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Nova Scotia Citizens’ Health Care Network Meeting

With the Minister of Health

Hon. Jamie Muir

 Thursday, July 25, 2002

                       10:00 a.m.


Good morning Hon. Minister.  My name is Debbie Kelly, Chairperson of the Nova Scotia Citizens’ Health Care Network.  We would like to thank you for the long awaited opportunity to meet with you face to face and discuss a few crucial issues facing us as Nova Scotians today.  Our brief submission is substantial and is inclusive of the Network members who worked on this brief.   However, are meeting comments will be limited to summaries of each presentation.


We direct you to view the many years of dedication and hard work our Network has dedicated to building a true coalition of members and organizations across this province and to the many achievements and struggles we faced and continue to face by standing up to save and improve medicare in our province and in our country.


The members of the Nova Scotia Citizens' Health Care Network are concerned as consumers of health care and as health care providers over the status of health care in this province.   We are here today to meet and discuss two of our issues:


   Private MRI Clinic and

   Single Entry Access


While there are other equally important issues, these two concerns are the priority at this time.  Our concerns require government immediately to take action to stop this specific clinic and any other private clinics from ever opening its' doors.  Contrary to media reports, citizens in this province stand firmly behind their publicly funded health care system. While the Single Entry Access is a panacea, a breakthrough, it is facing major problems with implementation and accessibility.   


The Department of Health should be working with the community organizations and health care unions to plan, organize and strategize to administer the "best" health care in Canada, supporting the five (5) Principles of the Canada Health Act, and ensure "dignity" for the people of this province while living and in dying.  There are a number of ways to achieve reductions of wait lists and affordability of long-term care.  We believe that the government must take its responsibility seriously and halt private MRI clinics.   The end result will see this province enjoying the benefits of happier and much healthier population. 


I would like to now introduce the members of the Network present and the agenda item that each will be speaking on:


Private MRI                                                                    

- Anne Smith, Shelburne Community Action Committee

- Heather Henderson, President Nova Scotia Nurses Union


Single Entry Access

- Ken Brown, Atlantic Director (NS) Federal Superannuates Br.

- Betty Jean Sutherland, President CUPE Nova Scotia Division

- Peggy Brown, Disabled Individuals Alliance



- Ian Johnson, Vice-Chairperson NSCHCN








Anne Smith, Shelburne Community Action Committee

Nova Scotia Citizens’ Health Care Network Meeting

 With the Minister of Health

Thursday, July 25, 2002

10:00 a.m.


Mr. Minister, Mr. Ward, Ms. Doiron, I want to thank you for meeting with us today.   With regard to the impending opening of the private for-profit clinic in Halifax offering Magnetic Resonance Imaging and similar services, we believe our concerns are well founded, well-researched, and evidence-based, and I trust you will give careful consideration to our recommendations and the attached sources.


Mr. Minister, I was present at the Romanow Commission hearings in Halifax in April when you commented that this province is in desperate need of radiologists.




Private for-profit MRI clinics do not propose to educate and train radiologists. They simply raid those that our publicly funded education and health care systems have produced, pirating resources while charging taxpayers at an inflated rate for an already-paid-for insured service.


CONCLUSION: We consider this situation to be contrary to the spirit and intent of Canada's Medicare system. To quote the Canadian Association of Radiologists (CAR): "Commercialism is incompatible with professionalism. Medical care should be the responsibility of physicians and not businessmen."


RECOMMENDATION: To alleviate immediate needs, we strongly recommend preventing the opening of the raiding private clinic and those that follow; the development and implementation of a retention and repatriation program for Canadian radiologists, and for the future, an increase in the number of residency positions in radiology.


REFERENCE: CAR "Looking Ahead" (Attached)

The Canadian Association of Radiologists has made submissions to the Romanow Commission and the Kirby Committee strongly opposing private for-profit non-physician owned medical facilities, and recommending that all private diagnostic-imaging services be controlled by physicians and funded by the health care system. They are asking the federal government to consider restricting OWNERSHIP of these clinics to medical doctors - with equipment funded by the feds, and the health system paying for the
service. Sounds like a profitable arrangement to me.   As the official voice of Canadian radiology, CAR claims the support of 9 official partners, including Cook Diagnostic and Interventional Products, GE medical Systems, Toshiba, Kodak, etc. The website is



MRI units present a safety hazard in an unregulated environment. The intense static magnetic field is always present even when the scanner is not imaging, turning magnetizable objects, tiny or large, into projectiles or missiles that can cause injury or death. Quality Management, Monitoring, Inspections, Regulations - all are essential for risk management. Has the Minister given written approval and registration for this facility? for the installation and inspection of the equipment? provided an inspector? established a commission to develop safety codes and hear appeals?  Do we have legislation and regulations?


