June 20, 2019
SOCIAL SERVICES COMMITTEE
Pursuant to Standing Order 68, Siobhan Coady, MHA for St. John's West,
substitutes for Derek Bennett, MHA for Lewisporte - Twillingate.
Pursuant to Standing Order 68, Alison Coffin, MHA for St. John's East - Quidi
Vidi, substitutes for James Dinn, MHA for St. John's Centre.
Pursuant to Standing Order 68, Sherry Gambin-Walsh, MHA for Placentia - St.
Mary's, substitutes for Scott Reid, MHA for St. George's - Humber.
Pursuant to Standing Order 68, Bernard Davis, MHA for Virginia Waters -
Pleasantville, substitutes for Elvis Loveless, MHA for Fortune Bay - Cape La
Hune.
Pursuant to Standing Order 68, Derrick Bragg, MHA for Fogo Island - Cape Freels,
substitutes for Pam Parsons, MHA for Harbour Grace - Port de Grave.
The
Committee met at 6:08 p.m. in the Assembly Chamber.
CHAIR (Bragg):
Okay, folks, thank you very much. Thank you for taking time out of your busy
evening and being here for Estimates today. I thank the minister and his team
and the Members opposite and their team.
We'll
start by doing a few introductions. We will start with the minister's team
first. When you see your light come on, wave to get it started. After that I
think it flows pretty good so carry on.
MR. MCGRATH:
John McGrath, Departmental Controller.
MR. HAGGIE:
John Haggie, Departmental Minister.
MS. STONE:
Karen Stone, Deputy Minister.
MS. HANRAHAN:
Heather Hanrahan, Assistant Deputy Minister.
MR. SMITH:
Paul Smith, Assistant Deputy Minister of Corporate Services.
MR. ANTLE:
Chad Antle, Audit Manager.
MS. SIMMS:
Colleen Simms, Assistant Deputy Minister.
MS. DICKS-PEYTON:
Kathy Dicks-Peyton, Media Relations Manager.
MS. ANDERSON:
Alicia Anderson, Executive Assistant to the Minister.
MR. BRAZIL:
David Brazil, MHA, Conception Bay East - Bell Island.
MS. TUBRETT:
Denise Tubrett, Deputy Chief of Staff, Official Opposition.
MS. COFFIN:
Alison Coffin, MHA, St. John's East - Quidi Vidi.
MS. WILLIAMS:
Susan Williams, Researcher for the Third Party.
MS. GAMBIN-WALSH:
Minister Sherry Gambin-Walsh, MHA for Placentia - St. Mary's.
MS. COADY:
Siobhan Coady, MHA, St. John's West.
MR. DAVIS:
Bernard Davis, MHA for the beautiful District of Virginia Waters - Pleasantville
– and historic.
CHAIR:
I'm Derrick Bragg and I'll be chairing this evening. I'm the MHA for Fogo Island
- Cape Freels.
We're
going to start off and we're going to give the minister 15 minutes as a
preamble. If you choose to not use your 15 minutes, we'll move right into the
Opposition for their questions.
Okay,
I'll call the subheads first. We'll do it by subheads. We'll start off with
1.1.01 and we'll move on into 1.2.02.
Minister Haggie.
MR. HAGGIE:
Okay. Thanks very much.
I hope
the House protocol will excuse my attire, but given the climate control I think
comfort is important. I'd like to thank my staff for all the hard work they have
put in, in preparing the documents that you see before you and the Estimates
process itself. With consummate skill they had prepared some excellent speaking
notes for me which I have lost, so I will start again in the way that I have in
previous Estimates.
The
mantra for the department has been around the three-legged stool, if you like,
of better clinical outcomes, better population health and better value for the
dollar. It's a three-legged stool, if you saw one leg off too much, the whole
thing will kind of tip over.
The
health care budget for this province is a significant portion of provincial
revenue. What I'm pleased to be able to draw people's attention to is that by
and large it has stayed static since we took office in 2016, and it has done so
in a way that has still allowed us, through reprioritizing, to expand the range
of services that we provide. This really speaks to the better value for the
dollar that we spend. We are one of only three provinces who have managed to do
that.
The
other metric, I refer people to CIHI's report which is around per capita
expenditure on health where we have not faired well as a province. I have argued
in certain areas that we are, in actual fact, more accurately a territory, in
which case we do very well. Regardless of that, accepting the fact that we are
the country's newest province, if you now plot our line, it is almost flat. It
is less than the rate of inflation and has been for three years, and with this
budget it will remain there.
As you
watch the rest of the country, you will see their lines of per capita
expenditure on the same graph have a significant upward gradient. If you plot
that out and extrapolate over time, those lines will cross sometime between 2025
and 2027, at which point we will be at least in the middle of the range of other
provinces, and I would argue fairly near the lower end. If we can do that, then
I think we will have fulfilled the triple aim because we are now starting to
measure outcomes and we are seeing those metrics that we're using trending in
the right direction, too.
That's
not to underestimate the challenge. We have a significant chronic disease
burden, we have a significant set of comorbidities. We are not the healthiest
province according to any of the metrics. Between myself in this portfolio and
the Minister of Children, Seniors and Social Development – who actually has the
mandate for wellness and social development – we are working together to try and
remedy those.
We have
a landmark piece of legislation, the one which title I always confuse, but it's
essentially the Public
Health Protection and Promotion Act which was passed the last session of
last year. This is germane in several ways because it requires us to provide a
five-year plan on public health issues and identify matters of public health. It
allows the chief medical officer to designate her or someone to mark us out of
10 on the results of that five-year plan. It also allows her to designate
important non-communicable diseases about which we need to have a strategy; so,
for example, she could designate diabetes as one.
Built
into that is a philosophy of Health in All Policies. We're only the second
province in the country to actually bring in legislation in regard to that,
which mandates essentially that any government Cabinet decision has to be
assessed through a Health-in-All-Policies lens. We are second after Quebec, and
I think New Zealand is probably the furthest along with that approach.
Basically what it says is when you're doing municipal planning, when you're
doing transportation and works, these kind of things, you look at factors in
municipal planning that will encourage health. Walking tracks, green spaces,
these kind of things become something that is of relevance and importance to
municipalities. This will obviously roll out as it becomes more fully fleshed
out and as the regulations develop.
I'm not
going to use all of my time to speak about that. We have several initiatives
we've highlighted in the Budget Speech and the Throne Speech around things that
we would like to do that are financed through this budget. I'll be happy to talk
about those as we go through, but I think in the interest of maximizing
everyone's time and the whole process, I'd probably draw my opening remarks to a
conclusion there and throw it back to the Committee.
Thank
you.
CHAIR:
Thank you very much,
Minister.
We'll
start off and we'll call the first subhead.
1.1.01
to 1.2.02.
Mr.
Brazil, the floor is yours.
MR. BRAZIL:
Thank you, Mr. Chair.
I
appreciate the opportunity here in the Estimates for Health and Community
Service to have some discussion, get some clarification and outline exactly the
direction for the department.
I'll
probably take a little bit of a different approach than directly into line
items. That will come also. I think we can elevate some of those by some of the
general questions I'll ask up front and get some answers there. That will speed
the process up so I'm not having to be asking questions on every particular
detail.
My
questions will be more relevant to what I think are significant changes in
salary items or grants or contract work and these type of things. My general
start at questions is about getting around the salary units as such to see where
they are and how they tie in, so I ask for your indulgence as I take you through
that. I do ask the general concept: Can I get a copy of your binder? Somewhere
before –
MR. HAGGIE:
We have it here.
MR. BRAZIL:
Oh, even better. Appreciate
that.
MR. HAGGIE:
High-tech, paper-free
Digital by Design.
MR. BRAZIL:
Even better.
I want
to start: Are we still applying the zero-based budgeting in your process in the
department?
MR. HAGGIE:
Yes.
MR. BRAZIL:
Okay. All in play? No
issues?
MR. HAGGIE:
Yes.
MR. BRAZIL:
Fair enough.
MR. HAGGIE:
And, it's done on an annual
basis to refresh.
MR. BRAZIL:
Perfect.
Under
attrition savings in '18-'19, do you have an estimated number, what it was? And
what particular positions, for example?
MR. HAGGIE:
Yes. We had financial
targets of $69,400 in '18-'19, and this budget has $55,700 baked into it. The
'18-'19 target was met, and the financial analyst position was removed. We have
some retirements coming this year, and we have altered the clerk typist position
for reception in the department. So, I think you'll find we're on target to meet
those for the department.
MR. BRAZIL:
Okay.
In
salary details for '19-'20, the total staff complement was 213; in salary
details from 2018-'19, the total staff complement was 180. This is an increase
of 33 positions. Can you explain why that occurred, and can we get a breakdown
of what type of positions we're talking about there?
MR. HAGGIE:
That really relates to the
bringing in-house of the Medical Transportation Assistance Program from AESL.
So, there are 27 from MTAP, there were two temporary positions in Grand
Falls-Windsor for out-of-province billing, and then we've got three – sorry?
OFFICIAL:
Contractual.
MR. HAGGIE:
Contractual. Yes, sorry, the
hieroglyph was wrong. We got three contractual, and we've got three for mental
health and addictions.
MR. BRAZIL:
Okay.
You
mentioned the contractual there. We've noted that 20 per cent of your total
staff complement – 43 positions – is either contractual or temporary. Do you
plan to target contractual and temporary positions as part of the attrition
plan?
MR. HAGGIE:
The attrition plan for this
year is baked in on the basis of the figure I gave you and the retirements, plus
the change of the clerical position on the front desk. The contractual thing is
related to specific programs, and that's expertise we bring in as and when
appropriate. So, that tends to fluctuate, anyway, from year to year.
MR. BRAZIL:
Are there stringent
timelines on these contractual ones? Are they one year, six months, two years?
MR. HAGGIE:
I would have to have a list
– we have a list in the back of the binder of the individual positions, but I
couldn't tell you how long a contract runs for.
OFFICIAL:
They vary.
MR. HAGGIE:
Yeah.
MR. BRAZIL:
No, fair enough. If that's going to be shared with us, I'm happy with that.
MR. HAGGIE:
They vary. I mean, there's a full position, there's PCN number and there's an
active staff complement by division, and it's whether they're permanent or
contractual.
MR. BRAZIL:
Yeah, so we'll know which division it's in and then, from there, we can
extrapolate exactly what the responsibilities would be, I would assume, based on
that.
MR. HAGGIE:
Yeah.
MR. BRAZIL:
The duties. Okay, fair enough.
How
many retirements have occurred in the department in the last year?
MR. HAGGIE:
We'll find that number out for you. I thought we had it, but we haven't
actually.
MR. BRAZIL:
Yeah, that's fair enough. Once you get that, you can get back to me on that or
let me know on it. That's fine, yeah.
Were
there any direct layoffs this year in the department?
MR. HAGGIE:
We haven't had any layoffs.
MR. BRAZIL:
Okay, fair enough.
How
many new hires have been there in the past year, in the department?
MR. HAGGIE:
Sorry, I'm looking at the A in my notes here, and it's under S for salaries.
The new
hires I think I enumerated were medical transportation, two temporary positions
in Grand Falls-Windsor for out-of-province billing, long-term care contractual
and three mental health contractual. The total there was 27 plus eight – so
that's 33.
MR. BRAZIL:
Okay, fair enough.
In
fiscal '18-'19, gross expenditures excluded of capital was almost $130 million
more than budgeted. Can you give us an outline of why that was, the additional
expenditures?
MR. HAGGIE:
On the global number?
MR. BRAZIL:
Yes.
MR. HAGGIE:
I think some of that really will relate to monies that came in, in terms of
federal monies. We've had money under the mental health and addictions, federal
money; we have had money coming in from the long-term care, federal money. Some
of that may also be – is that under capital, too? Yes, severance. We had the
payouts for severance. They would go through us, but we will claim them back
again as finance.
MR. BRAZIL:
Do you have a breakdown on how much went out in severance? A general concept,
was it a million, $2 million?
MR. HAGGIE:
I do. I've seen that.
Approximately $127 million.
MR. BRAZIL:
In severance?
MR. HAGGIE:
Yes.
MR. BRAZIL:
Thank you.
A
couple of the line items here under Minister's Office. I just wanted to note
some things there. Under Salaries in 2018-19, you spent $375,000 or 35 per cent
more in Salaries for Executive than budgeted.
Can you
explain that, Minister, please?
MR. HAGGIE:
Sorry, which head are we
looking at now?
MR. BRAZIL:
That's under heading 1.2.01,
Salaries.
MR. HAGGIE:
01?
MR. BRAZIL:
Yes.
MR. HAGGIE:
Okay.
The
over expenditure was paid leave and severance: $375,000.
MR. BRAZIL:
Okay, fair enough.
In the
salary details, you had three contract positions listed. Can you provide details
on those within the office?
MR. HAGGIE:
In the ministerial office?
MR. BRAZIL:
Yes – or in Executive
Support, 1.2.01.
MR. HAGGIE:
They will be in the back of
the binder.
MR. BRAZIL:
Okay.
MR. HAGGIE:
They're enumerated on a
salary tab at the end of the binder. I can read them out if you want, but –
MR. BRAZIL:
No, that's fair enough.
Under
Salaries, 1.2.02, Departmental Operations, in 2018-19 there was $275,000 less in
Salaries than budgeted. Why were positions eliminated or kept vacant there?
MR. HAGGIE:
The decrease between 2018
and 2019 is related to rightsizing of the salary plan based on requirements as
of April 2019, and it requires a lower budget by about $91,500.
MR. BRAZIL:
So, are there particular
salaries that were dropped there?
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Vacancies throughout the
year is my right ear telling me.
MR. BRAZIL:
Okay, fair enough.
So,
just to get a little bit clearer on it, when you're saying rightsizing, are we
talking about particular positions there that are coming and going, or is it
going to be a consistent flow of those positions no longer existing within the
system?
Define
to me what rightsizing would be, as you perceive it in your office right now.
MR. HAGGIE:
What happens is the salary
plan is based on the number of positions that we have. Obviously, there are some
contractual folk going in and out, and the permanent people will be permanent.
We have lined up, as best we can, our organizational chart with the programs we
have to deliver.
MR. BRAZIL:
Okay.
That
would then, in turn, mean that your budget line will be down next year also
because the contract people go out?
MR. HAGGIE:
Well, I mean, obviously there will be increments as people go up the scales.
MR. BRAZIL:
Okay, fair enough.
In
salary details '19-'20, under Acute Health Services and Emergency Response, you
have five contractual positions listed. Can you provide the details? Are they in
the back of that one also?
MR. HAGGIE:
Under which tab is that?
Sorry,
could you just rephrase the question again, Mr. Brazil? I'm not quite sure what
it was. I found the area in the binder now, and I'm –
MR. BRAZIL:
Fair enough.
In
salary details '19-'20, under Acute Health Services and Emergency Response.
MR. HAGGIE:
Yes.
MR. BRAZIL:
You have five contract
positions listed. Give us some more details and are these new contracts or are
they reallocated ones or realigned ones.
MR. HAGGIE:
Why don't you – Heather.
It
isn't a button.
CHAIR:
Just wave your hand.
MR. BRAZIL:
You're new.
MS. HANRAHAN:
Sorry.
MR. BRAZIL:
Everybody tried that when they first come in the House. Hit the button, yeah.
MS. HANRAHAN:
Three are working on long-term care, home support – contractual people, so it's
project work. As well, we got one person who's working on shared service as
project work and another one working on some nursing initiatives. So, these are
time-limited positions.
CHAIR:
Excuse me for a second.
If you
speak outside the minister, which I think (inaudible), just identify yourself
first, please. I know we're past press the button, so we're good now. For
Hansard reasons.
MS. HANRAHAN:
Okay.
CHAIR:
Thank you.
MR. BRAZIL:
Okay, thank you.
I just
wanted to go back again because I just made a note there and I'm trying to get
my head around it.
We
talked about in '19-'20, $91,500 less is going to be budgeted, but the minister
– as I thought I heard it said – it'll balance out and the budget will go up
again the following year, but, that obviously is a reduction. Is there a loss of
position there or is it a loss of non-renewed contracts that are going to go out
the door?
MR. HAGGIE:
So we're talking 1.2.02 and we're talking Salaries.
MR. BRAZIL:
Yes.
MR. HAGGIE:
Okay. So you want to see the variance there.
MR. BRAZIL:
Yeah.
MR. HAGGIE:
Okay.
We've
got vacancies in Pharmaceutical Services, Audit Services and information and
policy planning. So that explains the lower figure.
