional health boards to the district health authorities. It is still our intent, Mr. Chairman, where there have been administrative savings or program savings or whatever you have in effect that provided good health care service to the people in those areas, we are not going to mess with that. What we are talking about is trying to improve, well, retain some of the strengths that were worked out through the regional health board. There were some good things, I mean we never said that. They just didn't do the job that people wanted done here in Nova Scotia. That is what the problem was; they were not delivering the service that was there and there is a better way to do it. We are not going to toss out everything simply because we are changing.
MR. MACLELLAN: Mr. Chairman, the minister didn't answer the question. I would suggest to him that the administrative costs under his set-up that he is trying to create is much more expensive than the four regional health boards. I would suggest to him, as well, that by putting in these new people what he is doing is unnecessarily building up administrative costs because he has district authorities with no power, that are still going to be costly, and you are going to give the power to the Department of Health, three people of which will be these three people I mentioned: the assistant deputy, the associate deputy and the head of information technology.
Now you have this smokescreen and this scam that is being played in the regions by letting people think that the district authorities have some power but yet they are still accumulating expense, and you have these people in the Department of Health that you are hiring to compensate for the power you have taken away from the regions.
Now, you have to incorporate the cost of these people and the additional work in the Department of Health in the increased administration that is going on in the regions because it is obvious that they are part of the same thing. I would say to the honourable minister that I find it very surprising that he feels it natural that the QE II and the Nova Scotia Hospital would be together. The QE II is one-third of the acute care budget in Nova Scotia, at least one-third. To say that it is wrong to have them in a stand-alone position, I find, is quite
surprising. I have no idea why he came to that conclusion. He put the IWK-Grace in an independent position but he wouldn't put the QE II in a separate administrative zone. It is just mind-boggling.
I am running out of time for today and I just want to get a couple of other (Interruption) - how much? Sixteen minutes, well that is still running out of time because I have a lot of questions. I know the minister wants me to get them all in.
I want to ask him, while I am thinking of it, about the Nova Scotia Medical Research Foundation. Now when we were in government and when we left office, we had names of people - it was not for political purposes, they were across-the-board suggestions for the board of directors of the foundation. This government completely ignored those suggestions - good people who would have contributed significantly. Instead, the government has run the foundation with the Deputy Minister of Health, the Deputy Minister of Community of Services and, I think, the Deputy Minister of Finance; three senior bureaucrats, without any public participation in this foundation. I want to ask the minister why he has done this?
MR. MUIR: I can tell the honourable member that I supported the formation of that health foundation. I did have some reservations about the structure which he and his Minister of Health at that time were setting up. I felt that one of the dangers under the structure they had proposed, which incidentally, we have altered significantly, would lead to research directed by the Department of Education. In other words, I had some feeling it might have been, despite the fact that I know the honourable members who were proposing this would never do that, it was a way to get some more policy research for the Department of Health rather than looking at it as a research arm, and I think I expressed that during the debate on that bill. Well, the honourable member is shaking his head, that you would never allow that research foundation to be used for such things as that but, it did strike me as it was being formulated and debated in here that clearly that was a possibility I certainly was not comfortable with.
Let me continue on from that. Indeed, the Leader of the Liberal Party is absolutely correct. When I became Minister of Health, there was a list of names proposed for that Health Research Foundation, and I was never quite sure why, when his government was in power, they didn't go ahead and do the doings to get this thing up and running. Anyway, it fell to us. As the honourable member is aware, our government has provided money for the Health Research Foundation, but one of the things that had to be done was get these people through the ABC process. We just weren't in a position of being able to take this group, (Interruptions) Unlike the government that was ahead of us, we respect the ABC process, and these people had to (Interruptions)
Anyway, what I am trying to say, Mr. Chairman, there are a lot of honourable gentlemen and ladies on that thing, and a matter of fact, I knew some of them personally. I will give you an example of one of the things that happened, how well prepared they were.
They had a couple of names for chairpeople who had never been approached. I discovered that one when I got there. Anyway, to make a long story short, we were interested in getting the foundation up and running. We were running out of time. We had to take this slate, whomever it was, and some of these people had never even been contacted to see if they would be willing to sit on that board. (Interruption)
The ABC process we felt we couldn't get through in light of that so we wanted to get the money out, Mr. Chairman. We did the expedient thing, we appointed an interim board, and by the way, to try to get that money out before the end of the fiscal year, and I should say that despite the fact there were three senior civil servants who were the interim board, they did receive advice from the research community, they did get it from I believe the vice-president of research and a couple of others at Dalhousie University who hadn't presented grants to the committee to get their input on it. We are currently in the process of trying to get some people whom we will duly submit to the ABC process. I hope that perhaps clarifies. He may wish to tell me when they introduced that legislation and got that thing together, why that foundation wasn't up and running when we assumed office. There may be some reason for that he may want to share with us.
