May 20,
2015
SOCIAL
SERVICES COMMITTEE
Pursuant to Standing Order 68, Andrew Parsons, MHA for Burgeo – La Poile,
substitutes for Lisa Dempster, MHA for Cartwright – L'Anse au Clair.
Pursuant to Standing Order 68, Eli Cross, MHA for Bonavista North, substitutes
for Glen Little, MHA for Bonavista South, until 11:03 a.m.
Pursuant to Standing Order 68, Lorraine Michael, MHA for Signal Hill – Quidi
Vidi, substitutes for Gerry Rogers, MHA for St. John's Centre.
The
Committee met at 9:06 a.m. in the Assembly Chamber.
CHAIR (Littlejohn):
Good morning, everyone –
there we go, now we are getting there.
MR. KENT:
We are listening to you, Mr.
Chair.
CHAIR:
Thank you.
Good
morning, Minister. Good morning,
Committee. There are just a couple
of quick things. Before we get
started, I am going to ask Committee members to introduce themselves.
We have some substitutions this morning, so I welcome our substitutions,
familiar faces. I am going to ask
our Committee members to introduce themselves and then, Minister, if you would,
I am going to ask you or the individual staff members.
I
remind individuals of all parties to wait until your light comes on, say your
name and your position first, and that way we will get it on the record in
Hansard. That will be greatly
appreciated.
We
started at 9:05 a.m., so 12:05 p.m. would be three hours, and we will see where
we go from there.
We will
start with Mr. Flynn.
MR. FLYNN:
Stelman Flynn, MHA for
Humber East.
MR. A. PARSONS:
Andrew Parsons, MHA, Burgeo
– La Poile.
MS BUCKLE:
Joy Buckle, Researcher,
Opposition Office.
MS MICHAEL:
Lorraine Michael, MHA,
Signal Hill –Quidi Vidi.
MS WILLIAMS:
Susan Williams, Researcher,
NDP.
MR. POLLARD:
Kevin Pollard, MHA, Baie
Verte – Springdale, and Parliamentary Secretary to the Department of Health and
Community Services.
MR. CROSS:
Eli Cross, Bonavista North,
swam across the bay this morning because I am substituting for Glen Little of
the south side.
MR. CORNECT:
Tony Cornect, MHA for the
great and cultural District of Port au Port.
CHAIR:
Welcome, Minister, and
welcome to your staff. Minister, I
do not think you need any introductions, but you just point me in the right
direction and we will introduce your staff, please.
MR. KENT:
Sure.
Good
morning, everybody, we will start with Michelle to my right, your left.
MS JEWER:
Michelle Jewer, ADM,
Corporate Services, Department of Health.
MR. COOPER:
Bruce Cooper, Deputy
Minister, Health and Community Services.
MS TUBRETT:
Denise Tubrett, ADM,
Regional Services.
MR. TIZZARD:
Mike Tizzard, Departmental
Controller, Health and Community Services.
DR. ALTEEN:
Larry Alteen, Medical
Consultant, Acting.
MS HANRAHAN:
Heather Hanrahan, ADM,
Acting, Professional Services.
MS CHATIGNY:
Elaine Chatigny, ADM,
Population Health.
MS STONE:
Karen Stone, ADM, Policy and
Planning.
MR. SHEPPARD:
Keith Sheppard, Director,
Pharmaceutical Services, Health and Community Services.
MR. TOMPKINS:
John Tompkins, Director of
Communications.
CHAIR:
Welcome, everybody.
Before
we start, Minister, and I turn it to you for your first introductory remarks, I
am going to ask Kimberley to call the clause.
CLERK (Ms Hammond):
Subhead 1.1.01.
CHAIR:
Minister, you have fifteen
minutes if you so desire.
MR. KENT:
Thank you, Mr. Chair.
I am
not going to use the fifteen minutes.
I suspect my colleagues opposite have lots of questions.
I am very pleased to be here.
This was a job that I was a tad bit apprehensive about taking on.
I did not aspire to be the Minister of Health and Community Services, but
I can honestly tell you that within days of being on the job, I developed a love
for the job and a passion for the job.
Despite the significant challenges we face in health care, there are so
many good things happening as well.
So it has been a challenging and rewarding number of months.
Our
budget for the department is close to $3 billion, which we will be discussing
here this morning. It is about 40
per cent of the overall provincial Budget.
We have some major obstacles to overcome in the years ahead.
We have real challenges around sustainability, but I am pleased to say
that we have solid plans for making the health care system in this Province more
sustainable, working with our regional health authorities and other partners in
delivering health care.
I am
very happy to be here. I will do my
best to answer all of your questions in the next few hours.
CHAIR:
Thank you.
Andrew,
before you start, just for Committee members, we are on 17.3 of the Estimates
booklet, Minister's Office, 1.1.01.
The minister has asked that you direct the questions directly to the minister
and he will defer to staff. We will
go from there.
Andrew.
MR. A. PARSONS:
Thank you.
Before
I begin, thank you to the minister and everybody for making yourselves
available; we very much appreciate it.
I am going to start off on the salary details for the department and
staffing. I am just wondering,
based on your latest payroll, how many additional staff does the department
employ that are contractual? I am
looking at staffing numbers here.
This would have been in the salary estimates section, Schedule I.
MR. KENT:
Mr. Parsons's question is:
How many of the positions are contractual?
MR. A. PARSONS:
Yes.
MR. KENT:
I am going to defer to
Michelle. I am not sure we have
that precise figure, but we can get it for you.
I can tell you there are a fair number of positions that are contractual.
There are a number of competitions ongoing and like most departments in
government, there are a number of positons in the department that are indeed
contractual.
Michelle, do we have the precise number at the moment?
MS JEWER:
No, I do not have it with me, but I can get it.
MR. KENT:
We can get it for you.
I have no problem providing it.
I just do not have it here.
MR. A. PARSONS:
Okay.
Maybe
what I will say off the top – we usually do this – is anything I request I am
sure Lorraine will want and vice versa.
MR. KENT:
Yes.
If I commit on the record to providing it, we will provide it for sure.
MR. A. PARSONS:
Excellent, thank you.
MR. KENT:
We will keep a running list
of what those items are and provide them to you.
MR. A. PARSONS:
I am just wondering in the
last year – and I do not know if you have this here – how many temporary or I
guess thirteen-week positions have there been in the department?
MR. KENT:
I have not signed off on any
in my time as minister, but there likely were temporary positions prior to my
arrival. I do not know that we
would have the precise number either.
We do not have it here, but I am certainly happy to provide it.
Again, in recent months, I have not appointed any thirteen-week positions
in the department.
MR. A. PARSONS:
Okay.
Again,
going to the salary details, under Other Salary Costs there is just about $3.5
million for this year. I am
wondering what the breakdown on that is.
MR. KENT:
Can you tell us where you
are seeing the $3.5 million number?
I am looking at the salary details –
MR. A. PARSONS:
Under Schedule I, Summary of
Salary Details by Department, it lists all of the departments and then lists
permanent positions, Permanent Salary Costs, and then Other Salary Costs.
For
instance, in this case, Permanent Salary Costs would be –
MR. KENT:
Yes.
The
first number, the $13.2 million represents employees and positions that are, in
fact, permanent; the $3.5 million that you reference, which is broken down by
division, represents temporary and contractual employees, any of whom have been
in the positions for quite some time.
In fact, among officials here today, we have a number of temporary and
contractual employees, even at the most senior level of the department.
MR. A. PARSONS:
This is one of the things
that we will get a list of everybody that falls under $3.5 million.
MR. KENT:
That is not a problem.
MR. A. PARSONS:
Excellent.
I
noticed here there are 190 permanent positions.
I know there has been some talk of attrition and cuts.
How many of these will be cut over the next five years?
Is that part of the planning?
MR. KENT:
We do have an attrition
target, like all departments, for the next five years.
There are four positions that we need to find in this current fiscal
year, and the total over the five years is eighteen positions for the
department.
MR. A. PARSONS:
When you say four this year,
they have not been determined, you are trying to figure out where –
MR. KENT:
We are in the process of
finalizing our attrition plan right now.
There has been significant work done.
We have a number of vacancies in the department as well that need to be
considered. There are a number of
competitions ongoing. Because of
some of the work we are doing around system transformation and primary health
care, mental health and addictions, there may be changes to how we do business
within the department.
All of
that is being considered, but we do know that we need to achieve that attrition
target on top of salary savings targets that have been set as well.
MR. A. PARSONS:
This may be just a case of
the wording and stuff. Besides
through attrition, will there be any other positions that are eliminated under
this department for this year?
MR. KENT:
I cannot say with certainty
that there will not be. What I can
say is that we have a lot of priorities to achieve and scarce resources to
achieve them. I also know that when
budgets were reduced in 2013, the Department of Health and Community Services
was hit harder from a staffing perspective than most departments in government
on a percentage basis.
I do
not believe there is a lot of room to find further savings in human resources
within the department. That said,
because of some of the work we have on the horizon, we may need to do some
restructuring within the department.
There
are also a number of vacancies.
Some of those positions may need to be re-profiled to meet some of the
priorities we have set. Whether
there will be further reductions, it is possible.
What I can say with certainty is that there will be at least four
positions eliminated through attrition.
MR. A. PARSONS:
Okay.
Thank you.
MR. KENT:
This year.
MR. A. PARSONS:
Going back to 1.1.01,
Minister's Office, under Operating Accounts there was an underspend by about
just over $30,000. What was the
accounting for there?
MR. KENT:
Thirty thousand dollars?
CHAIR:
Subhead 1.1.01, 02,
Operating Accounts, Minister.
MR. KENT:
Oh, budget to revised.
Sorry, I understand your question.
The
reason for the savings in those various budget lines that are broken down, the
total of which you have just identified – like most departments, we implemented
an expenditure management plan in the fall in response to government's direction
to reduce discretionary spending, in light of the Province's fiscal situation.
We
reviewed the operating budget of the department to determine if there was
anything at all that was discretionary in nature that was not essential, or that
could be delayed to a later time.
That resulted in savings in those areas, travel being the bulk of it.
Some minor savings were related to supplies and purchased services as
well, but the bulk of that was through reduced travel activity.
MR. A. PARSONS:
Okay.
I am
going to move forward to 1.2.01, Executive Support.
Under line 01, Salaries, I think there is an extra $63,000.
Is this a position or is this part of the step by step and the 3 per
cent?
MR. KENT:
That line includes the
Deputy Minister, all of the ADMs including the medical consultant, the Secretary
to Deputy Minister, the ADM's secretaries, the Director of Communications, and
the Media Relations Manager. The
reason that line was over budget is due to the retirement of a senior employee
that resulted in a large payout, as well as another severance payout for an
assistant deputy minister who left government.
We had a retirement and a resignation, both of which triggered payoffs,
but the payouts were offset by savings as a result of vacancies as well.
MR. A. PARSONS:
This year there is $1.7
million budgeted as opposed to what was spent last year.
So there is an increase there.
MR. KENT:
As you alluded to, that is
the 3 per cent.
MR. A. PARSONS:
Okay.
MR. KENT:
The 3 per cent in the new
collective agreement. As well,
there are two ADMs who are currently on higher steps of the approved
classification level than the previous incumbents in those positions.
That is triggering the difference as well.
We have had some changes at the executive level.
As you heard from the introductions, we have a couple of people in acting
roles now so that attributes to some of that.
MR. A. PARSONS:
I am looking at the
Purchased Services line. Last year
there was $22,500 budgeted and $3,500 spent.
We know that by looking at Estimates the year before there was $22,500
budgeted and $7,500 spent.
This
year there is $22,500 budgeted. I
am just wondering in terms of practices in the case of – it seems like we over
budget by $15,000 to $18,000 yearly.
Is there a reason for that?
MR. KENT:
There is a reason for that.
There are a number of items that get charged to that budget line within
the executive section that we are talking about.
There are advertising and communications-related activities.
As well, there are costs for professional training, meeting room rentals,
and taxis.
The
reason for the dramatic decrease in this past fiscal was, again, the review of
expenses overall in the fall. We
needed to reduce discretionary spending based on the Province's fiscal situation
and we paused or stopped anything that was not absolutely imperative.
So that lowered that line by about $19,000.
What was spent in that budget line included media monitoring services,
catering services for a couple of meetings, an ergonomic assessment for an
employee, and that left the remaining funds unspent.
We do
believe we will require the full budget for this coming fiscal year.
We believe it will be used under the Communications Division for various
marketing communications materials that will be required to support the
department's activities. There are
a number of projects on the horizon where we feel there will be a need for those
funds, but the funds, we anticipate, will be largely used for marketing
communications purposes.
MR. A. PARSONS:
So that would not fall under
the Transportation and Communications line, it is just a different –
MR. KENT:
The marketing materials are
under Purchased Services.
MR. A. PARSONS:
Okay.
I am going to move forward to 1.2.02, Corporate Services.
You will see a jump there in the Salaries, listed as Salaries, operating.
There was $4.8 million spent last year and this year we are up to just
over $5 million. I am wondering the
same question: Is it extra salary or extra positions, or is it the percentage
increase step by step?
MR. KENT:
Yes, a good question.
My response on a number of these will probably be very similar, because
as you suggest, the reason is the same.
So, the revised budget increased due to a severance payout that occurred
in the last fiscal year. The
increase by $234,600 from the 2014-2015 budget is a net result of salary
increases as a result of the 3 per cent raise in the new collective agreement.
MR. A. PARSONS:
Okay, so that is not a new
position or any of this?
MR. KENT:
No.
MR. A. PARSONS:
Okay.
Looking
in the same section under Professional Services, $1.1 million was budgeted last
year for Professional Services, but just under $80,000 spent.
What was budgeted for that was not incurred?
MR. KENT:
There is a contingency fund
for federal/provincial/territorial agreements that could arise during any fiscal
year. Any agreements like those are
offset by revenue from various provincial, territorial, and federal sources, and
they are recorded within revenue in this area.
In the
department's final projections for the fiscal year there were no potential
federal agreements that we saw on the horizon before the end of the fiscal year.
In addition, the Audit Services within our department conducted less
audit appeals than we had projected in 2014-2015 which resulted in additional
savings.
That
said, you will note as well that the 2015-2016 Estimates are decreasing by
$750,000 over the 2014-2015 budget, and that is really based on historical
trends. We reduced the contingency
for federally funded projects by the $750,000.
This is 100 per cent offset by revenue, so it is money in, money out.
There are a number of federal/provincial/territorial agreements that we
are involved in through the health care system.
CHAIR:
Do you want to leave it
there for now, Andrew?
MR. A. PARSONS:
I will leave it here for now
and come back to this section after.
CHAIR:
Thank you.
Lorraine.
MR. KENT:
Oh, you are going to have
more questions? That is not it?
MR. A. PARSONS:
Just a couple.
MR. KENT:
Okay.
MS MICHAEL:
Okay, yes, I will continue.
Let's
keep looking at that same section then, Minister, and I think that you were
answering the question with regard to the Professional Services, correct?
MR. KENT:
Yes, we were just talking
about the Professional Services line within the Corporate Services activity
area.
MS MICHAEL:
Yes, and I understood your
answer.
Coming
down to Purchased Services underneath, again in the budget of last year the
revision was $589,800 down from what was estimated, so I think I would like a
bit of an explanation of that first.
MR. KENT:
Yes, that is a fair
question.
We saw
lower than anticipated purchased services expenditures during 2014-2015,
obviously, and that budget line includes funding for our office space leasing
costs, printing, and other general purchased services.
We implemented the expenditure management plan, that I referred to
earlier, back in the fall. We were
directed to reduce discretionary spending, and professional and purchased
services were an obvious area for departments to target.
We reviewed the department's operating budget to determine if there were
any items at all that were discretionary in nature or could be delayed, and that
resulted in lower purchased services costs.
We also
have decreased the 2015-2016 estimates by $334,200 from the 2014-2015 budget.
We looked at the drop balances that have traditionally existed.
We did a review of those drop balances to try and find areas in the
budget where we could reduce the budget, due to our current fiscal situation,
and we feel comfortable that we can meet our requirements with less resources in
this fiscal year as well.
The
reason the full budget is required ,though – I just want to make sure I present
the full picture. The reason we
think the full budget is required for this fiscal year is that we have built in
a contingency fund for a number of expenditures.
For instance, the work of the mental health and addictions all-party
committee's advertising costs, printed materials, and so on needs to be budgeted
somewhere. There is also funding to
deal with potential pandemics such as H1N1, or Ebola, or a matter like that that
could arise.
That is
why we feel the contingency remains important.
Hopefully some of those funds will not be needed, but some certainly will
be because of the work of the all-party committee.
MS MICHAEL:
Right, and actually I was
going to ask you about the all-party committee and where the expenditures for
that would fall. Obviously the
staff are doing their regular work so there is no extra staff –
MR. KENT:
Not at this point.
MS MICHAEL:
I was wondering about stuff
like communications and travel because your travel now is covering not just
people from your own department, but also the people who are on the Committee
from the other parties.
MR. KENT:
This is a portion of it,
which will cover printing and advertising and promotion.
