The Committee met at 9:00 a.m. in Room 5083.

CHAIR (Mercer): Order, please!

We will get started. I welcome the minister and her staff this here this morning. Minister, I am sure you know the drill of how we proceed by now.

MS J.M. AYLWARD: I do.

CHAIR: Just before I ask you to make some introductory comments I would ask the members of the Committee to introduce themselves to you and your staff, starting with our friend to the far right.

Mr. Osborne?

MR. T. OSBORNE: I just wanted to inform the Committee that Loyola Sullivan is replacing John Ottenheimer for this particular Committee meeting. I don't know if he has informed you already.

CHAIR: Yes. Just introduce yourselves, now.

MR. T. OSBORNE: Tom Osborne, St. John's South.

MR. SULLIVAN: Loyola Sullivan, Ferryland.

MR. PARSONS: Kelvin Parsons, Burgeo & LaPoile.

MS JONES: Yvonne Jones, Cartwright-L'Anse au Clair.

MS M. HODDER: Mary Hodder, Burin-Placentia West.

CHAIR: I am Bob Mercer, Member for Humber East and Chair of this Committee.

The procedure is simply this. We would ask that the minister make some introductory remarks and introduce her staff. I would remind the staff that when responding to a question if they could state there name. If there are people in the row behind the minister making a response, if they would come forward to the mike. We would like to get all those answers on tape for Hansard.

With that, Minister, as they say, you are on.

MS J.M. AYLWARD: I am on. Thank you very much and good morning. I would like to introduce my staff. To my right is our newest Deputy Minister, Debbie Fry. I want to welcome Debbie to her first Estimates Committee meeting in our department. Sitting next to Debbie is Donna Brewer, our ADM of Support Services. Sitting next to me at my left is Jim Strong, Director of Financial Services. Sitting at the end of the table is Pam Elliott, ADM of Institutions. Behind me there are a number of people as well. I have Gerry White, ADM of Policy and Planning; Helen Lawlor, Director of Community Health Services; Debbie Sue Martin, Director of Mental Health; and Eleanor Gardiner, Director of Continuing Care.

As some opening comments, I just would like to say that as you know last year, 1998-1999, was a very busy year for us because we of course had the merger of child welfare and family rehabilitative services as well as community youth corrections and the ongoing reorganization of the department.

From a perspective at a national level, our department was also quite involved with the Social Union Agreement, because a lot of it was about identifying new roles and responsibilities for social programs in Canada as it relates to CHST funding. As the lead minister it was quite a big commitment from my part and the staff, as well as the staff of IGA.

We also had a busy year with negotiations, particularly the MOU with the NLMA. Again, this is still in the process of micro-allocation but most of that is completed by now and we are just dealing with issues as they arise. The whole arrangement was changed from a bipartite to a tripartite agreement. Once before the agreement was between us and the NLMA, and the last agreement saw the boards come in as an entity in and of itself.

We also had key legislation brought forward this year including our Child, Youth and Family Services Act - which again is one we are very proud of - replacing a twenty-five-year-old act, and our new Child Care Services Act. We have done a lot of work on our adoption. We were really hoping to have it done this spring but we are fairly confident it will go forward in the fall. Again, this is one that I think will be very well received because it is much more of an open model for adoption compared to what we have been working with.

We also have been working very hard to implement our Strategic Social Plan. We are working very hard with the group, through the Premier's Council, to go the next phase which is developing the social audit for our Strategic Social Plan. Under our Strategic Social Plan and in conjunction with our National Child Benefit, we have been able to put in place a number of initiatives including new funding for family resource centres as well as moving to put in place the next phase, which will be our community youth networks.

We have also put forward a provincial tobacco reduction strategy of $900,000 over the next three years, and also a nutrition policy, which is one we have been working on for awhile.

Again, at the federal-provincial level we have been quite busy as a result of the Krever Inquiry and working with the federal government to establish the Canadian Blood Services. Again, that is in response to the Krever report. We are still working to finalize details: for example, the sites for various testings. As you can imagine, after the Krever report provincial governments are really working I guess in very much an advisory role because we know that the CBS is the one that is making the decisions. We all have representatives from our Provinces there.

Another big issue that we have dealing with is our Y2K issues around technology and trying to make sure that particularly our diagnostic machinery is in place for the year 2000, to make sure they are all compliant.

I could go on with some more details about some of the other initiatives but I think we can move on because we have, this year, invested a significant amount of money into health care.

As you know, we have put $40 million back into the health care budget to pay down our accumulated deficits for the institutional boards. We have also added $15 million for hospital equipment and $6 million to standardize our medi-tech systems, particularly for Labrador, Western and the Peninsulas.

In addition to that we have tried to put new drugs in our formulary, again, using evidence to make those decisions. In this year past we introduced drugs for multiple sclerosis and also type two schizophrenic drugs under the psychiatric category. We have also put money into the ambulance grants in the amount of almost $600,000. As I have already mentioned, we have put a significant amount of money into new initiatives under the National Child Benefit Initiatives.

I will now turn it over to you, if you would like to start with the questioning and clarification of the Estimates.

CHAIR: Thank you, Madam Minister. Just before we ask the Clerk to call the first head, which is the head on which we will do all of our questioning, is there consent and agreement on that? There usually is.

I would just like to welcome Mr. Tom Hedderson to the meeting, the Member for Harbour Main-Whitbourne. Good morning, Tom.

MR. HEDDERSON: My apologizes this morning, Mr. Chairman.

CHAIR: Not at all, sir. Madam Clerk.

CLERK: 1.1.01.

CHAIR: It is up to you as Vice-Chair whether you or your critic wish to lead off. It is entirely up to you.

MR. T. OSBORNE: I will lead off because otherwise Loyola will cover everything. I'm sure we want this meeting to be just as expedient as last night's.

AN HON. MEMBER: (Inaudible) I won't have a question then, will I?

CHAIR: After Mr. Osborne is finished, then we will come back to Mr. Parsons.

MR. T. OSBORNE: Some questions are related directly to the Estimates, Madam Minister. In 1.1.01.01, Minister's Office, Salaries, there is a difference in what was budgeted last year and what is budgeted this year. Is there new staff in the minister's office or is there a change in salaries?

MS J.M. AYLWARD: It is a combination of a couple of things. We had a senior person leave in the department and there was a significant amount of severance because it was a long-term employee. My senior secretary to the Minister's Office retired.

In addition to that, with the combination of the two departments under a new department, we did see some significant increase in demands in terms of secretarial work and organization, so there was an addition of a new staff member to assist along those lines.

MR. T. OSBORNE: In the secretarial staff?

MS J.M. AYLWARD: Yes.

MR. T. OSBORNE: As well, under 1.1.01.06, Purchased Services, there was a $2,000 increase in what was budgeted and what was actually spent.

MS J.M. AYLWARD: Yes. That, again, is related to entertainment, particularly of dignitaries and other people who visited the department.

MR. T. OSBORNE: Under 1.2.01.01, Executive Support, there was a considerable increase, $97,500 more spent last year than was budgeted in Salaries. I realize that part of that was due to the extra pay period. What would account for the remainder?

MS J.M. AYLWARD: The remainder is associated with the retirement of our former Deputy Minister, Dr. Bob Williams. As you can imagine, Dr. Williams has been with the department for quite a period of time so that includes severance, holidays and that sort of thing. In addition to that, we had a senior Deputy Minister come back to work in an associate capacity, working on special projects for a portion of the year.

MR. T. OSBORNE: What area would he have been working in?

MS J.M. AYLWARD: He worked under the executive and support services component as associate Deputy Minister.

MR. T. OSBORNE: Under .03, Transportation and Communications, there was an additional $50,000 spent last year over what was budgeted.