MR. MACLELLAN: I am all laughed out, I'm sorry. I am just weak here, lucky to be able to stand after the answer the honourable minister has given. The minister may remember there was an election that intervened after the bill was passed, and we never had the chance to make these appointments. I wanted to say to the minister, he talks about the fact that he wanted to get it up and running. Well, he has been in government and in charge since August 16th and today is April 17th. I would think the minister and the department have had sufficient time to appoint an appropriate board.
Now, this is a foundation and it is absolutely disgraceful what this government is doing, Mr. Chairman. The people of Nova Scotia and everyone have to remember that the money the provincial government is giving to the foundation is only going to be a fraction of the money that is going to be raised for medical research in Nova Scotia. It allows us to be able to lever probably twice the amount of federal money, and it is going to be more than twice the amount of federal money. It is going be able to lever private sector money, and we hope that corporate funding and support will be very, very significant. The minister for the last eight or nine months has had this foundation that these private sector companies are going to give funding to, that the federal government is going to give funding to, he has had it controlled by three seniors. (Interruption) Look, the Minister of Finance can have his own time, please. If the Minister of Finance wants to ask a question, he can do it. He has to go through the Chair.
I want the Minister of Health to understand that this has to be a broad-based board of directors because you have public and private funding. The province is only giving a small fraction of the money to this research foundation, and yet they have all three members of the
board. I mean, you have a deputy minister who probably only found out where Dalhousie was a short while ago, and here he is, the one who is calling the shots.
MR. MUIR: Point of clarification. I want to tell him that the Deputy Minister of Health studied at the IWK Hospital. He did part of his internship there when he was studying neonatology. Not only that, he studied under the great Dr. Goldbloom, whom this gentleman so often speaks of. So, to say he doesn't know where Dalhousie is, I would like to see him retract that. (Interruptions)
MR. MACLELLAN: I want to know when the minister is going to do the right thing and stop this sham, and get into the foundation the way it was meant to be and appoint a broad-based board of directors instead of controlling it through the province? It is not legal. It is just not legal. The foundation is not legally constituted and set up the way the minister has constituted the board of directors. I don't think anyone would challenge that because no one wants to see the foundation shut down, but I want to say to the minister that this is not right, and it should have been dealt with before. I want to know when the minister is going to have a proper board of directors for this foundation?
MR. MUIR: Mr. Chairman, I want to say I am pleased that the honourable member has talked about having a broad base on that foundation. If he would get the permission of his colleagues to his left that we could get away from the ABC process to appoint the board of this Nova Scotia Research Foundation, then I would be prepared to act on it, because our difficulty is, we did advertise, and the only applicants we received were from "researchers" and we didn't get the broad base we were looking for so that has slowed us down a little bit. If people are willing to allow us to side-step that little problem that we have right now, we would be pleased to, with their cooperation, work on it.
MR. CHAIRMAN: The honourable member for Cape Breton North, you have four minutes and 15 seconds.
MR. MACLELLAN: Mr. Chairman, that is no answer. The minister has not even approached either of the two Opposition Parties to suggest any names. He has not suggested any kind of process and I think that is totally unfair. Only the minister and the Easter Bunny believe he would not be able to get his choices through the ABC process.
I think the fact of the matter is that it has to stand scrutiny. The minister knows what he wants to do, as far as the appointment he wants to make, wouldn't stand scrutiny with some of the choices that I have heard he wanted to make.
Now if he wants to make good, solid appointments and responsible people who are politically at arm's length, then I know that we of this Party will cooperate with him and I am sure the NDP would as well. If he just wants to have political patronage in this Board of Directors then it is not going to work, nor should it work. I want to know when he is going to come forward with good nominees for this board of directors.
MR. MUIR: I share the honourable member's frustration but I can say quite honestly, when the positions were advertised, as they were required to be, the only applicants we received were from researchers and we are looking for a more broad-based field than that. If the honourable member is serious about trying to work something out, then we are quite prepared to talk on this. I am like you, I want to get the thing up and running.