We also have some funds within our Population Health budget.
We plan to find the other funds there to support the work of the
Committee. Regardless, we need to
find the funds, but we believe between this area in Corporate Services and
another area within Population Health that we will be able to adequately cover
it based on what is projected to occur over the next few months.
MS MICHAEL:
Right, thank you very much,
Minister.
It just
points to a broader question that we will not discuss here but just to make the
point – not just for the sake of making it, but I think it is important, in
making it, that as we move forward as a House of Assembly and we have a standing
committee that should deal with this when the time comes, we need to look at
things like if we have all-party committees where that responsibility falls for
covering the cost of all-party committees, because it is a strain on an
individual department right now.
MR. KENT:
I agree with you.
I think that that is a good discussion for the Management Commission to
have and maybe it is a discussion that other committees of the House need to
have as well –
MS MICHAEL:
Yes.
MR. KENT:
Certainly if they are
committees of the Legislature, then they need to be resourced by the
Legislature. This circumstance,
much like the shrimp all-party committee, is a bit unique, but I think you are
raising a valid question and a valid point that the House should consider.
MS MICHAEL:
As a member of the Standing
Orders Committee, I will make sure that it goes to the Standing Orders Committee
when we meet.
MR. KENT:
Sounds good.
MS MICHAEL:
Okay, great.
Could
we just go back up to the Professional Services.
Minister, could you give us an idea of what are the services that fall
under that category?
MR. KENT:
There are a number of items
that fall under that category. The
funding provides for unanticipated federal or otherwise funded projects;
$250,000 of the total budget represents a contingency fund for
federal-provincial funding agreements, which may arise during the fiscal year;
and the level of access varies in each fiscal year depending on what agreements
get signed, as we were discussing earlier.
The
balance of the funding for Professional Services – there is funding within the
Audit Services division for audited appeals and in the Information Management
Division for IT consulting services as well.
MS MICHAEL:
Okay, thank you very much.
Still
within 1.2.02, I am just curious about the provincial revenue, $350,000
budgeted, revised down to $300,000 and up to $350,000.
I am just curious about that drop of $50,000.
MR. KENT:
It represents income from a
number of sources such as recoveries related to default on bursaries, MCP
overpayments, refunds from workers' compensation, and other miscellaneous
revenues. Also included are
payments on other miscellaneous billings that occur throughout the fiscal year.
During 2014-2015, we received $50,000 less than what we originally
anticipated, but it is always a bit of a guess, to be quite frank.
We just look at historical trends.
MS MICHAEL:
Right, thank you very much.
Moving
to 1.2.03, Professional Services, in the Salaries you were $264,900 underspent
last year. Could we just have an
explanation of that, please?
MR. KENT:
Underspent last year?
MS MICHAEL:
Yes, the budget was
$3,401,000 and the revised was $3,136,000.
MR. KENT:
Correct.
So the decrease was close to $265,000 and that was a result of vacancies.
Those vacancies may have been for a part of the year or for all of the
year. They included the Director
and the Assistant Medical Director in the Physician Services division; a Claims
Processor and Mail & Messenger Clerk in the Newfoundland and Labrador
Prescription Drug Program Assessment Office; a Clinical Pharmacist I position;
and a pharmaceutical claims assessor I position in the Pharmaceutical Services
Division.
MS MICHAEL:
That is a lot of vacancies,
but they were not all at the same time.
MR. KENT:
They were not all at the
same time. They were throughout the
year. Frankly, it is a concern for
me as well. We have been actively
recruiting for a number of those positions.
Particularly when we are talking about our director and assistant medical
director, those are pretty critical roles in our Physician Services Division.
I would have to say that the folks who are involved in the division
currently have been carrying a fairly heavy load as a result of those vacancies.
Physician recruitment throughout the system, not just within our department, can
be a challenge. Not that both of
those positions would necessarily be physicians, but in both roles they have
traditionally been physicians.
MS MICHAEL:
Thank you.
Obviously you are hoping to fill them because you have brought the budget –
MR. KENT:
That is right.
MS MICHAEL:
You are keeping it at the
$3.4 million.
MR. KENT:
Yes.
MS MICHAEL:
Okay.
The
others are fairly straightforward.
Professional Services; there is not an anomaly, but a differential between the
budget and revised figure last year.
MR. KENT:
Yes, the revised budget
decreased by $112,500. That savings
related to a contract for a senior business analyst.
The funding is required in 2015-2016 because the current vendor contract
for the NLPDP system, the Prescription Drug Program system is actually nearing
completion. We anticipate an
analyst could be required as we work through a new RFP.
We will
go to market in this current year for a new provider for that NLPDP system.
Traditionally, we have had a business analyst contracted to support that
system. As we make the transition,
we anticipate there will be a need to have that support again.
MS MICHAEL:
Okay.
Minister, where does the provincial drug program itself fall?
MR. KENT:
That falls under 2.2.01.
MS MICHAEL:
Okay.
MR. KENT:
There is a whole section
dedicated to the Prescription Drug Program.
MS MICHAEL:
Yes, of course.
MR. KENT:
I am happy to work through
that as we get to it.
MS MICHAEL:
When we get to it.
I just forgot where it was.
CHAIR:
Lorraine, I am going to hold
you there and I will come back.
MS MICHAEL:
Sure.
CHAIR:
Thank you.
MS MICHAEL:
Thank you.
CHAIR:
Andrew.
MR. A. PARSONS:
Thank you, Mr. Chair.
I am
still on 1.2.02, Corporate Services, just under the Salaries.
Last year I believe it was said that two positions were hired or approved
for the enhancement of the Medical Transportation Program.
Were those two hired?
MR. KENT:
Yes, both of those positons
were filled.
MR. A. PARSONS:
Okay.
I am
just wondering, because we see the – when you hire, say, for the enhancement or
whatever, I am just wondering have you seen changes with the hiring?
Have wait-lists decreased?
Has the program benefitted for the people who avail of it?
MR. KENT:
There is lots of demand on
the program. Would you like to
elaborate?
MS JEWER:
Sure.
MR. KENT:
I will ask Michelle to
respond in more detail.
CHAIR:
Michelle.
MS JEWER:
We have seen an increase in the number of patients, or beneficiaries who have
come to the program from last year.
There has been an increase in expenditure as well.
MR. A. PARSONS:
I am just wondering, when it
comes to refunds or people trying to pay for it, there have been some complaints
about the wait time in getting reimbursed.
Has there been any decrease in that wait time?
MR. KENT:
It has not really changed.
The wait time remains consistent.
We are constantly trying to improve on that.
We have limited resources.
The
easy thing to do would be to throw money at the problem and hire more people,
but in these times we live in that is not necessarily the responsible thing to
do. So we will be looking, in the
months ahead, at how we can make that whole process more efficient to see if
there is a better way to flow claims through, a better way to do business in
that regard. The wait times right
now have remained pretty consistent.
MR. A. PARSONS:
What is the average wait
time?
MR. KENT:
The average time is about
eight weeks. I understand that
could represent a real burden for those who are availing of the program.
We will continue to try and improve it.
MR. A. PARSONS:
Okay.
Under Purchased Services there is $1.3 million budgeted last year and
$726,000 spent – $982,000. I
believe this provides for office space leasing and printing and stuff like that.
Am I on the right track here?
MR. KENT:
I think you are.
Yes, the Purchased Services line includes funding for office space
leasing costs, printing. There
would be some other general Purchased Services in that line as well.
MR. A. PARSONS:
Are we able to get after – I
do not expect you to have it here – a breakdown of the office leases for last
year?
MR. KENT:
Yes, I would be happy to
provide it now, actually.
MR. A. PARSONS:
Perfect.
MR. KENT:
I would like to keep the
list of homework as short as I can.
The
breakdown for anticipated expenditures in 2015-2016 includes the MCP office in
Grand Falls-Windsor, the total cost of which is just over $165,000.
We have an MCP office on Major's Path here in St. John's.
I should also note that both of those leases are long-term leases.
In
Grand Falls-Windsor, the term of that lease runs until 2021.
For the office on Major's Path, it runs until 2023.
The 2015-2016 cost is $283,716.
Then, there is space for the NLPDP office in Stephenville as well.
There are two separate leases, the same vendor, and the total cost of
those is just over $69,000. So the
total is just over $517,700.
MR. A. PARSONS:
Okay.
Thank you.
I am
just wondering – and I do not know if this exactly falls under there or not and
maybe you answered before – how many summer students did the department have in
2014-2015?
MR. KENT:
I will get that information
for you in a second. I think it is
about a dozen, but I will get the exact number for you.
The finance folks do not like it when I guess.
I think it is about a dozen, but we will get the exact number for you.
The number is twelve.
MR. A. PARSONS:
Okay, so that was twelve
last year.
MR. KENT:
Yes.
MR. A. PARSONS:
You might need that sheet
back. Twelve last year and what was
the cost?
MR. KENT:
The cost of students was
approximately $52,000.
MR. A. PARSONS:
Fifty-two thousand dollars.
Okay.
MR. KENT:
It is an interesting
discussion because we definitely benefit from having students in place for
summer relief and to help with, particularly, some of the clerical work that
slows down when people are on vacations.
I think we also have a responsibility to create opportunities for
students who are looking to gain professional experience.
We get
a lot of students apply who want to work in the health care system, for
instance. We also get people who
want general administration, or business experience, or whatever the case may
be. I think government has some
responsibility to create some of those opportunities for students, while at the
same time there is a legitimate business need that exists as well.
MR. A. PARSONS:
What is the anticipated
number of summer students for this year?
MR. KENT:
It would be about the same.
MR. A. PARSONS:
About the same?
MR. KENT:
Yes.
MR. A. PARSONS:
The same budget, obviously.
MR. KENT:
Yes.
MR. A. PARSONS:
Okay.
MR. KENT:
Is there any wage increase
for students?
OFFICIAL:
No.
MR. KENT:
No, so it is the same.
MR. A. PARSONS:
Okay.
MR. KENT:
Approximately.
MR. A. PARSONS:
Okay.
MR. KENT:
It could fluctuate slightly
just because of start dates and end dates, depending on the student, but we are
talking approximately $50,000 or $52,000.
MR. A. PARSONS:
Okay.
I am
going to move forward to 1.2.03, Professional Services.
Under the Professional Services line, there was $304,000 spent last year,
revised, and this year it is $394,000.
I am just wondering is there a list of the professional services that
were utilized and a breakdown.
MR. KENT:
Absolutely.
I would be happy to provide a breakdown.
The bulk – well, a good chunk of the funding was for a contract for the
senior business analyst services that we receive, which relates to the
maintenance and support of the Newfoundland and Labrador Prescription Drug
Program system.
That
amount in 2015-2016 – would you prefer the 2014-2015 numbers or the 2015-2016
numbers, or both?
MR. A. PARSONS:
We can start with 2014-2015.
MR. KENT:
Okay.
The
revised number for 2014-2015 was $127,400.
There was also money for an expert reviewer for the Newfoundland and
Labrador Interchangeable Drug Products Formulary at a cost of $5,000.
There is funding for the Drug Information Centre at $12,000.
We make
a contribution to the Pan-Canadian Oncology Drug Review at an annual cost of
$77,000. Newfoundland and Labrador
also contributes to the Atlantic Common Drug Review which is managed by the
Government of Nova Scotia. We
contribute $70,000 to that effort as well.
There
is also an NIDPF physician rep at a cost of $6,000.
There is a Revenue Canada contract that relates to the Newfoundland and
Labrador Prescription Drug Program Assessment Office at a cost of $7,000.
The
only thing additional – sorry, not the only thing additional, one of the things
additional in 2015-2016, we anticipate a small cost related to the publication
of our new Workforce Plan for the health system.
Because of the change that is happening with the NLPDP system, we suspect
that our business analyst costs will be higher than the revised budget for
2014-2015 but less than the original budget for 2014-2015.
MR. A. PARSONS:
Okay.
Obviously, I want to talk more about NLPDP when we –
MR. KENT:
Yes, no problem.
MR. A. PARSONS:
Okay.
I am
going to move forward in my little short period of time here, I will start with
1.2.04, Regional Services, and I just have the one question on Salaries before I
am cut off. Last year, there was an
under spend by between $550,000 and $600,000; this year it is up to $1.8
million. So can I have a breakdown
of that, please?
MR. KENT:
No problem.
Like
most of our divisions, there were some vacancies throughout the year in the
acute health services and emergency response division: two Management Analyst
positions, and two Management Engineer positions.
There were also vacancies throughout the year in the Long-Term Care and
Community Support Division. The
position was a Financial Program Designer.
In the Infrastructure Management Division there was a Director and Senior
Engineer position that was vacant, and the Program and Policy Development
Specialist in the intervention services division.
Now,
some of those positions have already been filled.
For instance, the Financial Program Designer and the Policy and Program
Development Specialist positions have already been filled.
There is a job competition currently ongoing for the Director of
Infrastructure Management, and we will be looking at other vacancies this year
to determine if the positions will indeed be filled, or if we can get the work
done through other positions. So,
as part of the discussion we are having around restructure and attrition, those
positions would be discussed as part of that to determine which we would fill
and which we may not fill.
The
increase from the 2014-2015 budget is a result of the 3 per cent raise that was
approved in the new collective agreement.
MR. A. PARSONS:
Okay, thank you.
CHAIR:
Lorraine.
MS MICHAEL:
Thank you.
Minister if we could go back to 1.2.03, where the appropriations provide for the
development and maintenance of policies, programs, and standards, et cetera.
Under the Health Workforce Planning, what does that involved, and what
would be involved in this coming year?
MR. KENT:
I would be happy to speak to
that. I am just going to find some
more detailed notes on Health Workforce Planning.
The
whole area of workforce planning is a high priority for the department, given
some of the human resource challenges that we have in the system.
As the Department of Health and Community Services, we want to show
leadership and help the regional health authorities tackle some of those
challenges. We work closely with
the Department of Advanced Education and Skills as well to look at some of the
trends that are occurring in the labour market to identify the need for training
opportunities and so on.
So, we
have a Strategic Health Workforce Plan that identifies a framework of five
strategic directions that will enhance the stability, the utilization, and the
productivity of the health workforce, while improving services to residents of
the Province.
In the
absence of the approved plan, we have not stopped undertaking strategic health
workforce related initiatives. This
would include several recruitment and incentive programs.
We are collecting and reporting on key workforce data such as vacancies,
employee turnover, retirement trends, seat capacity, and forecasting models.
Those are just some examples of current programs to balance the supply
and demand of health professionals in the Province.
Our new
plan consolidates existing and future initiatives and programs in a unified and
strengthened provincial approach to Health Workforce Planning.
This was something that the government committed to in the Speech from
the Throne on April 21.
As I
mentioned in response to Mr. Parsons's question, we had allocated a small amount
of money to deal with the publishing and preparation of the new plan.
We had funding in last year's budget that was not utilized so we are
going to need it in 2015-2016. Over
the next three years, we will select actions annually on a priority basis from
that plan based on the highest priority needs within the system.
Many of those actions are already underway.
The Health Workforce Plan that we are talking about can be implemented
within existing funding within the department.
We know
we need to make better use of existing resources if we are going to make the
health care system more sustainable and we also have to position ourselves to
meet the growth in need for health services.
It is incremental increases that we are seeing, but they are relentless.
We see relentless growth in the demand for health services.
This is
a really critical exercise and one that will be a high priority for the
department in 2015-2016, but the Workforce Plan will actually be a three-year
plan.
MS MICHAEL:
Minister, to what degree
does the department engage with an authority if a problematic area becomes
obvious to you, either through the authority or through the media?
MR. KENT:
We engage very directly
through – I was going to say through regional services.
In fact, through all divisions of our department we are engaging very
directly with the regional health authorities on a regular basis.
Much to the frustration, perhaps, of some – I am a pretty hands-on
minister as well. For instance,
when concerns have been raised about staffing levels in long-term care in St.
John's, I have directly been involved in discussions with officials in Eastern
Health and beyond to talk about how we are going to meet some of those
challenges related to LPNs and PCAs.
It is not something we can solve alone, but there has been a plan.
There have been a number of initiatives undertaken and there is more work
to do.
We are
working closely with the College of the North Atlantic.
We are working closely with Advanced Education and Skills.
We are working closely with the Centre for Nursing Studies.
We are looking at international recruitment, some of which has already
occurred. We are challenging
Eastern Health – just to use that example – to continue to make that issue a
priority as well.
We see
our role as being critical in providing leadership on these issues.
The regional health authorities have to deliver the services, but the
labour market – you have to look at it provincially.
You have to look at the whole picture and at the same time deal with
specific regional issues that may arise as well.
MS MICHAEL:
Minister, is that three-year
plan totally worked out yet on paper?
If not, can it be public when it is worked out?
MR. KENT:
It will be public when
finalized, which we anticipate happening very, very soon, I think would be a
fair assessment.
MS MICHAEL:
You better be careful, it is
not only the finance people who do not want you guessing at stuff.
MR. KENT:
Well, it is near
finalization. It is subject to
Cabinet approval, but we anticipate the plan being released and published very
soon.
