May 2,
2017
SOCIAL SERVICES COMMITTEE
Pursuant to Standing Order 68, Mark Browne, MHA for Placentia West – Bellevue,
substitutes for Betty Parsley, MHA for Harbour Main.
Pursuant to Standing Order 68, Steve Kent, MHA for Mount Pearl North,
substitutes for Tracey Perry, MHA for Fortune Bay – Cape La Hune.
Pursuant to Standing Order 68, Lorraine Michael, MHA for St. John's East – Quidi
Vidi, substitutes for Gerry Rogers, MHA for St. John's Centre.
The
Committee met at 9 a.m. in the Assembly Chamber.
CHAIR (Dempster):
Good morning everyone.
We'll
get started. Welcome to the Estimates for Health and Community Services
I want
to make note of three substitutions: Mr. Kevin Parsons will be sitting in for
Mr. Petten today; Mr. Hutchings will be sitting in for Mr. Kent. I'm not sure if
that's correct.
MR. KENT:
No, I'm sitting in for Mr.
Hutchings, I think.
CHAIR:
Okay. I've got the reverse –
as long as someone is there.
Mr.
Finn will be sitting in for Ms. Parsley. Some people may be en route, so I guess
there are no minutes to –
CLERK (Murphy):
Yes, there are.
CHAIR:
There are minutes. Okay.
Mr.
Browne is sitting in for Ms. Parsley. Okay.
We have
a set of minutes from Social Services Committee, May 1, Department of Education
and Early Childhood Development.
I'll
just ask for a motion to accept those.
MR. WARR:
So moved.
CHAIR:
So moved by Mr. Warr.
Thank
you.
On
motion, minutes adopted as circulated.
CHAIR:
We'll give the minister a
few minutes to introduce his staff and make a few opening remarks. I would just
remind people, for the purposes of Hansard downstairs, say your name at the
beginning each time you speak for the record.
Thanks
very much.
MR. HAGGIE:
Okay.
John
Haggie, Minister of Health and Community Services. To my immediate right is Ms.
Michelle Jewer, Assistant Deputy Minister, whose title may have changed in the
reorganization but essentially used to be corporate services.
To my
left, Mr. John Abbott, who is the Deputy Minister of Health. To his left is Ms.
Denise Tubrett who is the Assistant Deputy Minister for Regional Health
Services-ish.
Behind
Mr. Abbott is Ms. Tina Williams, Director of Communications for the Department
of Health and Community Services. Behind me is Ms. Alicia Anderson, Executive
Assistant to the minister. Behind Ms. Jewer is Mike Tizzard, the Controller
general of the department. Is that right, Mike?
OFFICIAL:
Departmental Controller.
MR. HAGGIE:
Departmental Controller. No
generals. Okay.
I don't
really have a lot of opening comments. Just to put it in perspective, the
Department of Health and Community Services is the biggest expense in
government. Over the period 2002 to 2017, health care spending has effectively
doubled from about $1.5 billion to $3 billion projected for 2017-'18. Our focus
has really been on trying to change the value we get for the dollars we spend
rather than focusing on absolute amounts. We've been talking about
cost-effective measures, innovative solutions in the short and long term.
In the
documents you'll see a number of variances for the department that can be
essentially explained with common themes. There's a decrease from the 2016-'17
budget to the 2016-'17 projected revised in the majority of the department's
Operating Accounts, things like Transportation and Communications, Supplies and
Purchased Services. This is really building on two things; one is the
expenditure management plan which was introduced 2011-'12 to reduce
discretionary spending. Then building on that is a zero-based approach that was
taken looking forward for 2017-'18. That cumulatively, those two measures,
account for a reduction of $510,700 over the course of that period.
The
department has also reduced its Operating Accounts by over $2.9 million, 57 per
cent compared with a baseline of 2011-'12. That is, again, a cumulative effect
from several initiatives. It was the first department to introduce a managed
print strategy. We have a very effective – one might even say rigid – inventory
control for office supplies. We've developed a policy regarding the purchase of
food and refreshments for meetings and we've increased significantly the use of
teleconferencing and video conferencing solutions.
I think
with that, it would probably be best use of the Committee's time if we were to
go through the Estimates book rather
than me to say anything else. Between us, I'll take the easy questions and the
really hard ones will go further back to the staff.
CHAIR:
Thank you, Minister.
So,
first responder, Mr. Kent, will have 15 minutes, and then for the remainder of
the morning it'll be 10 minutes back and forth. About mid-morning we will have a
five, 10 minute break, if that's okay with everyone.
Ms.
Michael?
MS. MICHAEL:
Madam Chair, I think you
were notified that I'm replacing Gerry Rogers for today.
CHAIR:
Okay. I don't have that on
my list, but for the record, Ms. Michael is sitting in for Ms. Rogers.
MS. MICHAEL:
Thank you.
CHAIR:
Mr. Kent.
MR. KENT:
You noted that Mr. Hutchings
will be sitting in for me. I'd be quite happy if he did, but I haven't been able
to find him yet this morning, so here I am.
Good
morning everybody. It's great to see some familiar faces. I said about two and a
half years ago that I never, ever aspired to be Health Minister, and I can
assure you I'm equally honest in saying that I never, ever aspired to be Health
critic. I avoided it for a year or so, but unfortunately have been saddled with
those responsibilities in the last number of months.
I
remain very passionate about health care. I learned an incredible amount during
the year I spent in the department, and I can honestly say the most talented and
passionate and committed people that I ever worked with in my time in public
service over the last 20 years were in the Department of Health and Community
Services. Some of them are sitting over with you this morning, Minister.
I've
got great respect for the work the department does. I didn't spend my career in
health care as you did, but even in the year I spent working in health care I
gained a real appreciation for the complexity and for the opportunity to impact
a lot of lives.
I know
we often focus on lots of the negative things that are going on in politics and
in government, and even in the health care system, but we don't focus enough on
the fact that the vast majority of people who have contact with the system have
positive experiences and their lives are improved as a result. So I won't go on
for too long with opening remarks, Madam Chair, but I did want to try and set
the tone for this morning.
Often
in this Chamber we get 45 seconds each to go at each other, and it's not
necessarily the most productive or informative. So I'm honestly hoping that this
morning we can have a more informed, productive dialogue, and I'll frame my
comments accordingly.
Anyway,
I continue to have great appreciation for the work the department does and that
the RHAs do as well.
CHAIR:
Mr. Kent, pardon me for a
moment. We just need to call the first – I let you start without calling the
first clause.
MR. KENT:
No problem.
CHAIR:
It's a slow start here this
morning.
CLERK:
1.1.01.
CHAIR:
Shall 1.1.01 carry?
We're
going to move through this – if it's acceptable to everybody, we'll just do it
by subheadings.
Mr.
Kent, go ahead.
MR. KENT:
Thank you.
Now
I'll speak to 1.1.01. Minister, if it's okay with you some of my questions are
sort of broad and impact multiple subheads, so I'll try and cover some of them
upfront. If you're comfortable and it makes sense to answer them that way, then
it may save us a bunch of time as the morning goes on but I'm comfortable with
whatever way you want to proceed.
One of
my initial questions related to 1.1.01 relates to some of the restructuring
that's going on in the department which I feel fairly confident in saying
couldn't have been easy. There are some sections of Estimates that have
significantly changed over last year. They're the ones I would have been
familiar with during my brief time in the department and ones that would have
been reviewed in last year's Estimates, even though I wasn't part of that
process.
For
example, some sections that are no longer identified separately include
Corporate Services, there are five: Corporate Services, Professional Services,
Regional Services, Population Health, and Policy and Planning. Now, just
anecdotally and just based on some of the discussion that has happened publicly
over the last month or so, I have some sense of how the restructuring has
happened but those five sections totalled about $30 million last year. I know
some of those responsibilities may now fall under the new departmental
operations heading but I'm having a little bit of trouble following the dollars.
I was
wondering if you might be able to begin by giving me some sense of where those
five sections are now included and identify where they could now be found.
MR. HAGGIE:
Sure. The departmental
reorganization essentially was phased and has resulted in the deputy minister
having three direct assistant deputy minister reports. What you will see in
1.2.02, under Departmental Operations, is a lot of those common functions that
you would have seen across Corporate Services, Population Health and the like
have been subsumed under that specific head there. Not all of them, because some
of the actual Grants and Subsidies dollars will still remain under, for example,
the provincial drug program. So there has been a homogenizing of those there.
It's
difficult to give you a categorical list simply because of the fact they've been
moved probably effectively twice over the course of the time. So it will pop up
from time to time, and I think the easiest thing to do is to highlight that
maybe as we go through and pick them up there.
MR. KENT:
Okay. Thank you.
Another
couple of upfront questions, I guess. In one of the other Estimates meetings
that occurred, we discovered there had been some technical or just mathematical
errors that had been discovered post-printing where some calculations had been
found that were incorrect and there are now adjustments being made or there will
be adjustments needed.
To your
knowledge at this point, are there any calculation errors that we should be
aware of? Or to the best of your knowledge, are the Estimates accurate as they
presently are presented?
MR. HAGGIE:
My understanding, and staff
will correct me, there are monies moved around from different heads as we've
alluded to.
MR. KENT:
Yeah.
MR. HAGGIE:
In actual fact, a bit later
on there's money moved in from outside, but I'm not aware of any mathematical
errors.
MR. KENT:
Okay.
MR. HAGGIE:
There may have been the odd
accounting adjustment but I don't think there's any –
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Yeah. I'm receiving
assurances that we're good on both counts, no mathematical or accounting issues
identified between last year's budget and this.
MR. KENT:
I'm not surprised to hear
that.
Thank
you.
Also,
related to your opening comments and zero-based budgeting, we've heard lots
about zero-based budgeting in recent weeks. Some of our caucus members had an
opportunity to be briefed by finance officials in the last week or so. Through
that process, we became aware of the $510,700 number that you referenced this
morning.
I have
the line-by-line breakdown of where the savings came from through the Minister's
Office, through Executive Support, through Departmental Operations. We can go
through the details, certainly, but I guess what I wanted to ask you upfront is
can you tell us a little bit about what that process looked like.
I
understand the principle of zero-based budgeting. That, I get. But I'm just
curious, practically, as you went through the department's budget, what did that
exercise look like? I've heard multiple ministers say it will have little impact
on operations. I suspect when I look at the line items that are impacted, in the
case of Health and Community Services that's probably true, but I'd just like to
– if you could give me a sense of how you went through that process, how you
tackled it and found the $500,000 successfully.
MR. HAGGIE:
Okay.
Yeah, I
mean, it was actually quite an interesting exercise because it got you down to
the level of operation in the department which was really – how many telephone
landlines do you need? We identified quite a number that were effectively
redundant, so we removed those.
We then
looked at the new organizational structure and said, well, how many people do we
need to be able to contact out of normal working hours? If the answer was yes we
did, they were the folk who got the Blackberries. We shed 11 Blackberries over
the department because of that approach to that issue alone. Each of those
generates a certain cost per month. So that wasn't factored in.
We
started with a blank slate and said, well, we need X-Blackberries where X was 11
less than last year, but we didn't look at last year's as a point of reference.
We looked at the new org chart and said how many do we need. Similarly, voice
mail, you pay for that service. How many people do you need voice mail on those
lines?
For
example, as well, in Transportation and Communications, we looked at travel for
the minister for FPT meetings. For example, we know for a fact there are two.
The minister will travel only with one person. So that's two tickets, no more.
That's your baseline. How much is that reasonably likely to cost? Then, bear in
mind, we have still some face-to-face meetings in association with the details
of the Accord money, for example, or the opioid strategy. Factor in maybe one
meeting each for those.
That's
the minister's travel, and the deputy will have two deputy meetings for Health
at PT level. The deputy will not take more than one person. How many tickets? So
you build up the budget for Transportation and Communications based on that.
That
was the kind of exercise we went through. I don't know whether that's specific
enough for you but I think that gives you a flavour of how it was done.
MR. KENT:
No, that is helpful.
Thank
you.
I'll
move to some more of the typical questions. I probably won't finish, Madam
Chair, in my two minutes, so I'll turn the floor over to Ms. Michael.
One
upfront question, would it be possible to obtain a copy of your Estimates notes
following this session?
MR. HAGGIE:
Yes, sure. I mean would this
binder be the sort of thing you're looking for?
MR. KENT:
That will be great. I think
it will feel familiar but I still welcome it, as I'm sure my colleague would as
well.
MR. HAGGIE:
Not a problem.
MR. KENT:
Regarding the Salaries in
1.1.01, the variance is minor. I'm sorry, I've mixed up subheads. It's exactly
the same for 1.1.01.
Given
the time, I'll pause there, Madam Chair, and let my colleague ask her questions.
CHAIR:
Thank you.
Ms.
Michael.
MS. MICHAEL:
Thank you very much, Madam
Chair.
Just to
put upfront so we don't have to say that at the end; obviously, whatever is
asked by either Party comes to everybody, that includes the binders.
Thank
you very much, Minister. I know you'll co-operate with that. We got it last year
quite well.
I will
be asking line by line and then at the end of each section I may have some
general questions. I'll put them in there as I go through.
MR. HAGGIE:
Okay.
MS. MICHAEL:
Thank you.
With
regard to 1.2.01, Minister –
CHAIR:
Ms. Michael, we haven't
called that one yet.
MS. MICHAEL:
Oh, just on 1.1.01. I have
no questions on 1.1.01.
CHAIR:
Okay. No questions on the
Minister's Office.
Well,
if it's okay we'll call – do you have more questions?
MS. MICHAEL:
It's too minor; the amounts
are very minor.
CHAIR:
Okay.
Ms.
Michael, do you want us to – we'll just go back to Mr. Kent.
MS. MICHAEL:
Sure, that's fine.
CHAIR:
Okay.
Mr.
Kent.
MR. KENT:
Thank you.
Some of
these questions, again, cross over subheads but I feel it's probably more
productive to ask them upfront.
Minister, given the changes that have happened in the department, I was
wondering if we could obtain copies of the revised organizational charts
including your branches and divisions and their responsibilities.
MR. HAGGIE:
It's in the binder.
MR. KENT:
Great.
I was
wondering if you could tell us how many people are employed in the department
today, I guess 2017 versus 2016.
MR. HAGGIE:
189.
MR. KENT:
And how would that compare
to last year? It would be slightly smaller I think.
MR. HAGGIE:
My recollection is it's not
much different, but we can get that number for you for sure. I don't actually
have it with me.
OFFICIAL:
I think it's 212.
MR. HAGGIE:
212, okay.
MR. KENT:
Okay. Thank you.
In that
total number, Minister, the 189, are all contractual positions included?
MR. HAGGIE:
Yes, there are three.
MR. KENT:
Would any temporary
positions, 13-plus week positions, would they be included as well?