MR. BRAZIL:
Yeah, but in '19-'20, the budget's going to be less. They're vacant now. Are
they going to be filled again or are they permanent positions that are gone?
MR. HAGGIE:
One moment.
MR. BRAZIL:
Yeah
MS. STONE:
That's rightsizing the budget. There is no position elimination there at all.
MR. BRAZIL:
So with the reduction, that still balances? All the same staff stay intact, as
are?
MS. STONE:
Yes, that's right. There's no change in staff.
MR. BRAZIL:
Okay, fair enough.
Professional Services, under 1.2.02. Can you please provide some details of
these expenditures in 2019? What will the budget of $1.1 million be used for in
'19-'20 under Professional Services?
MR. HAGGIE:
Okay, I have a list.
There's
a shopping list in your binder. It covers areas such as: Audit Services;
Pharmaceutical Services; NLPDP assessment; regional health services; long-term
care division; Provincial Blood Coordinating Program; awareness campaigns and
such under mental health; and addictions and primary health care. It also covers
a series of policy and planning label things, which are our payment
subscriptions to the C organizations, things like CADTH, CIHI, FPT ministers'
forum, provincial contributions to the blood portfolio, committee on health
workforce and that kind of thing. It's in your binder. It's all enumerated
there.
MR. BRAZIL:
Okay, that's perfect.
MR. HAGGIE:
And it totals up to $1.105 million.
MR. BRAZIL:
Perfect.
Under
Purchased Services, in '18-'19, over budget of $104,000. Can you just explain
what – was there a special project? Was there something purchased that was
necessary?
MR. HAGGIE:
Yeah. We needed new tamper-proof prescription pads for the Prescription
Monitoring Program. If you remember, we altered that so that there had to be a
licence number and a signature by the physician who was prescribing a controlled
drug. We also had some overages when we did some advertising around the public
health nurses' flu campaign.
MR. BRAZIL:
You don't anticipate any one-offs that may be necessary relevant to that that
may change the expenditure?
MR. HAGGIE:
The tamper-proof prescription pads is a one-off increment because we had to
replace the old ones. It will be an ongoing expense, but it won't be that
magnitude.
MR. BRAZIL:
Okay, fair enough. Thank you.
CHAIR:
Mr. Brazil, do you have anymore questions? Your 15 minutes has expired.
MR. BRAZIL:
No, I'm good.
CHAIR:
If you were down to one question, I would give you leave. If not, Ms. Coffin,
you have 10 minutes.
MS. COFFIN:
Thank you very much.
First
thing I would like to do is thank you all for coming and all your hard work and
expertise that you've put into making the Estimates possible and all that
background work because I know it's not as simple as here's the binder. There's
an enormous amount of work. Thank you for that and thank you for giving your
evening to be here for us. I appreciate that.
I am so
happy we're measuring outcomes. This is a wonderful thing. Can you tell me a
little bit more about the types of outcomes that you're measuring and how long
have you been at it? So I just kind of get a sense of what those outcomes are,
how long we've been measuring them, how they've been tracking over time. That's
a nice big nebulous question.
MR. HAGGIE:
It is a nebulous question, because it really kind of depends on which program
you want to pick. So, for example, with JASPER, the Joint Attention Symbolic
Play Engagement Regulation program under autism.
MS. COFFIN:
What now?
MR. HAGGIE:
That is part of an ongoing project with UCLA. We have actually partnered with
them to bring in the next iteration of JASPER.
We
submit a variety of metrics to CIHI for their database. Things like 30-day
readmission rates, complication rates post-surgery, post-surgery readmissions.
We use that database and we have been interactive with the CIHI data. We
actually had an examination, for example, of the cardiac cath lab and the
cardiac surgery program – well, the cardiac cath lab and leading into the
cardiac surgery program – that has produced significant reductions with a
co-operation between the cath lab, the reviewers that came in as a result of the
outcome data we were measuring and the Medtronic firm.
So, for
example, we now have a shrinking wait time for cardiac caths for outpatients. If
you're an inpatient, with the exception of Western Health, it's a day wait to
get a cardiac cath as an inpatient; 1.5 in Western, and most of that is
seasonal, it's related to weather because we use planes to fly folks in from
Western.
So,
again, it really is almost contextual. It depends on what you want to look at.
MS. COFFIN:
Right.
MR. HAGGIE:
Some of the areas we aren't measuring what we should. We are investing, for
example, in Eastern Health in a monitoring and reporting system for emergency
room visits, for example. We haven't been able to submit data to CIHI because of
a lack of that, but that's something we're correcting.
MS. COFFIN:
Okay, interesting. Can we just kind of keep going with that?
When
you're saying outcomes, it's specific to programs, which is just wonderful.
As an
aside, is there a wait-list for colonoscopies? Because I know – and I'm not sure
why someone is tried so hard that they want a colonoscopy. Maybe for Christmas?
I don't know if you're measuring something like that, but that's just an aside
I've heard, right?
MR. HAGGIE:
Yes, in actual fact, the RHAs are at different stages with that.
MS. COFFIN:
Right.
MR. HAGGIE:
There is a plan to try and
provincialize that program but, for example – I can speak from my own previous
experiences – in Central Health we have a central intake program, the request of
triage into one of three, four categories. So, if you are an urgent, we have a
14-day window and if you are elective, then there is a longer window. I couldn't
tell you now exactly what it was. In my day it was a bit longer than I would
have liked but I think it's something in the order of 90 days now.
MS. COFFIN:
Okay.
MR. HAGGIE:
Those are measured and
they're reported and, in actual fact, we have five databases/registries which
were amalgamated into one body through NLCHI when we amended the Newfoundland
and Labrador Centre for Health Information Act.
We have
the Cancer Care Program, we have the Cancer Screening Program and there's data
there that can be reported on a regular basis about those kind of things for
colonoscopy, for cervical smears and for mammography, for example.
MS. COFFIN:
Okay, interesting.
I come
at this from a slightly different perspective. Are you familiar with the
Community Accounts?
MR. HAGGIE:
I'm not –
MS. COFFIN:
Very interesting. It
captures a lot of qualitative data that we don't see captured in other places.
It's a database that's online. Have a look, it's housed in the –
MR. HAGGIE:
I have vague recollections
of something like that.
MS. COFFIN:
Yeah.
MR. HAGGIE:
I think my staff slides
something like that across my desk from time to time, yes. No, I just didn't
recognize it then.
MS. COFFIN:
Totally fair.
That's
something that is really interesting and some of the outcomes that you're
talking about might fit neatly into that. I know a lot of people who work in
economics, but also in health research and a pile of other places, would be more
than grateful to have access to some types of things like that. Just as an idea,
it might be an interesting place to put that data. Do we have ownership of the
data?
MR. HAGGIE:
The NLCHI data?
MS. COFFIN:
Yeah.
MR. HAGGIE:
Yes, it's ours.
MS. COFFIN:
Oh lovely. Okay, so if
that's something that's shareable, without identifiers and all of that, then
that might be a really valuable research tool that could be partnered with
independent researchers, but also the university.
In
that, in some of the things there when we say outcomes, now that I realize it's
specific to a program, one of the things I think about is looking at overall
health of our population. We're an aging population and with that comes
different rates of incidents and things like that. We win when it comes to
diabetes it seems; obesity we're out ahead of that.
These
are, I guess, indicators of health, so kind of teeing in our outcomes that are
associated with that, but that's much more of a general measure of the
well-being of the people in the province.
MR. HAGGIE:
Those exist; we have a
Population Health division as it were –
MS. COFFIN:
Yes.
MR. HAGGIE:
– an area within the
department. Those matrixes are collected –
MS. COFFIN:
Oh lovely.
MR. HAGGIE:
– and they are reported on
both provincially and through the national mechanism, through CIHI, for example.
MS. COFFIN:
Excellent, okay.
So
let's take that and we'll tee into now the Health-in-All Policies lens. I notice
over here in Departmental Operations they talk about prevention of illness and
disease as well. When we get to that piece there, the larger indicators of
obesity, diabetes, smoking, drinking and all of that good stuff – or bad stuff –
what are we doing to kind of map our prevention strategies into some of the key
things that we're seeing there?
MR. HAGGIE:
Well, there's a coordination
piece there because in 2014 there was a kind of a great divorce and the
prevention strategies were moved into Children, Seniors and Social –
OFFICIAL:
Development.
MS. COFFIN:
What?
MR. HAGGIE:
– Development. Yes, I was going to say wellness for a minute. That decision
predates my arrival here.
MS. COFFIN:
Right.
MR. HAGGIE:
So there is a considerable amount of overlap in the department and liaison
between ourselves and them. It's always a dynamic discussion as to what kind of
promotional material, who sends out kind of thing.
With
some of the more acutely focused things like, for example, the opioid issue, we
have tended to roll that into Mental Health and Addictions and be the lead on
that. With things like exercise, healthy eating, each of the RHAs has its own
staff and its own area, but at a provincial level the coordination of that would
come through CSSD.
MS. COFFIN:
Right. Okay, interesting.
I
haven't even hit the questions that I listed here; I'm just kind of taking off
some of the things that you have spoken about. Do we have, I guess, a policy or
do we have an ability for doctors to prescribe healthy eating and exercise? I
know that's been captured in some jurisdictions.
MR. HAGGIE:
It has. We have had discussions in the department about that. By and large,
where those initiatives have been taken up, particularly around the exercise
piece, it's been done with the collaboration of business, basically.
For
example, in Alberta, the groups around gym operators said we will give you a
free month at our expense, but you have to write the prescription, so it didn't
actually cost government anything. The motivation behind that for the gyms was
that those people who actually went and stuck it out for a month had a far
better likelihood – it was like a loss leader, and then they would enrol and
then they would pay their regular rates, whereas their retention rates for cold
clients were a lot lower.
MS. COFFIN:
Right.
MR. HAGGIE:
Basically, it was leveraging the physician, sort of, blessing, which has a power
of its own.
MS. COFFIN:
Wonderful. Okay, that's very
interesting.
I have
36 seconds so I don't know if we can actually ask and answer a question. In the
Departmental Operations I understand that a large number of these pieces were
all kind of combined together into one. I guess that's why the Salaries in this
section are a tenfold increase of many of the other sections that we see in many
of the other departments.
Is it
at all possible to maybe break that down a little bit so it kind of maps a
little bit more into some of the programs that were all combined? If it's in the
book, you don't need to go through a list of it.
MR. HAGGIE:
If you go to the position
breakdown, you'll see each of the divisions within –
MS. COFFIN:
Okay.
MR. HAGGIE:
– the operations sphere
itemized with PCNs, so you get a subhead of each of the salary elements for
those.
MS. COFFIN:
All right, that'll be
interesting. I'll definitely have a look at that and turn it over.
CHAIR:
Ms. Coffin will turn it over
to Mr. Brazil.
Mr.
Brazil, any more questions on this subhead?
MR. BRAZIL:
I have no more questions on
that subhead, Mr. Chair.
CHAIR:
No more questions?
Ms.
Coffin?
MS. COFFIN:
Oh yes, I have to get to the
ones that were written out for me. They're not bad.
Can we
have an update on the activities of the Mental Health and Addictions teams?
MR. HAGGIE:
Certainly. In actual fact, I
can think of no better person than Colleen to do that. She gave birth to them in
many respects –
MS. COFFIN:
Oh my.
MR. HAGGIE:
– if you don't mind using
that term.
There
are eight of them, and over to you.
MS. SIMMS:
We do have a series of
project teams under Towards Recovery.
As the minister mentioned, we have eight teams. We actually recently collapsed
one team together because we were looking at provincial programs as well as
service redesign. The two of them came together as the provincial Service
Redesign Team.
Each
one of the teams is chaired either by somebody from Health and Community
Services or from CSSD, EECD or a regional health authority. We have a really
good cross-section of government departments involved, as well as Justice and
Public Safety. We have over 300 individuals, people with lived experience,
family members, RHA staff involved in each one of the project teams, and they're
focused around a group of recommendations that came from the All-Party Committee
report –
MS. COFFIN:
Right.
MS. SIMMS:
– and came into our Towards
Recovery Action Plan. So, we're right at the two-year mark right now with that
action plan.
MS. COFFIN:
Yeah.
MS. SIMMS:
There were 54
recommendations and 29 of them have now been completed. The rest of them are in
progress.
The
focus for us right now is really on the service redesign, so really looking at
what we need to have in community, as close to home as possible for people, to
keep people well and also to treat people with severe and persistent mental
illness and additions, so the full continuum.
MS. COFFIN:
Lovely, okay. I guess
there's a set of outcomes associated with that as well?
MS. SIMMS:
There are. There's a full
indicator set.
MS. COFFIN:
Yeah.
MS. SIMMS:
Yeah.
MS. COFFIN:
Good. I look forward to
maybe chatting with you more about that.
MR. HAGGIE:
Just to elaborate on that,
there have been a variety of initiatives and some of these, of course, while the
coordination and the provincial element comes through the department and you see
it in operations, a lot of this is enacted through the regional health
authorities. It's provincially coordinated and run but it's actually Central or
Western who will do that. So for things like the act and the fact teams – the
assertive community treatment and the flexible assertive community treatment
teams – we've rolled out those three.
In
terms of hubs, for example, which is around addiction services hubs. So those
would be a nurse practitioner with suboxone and methadone prescribing to get an
experience in addiction services, mental health support, addiction support, and
they would be located in a regional centre. They would provide support to
practitioners in Spoke.
For
example, a physician out in Brookfield will have clients who he/she can discuss
with a hub or refer to the hub for extra support. In turn, those hubs connect to
a provincial centre of excellence which is set up and is in the process of
bootstrapping itself. There are opportunities there for patient orientated
research in that area if we can attract some more funding, and we've done that
with a combination of federal money, provincial money and the opioid emergency
money that came out in the last interprovincial meeting.
MS. COFFIN:
I hear scary things about the opioids, for sure. Certainly, what I'm hearing is
primarily affecting the opioid users. So much of a burden is being placed on
their parents. Quite often there's like a whole generation that is being
affected by that. Grandparents are often stepping up to take care of
grandchildren because the parents are absent or unable, right, which is an
unfortunate thing. So that's what I hear in some places, but that's not the
question.
Where
was the federal Health Accord money spent in 2018 and where is it planning to be
spent in 2019?
MR. HAGGIE:
The Health Accord money was, basically, allocated in two pots. It is in your
binder. I couldn't for the life of me just tell you which tab it's at, but,
essentially, it was spent in two main areas. One around mental health and
addictions and the other is around seniors and palliative care.
So
that's where that money will go. The exact amounts are in the binder somewhere,
and if I went from memory I would misspeak.
MS. COFFIN:
It's okay, we don't need the
exact amounts. If they're in the binder we can get them.
MR. HAGGIE:
It's in here somewhere. I
think it amounts to just shy of $29 million over the first five years.
MS. COFFIN:
Okay, good.
Thank
you.
Let's
see; have you completed the revised policy for the Medical Transportation
Assistance Program for Income Support clients?
MR. HAGGIE:
No, is the short answer.
That work is underway.
MS. COFFIN:
Okay.
MR. HAGGIE:
I'd be happy to elaborate
further on that. Essentially, we have brought in some additional resources in
terms of supervisory management, and that was referenced in the question
earlier, but we've also now tied into ASL's database so that we can run reports
and generate the indicators in that area, too. But we really need to look at the
policies and reboot them completely. They were written, some of them, nigh on 20
years, 25 years ago –
MS. COFFIN:
Yeah.
MR. HAGGIE:
– and I think there is a
huge room for improvement there.
Now we
have responsibility for all of the medical transportation budget, we can look at
what makes sense from a health perspective because whilst it's moving from one
head to another, there are significant savings to be had in medical
transportation; for example, for methadone services. We've moved – spoke out to
Bell Island to deal with issues there, but the upside of it is the money you
save on transportation, it still stays in the Department of Health and can be
redeployed to provide staff to provide that service locally.
MS. COFFIN:
Oh, wonderful. That's nice
to hear.
I'm
wondering about the insulin pumps for people over 25. When will it begin, and
will it only cover people who are currently in the program at 25? So it will
only be used for people to get a new pump after they're 25?
MR. HAGGIE:
The moment the situation was
– the ask from various groups was to lift the age restriction, and we've done
that. So, there is money. The pump program is funded through Eastern Health –
MS. COFFIN:
Right.
MR. HAGGIE:
– so there isn't a line item
as such here. It's in Eastern Health's operational budget. It is a provincial
program, and I think when it first started it was capped at 15 and then it went
to 18 and then it went to 24.