In Ontario, under regulations in the Regulated Health Professionals Act and the Healing Arts Radiation Protection Act, both MRIs and CT scans may be performed only if authorized by a licensed physician. This opens up the  "medically necessary" debate: will physicians refer patients for medically unnecessary services, leading to a breach of professional ethics?


CONCLUSION: If a private company offers medically unnecessary (and potentially hazardous) services, and fails to provide controls, then responsibility and liability must be shared by a government, and in particular a health department, that has allowed the company to open and operate.


RECOMMENDATIONS: We recommend that effective regulations, with penalties, be put in place prior to the procedures being carried out in a potentially unsafe environment  without proper and proven safeguards.


REFERENCES: "Medical Device Interactions with MRI Systems" U.S.  U.S. Department of Health and Human Services FDA.  The Toronto Star, Sun. July 21, 2002 Item "MRI rules

raise legal concerns; MDs must ok user-pay scans"



 In 2002, Western Canada MRI Centre (now Canada Diagnostic Centres) contracted with the Calgary Regional Health Authority to provide MRI exams at a cost of $450.00 for each basic exam, and $570.00 for each enhanced exam. Canadian Diagnostic Centre reportedly intends to charge $725.00 - no further details. Could you advise what MSI pays QEII for a basic MRI exam in Nova Scotia so that we may compare publicly-insured and private-for-profit out-of-pocket costs?


The Calgary Health Authority laid down in detail strict terms, requirements and guidelines with the onus on the company to provide radiologists and staff.


CONCLUSION: In Nova Scotia it appears there are no similar controls. Out-of-pocket costs for medically necessary procedures and exams at private clinics across the country - with the notable exceptions of Manitoba and Saskatchewan - are escalating.


RECOMMENDATIONS: Costs must be kept down by providing the more cost efficient, reliable, and safe public system with adequate resources.

A firm policy and a commitment to defend the system against private for-profit operations and incursions must be in place.


We strongly and urgently recommend that you prevent "MRIs for Sale" marketing ventures from opening, or Nova Scotia will soon be inundated with breakaway "clinics" sporadically staffed by moonlighters.


REFERENCES: MRI Services Provider Agreement between Calgary   Regional Health Authority and Western Canada MRI Centre

"About Us: The Canada Diagnostic Centres (formerly Western Canada MRI Centre)"


"It is hereby declared that the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada AND TO FACILITATE REASONABLE ACCESS TO HEALTH SERVICES WITHOUT FINANCIAL OR OTHER BARRIERS."     

Canada Health Act

Heather Henderson, President Nova Scotia Nurses Union

Nova Scotia Citizens’ Health Care Network Meeting

With the Minister of Health

Thursday, July 25, 2002

10:00 a.m.

#1. Recent editorials and media reports indicate that experts and private citizens have expressed approval of the proposed clinic, so that this new "option" should lessen the strain on the public system and shorten wait lists and wait times for publicly funded MRI services.  Our concern is the potential and even the expectation on the part of the clients who access the private clinic to "jump the queue" for specialist appointments and treatment if their private diagnosis results in a recommendation for treatment or further investigative services. This completely contravenes the principles of accessibility and comprehensiveness of the Canada Health Act, wherein access should not be limited to those with the dollars to pay.

#2. Allowing this clinic to open and be operated as a for - profit venture represents just the beginning of the introduction and acceptance of privatized  health care. In June, at the Canadian Nurses Association Annual
meeting I heard the Federal Health Minister Anne MacLellan assert that the responsibility to allow or disallow privatization in any province rests absolutely with the provincial government officials....the Provincial
Minister of Health. We urge you to take a leadership role and prevent this private clinic from opening as a for- profit venture.


#1. Rather than allow a for-profit clinic, look to the attached example of the successful approach taken in Manitoba, where a private clinic was taken over by the provincial government and provides appropriate and necessary services to any Manitoban in need, regardless of ability to pay under the publicly funded system.  


