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April 12, 2001
House Committees
Meeting topics: 
Supply -- Thur., Apr. 12, 2001

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11:22 A.M.


Mr. Brooke Taylor

MR. CHAIRMAN: The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, would you please call the estimates of the Minister of Health.

MR. CHAIRMAN: The estimates for the Minister of Health.

The honourable member for Dartmouth East.

DR. JAMES SMITH: Mr. Chairman, thank you for the opportunity within the committee, to address the estimates of the Minister of Health. We had made some progress through various initiatives. I think, initially, this morning, I would like to touch on the Point Pleasant Lodge issue. I know the minister says it is not his jurisdiction, but we know the minister is responsible for health care in Nova Scotia, and I am sure he would recognize that. There was always some mystery about different matters surrounding the Point Pleasant Lodge when I was minister, I can remember that. It was certainly an innovative and a very positive initiative of the previous government, that is prior to the Liberal Government . . .

MR. CHAIRMAN: Order, please. I would ask those honourable members who are participating in conversations other than the honourable member for Dartmouth East to please crank them down a little bit.

The honourable member for Dartmouth East has the floor.


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DR. SMITH: . . . as to how the mortgages were arranged. It was a not-for-profit society. It was rumoured for years that people had links to the Buchanan Government, as friends of the Buchanan Government, and that was never too clear. It was treated as a lodge. It was funded more or less, at least in the early days, as a hospital, and has continued, although now, through the central region.

I would ask the minister about his understanding of that, how he understands the structure, if payment to the lodge has been stabilized over this last while? You have a process where patients are really being turfed out of the hospital much earlier, much sicker people who are really not mobile. Now they are really being turfed in two ways. They are now being turfed out of the lodge that was set up as a hospital and funded as a hospital, very similar. Number one, now they are being turfed out when they come back, if they are home for a couple of days.

We know that it is good for patients to have some R & R at home, particularly when they are undergoing chemotherapy and specialized care for transplants and whatever the high-risk treatments are. So they have to change their room and the whole thing is really changed. In the hospital set-up, basically, hospitals tend, in the latter years, to open up more and patients would go home and their care was always the issue. We can't hold the hospital bed, we won't get paid for the hospital bed. We, being the hospital will not be paid if someone is not occupying that bed. That's how rigid the rules were, and the result of that would be poor patient care because they wouldn't be able to go home. From the lodge they do go home, now their room isn't being kept.

Secondly, the issue of meals. We have to realize, as a society, that these people normally would have been in a hospital. They have been turfed out, as somebody said to me this morning, of the hospital into the lodge, and now they are turfed out of the lodge. They have to go out to get meals on the weekends and that.

I guess my question to the minister is, what is his understanding of the history of funding of this particular institution, and is he satisfied that that is still properly constituted and set up? Also, if he knows anything about the mortgage, what is the mortgage on that place? I understand it has been remortgaged on a few occasions. What is his whole understanding of this whole issue, because it is an integral part of the health care system.

I think what brought it to light this year was the pediatric cardiac surgeon who is leaving the province, and this person is no longer able to deliver cardiac pediatric service. What we will see is those families requiring surgery for their children of a cardiac nature will have to go out of province. People in the Halifax area will learn of all the difficulties that people from around Yarmouth and Cape Breton and all the rural communities and small towns who have had to come in to Halifax to get specialized care, what they have been going through.

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As a society, I would say we have cancelled the railroads so people can't come in and out and travel as freely, and they have incurred a great deal of expense. Now we are continuing that burden by just making it more inconvenient, they have to take their things and move out, all these sorts of things, if they happen to go home for a couple of days, now with the meal issue. I personally haven't made a big issue of the meals.

I wanted to find out a little bit more. I am more concerned about the whole function of the lodge and the history. As a minister, I have asked several questions, and I might say the department is always forthcoming but I never seem to get quite the whole story on the lodge. What is the minister's understanding of the history of the lodge, the functioning of it, and does he agree with the direction they are going?

He can say that the capital region is doing it, and that is probably the answer I might give and I would hope to get away with it. The minister is not going to get away with that answer here in this House, because I think this last step, particularly on the weekends, not having meals available, and the costs where you now have restaurants offering meals to these people, it is a bit of sad state of affairs. Is the minister, overall, happy with the functioning of the lodge? Can you share that with the committee?

MR. CHAIRMAN: The honourable Minister of Health.

HON. JAMES MUIR: Mr. Chairman, the honourable member for Dartmouth East would know more of the history, the actual evolution of Point Pleasant Lodge than I do. It is a not-for-profit facility which operates under its own board of directors. The honourable member is probably correct, there were 68 beds at one time, funded directly by the Department of Health. They were treated, basically, as hospital beds, I guess you would say they were sort of in-patient beds. I think that over the course of time, as treatments have improved and more things are done on an out-patient basis, then it probably is more correctly termed a hostel rather than a hospital, and the hospital component. There was only a certain portion of that, I suspect, and those were the 68 beds that were funded through the Department of Health that would have been deemed as insured services beds.

[11:30 a.m.]

The Department of Health continues to pay the mortgage, and that was one of the questions that the honourable member had raised during his opening comments. The 68 beds, we have provided $524,000 through the Capital District Health Authority. That was the amount of money that was given last year and that is the amount of money that is given this year.

The honourable member has raised the issue of rooms. When people go home on the weekends, their room is not saved for them, that is correct. The reason for that, Mr. Chairman, is really to expand the service. In other words, there may be people who come in

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on the weekend perhaps to visit or whatever. As you say, it does provide a hostel service. It just means that that facility can better serve more people. My understanding is that is why the decision was made, so when a person goes in there, not to have the rooms retained seven days a week if they are only going to be there for five, it simply means that the room is then available for somebody else.

I think part of that may be, Mr. Chairman, that the patients - and I am talking about the out-patients at the VG or wherever it might happen to be - probably get their rooms free, but there may be a nominal charge for support people who are visitors. Effectively, it may be, and I am trying to get the information to verify this, that if they can rent these rooms out on the weekend, then what it means is that people who need the hostel, as patients, can stay for free. The meal service, I am trying to get some information on that. We did have one member of this caucus who did actually use that facility, and I am trying to get the information. I don't know the answer to that, honourable member for Dartmouth East.

DR. SMITH: Mr. Chairman, thank you to the minister for addressing some of the issues that I brought forward. It is an important service because if we are going to move in that direction, as the whole trend has been, and if we are going to have a sustainable health care system that we have our patients who need the system in the most appropriate area of treatment, I think any of these changes are always disruptive. Like I say, I have been not inclined to make too much of an issue, initially, and then I look back at the whole service. So, I think it is really the responsibility of the Department of Health to oversee the quality of care. Some of these people, obviously, are very ill and unable to access outside meals. I think that would be acceptable. We will return to this issue another day.

I just wanted briefly on hepatitis C, because I have been privy to some conversations early on with the other provinces and federal government and how they move. So I am sort of getting some information from various areas. The monies coming from the federal government, could the minister, just for the committee, clarify the $300,000 or a little more, whatever it is, yearly, coming down? Can he spell out exactly what his understanding is to cover specifically those persons with hepatitis C, what particular group that is and what this money is designated for? I know this has been covered a bit but I would like to get some clarification on that, whether it is within the window, outside the window and, if so, are there any strings attached?

Mr. Chairman, I think this is an extremely important issue here. We have federal monies flowing into Nova Scotia. We are always complaining, and I know the Premier has done his Campaign for Fairness and all those initiatives, and it is important we speak out for Nova Scotia, that we get a fair deal from Ottawa based on the reason we joined Canada at the time of Confederation. It also is a responsibility for us that we spend it correctly. There are agreements. I know, often, the federal government is drug in screaming and shouting into these programs. Then when they do come in, they can point and say, well look, there it is, there is an example. In Nova Scotia now, they are hell bent to balance their budget for the

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next election and they are going to take that money that should be going directly to programs and persons with hepatitis C and for whatever type - first it was being called by other names and now it is settled on hepatitis C. We know now there are various genotypes there. So can the minister share, briefly, to summarize, where we are with this program, how much money is being realized on a yearly basis and what he understands that money to be for, specifically the time of infection or deemed to be infected and, particularly, the program?

So I will cease that because I have given him enough time to get his papers and maybe his thoughts in order. Maybe he can enlighten the committee because I think there is a little bit of misunderstanding going on around this issue. The accountability for the federal government, because when we go back again in another program and ask the federal government, we want to be able to say, look, we have used the money for the reason that it was intended, and that is a crucial issue here. That, to me, is the main issue.

MR. MUIR: Mr. Chairman, I appreciate the question. He is specifically, I believe, referring to the recently announced federal assistance of $20 million for hep C. Nova Scotia should gain about $6 million from that agreement. I think the honourable member knows that. It is in payments which would be on average $300,000 a year. However, there is some front-end loading on that. The payments, the 20 year period, the money will be paid in less than 20 years. So the program is front-end loaded.

As I said yesterday to the press, Mr. Chairman, we appreciate the fact that the federal government has stepped up to the plate with hep C. Our Premier and the position of our province, as the honourable member would know - because I know he did the same type of advocacy when he was the Minister of Health - is that although we appreciate what the federal government has contributed, we feel that it should be more. The actual terms of the agreement, as I read them, would be, and I will read the shared objectives that the parties hereby agree that the shared policy objective is to ensure that persons infected with hep C, through the blood system, from January 1, 1986 and after July 1, 1990, have reasonable access to therapeutic health care services indicated for the treatment and cure of hep C. So that would be people who are outside of the window.

Mr. Chairman, what our government has done - and, by the way, I must admit, not that I have ever tried to hide it, is that I have not signed that agreement yet, formally, although all things, it is just a matter of putting a signature to it, and I think the honourable member appreciates that - is to maintain the programming that we have available for persons who have hep C. Unfortunately, the amount of money that was given really isn't enough to start new programs. There are two main hep C treatment centres in Nova Scotia, one at the Cape Breton Health Care Complex and the other at the Queen Elizabeth II Health Sciences Centre. People who have more severe cases of hep C normally make their way to one of those two centres.

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On the other hand, there are treatments that are available in the other district health authorities as well, but if you need more acute treatment, then one of those two centres is where you would go.

In the agreement, Mr. Chairman, between the federal government and Nova Scotia for this $6 million, there is an accountability framework built in, so how this money is being used has to be reported to the federal government. So the suggestion yesterday was that there was no accountability, and this was suggested by members of the New Democratic Party. As I understand the agreement, there is an accountability framework and the federal government must know how we were using this money.

DR. SMITH: I hope that is not the reason the minister hasn't signed the agreement - that accountability process isn't in place. I had some shared communication, so I can just question the minister relative to it being claimed that there was a $40,000 grant or payment to a local support group for hepatitis C. They were told they were not to criticize the government on that. In other words, they were implying there was a gag order attached to that. Would the minister share with the committee if he has any knowledge of that, and comment on that?

MR. MUIR: In reference to a gag order, I don't recall that. I know, last year, we did provide a $40,000 grant to the Atlantic hep C coalition, which is an advocacy and support organization for persons who have hep C. That particular group, that advocacy, although it is for all hep C victims, it is very much concerned with people who are outside of that window.

DR. SMITH: Can we assume it is not from this fund? That particular payment, obviously was done earlier? Genotyping is coming more into common use across the country. What is the status of that locally as far as the funding and the availability of that test for persons with hepatitis C? Essentially with that, my understanding is, you determine the genotype of particular people infected with hepatitis C, determine more subgroups as to what type of hepatitis C that person is infected with and which medications would be more appropriately used. That can vary by tens of thousands of dollars, perhaps, in a year. Those persons who receive this, there is no sense giving more medication or stronger medication to people who don't need it. At the same time, you wouldn't want to under-treat people. This is becoming very specialized, and we have those people here to do those tests and also to monitor the use of medication. To me, it is cost effective, both in financial terms and in human terms. We don't want to be like in Africa where they have pregnant women with AIDS, in an AIDS community, so if they have a scarcity of drugs they will treat them all because they don't have the test to determine who, in fact, has AIDS.

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We are almost doing that if we just have a one-medication regime fits all hepatitis sufferers. While we criticize Africa for that type of approach to health care, we are really almost doing it here, or, we are doing it here if we don't do the genotyping of the hepatitis C victims. Can the minister comment on that?

MR. MUIR: My understanding of the disease is, as the honourable member has indicated, that the genotyping is a very important part of the preparation - I don't know whether you would call it treatment or the diagnosing process to determine what treatment is most appropriate. That service is available in Halifax at the present time.

DR. SMITH: I think it's the payment of that and also the accessibility of it and whether that is going to be part of the program. I guess if you are looking for specific ideas on how to use that money and not just put it into general revenues, the way you could be accountable for it would be to make that test more readily available and also that there be no extra charges for those people who we know, particularly those who are fairly ill, that they have often limited resources.

With Alzheimer's, we did touch on the medication issue there. Does the minister feel that the formulary committee is getting good advice - certainly, they must be reading the literature like everyone else - and how the minister can justify not stepping in. I know it is difficult because the budget is limited in this area, but sometimes you have to bite the bullet on this. I was disappointed because I know the conversation - we ran into this similar issue with multiple sclerosis medications, with Betaseron, and where, Prince Edward Island, Newfoundland and others seem to be looking for a little support in not doing it. As minister, we had a meeting on that, but later we had to advise that we could no longer wait, the evidence was mounting and Dr. Jock Murray had set up a program to evaluate those persons who could benefit from the medication. It was quite a commitment of money, obviously, and we are looking at the same thing here with Aricept.

The numbers aren't that huge when you really look at those who eventually will qualify and will want to be on that medication. The evidence that has been gathered around the world, from Korea, Japan and circling the globe, that it's not a wonder drug but it's going to help those caregivers. That is why, in my final supplementary this morning in Question Period, I did speak in terms of whether the department itself, and the minister, are really taking that into consideration when they evaluate the use of this particular drug, which is Aricept or Exelon, either one. While their actions are dissimilar, they really would be targeting the same group, those early group of sufferers of Alzheimer's, that would allow them to stay in their home longer and there would be less heavy nursing care for those persons - often an elderly spouse - that we know about around this province who are now the caregivers for those persons in the early days with Alzheimer's.

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I know during Question Period the answers go back and forth, and in estimates we have a little more leeway. I would like to have the minister share whether he is hopeful that they will be able to make a move. I know he probably would be counselled. I think what the committee recommends is one thing. For instance, there are certain areas, I think, within your department you know pretty well what they are going to recommend. As a minister, you have decisions, you have a choice, the evidence is mounting, I wouldn't be standing here today if I thought this was hocus-pocus. I am not talking about apricot seeds from Mexico or something like that, we are talking about good studies that are done. It's not a wonder drug, not everybody qualifies. Which makes it even more the reason that it should be very strongly considered for use because it is not going to be a cure-all for everybody, and nobody is saying that. Can the minister just give a status update as to where he is as a Minister of Health responsible for that final decision as to who gets what, as to what is covered by the formulary, that would be covered on the seniors' program, particularly under the senior's program I am referring to.

MR. MUIR: The honourable member raises a very interesting topic for discussion, one which I have been involved in in the 20 months or so that I have been the Health Minister, indeed I know the discussion did not begin when I arrived, he went through much of the same discussion. His point that over time there has been more evidence generated is a good one.

Mr. Chairman, all I can tell you is that in the opinion of the formulary committee the quality of the evidence which would support the inclusion of Exelon or Aricept on the formulary is not there; our colleagues in the rest of Atlantic Canada have come to the same conclusion. The honourable member has pointed out a very good thing, that nobody touts this as a wonder drug, and talking with representatives from the manufacturers as well as with my own staff, they say it works with about 30 per cent - or at least this is the claim - of people who have mild to medium Alzheimer's disease.

Other people tell me, and I am not a pharmaceutical expert, that the very nature of Alzheimer's disease is that it has peaks and valleys. One of the things that research hasn't necessarily established, or at least as more evidence mounts and the evidence gets sufficient, then I am sure a positive decision would be made as to how much the improvement is necessarily due to the drug versus simply because that is the way the disease works - you are up and you are down.

The other thing of course, and I believe the honourable member did mention this, is the fact that it is not a wonder drug, and when it gets spun out here in the Legislature during Question Period where the comments go back and forth, not necessarily for information reasons, sometimes the characteristics are attributed to certain things that get into the category of urban myth, I guess you would call it. I am not saying that the results for Alzheimer's and the treatments for that are urban myths.