MR. HAGGIE:
Yes. There's a table in the
binder for your perusal later.
MR. KENT:
Okay, excellent. It will
give me something to read this evening.
Positions eliminated, would it be possible to get the list of what positions
were in fact eliminated?
MR. HAGGIE:
Yes.
MR. KENT:
Is that in the binder as
well?
MR. HAGGIE:
It isn't. No, that was part
of the reorganization. What there is, is a list of positions and position
numbers that are there.
MR. KENT:
Okay.
So
related to the position numbers, as you went through your restructuring, I'm
guessing there were some PCNs that were eliminated. Could you confirm that was
in fact the case?
MR. HAGGIE:
I think there were. Yes, the
exact number we can provide you with. There was a net because there was a couple
created.
MR. KENT:
Right. So the new hires
would be assigned new PCNs or were they assigned to existing PCNs?
MR. HAGGIE:
A combination.
MR. KENT:
Okay. Thank you.
I
recall we had a 2015 attrition plan. I'm just curious, is that still being
followed by the department?
MR. HAGGIE:
No.
MR. KENT:
No.
MR. HAGGIE:
We've reorganized.
MR. KENT:
Okay.
MR. HAGGIE:
We feel we're as lean as we
can reasonably be within the department.
MR. KENT:
I would tend to share that
view.
Madam
Chair, that's all I have on 1.1.01.
CHAIR:
Okay, we'll call that one.
Shall
1.1.01 carry?
All
those in favour?
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against?
Carried.
On
motion, subhead 1.1.01 carried.
CLERK:
1.2.01 to 1.2.02.
CHAIR:
Shall 1.2.01 to 1.2.02
carry?
Shall I
go to Ms. Michael now? We'll let you start here.
MS. MICHAEL:
Okay. Thank you very much.
Minister, under 1.2.01, obviously the big question does relate to the Salaries.
I don't know how complicated it is because I assume there has to be complication
with the changes that have happened, but maybe not so much in Executive Support.
If you could explain to us the variance between last year's budget and revision
and now this year's budget, please.
MR. HAGGIE:
Okay.
Essentially, the Salaries there include deputy, three ADMs, secretary to the
deputy, three secretaries to the assistant deputies, director of communications
and a media relations manager. The difference between that structure and the
previous year is a result of removing two ADM positions and the retirement of
the medical consultant. There were some moves to consolidate the support
salaries in there as well. So it's a net.
MS. MICHAEL:
Okay. So right now you have
three ADMs and before this you had five ADMs. Is that correct?
MR. HAGGIE:
And a medical consultant,
yeah.
MS. MICHAEL:
Okay.
MR. HAGGIE:
There will be a copy of the
new org chart.
MS. MICHAEL:
Okay.
MR. HAGGIE:
Which I think is far easier
to see rather than for me to try and describe it.
MS. MICHAEL:
Yes, exactly. That is why
getting the briefing book is good.
We do
have your salary report as well here.
MR. HAGGIE:
Right.
MS. MICHAEL:
Under that there are two
contractual positions: one at $144,000 and one at $78,500. That's probably in
your briefing book also.
MR. HAGGIE:
It is. Yes, along with the
PCNs.
MS. MICHAEL:
But could we get an idea of
what the contractual work is?
MR. HAGGIE:
They are the legal counsel
for the department.
MS. MICHAEL:
Okay. Thank you very much.
Transportation and Communications, some variance. Now this usually does happen,
but maybe you can give us an idea. I think you have explained maybe why it's
gone down with regard to Transportation and Communications in terms of decisions
around travel, Minister, travelling only with one person, et cetera.
MR. HAGGIE:
It was really those two
items I referenced –
MS. MICHAEL:
Right.
MR. HAGGIE:
– in the more generic
answer, but specifically it was how many meetings would the deputy go to, who
would go with him, how many blackberries we need for what staff. So that's a
net, starting with a blank slate and working upwards.
MS. MICHAEL:
Right, thank you very much.
Moving
on to 1.2.02, you have given us an idea of the reorganization that's gone on. So
it's a bit hard here to get at differences in Salaries, et cetera. But again,
last year there was a variance of $120,000 difference between budget and
revision, and this year there's quite a drop: $414,200. If you can explain that,
please.
MR. HAGGIE:
The over expenditure between
'16-'17 revised and the budget is due to severance and paid leave costs, folk
that retired.
MS. MICHAEL:
Right.
MR. HAGGIE:
The projection for 2017
compared with the revised is a result of one-time termination costs in '16-'17
not being required in '17-'18, as well as changes from the management
restructuring, because the salaries that are included there are, for example,
we've got the departmental controller, we've got director of audit and claims,
pharmaceutical services, director of physician services, and there's a list
there which we can share with you when you get the binder. It's fairly well laid
out there.
MS. MICHAEL:
So basically I just want to
name this, because it's what our analysis tells us, and I think that's what
you're telling us, that the salary that was budgeted last year was basically the
salaries for corporate services, professional services, population health
professional services twice, regional services and policy and planning. Okay,
and that's still what's reflected in this year's budget.
MR. HAGGIE:
They've just been moved
under this one head instead of scattered across five.
MS. MICHAEL:
Okay, thank you very much.
That's helpful to get all that straight.
Under
Transportation and Communications last year underspent by $111,000, and this
year we'll still be below what was budgeted last year. Could we have an
explanation, please?
MR. HAGGIE:
Yes, sure.
We have
removed 36 land lines, 26 blackberries and 55 voicemails. So there's the
communications piece. The transportation piece, again, is an attempt to
stipulate upfront what the likely meetings are and specify numbers who will or
won't go.
There
was also money added to the travel budget from salaries and operating moved into
the department for Canadian Blood Services and mental health. They had been
previously posts that were under Eastern Health and were brought into the
department to reflect the provincial responsibilities.
MS. MICHAEL:
Okay, thank you very much.
Moving
on to Supplies, again, a reduction – what would that cover, that line?
MR. HAGGIE:
Again, a zero-based budget,
so we have essentially removed any discretion as far as is possible and
practical. Some of it was based on historical estimates simply because we didn't
have any accurate way of tracking it; but if you look at the expenditure, for
example, on office supplies: paper and envelopes: $36,000; printer cartridges:
$13,000; nutritional items were for meetings and the like worked out to $20,500;
and general office supplies: $24,200.
Again,
we've got those broken down for you in the book, but that's the general flavour
of what that went to.
MS. MICHAEL:
Right, thank you.
I
assume this will be broken down in the book too, but I would like to ask a
question around Professional Services. Last year it was underspent by $516,000.
This coming year, it is budgeted at $348,000 less than the budget last year.
MR. HAGGIE:
Yes. The reason for the
reduction was there was basically less audit review and appeals. We didn't spend
as much on mental health review board fees, and some of those items were
budgeted as a contingency and we've removed those, so it's a net.
MS. MICHAEL:
Okay, right, so no more
contingency.
MR. HAGGIE:
Well, it was a contingency
for consultant help and we completed a lot of that work in-house and we think we
can probably continue to do that.
MS. MICHAEL:
Okay, thank you.
Under
Purchased Services, again, underspent last year by approximately $150,000 and
going up by $56,000 this year.
MR. HAGGIE:
Yes. We've actually
transferred some funds from the regional health authority to cover a lease cost
on Topsail Road. We've moving one of the mental health walk-in facilities. We've
saved money on the lease by taking over a lease from a different government
department, but to do that we transferred the money in from Eastern Health
because if we reassigned the lease, we would have had to renegotiate it. This
way it's still under a government department, so it is a cost-saving measure on
the lease. We also had some reductions from a zero base and there's some federal
money for drug treatment which ended which we don't see recognized.
MS. MICHAEL:
Okay, thank you very much.
Under
federal revenue you anticipate $60,000 federal revenue. What would that be?
MR. HAGGIE:
The agreement is for
transfusion safety initiatives.
MS. MICHAEL:
Oh, and that's the result of
taking the blood services into this department?
MR. HAGGIE:
Yes.
MS. MICHAEL:
Oh.
MR. HAGGIE:
Sorry?
MS. MICHAEL:
Is that correct?
MR. HAGGIE:
It's a new one.
MS. MICHAEL:
It's a new one.
MR. HAGGIE:
It's a new agreement.
MS. MICHAEL:
Right.
MR. HAGGIE:
It's officially called the
Canadian Blood Safety Contribution Program agreement.
MS. MICHAEL:
Okay, which would have been
covered by Eastern Health before and now it's here.
Okay,
thank you.
The
provincial revenue is down by $75,000. Can you explain that?
MR. HAGGIE:
It was based on a review of
actual revenues received. The budget was adjusted by that amount.
MS. MICHAEL:
And what are those revenues?
MR. HAGGIE:
Defaults on bursaries, MCP
overpayments and refunds from vendors, those are the three categories.
MS. MICHAEL:
So basically the same as
other years we've gotten that answer as well.
MR. HAGGIE:
Yeah.
MS. MICHAEL:
I'll ask one general
question: In your booklet or in the briefing notes, will you have information on
things like the average call volume for the HealthLine and those specific kinds
of questions or should we put those to you directly?
MR. HAGGIE:
I think those are not
covered directly in here. We can provide that information, but I'm not sure that
we'd be actually be able to answer specific questions accurately. I can give you
ballparks, but if you want the actual, the real numbers as it were, that's not a
problem.
MS. MICHAEL:
Right. Okay, well, we'll
decide what we'll ask here and what we might put in the letter and just request
directly.
Thank
you. I may want to come back after Mr. Kent.
CHAIR:
Okay. That's fine.
Thank
you, Ms. Michael.
Mr.
Kent.
MR. KENT:
Thank you.
I have
a number of questions that are a little broader. I appreciate Ms. Michael's
questions which saved me from asking them.
Minister, I was wondering if you could give us an update on the status of the
restructuring of the Medical Transportation Assistance Program and just give us
an idea of where we are with rollout of that.
MR. HAGGIE:
Yeah, there are some
specifics further down in line items relating to that.
MR. KENT:
Okay. I thought it was here.
Sorry.
MR. HAGGIE:
But essentially we're
looking at a common point of entry across both our department and Advanced
Education, Skills and Labour.
MR. KENT:
Yeah.
MR. HAGGIE:
It will be a phased process,
but further on you will see there has been some money transferred into Health
from AESL to cover parts of that transition. It's a work in progress and it's
started.
MR. KENT:
I definitely support the
concept of bringing the two programs together, as some of the folks here are
aware. Have there been any impacts – I understand the budget shift has happened,
but have there been any impacts on staffing at this point? Have any personnel
moved from one department to the other, or have any jobs been eliminated on the
other department side to deal with the restructuring?
MR. HAGGIE:
At the moment, we've got one
person coming into the department from AESL but they're still on AESL's payroll.
They kind of come over and work with the MTAP folk.
MR. KENT:
Are there more staff working
in AESL dedicated to the program that are not coming over?
MR. HAGGIE:
Well, at the moment, as I
say, it's a phased approach.
MR. KENT:
Okay.
MR. HAGGIE:
We started with dialysis
patients in the first instance because they're a fairly stable, predictable
population.
MR. KENT:
Yeah.
MR. HAGGIE:
We have some software
challenges, as well as the actual nuts and bolts of having a common financial
entry. So we want to take it in bite-size chunks. At the moment, as I say,
there's just one individual, staff member from AESL who's familiar with their
program, who's working with our staff.
MR. KENT:
Thank you.
Do you
anticipate changes to eligibility criteria for the program, and have any changes
happened so far?
MR. HAGGIE:
Well, the answer to the
second question is no. At the moment it's up in the air because there are some
discussions about financial eligibility issues in general because between us,
our department for our programs and between AESLs, we've certainly got two, if
not three different sets of criteria.
MR. KENT:
Thank you.
Would
this be the appropriate time to ask about the Deloitte home support review? Does
that fit here or does it better fit elsewhere?
MR. HAGGIE:
It would probably fit
further down under the RHA really because the money for home support is included
by and large – it flows through the RHA and is managed by each regional health
authority.
MR. KENT:
Okay.
MR. HAGGIE:
In practical terms, it
doesn't really matter when you want to ask it because it's not specifically in
the book.
MR. KENT:
I appreciate your
co-operation. If you don't mind, then, I'll ask my couple of questions while
we're on the topic and not have to ask them again later.
MR. HAGGIE:
Fill your boots, as they say
back home.
MR. KENT:
Thank you.
I'm
just curious if you could comment on the overall cost of the home support review
and where you are with implementation at this point?
MR. HAGGIE:
Okay. The second part of the
question is that there is an update coming shortly about where we are with the
implementation, but the review actually had 24 or 25 points and it was presented
in such a way, they were grouped in terms of an implementation plan. So, really,
the kind of implementation plan was there. Currently, we have a staff member
engaged in consultation with stakeholders and the RHAs to get their feedback on
the nuts and bolts of actually running through that program.
So
we're in the beginning phases of setting the plan out in the sense of announcing
it. We're at that kind of final feedback stage. The report really contained an
implementation plan.
In
terms of the cost of that review, I would have to look around for someone to
give me the actual dollar figure.
OFFICIAL:
$250,000.
MR. HAGGIE:
$250,000.
MR. KENT:
Okay. Thank you.
Related
to that, in the government's Way Forward
document there was a commitment to implement a home support action plan. Can I
assume then that's the update that's coming shortly?
MR. HAGGIE:
Yeah, they're all together.
The Deloitte report contained an action/implementation approach. That action
plan that you've just referenced specifically is going to be essentially that as
the foundation.
MR. KENT:
Thank you.
Switching to personal care homes, are you continuing with plans to expand the
Enhanced Care pilot?
MR. HAGGIE:
Yes. That was a little bit
delayed rolling out because of some logistical factors basically in terms of
paperwork and implementing it through the RHA. My understanding is there are 40
individuals in 24 homes who have already taken advantage of that. I think there
were somewhere in the region of eight new hires because of the money put into
the program. Yes, I'm receiving nods.
It's
been a slower uptake than we'd thought, but I think some of that was essentially
because of the delay in getting it rolled out in the first place. It really
probably didn't pick up steam until fall of last year.
MR. KENT:
Sorry, Minister, I didn't
quite catch the numbers. Can you give those again?
MR. HAGGIE:
Twenty-four homes with 40
individuals out of 100 places that were available in the first run.
MR. KENT:
Okay.
Well,
24 homes is considerably larger. I believe we started with like four.
MR. HAGGIE:
Three.
MR. KENT:
Three, so that's good to
hear.
How did
you select the homes, or was there an opportunity for all homes to apply?
MR. HAGGIE:
It was the latter. Any home
that was interested and – it was usually client driven. If they had someone, it
was up to them to go to the local RHA to do that. I think there were some
challenges around initially communicating that, maybe. That may have led to a
bit of a slow uptake but we seem to have fixed those now.