Politics in this thing, I would see medical research going above politics. I know that he may have had a different view of that earlier but right now . . .
MR. MACLELLAN: I would suggest that yes, I do have a different view of what the minister had in mind. I want to say to the minister that I really feel that this has to be done soon. There are major foundations in North America that I think would be quite willing to contribute funds to this foundation because they value the reputation of Dalhousie and the medical history in this community and in this province. All the minister and the government are doing is discouraging them from participating and it is costing this province and medical research millions of dollars by handling what could be a very prestigious foundation in the way that he is handling it.
I want to go on to another line, on the amalgamation or unification of services. The minister talked about administration but he has also talked about services, lab facilities and so on, in the Halifax Regional Municipality and what funding he anticipates would be necessary for these amalgamations and consolidations.
MR. MUIR: Mr. Chairman, one of the things, as the honourable member has pointed out quite correctly, the budgets for the affected institutions as we move into the Capital Health District, have been reduced a little bit this year. We believe, as they step up to the table, they are going to be required, including the IWK, to be part of that business planning process in the Capital Health Authority, so we believe that the savings will come.
We have met with all of the - we believe somewhere around $10.5 million will be effected in savings this year, as these institutions come together as part of the Capital Health Authority and make decisions that we will do this.
MR. CHAIRMAN: The honourable Leader of the New Democratic Party.
MR. ROBERT CHISHOLM: Mr. Chairman, the minister just said that he expects to save $10.5 million from re-organizing the capital district - I guess that is the Central Regional Board and then the boards of the QE II and the Nova Scotia Hospital. I wonder if he could indicate what evidence he has, what studies have been done to support that contention and would he be so kind as to table that information here in the House?
MR. MUIR: Currently what we would call the shared service areas here in the Capital Health Authority, the new one, roughly, it is approximating $200 million - actually $196 million and change. We took a very conservative estimate of about 5 per cent and that is where we came up with the $10 million.
MR. ROBERT CHISHOLM: I wonder if the minister would be so kind as to give us a list of what those shared service areas are that he has put a price tag of $200 million on. If he would do that, that would be helpful.
MR. MUIR: Well, I can give you a list of these things, Mr. Chairman: medical records; patient registration; laundry; central service, which is sterilization; housekeeping; food services; pharmacy; laboratory; diagnostic imaging; patient transportation; infection control; plant operations and building maintenance, by medical engineering; environmental services; administration, nutrition services; non-patient food; parking; beautician and barber. There would be a number of things like that.
MR. ROBERT CHISHOLM: Mr. Chairman, I wonder if he would table that document. I want to go through a few of the line items here and get some explanations. My colleague, the Health Critic, has done a great job, I think, of ferreting out a great deal of information but there is some additional information that I would like to try to dig away at, if I may. On Page 13.7 of the Supplementary Detail, the blue book, as I believe it was referred to by the people in the lock-up, the Special Drug Programs, I wonder if the minister would indicate what the special drug programs are and explain the increase from the actual figure of $6.3 million this year to $14.1 million next year.
MR. MUIR: The major increase in that, to the Leader of the New Democratic Party, comes because I think it is $7 million and that was part of the QE II budget last year and it has been moved into the Department of Health. Among the drugs that - these high cost drugs, last year at the QE II, well last year, as of January 2000, the QE II had spent $6.06 million on these high cost drugs. For administrative reasons we moved that into the Department of Health. Included in those, one of them is cyclosporin, which is a transplant drug, Erythroporten, DDI, GCSF, AZT, which I do know what that is, it is an AIDS drug, DDC, 3TC. Anyway, the MS drug therapies were about $22.4 million.
MR. ROBERT CHISHOLM: I am just curious, if the $7 million was on the QE II budget last year, why it is on the Department of Health budget this year under insured programs?
MR. MUIR: It had to do with risk management, Mr. Chairman. The QE II had the risk associated with administering that program. Now it has come to the Department of Health and the Department of Health assumes the risk. I don't know exactly what that is, but that is the reason. (Interruption) Oh, I take it back. I wouldn't have described it as risk. If it goes over budget, it is our problem, not theirs.
MR. ROBERT CHISHOLM: I will work on that a little more. (Interruption) Yes, I understand, the minister is telling me that if that item goes over budget, people have to have it, so therefore, they have to cover it. So, too, is the case with all the acute care facilities budgets, right? People need the care. They need emergency departments and so on. Anyway, I will get to that. I don't understand.