The
intent for this coming year is two-fold. One is we remove the age restriction so
anybody who's 24 will not age out. The other thing is that program is undergoing
a reboot, too, because there are significant opportunities for it to be run in a
way that would yield better value for money, and there is a new clinical need as
well.
So I
think there's a huge opportunity here to say, well, how do we do business in
that program? And there are opportunities through shared services. Whilst it's
run through Eastern Health, we could have a more centralized procurement and we
could actually save money per item and we can redeploy that money.
The
challenge with that is through the diabetes registry. Our data is now so much
better than it was before, and people have come to us and said: Well, you've got
a sudden increase in the number of Type 1 diabetics in this province. We
haven't; what we do is we're recognizing them now.
MS. COFFIN:
Right.
MR. HAGGIE:
Basically, at the moment,
only 10 per cent of people simply labelled as Type 1 diabetics are actually
enrolled in the program.
Now,
you've got to remember that not everybody with Type 1 diabetes is suitable for a
pump.
MS. COFFIN:
Right.
MR. HAGGIE:
Sorry; is eligible for a
pump, clinically.
MS. COFFIN:
Yeah.
MR. HAGGIE:
And of those people who are,
not everybody who is offered a pump can actually manage it.
MS. COFFIN:
Right.
MR. HAGGIE:
There is, depending on who
you talk to, anything up to 40 or 50 per cent of people with the condition end
up not being able to use a pump.
MS. COFFIN:
Oh.
MR. HAGGIE:
But the expansion there is
such that we haven't yet identified the source of funds to go backwards and say,
well, who would be next? Where would be the next group to expand it to?
Our
intention is, ultimately, to end up in a place where anybody of any age who's
got Type 1 diabetes – who needs a pump and the physician says it's a reasonable
thing – would be able to be supported in that way, with us as the insurer of
last resort, I hasten to add –
MS. COFFIN:
Right.
MR. HAGGIE:
– in the same way we are
with some of the children services also.
We are
not there yet, and until we find ourselves with some fiscal leeway, quite
frankly, it's going to be very difficult to do anything other than an
incremental program.
MS. COFFIN:
Right. And this will only be for Type 1, not Type 2?
MR. HAGGIE:
There is a great debate
about Type 2 in terms of whether or not insulin pumps are actually the
treatment.
MS. COFFIN:
Right.
MR. HAGGIE:
They are two different
conditions.
MS. COFFIN:
Oh, I'm well aware.
MR. HAGGIE:
One is insulin resistance,
the other is not producing any insulin. So they are, I am told, managed
completely differently.
MS. COFFIN:
Right.
MR. HAGGIE:
So that has not come up as a
question.
MS. COFFIN:
Okay. Yeah, and I didn't
figure they were –
CHAIR:
Excuse me, your time has expired.
MS. COFFIN:
Okay.
CHAIR:
I'll turn it back to Mr.
Brazil.
MR. BRAZIL:
I'm still good on that
subhead until you move to the next subhead, yeah.
CHAIR:
You're still good. Okay.
Ms.
Coffin –
MS. COFFIN:
I have a couple of other
quick questions.
CHAIR:
– can we do line by line
this time?
MS. COFFIN:
Can we have an update on the
activities under the home support action plan and the Home First philosophy?
MR. HAGGIE:
Yes. The Home First
philosophy has made significant differences. For the first time I can ever
remember, it has actually enabled patients to be repatriated home from long-term
care.
MS. COFFIN:
No way.
MR. HAGGIE:
Yeah.
MS. COFFIN:
Wow.
MR. HAGGIE:
So there is significant benefit to this. In 2018-19, we've had 1,000 people
access services that have avoided hospital admissions through this Home First
policy. We got $43 million in funding from the feds, over five years starting in
fiscal '17, to support home and community. So that's where that has gone in
terms of some simple, high-level matrix. In 2017-18, we spent $4.6 million and,
in '18-'19, we spent $8.5 million.
We do
now have a home care dementia approach. We have a dementia plan, which is valued
at $1.7 million, in addition to that, and that is a case-managed approach. So
you would have behavioural management specialists – it's based on the nurse
practitioner model. That would be the hub there.
So if
you want specifics, there is a whole pile of things in terms of better
assessment tools, better coordination between the various elements there. We've
been working very closely with the home care sector. That's divided between
individual pay and what we call self-managed care where the person simply goes
to somebody and asks would they look after them at home or, alternatively,
agency work.
One of
the challenges identified in the Deloitte report was around verification of
services. The traditional matrix for home care is hours. There is a huge
opportunity with the work we're doing with the home care sector to reboot that
and to talk about services needed, so it doesn't become a matter of hours, it
becomes a matter of care needs and how those are met in a coordinated way.
Obviously, if you have a more urban area and a fairly dense area, I'm sure a lot
of modest-sized communities do have areas where there are seniors clustered in
affordable housing or seniors housing, there are huge opportunities there to
have care provided at almost a street level by a group of people in a
needs-based way, which is much more focused on the individual care needs. We
think that with that, we can generate significant efficiencies in the dollars we
spend, better outcomes for the individuals concerned and better health for the
group of seniors.
MS. COFFIN:
This is very reassuring. I
had experiences with home care from a couple of different perspectives, one of
which my brother has home care for his son, so we've had very good interaction
and some wonderful, wonderful people there who have been helping take care of
our Little B, and that's particularly special.
I've
also talked to a number of people who work in home care, and some of the things
that they have told me about their work environments are a little concerning.
They say sometimes if they're assigned to a home or they're assigned to an
individual, they often don't know what they're walking into. It could
potentially be a dangerous environment; it could be someone who might have some
mental illness and they're not quite sure what that mental illness is and that
person is there just to manage some other issues, and they've told me stories of
being told how to give medications by the parents of the person they're there to
care for or by someone who perhaps was not the most appropriate person to give
training on delivery of medication, say, via G-tube or anything like that.
I think
it's an important piece to balance that as well, and I know that that's a very
difficult thing because it's a very special relationship between a home care
provider and a home care recipient. It's not exactly like employer-employee, but
certainly that's something that I have heard. It wasn't one of my questions;
it's just another piece that I hope that is being balanced along the way.
I am
wondering now: Has the department completed the new personal home care
standards?
MR. HAGGIE:
They are in process. They're actually part of another kind of three-legged stool
because the standards are linked to the levels of care, and, in turn, those feed
into the funding model. Each of those areas is being currently addressed, so we
have some work out in terms of informing jurisdictional scans of funding models.
We have
been working very closely with the personal care home operators association and
the Quality Living Alliance, certainly prior to the election, on a new set of
standards. Currently, we have four levels of care: 1, 2, 3 and 4. One and 2 are
manageable in personal care homes and the standards are geared around that; 3
and 4 tend to fall into RHA facilities, which are designated and called
long-term care.
Now,
one of the earlier developments was we kind of designated a 2-plus and we had a
pilot scheme that we inherited, and it ran very well. We debugged it a little
bit further and we've expanded that, and there is what we a call an enhanced
care arrangement for personal care homes who want to apply for it and is extra
funding that goes with that.
We do
have a level 3 transient payment arrangement as well, where a home would take a
level 3 patient on a short-term basis with extra resources – not just financial
for either of these, they would involve RHA staff and accessibility to services
that wouldn't typically be provided there. That was, in part, to try and take
some of the strain off long-term care while the beds situation was being
addressed. But what we've done is we've gone back to the association and we've
said: What about a seven- or eight-point scale?
How
about something that is nuanced that allows you to score for severity of mental
illness for example? Because we heard some questions about that earlier on
today. Whilst those are addressed in the old standards, they are done in an
older way of thinking and it doesn't really line up with best practices. So once
you've figured out what the levels of care are, you set the standards for those
levels and then you figure out how to match the funding with the levels of care.
At the moment, there is little recognition financially between level 1 and level
2. So there's no real incentive for a personal care home operator to take a
level 2 because their staffing requirements change but their compensation
doesn't – 2 plus does, but 2 doesn't.
MS. COFFIN:
Right.
MR. HAGGIE:
So those are the challenges
of their business model and we're trying work that with them. We're kind of on
the cusp of where we need to be but there is one piece of outside information
that's needed, and that's the discussion on funding models and our outside
consultant work about what to do. The rest of it is pretty well nearly nailed
down. But again that feeds in with the standards around education. So there's
some discussion there around who pays for what because we've had some surprising
comments about what some home operators think is the training requirement or
not, or people who work in that (inaudible).
MS. COFFIN:
Right. I look forward to that, but it's nice to hear that that movement is
happening.
One
last question: I just want to know what will be done in the 2019-2020 with
autism strategies. Was there some specific initiatives?
MR. HAGGIE:
Really glad you asked me that question. The short answer is there are.
Everything that was actually written into the strategy is there. In essence, it
goes at it from several directions. One is access for diagnosis and improving
access to clinics.
There
are five pillars. I'm not going to go through that. It's in the plan; you can
read it online.
MS. COFFIN:
Right.
MR. HAGGIE:
But the number of ASD diagnosis clinics, we need to look at ASD assessment
tools. There is a variety out there. But one of the things that we're doing is
revamping the Special Child Welfare Allowance Program and we're moving that to
what we're going to term supporting services for children. I think the name
change is just to really signal that the old is gone and the new is in.
What
that does is it looks at function. It looks at the needs of the individual in
terms of what support they may need. So it gets rid of IQ 70, but it's actually
a diagnosis-agnostic tool. At some point, children with any impairment will
actually be able to access this program.
This is
where the integration exists between the Autism Action Plan and our more
overarching strategy of a disability program through community support services.
The
focus has always been, and the pressure point in the public eye has always been,
around autism, but that's not the only diagnosis, and we're trying to move away
from diagnosis to function. We've got JASPER expanded, we're going to teach the
family, in the same way we've done through Strongest Families dealing with
anxiety. We found that if you treat the family – the parents as well as the
child – the results are not only better, but they're more lasting.
MS. COFFIN:
Of course it would.
MR. HAGGIE:
The I CAN anxiety thing for the kids through Strongest Families has an 82 per
cent success rate.
MS. COFFIN:
Wonderful.
MR. HAGGIE:
So that was a metric for you.
MS. COFFIN:
Yes.
MR. HAGGIE:
The education piece, an ABA up to 21 when they age out of the school system. So
there are lots of tangibles there. There is $2.5 million for the rest of this
year.
There
will be a little bit of a delay because we've got to get the tool right, because
we've already heard very clearly from some groups that it's too medicalized. The
ones that are out there that everybody loves are based on very much a medical
model. So we need to figure out how to get round that, train the staff, then we
pull the trigger. That's why there's less in this year's budget than there is
annualized afterwards.
MS. COFFIN:
Right. Wonderful. Thank you very much.
That is
my question, thank you.
CHAIR:
Okay, thank you.
So
hearing no other speakers, I'll ask the Clerk to call the subhead, please.
CLERK (Hawley George):
1.1.01 to 1.2.02
inclusive.
CHAIR:
Shall 1.1.01 to 1.2.02
carry?
All
those in favour, ‘aye.'
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against, ‘nay.'
Motion
carried.
On
motion, subheads 1.1.01 to 1.2.02 carried.
CHAIR:
Moving on to the next
subhead.
Clerk,
if you could call the subhead, please.
CLERK:
2.1.01.
MR. HAGGIE:
Before we start, Mr. Chair, I am reliably informed there were six retirements
from the department in 2018-2019.
CHAIR:
Okay, Mr. Brazil, that's the
information you required, right?
MR. BRAZIL:
Yes.
CHAIR:
Okay.
So
shall subhead 2.1.01 carry?
Mr.
Brazil.
MR. BRAZIL:
Thank you, Mr. Chair.
Just a
number of questions here for some clarification.
Under
the Professional Services, can you tell us the nature of the Professional
Services? What they're for and some type of contractors that might have been
contracted for these services?
MR. HAGGIE:
Okay, the 2.1.01 is an
agreement with Bell Aliant for real-time processing for the NLPDP, and that's a
contract price. Its current contract is extended until the next financial year,
and we're working on a new RFP.
MR. BRAZIL:
Okay, perfect.
MR. HAGGIE:
That's real-time
adjudication. There are 11,000 claims a day processed by that system for NLPDP
eligible clients.
MR. BRAZIL:
When did that come into
play?
MR. HAGGIE:
Well, going back to the dawn
of time it was Xwave and then it morphed through several things.
We have
a challenge in that whatever replaces it has to be bulletproof, so we've been
very careful about writing the RFP because whoever comes in needs to make sure
it will run, first time, right. So it may need a period of shadowing running
with two systems, the changeover. But if that changeover isn't done properly,
that's our main worry because, as I say, 11,000 a day.
We have
had odd little downtimes, but it's got a 99.999 per cent uptime reliability. So
it's only been done for half an hour, kind of thing, on those occasions.
MR. BRAZIL:
Fair enough.
MR. HAGGIE:
That's what that is. That
came out of the dawn of Xwave.
MR. BRAZIL:
Yeah, I'm quite aware and
sat in, as a minister, and had discussions around how do we move it, and knowing
that it hasn't moved.
How
close are you guys to being able to put an RFP for another provider or equal
provider just with a new type of service?
MR. HAGGIE:
I don't think we're that far
off. We would anticipate –
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Okay, we're well advanced.
The proposals are in. It's out and back.
MR. BRAZIL:
Okay.
Thought
so, that's why I only asked because I–
MR. HAGGIE:
See that's what happens when
you go and have an election, you see, you come back and you have to catch up.
MR. BRAZIL:
Yeah. That's why I ask
because I had heard a rumour it was out there but I wasn't quite sure if they
had closed and they were accepted back in.
MR. HAGGIE:
No.
MR. BRAZIL:
Okay, fair enough. That will
be curious.
Do we
know the opening date, or closing date, I should say?
MS. STONE:
It has closed
MR. BRAZIL:
It has closed, yeah, but the
opening date I meant. When are we going to open to know the awarding of the
contract itself?
MS. STONE:
Very soon.
MR. BRAZIL:
Okay, fair enough.
Allowances and Assistance under 09, you're $2 million budget difference there,
it went over in '18-'19. Can you just explain what that was relevant to?
MR. HAGGIE:
Yeah. It's actually pretty
much the same reasons as last year. It's higher utilization of antivirals,
principally Hep C antineoplastics, which are hematological oncology drugs and
methadone and Suboxone.
MR. BRAZIL:
Okay. So the money to cover
that, is that federal money coming back in?
MR. HAGGIE:
We do have some revenue in
this heading.
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
We have revenue from the PLAs, the product listing agreements, we have rebates,
and they are based on agreements that we have with the drugs companies. So, we
had a change between 2018-19, revised in the 2018-19 budget, which was an issue
around submission of claims.
MR. BRAZIL:
Okay.
So,
just so I'm clear, the $2 million extra, that was transferred in from another
line area or from the revenue that –?
MR. HAGGIE:
We just had savings in other
areas to offset the cost increases.
MR. BRAZIL:
What kind of programs would
you be able to save $2 million in?
MR. HAGGIE:
I think it was across …
OFFICIAL:
Capital.
MR. HAGGIE:
Capital.
MR. BRAZIL:
Okay, capital costs. Fair
enough.
In
Budget 2019, you announced 15 new
drug therapies at a cost of $4.9 million. The budget for drug costs in 2019 has
only increased by $200,000, plus you also went over budget in '18-'19 by $2
million. How are you going to fund the new drug therapies as it doesn't seem to
be through in the budget right now? Can you just clarify where that money will
come from?
MR. HAGGIE:
Okay, let me just have a
look and see. I have a list of (inaudible).
So your
question was: Where's the money coming from for the new drugs?
MR. BRAZIL:
Yes.
MR. HAGGIE:
Okay.
MR. BRAZIL:
Keeping in mind, your budget
lines are only up $200,000.
MR. HAGGIE:
Yeah.
No, I
mean, this is where we anticipate savings in other areas, cumulatively, to be
able to move those in.
MR. BRAZIL:
Can you give me an example
of where those savings potentially could come from? It seems fairly substantial,
almost $5 million.
OFFICIAL:
(Inaudible) capital savings.
MR. HAGGIE:
Most of the time it has come
from capital and that seems to be where our eyes are set at the moment.
MR. BRAZIL:
Fair enough.
Can you
just outline here the revenues that are outlined in 02, an additional $4,750,000
was received in '18-'19, can you outline where that came from and what it was
for?
MR. HAGGIE:
Which one that came?
MR. BRAZIL:
Yeah, revenue in 02, the
difference there between what was anticipated and what came in after, the $12
million that actually was revised to the $7.250 that came in.