MR. KENT:
What's the rate structure
for personal care homes that are participating? They would be paid a higher rate
for the enhanced care residents. I'm just curious what that rate structure looks
like.
MR. HAGGIE:
I could give you a ballpark
but we can get the exact figure for you.
MR. KENT:
Okay. That would be great.
Thank
you.
This is
another one where you may have to get the detail for me, but Chancellor Park,
which is familiar to some of the folks here I'm sure. I'm wondering what is
currently paid at Chancellor Park for a Level 3 bed.
MR. HAGGIE:
Again, I could give you a
ballpark but the exact figure we can find for you.
MR. KENT:
I appreciate that.
Thank
you.
Given
that this subhead covers NLPDP as well, I'm just curious if there are any
changes at all happening within the drug program in 2017-2018.
MR. HAGGIE:
The program itself, the main
thrust of it is to continue with efforts to use the national and regional
purchasing bodies to try and increase the proportion of generics, particularly.
Although, I think really we've got the low hanging fruit there at the moment. It
is, again, to try and use bulk purchasing to reduce the cost where possible, or
at least slow the rate of rise of cost through the drug program.
MR. KENT:
In doing so, as you work
through those processes at the Atlantic level and at the federal level, do you
anticipate making changes to our formularies as a result?
MR. HAGGIE:
I think the issue of a
provincial formulary; we effectively have that through the NLPDP because of the
listing process. I think from the point of view of the discussions at the
national level, we've seen the issue of the 117 essential drugs that World
Health Organization put out. One of the challenges, actually, is to Canadianize
that because of those 117 drugs. I think 40 or more of them are actually
specific for tropical diseases we would not see here but on a global scale
affect significant percentages of the population.
We
haven't engaged in any discussions along those lines specifically in any
granularity but it is part of the Pan-Canadian Purchasing Alliance discussions
of which we are a member.
MR. KENT:
Are there any plans to
consolidate the drug formularies? I understand and I appreciate your comments
related to the NLPDP formulary but there are still regional formularies. I'm
just curious, is it your intention to see those consolidated or are you
satisfied with the current structure?
MR. HAGGIE:
I think it may actually
occur de facto, because if you look at another piece, which is the shared
services concept, if you have a provincial purchasing system for the
institutions, which is a presumed, what I'm reading from your use of the word
regional formulary, then I think ultimately that would probably come to pass by
default.
MR. KENT:
Okay, and seeing as – oh,
I'm out of time. I have a couple more questions, but I'll hold them for now.
CHAIR:
On 1.2.02?
MR. KENT:
Yes.
CHAIR:
Yes, okay.
Ms.
Michael.
MS. MICHAEL:
Minister, I'll try to not
ask questions that are so statistical that we'll put in writing, but I have
questions that aren't. I'm interested in knowing what the status of the
midwifery implementation is. We have the regs in place, et cetera, but what's
happening with regard to implementing?
MR. HAGGIE:
The first piece was to find
a consultant whose responsibility would be two-fold, which would be to help
craft the professional end of things, in terms of regulations, educational
requirement, then to work on a policy level. Once that framework had been done –
and we anticipate that would be done by maybe mid to fall of next year, then
they would be responsible for helping recruit three midwives to the initial
pilot site, which will be located in a rural setting, probably Central.
They
would act as clinical lead and then move their policy development regulatory
piece to look at an urban site in the St. John's area somewhere. So the
interview process has been completed, and I think we'll be in a position to make
an announcement about the consultant in the not-too-distant future.
MS. MICHAEL:
So the implementation
coordinator is not in place yet, but you're in the process?
MR. HAGGIE:
I will hopefully be able to
make an announcement about that in the near future.
MS. MICHAEL:
Okay, thank you.
I'm
also interested in the rapid response team pilot project for seniors coming to
emergency rooms and wondering at this point in time what the outcomes have been.
I, just on a personal basis, know many friends actually – four or five – who've
really benefited from it. I'm just wondering how you've looked at it, how you've
evaluated how things are at the moment. Are the teams going to continue? Will
there be an expansion?
MR. HAGGIE:
There have been some
significant challenges on my initial read of the data in terms of making those
effective in terms of their stated goals. I'm pleased that you've had some
people who have had a successful result from those encounters. The report, the
jury isn't quite in, but I am pessimistic about their efficacy. On that basis,
given my other comments, then I think we'd have to look at a different way of
achieving the same ends.
MS. MICHAEL:
Can you give me some sense
of why you have that pessimism?
MR. HAGGIE:
Well, the figures I've seen
would suggest that each team sees less than four patients a week.
MS. MICHAEL:
Okay.
What
would cause that? Is that the nature of what gets presented to them (inaudible)
–?
MR. HAGGIE:
I think they're in the wrong
place, quite frankly. They're in emergency department; they need to be outside.
MS. MICHAEL:
Right, okay.
MR. HAGGIE:
By the time people get to
the emergency department, the ship has sailed.
MS. MICHAEL:
Right, okay.
So it's
not doing away with the teams but looking at where they're located and how it
might –
MR. HAGGIE:
I think they need to be
revamped as a minimum but, as I say, the jury is not quite in yet in terms of
what the data really show and what we're going to do with it. So I would reserve
final comment, but that's where my head is at the moment.
MS. MICHAEL:
Okay, thank you.
Because
the people I know for whom it's been effective, it's people who have had
accidents; friends who've fallen, sometimes in their homes, sometimes on the
street.
MR. HAGGIE:
And maybe that's a subgroup
for who that kind of approach would work but, by and large, it hasn't achieved
what we had hoped –
MS. MICHAEL:
Right. I think that is –
MR. HAGGIE:
Had been hoped when it was
set up.
MS. MICHAEL:
That's the group I'm aware
of because all the friends I'm talking about, that's their situation. So getting
through the service, being sent home, getting the home care immediately, being
able to do the physiotherapy, et cetera, at home has been extremely effective
for those people.
Thank
you. I am interested in a few other things that we've been waiting on for a
while, not just from your government, prior to you. The electronic medical
record, is this still being looked at? Is implementation being worked on?
MR. HAGGIE:
Yes, there are several
thrusts; NLCHI has the kind of electronic health record brief with regard to the
NLMA and their joint venture. There were 300 licences initially allocated. My
understanding is – 60?
OFFICIAL:
Fifty.
MR. HAGGIE:
We have the early adoption
of 50. At the moment we've had some discussions with Telus about the
requirements under PHIA to be able to link all those and, hopefully, those will
be settled very shortly, but there are 50 licenses up and running currently as
stand-alone. There is a connection issue.
MS. MICHAEL:
And the goal is 300?
MR. HAGGIE:
There were 300 initially
allocated. There are 200 expressions of interest, but I think the rollout has
been a little bit slower. Some of it, I think, relates to network issues around
PHIA and who is the custodian and who the company have to have agreements with.
Rather than just NLCHI, it should probably be under the PHIA, the individual
practitioner who's using the licence because, technically, they are a custodian
under the law.
There
is a PHIA review ongoing at the moment. We haven't received that report yet.
MS. MICHAEL:
Okay.
MR. HAGGIE:
That was that five-year
assessment mandated or written into the original act.
MS. MICHAEL:
When do you hope to get that
report?
MR. HAGGIE:
The commission is up and
running. Dr. Morgan is its chair. I don't have a timeline yet, but I was led to
believe it wouldn't be a lengthy process.
MS. MICHAEL:
It would be or wouldn't be?
MR. HAGGIE:
It wouldn't be a lengthy
process.
MS. MICHAEL:
Wouldn't be.
Thank
you.
With
regard to the ambulance central dispatch centre, what's happening with that?
MR. HAGGIE:
Internally we are at the
stage of trying to craft some specific requirements, but we feel that is the
next step in terms of the improvement and stabilization of the ambulance service
in general across the province. It's very much on our radar, but there's been a
little pause because of this process here which has seized the department's
activities for the last little while.
MS. MICHAEL:
Okay, I'm glad to know it's
still on the radar.
MR. HAGGIE:
Oh, very much so.
MS. MICHAEL:
I think it's absolutely
essential.
MR. HAGGIE:
In actual fact, I had a
meeting about it yesterday.
MS. MICHAEL:
Okay.
MR. HAGGIE:
It's very active.
MS. MICHAEL:
Thank you.
I'm
also interested in and have great concerns with regard to our chronic disease
situation and needing a province-wide diabetes database. If you can bring me up
to date on the chronic disease and diabetes prevention and management programs
in the province.
MR. HAGGIE:
That really falls into a
strategy, a plan to deal with chronic disease in general as an umbrella. Whilst
diabetes has been very much a talking point simply because of its numerical
size, I mean we would envisage a stream for COPD, congestive heart failure; we
have the kidney program and also then diabetes.
In
terms of the specifics of a registry, we currently have a database. One of the
challenges has essentially been to get that converted from a database into a
registry. That had never been done with anything. Recently, we did that with the
Cancer Care Registry. That's become the database. Well, there were five, in
actual fact, which were amalgamated under the Newfoundland and Labrador Cancer
Care Registry.
That
process has been completed and now will act as a template for the other
diseases. Diabetes is the next one in the stream currently waiting for privacy
impact analysis, which the regulations, the legislation, stipulate has to
happen. That's been completed and I'm waiting to get that on the diabetes piece.
That's the final piece before then we put the package together and submit that
through the same process that we did with the Cancer Care Registry. So it's in
train, but it's one of those pieces where there's some crafting of regulations
and legislation needed.
MS. MICHAEL:
Okay, thank you
Could
we have an update on the chief medical officer review?
MR. HAGGIE:
I have no role in that,
directly; that's done through JPS. My understanding is the Office of the Chief
Medical Examiner was reviewed. I met Dr. Bowes, when he came over. My
understanding from comments from the Minister of Justice is that he expects that
report to be delivered to him in the near future.
MS. MICHAEL:
Okay, thank you.
A real
concern that I have: Government did commit to eliminating the IQ 70 threshold
for services to individuals with autism and create a provincial autism strategy.
Where are things with that? Because we all know autism is a growing issue here
in the province
MR. HAGGIE:
I think there's been a shift
in the way we've approached that in the sense that certainly in discussions with
Children, Seniors and Social Development, who have a significant role in this,
the idea is to look at functional capability and capacity for folk with
disability rather than diagnose these specific groups.
That
would roll into a more functioned-based assessment of people's exceptionalities
and abilities to cope in the community or with life in general. It has certain
implications that we are still trying to unravel between the two departments.
Again, it's an active file; it hasn't gone away. I think it's just a question of
there are more nuances to it than we'd anticipated.
MS. MICHAEL:
Well, certainly the
evaluation of functionality is the key thing. We all have enough knowledge of
autism to know that IQ is not the factor here –
MR. HAGGIE:
No.
MS. MICHAEL:
– but it's still there on
the books and we're still operating under it.
MR. HAGGIE:
The difficulty is – the
temptation to blow it up is enormous, but you really have to have something in
place for when you do. You can't just leave a vacuum. The challenge is how to
craft assessments that are evidence based and tested and makes sense to both the
disability community, CSSD, ourselves and community services, and also education
because there's a piece in that there as well.
MS. MICHAEL:
And I do understand that it
will require more resources from an HR perspective. I think it will require much
more time doing an analysis if you're looking at functionality and social
interaction than just looking at IQ.
Thank
you.
CHAIR:
Ms. Michael, are you
finished with that section?
MS. MICHAEL:
Yes, I am, actually.
MR. HAGGIE:
Just maybe to help the process; a lot of the questions that you've referenced,
both Mr. Kent and Ms. Michael, they are actually covered under other heads as
well because of the way this structure has changed slightly. So there's an
opportunity to beat these to death a bit more, if you want to.
CHAIR: Mr.
Kent.
MR. KENT: No, I
appreciate that and I appreciate the minister's willingness to be flexible
because I think we'll be able to whiz through a lot of the other subheads by
allowing us to cover some of these topics. Ms. Michael covered a number of
topics that I had intended to ask you about.
While we're still under this subhead, I had a few others
noted that I'll ask and then we'll perhaps move on to other subheads, but I
think they'll be much quicker, given your co-operative approach to the process
this morning.
Minister, in response to one of Ms. Michael's questions,
you mentioned moving a mental health clinic and you referenced Topsail Road,
which I have a keen interest in. I'm just curious if you could tell us a little
bit more about where the clinic is moving and what's the impact on the Topsail
Road site.
MR. HAGGIE: My
recollection is that the clinic is on Ropewalk Lane and is going to Topsail Road
because the lease has expired. We could take over a TW lease with a property
that was suitable at a lower cost – have I got that the right way around?
OFFICIAL: Yes.
MR. HAGGIE:
Sorry, people are talking behind me and I'm wondering if I'm digging myself a
hole here.
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Carry on digging, yes.
MR. KENT: They
used to cut me off when I'd do that.
MR. HAGGIE:
They obviously don't like me as much.
MR. KENT: I
doubt that. I think they probably like you more.
MR. HAGGIE: To
resume – the lease was up, the space on Topsail Road was already in a longer
lease, is suitable and was underutilized.
MR. KENT: Are
we talking Mount Pearl Square or are we talking another site on Topsail Road?
OFFICIAL:
(Inaudible.)
MR. KENT: Oh,
west end, next to Jungle Jim's.
MR. HAGGIE:
They're virtually adjacent to each other because that was one of the reasons why
the move from Ropewalk Lane was potentially difficult because it services a
clientele who have significant transportation/mobility challenges.
MR. KENT:
Right.
MR. HAGGIE: So
we kept them there. The lease would have been held by TW and was still in its
early stages. So rather than reassign the lease to Eastern Health, we took the
money from Eastern Health into the department and reassigned the lease between
departments in government.
So effectively, TW still takes the lease; we pay TW on
behalf of Eastern Health.
MR. KENT: Okay.
MR. HAGGIE:
That's how the money flows, and it's open, by the way.
MR. KENT:
Sorry?
MR. HAGGIE:
It's open. The move has taken place.
MR. KENT: Okay.
So the clinic has moved but there's been no change in services, other than the
location?
MR. HAGGIE: No,
nothing. It's just a cheaper lease and a suitable space in the same area.
MR. KENT: That
makes sense.
OFFICIAL:
(Inaudible.)
MR. HAGGIE: Oh
yes, we did combine Ropewalk with another facility. What was that one?
OFFICIAL:
Again, it was mental health.
MR. HAGGIE:
Yes, we put two mental health clinics, one from Ropewalk Lane and another one in
the same building.
MR. KENT: Where
was the other one coming from?
OFFICIAL:
(Inaudible.)
MR. KENT: It
was on that stay, okay. So it's a consolidation but the clients are still being
served. So staffing is moved together; there are no cuts.
