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April 8, 2003
House Committees
Meeting topics: 



2:26 P.M.


Mr. William Dooks

MR. CHAIRMAN: Good afternoon.

The honourable Government House Leader.

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

MR. CHAIRMAN: The time being 2:26 p.m., I'd like to recognize the Liberal caucus, the honourable member for Dartmouth East who has 14 minutes to ask questions to the Minister of Health.

The honourable member for Dartmouth East.

DR. JAMES SMITH: Mr. Chairman, I'd just like to return to some matters following last evening's intervention during the debate on the estimates. A few short comments on the budgeting process in general. It's becoming increasingly difficult to follow the estimates and the flow of money, particularly from Ottawa, where it's finding its way into various programs, specifically designated for specific programs and others that allow some flexibility. Flexibility seems to be the key word. Many members of the government bench are using that word when referring to various programs. It certainly makes accountability more difficult and puts more pressure on those who are responsible for signing off on this budget, ascertaining and also verifying that it is a legitimate budget and that the money is in the places where it's supposed to be. We know if the money is not where it should be, that is generally considered to be fraud in the accounting business, is my understanding, what limited knowledge I have of that.


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We as an Opposition have an obligation and we've come to the House during these times to hold this government accountable on how it is using money that is flowing, particularly from Ottawa, which is taxpayers' money and Nova Scotian taxpayers' money and along with money gathered in different ways from the federal government, obviously. So one would assume in preparing a budget, one would look at what was spent last year and then what, if any, additional pressures can be expected this year and then incorporating that into the budgets, incorporating numbers that reflect a basic set of assumptions and pressures.

That was my point today about the Pictou area and the district health authority there where they had a substantive increase last year and less money this year. One would think then where are the pressures? The government seems to be saying there's not pressures - we've actually relieved a lot of pressure from that area, particularly that Aberdeen Hospital, yet we know that just short of a sign of no vacancy on the hospital at times when they're into a lock-down mode and diversion is taking place. One has trouble following the logic here to maintain good accounting practices during that time.

In that brief summary, from a layman's point of view, most accountants I think would probably tell you that is how a budget is prepared. It's using the process, that the budget becomes defensible and that's the job of the minister here today, to come to this House of Assembly and be accountable and that's our job as Opposition members to hold that minister and that government accountable. So following a proper process of accountability and transparency, the numbers can be easily defended at the end of the day, that those numbers in fact, do represent reality, both from a legal point of view and from a professional accounting point of view.

I can't help, the more that I look at the budgets for the district health authorities, wonder whether the numbers used in the Health budget follow this process. Are these numbers defensible at the end of the day? Do they really reflect the realities of what's being faced out there in our health care system? Are the numbers being used merely as plugs? In other words, plugging in numbers that are inserted so that everything balances at the end of the day.

[2:30 p.m.]

I have to ask myself whether this is indeed what is happening in this budget as reflected in the estimates that we are holding the minister and her staff accountable for today. It's ultimately the minister as we well know.

Based on these comments, one must have questions relating to the specific district health authorities as I mentioned earlier. District Health Authority #6, Pictou County on Page 12.15 of the Supplementary Detail. Despite the fact that District Health Authority #6 experienced an increase of 9.1 per cent in the year 2002-03, they have a reduction this year of 0.2 per cent.

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Mr. Minister, this is a district health authority that despite this government's increased commitment to district health authorities has reduced their budget. So one would ask the question, why has the District Health Authority #6 budget in the Pictou area been reduced? Why, in light of increased costs in health care and the fact that they've experienced the 9.1 per cent increase last year would you reduce that particular district health authority? The questions you might ask would be, are there fewer people in the system? Is Pictou that much of an aging community? Are there less costs? Are there fewer nurses? Fewer doctors? Are patients being transferred to other district health authorities?

That's an important point. We know that money should flow through the system and within the system the dollar should follow the patient. So, are patients being transferred? Have there been closures of certain services that are being provided in another area? Why a reduction in light of last year's performance? What has changed so dramatically to justify this budget slashing?

I want to turn to the Capital Health District as another district health authority. That has seen an increase of $4.5 million in their budget, roughly. This equals 0.9 per cent, not even a 1 per cent increase, yet last year, according to the numbers provided to us, there was an increase of 1.2 per cent. How is it reasonable to expect that a 0.9 per cent increase, less than 1 per cent increase, will cover costs when the increase last year was recorded at 1.2 per cent? Could the minister indicate in her comments when the forecasted number for the Capital Health District was obtained? According to Page 12.16 of the Supplementary Detail, the deficit for the capital district is forecasted to be about $5.3 million. Yet we clearly recall and have copies of reading an article before Christmas that the district health deficit at that time was projected to be between $6 million and $7 million. That's with several months left to go.

One would have to question, and I question, whether the forecasted numbers used are realistic and whether the new budget numbers which would be based on the forecasted numbers are accurate. Is there inaccuracy there? We would like to hear an explanation of that because we are a little suspicious here, and maybe more than a little suspicious, that some wink-wink, nudge-nudge work has been happening here, going on between the department and the district health authorities. In other words, just stay quiet, don't panic when you see the budget, we will help you later, just play along with this. Is this, in fact, true and are these budgets just using numbers, to plug in numbers to give an appearance of balance to ride out this next election. As an Opposition Party on this side of the House, we are asking that question and I think we have reason to ask that question and expect a forthright and open answer.

Perhaps where my time will be limited, I would just have one further issue that I would like to address and it's on Page 12.6 of the Supplementary Detail and under Adult Protection Services. It took over a $0.5 million hit in their budget. That represents a 79 per cent cut; pretty substantive. Mr. Chairman, through you to the minister, Madam Minister, this

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impacts greatly on seniors in our province. The need is there, albeit sadly that it's needed, but it is and most cases that are dealt with in Adult Protection are seniors. Could the minister explain why this component of the continuing care budget was reduced, reduced so dramatically, almost an 80 per cent cut and, specifically, what part of Adult Protection Services is being cut? It is forecasted the Adult Protection Services will have spent $832,000 when all is said and done in the 2002-03 budget. Yet this year they are expected to do with $175,000, cut from $832,900 to $175,000. Why is that being done to the care of Adult Protection mainly for our seniors?

MR. CHAIRMAN: Before I recognize the honourable Minister of Health, would you permit an introduction?

The honourable Minister of Service Nova Scotia and Municipal Relations.

HON. PETER CHRISTIE: Mr. Chairman, I would like to draw the attention of the members of the House to the east gallery. You will see sitting there Mr. Don Zwicker. He's up from Lunenburg. He's also the President of the Union of Nova Scotia Municipalities. He's here today to encourage us all to do speedy passage of the bill that they have requested us to do, the Union of Nova Scotia Municipalities Bill. So I would ask the House to extend a warm welcome to Mr. Zwicker. (Applause)

MR. CHAIRMAN: The House does welcome you, sir. I hope you are enjoying your afternoon.

The honourable Minister of Health.

HON. JANE PURVES: Mr. Chairman, I do have answers to those questions and I would like to say though that the department staff, including the chief financial officer, has worked very hard on these statements to make them as accurate as possible. I know the member for Dartmouth East recognizes what a job it is in such a big department and he recognizes good people.

Mr. Chairman, the first question of detail was raised around the Pictou County District Health Authority and the answer to that briefly is that estimate to estimate the budget is going up. The forecast estimate does show a decrease, I believe actually one of the reporters asked that question in a lock-up, because there was an overestimation of wages in last year's budget and that is the bulk of the money although there was also an issue of an orthopaedic program that was set up. The cost there would make a difference, too, but overall the budget of that health authority has gone up 8.8 per cent which is in line with the increases in other health authorities.

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The next question was around the capital district and, yes, they did have a deficit, Mr. Chairman, and we forgave that deficit but, as well, there were some costs that we took over in the House. Pardon me, I have to get my magnifying glass out here because the print is so small. Pathologist fees transferred to alternative funding, for example, for about $2.4 million. (Interruption) Yes, sorry, the nursing education transfer to the Department of Education from the capital district for about $1.2 million and dialysis transferred to DHA #8 and there was also a budget adjustment for mental health. So again, if you look, there are explanations for these numbers. We're not trying to hide anything and the capital district's budget has gone up in line with other DHAs.

The question was asked regarding Adult Protection and the decrease - again I have to get my magnifying glass here - is due to the reallocation of professional and legal services to care coordination. So, again, we have not certainly dramatically cut that budget by any means.

MR. CHAIRMAN: The time has expired for the Liberal caucus in turn. I would like to recognize the NDP caucus.

The honourable Leader of the Official Opposition, one hour in turn.

MR. DARRELL DEXTER: Mr. Chairman, I appreciate the opportunity to engage in discussion of the estimates of the Minister of Health. Obviously, this process is one that is important for us all in terms of being able to understand what it is the program of government is and how they intend to fund it.

It's no secret at all, Mr. Chairman, that I have been very disappointed in the performance of the Department of Health over the last little while. I should say, to qualify that, the ministers in that department over the last number of years because of their inability to recognize what is important in the lives of Nova Scotians and particularly that's the case with respect to long-term care which I can tell you right now, I consider the long-term care system in this province to be brutalizing. What it does is it strips people of their dignity. It takes away virtually every cent that they have. It impoverishes them in a way that is so fundamentally unfair that it is hard to believe that it is a system that has been allowed to perpetuate itself in this province.

I can tell you I've gone community by community through this province and had people come out to public meetings and pour out their hearts about the way in which their family and their loved ones have been treated in this system and the way that the things they worked a lifetime for, to try to build up a little something that signifies all the work that they've done over their lifetime, only to see it totally consumed to pay for services that they see readily provided to everyone else as part of the publicly-funded Medicare system.

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[2:45 p.m.]

Mr. Chairman, in recent announcements the minister has tried to say that this is some kind of step-wise progress. You don't recognize that something is wrong and say, look, we understand that this is fundamentally wrong and the people of Nova Scotia don't approve of this system but we are going to allow it to continue for years after the exhaustion of our mandate, we intend to put thousands of more people through this system and allow it to happen to other citizens in our province, as has already happened to so many thousands of people who have already been allowed to go through that system.

Mr. Chairman, you will know that earlier today I tabled in the House of Assembly a briefing note that talked about the fairness issue within long-term care and it particularly talked about the fact that one of the things that the changes did in November was to allow for a spousal exemption so that you could essentially designate $25,000 of an asset and have that transferred over to your spouse. Now, this is done by the government in a positive way. It is said to them, well, because you have a spouse, this is exempted. If you turn that on its head and have a look at it, what it really is is a discriminatory practice and what it says is that people who are married and enter the long-term care system will be treated differently than those who are single and enter the long-term care process, the assessment process.

So, Mr. Chairman, if you are a widow or a widower, someone who does not have a spouse living at home, you're treated even more differently than people who are married. So this is a system of compound discrimination. In the first place, people who are entering the long-term care facility are treated differently than everyone else in the province who receive their medical care covered as part of the publicly-paid Medicare system and then once you get into the system, they're then divided up and people who are single are treated completely differently than people who are married. I guess the question that I have for the minister is, what in the name of all that's good and great is the justification for discriminating against people in such a fashion?

MISS PURVES: Mr. Chairman, the $25,000 exemption for a spouse, we decided to go that route in order to leave the spouse, or dependant with more money than they had before and that was the reason for the decision. It was not an intent to discriminate, it was an attempt to provide more resources for the person still in the community.

MR. DEXTER: Let me ask this simple question, if I could get a simple answer on it. Does the minister recognize that two people who enter the assessment system on the same day, who can be exactly the same age and have exactly the same financial resources, will be treated differently based on their marital status?

MISS PURVES: Mr. Chairman, I recognize and the government recognizes that there are many things about the system that are unfair. We moved to correct some of them. We will be moving to correct more of them; and it is not "eventually", it is four years. We are

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doing that because we believe there are unfairnesses in the system and we're moving to correct that.

MR. DEXTER: I wonder if the minister could remind us how many people are in the long-term care system now?

MISS PURVES: Mr. Chairman, we have about 5,800 beds and most of them are filled. Of course, at any one time, roughly 80 per cent of those are public-pay patients.

MR. DEXTER: Does the minister know approximately how many people will go through or flow through the system over the next four years?

MISS PURVES: Mr. Chairman, that is roughly, on average, 2,000 a year who would be going through the system. So over the next four years, that would obviously be 8,000.

MR. DEXTER: That doesn't take into account, of course, Mr. Chairman, the fact that demographics are increasing, that there is in fact a shortage of long-term care beds. One would hope there would be some increase in that regard. So what that means - just so we all know - is that there is going to be another 8,000 people in this province who are going to be systematically stripped of virtually everything they have worked a lifetime to try to save, and they're going to be put through this system over the next four years because the government has decided it's more important to send out a $155 cheque than it is to support the seniors and the people in long-term care facilities, who all their lives have paid taxes to support the government of this province. I mean that is sad and what always bothers me about this discussion is, that many times the government treats it as if this is a rhetorical thing, as if it somehow is an exaggeration, but it is exactly what happens.

Mr. Chairman, what makes it so profound is the fact that these people, most of whom are defenseless, have no one to advocate on their behalf, are left to the mercy of a system which was supposed to be there to advocate on their behalf, supposed to be there to respond to their needs at a time when they were unable to care for themselves. That's what I find so completely disappointing about the way in which the government continues to treat these people.

