Nova Scotia 2013 Election Campaign

Question 1: response:

It will be a constant battle to keep the price of prescription medications as affordable as possible. The work being done by all of Canada’s premiers to have governments collaborate to bring the cost down has great promise, and Jamie Baillie would want to champion that work. The outgoing government missed an opportunity to bring people into more regular contact with their pharmacists by failing to expand their scope of service, as has been done in other provinces. In the long term, this will likely lead to pharmacies in smaller centres closing or reducing hours, which will be a great impediment to people. We would fix that, which has the side benefit of controlling health costs better, freeing-up resources for better care.

Question 2: response:

Given the prevalence of lymphedema amongst those who have received treatment for breast cancer, and the fact that we can achieve better outcomes by making services more accessible, it is simply impossible to accept the current MSI classification. We plan to create a number of Community Care Centres to bring important health and other services to people and make them more accessible.

Question 3 response:

One of the horrible aspects of dealing with a cancer diagnosis is delay, of any kind, while a horrible life threatening thing is growing inside your own body or when symptoms of the disease of side effects from treatment are sapping the body. We will work with you to identify the delays in getting medications and treatments to improve outcomes and make the approach to this disease more effective and humane. Because we are committed to redirecting resources to front line care, we expect to have capacity to improve the way we do things in health.

Question 4: response:

Having emergency treatment accessible when something goes horribly wrong is essential. The best solution available involves deploying resources more strategically thereby allowing the most ERs to remain open longer, making services more accessible on a community level through, for example, Community Care Centres so more people can get in to see help earlier, and having a responsive near-emergency and emergency system so people are encouraged to pick up the phone sooner.

Question 5 response:

We have far too many health boards for a province our size, which means multiple CEOs, vice-presidents and other senior administrators, plus all the structure around them. We would reduce that to 3, recognizing that health care delivery at the IWK and outside of Halifax has challenges that differ from those in CDHA. The rationale is simple: it isn’t right to spend money on administration that should be spent on care. Doing things differently means being willing to take a fresh look so that out limited resources can be used to provide the best health outcomes possible for our citizens.

Some resist, arguing there will be disruption, but the change will be to administration NOT to front line services.

Every cent saved will be reinvested in health care.

A more significant transfer of resources to the front lines of health care delivery will come from accepting all of the recommendation of the Ernst & Young Report. The current government’s decision, under pressure from a few of their key backers, not to accept several recommendations meant that tens of millions of dollars a year that could now be funding patient care and preventative programs has been and will be wasted until somebody fixes this. A government has to decide what the priorities are, and our decision will be very different.

These reforms are a vital part of Change that Works, which is the name of our platform, our motto and an ethic by which a Jamie Baillie PC Government will approach governance, including improving our health delivery.

Question 1 response:

In the 2009 election campaign, the NDP committed to the creation of a Drug Management Policy Unit. As a result of the work of that group, the Fair Drug Pricing Act was introduced and passed in the Legislature, and went into effect on July 1, 2011. Seniors and other Nova Scotians enrolled in the province’s Pharmacare programs now pay less for each prescription of most generic drugs at the pharmacy counter. Prices went down on July 1, 2011 and again on January 1, 2012, and again on July 1, 2012. Through the Fair Drug Pricing Act, the NDP is making sure that Nova Scotians covered by Pharmacare are getting better prices for generic drugs – prices in line with those paid in other parts of Canada. The Data in the 2012 CMAJ article you cite would not capture the advances the NDP government has made on drug prices during this mandate. And, using overall data for the Atlantic provinces may mask the effects as well. That being said, there is more to do, and the NDP will continue to take action in government to drive down the cost of drugs.

Question 2 response:

As you may be aware, the NDP recently announced a new program to cover some of the costs of hearing aids for seniors in Nova Scotia. In reviewing options, the Ontario program provided some very useful insights. The Ontario Assistive Devices Program provides coverage for compression garments and is a potential model for Nova Scotia, should funding become available in the health spending envelope.

Question 3 response:

The Cancer Systemic Therapy Policy Committee provides the Nova Scotia Department of Health and Wellness with advice on what cancer drugs should qualify for public funding. The Committee is made up of 23 people, including cancer specialists, a cancer survivor, a pharmacist, ethicist, other health care providers and Department representatives. The Committee reviews cancer drugs using a values and evidence based on a decision making framework. The framework is used to guide discussions around the economics, ethics, and evidence to make recommendations to the Deputy Minister of Health about additions, changes and deletions to the cancer drug formulary. Decisions about specific drugs should not be made by political parties – they are medical decisions and the NDP relies on the advice and experience of the people on the Committee to that end.

Question 4 response:

When elected, the NDP government hired Dr. John Ross to help develop a new approach to pervasive ER closures across the province. As a result, CECs – now regarded as a model across the country – were developed. In communities with a CEC, ER closures have decreased by as much as 93%. But there is still work to do. The NDP will open more CECs in consultation with communities and working with DHAs to meet local health needs. In addition, during this campaign, the NDP committed to a network of nurse managed clinics – Better Care Clinics – to provide better care to those suffering with chronic diseases or conditions. Cancer survivors will get better care with these clinics too, since nurses are often able to spend more time with their patients and can take a more holistic approach to their care plans.

Question 5 response:

Dr. John Ross hit the nail on the head when he said that the push to amalgamate the DHAs in to centralized superboards will waste money on “administrative busywork.” Under the NDP government, health administration spending was reduced by 23.3%, the best record in Canada over the same time period. Mary Jane Hampton, a well-respected health consultant said, “To suggest that the solution to saving health care is to yank millions of dollars out of administration and put those dollars into patient care is a dangerously simplistic argument.” Losing local control in decision making is simply wrong. The NDP has committed to reducing administrative spending in health further, but without throwing the system into chaos.