MR. HAGGIE:
Those were rebates. What
happened was the '17-'18 claims for rebates were submitted late so they appeared
in '18-'19.
MR. BRAZIL:
From previous fiscal?
MR. HAGGIE:
From the PLA, product listing agreement, we had $4.75 million that was late
going in 2017 fiscal and came in 2018.
MR. BRAZIL:
Can you outline a little bit
more about the new drugs that are going to be added to the system?
MR. HAGGIE:
I have them here. Certainly.
There's
one for
hidradenitis
suppurativa, there's one for primary biliary cholangitis, there is one for type
2 diabetes with high cardiovascular risk, one for infantile hemangiomas,
one for multiple
sclerosis, one for the prevention of stroke in coronary artery disease, giant
cell arteritis, polycythemia rubra vera, acute myeloid leukemia, one for ovarian
cancer, two for lung cancer, one for chronic lymphoblastic leukemia and one for
lung cancer.
MR. BRAZIL:
Okay, that's a good cross-section and good additions to the drug list itself. My
concern is that we were over budget before and had to take it from capital. Now
we're adding new and you're anticipating taking from capital again the savings.
Is that not a risk to ensure
that you're going to be able to cover those drugs within the system? I mean is
your priority that these drugs will stay and there will be no limit on the
access for those who qualify?
MR. HAGGIE:
The criteria around the drugs and their availability is clinical, not
administrative. I mean the facts of the case are there are two pressure areas on
the health budget globally; one is the price of drugs. We participate in those
pan-Canadian negotiating arrangements – the pCPA and such, pCODR – that allow us
to leverage nationally volumes. A lot of it is not directly within our control.
Adding on to that, of
course, now, is the federal announcement about pharmacare and it is not clear in
any way, shape or form how that is going to work. The final report is fairly
vague except for the fact it's a universal single-payer system.
It is a challenge, and it
always is every year, to try and make sure that we cover the cost of drugs
because the only other alternative is to reduce the number of new drugs we bring
in each year. That then puts us at odds with other provinces and creates
inequalities. Every year this area is subject to a lot of hard work by staff to
try and find a way to fund it.
MR. BRAZIL:
Fair enough. I applaud the fact that there are new drugs being added and I
understand the agreement of the provinces in having to have that in play, but my
concern still lies in the fact of knowing that it's going to cost additional
revenues that you don't have earmarked right there.
Have
you talked about it? Is there already an earmarked capital cost that you're not
going to go through with this year?
MR. HAGGIE:
We haven't –
MR. BRAZIL:
Or is there somewhere you're anticipating savings? Is there some piece of
equipment? Is there some facility?
MR. HAGGIE:
Well, as you are probably aware, capital cash flows are very unpredictable.
We'll get into that when you come down to the capital piece, when we go through
that line item.
There
are a modest number of inflow and outflow gaps over the course of a project and
it is robbing Peter to pay Paul. The main thrust has been around generics and
the opportunities to replace expensive patent drugs, particularly biologics.
Biosimilars is the new buzz category and we are often subject to considerable
lobbying by what could be charitably called patient groups but are often, in
fact, agents of the manufacturers to restrict physicians' abilities to prescribe
cheaper drugs.
One of
the things that we have looked at doing is trying to advise physicians of the
costs of therapies. That hasn't, on an evidence-based way, produced some of the
behaviour changes that we would like to see but it's a start; it is part of an
education piece. The facts of the case are that there are increasing numbers now
of biosimilars and we will be looking to those to reduce costs because some of
them are a factor of 15, 20 cheaper than an equivalent, patented medication.
That's
one of the challenges around the drug-pricing system and one of our concerns
about changes on the national level that might affect our ability to do that.
CHAIR:
Thank you, Minister, and we'll be moving on.
Mr.
Brazil, I'll get back to you, but before I do, I remind everyone that we will be
moving to 2.3.01 before we call the subhead –
MR. BRAZIL:
Yeah.
CHAIR:
Okay. So, we're good.
Ms.
Coffin, your 10 minutes, Ma'am.
MS. COFFIN:
(Inaudible) questions. The
first one: Can we have a list of the expenditures and number of clients in each
drug plan in 2018, please?
MR. HAGGIE:
I think that might actually
be in your binder.
MS. COFFIN:
Oh, wonderful. And that was
an easy answer.
MR. HAGGIE:
Yes, there is a list of
numbers, and there is another table with expenditure for each of those plans.
MS. COFFIN:
Okay.
MR. HAGGIE:
So it's not one table; it's
two.
MS. COFFIN:
Okay. That's fine.
How
much is budgeted for the Smoking Cessation Program?
MR. HAGGIE:
I would have to look for
that.
I think
it's $10,000. 2.1.01. Yes. Yes.
Sorry;
yes, it is. I was actually staring at it in front of me.
Annualization of the Smoking Cessation Program is $10,000. We had 1,779 people
avail of it in 2018.
MS. COFFIN:
Did they stay stopped
smoking?
MR. HAGGIE:
Good question. I'd have to
go back and ask that specific question.
MS. COFFIN:
Sure. Yeah.
MR. HAGGIE:
We do have that, but CSSD
would be the people who would tell you the answer.
MS. COFFIN:
Right. They are the keeper
of the data.
MR. HAGGIE:
Yeah.
MS. COFFIN:
Yes. Okay.
One
more other question here, and this is something that is of interest to me, but
also something that I heard on the doors from a number of people who are
involved in this program. I'm wondering about the coverage of medical marijuana.
Certainly, a couple of very astute doctors in that area said she's having
remarkable success with that and it's gotten people off a lot of the other
drugs, but because medical marijuana is not covered, people sometimes can't
afford it and stay back on drugs that tend to have some very negative side
effects.
MR. HAGGIE:
Yeah. I mean, the first
problem is that, by legal definition, marijuana is not a drug.
MS. COFFIN:
Yeah.
MR. HAGGIE:
So, your first problem there
lies at the federal level because it requires a DIN number, a Drug
Identification Number.
MS. COFFIN:
Right.
MR. HAGGIE:
Without that, it cannot be
prescribed, and without a Drug Identification Number, it can't even be
considered for a provincial formulary.
MS. COFFIN:
Right.
MR. HAGGIE:
So, that's your first
challenge around that. There is no doubt there is evidence out there of,
certainly, anecdotal benefit, and I would suggest there is probably some more
structured research that would back it up. The problem is a federal regulatory
piece, and it's outside my jurisdiction.
MS. COFFIN:
I'll happily write a letter
for you – or on our behalf.
That's
all my questions in this section.
Thank
you.
MR. HAGGIE:
Thank you.
Oh,
sorry. We have some updated money for Smoking Cessation. The $10,000 was an
annualization of our bit, but the bill for the total cost of Smoking Cessation
was $1.068 million.
MS. COFFIN:
Thank you.
MR. HAGGIE:
Thanks.
CHAIR:
I'm sorry, we're going to have to pause, just recess for five minutes, if you
don't mind.
OFFICIAL:
(Inaudible.)
CHAIR:
Okay, you usually do it at 7:30, so we'll come back at 7:30, if that's fair.
Okay?
MR. HAGGIE:
I don't mind. Yeah.
CHAIR:
Thank you very much.
Recess
CHAIR:
Okay, we're ready to go
again. Thank you, and I hope everybody enjoyed the little recess.
Mr.
Brazil, you're up for your 10 minutes, Sir.
MR. BRAZIL:
Thank you Mr. Chair.
Under
Medical Care Plan, 2.2.01, Physicians' Services, can we get a breakdown of the
number of physicians in the province by salary versus fee for service and
specifically by the regional health authorities?
MR. HAGGIE:
I can read it out; it's in the binder.
MR. BRAZIL:
Okay, it's in the binder.
MR. HAGGIE:
We have both of those there. Just as an overview, in the last 10 years our
physician numbers have increased by 19 per cent but physician compensation has
increased by 57 per cent.
MR. BRAZIL:
Okay, fair enough.
Under
Professional Services, fiscal '18-'19, you went over budget by $2 million. Can
you explain what that was for?
MR. HAGGIE:
And that's under Physicians' Services.
MR. BRAZIL:
Professional Services, 2.2.02.
MR. HAGGIE:
2.2.02, that's the Dental Services one you're looking at now.
MR. BRAZIL:
No, MCP fees for service (inaudible).
MR. HAGGIE:
Oh, sorry, 2.2.01.
MR. BRAZIL:
Under Physicians' Services.
MR. HAGGIE:
Under Professional Services, 2.2.01, two things driving that: We have increased
utilization and the increase in surgical dental. Some years ago, really, as a
precursor to the idea of doing in private offices what was only done in regional
health facilities, some of the dentists were allowed to bill fee codes for
surgical procedures in their own offices and that has driven the cost increase.
MR. BRAZIL:
Okay.
How did
you cover that off, the $2 million?
MR. HAGGIE:
Same discussion really, as before. We have identified savings in other areas,
and moved the money in.
MR. BRAZIL:
Any particular one that stands out, where the money was saved that was moved in?
MR. HAGGIE:
Again, last year was capital – we had a significant amount of leeway there
because of timing of some of the projects, and we'll get down to that bit
further down.
MR. BRAZIL:
As you know, during the election, myself and you were in a debate around chronic
diseases. We obviously had a conversation with what the demand was, and
particularly most agencies there would talk about the aging population as part
of it, knowing that there's going to be a bigger demand as we move forward. I
notice there hasn't been any dramatic increase in the budget. Shouldn't that be
taken into account, knowing that the needs are going to obviously increase?
MR. HAGGIE:
It's difficult to project what increase in demand is going to be. The budget
there is a modest increase, 2019 over 2018. I think, really and honestly, beyond
that, the forecast there is predicated on an increase for more doctors and
higher frequency of visits, but also realignment between fee for service and
salary. When the funding for the last agreement was put in, there was more money
put in one pot than another, and that's been moved back to the – I think it went
from salary to fee for service, didn't it? Yeah, it went from salary to fee for
service. They were put in the wrong pot when the – sorry, the other way, fee for
service to salary. So it nets out.
MR. BRAZIL:
The full $2-million overrun?
MR. HAGGIE:
No, what happened was the overrun is a netting out – oh, sorry, I misspoke. I've
been looking at the wrong section here. The cost overrun of $2 million was
around increased utilization, essentially as I said before.
MR. BRAZIL:
Okay, fair enough.
Under
Allowances and Assistance, under 09, budget '19-'20, the budget increased by $1
million over the revised budget. Can you explain that?
MR. HAGGIE:
This is for payments for services received by residents out of the province, for
residents of other provinces while in, under reciprocal billing. That's totally
unpredictable. In that sense, we don't know how many Newfoundlanders and
Labradorians are going to be out of the province and require coverage. Likewise,
the other way around.
MR. BRAZIL:
So there are more projected for costing for patients moving out the province
than it would be for investing in having additional doctors here to provide
services?
MR. HAGGIE:
No, these are people who are resident in the province but are actually outside.
For example, if you went to Fort Mac to work, we would cover you. If you're ill
out there, we pay, and that's where this appears.
MR. BRAZIL:
Okay, fair enough.
MR. HAGGIE:
The rates are set under reciprocal billing arrangements.
MR. BRAZIL:
Okay.
Under
2.2.01.10, Grants and Subsidies, in fiscal 2018-19, you went over budget by $6
million. Can you explain that one for me?
MR. HAGGIE:
The following funding was
removed related to efficiency initiatives. In the last couple of years there's
been development of a physician hiring approval committee, salaried physicians'
compensation benefits in lieu, and limited use of salaried physicians' locum.
The full realization of those services has not been achieved yet, hence the
overrun. We only got $800,000 of it, so that's the difference.
MR. BRAZIL:
So, how did you cover that
overrun?
MR. HAGGIE:
We've, again, realized
savings in other areas and moved them over.
MR. BRAZIL:
Similar to other line items
there, are we talking capital or are we talking change in program services?
MR. HAGGIE:
Capital last year – there
was some comment about some savings on the blood program.
MR. BRAZIL:
Okay, fair enough.
You
spent $6 million more in budget '18-'19, yet the budget '19-'20 only increased
by $3.5 million. Do you feel it's reasonable that you can cover that and there
wouldn't be any additional increase? We're noticing there's obviously, because
of the uptake and the demand and the change in the demographics, always an
increase in particular lines. Have you budgeted enough there to cover the change
from last year, and what potential additional uptake there may be this year?
MR. HAGGIE:
It's a reasonable estimate
of what we think the change will be based on past performance.
MR. BRAZIL:
Okay.
Because
of the changes in the costing there, is there a plan to cut some salaried
physicians in the regional health authorities in '18-'19?
MR. HAGGIE:
No. The salaried physicians'
position numbers are fairly static. New positions are reviewed through a needs
assessment. Some physicians who are fee for service will transition into salary
as they get near the end of their career. As long as there's enough billing on
their fee-for-service budget, we will transfer the salary over from fee for
service.
MR. BRAZIL:
Okay, fair enough. But it
just seems like we're consistently over budget in the salary units and there's
no realization there of how to be able to sustain that as we move forward.
Last
year in Estimates you said that $1.7 million was removed from the salaried
physician budget because some physicians were getting two sets of benefits. Has
this change been made for this year?
MR. HAGGIE:
My understanding is it has,
yeah. It's out.
MR. BRAZIL:
And we don't anticipate any
issues with that? That's a savings?
MR. HAGGIE:
Yes.
MR. BRAZIL:
Any idea how many physicians
we're talking here?
MR. HAGGIE:
I can find that number out
for you but I'm not sure it's the GFT (inaudible)? We can find that number out.
MR. BRAZIL:
Okay. Fair enough. That's
good.
Under
2.2.02, Dental Services, Professional Services, fiscal '18-'19 you went over
budget by $300,000. Can you explain what that covered?
MR. HAGGIE:
2.2.02. Stainless steel
crowns and complicated extractions in children.
MR. BRAZIL:
How many patients are we
talking? Twenty, 50, 100, 500?
MR. HAGGIE:
We can find out for you for
sure.
MR. BRAZIL:
Oh yeah, fair enough.
Any
note like that, it's not immediate to get it but it'd be nice information to
have as we assess the Estimates themselves. The additional money to cover that?
MR. HAGGIE:
Again, the same discussion
as before.
MR. BRAZIL:
Okay.
MR. HAGGIE:
The finances of the
department are dynamic; it isn't just cast in stone. If we have areas that are
overrun, we will look internally for savings and move them over rather than go
and look at the contingency fund or special warrants.
MR. BRAZIL:
Is it the norm, though, that
you would save on a program? Because normally – I've worked in government for
many years and Health was one of the departments I was in for a period of time –
once program money is allocated, 99.9 per cent of it gets spent, and I
understand.
Coming
from another background, I can see in capital a project doesn't move forward, so
you can realize that savings internally and make the transfer. Is this where
most of the additional costing will be covered off on capital projects so that
they'll move forward in a timely fashion?
MR. HAGGIE:
Capital is the place where
we've gone. We have a lot of capital projects of varying sizes on the go, so,
yeah, that's our go-to place first. Then there may be vacancies in some areas
and they're not filled for a couple of months and there's a couple of months of
salary there. Again, it's a dynamic process.
MR. BRAZIL:
Fair enough.
CHAIR:
Thank you, Mr. Brazil.
MR. BRAZIL:
Yes, Mr. Chair, you can come
back to me after.
CHAIR:
I'll move on.
Ms.
Coffin, your 10 minutes.
MS. COFFIN:
Thank you very much.
A few
relatively easy questions I think. I guess the first thing that stood out for me
was that Professional Services is about three times as Grants, or Grants and
Subsidies represent about a third of the Professional Services budget. Grants
and Subsidies include locums, malpractice insurance and there are a number of
other things in there, yes?
MR. HAGGIE:
Are we talking about
physician services?
MS. COFFIN:
Yes, sorry.
MR. HAGGIE:
Oh we went back, okay.
MS. COFFIN:
2.2.01. I'm sorry. I should
have said that.
MR. HAGGIE:
No, that's all right. I just
want to make sure that I'm on the right page with you.
MS. COFFIN:
Right.
MR. HAGGIE:
You were asking about the ratio of Grants and Subsidies to …?
MS. COFFIN:
To Professional Services. I mean, that seems like quite a large number. If it's
locums that represent the bulk of Grants and Subsidies and that are Professional
Services – so we're looking at a large chunk of money being used for locums to
fill in for those Professional Services.