MS J.M. AYLWARD: Yes. I think in my opening comments I mentioned about some of our added responsibilities associated with a number of initiatives at the federal-provincial level. Whenever you have the minister involved in extra responsibilities, you often will see that the deputy ministers and ADMs also have to go in preparation of those extra meetings.

For example, last year, particularly, I was quite involved in the Premier's meetings because of the heavy agenda that was set forward with respect to the social union agenda, talking about, mostly, health education and social services as it relates to roles and responsibilities around the social union. That is one example.

In addition to that, there was a number of other meetings around the National Child Benefit Initiatives, which my department played a significant role in as well, because most of them focused around children. As you know, that component is now moved over to my department as well.

Again, whenever you see transportation increased generally in a minister's office, you will often see an associate increase with the executive in preparation of those minister's meetings.

MR. T. OSBORNE: (Inaudible) for both the Minister's Office and Executive Support has increased this year under the Estimates, but the Minister's Office is almost the same as what the revised amount was last year. Executive Support is considerably less.

MS J.M. AYLWARD: What are you talking about, and which category? Under Salaries or -

MR. T. OSBORNE: Transportation and Communications.

MS J.M. AYLWARD: Under travel. Yes, but again I would say, in terms of the travel, that some of my travel that I do as minister with respect to the social union specifically is in relation to the IGA department. I'm the lead minister for the social union talks, but my support staff, for the most part, come from IGA, so that would account for that, in addition to the Premier's meetings, which is also an IGA function.

Not all of the minister's meetings that I attend, and those on behalf of the Province, are directly related to the department. Some of them cross over to Intergovernmental Affairs.

MR. T. OSBORNE: Let me clarify my question. The level of increase in Transportation and Communications for the Minister's Office, the ratio of the travel increase from last year's budget to this year's budget, is not quite double. When you look at what the revised amount was last year for the Minister's Office there is not a lot of change. There is only $2,000 less, I think, being spent in the Minister's Office this year for Transportation than last year, whereas in Executive Support there is $30,000 less.

MS J.M. AYLWARD: Yes. I think I mentioned it again. We had quite a bit of travel associated with the merger of HRE and with my department. I think that would account for it because a lot of the national meetings crossed over. In some cases you would have executive from both departments in the transition period.

MR. T. OSBORNE: Basically, I guess, you are going to require less executive support travel with you this year than last year.

MS J.M. AYLWARD: As much as you can predict, based on what is happening in my own department, but as I have said I definitely have two distinct roles that you see under minister's travel. A lot of my minister's travel is related to my department. You have to remember that I attend ministers' meetings for social services ministers, for health ministers and for seniors ministers, and in addition to that I also do the social union for the country, and also some of the IGA work associated with that.

This year, particularly, the executive did most of their travel around the transfer of both departments. It should not be as much next year because, hopefully, we will have the transition completed. There still will be some travel because we are still working on the National Child Benefit Initiatives and that is a big component of my department now.

MR. T. OSBORNE: Under 1.2.02, Administrative Support, the amount budgeted and spent last year was almost the same. There is an increase this year. I was just wondering if you could clarify whether there was a change in staff.

MS J.M. AYLWARD: The majority of Administrative Support increases that you are seeing there are related to .12, Information Technology. That is the second phase of our client referral management system. That is what is being used out in our community health system by the community health boards. That is what we use to actually look at identifying areas around disease tracking, integrating waiting lists, looking at drug dependency issues, those kinds of things. It is an IT increase.

Are you talking about the Salaries now, specifically? Because Salaries were almost identical there.

MR. T. OSBORNE: No, there was a slight increase in Salaries -

MS J.M. AYLWARD: Yes.

MR. T. OSBORNE: - from what was spent last year and the amount budgeted this year.

MS J.M. AYLWARD: Yes. That was mostly in relation to a one-time expenditure that we had for our line-by-line financial review of the health care system, the institutional budget. That would account for that increase.

MR. T. OSBORNE: That is anticipated to be spent this year then?

MS J.M. AYLWARD: It was a one-time increase, yes.

MR. T. OSBORNE: Under 1.2.02.12, Information Technology, is that increase there, $334,300 -

MS J.M. AYLWARD: Some of that is replacing our outdated Y2K technology. Again, some of it is the client referral management system. Both of those combined.

MR. T. OSBORNE: Under 1.2.03.01, Health Policy Support, Salaries, again there is a $49,400 increase there this year over what was spent last year. Are there changes in staff in that particular -

MS J.M. AYLWARD: Yes. That in the Salary component is mostly related to - as you know, in my opening comments I talked about a number of pieces of legislation we have been working on. Under the Health Policy Support division, that is where we go through the process of using our legal counsel and our research and policy analysts to get ready for the legislation. That is what accounts for those. Use of the legislative component and also some of our research services that are required.

MR. T. OSBORNE: Under 1.2.03.06, Purchased Services, the amounts budgeted last year and this year are the same yet the amount that was spent was less than half of the amount budgeted. We won't complain that you spent less there, but I am just wondering why those Purchased Services were not needed.

MS J.M. AYLWARD: Wow! That is an interesting question, why we didn't spend the money.

The comment that we have here is in relation to the cost of printing services under this particular policy component. Had we gone ahead and printed the adoption documents and that sort of thing for the consultation and for the distribution, it probably would have been that much money. We had anticipated that happening, but as I said, that will now probably go forward this fall. So there was less printing.

MR. T. OSBORNE: Under 2.1.01.03, Administration and Consultative Services, Transportation and Communications, there is an increase there of $31,500. Where are you anticipating the extra travel there this year?

MS J.M. AYLWARD: As you know, we passed our child welfare legislation in December of last year but it has yet to be proclaimed. The reason it has not been proclaimed yet is because we are travelling around the Island to do the necessary education and training of the staff. That is what we are doing under that heading.

MR. T. OSBORNE: 2.1.01.06, Purchased Services, again, under that heading there is $8,000 more under Purchased Services. Last year what you spent was right on budget. I'm just wondering what the additional Purchased Services would be.

MS J.M. AYLWARD: Printing again.

MR. T. OSBORNE: Under 3.1.01.10, Memorial University Faculty of Medicine, the Grants and Subsidies there is up $360,000. I'm just wondering where those expenditures are going, what they will be used for.

MS J.M. AYLWARD: The reason they are increased is because the Board of Regents approved a tuition rate of increase of $6,250 which left a shortfall of about $360,000. What we have done is added that as part of their permanent base adjustment, because they were operating in a deficit.

MR. T. OSBORNE: That is to maintain the tuition levels for students?

MS J.M. AYLWARD: No. It is because originally they had intended to put a higher tuition in place, but in fact the Board of Regents agreed on a $6,250 increase. Therefore, their budget was based on, perhaps, a higher tuition going in place that never happened. As a result of that they were short, so our department has added the amount of money they are short in the amount that you have identified. That is gone as part of their permanent base adjustment.

MR. T. OSBORNE: Under 3.2.01.05, Administration, Professional Services, there is a $45,000 increase there this year over what was spent last year. I wonder if you could put some clarification on the need for that increase.

MS J.M. AYLWARD: Under the Professional Services fees?

MR. T. OSBORNE: Yes.

MS J.M. AYLWARD: Those are the fees that we use (inaudible) for processing drug plans. I guess there is a whole rationale for some of the costs associated with that. We also had a fee increase associated with the pharmacists of an extra fifty-eight cents and that accounts for some of those increases as well. In addition to that we have had the MS and psychiatric drugs added to the list.

MR. T. OSBORNE: Under 3.2.02.09, Indigents, Allowances and Assistance, there is an increase there of $2,247,000. That is, I assume, from the appropriations heading for drug cards under Human Resources and Employment. Subsidized -

MS J.M. AYLWARD: No. The part you are looking at now is the social assistance recipients. Indigents are what you are talking about. What that increase actually is about is because we have increased $1.8 million, as I pointed out, in the MS drugs and the type two schizophrenic psychiatric drugs.