I want to be clear about this, I don't blame this government in particular, they did inherit the system, but the reality is that they have had four years in which to become familiar with it and they have had ample opportunity to deal with it. They could have dealt with it in this budget and there is no clearer choice between the choice to spend money by handing out what is essentially just a pre-election gimmick and supporting people who earnestly and honestly and compassionately demand your assistance.

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Mr. Chairman, that is the choice that you have in your estimates, that's what's reflected in here. People look at them and see just numbers on a page, but that's not the case. In each one of these estimates hangs the life of some person and how they're going to be treated by the government they supported and on these counts we have - and I say this collectively - as a society failed to provide these people with what they ought to have, the support they ought to have.

I'm going to move on for a second, I may come back to this, but I'm going to move on for a second because earlier today I heard the Minister of Health talk about the Pharmacare system and talk about how there was increased support for the seniors of this province through Pharmacare. So I wanted to ask the Minister of Health if she could remind me what the premium was when she was elected and what the premium is today?

MISS PURVES: It may take a few moments to go back to the actual amount of the premium in 1999, but I will provide that information. If I may respond to some of the previous remarks, I would simply like to remind the Leader of the Opposition, and I know he knows this, that of the thousands of people who will be coming into the long-term care system, about 20 per cent, or about 1,600 of those would still be private pay, and that we will be making improvements for those people, but a system is there for those people and the people who are on private pay.

Is it the best system in the world? Not necessarily. Is the way of doing assessments entirely fair? No, not necessarily, but the fact is that we are moving on this and we have been moving on it for three years. The wait list for nursing homes was the most serious waiting list problem we faced on coming to office, which is the reason we tackled it. We tried to bring the nursing homes in under a coordinated way, to go to a provincial waiting list. We were the last province in the country to start single-entry access, but we did do it and we were making progress before that - I recognize not enough progress for some people, but it was certainly progress.

MR. DEXTER: Sorry, I actually missed the first part of what the minister said. Was she going to supply the premium information now or . . .

MR. CHAIRMAN: Would you like the minister to answer that?


MR. CHAIRMAN: Yes, she nods yes.

MR. DEXTER: As often happens, the minister gives a response and in response to the response I can only say, this is completely different than what was said at the November press conference, I was there. The officials in your department were asked how many people coming into the system come in with some assets, and the reply was almost everybody comes

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in with something. Then a further reply was that about 50 per cent of them, when they come in, have something that takes at least some period of time to be depleted and I think they indicate that most people had been pretty much stripped of their assets by the end of the year, I think was what I recall hearing at that time.

Of course, the absolute truth is that after you take everything that you have, you then subsidize their care. They talk about the numbers and they say that 80 per cent of the people in the system are subsidized. Well, after you take everything, of course they're subsidized, they have nothing left and you can't put them back out on the street. I've met with administrators at long-term care facilities who said to me that even if somebody shows up at my facility and says look, I don't want to go through the assessment process, I'm prepared to pay privately and so I don't want to do that, they said we won't take them because what happens if they run out of money? If they haven't gone through the assessment process for the Department of Health and we don't have an agreement with the Department of Health to support them while they're in the facility and they run out of money, we can't put them out on the street and then we would be stuck with them. We would be stuck with them, that's what they said.

So, whether you like it or not in this province, you're going to end up going through the assessment system. They have an eligibility review unit that was designed to efficiently identify the amount of wealth that an individual had, and decide how long it would support the health care services that were required within the facility and then systematically, month by month, take what it is that they had. That's the reality of this situation as brutal and as unbelievable as it seems, but that's what exists today and that's what will exist tomorrow and if this government is re-elected, it will exist until 2007. Then, of course, we have to depend on them to do what it is they say they're going to do - and despite all the huffing and puffing of the government the reality is that we've got a long list of commitments that this government made in 1998 - some with respect to Pharmacare, I might add - and then in 1999 that they simply ignore. So I think the skepticism of people with respect to that is really quite something.

[3:00 p.m.]

I wanted to ask a question. I suppose there are some people who are in long-term care facilities because they may have, in the year before they came in, had a catastrophic illness of some kind, or may have had investment income of some kind and would have to have paid income tax. Can the minister tell me, will these people receive the $155 cheque and then will the government take it back?

MISS PURVES: Mr. Chairman, we had not discussed that issue, but staff inform me that other cheques that come in, in terms of rebate cheques and so on, the residents keep. So although I will consult further, it would seem that that would follow this pattern. Earlier the

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member asked about the Pharmacare premium when we came to office and it was $215. It went up in 2002-03 to $336 and that's where it is now.

MR. DEXTER: Before we get off this subject of the $155 cheque it was, as I understand it, not meant to be treated as income, it's not going to be treated as taxable income. I would urge that for the some small number of people in those facilities who might benefit from this, the minister make the decision and exercise her discretion and see to it that at least they are entitled to keep that. Mr. Chairman, I intend to come back to the Pharmacare Program, but since we're going into this a little deeper, I would like to point out that in the memo I tabled, one of the recommendations in that memo was that the long overdue increase to seniors' monthly allowances be increased.

I guess I would like to ask the minister, since that was the recommendation - and clearly what it says in this memo is that this present policy discriminates on the basis of wealth, actually those who are rich and come into the system are treated differently than those who are poor and come into the system - I wonder if the minister could tell us why the decision was made not to act on the recommendation to increase the monthly allowance?

MISS PURVES: Mr. Chairman, there are many things that staff in the department would like to do to improve the system that we have in long-term care to improve fairness, and increasing that monthly allowance is one of them. That may, in fact, happen but that is not a promise I'm prepared to make at this point, at least not for this year, because we have not budgeted for that. It is certainly one of the issues that we will be looking at in the coming years and certainly staff feel very strongly that a change should be made there and I agree, but there are other things we have to look at as well.

MR. DEXTER: Mr. Chairman, my recollection - and maybe the minister knows - is that the Finance Minister has indicated to the House that the cost associated with sending out $155 to every person who paid $1 of income tax in this province is in the area of $68 million. Could the Minister of Health indicate to the House whether or not $68 million would be adequate to pay the costs associated with long-term care that still needs to be covered?

MISS PURVES: Mr. Chairman, as I said last night, it is debate on Health estimates, you know, I'm not here to argue the merits or otherwise of lowering taxes. That was a promise that we made in 1999 and that is a promise that we felt obliged to keep and are keeping. I understand very well the member's question that could that money not go elsewhere and certainly the government could have chosen to put that money to satisfy many, many needs in the system, but what we feel that we have done here, at the end of the day we fight our battles for our budgets in Cabinet, that we are trying to put our new money in the places of the highest priorities. Long-term care is one of those priorities, seniors are one of the priorities, but we have other areas that we have to look after, like cardiac care, like increases to the DHAs, like wage increases.

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There are many, many pressures on the system and does this budget answer them all? No, and I'm not sure that they ever will, but we feel we have made the right decisions in terms of trying to put more money in health and education and other areas where it's needed, as well as keeping our promise of lowering taxes.

MR. DEXTER: Mr. Chairman, I just got glasses so I know I'm losing some of my eyesight, but I think I must be losing my hearing as well because my question to the minister was pretty simple, I asked whether or not $68 million would be sufficient to cover the remaining costs that are not covered in health care costs in long-term care.

MISS PURVES: The answer to that, of course, is yes, Mr. Chairman.

MR. DEXTER: There that was easy. So I want to go back, I started on a little bit of a dissection now of the Pharmacare Program and I want to return to that because, as I said, I heard the minister say earlier that they were relieving some of the pressure on seniors by capping Pharmacare costs and saving them money and I think I just had the minister tell me that, in fact, what had happened since this government has come to power is that the premiums have actually increased from $215 to $336. That's my understanding of the answer that was given by the minister. Of course, that's not the only cost that the seniors pay so I would like to ask the minister, could she tell me what changes have been made in the co-pay since her government came to power?

MISS PURVES: Mr. Chairman, in 1999-2000, it was 20 per cent to $200, that was what was existing at the time. It went up in 2001 to 33 per cent to $350. That is where it remains and we have maintained the 70/30 split. I would like to add that the costs of the Pharmacare Program itself, as the member opposite knows, have risen steadily. They've risen, you know, more than we could have anticipated, that we're intending to keep the cap, that we introduced the cap per prescription this year to try to help seniors in terms of the amount they have to pay, you know, for one prescription. That was the recommendation of the Group of Nine.

I would also like to say that many seniors, including those represented on the Group of Nine, while some find the costs of drugs very difficult, most realize that rising costs in our society, they understand that part of that burden has to be borne by them. What they don't want is too much of the burden to be borne by them and many feel a point of pride in that they should be paying some of their costs. We do have a generous Pharmacare Program in Nova Scotia.

MR. DEXTER: Mr. Chairman, you know, the Pharmacare Program and the explanation of it, both in the estimates and in the Supplementary Detail, is pretty insufficient. So it's difficult to know what is involved in the Pharmacare Program and so I have a fairly simple question. Can the minister tell us, because the Pharmacare Program only says Pharmacare payments, what percentage of this is involved in administration?

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MISS PURVES: The administration costs, the only thing is the dispensing fee to the pharmacist.

MR. DEXTER: Do we know what percentage that would be? How much does it cost in dispensing fees, who processes it when it gets to the department, is that not administrative costs?

MISS PURVES: Atlantic Blue Cross, Mr. Chairman, pays that.

MR. DEXTER: Well, somebody pays Atlantic Blue Cross. I mean they don't do it for free. Okay, well, maybe we can go at it from the other end. Do we know how much of the $95.692 million that is estimated for 2003-04, how much of it is actually drug costs? That's the other end.

MISS PURVES: Mr. Chairman, I can have the answer to that question in a few moments if the member would like to ask another question in the meantime.

MR. DEXTER: Mr. Chairman, people who are regular watchers of this program out there will know that over the years I've asked and have gotten from the minister, or from the previous minister, responses to questions around what happens to people when you increase things like the co-pay or the premium and, as we all know, there was quite an exhaustive study done out of McGill that talked about a number of things that happened to seniors when these costs increase. They included an increase in the mortality rate, an increase in visits to emergency rooms, an increased length of stay in hospital and increases in the amount of visits to primary care physicians. So these were fairly important and profound effects upon the lives of seniors.

I know the previous minister used to like to say, well, that was a controversial study and, you know, we want to take every effort to try to minimize the research that was done on it. But the reality is that under this administration, in fact, over the last couple of years there has been a study going on in this province on that very thing, to verify whether or not the results are the same, and I guess I would like to know from the minister, have you received the results of that study and, if you have, are you prepared to release them?

[3:15 p.m.]

MISS PURVES: Mr. Chairman, I have not seen or been informed of that study or the results of that study. I know we have some information and we can endeavour to get that. We have had a steady increase in the users of the Pharmacare plan.

MR. DEXTER: Mr. Chairman, again I'm trying to figure out what it was the minister has said. Now, this study was completed. It was sent to the Department of Health for comment which I always find somewhat interesting because, of course, it is a way to reshape

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the study before it actually becomes public. I guess what I'm trying to find out is, has the minister or the minister's office, the Department of Health, received a final copy of this report and will they release it?

MISS PURVES: I'm sorry, Mr. Chairman, if the member would clarify which study he means, my officials here are not aware of the study to which he refers.

MR. DEXTER: Mr. Chairman, there's a study underway at Dalhousie University and the point of which was to follow up on those items that I identified and that were done in the McGill study. It was completed, it was sent to the Department of Health for commentary and it was sent back. What I want to know is, do you know whether or not it has been completed and if you've received the final report?

MISS PURVES: Mr. Chairman, if such a study is in the department, we will make inquiries of the woman who runs the Pharmacare section to see if she has it and I will commit to do that. The associate deputy has not seen the study and I have not seen the study and we have not been made aware of it if it has been completed.

MR. DEXTER: I guess the other part of that is if you're committing to finding out if there is one, it's one thing, committing to release it of course is a completely different thing, so I would like to ask the minister to go one step further and commit to releasing the report if it's resident within your department.

MISS PURVES: Yes, Mr. Chairman, certainly we will make inquiries and that would be released, it would be public information.

MR. DEXTER: Mr. Chairman, I don't know if they have managed to isolate the drug costs as of yet or not.

MISS PURVES: Mr. Chairman, we only have the increase, but we can get that for the Leader of the Official Opposition for tomorrow.

MR. DEXTER: Mr. Chairman, I wanted to ask I guess an associated question which has to do with the coverage by Pharmacare of Alzheimer's drugs and I wonder if the minister could tell us where that discussion is for, I believe - I think I have the names right - Aricept and Reminyl - is that the other one? I just wanted to know where that is in the scheme of things.

MISS PURVES: Mr. Chairman, the work on those drugs has been done by the Atlantic group. The results and recommendations will be going to the deputies of the Atlantic Provinces within a week or two. What we are looking at is that if we were able to provide coverage for these drugs, or some of these drugs, that we would agree to adhere to certain protocols and do some original research as well here in the Atlantic Provinces, that we would

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also provide some physician education on the use of these drugs and whether to continue use under some circumstances. As I understand it, they can be effective, but they're not necessarily effective forever and what we would need to do is try to provide the education to physicians on the different forms of dementia and which drugs would help which people.