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All I can tell the honourable member is that clearly this is a major concern because people are living longer. At one time it used to be acceptable for old people, the elders, to be what we might say, and I say this most respectfully, they are getting old, they are a little odder, or something like that. Now we have been able to say there is something that causes that; therefore rather than being as accepted as it was, it is now a disease and people are trying to make a treatment. Because of the aging population, the older the population, the more prevalent this is going to become. Therefore, as the honourable member is pointing out, I think it is important that this evidence be continued to be monitored regularly. We are doing that; indeed it was in February when this was last reviewed. (Interruptions)

Mr. Chairman, I just want to assure the honourable member, and the honourable member for Dartmouth North who, I believe, has raised this in the House, perhaps not this session but last session, that the Department of Health is very concerned about people who have Alzheimer's. If, indeed, the efficacy of these drugs can be proven conclusively and have wide benefit, then I am sure that the formulary committee will recommend that they be added to the list.

DR. SMITH: I think there is no question now that the minister will have to be involved, because they will probably be telling him what he wants to hear for awhile and give him reasons not to be involved. I would just ask the minister not to use the other Atlantic Ministers as an excuse not to do anything, not to do the right thing, because there is a fairness here. The numbers who might benefit from that may be small, but those who do benefit will benefit well, and it will take the burden of caregiving off, particularly, their spouses. I think it is the right thing to do. Money seems to be flowing in a little bit now, you have a little extra to be flexible with and, rather than just trying to keep everybody happy, why don't you pick priorities. If you pick a priority, this has to be one of them. It is the right thing to do.

I think the minister is right, some days politics is played in this House, but that is the name of the game, this is a political process that we are in; the questions are political and the answers are political. But there are other days, particularly in estimates, when we bring concerns that we have. That is why I try to look beyond whether somebody has $5 or $10 for a meal chit at Point Pleasant Lodge. I am more concerned about the total operation and the approach to people when they leave the hospital, whether they are somebody who has a discharge plan. When you are admitted to a hospital, it should immediately kick in if you have a good health care system, a discharge planning process. How you can look those people in the eye, if you are turfing them out next door, and then the weekend comes. There is a process there, there is a continuum of care. We are still really not making the strides in home care that we should be.

This whole issue of how you have access into the system, which is a major issue, a lot of it is due to the fact that we don't have a good primary care system in this country, but here we have to speak for Nova Scotia. We have some pilot projects that are dragging on, still not addressing the funding issue really, that I want to get to in a minute, particularly for family

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doctors. So we have people lined up for access, when they finally get through the system, they generally really like their care, they identify well with the nurses and doctors and speak very highly of them, and they realize that they are being stressed and overworked, almost all of the people who have been in the hospital notice that.

Now, at the other end, and he quoted Saskatchewan - Saskatchewan closed 52 hospitals under Mr. Romanow, who would now be under the employ of Mr. Chretien; that is going to be interesting - Mr. Kite, I believe, recommended even more closures. They have studies they are quoting, and it seems to be if the studies coincide with your own beliefs, like in Saskatchewan, by closing hospitals they improved the health they said. So they measured the outcomes in that.

That happens in the Liberal caucus, too, because every time we lose a member, we go up in the polls. But I have no great initiative to be up around the 90 per cent, we are around 40-some per cent now, I think that is good enough for awhile. (Laughter) I am looking around this morning to see where my colleagues are, and notice the able member for Lunenburg West is always here, because he is waiting to get on. He doesn't want me to ramble on, so I will quickly move on.

Health is probably more politicized - other than Education - than any other department of government. I know the minister is besieged by a lot of decisions. I think that rather than this last budget that really just spread out a whole bunch of money all over the place, or quite a bit of money all over the place, band-aid and keep the troops happy out there, I think you have to make choices. It is about decisions, and some of them will not be popular. You have to leave somebody out of the equation occasionally.

But Alzheimer's medication, the time has come, you have to do the right thing. Don't hide behind the other ministers in the province. We got a very nasty response from P.E.I. when we did the betaseron for multiple sclerosis but, as I look back, that was a decision that eventually came to me, that I made, and I am pleased that I did it. We did it the right way, we set it up with a very credible physician, Dr. Murray and his team, on the multiple sclerosis issue. I will just share with the minister that after you do the right thing, something funny happens, everything goes quiet.

[12:00 noon]

I never had, as a minister, any more difficulties after we set up the proper way of doing it, the proper evaluation and doing the right thing. So the time has come on Aricept and Exelon or whatever medications come and they will be coming, there is no question. Those are going to be more decisions to make, which ones would be qualified. But there is a need. The proof is in. It is global. You can no longer hide behind that and you can't use the committee either because they are saying that is advice to you as minister. You have the choice and the choice is yours. So the priorities have to be recognized.

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Mr. Minister, through the chairman, I know there are negotiations going on with the Medical Society and I did want to get into it just briefly. We spoke earlier about physicians in rural communities. I just have a couple of initiatives here on that. I have been quite taken, I mentioned primary care, and I could have gone back probably after we lost government to do some private practice again as a family physician. I would have had to take some studies. (Interruptions) I wouldn't have particularly gone to Truro, Mr. Minister, my community is Dartmouth East and I have been there for quite a period of time, but I could have done some. But you know, I decided not to.

The main reason I decided not to is because I didn't feel that I could go back and deal with some of the mental health issues and deal with adolescent and youth issues and children's health, which I really loved to do, on a fee-for-service basis. It is geared for the quick turnaround, the three minutes, the five minute appointment. I think it is something whose time has come.

I don't know where the Medical Society stands on that issue now, but we are not going to solve the issue of primary care and access in the health care system unless we deal with how family physicians are paid. There are some formulae. You need accountability. You just can't put everybody on salary. That is not going to work either. We have some concerns in areas where physicians are already on salary now and whether they are being accountable. But these aren't insurmountable. They can be dealt with and there are formulae out there for partly blended and partly salary.

So I would just ask the minister if there are any initiatives coming from his department and himself to look at alternate funding programs for family physicians particularly, and then maybe to save the time, if he would remember the questions, I would just say, in the budget, can he indicate where one would find the rural physician stabilization fund and the education re-entry program in the estimates? Are they being budgeted for this year and where can we find them and then I will try to dovetail the question on a blended formula, partly salary, partly fee-for-service or whatever alternate funding mechanisms might be there. If there is anything he wants to share, I will understand if he says he can't discuss it because he is under negotiations with the Medical Society, but I would like his thoughts on that.

MR. MUIR: Mr. Chairman, Nova Scotia leads the country in alternate payment schemes for physicians. I know that the honourable member is referring specifically or his main consideration is for family practitioners or general practitioners. We continue to review how physicians are paid on a regular basis and as part of our human resource strategy, we look at the salaried general practitioners and as the member would know, I believe that is a suggestion as well from the Canadian Family Practice Association, that more consideration be given to physicians who are general practitioners on a salary basis.

In our primary care projects, Mr. Chairman, the physicians in those four projects are on salary and I believe the honourable member would know that. So we do have at least four

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who are practitioners in that. In addition to that and as part of our rural incentive program, we do have certain guarantees which would be salary guarantees for general practitioners entering new practice. So there is the scheme there.

I just want to say something about groups of specialists too, because this was one of the things that hit me very early on in my tenure as Minister of Health. It had to do with a group of specialists who, there were two and a third person came in on a salary because that is the way the incentive package worked: we will guarantee you whatever it is for the early part of your stay. Apparently, in that case, the group had the opportunity to stay on as a group on a salary basis. But the policy is that you must all be on salary. You can't have two on salary or one on salary and two on fee-for-service. So, in that particular situation, the persons who had been there the longest time were quite comfortable in their fee-for-service structure and would not consider going into a salary arrangement. The consequence of that was the third specialist did leave. So it is there. It is just not always as straight sailing as it may be.

The honourable member asked where the rural stabilization lines were in the estimates. If he would turn to Page 15.7, he will see that it is under Medical Payments, the line there, of about $372 million.

DR. SMITH: Is that in the Estimates Book?

MR. MUIR: It is the Supplementary Detail. In the rural stabilization formula, there was about $9.25 million allocated to rural stabilization.

DR. SMITH: Sorry about that, Mr. Chairman, I had these pages stapled together for some reason. I just wonder if I could get a repeat on that amount and I am sorry about that.

MR. MUIR: Mr. Chairman, the physician payments were about $372 million and the money allocated for rural stabilization was about $9.25 million.

DR. SMITH: Mr. Chairman, I thank the minister for elaborating a bit on the specialist issue and some of the matters to alternate funding. With specialists, particularly in certain areas - and the honourable member for Cape Breton East had spoken about secure treatment and it is proposed in the minister's riding or in his area, his community - how does the minister see, particularly the physician component, but also the specialized nursing, the psychiatrist and those types of health care workers that would be essential if we are going to have a national standards secure treatment? In other words, the young people with behavioural disorders that we are sending out of the province, that they would be in that particular institution, how does the minister see the Department of Health, who I suppose would be involved with that, accessing child psychiatrists, psychologists and particularly specially trained RNs and nurses for a facility like that that would deal with these high-risk people?

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We are talking big money here. This is a very expensive, highly specialized unit that this government has apparently decided is going to be outside of the Halifax area. How does the minister propose that they will attract psychiatrists, psychologists, social workers, nurses to that community? I know it is under Community Services, but surely it is going to impact, number one, where physicians are located in this province. It is going to impact dramatically on recruitment and retention, those we already have. The reason I am saying this is because there is not a great deal extra of these people around the country. So how does the minister propose that his department, along with Community Services, will recruit, retain and meet the full complement of a health care team to give care to these extremely high-risk children and adolescents?

MR. MUIR: The honourable member raises good questions, Mr. Chairman, and before getting into that area, I would just like to revert back to his last question on alternative funding arrangements. Approximately 35 per cent of the amount of our physician payments here in Nova Scotia are funnelled through alternative funding arrangements.

The issue of the preparation and the availability of appropriately trained psychiatric personnel is, of course, a challenge for us all. To be quite frank, Mr. Chairman, one of the difficulties that we experience in health human resources in the province is trying to locate psychiatrists in areas other than Halifax and Sydney. I guess if you were to talk about a full complement of psychiatrists, you would say that there probably is in Halifax and there probably is in Sydney, but most of the other, what we will call sort of the district hospitals, those services, they are all looking for personnel.

Under our nursing strategy, Mr. Chairman, part of that was for retraining and putting money into nurse education so people who wish to specialize through continuing education, we have made some of that money available through the nursing strategy and we hope that that will help people who wish to either become a cardiac specialist, or a psychiatric specialist, as a nurse, to be able to do that.

Secondly, in the preparation of psychiatrists, as the honourable member knows, the Department of Psychiatry at Dalhousie, which does train people, has evolved considerably over the past three or four years. The amount of research money that has come into that facility has increased and, of course, when you get the increased research money in, you get more people in and then you are able to increase the intake.

Secondly, one of the things that will help us is when the new CorFor facility opens over there in Dartmouth, the forensic centre, and although we don't call those young offenders as forensic people, probably they may in some cases be exhibiting some of the characteristics that in later life might be treated in a forensic centre. So the new CorFor centre which is going to be state of the art, the forensic facility over there is going to be an added incentive to attract more people into the field of psychiatry here in Halifax, and hopefully they come and train here because we have that new facility and they will stay here.

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The honourable member referred specifically to the secure treatment centre which is soon to be under construction in Truro. A lot of the people who service the population of those aren't necessarily psychiatrists, but they may be psychologists or specially trained social workers, and obviously those people would be available there. One of the things about being in Truro and why it is perhaps an appropriate location for that centre is that psychiatrists who specialize in that type of work that needs to be done, most of those people who have that very specialized training would be located in Halifax and the distance from Halifax to Truro is really a pretty comfortable drive. So the access is there because that facility is going to be located in Truro as opposed to perhaps some other community.

DR. SMITH: Mr. Chairman, time is running out so maybe we can go back on another day and I know the member for Cape Breton East is interested in this. I just hope that the minister feels comfortable that this facility, number one, is being built outside the Halifax area. I think that is a big step, secure treatment, and I hope he is optimistic that you are able to recruit the team, and I emphasize the team. I agree with the minister, it is not just psychiatrists, there is a whole host, but it is an extreme specialty. It is high risk and it is very demanding. So maybe we can come back to that another day, but the whole recruitment of the specialists at any level, whether psychiatrists, psychologists, social workers, nurses, I think that is the issue and when you start setting up a system and you are transporting people back and forth, well, good luck on all that.

I just think, in its wisdom the government has made that decision, and I wish them well because this is extremely important and one thing I can say, if you are going to do it halfway, shame on the government, shame on all those involved because this is something that has been needed for a long period of time. I know it is something our government faced and one of the issues we had as priority. I certainly have strong feelings on the location and the type of staff who are working there. It is costing an awful lot of money to send these people out-of-province now. So if we are going to bring them home finally, the service has to be of top-notch quality.

Maybe we will have to come back another time, but the health information systems, I am really concerned that I cannot find the budgeting for the amounts, but I wasn't clear the other day in Question Period. I asked the minister about the status with MediTech, whether he has any knowledge that there has been a contract signed for the health information systems, or a component of it, and if anyone has signed in government. He said he didn't and I realize that was not the question I should have asked, but does he know if there has been any contract commitment made to MediTech on the health information systems?

MR. MUIR: Mr. Chairman, there was a proposal and he did ask me the other day if the RFP that precipitated this was the one that was issued by his government. I didn't know and I can basically say yes, indeed, it was his initiative and it did stem from that, that I did discover.

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AN HON. MEMBER: So was he a good minister then?

MR. MUIR: No, no, but a nice fellow. (Laughter) But anyway, we are building on that.

Mr. Chairman, I am not going to try to hedge that answer, but next Thursday I will be making a public statement about our plans in the information technology field, making a public announcement about where we are going, and I would ask the former minister's indulgence to allow me not to answer his question because I am going to do that.

DR. SMITH: I think, just maybe to help the minister where we are coming from, if it is the original proposals, then we don't find that acceptable. Number two, if the contract is already signed with MediTech, we don't find that acceptable. So I hope the information is forthcoming because we will do a freedom of information on this. So the more the minister would like to share with us, the better, because there is really concern in the community that there are things happening behind closed doors that are not right, and if they have gone, even some people feel that there have been payments made already.

So if on that original proposal tenders have not been called through procurement and properly done through the system, then that minister will have to stand and answer for that and that is where I am coming from. Let's not beat around the bush while we are talking about it. If four or five years ago those proposals were taken in and nothing has been changed and they haven't gone to tender and opened this process, then that minister will be hearing about it from this side of the House. I don't know if he wants to comment on that or not.

MR. MUIR: Mr. Chairman, as I indicated, in 1997 - and I don't know if the honourable member for Dartmouth East was Health Minister then or not, I think probably he was - there was a request for proposals for an enterprise information system for the Cape Breton Health Care Complex. We would prefer not to go into this, and you won't have to get anything through freedom of information after next Thursday. There have been decisions made, but some of the people who have bid on the process have not yet been notified that they were not successful and we would like to notify them before we make a public statement. That's basically the reason for my reluctance to answer his question.

MR. CHAIRMAN: The member for Dartmouth East has about 45 seconds.

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DR. SMITH: It is very simple. Have there been tenders called for the health information system? Have there been tenders let for that system? Have they been called? I know it is different than the original proposals, but have there been tenders called through the procurement process of this government?

MR. MUIR: What I can tell the honourable member, Mr. Chairman, is that the appropriate procurement processes have been followed.

MR. CHAIRMAN: The honourable member for Sackville-Cobequid.

MR. JOHN HOLM: Mr. Chairman, I could start off by asking the minister if he is having fun yet, but I can tell that he is. I have just a few questions or topics that I want to address to the minister through you. The first one, I am sure, comes as no surprise to the minister, and that has to do with the Cobequid Multi-Service Centre. The minister, of course, knows that the Capital Region has made a recommendation as to the proposed site or what they think would be the best site for the Cobequid Multi-Service Centre. I am wondering, could the minister advise us where things stand as of today?

MR. MUIR: Mr. Chairman, there was a site selection committee, a community committee which carried out the site selection process. They did make a recommendation to the Capital District Health Authority. The Capital District Health Authority presented that recommendation to me and I wrote to the authority two weeks ago, last week - whenever it was - indicating that I accept the recommendation. My understanding is that the next step in the process is that the Capital District Health Authority will be setting up a community meeting to discuss this and whatever the nature of the committee would be. The reason for the delay, to be quite frank, is a person within the Capital Health District, who had a very prominent role in this whole process, went off on vacation for three weeks and, therefore, the meeting will not occur until he returns.