MR. HAGGIE: The
constraint was the clientele that we served were not able to travel at
significant distances.
MR. KENT:
Right.
MR. HAGGIE: We
have not altered any of the staff or any of the reporting structures.
MR. KENT: Okay,
thank you for the explanation.
You mentioned shared services earlier. I was just wondering
if you'd give us an update on where you are with implantation of the shared
services organization.
MR. HAGGIE:
There are documents in the system going up to Cabinet in the not-too-distant
future about initiating the first block of shared services, which would be the
block that was being worked on at the transition, which was inventory and supply
chain.
MR. KENT: So
inventory and supply chain hasn't been implemented at this point, but there's a
Cabinet Paper pending?
MR. HAGGIE:
Yes.
MR. KENT: And
the reason for the delay would be the fact that we got kicked out of government?
MR. HAGGIE:
Well, the reason for the delay was reworking some of the organizational
structure and there are some software challenges around IT. The question was the
affordability of some of the options, quite frankly, given the fiscal situation,
but we think we have a way to examine that, which will allow us to proceed with
setting up the organization.
MR. KENT: I'm
pleased to hear you are moving forward with supply chain and purchasing and all
that goes with it. I'm wondering, are you still committed to the consolidation
that was envisioned in the original plan? Are you still moving forward with the
rest of the shared services approach in other areas?
MR. HAGGIE:
There are, as far as I can recall, four or maybe five areas that were discreet
entities where there was duplication in each of the RHAs and kind of a low
hanging fruit that had been worked up the most was supply chain and inventory –
MR. KENT:
Correct.
MR. HAGGIE: So
that's why we started with that. The others are in different degrees of
preparation and there are also different views as to their practicality in terms
of bang for your buck by moving to that kind of model. So we would see
moving ahead with certainly
one or two of the others, whether number five would ever be doable – and I think
that was the IT piece, but I couldn't swear to that. But they were at different
levels of practicality, and some of that may be down to the fiscal challenges of
the up-front investment if you wanted to move to a common IT platform, for
example.
MR. KENT:
Yes, and that was actually
the next thing I was going to ask you about, because I recognize the significant
costs of consolidating a whole bunch of independently functioning IT platforms
that exist within the health care system. Meditech alone is quite complicated,
as I'm sure you've gained an appreciation for, if you didn't have one already.
I'm
just curious – well, first of all, I'd respectfully encourage you to keep
pushing on the IT front because I think there are potential efficiencies and
savings that can be realized, even if it takes a number of years to get there by
consolidating those systems and processes.
Could
you give me an update on where you are with Meditech consolidation and dealing
with the technology challenges in the system overall?
MR. HAGGIE:
At the moment, the Meditech
piece, the last bit, was the amalgamation of Lab-Grenfell with Eastern Health.
Immediately prior, or probably around the same time, there'd been an
amalgamation of the Central-East and Central-West as they had been systems. That
was moved to Grand Falls-Windsor on the basis that their hardware was newer than
Eastern Health's, even though their software iteration in Central-East was newer
– because Meditech, as you know, is a hardware and a software platform. It can't
be run on any machine; it has to be run on dedicated hardware.
At the
moment, that piece is paused essentially. There hasn't been any more
amalgamation of Meditech across the province. What has happened in the last
little while is the completion of the telepathology. That runs through a
different system analogous to PAX. The challenges there have been quality of
images, because the resolution there requires colour.
That's
rolled out, and I'm told in recent conversations with a couple of pathologists
that that's working very well, certainly on an intra-provincial basis. There are
some challenges in hooking up with outside jurisdictions directly on an
electronic basis because of the deficiencies in their hardware, not ours.
They're not up to date. Manitoba is the only other iteration that's got the
telepathology.
We're
looking again in a slightly different direction with a similar process for
non-invasive cardio respiratory data, so the Epiphany system. But in terms of
Meditech specifically, that's kind of paused at the moment.
MR. KENT:
Okay. I appreciate the
explanation.
My
final question related to this subhead – well, not related to this subhead but
I'll ask it anyways – is just to pick up on your commentary with Ms. Michael
related to EMR. Did you say there have been 200 applicants? There were 300
spots. There have only been 200 applicants from fee-for-service physicians? Is
that what I heard you say?
MR. HAGGIE:
There are 200 expressions of
interest and 50 of that subset actually have the hardware up and running,
software.
MR. KENT:
Two follow-up points. That
surprises me. I'd welcome your thoughts on why only 200 because my thought was
the 300 would be snapped up really quickly and there would be a demand for more.
So it's interesting that hasn't happened. I'll ask you one question at a time.
Can you share your thoughts on why that is?
MR. HAGGIE:
Wearing a hat I used to
have, I would suggest that given the demographic of a lot of fee-for-service
practitioners in this province, a significant number of them are at that: I've
only got five years; I'm not going to learn new tricks. I've got a system that
works for me, whoever takes over can look at that.
I think
there's an element of that because certainly we do have the same demographic
bulge in the fee-for-service physician population as we have in the population
in general. There's a significant predominance of practitioners in that 55-65
age group.
MR. KENT:
Okay.
MR. HAGGIE:
I think that's part of it. I
think to be honest the others are probably waiting to see the results from the
first 50. Word of mouth is going to be your best advertisement in that group.
MR. KENT:
Yeah.
MR. HAGGIE:
I think the full
functionality of the system hasn't actually become apparent yet because of the
discussions between Telus and the individuals concerned over this PHIA element.
But we think we've got that resolved and hopefully, once they get online and see
the connectivity piece – which really is like night and day when you compare the
two systems, stand-alone versus connected – I think the buzz that will generate
will be the next kick to get the other 150 onboard and then the next 100 may be
interested.
I think
probably the number 300 is about the right place to be for fee-for-service
physicians currently. We have only 589-odd primary care physicians in the
province and the 300 will probably take care of the fee-for-service ones.
MR. KENT:
Oh, okay.
Madam
Chair, can I ask for leave to just ask my final follow-up question related to
this?
CHAIR:
Are you okay with him –?
MS. MICHAEL:
(Inaudible.)
MR. KENT:
Can I just ask one more
question, Lorraine, if you don't mind, just quickly?
MS. MICHAEL:
Oh, sure, yes.
CHAIR:
Mr. Kent.
MR. KENT:
Thank you, Madam Chair.
Just a
final question on that issue – I was receiving a small amount of pressure from a
number of salaried physicians who also saw value in accessing the system. So
given that there are only 200 fee for service have applied at this point, has
there been any consideration in places like Labrador West, for instance, just to
use a random example, to allow salaried physicians who might have an interest to
access EMR and be part of the initial 300?
MR. HAGGIE:
It's funny you should
mention that. Yes, we have some discussions with Telus around what enterprise
solutions may be available, for example, rather than steal from the NLMA's pot
of licences.
MR. KENT:
So you would use a different
system?
MR. HAGGIE:
No, same system, but they
call it an enterprise solution for some reason.
MR. KENT:
Okay.
MR. HAGGIE:
It's a different licensing
arrangement.
MR. KENT:
So it's just about
licensing?
MR. HAGGIE:
Yeah.
MR. KENT:
It would be the same
platform?
MR. HAGGIE:
Same stuff.
MR. KENT:
Okay, that's –
MR. HAGGIE:
It's just how it gets the
money back to Telus.
MR. KENT:
That's good to hear. I'm
glad you're continuing to solve some problems that were lingering.
That's
it for me on this subhead, thanks.
CHAIR:
Okay.
Ms.
Michael.
MS. MICHAEL:
Thank you, Madam Chair.
Just
some questions, Minister, with regard to mental health and relating of course to
the report of the All-Party Committee, and just to say, just of interest to you,
last night I did attend the public forum that was held by the coalition on
mental health at city hall, and there were about 50 people. There were six
tables with eight at each table and then you had the committee and some others
there.
There
was a general, very positive reaction of the 50 people who were at the tables to
the report and I think had some good comments to make to the coalition, and they
were also members of your provincial advisory committee there as well.
So I
thought it was a very good session and we all encouraged the coalition to have
more of these sessions, but it was a very positive response, just to put that
out.
MR. HAGGIE:
Good.
MS. MICHAEL:
Having said that, the
province has committed to spending 9 per cent of the health budget on mental
health and addictions by 2022. How is that going to happen? What is your plan or
do you have it in place yet?
MR. HAGGIE:
No, the undertaking from
government's side was that there would be an implementation plan in place by the
end of June, and we're on track to deliver that. The budget did actually
allocate $5 million specifically for actions that would fall out of that plan.
In
addition to that, whilst we haven't finished our discussions with the federal
government, they have suggested that they would give us $2.5 million of the
mental health money pot for use on a fairly liberal basis outside of whatever we
agree subsequently in terms of mental health. Their emphasis is very much on
access for youth as a subset of mental health in general.
I think
at the moment we've made steps on that journey, but in terms of an exact plan, I
think we need to wait for the implementation plan to come out.
MS. MICHAEL:
Is the department working
with the RHAs in creating that plan?
MR. HAGGIE:
Yes. Not only have we done
that, as you will see from the new organizational chart, the director of Mental
Health now reports directly to the deputy minister.
MS. MICHAEL:
Right.
MR. HAGGIE:
We've tried to streamline
internally in the department to make sure that there is a ready route for mental
health issues to get the level of attention they need to get fixed.
MS. MICHAEL:
In the spirit of a lot of
the recommendations, but one in particular from the All-Party Committee, are you
engaging the community in this discussion as well?
MR. HAGGIE:
Yeah. I mean one of our
ports of call, really, is the provincial advisory committee which is really a
very large table of groups and coalitions.
MS. MICHAEL:
Right.
MR. HAGGIE:
I think it's a fairly
Catholic with a small “c” church as it were. I think, in addition to that, we
have our usual meetings with a variety of groups like CMHA, the coalition and
others. So I don't think there's any shortage of voices eager to have some say
or some commentary on what we've proposed even to date.
MS. MICHAEL:
Thank you.
Separate from that, are you – well, I know you're still working on it, but when
can we expect to see the new methadone treatment policy?
MR. HAGGIE:
Again, that's a specific
subset. One of our challenges that's highlighted in the All-Party Committee
report is really a grounding in addictions medicine within the province, and I
use that really with a small “m” as much as a large “M.”
One of
the recommendations is that there be some kind of academic lead within the
university to help build a body of expertise. To be honest, I think methadone as
a title may be outdated. I think I would much prefer to refer to opioid
dependency treatment as an umbrella term.
One of
the challenges is the potential for Suboxone and removing barriers to access for
that and making sure it is the – really for youth, particularly. The evidence
would suggest, I'm told, that should be the first-line treatment rather than
methadone. I think rather than get hooked on the labels of methadone and the
baggage that that carries, I'd much prefer to see a more widespread availability
of opioid dependence treatment, not otherwise specified, and leave that to the
individual practitioners. As I say, I think the fundamental to underpin that
would be some kind of educational/academic base for addictions medicine.
MS. MICHAEL:
Okay.
Thank
you. I think that's the end of my questions at this point.
CHAIR:
Okay.
Mr.
Kent, you were finished with that subhead as well?
MR. KENT:
I was.
CHAIR:
So we'll call that, okay.
Shall
1.2.01 and 1.2.02 carry?
All
those in favour, ‘aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, ‘nay.'
Carried.
On
motion, subheads 1.2.01 and 1.2.02 carried.
CHAIR:
We'll do one more subhead
and we'll take a brief break.
CLERK:
2.1.01 to 2.3.01.
CHAIR:
Shall 2.1.01 to 2.3.01
carry?
Ms.
Michael had four minutes on the clock. Do you want me to just start clean with
Mr. Kent?
MS. MICHAEL:
Sorry, I wasn't listening.
CHAIR:
Okay.
MS. MICHAEL:
I was concentrating on
(inaudible).
CHAIR:
You did have three or four
minutes on the clock. Do you want me to start with Mr. Kent and we just go 10
and 10 again or –?
MS. MICHAEL:
Yes, and we're going all the
way through to 2.3.01 without a break?
CHAIR:
Yes.
MS. MICHAEL:
Is it possible to have the
break earlier than that?
CHAIR:
We can have a break right
now if it's okay with everybody. We're about midway through the morning; take
six or seven minutes.
MS. MICHAEL:
If we could, that would be
helpful.
CHAIR:
Okay. Is that okay with you
guys?
Okay.
All
right, so we'll resume at 10:25.
Recess
CHAIR:
(Inaudible) are starting
with Mr. Kent, I do believe. Was that how –? Yes, Ms. Michael is okay with –
because she did have four minutes on the clock but we'll start with Mr. Kent on
the 10 and go.
Okay,
Mr. Kent, 2.1.01.
MR. KENT:
Thank you.
For the
record, in the spirit of co-operation and openness, the Opposition currently
controls the majority of the Estimates meeting and would be able to vote down
the Estimates if we wish to do so, but in the spirit of co-operation, and given
the minister's tone and approach this morning, I'm not going to make a motion to
vote down the Estimates even though I have technically the ability to do so. I
hope that that's duly noted for the record.
CHAIR:
I'm noting that there is
some good in you.
MR. KENT:
There's more good in me than
the minister probably realizes, but that's understandable.
OFFICIAL:
(Inaudible.)
MR. KENT:
Yeah, right.
Let's
move on to 2.1.01; Minister, I don't have a lot of questions on 2.1.01 because I
already asked you this morning about NLPDP, but could you make a general comment
on the increase of, it is roughly $6.2 million in the Allowances and Assistance
line.
MR. HAGGIE:
The change is basically a
net. On the book here we'll give you the details of what that net is, but
essentially you have an annualization of the Smoking Cessation Program which is
a plus of $12,000. You have some annualization of budget deficit reduction
initiatives from last year which is a negative of $1.75 million. GRI
initiatives, the NLPDP reform around over-the-counter medications and changes to
the foundation in 65Plus, that's a negative of $552,000.
There
was funding back from the 2015-16 budget. There was $5 million taken out for
pharmacists for compensation and we did not achieve that so we put that back. We
haven't renegotiated that.
Projected revenues have increased due to an increase in expenditure for
therapies, PLAs. The average increase in expenditures coincides with this trend
and it's offset by an increase in revenue of $3.5 million. So there's a net
there, and that's explained in the booklet in a bit more detail.
MR. KENT:
Thank you.
MR. HAGGIE:
Rather than trying to
remember those numbers, if you're anything like me.
MR. KENT:
Yeah, no problem. I'll
review them in the booklet then.
I have
no further questions on 2.1.01.
CHAIR:
Mr. Kent, it's been called
up to and including 2.3.01.
MR. KENT:
Oh, okay. Well then I'll
carry on.