This would not only be because we want people to have the best drugs that are affordable, but also we would like to be able to obviously be able to predict the costs and I believe that the figure that I was last given for an estimate of the cost here in Nova Scotia for a year, even covering these drugs with very strict protocols, would be about $3.7 million, but we are moving forward.

MR. DEXTER: Mr. Chairman, I must say, I don't know if it's a false sense of optimism, but I sense from what the minister says that they know what the recommendation is going to be and she seems to be talking about things that are post it being added to the formulary. So I'm going to take that as a positive sign and then I'm going to ask the follow-up question which is, if that is the cost associated with those drugs, is it allowed for in this year's estimates?

MISS PURVES: Mr. Chairman, no, that is not allowed for in this year's estimates because we did not necessarily plan on doing it this year. Obviously, that may change. I would like to add something as well, that it would take a little bit of time to introduce so even if we did decide to go ahead, we would not be looking at a full year's cost this year if we were to go ahead. Another comment I would like to make about the common formulary is, even though we in the Atlantic Provinces do prefer to go together rather than hang separately on some of these things, the option is always there to accept or not accept a recommendation.

MR. DEXTER: Could I ask the minister, when that recommendation comes forward, would there be any reason why that recommendation would not be released so that we would know what the recommendation was?

MISS PURVES: Mr. Chairman, no, there is no reason why it wouldn't be. It would be up to the Premiers and the ministers to decide that, but there would be no other reason for not releasing that information. It would be a decision by the Premiers and the Health Ministers.

MR. CHAIRMAN: I would like to advise the honourable Leader of the Official Opposition that he has 19 minutes left in turn.

MR. DEXTER: I realize there's just a short time left, so I will try to do my best to get through as many questions as I can. I didn't quite understand that last reply because you seem to be mixing two things here. One is the decision of whether or not the recommendation would be followed, which would be a question for the ministers and the Premiers to decide,

[Page 71]

and the question of whether or not the substance of the recommendation would be released. I'm wondering, is there some reason why the substance of the recommendation wouldn't be released so that we would know what the recommendation was, even if the decision of the ministers or the Premiers does not follow it?

MISS PURVES: Mr. Chairman, I see no reason why the recommendation would not be released regardless of the decision made at the political level whether to cover these drugs or not. Obviously, decisions are made partly on the basis of affordability, as all government decisions are. I think that the recommendation would probably release itself even if governments did not release it.

MR. DEXTER: Mr. Chairman, I want to now move on to something which I have, again, been addressing with various Ministers of Health over the last couple of years. This one has to do with hepatitis C. You may know, Madam Minister, as I do, that there was an agreement between the federal government and the provincial government with respect to hepatitis C, and there was money allocated by the federal government that was supposed to be put into specific programming for the sufferers of hepatitis C. Indeed, on Page 12.11 of your estimates, there is a line item that says Hep C Recovery. What I would like to know is what programming, specific to the sufferers of hepatitis C, is being provided by the provincial government, for which you are recovering $0.5 million?

MISS PURVES: Mr. Chairman, I do have a list of some of the programming that we provide. The money that comes from the federal government is $6 million over 20 years. Obviously a lot more than that is spent in the province on programs for hepatitis C patients. We spend roughly, in Nova Scotia, about $2.5 million a year on such programs as genotyping, the liver clinic, specialists and vaccines - for instance hepatitis A vaccines for all hepatitis C sufferers - there are a number of programs, and I can get that list. The federal contribution, although we have not been as clear about it as we might have been, if you average out the money over the amount of time, it would be about $300,000 a year.

We're certainly spending, as a province, far more than that on services to victims of hepatitis C. Are there services and drugs we're not providing? Probably yes. Is there more we could do? Probably yes, but I can't say that we're not spending the federal money and more on programs for people with hepatitis C.

MR. DEXTER: Mr. Chairman, the point was that there were, in existence at the time - as far as I know - all the programs that exist today, and the idea of this designated money was that it was to be used for new programming, over and above what was already in existence, much like the money from the Department of Housing that came from the federal government was to add to the ability of the department to provide service. That was the idea from here. So I have two questions on it. The first one is, can you identify what new programming is supported by this money, as opposed to the programming that existed beforehand?

[Page 72]

MISS PURVES: Mr. Chairman, I do know that the genotyping is new. The money that we give to the hepatitis C society is new. I would have to go back and double-check what else might be new, but definitely those two.

MR. DEXTER: Mr. Chairman, the minister was indicating - and I notice that the forecast number for Hep C Recovery is some $981,500 last year, this year it's estimated at about $0.5 million - it was $6 million over 20 years. At that rate, that $6 million would be drawn down a heck of a lot faster than 20 years. I think that if you averaged it out over 20 years, it would be about $300,000 a year. Does the minister know how much money is actually left in that fund, to be drawn down?

[3:30 p.m.]

MISS PURVES: Mr. Chairman, the amounts that come each year are not the same amounts each year, they don't come in regular increments. I can get back to the member with more detail on that. I do know that they don't come at $300,000 a year or whatever, they come in different increments, from the federal government.

MR. DEXTER: I understand that. Just to give you an example, Mr. Chairman, the actual in 2001-02 was $2 million, last year it was $981,000, next year it's going to be $500,000. So, of a $6 million fund, that's some $3.3 million that has gone over the three years that I can see on the documents that are before me, which must mean, over the 17 years left to come, it's going to become rapidly-diminishing amounts of money. Is that, in fact, the case?

MISS PURVES: Mr. Chairman, this is one of the programs from the federal government that was front-end loaded as opposed to back-end loaded, like some of the other money that is coming for Health. It's my understanding that most of the provinces have taken it this way, in front-end loaded monies, so that the increments will continue to be unequal and some years, not available.

MR. DEXTER: I guess that was really my question, because it seemed obvious to me that at that rate it was going to be depleted fairly quickly. I wanted to ask a little bit about the information technology initiatives that are in the estimates, because it goes from $11.842 million to $22.123 million. If you look back, between 2001 and now, there has been a pretty significant increase in the amount of information technology initiatives. Could you indicate to us what it is that we're getting for that money, and whether or not this is a one-time increase in the cost that we will see fall back next year to something closer to - I don't know whether it would be the average of $5 million and $11 million. Do we have some sense of what, in a year, should be the amount of money that we're going to be spending in information technology?

[Page 73]

MISS PURVES: Mr. Chairman, the capital in any district or any area would only occur once. We all know, with information systems, it happens again and again, but for a major initiative, only once for a period of time, but the operating costs would be ongoing. This is actually an initiative that we would like to be able to roll out faster than what we have done, but we are proceeding because it is one of those areas that actually really is an investment as opposed to an expenditure, because we will be able to provide doctors, patients, paramedics and nurses with information about patients that will be really useful to them. There will be a lot of duplication that will be able to be avoided.

This is also something that the federal government is very keen on having developed, nationwide, an information system of that type, though, that we have here, would probably, right now, the estimated cost is $4 billion to achieve Canada-wide. We really need to have the kind of information available whereby if you were from Dartmouth and you were in a car accident in Sydney, a paramedic would be able to access your medical records to know about your history, to know what drugs you're allergic to, et cetera. It's not really pie in the sky that we will be able to do that within a few years. This year, the operating costs for the DHAs are about $5 million, and the system is being rolled out in Antigonish and Cape Breton to start.

MR. DEXTER: This is different than DHA funding. You have your DHA funding that is listed line by line in here. This is an additional health care initiative that you would work with in conjunction, I assume, with the various health authorities. What I'm trying to figure out is, are they capital costs, are they operating costs, what can we expect when I look at the books in five years' time and look back and average the cost of information technology, given that there will be some natural increases, inflationary pressures? Am I going to see a constantly-rising number this year or next year, or is it going to be closer to $11 million, last year's, or is it going to be closer to $6 million that it was the year before? What am I seeing?

MISS PURVES: Mr. Chairman, you're seeing amortization costs and operating costs. There will be a bubble as the capital costs finish up, but then it should level out. This is money that, in the jargon, is held centrally from the data centre, but it is done with the DHAs, in conjunction with them.

MR. DEXTER: I understand that the minister is really attempting to give me the information that I want here, but maybe I am not making myself clear. What I am trying to figure out is, next year, are we going to see another $22 million figure? In that bubble, have we reached the top and are we going back down, or are we still going up?

MISS PURVES: Mr. Chairman, no, we haven't reached the top. Next year you will see an increase, likely not as big as the increase this year, but there will be an increase and a lot of it will be capital costs.

[Page 74]

MR. DEXTER: Mr. Chairman, I only have a few minutes left, and I wanted to just briefly ask the minister if she is aware of a program, the Child and Adolescent Day Treatment Service, that exists at the IWK. This is a service to children and teenagers. As I understand it, there are 12 full-time adolescent spots and six part-time spots, and then there are 12 spots for children only. The majority of the cases that are treated there are children who suffer from ADD and ADHD and depression.

This is the only service of its kind in the province. It is, obviously, very difficult for people outside the metro area to access. Some of them who do access it from outside, come in and stay in group homes in order to access it. When you actually ask them what is the waiting list in order to get into that program, they are very hesitant to tell you, mainly because it is geared to need. So if you're in an emergency, much like when you go to an emergency room, they categorize you and you don't get seen on a first-come, first-served basis, you get seen as it's important for you to be seen.

The reality is that there are some very long waiting lists for children who need that kind of help in that program. What I would like to ask the minister is, has this come to her attention, and is there some plan for dealing with this to see that the children of the province who need this assistance actually get it?

MISS PURVES: Mr. Chairman, I have heard of this program, but I am not aware of the details that the Leader of the Opposition presented. I do know that this was not presented as a priority pressure by the IWK in its business plan. I can say that.

MR. DEXTER: I am going to go back to long-term care for a second, because we have a few minutes left and I wanted to ask a couple of questions about it. The assessments that are done for the eligibility review unit, in most cases, I guess, are done, in fact, by the community care coordinators, is that right?

MISS PURVES: Mr. Chairman, the care assessments are done by those coordinators, in other words, determining whether a person needs to go to a nursing home or not, but the financial assessments are done by the eligibility review unit, centrally.

MR. DEXTER: You're saying that the community care coordinators don't play any role whatsoever in the administration or collection of financial information of people who are being assessed by the eligibility review unit. I just want to be clear.

MISS PURVES: Mr. Chairman, as I understand it, the care coordinators may ask a couple of questions, but the actual major assessment, the full financial assessment, is handed over to people in the eligibility review unit in the city.

[Page 75]

MR. DEXTER: In their job descriptions, in the community care coordinators' job description, is any portion of their job assigned to that particular, which is financial eligibility?

MISS PURVES: Mr. Chairman, that is very minimal now. It used to be that it was the job of the care coordinators to do this, before we went to the provincial waiting list and the new system that was meant to see that people in the most need got the care first, when we changed that part of the system and went to single-entry access. The care coordinators, now, are not supposed to be doing financial review. That is a job of the review unit.

MR. DEXTER: I wonder, could the minister tell us how many people work in the eligibility review unit?

MISS PURVES: Mr. Chairman, there are about eight to 12 people, and when I say people, there are some vacant positions there as well, but there are about eight to 12 people in that review unit.

MR. DEXTER: I wonder, would the minister be able to indicate to us what the salary and benefit costs for that unit are over a year?

MISS PURVES: Mr. Chairman, those costs are about $750,000 a year. Those costs, by April 1, 2007, will no longer be associated with that unit, because we won't need the unit.

MR. CHAIRMAN: The Leader of the Opposition, you have 50 seconds left.

MR. DEXTER: Mr. Chairman, I am going to very generously cede the rest of my time.

MR. CHAIRMAN: The honourable member for Cape Breton West. You have one hour, starting at 3:45 p.m.

[3:45 p.m.]

MR. RUSSELL MACKINNON: Mr. Chairman, at the outset, I think I would be remiss if I didn't bring to the attention of all members of the committee the very special day

for a colleague of ours, the member for Cape Breton Nova, who is celebrating his 60th birthday. I think it's only befitting that we recognize this. (Interruptions) That's correct. He's far more youthful than the Premier, if that's what you're alluding to.

Mr. Chairman, my first question to the minister is with regard to the Nova Scotia Health Research Foundation. As the minister may be aware, in weeks past, we had a representative from the Nova Scotia Health Research Foundation before the Public Accounts Committee to address a number of concerns that members of the committee had. One in

[Page 76]

particular was with regard to the fact that the previous Minister of Health consistently budgeted $2.5 million for the research foundation, when in fact they were receiving $5 million.

I would ask if the minister has received an official request from the research foundation for $5 million this year. I must apologize, I didn't get a chance to go through the micro-detail to see if, in fact, that's what's budgeted for this year or not. I would suspect that it is. Could the minister confirm that? Could the minister also confirm if there was a request for additional monies, over and above the $5 million, and what would that represent?

MISS PURVES: Mr. Chairman, yes, I was aware of that session of the Public Accounts Committee. The grant this year, to the foundation - it's in the Supplementary Detail - is $4.5 million. I know that the ask was for beyond the $5 million, but I don't have that detail with me now. I can find that out. I am well aware the Auditor General questioned where the other $2.5 million came from, so this year we have given them $4.5 million and it's straight-up. They will be able to continue with some very good research and matching grants. We would have liked to have given more, but $4.5 million it is for this year.

MR. MACKINNON: Mr. Chairman, on Page 12.11 of the Supplementary Detail, the forecast for 2002-03, they're forecasting $2.5 million. That's totally contrary to what was presented to the members of the Public Accounts Committee. I am wondering where that other $2.5 million went that the minister seemed to have missed in her response.