MR. HAGGIE:
The professional bit covers the fee-for-service physicians. The Grants and
Subsidies covers the salaried physicians. Locums would, by and large, fall under
the Grants and Subsidies, because the vast majority of locums actually come on a
salaried basis.
MS. COFFIN:
Right. Okay.
MR. HAGGIE:
This is where you would see the subsidy for CMPA. We pay approximately 75 per
cent of their costs.
MS. COFFIN:
I'm glad I asked that question. Okay, so actually that's quite interesting.
Let's
go over to here. Can we have a breakdown of the current number of family
physicians, the number of specialists, broken down by salaried versus
fee-for-service and by region, please?
MR. HAGGIE:
It is in the binder.
MS. COFFIN:
Lovely.
MR. HAGGIE:
We have, I think, the second-highest number of physicians per capita in this
province in the country.
MS. COFFIN:
Wow.
MR. HAGGIE:
We actually have the highest per capita of nurse practitioners in the country.
We're double the national, the Canadian average for nurse practitioners per
capita.
MS. COFFIN:
Good on nurse practitioners. You say we have the highest number of physicians?
MR. HAGGIE:
No, we have the second-highest per capita.
MS. COFFIN:
How come I can't find a doctor?
MR. HAGGIE:
Yes, good question. The problem is not the number; the problem is where they
are.
MS. COFFIN:
Right.
MR. HAGGIE:
Because of our critical mass issues, if you look at it, the first thing that
would strike you is that we have way more specialists than we do family doctors.
MS. COFFIN:
Right.
MR. HAGGIE:
Some of that is simply critical mass. We have various locations and you need
three, four specialists to provide 24-7 service, even though under other
circumstances workload may only warrant one or two by day.
Having
said that, if you look at family physicians and add in nurse practitioners the
numbers balance out. They're about 50/50. The difference there, of course, is
the pattern of work, because nurse practitioners, by and large, work shifts and
regular hours. They will not do a call, whereas family practitioners do in
certain areas.
MS. COFFIN:
Right.
MR. HAGGIE:
The difficulty when you say finding a doctor, it's all around primary care.
That's why we've put our emphasis on primary care teams and we have started to
roll these out, because it allows a range of practitioners to support. What
would have been, say, a five-person family practice, may actually end up as a
primary health care team which has three GPs, a nurse practitioner, a mental
health counsellor, social worker, foot care nurse, a diabetic educator: these
kinds of things.
MS. COFFIN:
Good.
MR. HAGGIE:
When you make an appointment, in the ideal world and when it's fully iterated,
you will find yourself in a situation where they'll say, well, why don't you go
and talk to the foot care specialist nurse rather than the GP?
MS. COFFIN:
That's wonderful. Like a dietician –
MR. HAGGIE:
They're there if you need them, but that then frees the physician up to do what
they're best at, which is managing complex, chronic conditions where you have,
say, four or five conditions and the algorithms, the treatment guidelines
actually compete with each other, which is not at all uncommon. Then you have to
have that discussion with the patient about what their goals and treatments are.
Is it more important to you that your exercise tolerance is better, or is it
more important to you that you have less breathing trouble or these kinds of
things?
MS. COFFIN:
Right. Okay, that's very reasonable.
I will
tell you, the couple of times I've called the doctor to get in to see someone
the first question they ask is: Do you require opioids? Which is a disturbing
first question, right? I don't, so I get in, right, but that's an unfortunate –
MR. HAGGIE:
Well, we brought that up with the college actually. It is a standard-of-practice
issue. The College of Physicians and Surgeons here doesn't actually have
required practice standards in the sense that the pharmacists would, for
example; the Pharmacy Board has required practice standards.
That's
part of it but, in general, the College has expressed disapproval about
screening of patients. We haven't here seen the same kinds of problems that
you've seen on the Mainland where it's one visit, one problem. The College
frowns on that, too, and has actually been, I think, fairly overt in saying
that.
MS. COFFIN:
Right.
MR. HAGGIE:
The availability piece,
we've also tried to supplement with other things like HealthLine and this kind
of stuff. That's been very successful indeed. If you take a hundred people who
ring HealthLine stating at the beginning they want to go to the emergency
department, by and large 80-odd per cent of them will not after the HealthLine
consultation.
MS. COFFIN:
Yeah.
I've
actually called the HealthLine. Apparently I don't need to go if my toe is
broken. The HealthLine is an excellent thing. They were very competent and very
professional so I must say good on them.
What is
the status of the memorandum of agreement with the NLMA to set up
interdisciplinary teams in doctor clinics around the province, so kind of that
team thing? You have the memorandum of agreement. Is that being implemented?
MR. HAGGIE:
The primary health care
teams were actually set up previous – maybe two pervious – memoranda ago. We
have a primary health care renewal program. We provide the NLMA for funding and
they have a coordinator there. We have dedicated stuff in the department here
who work with them. That program in gaining momentum; it's certainly out here.
MS. COFFIN:
Good. It is an excellent
approach for sure.
Question: Can you give me the number of malpractice suits that are currently
outstanding?
MR. HAGGIE:
Wouldn't be able to tell
you.
For
fee-for-service physicians, that's not a figure we would collect. If you want to
get that data, the Canadian Medical Protective Association would be my first
suggestion. That's data we don't collect.
MS. COFFIN:
Okay, that's grand. Thank
you.
Can we
have a list of the expenditures and the number of clients in the Adult Dental
Program and the Children's Dental Health Program in 2018?
MR. HAGGIE:
Yes, we do have a breakdown
of costing between the two. If you pause for a moment, I will endeavor to find
this in here. Unless someone here can get that before me, which is highly
unlikely.
Children and youth, $9.5285 million; adult, $2.251 million. That was the
expenditure. We can get you numbers, I don't actually have those (inaudible).
MS. COFFIN:
Okay, that's great.
Just
teeing into perhaps another question or another discussion that we had a little
bit earlier. When it comes to around prevention, I know that flossing is like
the best thing you can do for your teeth.
Is
there any thoughts to having flossing in schools?
MR. HAGGIE:
You'd have to speak to
Education and Early Childhood Development for what they teach in schools.
We did
get a shout-out from the president or CEO, I can't remember, I think it was the
president of the Newfoundland and Labrador Dental Association about how good our
child dental program is in terms of the issues that they see or don't see. That
was in the media, I think, earlier on this week, for example.
So we
do have a comprehensive dental program for children. We are the insurer of last
resort, ideally. I think that's been working very well.
MS. COFFIN:
Lovely, okay. Thank you vey
much.
That's
all my questions for this section.
Thank
you.
CHAIR:
Mr. Brazil?
Mr. Brazil: I
need to go back on something Ms. Coffin just – the discussions here on Grants
and Subsidies; get my head around the numbers again weren't quite – not that
they weren't adding up but just what I think is underestimating here.
I just
went back, and it's not in the Estimates book, it's '17-'18 under Grants and
Subsidies, 2.2.01, Physicians' Services. In '17-'18, there was $121 million-plus
budgeted under that line item. In '18-'19, it was $116 million budgeted so,
obviously, there was an indication there was going to be a $5 million decrease
in some way, but the revised was $122 million, which was actually $1 million
more than the previous year, but in '19-'20, now we're at the $118 million.
Looking
at the trends, there are two things here. One, I have a concern that we're
definitely underestimating where we're going to be in '19-'20 to cover that. The
other is, if we were at $121 million the previous year and we're cutting,
estimating cutting by $5 million, how were we saving the $5 million? Were we
cutting physician positions or were we transferring responsibilities out through
some other system we have?
MR. HAGGIE:
There's a realignment of
funding there. We took $2.6 million out from the fee – which way did this go? It
went from fee for service to salary, is that correct or the other way around?
OFFICIAL:
Yeah, fee for service to
salary
MR. HAGGIE:
Okay.
And
we've taken money out permanently to transfer to Eastern Health for a salaried
nurse practitioner. So, that explains the variance between 2019 budget and 2018
budget.
MR. BRAZIL:
Yeah, fair enough.
So tell
me about '17-'18 to '18-'19, the $5 million savings that was trying to be
realized, which didn't materialize?
MR. HAGGIE:
Sorry, '17-'18?
MR. BRAZIL:
Yeah, '17-'18, it's
obviously not in the Estimate books, but I just looked it up on Public Accounts.
There was $121 million plus allocated, so it's a difference of a $5 million
decrease. How were you going to realize that savings?
Obviously, it wasn't realized because it actually became a $6 million addition
to the bottom line.
MR. HAGGIE:
Okay, I don't have 2017-18
figures here, so you have me at a disadvantage.
Paul,
do you have some comment?
MR. SMITH:
When it comes to physician
services, there were reduction initiatives that the minister mentioned that the
presumption being we would have realized the savings from those during '18-'19.
Hence, $6 million came out, but the anticipation is that we will get the
expenditure base down because, ultimately, we will realize those savings.
They'll just be in '19-'20 onward.
MR. BRAZIL:
So would these have been
physician positions?
MR. HAGGIE:
These were the initiatives,
I think, here listed in the binder under the physician hiring approval
committee. There was a saving there that was attributed for $3.2 million. The
compensation benefits have started to come out, that's the double accounting
from before and a limit to salaried physician locum coverage, an expectation
that less than three days wouldn't provide for coverage. Where possible, where
practical, it would be between the existing physicians. That's an annualization
issue.
MR. BRAZIL:
Yeah, fair enough.
The
$3.2 million that you'd mentioned as a saving, what would that have been for?
MR. HAGGIE:
That's as a result of a physician hiring approval committee process.
In the
past, we had control, to some extent, with the medical association over where it
would be reasonable to put salaried physicians. This mechanism wilted, shall we
say. We've proposed bringing this back in. It's only just started. We had
anticipated it would go a little bit earlier and a little bit further.
We see
rationalization of salaried physicians in locations where their services are
being provided by other practitioners, such as fee for service or nurse
practitioners. So, when those positions come up for renewal, they turn over,
then there would be a decision as to whether or not another physician was needed
to provide that service or whether it was already being provided by a nurse
practitioner or fee-for-service physicians.
MR. BRAZIL:
Fair enough.
Unfortunately, it wasn't realized in the savings for the revised, and I do still
have a concern if it's going to be obtainable in '19-'20, but I guess we'll have
that conversation this time next year and see –
MR. HAGGIE:
Yeah. No, I think –
MR. BRAZIL:
– if it worked, perfect, even better.
MR. HAGGIE:
– that will be a check on that.
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
On the issue of the $1.7 million in benefits, I have information that it
affected 160 geographic, full-time equivalent positions. These are ones who have
joint appointments with the health authority and with Memorial.
MR. BRAZIL:
Okay, fair enough.
Under
2.3.01, Memorial University Faculty of Medicine, Grants and Subsidies, budget
'19-'20 had decreased by $721,000. Can you just explain why?
MR. HAGGIE:
That was the last year of a five-year phased reduction from budget '16 of the
funding envelope for the Faculty of Medicine.
MR. BRAZIL:
Okay, fair enough.
Public
Accounts in '17-'18 show that they received additional funding. Can you outline
what that was for?
MR. HAGGIE:
The Faculty of Medicine?
MR. BRAZIL:
Yeah.
MR. HAGGIE:
I don't have '17-'18 details here. We can go find that for you.
MR. BRAZIL:
Okay, fair enough.
Now a
decrease in '19-'20, again, not knowing why it was decreased and why it was
added, adds me to think that there's still going to be a challenge again this
year.
MR. HAGGIE:
I mean, the issue around the funding envelope for Memorial University is there
was a plan in place with the previous dean, maintained by the current dean,
which was talking about rental space reduction, using teleconference. They had a
very high travel budget, as far as I can remember. They were looking at office
management. They have been asked to do the same as we do, if we have a lunchtime
meeting it's pack your own lunch rather than have it catered.
There
were reorganizations of the Office of Professional Development at Memorial and
deferred recruitment of positions, and two positions by attrition. So those were
discussions we had with Dean Rourke and currently continuing under Dean Steele.
MR. BRAZIL:
Yes, fair enough, and we all see the value of investing in the university,
particularly the faculty of medicine. No doubt, I suspect this time next year
we'll have a discussion around what the needed number was at the end of it and
if there were monies that was transferred in. Because I look at it from '17-'18
to what was budgeted of $56 million to actually what was spent of $66 million.
It's a substantial $10 million increase.
MR. HAGGIE:
I don't have that information here.
MR. BRAZIL:
No. No. And I realize that.
MR. HAGGIE:
I have vague memories of things, but, quite honestly, we'll get you the
information.
MR. BRAZIL:
Okay. I appreciate that. I'm just curious to see how we go next year on that.
Mr.
Chair, that's it for me on subheading 2.1.
CHAIR:
Okay.
Ms.
Coffin.
MS. COFFIN:
No, I'm good.
Thank
you.
CHAIR:
You're good? So we're good all the way through?
MS. COFFIN:
Yeah, always good. And all my questions have been answered.
CHAIR:
I'll ask the Clerk to call the subhead, please.
CLERK:
2.1.01 to 2.3.01 inclusive.
CHAIR:
Shall 2.1.01 to 2.3.01 inclusive carry?
All
those in favour?
SOME HON. MEMBERS:
Aye.
CHAIR:
All those against?
Carried.
On
motion, subheads 2.1.01 through 2.3.01 carried.
CHAIR:
Moving on; I'll ask the
Clerk to call the next subheading, please?
CLERK:
3.1.01 to 3.2.02 inclusive.
CHAIR:
Shall subheading 3.1.01 to 3.2.01 carry?
Mr.
Brazil.
MR. BRAZIL:
Thank you Mr. Chair.
Under
02 heading, Supplies, in fiscal 2018-19 you went over budget by $300,000. Can
you explain what that was all about? What that covered, please?
MR. HAGGIE:
Two things; principally, around vaccines and the price of vaccines, and there
were increases in TB medications because of the outbreak in Nain. We had a very
successful vaccination program. So we had to pay more for vaccines as well as a
higher cost.
MR. BRAZIL:
Okay. So other than the TB additional vaccine, there were no other new vaccines
approved were there?
MR. HAGGIE:
Not that I'm aware of.
MR. BRAZIL:
Okay, fair enough. Good.
MR. HAGGIE:
I think there may have been some additions to the pediatric vaccines.
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Oh, right.
Yes,
sorry there was. Tdap vaccination to all pregnant women.
MR. BRAZIL:
Okay.
Under
Purchased Services, in fiscal '18-'19 you went over budget by $2.6 million. Can
you explain that one to me please?
MR. HAGGIE:
Yes, that was air ambulance medevacs.
MR. BRAZIL:
How did you cover off that shortfall?
MR. HAGGIE:
Primarily, the same answer. We had capital money that we could access to defer –
well, to cover those costs. So keep that one for last year.
MR. BRAZIL:
The overruns there, known for your ambulance, but exactly what would that entail
to be $2.6 million? Another contract, extra flights?
MR. HAGGIE:
Yeah. There are two private companies we use for medevacs for charter when the
government air services planes are unavailable, and that was essentially split
between the two of those.
MR. BRAZIL:
Is that a standing offer between the two as it exists?
MR. HAGGIE:
They're on a retainer. They were paid, in '18-'19, $2.62 million for PAL, $1.45
million for EVAS, and $470,000 for out-of-province air charters.
MR. BRAZIL:
Okay, perfect.
So they
were the only contracts awarded in '18-'19, EVAS, PAL and the out-of-province
flights.
MR. HAGGIE:
We've had a situation where we've used contracts in one form or another going
back well before last year; simply because of the fact that we only have two
government air service aircraft.
MR. BRAZIL:
Are there still existing contracts with PAL and EVAS Airline?
MR. HAGGIE:
Yes.
MR. BRAZIL:
Okay. Are there any deadlines on those?
MR. HAGGIE:
I think they've both been short-term contracts of several months, and I couldn't
tell you exactly when they expire.
MR. BRAZIL:
What's the competitive
process for – like, is it a tender or RFP, or just a standing offer for the
contracts to put these in place?
MR. HAGGIE:
RFP.
MR. BRAZIL:
They're offered how often?
MR. HAGGIE:
Well, we had been doing some
thinking around how to provide air ambulance services, along with TW, because
it's a hybrid service and Health is a customer; but, TW supplies some of service
and it's covered off out of their budget and we, in Health, go and buy the
other. The reissue will be done for a longer period.
MR. BRAZIL:
Has there been any
discussion on privatizing the air ambulance service?
MR. HAGGIE:
Only in an abstract sense.
MR. BRAZIL:
No formal –
MR. HAGGIE:
No.
MR. BRAZIL:
– internally or externally?