In addition to that we are seeing a change. We just had some information in fact where we now probably have the highest rate of prescriptions of antibiotics in Canada from Newfoundland. We have that (inaudible) as well. Mostly we are talking about the added increase of the MS and psychiatric drugs up to about $1.8 million.

MR. T. OSBORNE: It is kind of a harsh title.

MS J.M. AYLWARD: Indigents?

MR. T. OSBORNE: Indigents, yes.

MS J.M. AYLWARD: I do not know. That is what it has always been called, as far as I know. What would you suggest?

MR. T. OSBORNE: I do not know. Maybe drug allowances. Indigent is almost an insult to the people that are receiving that subsidy. The basic definition of the word -

MS J.M. AYLWARD: I do not know what the basic definition of the word is, actually. Do you know what it is?

MR. T. OSBORNE: I do not know. In my understanding of that, I have always understood indigent to mean less fortunate, poor, somebody who is unable to provide for themselves. While it is correct it should probably be called something else. It is a harsh title. Just a suggestion for next year. Am I correct in that Loyola? You are pretty up-to-date on -

MR. SULLIVAN: I'm no expert on definitions of words, but I guess it certainly is a good suggestion to maybe come more just a little softer out there. It might be something to think about.

MS J.M. AYLWARD: I think we are the only ones that know what - it is never referred to as the Indigent budget. The first time I saw it referred to as the Indigent budget was when I looked at the Estimates. Because we call it our budget for social assistance recipients and our senior citizens. That is how it is split.

MR. SULLIVAN: It is better to call it that than say social services (inaudible).

MR. T. OSBORNE: Yes. Drug allowances or something of that nature may be a little softer than identifying the people as unable to - where we all know that is what it is for it. I mean, it is a harsh title, I think.

Now to 3.3.02.10, Physicians' Services, Grants and Subsidies.

MS J.M. AYLWARD: Let me catch up here now. Where are you again, 3.3.02?

MR. T. OSBORNE: 3.3.02.10, Grants and Subsidies. There is a $10,041,900 increase in the amount that was spent last year and the budgeted amount this year.

MS J.M. AYLWARD: Thirteen million dollars, isn't it, if I am looking at the same as you, from the budget to the revised budget?

MR. T. OSBORNE: No, from the revised budget to the Estimates this year.

MS J.M. AYLWARD: Yes, that is approximately $10 million.

MR. T. OSBORNE: I am just wondering what the increase there would be accounted by.

MS J.M. AYLWARD: As you know, we just signed a Memorandum of Understanding agreement with the physicians that gave a $32 million increase spread over a period of years. Some of that is for the allocation of the yearly amount. Others of it include dental costs and new salaried physicians which we have put into the system. They are the two things: MOU and salaried physicians. They are the new ones that we have put into the system plus the component of the $32 million. That has to go on top of the base salaries.

MR. T. OSBORNE: Under 3.4.01.01, Emergency Health, Salaries, there is an increase there of $25,200 over what was budgeted last year and this year. I understand the revised amount would have accounted for an extra pay period.

MS J.M. AYLWARD: Yes, that is right.

MR. T. OSBORNE: What was that increase in the Salaries?

MS J.M. AYLWARD: What happened was there was a position which was incorrectly funded under Professional Services in last year's budget. Now it has been transferred to the appropriate one. The budget for this coming year only increased by $25,200 because, as you pointed out, there is the elimination of the twenty-seventh pay period, which people would like to see put back in here, I understand, but we do not have that ability to do it.

MR. T. OSBORNE: I am going to move away a little bit from the Estimates. I have a couple of other questions so I will save some of the titles in the Estimates for my colleagues.

Can you elaborate on the $40 million that was allocated for the regional board deficits?

MS J.M. AYLWARD: What we did was we went out to each of the boards. We asked them to put forward in writing their deficits. We also had done, as you know, our own line-by-line budget analysis. We looked at what they had put forward, we also had our own analysis done with the boards, and of that we identified $40 million. It was allocated based on those needs on a one-time basis.

MR. T. OSBORNE: That only covers 1997-1998, it does not go beyond that?

MS J.M. AYLWARD: That is right.

MR. T. OSBORNE: Are you anticipating that they will not have a deficit beyond this year, or are there going to be allocations next year to cover future deficits?

MS J.M. AYLWARD: As you will probably remember, in addition to the $40 million we also announced an additional $15 million. That $15 million was put in place to help address the deficits for this year.

We are now in the process of working with each of the boards. They are in the process of submitting their budgets for this year, and we will be working with each one of them individually to identify if that will completely meet their needs or if there will be some slight deficits, but we will be working with each of them individually. It is just a little bit too soon to answer specifically.

MR. T. OSBORNE: The new hospital fund, can you tell me where that money is coming from? Is that the federal Immigrant Investment Fund?

MS J.M. AYLWARD: Some of it, I believe, or I know, is the Immigrant Fund and some of it is from our own provincial capital.

MR. T. OSBORNE: There were a number of new hospitals announced over the past eighteen months or so. Is all of the funding for those new hospitals reflected in this year's estimates?

MS J.M. AYLWARD: As you know, you do not put the whole amount of the project in the budget unless you are going to spend it in that year, and there is a process that has to follow. For example, after you do your assessment of the needs then you have to do your planning and programming. Then you do your mechanical, engineering, and the list goes down.

What you have seen budgeted is what we are anticipating spending in this budget year. That will vary from site to site depending on the programming.

As you remember, there was an announcement made just last week about the Gander part of the process. Gander is proceeding with another $4.5 million to proceed with - I think it is the mechanical and engineering component that has been identified through Works, Services and Transportation.

Each of the various facilities will have work done based on what is able to be done within that budget year. For example, in Bay d'Espoir they are moving on to the next phase. In some of the other areas they are working on the programming base. It depends, really, what stage they are at.

MR. T. OSBORNE: Can you give us some idea of, I guess, the time frame in which you are hoping those hospitals will be built, over the completion of the new hospitals that were announced?

MS J.M. AYLWARD: From my perspective, I can only speak to what is in the budget. I cannot tell you what year anything will be completed because that would be a decision that would be made through the budget process and the Cabinet process. All I know is that generally when you begin a process you go through all the stages and, as your money and needs allow, you complete it.

I know, for example, the Janeway site is moving on and it is on schedule. In fact, the last I heard it was ahead of schedule. I understand as well that the Bay d'Espoir hospital is also working on schedule. I know that the Goose Bay hospital is on schedule. As you know, Inco made the financial contribution, as well as the Province, and that is on schedule.

I would not be able to tell you today what the dates of completion would be without having my colleagues here from Works, Services and Transportation, and also without having the directive from Cabinet with the budget process. I can only let you know what has actually happened this year and where we are planning to go with the projects, and I think I have just sort of given you a very brief overview.

The other outstanding one, Stephenville, I understand that is in the programming component and that is ready to move forward. The Fogo Island centre, as you know, is in the process now of completing the final report to identify the site. Once that is decided we will move on with the next phase. There is no intention not to move forward with any of the facilities that were announced, including Bonne Bay.

MR. T. OSBORNE: One final question. The doctor situation at the Agnes Pratt Home, can you give us an update as to the progress being made to alleviate the concerns there?

MS J.M. AYLWARD: From the information I have gotten from the boards, they have physician services covered. They are still actively recruiting and, as far as I can tell from some of the comments I have received, the residents are quite okay with the services that are being provided there right now. I know that one of our own physicians has also been helping out in that area.