MISS PURVES: Mr. Chairman, because of money left over from a previous year, they would be able to spend that money for a total of $5 million. As I understand it, because they are part of our consolidated accounting, the Auditor General would prefer the money accounted for in a different way, which is what we're attempting to do this year.

MR. MACKINNON: The fact of the matter is, Mr. Chairman, they got caught. They got caught budgeting $2.5 million, when in fact they were allocating $5 million. The witness before the Public Accounts Committee conceded to that point. I would ask the minister again, could she ascertain where the other $2.5 million is that should be budgeted in the forecast?

MISS PURVES: Mr. Chairman, the money came from unexpended funds. As I understand it, the carry-over procedure is what the Auditor General objected to, so we are attempting to change that this year by saying, at the beginning of the year, that the grant is $4.5 million and that is what it will be. There is no unspent money from previous years to spend, this is the grant of $4.5 million.

MR. MACKINNON: I hate to sound a little facetious but I think she's taking lessons from the Prime Minister on new money, old money and old money, new money. As I understand from the witness at the Public Accounts Committee, they applied for $2.5 million

[Page 77]

in their first year and they received $5 million, and the second year they applied for $2.5 million - well, that is what was budgeted for - and they received $5 million. The witness indicated - and I stand to be corrected - that they were planning on applying for upwards of $7.5 million. It was well in excess of $5 million anyway. Now the minister is saying that that's not the case. Could the minister please confirm what the research foundation applied for; do we have any documentation as to what they applied for, and would she please provide that to the members of the committee?

MISS PURVES: Mr. Chairman, I believe I answered that question at the outset, but I will repeat my answer. The foundation, to the best of my knowledge, did apply for more than $5 million. I do not have that documentation with me. I would be glad to provide the information. They applied for more than $5 million, but what we have provided for and what they are getting is $4.5 million.

MR. MACKINNON: Could the minister, since she knows that they applied for more, give us some indication of what the research foundation applied for, how much?

MISS PURVES: Mr. Chairman, as I said, I don't have that documentation in front of me, it is in none of the briefing books, but I would be glad to supply that information to the member when I get it from the department. I believe they applied for more than $5 million. I know they indicated they were going to be asking for about $7.5 million. Most people, as the member is well aware, and most organizations apply for more than what they get, and that is the case here. The exact amount they applied for, I will supply that information.

MR. MACKINNON: Mr. Chairman, actually I agree with the minister that most organizations will apply for more than what they will generally receive because of pressures on government. Ironically, for the first two years, they only applied for half of what they received. There didn't appear to be any paper trail to confirm the concerns as to why they would apply for $2.5 million and receive $5 million. That was essentially the concern that was raised at the Public Accounts Committee. I am glad to see that the minister is now correcting that process, because it's the first time in three years that we've actually seen some accountability. Well, we're going to take the minister at her word that she will provide that paper trail, because that was a concern not only by members of the Opposition but also by the Auditor General's office.

One of the issues that was raised at the Public Accounts Committee - obviously it's a committee for doing value for dollar for the taxpayers - we kind of did a cursory review of some of the projects that were supported financially, the research projects. One of them was a $47,500 research grant to Kenneth Rockwood, entitled A Novel Outcome Measure: Developing a New Outcome Measure for Detection of Disease Progression in Treated Alzheimer's Disease. In fact, I asked if the representative from the research foundation would provide us with a copy of that report. To date, we have not received that report.

[Page 78]

Has the minister seen this particular report, and would she be kind enough to provide members of the committee with what the department has done with that particular report in terms of making a decision as to whether the department would fund such medications as Aricept or any other type of medication to deal with the progression of Alzheimer's?

MISS PURVES: Mr. Chairman, I will double-check on that, but the practice is that as soon as the study is finished, it is public. People doing research generally want as much publicity as they can get for their study. Certainly, it's not something that we have that we're keeping to ourselves. The health foundation commissions the research or pays people for the research, and it will be made public as soon as it's done. I will certainly double-check for the member, but it would appear that the study is not yet complete.

MR. MACKINNON: Mr. Chairman, I beg to differ with the minister because I spoke with committee staff just moments before I came in to ask questions, and my understand is that the representative from the Nova Scotia Health Research Foundation was going to supply that information the first week of April. Now that has passed and no one has heard anything. I am sure that individual would not have been paid unless there was a final report prepared, because the indications are, from the presentation at the Public Accounts Committee, that individual, as I understood the presentation, the way it was listed, was paid. Maybe I am not correct on that.

Essentially, to cut through all the detail, we would like to know if the Department of Health is aware of this report. Can you tell us with certainty whether it has or has not been concluded? We haven't been able to determine that. Where does it fit into the issue of determining whether the department will proceed with medications such as Aricept or what have you? I think this report would certainly be helpful in determining whether the use of medications such as Aricept, or whatever other medication could be applied, would help to prevent or reduce the effects of Alzheimer's or the progression of Alzheimer's? I would think that this would be a very important document that any government would want to jump on pretty quick, particularly if we've paid for it through departmental funds.

MISS PURVES: Mr. Chairman, all we can do is check on the status of that report, whether or not it is complete and if it's ready for publication. Certainly, a report that was supposed to be ready the first week of April, by any kind of government standard, you would have to ask what year. Anyway, we will check on the status of that report.

A separate study and recommendations have been made by the Atlantic formulary group that will be studied and a decision made in the next few weeks regarding the coverage of the Alzheimer's drugs of which you spoke. That is something that the Premiers and ministers will ultimately decide on, but the deputies are going to have a look at the recommendations of the Atlantic formulary people on how and if several of the Alzheimer's drugs should be made available in the Atlantic Provinces. That decision is pending, regardless of the outcome of this particular study.

[Page 79]

[4:00 p.m.]

MR. MACKINNON: Mr. Chairman, the minister is saying something a little different than what her deputy said when he was before the Public Accounts Committee, that the determination of the results or the findings of this study have absolutely nothing to do with the determination of whether the government would proceed with a decision on Aricept or any other medication to combat Alzheimer's. There's a bit of confusion within the Department of Health. I guess I will leave it with them right now and since they're in a state of confusion, I will allow them to kind of think about it for a while.

Maybe we will move on to another issue that we can get some clarity on. That is with regard to the recent announcement by the minister regarding nursing home funding. I was pleased, quite frankly, to see that there was some movement in that with regard to reducing the burden for seniors in terms of nursing home costs, the medical costs. I think that's essentially what the minister was moving towards, having absolutely zero medical costs by the year 2007 which would result in a significant benefit to seniors right across this province.

There was one missing factor in the equation, as best I could determine, and that is with regard to some of the new nursing homes that are being constructed, present-day. As the minister will be aware, Harbourstone Nursing Home replaces Breton Bay Nursing Home in Sydney. I must say it's an excellent facility, but the per diems for seniors have gone from $135 a day to $195 a day. That's a rather significant increase. I understand that the private proponent has costs, and in all likelihood are providing additional amenities and support systems and perhaps a whole lot of other components that wouldn't be provided in the older facility. I understand that, but that doesn't appear to be taken into the equation of what the minister announced.

When you go from $135 a day to $195 a day, effective, I believe, April 1st this year or sometime in the early part of 2003, that throws all these figures out the window. I will give you an example. For an Alzheimer's patient who would have entered into the nursing home four or five years ago, and all the calculations for what percentage of the family income would go towards his/her support in the nursing home, vis-à-vis what would be left for the family, all that is out the window now because of the new fees. None of that was contemplated. There are considerable numbers of families that are adversely affected. Now that's only one institution, and I am sure there might be other institutions. Has the minister taken into account these unexpected fee increases?

MISS PURVES: Mr. Chairman, before I talk a bit about that, I would like to go back to the issue of the study on the Alzheimer's drugs. I may not have made myself clear. I was saying that the Atlantic formulary group has done a review of these Alzheimer's drugs, and that review will be presented to the deputy ministers within the next couple of weeks, irrespective of the study that was done for the foundation. So, we are proceeding on that

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track, whether or not the study that that member for Cape Breton West referred to was published last week, this week or next week.

As the member knows, the capital costs of the nursing homes are figured into the per diems and, obviously, the newer, more expensive homes have higher per diems for now. What we will see at the end of the four-year period is all the medical costs will be paid by the province and the per diems are going to be averaged across the province, so no matter what your income, you will be paying the same. You're not going to see a situation where, again, if you're wealthy or you're in the newer, more expensive nursing homes - I think members are also aware, some of the older ones are very nice nursing homes and have very good reputations and people are very anxious to get into them. We are not looking at a new form of discrimination. Your daily rates are going to be based on your income, not your assets.

MR. MACKINNON: I'm not sure exactly what the minister is trying to tell us here. I understand that you're going to change the formula for calculating entrance requirements. You're going to go from a total asset base to just strictly income. Now, someone, when they retire, most people, their income will drop. If they have a significant asset base, they may convert that into capital, which they will put into the bank. You're saying that that won't be included now. Is that what the minister is saying?

MISS PURVES: Mr. Chairman, the idea is that by the end of this time period we will be out of the asset business. In Ontario and in the western provinces the rate that seniors pay for nursing homes is based on their income. Generally, there is some income; pension income, so on. What they can afford to pay is what they pay.

MR. MACKINNON: Mr. Chairman, I would submit that there are a lot of shrewd business people around Nova Scotia who could certainly depress their level of income through different corporate tax shelters, and their ability to move dollars around in different pockets. So that really doesn't answer - all we're doing is eliminating one problem and creating another. The inequity may go from bad to worse, based on what the minister has just indicated. Based on the intent of what she hopes to achieve, does she have anything substantive, any documentation or any analysis, financial detail that would be able to show a projection of what the government hopes to achieve by moving from formula A to formula B, so to speak?

MISS PURVES: Mr. Chairman, my guess would be we probably have about several dozen tons of documents looking at this issue from various points of view. What we're doing here is moving to a new model that is based on income. I know what the member for Cape Breton West is talking about. It is one of the things that we discussed among ourselves during discussions about changing from asset-based to just strictly income-based assessments. Yes, it is probably true that some shrewd person or estate planner can find a way to hide assets, but obviously, this is happening right now. If a family chooses or a person

[Page 81]

chooses to take the point of view that, well, you better prepare for the day you have to be in a nursing home and - it's happening right now. Those with the means are able to divest themselves of assets before they go into nursing homes, whether it's three years before or two years before or one year before in terms of the look-back period.

What we have decided is that even though it will take several years, we don't want to be in the business of doing that anymore, that people will pay based upon their ability to pay, on their income, and that if they want to leave assets to their families or to charitable foundations or whatever they want to do with it, that the province should be out of the business of doing that. We think the so-called losses to the province will be minimal compared to the gains for seniors in the nursing homes.

MR. MACKINNON: Mr. Chairman, the minister still hasn't answered the question. What is the cost analysis? Have you done a cost analysis? How much will it cost the province by shifting from one model to the other model? That's as simple as we can make it.

MISS PURVES: Mr. Chairman, yes, we obviously have done the analysis, because our analysis shows us that this will cost the province roughly $40 million a year to move ahead to this model when it is fully implemented. That $40 million is in today's dollars, so it will obviously be somewhat more, depending on the economy and other costs in years to come. But those costs would be incurred, regardless. We would still see a certain amount of inflation, we would still see increases in wages, those costs would be incurred, regardless.

What we are saying is, all the modelling that we have done shows that to do the medical costs alone would cost us $35 million, approximately, in today's dollars, at the end of the four-year period, and to move to this other step of eliminating the asset inspection would add another $5 million a year. We believe this is fairer to all seniors, and it is time that we did move to the model used in other provinces. It will cost more than just paying for medical costs, but it will not be a huge cost.

MR. MACKINNON: I'm looking for a little more clarity on the income model, because this is where the clawback period would be very important, I would think, because someone, the day before they decide they want to apply to go to a nursing home, can convert all their assets into liquid, into dollars. So, the minister is saying, okay, well that's fine, they can convert their assets, convey them to someone else or they can convert them into dollars and give them to their children. That factor still has to be considered somewhere, otherwise, you're not talking $35 million or $40 million - you could be talking twice that amount of money when you take the total number of seniors that you're dealing with in this province.

[4:15 p.m.]

Would the minister please be kind enough to provide us some detail as to what are the other factors that are attached to the income model?

[Page 82]

MISS PURVES: Mr. Chairman, the department looked at what is done in other provinces and how it works, what the averages are. We looked at maximum and minimum exposures of moving to this model and our best estimates are that $40 million a year in today's dollars is about right.

If you took every worst-case scenario you could think of, you might be at $46 million. I believe that's what our modelling shows, but we are looking at the majority of people being honest and the majority of people do have some income to apply to their room and board. Bottom line? We believe this is a better and fairer model. Thank you.

MR. MACKINNON: Mr. Chairman, I sense that the minister and her government are panicking because of pressures by the socialists because they tried to capitalize on not only the fact that there was a real issue here, but they went around the province in an emotional roller coaster performance scenario, going from town hall to town hall telling the seniors what a terrible job. But they would never say themselves precisely what they were going to do, it was all the things that others did that were so terrible.