Minister, related to Physicians' Services, I recall the annual increases that
occur in that area even if you stand still, so to speak. Do you want to briefly
comment on the $12.7 million increase under Physicians' Services under
Professional Services?
MR. HAGGIE:
Yeah.
That is
an accommodation of a forecast provision for fee-for-service utilization and
manpower increases, and funding for the new agreement within the LMNA itself. So
that breaks out at $5.5 million for utilization and increases, and $7.259
million for the new agreement with the LMNA, the MOA.
MR. KENT:
So moving on to 2.2.02,
there's been a slight decrease in the Professional Services related to
dentistry. I was just wondering why that would be. We saw significant changes to
dental services last year, I've commented on that in the past. I'm just curious,
what changes are occurring to dental services in this year's budget, and is the
decline in Professional Services related to last year's decisions?
MR. HAGGIE:
There's no change to the
dental plan this year. The changes were as a result of an annualization of the
initiative from the previous year.
MR. KENT:
Okay, thank you.
Madam
Chair, you said to go as far as 2.3.01, is that correct?
CHAIR:
Correct.
MR. KENT:
I guess a general question
then on 2.2 and 2.3, the ones we just talked about. We had some back and forth
publicly around the budget process and anticipated cuts. While we have an
opportunity to actually have a conversation – and I really appreciate your
directness and openness this morning. What I recall from going through this
process, when I sat in your chair, is that before we started the process we
faced a 3 per cent to 5 per cent increase just based on things like the issues
we just talked about: the contracts with physicians, demands on the system due
to aging demographics, other contractual obligations related to other health
professions and inflation. So based on that, to have what's effectively a status
quo budget overall, there would have had to have been some savings.
Now, I
tried to add up the numbers. We talked about, for instance, the savings related
to zero-based budgeting; we talked about the restructuring that's happened in
the department. That accounts for some of that savings, but there would still
have to be significant – and I know we're not in the RHA budget yet, so I can
ask the same question then, but my question is: Overall in the system, how did
you find the savings, because the zero-based budgeting and the restructuring
wouldn't produce that 3 per cent to 5 per cent, based on my quick math.
Are the
RHAs simply going to run larger deficits, or have there been other savings
realized to get you to what's effectively a status quo budget overall?
MR. HAGGIE:
Well, I mean if you look
back at the trend for the Health budget over the last five years, in actual fact
the flattening started the end of 2012 really, and plus or minus 1 per cent
seems to have been where you've landed pretty well with every budget from 2013
right up to today.
I think
in general there has been within the department a very conscious decision to
say, what is the value of any dollar that we spend? We have done a very thorough
job, I think, within the department itself of looking at the dollars. I think
zero-base is a useful epithet. It's a useful label for it, but the concept of
actually examining what you're spending and avoiding spending things that you
don't need to you. What's your core business? So I think that's part of it.
I think
in terms of the drivers, quite frankly, the federal government may have had some
justification for saying that simply putting 6 per cent escalator per year
hasn't produced any increase in value.
MR. KENT:
I agree.
MR. HAGGIE:
I would flip that around to
say that in terms of the dollars spent, having a fairly static budget since 2013
has not produced any reduction in value from the consumer's point of view.
I think
really what we're doing is by an approach between the department and the RHAs is
to say where is the money going and is that a wise use of the money? When you
look and stand back globally, it's actually very difficult to pinpoint any one
thing in all those moving parts that's made the difference. I think the
difference is cumulative on lots of little moving parts where you have managed
to not spend more than last year.
MR. KENT:
Okay. I appreciate that
explanation. While I definitely don't have your experience, and you've been in
the portfolio for already much longer than I was, I do have some appreciation of
the challenges you face and, obviously, a unique perspective as a result.
When I
look at the overall challenges around system sustainability and the drive toward
system transformation, which is not easily achieved, when I see a request from
the NLMA – which we've also talked about publicly, so I don't intend to rehash
that, but when I see a request like that that says, okay, why don't we step back
and do sort of an independent review of services, locations and do it in an
objective, independent way that would potentially make some of the really
difficult challenges we face maybe easier to deal with, I just wonder why
government wouldn't embrace that kind of approach.
So to
me – and I'm saying this sincerely, it seems like a reasonable approach. I'm
just curious, is there an alternative approach you're taking that is the reason
why you wouldn't be open to pursuing the route that LMNA is proposing in terms
of that review?
MR. HAGGIE:
The LMNA and I, and the
department have been in discussions about their rebuilding NL, rebuilding Health
NL – forgive me if I've butchered their title. The eight points or nine points
they bring out are policies that have been extent in the department from your
time and even before.
MR. KENT:
I agree to a degree.
MR. HAGGIE:
It's not anything new.
There's no magic bullet in there.
One of
the things that has been going on, and it probably predates my time, is a
realization again of looking, for example, in mental health or in primary care,
or whatever, looking at each of those areas as a piece, recognizing it's a piece
of a bigger puzzle, a bigger machine but saying, well, what are we doing here?
What is best practice and how do we line up with that?
I think
what you've actually effectively had is multiple internal reviews as a way of
life. Certainly in the department now it is not unusual for people to come to me
and say, we went back and looked at that and we found a, b and c, what should we
do about it/
So I
think on one level the machine has become much more self-examining in the way it
deals with itself. I think by providing some overview and some strategic
guidance in terms of where things go the machine will by and large do that.
Stepping back, if you look from Lalonde in '74 all the way through the more
recent iterations of Kirby and Romano and those kinds of things, they're all
sitting on a self somewhere saying exactly the same thing having gathered dust.
People have cherry-picked a bit here or a bit there and run with what they
fancied.
The
biggest example of that was the Barer-Stoddart fiasco of the early '90s where,
suddenly, we were going to have way too many docs, they put the screws on and
then we have a huge gap in primary care. That was an example of a report that
didn't do what it was supposed to because people cherry-picked the bits they
want and ignored the rest.
My
view, in general, is that big reports, by and large, have tended not to add to
the discussion in terms of moving things along – sorry, they've added to the
discussion; they've not added to the action. Also, by and large, the bulk of
those have gathered dust, after delaying everything for 18 months or two years,
because people say we're not going to do anything now because we got this report
on the go.
In a
sense, we have colluded, in actual fact, perfectly legitimately I think, because
that's the other end of the argument on the issue around the All-Party
Committee. In a sense, you started that on a recommendation from the Third Party
and the consent of the House and ran with it. I think, on that situation, it was
perfectly justified because mental health, with the exception of Kirby, has been
ignored for 20 years, and that's your big review there that we've done.
You can
see, in a sense, that the discussion around mental health, all parties have said
let's wait for the report; let's wait for the implementation plan. There's been
a degree of, from the outside, community groups would argue paralysis; but, in
this particular case, I'd argue useful reflection and data gathering. But I
think out of mental health, a lot of that work has been done and done
repeatedly.
CHAIR:
Mr. Kent, I've been a little
bit lenient with the clock, and I know it's flowing good but I don't know if you
just want to hold that thought and go back to Ms. Michael.
MR. KENT:
With Ms. Michael's
permission, I'd like to ask one follow-up question, if that's okay.
MS. MICHAEL:
Fine with me.
CHAIR:
Okay, Mr. Kent.
MR. KENT:
I appreciate those comments,
Minister. The only thing I'd say in response is more an offer. I agree with you
on the mental health example. When I look at the challenges you face, when I
look at the challenges we face, I wonder if there are other issues.
What
I'd extend to you this morning is a sincere offer that if there's another issue
within health care related to the sustainability of the system or the kind of
transformation that's required, or even a more specific issue, if that kind of
collaborative approach would work to solve some of those challenges or to help
get us to a point where we've gotten with mental health, then that's something I
believe our caucus would be open to and I, personally, would be very open to.
Let's
face it, politics and party stripes aside, we all have a vested interest in
making the system better. When you talk about health care and when I talk about
health care, we're often saying much the same things about the general direction
and vision for where the system needs to go.
So if
those opportunities present themselves – in light of your comments a couple of
minutes ago – then I'd be open to a non-political discussion about that and
would rather be part of the solution than simply highlighting some of the
problems we know exist.
I have
no further questions up to 2.3.01, Madam Chair.
MR. HAGGIE:
Thank you.
CHAIR:
Thank you, Mr. Kent.
Ms.
Michael.
MS. MICHAEL:
Thank you very much, Madam
Chair.
Just
coming back to 2.1.01, Minister, a specific line item question: The provincial
revenue, could you explain what that's about and why there's been such a jump in
that?
MR. HAGGIE:
2.1.01, one moment and I
will find that for you. I can't turn the pages fast enough.
Provincial revenues: Projected revenues have increased due to an unanticipated
increase in expenditures for therapies that have PLAs. Does that answer your
question?
MS. MICHAEL:
No. Could you explain that,
please?
MR. HAGGIE:
Okay. The revenues from the
product licensed agreements are a slightly complicated issue, which I would
suggest somebody else would be able to answer better than I; it's a more
technical question.
MS. JEWER:
I can answer it.
MR. HAGGIE:
You can answer it? Fire
away, Michelle.
MS. JEWER:
What happened is when we sign PLA, product listing agreements, we get rebates
for revenue but we also have a corresponding expenditure because a new drug is
coming on. So what's happened, we're finding we're getting more rebates for
those drugs coming on, so revenue has increased. But there's a corresponding
increase in expenditure as well.
MS. MICHAEL:
Right, thank you very much;
that helps.
One
more question under 2.1.01; you gave information with regard to the smoking
cessation program in terms of the cost being annualized throughout the budget,
but could you just let us know what is happening with the program. Is it
continuing, is it doing well and could we have the figures for 2016 of the
numbers of people who went through it?
MR. HAGGIE:
The short answer is yes, we
can get you the figures. They're only globalized as a number in the booklet
here. But if you want the figures of people who have accessed the program, those
are fairly readily available and we can supply them for you.
MS. MICHAEL:
Okay, thank you very much.
I'll expect those, then.
2.2.01;
again, the only thing I'd like to ask here is something you will have to get to
us, I'm sure you don't have it there, but the number of family physicians and
the number of specialists in the province.
MR. HAGGIE:
It's in the binder.
MS. MICHAEL:
It's in the binder? That's
fine.
MR. HAGGIE:
There are 589 family docs
and 629 specialists.
MS. MICHAEL:
Great.
Thank
you very much.
MR. HAGGIE:
But the numbers are broken
down by region and by discipline for you.
MS. MICHAEL:
And are they broken down by
salaried and fee-for-service and alternate fee payments as well?
MR. HAGGIE:
They are, yes.
MS. MICHAEL:
That's great.
MR. HAGGIE:
There's a matrix and it's in
the book.
MS. MICHAEL:
Okay, that's great. We don't
need to go through that. We'll get that.
Thank
you very much.
MR. HAGGIE:
The global number is 1,209
as of the day that was done because they do tend to move around a bit.
MS. MICHAEL:
Right.
Thank
you very much.
Dental
Services; here it's just a question, again, with regard to statistics. Could we
have – this may be in your book as well, it probably is – the expenditures and
number of clients in the Adult Dental Program in 2016 and the same thing in the
Children's Dental Program for 2016.
MR. HAGGIE:
We can get those. I don't
think it's actually in the book.
MS. MICHAEL:
Okay.
Under
2.3.01, is that included?
MR. HAGGIE:
Yes.
MS. MICHAEL:
Yes, it is. That's part of
what we're discussing.
There
is a big reduction in the grant to the School of Medicine, $924,600. Obviously,
the School of Medicine had to deal with that cut. Do you know how they've dealt
with it and how they've been able to make this adjustment?
MR. HAGGIE:
This was a
Budget 2016 announcement. If you
remember, the grant to faculty went down by 3 per cent that year to this year,
one and one. It was predicted, there is a net because of the MUNFA collective
agreement which adds to that and the annualization of a Faculty of Medicine
reduction plan which was in place already beforehand. The GRI piece from last
year is the bigger chunk of that.
There
is a breakdown in the book. Essentially, the Faculty of Medicine reduction plan
talked about things like elimination of rental space. They had a team in place
to oversee the expansion of the seats from 65 to 80. That team is now being
dismantled because that expansion is complete, use of teleconferencing and a
variety of other issues there. They're in the binder in a bit more detail, but
that explains it for you.
MS. MICHAEL:
Thank you.
That's
it, Madam Chair, for me.
CHAIR:
Okay.
Mr.
Kent, did you have anything else up to –? Okay.
Shall
2.1.01 to 2.3.01 carry?
All
those in favour, ‘aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, ‘nay.'
Carried.
On
motion, 2.1.01 through 2.3.01 carried.
CLERK:
3.1.01 to 3.2.02.
CHAIR:
Shall 3.1.01 to 3.2.02
carry?
I don't
know – Ms. Michael, do you want to use your remaining four minutes and start?
MS. MICHAEL:
Yes, I can start off and use
that time.
CHAIR:
Okay.
MS. MICHAEL:
Okay, this one gets a bit
more complicated.
First
of all, just to ask this question then. Minister, I think the operating funding
for the Newfoundland and Labrador Centre for Health Information is not here.
That's new is it, coming in under this head?
MR. HAGGIE:
It's always been there.
MS. MICHAEL:
It's always been there?
MR. HAGGIE:
Yes.
MS. MICHAEL:
Okay.
Thank
you.
Coming
down, the Allowances and Assistance has gone up significantly, by $6,400,000, I
think – yes. Could we have an explanation?
MR. HAGGIE:
That's a net effect. The
bulk of that is the transfer in from AES, which I mentioned earlier on for the
medical transportation.
MS. MICHAEL:
Okay.
MR. HAGGIE:
That's actually $7.4
million.
MS. MICHAEL:
Right.
MR. HAGGIE:
There is a reduction of
that, of workforce planning bursaries, which haven't flowed through the RHAs in
the time that we'd expected. So they've been credited against that. The bulk of
it relates to MTAP.
MS. MICHAEL:
Okay.
Under
the Grants and Subsidies, there is a variance between the budget and the
revision last year. This year it's going up by $14.7 million approximately.
MR. HAGGIE:
Yes, it's a net result.
I've
got a detailed annex in the booklet for the RHAs, but essentially it boils down
to increases from minimum wage and JES. For example, new initiatives in primary
care, mental health and addictions in the Home First Program. Some of the
repairs and renos were re-profiled to capital, and there were new contracts in
place for home support personal care and the private road ambulances. Some
management reduction set against that and some annualization from previous
budget decisions, but there's a full sheet breakdown in the back of the book
that tops up to $14.69 million.
MS. MICHAEL:
That's great.
Thank
you very much.
Under
the Federal revenue, where does this fit with regard to the agreement with the
federal government with regard to funding, because we have a major decrease of a
million dollars?
MR. HAGGIE:
Yes, this relates to changes
with relationships with Health Canada, Workforce Planning Canada and an
agreement entitled the Project for Enhanced Rural and Remote Training, PERRT.