Again we are also in the process, as you know, of graduating nurse practitioners with geriatric experience; so we are hoping again to put together in St. John's, where we have a number of nursing homes, another form of a clustered model of services for long-term care which would not only include physicians but would include physicians, nurse practitioners and nurses, as well as LPNs, and to try to maximize the capacity for each of those to deliver all of the skill sets they are able to deliver.

CHAIR: Thank you, Mr. Osborne.

Mr. Parsons.

MR. PARSONS: I have no questions, Mr. Chairman.

CHAIR: We will go by seniority. Loyola.

MR. SULLIVAN: Thank you, Mr. Chairman.

I will probably start where Tom just stopped and sort of finish that particular aspect. With reference to Hospital Facilities, 4.3.02.19., Development of New Facilities, there is $30,850,000. Do you have a list of the targeted ones - I know generally which ones are out there - of that $30,850,000 and how much was allocated to each site? When we say Gander, $4.5 million, for example; each of the locations and the dollar value that has been projected in this (inaudible).

MS J.M. AYLWARD: I do not have the exact amounts with me here today on each of the ones -

MR. SULLIVAN: Even ballpark is fine. I do not really -

MS J.M. AYLWARD: Well, I think I have sort of done ballpark. I would not be able to give you the ballpark figures because again, I do not identify the contract amounts through Works, Services and Transportation. Our role, as a line department, is that once we get through the programming piece then Works, Services and Transportation takes over the responsibility of letting the various contracts to move forward.

I do not have the amounts of money here with me. All I know is that, from our perspective, we are moving forward on all of the ones that have been announced to either - like, for example, Fogo. The first obstacle, obviously, is identifying the site. Once we move there we go on to the next phase, and we are moving forward with that. Fogo Island, again I understand the programming is moving right along with that. The site is chosen and there is not any difficulty with that.

With the Melville Hospital, the money has been put in place - the $3 million from Inco - and they are moving forward with that. Harbour Breton is moving right along, and I know they are into their next phase. The last I heard they were on schedule, and I do not know but maybe they are ahead of schedule by now for this year.

I can identify for you, if you want, with Works, Services and Transportation, what -

MR. SULLIVAN: Sure, at you convenience, maybe you can just get the ones and the rough dollar value. I do not need specifics, just to have -

MS J.M. AYLWARD: What has been identified?

MR. SULLIVAN: Sure.

MS J.M. AYLWARD: But I would imagine the budget would give you as good an idea about that as what I would give you.

MR. SULLIVAN: Am I right in assuming that all of the hospitals that are now being constructed - new facilities, additions or whatever - are being allocated out of this here with the exception of the Health Care Corporation? That is my understanding. I know it was the plan that financing would be arranged by them and carried out through them and the other facilities would be included here. Would that be correct?

MS J.M. AYLWARD: I understood what you said about the St. John's Health Care Corporation, but what are you asking about the other ones?

MR. SULLIVAN: They are included directly in your estimates here. It is my understanding that the Health Care Corporation of St. John's, in their initial announcement - I attended when they had their first AGM - they indicated there, they estimated, that there would be roughly - and I asked the question actually at the time - that where the initial cost was projected at roughly $100 million and over twenty years it would be financed, that would cost really another $100 million and they would pay it back at the rate of basically $20 million a year. I think at $20 million a year they would pay it back, or whatever, but $10 million would go toward the debt and there would be $10 million identified in savings out of that.

I was told in subsequent questions, too, that would be financed by the Health Care Corporation and they would be the ones that would finance that and pay that, and they would use the savings then to channel the money back into the system. I do know, since that, the statement has shown that it is now going to be $135 million, excluding the five-year plan of projections that is estimated at another $20 million.

I am just wondering, is it still with the Health Care Corporation? Are all of these being conducted and expended and showing here in the estimates, or are they showing in a financial statement at the Health Care Corporation?

MS J.M. AYLWARD: No, the Health Care Corporation is assuming the payments for that.

MR. SULLIVAN: All the payments.

MS J.M. AYLWARD: Yes.

MR. SULLIVAN: Yes, that is my understanding.

MS J.M. AYLWARD: As you know, the extra $30 million - and I think it is important for the record because we have talked about it before - the initial $100 million was identifying just the construction of that facility. The extra $30 million - and we have discussed this many times - has been identified to make renovations and changes at the Health Sciences and at St. Clare's site. It included an expansion of the cardiovascular unit; it included parking facilities and upgrading the ORs. So that extra $30 million has been identified as a separate piece over and above.

MR. SULLIVAN: It is $35 million actually now.

MS J.M. AYLWARD: Because a portion of that would be for their capital equipment which was never included in there as well.

There is a distinct difference in the original $100 million which was for construction, as opposed to other renovations required associated with it; but yes, the answer to your question is they are carrying the payment scheme for that facility.

MR. SULLIVAN: The other facilities, of course, are all directly included. None of the other boards are carrying capital debt on their books, basically; that is being absorbed directly in the estimates here. Would that be correct?

MS J.M. AYLWARD: Some of them are being funded through the Immigrant Investment Fund, and there is a possibility that we are still working on; some of them will be undergoing a self-financing model. Again, those are yet to be determined.

MR. SULLIVAN: Do you have an estimated cost to complete - surely a ballpark figure - for instance, the Gander Hospital. How many more new dollars, in addition to this contract, the mechanical one that was just awarded there, what is the targeted amount now to complete that?

MS J.M. AYLWARD: I would not have that with me right now because a lot of that will depend, of course, on the time frame that it is completed in. In terms of the ongoing needs, I would not be able to give you that at this time.

MR. SULLIVAN: It was my understanding that - and maybe someone might be able to - based on current costs, let's say, as of today completed, to my knowledge there is probably close to $20 million being spent now, I think, with this latest contract. I think initially there was an estimated probably $45 million which would leave, I guess, $25 million or more there, which means it would be less than half completed. Would that be still fairly accurate? Because we basically only have a shell there at this point, right?

MS J.M. AYLWARD: That would be something I have to ask of Works, Services and Transportation in terms of the letting of their contracts, what they see, and how they see it progressing, quite frankly.

MR. SULLIVAN: With reference to recent costs now, since budget and estimates here, there have been other basic announcements and other costs incurred within the department; for instance, new nurse allocations and so on, other staff, LPNs, and I think fifty others announced. Would this be coming out of the contingency reserve fund?

MS J.M. AYLWARD: Yes.

MR. SULLIVAN: All of it would be?

MS J.M. AYLWARD: I do not have the money so it has to come out of somewhere.

MR. SULLIVAN: Okay, I assumed it would be.

With reference to Long Term Care Facilities, 4.3.03., they are basically all lumped together. Do you have a breakdown on the allocations to each? I know the funding goes out to each of the specific boards that administers these. Some are, I guess, under institutional boards outside the St. John's area, except one, and in St. John's they would go to a nursing home board.

MS J.M. AYLWARD: That is right.

MR. SULLIVAN: Do you have a breakdown on what is provided to each of the long-term care facilities in the Province, and how much they actually receive?

MS J.M. AYLWARD: No, I do not have that breakdown.

MR. SULLIVAN: Or if I could receive it at a future date it would be appreciated.

MS J.M. AYLWARD: Sure.

MR. SULLIVAN: I do not expect you to have it at your fingertips.

MS J.M. AYLWARD: No, because we do the block funding and particularly where we have the boards. All of our nursing homes, with the exception of one, are under a (inaudible) board structure. In St. John's there is a long-term care board, or a nursing home board here, and all of the others are associated with the community boards across the Province, so that would be added into their total board budget.

MR. SULLIVAN: Could I get a breakdown of your allocations to each of the boards in the Province? I guess there are eight institutional boards and, I guess, four separate community boards, which would be twelve, and the nursing home board would be the thirteenth. I am not sure if I am missing either one. Could I get the general budget allocations that go specifically out to each of them? The Estimates does not provide - everything is just lumped together under the one heading.