 April 02, 2001

Pan Am Clinic Joins The WRHA

The Winnipeg Regional Health Authority (WRHA) and the Pan Am Clinic have agreed to convert the facility into a non-profit operating division of the WRHA. Manitoba Health supports the innovative agreement which will enhance Pan Am Clinic’s responsive, cost-effective, high quality care.

Converting the Pan Am Clinic to the public system will require a $4 million investment by Manitoba Health to buy the building, equipment and operating rooms.

This new made-in-Manitoba service model provides cutting edge treatments and state of the art technology within the publicly funded health care system. Health Minister Dave Chomiak, WRHA CEO Dr. Brian Postl and Pan Am Clinic CEO Dr. Wayne Hildahl made the announcement today at the Pan Am Clinic.

"This made-in-Manitoba approach highlights the way our public system can better serve Manitobans by integrating these innovative medical practices," said the minister. "This unique plan complements other health services and demonstrates that cutting-edge services can be delivered under the public umbrella."

In addition, a $3.3 million expansion will double the size of the Pan Am Clinic so it can increase services and continue attracting physicians, surgeons, physiotherapists and other health professionals to the state of the art facility.

The 30,000-square-foot addition will increase the volume of day surgeries the clinic can handle and provide more space for supportive medical services. Pan Am will become an important part of the WRHA’s efforts to take advantage of modern surgical procedures and the growth of day surgeries as a preferred medical option.

"This provides the right service in the right place at the right time and ultimately provides improved health services through the publicly funded health system," noted Postl. "This is a unique undertaking that is beneficial for both the WRHA and the Pan Am Clinic."

The Pan Am Clinic began operations in 1979 focusing on athletes and sports related injuries. It has evolved to deliver musculo-skeletal medicine including primary care, orthopedics, rheumatology and other related services. Through ongoing reinvestment in equipment and services, the clinic has established itself as a preferred medical environment offering cutting edge treatments and state of the art technology.

"The planned expansion provides a response to an increased demand for our services," said Hildahl. "Evolving into a not-for-profit medical facility provides more services, enhances patient care and supports existing health care services."

The WRHA board of directors will oversee the operations of the clinic and Pan Am Clinic staff will be accountable within the WRHA management structure. As a not-for-profit speciality care facility, the clinic will receive revenue from facility fees paid by the WRHA, rental income from tenants, and fees from third party insurers such as the Workers Compensation Board of Manitoba and Manitoba Public Insurance. Any year-end operating surpluses will now be reinvested in the clinic to maintain its standing as a preferred medical environment.

- 30 -

                                                                               Pan Am Clinic

Background Information

The more efficient use of resources at Pan Am Clinic will help to address waiting lists.


September 19, 2001


- - -
Innovation Within Manitoba's Public Health Care System: Chomiak

Manitoba today launched a unique model of health care delivery blending the principles of the public health care system with an entrepreneurial spirit.

As a result, approximately 800 surgical procedures will be redirected to the Pan Am Clinic from Health Sciences Centre and the clinic will take on an additional 700 procedures from waiting lists as a non-profit, responsive and cost-effective option for delivering high-quality health care in Manitoba.

The announcement of the additional 1,500 surgical procedures was made today by Health Minister Dave Chomiak, Winnipeg Regional Health Authority (WRHA) CEO Dr. Brian Postl and Dr. Wayne Hildahl, CEO of the Pan Am Clinic.

"This is a made-in-Manitoba service model that provides Manitobans with a state-of-the-art facility for day surgery within the public health system," said Health Minister Dave Chomiak. "This model gives our system the tools it needs to ensure we’re using our resources more effectively by matching care needs to facility strengths."

Surgical procedures now being booked at Pan Am include arthroscopic and reconstructive surgery of the knee, ankle, wrist, hand, elbow and shoulder, tendon repairs, and lacerations and facial fracture repairs. The additional 1,500 surgeries will be added to Pan Am’s existing surgical slate of an average of 1,500 surgeries per year.

"Pan Am gives us more flexibility to provide the care our patients need," said Postl. "It adds to the mix of tertiary and community facilities that provide different levels of care and gives us the ability to deliver the right care in the right place at the right time."