MR. HOLM: I knew all the information, but I hadn't had any of that put out in a public forum. I even know, I believe, unless I have been misled, the proposed site. I am wondering if the minister is prepared or if there is a reason why it cannot be said publicly which site has been recommended by the Capital District Health Authority and which site the minister has said by letter he has accepted?

MR. MUIR: I don't really suspect it is any great secret in the communities out there, if it is anything like communities with which I am familiar, which site was recommended. This is a process which is being carried on by the Capital District Health Authority and I expect that they would make an announcement in due course. I think probably it is more appropriate that that announcement come from the authority than from the minister.

MR. HOLM: But the minister will confirm that he has accepted the site that they have recommended?

[Page 361]

MR. MUIR: Yes.

MR. HOLM: Mr. Chairman, as much as I would like to tell people, I will refrain from making the announcement here today as to which of those particular two sites has been chosen. I know there were originally three, but there were two on the short list, as I am sure the minister knows or probably should know anyway, that were getting the most scrutiny at the end. So I certainly look forward to, in the shortness of time, having the anxieties of the community laid to rest so that I, or others who certainly are familiar, don't have to announce what the government is planning to do.

I am just wondering if the minister can tell us, and he has sent a letter, he said, to the Capital District Health Authority advising that he has accepted, did you copy that letter to anybody?

MR. MUIR: I can't remember whether we copied it conceivably to the MLAs. I am not sure, I know I had a conversation with the honourable member who just asked a question about that very thing. I can't remember. I know that you had raised it, so I wanted to make sure that he was informed of what was transpiring. I would have to look, I don't know.

MR. HOLM: Mr. Chairman, indeed, I had raised it with the minister and the minister and I did have a conversation. I certainly acknowledge that and the minister did confirm. I am just wondering, because the minister has said he is not sure he copied it to the MLAs, I just want to remind the minister - and that is really what I was wondering about because - I am the MLA for the area where the current and proposed future Cobequid Multi-Service Centre is going to be located. There are MLAs of a different political stripe who occupy areas in close proximity.

I was wondering if, by any chance, inadvertently, the minister might have shared a copy of the correspondence with some MLAs on his Party's side, without having shared the same information with the MLA for the immediate area. I am sure the minister would never do that, but could I get the assurance from the minister that if, by chance, those correspondences have been shared with the other MLAs in the area, that it will also be shared with the MLA for the area where the Cobequid Multi-Service Centre is located?

MR. MUIR: That is interesting. Yes, I will do that, Mr. Chairman, and I do believe that I discussed it with the member for Sackville-Beaver Bank and also the member for Bedford-Fall River, as I did with the member for Sackville-Cobequid. So I don't think any of the MLAs were more or less directly affected by that. On the other hand, I do know that there are people who use that clinic who do come from the Minister of Transportation and Public Works' area. I do know that I did not discuss it with him and I know that some folks from the other side of the water over there too, I don't believe I discussed it with the member for Dartmouth-Cole Harbour, nor the member for Dartmouth North, nor the member for

[Page 362]

Dartmouth East, nor the member for Dartmouth South. But, sir, you were among the three people that I did discuss it with.

MR. HOLM: Mr. Chairman, I feel honoured by that. I feel absolutely honoured by the minister's confidence (Interruptions) As somebody said, I have to be careful that I don't get misty-eyed over this. I just want to make sure, and I am not going into anything here, but some might suggest that there were some games trying to be played behind the scenes - I am not suggesting the minister is involved in this, and I want to make that clear - about locations. I just want to make sure that all the information that is available to one is available to all.

[12:30 p.m.]

I truly believe in what the Cobequid Multi-Service Centre does. I believe it is a model type of facility. There has been, it is certainly right now, taxed beyond its ability to deliver the services. I think - in fact I know - for many years people, not only from across Nova Scotia and across Canada but from other parts of the world, have come to look at the Cobequid Multi-Service Centre and the idea of the community-based delivery of services that it offers. So, I truly believe that it is a model, but it is taxed beyond its abilities to even begin to meet the needs of these communities. Not only mine, but as those surrounding it grow; people, as the minister knows, do indeed come from Hants, Windsor, people come from all over to that facility.

My next question before I leave the Cobequid, could the minister tell us how much money he has in his budget that is earmarked for the Cobequid Multi-Service Centre - not in terms of operations, but in terms of the planning and the development in the next phase that we are on?

MR. MUIR: That is a tough question, but I will answer it - $3.4 million for 2001-02.

MR. HOLM: That is encouraging. I just wanted to say it is important to have that number out there and to instill confidence within the community. There are people - the minister mentioned some of them - who have been working very hard, but there are all kinds of others. Those who work in the foundation, the staff at the facilities, the volunteers who work there who are also driving the effort to raise monies and to be involved in the planning process. That figure is encouraging for this year.

The next topic that I want to briefly touch on with the minister has to do with long-term care beds. The minister, I am sure, may be aware that there was once a proposal to develop a First Lake Village and once had lands located on the First Lake Drive for that, and that land has subsequently been de-designated and is no longer being held. I am wondering, could the minister tell me if his department is currently in active negotiations or discussions - maybe I should use the word discussions - with another organization - quite possibly

[Page 363]

Northwood - to develop long-term care beds for not only Sackville, but the community around there?

MR. MUIR: As the honourable member knows, we continue to wrestle with the issue of the appropriate number of long-term care beds here in the province. As part of our decision making, we implemented the single-entry access system and as of February 1st, all people who enter long-term care in a licensed facility in Nova Scotia now have to be classified, which was not the case previously. Although, I can say that in most cases people were classified. The answer to the honourable member's question is that we are currently in discussion with Northwood - Northwood does need 100 beds replaced - on the replacement of those beds and again, there has been nothing concrete. These are preliminary discussions. It is going ahead. Northwood has indicated that if they replaced the beds, they would be agreeable to seeing these beds located somewhere besides the centre of Halifax.

MR. HOLM: I am glad that you have confirmed the number that I threw across the floor, because yes, indeed, it was my understanding that there are 100 beds that they wish to replace. Those beds, I don't believe now, are currently being used. Those are 100 vacancies. That is not even increasing the number of approved spaces. That is just a matter of filling the unused beds, so to speak.

As the minister would know, I don't say this to detract from the needs of the community of Halifax, but the population is shifting somewhat too in terms of its location and in the surrounding areas, communities like Sackville, Bedford, Fall River, Timberlea-Prospect and so on, there are growing numbers of people in those areas and unfortunately, they do need long-term care beds as well. I am wondering if the minister would be able to tell us - I know about the single entry, I am not trying to get into those kinds of things - when does the government anticipate it will be in a position to make a decision on whether it will approve the replacement of those 100 beds?

MR. MUIR: I would hope that decision would be made within the next 12 months. The question is - and the honourable member has alluded to this - if additional beds are really needed. These are replacement beds. We also are going to lose some capacity in the metro Halifax area because of the major renovations that have to take place at Armview Estates and Fairview Villa, there is going to be some decrease in the capacity there. As the honourable member knows to perhaps slightly compensate for that, indeed there were some beds, temporary licences that were granted to Mother Berchmans and I believe it is 15.

Just one of the things that appeared when we went through the clinical planning process is that in District 9, which is this area, the number of beds per thousand population is 121.2 and this is the highest in the province. One of the things we are trying to figure out is exactly what that really means.

[Page 364]

When I talk to my colleague, the member for Cumberland South, he tells me that he has the oldest population in the province. When I talk to my colleague, the member for Dartmouth South, he tells me they have the greatest number of seniors in the province. When I talk to my colleague, the member for Antigonish, he is concerned about the great number of seniors down there. If you go up into my area where I come from, we have less than 50 per cent of the number of beds per thousand that they have here in the Capital District. So, one of our tasks, as the honourable member will appreciate, we have to decide - we have the data now, but, really, what does it all mean and where should we go, and so we are faced with that. You answered and I said basically within a year if we can.

MR. HOLM: I guess what the minister is confirming is he can't always take the information that is given to you by your Tory colleagues as being accurate. They all seem to be telling you something different, so I would suggest maybe there are more reliable sources of information. The census that is being undertaken will provide some of that kind of information. (Interruption) The minister says, of course, Phase II of the clinical long-term planning process, and I appreciate that, but this process seems to have been going on forever, not only during the regime of this government, the Tories, but under the previous regimes of the Liberals. It seems like this studying just goes on (Interruptions) The minister says we are doing it and there is the difference. I want to assure the minister I am never going to try to defend the record of what the other bad team did.

The reality is that many people are certainly still very anxious. I say this to the minister, and I am not going to pretend because I don't believe it is true, I don't believe that Sackville does have the largest number of seniors. We don't and I am not pretending we do, but we don't have any beds either. That is exactly true. It isn't only residents in Lower Sackville who would benefit, it would be from your colleague and mine, the member for Sackville-Beaver Bank, from Bedford-Fall River as well, plus people come from quite some distances often to occupy these beds. What is it, up to 100 kilometres from their home that they can be placed?

Mr. Chairman, my point is it just seems to me, in terms of a planning process, that you want to place those beds in a convenient location for the families so that those who do become residents in one of these facilities, that the family members are also going to be able to visit them. If you have to travel 100 kilometres to try to visit a loved one, people will do that if they can, but it certainly cuts down on the ability. You have to not only be looking at which has the largest percentage, but where the greatest numbers are. Communities like Sackville - when I went to live there I had hair that was not much darker but it was a different shade of blond. (Interruptions) It was down to here, I can tell you that.

The communities are aging, and more and more people in the communities around us are moving to that stage. I guess what I personally favour is the kind of concept where people can go in in independent living and go through the various stages, so that if they do progress to the stage where they need the intensive care that that intensive care will be made available.

[Page 365]

I just want to ask the minister, and I think I know the answer to this question, how many dollars are in your budget for this year, for planning and in co-operation to develop beds to service that area, like the discussion to replace the beds for Northwood? How many dollars are in this year's budget to address those needs?

MR. MUIR: Mr. Chairman, I am just looking. Our systems development office, which would be responsible for looking at the need in Sackville or Northwood Centre or Richmond Villa, all of these, the budget is about $635,000 for that office.

MR. HOLM: That is for the office for the whole area, that is not money (Interruptions) For the development, but there is nothing there, obviously, in terms of money going in that would do anything to be developing some capital or detailed plans for the production or development, in the preliminary stages, of a facility.

MR. MUIR: One of the things is that a lot of the preplanning would be done in that office, so there would be money allocated in that office. As the honourable member, I believe, is aware, in terms of capital costs the organizations go out and generally put some bridge financing in place, but it is paid through the per diem. To see a specific capital item, that isn't the way it works.

MR. HOLM: Fair enough. I shouldn't have asked the question, certainly in the way I had. Of course, in order to be able to pay it by per diems, you have to know that you are going to have it approved. You can do your bridge financing and borrow the money, but you can't if you don't have a business plan that says there is going to be money coming in to pay for it. Obviously, the government hasn't allocated any funding, and you can't do it anyway until you (Interruptions) Yes.

Mr. Chairman, with that, I will thank the minister for his comments. On behalf of those who will be benefiting from the $3.4 million that is going to be spent this year on the Cobequid Multi-Service Centre, I thank you. We look forward, in next year's budget, to the balance that is needed to have it (Interruptions) The minister is hoping that it will be the Tory vote out there in three years. Well, I look at the things they are doing, and I say, first of all, most genuinely, I don't care who gets the votes because, most genuinely, the thing that counts is the service. Whether I am there next year or the year after or after the next election, really doesn't make a hill of beans of difference in the broad scheme of things. Nor, with any disrespect intended, does it make a hill of beans of difference whether this minister or another minister is in the chair, because we all get forgotten very soon.

[Page 366]

What does count, what is extremely important is that the services to our citizens that we have been fortunate enough to be elected to represent for however brief or however long a period of time, that they get the services that they and their families need and deserve. The minister knows this. I suggest that the Cobequid Multi-Service Centre is an essential service.

The current facility is on Memory Lane. I don't know if the minister knows why it was called Memory Lane, but people refer to it as Memory Lane because that is where the old liquor store used to be. The Cobequid Multi-Service Centre used to be a liquor store. I even know why the fence is there, it was there to stop the people who were coming off the highway from running over into the liquor store on their way home to get something. Mr. Chairman, I don't know if the Minister of Transportation and Public Works is saying he used to run across or not, but I can tell you, I did, once or twice, back in those days. It was on Memory Lane. The fence certainly put a stop to that. That was converted into the Cobequid Multi-Service Centre, and then it was expanded.

The minister knows that there are serious problems with the building, structurally, safety, and he also knows that it can't begin to provide the proper level of services, as they are growing, in that cramped space. I want to thank the minister, and just say that I hope that the ribbon-cutting, whether it benefits you or benefits me politically, or whoever, who cares. I just hope that the ribbon-cutting happens before the next election.

MR. MUIR: I just want to confirm what the honourable member said. Clearly, the recognition of the Cobequid Multi-Service Centre is as an integral part, it delivers. As the honourable member would know, I was out there and visited, and personally I was quite impressed, very impressed with the model that is presently out there. That is one of the reasons, to be quite frank - well, it was the only reason, I guess you could say - that we felt that was a priority, to improve and modernize that centre. As the honourable member knows, the projection over three years is it is about a $20 million project.

As my colleague, the member for Bedford-Fall River would know too, who obviously supports that, the community is expected to contribute about $5 million to that. I don't know where the fundraising stands at this particular time. If the community wanted to contribute a little bit more than that, we would welcome that too. Obviously, the Department of Health has about a $15 million commitment in this. We look forward to the further establishment of that. It does provide a good service in that area, and we think it is a model that could be looked at elsewhere in the province.

MR. CHAIRMAN: The honourable Leader of the Opposition.

MR. DARRELL DEXTER: Mr. Chairman, I want to thank the member for Sackville-Cobequid as well, for the trip down Memory Lane, literally. Whenever he speaks he always enlightens this Chamber. I know the minister benefits greatly from his experience in the

[Page 367]

House, and we are certainly grateful on this side for his prodigious contribution to the House of Assembly.

Mr. Chairman, my question for the Minister of Health really has to do with one of the problems with this particular set of budget estimates, and that is that it is very difficult to compare this data with what happened last year. If he wouldn't mind, in the Supplementary Detail, going to Page 15.6, this is the page on which Mental Health Services are detailed. You will see there are three line items there: Administration, Mental Health Adult Services and Mental Health Children's Services. There are significant changes in the line items.

For example, Mental Health Children's Services is listed as going from $93,900 to $256,000. I wonder if you could just explain what is going on in those line items, because Adult Mental Health Services goes from $604,000 to $541,000; then, Administration goes up to $254,000. There are significant changes in the way that those figures are being presented, and I don't entirely understand what that means for the delivery of that service, if the minister could tell us.

MR. MUIR: Mr. Chairman, in regard to the numbers that the honourable member is referring to, the Administration, which went from zip to $255,000, was simply a reallocation. The money is now, basically, targeted as mental health administration, before it was included in a broader administration category. Although there is additional money for mental health, you can't look at that as just straight new money.

The particular one, from $94,000 to about $257,000, as the honourable member perhaps knows, we have a CAYAC initiative underway, which is targeting children, the mental health of children, and children and youth in conjunction with the Departments of Community Services and Justice, and it reflects that project.

MR. DEXTER: The assumption in that is that the amount for adult services has not changed. I don't know that to be the fact, but because he didn't mention it, I am assuming it didn't change, but he can tell me if it did. This initiative, the CAYAC initiative, was something that was mentioned earlier today by the minister, and I wonder if he might explain a little bit more about that initiative so that we know if it is new programming or if it is the consolidation of programming that already exists. If it is new programming, what are we expecting to see in it?

MR. MUIR: Mr. Chairman, just before I get into the CAYAC initiative, basically the $604,000 to $541,000, those are administrative costs; these three numbers are for administration, they are not for the programming. This strictly refers to administration reduction. The programming figures appear elsewhere. One of the difficulties that we have had over the past number of years in dealing with child and adolescent mental health, it has been all over the map, to be quite frank. Although people have received service, and in some cases quality service, the point was that it was not a coordinated delivery service. We had

[Page 368]

some programs in our department, the honourable Minister of Community Services had programs in his department, and because of the role of the justice system, sometimes with young people, Justice was also thrown into this hopper.

What the CAYAC project is is an attempt to come up with a coordinated, concentrated and, I guess, a rational approach to the delivery of mental health services to children and youth here in the province. To be quite frank, the services were fragmented and not interrelated in all of those things, and I think my colleague, the Minister of Community Services may be able to add to that when he stands.