MS J.M. AYLWARD: I guess we can get the general board amounts there.

MR. SULLIVAN: They are showing, for instance, in 4.2.01.10, under Health Facilities Operations, Grants and Subsidies, $650,555,500 allocated this year. If I could have them for each one. I guess you would not have them for institutions because technically it is all under their umbrella anyway and what they do -

MS J.M. AYLWARD: It might be all under the umbrella of the boards. I will have to see.

MR. SULLIVAN: That is right. There is a lot of movement of services and it would be impossible really to break all of that down to what exactly each facility uses.

MS J.M. AYLWARD: It might be the same for here. Like I said, I will see what we have in terms of the breakdown and give you what we have.

MR. SULLIVAN: Okay.

Also, there was always a breakdown before. You used to have a breakdown, like personal care homes and nursing homes and then other acute care institutions. In the past, the Estimates would look at a breakdown of each of these. Now they are all lumped under the one, so if I could also have the allocations there. How much is the government expending - I am sure you have that general figure there - on personal care homes? What is the dollar value that personal care homes are costing?

MS J.M. AYLWARD: I believe it is $9 million, is it?

WITNESS: Approximately $9 million.

MS J.M. AYLWARD: Yes, $9 million approximately.

MR. SULLIVAN: That would be including the resident or bed subsidy cost plus the provision of various material and things, and disposable things to those subsidized -

MS J.M. AYLWARD: It covers three components. It covers the medical surgical supplies, it covers night security, and it covers the cost associated with the person staying in the home.

MR. SULLIVAN: How many would there be right now? It is my understanding that back in 1995 there were 1,374 at that time and right now there is in the ballpark of 1,000 subsidized beds. Would that be accurate?

MS J.M. AYLWARD: I think there are around 1,100 if I am not mistaken, are there?

WITNESS: Eleven hundred.

MS J.M. AYLWARD: Eleven hundred.

MR. SULLIVAN: Roughly 1,100 now.

If one of those homes has a vacancy and they are not able to fill it right away with a subsidized, and they put in one who is non-subsidized, do they lose that out of the system then?

MS J.M. AYLWARD: You can only put one person in the bed, so as long as the person is in the bed -

MR. SULLIVAN: I know before - I will just use this as probably an example - back about four years ago a specific home had a job to fill a bed at that moment with one that was subsidized so they put in a person who was not subsidized even though they had - I will use an example - let's say twenty beds. Let's say a dozen of those were subsidized and eight were not subsidized. Normally, if they had twelve subsidized and eight not, and they could not fill one of the subsidized ones and they only had eleven so they put in a person to make it eleven and nine, would that home in the future, if they needed to add one, lose that? Because it happened before.

I went over and met with the previous minister about four years ago and said that it is not right to be pulling beds out of the system when someone cannot fill it with a subsidized. To leave it vacant is costing money, so if they can fill it with another one it should not take away the number they have been allocated for that facility. Can they get back to their allocated level again or will they lose that now?

MS J.M. AYLWARD: How is leaving it vacant costing money?

MR. SULLIVAN: Because they were not getting income and they had the same overheads and staff.

MS J.M. AYLWARD: It would cost them money, not me, not the government, not the people.

MR. SULLIVAN: Yes, that is right. For the person operating that, if they have nineteen or twenty beds they would like to fill them, or as high a percent as possible. Every one that is vacant is extra loss of revenue, and it is difficult to operate as it is. Would somebody be able to answer the question? If they fill what is called a subsidized with a non-subsidized, can they again, when that non-subsidized is vacant, fill that with a subsidized one again?

MS GARDINER: In the subsidized beds, if an operator is approved for twenty subsidized beds and he has only filled eighteen with his subsidized clients, and fills two beds with private paying clients, if those private paying clients move out, his two beds are returned to him.

MR. SULLIVAN: Okay, thank you.

MS J.M. AYLWARD: What I just want to say, and I think it is important for the record, is that in terms of how we spend our money, if the bed is vacant it does not cost government any money. I think that is my main concern, as minister responsible for the scarce resources we have, not making sure that the private operators get their money regardless if anyone is in the bed or not. I think that is a fair statement.

MR. SULLIVAN: Oh, yes. I understand quite clearly there. I guess the other point of view I made was that there are people out there operating with vacancy rates which are reasonably high and it is pretty difficult for them to operate. Some have gone out of business and others are going out of business. I have talked to some of them. They have to look at it from a viability point of view, and if they do not have the revenues we would not want to see the quality go down in those homes because they have (inaudible). I think the ultimate result in the resident there, and the care they are going to get. If the revenues are not there to provide that care, I think we are compromising something.

MS J.M. AYLWARD: I am glad to hear what you say about the quality because you know, as well as I do, that some of the personal care homes out there are vacant because people under our single-entry system do not choose to live there; and the reason they do not choose to live there oftentimes is because the aesthetics of the place is not what they would consider acceptable for a place where they would like to live. One of the things that we are finding is that we have homes in this Province that are full to capacity with non-subsidized beds because the homes are beautiful and well-kept.

We have other homes that have vacancies with subsidized beds because the homes are not that nice and people do not want to live there. So one of the things we have found, with the subsidies and with the non-subsidized beds, that people will choose will go to a place in which they want to live. That is one of the benefits of a single-entry system that we are very proud of, too.

MR. SULLIVAN: Also, to put new facilities in and with the requirements, it is sometimes cheaper than having to renovate and make all these changes in old facilities. It is a pretty cost, especially when you are doing it on the declining numbers.

MS J.M. AYLWARD: It depends. In some cases, people want to stay in an environment because they have lived there all along. The renovations are worth it. In some cases it is cheaper to build, particularly when a lot of these are being built with federal ACOA monies. A lot of people are getting a lot of federal funding to build. While they say it is their own money, a lot of it, as we know, is being built with federal funds.

MR. SULLIVAN: The $40 million was used to eliminate the debt - I know Tom made reference to it - up to March 31, 1998. What was the total deficit for all the boards up to March 31, 1999? I know it has been taken care of up to March 31, 1998.

MS J.M. AYLWARD: Right. That is where we are looking at now. We are right in the process of getting their budgets in to look at how we are going to allocate that $15 million. We believe that it will be close to the $15 million but again, we are looking to see how the budgets are coming in, in terms of what the various boards are going to do, in terms of what they can do to try to maximize efficiencies without jeopardizing quality of service and care. That is what we are in the process of working through with the boards right now. That is why our money - the $40 million - goes up to $98 million. We have allocated an amount of notional. We have allocated $15 million to deal with those deficits and we will have a better idea now when we meet with the boards.

MR. SULLIVAN: Yes, because last year, it was my understanding, there was $25 million of debt incurred, I think, with your -

MS J.M. AYLWARD: We had $10 million put down.

MR. SULLIVAN: That is right. Out of the -

MS J.M. AYLWARD: That is why I am saying why we allocated the $15 million, but in terms of the accurate numbers, for the purpose of giving you the answer, Loyola, we would need to meet with the boards to actually say.

MR. SULLIVAN: Sure, yes. I was just saying that my understanding, from what I heard from the boards and probably, I'm not sure, maybe from you - I can't remember exactly where I heard it - is that initially, yes, you had sort of set aside $10 million, anticipating that maybe some boards might have problems meeting on the budgets they were initially given. At least you would have $10 million to be able to move to trouble areas and areas that needed that. Then, with the announcement of $20 million after that - I think $5 million for basic equipment and $15 million to go toward it - I drew the conclusion that this $15 million, along with the $10 million, whether rightly or wrongly, would be enough to satisfy the deficit for this past year of this $25 million.