Let me go to the Home Care Program. In the Home Care Program for the central, eastern, northern, western regions, there has been a slight reduction in each one of those budgets. Actually, for the central region, it is almost $3 million, nearly $2 million in the eastern region. I guess my question is twofold: why the reduction in those regions and why the big jump in the provincial programs? If the minister would, in his explanation, please differentiate between the regional programs and provincial programs for health care?
MR. CHAIRMAN: Members, before I call for the Minister of Health, could I have some order here, please. It is getting quite loud and hard to hear the gentlemen in their debate. Thank you.
The honourable Minister of Health.
MR. MUIR: The big answer to that, Mr. Chairman, in the provincial programs, the increase is because, when we moved over the facilities from Community Services, we transferred them straight to the provincial programs rather than try to break them out into the regions at this particular time. It was roughly about $8.2 million, the transfer to the Department of Health from the Department of Community Services and those were facilities for seniors, and that is the major reason.
MR. ROBERT CHISHOLM: To save me doing the comparison, would the minister advise whether that $8.2 million is what was spent last year for the services that are being transferred?
MR. MUIR: That program, Mr. Chairman, I have been advised, is actually a $20 million program, but for the past number of years, the Department of Health has transferred $12 million to the Department of Community Services for our portion of it, so when it came
back, we essentially picked up $8.2 million. So the program is actually a $20 million program, but we had already been paying $12 million.
MR. ROBERT CHISHOLM: To the minister, I want to ask about a couple of programs: the budget for the Teen Health Centre, the one at J.L. Ilsley High School; the Red Door, which is a similar type of public health program in Kentville, servicing the Valley; and what is the funding level for Planned Parenthood this year as opposed to last year? While the minister and his staff are working away at that, I want to ask about what the government's plans are with respect to long-term care beds. This may have already been dealt with, but the minister will recall undoubtedly the issue as it affected the Mother Berchman's Centre at the Mount. There was quite a battle in this House, in fact, before the last election, fought by both the Opposition Parties to try to get the government to recognize the need to fund those. Tied with that, of course, was the de Paul Centre for family members attending to people who were in the hospital. They could provide that kind of support in their facility at a much cheaper cost than could be provided for downtown in other ways. It was a way also of the centre at the Mount being able to expand their services. Now, they have been primarily providing care to Sisters of Charity, but they want to expand their capacity there to provide long-term care beds to the community in general. When the minister was in Opposition, he thought this was a great idea, and really pushed for this to happen. I wonder if he could indicate whether, in fact, that plan will go forward.
MR. MUIR: The issue of Mother Berchman's is a rather complex one. There were a number of issues to it. To back up, Mother Berchman's was looking for about a 70 to 75 bed nursing home, and among other things, with Mother Berchman's they have a facility out there which is under-used, and they saw the addition of a rather comprehensive nursing home as a way in which, as you know if you run a nursing home, it generates revenue for you, and they have a revenue problem out there. This is one way to help alleviate that. If you talk with the folks at Mother Berchman's they will tell you that.
A second aspect of that was the whole question eventually, although they are not looking for it now is down the road of the potential of providing support for sisters in a nursing home setting. We have had rather long discussions with Mother Berchman's, good discussions by the way, and I believe that we may be in a position to announce an agreement of some type with them before too long.
MR. CHAIRMAN: The honourable Leader of the New Democratic Party, you have 10 minutes left.
MR. ROBERT CHISHOLM: Thank you. I appreciate that information. Now, I am going to just go back and ask the minister, I am sure other people have canvassed this, but in particular the funding reductions to the IWK. I will just deal with the IWK-Grace first, because we only have a minute or so, and ask the minister what his department, and his government, is planning to do with respect to the service reductions that will result from the
funding reduction of nearly $10 million for the IWK-Grace Health Centre. They have talked about some services that are provided by that facility alone that will have to be cut as a result. They have talked about other problems there; I wonder if the minister would indicate what his department, his government, is planning to do in order to ensure that those services are, in fact, not reduced.
MR. MUIR: Mr. Chairman, I am not trying to go back, and I will come back to that, but you had asked about the Red Door Centre and the J.L. Ilsley Teen Health Centre and they are both funded through the capital regional health boards rather than direct grants from the department.