"Today’s announcement is one more step towards my dream of establishing Pan Am as a world class centre of excellence for day surgery," noted Hildahl. "I’m delighted to blend our expertise and experience within the public health care system where we can continue to provide high quality, responsive services."

The integration of the Pan Am Clinic into the WRHA creates an innovative and flexible model of health care delivery. Lower overhead costs and specialized expertise allow Pan Am to provide a range of outpatient surgical procedures that are best suited for the facility. Bringing this capacity into the public health care system is part of an effort to perform more day surgeries in lower-cost, patient-friendly settings and to use hospitals for more complex procedures. This approach responds to medical advances that allow more surgeries to be performed on a day surgery, out-patient basis.

"I anticipate that the role of Pan Am will continue to grow and evolve and provide our public health care system with more options to improve care," noted the minister. "This cutting edge model not only provides excellent care but helps attract and retain outstanding surgical talents."                                                 - 30 -


Subject: [OHC] For Profit MRIs and CT Scanners Grave Threat

Health Minister Tony Clement announced that bidding will open later this summer for up to 20 MRI clinics and 5 CT scan clinics.  Bids will be open to for-profit corporations.   This announcement marks the privatization of key hospital diagnostic services provided currently on a non-profit basis. Clement is also cited in the National Post newspaper as saying that non-OHIP funded MRIs will be available at the clinics (2 Tier Medicare) thereby opening the door to queue jumping for those with the ability to pay. The following release contains the Ontario Health Coalition's response to the announcement.

Please send your responses to the following:
Ernie Eves: or
Legislative Building
Queen's Park
Toronto, ON  M7A 1A1
Toronto Star -
Globe and Mail -

Issued: July 8, 2002

 For Profit MRIs and CT Scanners Extremely Grave Threat
 Ontario Health Coalition Warns of Public Response

Toronto - The Ontario Health Coalition reacted with outrage over Health Minister Tony Clement's announcement of the opening of for-profit bidding on 25 MRI and CT scan machines for Ontario.  With this announcement, the provincial government has made clear its intention to take non-profit public hospital services and fund for profit corporations to provide them in private clinics.

"Stubbornly clinging to an ideological approach with no public mandate and no outcome-based evidence, the provincial government is risking the future of our public Medicare system and must be stopped,” said Irene Harris, coalition co chair. "We view this announcement as an extremely grave threat to the future of our Public Medicare system and will respond in kind."

-   The Minister still has not justified creating for-profit cancer treatment at Sunnybrook Hospital in the face of a Provincial Auditor's report that found that the for-profit treatment was more expensive and that waiting lists had not changed.

-   Similarly privatized eye treatment in Alberta has proven to be ineffective against waiting lists.  The Alberta Consumer's Association reports that waiting lists for cataract surgery in Alberta is longest and costs are highest in centres where the proportion of private clinics is highest:
      -- In Calgary where most surgeons work and where all cataract surgery is done in private
 facilities, Albertans had a 56% chance of having surgery in less than 12 weeks.
      -- In Edmonton where most cataract surgery is done in public facilities, Albertans had an 87%
         chance of having surgery in less than 12 weeks
      -- In Lethbridge where all cataract surgery is done in public facilities, 100 % of patients had
         surgery in less than 12 weeks.   (Consumers Association of Canada - Alberta Branch, March 1999.)

- The government has not answered in any way what will be done if the private MRIs and CAT scans drain scarce personnel out of the public system as we have seen in the case of other privatizations.

- The government's claims about keeping OHIP services public are spurious as allowing out-of-pocket payment for "non-medically necessary" services amounts to 2 tier Medicare or queue jumping for those with the least medically pressing conditions and the wealth to pay to jump the queue.

- Last summer's so-called health survey used as justification in the Ministry press announcement today included not a single mention of providing services on a for-profit basis versus as a public service.

"The government has run two consecutive elections on a promise not to dismantle Medicare.   Yet the hand-over of public services to private for-profit corporations is as sure a way of destroying Medicare as any", added Bea Levis from the Ontario Coalition of Senior Citizens' Organizations.  "Experience from around the world is that profit seeking in a publicly funded health system drives up costs and leads to two-tier Medicare with deterioration of services and longer waits for most people."