Because I heard some public figures from some boards that they were operating a deficit, so I drew the conclusion that the total accumulated deficit of all boards last year would be more in the $25 million range. When we have this year, in the one we are on, 4.2.01.10 Health Facilities Operations, $21,641,900 less allocated in Grants and Subsidies this year than we last year, I'm just wondering this. Are we not going to be faced with the same situation again where $15 million is not going to be near enough to meet that?

MS J.M. AYLWARD: That is why I answered the way I just did when you asked the question. Before you can actually give the answer you need the audited statements and they are due fairly soon. You need to look at those statements and work with each of the boards to see. Because as you know, a number of our boards have done a number of initiatives that have reached their maximum capacity for operating and some of the boards have not.

We are working with all the boards and once we get the audited statements, as well as going with them through our line-by-line budget analysis, I think we will have a much better idea. We do acknowledge that when you pay the $10 million down, obviously it impacts on what you are carrying over for the next year. That is why we had a $15 million allocation. We would need to see their audited statements and work with each of them to see exactly what is involved.

Also, you know, the situation has changed. As we know, we have just put more money into the system to try to address some of those needs, so that is the baseline budget that is not going to go away. The money we added in it was not a one-time money: the $4 million we have put in this year, for example. By nature of what we have done, you know the answer to your question. If you have added $4 million more, then you know that we are going to have to adjust the base budget again next year because we did that to address the support staff issues.

We also put in $7.1 million to address the creation of new nursing positions, plus we put in up to $1.5 million for extra conversions. So that, in and of itself, would mean that the baseline budget for next year would be increased based on those alone, without even looking at the audited statements.

MR. SULLIVAN: Was there any planning when the figure was given to give the grants to those facilities that facilities would be operating with less acute care beds this year than last year? I know the shift has accommodated as much as possible day surgery, and to beef up community health, and trying to move people. I know there are less beds now, and we are hearing this regularly. I guess by this summer there will be a lot more. Not necessarily precipitated by your planning but by -

MS J.M. AYLWARD: Every year, we close the beds every summer.

MR. SULLIVAN: Yes. Normally it is late in June when you close beds.

MS J.M. AYLWARD: No, not necessarily. In some places it is much earlier because it depends on the number of people you have to get through your system. In a larger place, for example in St. John's, some of the hospitals have closed their floors - I know, I have worked there - much earlier to accommodate for vacations. Every single board in the Province have had bed closures every summer as long as I have known the system.

MR. SULLIVAN: I have gone back to some releases and looked at them. They say beds will be closed from this period in June to a date in September. That has been the tradition.

MS J.M. AYLWARD: Yes, some of them have, (inaudible).

MR. SULLIVAN: Some of them have. I checked some of these. The recent ones have come in April and May, which really spells problems and people still have not taken vacation. The question I ask -

MS J.M. AYLWARD: We are saying, and you have heard me say it publicly, that yes, if you are trying to make your priorities to give people vacation - which is what the priority is, if it is vacation period - there is only one way to do that, and that is the way we have always done it, and that is to close beds. Albeit, we will probably have to close some of them earlier this year because they have already done it. Yes, there is no doubt about it that you do close beds to grant vacations.

MR. SULLIVAN: Yes. The beds closed last year and when it came September or October there were twenty that did not re-open really. Technically, starting last September or October there were really twenty beds moved out of the system, and again since that.

My question was this. When the Estimates were prepared was there, in the allocations given to these, the understanding that there were going to be less beds budgeted for, therefore less staff and less appropriate things? Would that be one of the reasons the figure is less in Grants and Subsidies under Health Facilities Operations facilities this year? Is that one of the factors? I know there is -

MS J.M. AYLWARD: Definitely not.

MR. SULLIVAN: That wasn't.

MS J.M. AYLWARD: Not one of the figures, no. Because first of all you are making the assumption that the only place to spend money is on beds. The reality is that in this Province - I do not ever expect you to believe it - we still have one of the highest bed occupancy rates in the country. We have not met the national targets for reducing the number of beds and increasing the number of ambulatory care. We continue to increase the number of ambulatory care but we also have one of the highest rates of bed occupancies in the country. That has been brought to our attention by accreditation groups - not me, and not internal - from across the country when we are measured in terms of the service we give. We have had 100 per cent accreditation in this Province. One of the points that comes out time and time again is our high bed utilization.

So no, that was not one of the factors, and I do not think it was ever an intention, and will it be in the future, because you do not save money. You put money in other services and that is the whole idea and that is what we have been doing.

MR. SULLIVAN: As to bed utilization, we also have certainly the highest incidence rates in certain areas, in heart circulatory disease and so on.

MS J.M. AYLWARD: You are making an assumption again that you have to be in a bed to correct that. That is why in this Province, in this government, we focus very much on prevention. We know ourselves if you look at open heart surgery, statistics show that the mortality rates probably do not even change significantly after a year with or without open heart surgery. If you are trying to gather - for example what you are referring to, increased incidence of heart disease and stroke, you are better off to prevent those things than treat them after the fact. You have to have your beds for the surgery but you also have to have your programs all the way through. Any cardiologist will tell you that it is a combination of the prevention, early diagnosis and treatment.

MR. SULLIVAN: Plus I think another factor possibly is lately we have had a net out-migration of 43,000 of which most are younger people and less likely to depend on our system. Where we are getting an aging population, therefore maybe based on a Canadian average we may have more that would need some medical intervention, whether it be hospitalization or whatever. Our population is going to increase as it is not really the elderly people, the over sixty-five, who are moving out of this Province. It is generally the younger people. That alone, in a small population figure of only over 500,000 people, is going to really skew figures and make us look less attractive in our per bed utilization than in other parts of the country.

MS J.M. AYLWARD: Not necessarily. Because if you look at other types of treatments - for example, walk-in clinics, home support programs, community health centre models - you do not necessarily need to see people in acute care facilities. You are making an assumption that because you are older you are sicker, and that is not necessarily true. What you find is that it depends on the variety of services that you offer.

I mean, even look at the project up your way and the impact that has had in terms of hospitalization - and I'm sure you must be very proud of that - and the impact on prevention, because of the intervention of the nurses in a primary health care model. It has been proven, and it has been proven right across the world. You cannot make the assumption that because you have an older population you are automatically going to fill up the beds. What you will find is there will be an increased need for services but it will probably be a combination of home support, preventative and long-term care services. The issue of an aging population is one that is true for the whole country. We do not have the monopoly on that in Newfoundland.

MR. SULLIVAN: With reference to community health - I do not, Mr. Chairman, if I am going (inaudible) my time?

CHAIR: No, you can keep going. We usually let the members speak until they have nothing else to say or until the clock expires.

MR. SULLIVAN: I thank you for that.

CHAIR: Or until the clock expires, which is noon.

MR. SULLIVAN: I will not overdo it, I can assure you. I (inaudible) then. (Inaudible) comments (inaudible) specific ones.

With reference to shifting resources into the prevention aspect - I know 2.1.01, Administration and Consultative Services -

MS J.M. AYLWARD: I am sorry. What was that number again?

MR. SULLIVAN: 2.1.01. Under Administration and Consultative Services it does show a decrease there with some of the areas in consulting, promotion, disease control, epidemiology, et cetera. Is there a particular reason? It isn't that the emphasis is any less, really, on that aspect. Why might it be down that much, which is a very significant drop?

MS J.M. AYLWARD: Under which category are you referring?

MR. SULLIVAN: That is under .01, Salaries.

MS J.M. AYLWARD: Under Salaries. The estimate for 1999-2000 is down as much as it is because we do not have the twenty-seventh pay period. That is one reason. As well, we have re-deployed about $80,000 to meet critical staffing needs in accordance with our reorganization plan. The funding of a director of personal care homes and a Nurse II was discontinued in order to achieve savings, and that is the main reason.