MS MICHAEL:
Okay.
Thank you very much. That is
all I have for that area.
Going
on then to 1.2.04, which Mr. Parsons began – just let me check my notes here
now. We keep coming to this point
in each area, but let's come down to it here.
The Professional Services, again $843,000, approximately, budgeted, but
$590,000 spent.
MR. KENT:
The funding here provides
for the cost of consulting services in a number of areas depending on the
priorities of the department and initiatives that we are undertaking in any
given year. The expenditures were
less than budgeted in this past fiscal year, primarily due to less consulting
services required for wait-time reviews.
We had
done a lot of consulting work in recent years in that area, and there were less
resources required for consulting services in that area in 2014-2015.
The department, along with the regional health authorities, continued
with the emergency room reviews, which I know is a major concern for people in
the Province. That was funded
through the regional health authorities as opposed to here, hence some of that
difference.
Now you
will also note that the Estimates for this fiscal year have decreased slightly
from the 2014-2015 budget.
MS MICHAEL:
Yes.
MR. KENT:
We looked at historical
trends. We reduced funding for
acute care and long-term care reviews by about $43,000, just based on historical
trends and recognizing the Province's current fiscal situation as well.
MS MICHAEL:
Thank you.
Could
you just give me an idea of what gets included under Purchased Services?
You had a big drop last year in expenditure.
MR. KENT:
Yes.
The funding in that budget line and this area of the budget relates to
the cost of advertising, printing services, and other miscellaneous expenses.
There was an effort through the expenditure management plan in the fall
to reduce any discretionary spending and to defer or stop any items that were
discretionary. That resulted in the
lower Purchased Services costs.
We do
need more funding in 2015-2016 because we have some plans to do a relaunch of
the Newfoundland and Labrador HealthLine.
That was an issue raised in recent years by the Auditor General.
We have a solid plan in place for marketing the HealthLine, which we
intend to roll out in this fiscal year.
That is why those funds are necessary.
We
acknowledge that we need to increase awareness of the HealthLine and also update
the HealthLine service. We have
some pretty exciting initiatives that I hope to announce over the next couple of
months.
MS MICHAEL:
Thank you.
I have
some questions related to community support services and care.
With regard to the Paid Family Caregiving Home Support Option, how many
clients are in the pilot project per region?
MR. KENT:
I will endeavour to get you
the specific numbers by region. I
am just checking to see if I actually have them with me.
I only
have the total number. I will walk
you through those numbers, but happy to give you a regional breakdown.
We can take that away and provide those numbers.
Just to
provide a little bit of context first, this Paid Family Caregiving Home Support
Option was launched in March of 2014.
We had a made a commitment to increase choice for those eligible seniors
and adults with disabilities with respect to how their acquired home support
services are delivered. The concept
is to allow the hiring of a family member.
It was
introduced through a very controlled program admission.
We limited update in the first year to 250 subsidized clients.
We did not fill all of those spaces for the 250 subsidized clients.
The approach was to provide an opportunity to assess the uptake, refine
the processes, really ensure quality, and make sure we have planned for program
development.
So we
anticipated quicker uptake and we anticipated higher monthly costs.
I want to see that program utilized because I think it is a beneficial
concept that can help a lot of families in our Province.
I know we both agree that there are challenges that need to be addressed
when it comes to home support. How
we address those challenges we may have a different view on –
MS MICHAEL:
We do.
MR. KENT:
– but we both acknowledge
that there is definitely work to be done.
MS MICHAEL:
Yes.
MR. KENT:
So, the annual budget has
been adjusted going forward to more accurately reflect the uptake and the
average client costs, not just the uptake.
Expenditures of approximately $1.2 million in 2014-2015 are related to clients
utilizing the program. That is a
very long-winded answer to your question and I have not really answered it yet,
so let me get to that.
As of
the end of March of this year over 290 clients had been assessed for the Paid
Family Caregiving Option, and 103 were actively receiving care through this
option. It concerned me on the
surface when I heard those numbers so I dug a little deeper.
What we
have learned through the assessment process is that following the assessment
some individuals have chosen another care option or they have declined home
support services. As with other
home support options, discharge can occur as a result of the client choosing not
to continue with the option, or there is no longer a need for home support
services in some cases. That has
actually been the case for an additional sixteen individuals who have utilized
the option.
On a
positive note, there is no wait-list for the Paid Family Caregiving Option.
I have asked our officials to look at the program to see if there are
modifications we can make to the eligibility criteria and to the process to
increase utilization. I would like
to see more families avail of this option and we have maintained budget
resources to fund additional capacity.
We are not capping the program at current use because we still would like
to fill those 250 spots.
We are
only a year in, so there will be a need to continue to monitor, evaluate, and
figure out if there is a better way to do this.
I would have anticipated greater uptake, so clearly there is something we
need to do differently. We are
currently working through how to achieve that.
MS MICHAEL:
If I could just do a
follow-up directly to that point.
CHAIR:
Okay.
MS MICHAEL:
When you announced this
program, existing home care clients were not accepted.
MR. KENT:
That is correct.
MS MICHAEL:
Has that been revised?
Are you going to look at that?
Obviously there are people out there who wanted to apply, but could not
because of that criterion.
MR. KENT:
That is one of the things we
will consider in our deliberations.
However, we have to be careful about opening up the flood gates at the same
time, given the financial constraint that exists on the program.
We are open to all possibilities.
I want to make sure the program is better utilized.
Maybe
there are certain cases of existing clients where we should look at
accommodating, but that is all still being discussed.
We have not made any decisions.
I just want to find a way to get more families accessing this program.
It is
also important to note that it is not the intention – and I think we probably
all agree on this as well – to pay people for natural caregiving roles that
families should, and in many cases, as many of us know personally, as we do
provide. This is about providing
clients with an enhanced choice while maintaining informal caregiving
relationships as well.
MS MICHAEL:
Okay.
Thank you.
CHAIR:
Andrew.
MR. A. PARSONS:
Thank you.
I am
still on 1.2.04, Regional Services.
I will apologize in advance because some of the sections sort of jive together.
If I ask a question on a topic and you want to defer it to whatever, just
tell me.
MR. KENT:
No problem, yes.
MR. A. PARSONS:
I want to talk about
Purchased Services and Professional Services.
Last year, there were a number of reports or projects that were to take
place. I just want to sort of check
and see what the status is or the cost.
I think one of them last year was the review of the James Paton Memorial
ER. That was to be done, so if I
can get the cost and the status.
MR. KENT:
That would be contained
within the budget for the regional health authorities.
That relates to the wait-times review that was, in fact, done.
There was an additional announcement related to that as part of the
budget as well.
MR. A. PARSONS:
Okay.
Like I
say, you look at Regional Services and then there are a lot of topics.
MR. KENT:
No problem.
We are happy to jump around a bit as long as I can follow.
MR. A. PARSONS:
I appreciate that.
Some ministers are not so accommodating.
MR. KENT:
This is much friendlier than
Question Period, so I am happy to keep going.
MR. A. PARSONS:
Okay.
There
was a bed projection modelling project which was supposed to be completed last
year. I am just wondering is it
complete, and if so, what are the results?
MR. KENT:
There is funding that was
spent in 2014-2015. In fact, we
spent more than anticipated on that modelling project.
We are working with the Department of Finance, through the Economic and
Statistics Branch, on that as well.
I believe there is more funding required in this fiscal year to continue that
work. There is.
MR. A. PARSONS:
So how much was spent in the
last fiscal year?
MR. KENT:
There was $380,000 spent.
MR. A. PARSONS:
Now am I correct in saying
that the – was the amount supposed to be $243,000.
MR. KENT:
You are right, yes.
In the revised budget numbers it went from $243,200 to the $380,000 I
just referenced.
MR. A. PARSONS:
What are you anticipating?
You say more is needed to finish, what are you anticipating for this?
MR. KENT:
I am going to allow Bruce to
answer that.
CHAIR:
Bruce.
MR. COOPER:
There is still some more
work to be done in terms of bringing in some data around chronic disease
profiles to triangulate within the data set that we had.
It is some of the finishing touches on the model essentially.
There
is a process that we will have to go through to keep the data evergreen because
as we implement new beds, then we need to assess.
So I expect that over time we will have to slip this into our core
operations in terms of how we – because the model is being run by the Economics
and Stats area. I expect we are
going to have to have some funding to be able to support that work and
continuing to ensure the validity of the model.
MR. KENT:
If I could just add one
thing, Mr. Chair.
CHAIR:
Minister.
MR. KENT:
I agree with everything
Bruce just said, which is good for both of us.
In addition to that, I would add that the work that has been done to
date, while it is ongoing, has actually influenced recent decisions we have made
around new long-term care beds for Western, Central and Eastern Regions.
We know that the need is great over the next decade and we know that
there are hundreds more new beds required.
The
goal of course is to keep people in the community and in their homes as long as
possible which ties in with our Close to Home strategy.
At the same time, even despite our best efforts to keep people in their
homes and keep people in their communities as long as possible, we know given
the age of our population and the fact that we have a population that is less
healthy than the rest of the country and aging faster than the rest of the
country, the trends tell us we are going to need hundreds of new beds.
As you know, we have chosen a different procurement approach for the next
number of beds that we are going to construct.
MR. A. PARSONS:
So is there any timeline on
when you expect this report to be complete?
I know it is sort of an ongoing thing, but it was supposed to be
completed last year. Do you have a
time that you would like to see it done?
MR. KENT:
I would like to see it done
in this fiscal year. I do not know
if we can be more precise than that at this point.
There will be no final report per se because the model will continue to
generate numbers, but the expenditure certainly will not be as great going
forward, I would not anticipate.
MR. A. PARSONS:
If I understand – maybe you
have to dumb it down for me. I
believe the deputy minister said that you may have to change where the money
comes from. You say it might have
to be absorbed. Is there a figure
though, a cost we anticipate that will cost on top of the $380,000, no matter
where it comes from?
MR. KENT:
Related to the modelling?
MR. A. PARSONS:
Yes, to finish this off.
Are we talking another $380,000, less than that?
MR. KENT:
I would say less, but I will
allow Bruce to elaborate.
CHAIR:
Bruce.
MR. COOPER:
Essentially, we are in
discussions with finance now to talk about how we – now that we have gotten
through the development phase and we are into kind of fine tuning – structure
our relationship going forward. I
anticipate it would be a lower amount because we are moving from development
into maintenance.
MR. A. PARSONS:
Okay.
Thank you.
Still
on the reports, there was a review done on midwives.
I think it was projected for $145,000.
I believe the report is done.
I do not know if the report is available.
MR. KENT:
The funding for the review
related to midwives was actually only $25,000.
The other amount, the $145,000, related to funding for the implementation
of a shared services model, which we recently announced, and also work related
to road ambulance and patient safety initiatives.
We have
made significant progress on the midwife review.
The report you are referencing is actually online.
MR. A. PARSONS:
Okay.
MR. KENT:
So it is complete.
We are actually in the process of finalizing recommendations – I am sorry
regulations, I meant to say. I am
happy to provide you with more detail if you wish.
MR. A. PARSONS:
The regulations, do we
anticipate them being – will we see them this year?
MR. KENT:
Yes.
MR. A. PARSONS:
Okay, so now I am going to
get more specific; this session or if there was a future session?
MR. KENT:
Do we actually need to go
into the Legislature for regulations?
I do not think we do.
MR. A. PARSONS:
Not usually.
MR. KENT:
In terms of precise timing,
I can tell you that I have asked this to be a priority and that we get the
regulations concluded as quickly as possible.
I do not know if someone else would like to elaborate on time frame?
Karen?
MS STONE:
We are working with the
Council of Health Professionals and a number of advisory bodies on the
regulations. The process is well
underway. We have had multiple
drafts and continue to work with them.
MR. A. PARSONS:
Okay.
Thank you.
I think
there may be a few more under that, but I want to just move forward for a
second. Under Purchased Services
again for this year, do you have a list of what you intend to purchase for this
fiscal year, this coming year?
CHAIR:
We are still under 1.2.04
for Committee members.
MR. KENT:
Thank you for that, Mr.
Chair.
You are
looking for detail on what is going to be this year's –
MR. A. PARSONS:
Yes, you have a budgeted
amount. What do you expect to get
for that budgeted amount?
MR. KENT:
It includes advertising,
printing services, and other miscellaneous expenses.
The reason we anticipate needing funds that we did not spend in 2014-2015
relates primarily to the HealthLine.
We are going to meet our commitment to launch a campaign to increase
awareness and to update the HealthLine.
We will have some good news to share over the next couple of months.
MR. A. PARSONS:
You have my curiosity peaked
here. What do we do to update the
HealthLine? I think those were the
words you used, update it.
MR. KENT:
There are a number of things
we are going to do. I prefer to
save that for the announcement. A
couple of hundred thousand dollars of this budget is earmarked for that purpose.
Let me give you a sneak peek though.
We want
to launch an awareness campaign to make sure that everybody in the Province is
well aware of the service. It is a
good service. It provides
twenty-four seven access to a registered nurse to everybody in Newfoundland and
Labrador. Last year, we received
approximately 40,000 calls, about 110 calls per day.
We are spending about $3 million annually for this valuable service.
I never
really appreciated the value of the service as a resident until I became a
parent. My wife and I have had
reason to call the HealthLine a few times over the last five years or so and it
has proven to be a very valuable service.
It is not just a service for young parents, it is valuable service for
anybody who has a question and wants to get immediate access to a registered
nurse.
We want
to expand the role of the HealthLine.
I will provide more detail over the next couple of months because I think
there is great potential to make it more accessible, to enhance the role, and to
make it easier for people to access.
CHAIR:
Follow-up?
MR. A. PARSONS:
Just one follow-up on that.
MR. KENT:
Yes.
MR. A. PARSONS:
Excuse my ignorance; you say
you got 40,000 calls. Is there a
tracking done that you are able to access to show what the results were of each
call and how many calls.
I was
actually at a town hall where somebody was talking about it.
He said the constant refrain was to go to the emergency room – go to the
emergency room. So is there a
breakdown of what percentage of people was referred to an ER and what percentage
discussed this or that?
MR. KENT:
We would have some
statistics, but I do not have anything I can share with you right here.
There was actually an evaluation conducted by the Newfoundland and
Labrador Centre for Health Information a couple of years ago.
It actually found that the HealthLine reduced unnecessary emergency
department visits. So, 18.5 per
cent of users had originally intended to go to the emergency department, but
after speaking to the HealthLine they sought a lower level of care.
We also
found through that research that – and we do the evaluation on an ongoing basis.
In this particular comprehensive evaluation we also found that the
HealthLine promoted higher levels of self-care at home.
There was also a very high satisfaction rate.
Because
the registered nurse on the other end of the phone cannot physically see and
touch the patient, there are times when you have to err on the side of caution.
It would not be uncommon for a nurse to say: if your conditions worsen,
if these things happen, you should get to a hospital.
I know
from my own experience with our children, I have heard that said, but in most
cases we have not needed to go to an emergency department or even the family
doctor. We may have had to go to
the pharmacist the next day or even overnight.
It is hard to be incredibly precise over the phone, but it has
definitely, even in my own case, prevented trips to the emergency room.
MR. A. PARSONS:
Okay.
Thank
you, Mr. Chair.
CHAIR:
Lorraine.
MS MICHAEL:
Just some more questions
under that section, Minister, related to the broader community support services.
Just
going back the midwifery report for a minute, you referred to the regulations,
but do you anticipate legislation?
Of course we took the act that was in place around midwifery off the books a
couple of years ago, understandably, because I do not think it related to
anything real. With the attempt to
bring midwifery back in, can we anticipate legislation?
MR. KENT:
We do not believe at this
point that legislation will be necessary.
We believe we can achieve it through the regulations that are now being
prepared.
There
is a committee, as Karen alluded to.
We have a regulatory and policy advisory committee that is developing the
regulations. That will cover things
like entry to practice, continuing education requirements, and standards of
practice. This committee actually
includes practicing midwives, educators, a registrar from another Canadian
jurisdiction, Health and Community Services, the Newfoundland and Labrador
Council of Health Professionals, and the Association of Midwives of Newfoundland
and Labrador.
We are
getting close to getting the regulations done.
There has also been a provincial implementation committee established to
assist with developing processes and policies to establish and integrate the
services of midwives into the health care system.
MS MICHAEL:
Thanks Minister.
I am
trying to remember because I did not think of this, actually, prior to the
question given to you. We have an
umbrella piece of legislation with regard to medical professionals.
Are midwives at this moment in that?
I cannot remember.
MR. KENT:
Yes, they are.
MS MICHAEL:
Okay.
That is fine then. I agree
then. In that case we do not need
any more legislation because they are in that act which I remember well.
MR. KENT:
One of the beauties of the
microphones on but cameras not rolling is I can turn and ask questions, and
people at home do not know that.
They think I know all the answers, so it is a great format.
MS MICHAEL:
Okay, no comment.
MR. KENT:
Members can sneak out and go
to the bathroom without anybody noticing as well.