That's the same, not just on this issue, but also in the insurance issue and so on. But, based on what the minister has just explained, it's almost as if there was some political pressure there to kind of move in that direction because the public opinion was, or the perception was, that the government's a big bad wolf taking from these seniors. In many cases, that's true. But jumping from the grease into the fire isn't necessarily the answer either just because the socialists are on a roller coaster ride with public opinion and emotion, which they usually try to capitalize on to get anybody's (Interruptions) Perhaps, Mr. Chairman, if the member who just answered had listened to the entire conversation he would know that I addressed some of his out-of-context quips. But, being a socialist, they only want to know all the bad things that other people do. They don't want to know the good things. I appreciate that because generally their philosophy is, what's theirs is theirs and what's yours is theirs and what's yours is also ours. They've got a mixed philosophy, so we have to take that into perspective.

My concern is, number one, that a lot of seniors and their families, particularly if you have a couple who have worked all their lives and they may save, let's say $40,000 or $50,000, they may have three or four children and x number of grandchildren and they want to give that to their family. Maybe they don't even have that much money, maybe they just have their pensions and their supplements and a little bit of a company pension or whatever. They may have their family home or maybe a piece of land and a cottage and then all of a sudden, that's stripped away from them in essence. Under the present formula, the minister has indicated, they're going to try to move from that, but essentially, the overwhelming majority are the ones that are on asset base because that's all they have. Those who have the good fortune of being able to have sufficient asset base to move it into a liquid form and still have an asset base that they can shelter or they can shelter on one side or the other - there are

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a fair number in Nova Scotia and that's why this moving from one formula to the other is of absolute importance.

I remember quite distinctly back in the early part of 1999 when the member for Lunenburg was on this side of the floor and he was very anxious to see the government compel seniors to spend more of their pensionable income because there was so much income that was, in his view, socked away. The concern is that the government will move to this other model and although the optics will be, well yes, we're going to take some pressure off all these people who are suffering today, but we'll have a whole new series of problems tomorrow that will impact on a greater number.

The government hasn't clarified in sufficient detail that would give a comfort level, in my view anyway, because the minister, herself, just moments ago, indicated that it would depend on the economy, the budgetary situation. So it's only a plan into the future, four years down the road. I mean, is the minister contemplating introducing legislation to make that a reality? Is the minister going to have regulations that would clearly spell out how this process would unfold? Is she going to do it before the election? Or, is it just a promissory note?

It sounds good at the outset, but when you start looking into the details, it gets pretty ugly. If you think the NDP with their scare mongering is bad, wait until the people of Nova Scotia start to absorb the real concern that this could create. That's the problem I have with it. I'm not suggesting that what the minister is doing is wrong, I'm not suggesting it's right. What I'm suggesting is that the minister hasn't provided enough detail to tell us anything other than the good press release that she put out. That's not enough. (Interruption)

The last thing we ever need is any more questions from the NDP because they've been asking them for years and it's to the point where they can't even answer their own questions. But I'll leave that particular issue.

MR. CHAIRMAN: Order, please. The honourable member for Cape Breton West shouldn't be distracted by the rabbit tracks from his colleagues to the right.

MR. MACKINNON: That's right, Mr. Chairman, and I thank you. Not to be distracted by socialist rabbit tracks.

I would submit to the minister that perhaps she could provide the committee with a little more detail other than the generalities that she seems to have put here before the committee today.

MISS PURVES: Mr. Chairman, this change won't require legislation. It's a change in departmental policy and at the end of the four years, seniors won't be forced to liquidate their assets. They won't even have to think about that. It's going to be a model that is not based on a socialist system, if you will. Right now and the way the system has grown up, it's

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an issue of the government deciding what it will take from you, what you can afford, and so on and so forth.

The other model which is used in socialist provinces as well as non-socialist provinces is based on the income of the people involved. We don't go in to look at their woodlots or their cottages, or cars, or anything. What people choose to do with those assets will be entirely their own business. They will pay per diem room and board costs and the province will pay their medical care costs. I mean, obviously, right now we even pay the medical care costs if they go to hospital, but what we're referring to are the medical care costs of their actual care in the nursing home, which is the issue. No one in this House really believes it's entirely fair the way it works now, that is one thing, but the worst irritant to people going through the system, the thing that bothers them the most about the present system, aside from the philosophy of it, is people from the government going through their private affairs and telling them what they can and can't have and what they can do with their stuff, whether they have very little or none, or a lot, and that is the system that is going to change and should change.

MR. MACKINNON: Mr. Chairman, I hardly suspect that the minister would ever agree with the socialists, but it's important for the member for Sackville-Cobequid to be an optimist. He knows full well that socialists will never, ever get in government in Nova Scotia. They have a better of chance of getting hit with a Soviet missile than they do of getting to be government. (Interruptions) We will be working with them on that side of the floor, I can assure you that.

Anyway, Mr. Chairman, I'm going to ignore the rabbit tracks from the socialists. I want to focus on a local concern and that's in the communities of Donkin, Port Morien, Birch Grove, Tower Road, referred to as one of the catchment areas for the Glace Bay General Hospital. That's a community hospital, as we all know, but the emergency room at the Glace Bay General Hospital closed, I believe, 32 times in the last year and I would ask the minister what steps she and her department are taking to correct that problem? The reason why I ask it is because, as she well knows, in Cape Breton we have an aging population and that's no different in these communities than it is for the rest of Cape Breton Island. It's in close proximity, much closer than if they had to go to the Cape Breton Regional Hospital or the New Waterford hospital, or whatever, and it's an area of growing concern and I would ask the minister if she could give us some clarification as to what the plan is for this year?

MISS PURVES: Mr. Chairman, the member's colleague, the member for Glace Bay, was asking this and similar questions yesterday and I endeavoured to provide an answer, or undertook, sorry, to provide an answer. I do have some answers here to the questions that were asked yesterday and I will table this document, but I would like to read some of the points associated with the question the member asked. Some of the actions and results are a new emergency physician began practising in March. Another will be starting soon, if not already; another, with the exact date not yet clarified, will be doing emergency in Glace Bay

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and Sydney. A family physician has begun work in Glace Bay this week. An emergency room physician will begin work in July after finishing a residency program. A family physician will begin within two weeks in New Waterford. There have been six site visits set up by the recruitment office since January with four recruits. These visits are all booked and financed through our office and, in general, the DHA and the Department of Health have been working together to ensure that the medical needs of the community are met.

[4:30 p.m.]

We're very well aware of the situation in Glace Bay and area, I will table that document, and are aware that the lack of physicians, even though it's an attractive area for physicians, is what has been causing the issue at the Glace Bay General Hospital and, obviously, closing the emergency ward 32 times, or even 30 times, whatever, is definitely not good because people cannot rely on an emergency room that's closed that often. There is no plan or belief that the emergency ward should be anything other than open seven days a week, 24 hours a day.

MR. MACKINNON: I'm winding down on my questions, Mr. Chairman, for my colleague, the member for Cape Breton Nova, to fill the rest of our hour, but one final issue is with regard to the air ambulance program. As the minister is aware, the province took over the administration of that program in the last fiscal year. Would the minister be able to confirm whether the province is able to operate that more cheaply than the private proponent who was operating it prior to because that was the undertaking that was given to members of the Legislature last year?

MISS PURVES: Mr. Chairman, I will have to provide that information either later today or tomorrow. There were staff savings involved in this change, but there were other costs that went up after 9-11. So we're going to have to look at how exactly that breaks down as to where the savings were and what were extra costs incurred that might not have been anticipated.

MR. MACKINNON: Mr. Chairman, I hope the minister wasn't being mischievous. This reminds me a bit of the Premier saying that one of the reasons tourism was down last year was because of 9-11, but when you look at the statistical analysis that was provided showing the Premier at that time why tourism numbers were down, all the factors were pre-September 11th. So if the minister is going to provide that type of detail, I would hope that she would break it down so we would see exactly how 9-11 was a factor because, let's not forget, if what the minister is saying is correct, then that's an issue that should be charged back to the federal government through EMO and the minister knows that.

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So I think it's very important, the promise by the government, when that transfer of responsibility was taking place, that the government could do it cheaper. What I've heard here today is that the government is not doing it cheaper, it's more expensive, and maybe or maybe not 9-11 was a factor.

It's important to note, as well, that there was considerable documentation provided at that time by a number of different stakeholders that would suggest it could have been and it was being done cheaper than the government could possibly do it. I will take that on notice from the minister, and I thank her for her answers to my questions.

MISS PURVES: Mr. Chairman, I just wanted to clarify, it wasn't direct cost to do with 9-11 that I was referring to, but simply that 9-11 triggered increased costs in running airplanes and air travel for everyone involved in that industry, regardless of whether it's a business like Air Canada or whether it's air ambulance.

MR. CHAIRMAN: The honourable member for Cape Breton Nova. The member has until 4:45 p.m.

MR. PAUL MACEWAN: Hardly enough time to get warmed up, but let me get started anyway. Mr. Chairman, I am very glad to see you in the Chair this afternoon, because I know what a great representative you are, not just of Colchester-Musquodoboit Valley but also of the truckers of Nova Scotia. I know that your heart is with the truckers, left, right and centre. Having said that, I think you will agree with me that it would have been very convenient, perhaps more convenient to have been a trucker in the days of Premier Donald Cameron than it is today.

In those fine times, if a trucker had the right type of vehicle and a bucket of white paint, he could set himself up in the ambulance business pretty quickly, with perhaps a red cross on the side of each door. There weren't any governing regulations in those times to set up an ambulance. I know that most funeral directors in the province also ran ambulance services, but not necessarily, and neither was the practice restricted to the funeral directors. Anyone who had a vehicle, who wanted to call themselves an ambulance service could set one up.

Now, it's when I reflect on the good workings of the Liberal Government that I think how we brought that to an end and replaced it with the system we have now, the emergency health care service which, while not perfect, certainly contains a lot better potential for delivery of service and perhaps is a lot more reliable, I should think. It certainly has, perhaps, better-trained, quality crews, professionals working on the ambulances who have gone to courses and learned, not what a doctor knows necessarily but learned enough to be able to administer first aid on the spot and get victims to the hospital as promptly as possible, and do that not as a filler-in between delivering dead bodies for burial or other such services but as a full-time occupation.

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When I drive home through the riding of my good friend, the member for Richmond, who I don't see here right now but I am not supposed to say that, I notice the ambulances parked overhead on a certain overpass that you go underneath as you go on the Fleur-de-lis Trail, as you get up to Sydney. I wouldn't say they're there waiting for the next accident to happen, any more than I would say that about fire trucks that are parked on the ready at the fire station waiting for the next fire, but they are on the ready. They are following the old Boy Scouts' motto, be prepared. That is something that our Party did during its years in power that is reflected in the estimates now before us, if you want me to make my remarks relevant to the estimates.

MR. CHAIRMAN: I might just comment, honourable member, since you referenced my former vocation, I don't recall any of my colleagues taking a bucket of white or red paint and plastering it on - or blue paint - the sides of those dump trucks, but carry on. The relevance, I'm sure, is coming.

MR. MACEWAN: Well, sir, I think what they needed was more of a van-type, something of that type. If you owned a van and you could put a stretcher into the back part . . .

AN HON. MEMBER: A suburban.

MR. MACEWAN: A suburban, perhaps, something of that sort, a station wagon, or maybe one of these long limos that I see being driven around town, the Cadillacs that are about 75 yards long, if you had that type of truck, you were all set to go trucking. That's the point. Now it's not quite the case.

The reason I'm mentioning that is that we're dealing here with the estimates of the Department of Health. Many good friends of mine served in the capacity of Minister of Health, the honourable Bernie Boudreau, Dr. Jim Smith, Dr. Ron Stewart, among others. (Interruptions) Yes, they did and they did their best, just as I am sure this minister is doing. She is somewhat new on the job, because the minister before her had done what he could do. So it was time for him to move on to other tasks. That's the way it goes.

I've seen all these people at close range, struggling with all the work they had to cope with. I remember Bernie Boudreau taught me, very soon in the game, that Health consumes one-quarter of the provincial budget. It's the largest department. Take any other two or three and add them together, and you're not getting to the size of Health. I remember when Mr. Boudreau was Minister of Health, I called his office one day and asked his secretary, is that memo I sent over to Mr. Boudreau on his desk? Oh yes, she said, it's on his desk. Well, there was something about the tone of voice that made me think, I wonder where it is on his desk.

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So I went over to the fourth floor of the Provincial Building, and I went past the secretary to the minister's desk. He had a huge desk, it was about as big as that table or bigger. On the desk there were piles of files about that high up, one, two, three, four, five, six, seven, eight of incoming work that he had to deal with. I'm sure that the memo I had sent the minister was somewhere in one of those eight piles. The secretary was right. But whether he would ever get to see it, in that context, I wasn't sure. I found my memo, knowing what to look for, pulled it out and gave it to the secretary and said, when Mr. Boudreau comes in, you give him this file for me, would you, please. She said, yes, I will. So then I was sure that he would get it.

I say that story to illustrate the pressures under which any Minister of Health operates. This is a big portfolio. This covers one-quarter of the total budget of Nova Scotia, and one-quarter, approximately, we shall say, of government activity in the province. When we meet here, I guess we will have to say one-quarter of our time should be devoted to Health, meaning that Monday and one-quarter of one further day, weekly, should be devoted to Health, just to give it proportionate treatment, what it deserves.