MR. HAGGIE:
No, not that I'm aware of.
It did come up for consideration as a concept but, in actual fact, that would've
been TW that would've been leading that kind of thing. From my point of view,
we're kind of the customer. At the moment, we're getting a very good service
from both PAL and EVAS.
MR. BRAZIL:
Perfect.
Has
there been any consultants contracted to do some analysis of the air ambulance
service?
MR. HAGGIE:
Was that TW?
OFFICIAL:
TW.
MR. HAGGIE:
I think Transportation and Works had something done.
MR. BRAZIL:
Recently, or is it still in the works? Do you know?
MR. HAGGIE:
I think it was done last year, was it? Yeah.
MR. BRAZIL:
Any concerns about the government owned air ambulance and the reliability,
particularly with the downtime and maintenance issues?
MR. HAGGIE:
I think those questions would be better addressed to Transportation and Works.
We have an arrangement with government air services. They do the dispatching.
We're simply, you know, send us an airplane.
MR. BRAZIL:
Fair enough.
Do you
have all the positions filled with the medical flight teams?
MR. HAGGIE:
There has been some recruitment recently but I think they're all filled now,
yes.
MR. BRAZIL:
Okay.
Under
the HealthLine contract, I just have a few question around there. Give us some
utilization stats for the HealthLine for the last year. Has it been up, down,
stable?
MR. HAGGIE:
It's slowly growing. I'll see if I can find a number for you.
Okay;
2018-'19 saw 42,725 inbound calls and 2,562 outbound calls. The volume of
inbound calls has been stable since fiscal 2015.
MR. BRAZIL:
Perfect.
Is that
in line with your projected utilization of the program and the service?
MR. HAGGIE:
I think, if memory serves me, it's within what we expected; it's within the
contracted price.
MR. BRAZIL:
Okay, fair enough. Because I know there was a full media program there, or a
media approach, to try to get the word out there because of the value of the
thing, and I didn't know if it was a big spike that you would see just after the
campaign itself.
MR. HAGGIE:
That was a couple of years ago, and I couldn't tell you offhand. I vaguely
recall an increase in utilization, but it certainly doesn't show up in the
long-term statistics. It has grown since it was changed from the old 1-800
number to the 811. We, in Budget 2018
or Budget 2017, added
Dial-a-Dietician into there. I think it was
Budget 2018. There's a lot of scope,
actually, for expanding the range of services there.
The
outbound calls that they make are actually mental health clients and people who
leave emergency departments without being seen. We actually actively go and seek
them out within 24 hours. That's what the outbound calls are for.
MR. BRAZIL:
What was the number on the outbound?
MR. HAGGIE:
It is 2,562 in '18-'19.
MR. BRAZIL:
Fairly substantial. Okay, fair enough.
Any
plans to further expand the program itself and the access?
MR. HAGGIE:
It's funny, actually, we've had some high-level discussions about where we could
go with the next iteration, but there's nothing other than ideas I have in the
shower at 8 in the morning or 7 in the morning, as yet.
MR. BRAZIL:
Fair enough.
I want
to move on, now, to Allowances and Assistance under the MTAP program. Fiscal
'18-'19, you spent $1 million less than budgeted. Can you just explain that one
to me? That's in 3.1.01.09.
MR. HAGGIE:
Sorry, the 2018-19 revised compared with the 2019 budget, is that correct?
That's what you're looking at?
MR. BRAZIL:
Yeah.
MR. HAGGIE:
We had some remaining funds from 2017-18 before we got into it. It was a
one-time saving from some money in the RHA. Again, it speaks to the dynamic
budget approach we've referenced before.
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Yeah, that was it. Bursaries were not taken up to the extent we anticipated, so
we had money there and we moved it in.
MR. BRAZIL:
Okay.
Can you
just give me a little outline on the revised budget now and the breakdown of the
$12.53 million?
MR. HAGGIE:
The $12.53 million – we got $3.4 million for medical transportation
reimbursement; $6.4 million for income support; just over $2 million for
Workforce Planning; bursary programs, just under $1.7 million.
MR. BRAZIL:
Fair enough, thank you.
On the
MTAP, what's the processing time? What's the average – we all get a number of
calls from people saying they're still waiting. What's the norm?
MR. HAGGIE:
For the reimbursement process, there is a turnaround time of between four and
six weeks currently. We had several staff members leave. We have replaced them
but there is a two-month lag time in terms of training. We have a high staff
turnover at the client services level there because it is regarded as an
entry-level job into government.
CHAIR:
We're going to move on now.
Ms.
Coffin.
MS. COFFIN:
Thank you very much.
MR. HAGGIE:
Just to steal a minute or two of your time, you asked about the number of
clients in dental programs.
MS. COFFIN:
Yes.
MR. HAGGIE:
We got 18,119. We have 40,420 in children. That's the denture program, is it?
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Okay.
MS. COFFIN:
Lovely, thank you.
A
couple of questions – some of these are just numbers that I'm looking for – the
number of individuals of subsidized home support clients and how many of those
are in the Paid Family Caregiving Option.
MR. HAGGIE:
Okay. This is where I look under L, is it?
I have
it somewhere – one moment.
MS. COFFIN:
Okay.
MR. HAGGIE:
Okay. Sorry, could you repeat the categories you were looking for?
MS. COFFIN:
Just the number in the subsidized home support and within the Paid Family
Caregiving Option.
MR. HAGGIE:
I don't have the paid family caregiver – oh, here we go. We have 270 individuals
who are availing of the Paid Family Caregiving Option as of March 31, 2018.
MS. COFFIN:
Okay.
MR. HAGGIE:
Sorry, '19. My eyesight is failing.
MS. COFFIN:
And the total number of subsidized home support clients. So that's a subset of
paid family caregiver – right?
OFFICIAL:
No, it's the other way around.
MS. COFFIN:
Oh.
OFFICIAL:
Paid family caregivers are a subset.
MS. COFFIN:
Yes, that's what I meant.
MR. HAGGIE:
We got 216 here is the number I've been given.
MS. COFFIN:
It is 216 in the home support clients? That doesn't sound right.
MR. HAGGIE:
No, that's the Special Child Welfare. We have 3,339 adults under 65 and 4,026
seniors.
MS. COFFIN:
Okay. And then children is a separate –
MR. HAGGIE:
Well, the SCWA is Special Child Welfare Allowance Program – the one I referenced
when we talked about the Autism Action Plan. That would be rebadged as something
else.
MS. COFFIN:
Okay.
MR. HAGGIE:
That's as of June. That's as of this month.
MS. COFFIN:
Right.
MR. HAGGIE:
So these are snapshot figures, obviously.
MS. COFFIN:
Of course, yeah, and then some people would transition in and out of that if
whatever is requiring to get home support is temporary. And I imagine there are
also some individuals who are in for as long as they're alive, I guess.
MR. HAGGIE:
Well, Special Child Welfare Allowance Program, they age out I think, don't they?
They fall into the adult program.
MS. COFFIN:
Right, but they're still somehow receiving home support, but they just fall into
another program.
MR. HAGGIE:
Yeah, but they just fall into a different label, different pot.
MS. COFFIN:
Yes, right. That's what I understood.
How
many personal care homes are providing level 3 nursing home care through the
enhanced care program?
MR. HAGGIE:
The enhanced care program is not level 3, the enhanced care program is 2 plus.
MS. COFFIN:
Oh, okay.
MR. HAGGIE:
The level 3 is a transient
arrangement done for individual clients who, you know, there may be delay in
getting them a bed, but the personal care home is able to provide that level of
extra care. I don't have the number of level 2-plus enhanced clients at the
moment, but we can get that for you.
MS. COFFIN:
Lovely, thank you.
Can I
have a list of the number of people on wait-lists for nursing homes by region –
with the number of waiting in hospitals?
MR. HAGGIE:
So, that would be long-term care homes, when you say nursing homes?
MS. COFFIN:
Yes, nursing homes, long-term care.
MR. HAGGIE:
Yeah, okay. We can provide that for you for sure.
Have we
got it here?
OFFICIAL:
Yes.
MR. HAGGIE:
Oh, right, okay.
MS. COFFIN:
Oh, boom, all right.
MR. HAGGIE:
Number on placement list – for long-term care, there are 78 in Eastern, 87 in
Central, 55 in Western and 15 in Labrador-Grenfell, for a total of 235 as of
this month.
MS. COFFIN:
And that's in general, is there a number that we know that are waiting in
hospitals?
MR. HAGGIE:
I haven't got that breakdown here.
MS. COFFIN:
Okay. That's fine, thank you. I'm sure you can get it for me if that's all
right.
MR. HAGGIE:
That's no problem.
MS. COFFIN:
Wonderful.
What's
the percentage of hospital beds that are occupied by people waiting on a nursing
home or home care, or I guess long-term homes or –?
MR. HAGGIE:
We refer to that, for data collection, as Alternate Level of Care patients. It's
a broader bunch; it's basically people who are medically dischargeable from
hospital but need something.
MS. COFFIN:
Right.
MR. HAGGIE:
So that figure would also include people who are simply waiting for a toilet
rail in their house.
MS. COFFIN:
Oh yes, of course.
MR. HAGGIE:
As well as someone who was waiting for, maybe, personal care or long-term care.
We have some numbers here. The numbers of ALC patients awaiting long-term care
in Eastern is 37, Central is 54, 36 in Western and 11 in Lab-Grenfell, for a
total of 138. They represent, over average, 50 per cent of the ALC patients that
are in hospital; the other 50 per cent are waiting, usually, for something else.
MS. COFFIN:
Okay. Thank you.
Can we
have a list of the expenditures and numbers of recipients in the MTAP program
and out-of-province travel by region?
MR. HAGGIE:
By region. We don't have it
by region but we can get it for you.
MS. COFFIN:
Lovely. That's great. Thank
you.
Under
the same section, 3.1.01, the numbers here are enormous. There is lots and lots
of stuff going on, so sometimes it's difficult to get the right question to get
at some of these things. I've had a lot of experience with a lot of the nursing
staff in the Janeway and the PICU and they are just remarkable, really, really
great staff, but I know that they're quite overworked.
I'm
trying to get now at the staffing and overtime. I know this is an issue because
someone has the wrong number in the Health Sciences and occasionally I get phone
calls to see if I want to do overtime. The last call was the day after the
election, which was a little traumatizing because that was the day I really,
really, really wanted to sleep in. I know that's an issue.
Is
there anything being done to address the staffing and overtime issues? I know
we're spending tremendous amounts of money there, the staff are overworked, it's
hard on them and it's hard on their families. How is that being approached or is
it, even?
MR. HAGGIE:
The overtime issue in the
RHAs – each RHA does have a sick leave and overtime policy.
MS. COFFIN:
Yes.
MR. HAGGIE:
It varies slightly from
region to region, but there is a significant bill associated with that. I'm not
sure that we have that breakdown here, but we can find it for you.
MS. COFFIN:
That would be lovely.
Does
the department have any authority over doing a staffing review and maybe
changing the number of positions so they can offset the number of overtime
hours? Is there anything like that?
MR. HAGGIE:
The staffing levels on the
floors are related to the acuity of care, a kind of national standard. As a
result of discussions with the RNU, the agreement was that we would review
samples of acute care and long-term care to try and see whether or not the fact
that we meet the national standards or exceed them was actually doing it for the
acuity in those areas.
There
is workforce management software and a joint committee with the RNU,
particularly, around the management of staffing to acuity. There are several
threads on the go all at the same time and it's a problem that is not unique to
this province by any manner of means.
MS. COFFIN:
I'm aware of that. I know
when my nephew was in PICU he has a nurse full-time, which is just fantastic.
When he moves out just onto the ward, one of us is always signed up for night
duty. I'm the Auntie Al so I get to go in quite often which is nice; the beds
are kind of comfy. I understand that ratio; I guess this goes a little bit
beyond, though. The nurses' union and LPNs and PCAs as well are having a lot of
overtime. They're saying that they are stressed, they're burnt out and they're
angry enough to protest.
Is that
same model being –?
MR. HAGGIE:
Yeah, I mean the workforce
management program, the software that we're putting in place, works for health
care providers. It will work within the categories. The short answer is, yes,
they are factored in. We've had discussions with NAPE, for example, and CUPE and
the staffing review will look at the case mix as well – the staff mix, the skill
mix, sorry.
MS. COFFIN:
Right.
MR. HAGGIE:
There are certainly
significant changes over time with skill mix, for example, in long-term care.
There's far more emphasis on the Mainland, for example, in a mix that really is
70 per cent PCA, maybe 25 per cent LPN and 5-10 per cent RN, that kind of ratio.
MS. COFFIN:
Right.
MR. HAGGIE:
We don't achieve that in all
our regional health authorities. Some do and others don't. There's still a
predominance of RNs in certain areas. Those are things that one would work
through with the workforce management software and matching workload to skill
set.
MS. COFFIN:
Good. Thank you.
CHAIR:
Mr. Brazil.
MR. BRAZIL:
Mr. Chair, I just want to go
back again under Allowances and Assistance when the minister noted that the
million-dollar savings or less spent was around some of the bursary money. Can
you explain some of the particular bursaries that we're talking about there?
MR. HAGGIE:
There are 22 bursaries that
are offered across the system. They cover a variety of disciplines. It includes
physicians, it includes midwives and it includes nurse practitioners. It also is
broken down into whether or not these folks are undergrads or residents, for
example, in the case of medical students.
If you
look in the Bachelor of Nursing program we have health professionals, nurse
practitioners, dentists, medical residents and undergraduate medical school.
There's a significant breadth. I think there's 22 and we have had around 228
individuals enrolled in the bursary program.
MR. BRAZIL:
Okay. Thank you.
Under
Grants and Subsidies, 10, I'm just looking there but I'm looking at the bigger
picture here. You spent $117 million more than budget of '18-'19, yet budget
'19-'20 decreased by $88 million.
Is this
even reasonable, to be able to think that you could sustain that? How are you
going to manage for lower budgets? Are there certain things going to be cut?
That's a dramatic amount of money.
MR. HAGGIE:
Yeah. The big bit there, the
bulk of it, was severance. That was reimbursed by the Department of Finance. Let
me just have a look to see if I can elaborate still further.
Yeah,
there was $126 million paid out in severance. We had a $5-million savings in
Canadian Blood Services, we had savings in primary health care, long-term care,
needing some further analysis around the home support review, so there's some
money deferred there. This is in the binder but the variance nets out to $117
million.
MR. BRAZIL:
Okay. Thank you.
Under
the regional health authorities' projected financial positions, what's the
projected financial position of the RHAs for '18-'19? Can we have a breakdown
and any deficits that may be noted?
MR. HAGGIE:
They're currently being
audited as we speak. That's not cooked yet or baked, whatever the appropriate
financial term is. I bow to the experts.
MR. BRAZIL:
Fair enough, but somewhere
in the budget it's reflected about the estimated monies that are going to go to
the authorities I'm assuming.
MR. HAGGIE:
Okay. There are some figures
here and they're in the binder for you.
MR. BRAZIL:
Okay.
MR. HAGGIE:
Provincial planned revenue
for the RHAs and NLCHI is in the binder there.
MR. BRAZIL:
Okay. Perfect.
MR. HAGGIE:
That will save me reading
out telephone numbers.
MR. BRAZIL:
Yeah.
The
stabilization funding in '18-'19 to the four RHAs to cover deficit – can we have
a breakdown on what was paid out for there?
MR. MCGRATH:
Stabilization provided – the
most recent ones – $6.6 million for Eastern Health, $1.9 million for Central
Health, $1.9 million for Western Health, and $1.3 million for Labrador-Grenfell.
MR. BRAZIL:
Has that been factored into your Estimates for this upcoming fiscal?
MR. MCGRATH:
Stabilization funding is not part of the departmental budget; it's usually
achieved through savings throughout the year, and whatever is kind of left, we
flow out for stabilization funding.
MR. BRAZIL:
Okay, thank you.
Just
curious though, I understand why the fund is there, but in this case now, what
were the incurred deficits that the health authorities ran into? Was it
consistent across the board? Was it all over the place? Any particular line
items that stood out?
MR. MCGRATH:
The audit is ongoing right now for 2018-19, for March 31, 2019, so to my
knowledge, it's coming in very shortly.
MR. BRAZIL:
Fair enough.
Again,
the concern I have here, budgets are put in play, and I know there are also some
discrepancies to that, but there was nearly $12 million additional given to the
regional health authorities. Is that a healthy way to do business right now,
knowing the fiscal challenges that we have?
