Pursuant to Standing Order 68, Wally Andersen, MHA for Torngat Mountains, substitutes for Roland Butler, MHA for Port de Grave.

The Committee met at 7:00 p.m. in the House of Assembly.

MADAM CHAIR (Ms Jones): Order, please!

I would like to bring the meeting to order. I want to welcome everybody this evening, the committee members, the minister and his officials from the Department of Health. I ask the committee first of all to move the minutes of the last Social Services Committee.

On motion, minutes adopted as circulated.

MADAM CHAIR: I will start off this evening by asking the committee members to introduce themselves by name and district and then we will ask the minister to introduce his officials.

The hon. the Member for Burin-Placentia West.

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

MR. ANDERSEN: Wally Andersen, MHA, Torngat Mountains.

MR. MERCER: Bob Mercer, MHA, Humber East.

MR. MANNING: Fabian Manning, MHA, Placentia & St. Mary's.

MS S. OSBORNE: Sheila Osborne, MHA, St. John's West.

MR. ROSS WISEMAN: Ross Wiseman, MHA, Trinity North.

MR. SMITH: Gerald Smith, Minister of Health and Community Services; Robert Thompson, Deputy Minister; Donna Brewer, ADM for Finance; Jim Strong, Director of Financial Services. We have a couple of new faces. Moira Hennessey was with us the last time. Loretta Chard was fortunate to be on holidays, I think, the last time we were here. We captured her this evening. We have Lynn Vivian-Book, Gerald White and Dr. Ed Hunt.

MADAM CHAIR: Thank you, Minister.

My name is Yvonne Jones and I am the Member for Cartwright-L'Anse au Clair. This is the second meeting of the Estimates Committee for the Department of Health and Community Services. We were not able to clue up in the last session, so we will continue this evening from where we left off.

Normally, committee members will speak in twenty minute intervals or ask questions in twenty minute intervals. We will go around and if you do not finish in your twenty minutes you will have an opportunity to have another twenty minutes, of course, until we conclude the business of the health estimates.

I will start tonight with the Vice-Chair, the Member for Placentia & St. Mary's.

MR. MANNING: I am going to defer to the Member for Trinity North.

MADAM CHAIR: The hon. the Member for Trinity North.

MR. ROSS WISEMAN: Thank you, Madam Chair.

I welcome all the minister's staff back again. We will get this concluded this evening for sure.

The last time we left off we were talking, or at least I was talking a little bit about health boards' budgets. That is where, I think, we concluded that day. I thank the minister for having tabled the budget letters that went out to health boards last week. If I could, Minister, could we start by going back to the health boards' budgets again? I think this is where I left off with some questioning the last time, and just to help me in terms of fraying the discussion, because I would like to use the budget letters, and more particularly the schedules that you distributed last week, as a point of reference for some discussion. I appreciate and understand the boards have not concluded their year-end yet and that the figures you may give me in response to the question are based on, what you know to be, the last monthly report you got from boards and what you got from boards in terms of their estimates, but could you walk through the fourteen boards with me and give me a sense of what they estimate to be their accumulated operating deficits as of the end of March?

MR. SMITH: Either Donna or Jim has that information there.

MS BREWER: The Health Care Corporation of St. John's is projecting a balanced budget position for the fiscal year 2001-2002.

MR. ROSS WISEMAN: They would have had an accumulated deficit -

MS BREWER: An accumulated deficit of around $21 million.

MR. ROSS WISEMAN: Twenty-one, the balance for the year.

MS BREWER: Yes.

MR. ROSS WISEMAN: Thank you.

MS BREWER: Mr. Wiseman, I believe we are circulating some information and this particular table is in that information.

MR. ROSS WISEMAN: Okay.

MR. SMITH: This is the information that was requested at our last session. We just had the one copy so we are getting it copied so we can distribute it to everyone.

MR. ROSS WISEMAN: That is excellent.

MS BREWER: You asked the same question at the last session, Ross, and you asked that it be tabled.

MR. ROSS WISEMAN: This was the accumulated deficit here. The other projected -

MS BREWER: And the latest projections.

MR. ROSS WISEMAN: Okay, that is excellent.

The Minister is fairly prompt with his tabling of budget letters.

MR. SMITH: They are better than I am (inaudible) came over this evening with them.

MR. ROSS WISEMAN: I thank them for that.

If I could just get back to some discussion we were having about these deficits and forecasts for next year, particularly. In the budget letters that went out, or the schedules that went out to most boards, there was a - I have not looked at them all in any length of detail to be frank with you, but I had a quick glance at some of them. I notice the layout talks about last year's budgets and then some adjustments, but on the bottom it talks about these budget adjustments for 2002-2003.