Question 1 response:

There are several challenges facing the health care system over the next few years. The Harper Conservatives will reduce Canada Health Transfer funding to our province – some $900 million over the next ten years. Coupled with this challenge is the fact our drug supply, both nationally and provincially, has been facing severe shortages over the past two to three years. Further government mandated price reduction prices will worsen this situation. Governments at all levels have to weigh the benefit of price reduction with the availability of prescription medications. A decreased price benefits no one if the patient is unable to access the drug in the first place. A Liberal government will work with pharmacists to ensure we save money in our pharmacare budgets which in turn can be reinvested back into services and funding of new drugs. It is important to acknowledge that drug costs, while always challenging for some, represent a portion of the monthly costs in a household which includes such necessities as power. If elected, we have also made a commitment to reducing the cost burden associated with the price of electricity.

Question 2 response:

The Liberal Party understands the importance of covering costs associated with the treatment and management of lymphedema. In 2008, the current Health and Wellness Minister, Dave Wilson, brought representatives of BCANS to the legislature to impress upon the former Conservative government the importance of funding pressure garments necessary to treat lymphedema. Five years later, there is still no coverage. Currently there is a comprehensive review ongoing around changes to MSI regulations and we trust the costs of compression sleeves and treatment costs are being considered in this review.

Question 3 response:

The Department of Health and Wellness relies on the expert opinion of the Cancer Systemic Therapy Policy Committee to make decisions on the types of cancer drugs that should qualify for funding. This group relies on clinical evidence when it comes to making decisions around coverage. The challenge oftentimes remains that once certain drugs are approved, coverage does not occur until such time as the Department of Health and Wellness approves funding. For some patients, drug budgets within the Districts will provide coverage if the drug is approved by the Cancer Systemic Therapy Committee however these budgets can only sustain these types of extra pressures for so long. As indicated in previous questions, there are unprecedented challenges coming in our health care budget. We will continue to rely on the advice of the Cancer Systemic Therapy Committee and attempt to do our best in light of significant fiscal challenges to ensure cancer patients receive timely access to medications.

Question 4 response:

This NDP government, after four years, has ignored the root cause of emergency room closures across the province. Emergency rooms remain closed because of a lack of physicians available to provide coverage. According to the Nova Scotia Physician Resource Plan this situation is about to become worse as 31% of doctors in Nova Scotia are due to retire over the next eight years. This is why a Liberal government will provide up to $120,000 in tuition relief to 25 new doctors per year for the next four years in exchange for a return of service agreement to serve in under-serviced communities throughout Nova Scotia. We have also committed to the appointment of an expert physician recruitment and retention team to ensure we are best positioned to recruit new doctors and retain the ones we have. Cancer patients rely on the care of physicians. There is no question, CEC’s are fulfilling a valuable health care need and the professionals in the system are providing the best possible care they can within their scope of practice. However patients need to be cautioned that some of the CEC’s have changed their protocols on the types of patients that can be accepted. In certain instances, there may be situations that even if a CEC is open, care for a cancer patient can no longer be provided because there is no longer a physician providing care on site. The NDP have ignored the root cause of emergency room closures – the lack of physicians – a key health care provider in the ongoing care of cancer patients.

Question 5 response:

A Liberal Government would reduce the number of CEO’s and VP’s by reducing the number of DHA’s from 10 to 2. The Liberal Party is proposing fewer CEO’s, fewer VP’s and fewer Directors in our health care system so a reinvestment can be made back into front-line health care. There will be one CEO and a lean executive leadership team. Health care will be delivered through four regional zones. Site based management and site based decision making will be strengthened and implemented providing health care workers with the ability to make a difference for the patients they provide care for. Community Health Boards will remain in place and their role and linkages with the health care system will be strengthened. The delivery through four zones coupled with site based management and decision making, and a strengthened role for Community Health Boards will strengthen community decision making. There will be one volunteer provincial board that will work with the executive leadership team to plan and manage health care for the province. Membership of this board will consist of one member from each of the current DHA’s. The cost savings from this restructuring – $13 million annually – will be re-invested into front-line health care. The IWK will remain as its own entity due to its Regional status and funding extends beyond Nova Scotia. Currently, the NDP would like nothing more than have this discussion focus on the costs of administration in a sorry attempt to cover up the significant challenges that exist within our health care system today. Our plan is much more than an attempt to save administrative costs, It’s a plan that will enable patients to travel more readily to facilities if they so choose for the purpose of accessing treatment and surgeries faster. Right now, this does not happen as frequently as it should because each DHA must protect its own budget envelope. As a result, we have OR’s sitting idle in some parts of the province while wait lists for procedures are bursting at the seams at others. The Liberal Party is equally concerned about the fragmentation that has developed around certain public health programs in our province. Your civic address oftentimes dictates the type of public health program support you can receive in your District and we in the Liberal party believe this is wrong. We need a system which will allow planning to occur utilizing all of our health care assets, not just those that are located within artificial budget boundaries. We need a system that enables patients to travel to other sites, if they so choose, to access their surgery faster. We need a system that, irrespective of where a patient lives, they are able to access the same level of public health programming. Nova Scotia has a population of less than a million people, why is it acceptable that we have 10 CEO’s and 10 executive leadership teams managing our health care system while wait lists continue to grow and inequitable public health programming continues to be delivered in this province? The Liberal Party does not believe this is acceptable and is proposing a structure to address these ongoing pressures and inequities.