MS MICHAEL:
Minister, with regard to
personal care homes and nursing homes in the Province, can we have – if you do
not have them here, could we receive them – up-to-date statistics with regard to
the number of personal care and nursing homes, and also the numbers of residents
by region?
MR. KENT:
Absolutely.
I will give you the numbers that we do have here.
If there are additional numbers that you would like to have, we can do
our best to provide them.
There
are eighty-nine personal care homes in the Province.
Just to give you the quick breakdown on that, forty-eight of those homes
are in Eastern Health, twenty-two are in the Central Region, fifteen are in
Western, and four are in Labrador-Grenfell.
As of
December last year, so as of five months ago, there were 3,982 personal care
home beds available; 3,192 beds were occupied with about a 20 per cent vacancy
rate; and at least 2,479 received a government subsidy, which is approximately
78 per cent of all personal care residents.
A
further breakdown of occupancy by region – we can get those numbers for you, but
I do not have them here.
MS MICHAEL:
Okay.
Minister, in reference to the subsidies, do we have figures on what percentage
of the total of residents in personal care homes have portable subsidies?
MR. KENT:
I am looking for that
figure. I can tell you that in the
last number of years we have provided new funding for new portable subsidies and
some additional respite care beds as well.
We have also increased the monthly subsidized rate.
Do we have –
OFFICIAL:
Most are portable. We do not have
the numbers.
MR. KENT:
I do not have the precise
number, but more are portable. We
can get you the number, but more are indeed portable.
MS MICHAEL:
Okay, thank you very much.
Just
some more specific programs that fit, I think, under Professional Services.
The diabetes database pilot project with Western Health, can we have an
update on that please?
MR. KENT:
I am actually glad to be
asked. It is an important issue
that I know both you and Mr. Parsons have raised on several occasions and it was
flagged by the Auditor General previously as well.
When I
became aware of that I asked that we step up our efforts to make progress on
this. We have been actively
working, not just with Western Health, but we have been working with all the
regional health authorities and the Newfoundland and Labrador Centre for Health
Information to develop a truly provincial solution that will measure outcomes.
To date
– I was really hoping to get asked in the House – I am pleased to report on a
number of pieces of progress that have been made.
We formed a clinical working group to provide advice.
We finalized a case definition of diabetes.
We have identified the key outcome indicators to be monitored.
We have identified the key data sources to link and draw on.
So we
are actually going to have an initial set of test reports from the new database
by early next month. That will
allow us to adjust, as required, the database and data collection processes.
The database, when fully up and running, is going to support the delivery
of diabetes management services in a number of ways.
It is
going to allow us to monitor trends related to the prevalence of the disease.
It is going to monitor the quality of care for clients with diabetes.
We are going to be able to monitor outcomes for residents with diabetes.
It is going to support future research related to diabetes.
I have
tasked the Newfoundland and Labrador Centre for Health Information with
maintaining this new database. They
will produce quarterly reports that will help us at a regional level and also at
a departmental level when making program and policy decisions.
We took
the concerns that were raised in 2011 by the Auditor General quite seriously.
Western Health had been doing some work, which we intended to stretch out
across the Province, but in reviewing that progress we adjusted course to try
and bring about the progress quicker.
The Newfoundland and Labrador Centre for Health Information has shown
good leadership. I approved a
revised plan to develop the database back in February in response to concerns
that I had about progress to date.
MS MICHAEL:
That is great, Minister.
Thank you very much.
MR. KENT:
If you could ask me the same
question at Question Period today, I would really appreciate it.
MS MICHAEL:
I might have a twist on it.
Thank
you, but it is really important information.
As you know, and as I know, people who are living with diabetes and the
whole community around them have great concerns.
MR. KENT:
Absolutely.
This is necessary. It is
overdue. Like I said, with test
results coming next month we will quickly be able to get a provincial solution
in place that will help us on a number of levels.
I appreciate the fact that all parties in the House have been advocating
for a solution and I am pleased to tell you today that we are way, way closer
than we have ever been.
MS MICHAEL:
Wonderful.
That is good to hear.
How
about the electronic medical patient records?
MR. KENT:
I am pleased to provide you
with an update on that as well. You
have asked specifically about the electronic medical record.
We remain very committed to establishing a Province-wide EMR program that
meets the needs of physicians but also the needs of other stakeholders in the
health care system. We have been
working closely with the Newfoundland and Labrador Medical Association and the
Centre for Health Information. A
lot of work has been done to ensure that the development of the EMR program
continues to progress.
A big
milestone was achieved this past year.
We issued, through the Centre for Health Information, an RFP for the
electronic medical record program.
It was issued in mid-October. The
RFP closed in mid-December and we anticipate that the project will be awarded
any day, hopefully before we are into the summer.
That will connect, I believe, approximately 300 physicians to the EMR,
which is an exceptional start, with more progress to come.
What we
are talking about – just for the benefit of those who may not be aware – the
electronic medical record is a really critical part of the overall electronic
health record. It is a
comprehensive electronic record of a patient's health information and history
that maintains those traditional paper files with all of the coloured tabs that
you see in physicians' offices. It
will allow patient information to be maintained, manipulated, analyzed, and
shared way more easily, which should lead to better patient outcomes, which is
really our focus.
All
other provinces are going down this road as well.
Some have fully implemented; a number are just beginning implementation.
We want to make progress in a hurry, so this RFP that will connect 300
physicians is a major, major step forward for us.
MS MICHAEL:
How do you get the
physicians on board? Is the
department working with the Medical Association in that or is it directly with
the physicians?
MR. KENT:
We are working through the
Newfoundland and Labrador Medical Association and we have actually reached a
general consensus with them on the financial model for the EMR program, but
there is some further analysis required to figure out the precise governance
model. The Centre for Health
Information and the department are continuing to work with NLMA on that.
We are focusing on those two issues really: the financing model and the
governance model.
It is
also worth pointing out that the 300 fee-for-service general practitioners that
would get connected, that will capture the majority of fee-for-service general
practitioner physicians; it will capture 73 per cent of GPs.
While it is only 300, that captures the majority, so it is a great step
forward.
In
discussions with physicians that I have had when visiting regions, physicians
have actually expressed a desire to get connected.
I think most physicians in the Province recognize how important this is.
It seems obvious to me, if I show up at an emergency room and if I happen
to be unconscious I would like the folks who are going to be treating me to have
immediate access to accurate medical history, medical records.
We also want to make sure that everybody in the system is well connected
and is getting the most up-to-date and accurate information.
This is
fundamental and I am glad we are going to be making major progress this year.
CHAIR:
Minister, I am going to
suggest that we take five. You
mentioned earlier that people can sneak off, but your staff cannot sneak off.
So, we are going to take five, come back and we will continue.
Can we make it five minutes because I know there is a lot more
information we need to go through and all of the rest?
We will take five minutes and we will reconvene at 10:31 p.m.
Thank
you.
Recess
CHAIR:
Welcome back everybody.
We are ready to start, so thank you.
Andrew.
MR. A. PARSONS:
All right, thank you.
I
believe that the topic of personal care homes was brought up in the last line
there. So I just wanted to ask,
specifically –
CHAIR:
Just to be clear, Andrew, of
where we came back, we are still at 1.2.04, Regional Services?
MR. A. PARSONS:
Yes.
CHAIR:
Okay.
MR. A. PARSONS:
I think this was brought up,
so I just want to follow along with that line.
CHAIR:
Okay.
MR. A. PARSONS:
In the budget there was $24
million allocated to personal care homes, but I do not know if I saw any
increase in the subsidy. I am just
wondering if there is a breakdown of that $24 million.
MR. KENT:
I am just trying to find the
$24 million.
To Mr.
Parson's question, I do not know that we have the detailed breakdown of the $24
million here. That funding is
contained within the budgets for the regional health authorities.
So we can get you more information, but I do not think we are able to
provide it at this very moment.
MR. A. PARSONS:
That is fine.
I know the minister will get us the –
MR. KENT:
We can tell you about the
increases that have occurred over the last number of years, but I do not know if
that is what you are actually looking for.
MR. A. PARSONS:
No, I think there was a new
$24 million announced. That is my
understanding.
MR. KENT:
That represents new base
operational funding which was provided over a number of years.
We can give you that breakdown.
MR. A. PARSONS:
Yes, okay.
That would be great.
MR. KENT:
I will just ask Bruce to
briefly speak to those numbers.
CHAIR:
Bruce.
MR. COOPER:
So yes, according to my numbers we have added about $7 million in base funding
to personal care homes between 2012-2013 and this year.
There is no new base operating funding in this year's Budget for personal
care homes. The subsidy rate is
consistent with what it was.
MR. A. PARSONS:
I just want to make sure I
am clear. I am pretty sure it does
say $24 million in this year's Budget for personal care homes, so that is the $7
million right?
MR. KENT:
Yes, that is right.
That is accurate.
MR. A. PARSONS:
We just do not know what the
rest is for. Is that $7 million in
base funding, you said, since 2012-2013?
MR. KENT:
The $7 million relates to
increases in base funding. The rest
would relate to the subsidies, the core operation of the program.
That is the total expenditure.
MR. A. PARSONS:
Okay.
There
was a pilot project with personal care homes.
MR. KENT:
Yes.
MR. A. PARSONS:
I am just wondering if there
is any – did you ask that?
MS MICHAEL:
No, no.
I said I do not have to ask that.
MR. A. PARSONS:
Okay.
MS MICHAEL:
(Inaudible).
MR. KENT:
Yes, it is a pilot that we
are quite excited about. We have
received a draft of the evaluation report and looking forward to getting that
finalized soon. The pilot phase of
the project was actually completed in February, but it will continue at the
three sites where it was being piloted until we make decisions about the future
of the project.
I am a
believer in the approach at this point. I
have not yet seen evidence that suggests this is not something we should do more
of. The idea was to look at
providing enhanced care in personal care homes.
That really is consistent with our ten-year long-term care strategy Close
to Home.
This
pilot project began in 2013. We had
$1.5 million for the implementation of the project.
Like I said, the evaluation is being finalized.
There has been some early work done and hoping to get that finalized
soon. I would love to see the
program grow, but we need to make sure it is actually effective and that it does
make sense for families, makes sense for patients, and makes sense from a
financial perspective as well.
MR. A. PARSONS:
The pilot aspect was
completed, you said, February.
MR. KENT:
It was technically
completed, but we are allowing it to continue until we decide what we are doing.
MR. A. PARSONS:
Okay.
MR. KENT:
If the decision is to
continue it or the decision is to expand it, it would not make sense to disrupt
the care of those who are receiving care right now.
We are continuing the project at the three sites until we make decisions
about next steps.
MR. A. PARSONS:
Like you said, the original
announcement of 2013 allocated, I think it was, $1.5 million.
That is expended so there is additional funding to allow for this to
continue on.
MR. KENT:
That was the funding that
was originally allocated. There
will be an additional cost to continuing the program beyond into this fiscal
year.
MR. A. PARSONS:
What would you anticipate
that cost to be?
MR. KENT:
It would depend on how long
we continue. We have the full
amount in our budget which is, what, for this fiscal?
OFFICIAL:
It is $1.5 million.
MR. KENT:
It is $1.5 million for this
fiscal. So there is $1.5 million in
the budget for this fiscal.
MR. A. PARSONS:
Okay.
Just
quickly to the side a bit; the community care homes.
I believe that there have been some negotiations going on with community
care homes and the department. I
guess they have a shortfall in the funding they require.
I understand there have been ongoing discussions, but it is my
understanding that is, sort of, off the rails. I am just wondering is there any
money allocated for that?
MR. KENT:
I would not agree with that
assessment, I would say respectfully.
There are meetings ongoing between the community care home owners and
operators, and Eastern Health to figure out what can be done about some of the
operational issues that they are experiencing.
You would definitely be right in suggesting that there are issues to be
resolved, but I am actually pleased that the meetings are ongoing and that we
are working towards solutions.
We are
committed to the services that are being provided through Eastern Health's Home
and Community Care Program. They do
provide a unique and valuable service.
We expanded financial support to the community care home operators in
Budget 2014 when funding was approved to increase the monthly subsidy rate from
$1,850 to $1,950. That was to
offset increased operating expenses that operators were, indeed, experiencing.
For
those who may not be familiar with it, this is a mental health and addictions
housing program within Eastern Health.
It has existed for quite some time.
Today, there are thirteen homes with a total of 166 available beds.
There was a meeting earlier this year at the request of the Community
Care Home Owners and Operators Association to discuss concerns they had with the
funding model. That is probably all
I have to say at this point unless you have further questions about it.
MR. A. PARSONS:
Okay.
I am going to move on to 1.2.05, Population Health.
Looking at the Salaries line what was spent last year was very close to
what was budgeted, but there has been a bump this year.
I guess the question is: Is it new salaries or is it the bump/increases?
MR. KENT:
The increase in this year's
budget is your question?
MR. A. PARSONS:
Yes.
MR. KENT:
The increase is the result
of the 3 per cent raise approved in the new collective agreement, but also the
approval of two new temporary positions in mental health.
They are being funded from an agreement with Health Canada related to
mental health and drug treatment funding.
This area is also offset by a reduction related to the attrition plan,
but what you are seeing, in addition to the 3 per cent, is the two new temporary
positions that are being funded from a federal source.
MR. A. PARSONS:
So what are those two
positons; what are their titles and where are they based?
MR. KENT:
They are based here in the
department in St. John's and they are temporary positions – I am looking for the
exact titles. They do not have
specific titles at this point. They
are contractual positions under the mental health drug treatment federal
agreement. They are consultants,
but there is not a specific job title that has been classified at this point,
given they are contractual.
MR. A. PARSONS:
Okay.
Under
Professional Services, under the same heading, last year there was an under
spend by just over $500,000. What
was budgeted for that was not actually completed?
MR. KENT:
The funding here relates to
a number of consulting services.
The savings is related to delays in a number of items such as the development of
an environmental health strategy, and reviews and training around mental health
and addictions.
In
addition, there was $300,000 transferred from Professional Services to the
regional health authorities for the Strongest Families Initiative, which we
announced in recent months. I know
members are familiar with it. It is
a non-profit corporation that provides evidence-based services to children and
families seeking help for mental health and other issues impacting health and
well-being.
MR. A. PARSONS:
I have one question left for
this heading, with Lorraine's indulgence.
CHAIR:
Okay.
Andrew, go ahead.
MR. A. PARSONS:
I am just wondering while we
are under this heading – there has been some news lately about the tuberculosis
up in Labrador, specifically Nain.
Obviously it is a concern for everybody, so I am just wondering what steps are
being taken – I actually had a number of calls, people saying this seemed to be
ongoing for a while before it became public and there is some concern about a
possible outbreak. From the
department's point of view what is the plan of action?
MR. KENT:
I really want to start by
commending the Nunatsiavut Government for its leadership in this area.
We have been providing whatever support we can on three different fronts.
Through the public officials within Health Canada, there has been direct
support being provided. The
Department of Health and Community Services has been actively involved in
supporting the effort on the ground within Labrador-Grenfell region,
specifically in Nain.
Labrador-Grenfell Health, who is directly involved in providing care, has been
active as well.
Over
the last number of months there has been an increase in clinics actually being
provided on the ground. There is
contact testing being done – very extensive testing – involving anybody who has
come in contact with a patient with tuberculosis.
There has been an all-hands-on-deck approach.
It is an issue that we must take really seriously, and the statistics
continue to be concerning. The
Aboriginal population of our country is seemingly at greater risk of contracting
tuberculosis. The incidents rates
are higher among our Aboriginal population and to have such a number of cases in
a small community is obviously concerning.
I have
to say that I am pleased with how the Nunatsiavut Government has responded, with
lots of support from Labrador-Grenfell Health, the Department of Health and
Community Services, and Health Canada as well.
MR. A. PARSONS:
Okay, thank you.
CHAIR:
I am going to hold you
there.
Lorraine.
MS MICHAEL:
Thank you.
Minister, I still have a couple of more questions relating back to the Regional
Services. You do not need the line
items, but with regard to some things under Regional Services –
MR. KENT:
No problem.
MS MICHAEL:
– one is the Clinical Safety
Reporting System. Is the reporting
of adverse events and occurrences happening Province-wide?
MR. KENT:
The reporting of adverse
events is absolutely occurring. I
am going to defer to one of my assistant deputy ministers to provide you with a
little further detail.
Karen.
CHAIR:
Karen.
MS STONE:
The system is being used in all four regional health authorities.
MS MICHAEL:
May I ask a further question
then, Minister? Will occurrence
reporting statistics be made public?
MS STONE:
We have not done that as of yet.
This is the second year when we have had the system up and running in all four
regional health authorities, so it is at this point that we are beginning to
feel confident that everyone is understanding and using the system
appropriately.
MS MICHAEL:
The hope is that it would
become public eventually. Is that
correct, Minister?
CHAIR:
Minister.
MR. KENT:
Yes, that is correct.
MS MICHAEL:
Thank you.
Minister, when I asked you for statistics with regard to the number of personal
care homes, I also included nursing homes, so just to make sure that you know
that it is both the personal care homes and nursing homes and the residents when
I asked you for the statistics.