Having made those fine points, I think my time has just about run out. (Interruptions) Two minutes? It is pretty hard for me to sum up the rest of what I feel about Health in two minutes, Mr. Chairman. Let me say that it is a big subject, and we will want to deal with it here in the estimates in some amount of time, I'm not saying to hold it up or to prevent the other departments from being heard, but certainly there is a great deal in this field that warrants exploration. There is much I could say on that.

I can tell you that most of the hospitals within the service area that I represent are in a continuous state of fear and trembling, not shocking and appalling but fear and trembling. Why? Because they don't feel confident that their facility will continue to be in operation. The New Waterford Consolidated Hospital has been lingering under a cloud of uncertainty for years. The Glace Bay hospital seems to be in an even worse situation. The outlook in New Waterford is, can we keep the hospital going? In Glace Bay the outlook seems to be more that the hospital is almost doomed, and it's just a matter of staving off the inevitable until it actually happens.

I am not sure that this kind of health delivery system is good for the communities, because in each community a hospital is sort of like a mainstay of the community, it's like the school, it's like the fire station, the post office. When you take those things away, many people think we don't have a community any more, it's gone. I think we have to be very careful. We have to be ultra-protective, if that word is parliamentary, of our hospitals and keep them in full operational capacity, wherever we can.

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If we have a surplus of hospitals, because past Tory Governments built too many, one on every corner (Interruptions) Oh, you don't want me to get into that one, Mr. Chairman. Well, you know what, sir, I agree with you. I think my time is up, and we will continue on a future date.

[4:45 p.m.]

MR. CHAIRMAN: The honourable member for Halifax Fairview.

MR. GRAHAM STEELE: Mr. Chairman, I would like to take only a few minutes of our time today before I pass the floor back to my colleague, the member for Halifax Needham.

I would like to tackle a subject that has been referred to by the member for Cape Breton West and that is the Health Research Foundation. One has to keep in mind here that we actually feel that the Health Research Foundation came into being because of the work that we did on this side of the House. The Liberals had promised it in two elections and failed to deliver, and it was because of the pressure that we put on the MacLellan Government in 1998 that they felt that they had no alternative but to finally keep their election promises, which is not something they were used to doing.

At the time the Minister of Health, the member for Dartmouth East, as he was then and is now, made a commitment that the funding for the Health Research Foundation would be at least $5 million per year, and that's what the government has done. Now the problem is - well let me just wrap up that thought by saying that's why I think we in the NDP feel particularly possessive and particularly proud of the Health Research Foundation - the problem is the way it's reporting the accounts. The reason it became such an issue was because last year the government had a razor-thin surplus at budget time, $1.8 million, and it seemed clear that among the multitude of budgetary flim-flammery that the government was pulling last year, one of the most obvious ones was the fact that year after year they were allocating $5 million to the Health Research Foundation, but they were only reporting $2.5 million.

Now, various ministers and departmental officials have tried to explain that, but there is no explaining it. You can perhaps in the first year of operation, perhaps in a partial year of operation, you can say okay, on a full-year basis it was $5 million but in the partial year it was $2.5 million. But what nobody can explain is how you can do that year after year after year - spend $5 million and report $2.5 million.

Because this is a particular interest of mine, I turned to the Health Research Foundation grant in this year's supplementary estimates and what do I find? Have they done what they've done before? No, they've done something that seems incomparably worse. So my question to the minster is, the estimate for last year, as usual, was $2.5 million, but the

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executive director of the Health Research Foundation came to this House and said that the government had committed $5 million, the foundation was spending $5 million. Later that same day, the Minister of Finance said medical research is a priority of this government. What the minister was trying to say was that the $5 million was going to be an ongoing commitment of this government. So I wonder if the minister could explain to me that if the executive director says they got $5 million and spent $5 million, if the minister says that he gave the foundation $5 million, how in the name of tarnation can the estimates report that $2.5 million was spent? What's going on?

MISS PURVES: What we're doing here with the $4.5 million that we're giving to the foundation is as close as we could manage in this year to giving the $5 million in a way so it's $4.5 million instead of $5 million, in a way to make the grant more transparent. That's what we're doing. We would have liked to have that line read $5 million, but there was a lot of pressures on the health budget this year so we made it $4.5 million.

The member does know that, of course, what we give the foundation and what they spend aren't necessarily the same because of all the matching grants and so on that they're able to lever. It's important that they be able to do that. The Auditor General and the Opposition and so on, the accounting procedures were questioned, so what we're endeavouring to do here is to clear that up by saying straight out there's your $4.5 million, even though they would like more.

MR. STEELE: Thank you to the minister for that answer, but the minister answered a question that I didn't ask. I'm not asking yet - although I'm going to get to that about the $4.5 million - I am now asking about the forecast figure for 2002 or 2003. The Minister of Finance says they spent $5 million, the executive director of the foundation says they spent $5 million, but the forecast figure says $2.5 million. What's going on, when everybody agrees that $5 million was spent but the forecast says it was only $2.5 million, how can you do that?

MISS PURVES: It's because of the previous year issue. We gave them $2.5 million and forecast they would spend the $2.5 million that we gave them that year, but there was still other money that they had, as I understand it.

MR. STEELE: The problem with that answer is it's just not true. The province didn't give them $2.5 million - the province gave them $5 million. The Minister of Finance says so, the executive director of the foundation says so, and for the life of me I cannot understand how people can keep getting up in this House in trying to explain how $5 million in reality becomes $2.5 million in the estimates.

I'm going to leave that because I'm getting the same non-answers from this minister that I got from the previous minister. I'm going to move on now to the answer that the minister gave to the question I didn't ask. The minister says they're trying to clear things up,

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make it more transparent - to that I say, hallelujah, it's about time. I do agree with the member for Cape Breton West that what's really going on here is that the government got caught, they got caught misreporting the finances of the Health Research Foundation because it was convenient for them to do so.

The minister says this year, okay, finally it's going to be open and transparent, and yet the commitment of the Liberal Government and the commitment of this government was to give the foundation at least $5 million a year and now I look in the estimates and it's not $5 million anymore, it's less than that. Is this government backing off on its previously firm commitment to give at least $5 million a year to the Health Research Foundation? If it's not backing off that commitment, why is it reporting a lower figure in this year's estimates?

MISS PURVES: I think I've been fairly clear about that. We looked everywhere for that half a million dollars, we had a lot of pressures in health this year, including some help for seniors in long-term care. There comes a point in the budgeting process where you cannot find that half a million dollars - or $1 million or $10 million or whatever it is that you need and would like to put into a particular area - so what we're doing here is giving them $4.5 million. We feel that is manageable, it is enough money to allow the foundation to lever other money from other sources. We'll look at what we can do in upcoming years. This year the figure is $4.5 million.

MR. STEELE: I would like to thank the NDP Health Critic, the member for Halifax Needham, for allowing me some time. I would now like to cede the floor to my colleague, the member for Cape Breton Centre.

MR. CHAIRMAN: The honourable member for Cape Breton Centre.

MR. FRANK CORBETT: A quick question to the minister. Mr. Minister, a problem that seems to be arising more and more through the hospital locations is fees for parking. When I first approached the CEO of my DHA, he said that parking lots are items that are not covered by the budgetary process in the province. Can you explain why that would be, why wouldn't you cover parking lots?

MISS PURVES: Mr. Chairman, again the simple answer is, the competition for health care dollars and parking is necessary for a great many people. The fees are not terribly high, depending on your income or how often you have to be there. It is common to have parking fees for hospitals across the country and it is a way in which the hospitals can recover some revenues, because regardless of whether it comes from their area or their budget, or the provincial taxpayer, or the federal taxpayer, it is still a cost that has to be covered. There are abilities for hospitals or administrations to waive these fees in certain circumstances of extreme hardship, but I certainly do not see that any of the parking charges in our hospitals in Nova Scotia are excessive to most people - only maybe excessive to some.

[Page 92]

MR. CORBETT: Mr. Chairman, I guess that's a fundamental debate around health care at all, you know, accessibility, and what may not be onerous to me, may be onerous to my neighbour and vice versa. So, you know what's extremely frustrating is when you see facilities that have been in place for years that didn't have a parking fee now are being visited upon, and in particular I'm thinking about the Glace Bay General Hospital, that hospital has a fee coming up now. We're not talking about facilities in areas that are here at the QE II site, where you have a high volume of automobiles and very little real estate in which to park your vehicles and it's a way to garner revenue, but I mean one would assume that would have been part of the whole health care package.

I hear what the minister said and I know that, in fact, at the regional complex in Cape Breton, where if you have a family member, or whatever, who is receiving some form of long-term care you can buy a voucher, or something like that, that would reduce the price over the week.

But really it is at times onerous for people, and some people have very modest means. I know many people in my constituency who are in receipt of community services and have to go to regional from time to time and they kind of talk a friend into taking them there, and they're going to stay and they feel rather embarrassed. The $2 means a lot to them, you know, and to merely say that it's just coming from another pot, I don't think is proper, Madam Minister. I think that what we allow people on community services is the very bare minimum and I think that that should be taken into consideration at all times, parking fees and so on. So to merely say that it's just coming out of one pot versus another, I don't buy it, but nonetheless I wanted to say that for the record.

Now I'm going to move into another area for a minute or two. You may not have seen this coming, but it's about the emergency room in New Waterford's Consolidated Hospital and its future. I know I should give you a few minutes to compose yourself and get your notes because you probably never heard me talk about this but, Madam Minister, this is a very - although I make a little joke there - serious item in my constituency because, you know I think without fear of too much contradiction there's probably not too many communities in this province that have given as much to the economic and the energy, the actual energy usage of this province, more than the Town of New Waterford, considering the amount of coal mines and that we have the largest generating station in the NSPI grid in Lingan, and may I say that by doing so, New Waterford not only used our real estate, but probably gave up one of the finest beaches in all of this province to do so.

[5:00 p.m.]

I don't know whether - that was done in the mid-1970s - I don't know whether a community would be that generous today, to put it mildly, but I guess where I'm going with this, Madam Minister, is the fact that there are a lot of people in that community who had given their life's work to helping this province, and we find ourselves in extremely hard

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economic times and those very industries that supported this province through the World Wars and through international oil crises and so on, these people now find themselves elderly - some not so elderly - but most of them find themselves without employment, and it's a very hard thing to find in this day, so I want to know from you, are these factors taken into consideration? I know we see the C-TAS scores on the types of ailments that present themselves in emergency, but I want to know, is the real social cost taken into account when the DHA is looking at reducing hours in that emergency room?

MISS PURVES: Mr. Chairman, the short answer for that question is, yes, you have to take all kinds of social factors into consideration whether it's an emergency ward or some other aspect of a hospital - or a school for that matter. Communities are different; their histories are different; their acceptance of change is different. None of us would say nothing should ever change, but on the other hand if the CEO in Cape Breton, whom we all know is an excellent CEO and has achieved a great deal in the area, does not feel convinced that the emergency ward would be closed there, we would not have provided the funding that we did while further options are explored.

I know they needed the extra funding to keep it open, but I know there were questions about that consultant's report that was commissioned, you know we've talked about that privately. Not all hospitals, not all emergency wards can be open all the time, but yes, the community factors play a strong role in decisions and whether or not they stay open. It's fairly obvious that the people of New Waterford want their emergency ward.

I would also like to refer back to something that the Health Critic for the Liberal Party said yesterday and it was to do with the amount of change that the community has accepted in general in industrial Cape Breton and indeed they have in communities across Nova Scotia accepted some of the change that's going on - sometimes they accept it faster than the people in the professions actually, and it is a testament partly to them and partly to Mr. Malcom and all the people involved in the system, and perhaps even my associate deputy, that some of the things that need to change have been done and have been accepted. We can only ask so much of people in communities in terms of the pace of change that we ask them to accept.

MR. CORBETT: Mr. Chairman, while I agree with the minister when she talks about being hard to accept change and that's fine, but I think change is relative, I mean if you change your tissues from Scotties to Kleenex, that's a change that most people would find fairly unobtrusive and move on, but when you have a service that you have depended on for years and to see it being kind of removed by virtue of an issue that they don't see in black and white in front of them, it's a hard change to accept. Madam Minister, you and I have publicly and privately talked about the opening hours and why that emergency room has been able to sustain the hours it has up to now with physician availability. We hope to continue that. We realize that's kind of a wild card in this whole issue.

[Page 94]

What we want to get to is when we talk about the 7 per cent being there and giving it long-term funding and the services would stay, at worst, at the base level and hopefully grow. I realize that you as minister just can't arbitrarily say that New Waterford Consolidated Hospital will have emergency services 24 hours, 7 days a week. I appreciate that, it's up to DHA budgeting. I was actually looking to you for comfort, that we agree on Mr. Malcom and his abilities and what he's meant to that DHA. What I'm looking for from you is that there is no directive coming from your department that it's on the block to be axed, that you will continue as minister to support that 24/7.

MISS PURVES: I'd like to confirm that there is no directive from my department that that emergency ward or any other should close, and there won't be. If we wanted to indulge in that level of decision making, then we wouldn't have DHAs. We have to have people in local areas to manage the delivery of services. That can't be done from Halifax, even for Halifax.

MR. CORBETT: I want to thank the minister for her time and openness in answering the questions. I'm going to now cede the floor to my colleague, the member for Sackville-Cobequid.