Ontario Health Coalition
15 Gervais Drive, Suite 305
Toronto, ON  M3C 1Y8
Tel: 416-441-2502 Fax: 416-441-4073



Pamela Cowan
The Leader-Post (Regina)

Thursday, July 11, 2002

Saskatchewan will not follow an Ontario trend and allow private MRI and CT clinics to open, a Saskatchewan Health official said Wednesday. Ontario's Health Minister Tony Clement announced Monday that private firms, including foreign-owned ones, can submit proposals to operate one or more of the 20 magnetic resonance imaging (MRI) scanners and five computed tomography (CT) machines the province will licence.  "As the Action Plan for Health Care that was released last December stated, the government's position is to continue to support a publicly-funded, publicly-administered health system and that's still the basic position of the government," said Duncan Fisher, assistant deputy minister of health. Saskatchewan has three MRIs -- two in Saskatoon and one in Regina. The province's seven CT scanners are located in Saskatoon, Regina, Prince Albert
and a mobile unit serves Moose Jaw and Swift Current. As of January 2002, there were 3,000 Saskatchewan residents waiting for an  MRI and 2,000 on the list for a CT scan.
Emergency treatments are done immediately and urgent exams are done within a
couple of weeks, Fisher said. "The people primarily on the waiting list are those who have been classified as non-urgent. ... We've done quite a bit over the last number of years to expand capacity in Saskatchewan." In 1992-93 about 1,500 MRI scans were done in the province. That number has increased to approximately 13,000 exams done yearly.  Similarly, CT scans increased from 32,000 in 1992-93 to 66,000 scans in
2001-02.  "As resources become available we'll invest them in the public system to
continue to improve access to services like diagnostic imaging," Fisher said.
"This is something that we recognize as an issue and something we will continue to work on." Too few physicians, radiologists and technologists to run the machines are a
big concern, Fisher said.  "It's actually one of the reasons why we're concentrating on the public sector -- we want to make sure that the human resources out there are used
in the public sector. There are concerns that if a private clinic were to be established then they would siphon off some of the people that would be available to work currently in the public sector and we'd have even more difficulty recruiting and retaining staff."
Fisher estimates the price tag on a new MRI is about $1.8 million and costs approximately $1 million to run eight hours a day for a year.




Ken Brown, Atlantic Director (Nova Scotia) Federal Superannuates Branch


Nova Scotia Citizens’ Health Care Network Meeting

With the Minister of Health

Thursday, July 25, 2002

10:00 a.m.

As the representative of seniors on the Healthcare Network, I have been asked to address the issue of Single Entry Access.

As a member of the Group of IX, members of your department have briefed me on the Single Entry Access program during the past two years.  This enabled me to have a working knowledge of the objectives, design, development and implementation of the system.   I am aware of the complexity of the system and the problems that have been encountered in getting the system up and running province-wide.  I have been briefed on the results of the demonstration project in District 7 & 8 in 2000.

 More recently, in fact during the past week, I have had the opportunity to discuss the S.E.A. system with Valerie White, a member of the Provincial Advisory Committee and Karl Nightingale, Co-coordinator Dartmouth Community Health Board.  Mrs. White loaned me the minutes of a recent meeting of the Advisory Committee and a copy of the Livision 2 of the S.E.A.  Case Management Model.   Mr. Nightingale provided me with a copy of the Long Term Care Facility Placement Policy, which we reviewed together.

 I now have had the opportunity to become acquainted with the current status of the S.E.A. System.  As I said earlier, it is a very complex system.  Although to the client, it's designed to be quite simple, one call to a 1-800 number provides access - but beyond that lies the assessment process - not quite as simple, but time does not permit us to have further discussions.

 In the interest of brevity, I would like to raise the 3 main concerns of seniors and their families in relation to this program:

1.  First and foremost, the very high "per diem" rates for nursing home care.

Q:  does the province have any long-range plan to reduce this cost, by insuring the nursing care component of long-term care?

2.  The placement problem - in light of our aging population and the resulting increased demand for cursing care beds:

Q:  does the province plan to increase the number of nursing care beds in the near future?

 3.  The shortage of adequately trained staff in the home care field.

Q:  how does the department plan to overcome the problem


-        more facilities

-        more long term care beds

-        reduction in the cost to the user, i.e. per diem rates

 Under funded and Understaffed:

- the nursing shortage has been more acutely experience in Long Term Care directly related to the limited offer of parity and improvement in working conditions.

- low wages and poor working conditions have contributed to job actions by long-term care workers.