MR. KENT:
By region?
MS MICHAEL:
By region.
MR. KENT:
No problem.
We can provide that.
MS MICHAEL:
Okay, thank you.
What is
the status of the rapid response team's pilot project for seniors?
MR. KENT:
We have invested over $3
million for a two-year pilot project for four new Community Rapid Response
Teams. The idea is that health
professionals will assess patients at emergency departments to determine if
medically stable patients can return home safely with enhanced community-based
services, which could include increased nursing care, priority access to OT,
physical therapy, short-term home support, which would avoid costly hospital
admission.
There
are teams located in Grand Falls-Windsor, here in St. John's at the Health
Science Centre, at St. Clare's Mercy Hospital, and at Western Memorial Regional
Hospital in Corner Brook. Two teams
in Eastern Health began operating in September of last year, and the teams in
Central and Western started to serve clients in November of last year.
We have a provincial steering committee in place and we are working with
the regional health authorities to operationalize the teams.
I would
say that there is more work to be done.
There is capacity in each of the teams to provide care to additional
individuals, so we definitely have some more work to do.
This is an important initiative that requires some more attention in this
fiscal year.
As of
earlier this month, 251 individuals have been admitted for service through the
Community Rapid Response Teams and they have received enhanced health services
in the community setting: 182 in Eastern Health, thirty in Central, and
thirty-nine in Western.
We are
pleased there has been some uptake but to increase uptake, we have just expanded
the eligibility criteria to include individuals at risk for re-presentation to
the emergency room or at risk to be admitted to hospital at present or in the
near future, as well as those that present to the emergency room after the hours
of operation for the team but appear to meet the criteria.
We are
continuing to monitor. We are going
to probably need to make more changes to ensure full utilization.
It is still a new initiative.
It only launched in the fall, but we are acting with a sense of urgency.
We know it can improve patient care, it can improve outcomes, but it can
also result in significant savings due to less hospitalizations and it will
result in less people sitting in emergency rooms, less patients in hallways,
less people tying up acute care beds.
It is a
high priority, we have made some progress, and we need to make more progress.
MS MICHAEL:
That is really good to hear,
Minister. I did not know that we
had four of them. That is great.
I have to say that I have two friends who are two of the 182 in Eastern
Health and it was amazing actually how quickly they were taken care of, number
one –
MR. KENT:
Oh, good to hear.
MS MICHAEL:
– and then back in their
homes, one of them with a cracked pelvis, within two weeks on her feet.
I am sure it is the care she had that allowed that to happen.
One who is there now, she fell last week.
They both were falls.
I think
my friend in the fall was told she was the first one – I cannot remember if it
was St. Clare's or Eastern Health – to actually benefit from it.
I have to say it really is meeting a wonderful need, and I am sure it is
beneficial in both ways that you have indicated.
MR. KENT:
It is, and I am really
pleased to hear that feedback. We
appreciate that. I should note as
well that the primary target group for this initiative is seniors, but the
service is available for all adults.
MS MICHAEL:
Yes.
MR. KENT:
So it is not only seniors.
We are getting good feedback, but we want to make sure that the teams are
operating at capacity. We will
continue to work on that.
MS MICHAEL:
Great.
Thank you.
This is
just a small one, Minister; could we have the current wait-list for home care
and long-term care –
MR. KENT:
Absolutely.
MS MICHAEL:
– and the number waiting in
acute care facilities, by region?
MR. KENT:
Sure.
I will provide you with some statistics that we have as of March 2015 for
long-term care. We have, as of
March – so the stats are a couple of months old, but they have not changed a
whole, whole lot.
MS MICHAEL:
Right.
MR. KENT:
In Eastern Health, the
number of clients awaiting placement was sixty-seven.
In Central Health it was sixty.
In Western Health it was fifty-seven.
In Labrador-Grenfell Health it was sixteen.
Can you
just recap what other numbers you would like in addition to the long-term care
wait numbers?
MS MICHAEL:
Long-term care, home care,
and those in acute care facilities waiting to get into long-term care or other.
MR. KENT:
On homecare – I will address
that first of all – we do not maintain a wait-list.
MS MICHAEL:
I thought that.
MR. KENT:
If people need care, we
endeavour to get them the care they need.
As far as wait for acute care, would we have those –?
MS MICHAEL:
No, waiting in acute care
beds.
MR. KENT:
Oh, the ALC numbers.
MS MICHAEL:
Yes.
MR. KENT:
Yes, we do track those.
I do not have them handy at the moment, but we can easily get you those
numbers.
MS MICHAEL:
Thank you.
MR. KENT:
I am pleased to say that
there has been some reduction. We
have had a large number, traditionally, of Alternate Level of Care patients,
people in acute care beds who should be elsewhere within Eastern Health in
particular. The new CEO has been
monitoring those numbers extremely closely, and even in individual cases is
trying to drill down and determine how we can move people into a more
appropriate place.
Increasing our long-term care bed capacity will make a huge difference, but in
the meantime we are finding efficiencies within the system to try and reduce
those numbers. It is a real problem
and there is not a family in this Province that has not directly or indirectly
been touched by that challenge in our system.
MS MICHAEL:
Thank you.
One
more question of this nature under this section.
You did make reference to the ER wait times and the continuing work that
will be done there. What is the
strategy with regard to addressing wait times for specialists and for heart
surgery? I know specialist is a
broad term because it is different for different specialists.
MR. KENT:
That is a good question.
When it comes to wait times, the issue you are raising is probably the
next big one for us to tackle. We
have made major progress with wait times in a number of areas, as you are aware,
but there is still work to be done in some other areas.
Just to
give you an example within the cardiac program, Eastern Health oversees the
provincial program and works with regional health authorities to ensure that
patients are seen in a timely manner based on urgency.
There are standardized assessment tools being used.
There
is a well-defined wait-list management process in place.
For patients who are awaiting surgery, the list is reviewed on a daily
basis. The cardiac care team holds
weekly rounds to review the patient priority for surgery and if conditions
change, then there are processes in place to ensure they are re-evaluated as
well. There is a 182-day benchmark,
and currently there are no patients awaiting cardiac bypass surgery beyond the
182-day benchmark.
More
broadly I would say while we have improved wait times in a number of areas and
we are ranked, actually, as the best in Canada in wait-time benchmarks for
cataract surgery and hip and knee replacement for instance, we do know that when
it comes to access to specialists, there is still more work to do.
On a positive note, we are the only Province to achieve nine out of ten
benchmark results compared to the rest of Canada, in which eight out of ten
patients are receiving access to priority procedures.
We are
doing well, but when it comes to certain speciality areas, we know there is
still work to do to improve wait times.
We are tackling each area specifically to try and figure out how we can
best do that.
CHAIR:
Okay.
Lorraine, can I hold you there, or do you just have one quick follow-up?
MS MICHAEL:
Yes, it was just one
follow-up to that.
CHAIR:
Okay.
MS MICHAEL:
What can be identified at
the moment, Minister, as the worst areas with regard to specialities?
MR. KENT:
Your question was: What are
the worst areas for wait times for specialists right now?
MS MICHAEL:
Yes.
MR. KENT:
I am trying to think of what
areas would be the worst.
I am
actually going to ask Dr. Alteen to comment because there are certainly areas
where we do have challenges around physician recruitment.
Attracting specialists to fill certain roles can sometimes contribute to
longer waits.
MS MICHAEL:
That is right.
MR. KENT:
So I will see if he wants to
add anything.
CHAIR:
Dr. Alteen.
DR. ALTEEN:
I think the two problem areas that I would identify are probably neurology and
rheumatology as being the high priority.
MS MICHAEL:
Still the same.
DR. ALTEEN:
Yes, and there are issues with recruitment into those areas.
If you
look at urology, for example, we had major issues three years ago.
We have done substantially better in terms of recruitment.
We are now up to seven urologists in St. John's and eight next year.
The urology wait-list has been taken care of.
There are significant areas of recruitment in those areas that we are
working on.
MS MICHAEL:
Okay.
Thank you.
CHAIR:
Okay, Andrew.
MR. A. PARSONS:
I am on 1.2.06, Policy and
Planning. I specifically wanted to
talk about legislation and policy.
This is further to my questions in the House yesterday about e-cigarettes.
I know the Premier answered and talked about how this is a concern.
I am glad to hear that.
I am
just wondering, in terms of the actual work that has been done, where are we on
it in terms of when we could expect to see legislation?
We are in the House and we hear, I am working on it.
It might be soon, whatever.
I am just wondering constructively when –
MR. KENT:
I will give you the best
answer I can. The reason I cannot
be precise is that I am not responsible for that work.
That initiative has fallen under the Department of Seniors, Wellness and
Social Development. The reason I
did not answer the question yesterday is that I am not the alternate to Minister
Jackman who was not available to answer the question at the time.
On
behalf of Cabinet, I can tell you it is an issue that is actively being worked
on, but I would encourage you to pose the question to Minister Jackman who can
probably give you a more precise idea on when it is going to be brought forward.
MR. A. PARSONS:
Sometimes that line between
wellness and health –
MR. KENT:
It is a blend.
On that issue, it is one that we are very concerned about, as people
working in the health system. The
responsibility for moving that new legislation forward and continuing that
analysis has fallen under the new department.
I do
know, just from discussions – because we are in discussions every day with
Seniors, Wellness and Social Development, given the obvious link as you just
pointed out. I do know that it is
truly actively being worked on. We
have been watching very closely what is happening in other jurisdictions to see
if we can learn from their best practices.
I know a number of provinces even close to us have recently tackled this.
MR. A. PARSONS:
Nova Scotia, yes.
MR. KENT:
There is a need for
regulation, there is a need for legislation, and the new department is
continuing to work on that.
MR. A. PARSONS:
Thank you.
I am
going to apologize again in advance because we are at 11:00 o'clock and there is
so much to cover. So I am going to
just, sort of, go through a little list I have.
I apologize. I may jump all
over the place.
MR. KENT:
No problem.
Prioritize as you see fit and we will do our best to respond.
MR. A. PARSONS:
I really appreciate that.
I am
going to start with the Waterford.
We know that there is a draft functional plan – I guess it was four years ago
there was $4.5 million invested.
There was a draft functional plan that cost roughly $500,000.
I am
just wondering in terms of the timeline, given that right now, am I correct in
saying that 2019 is the year you would expect the – and I hate to use the term,
'unpause'. Right now it is on
pause. That is the term that has
been used. Would you say 2019 would
be the go forward year?
MR. KENT:
We are going to continue to
monitor the Province's fiscal situation really closely.
If we can find a way to 'unpause' so to speak, prior to that, I would
love to do so.
I have
publicly expressed my disappointment at this project being paused, but there are
a number of things that we are going to do in the meantime.
We want to ensure that patients at the currently facility continue to
receive high-quality care from well-trained professionals, obviously.
We also want to figure out what changes can we advance within the
existing facilities while we wait for the new hospital.
For
instance, one of the things I suspect we will talk about, through our All-Party
Committee work, is the need to focus more on recovery as we move forward.
We are looking at how we can integrate the recovery model of care where
patients are put at the centre of decision making.
We want to introduce that regardless of when a new building is
constructed.
The
work that has been done to date on the master plan and on the functional program
is really good work. It is not lost
and it will help contribute to the design of the new facility when we can move
forward. Could it be as late as
2019; it could be, depending on the Province's fiscal situation.
I can
assure you that we want to continue to improve programs and services in the
meantime. We want to improve what
is going on within the existing infrastructure in the meantime.
I will continue to be looking for ways to get the facility constructed
faster and hopefully cheaper.
There
may be some work that needs to be done to the existing facility while we are in
that pause state. It truly is a
pause. We are not cancelling the
project. We are still committed to
the project. As soon as we can
afford to move farther faster, we will do so.
MR. A. PARSONS:
You mentioned cost there.
I think in last year's Budget the approved budget for the facility was
$470 million. Is that the most
recent number? Or does the
department have an updated number on the cost and that is one that was used to
sort of make this current decision?
MR. KENT:
We are just looking for
those numbers for you. The design
phase, if we had proceeded, would be another $20 million.
I thought the anticipated cost of the facility itself was over $300
million. We can get you more detail
on those numbers.
MR. A. PARSONS:
I think last year in the
budget it said $470 million.
OFFICIAL:
Yes, I do not have the exact
number in front of me.
MR. A. PARSONS:
This is something that can
go on the list.
MR. KENT:
Yes. Not a problem.
MR. A. PARSONS:
I would appreciate that.
Not a problem.
The
last question I have for this is the dialysis section.
In the plan that you have, what is the plan for the dialysis units at
this facility? Would they be still
there or moved?
MR. KENT:
We still believe that the
dialysis units need to move. We
have been working to invest in some new equipment for the unit, but even with
new equipment the current location is not ideal at all.
We are actively working with Eastern Health to try and figure out how to
move forward, despite the fact that the whole hospital redevelopment is on hold.
The
intention was to move that unit into another space into the community.
That is still the intention.
We have to come up with a way to achieve that.
MR. A. PARSONS:
Okay.
I am
going to move to the long-term care facility in Pleasantville.
I will certainly give you time to put the binder around.
The question I would have is how many beds are in that facility?
MR. KENT:
The total number of beds in
the Pleasantville facility. I know
the rough number. I am just trying
to find the exact number. It is 460
beds.
MR. A. PARSONS:
Four hundred and sixty.
MR. KENT:
Yes.
MR. A. PARSONS:
Okay.
How many are currently open?
MR. KENT:
There are thirty beds
remaining unopened, so there are 430 open.
MR. A. PARSONS:
What is the reasoning for
these beds being unopened?
MR. KENT:
The reason for those beds
being unopened relates to the need for additional staffing.
We need to hire additional, primarily, licensed practical nurses and
personal care attendants in order to open those additional beds.
There have been really concerted efforts made to staff up to address that
There
was the recent recruitment of additional LPNs from Jamaica.
There were local graduates from the LPN program in Newfoundland and
Labrador. We anticipated that with
those new graduates plus the Jamaican graduates coming in, that would give us
sufficient staff to open the remaining thirty beds, or I should say it would
give Eastern Health the sufficient staff to open the remaining beds, but
retention of staff has continued to be a challenge.
While the new staff have come in, we have had other losses.
So these new staff who have come in have been required to meet core
staffing needs for the facility.
We need
to make sure we do not compromise quality of care, so we will not allow beds to
open if we not adequately staffed to do it.
We can make the decision to open the beds now, but if we are short
staffed in the facility overall it just would not be responsible to do so.
We have
been able, though, to open up some additional beds at Chancellor Park until the
remaining beds at the St. John's long-term care home can be opened.
That has addressed some of the demand.
We have opened fifteen of the thirty.
We have opened fifteen additional beds at Chancellor Park to offset those
beds that are not yet open in Pleasantville.
It is
very difficult for us to say exactly when those beds will open.
We had hoped that it would be by now, but with some of the attrition
issues at the Pleasantville facility the new staff who have come in have not
been sufficient to allow the new beds to open.
MR. A. PARSONS:
You say that you are short
staffed. How many staff do you
estimate that you need to get these beds open?
MR. KENT:
We require an additional
twenty-six staff.
MR. A. PARSONS:
Twenty-six staff.
Okay.
MR. KENT:
To be as precise as possible
we anticipate two registered nurses, eleven licensed practical nurses, and
thirteen personal care attendants.
There are staffing shortages throughout the long-term care system within
Eastern, so we also have to look at the full picture.
If we
channel all the new staffing resources into opening up those thirty beds and
leave other facilities short, then we are only going to create a problem this
summer that would not be reasonable.
Patient safety has got to be the top priority.
As any nurse will tell you, overtime, unfortunately, is being used to try
and address staffing shortages.
I would
also like to highlight, though, the things we are doing to try and address this.
It is far beyond the Jamaican initiative.
There are a lot of things being done to try and deal with this issue on
an ongoing basis, recognizing that we are going to need more staff in the
future.
Eastern
Health has commenced a cross-country recruitment drive.
They have actually been to New Brunswick, Ontario, and Alberta to recruit
staff. We have strengthened
partnerships with licensing body and immigration officials to try and make sure
people are getting through the processes quickly and to try and identify early
promising talent pools nationally and internationally.
Eastern
Health has issued a Request for Proposals for an international recruiting firm
to target recruitment in specific countries.
We are evaluating the potential to recruit additional graduates from the
Centre for Nursing Studies program in Jamaica.
We are working with Advanced Education and Skills and the Centre for
Nursing Studies to actually get more students enrolled.
We have lots of seats available in Newfoundland and Labrador.
We need more people to enroll in the program.
Eastern
Health has been reducing non-nursing duties for nursing staff to ensure they are
working the full scope within their area of clinical practice.
They are looking at hiring temporary administrative and other support
positions to assist in resident care areas.
They are also looking at revising the current schedule to maximize
nursing staff availability.
There
are a dozen things being done to try and address this.
It is a real problem. It is
not going to be solved overnight but for many months, people have been trying to
solve it. I have just been pushing
to ensure that everybody is doing everything possible, given the urgent need.
MR. A. PARSONS:
Thank you.