MR. DEXTER: I guess this is part of the difficulty you have, because it must be difficult to draw lines around which dollars are kind of general administration of the department, which lines fall into this category of Administration that is under the broad heading of Mental Health Services, and then sub-lines on that which just say Mental Health Adult Services, which is, apparently, a different kind of administration. Maybe there is a perfectly plausible explanation for it, but generally speaking administrative costs are administrative costs. Perhaps the minister could just let me know why it is the administrative costs are broken out that way.

MR. MUIR: The budget for the delivery of the mental health programs is really with the district health authorities. What you see here reflects the actual dollars that are in the Joseph Howe building, primarily, and that is one of the major differences. I just want to go back to my previous question, because I was reminded by the associate deputy minister that with this CAYAC project, we had the Bland Report on Mental Health Services, and it is going to make some recommendations on how best to implement those things which ought to be implemented which were contained in the Bland Report.

MR. DEXTER: Mr. Chairman, I am going to be sharing my time with the member for Dartmouth North, so I am going to leave that for now and perhaps I will go back to it at a later time. I did have a couple of other questions, before that member gets to his feet, around an institution that is very important to the member for Dartmouth North and to myself as a representative of Dartmouth-Cole Harbour and, I am sure, to the Chairman as well, and that is the Dartmouth General Hospital.

I think there is generally a well-held belief that the role of the Dartmouth General Hospital is changing in very significant ways and has been over the last number of years, perhaps starting with some of the initiatives in 1994 and, again, now with the investment in the expanded emergency facility at the DGH. I guess, as with any change, the change makes people uncomfortable because it means that there are services that are going to be taken out of the institution and new ones will be added, and the delivery to the community will change. People are often skeptical as to whether or not that is actually for the greater good of the community.

[Page 369]

I wonder, could the minister indicate whether or not there are going to be significant changes in the services delivered by the Dartmouth General Hospital over the coming year, or is there a long-term plan for the change in the role of the Dartmouth General Hospital?

MR. MUIR: Mr. Chairman, interesting question, interesting in two ways. I guess one of the ways, positively, is, as you know, with the expansion of the outpatient and the emergency departments there is clearly an enhanced service. The other answer to that, and I don't have the history that either of you folks do or the member for Dartmouth East or the member for Dartmouth South with the hospital, when you say you see a change, that doesn't really mean a whole lot to me. I don't think the delivery system has changed. The services that are being offered there this year, I expect, are very similar to what was offered there last year, hopefully in a more efficient fashion, and that is not to criticize, it is just that we hope that it is.

One of the things that the honourable member would be aware of is that the Dartmouth General Hospital is part of the Capital District Health Authority and the long-term plans for any facility that is in that authority would be made by the authority. We are not directing that.

[1:00 p.m.]

One thing I can tell you that was interesting, and I will just pass this on for information, where I was yesterday and we were talking about cancer care, we were talking about mammography and whatnot, and for what it is worth, they were talking about mammography at the Dartmouth General Hospital and the fact that there is no waiting list over there which was an interesting thing to me. The reason I say that is that it seems to me in the Capital District Health Authority, one of the things they are going to have to work out is that people can come across the bridge this way, but going back the other way hasn't always worked that way.

MR. DEXTER: I want to thank the Minister of Health for that answer to the extent that it is an answer because what he is really saying is you have to wait and see what the Capital District Health Authority is going to do. I can assure him that the years that I spent on the Dartmouth General Hospital Commission, I saw, even in the few years that I was there, a change and, you know, not necessarily one that had a negative effect on the institution, it was just a change and certainly the expansion, an investment in the expanded emergency services unit is a good one. For a long time we were dealing with very difficult times in that emergency room. There was always a feeling that something had to be done in order to accommodate the actual numbers that were coming into that facility.

I am pleased to see that that is happening, but I guess the suspicion is that the hospital is being turned into essentially a triage unit, you know, where people come in there, they get their emergency treatment and they are held long enough for transport out of there. It is not

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really being treated like a community hospital which is what it is. We see the number of long-term care beds at the Dartmouth General Hospital become institutionalized virtually and that changes the complexion of the institution. That really is just for the information of the minister and I am now going to just turn this over to the member for Dartmouth North.

MR. CHAIRMAN: The honourable member for Dartmouth North.

MR. JERRY PYE: Mr. Chairman, when the minister was speaking with respect to the drugs, Aricept and Exelon with respect to persons with Alzheimer's, I was somewhat puzzled because he was speaking to the member for Dartmouth East at the particular time and he indicated that somehow there had been some survey, or research, or data, or information that implied that in only 30 per cent of those who, in fact, had used these drugs were effective on. I would say to the minister, according to the Alzheimer's Society of Nova Scotia, there are some 7,000 persons afflicted with the disease of Alzheimer's in Nova Scotia and if, in fact, only 30 per cent of that 7,000, it would result in the number of 2,100 persons who might very well benefit and not only that, it would ease the pressures on the caregivers of those individuals, often parents and often spouses of those individuals who are suffering from Alzheimer's.

So I am wondering, Mr. Chairman, through you to the minister, if the minister can clarify his position with respect to those kind of comments?

MR. MUIR: Mr. Chairman, I indicated that the evidence that was presented to the pharmaceutical formula review committee in its opinion was not strong enough to recommend the placement of Aricept or Exelon on the approved formulary. Some of the research, and I don't know the research in detail and this kind of comes out in the manufacturing, probably a note that I had seen, is that there was some suggestion that it may be - not is - may be effective, and I think they said in 30 per cent of those who would be considered mild to moderate. That is not 30 per cent of the people, okay, but that is a claim, as I understand, that is said by the manufacturer based on studies and it would be such studies that would be reviewed by the formulary committee.

MR. PYE: Mr. Chairman, we do know that there are varying degrees of degenerative disease with respect to persons with Alzheimer's. I am just wondering, Mr. Chairman, through you to the minister, if in fact the pharmaceutical formula review committee has done some research and some of the evidence that has gone before the pharmaceutical formula review committee, if in fact we recognize that there are differing degrees of disability within the Alzheimer's patients, then I am wondering if that committee has looked at some kind of a means test, or some sort of a test that would allow those individuals who have mild cases of Alzheimer's being recipients of the drug Aricept or Exelon?

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MR. MUIR: Mr. Chairman, the formulary review committee operates basically at arm's length from the minister. I guess you could say they do conduct their business in private and I can't answer that question because I don't get reports of what they are doing there.

MR. PYE: Mr. Chairman, when does the role of the Minister of Health come in then with respect to the authorization of drugs for persons who are afflicted with disease, not only Alzheimer's, but other diseases such as epilepsy, cancer and so on? When, as Minister of Health, and where does your role come in with respect to the authorization of drugs?

MR. MUIR: Mr. Chairman, we were actually discussing what the appropriate answer to that question was. One of the reasons that the formulary review is set up where it is, is so it is not subjected to political influence and I think the honourable member knew that. The matter of health is not a matter of politics. It is a matter of what is the best treatment, in this case the best pharmaceutical treatment, and the committee that makes those decisions, I think, is an excellent committee. I guess if the honourable member wants to know what studies they have reviewed, I may be able to get that information for him, but they don't report that to me.

What they would do, Mr. Chairman, is that in the course of a year - I think we have got about 3,500 things on that formulary - there would be more things added than were taken off, but basically it went okay. One of the things that you could appreciate is that where possible, we are in the business of the cheapest drug that does the job and that is the case. So when the patents run out on some of these patented drugs and, obviously, if there is a knock-off that becomes available that does the job just as well, you know, then that is the one that is prescribed. So part of the activities of that formulary committee is to review that type of thing as well as to make decisions about whether something, or a class of drugs, should be added and for whom.

He asked whether that committee would make a decision to say, well, we should pay part of a particular drug. In this case, I think he is referring to the Alzheimer's drugs. What the committee has recommended is that they not be added to formulary, therefore, the business of whether to partially pay or wholly pay is really not an issue.

MR. PYE: Mr. Chairman, I think it is unfortunate, even if it were to benefit some 30 per cent of Nova Scotians who are afflicted with the disease of Alzheimer's.

Last evening when I was questioning the Minister of Health I was going to bring about a series of questions around small options homes for seniors and that was just before the moment of interruption and I didn't get the gist of some of the responses. If the minister will be so kind, I would like to go through that once again.

We know that the small options homes review that was completed by Dr. Kendrick did not include seniors because they just had been transferred to the Department of Health. The minister must surely be aware that many of the problems facing the small options homes

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systems for persons with mental health difficulties and persons under the age of 65 are the same problems that face small options homes for seniors. Those who are under 65 have had the benefit of having their small options systems thoroughly reviewed. There are recommendations put forward, the government has the opportunity to make real changes to the system, but unfortunately, seniors in small options homes will not benefit from that. My question to the minister is, why did the minister not include seniors small options homes in this review?

MR. MUIR: Mr. Chairman, the first response would be that the Department of Community Services set up the review, we did not. We are, however, working with the Department of Community Services to try to ensure that the service gap which the honourable member fears might occur does not occur. We will continue our co-operative efforts to see that service continues.

MR. PYE: I wonder, to the Minister of Health, if I can read from that, is his department planning on reviewing seniors small options homes?

MR. MUIR: We are currently doing that, Mr. Chairman. Indeed, we are visiting the individuals who are now responsible for programming delivered by the Department of Health. We are visiting them all and trying to assess if their needs are being met and what, if any, changes need to be done in our delivery system.

MR. PYE: Mr. Chairman, the minister will be aware that a few years back when the Standing Committee on Community Services toured the province, we had a stop in the Town of Truro. There were some seniors' problems with respect to that issue, as the minister is very much aware. Seniors were then covered under the Department of Community Services. There were many issues and I just want to name a few: the absence of enforceable standards, the inadequate supply of poor review processes and reviewing standards, and guidelines set out for small options homes. The minister happened to be in Opposition when that was going on and there were questions put forward to the then Minister of Community Services, Francene Cosman.

Now the Minister of Health has taken over the responsibilities of seniors - and we have heard this from Yarmouth through to Cape Breton - and is very much aware that there needs to be a resolve to this particular issue. So, I am wondering, if the minister is doing a review, is that minister including parts of these components in that review?

MR. MUIR: We, as I indicated, are visiting individuals who are in the seniors' options homes to ensure that their needs are being met. Secondly, we are reviewing these services on a long-term basis and in conjunction with that, or as part of that review, I think the honourable member will be pleased that we are about to enter a review of the Homes for Special Care Act. I think that is one of the elements of this whole thing that is probably going

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to have to be - I use the word modernized, for the lack of a better descriptor - reviewed to allow some of the changes which might be desirable to take place.

MR. PYE: Mr. Chairman, the minister is aware and I think it is still happening and the minister is sure to tell me, there had been a moratorium on small options homes. I believe that moratorium still is on small options homes. I guess there are a number of seniors on waiting lists to get into small options homes. I am wondering what the minister is planning to do with respect to the moratorium? Are you planning on lifting the moratorium if it is still there? And what are you doing for additional spaces in small options homes?

MR. MUIR: That review is ongoing, Mr. Chairman, and I was just consulting with my colleague. One of the things that will happen for seniors as part of that is they would be placed through the single entry process. They would be part of that, as well, in the small options home. Whether you are asking the question, are we adding new space or have we committed to new spaces, at this particular time we don't feel that we have sufficient information to go ahead with that so we are trying to get that information to find out exactly what needs to be done.

MR. PYE: Mr. Chairman, the minister hasn't responded as to whether the moratorium has been lifted on small options homes or not. I think the minister might have been remiss in bringing that response back to me. We have talked about the conditions, the guidelines with respect to small options homes for seniors. I am just wondering, as well, is the minister considering the licensing of small options homes?

MR. MUIR: As we review the Homes for Special Care Act, probably as a result of those deliberations, we will make a decision about what size or what capacity or what number of residents a facility would have, where it would be licensed. I think the honourable member is very concerned about standards for small options homes because that is sort of what created the kerfuffle in the first place. Clearly, we are in the process of examining and there will be standards in place for these homes. I think that should provide some comfort for him.

MR. PYE: It provides some comfort, Mr. Chairman, but it doesn't provide total comfort because if in fact the facilities are licensed, then there are guidelines that are set in and you can withdraw or pull the licence from the operators of small options homes if they are not doing the job or not complying with the legislation that is put forward or the regulations. That is a concern that the minister didn't answer - whether he is considering or would consider licensing small options homes. The other question to the minister, as well, if he responds to that one, is, I have been looking through the Health estimates, and I am trying to find out where the dollars are put aside for the budget of small options homes. I have had difficulty finding that. Could the minister bring those two questions forward? I would appreciate it.

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MR. MUIR: The issue of licensing, and you are making a pitch, I think, that anybody who has clients or residents should be licensed. That question will be considered as we review the Homes for Special Care Act. The other thing, the second question was where is the money for these small options homes, and you would find it on Page 15.28 of the Estimates, under Long Term Care Program.

MR. PYE: Mr. Chairman, I see it is all lumped here together, though. It is lumped under Long Term Care, Residential Care and Community Based Option facilities. I am just wondering if you could specifically spell out to me how much is placed with respect to small options homes?

MR. CHAIRMAN: Order, please. The time for that session is over.

The honourable member for Lunenburg West.

MR. DONALD DOWNE: Mr. Chairman, I appreciate the opportunity to enter into discussions in the House on estimates with regard to Health. The first comment I have to the minister is, Mr. Minister, since you have taken over as Minister of Health, and your government has taken over the government of the Province of Nova Scotia, I have tried to work with our Health people in my area of Bridgewater. I have gone and talked to the individuals, as I have in the past. I am being told that they don't want to talk to me any more; I am being told, I cannot discuss anything with you as a member of the government, on issues of health; and I am being told that if I have any questions to do with budgets or details, go talk to the minister or go talk to someone else, don't talk to them. They are scared they are going to lose their jobs.

I find that is such a regressive approach to health care in the Province of Nova Scotia, and the ability for members to access information. I have never seen it done before. I have had ambulance operators talk to me until finally I was told that they will not be able to talk to me again, because they have been told that if they talk to me about the issue of ambulance delivery in Bridgewater and the South Shore area, that person could very well lose their job. I am being told to leave it alone.

My very first question to you, Mr. Minister, is, what assurances are you going to give me in this House today that you will contact the health delivery people in my riding and tell them I can ask them anything I want, and that they have no worries that they will lose their jobs by allowing me to ask factual questions about information that pertains to the health delivery for the people in Lunenburg West?

MR. MUIR: Mr. Chairman, I would suspect that there is probably a procedure for getting information, not only for the honourable member for Lunenburg West but for basically anybody who cares. This is a matter of public information. To say that they are shutting you out, I am very surprised. It is a locally-run board. I would actually have some difficulty

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believing that. On the other hand, the way that government operated before was with a lot of political interference, and it may be that they just see it as a carry-on from the former government, where there was a lot of political interference and they are tired of it. (Interruptions)

MR. DOWNE: Mr. Minister, if you are insinuating that I have had political interference or I am providing political interference in the health care system, then you prove it. You prove it, Mr. Minister. What I will say to you, Mr. Minister, is I find it very frustrating because staff are scared to talk about normal, run-of-the-day operations with me. I want to know from you, because we will have transcripts from this, what assurances are you going to give this House or me in this House today so that I can go back to my people and I can show them that they have no worries whatsoever in confiding or answering questions pertaining to the health delivery system in my constituency as it pertains to the health and the well-being of the people of Lunenburg West? What assurances do you have for me to give to them, that I can have that information?

MR. MUIR: There is probably an appropriate channel to get most information. I don't know, certainly my office hasn't given any directive not to talk to the honourable member. If he has specific things, we could draw it to the attention of the people down there. I really don't know what he is talking about. Certainly, I haven't heard it in any other section of the province. I have some difficulty believing that it would be widespread. I am not saying that some person might not want to talk to you or may think that the question you have asked is inappropriate, because there are certain matters, to be quite frank, that aren't a matter for the MLA.

MR. DOWNE: The minister is skating around the issue. He knows darn well what I am talking about. I am disappointed. I had hoped that the minister would have said, as an honourable member of this House the member for Lunenburg West has my assurance that I would support him asking obviously fair questions - I am not asking for information that I shouldn't receive, information that is not my business, I have never done that - on a normal, run-of-the-day basis, how are things going, how is this thing going to affect our area, is our bed utilization right, whatever information is fair and straightforward.

The minister knows, as sarcastic as he wants to be and as arrogant as he wants to be in this House, he knows darn well that I am just asking for basic information. He is afraid to give that assurance. I can tell you something else, Mr. Minister, it is not just myself, even the local media is saying the staff is scared to death to talk about anything to do with health for fear that the head office in Halifax or somebody is going to go after them and take them out. Whether that is perceived or factual, you have a problem there, Mr. Minister. I would hope that as a Minister of the Crown you would try to alleviate that problem in Nova Scotia and in Lunenburg West. You know, the Brenda Montgomery letter is a prime example.