Home Care Nova Scotia has not been properly planned or implemented.

- serious shortage of home care support workers

- all services should be provided through the Provincial Homecare Program

- only small portion of funding saved with hospital cutbacks being allocated to  Homecare.

Access to Homecare appears difficult, lengthy and poorly defined:

- reduced range of services available

- expansion to related programs such as palliative care and respite care has not happened as originally promised and is critically needed.

- Homecare should hire professionals, such as occupational therapists, physiotherapists, social workers and nutritionists as direct employees, not as external consultants.


Thank you



John Ryan, Representative Canadian Pensioner’s Concerned


Nova Scotia Citizens’ Health Care Network Meeting

With the Minister of Health

Thursday, July 25, 2002

10:00 a.m.


Is the SEA operational in all Nova Scotia Health Districts now?

The pilot project in Cape Breton was supposed to rationalized Wait Lists for LTC.

What has been the experience in all health care districts?

Anther benefit of SEA was to have been that with the reduction of Wait Lists beds in active treatment hospitals would not be" blocked" by patients designated as requiring LTC beds. What has been the actual experience?

There have been reports of patients being sent to LTC facilities quite far from their families (up to 100k). Has this problem been resolved?

Demographic studies like "Shifting Sands" indicate that the percentage of older adults in the N.S. population is increasing particularly in the 75 and older category. Is the number of LTC beds consistent with the statistics?

It is also reported that there are slightly more than 125,000 persons in N.S. over the age of 65 and that this number is increasing by about 5000 per year. What measures are being taken to address this growth in terms of LTC beds?

Studies have indicated that the average age of older adults being admitted to LTC facilities is increasing and that those being admitted are sicker and require more care. What measures are being taken to deal with this?

One of the major concerns we hear is that care in LTC facilities is not a benefit under Nova Scotia’s Health Insurance Program. This results in extremely high co costs to individuals and their families for their care. Other provinces west of the Atlantic Provinces and some federal agencies (like VAC) bill patients only for the room and board portion of the cost of LTC. When will Nova Scotia implement this type of payment program and cover LTC under the Hospital services and Insurance Act?

The Financial Assessment system in N.S. requires the reporting of all Income and assets, except a designated home, prior to admission to LTC facilities. Other provinces require only Income reporting. When will Nova Scotia change the system? The present requirements are very stressful for many older adults who see their life savings liquidated so quickly.

In 2001 there were 75 facilities providing Level 1 and Level 2 care with approximately 5900 beds. These were classified as Nursing Homes for Homes for the Aged. Has this number increased or decreased? What is the present number?

There were also 34 Residential Care Facilities with approximately 750 beds and 52 unlicensed facilities providing Level 1 care with approximately 120 beds. This totals 6750 beds or a sufficient number to accommodate about 5% of the 65+ population.

How does this compare with other provinces?

There are also reports that there is queue jumping in the SEA system, which the SEA was supposed to eliminate. What is being done to ensure this doesn’t happen?


The Financial Assessment system for eligibility for admittance to LTC facilities in Nova Scotia be based on Income only.

That health care in LTC facilities be a benefit under the Health Services and Insurance Act in Nova Scotia.

That when it is determined that a patient in an active treatment hospital requires transfer to a LTC facility and no bed is available at that time in a LTC that the patient not be required to pay any fee.

That in view of the advanced age and worsening medical condition of older adults being admitted to LTC facilities that a review of nursing staff requirements be undertaken to ensure a high level of care is being provided.

That the SEA system be monitored closely to ensure there is no queue jumping.

That all the conditions previously mentioned apply to disabled persons as well as older adults.


Thank you


       Peggy Brown, Disabled Individuals Alliance


Nova Scotia Citizens’ Health Care Network Meeting

With the Minister of Health

Thursday, July 25, 2002

10:00 a.m.


Good morning, my name is Peggy Brown. I would like to say a few words about the provincial home care program based on my own experience and that of other persons with disabilities.


When the program was first announced, it appeared to be a good one.   However, my experience has shown it to be otherwise.


In my first encounter with it, there were not any homemakers in place.


I did finally get the services of a homemaker but fifteen months later, the number of hours I received was cut in half, from 16 to 8 hours.  I also started to hear stories from people being cut off from home care services altogether for no apparent reason.