CHAIR:
Lorraine.
MS MICHAEL:
Thank you.
Minister, I have two questions but they are totally related.
It has to do with the chronic disease policy framework.
I am wondering: Are there new initiatives around that being planned; and,
related to that, how many people have participated in the web-based Chronic
Disease Self-Management Program?
MR. KENT:
That is a good question.
The
self-management program launched in 2011 and 1,275 individuals have met and
supported each other in finding solutions to the common challenges they face in
living with a chronic disease.
There
was a recent evaluation of the Chronic Disease Self-Management Program and it
showed improvements in health outcomes even six months after completing the
program: improved energy levels, decreased health distress, less pain, positive
impacts on life, improved quality of life, better communication with health care
providers, greater confidence, and fewer nights spent in hospital.
It is
also worth noting there are twenty-four diabetes clinics that operate throughout
the Province. We are making some
really good progress so far and great feedback from participants in the
workshops and in the groups – 84 per cent of participants were women,
interestingly enough. I am not sure
why that is, but it is interesting to know.
The
statistically significant improvements in eight outcome areas are really
significant as well.
MS MICHAEL:
Could we have that
information of the improvements?
MR. KENT:
Yes, we can provide that.
The evaluation information, you mean?
MS MICHAEL:
Yes.
MR. KENT:
Sure, no problem.
MS MICHAEL:
Thank you.
Minister, under 2.1.01, Memorial University Faculty of Medicine, the Grants and
Subsides. It is a general heading
of course, but it was down by $393,500 from what was budgeted.
How are
these grants and subsidies given?
Obviously, it is not just a lump sum given or else the $57,800 approximately
would have been given to them.
MR. KENT:
The Faculty of Medicine
would make a budget submission – would make a funding proposal to the department
on an annual basis. This is the
only Province in Canada where the medical school is actually funded through the
Department of Health and Community Services.
So it is a bit of a unique circumstance in our jurisdiction.
We saw
savings of $750,000 in 2014-2015 related to the initiative for medical student
and resident accommodations. The
strategy for this initiative was changed, as the Faculty of Medicine was not
able to assume responsibility for the management of the accommodations in
various communities across the Province.
So the department has been working with the faculty and with the regional
health authorities on another model.
We will be going to Cabinet for approval on that in the next three or
four months, I suspect.
The
need for those accommodations will gradually be rolled out over the next few
years as the impact of the expanded medical school class size is realized.
The savings was partially offset by one-time negotiated signing bonuses
paid out to facility and staff during the year as well.
MS MICHAEL:
Okay.
Do you
receive their budget prior to the provincial Budget being done?
How does that work?
MR. KENT:
Yes, we receive a submission
prior to the provincial Budget being finalized.
MS MICHAEL:
Okay, and basically what
they submit was approved.
MR. KENT:
What they submitted was not
approved in its entirety, no.
MS MICHAEL:
All right.
Is
there any danger down the road of tuition hikes having to happen in the Facility
of Medicine?
MR. KENT:
I would say that is
possible, yes.
MS MICHAEL:
Are the discussions going on
with the faculty about that?
MR. KENT:
Yes.
MS MICHAEL:
Thank you.
Moving
down to Drug Subsidization, 2.2.01, Provincial Drug Programs, I do not have many
line questions because there are not many lines, but under Allowances and
Assistance, basically $9.5 million was not used last year.
Is that just because of lower than anticipated uptake?
MR. KENT:
Savings were due to the
delayed implementation of several new drug therapies that were approved in
Budget 2014; $4 million actually relates to one drug, Zytiga, and $1 million was
for other drugs that were delayed such as Everidge, which is an easier name to
pronounce.
There
was also $2 million in savings related to lower costs of brand name drugs due in
part to the increase cost of generics, and $1.5 million in savings from a
reduction in the generic markup that was not factored into the budget.
There were savings realized in the Smoking Cessation Program.
MS MICHAEL:
What was the uptake for that
program, Minister?
MR. KENT:
That is a good question.
The
actual number was 1,185 and some beneficiaries may have changed drug plans
during the treatment cycle and could have been counted under other plans but the
actual number, to the best of our knowledge, is 1,185.
MS MICHAEL:
Is there follow-up done to
see the effectiveness of the program, that people continue to be non-smokers?
MR. KENT:
There is some monitoring and
evaluation being done. I am just
wondering if one of my officials would like to speak to that in more detail.
Elaine.
CHAIR:
Elaine.
MS CHATIGNY:
Thank you.
Yes, in
collaboration with the Department of Seniors, Wellness and Social Development,
we are going to be partnering to do an evaluation.
They have a piece of this program, we have the drug dispensation piece of
the program, but together we are going to evaluate to try to do just that, the
ongoing monitoring of whether or not this program, the drug medication program
plus the other wraparound services that are part of the overall service
offering, actually led to long-term cessation.
MS MICHAEL:
Right.
Thank you.
Minister, you may not want to give me this information now in the interest of
time. Maybe it would be sufficient
for you to send to us the breakdown of expenditures by drug program, and the
number of clients in each program for the past year, not coming up, but
2014-2015.
MR. KENT:
We would be happy to provide
that information. Some of it I do
actually have here.
MS MICHAEL:
Okay.
MR. KENT:
The breakdown of expenditure
by drug program for the last year, I will just give you the approximate numbers.
MS MICHAEL:
Sure.
MR. KENT:
Through the Foundation Plan,
it was over $62 million; for the 65Plus Plan, it was almost $46 million; for the
Access Plan, it was $7.6 million; and, for the Assurance Plan, it was $19.4
million. There is also funding for
special needs such as growth hormones and the cystics program.
That was $935,000 for a total of almost $136 million.
MS MICHAEL:
Minister, is the budget for
each of these plans basically the same in this upcoming year?
Have there been changes?
MR. KENT:
It is basically the same.
I am just going through the numbers to see.
Yes, it varies. There is
about a $170,000 difference spread across the board.
So they are virtually the same when we are talking about a $147.5 million
budget.
MS MICHAEL:
Right.
Thank you very much.
I only
have thirty-nine seconds. I will
just pass it back to Andrew.
CHAIR:
Okay.
Andrew.
MR. A. PARSONS:
Thank you.
CHAIR:
You have totally lost me so
you continue on.
MR. A. PARSONS:
I have sort of lost myself
here, Mr. Chair.
I am
going to start with the hospital in Corner Brook.
MR. KENT:
Yes, I thought you might
bring that up.
MR. A. PARSONS:
You did not think you were
going to get to 12:00 o'clock and not have that happen.
MR. KENT:
No, I love talking about it.
MR. A. PARSONS:
Just a few questions on it.
Last year's Budget document said the approved budget was $608 million.
I am wondering what the approved budget is today.
MR. KENT:
We anticipate that the
project will cost in excess of $800 million overall.
MR. A. PARSONS:
Okay.
I think in March you had indicated you were close to finalizing the
functional plan.
MR. KENT:
That is right.
MR. A. PARSONS:
Is it complete now?
MR. KENT:
No, but it is going to be
complete very, very soon. When I
say very, very soon, I am talking within several weeks.
MR. A. PARSONS:
Okay.
MR. KENT:
It is really, really close.
MR. A. PARSONS:
So once it is complete and
you get it, do you anticipate that the public will have an opportunity to see
it?
MR. KENT:
Absolutely.
MR. A. PARSONS:
Okay.
MR. KENT:
I would like to get it out
there very soon. It is just about
final. We anticipate being able to
release the functional plan this month.
MR. A. PARSONS:
Okay.
MR. KENT:
We want to make sure we
communicate better on this particular issue.
I think it is important to get more out in front of it than we
traditionally have been. There have
been lots of challenges over the last seven or eight years with this project and
I have acknowledged that multiple times.
So as
we release the functional program, people will have lots of questions.
We want to prepare for its release and be as transparent and forthcoming
as we can be in answering people's questions about what that final functional
program looks like. I should be in
a position to release it before the end of this month.
MR. A. PARSONS:
Okay, excellent.
Thank you.
Two
questions left on the hospital; one, from your understanding of the plan as it
stands, what can you tell us about obstetrics beds?
I understand there is going to be a reduction, but I am just wondering
about the number.
MR. KENT:
There is a reduction.
The number of beds overall in the new hospital is greater.
The number of services and programs being offered in the new hospital is
greater. In certain areas there may
be a reduction based on the historical realities of usage.
When it
comes to obstetrics – my officials may be able to provide me with exact numbers,
I am just recalling from memory – traditional usage was around 50 per cent.
So there were eleven beds, I think, in the current hospital.
Andrew, I am doing this from memory.
MR. A. PARSONS:
I understand.
MR. KENT:
My numbers might not be
precise, but they will be pretty close.
I believe there are six suites proposed in the new hospital.
There will be fewer maternity beds in the new facility, but that does not
equate in any way to a reduction in service.
Now the Member for Bay of Islands may have some other things to say about
that, but –
MR. A. PARSONS:
Really?
MR. KENT:
– the need for the six beds
is actually based on demographic and population projections for the region, and
it is based on the current utilization.
I have
found the numbers now, it is eleven to six.
The current utilization is about 40 per cent.
Why would we spend public funds to overbuild a facility in that
particular area if those beds can be better utilized in another area?
Overall, more beds, more services, and the facility will be modern.
There will be flexibility so that if needs change over time,
modifications can occur. Based on
current usage, we are only using the beds 40 per cent of the time.
It would not make sense to construct the exact same number of beds for
each area.
In
fact, that is what got us into trouble.
When this process started, we got to a final master plan and functional
program in 2009-2010 that was basically proposing to build a replica of the
current hospital. We want to build
a hospital that is going to meet the needs of the West Coast of the Province
well into the future. It did not
make sense to just simply replace exactly what is there, which is why the due
diligence review was done by Stantec which has led us to the new functional
program that is about to be released.
It is
unfortunate that it has taken that much time, but I think we have come up with
the right answer as a result of this extremely long process that we have been
through. We also did not
contemplate the PET scanner and radiation therapy services in the original plan.
That is included in the new functional program as well – space for the
PET scanner.
MR. A. PARSONS:
I am just wondering now,
when it comes to the statistics – again, I do not have this, but this is sort of
anecdotal.
MR. KENT:
Yes.
MR. A. PARSONS:
I have no doubt that the
number of births has likely gone down, but I get reports that there are times
when all eleven beds are in use. It
might not be frequently, but there are times when all eleven beds are in use.
I have my own experience there where my wife was brought in and there was
no bed available. That is my
concern; what happens in those situations.
MR. KENT:
All hospitals in our system
build in surge capacity to deal with that.
The design of the new hospital will certainly accommodate that.
There may be those rare occurrences, as you say.
That would be true not just in obstetrics, but in any area of the
hospital.
Any
young parent would expect that there would be a bed readily available to
accommodate them when the need arises and those patients will absolutely be
accommodated. It would be very,
very rare today for those eleven beds to be in use.
MR. A. PARSONS:
Okay.
MR. KENT:
I would suspect it is
extremely, extremely rare.
MR. A. PARSONS:
It is not fun when you
travel that 220 kilometres in the winter and you get in and there is no bed.
That is not a pleasant experience.
MR. KENT:
No, absolutely not.
MR. A. PARSONS:
Okay, last question, for the
hospital – sorry to get your hopes up.
Is there any contemplation with this hospital of the P3 partnership being
used for the construction?
MR. KENT:
At this point in time, it is
all systems go for the current plan, traditional build, using the procurement
approach with the Corner Brook Care Team.
The funds that are in this budget for the West Coast hospital project
will allow the Corner Brook Care Team to continue its design and planning work
on the acute care facility. There
are also funds to do more site work and to construct the water treatment
facility.
Despite
our change of the procurement approach with long-term care, there is going to be
activity on that site this year. As
a result of the move we have made with long-term care, we will able to get the
long-term care facility open a year earlier than planned, despite the fact that
construction will be probably a few months late starting and we still plan to
get a contract awarded this fall for the long-term care facility.
I am
open to exploring other procurement approaches.
I want to be upfront about that.
If we can find a way to build the West Coast acute care facility faster,
cheaper without compromising quality or care in any way, shape or form, then I
am definitely open to that possibility; but, at this point, that is not the
direction we are taking and that is not the decision that Cabinet has made.
We are continuing with the current approach.
Could there be a better approach?
Well, I am open to exploring that, absolutely.
MR. A. PARSONS:
What is the construction
date anticipated now, start of construction of the hospital, the fall?
MR. KENT:
We would hope that
construction would begin – for the acute care?
MR. A. PARSONS:
Yes.
MR. KENT:
Not this fiscal year, but
next fiscal year.
MR. A. PARSONS:
I am going to sort of go to
the side again when we talk about the long-term care, which was just brought up
there. I have a number of
questions, somewhat specific. This
facility, the long-term care is for Level 3 and above, will you allow them to
take Level 1 and 2?
MR. KENT:
In the long-term care
facility?
MR. A. PARSONS:
Yes.
MR. KENT:
No.
That is not to say that could not change in the future, but that is not
the approach and that is not the plan today.
We will always adjust our plans based on what the needs of the population
are, but we have personal care homes for Level 1 and Level 2; we do not except
Level 1 and Level 2 patients into our long-term care facilities.
CHAIR:
I do not mean to interrupt.
We are edging a little bit away from Estimates and more into policy
statements and stuff, Andrew. Again
if the minister is willing to answer, I am fine, but I am just saying we have
strayed a little bit away from Estimates.
MR. A. PARSONS:
The minister has been very
forthcoming and I appreciate that and if the minister does not want to answer a
question, I appreciate that as well.
MR. KENT:
I appreciate, Mr. Chair, you
are correct, but I will do my best to continue to answer as many questions as we
can.
CHAIR:
That is fine, as long as
everybody is comfortable.
MR. A. PARSONS:
Do I get my last five
seconds back?
CHAIR:
You do.
I stole it from you; I will give it back to you.
MR. KENT:
You can have ten.
MR. A. PARSONS:
I tell you what, I do have a
number of questions, so I will hold on that and I will go to Lorraine.
CHAIR:
Okay.
Lorraine.
MS MICHAEL:
Thank you.
Let's
come to 2.3.01 –
MR. KENT:
Oh, so we are actually going
to talk about the budget now. That
is great. Thanks for bringing us
back.
MS MICHAEL:
For the moment.
MR. KENT:
All right.
MS MICHAEL:
Here we are looking at the
Physicians' Services. First, you
have the Operating Accounts which were down by $2 million last year from the
budgeted to the revised, and up to $4.5 million this year, so if we could just
have an explanation of that.
MR. KENT:
This budget is challenging –
well, actually the entire budget is challenging, but this one is particularly
challenging because it is largely based on utilization.
In 2014-2015 that revised decrease of $2 million was because the
fee-for-service budget trended at a lower rate than what we anticipated.
The increase for 2015-2016 is related to funding for anticipated
utilization increases in the fee-for-service budget.
This
budget grows – I mean, it typically grows.
There is some fluctuation, but our best guess at anticipated utilization
signals the need for that increase in 2015-2016.
MS MICHAEL:
Okay.
MR. KENT:
It is hard to predict
because it is based on utilization and largely based on what doctors are
billing.
MS MICHAEL:
Well thanks, Minister, maybe
what you can do is just go down the line and explain Allowances and Assistance
and also Grants and Subsidies.
MR. KENT:
Sure.
CHAIR:
We are at 2.3.01,
Physicians' Services, for anybody following along.
MS MICHAEL:
Subhead 09, Allowances and
Assistance.
MR. KENT:
Okay, yes.
MS MICHAEL:
Just explain the
differentials there, please.
MR. KENT:
Sure.
In Allowances and Assistance, this is payments for services received by
residents out of Province and for residents of other provinces while in this
Province. We have reciprocal
billing agreements that are in place, and payments on behalf of residents of
other provinces are recovered from the other provinces and received as revenue
under this activity. That varies
from year to year as well and it is a little difficult to predict.
The
budget decreased due to lower than anticipated expenditures for payments to
other provinces under our reciprocal agreements for medically necessary services
provided by physicians in the other province to our residents.
So somebody is out of Province for a medically necessary service that is
provided by physicians in the other province.
We saw
the decrease by $1 million this year over the 2014-2015 budget, and that is just
based on historical expenditures and a decrease in utilization.
We have adjusted the budget accordingly.
MS MICHAEL:
Okay.
MR. KENT:
What was the next one?
Did you say Grants and Subsidies?
MS MICHAEL:
The Grants and Subsidies,
yes.
MR. KENT:
That includes salaried
physician payments, Canadian Medical Protection Association subsidy, which
relates to medical malpractice insurance and that is subsidized by the Province
for our physicians. The decrease in
the revised budget includes payments to physicians for salaries, for locums, and
additional workload. As the number
of physicians has increased in the Province, the requirement for locum
replacements and additional workload has actually diminished.
Despite the fact that in certain places we have had some recruitment
challenges which we are also addressing, the requirement for locum replacements
has actually gone down.
In
addition, in some clinical situations, alternate providers are being utilized to
provide services that are historically done by physicians.