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I am serious when I ask this question. I really want that resolved, Mr. Minister. I would like to be able to feel that the staff shouldn't feel nervous or whatever when talking about basic health care type of questions without worrying and being scared that if I ever said anything they could lose their jobs. There is that nervousness out there, whether you believe it or not, I will take you down to my riding, I invite you down to my riding, I invite you to talk to the people, and I will make sure they don't get threatened with their jobs in that particular instance, and we will see just what is going on. That is a reality, Mr. Minister, and I would hope that in the secrecy of this re-evaluation that you are doing within health care that you will try to fix that problem.

Mr. Minister, I want to talk a little bit about mental health in the South Shore. I brought this issue up before in the House, I brought it to your attention during the last sitting of the House, that in the South Shore, I believe we are supposed to have somewhere around five to seven people, somewhere in that vicinity, to look after mental health. The last I heard, there was 0.2 of one person, because of the fact that people were leaving and so on and so forth, 0.2 of one person for mental health down on the South Shore. In fact, I have understood that they hired back Dr. Milligan, who had just retired. They hired her back on because of the shortage. I realize that people go on, people move, whatever the situations are, but that problem is so critical, it is a serious issue, and I know you agreed with that before. It is a serious issue. I don't know how it is in other areas of the Province of Nova Scotia, but having the proper complement of professionals dealing with mental health, is a serious, serious concern.

[1:30 p.m.]

I understand at one point the response came back that what we are going to do is tele-health or we will videotape them and we will do a video conference analysis. Well not everybody is suitable for that, especially dealing in mental health. Not everybody would cotton-up to that idea. Some people might be intimidated by that. In some people it might create more anguish, frustration and worry. So my concern, Mr. Minister, is what are we doing in this province and what are you doing, specifically, in the province to alleviate the shortage of professionals in dealing with mental health - I will ask specifically and I will be a little parochial here - in the South Shore?

MR. MUIR: Mr. Chairman, the honourable member is correct, unfortunately. I say unfortunately not that (Interruption) However, what he is talking about is something that we are wrestling with right across the province, particularly with the availability of trained psychiatrists. Specifically, I believe, this is the health professional that the honourable member is referring to. We have enhanced our recruitment efforts. In addition to that, I am pleased that the person who was there agreed to go back, that is good because that increases the service in that area. In the case of Bridgewater, what we are trying to do, and had some success, not as much as we would like, is to encourage people who are located in the metro

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area to spend a day or so or a day or two a week in Bridgewater to try to get the service down there.

I am confident that the psychiatric program is being built up at Dalhousie University. I indicated to the honourable member that the new forensic facility is going to perhaps be something that will help attract people to study here and if we can get people to study here, hopefully they will stay here. I acknowledge with regret, Mr. Chairman, that we don't have a full complement of psychiatrists there, nor do we in Truro, nor Amherst, nor Yarmouth, New Glasgow or Antigonish or Sydney - no Sydney, I guess we do - nor in Inverness. (Interruption)We have them up in the Sydney area, but not in the Inverness area, so.

MR. DOWNE: Mr. Chairman, I appreciate the comments by the minister, but you know what? The bottom line is that this problem isn't going to go away until we find the ability for you to bring specialists to the Province of Nova Scotia. This recruitment problem is an acute problem. It is becoming a critical problem in health delivery, whether it is doctors in Cape Breton or whether it is professionals in the mental health delivery system, we have a serious problem. I know your colleague in Cabinet, whose brother is very much familiar with the health delivery system in my area, would agree that we need a major front in health care to go after and recruit people to deal with some of these very serious issues.

I want to say to you, Mr. Minister, I haven't seen anything other than your words to say that we are trying. Well, you know, 0.2 of one person for the South Shore is not acceptable and 1.2 persons out of a complement of 5 or 6 or 7, the requirement that is there, is not acceptable. It is a crisis. You know the sad part about it is that families are affected by this. Families are abused by this situation and it becomes even a bigger problem for communities and for Community Services and for the health and well-being of our local area. So I want to impress upon you, Mr. Minister, that you wanted this job, you wanted to be Minister of Health, you wanted to be the government. You wanted to take over the power of the Province of Nova Scotia. Well you have it, now you fix it because you promised Nova Scotians you could, you would and you would do it for $46 million. There is no other excuse than saying, I am trying. Well, that is not good enough. People want results.

I remember you standing on this side of the House, Mr. Minister, demanding results. Well I, too, can stand here and demand results. I know that you will take that seriously and try to deal with it. But I tell you, we need that help, seriously. We need that help. Mr. Minister, I would like to see what your plan really will be in regard to recruitment programs for mental health.

I want to move on, Mr. Minister, to another area that is very important and that is it has been brought to my attention recently that individuals who are going in the hospital for surgery, an amputation of a limb, historically they have had the prosthesis dealt with in the Valley. That is where they would do the surgery or that is where the specialists were that would do the fittings and so on and so forth. Normally, it would take, I think it was

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somewhere around four months or whatever. There is a certain recovery time after the surgery and then the individual would be taken to the specialist. They would be fitted with a prosthesis and they would go on and learn how to operate and go through the therapy with that.

It has been brought to my attention that there is a major backlog in having people looked after on the issues of being fitted for their prosthesis. I understand that the reason there is a backlog is because you don't have enough staff to look after the individuals who are going for surgery. You have a shortage of staff and specialists when it comes to dealing with prosthesis, the fitting and so on and so forth. In fact, some patients are being told - I hope you are listening to this - to go to New Brunswick because there is a private care facility in New Brunswick, I think it is in Moncton. Go there because they can look after you. We don't have the staff here to look after the patients in my riding. I have patients in my riding who have gone through a great deal of trauma.

It is a substantial trauma losing a limb. It is even more of a trauma when you are told by specialists, this is the road map that you will take in that process and here is how long you will have to wait before you are fitted. This is what the road map looks like. Well, that road map has come and gone and these individuals have waited for months to be fitted for proper care and they are not. My question to you, Mr. Minister is, can you enlighten this House as to why there is that shortage, how short a number of specialists that we have for that, and when are we going to be able to have that problem resolved?

MR. MUIR: Mr. Chairman, the honourable member raises some items that I can't give him an answer to. First of all, I didn't know you had a prosthesis fitter down in your area.

MR. DOWNE: In the Valley.

MR. MUIR: I am sorry, in the Valley. Well, that would make sense because they have the orthopaedic people and higher surgery. I will look into that. I do know that there is, again, somewhat of a national shortage in terms of people who are experts in prothesis fitting. I can tell you that in the period of time that I have been in the office of Health Minister, I believe I have received one letter of concern about a delay, but it wasn't the period of time; from the letter that I received, it seemed to me that there was some miscommunication tossed into the hopper too. So I will have to take that under advisement.

MR. DOWNE: Mr. Minister, there is no miscommunication from the people in my riding. I ask you to come down and I will bring those people to your attention while we are talking about health issues in my riding. I will bring them to you and you can talk to them and hear about the problem first-hand, as I have in my riding, about their very serious frustration.

It is pretty difficult, you know, when you have somebody in your office, a husband and a wife, and the wife had lost a leg. She starts crying in your office, and I am telling you

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seriously, you laugh at it, Mr. Minister, I am not laughing a bit. They start crying in my office because they have been told one thing and they are having a hard time coping. They don't feel they are being treated one bit fair in regard to the time frame and they go back to the specialist. The specialists are frustrated because they didn't know that there is going to be those shortages there. Mr. Minister, I will bring that person to you. Now I understand that that individual has been looked after.

There is another person in my riding who has had the same problem. It is a real serious problem and I am surprised you haven't been aware of that before, but I would be happy to invite you to my riding. We will talk to those people and I can explain the situation to you but, more importantly, you know you have a shortage of staff in the Kentville area, in the hospital there. That is what I was referring to earlier, that is where they specialize in that area, you have a shortage as I understand it. You know there is a national shortage. Well, there might be a national shortage, Mr. Minister, but you have a shortage of doctors and you keep saying we have got this recruitment program out there, but you still have a shortage.

You have got a shortage of individuals for mental health. We have talked about that now for a year and, oh, there is a big problem with shortages, yes, you know, you talk about it, but that problem still exists in my riding. We have a problem with individuals in the Valley, who are dealing with prosthesis. There is a shortage of those specialists. There is a national shortage. Well, there isn't a shortage in Moncton, New Brunswick, in a private sector, in a private clinic. They have got them there. I will let your deputy explain to you. I am just saying in New Brunswick there is the private sector clinic that has a specialist and your people are suggesting to the people of Nova Scotia that they should go there. I am saying that is wrong.

Your specialists, or anybody, shouldn't be telling our people to go to a private clinic. We should be able to provide that service right here and your deputy is right. If I could read her lips correctly there when she was whispering in your ear, that it is a two-tier system that they have in New Brunswick, unless you're looking at going to a two-tier system, I don't know. Maybe you are going to, you know, freeze frame the system so much now that you are going to be bringing in a two-tier system because you just cannot handle the fact that you have got to hire those people, but that is your job. That is what you asked for. You went knocking on every door in Truro begging for this job, to be in power. Well, you are in power now. Fix the problem. That is your job, Mr. Minister, to provide health care delivery to Nova Scotians. That is your job - to provide health care throughout all Nova Scotia. That is your job and you are not doing it.

Mr. Minister, I don't want to take all my time up. I have my colleagues back here who are wanting to get at some of these issues and I want to talk about another shortage and that is in nursing homes. We have a problem in Lunenburg County. Mr. Minister, I have brought this to your attention a whole bunch of times. What I understand is we have been studying this issue of facilities for individuals in long-term care needs, principally Level 2 care and there is an acute problem in my area. We have a problem in my area. We need beds built in the

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Rosedale Home for Special Care, the Minister of Justice's riding. I don't mind lobbying for him if he is afraid to lobby for it. I don't mind standing up and fighting for the good people of the constituency of Lunenburg because I know it is needed. (Interruption) I am also prepared to fight for Lunenburg West where I live and Hillside Pines needs those facilities.

This has been studied, as I understand, it has been studied in spades. The good Minister of Justice will appreciate my lobbying on his behalf. I don't know if I constitute part of this lobbyist regulation, I don't know if I am going to get fined $25,000 for lobbying on the floor of the Legislative Assembly for the minister or not, but if I am, we (Interruption) Yes, exactly, tobacco, but anyway that is a serious problem.

I read with interest when you talked about the single entry system and how well that system has worked in Cape Breton. They had a backlog of hundreds of people and now they hardly have any, if I recall correctly, and it is because people had their name everywhere in fear that they won't get into any location at all. Well, I don't know, the single entry system sounds good and I hope it works as good as it sounds. I trust what you have said as being accurate, Mr. Minister. Pardon me? (Interruption)

I trust you, Mr. Minister, I trust what you are saying on that issue is accurate, but the single entry system, I think, will also show you in my riding that there is a need, there is a huge need. The reality is that I would like to hear first before I get into another question on that, I would like to hear, Mr. Minister, if you would inform me as to what the status is and how much longer we are going to have to wait for Level 2 long-term care facility beds in the Rosedale Home for Special Care and Hillside Pines?

MR. MUIR: Let me begin by just going back a little bit in history to remind the honourable member for Lunenburg West that it was his government that put the moratorium on the building of long-term beds, not this government. Back in 1993 he was a member of the government that stopped construction. The unfortunate part of that was, Mr. Chairman, and I can understand why they did, they found themselves in money trouble and one of the things they felt they could not afford was to go ahead with capital construction and similarly during that period of time and probably fairly appropriately so, you reduced the number of acute care beds significantly. As a matter of fact, I think you probably took about 40 per cent of those beds out of the system.

The difficulty having done that, Mr. Chairman, you know, nobody liked it, I didn't like it and I complained about it as much as anybody else did in this thing, but the fact is that if that was to be done, there had to be some other steps put in place. This is where the failing was. I recognize that there were some things that people didn't like that had to be done and that is the way it was and although I have been critical in other situations, sitting where I am now, I have a slightly different perspective. But the fact is that the thing like the single entry access, I mean that was around for years and that should have been brought in as part of that

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reduction to go towards that thing, the expansion of home care and things like this. This was not done.

The member for Dartmouth North talked about small options homes and seniors. It is not basically what they did that was the problem, it was what they didn't do and, of course, we were faced when we came into government with trying to do those things to get this system functioning. After our last conversation about Rosedale, I do understand this, I did have a talk with my staff and we do recognize that the number of beds per 1,000 in that particular district is less than the provincial average.

Now, whether that is a good thing, or whether that is an appropriate number of beds, or not an appropriate number of beds, I really don't know, but I can tell the honourable member that we are taking a look at that because my colleague, the honourable member for Lunenburg, also occasionally mentions that to me in rather forceful terms, this is something that that has been drawn to my attention. And if you want to go look further down the shore, I have my friend, the honourable member for Shelburne, who has reminded me in a number of cases and then I can go down a little bit further and my friend, the honourable member for Yarmouth and I can go around to my friend over there in Digby and so on. I mean this is something I think the honourable member will appreciate that we have to get a plan on. You just can't do the one-offs and that is the way this province operated for too long, was the one-off business.

We are taking a look at your needs down there, I can tell the honourable member that. I appreciate that and I have listened to what he has said and the concerns he has articulated. I have heard them from others who actually support what you say, from our side of the House, and I don't like to admit that, but it means that on occasion there might be at least something that you say that is worth taking a look at, but we can't get into the one-off business. We have to get a plan and that is what we are in the process of doing. We are doing a long-term care infrastructure inventory trying to bring together, so we have the information to make appropriate decisions.

The honourable member would know this and the member for Dartmouth East would support this. One of the difficulties that we have is that some of the nursing homes or long-term care facilities, there were people in there who didn't have to be in there. I mean, you know that. So we think we have got some sort of control on admissions now which is going to help this problem, but if we address this and, to be quite frank, I hope that we will be in a position, I would sooner find out that there is not the need down there, but if there is the need, I want to assure the honourable member we will do everything in our power to address it.

MR. DOWNE: Mr. Minister, I appreciate your comments. I note, I was listening and you mentioned the Rosedale Home For Special Care and every other area on the South Shore. I didn't hear Hillside Pines.

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MR. MUIR: I will throw that into the hopper.

MR. DOWNE: What is that?

AN HON. MEMBER: Hillside Pines.

MR. DOWNE: Good. I just wanted to have it on the record, Hillside Pines. (Interruption) No, no, I knew you wouldn't be deliberate about that, but I will say, Mr. Minister, it is an issue and I will continue to bring it forward. I appreciate your colleagues around you agreeing with the need. So the bottom line is that we are all speaking on the same serious note with regard to the need that is there.

I won't go back to all the comments about what happened in 1993, but I will say that after the Buchanan era we had an operating deficit of roughly $1.8 billion; a one year deficit of $1.8 billion. I think when you realize that, Mr. Minister, you know, that is a huge amount of money. I think that the battle to conquer that Buchanan era is going to take some time. In fact, when Buchanan took over, the total debt of the Province of Nova Scotia was approximately $500 million and when he left, I think it was somewhere close to $8 billion to $9 billion. Just recently, after LeBlanc, one year in LeBlanc's ministry, you got $1.3 billion more on that. I think if you want to look in the rear-view mirror, Mr. Minister, I would be happy to look in the mirror with you and I will compare notes with you any single day of the week if you want to go in that game.

Mr. Minister, I want to go into the single-entry system. Are you putting the single-entry system on hold or why isn't it coming forward immediately in my area to deal with the problems that we just finished talking about?

MR. MUIR: We are in the process of rolling that out. It may not be up and running in your area, but it will be hopefully before too long, Mr. Chairman. We allocated $1.5 million to roll that out province-wide.

MR. DOWNE: It was supposed to be April 1st, Mr. Minister, and when you say very shortly, could you give me the month and the year that you are talking about?

MR. MUIR: We indicated, Mr. Chairman, that we would begin the rollout province-wide on April 1st and we have done that. I can't give you a fixed date for the full rollout in your area, the DHA that is in your area. We will have that date within a couple of weeks.

MR. DOWNE: Mr. Minister, I would appreciate that because I think you are not going to roll it out at all for another year, but we will wait and see. In a couple of weeks I would be happy to hear that. I see the deputy smiling and so, obviously, she is hoping that it is going to be done very quickly or she wouldn't be smiling. She would probably be concerned if I said that statement. So I am happy to hear that.