MR. SULLIVAN: Which ones were discontinued again?

MS J.M. AYLWARD: The director of personal care homes and, as you know now, that comes under the auspices of Eleanor. It has really been reorganization. We have not lost the person who has been doing it. Also, there is a Nurse II, as well. The other reductions - I think that is it, yes.

MR. SULLIVAN: Yes, that would be generally it, because the pay period would be about $800,000 there, roughly. I am just wondering, does that have any impact on the monitoring aspect of personal care homes? Because even though we are the -

MS J.M. AYLWARD: That is not the monitoring piece, because the monitoring is done by the community health nurses when they are out and about.

MR. SULLIVAN: So, basically responsibility has probably come more with them so the need wasn't really there to have what we call a full-time director?

MS J.M. AYLWARD: Loyola, need? We would triple our staff if we could, in terms of need, in our department, but what we are saying is that when we were looking at achieving savings, we made a decision that we did not really remove any front line workers from the system and we merged the management under the existing manager.

MR. SULLIVAN: I do not disagree. I am pleased with the response.

MS J.M. AYLWARD: No, I am just saying. If you asked me if I have enough staff, I would say I would like to triple my staff. So put that on the record. Anyone here disagree with that?

WITNESS: No.

MR. SULLIVAN: Under 3.4.01.05, Emergency Health, page 203, Professional Services, I know it was anticipated last year that it would be $290,000. It was $100,000 less, and now it is $254,000. What would be, first of all, the $100,000 that was projected? What didn't materialize? Then, what would necessitate another $64,000 over what was spent?

MS J.M. AYLWARD: That included training for our ambulance attendants. We provided travel training to both the ambulance drivers and the attendants, and also disaster preparedness training. So that is what that accounted for under -

MR. SULLIVAN: Okay, but the $100,000? You mean the -

MS J.M. AYLWARD: Are you talking about Professional Services?

MR. SULLIVAN: Yes. It was budgeted at $290,000 last year and it was revised as $190,000, so actually you spent $100,000 less. Was there something that you had planned on doing, or did you identify a major expenditure that didn't occur -

MS J.M. AYLWARD: I presume.

MR. SULLIVAN: - and some of it is going to be done this year? See, it is back to $254,000.

MS J.M. AYLWARD: What we noted was that our savings were due to decreased training needs; because we have obviously, as you know, been increasing the level of attendants on the ambulances. Therefore, if they come with the training they do not require it. However, the increase is proposed to do some upgrading and retraining in the coming year.

MR. SULLIVAN: So I guess the people getting hired now are people who are probably trained on their own before they come now, a lot of these people, are they?

MS J.M. AYLWARD: Well, if you do the Emergency Medical Attendants course - and most of them do because, as you know, they get a higher rate of pay depending on the level of attendant they have in the ambulance. So if you have your sooner, we would sooner hire someone with more training because you can get more money through the mileage and grants program and that requires you, as an employer, to provide less training. However, as the department responsible for it, we are trying to keep the upgrading by providing these professional services.

MR. SULLIVAN: Okay.

With Road Ambulance, page 204, 3.4.02., Allowances and Assistance last year, it was only down slightly, I guess -

MS J.M. AYLWARD: I can see why you would be asking questions on that one because I asked a few on that one myself, the numbers.

MR. SULLIVAN: Yes. Why the difference there?

MS J.M. AYLWARD: You mean between the Allowances and Assistance and the Grants and Subsidies?

MR. SULLIVAN: Yes. What exactly are you putting under Allowances and Assistance? Does that come under the kilometrage?

MS J.M. AYLWARD: What we did was we transferred the Allowances and Assistance to the Grants and Subsidies. That is why you can see the decrease in the first line and the increase in the second line.

MR. SULLIVAN: So would the grant, whatever it is now -

MS J.M. AYLWARD: Well, it depends. The grant depends on if it is the first or the second or the third -

MR. SULLIVAN: Yes, or whether it is a full grant.

MS J.M. AYLWARD: If it is community versus volunteer.

MR. SULLIVAN: The direct grant out there now is under Grants and Subsidies; I would be correct in assuming that would I?

MS J.M. AYLWARD: Yes.

MR. SULLIVAN: And when you submit based on distance and kilometrage and that, would that be under Allowances and Assistance?

MS J.M. AYLWARD: Yes, that is my understanding.

MR. SULLIVAN: That is basically what is in that category?

MS J.M. AYLWARD: That is right.

MR. SULLIVAN: Okay, I just wanted clarification of what is what.

Under 4.3.01., Furnishings and Equipment: Appropriations provide for the purchase of furnishings and equipment for health care facilities...

MS J.M. AYLWARD: Hang on for a second would you, Loyola, so I can get this right.

MR. SULLIVAN: Yes, page 206, 4.3.01.

Last year there was a projection of a budget of $4.5 million and an expenditure of $25.5 million. What specifically did the other $20 million...?

MS J.M. AYLWARD: Well, you have probably heard most of those announcements but I can go through them again.

MR. SULLIVAN: Yes, I am just wondering where they are.

MS J.M. AYLWARD: Medical equipment was $9.5 million. We have announced the Medi-tech Information System. This is bringing in the financial management for Western Labrador and Peninsulas. The Health Care Corporation has $5 million. Again, that is equipment that they are requiring. The other $5 million is the Y2K money that may or may not be used, depending on what is out there in the system designated as essential. So that money is under the Newfoundland and Labrador Health Care Association.

MR. SULLIVAN: That is basically money now that -

MS J.M. AYLWARD: It is one-time money.

MR. SULLIVAN: - because of the extra money that was there last year, it is -

MS J.M. AYLWARD: No, the $4.5 million is what is there on a regular basis.

MR. SULLIVAN: Yes. I was not going to say that. What I was saying is that last year, because there were extra dollars available, they allocated these in the 1998-1999 budget, really. Even though they may not be expended, they have been applied to that and that is money they would have at their disposal as it filters through. Would that be -

MS J.M. AYLWARD: Some of it was expended.

MR. SULLIVAN: Because sometimes you do your accruals and everything at year end. It is allocated in last year's budget. Is it prepaid? Probably in some cases, I would assume.

MS J.M. AYLWARD: In come cases it is prepaid and in some cases it is - obviously the Y2K is in anticipation of, because we need it this year. We know we are going to spend it, and some of it we will be spending along as we go. Some boards are further ahead in identifying what their Y2K needs are.

MR. SULLIVAN: Okay, so there is some already expended up to March 31, 1999, and the rest of it was really allocated the 1998-1999 year and it is a prepaid expense on 1999-2000.

MS J.M. AYLWARD: No, actually some of it the boards had already gone out and made the arrangements for, so that would have just been paying them what they had spent.

MR. SULLIVAN: What did you say the Medi-tech cost? Was that -

MS J.M. AYLWARD: Six million.

MR. SULLIVAN: Six million, okay.

MS J.M. AYLWARD: That would bring them in line with all the other boards.

MR. SULLIVAN: Okay, that is it for now.

CHAIR: Thank you, Loyola.

Ms. Jones, and then back to Tom.

MS JONES: I have no questions.

CHAIR: No questions?

MR. HEDDERSON: Minister, they stole all my questions on me. I don't know what to do.

Minister, I am just looking at some of the issues in education regarding health. One of them is the smoking, the list of drugs and that sort of thing. I understand you have a program already announced for smoking. Is that from health or from education?

MS J.M. AYLWARD: That is from all of us. There is health, education, justice, cancer society, Newfoundland lung, Newfoundland heart; it is a whole community initiative. It is not my initiative. I am just one of the partners involved. We have not announced it yet.

What we have announced as a government is the money, the $900,000 over three years to do an education program. What we have announced as the first piece of that is the new tobacco control strategy whereby we would issue licences to anyone who sells cigarettes, and if they sell to a minor they will be fined and eventually lose their licence to sell cigarettes.