The Member for St. George's – Stephenville East has raised the issue of
Jeffrey's and St. George's a number of times in the House of Assembly.
We are actually recruiting nurse practitioners to be part of the solution
in those areas. So that may lead to
some slight changes to these budget areas because minor amounts of funding will
need to shift to deal with those new delivery models.
We are
not just talking about those new delivery models.
In the case of the communities on the West Coast, as I shared with that
member several months ago, we are actually making progress.
We are committed to coming up with a better approach that is sustainable.
MS MICHAEL:
Thank you, Minister.
You have to forgive my doing this and so does the Chair; I am really glad
to see what I continue to say about health care is that if we do exactly what
you are talking about, it is cost effective.
I am glad to see it happening and you have the proof, so that is great.
With
regard to the family physicians, could we have the updated numbers of how many
family physicians we have now and the new hires last year?
How many new positons did we get?
MR. KENT:
We sure can.
In terms of physician supply currently – actually this information is as
of March of last year.
MS MICHAEL:
Okay.
MR. KENT:
We do not have the new
numbers yet, but they are being compiled.
As of March 31, 2014, there were 579 GPs and 604 specialists for a total
of 1,183 physicians.
Just to
give you the breakdown we had 391 salaried, 740 fee-for-service, and fifty-two
who had alternative payment arrangements totalling the 1,183.
To give you the breakdown by region, which better total 1,183 as well:
807 within Eastern, 167 within Central, 151 in Western, and fifty-eight within
Labrador-Grenfell Health.
MS MICHAEL:
Thank you so much.
Moving
on to the Dental Services, 2.3.02, the big thing here of course is the
Professional Services. Last year,
the revision was $3.5 million lower than the budget.
This year the estimate is approximately $1.3 million lower than the
budget last year. Could you explain
that please?
MR. KENT:
I can.
I would also draw members' attention to an announcement I made yesterday,
through a news release, to actually make some improvements to these programs.
Despite
that, we had savings last year. We
introduced measures in 2013 to ensure that the Adult Dental Program was
operating within its allocated budget appropriation.
There was lots of concern raised at the time about doing that, even
though it was a necessary move.
There
was a cap placed on basic adult dental services of $150, which we increased to
$200 in Budget 2014 and which we have just increased to $300.
There was a cap on adult denture services of $750 each year.
That was also a concern that we have heard a number of times over the
last couple of years so we have increased that cap to $1,500 as of July 2 for
both of those, right?
OFFICIAL:
Yes.
MR. KENT:
A prior approval process was
also implemented for these adult denture services.
These measures provided clients and providers with the ability to design
and develop dental treatment plans, as well as prioritize needed services.
So the
variance is a result of lower than anticipated uptake in the Adult Dental
Program after the implementation of those restrictions.
That resulted in some savings.
In addition to that, children's dental services had lower than
anticipated uptake which resulted in about $500,000 of savings, even though that
is a universal program as you are aware.
We want
people to be able to access the program.
We know that the restrictions we put in place worked, but maybe they
worked a little too well. So we are
now increasing the cap for both dental and for dentures to make it easier for
people to get the services they need.
Obviously, as you know, we are targeting low-income earners.
The
decrease you referenced from 2014 to 2015-2016 – we did a review of historical
dropped balances. We have
traditionally had surpluses in both the Adult Dental Program and the children's
dental program so we have made some adjustments as a result.
MS MICHAEL:
I take it you took into
consideration the announcement that you made yesterday in doing that.
MR. KENT:
Absolutely, yes.
MS MICHAEL:
Thank you, Minister.
With
regard to oral surgery – which I think does continue to be a bit of a problem
here in the Province. How many
people were sent out of Province for oral surgery last year?
MR. KENT:
I believe I do have those
numbers. I just need to find them
here for you. Maybe I do not.
We can get you those numbers.
We still have allowed a continuation of surgery and extended eligibility
thorough MTAP, our Medical Transportation Assistance Program, for patients who
have been required to go out of Province; the exact statistics that you are
asking for we will have to get for you and provide.
The
number of out-of-Province surgeries eligible for MTAP is actually declining as
more surgeries are being done by a resident oral surgeon, and wait times are
decreasing. There is some good news
to report here. There have been
periods of time where we were without oral surgery services, but that is not the
case today. In fact, in May of last
year we had a second oral surgeon return to the Province, establish a
full-service practice, and opt into the Medical Care Plan, MCP.
With
two full-time resident oral surgeons opting into MCP we anticipate that
referring dentists and physicians will avail of those services.
We are continuing to recruit in order to provide additional oral surgeons
who will provide a full scope of oral surgery services.
I believe in the next number of months we have another oral surgeon
coming here. It is very soon, like
in the next –
OFFICIAL:
In July.
MR. KENT:
In July there is another
oral surgeon who has signed a contract to come.
So we are continuing to see improvements.
That will mean we will have four oral surgeons in the Province.
MS MICHAEL:
Great.
Thank you very much, Minister.
CHAIR:
I am going to hold you
there, Lorraine, if that is a good spot for you?
MS MICHAEL:
Yes, sure.
CHAIR:
Okay.
Andrew.
MR. A. PARSONS:
Thank you, Mr. Chair.
I am
going to go back to the long-term care in Corner Brook where I left off.
MR. KENT:
Yes.
MR. A. PARSONS:
I think the commentary,
publicly, has been sort of – you are saying it is cheaper to have private
partners run these facilities than the public partners.
MR. KENT:
Yes.
MR. A. PARSONS:
So I am wondering where does
that come from? Is that based on
comparing it to, say, Chancellor Park?
Where does this knowledge come from?
MR. KENT:
It is based on our own
experience in Newfoundland and Labrador, but definitely not exclusively our own
experience in Newfoundland and Labrador.
We have looked at what has happened in other provinces.
Every other province in Canada has a mix of public and private providers
for long-term care, so we are not breaking new ground here.
As you
mentioned, we have Chancellor Park here in our Province that has been providing
private, long-term care services for quite some time, publicly funded as well.
All of these beds will be publicly funded beds.
Chancellor Park has some private funded and some publicly funded.
We have increased the number of publicly funded beds at Chancellor Park.
What we
have learned from other jurisdictions in Canada is that they are spending 10 per
cent to 20 per cent less on delivering the service in partnership with a private
provider than what they are spending through the traditional publicly delivered
route. We would anticipate, based
on our own experience in Newfoundland and Labrador and based on the experiences
of other jurisdictions, that it would be very similar for these new beds.
It is
hard to be precise about what the savings will be until we go to market.
So once we go to market and we get responses to proposals – we know what
our cost is which is in excess of $10,000 per bed, per month and rising.
We anticipate that we will achieve somewhere between 10 per cent and 20
per cent savings as well, just like other jurisdictions are experiencing.
MR. A. PARSONS:
You referenced other
jurisdictions. I think you have
said Nova Scotia and New Brunswick before.
Is there a specific example that we can see a similar model?
MR. KENT:
You can go to any province
in the country. I have cited the
examples close to home just because it is the most relevant, I guess.
It is the most similar to our Province in terms of labour market, in
terms of economy, in terms of geographic location.
The trend across the country is very much the same, so you could look to
any province in the country – PEI is obviously rather small, but you could look
to virtually any province in the country and you would find that their savings
is between 10 per cent and 20 per cent.
Certainly, the consultant that we have engaged to help us with this work has
extensive experience on the West Coast of the country, has done work in other
jurisdictions to support projects in other jurisdictions, but their most
extensive experience is in British Columbia.
Nova Scotia and New Brunswick, over the last decade, have both entered
into agreements with private providers and they are seeing the kinds of savings
that I anticipate we will see as well.
MR. A. PARSONS:
Does the private operator
control the cost charged to the senior?
MR. KENT:
Does the private operator
control the cost charged to the senior?
These are subsidized beds, so we are paying the cost.
MR. A. PARSONS:
Okay.
So therefore the Province would also control the level of care?
MR. KENT:
Yes, absolutely, we control
the level of care. That is actually
a really important point. These
private providers have to meet the same standards of care.
I know there has been lots of concern expressed in the House of Assembly
and there has been concern expressed by unions saying that somehow quality of
care will be compromised, and that is just not the case.
There
will be very strict monitoring in place, just as there is for Chancellor Park,
and just as there is across the country for private facilities to ensure that
quality of care is not compromised in any way and that standards are maintained.
The
standards that are in the publicly run facilities today will be the same
standards that are applied to privately run facilities, even though they are
publicly funded. All we are
changing is who builds the infrastructure and delivers the service.
The standards have to be the same.
They will still be publicly funded beds.
MR. A. PARSONS:
Okay.
I am
going to switch out of that one and go to a new one – and again I apologize, the
minister has been very open so I have to take advantage of this.
MR. KENT:
I am all about openness.
I have been telling you that for years.
MR. A. PARSONS:
I might actually start
believing you now.
MR. KENT:
Good.
MR. A. PARSONS:
This is good.
MR. KENT:
I will be clipping that from
Hansard.
MR. A. PARSONS:
I want to ask you about the
HPV virus. I do not know if we have
talked about this in the House, it has been a topic outside and we talk about
how right now we fund females but not males.
We know that other provinces have gone down that route.
I am wondering if there is a position on why we have not followed suit in
this.
MR. KENT:
Most other provinces have
not yet offered the HPV vaccine to males, but we have seen three provinces go
down that road: Alberta, Prince Edward Island, and most recently Nova Scotia.
We have been monitoring what is happening across the country very
closely, as we do with all vaccinations.
We try and monitor trends and see what others are doing.
We consult closely with other jurisdictions because in a country our
size, despite our vast geography, we need to work together on these things.
Even when we are dealing with vaccine supply issues, it is important that
we are co-ordinating with other jurisdictions.
So,
overall, we have some of the best immunization coverage rates of anywhere in the
country. As part of HPV
immunization program, all females are offered the HPV vaccine.
Close to 95 per cent of Grade 6 females in the Province have received the
HPV vaccine to prevent cervical cancer.
That is the highest immunization coverage rate for this vaccine anywhere
in the country.
Because
we have such a high coverage rate and because we have vaccinated about 50 per
cent of the population, that significantly lowers the possibility of acquiring
the virus, as it is transmitted between sexes.
That is not to say that all males are therefore covered, because they are
not; but, it significantly lowers the possibility of others acquiring the virus.
We are
going to continue to monitor this.
In this Budget, we did not find new funding to provide the HPV vaccine for boys.
We are going to watch closely what is happening in other jurisdictions.
Only three provinces have gone there so far.
We have to acknowledge that because of our high immunization coverage
rate, the vast majority of our population is actually protected.
MR. A. PARSONS:
Well, half you said.
MR. KENT:
Yes, but it is more – you
know the point I am trying to make.
MR. A. PARSONS:
I know.
Does
the department have a cost estimate, though, for what it would cost if the
department were to go down that road?
MR. KENT:
The last estimate that I
looked at it was about $300,000.
MR. A. PARSONS:
Annually?
MR. KENT:
Annually.
MR. A. PARSONS:
Okay, thank you.
MR. KENT:
That is not to say we will
not do it down the road.
MR. A. PARSONS:
No, no –
MR. KENT:
We just did not, as part of this Budget process, make the decision to proceed,
but we are watching very closely what other jurisdictions are doing.
There is a reason that a few jurisdictions have gone down this road.
There is probably a reason why most have not, but we are continuing to
pay attention to all of that because we want to protect our population.
MR. A. PARSONS:
Now I have to go back to
something that was brought up earlier and I just have one question on it; that
is the dental plan. Again, you made
the announcement yesterday that you referenced.
I am just wondering, the Budget came out I think it was April 30 and I do
not think in the Budget itself there was any new money announced for the adult
dental plan –
MR. KENT:
That is right.
MR. A. PARSONS:
I am wondering: Where did
this funding that was announced yesterday come from?
MR. KENT:
It is coming through savings
in the program. We just reviewed
the numbers and there have been some adjustments to both the Adult Dental
Program budget and the Children's Dental Program budget.
Within the remaining budget, we are able to accommodate increasing the
caps. There has been traditional
drop balances and there has been underutilization.
When we instituted the caps in 2013, it reduced utilization.
Within
the resources we have, we want to make the program available to as many people
as possible. Both issues were
really critical to address. The
dentures issue really struck home for me.
It did not make sense that somebody would be able to get the job half
done, so to speak.
MR. A. PARSONS:
Yes!
MS MICHAEL:
Thank you.
MR. KENT:
We needed to find a
solution.
MR. A. PARSONS:
Thank you.
MR. KENT:
I acknowledge that members
of the Opposition have raised the issue.
I appreciate the fact that you have done so.
We knew there were concerns.
This announcement yesterday is a direct response to those concerns.
Believe it or not, you can write this one down too, Mr. Parsons, we are
actually listening and sometimes you make good points.
We want
to make the program more available.
So this is not to say that these changes will address all the needs that are out
there, they will not, these programs are still capped; but we will be able to
better utilize the resources that we do have.
MR. A. PARSONS:
Thank you.
I guess
it is Lorraine's turn.
CHAIR:
Okay.
Lorraine.
MS MICHAEL:
Thank you very much.
Basically my questions relate directly back to the budget, what I have left.
Subhead 3.1.01, Regional Health Authorities and Related Services, there
are a number of variants which is what my questions are all about, Minister.
Under Supplies, $730,000 approximately less in the revised than the
budget of last year, and then this year $303,000, approximately, less than last
year's budget as well.
MR. KENT:
In terms of the revised
decrease, the vaccine budget had lower than anticipated cost.
We are constantly negotiating prices, we are working with other provinces
throughout the country, but there has been some particular co-operation within
the Atlantic region and we avail of the ongoing national discussion on those
issues.
There
were some price reductions, but the decrease from 2014-2015 to 2015-2016 we went
through the historic drop balances and we looked at our requirements and
determined that there was surplus that we could use elsewhere.
There are lots of needs, but we were able to identify some savings based
on the existing programs and that helps us meet other demands in the system,
which we are all aware of.
MS MICHAEL:
Minister, this is more a
question of curiosity, actually.
How many vaccines is part of the health system at the moment?
MR. KENT:
Wow, there is a lot.
Who knows the number?
Elaine
would like to take a stab at it; pardon the pun.
MS CHATIGNY:
Yes, exactly; although now we have a lot of oral vaccines, which is good news
for our children.
I will
provide you, through the minister, with the exact number but they are in the
dozens for both pediatrics vaccine and adult vaccine – in the dozens.
MS MICHAEL:
It would be good for us to
get that information.
MS CHATIGNY:
Absolutely, we can give you the list.
MS MICHAEL:
Okay, thank you so much.
Minister, coming down to 09, Allowances and Assistance, the number is down from
the budget last year. The revision
last year was significantly down by $2 million, approximately, and this year it
is down $344,000 from last year's budget.
MR. KENT:
Yes, it is a significant
decrease. It is a net result of a
couple of buckets of adjustments.
There was a surplus in physician services and workforce planning.
The RHAs hold funding to support bursaries.
In 2014-2015, this funding was utilized first to support the approval of
bursaries with the balance funded by the department, so expenditures were less
than budgeted in that area and that accounts for over $1.4 million of that
savings.
There
was also surplus in the Medical Transportation Assistance Program due to a lower
than anticipated uptake of the program in 2014-2015.
That accounted for almost $613,000 in savings.
That is the reason for the decrease from the original budget to revised.
MS MICHAEL:
Right.
MR. KENT:
In terms of the decrease in
the estimates, which as you mentioned is $343,900, last year we improved
enhancements to the Medical Transportation Assistance Program by increasing the
monthly accommodations cap, changing the reimbursement formula for eligible
expenditures. There were some other
improvements as well. So $158,500
represents the annualization of that initiative and the increase was offset by a
reduction to health professional recruitment and retention incentive programs
that totalled $502,000.
We had
an increase on one side, a decrease in the other area.
The four incentive programs reduced, based on utilization, based on
anticipated demand include the Nurse Practitioner Grant Program, the Bachelor of
Nursing bursary program, the Signing Bonus Program, and the Provincial Physician
Bursary Program.
While
the Provincial Physician Bursary Program was reduced, the Medical Association
and our department jointly announced a new Physician Signing Bonus Program, and
that is meant to provide a signing bonus for physicians that are trained in the
Province or in Canada to fill positions that have been historically difficult to
fill or retain and who have not received a provincial physician bursary.
The
bonus is for a three-year commitment, as evidence shows that physicians who stay
for the initial three years are more likely to be retained beyond the three
years. So, that explains that.
MS MICHAEL:
Okay, thank you.
Complicated, but I think I got it.
MR. KENT:
If I could summarize, there
were some enhancements to MTAP that cost us more money and there were some
savings in the bursary programs that saved us some money.
MS MICHAEL:
Right.
Mentioning MTAP – you did give us the figure – could we have a breakdown
by region of number of recipients and amount if you have that?
MR. KENT:
Is it possible to organize
that by region? I am just thinking
about –
MS JEWER:
I have it broken down
between the Island versus Labrador.
MS MICHAEL:
That would be helpful.
MR. KENT:
I will ask Michelle to
quickly provide you with that breakdown.