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I want to move on to the nursing program and I want to compliment the government for following another Liberal initiative and the former Minister of Health who is here, who did an excellent job of trying to work towards providing a health care delivery system that will be sustainable, that will be predictable, that will be dependable, and I note with interest that your government ran against that campaign and although you have spent $300 million more in health care since you have been in power and borrowed money, you still have yet to fix the problems that are there.

I think the budget when you took over was $1.52 billion and we are spending about $1.8-plus billion right now, but that aside, my question in regard to the nursing program, four of those initiatives were already started. The fifth initiative was one that you brought forward. I sent that program to some people in my riding, Mr. Minister, and they were very impressed with that. I want to say that to the staff, they were impressed with it. The question they came back to me with was the $300 for a cooperative education program for student nurses, how do they apply for that?

Mr. Minister, if I give you their name and their phone number, could you ask somebody from your staff to inform them about that process? They think it is a great opportunity. Their son is planning on going into the nursing profession and I compliment them for that, but they are very interested in knowing of any kind of assistance that they could have in assisting their son in following a career in a field that we are grossly short the number of nurses in the province. I will hand that to you later, Mr. Minister, but I understand that that program that was announced, the $300,000 for the co-op program, would help individuals get into that nursing field.

MR. MUIR: No, it is intended for students primarily in their third year and having completed the third year of the Bachelor of Nursing program, Mr. Chairman, to go out in the field and get more practical experience. This is what it is allocated for. In terms of providing that information, I don't have any difficulty in asking staff to do that, but I am kind of puzzled with requests because certainly that information would be readily available from the programs in which they are participating. That information is out there now.

Now, I just want to say the co-op program, which we think is very good, I noticed that when the member for Dartmouth East was on the floor asking questions yesterday he did indicate that he felt that the practical experience of nurses should be greater, that the current training program did not provide enough in-hospital, and I think actually he was talking about giving injections, that somebody had graduated from a program and had not given an injection for a year. He said they would be going back to the oranges again or something like that in starting out.

This program will help that, Mr. Chairman, but the other thing more importantly I think it will do, or just as importantly, it will give people an opportunity to practice in particular situations and evaluate whether they would like to go to work there. Secondly, it

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would also give those agencies the opportunity to say whether they would like to have these people come back. I can tell you, from one who did education and was involved in supervision of student teaching, that that type of situation provided a very valuable opportunity for people to have their skills and their personality known and quite often success in that type of situation was a key to success in procuring a job in a particular place in the future.

MR. DOWNE: Mr. Minister, I am going to close and allow my colleague, the honourable member for Richmond, to ask a few questions. If I came across a little strong in the beginning, it is not personal, it is just that health care is a major issue for my riding and for my community, and I want to say that the issues I brought forward are real to me, they are real to my constituency, and the issue of the handcuffing or shutting down the communication is an issue in my riding. I welcome you to my riding, Mr. Minister, I welcome you for a friendly visit.

[2:00 p.m.]

MR. MUIR: There is a Tory meeting next Friday night.

MR. DOWNE: A Tory meeting next Friday night; I think I have a Liberal meeting next Friday night as well, Mr. Minister, and if you want to spend the first couple of hours, I will spend the first couple of hours with you. You come into my Liberal riding meeting and we will have fun together. But it is an issue, Mr. Minister, and I hope you take it seriously because it is a serious issue and I do extend an invitation. I will arrange for people who are legitimately concerned to talk to you and meet with you. We all want to make this health care system better and I will work with you whatever way I can, but it is incumbent upon me to bring to your attention the serious problems that are there.

The first thing you have to open up is the ability for me to be able to communicate in a professional way on things that I should be responsible for and able to discuss with my people, and the people in my riding should not worry that somebody in Halifax is going to grab them by the throat and tell them to be quiet or they will lose their job. That should never happen in the health delivery system. Anyway, I wish a Happy Easter to the staff and to yourself, Mr. Minister.

MR. CHAIRMAN: The honourable member for Richmond.

MR. MICHEL SAMSON: Mr. Minister, as you are hopefully aware by now, it is going on about 110 days that there has been no doctor to cover the emergency room at the Strait-Richmond Hospital during the daytime. We all recognize that physician recruitment is a difficult issue. It is one, as I have said to the minister on a number of occasions, we faced back in 1998 and with the help of my good colleague, the minister at the time, the member for Dartmouth East, my colleagues, Charlie MacDonald, Ray White, and Hyland Fraser in the

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Strait, we fought together, with the communities, with the organizations, and not only did we get Dr. Thomas as a full-time doctor at the Strait-Richmond, I am happy to say we also got four additional family physicians for Richmond County.

The people of Richmond County, Inverness, Guysborough, who are all serviced from this hospital, have absolutely no idea why this government has waited this long to find a replacement physician, Mr. Chairman, not even a locum - for those who don't know what a locum is, it is a doctor who comes in and does a period of service on a short-term basis, a week, two weeks, a month - not even one locum has been sent down by the Department of Health to cover the Strait-Richmond Hospital. The people in the Strait have come to the clear conclusion that this minister has abandoned them. His department appears to have abandoned them and there is no sign that there are any efforts taking place.

I would like to ask the minister now - here is your opportunity, Mr. Minister, to tell the people of the Strait - why is there still no full-time doctor at the Strait-Richmond Hospital and why not even one locum has been sent in 115 days?

MR. MUIR: The honourable member raises a very important question about the delivery of service at the Strait-Richmond Hospital. I can tell you, Mr. Chairman, the fact that there has not been a locum there is not for the lack of trying on the part of the Department of Health, those people who are responsible for that. It is not positive, you know it is certainly more positive than it was, our department has been working with the community to try to find a solution which includes other physicians.

I think we are going to have a solution. It is not the solution we would all like, which is the addition of physicians at this particular time, but there is a solution that will see service provided to that facility and it is going to take a lot of cooperation among those in your community, the member for Richmond and Guysborough-Port Hawkesbury, the member there - it will serve his community, too - but we think we are approaching a solution that will work. It is not the ideal one, but it will work until we are able to get the bodies in there that are needed.

[Page 386]

MR. SAMSON: Mr. Chairman, I think I know what solution he is talking about and I am hoping he is going to tell us because the people of the Strait don't want to wait any more, Mr. Minister, and platitudes just aren't going to work. If there is a solution there, we want to know what it is.

On January 9th, if I am not mistaken, the chief of staff at the Strait-Richmond Hospital, Dr. Ben Boucher, on behalf of the doctors throughout that catchment area that provided service to the Strait-Richmond Hospital, sent in a proposal to Derek Dinham in the Department of Health and to the minister as to whether they could work on a fee-for-service basis so that local physicians could provide daytime coverage, in the meantime that the Department of Health could find a full-time replacement. They came forward with that initiative and I commend them for that and I commend them for the service that they have provided, because they were there in 1998 and fought with us to bring in Dr. Thomas and to bring in more family physicians.

They waited almost three months without even having the dignity of a response from the Department of Health to their proposal. It took another letter from Dr. Boucher, in March I believe, written to myself, the honourable minister from Inverness, and the honourable member for Guysborough-Port Hawkesbury, pleading that the Department of Health at least give them a response to their proposal, open the discussions, and why would the department not talk to them with the proposal they had put forward? Could the minister explain today, not only to those doctors, but to the entire community affected by this, why your department, for almost three months, would not even dignify this proposal with a response?

MR. MUIR: If that occurred, Mr. Chairman, it should not have occurred, the fact that there was no response forthcoming for three months. I just wonder, I know that our staff was meeting with representatives of that community on a number of occasions, an ongoing dialogue, and perhaps the reason that a letter did not come back is that, you know the dialogue was continuing among those who were affected. I don't know if that is an answer or not, but three months should not be three months.

MR. SAMSON: Well, I can tell you, Mr. Minister, and you can verify to your department, I can table the letters here. Unfortunately, they are in my constituency office, they are not here, and it is unfortunate that the members for Inverness and Guysborough-Port Hawkesbury would not have brought this to your attention. A meeting was held, I believe a week and a half ago, with the Eastern Regional Health Board with representatives from your department. That was the first time that there was a face-to-face meeting on that proposal sent in on January 9th.

Mr. Minister, with all due respect, I know you have a big department, I know they are very busy, and I know there are many issues facing it, but for the people of the Strait area that is an absolute disgrace; it is an insult and it is incompetence. As far as I am concerned, it is an intentional slight against the people of the Strait. Three months, knowing that there was

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not a doctor at this hospital, with local physicians putting a proposal, which still put them at a disadvantage economically but trying to address the problems the community was facing, three months, with no response from your staff - that is an absolute disgrace. One can only hope that you will give your staff direction now that you personally will take the lead on this and if there is that proposal, if that is the solution you are referring to then, by God, act on it now. Don't wait any longer. Get that agreement in place and get a daytime physician at that hospital before there is a serious emergency and there is a death that is caused because of your government's inability to address that situation.

Mr. Chairman, the minister has been quick to point out that the recruitment numbers are great in this province, we have the best system in the world. Mr. Minister, how many doctors did your government recruit in 1999 to this province, in the year 2000, and how many have you recruited to date in the year 2001?

MR. MUIR: Mr. Chairman, in 1997 there were 1,853 physicians in total in Nova Scotia which was a net increase of 95 over 1996; in 1998 there were 1,900 physicians in total which is an increase of 48 over 1997; in 1999 there was a number of 1,934 which was a net increase of about 34 or 35; in the year 2000 there were 1,962 physicians which was a net increase of 28 physicians. What we are talking about here is net increase. You see the number is increasing each year. This does not really answer your questions about the number recruited because there would have been doctors left at the same time.

MR. SAMSON: Mr. Chairman, how many have been recruited to the Province of Nova Scotia since January 1, 2001?

MR. MUIR: Mr. Chairman, the last number that I had was 15. I will update that for you.

MR. SAMSON: Mr. Minister, how many have left the Province of Nova Scotia since January 1, 2001, that you are aware of?

MR. MUIR: That information is perhaps not quite as readily available. We will get it for you but, as you may know, the College of Physicians and Surgeons, sometimes these people hang on to their licences and what they do is they go on and off the register and I get a periodical report of who was added to that register and who was taken away from it. We will get that information for you, but I don't have it at my fingertips.

MR. SAMSON: Mr. Minister, like every other Nova Scotian, I can list you four. There was the liver specialist who left the province, we have the pediatric specialist who left the IWK and we have two from Inverness now, so there are four right off the bat who I can name, and I would go so far as to say there are probably many more than that.

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The whole message, Mr. Minister, the platitudes that you give to Nova Scotians to sit back, and say our recruitment numbers are great, we have the best numbers in the country, well they are not second-best. Even if we are number one, I can tell you, today, on behalf of the people in my county, that they are not good enough. They are not good enough, so therefore, for the minister to stand here each day when he is asked questions and say we have the best numbers, that is not good enough. Therefore, I ask you, knowing that there are still deficiencies, Mr. Frank Peters we know is the provincial recruiter, a very busy man, since you have taken office and in light of the problems of the Strait-Richmond and other communities, what additional resources have been put in manpower and financing to work on physician recruitment in this province?

MR. MUIR: Mr. Chairman, the honourable member will go back into Question Period today where I was asked a question about physician recruitment and one of the things that I said is that we have been extremely successful in Nova Scotia, comparatively speaking. We are second best, but I said despite that, for the communities that are looking for a physician, the gross figures don't mean anything. People don't care if we recruit a physician to Truro. To the people in Richmond that doesn't mean anything to them you know, so we are talking about overall success and I agree that this is something.

The fact is, Mr. Chairman, we are successful. We have been very successful. Unfortunately, we have gaps. I acknowledge that there are gaps and as I have said in this House, I wish I could snap my fingers and make those gaps go away, but I can't. We are doing the best we can. We get our message out there, you know we have just put money into a rural incentive program, we lead the country in alternate payment schemes. Nova Scotia is a pretty attractive place in which to practice and to live. There are a number of initiatives and some of them were begun when he was in government, but I can tell you, the debt repayment program which we have just put in, and so basically the net gain since we have been here has been reflective, it has been better than the net gain when that man was sitting at the Cabinet Table and he could have put all kinds of resources into physician recruitment.

MR. SAMSON: Mr. Chairman, I will stand by my record of physician recruitment and in supporting physicians in Richmond County and in the Strait area. I will put my record up against the minister's any day on that issue. We know that the minister cannot snap his fingers, as he says, and make physicians appear, nor can he wave his wand, but as I have told him before, the minister standing in his place and sticking his thumb in his mouth and sucking on it is awful little comfort to the people of the Strait also, Mr. Minister. I asked you a specific question, and you went all around it and did not answer it.

Other than Mr. Frank Peters, based on the deficiencies in physician recruitment in this province, what additional manpower and resources have you put specifically in the field of physician recruitment, not incentive packages, not payments for doctors, other than Mr. Peters, who is doing physician recruitment in this province and what money, if any, have you put additionally in that sector?

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MR. MUIR: Mr. Chairman, that type of question shows the extremely limited grasp of the issue of physician recruitment that he has, and if he had done such a great job for physician recruitment in Richmond, as he says, why is he standing up here haranguing the department? I mean, you know you can't blow and suck at the same time. He should know better than that. That is a disgrace, an utter disgrace. That man should resign. Resign. (Interruptions)

MR. CHAIRMAN: Order, please.

MR. MUIR: Mr. Chairman, we have to take a look at the incentive programs which we have for physicians (Interruptions)

MR. CHAIRMAN: Order, please. The honourable Minister of Health has the floor.

MR. MUIR: Mr. Chairman, you cannot just look at Frank Peters and his staff. You have to take a look at the other programs that we have, the rural incentive program, the debt repayment program, the job fairs, our Web sites. We have increased our support and our efforts in this and to look and say well, Frank Peters doesn't have an assistant therefore you haven't done anything is ludicrous, and not only does it show such a limited understanding of physician recruitment, he shouldn't be asking questions about it.

MR. SAMSON: Mr. Chairman, when it comes to the health and safety of the people I represent, I will stand here, and until their health and safety is being provided adequately, Mr. Minister, whether you like it or not I will stand in this position, and if you want to know where physician recruitment went wrong in this province, July 27, 1999, is where physician recruitment went wrong in this province. I will tell you right now, Mr. Minister, until you personally put the efforts into physician recruitment which are required in this province, you will keep having the same debates that we are having here today and we will keep representing our communities as we have.

If the MLA for Guysborough-Port Hawkesbury and the MLA for Inverness want to sound like mice on this and not make any sound, the voters of their constituencies will judge them on that, but the voters of Richmond County know what I have done to support physician recruitment. For the minister to say that the community of Richmond County and the Strait area has simply relied on Mr. Peters and the Department of Health to do physician recruitment, Mr. Chairman, is an insult. It is an insult to the Strait Area Physician Recruitment Committee, to our local physicians, and to all the organizations and hard-working volunteers in the Strait area who have worked on physician recruitment for years and years. Yet the minister now says that we are sitting back and just waiting for Mr. Peters.

My question specifically was, what additional resources had he put into physician recruitment to assist Mr. Peters, to put some financing in place to assist these communities that go to these different job fairs to try to attract physicians? It is quite clear today that this

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minister would rather play politics with the health and safety of Nova Scotians and especially that of the people in the Strait area than addressing that particular issue.

Mr. Chairman, if there is one person who is a disgrace in this House, the minister need only look in the mirror and he will see who that person is. That minister sat here time and time again and although he knows that there are problems in these communities, what does he do? We have great numbers and, oh, well, if we get a doctor in Truro, Richmond County is not going to like it. Mr. Minister, the numbers which you have given show that there has been a decline in the recruitment of physicians here in this province. We may still be number one. The numbers are down - or number two, whichever one he wants to use - the number of new physicians coming into this province is going down every year, and more and more communities are going to be affected by these shortages.

Mr. Chairman, we are fortunate in Richmond County that we do have St. Anne's Nursing Care Centre, which does have an outpatient emergency room. We are blessed by the Lord Himself that Dr. MacNeil has been able to stay in the community of Isle Madame and provide the service that he has been providing. Fortunately, there is one new doctor who has come to that area; unfortunately, he was on a part-time basis for quite some time; his status still is not certain.

Mr. Chairman, I want to tell you right now, and I will serve notice on the minister, the people of the Strait area have had enough - 110 days without having basic emergency room services during the daytime at the Strait-Richmond Hospital is unacceptable. We have the Point Tupper area, which is the first place to receive natural gas, and yet there is no immediate hospital in that area. The longer this minister waits, the longer he sits back and sucks on his thumb and does nothing, the greater the chance that the lives and the safety of the people in the Strait area will be put at risk.