In addition, persons with disabilities have clearly told me that they are not getting all the services they need.  This includes light housekeeping such as cleaning, laundry and changing of sheets.


We are now hearing that there are long waiting lists for people wanting to get services.


There are four recommendations I would like to make about home care:


       The program needs to be improved, not cut back or “de-proved”.

       More services by homemakers and home support workers are needed, not less.

       More money should be put into home care to provide the services we need in order to allow everyone receiving these services to live comfortably.

       The recent logs of services being provided that have been required by Home Care Coordinators seem to be more paper work and a waste of money.

       Home care must be improved to help keep people out of nursing homes.


Thank you






Ian Johnson


Nova Scotia Citizens’ Health Care Network

For Meeting with Minister of Health

Thursday, July 25, 2002


Thank you, my name is Ian Johnson and I am the Vice-Chair of the Nova Scotia Citizens Health Care Network.  My task at this point is to somehow summarize the main points we have tried to raise with you today, Mr. Muir and other representatives of the Department.

 As you will have read in our background information statement, the Nova Scotia Citizens’ Health Care Network is dedicated to protecting, strengthening and expanding Medicare.  Since our beginnings in November 1996, the Health Network has grown to become a provincial organization of concerned individuals and organizations representing seniors, women, anti-poverty, persons with disabilities, community groups and labour. 

 We therefore feel that the two issues we have brought before you today represent the concerns and recommendations of a broad cross-section of Nova Scotians, these two issues being the Private MRI Clinic and Single Entry Access.  We are not here simply to be critical but to offer what we consider to be thoughtful and considered concerns about these issues and at the same time, to propose positive and progressive recommendations for change and improvement.

 On the Private MRI Clinic, we want to see action by your government to stop the establishment of the private MRI clinic being established by Canadian Diagnostic Centres in Halifax to open on August 1.  We are very concerned about the likely adverse impact this clinic will have on our public health care system in this province in terms of the loss of staff and money away from the public system.   We do not see it helping in any way the perceived or actual problem with waiting lists to receive diagnostic services and treatment. We are troubled with the potential for lower quality care and even, with possible risks to public health and safety.  We are especially disturbed by how this facility will violate the principles of the Canada Health Act, especially those of universality and comprehensiveness.  We wonder why anyone should have to pay for an insured service or how anyone can try to make a profit from the provision of an insured service.

 We urge you to accept the 1994 commitment of federal, provincial and territorial ministers of health to regulate the development of private clinics in Canada and to accept more recently the recommendation of your federal counterpart in June that it is provincial responsibility to allow or disallow privatization of health services.  In our view, this action and leadership can take a number of different forms such as legislative or regulatory action to disallow a private clinic, direct measures to deal with and resolve serious problems with waiting lists such as extended hours, turning private clinics into publicly funded services to directly deal with waiting list problems as has been done in Manitoba, and major initiatives to support and enhance publicly funded services such as community health clinics.  Your recent commitment to seek a legal opinion is a good first step in our view but only one of several possible measures needed now and in the near future.

 On Single Entry Access, we were pleased when SEA was first announced and we were hopeful of its potential such as in reducing waiting lists for beds in hospitals, in nursing homes and in home care.  At the same time, there are clearly some major implementation issues and concerns.  The Provincial Home Care Program is not as broad and extensive as it was originally envisioned.  It appears to be more selective and more restrictive in what services it does offer, to whom and for how long.  There appear to be assessment and intake problems with SEA including the length of time required, waiting lists and possible queue jumping. We are also very concerned about the high costs to individuals and families of nursing home care, and about the shortage of adequately trained staff in all types of facilities and services.

 To help achieve the original potential of SEA, we urge you again to take leadership in the following ways: expanding the services and operations of the home care program, making the health or medical care component of long-term care an insured service, the elimination of daily charges to patients waiting to be transferred from acute care facilities to a long-term care facility, improving and monitoring the assessment and intake for SEA to reduce waiting times and ensure appropriate placements, and addressing the shortage of adequately trained staff.

We look forward to your response to these concerns and

recommendations and we would later appreciate a written

response to them.   We have tried to suggest positive

options for action by you and the Department.  At the same

time, we are prepared to do all we can to offer solutions and

to propose meaningful consultations and participation,

especially by the public and front-line health care workers. 

We thank you again for this opportunity to meet today.