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

MR. JOHN HOLM: Mr. Chairman, I was going to stand up and ask the minister what the Premier has against her for having moved her into this portfolio just before the election, but then it's such an easy portfolio to manage without any difficulties. I'm sure that it was as a reward moving the minister into the Department of Health, rather than the heavy Tourism Ministry.

On a more serious note, I really don't want to go into a tirade, at this point in time anyway, with the minister. It's a little too early for that. I don't want to use up the full remaining hour unless motivated to do so. However, what I really would like to do is just really lob some gentle questions to the minister, who has certainly had the very difficult task of trying to defend the indefensible when it comes to the way in which the government has been treating the seniors of this province.

I thought I would like to give her an opportunity to talk some positive good news and that would be about the Cobequid Community Health Centre, to give the minister an opportunity to rise in her place and to inform all of the multitude who may be listening, where exactly things stand at the present time. I certainly am aware of the fundraising and I know about the tenders being called, but I'd like to get some more clarification and on the public record as to when the minister now is foreseeing the ground being broken, when the minister is foreseeing when it is committed to having this new facility open.

[Page 95]

I will say at the outset that all of those who are on the foundation and on the body, who have been working so hard within the community to get the new Cobequid Community Health Centre up and running, which it eventually will be, those people really deserve a tremendous vote of thanks and gratitude for all of the very hard work that they have been doing, all of those who, for many years, have been pushing very hard for a replacement to the current multi-service centre. Of course, the current Cobequid centre is an old liquor store. It is located on Memory Lane - I don't know what came first, the name Memory Lane or the liquor store and I don't know what is being remembered.

The reality is, even with the additions that have gone on, that facility certainly is nowhere adequate to be able to meet the current needs of the growing communities around it. I'm sure that my colleague, the member for Sackville-Beaver Bank, would agree to that in spades. This facility is desperately in need. The staff who work in there, they're fantastic staff, but they're working in an extremely difficult situation. In addition to that, there isn't the room to be able to develop the kinds of programs that are going to be developed.

With that, I wonder, would the minister like to tell us how much money is in this year's budget allocated for that - I'm sure all that kind of information would be at the minister's fingertips - and tell us the time frames and, hopefully, tell us that we're ahead of schedule now, not falling further behind as the past minister did?

MISS PURVES: The funding for this year for the Cobequid centre is in the capital grants section, it's not detailed in the capital grants section, but it will be about $5 million for this year. That means construction will start this year. I suppose, to be mischievous, you could have a ground-breaking ceremony any time you wanted, but my best guess, it wouldn't be before the election. Construction would start this year, the drawings are being done. It should be complete within two to two and a half years. Everything so far is on track and for the record, there are many, many people, not just from that area but from around the province, even some Tory supporters, who think this is a model for service delivery, the Cobequid Multi-Service Centre, and that there should be many more of them in the province.

MR. HOLM: Indeed, Shirley Freer was quite a Tory. Shirley Freer was one of those who was so key and instrumental in getting the original Cobequid Multi-Service Centre up and running. Even some Tories can be visionaries and she certainly was one who worked very, very hard. They seem to be becoming rarer, but it's still possible.

The minister is absolutely correct that the Cobequid Multi-Service Centre is a kind of model and we've had people visit that centre from not only other parts of Canada, but from other parts of the world, come and look at the kind of model integrating both your health care and your social services within one kind of facility. It's an excellent model and I've always been a supporter of it and I can't wait to see it up and running.

[Page 96]

[5:15 p.m.]

I'm not interested in a sod-turning just before an election. In fact, that tends to make one a little bit skeptical. I remember a former Tory Government back in the election campaign of 1978 - even before my time - when the Tories were in Opposition, promising that they were going to build a vocational school in the community of Sackville. Then, of course, nothing happened. In 1981, they announced it again. Mr. Chairman, surprisingly, nothing happened.

Just before the 1984 election, when they announced it yet again, they sent out the clear-cutting team that went out and chopped down all the trees. They also announced that they were going to put a pool in, surprising. That was three elections they were going to try to get out of it. Then, of course, when they didn't win that time (Interruptions) We won't get into the history of who won. Then some enterprising local constituent went out and put up another sign on that site, beside the one which had said, the future home of, and it was called the Sackville Tory reforestation project. That vocational school, of course, never did get built.

Just having a sod-turning and an announcement isn't, in itself, any kind of commitment that projects, that somehow seem to get announced just before an election - what I'm interested in is actually those kinds of concrete things the minister is talking about. I am wondering, Madam Minister, because the capital amounts aren't budgeted in detail, would you agree to provide to me the actual amount that is - get this later on from staff - budgeted for it, and the date on when you anticipate - I am not holding you to an exact date - that the architectural drawings and all the other kinds of things that need to be done will have been done, and a tender call be able to be issued, so that residents can know or have a fairly good handle on when, exactly, they can expect the construction will get underway?

With that, Mr. Chairman, if the minister agrees to those requests, I will resume my seat and let somebody else continue the discussion with the minister. I won't go into all of the needs, because I know others are covering things, like the inadequacy of the mental health services for children and others in the community, and all kinds of other things that are in desperately short supply. I will leave that to others who are covering it on a broader provincial basis.

MISS PURVES: Mr. Chairman, certainly, we will be providing those details. As I understand it, things are different in Health than they are in other departments. Surprise, surprise. For the approval of capital projects, we have the approval of the envelope money for individual projects, and we require an Order in Council, but we can still provide the information, as quickly as possible, to the member.

[Page 97]

MR. HOLM: I am really just back up to get some clarification, because of the minister's last comments. You're saying that there has been an envelope approved for capital projects, but it sounds like that envelope has a bunch of different little slots that government hasn't necessarily decided how many dollars go into each folder in that envelope. If that's not correct, if there is, of that amount, a certain amount that is designated for the Cobequid centre this year, I would like to hear that figure. Secondly, the minister didn't come up with her best guesstimate as to when she expects that the tender calls can actually be made.

MISS PURVES: Mr. Chairman, to clarify, the department would look at the ask list, which we already have looked at, for various capital projects, and we make decisions about that. The $5 million for Cobequid has been decided. There may be some others that will be bigger or smaller. We would expect a tender call by late summer, early Fall. We would expect a sod-turning by October.

MR. HOLM: Mr. Chairman, genuinely, I thank the minister for that. Did I understand you correctly - my ears are youthfully challenged sometimes, and I don't hear things as clearly as maybe I should - I think the minister said that there is $5 million that has been approved but it is possible that there could be more out of that envelope going to the Cobequid centre, but not less than $5 million?

MISS PURVES: Mr. Chairman, I wouldn't want to commit to that, but the major projects, we know what we're doing. It's some of the smaller projects that - within that $30 million envelope - we still have to have a look at. The capital projects, over $1 million, do require an Order in Council for the final sign-off on them.

MR. HOLM: What you're saying then - I hope, I think you're saying, anyway - is that it's a formality to have this decided - and yes, I appreciate there has to be an Order in Council, actually, to spend it - but that the request coming from this very thoughtful minister who is concerned about these important health care needs out there, that this minister is anticipating putting forward a request for an Order in Council for at least that amount of money this fiscal year.

MISS PURVES: Mr. Chairman, yes, and that is absolutely correct.

MR. CHAIRMAN: The honourable member for Halifax Needham.

MS. MAUREEN MACDONALD: Mr. Chairman, I want to resume my time questioning the minister with a number of quite varied areas where people certainly ask me to provide information that I haven't been able to sort of update for some time. One of the things I want to ask the minister is around the Provincial Health Council. I see that the Provincial Health Council, essentially, has a small increase in their budget for next year but, more or less, will be operating at the same level. Now the Provincial Health Council was a focus of a lot of controversy back in 1998, when I first arrived here. The former Liberal

[Page 98]

Government had allowed the people who were appointed to the Provincial Health Council - those seats, positions to become vacant.

As I understand it, right now, on the Provincial Health Council, there are a number of vacancies, that people have not been appointed for some time, that there may be as many as five vacant places on the Provincial Health Council. This is certainly of concern to people who see the Provincial Health Council as a very important advisory committee to government, and a watchdog in some ways for Nova Scotians, although I think the watchdog function has been minimized by this government in many respects. Could the minister please clarify, is it the intention of her government to fill those vacant council positions? If so, when will they be filled? If not, why not?

MISS PURVES: Mr. Chairman, yes, it is our intention to fill those vacancies. We are behind in filling vacancies on a number of boards. It is our intention to try to speed that up. We have a new person taking over the process to try to speed it up. I believe, also - this may not be the case with the Provincial Health Council but with some other boards with vacant positions - sometimes the issue is not enough applications or not the right kinds of applications. There will be another ad going out, I believe this month, sometime in mid-April, looking for new applicants. I am certain that if the member has anyone in mind who might like to apply - I would encourage all members who know of people who might be good on the Provincial Health Council - to encourage people to apply.

Yes, we do need to improve the process, because we have a number of boards that really can't function very well without the appointments, and we should hope to have that done within two to three months.

MS. MAUREEN MACDONALD: Mr. Chairman, I want to thank the minister for that. There are certainly a lot of people who are very capable of sitting on the Provincial Health Council, who would bring different perspectives. I know that the council, in the past, has tried to reflect a fairly broad diversity, the diversity of the province, gender balance, representation around race, ethnicity and people from a variety of different kinds of backgrounds, professional, working class and other kinds of backgrounds, which were really quite important, and people with a real interest and passion for health care and for wellness and health promotion. I think it is important to keep that council functioning at an optimal level, with participation from members of our community.

I want to ask the minister about community health boards. Specifically, I want to talk about what I think are rather small, almost miserly amounts of monies that community health boards have to do what is really important work. This government does talk about health promotion and wellness, and how important this is, but yet when you look at the amount of work that community health boards have to do many of their projects and programs, there is very little money assigned for their work.

[Page 99]

I will give you an example from the Capital Health District, because I am most familiar with the Capital Health District. The Capital Health District has quite recently set up what they call a community development fund, so that initiatives that come from the community that correspond with the health goals and objectives that have been set by the districts can actually be put into practice. That may be encouraging healthy behaviours around nutrition, a whole range of ideas that come from the community.

Last year, the Capital Health District's community health board had $20,000 to spend on these kinds of health promotion and wellness kinds of programs. They had $180,000 worth of projects seeking the $20,000 funding. So the demand and the need is much greater than their ability to correspond to what's required. Well, $20,000 sounds like nothing, it sounds like a really small amount in the metropolitan area and beyond, which the Capital Health District serves. I think, for example, of just the issue of youth violence. In the U.S., the strategies for dealing with youth violence, all the way from bullying to very serious gun/weapon violence, it's been defined as a public health issue. A lot of the initiatives for dealing with youth violence, for example, have been community-based, community development foundations for the interventions.

Here, if we wanted to do a similar kind of thing, we have no ability to access health dollars unless we go through the community health board. But with $20,000, they, realistically, are unable to develop meaningful strategies and to support the community in those strategies. I want to ask the minister about the department's monitoring of the district authorities. You approve their budgets, you look at what they're allocating for the community health boards. What is your plan to try to ensure - ensure, not to try to ensure - the community health boards have adequate amounts of money to do the kind of community development and the development of primary health care, a broad definition of primary health care that should be occurring at the community level? It can't happen with this amount of money.

[5:30 p.m.]

MISS PURVES: Mr. Chairman, the member for Halifax Needham raises one particularly interesting issue, but the points are well made. The community health boards do a fantastic job and they could do a better job with more money, obviously. We have looked at what the districts allocate, and obviously the demand exceeds the supply of money. That's true everywhere in government. We do know enough about what they do to know that they do some really great things, not just in the Capital Health District but elsewhere. I know that the Office of Health Promotion is going to be looking at what it can do to assist community health boards, whether it's in anti-smoking initiatives or whatever it is they have in mind. I don't wish to speak for my colleague, but I know there is going to be some interest in projects that they can tackle that they hope can make a difference in promoting better health.

[Page 100]

The issue of violence as a public health problem is an idea whose time has definitely come. Again, I won't speak for my colleague. I have read some recent articles regarding the World Health Organization's classification of violence as a public health problem. It's an issue that actually bears a lot of discussion, because it is something that the Senior Citizens' Secretariat people are really interested in, in terms of the amount of elder abuse that goes on. It's something that the Advisory Council on the Status of Women is very interested in looking at. Certainly, the executive director there feels that if domestic violence were looked at as a public health issue rather than a women's issue, perhaps more might be done about it.

I think that over time there is a lot of good work that can be done there, whether it's for women, older people, youth and bullying, and all these other situations that are occurring more and more in our society.

MS. MAUREEN MACDONALD: Just to pursue this a wee bit, I think that domestic violence will probably always be a women's issue as long as women are the people who tend to be the victims in the vast majority of cases. I think one of the things about defining violence, in terms of it being a public health issue, is it is so prevalent for so many groups, like children, elders, women and youth. Just to let the minister know and people from her department and maybe the Minister of Health Promotion, if they're going to be looking at this, specifically around youth violence, there's really quite a brilliant publication that's just come out, called the Best Practices of Youth Violence Prevention, that was done by an American public health institute that has pulled together, sort of looking at all of the American states that have been working on this for 15 years, this issue of youth violence, and looking at the best interventions to decrease youth violence.