Until the minister decides that he will take charge and he will make sure that this issue is addressed, I will continue to raise this in this House. I believe the frustration he has shown us today is a sign of shame; when we are shamed by others we like to fight back. And some silly remarks that he made, they were incomprehensive, some hollering, it is because of shame. I will continue to shame this minister and shame this government until we have the necessary doctors to serve the people of the Strait area.

MR. CHAIRMAN: Order, please. The member's time for debate has expired.

The honourable Leader of the Opposition.

MR. DARRELL DEXTER: Mr. Chairman, there are a number of things I want to deal with, with the minister. I wanted to start with something that occurred just recently, and I think it is worth sharing with the minister. I don't know if you had an opportunity today to read, in the local newspaper, The Chronicle-Herald, the letter that was written - it was the

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feature letter on the letters to the editor page - by Audrey Boudreau, who lives in Petit-de-Grat, a registered nurse. When she talked about some of her experiences with the health care system, I found it both instructive and enlightening. I want to just share with the minister some of what her view, a first-hand kind of look at the health care system, especially with respect to seniors.

She says in this letter to the editor that millions of dollars have been spent on the health care system and more funds are earmarked in an attempt to improve the existing system, such as the reclassification of conditions to gain admission into nursing homes. The inability to free up acute care beds in our hospitals because of the lack of outside programs makes for a very dysfunctional and costly system. For example, in regard to classification for placement in nursing homes, she observed during her work experience that all nursing homes have their own assessment authority that enables them to merely accept patients who are considered appropriate for their particular setting. Essentially, this stems from the ongoing lack of resources . . .

MR. CHAIRMAN: Order, please. I would appreciate it if some of the members having some very loud private conversations would take them outside of the Chamber, please.

MR. DEXTER: Mr. Chairman, I appreciate your attention. To continue, it says that essentially this stems from the ongoing lack of resources and funding to provide adequate care; paying guests, however, are given top priority to gain admittance to nursing homes. The minister made an announcement a short time ago with respect to the assessment of seniors for nursing homes, and what she wanted to ask first off was, how does it address that concern?

MR. MUIR: Mr. Chairman, I did not read the letter to which the honourable member refers, but clearly Ms. Boudreau did document something that I have mentioned from time to time, changes to the approach delivery in long-term care and that was that people - and I said it earlier today in response to the member for Lunenburg West - that one of the problems we had in Nova Scotia is there are people occupying spaces in nursing homes who shouldn't be there. Back on February 1st, we introduced a mandatory classification system. I believe Ms. Boudreau said, well those who had money just walked in. Our announcement back on February 1st was that was true in some cases. We recognized it and that is why we had put in this classification system. Now, anybody who enters long-term care in the province, a licensed facility, has to go through a classification process, and those who need the care most will get it first.

MR. DEXTER: The most important thing that you said, Mr. Minister, was just after you sat down, because you said, at the very end - and I don't know if the transcription service picked it up - but what you said was those who need it most will get it first. That is really what I am wondering about. I am wondering about whether or not you have taken away from

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the licensed facility their ability to do their own assessment and to say to you, no, I don't want that person because it is an inappropriate setting for them.

MR. MUIR: There is a single classification process now for the province. There are some cases, to be quite frank, where a particular location wouldn't be a match for a particular person; indeed, as the honourable member would know, sometimes people are retained in acute care facilities because they can't be appropriately cared for in a long-term care facility. We think that introducing that classification system on February 1st should do that.

The other thing about that is it was implemented at the same time, if a person needs care then we have asked them to go into care in a home within a 100 kilometre radius. We recognize that it is not necessarily the most desirable thing for some people, but they have the opportunity to say I would like to be here or I would like to be there. If they take the placements we give them, they stay on that priority list. Sometimes it might be a week and then they are able to be moved; sometimes it might be a little bit longer than that. We have tried to combine the best of both worlds, the classification system and trying to match it with the place where the person would like to be.

MR. DEXTER: Mr. Chairman, here is the point, and it is the point that I think Ms. Boudreau was trying to make as well. If you allow the institution to decide which of the patients, the seniors, those people requiring the service, come in based on the criteria of what is appropriate, then the institution gets to choose, they apply that criteria. So my question is, have you taken away from the facilities the ability to use that criteria to decide who they want off the list, and have you said to them no we will decide whether or not your institution is appropriate for this particular individual?

MR. MUIR: I guess the classification is done independent of the institution, but their opinion is still sought as to whether it is a match between the patient and the home.

[2:30 p.m.]

MR. DEXTER: Well, I guess over the next year or so we will find out how big a loophole that really is, because clearly there is an ability for the institution to look at the individual who is coming in and decide whether or not they want that particular individual. I understand it is a potential source of some difficulty for the classification system. In and of itself, that doesn't affect the desirability of a classification system, you still want to do that. I guess we will have to see what the criteria are; see how those classifications are taking place, but the idea of making sure that people are ranked according to need, with some adjustment given for the geographic area that they are from and their home is certainly something that we would expect would have been done a long time ago but wasn't.

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I guess the next point to be made is that the classification system itself is really nothing more than that. It doesn't create one more space; it doesn't shorten the actual number of people who need spaces. The minister used the example, I think, of the Cape Breton region, they looked at it and they shortened the waiting list because there were a lot of people who were on a number of lists. That was an exercise of drawing lines through names. You essentially combined the lists and took off the people who were on more than one, which for your own internal data gathering was a good thing to do, but it didn't in any way affect the number of people who were waiting for the spots in those facilities.

You had the same number of people before you started the exercise as you did afterwards. You have different numbers of names, because some of them were the same. You didn't really accomplish anything that is of benefit to any of those people who were on the lists. (Interruptions) That is what I want to hear, Mr. Minister. Perhaps I am wrong, if I am, you can tell me.

MR. MUIR: Mr. Chairman, one of the things, in trying to explain, we don't have it up and fully running yet, but I think we have made reasonable strides and obviously will continue, is the issue of people going into long-term care who did not or do not have to go into long-term care. In talking to some of the people who are in the business, they say there was a significant number of people admitted to long-term care who could have been cared for with home support or something else.

This classification system, I think what it is going to do, what it is intended to do - and it has worked in other jurisdictions, very successfully - is to see that the people get the appropriate care from the appropriate caregiver in the appropriate place. What has happened is that a significant number of people who were then entering long-term care didn't have to be in long-term care. We have a significant number of people in Nova Scotia, at least the care providers tell me, who, if there was another option such as the expansions, in home care and all of these things, they wouldn't need to be there.

MR. DEXTER: The minister makes an interesting point, and interestingly enough, the headline on Ms. Boudreau's article is The Tragic Failure of Home Care. You are quite right in the sense that there may have been people on the list for long-term care spots who didn't need to be there, but the classification system that you set up, this person would have been assessed at some point in time anyway, upon entering the facility. Surely to goodness, when they showed up, the assessment would be done at that time to determine whether or not they needed the long-term care bed that they sought. Maybe that is not true and, if it is not true, that is a serious difficulty with the existing system. If the present classification system deals with that, well, that is a good thing because, obviously, as you said, it should be the appropriate level of care for the individual's needs.

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But let's say - we will give you benefit of the doubt - that in some instances that is the case. I would suggest to you that of the number of people you have on the waiting list, that would make up a small percentage of the people who are actually there. Most of the people who are on those long-term care lists need long-term care, make no mistake. But, if you say that there is another level of care that is more appropriate that would include staying in their own home then you have to do something about that.

This is after the paragraphs I already read to you, this is the next paragraph: With the recent enactments of the new admission policies for senior citizens to Nova Scotia nursing homes, our present government, primarily consisting of myopic bureaucrats, has failed seniors once again by not increasing services for those of us wanting to remain in our home environment. Never in her wildest dreams did she think that she would witness a system that would become so flawed with bureaucratic rhetoric.

Mr. Chairman, that is an individual who is on the front lines, who is seeing this, as they say, eyeball-to-eyeball. I think you can go to most members in this House and most of them will be able to relate a story to you out of their constituency about how home care has failed in one capacity or another some of the people who they are charged with taking care of. I can tell you that they often come into my office. In one case I had a lady who was more than 80 years old, she had a pacemaker, she had been receiving some homemaking services, including the washing of the floors, and at some point in time somebody comes in and assesses her and says you don't need this service anymore. You don't need this service any more, you are perfectly capable of washing your own floors, you are perfectly capable of doing this work yourself. You are not going to receive any further services.

That was devastating to her and it was devastating to her family. It was an abandonment of this woman. We have other examples in my office of people who have special needs for bathing and for other types of requirements that they have specifically, and the people from home care who show up to deliver that service are unfamiliar with the equipment that they have. They have to go through the process of training them on the equipment that they have, and they are there for a little while and then they are gone. Then there are new people who come in and they have to train them. The hours are insufficient, and the level of expertise is not sufficient. It is a system that is just failing people in almost a wholesale way.

If you are right in your assumption, if you are right that the classification system will weed out those people who could better be served in their own homes, then you have to provide the service that keeps them in that home. Quite frankly, Mr. Minister, Mr. Chairman, I understand full well that the minister has control at this point only over his own budget, but he has to communicate with the other members of his Cabinet, and he has to communicate with the other members of his government, and he has to tell them that if you really want to keep the frail, elderly, those who are still able to look after themselves but need some assistance, in their homes, there is a whole lot more you have to do.

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There is a whole lot more you have to do. You have to provide an appropriate level of home care service, and you also have to make sure that the income levels that they have are sufficient to be able to allow them to live in dignity. In my constituency, quite frankly, I have senior citizens who are unable to make ends meet, who receive assistance from various other organizations within the municipality in order to allow them just to have some measure of dignity in their senior years.

Mr. Minister, it is not good enough to say we have done a good job on the classification system. I am telling you that if you resolve this problem with the classification system, I think that is a good thing; I think it should have been done a long time ago; but it is a far cry from being sufficient to service the seniors population that exists in my community at this point in time. As you know, and as I know, demographically we have a population that is going to continue to get older, and in the next 25 years it is going to get significantly older. You have to put the nose to the grindstone right now and say we are going to deal with this problem.

I believe that has been a long explanation of my frustration and how I see what is happening, but I would like to hear from you, Mr. Minister, whether or not you recognize this as a significant problem and what it is we can expect to see done about it.

MR. MUIR: Mr. Chairman, interestingly enough, and it probably won't happen again, there is not a whole lot of what the honourable member said that I don't agree with. Just don't get your hopes up. The fact is that we do recognize this pressure and the increasing numbers of seniors and the shifting. It is a remarkable thing, I guess I can say, and this explains, and he understands why we have taken the steps in long-term care that we have. The honourable member pointed out, quite correctly, that the database with which the province was trying to make decisions was flawed. We have tried to correct that, and that is a good thing. The former government was going to do something about it, too, and they didn't, but we did.

I can tell the honourable member that the increase in home care, for example this year, which you referred to, we recognized that. Our increase in home care this year is $24 million. The home care increase is 13 per cent this year, and that is a significant amount. If we are going to keep people out of the facilities, the residences, then obviously the improvements in home care are something which we are working at and we are well aware of.

Another thing that the honourable member didn't mention - and an interesting conversation I had last night, actually, was with the Executive Vice-President of the Bayer Pharmaceutical Company - that we have to wrestle with, which is coupled with this, and I didn't get this comment that I am going to make now from him, but I think it was the member for Dartmouth East or somebody who may have made it, or somebody said that our pharmaceutical costs have gone up. One of the reasons that they have gone up is because they have gone up or better pharmaceuticals have come on the market, this is one of the reasons

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the honourable member for Lunenburg West, when I chided him about cutting down the number of acute care beds, one of the reasons the province was able to do that is simply because there are pharmaceuticals now, surgical techniques are much better, people don't have to spend that time.

Some time ago I was talking about an illustration of that over in your area - although I guess perhaps it is in the constituency of my good colleague, the member for Dartmouth South - is the Nova Scotia Hospital. We used to have, I think, about 600 beds in the Nova Scotia Hospital. I think now there are about 170 beds. I know, from a meeting that I attended two days ago, and from others, that the burden of mental illness is increasing. The question you have to ask is if this burden is increasing yet the number of beds can go down, why is it? Obviously, it is because a lot of mental illnesses can now be controlled by chemicals as opposed to beds. We recognize that.

The point I wanted to make when I was talking about the gentleman from the Bayer Pharmaceutical Company is the increase in Canadian pharmaceutical usage over the past year was 19 per cent. He said you and I both know that a 19 per cent increase is not sustainable. What they did is - and this is an international thing, by the way - people got together and took the use in the United States, the use in Denmark, the use in Germany and the use in Canada and whatever countries, and Canada is 19 per cent above average. Canada is 19 per cent above average, and some countries are below that. Average means people are up and down below it. His point was that we were significantly above that.

Given that is something we know, and of course the Council of Ministers commissioned the study on cost-drivers in the Canadian health care system, and the member has probably seen that study or at least seen a summary of it, one of the things that is in there is aging. Part of aging is, of course, not only the increased care - people are living longer - but it is the increased pharmaceuticals. People live longer and we know that about 60 per cent of their care are the costs accumulated in the last three years of life.

Part of the solution to this, I think, are our efforts in primary care, in the education aspect. Unfortunately, you don't get a return on that today or next year or the year after that. So, some of our initiatives in trying to improve the health care system are starting earlier, and it is going to take some time for them to level out. I had mentioned this morning, and indeed tabled the document, the National Post story that summarized the Fyke study, the findings of Ken Fyke, out there in Saskatchewan. I was interested to see that many of the recommendations or things that he said, that he found in that brief study out there in Saskatchewan, were things that we have said in the 20 months that we have been in government here.

One is that more money is not the answer. You can dump money into it, and it just disappears if you don't do other things differently. Secondly, you need emphasis on primary care, and the need for community health centres and things like this to serve the population.

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Mr. Chairman, my point is - and that is a long way to answer the honourable member's question - I agree with what he said, but we have to kind of look at it as a total package. We have to get into the health activities as well as the health care activities.

MR. DEXTER: One of the things that always amazes me about having this kind of conversation with the minister is I set out an explanation for him, and he stands up and says, well, you know, I agree with the member opposite. Then, after he agrees with me, he then goes down to lay out a whole lot of things that don't make one particle of sense. I find it hard to believe that you could come up with a formula like this, better drugs mean we are going to be able get people out of hospital quicker, mean that hospital costs are going to go down, so that is a good reason to attack the Pharmacare Program, which is what you have done.

What you have is you have recognized that there are savings in acute care, there are savings in your institutional costs by getting people out of the system quicker with better drugs. Okay, that is fine; I suppose we would say that is a good thing to get them out quicker. What is not a good thing is to then turn around the next day and jack up the co-pay for seniors and to cause that burden to be transferred to their shoulders. Mr. Minister, that makes no sense to me whatsoever. In fact, the argument that you made is a good one for continuing to support Pharmacare, in fact enhancing Pharmacare, because you are getting the savings on the other end.

Mr. Chairman, he agrees with me on the one hand, and then he makes this statement about some of the statistics around health care that, quite frankly, the conclusion that he draws completely escapes me. That is the first one. The second one is that he then uses the example of the decline in the number of beds at the Nova Scotia Hospital in the riding of Dartmouth South. He says well this is because they can be more effectively dealt with by drugs. That may be partially true. But, let me tell you, originally, - and it wasn't this government - that decision was made because they could move those people out of that facility and they could transfer the housing costs onto the municipal rolls for a significant period of time, therefore, freeing up money in their budget because they transferred to another level, and the people who needed the service were the ones who suffered.

Let me tell you what has happened to a lot of those people, Mr. Minister. A lot of those people, do you know what they did? They got out of that institution and they found housing in close proximity to the institution because they knew that they still needed help. They go back in on a day program or they go back in and they still have regular contacts with the people in that facility. I don't think that simply by cutting the number of beds that you did anybody any kind of a service. That stuff just doesn't follow, you can't just say, we cut the number of beds, therefore, these people are better off because their illness can be better controlled by drugs. Those two things do not equate one to the other. I take great issue with you agreeing with me on one hand and then going on to state as if I agreed with a whole lot of things which I don't agree with. Just for the record.

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Mr. Chairman, we talked a little bit about the single classification process, and that is one thing the minister has talked about. I am not sure how the minister did this, but he made some kind of a connection between single-entry access, the single classification system and the $50 they are going to be charging seniors who are going to be held in acute care beds for long-term care. When they should be, as he admits, in a long-term care bed in a long-term care facility. But, guess what? There are none. He can't do that, so these people are stuck in a Catch-22 situation because they have nowhere else to go. It's just pure and simple, a grab of money right out of their pockets.