MR. HAGGIE:
The balancing of budgets is a dynamic process, and the facts of the case are we
have committed to controlling our cost at the same time as expanding our
service. We need to make sure we get the best value for the dollar we spend, and
if there is deferred money in one area, then, as a process of getting from where
we are know to where we need to be, we've taken the opportunity to use that.
Over
time, as the fiscal situation improves, the pressures on there will also
slacken. If you go back over the previous years, back to 2016, you'll see that
the deficits of the RHAs are slowly shrinking at the end of each financial year.
It's been extrapolated that if we keep on with the same rate of shrinkage, then
in about three or four more years' time, we should be down to deficits on the
order of $9 million and, within a year or so of that, a balanced budget.
That's
been the approach we've taken. We accept that it's not ideal to have to juggle
money between heads, but if we save money in one year, in one area, I think it's
responsible to try and use it for the purposes, in general, for health, for
which it was intended.
MR. BRAZIL:
Yeah, fair enough, but if the regional health authorities have had an increase
in their demand, financially, in a particular year, particularly '18-'19, why do
you expect that they'll be able to maintain it this year, knowing the demands
are obviously increasing dramatically on each of the regional health
authorities? Wouldn't it be better to give them a stabilizing fund up front so
they now know, from an accounting point of view?
MR. HAGGIE:
One of the challenges is that initiatives that have been announced in previous
years, particularly in the last two budgets, have been delayed. We have a
significant savings to be realized through things such as shared services, but
the implementation of that had to be delayed pretty well 18 months because of
sequential collective bargaining, during which we had a freeze on changing work
of the bargaining unit.
There
are significant savings to be realized through that, but the delay has led to
some of the budget pressures. As that program ramps up, you'll start to see
those savings begin and then annualize, but they are at least 18 months later
than anticipated.
MR. BRAZIL:
Can you give me some examples of what some of these initiatives may be?
MR. HAGGIE:
The shared services one, for example. There was projected savings of the order
of, initially, $20 million that would be phased in over a period of a couple of
years. By altering the purchasing arrangement, the RHAs on average will buy $4
million worth of consumables and medical supplies in a year. The shared services
model will allow economies of scale and inventory control, particularly, to
realize significant savings.
That's
the big one that hasn't happened because it's at least 18 months behind. The
management structure could change but it had to wait for the bargaining process
to be done. We're in discussions now with the unions around how the work of the
bargaining unit will shift to align with the new structure and the new
methodology. So, that was, in my view, a principle source of challenge.
MR. BRAZIL:
Fair enough, and realized savings obviously is another plan for reduction.
Do you
have targets of how much you'd like to reduce the health care spending?
MR. HAGGIE:
I think philosophically long-term inflation will do it for you because, at the
end of the day, if you can do what we have done over the last three years, and
I'll go back to the CIHI data on the per capita expenditure, those lines will
cross. I think you would be very optimistic if you ever thought you were going
to reduce the budget in health, but as time goes by, you will realize those
savings.
If you
want to do just a rough back-of-the-envelope calculation, if inflation has been
running at 2 to 3 per cent per annum for the last four years, then, in actual
fact, the fact the budget has stayed pretty steady means you've saved 6 per cent
already. Which, on a $3 billion budget, is actually quite a large dollar figure.
So, I
think a slow steady balanced approach is the way to go. You could turn around to
the RHAs and say I want you to save $20 million each next year, and that's been
tried and it's always failed because they can't do it.
CHAIR:
Ms. Coffin.
MS. COFFIN:
Thank you very much.
(Inaudible) what I think might be quick questions and then I'm done.
Purchased Services under Health Care Infrastructure, so 3.2.02. So, we're moved
over to the Capital section of this now. It's the very last section.
The
thing that jumps out to me, I suppose, mostly significantly is the, well, I
guess, the Allowances and Assistance, which is $5.5 million. That's a big chunk
of money there. Do we know what that's for?
MR. HAGGIE:
Yes, Pomerleau. That was a lawsuit we paid out through a mediated settlement on
Lab West.
MS. COFFIN:
Is that the one that was at the university?
MR. HAGGIE:
No, Lab West Health Centre construction. It was a settlement for a suit against
the government.
MS. COFFIN:
Okay, very good.
MR. HAGGIE:
It was determined through a mediation process –
MS. COFFIN:
Fair enough.
MR. HAGGIE:
– in the last fiscal year.
MS. COFFIN:
Okay, all right.
I guess
the other thing that jumps out is the money from budget '18-'19. Budget versus
revised was down by about $20 million and it seems that a big chunk of that
change went over into the budget for this year.
MR. HAGGIE:
Sorry, which area are we looking at?
MS. COFFIN:
Purchased Services, I'm sorry.
MR. HAGGIE:
Okay. No, it's all right. I'm a bit slow this evening. I get there in the end, I
just slow down a little bit after 8 o'clock.
MS. COFFIN:
That's good, the tortoise does that as well.
MR. HAGGIE:
Sorry, rephrase your
question, I'll catch up.
MS. COFFIN:
I'm sorry. I just noticed that there was – we started off at $35 million in the
budget, it was revised down to $15 million. So the carry over was there was a
difference of about $19 million. Then when you flip over to '19-'20, we see that
the total number in Estimates is $51 million. So we're up by $15 million from
the budget of – so what's going on there?
MR. HAGGIE:
Those are the changes in capital projects, some of which did not proceed as they
could have –
MS. COFFIN:
Right.
MR. HAGGIE:
– in the original timeline. So money that you didn't spend in 2018-19, it's
deferred and it crops up again.
MS. COFFIN:
Right.
MR. HAGGIE:
The money doesn't go; there's no savings. It's just it's shoved from one –
MS. COFFIN:
It just rolls along, yeah. That's what I had thought.
MR. HAGGIE:
– year's pot to the next year's pot.
MS. COFFIN:
So what's being delayed here? Is that the Corner Brook hospital?
MR. HAGGIE:
Actually, that isn't.
MS. COFFIN:
Oh.
MR. HAGGIE:
Well, sorry, not the Corner Brook long-term care. That's on track.
MS. COFFIN:
Good.
MR. HAGGIE:
The principle variances are
around the electrical substation, for example, for the Health Science Centre.
There is felt to be insufficient power from the existing substation because it
now has to feed the core science building and some facilities in MUN.
MS. COFFIN:
Oh.
MR. HAGGIE:
So a second substation has
been there, but I got really mired. It's been a glacial process because it
involved Newfoundland and Labrador Hydro –
MS. COFFIN:
Right.
MR. HAGGIE:
– it involved the City of
St. John's, it involved MUN, it involved the Department of Health and it
involved Pippy Park Commission. So I think we're finally working our way through
that.
MS. COFFIN:
Yes.
MR. HAGGIE:
But that's been one of the
principal problems there.
So, we
have a list of these. There's the Central Newfoundland Regional Health Centre,
lab redevelopment, medical device reprocessing. There's some money there that
had been allocated a little bit earlier in planning for Central Health long-term
care, but that's because of the way the money will flow. It's not going to be
needed until next year, and the expansion of the Hugh Twomey Centre. The
protective care beds, that kind of thing.
MS. COFFIN:
Right.
MR. HAGGIE:
And Springdale is the new hospital there.
MS. COFFIN:
When I was working with MUN – what feels like a lifetime ago, which was actually
back just in January – I remember those giant extension cords that they were
plugging in, because my office was right next to the core science, so you step
over the extension cords. So, I understand that part, which is good.
I've also, on a personal note, always lived very close to a hospital. I'm really
near St. Clare's now, and I used to live very close to the Health Sciences. I
never lost power. It's awesome. So, that's good.
Okay. Under our capital budget there, does that capture the public-private
partnerships that we're seeing to facilitate the development of a lot of these
new areas, a lot of these (inaudible)?
MR. HAGGIE:
Some of the funds under Professional Services and Purchased Services will
actually relate to the Corner Brook long term care and some of the development
work for the other P3s as well.
MS. COFFIN:
Okay.
I have some concerns in that, and there are some inherent concerns in P3s; but,
beyond that, I have been talking to – I think he was an oncologist, and he's
been helping with the plans for – I hope I get this right – the new hospital out
in Corner Brook that is being developed under a P3 model.
MR. HAGGIE:
Yes.
MS. COFFIN:
He's been consulting on that a little bit, and he's saying some of these
negotiations are a little bit ridiculous because the contractor comes to him and
says: So, the big, thick walls that are needed to house radiation units and
materials that need to be housed in big, thick walls, the contractor is saying:
Well, can we make them smaller? They seem like they don't really have the
comprehension to realize that this is international and national standards, and
these are some of the bare
minimums that they have. So he's finding those negotiations a little bit
difficult.
The
other thing he's talking about is because of the model that's being used, where
it is a design-finance-maintain, part of that means that the maintenance refers
to everything that is attached to the physical structure. So if it's attached to
the structure, the contractors will maintain it or the individuals involved in
that public-private partnership will maintain it.
What's
trying to happen now, and he said he's having a little bit of difficulty with
it, is they're attaching everything to walls. Like desks are getting attached to
walls and I guess like chairs, or whatever that can possibly be attached to a
wall so it can get captured in that maintain bundle is happening. He had some
concerns about the issues around, well, what are the long-term implications of
that?
So I'm
starting to already see some of the problems that we hear about in P3 models,
and I'm wondering if there's anything being done to mitigate that.
MR. HAGGIE:
Yes, that's exactly what I was just (inaudible). We're thinking along the same
lines.
MS. COFFIN:
Uh-oh, that's dangerous.
MR. HAGGIE:
Yeah. At financial close, the design is only 30 per cent complete. What that
means is that the bulk of the detail work you're describing has yet to actually
be designed. So the issue around the construction company coming to an
oncologist, radiation oncologist about the construction of a bunker –
MS. COFFIN:
And I may be wrong about the type of doctor (inaudible).
MR. HAGGIE:
No, I know. It probably was a radiation oncologist. I mean, that's not an
unreasonable person to go talk to about a radiation bunker because that's what
they use. It will be at a later stage that the design standards, the national
standards and the assessment by the appropriate nuclear agencies, if they're
involved, like they were with the PET scan –
MS. COFFIN:
Right.
MR. HAGGIE:
– and the cyclotron. That will be factored in to the next 70 per cent of design.
They don't have to have that detail to rough out the price envelope that they
want. For example, the PET scanner room will have a slab that is capable of
taking the weight of a PET scanner, and the walls will be built to radiation
standards as if they were in there. They'll be part of the X-ray department.
So
those are questions for the next phases. That is why you have a very close link
between the project teams, and there is a huge cast list of project teams for
the acute care in Corner Brook. There's a non-clinical lead, there's a clinical
lead, there's an infrastructure and IT group. There is a group such as that.
Similarly, with the maintenance thing, there has been discussion around the
long-term care about what's in and what's out, and there would be some
maintenance staff from the RHA on site. What would they do versus what would
fall under the M of the DBFMP3 –
MS. COFFIN:
Right.
MR. HAGGIE:
– and those will be settled nearer the time.
It's
broad brush at the moment. Particularly with the acute care one, I really
wouldn't get too concerned and I would reassure your radiation oncology
colleague that they'll be coming back to him later on and say, you know, we're
building to this Canadian standard for a radiation bunker.
MS. COFFIN:
Right. Okay.
I have
fears that this is going to cause cost escalations if the individuals or the
company that's designing and will eventually take over the maintenance of it.
MR. HAGGIE:
The specifications will somewhere have in there that you have to build to those
specifications. The one reassurance we have with this mechanism is that once
it's signed at financial close it's their problem if they need to spend more,
not us.
MS. COFFIN:
Okay.
CHAIR:
Mr. Brazil, your turn, Sir.
MR. BRAZIL:
Under personal care homes, I have a few questions there and some general
comments for the minister.
How
much did we spend in personal care homes in '18-'19, and what is the budget for
'19-'20?
MR. HAGGIE:
Sorry, and what's what?
MR. BRAZIL:
What is the budget for '19-'20?
MR. HAGGIE:
Okay.
Long-term care in community supports area is flowed through the RHAs. If you
look at the personal care home program, for 2015-16 we spent $34 million, for
'16-'17, $39 million, and for 2018-19, $43 million. The number of subsidized
residents has gone from 2,650 to 2,760 from 2015-2019. The average monthly RHA
subsidy is $1,100.
So
those are the broad brush stats. We have 2,685 subsidized residents currently as
of March 2019.
MR. BRAZIL:
Is there any movement, contract time for renegotiating the costing for the
subsidies or any of that, or is that a long-term commitment?
MR. HAGGIE:
The funding model for personal care homes is part of the work that we're doing
with the PCH owners association and other representatives of the personal care
home fraternity to revamp the whole system. So it's tied into standards.
We have
a consultant out on an RFP to produce a funding model and we are working on
revised levels of care standards, as well. That, when it all comes out, will
inform how much an individual resident would be compensated for a specific level
of care, were we to be totally responsible for their funding, because they are
private businesses and there are people who can just choose to go and pay if
they don't meet our financial eligibility criteria.
That's
where this will shake out. Those negotiations have not stopped, say, for a pause
over the caretaker period.
MR. BRAZIL:
Is there a time frame, is there an end time, outlook time that you want to get
it achieved by?
MR. HAGGIE:
We're expecting the report back from the consultants over the course of the
summer. That's the last piece of external work that needs to be done over which
we have some uncertainty about the time. The rest of it, the levels of care are
not far off and the standards of care that go with those are not far off. It's
simply just got to be tied up and tweaked so it all lines up properly.
MR. BRAZIL:
Perfect.
During
the election we all heard about the Lionel Kelland Hospice in Grand
Falls-Windsor. Is there a budget line somewhere, or under one of the programs
any budget money for the hospice to move forward?
MR. HAGGIE:
We've had meetings with the committee and they have some work to go away and do
yet so that we can see what their numbers actually look like. There is a budget
for capital for the RHAs which is uncommitted and that's one option for there.
The
operational costs, again, we don't know what those are. It really rather depends
on what nursing model they use and so that's still a subject of discussion. The
answer is we will find the money; we just simply haven't got the number to go
looking for yet.
MR. BRAZIL:
From the department's additional funding for Central Health, or would it come
out of Central Health's system budget?
MR. HAGGIE:
Well, the capital piece – there is a capital part. If there is extra staffing
that is required, then obviously, there are sources of, for example, federal
money, that could be reprioritized from palliative care because this would fit
under end of life. Again, until we know exactly what we're talking about, it's a
little difficult to be more specific than that.
MR. BRAZIL:
Fair enough.
Can we
get an update on the implementation of the EMRs and how many doctors' offices
have EMRs implemented?
MR. HAGGIE:
We can indeed, yes.
MR. BRAZIL:
Perfect.
MR. HAGGIE:
One moment. I kind of hoped you'd ask that question.
We have
275,393 patients enrolled in the EMR as of June 4. There are 304 physicians and
18 nurse practitioners on the EMR. This is the fee-for-service piece and that's
the data that I have here. I think they're all as of June 4.
MR. BRAZIL:
What percentage? Is that 100
per cent, 80 per cent, 50 per cent?
MR. HAGGIE:
Of physicians?
MR. BRAZIL:
Yes.
MR. HAGGIE:
Well, in terms of primary
care physicians, I don't actually have the denominator, but we only have 449, I
think, in the province.
MR. BRAZIL:
Okay, perfect. Thanks.
Can you
give us an update on the rollout of the automated appointment reminder system in
the RHAs?
MR. HAGGIE:
Yes, I can. I can indeed,
just bear with me a minute.
I'm
slowing up even more. But don't worry; I have stamina if not speed.
It's
currently doing endoscopy, rheumatology, DI, cardiopulmonary, respiratory,
cardiology and ophthalmology outpatients. Eastern Health had a 30 per cent
reduction in no-shows there, and there's work under way to expand it for
psychiatry, counselling and ambulatory care specialists.
OFFICIAL:
(Inaudible.)
MR. HAGGIE:
Sorry, I misspoke.
Everything is across the province, with the exception of ophthalmology
outpatients, which is unique to Eastern Health.
MR. BRAZIL:
Is that information in the
binder or is that a separate document that we could get a copy of?
MR. HAGGIE:
We can give you those
figures, yes.
MR. BRAZIL:
Okay, I appreciate that.
Obviously, we've had discussions; we've had it here in the House and it's been
out in the general public. Any plan on the cardiac centre of excellence that's
been discussed? I know you've had meetings with the various numbers of people in
the speciality.