Again, there's a summary in the book and a detailed breakdown in the annex of
where those monies come from. So there are some increases in revenue from the
transfusion surveillance project, which would not have been budgeted, and the
breakdown is all there for you.
MS. MICHAEL:
Okay.
MR. HAGGIE:
Rather than me read it out –
MS. MICHAEL:
No, that's fine. Just so we
know it's there, we can find it.
Minister, where do we find the $2.5 million to expand the primary health care
teams? Where does that show up?
MR. HAGGIE:
It's in the Grants and
Subsidies.
MS. MICHAEL:
Pardon?
MR. HAGGIE:
It's in the Grants and
Subsidies. I was just looking to my right, sorry, I wasn't pointing (inaudible).
MS. MICHAEL:
Okay, so under number 10
there?
MR. HAGGIE:
Yes.
MS. MICHAEL:
Yes, okay.
Thank
you very much.
Do you
have a plan yet in how that's going to work?
MR. HAGGIE:
For the primary care?
MS. MICHAEL:
Yes.
MR. HAGGIE:
We are discussing locations
for primary health care teams. You remember, we did announce in
The Way Forward one for Burin and one
for Corner Brook.
MS. MICHAEL:
Right.
MR. HAGGIE:
The emphasis on those,
really, is because of gaps. It's to put something where currently very little
exists.
I think
in addition to that there are, however, some lower hanging fruit, if you might
call them that, of primary health care clinics, which are really functioning
almost at the level of primary care teams. With a little bit of money and a
little bit of extra support, maybe an addictions counsellor here or a housing
support worker there, or some alteration of the technology to include the EHR,
they could become primary health care centres as well.
So I
envisage over the next little while two streams. The difficult problem areas
where obviously there's a challenge but also those areas – and they exist
around the province – where there's very high quality primary care delivered by
pretty well the team that we would have envisaged on the basis of a needs
assessment doing
cutting-edge primary care.
It
would be very straightforward to be able to support them just a little bit
further and to put primary care teams there and label them as such. Not just as
a labelling exercise, but really to encourage the development of the teams in
more challenging areas so they can see areas where it's succeeded because I
think the best marketing tool for those kinds of primary care teams is examples
where they work well somewhere else.
It's
not all doom and gloom. We have some really good, primary health care team
environments, even though they're not called teams. I point you to Central and
Twillingate, for example, Botwood just down the road. I'm not trying to create
problems by leaving others out. I know of those simply from a geographical
perspective, but they're not the only ones.
MS. MICHAEL:
Right.
MR. HAGGIE:
I think it's very important
from time to time not to focus on all the problems but to enhance some of the
potential solutions that are already working.
MS. MICHAEL:
With co-operation from Mr.
Kent, could I just ask one more thing, directly related?
MR. KENT:
Go right ahead.
MS. MICHAEL:
I thought of this before,
but also as a point that was brought up last night at the forum. Is there a plan
to have on the primary health care teams or primary health care centres – I
prefer to use that term – to have mental health included directly in the primary
health care?
MR. HAGGIE:
Personally, I see no
difference, philosophically or practically, between good mental health and good
physical health. I would regard the primary care centre as a single point of
entry to the health care system or the wellness system – however you want to put
it. So if you go there with an addictions issue, a mental health issue, an
obstetric issue, the system works.
MS. MICHAEL:
Well, I mean that's what
exactly I'm looking for, and that would mean that part of the team then is
somebody to deal with – there are people to deal with all aspects of health. I
totally agree with you philosophically on that.
MR. HAGGIE:
I would see that as being an
integral part of a primary health centre or however you'd like to label it.
MS. MICHAEL:
Is that in place at this
moment or do we have a lot of improvements to make even with the centres that
are working well?
MR. HAGGIE:
Well, I think if you look at
the downtown collaborative, their emphasis is probably as much on mental health
and wellness and addictions as it is on physical health. They're virtually equal
workloads and inseparable.
You go
to Botwood, for example, they have recognized that their challenge there is they
would need someone with an addictions background to help them out, and then they
would have the complete suite. You go further west and Springdale or the clinics
there, which are very – there's a great emphasis on addictions and mental health
as part of primary care. It's not ignored, and certainly the newer practitioners
that are coming out are very conscious of tilting the balance to make sure that
mental health and addictions is included in every location where they practice.
MS. MICHAEL:
Right.
What I
would hope is that the work that's been done through the All-Party Committee and
through the recommendations would move us in that direction for a more holistic
approach to our health care, recognizing there are no compartments. You don't
put cancer over here and mental health over there, and something else somewhere
else.
MR. HAGGIE:
And that was clear from the
recommendations of the committee.
MS. MICHAEL:
Right.
MR. HAGGIE:
That was emphasized pretty
well on every page in some way or another.
MS. MICHAEL:
Right.
Thank
you very much.
CHAIR:
Mr. Kent.
MR. KENT:
Thank you.
Minister, the first specific question to budget lines that I'd like to ask you
relates to Allowances and Assistance. I suspect it has something to do with the
restructuring, but the amount budgeted this year is more than twice the revised
budget of last year. I am just wondering if you can explain why that would be.
MR. HAGGIE:
This is 3.1.01, line 09 is
it?
MR. KENT:
Correct, yes.
MR. HAGGIE:
That's the MTAP.
MR. KENT:
Oh, that's MTAP, sorry.
MR. HAGGIE:
Yes, that's the MTAP piece.
MR. KENT:
Okay, thanks.
Federal
Revenue, I presume, has fallen related to the expiration of a previous
agreement?
MR. HAGGIE:
Again, the binder has the
details, but it references a decrease in the net from workforce planning
agreement ending.
MR. KENT:
Okay.
MR. HAGGIE:
So that's a loss of revenue
of just under $500,000. Mental health drug treatment, two-year agreement offset
by federal funding ended, and that PERT program was just shy of $200,000 as
well.
Again,
there are some increases in revenue from the transfusion system. Revenue was not
budgeted, family medicine training, revenue higher than anticipated. There is a
page in the binder which explains all those net shifts for you there.
MR. KENT:
Okay, great.
Thank
you.
Moving
on to more interesting topics then; has the healthy living assessments for
seniors, have they begun at this point?
MR. HAGGIE:
The short answer is not yet.
MR. KENT:
When would you anticipate
that happening, and who would be responsible for doing it?
MR. HAGGIE:
One of the desires in the
department was to make it as easily usable as possible. So we would try and have
an assessment that could be used by a broad variety of folk who would interact
with that population and not just, say, an RN or a nurse practitioner or
anything like that. My anticipation is this will roll out over late summer and
fall.
MR. KENT:
Okay.
How
about the child health risk –
MR. HAGGIE:
Oh, sorry, I misspoke. It
will be next spring.
MR. KENT:
Next spring. So we're about
a year away.
MR. HAGGIE:
Yeah.
MR. KENT:
Okay.
What
about the child health risk assessments for school-aged children, can you give
us an update on that?
MR. HAGGIE:
The same, next spring.
MR. KENT:
And who would be responsible
for doing them?
MR. HAGGIE:
We are looking at community
level personnel but, again, we're trying to make that as user friendly as
possible so we don't restrict it to one particular kind of practitioner, given
the rural challenges we have with personnel sometimes.
MR. KENT:
What kind of deficits do you
anticipate the regional health authorities running this year compared to last
year?
MR. HAGGIE:
I'm hoping it will be zero.
MR. KENT:
I'll shake your hand if it's
zero.
MR. HAGGIE:
We have encouraged them to
do that.
MR. KENT:
I'd encourage my friends in
Gander to vote for you if it's zero.
MR. HAGGIE:
You have friends in Gander?
MR. KENT:
I don't have many friends
anywhere after the length of time I've been doing this work.
MR. HAGGIE:
I mean realistically
speaking, we have made the health authorities aware that they have a budget and
they're expected to live with it.
MR. KENT:
I don't want to put words in
your mouth, so I'll just ask a follow-up question. Do you anticipate the
deficits to be reduced?
MR. HAGGIE:
I would anticipate that as a
minimum.
MR. KENT:
Okay, that's good.
I don't
think that will be easy for the RHAs to achieve but I think it's a good goal,
and we'll see how that goes. Hopefully, I don't have to make phone calls to
people in Gander.
MR. HAGGIE:
I can give you some numbers.
MR. KENT:
I have a few, not many. It's
a lovely place, though.
I want
to talk about homes first, it's an initiative that I very much supported and
tried to find money for. I'm encouraged to hear recently that there has been
some money found for it. I feel like it fits very much with our previous close
to home strategy, and I know Eastern Health had a keen interest in pursuing
Homes First.
Can you
comment on what's envisioned as a result of the recent announcement? What will
that look like this year? Will it be specific to this region or will it be
province wide? What will that look like overall?
MR. HAGGIE:
Well, I think it's going to
look different in detail between an urban area and a rural area for sure. Some
of it, the challenge is to actually identify folk at a stage before they
decompensate. We had a discussion a little earlier about the rapid response
teams which, I think, were in the wrong place and a bit late.
MR. KENT:
Yeah.
MR. HAGGIE:
Essentially, my vision ties
in with the healthy living assessment in a sense that that's your screening
tool. What that would then do is allow you to identify those people who had
challenges and see if there are resources locally that can be employed to deal
with those.
It's a
very nebulous answer, but I think the answer is going to be very contextual in
terms of (a) where you live and (b) who you are. So something in the Member's
district in Cartwright – L'Anse au Clair is going to have to look something
different than Nain or in Gander or, in turn, in urban St. John's.
I think
there are elements there in terms of the Home Support Program; there are
elements there in terms of social inclusion. We don't really have a mechanism
identified, for example, to deal with social inclusion; yet, that's one of the
biggest determinants of certainly mental, psychological well-being in the
elderly.
One of
the challenges I see with the Home Support Program is that a lot of the time the
hours equate to company and not necessarily care. We don't have a way of dealing
with that. I think there's a huge opportunity there for not-for-profits and
community groups to become involved.
MR. KENT:
I agree.
MR. HAGGIE:
I know in some areas there
have been small pilot schemes with the community hours, for example, from high
school students. What they've done is they've introduced them to personal care
homes, long-term care homes to put a link between the elderly and the young.
Whether that would work in downtown St. John's or Gander is very much dependent
on the environment there as well.
So it's
an approach and I think it also feeds into another element really, which is the
Health-in-all-Policies approach. These things aren't so much purely fiscal as
they're policy, they're social issues. It's sometimes very difficult to finance
and certainly almost impossible to legislate.
MR. KENT:
Agreed.
You had
previously committed to streamlining the financial assessment process for
community support services and long-term care services, which is a goal that I
do support. Can you give me an update on where you are in that process?
MR. HAGGIE:
That feeds into the home
support action plan –
MR. KENT:
Okay.
MR. HAGGIE:
– and that work is in
progress. I'm not sure whether that will be one of the first parts of an update
or whether it will be an announcement of a work in progress because, as you
commented on earlier on, there are sensitives around that.
MR. KENT:
I'd like to ask you a few
questions about long-term care but I suspect we'll run out of time. So I'm going
to let Ms. Michael continue with her questions and then I'll pick up where I
left off.
CHAIR:
Thank you.
Ms.
Michael.
MS. MICHAEL:
Thank you very much.
Continuing along with these types of questions; I do have some statistical ones
but I'll hold those. What we'll do is if the answers are in the briefing book
we'll look for them; if not, then we can go seek them rather than name them all
here. Some are general ones.
With
regard to the private paying of long-term care in 2017, will there be a fee
increase?
MR. HAGGIE:
There isn't one in the
budget.
MS. MICHAEL:
There isn't?
MR. HAGGIE:
No.
MS. MICHAEL:
Okay, because currently it's
$2,990 a month, I think.
MR. HAGGIE:
Yes.
MS. MICHAEL:
Yeah, so that's going to
stay.
MR. HAGGIE:
Off the top of my head, that
number is accurate and there's no plan to change it.
MS. MICHAEL:
Okay, great.
Thank
you very much.
A lot
of my questions, Mr. Kent has asked. That's why I sort of have to go into my
notes here. I'm sorry for the slight delay.
I'm not
sure this is something that the government could actually get a handle on, but
we would like to ask the question. Do we know the number of private paying home
care clients in the province, or is that something that's too difficult to
ascertain?
MR. HAGGIE:
A good question. I think we
can make a stab at finding out for you. It may be difficult but we'll make a try
and see.
MS. MICHAEL:
That would be good. It would
be very helpful actually.
Thank
you very much.
MR. HAGGIE:
It may be we can't determine
that, and if that's the case then so be it.
MS. MICHAEL:
That's right, because I
suspect a lot of it would be if people are getting home care and they're using
the agencies. The agencies know who is paying privately and who is subsidized, I
would imagine.
MR. HAGGIE:
Yes.
MS. MICHAEL:
Do they have to report that
to you at this moment?
MR. HAGGIE:
No.
MS. MICHAEL:
Or if you seek the
information they would give it to you, or not?
MR. HAGGIE:
Presumably, we would only be
involved with those people for whom we provide some financial assistance.
MS. MICHAEL:
Right.
MR. HAGGIE:
We don't know what we don't
know beyond that.
MS. MICHAEL:
Right.
Well,
you're going to make a stab at this –
MR. HAGGIE:
We'll see. As I say, on
behalf of the staff, I honestly would have to make no promises there because
that may simply not exist.
MS. MICHAEL:
Right.
Okay,
thank you.
Again,
as I said, we have some statistical ones but we'll hold up on that.
In that
case, let's go to 3.2.01, the Grants and Subsidies, Building Improvements,
Furnishings, and Equipment underspent by $17 million last year and going up by
$2 million this year.
MR. HAGGIE:
The under spend was – in
actual fact, was that the deferred revenues piece? Yeah, there was – cash flowed
through to the RHAs which was used to offset those. So the budget piece from
2016 appears to be underspent. The work was done but the difference was made up
with deferred revenue from the RHAs.
MS. MICHAEL:
I'm not sure I'm clear on
what you mean.
MR. HAGGIE:
Okay. There was money flowed
through to the RHAs which was –
MS. MICHAEL:
In 2016?
MR. HAGGIE:
In previous years.
MS. MICHAEL:
Okay.
MR. HAGGIE:
– which was not utilized. So
the work was done but the RHAs were instructed to use what cash they had in
deferred revenue –
MS. MICHAEL:
Got it.
MR. HAGGIE:
– before they drew down on
the department's grant.
MS. MICHAEL:
Okay, that makes it clearer.
Thank
you.
Then
this year, what is the anticipation which has you putting an extra $2 million
over what you budgeted last year?