In the IWK, we expect that the percentage reduction from 1999-2000, roughly about 4.7 per cent, part of it is Y2K-related. We had allowed $5.5 million for Y2K in the IWK; shared service around $2 million; we had projected about $575,000 for revenue volume price adjustments, you get into this thing; about $430,000 in transferring some mental health services owed into the regions; and roughly $200,000 in capital costs. We don't really anticipate any changes in programs from the IWK, that is not something we are looking for. I think we have indicated in going through this exercise, trying to protect patient care services is the number one priority that we have.
MR. ROBERT CHISHOLM: I wanted to go back to the question I had asked about funding for the teen health centre, Red Door and Planned Parenthood and the minister said that was under the capital regional health board. Nonetheless, the budgets are approved by the minister's department and I would ask him if he could give me the information as to the funding level for those programs.
MR. MUIR: I guess I can ask for that, whether that has actually been determined yet, the Red Door by the way, is again funded through the western regional health board as opposed to the Department of Health. We will see if we can find that information for you if it is available.
MR. ROBERT CHISHOLM: Thank you to the minister. It is difficult to get that information when you don't have anybody who wants to be held accountable for the budget. Maybe the minister could indicate whether the business plan for the central regional health board has been approved and if so, would he table it here in the House?
MR. MUIR: As the honourable member knows, we are moving towards a new district health authority and the business plan is currently being evolved. It hasn't been finalized yet.
MR. ROBERT CHISHOLM: Trying to nail down how much money is going to these specific programs, very important programs in the community and the minister is telling me he doesn't have that information or that things are in such a state of flux that hasn't been determined yet, how are we supposed to, in this Chamber, identify what the specific level of
funding is for these important programs that are being delivered if the minister doesn't provide us with the answers? How are those programs supposed to continue if they are not told what their funding levels are? Surely the minister will understand the frustration that I may be expressing in response to his answer that, well, we don't really know yet. I would ask the minister to please provide this committee with more specific detail on the programs as requested.
MR. MUIR: I do realize that one of those programs happens to be in his home constituency as well, is that correct; the Ilsley program? I understand that there is probably a double-barrelled reason for asking for that. I will see if we can get that information for him, Mr. Chairman.
MR. ROBERT CHISHOLM: I want to go back now to the minister's response with respect to the IWK-Grace Health Care Centre. The minister says it is not going to be a problem, no sweat, this reduction of $10 million isn't going to affect any services whatsoever. That is a completely different answer from what we are getting from the chairman of the board and from the staff of the IWK-Grace Health Care Centre. I would like to ask the minister if he could square with members of this committee why it is that there is such concern at the IWK, that services are going to be reduced as a result of this funding level that has been approved by the department and this minister's answer.
MR. MUIR: I can tell you that on Friday afternoon I met with the chairman of the board of the IWK-Grace Health Care Centre, along with the Chief Operating Officer, Mr. Nurse and we discussed this matter. I do think that there were perhaps some communication problems, but I can tell you that we are working on this matter together and will continue to do so. I guess the answer is that we have kept these health authorities, not only the IWK but the QE II and anybody else - since last November they have basically been at the table with us as we develop these guidelines. One of the things that, and I don't say this disrespectfully because we are all doing the same thing - first thing, we have to cut this - but the fact remains that there are certain things that may be done, but you have to get to the table and try to do them and I haven't been to the table yet. After one has been to the table and puts forth the effort which we think they will, there are tremendously able and creative health care professionals out in our community and I am not prepared to underestimate them. I think that the challenge that they have been given, they are up to it and I look forward to the results of their deliberations.
MR. ROBERT CHISHOLM: I guess what I understand the minister saying is that the IWK-Grace Health Care Centre will work with a budget of $86.514 million and that there won't be any reduction in services and that there is no reason for the chairman of the board at the IWK-Grace Health Care Centre, the chief executive officer to be concerned whatsoever. It is just a matter of him and his staff working with members of the Department
of Health staff and I assume then that that is so too with the QE II where the reductions have been indicated as fairly significant and there has been talk of 150 to 200 bed closures. I wonder if the minister would also assure members of this committee that while things are going to be fine at the IWK-Grace Health Care Centre, they are also fine at the QE II.
MR. CHAIRMAN: Order, please. The time allocated for debate in the Committee of the Whole House on Supply has now expired and the committee will now rise and report progress and meet again on a future day.
The committee stands adjourned.
[7:35 p.m. The committee rose.]