MR. HAGGIE:
I spoke to Dr. Connors not
long after Christmas. Work is under way in Eastern Health to allocate space
within Eastern Health, within the Health Sciences Centre, to put the whole lot
in one co-located area and have it there. That's predicated on some shuffling
around of ambulatory care services in Eastern health. So that is in discussions
with Dr. Connors and the cardiology group.
MR. BRAZIL:
That's good to know. Thank
you for that. That's moving in the right direction from what I understand.
MR. HAGGIE:
Oh, yeah, Dr. Connors seemed
quite happy.
MR. BRAZIL:
Good.
Can you
give us an update on the road ambulance program? Central dispatch, obviously.
Any rumours, dispelled rumours that it's being looked at as a sole provider for
the service in the province?
MR. HAGGIE:
The dispatch in Eastern
Health has been upgraded very recently; they have a new software package. The
current agreement has been extended by two years with the private operators,
with the aim of giving us all time to sit down and talk about it.
I've
had some preliminary discussions with Max Taylor from the Community Ambulance
group. Just for background, we have currently 60 ambulance services providing
179 funded ambulances across the province: 13 are RHA; 25 are private,
for-profit; and 22 are community, not-for-profit.
We've
also met with and are going to meet again with the Paramedic Association of
Newfoundland and Labrador. We have significant opportunities now with the
passage of the emergency health services and paramedicine legislation last year.
We're the last province, I think, in the country to actually have proper
emergency health service legislation. There will be a process of regulation
drafting there and a move to get paramedics to become self-regulating.
Currently, Provincial Medical Oversight deals with licensing as well as quality
assurance. Whilst they have different people involved in that, it's in the same
organizational structure. That inherently is a conflict in my view and we're
working to move that out. The question is whether we can do it in a clean
(inaudible) and the Paramedic Association would be interested in taking it up as
a regulator or whether we have to do it a phased way. Those are the subjective
discussions at the moment.
MR. BRAZIL:
Okay, fair enough.
Can you
give us an update on the shared services? The purchasing, the IT, anything else
that was talked about?
MR. HAGGIE:
I alluded to it in my previous answer around the delays with inventory and stock
control. There has certainly been a challenge there around that. We are looking
at payroll. The challenge in some respects is how to integrate it with Digital
by Design across government. We've not really come to a conclusion on that yet.
That
work has really progressed slowly, I think, would be the most accurate way of
saying it. I think people are conscious of the delays with the shared-services
model and they had hoped to learn from that before they walk down another road.
I think, again, speaking to the delays, it's kind of caused some difficulties
there, but those are still on the blocks for the next iteration.
IT, in
a sense, we did through a different route because we brought it all under the
remit of Newfoundland and Labrador Centre for Health Information. The network,
the pipes, purchasing and that kind of stuff, the provision of services, housing
the data and that kind of thing are actually all under their mandate now.
MR. BRAZIL:
Okay, thank you.
CHAIR:
Ms. Coffin.
MS. COFFIN:
That's the last of my questions, so I want to thank everyone for your time and
your professionalism. And I want to congratulate you; this has been the shortest
Estimates that I have gone through.
Thank
you very much.
MR. HAGGIE:
So far.
MS. COFFIN:
I'm done.
MR. HAGGIE:
Oh, you're out, are you?
MS. COFFIN:
I'm tapping out on Jim now. He's got the next two.
MR. HAGGIE:
Oh, you're out of Estimates jail.
MS. COFFIN:
Yeah, I got my badge.
MR. HAGGIE:
Very good.
CHAIR:
Thank you, Ms. Coffin.
Mr.
Brazil.
MR. BRAZIL:
Thank you, Mr. Chair.
I have
a couple questions, here around the laboratory services. Last year we had talked
about it here in Estimates that it would be centralizing under Eastern Health.
Can you provide an update? Are we getting there? Is it viable? Has it been
assessed?
MR. HAGGIE:
Heather has some information. Did you want to share that? And you'd be accurate,
rather than me being waffling.
MS. HANRAHAN:
There are a couple of different initiatives happening under laboratory. We have
streamlined and created a provincial formulary for all our laboratory sites. We
have implemented point-of-care testing, which means the testing can go on right
at the patient's bedside, and can be quicker than actually getting someone to
come and taking the test and processing it back to the lab. There is opportunity
to increase point-of-care testing.
A lot
of our lab equipment, periodically, needs to be replaced, particularly the very
expensive analyzers that are in the main labs in the province. And we're looking
at, this time around, driven by shared services out of Central, having a
provincial RFP. So that would allow us to look at the lab equipment needs,
provincially, as well as, in our purchasing, if we purchased standardized
equipment across the province, I think we'd get better pricing and we'd use the
same kind of reagents, same supply source, supply costs would be reduced. And
looking at, really, how we can work together with labs more strongly
provincially. So those are the main things that we're thinking about in terms of
that.
MR. BRAZIL:
Okay, that sounds good. It's moving in the right direction, perfect.
The
Botwood emergency room, it was talked about by everybody during the election. Is
that a reality? Is it being assessed? Is it something that's planned to move
forward?
MR. HAGGIE:
The discussion around Botwood is actually predicated on the new 20-bed
protective care unit – that's the phrase I'm looking for – that will be added
there. There was discussion about the availability then of extra staff and
whether or not this would make sense to revisit the concept of the emergency
room. There's no clear guidance yet because that decision won't be up for grabs
until 2021.
The
other interesting piece, as well, is around some of the possibilities with
emergency services in smaller places using other care providers around community
emergency centres, such as has been done in Nova Scotia. And I think you might
find that by 2021 those kinds of initiatives may already have made a change in
thinking – the new way of doing business.
The
answer is, it depends on what the situation is in 2021, but the undertaking was
to look at it if that was a reasonable thing to do.
MR. BRAZIL:
Okay. So there will be no movement in the immediate future, obviously?
MR. HAGGIE:
It's all predicated on the staff availability and that staffing won't change
until the protective care unit opens. That was, I think, quite clearly stated on
several occasions. The build may finish in late 2020 or early ֹ'21 but we won't
staff up until 2021.
MR. BRAZIL:
Okay, fair enough.
Can we
get an update on the roll out of the healthy living assessments?
MR. HAGGIE:
We went to look at a particular model and we ran into some challenges with how
it would be delivered as a pilot scheme. So, this has gone back to the drawing
board. We thought we were ready to move and there were some significant flaws
that we uncovered at the last minute. The discussion, now, is very much around
how this would be done on a proactive basis through the regional health
authorities and an existing model.
The
short answer is that's stalled a little bit because of the model that we thought
we got.
MR. BRAZIL:
Okay, fair enough.
The
Health-in-All–Policies – and I know it was a program that was going to move
forward and I wasn't overly adverse to it and I know your former DM was going to
be tasked to do that and I understand he's since retired. Has somebody else been
tasked with that program or process?
MR. HAGGIE:
He was seconded to Executive
Council because, at the time, that's where Health-in-All-Policies had resided.
It was put there as a placeholder while we fleshed it out. He did all the policy
work and all the background work and was well equipped to do so because he had
experience with it in Ottawa and across the country.
That
work is completed and he has decided to move back into the private world. The
department has an identified lead and it's been repatriated into Health.
MR. BRAZIL:
So it'll come back to the department for (inaudible).
MR. HAGGIE:
The lens exists. It's simply physically located, from a staff point of view, in
Health and the policy work that the previous deputy had done is there as the
basis for their operation.
MR. BRAZIL:
Okay, fair enough.
Can we
get an update on the IQ 70 process? Any changes?
MR. HAGGIE:
Certainly. Once the budget passes, if that's the will of the House, then the
assessment for people with home care needs around Autism Spectrum Disorder will
no longer have IQ 70 in it at all. It will be a functional assessment based
around their needs in the community, because it is a spectrum. Some people range
from needing 24-hour care and some people actually function independently.
The
needs of the individual will determine what services are necessary and it will
have nothing to do with an IQ test.
MR. BRAZIL:
Fair enough.
MR. HAGGIE:
Now, it will take a little bit of training time to get the tool out there into
the community. So that's why there's only $2.5 million in this year's budget.
MR. BRAZIL:
Okay, so we're talking six months a year, 18 months before everything is in
play.
MR. HAGGIE:
I would really like it sooner than that. I think the challenge is around the
assessment tool that I mentioned before. There are some out there. They are, in
some people's minds, too intensely medically focused and we want to make sure
it's individual focused and family focused and needs based, based on their
functional issues, not their diagnosis.
MR. BRAZIL:
Yeah, fair enough.
MR. HAGGIE:
Because that tool will then be cloned for our disability plan.
MR. BRAZIL:
Exactly. It would make sense.
Rather
than get in the House and ask questions about rumors we're hearing about, you
know, wait-list and long-term care, do you have a wait-list number for long-term
care beds in the RHAs?
MR. HAGGIE:
Yes, in actual fact, I
referenced it earlier and I think we'd be happy to provide it. The short answer
is there are 235 people on a placement wait-list between community, personal
care homes and acute care waiting for long-term care as of March 2019.
Over
the last year, we've repatriated 25 people from long-term care back into
community, either home or a personal care home, which is a first. I honestly
can't recall that having happened in the past.
We're
looking at concepts around restorative care. Indeed, that's part of the idea
around the new long-term care beds that we physically located in the hospital in
St. Anthony, that the people there might be suitable for rehabilitation.
MR. BRAZIL:
Those 25 repatriated, are they all different regional RHAs; not one specific
area?
MR. HAGGIE:
Principally Central, but it's across the province.
MR. BRAZIL:
Okay, fair enough.
Any
changes coming to the Special Assistance Program?
MR. HAGGIE:
Yes. The medical device bit, I think the RFPs – has the RFP been awarded? Where
are we?
Yeah,
it's been awarded to Eastern Medical Supplies starting 5th of July, 2019, so
that takes the medical equipment out of SAP.
There
is a request for information being worked on by shared services in Eastern
Health, and then that will be used to develop an RFP for the Special Assistance
Program. We had had some earlier thoughts that it might be possible to
incorporate that in some other services with, unfortunately, no success.
MR. BRAZIL:
Perfect.
CHAIR:
Mr. Brazil, your time is up, but are you – a few more questions?
MR. BRAZIL:
Yeah, a few more questions here.
CHAIR:
Ms. Coffin, good?
Okay.
We'll reset the clock.
MR. BRAZIL:
Okay, thank you.
We hear
rumours about the different number of nurses and that. Can we get an accurate
number of how many nurses we have in this province? I'm curious how it compares
from a standard across the country itself.
MR. HAGGIE:
We have the second-highest number of RNs per capita of any Canadian province. We
will get you the – hang on, here it comes; 6,300 and 5,500 of them work in
regional health authorities. That's RNs.
MR. BRAZIL:
RNs, perfect.
Your
perspective after the campaigns from the nurses' union and that, do we need more
nurses or do we need a different approach on how we provide nursing services?
MR. HAGGIE:
I think we need to go back and look at skill mix.
One of
the challenges that the nurses have identified I've seen from my own previous
experience before and I think we're all agreed on is there's a significant
amount of nursing time – and I think one of the surveys by the RNU itself
suggested that figure was about 25 per cent of nursing time – spent doing what
they describe as non-nursing duties.
From my
own experience, someone to answer the phone after 5 o'clock up to midnight,
someone to maybe help with some of the more straightforward tasks on the floor.
Because LPNs have a hugely increased scope of practice now, and I think in some
areas they are underutilized. Similarly, the PCAs can take some of the more
routine work off them.
I think
the issue around documentation and charting, there are mixed messages from the
electronic health record, and I think we can do better at how data is entered on
nurses' behalf into the electronic health record. Those would certainly be
things I would stress.
Again,
big picture, we have the workforce management software, which will match acuity
to staffing. We've also talked to the RNU about undertaking staffing review more
broadly in areas such as speciality acute care, regional acute care and
long-term care.
MR. BRAZIL:
Yes, fair enough.
I'm
going to take you back to the binder there now because I have a couple of
questions around line items there.
3.1.01,
Regional Health Authorities and Related Services, under Revenue - Federal. The
$16 plus-million in budget line. Can you just outline what that's for? It would
be nice to know.
MR. HAGGIE:
Yes, sure. I just need to flick back. 3.1.01, you say?
MR. BRAZIL:
Yes, Sir, federal revenues.
MR. HAGGIE:
Revenues – I'm getting there.
Okay,
federal revenue, we have First Nations and Inuit Health Funding Agreement – and
there's a number there, but that's for medical transportation for Inuit and Innu
of Labrador, that's $432,000. It's in the binder. We got money from the feds for
Vera Perlin.
MR. BRAZIL:
Okay.
MR. HAGGIE:
We have the combined home care and mental health care transfer, which is, for
this year, $15.5 million. We have provincial revenue – you asked about federal
though, was that correct?
MR. BRAZIL:
Yes, federal. Provincial's fine.
MR. HAGGIE:
It's in the binder.
MR. BRAZIL:
Okay, I'm going to go with the binder and move along under 3.2.01, Health Care
Infrastructure and Equipment. Under Grants and Subsidies, the difference here,
you spent $3,700,000 less in the budget. Can you outline why?
MR. HAGGIE:
Yes. The decrease was related to $3.7 million not being advanced to NLCHI for
the EMR as NLCHI had deferred revenue balances to fund it. So we didn't give it
to them.
MR. BRAZIL:
Okay. In the binder, would it be a breakdown of what this budget covers in
'19-'20, the rest of it?
MR. HAGGIE:
For the '19-'20 budget?
MR. BRAZIL:
Yes.
MR. HAGGIE:
Yes, it's RHA furnishings and equipment, $22 million and building improvements,
$10 million.
MR. BRAZIL:
Okay, fair enough.
MR. HAGGIE:
That's a broad envelope.
MR. BRAZIL:
Under Health Care Infrastructure, can you provide an example of why you had
planned to spent $46 million on capital infrastructure projects, but you only
spent $21 million in '18-'19? A significant drop. Is there one project or group
of projects that didn't go forward, or equipment?
MR. HAGGIE:
There is an item in the
binder that describes the changes in cash flow over time. Again, sometimes you
spend a little bit more one year and sometimes you don't get to spend any and
move it out to the next year.
MR. BRAZIL:
Fair enough, Minister.
Perfect.
I'm
getting to the end of it there now.
Under
Allowances and Assistance, can you just explain the $5.5 million? It maybe
already one that you said but I'm just curious of what –
MR. HAGGIE:
That was Pomerleau for the
Labrador West lawsuit.
MR. BRAZIL:
Can you give me a little bit more detail?
MR. HAGGIE:
Sorry?
MR. BRAZIL:
A little bit more detail on the settlement with them, on the Labrador West
facility?
MR. HAGGIE:
I'm told there's something
called settlement privilege, which I am not supposed to talk about.
MR. BRAZIL:
Okay, fair enough.
MR. HAGGIE:
I've told you all I can.
MR. BRAZIL:
Fair enough. I do understand
that.
With
that being said, I, too, thank the minister and his staff, the Table Officers,
the Chair and the Committee themselves for the indulgence tonight. We got a lot
of good answered to a lot of questions. I appreciate the copy of the binder and
that other report that we noted, it will go a long way in keeping us
knowledgeable on what's happening within the department.
Thank
you for that.
CHAIR:
Thank you.
Seeing
no further questions, I would ask the Clerk to call the subheads, please.
CLERK:
3.1.01 to 3.2.02 inclusive.
CHAIR:
Shall 3.1.01 to 3.2.02 inclusive carry?
All
those in favour, ‘aye.'
SOME HON. MEMBERS:
Aye.
On
motion, subheads 3.1.01 through 3.2.02 carried.
CHAIR:
Shall the total carry?
SOME HON. MEMBERS:
Aye.
On
motion, Department of Health and Community Services, total heads, carried.
On
motion, Estimates of the Department of Health and Community Services carried
without amendment.
CHAIR:
Earlier this evening, the
minutes of the last Social Services Committee were distributed.
Can I
ask for a mover for that?
Moved
by Mr. Brazil.
I don't
need a seconder, do I?
CLERK:
No.
On
motion, minutes adopted as circulated.
CHAIR:
Alison, do you have any
closing remarks?
MS. COFFIN:
No, I said mine, I can't second this because I wasn't there.
CHAIR:
Okay. We don't need to
seconder anyway, that's fine. So we're all good.
The
next meeting is gong to be Tuesday, June 25 at 9 a.m. It's the Estimates of
Education and Early Childhood Development.
Now I
look for a mover to adjourn.
Mr. Davis: So
moved.
CHAIR:
Mr. Davis.
So
adjourned.
Thank
you very much.
On
motion, the Committee adjourned.