MR. HAGGIE:
The breakdown is in the
book, but essentially it's $20 million for Furnishings and Equipment, $10
million for Building Improvements, and $1.9 million for the EMR, which totals up
to $31.9 million.
MS. MICHAEL:
Okay, so all of that is in
the book.
Thank
you very much.
3.2.02,
could we have an explanation of the salary line there, please? It was underspent
by $573,600 and going back up by $505,000.
MR. HAGGIE:
We use staff from TW to
perform duties related to health care facilities. It was underspent last year
and the budget is an estimate of what is likely to be needed for the coming
year.
MS. MICHAEL:
Okay, thank you.
Under
Professional Services, again, there was a big under spend there and this year
going up radically. What –?
MR. HAGGIE:
The decrease essentially is
because some of the projects didn't go ahead. Weather, manpower shortage and
delays in project design. So it's a cash flow issue.
MS. MICHAEL:
Do you have that list of
which projects in particular?
MR. HAGGIE:
We have a listing of those
budgeted for next year. Do we –?
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
It's in the book. Okay,
we've got a listing at the back of those that are on the go. There's a projected
revised budget for 2016-2017 on the current infrastructure builds, and that
explains the flow over 2016-2017 projected and revised variances and the
2017-2018 Estimates.
MS. MICHAEL:
Okay, and so you have –
MR. HAGGIE:
It's in the book, and if
it's something that isn't self-explanatory, then let us know.
MS. MICHAEL:
Okay, thank you very much.
Then
under Purchased Services, again, underspent by almost $20 million and down by $7
million, approximately, this year.
MR. HAGGIE:
Yes, similar cash flow
issues with projects. Again, it's probably better seen in a graphical display –
MS. MICHAEL:
It's all explained.
MR. HAGGIE:
– on the table at the back.
Again, if there's something that isn't self-explanatory we'd be happy to provide
some feedback.
MS. MICHAEL:
Thank you very much.
That's
it for the moment, Madam Chair. I may have a couple of more afterwards, but
we'll see what happens in further discussion here.
CHAIR:
Okay.
MS. MICHAEL:
Thank you.
CHAIR:
Mr. Kent.
MR. KENT:
Thank you.
I'll
start with long-term care. I would appreciate getting some current statistics on
the wait-lists, but also the current wait times. I know that varies based on the
client, but would we be able to get some updated, fairly recent statistics on
both length of wait and also the size of the current wait-list?
MR. HAGGIE:
Yes.
MR. KENT:
Thank you.
I know
some of these things wouldn't logically be in the binder, so I appreciate that
you'll provide them as soon as you can. In term of the binder content, do you
anticipate providing that to us today?
MR. HAGGIE:
I can leave you mine if you want.
MS. MICHAEL:
You need two copies.
MR. KENT:
Well, yeah, so –
MR. HAGGIE:
Well, what we'll do is –
MR. KENT:
I don't want to share with
Lorraine.
MR. HAGGIE:
– we'll get two suitably
bound documents for you and your colleague as soon as we can.
MR. KENT:
Excellent. Okay.
I
wouldn't mind sharing temporarily, but two copies are probably more practical.
We've gotten a little more friendly since I've been over on this side but we
don't want to get carried away.
Has
there been any long-term care beds created in the past year?
MR. HAGGIE:
I'm not sure whether you
could say in the past year. I know Central Health repurposed 11 beds across its
region in the recent past from respite beds to permanent, long-term care beds.
In
terms of new builds; the new builds that you'd be aware of are the ones that are
(inaudible) the Corner Brook issue, and there is planning ahead for Central.
MR. KENT:
Can you tell us a little bit
more about the planning for Central? Will it be a similar model to what is
proposed for Corner Brook? Would it be the 120 beds that was previously
envisioned, or are you looking at something different?
MR. HAGGIE:
Well, there were two reports
for Central.
MR. KENT:
That's right.
MR. HAGGIE:
One of them predated the
other, and I think there was some debate or differences between the two. So at
the moment, staff have gone back and kind of asked them to update the numbers.
The
challenge in Central is it's physically the largest geographical region on the
Island. So the question then becomes one of distribution, because the big debate
of late has been about proximity to their community and travel for family as
much as actually accommodation itself.
So
there's always going to be a point where it's difficult to reconcile those two
competing – economy of scale versus an economy of operation versus geography. I
think we would look to see what those numbers break down by community, and we
haven't got those finalized yet. It's coming in the near future.
MR. KENT:
Okay, thank you.
What
about Eastern Region? I suspect the wait-list in Eastern is – I don't know if
it's still the longest, but I suspect it is. Is there a plan to expand the
number of long-term care beds in the Eastern Region?
MR. HAGGIE:
I think the short answer at
the moment is we've worked our way – or between us – from East to Labrador, to
West and back to Central. I think the issue of distribution of beds on the
Avalon is, again, something we would need to keep monitoring because, you're
right, the wait-list does fluctuate.
Our
current pressure points in terms of numbers – in actual fact – is currently
still Central.
MR. KENT:
Okay.
Switching topics completely, the PET scanner: Is there a new provider or is
there a new contract? I understand there was some time lapse with the original
proposal. I believe there was something new awarded in the last 12 months. Is
there anything to that? Has there been any change, or was there simply an
extension or renewal of the existing contract, or was there a renegotiation? Is
that something you can comment on?
MR. HAGGIE:
I don't have those details
quite honestly. I mean my understanding was that the scanner would be up and
running by May and that the cyclotron and isotope production would be online by
the fall. In terms of the contracts, I think I'd have to take a rain check on
that. I couldn't answer it off the top of my head, no. We're not aware of
anything.
MR. KENT:
Okay.
So if
you could get back to us on that I'd appreciate it, because we understand there
might be a new provider involved. It's not problematic; we're just interested in
getting an update and getting the information. I'm wondering if there are
additional costs associated with that. If you can get back to us, that would be
great.
MR. HAGGIE:
At the department level,
currently we're not aware of any changes or any changing cost.
MR. KENT:
Okay, so we'll see.
I
recognize that this next issue spans multiple departments and it's related to
mandatory reporting of critical incidents. I know that while the issues related
to the Child and Youth Advocate are being led by another minister, I recall
significant discussions within the Department of Health around addressing the
issues as they pertain to the regional health authorities and the health system.
I'm
just wondering, given that it felt like we were close to a solution, I'm just
wondering if you can comment on any progress from the health system's
perspective?
MR. HAGGIE:
The only bit I would have
any real insight into is around the regulation crafting for the new
Patient Safety Act and quality
assurance framework. As yet, we haven't crafted the level at which those
mandatory reports would occur, if you use a five-point scale for severity of
incidents, you take three or two or four. I think we're still looking at
guidelines and jurisdictional scans about that at the regulatory level.
MR. KENT:
Okay.
I'm now
going to ask you a question that I was previously asked when I sat where you now
sit. Is there any update on the whole issue of HPV vaccinations for males?
MR. HAGGIE:
Currently, no, but we're
still working on that.
MR. KENT:
Okay.
Well,
that's good to hear. I'm glad it hasn't fallen off the radar because I believe
there's – I sense that over the last couple of years there's been growing
evidence to support making a change, but I do understand the reason for the
current state quite well.
Another
issue I was asked about in the past that I'll now ask you about: Any plans to
change coverage or services in the province related to IVF?
MR. HAGGIE:
Again, that's something
we're looking at. One of the challenges around IVF is critical mass in terms of
patient volumes and skill. We are not sure we'll ever be in a position to fix
that, simply because of our population size. That's a big factor, and the
question then is at what point you're and how you hand off that to another
jurisdiction, if that's the way you have to go.
MR. KENT:
Okay.
Minister, I'm aware of the ongoing and historic challenges around staffing the
obstetrics unit in Gander. Given your love for Gander, I'm sure it's an issue
you've spent some time dealing with. While it's a regional issue, I know it's an
issue you'd be familiar with. I'm just curious, what's the current situation and
has there been any progress made to create some more stability there?
MR. HAGGIE:
My understanding is that
Central Health has five physicians in the pipeline currently for recruitment
with various stages. Most of them, my understanding is – and I don't know what
most means in this context – have signed some kind of paperwork. One of them is
a Canadian trained obstetrician.
The
current obstetrician there is unavailable, certainly, for the next month or so.
In regard to other pieces of that puzzle, we have the midwifery project that we
mentioned earlier on, and Central Health would be part of that.
My
understanding at the moment is there are actually currently only two
obstetricians in Grand Falls. So it's important to be able to stabilize this
service across the Central district. My position has always been that we should
have vibrant antibaryon post-partum care in both sides.
MR. KENT:
Thank you.
I
probably need, Madam Chair, another 10 minutes. The clock has run out. I'll
pause to see if Ms. Michael has some additional questions.
CHAIR:
Ms. Michael.
MS. MICHAEL:
Thank you, Madam Chair.
Yes, I
do have one, in spite of what I said about statistics. You might have this one
because it is a bit of a crucial question. It has to do with people waiting in
acute care to get into long-term care. Do we have the numbers on those and the
percentage of acute care beds that are still being occupied by people waiting
for alternate care?
MR. HAGGIE:
I can provide you with a
snapshot set of data. I actually have one being passed to me currently. We have
– those down at the bottom. Yes, okay.
We have
alternate-level-of-care patients here, but I don't have the percentage of those
that are waiting for long-term care beds. My experience is that as of March 31,
there are 285 people who are ALC, which represents 19 per cent of acute care
beds. Of those, traditionally – and it varies by day and by jurisdiction, but
anything up to 50 per cent of those could actually be waiting for care in the
community. They may be waiting for a shower rail to be put in or a ramp to be
put to their front door rather than waiting for a long-term care bed.
MS. MICHAEL:
Right.
MR. HAGGIE:
It's unlikely they'll be
waiting for a personal care bed.
MS. MICHAEL:
Do we have any idea – you
may not – of that breakdown so that we can get a better idea of the ones who are
there for a much longer period because they're waiting for long-term care?
MR. HAGGIE:
We can certainly provide, I
think, a breakdown of those people who are ALC and waiting for long-term care.
MS. MICHAEL:
Okay.
MR. HAGGIE:
I think that would be easier
than trying to specify all the reasons.
MS. MICHAEL:
Yes.
MR. HAGGIE:
Because the other pot would
be a group of people who had other issues which weren't going to be necessarily
reflective of the health care system.
MS. MICHAEL:
Right.
No, and
we're interested in the long-term care because, obviously, it still remains a
problem. I don't have to tell you what's just happened in Gander with somebody
having to travel quite a long distance because of beds being needed in the
hospital for acute care. It still remains a big issue, as we know.
I think
I'll pause there.
CHAIR:
Mr. Kent.
MR. KENT:
Thank you.
Hopefully we'll cover it in the next 10-minute interval. I'll try and keep my
preamble short just like Question Period, although they don't let me up often
enough in Question Period. That's a whole other story.
Mr.
Speaker – I'm practicing. Maybe I'll ask you something this afternoon, although
I don't think there will be anything left.
Minister –
CHAIR:
You're in the wrong
profession, Mr. Kent.
MR. KENT:
Am I? My wife tells me the
same thing. We just don't have a good answer as to what the right profession is,
although I do need some professional help probably.
Air
ambulance, any new developments? I know the challenges. I know there's been some
controversy in the past year. I'm just curious if there's anything new on the
air ambulance file that you're willing to share with us at this point.
MR. HAGGIE:
Well, only that there is in
the binder an explanation of some variances in costs. Transportation and Works
have been challenged to keep one of their planes going and sometimes they've had
some crewing issues. So we've been outside and used the contracted alternative.
MR. KENT:
Yes, I'm aware of the
ongoing challenges with Transportation and Works and I believe there's a new
service delivery model required. Is that something that's still being explored?
MR. HAGGIE:
I think you'd have to ask
Minister Hawkins that in detail. We're simply the consumer of the product in
some respects. Certainly, from my point of view, I've made it plain that really
the Department of Health requires a one-number fix where you can ring and use it
in the instances where it is determined that air is the best form of
transportation.
The gap
in our service is nighttime and IFR rotary operations. We, in actual fact, are
very fortunate in having 103 in Gander because they fill that gap and they
actually do it at no cost to the province. So, in a sense, that may be an
opportunity rather than a cost.
We have
had discussions – Transportation and Works and myself, our department – about
how to ensure a reliable 24-7 service for fixed wing.
MR. KENT:
Okay. I'm glad to hear there
are still discussions happening on that.
Switching gears once again – actually, let's stay on ambulances. I know there
were some previous questions by Ms. Michael related to Central dispatch and the
provincial ambulance service overall. It's another area where we've got a
challenging model and one that's not easily solved.
I'm
just curious if there any updates in terms of provincial ambulance service
overall, any changes coming this year, anything happening on that front?
MR. HAGGIE:
I think you're probably
aware that the contract with the ambulance operators I think expires this year
and we'll be starting negotiations again around that.
I think
if you look at the business model outside, it's tending to be a clumping of the
private providers. There have been some buyouts and changes over the last five
years which have consolidated the management structure of the bulk of the
private ambulances into two or three principal players as it were.
I think
really and honestly beyond that, I would see sorting out a provincial central
medical dispatch either in conjunction with the current 911 mechanism or through
some alternate would be the first brick, the first foundation in any changes to
the ambulance service. I think given discussions on a jurisdictional scan, there
is a feeling we could get better value for our dollar by looking at slightly
different ways of doing it.
MR. KENT:
I would agree with that.
Now,
switching gears completely, Steamplicity. I regularly get photos sent to me from
various people in various places in the health care system and some of them are
familiar situations that don't require any follow-up and others may require a
little more investigation. It's evident from some recent photos that
Steamplicity hasn't yet been fully implemented at the Health Sciences Centre.
I'm just curious what the status is and when you would anticipate a change in
food services at the Health Sciences?
MR. HAGGIE:
The problem with
Steamplicity, if I recall correctly – and I'm sure there'll be people whispering
vigorously if I get it wrong – was the challenges in getting the building sorted
out for the accommodation for the new equipment which, if I believe correctly,
is Mount Pearl, if I'm not ….
MR. KENT:
I think it's Donovans, yes.
MR. HAGGIE:
Yes. So that's delayed its
implementation, but other than that the project is funded and is due to roll out
when those kinks have been ironed out.
MR. KENT:
Okay.
So
probably this year, certainly.
MR. HAGGIE:
Well, my understanding is,
yes, it will be over the course of this year that it will get up and running
properly.
MR. KENT:
Yeah, and I recognize there
are some impacts on the location of people in the system as a result but I think
we're both committed to trying to improve food quality in our health care
facilities, which is desperately needed.
MR. HAGGIE:
Well, certainly Steamplicity
got a very good sort of write up as part of the evaluation process for going in
that direction in the first place.
MR. KENT:
Yeah. No, I'm a believer,
based on what information I had anyway.