I have this publication, courtesy of a student social worker, who did her field placement in my constituency office this winter. We have been using it with a new group in my constituency that Councillor Dawn Sloane, Alexa McDonough and I sort of pulled together after an incident where youth were involved with handguns in our community. This group has been working on the issue of youth violence in the North End of Halifax and we would really very much like to pursue the notion that violence, especially in communities, is a public health issue and contributes to a lot of anxiety in the population. It brings out mental health issues in terms of people's sense of security in their community, and it puts a lot of stress on the health care system as well when people are in emergency departments and calling for ambulatory services, calling the Help Lines, all of these kinds of things.

I think it is an idea that we need to pursue in a really serious way and I think that the community health boards are certainly ideally placed to work with communities on local programs and projects, to try to build an anti-violent kind of culture in the communities where violence is occurring. So that's something maybe I can share with the minister, or the ministers, and I would be happy to do so. It's a really interesting publication.

[Page 101]

I also want to ask the minister, whatever happened to midwifery and this province's commitment? I think there has been a working group looking at integrating midwives into our health care system for a long time, but nothing seems to concretely happen in terms of moving that particular issue forward to ensuring that midwives have a place in health care in this province. Other provinces have licensed midwives. They have included them in the continuum of options that are available to women through their prenatal and postnatal care and I think that for people who have worked so hard on this issue in the midwifery coalition, there is some sense of frustration in not being adequately heard and valued. So I'm wondering where is that initiative, what is the province's plan, why haven't we heard about this issue and when can we expect to hear something concrete?

MISS PURVES: Mr. Chairman, it is true that there are licensed midwives in other provinces - not all, but many others. It is also true that some representatives have been working with the primary health care group. This is an issue that was brought up earlier in Question Period in terms of the Primary Health Care Transition Fund and what we access from Ottawa and this fund is meant to assist provinces in changing from one system to another and I don't think there's any question that the midwives have to be a part of primary health care reform. It's a no-brainer really, particularly when you look at some of the trends in medical school enrolments, where fewer and fewer students choose to be obstetricians. That is definitely an emerging trend and I'm sure there are many reasons for that.

Doctors want lives too and being an obstetrician is a very demanding, non-lifestyle-enhancing kind of a job and family physicians again, it used to be common for family physicians to deliver babies. That is less and less the case. I mean, obviously, someone will, if you have to, but there are so many issues in our society around needing a certain critical mass of expertise. You know, I'm long past the stage, but if I were younger, I probably wouldn't want my baby delivered by someone who had only done one or two a year because it would scare me to death, the idea. So there's no question that midwives who choose this occupation are going to have to be part of primary health care reform. So I realize progress is slow and I'm sorry if they feel neglected, but they are a part of the process and they will have to be a part of the future.

MS. MAUREEN MACDONALD: Mr. Chairman, I also want to talk to the minister for a moment about teen health care centres in the province and whether or not they get any direct funding from the Department of Health and what the government's plan is to sort of stabilize teen health centres. We've seen the Red Door in Kentville, for example, have some difficulties in terms of their funding and teen health centres, the ones that I've visited, are very, very heavily utilized by young people, which is probably a good thing.

We've seen a small drop in the incidence of teenage pregnancy in Nova Scotia, not a huge drop, but there has been a bit of a drop which I think is a country-wide trend, I'm not sure about that, but I think so. Just the same, I think teen health centres have a huge role to play in terms of the health of young people, the mental health, the physical health, the sexual

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health of young people, and so the question is, are they reliant on the district health authorities for their funding or are there any grants that are provided directly from the Department of Health to them, is there a strategy for teen health centres in the department?

MISS PURVES: Mr. Chairman, that's another interesting issue there. There are some fairly well-established teen health centres in some schools and school boards in the province. There aren't teen health centres in others. It is something that is wanted in most of the newer schools that are built. I'm not as up on my schools as I used to be a couple months ago, but it's either in existence or going to be in existence at the new Halifax West High School. That's an issue, in terms of strategy, that people in public health have brought to the attention of the associate deputy and people in her area of the department as needing a strategy, because right now they are funded through the DHAs at their discretion. There are no direct grants from the Department of Health.

Whether there should or shouldn't be, I don't know at this point, but obviously if we're going to be supporting them through tax dollars, which we are at the present time, then we should know the kinds of outcomes we expect and we should have some better types of measurements of what they achieve. Now, whether or not those would actually in the end be associated with the Department of Health, or the Department of Health Promotion, I'm not quite sure. It might be a natural for the Department of Health Promotion, but they are really important - the member for Halifax Needham is right - in terms of having a place where kids can go and talk to someone about birth control, bullying, whatever it is that they want to talk about.

I'm sure she's familiar with some of the health centres, perhaps not a teen health centre per se, but some of the centres that are in malls and other areas where teens can go - for instance, the one at the Halifax Shopping Centre - and again it does in a way relate somewhat back to the problem of violence - that one does - but teen health centres are a lot more than that and, again, we know we need a strategy and we're working on that.

[5:45 p.m.]

MR. CHAIRMAN: The honourable member's time for questions has expired.

The honourable member for Richmond.

MR. MICHEL SAMSON: Madam Minister, congratulations on your new posting. I'm sure you will appreciate that health is one of the main issues facing the people of Richmond County and that is one of their top priorities and I wanted to ask a few questions in that regard. I'm sure your predecessor will be familiar with some of these questions as I've been asking them for the last three to four years, I guess, and some of them haven't changed, unfortunately, which requires me to ask them one more time.

[Page 103]

Madam Minister, the in-home support program, as you may or may not be aware, was a program which was being offered and which provided some financial assistance to family caregivers who were staying at home to take care of loved ones, loved ones who technically would probably qualify for nursing home care, but who chose instead to want to remain at home. The money being invested to these caregivers was but a fraction of what the cost would have been if these loved ones were to go to nursing home facilities and have to pay a daily rate for years to come. I believe the figure was approximately $400 a month that was given to the caregiver to provide for loved ones. Now, I'm using the $400 figure, that's for the two loved ones in the case I'm thinking of. So maybe that number is not exact, but I'm sure the minister won't argue with me that $400 a month being provided to a caregiver is a lot cheaper than what it costs if that loved one is in a nursing home facility.

Now, Madam Minister, I don't need you to give me the history of the program and the problems with it, we all know that. Your government has told us that it was the municipalities that were providing it, it was inconsistent, and you needed to bring some consistency to the program. No problem, no one disagrees with that. Yes, we want to see a province-wide program that's equally applicable whichever area of the province we find ourselves in. So we don't need that history, but it has been three long years since you undertook the review, three years where you said no new applicants will be permitted under the program. Yet anyone who was in the program, their funding was maintained, but no new applicants for three long years.

For three years I have written to your predecessor. I will write to you, Madam Minister, if you need more information, on the dozens of people in Richmond County who are asking when will we qualify for this program, and the problem is they're having to make a decision that says, look, financially we cannot continue to provide care 24 hours a day to our loved one, therefore, we have no choice but to place mom, dad, auntie, uncle, in a nursing home because we need to return to the workforce to provide for our family.

Therefore, Madam Minister, I ask you today, can you please indicate to us what the status is of the in-home support program, when can we expect that people in Richmond County, or anywhere else in the province, will be able to make application and provide funding under the in-home support program?

MISS PURVES: Mr. Chairman, well, I won't try to turn that into a long answer, it is mainly a funding issue. It's very unlikely we will be able to do anything this year in that program, particularly in terms of care of elderly people. One thing that we are doing is the children who are turning 19, who are being taken care of by Community Services, when they turn 19, we are taking that over and helping to provide continuing care for those young adults.

[Page 104]

MR. SAMSON: Madam Minister, I appreciate the funding challenges that you do face and I respect the fact that I was expecting that you would reply by saying, look, the member is telling us not to spend, now he's telling us to spend, but the fact is that the in-home support program is not spending, it is an investment being made which at the end of the day would save your government money.

We've heard you say many times the cost of long-term care, the challenges faced with that, how expensive it is, and we all know it's not going to get any better. It's going to get worse. There are going to be more loved ones going to nursing homes. There's going to be more cost for government to face which is going to make a greater challenge and which is why the in-home support program was a strategic investment which at the end of the day provided government with savings because loved ones will remain in that home for a minimal cost to the government rather than them being in nursing home facilities.

So I'm disappointed, I do appreciate the minister's honesty, I can tell you. It would have been great if the former minister would have been so upfront and just told us, don't expect any funding for the program. Yet he continued just to rag the puck and refused to tell us with the forthrightness that at least this minister has told us. I can go back to Richmond and say don't expect any funding this year, the minister has at least indicated to us. It's unfortunate, but at least we know that. When they call, I can give them at least that level of certainty.

Can the minister indicate for these individuals who have been waiting three years, is there any hope in the near future that there will be another in-home support type program or is the government indicating now, listen, in-home support was a thing of the past, it's gone, don't look for it any more. Could you give us some form of clarification as to where that program lies and what the chances of seeing it again are?

MISS PURVES: Mr. Chairman, the department does see this program as a priority, but I can't put a timeline on it. We do need to have the funding. We have spent time working on this. We have, in fact, a plan for the standards and a plan for accountability of the spending of the money and it's a matter of having the funding for that in place which we don't have this year because of other pressures on the budget.

MR. SAMSON: Madam Minister, in one sense I appreciate what you're saying. In the other sense, it does cause me some form of confusion because at the end of the day by not having this program, you're having more people going into long-term care facilities which is putting more pressure on your budget which is costing you more money, which you're trying to make ends meet at the end of the day. I guess, just for my own appreciation, my question to the minister would be - and I know she has been quite honest and forthright which I do appreciate - does the minister agree that the in-home support program, in theory and in practice, did actually save the government money in the long term in regard to health care costs?

[Page 105]

MISS PURVES: Mr. Chairman, I know what the member for Richmond is saying is true. What I also know both from this portfolio and the previous one - and I'm sure he knows - there are so many good ways to spend money, there are many needs in the system, and almost everything we can do to help people can be seen as an investment and it usually is, but the fact is that my present department could very easily handle spending the whole provincial budget on its own and the demands are very high.

MR. SAMSON: Madam Minister, I guess it draws me to the conclusion that your department, under your government, does not have a clear and comprehensive plan for health care in this province because if you did have a clear plan, a realistic plan, it makes no sense to me that the in-home support program would not be part of that plan because at the end of the day you need to get control of your nursing home costs. You need to get control of long-term care costs. If there's a way where certain investments can be made which will save you money at the end of the day, one would think that that needs to be part of your plan.

It causes me great concern when you tell me that in-home support is not on the radar screen this year because your department - you know, when the minister says my department could swallow up the whole provincial budget, well, to me, that is a clear admission that your government does not have a plan for health care because if you did have a plan, a realistic plan, you would say here's how much money I need and I'm going to make it work.

By saying I could use all this money and all the budget, that means I don't have a plan and could take the whole provincial budget because we don't have a vision, we're just going to continue throwing money and hope it gets better, and that is unfortunate. I can tell you - and I use Richmond County as an example, but I have no doubt this applies to all of Nova Scotia - where loved ones would stay at home and provide for their ailing family members in their last days, when they want to remain at home, there is a financial price to be paid for that. There is significant cost. We see more and more that there are care support societies that are being formed to help people who are dealing with loved ones, some of the frustrations that are involved with that.

I have to say I do appreciate the honesty of the minister, but I can't emphasize enough that if you're going to start putting a plan together, look at the in-home support program. I have seen how it works back in Richmond County. I can count how many people could be in nursing homes right now, but instead they are at home, being cared for by loved ones, where they wish to be, at a tremendous saving to the taxpayers because of the fact that they are staying home. If we are ever going to get control of nursing home fees, get control of the costs, we need to look at making these strategic investments, do so in a responsible way, but at the same time provide for a quality of care that some individuals want at home rather than being placed in nursing homes.

[Page 106]

The other point I wanted to make is that I do hope through this you will start looking at in-home support. The last correspondence I believe I received from your predecessor had indicated your department was looking at in-home support, bringing it back, but if it did, one of the conditions would be that family members wouldn't qualify under the program. Madam Minister, I hope you will appreciate that in most of these cases, it is family members who remain at home to care for a loved one. It's usually their sister, brother, daughter, daughter-in-law, son-in-law, son, a close family member.

For the previous minister to say that family members wouldn't qualify, well I would almost argue it's questionable how worthy the program is if you're saying the family members wouldn't qualify under that. His response at the time was well, it might be open to abuse. Well, now, there could be abuse in every single government program that's out there, but what do you have in health? You have home care workers, you have the people who do the intake, you have the nurses who go do home visits. There is your support network, there is the network you have to make sure there isn't abuse and that the program is not being abused.

I do not accept that family members shouldn't qualify under this. First of all, I believe it's discrimination. Second of all, I do believe you have the checks and balances within your current system that could address this. I am curious if the minister could indicate if that is what her department is looking at in regard to a possible new in-home support program, and will she commit today that family members would be able to qualify if the program is brought back in the near future?

MISS PURVES: Mr. Chairman, I will have to double-check on that for the member opposite. It would seem to me that we need the kind of accountability measures in place that would apply to a family member or a non-family member. He's quite right, any system is open to abuse. I would like to mention, just briefly, that we do have a new and expanded program with the Red Cross. It's an equipment loan program for some of the kinds of supports that are needed for people who are being looked after at home. This is one thing that we are moving on.

MR. CHAIRMAN: The honourable Government House Leader.

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

MR. CHAIRMAN: The motion is carried.

[5:58 p.m. The committee rose.]