I would like to ask, again, if the minister could explain that connection for me because I would like to hear it again, given that this is part of the rationale he uses in coming to his budgetary estimates.

MR. MUIR: Mr. Chairman, look, he's again - slow learner. I have gone through this on a number of occasions but, anyway, I will do it again for him. By the way, I want to put this in perspective before I get into the fee, the idea from the fee didn't come from the Department of Health, it came from the health authorities but, nevertheless, it is in our budget and that is what he is referring to.

What happens, Mr. Chairman, in Nova Scotia if you are in long-term care, you contribute to that as you can. Some people can pay $5,000 a month, or whatever it costs, and they pay that much for long-term care. If you are a private-pay patient, they go in, they assess your means. This is the way it is because you are in long-term care, you pay as you can pay. If you can afford to pay for it all, you pay for it all, if you can afford to pay for three-quarters of it, then you pay for three-quarters of it, if you can afford to pay for half of it, you pay for half of it. Everybody in this House knows that it is your resources. Okay, so if you are in long-term care, then you contribute as you can.

What is happening - and you can talk about the availability of beds, or whatever you want to and I recognize that - the fact is, if a person is medically discharged from a hospital yet remains there and they are effectively discharged into long-term care and that long-term care is being delivered, in that case, in part of a hospital - when I give you an example, the member for Cape Breton The Lakes the other day, I think the first day we were involved in these questions, asked me about money being spent on renovations on the fourth floor of the Northside General Hospital. The member for Cape Breton West is nodding his head, he remembers and you probably do too. One of the things they did there was they made some renovations because what they have done is they have designated beds on that floor as long-term care beds. So people who are occupying those beds - he was talking about the $50 fee. Well, the fact is, if those beds are being classified and designated as long-term care beds, they aren't paying $50 for those beds, they are paying some other fee which is more appropriate to the cost of them. I can tell you, it is more than $50 because they are in long-term care. They aren't in acute care anymore. Acute care is an insured service, the long-term care is not insured.

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So that is what the situation is. The person may still be in an acute care facility but is in a long-term care bed and is receiving long-term care, then the policy in Nova Scotia and I think in just about every jurisdiction in Canada is that you pay for it. What has been done is a nominal charge of $50 a day. I can tell you that if that person was receiving that care in Northwood - or what is the facility out in the honourable member's constituency - it would probably be $130 or $140 a day that person would pay. The case of the $50, if they can't pay the $50, it's the same as in long-term care, if you can't pay it, you don't pay it; but they might be paying $10 a day or $11 a day or $8 a day, whatever they can contribute.

MR. DEXTER: At the beginning of the minister's response to me, he continues to, he likes to chide me about being a slow learner. Mr. Chairman, well, the first thing about that is, as a teaching professional he knows that is a term that he would never use in a classroom about anybody in his classroom and that it is inappropriate. The second thing about it is that the minister also knows that wasn't the question I asked. What I asked him was, he made a connection between the single-entry access and the classification system and the $50 fee. I asked him what the connection between those were?

MR. CHAIRMAN: Thank you. Before I recognize the Minister of Health, I would ask the member for Dartmouth-Cole Harbour if he would allow time for the member for Lunenburg West to make an introduction?

MR. DEXTER: Absolutely.

MR. CHAIRMAN: The honourable member for Lunenburg West on an introduction.

MR. DONALD DOWNE: Thank you very much, Mr. Chairman and to members of the House, it is my pleasure to introduce in the west gallery, Chief Terry Paul, and joining him is Bernd Christmas, who is a lawyer for the Union of Nova Scotia Chiefs. I would ask the members of this House to give a warm welcome to these very important and friendly people to the Province of Nova Scotia. (Applause)

MR. CHAIRMAN: Gentlemen, we welcome you here today. The honourable Leader of the Opposition.

MR. DEXTER: I would also like to extend my welcome to the visitors in the gallery. I am glad you could join us today for an examination of the minister's estimates on the Department of Health.

When we left off, I was asking the minster to tell me what the connection was between single-entry access and the $50 fee and the classification of the $50 fee.

MR. MUIR: Mr. Chairman, what it is, part of the single-entry access process, anybody who enters long-term care has to be classified as a candidate or somebody who should have

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long-term care and that's what it is, that is the connection. Anybody who would get into that situation would be classified and determined as a long-term care person.

MR. DEXTER: I want to be clear about what the minister is saying. What he is saying is the money that is being charged to seniors is being used to underwrite the cost of assessing and classifying them. Is that what the minister said?

MR. MUIR: I guess the answer to that is no, unless there is something I don't understand, because they would undergo the classification process and then if they were "long-term care is needed" and you are here, because long-term care, the charge would apply.

MR. DEXTER: I asked the minister if he could explain to me the connection between the two. I then repeated what he said and then he says, no. So I am going to ask him if he will, again, repeat what he said so I can try to ingrain in my mind what the connection between these two are?

[3:00 p.m.]

MR. MUIR: Mr. Chairman, what I said was that anybody who now, as of basically February 1st, enters long-term care in the province has to be classified. If a person is medically discharged from the hospital, it would be determined whether they would be in home care or long-term care or whatever it would happen to be. In the case, if it is determined that they are going into long-term care and the only suitable place for them to receive appropriate long-term care is some place in that hospital and that bed is designated as a long-term care bed, then the $50 charge would apply. So the connection is that they would be assessed. The point of the single point of entry is that you deal with one situation and you are classified. That's what would happen. That's the connection.

MR. DEXTER: Mr. Chairman, with all respect, that doesn't seem to be any connection at all. You have set up a system of classification. You have set up a single-entry access point. Those are assessment vehicles. That's what they are. They are not a delivery vehicle. They are not delivering the service. So, again, what is the connection? You are talking about the delivery of the service to the individual for which they are being charged $50 a day for, but you said earlier on, there was a connection between the $50 fee and the assessment service, which is single entry. I assume, as it gets up and completed it is going to be both single entry and classification.

MR. MUIR: An integral part of the single-entry system is the classification process. So the relationship is, a person is there and somebody medically discharges them, since they are medically discharged, somebody determines, through this classification system, as part of the single-entry process, that long-term care is where you have to be. We are not going to have a bed in x facility down the road until two weeks. If you are in that facility you would have to contribute to your care as best you can. You are in long-term care now in this facility

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and we are not requiring - well, in some cases it may be, but it is a flat fee. In some cases down the road they might be paying $140 or $150 dollars and they might be paying $10.

MR. DEXTER: Let me try coming at this from the other side instead of asking, what is the connection. Mr. Minister, do you agree that there is no connection between the classification system and single-entry access and the $50 fee? Those two things are not related to each other. The $50 fee is, in fact, related to the delivery of the service, as you explained it.

MR. MUIR: A single-entry point and the classification system determines whether a person is a candidate for long-term care. If it determines that they are a candidate for long-term care, then that's designated, then it has been determined that the person will be charged $50 on a per diem basis.

MR. DEXTER: I guess the minister just doesn't see the problem I see with this because every explanation you give says there is no connection between that assessment service and the actual $50 fee. The minister has had a tendency to do this for some time, to use the classification system announcement and the single-entry access announcement as a kind of scapegoat for the charges that are going on in the system and/or as to try to tell people that this is going to be some kind of panacea. I mean the reality of both those systems, let me be clear, it is not that I disagree with them at all, I very much agree that you should have a single-entry access system, something that has been in other provinces for a long time now. That's not a point on which we disagree but, in and of itself, the single-entry system, just like the classification system, does not deliver one new service to anybody. It's not a program that is set up to deliver a service to an individual. All it is set up to do is direct the individual to the appropriate place to receive the service they need. That's what it does. So any of the existing difficulties in the system, that is not going to cure them.

Now the argument the minister can make is that they can have a smoother allocation of resources through single entry. I understand that, but that is not going to cure waiting lists. It is not going to cure the (Interruption) Well, it's not. We will see, but it's not. It's not providing one new nurse, not one new doctor, not any additional services to anyone. That's not what single entry is designed to do.

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I wanted to ask the minister this question. I know we are rapidly running out of time here. You had an announcement about a nursing strategy and you talked about some of the things that you are going to do to help retain nurses and to assist them and to make this a better place for them to work. Part of that was an education component. Perhaps, just for the record, you can tell us what the amount is that is being dedicated to that and whether or not it is going to be drawn down this year?

MR. MUIR: Mr. Chairman, I appreciate the question because it gives me the opportunity to highlight once again one of the very positive announcements that has been made, among a number, in the past couple of weeks. The total is $5 million this year. The support to practising nurses includes funded orientation of $2 million; continuing education - and, if you will remember, Mr. Chairman, perhaps you weren't in the Chair, somebody asked about nurses specializing or wanting to specialize, that money, that type of thing, I guess perhaps the honourable member asked that question - speciality education programs, $600,000; the support to student nurses, including the co-operative learning experience which will be implemented this summer, is $300,000; the enhanced recruitment resources is $300,000; one of the things that is part of that, which is brand new, is the relocation allowance; fourthly, there is $300,000 for workforce development and utilization. What this means, or part of it, is that we have had a situation in the province and, undoubtedly other jurisdictions as well, where people are able to do certain things but, because of the way the system worked, they aren't able to go to the full scope of their practices and we think this will help both LPNs and RNs and lead to greater job satisfaction if they are able to put into practice those things they are trained to do.

MR. DEXTER: What I would like to ask the minister is, is this money that is being allocated here going to be used to familiarize nurses and to bring them up to standard, or up to speed on single-entry access and the classification program? Is that part of the education they are going to get?

MR. MUIR: I guess when we are thinking of support to nurses, we are thinking of practising nurses. Another tool we have out and implemented last year on a pilot basis was something called MBS RUGs. As part of our long-term care plan - and we haven't talked a whole lot about it - is that this particular assessment tool will help care providers determine what is the most appropriate care for an individual. I suppose the extension is down the road. I guess it was your colleague for Dartmouth North that raised it, as having money tied to an individual as opposed to a thing. Currently, in long-term care facilities, people are funded at a per diem rate, which is flat. In other words, everybody is charged the same amount. Using this MBS RUGs experience, it's not going to be in the immediate future, but it is a fair chance that if you are entering there and you need hired care, then money would be provided for you to get greater care than somebody else who doesn't need that much care.

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MR. DEXTER: Mr. Chairman, my question is very straightforward. Is the money announced in this initiative going to be used to train nurses in the classification system and/or the single-entry access system?

MR. MUIR: Mr. Chairman, I wonder if he would mind repeating the question, please?

MR. DEXTER: Is the money in this initiative going to be used to train nurses in the classification system and/or the single-entry access system that you have announced?

MR. MUIR: Mr. Chairman, no, we have allocated $1.5 million this year to implement that.

MR. DEXTER: I wonder, Mr. Chairman, if you could tell me how much time I have left?

MR. CHAIRMAN: The member has 10 minutes left.

MR. DEXTER: Because I could see the clock ticking down, I was thinking that this was ending at 3:12 p.m., so that will explain a little bit of my frustration with the continuing back and forth on this.

So, that money is separate for transition to that system for the continuing education of the nurses?

MR. MUIR: Yes, it is. It's separate. It's a different line item and it's also separate from the line item which contains $3.2 million for nursing education.

MR. DEXTER: I appreciate that answer because, of course, that would have essentially made not only that fund a heck of a lot smaller but, in my mind, would have made it pretty much a farce because your (Interruption) I said it would have. I didn't say it did.

I brought to your attention earlier today the transportation subsidy for children who require the service at the IWK. I thought when we were having this discussion, Mr. Minister, that you perhaps weren't quite remembering the questions that were asked last year in respect to this. You may recall that it was brought to your attention at that time that this program had been cut. It was a program that had been funded under the Department of Education and what we had asked was, because it was an important program that should have been incorporated under the Department of Health, that you put it into your budget to see to it that the children of low-income families actually had access to this program. You may remember that at that time your suggestion was that perhaps service clubs would be able to compensate for the loss of this money under that budget, but that you didn't have it in your budget to support the initiative. Just so I am clear on it because I didn't quite understand your answer. Is that

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service included anywhere in your budget estimates or is it simply the fact that these children will not be able to get that transportation subsidy?

MR. MUIR: Mr. Chairman, I guess that money was not included in our budget, and last year it was in the Department of Education's budget and I believe it may have been part of the direct grant to the Halifax Regional District School Board. We haven't seen the final business plan of the IWK yet, and to say that some agency or perhaps that, if it's the IWK that they have it in, I can't answer. We don't have it in ours.

MR. DEXTER: One of the frustrations, Mr. Chairman, over and above the fact of the change in accounting for the Department of Health, the fact that the line items don't add up from year to year, you can't do comparisons. The other frustration (Interruption) the minister says they will next year, but that doesn't do me a lot of good as I stand right here. One of the frustrations is that, over and above that, every time you ask the minister a question, what he says is, well, that's up to the district health authority, that's up to the Capital District Health Authority, I don't have any control over that. I want to remind the minister that, in the end, the minister is responsible for all of the programs. He is the person who approves those business plans. He is the person who gives direction to the Capital District Health Authority and, in fact, we have seen e-mail that has been tabled in this House by people who have resigned from district health authorities because they say they are being driven out of Halifax, that they are being driven out of the minister's office and that he is the one who is essentially controlling what is going on in the district health authorities.

So we know, and the minister knows and he said, that they have seen draft plans. They have sent those back. They have made their comments on them. The safe thing for the minister to do, quite frankly, Mr. Chairman, is to simply sit there and say, we can't comment on that because we haven't seen the final plans, and to make sure that the final plans from all the district health authorities do not enter his office until after this House adjourns. That's what happened last time. I think what was most insulting about it, really, was I believe it was the day after the House adjourned but, at the very least, a couple of days after the House adjourned, that the business plans for the regional health boards, at that time, were dropped on the table.

So no opportunity for the minister to be accountable, and that's what is so frustrating. After all, Mr. Chairman, this is a government that got elected talking about transparency, that talked about accountability, that talked about openness, that talked about moving decisions in health care off of Hollis Street and onto Main Street of the communities right across this province. You know what has actually happened? What has actually happened has been the exact opposite from that procedure. This department has become more and more closed. It has become more and more secretive. It has become less and less open. It has become more divorced from people. It has reeled in control out of the communities and it acts, quite frankly, in a bureaucratic and dictatorial manner towards the health authorities, telling them what it is they can and cannot do in the communities in which they are charged with their

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responsibility. The evidence for that comes from things like the letters we see tabled from people who are complaining about just exactly that.

As it happens, what we know has happened, let's take the Capital District Health Authority just as an example, the Capital District Health Authority gets an edict from the Minister of Health. He didn't go up and nail it up on the doors so that everybody could read it like some historical figures have done, but I think that is what it is coming to, Mr. Chairman. That is where we will soon find out what the latest direction from his department is, not through any other kind of an open process. What he did was he made an announcement that said that the Capital District Health Authority was going to get the same budget it had in the last budget year. He didn't explain whether or not that was going to be the amount that was set for the budget last time, the actual budget estimate, or the actual budgeted amount which was, of course, considerably more than what was estimated in the last budget year, but, nonetheless, they said they were going to get the same amount.

They gave that to the Capital District Health Authority and they went away and they looked at things like the step increases and they looked at all the accelerator costs in their budget and they came back and they handed to the Minister of Health the plan that was going to have to be put in effect in order to actually affect what it was that he had allocated in his budget. That become so unpalatable, that meant there were going to be such drastic cuts in the health care community and front-line health care workers, in the services that were going to be delivered in the capital district.

What the Minister of Health said was, oh my goodness, we could never do that. Politically, we would never be able to get away with that, so what we are going to do instead, is we are going to go back and rethink this. So they came back and what they came in with was a new budget estimate that is considerably more than even the last actual amount, because they knew, what should have been obvious to the minister, they weren't going to be able to deliver even a shadow of what they needed to deliver in the capital district if they maintain the position that they took.

I realize we are running out of time here, Mr. Chairman. I thank you for your indulgence.

MR. CHAIRMAN: I would like to thank the member. Also, I would like to say that the committee will recess for five minutes.

[3:22 p.m. The committee recessed.]

[3:26 p.m. The committee reconvened.]

MR. CHAIRMAN: I would like to call the committee back to order. Today's time for consideration of the estimates has expired.

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The honourable Government House Leader.

HON. RONALD RUSSELL: Mr. Chairman, I move that the committee do rise and report considerable progress and beg leave to sit again on a future day.

[3:27 p.m. The committee adjourned.]