Because of the way the program is administered it is not administered
regionally, but we can give you the breakdown – the challenges for Labrador
residents are greater so we can provide you with that breakdown.
I will ask Michelle to respond.
MS JEWER:
You are asking for the
number of patients?
MS MICHAEL:
Yes.
MS JEWER:
For 2014-2015 the number of
Island patients was 2,101; and Labrador was 1,043.
The number of claims for Island residents was 3,057; and for Labrador it
was 1,620.
MS MICHAEL:
Thank you very much.
Minister, subsection 10, Grants and Subsidies, is going up quite significantly.
MR. KENT:
Grants and Subsidies.
MS MICHAEL:
Yes.
Last year, the revision was approximately $22 million above and this year
it is $42 million above last year's budget.
MR. KENT:
Right.
In terms of going from the original to the revised budget, there was an
increased there as well. It was
required due to a one-time signing bonus for the nurses' collective agreement.
That was over $8 million and retroactive costs relating to occupational
reviews for LPN and other classifications, which accounted for over $22 million.
So
funding for these items was not budgeted in our original budget but was
transferred from the Department of Finance during the fiscal year.
So when you do Finance Estimates, you will find that on the other side.
MS MICHAEL:
Okay, I will remember that,
to save a question.
Then
this year the plus $42 million over last year's budget.
Some of it is obviously because of the collective agreement.
MR. KENT:
Right.
The Grants and Subsides have seen that increase of over $42 million due
to a number of adjustments and approved initiatives.
Just to
give you some of the big ones that would account for the bulk of that: 3 per
cent salary increases, of course, which accounts for about $35.5 million; there
is an increase in pension contribution, that is $19.2 million; and there is some
additional funding approved in Budget 2015 for other initiatives.
So that would give you the big stuff that is driving cost.
MS MICHAEL:
Okay.
Thank you.
MR. KENT:
We are feeling cost
pressures everywhere in the system.
MS MICHAEL:
Yes.
Then
come down to the provincial revenue – I always ask this question because it is a
different answer in each department actually.
What is the source of the provincial revenue in your department in this
division?
MR. KENT:
The provincial revenue comes
from a variety of sources. The
revenue source's high level is the vehicle levy program, third-party liability,
and reciprocal billings.
Vehicle
levy revenue is revenue received from insurance companies to recover third-party
liability related to medical costs based on accident frequency index – it is
exciting stuff. Then the
third-party liability revenue is recoveries from third parties who are
financially liable for the cost of hospitalization provided to residents as a
result of third-party negligence.
Although the hospitalization is provided as a benefit under the provincial
hospital insurance program without charge to the patient, we make every effort
to recover that funding from the third party.
MS MICHAEL:
Right.
MR. KENT:
VLT operators: We receive
money from VLT operators to support gambling addiction services and we also have
the issue of reciprocal billings.
There are recoveries from other provinces through the Reciprocal Billing Program
on account of payments made by this department to Newfoundland and Labrador
hospitals for other provinces' residents who receive insured services in this
Province.
MS MICHAEL:
Okay, thank you.
I do
not think the budget for the government is done this way, because it would be
rather detailed, but how much of a correlation is there between the money that
we put into addiction services and the money that we get from VLT operators, or
do you know?
MR. KENT:
I do not know if we would be
able to say with precision.
MS MICHAEL:
Yes, that is what I thought.
MR. KENT:
I am glad that as a
government we have reduced VLTs. I
think we have more work to do.
MS MICHAEL:
I think we do too.
MR. KENT:
I believe that VLTs are
ruining lives in this Province.
Gambling addiction is real, and we have lots of good programs to provide support
and services. We even have a
counselling service available by telephone to help those dealing with gambling
addiction. There are lots of
programs and services in place, but I remain very concerned about the prevalence
of VLT use in this Province and while we have made major reductions to VLTs, I
think it is something we need to continue to talk about.
MS MICHAEL:
I am glad to hear you say
that.
MR. KENT:
I am straying far from my
script –
MS MICHAEL:
You are.
MR. KENT:
– but I definitely feel it
is an issue we need to continue to pursue.
CHAIR:
Lorraine, I am just trying
to get a sense here – we are at the three-hour mark and I know Mr. Parsons has
some questions, are you close, or do I go back to Andrew and come back to you?
MS MICHAEL:
Maybe I could ask this one
because it is a big one and it is directly related to the budget and then I
might not have any more.
CHAIR:
Okay.
MS MICHAEL:
Under 3.2.01, Furnishings
and Equipment, there has been a major reduction in the Furnishings and Equipment
for the health care facilities.
CHAIR:
Subhead 3.2.01, Minister, on
Page 17.10 of the Estimates booklet; I am not sure what page that would
correlate to you.
Ms
Michael is referring to the reduction in Furnishings and Equipment; the budget
last year was $61,432,000 and now it is down to $46,932,000.
MR. KENT:
In that $14.5 million, there
were a couple of projects that ended in 2014-2015 that are no longer required in
this fiscal. There was a labs
project, the iEHR/Labs project that ended in 2014-2015.
So there was $4 million previous that does not need to be in this year's
budget. Also, there was capital
equipment needed for the new dialysis unit in Bonavista that cost about
$500,000. So that is one time as
well.
MS MICHAEL:
Right.
MR. KENT:
There is $10 million removed
from the department's annual capital equipment block, which is block funding for
equipment for the regional health authorities.
Literally, every week in the department, we receive requests from the
regional health authorities for various equipment needs.
At the beginning of the year, they prioritize what they project they are
going to need for the year, but then equipment breaks, things come up during the
course of the year.
Since
2004 we have invested more funds than ever before.
In fact, it is $425.5 million in much needed equipment.
So given such a significant investment, we can reduce this budget from
$50,000 to $40,000 –
OFFICIAL:
Fifty million.
MR. KENT:
Fifty million to $40 million
– it has been a long three hours.
My speech is starting to slur. This
is only water, I assure you.
We have
reduced it from $50 million to $40 million.
We think we can do that without negatively impacting the capital
equipment needs of the regional health authorities.
It will be challenging because if we had double the budget, the RHAs
would find ways to spend it, but the $40 million that we still have will allow
for the replacement of high-priority equipment needs.
We can definitely accommodate that.
MS MICHAEL:
You are sure of that?
MR. KENT:
We will do the must-do
things. Some of the nice-to-do
things might have to wait, but the must-do things will still get done.
MS MICHAEL:
Okay, thank you very much.
CHAIR:
Thank you.
Andrew,
to clue up.
Minister, are you satisfied – we have done our three hours.
MR. KENT:
I am good until 1:30
o'clock.
MR. A. PARSONS:
I will not take that much
time.
CHAIR:
Okay.
MR. A. PARSONS:
I have three topics left and
you can be as brief as you would like to –
MR. KENT:
Sure, no problem.
MR. A. PARSONS:
I appreciate that fact that
you are willing to take them.
The
first one is a specific question on the 2015-2016 budgets on each of the health
authorities.
MR. KENT:
Yes.
MR. A. PARSONS:
I know the numbers for last
year's budget. I am wondering if
you can give me this year's budget.
You can start Eastern, Central, Western, and Lab-Grenfell or whatever is there.
MR. KENT:
Yes, I am just gathering
that for you.
MR. A. PARSONS:
Perfect.
MR. KENT:
These are approximate
numbers because these are based on draft.
There is still discussion ongoing with the regional health authorities.
Adjustments get made throughout the year, but this will give you a
ballpark.
For
Eastern, the largest, it is $1,186,732,028, give or take.
MR. A. PARSONS:
Okay.
MR. KENT:
For the Central Health
Authority, it is $308,300,978; for Western, it is $299,541,697; and for
Labrador-Grenfell Health, it is $131,618,811.
The grand total is $1,926,193,514.
There are a number of things going on.
Of course there are the salary increases, which drive cost.
Utilization is an issue, and pension reform.
There have been some reclassifications of positions, so that would
explain some of what has gone on there.
MR. A. PARSONS:
Okay, thank you.
Topic
two is road ambulance.
MR. KENT:
Yes.
MR. A. PARSONS:
I do not believe there was
any new money in the budget this year for ambulance.
Now last year there was money for Central dispatch and I think the figure
I had was that it was about $18 million to complete that.
I am just wondering: What is the plan this year?
It seems like it is going to be delayed.
Where are we on it?
MR. KENT:
What I can say is that
negotiations are ongoing with road ambulance organizations in the Province.
There is progress being made.
We have seen real significant growth in the road ambulance program over
the last decade. Budget increases,
over the years, have resulted in more ambulances on our roads and highways,
which is good news for people in the Province, more professional and trained
staff available to respond to calls.
We have invested in on-board medical equipment, and there are also
ongoing operational costs such as fuel and vehicle maintenance.
We need
to work with ambulance operators on the issues that have been raised in the road
ambulance review and we continuing to implement recommendations.
MR. A. PARSONS:
That is the one thing – I
understand contract negotiations are ongoing, but the Central dispatch issue
itself that was talked about last year, where do we stand on that?
Is that still going to be done on time?
MR. KENT:
I am very much committed to
moving forward with the Central Medical Dispatch Centre.
I think it is the cornerstone of a high-performance ambulance system.
I think it is long overdue.
It was a key recommendation in the provincial road ambulance program review.
Fitch & Associates completed that.
I intend to issue a Request for Proposals for a central medical dispatch
centre and associated technology planning project in the coming weeks.
MR. A. PARSONS:
Okay.
Thank you.
Finally, my last –
MR. KENT:
Sorry, if I could just also
add to that.
MR. A. PARSONS:
Yes.
MR. KENT:
Transportation and Works has
allocated some funding in its planning block for the planning project.
MR. A. PARSONS:
Okay.
MR. KENT:
So while the funds may not
be reflected here, there is some money set aside for that as well.
MR. A. PARSONS:
Gotcha.
MR. KENT:
See I am even answering
other minister's questions.
MR. A. PARSONS:
You are good.
MR. KENT:
Thank you.
I will be clipping that as well.
MR. A. PARSONS:
You go right ahead.
My last
topic is more of a general one, but it is something you have brought up in the
past and you are aware of. Have
there been any proposals regarding IVF brought to the department or Eastern
Health for the implementation of IVF in this Province?
MR. KENT:
It is a topic that has been
raised with me by citizens a number of times since becoming minister.
To your specific question, I cannot say with certainty that there have
not been proposals received by a region, for instance.
We do have medically necessary services provided to MCP beneficiaries
that are free of charge. That
remains the same.
The
importance of IVF to some families in the Province cannot be understated.
IVF is provided as a partial service in St. John's through Newfoundland
and Labrador Fertility Services, which is a clinic on Major's Path.
We
provide annual funding of $350,000 a year for professional staff for that
program. We are currently, through
Eastern Health, investigating the logistics and feasibility of providing more
services here in Newfoundland and Labrador.
That
examination is including the consideration of costs of providing such a service,
determining the appropriateness and availability of the required human
resources, and the required space and infrastructure needs such as laboratory
space. It is still being looked at.
I know
lots of families, personally, who have needed to go out of Province or have
chosen to go out of Province for this service.
We continue to look at what we can do through our provincial program.
We expanded the program in 2006.
There is lots of interest and demand.
It is one we are going to continue to work on.
MR. A. PARSONS:
Okay.
I can
stay here for another three hours, but I do not think that is fair to the
minister or his staff so I am going to –
MR. KENT:
It would be awkward in
Question Period if we are still here too.
MR. A. PARSONS:
I will conclude.
I had to put this on record.
I give credit where credit is due.
Not every minister that you deal with in any department has been as forthcoming
as you and the department today. So
I am appreciative of the fact that we went off the line items and you answered
questions. I do appreciate that.
That is not as common as we would like to see so I give you full credit,
Minister, for doing that and making everybody available today.
I really do.
MR. KENT:
I really appreciate the
acknowledgment. I am happy to
participate despite the fact that the Chair tried to whip us into line several
times.
CHAIR:
That is my job.
Lorraine.
MS MICHAEL:
Before I give you kudos I do
have one more line item that I would like to –
MR. KENT:
If you are also going to
give me kudos, I am taking the rest of the day off.
I will let someone else answer my questions at 2:00 o'clock.
MS MICHAEL:
Subhead 3.2.02 is the final
section of the Estimates for your department.
I know it has to do with decisions that were made with regard to hospital
construction. The Purchased
Services is down $44.5 million from last year's budget, but I just would like
the details. I guess some of it has
to do with the Waterford.
MR. KENT:
Yes.
You are correct. The funding
in Purchased Services has provided for the acquisition, planning, construction,
and redevelopment of various hospitals and long-term care facilities.
The decrease in the revised budget is a result of some projects not
advancing as quickly as we had hoped.
There were construction delays such as weather delays, manpower
shortages, et cetera, and other delays in terms of getting the necessary
mandated approvals in place.
The
decrease in the 2015-2016 budget of $44.5 million – we have a number of
infrastructure projects in various stages of construction which would include
planning, site preparation, tendering, and actual construction.
Each project requires different levels of funding in any given year
depending on the stage of construction.
There
were a number of projects completed in 2014-2015 resulting in a lower budget for
this coming year. Those projects
would include the Labrador West Health Centre, the St. John's Long-term Care
Facility, and the two youth treatment centres in Paradise and Grand
Falls-Windsor. As a result of those
now being done, even despite all of the ongoing projects, we saw fit to be able
to reduce the Purchased Services budget accordingly.
MS MICHAEL:
The line above, the
Professional Services which was $5.7 million under in last year's budget and
$374,000 above this year.
MR. KENT:
It is a slightly simpler
answer on those lines. The decrease
from original to revised is a result of some projects not advancing as quickly
as originally anticipated. Again,
it is construction delays or delays in getting the mandated approvals in place,
but the estimates increase by $374,800 is actually an allocation error.
When adjustments were made to the budget, there was an error made in
where the adjustment needed to occur.
MS MICHAEL:
Okay, thank you, Minister.
Last
year you actually made your briefing notes available to us, the briefing notes
on your budget, that we found very, very helpful.
Would you consider doing the same thing this year?
MR. KENT:
Briefing notes on budget –
are you requesting documents that we are using here in the Estimates process?
MS MICHAEL:
Yes.
MR. KENT:
Yes, we would be happy to
make the information available.
MS MICHAEL:
That would be great, thank
you.
I will
add to what Andrew said and I will say thank you for being so up on your
ministry.
MR. KENT:
Thank you.
I am
going to preserve a copy of Hansard because it is not every day that I get two
members of different Opposition parties saying nice things to me, so thank you
for your participation. I actually
find, if approached the right way, this can be a very civil and productive
process. It would nice to see more
of this happening within the walls of this Legislature.
So I am happy to participate, and I want to thank all members of the
Estimates Committee for your questions and participation, even though two of you
really dominated today.
MS MICHAEL:
Thank you to all your staff
too for being here with us.
MR. KENT:
Absolutely.
My officials, while I get some of the credit and sometimes get blame,
they deserve the lion's share of the credit for us being as well prepared as we
are.
MS MICHAEL:
That is right.
MR. KENT:
I want to thank them for
their efforts as well.
CHAIR:
Thank you, Minister, and I
want to thank Committee members.
There
are just a couple of things we need to do to clue up.
We need to call the clauses.
I ask the Clerk to call the first clause, please.
CLERK:
Subhead 1.1.01.
CHAIR:
Shall 1.1.01 carry?
All
those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, 'nay.'
Carried.
On
motion, clause 1.1.01 carried.
CLERK:
Subhead 1.2.01 to 3.2.02
inclusive.
CHAIR:
Shall clauses 1.2.01 through
3.2.02 inclusive carry?
All
those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, 'nay.'
Carried.
On
motion, clauses 1.2.01 through 3.2.02 carried.
CLERK:
The total.
CHAIR:
Shall the total carry?
All
those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, 'nay.'
Carried.
On
motion, Department of Health and Community Services, total heads, carried.
CHAIR:
Shall I report the Estimates
of the Department of Health and Community Services carried without amendment?
All
those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, 'nay.'
Carried.
On
motion, Estimates of the Department of Health and Community Services carried
without amendment.
CHAIR:
Can I have a motion to
approve the Social Services Committee minutes from May 12, 2015 for the
Newfoundland and Labrador Housing Corporation?
MR. POLLARD:
So moved.
CHAIR:
Moved my Mr. Pollard;
seconded by Mr. Cornect.
All
those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, 'nay.'
Carried.
On
motion, minutes adopted as circulated.
CHAIR:
I remind Committee members
our next meeting of the Social Services Committee is Monday, May 25 at 6:00 p.m.
We will have the Department of Education and Early Childhood Development.
I want
to, as well, Minister, thank you for your openness this morning.
It is a pleasure to Chair when the minister is as open as you have been
this morning. I found it very
beneficial. I want to thank all
your staff for their time and effort they have put into this as well.
I thank the Committee members once again for their co-operation.
A
motion to adjourn?
Moved
my Mr. Pollard; seconded by Mr. Parsons.
All
those in favour, 'aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
Carried.
Thank
you.
On
motion, the Committee adjourned.