MR. HEDDERSON: Is it going to be extended to - I know addiction is a problem with the alcohol and the illicit drugs, but also the prescription drugs now seem to be appearing on our playgrounds, so to speak. Are there initiatives going to be taken in that direction, would you think? Again, has anything come across your -

MS J.M. AYLWARD: There is another approach, and there are two pieces to this. Under the addictions piece - one of our main concerns under addiction is smoking because, as you know, that is more addictive than heroin so that is one of our main priorities. In terms of other drugs like Ritalin, Valium, and other drugs that they are selling in the school yards, we are working closely with the RNC, with my department, the Department of Justice, and with the Department of Education. One of the main pieces around that is the whole prescribing piece with physicians.

MR. HEDDERSON: Yes.

MS J.M. AYLWARD: They are also an active partner in this as well. That is why we have been working with all of the partners to try to come up with a way to deal with a confidentiality piece. That is a bigger issue here, trying to identify.

For example, if you know a physician has been over-prescribing, what happens? Who do you report it to? How do you access that information? How do you report it to the medical board? They need to have (inaudible) to act upon it. So we are trying to work through that process as sort of a side piece to this. It is an issue, one that we are concerned about. These kids have to get prescription drugs from a physician.

MR. HEDDERSON: Exactly.

MS J.M. AYLWARD: You cannot get them without a prescription, so the bigger issue is trying to get to some of the roots associated with some of the problems. We have been working with the medical association - well, not the medical association as much as the medical board, on this.

MR. HEDDERSON: Two conditions again regarding education with the dyslexia and autism. I was out on the West Coast last week and one of the paediatricians out there indicated that there is nowhere in Newfoundland really where you can get that diagnosed. Is that correct or is this a West Coast thing? He had talked about referring a couple of his people to Nova Scotia. I was just curious. He also referenced that there had been a diagnostic centre at the Janeway closed down in 1991 or something.

MS J.M. AYLWARD: We are certainly not as far along in some of our children's programs as some of the other provinces, and a lot of that is around resources. We have just identified a pilot project to look at doing some of those things around autism and early diagnosis, and around some of the treatment programs. Most of the work for autism, in terms of early diagnosis, is being done out of Montreal and in the U.S. That is where they are sort of leading the way.

We have been working very closely with a number of the other provinces and we have put together a pilot project based on two models that we will be testing. One is an APA model and another is a physician resource model out of Montreal. We have the parents involved, and the participants, so hopefully that will help us sort of get the process under way.

In addition to the child one there is also the youth autism and there is the adult autism, so we have been heavily lobbied on all three pieces of that. We are trying to work, first of all, with the younger ones based on our principle of prevention and early intervention. The earlier you diagnose a child the more success they will have. We are aware of some of our shortcomings in terms of early diagnoses with autism.

Dyslexia is another area that is being handled, perhaps more effectively, by some of our reading specialists in the Province through your system or through the education (inaudible). With some of our reading specialists we have seen some very good progress in terms of moving even up to three reading grades, once they are diagnosed and given the proper reading advice. We are seeing some minor improvements there but, again, almost every child in the school was having difficulties. Unfortunately, when the process is happening they are ADDH or dyslexia. That is another issue to deal with.

MR. HEDDERSON: Again with the schools, the air quality seems to be again another issue. What part is your department playing in the air quality in schools?

MS J.M. AYLWARD: When we are notified of air quality we work under our Departments of Environment and Labour and Health, most (inaudible) community health boards, and they work with the various agencies to ensure that the testing is done in terms of the fungus growth and any other bacterial sources that may cause a health problem. Once they are identified as having an air quality control, they are brought in to do the environmental assessment piece of it.

MR. HEDDERSON: The last one deals with the private ambulances. (Inaudible) one of the people in my district had gone in and upgraded (inaudible) course - Paramedic II or whatever - but the concern he had was that he had the training but he did not have the equipment. He is a private operator. Is there any consideration given to assisting the private operators to upgrade not only their qualifications, but of course the machines that would go along with it, or the equipment?

MS J.M. AYLWARD: That is the whole idea of the Grants and Subsidies. They are given an amount of money and I guess they choose if they are going to put it on a vehicle or buy some new equipment. Last year we put $566,000 back into the system. Or not back, but reallocated an increase in the overall base budget. Some of that went for grants and some of it went to allowances and subsidies.

MR. HEDDERSON: So he could apply for that sort of a -

MS J.M. AYLWARD: I am sure if he is in the business he knows exactly what he is able to get because it is a very small operation in the Province. They are aware. They would have been represented at the table. Because we had community ambulance operators, we had the private and we had the medium, the three groups. It took a while to get all the three groups of ambulance operators to meet together in the same room, but once we got that working we were able to move on to the other pieces of it. I think, Donna, you have been working specifically with the ambulances. Their issue is $566,000.

MS BREWER: Yes, $566,000 was the actual increase to the grant but that is a fixed amount. What they do with it, as the minister indicated, is their choice.

MR. HEDDERSON: Thank you, Madam Minister.

CHAIR: Thank you, Mr. Hedderson. Ms Hodder.

MS M. HODDER: I do not have a question for the minister but I am glad to see her staff here this morning so that I have an opportunity to thank them for the cooperation, the efficiency and timely fashion they have dealt with many issues and concerns that I have come to them with, the little ones and the major ones. We have Debbie initiated right from the very beginning. Thanks Debbie, for all of your cooperation and help last week.

I also want to have a positive word for the minister. It is something I can say in all certainty, that we have one of the finest, most responsible, most knowledgeable ministers of health -

MS J.M. AYLWARD: Take notes now, Loyola.

MR. SULLIVAN: I am taking notes. I am writing extra fast.

MS J.M. AYLWARD: Get it all down.

MR. SULLIVAN: Could you just slow down a little bit, Mary?

MS M. HODDER: - that we have ever had here in this Province, and I think we will have for some time to come. This is not just my own opinion, Loyola. That has been expressed to me by members on your side but I am sure I would not expect them to come out and say that.

I just want to thank you, Minister. I hope you are feeling better today.

MS J.M. AYLWARD: Thank you very much.

MR. T. OSBORNE: That was discussed in great detail at caucus.

MR. SULLIVAN: We just have a job to do, that is all. It is just a job. If we didn't do it we would be delinquent in our responsibility.

MS J.M. AYLWARD: I would like to say, if I could, that I would like to take this opportunity too, for the record, to thank my staff. Mary, I appreciate your comments as well, and the comments of other people here. I do believe they work the hardest of all the staff. I know I am biased because I said that in my last department too, but I do believe they work so hard, and I really want to thank you all very much for all the time you have put in. It is very much appreciated and there seems to be no end to it, and there will not be I am sure.

Anyway, thank you all very much, we really appreciate your work.

CHAIR: Any further questions?

MR. SULLIVAN: Just one final one. Could I have a copy of the Atkinson report?

WITNESS: For the record.

MR. SULLIVAN: For the record, no response, Mr. Chairman.

MS J.M. AYLWARD: For the record, Mr. Chairman, it still hasn't gone through the Cabinet process yet. I think I have made it quite clear I have not said I would not release it, it is not up to me, but if it goes through the process I look forward to doing that.

MR. SULLIVAN: Good, thank you.

CHAIR: There being no further questions I would ask the Clerk to call the heads.

On motion, subheads 1.1.01 through 4.3.03, carried.

On motion, Department of Health and Community Services, total heads, carried.

CHAIR: Thank you kindly.

Unless there are some concluding remarks from any members of the Committee, the minister, or her staff, I would ask for a motion to adjourn.

This being the last meeting for this year of this Social Services Committee, we will not be reconvening until next year.

The Committee adjourned.