MR. HAGGIE:
One of the things we were
trying to do was make sure that local ingredients could be sourced.
MR. KENT:
That's a great idea.
MR. HAGGIE:
I mean some of it has to be
partly prepared.
MR. KENT:
Yeah.
MR. HAGGIE:
I'm thinking of the beef,
the meat and that kind of thing, but we have had some tentative discussions with
the health authorities about local source of produce for example.
MR. KENT:
Excellent.
Opioid
Action Plan, there have been some recent deaths. I know the Action Plan is in
place. I'm just wondering have there been any issues with implementation and any
gaps you've identified, any changes coming that we should be aware of.
MR. HAGGIE:
No, I mean it was kind of
inevitable. I think to flip the statistics around, out of the 16 overdoses, 14
survived. So that's a testament to the fact that there's been some benefit from
the plan.
In
terms of the kits, there are still some left that haven't been deployed. The
final piece was rolling out the nasal spray to the EMRs, the emergency medical
responders. The paramedics have the injectable, but we've sourced nasal spray
now for the EMRs who have a different skill set.
MR. KENT:
They now have it?
MR. HAGGIE:
It's being rolled out. Some
have, some not yet. It's not quite – the rollout is not complete.
MR. KENT:
Is that for all EMRs in the
province?
MR. HAGGIE:
My understanding is, yes, it
was done through PMO.
MR. KENT:
Okay.
Any
plans to make the naloxone kits available anywhere else?
MR. HAGGIE:
Well, they're available
through 811 or through the numbers that we published on the government website
in the news release.
MR. KENT:
To individuals.
MR. HAGGIE:
Yeah. All we ask is that you
give us a contact number and we number the kit. We do that because they have a
two-year shelf life and we also would like to know when they're used and how to
replace them.
MR. KENT:
If somebody in the community
wanted to have a kit who's not a drug addict or not somebody who, because of
their medication, would necessarily require a kit, but if there's somebody in
the community who works with affected populations who wanted a kit, can they
call 811 and get one as well?
MR. HAGGIE:
Yeah.
I mean,
in actual fact, those are the people you want to have them because by and large
they're not likely to be incapacitated. So 811 is the generic catch-all from my
memory, which is not good with multiple telephone numbers. But there are a whole
variety of RHA sites that have stock to give out as well as the SWAP program and
some of the community groups. In actual fact, the launch took place at the SWAP
program.
MR. KENT:
Okay.
Madam
Chair, I see I'm going to run out of time. I don't have many questions left but
I still have a few more. I'll pause and see if Ms. Michael has anything
additional and then I'll continue.
CHAIR:
Thank you.
Ms.
Michael.
MS. MICHAEL:
I'll just ask one question
as part of the discussion that Mr. Kent was just having with the minister. I
know this is more informational than anything, but last night at the town hall
on mental health, an issue was brought up with regard to the experience of some
people, here in St. John's it's happened, where a pharmacist has refused – some
pharmacies, it's not general – to sell needles to someone whom they are
treating. Is that the pharmacist's call?
MR. HAGGIE:
You would probably be better
directing that to either the Pharmacists' Association of Newfoundland and
Labrador or the Pharmacy Board because I don't really have enough knowledge,
quite frankly, to answer that question.
MS. MICHAEL:
Because if somebody is being
treated at that pharmacy, that person still is in control of his or her own
addiction. I just question what right the pharmacist would have to make that
call, to say I'm not selling you needles.
MR. HAGGIE:
No, and I don't have the
answer to that question.
MS. MICHAEL:
Okay.
MR. HAGGIE:
I think you would be best
asking either one of those two groups or the pharmacist concerned.
MS. MICHAEL:
Right. Thank you.
That's
all.
CHAIR:
Okay.
Mr.
Kent.
MR. KENT:
Thank you.
Just an
offer of support once again before I move on to other topics, on the mental
health implementation plan that we know is coming over the next month, if
there's anything we can do to be of assistance with any of that work. Despite
the fact the committee has concluded, there's a lot of work to be done over the
next number of years and there are a number of us who remain willing to support
your efforts to implement those 54 bold and broad recommendations. That's a
standing offer.
I have
a couple of questions for you related to the overall RHA budget, and this comes
from the briefing we received from Finance officials. Through, I guess, the
zero-based budgeting exercise, there was a reduction in salary and benefits of
$30.8 million. From the comments that Finance officials made, we think about $20
million of that probably relates directly to the RHAs.
The
Department of Finance assures us that between $20 million and $30 million that's
coming out of the RHAs will have no impact on front-line services. Is that all
related to the management changes that recently happened at the regional health
authorities, or is there more to that story?
MR. HAGGIE:
You're talking about $20
million that was saved over last year?
MR. KENT:
Yes.
MR. HAGGIE:
Yeah.
Okay,
that comes from three areas, essentially. One is, for example, Steamplicity,
which was budgeted but the cash didn't all flow because of the delays –
MR. KENT:
Right.
MR. HAGGIE:
– and that accounts for part
of it. The other piece is around changes to the way capital and current accounts
are being registered, and the other piece was about accrual versus cash. There
was no change. It's to line up with an accrual accounting mechanism.
You've
reached the limits of my financial competence there. Was that right?
OFFICIAL:
That's good, yes.
MR. HAGGIE:
Oh, it's good. Okay, yes.
It's just not said with enough confidence.
MR. KENT:
Your accent inspires
confidence, so that helps a lot.
When it
comes to the zero-based budgeting and the RHAs, what will the impact really be
then? There has been funds taken out, we've been told by another department that
won't have any impact on services, but can you just tell us what the impact of
zero-based budgeting on the RHAs actually is, in practical terms?
MR. HAGGIE:
Well, what we have done with
the RHAs is directed them to use a zero-based budgeting approach. They didn't do
it in any great and determined way in the terms of this year's budget process.
Essentially, it is a very granular approach to the way they do business.
Do you
really need to have half a dozen boxes of 24 ballpoint pens on every ward
clerk's desk? Do you need to have BlackBerrys for automatically anybody who's
above a certain level on the org chart? Because there are some people, quite
frankly, who are never going to get called. We have whittled away in our
department at the number of BlackBerrys, the number of voicemails. Can you
amalgamate some voicemails? It really does get down to simple things like that.
Print
management, for example; there is talk now of discussion through Service NL of
some of Eastern Health's printing, for example, being done on this huge, new
machine that they're going to acquire for Service NL. It'll have capacity, and
it doesn't just have to run for the benefit of GNL.
I think
it's more of an approach, and you can see how that is not going to have any
impact, should not have any impact on front-line services.
MR. KENT:
Right.
MR. HAGGIE:
How many vehicles does a
hospital or an RHA need to purchase? It will vary. You may need a lot more in
Central because it's so big. You may need a different vehicle in Labrador
because the winter conditions are what they are.
It's
very difficult to be specific, but they've certainly been told that when they go
through a zero-based approach, it is not to be directed at front-line workers
and programs. I think you could probably manage with maybe 50 per cent of the
ballpoint pens that you have at the moment, paper stocks, these kinds of things.
I think there is a lot of room there.
I think
on the other side, what will make that a whole lot easier, is the
shared-services approach for inventory control. Not only are you going to look
at purchasing across the RHAs, but you will actually have some kind of inventory
management system.
There
are some across the province. Western has quite an interesting one whereby stock
levels of needles for the emergency department are kept at an optimum level.
Instead of having boxes and boxes, which people trip over and get tucked in
corners, they have their stock levels determined by level of utilization. It's
very, very apparent if you don't have enough needles in the tray. Someone will
find out about that and that will be fixed very, very rapidly. On the other
hand, nobody ever did anything about the 16 extra boxes of green needles tucked
in the corner; yet, that was money that had been spent that was actually not
benefitting patients. It's that approach.
There
is no one person or no one group that's going to make a difference of the whole
system. It's going to be lots of people adopting that approach that will make
the difference.
MR. KENT:
Okay. Thank you.
Moving
on to 3.2.02, Ms. Michael asked some questions about the change in the salary
line. There was some comment by the minister related to what's anticipated
broadly.
I'm
just wondering if that relates to some of the planning that's ongoing for
facilities like the Waterford and a new West Coast hospital. Is that the
anticipation you referred to?
The
salary increase in under Health Care Infrastructure – well, it's up more than $1
million from revised, but it's about $500,000 from last year's budget. Is that
in anticipation of further planning work related to those projects?
MR. HAGGIE:
Yes is the short answer.
MR. KENT:
Okay
I just
ask for a little bit more clarity then. I know there's some money budgeted for
planning related to the Waterford Hospital for this year. I think we're in
agreement that – I know we're in agreement that simply replacing the existing
infrastructure would be a mistake, which is part of why the project hasn't
proceeded sooner, and I know you'd be aware of all of that history. I'm just
curious, can you comment on what that planning work looks like and how far we
will get during this fiscal year and whether there's active consideration being
given to a P3 build for the portion that will be built?
I know
there will be some services that will come out and be located elsewhere in the
community and in the province, hopefully, which is I believe the right approach
but for whatever will be built to replace the Waterford, can you just give us a
sense of how far that will get this year?
MR. HAGGIE:
The process of devising a
kind of functional plan and a master plan, you know the shopping list of things
you need in a facility, that had been done for, if you like, the old Waterford
concept.
MR. KENT:
Correct.
MR. HAGGIE:
And really that has been put
on one side given the deliberations of the All-Party Committee. What has
happened is it's been taken out now and there are discussions in the department
about what the new Waterford project would look like, and I would anticipate
that document will get fleshed out over the course of the next couple of months.
In
terms of what and how that will be built, generated, I think there has been a
patent apparent of looking at value for money and then seeing what the role of a
P3 might be. I would envisage that between Health and TW, we would probably go
down that road again with any new infrastructure build whether it's the
Waterford or long-term care in Central.
MR. KENT:
Thank you for that.
I think
doing that exploration makes sense. I know I may differ with my colleague on
that particular point but I think doing the value for money analysis and being
as transparent as possible about it will allow the right decision to be made.
Given the challenges that surround the Waterford, it's one of those areas where
I'd say if we can be helpful and be collaborative then there's certainly a
willingness on my part to do so.
Are
there any consultants engaged in all of that planning work at this point? Do you
have somebody engaged who's doing a value-for-money analysis related to the
Waterford, or who is doing the design work at this point?
MR. HAGGIE:
We have no one engaged on
design work. We're still at the in-house stage of kind of a shopping list.
As
regards to the value-for-money pieces, those have all been done through TW and I
don't have any visibility into that at the moment. I would suspect however, that
until we've got the master plan, the functional plan sorted out that there're
wouldn't be anything on which you could base a value-for-money assessment
because you wouldn't have your plan.
MR. KENT:
So in terms of the
functional plan – and I'm nearly done, Madam Chair. I know the clock has run out
but can I ask for leave to just finish up?
CHAIR:
(Inaudible.)
MR. KENT:
Thank you.
I would
have anticipated that you won't be able to complete the full functional plan in
house. So is it the intention during this fiscal year to engage somebody to help
with that work?
MR. HAGGIE:
That's what the planning
money is. One of the reasons the planning money is set aside.
MR. KENT:
Okay.
MR. HAGGIE:
Yes, sorry, I may have
misled slightly and I didn't mean to. We have not gotten to the stage where what
we've done in house yet is ready to hand out to a designer/planner to convert
into a functional plan.
MR. KENT:
Okay.
So
there will be some kind of RFP, I would presume.
MR. HAGGIE:
It will go through the usual
channels kind of thing –
MR. KENT:
The usual procurement
channels.
MR. HAGGIE:
– until we get to the stage
of having something to take to the market to flesh out. We're not quite ready
yet.
MR. KENT:
Ms. Michael and I have both
asked for a number of pieces of information that are outside of the binder that
we're going to be provided with. I trust you'll ensure that whatever we've asked
for, we both will receive.
MR. HAGGIE:
You'll get handwritten, if
need be – hand autographed letters with the same content.
MR. KENT:
Okay, great.
Thank
you.
I just
want to conclude by expressing my thanks to you in particular for your approach
this morning and for your openness. It's well received, it's helpful and I
appreciate your flexibility in answering all the questions. It's an approach
that I believe worked well and I'm glad to see you continuing in that tradition.
I think it makes this process more useful for everybody.
I want
to thank the staff who support you in that work. I won't repeat what I said at
the beginning. I've got great respect for the folks that work in our health care
system, particularly the ones I've worked directly with in your office.
So
thank you for your approach and for your answers. I'll look forward to more
sensible conversations like the one we've had over the last three hours.
MR. HAGGIE:
Thank you.
CHAIR:
Thank you.
Ms.
Michael.
MS. MICHAEL:
Thank you, Madam Chair.
Just
again to thank the minister, his deputy and all his staff for being here with us
today, for giving us all the information that we're looking for. I appreciate
the fact that we can get the binders and that you will give us information we're
looking for.
I've
chosen, Minister, deliberately not to put out my differences of opinion with you
with regard to some of the directions government is taking. I do that when I
have to do it, do it in the House of Assembly. I don't think this is the place
for me to do it, but you know where we stand on P3.
I think
the one thing I would urge is when you talk value for money, that there are
many, many aspects to that when looking at P3. That's all I want to say, just to
put that on the record.
Thank
you very much. I really do thank you sincerely for today.
CHAIR:
Thank you, Ms. Michael.
I don't
know if the minister has some closing remarks.
MR. HAGGIE:
Really only to reiterate
what others have said. I mean this process has been as smooth, apparently, as it
has been is entirely due to the people around me, not me. I would just like to
go on record again as thanking them and, Chad, who is not here and all those
other people who labour on behind the scenes. That's really all I have to say.
Thank
you.
CHAIR:
Thank you.
3.1.01
to 3.2.02, shall it carry?
All
those in favour?
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against?
Carried.
On
motion, subheads 3.1.01 through 3.2.02 carried.
CHAIR:
Shall the total carry?
All
those in favour?
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against?
Carried.
On
motion, Department of Health and Community Services, total heads, carried.
CHAIR:
Shall I report the Estimates
of Health and Community Services carried without amendment?
All
those in favour?
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against?
Carried.
On
motion, Estimates of the Department of Health and Community Services carried
without amendment.
CHAIR:
A couple of notes, the next
Estimates of the Social Services Committee will take place here in the Chamber
at 6 tonight. I can't wait again. That will be Municipal Affairs and
Environment. If substitutions are required for this evening's meeting just a
reminder to notify the Government House Leader in writing.
With
that, I'll thank all Members for their co-operation this morning. I wish them a
fantastic rest of the day.
I will
call for a motion to adjourn.
MR. KENT:
So moved.
CHAIR:
So moved by Mr. Kent.
Have a
great day everyone.
On
motion, the Committee adjourned.