The annualization, that extra $5 million that you put into health care this year, do you have a breakdown of how you distributed that over the fourteen boards?

MR. SMITH: Not today.

MS BREWER: I can get that for you. I have some rough notes. I can get it summarized for you or I can read out each one. It is up to yourself. Which would you prefer? Would you want us to read out each one or would you -

MR. ROSS WISEMAN: It is only $5 million. Is it distributed equally among all fourteen boards?

MS BREWER: No, the methodology we used is - there were three boards which had indicated utilization increases on renal dialysis and the Cancer Foundation had indicated a significant projected increase on the chemotherapy drugs.

The Health Care Corporation, in total, was provided a million dollars. That left a balance of around $2.289 million and we allocated that among the remaining boards based on their percentage share of drugs, med surg. supplies, laboratory supplies, diagnostic imaging supplies. That was just a straight mathematical calculation, but as I say, once I get back in the office I can do you up a schedule if you like, then you will be able to see those calculations.

MR. ROSS WISEMAN: I appreciate that.

This might sound like a selfish question because it happens to be relative to the board that provides services in my district of Trinity North, but I am looking particularly at the one that went to out to PHCC, and I am looking at their schedule. You can correct if I am wrong, but it appears that it is the only board that has an adjustment for a reversal of the stabilization funding that was provided. On the bottom of the schedule it says: an adjustment to stabilization funding. There is $550,000 peeled back from that board's budget but I did not see that same kind of calculation in the other boards. Could you give me an explanation for that?

MS BREWER: When we allocated the $50 million, roughly around this time last year, we did so on the basis of what the boards had indicated their projected deficits were. When we finally received the peninsula's financial statements - I think it was some time in September or October - their deficit projection had come in a lot less than what they had indicated back in February, in the previous. So, based on the information we had, we really gave them too much of the $50 million. Basically, what we said to them is - they are projecting to incur a surplus this year of around $1.1 million - we will cover half of that and leave you with the remaining. On top of that we gave them an inflationary adjustment, I think, of around $290,000.

MR. ROSS WISEMAN: So the 550 being peeled back in this fiscal year has to do with the funding that was provided in the last fiscal year?

MS BREWER: Right, yes.

MR. ROSS WISEMAN: Which left them in a situation - as of the end of the year, they were going to have a balance - they are looking at here of having a surplus of $1 million.

MS BREWER: It is a surplus. It is a bracket number. It is a surplus number, yes.

MR. ROSS WISEMAN: So they are projecting a surplus, as of March 31, of a million dollars?

MS BREWER: Yes. Actually, I think, roughly it could come in as high as $1.1 million.

MR. ROSS WISEMAN: Why would they - I know it is probably an operational decision but I am not sure if you have had some discussion with the board. I understand that they made some adjustments last year, and I think particularly of Cross Memorial in Clarenville where they closed some beds last year as a result of a budgetary initiative in the summer and they kept them closed for the balance of the year as a part of their financial restraint process. Why would they have done that, yet end up with a million dollar surplus at the end of the year?

MS CHARD: Last year they would close six beds in Clarenville and Burin and it was primarily due, Mr. Wiseman, to nursing staffing issues at the time in being able to fill these nursing positions.

MR. ROSS WISEMAN: So you have beds closed in Burin and Clarenville and it was more to do with the availability of nurses then it was budget?

MS CHARD: Yes, primarily.

MR. ROSS WISEMAN: So they had not made any adjustments. The reason I am asking the question is I have had, over the course of the year, several discussions with some members of the administration on sometimes very specific kinds of issues and in the course of the conversation was broadened to more general discussion about where they were. I understood last year that they were, throughout most of the year, operating with a very tight budget. They had made some conscious decisions about not filling certain positions because they just did not have the resources to be able to do it. I am kind of puzzled now because if I look at this figure here, there appears to be somewhat of a contradiction. They are going to have a million dollar deficit, whereas last year they were operating under somewhat - they were defining as being restraint because of some budget problems they were having. Now, to have a surplus, that is somewhat of an ironic situation that they find themselves in.

MS BREWER: Their budget is in the range of $50 million; so a million dollars, you are talking a 2 per cent variance.

MR. ROSS WISEMAN: They are fortunate, I suppose, in that they are the only ones - by the look of this - that will end up with a surplus. Based on your projections on this grid, they are the only board that will have a surplus in this past year. Others have had small deficits or balanced budgets. A million dollars is a fair chunk. I appreciate the rationale for peeling back the 5.5, but you have now peaked my curiosity around the operational decisions that the board has obviously made if they have curtailed some services on the basis of what they are assuming to be an operating deficit and will have a significant - either something is wrong in their forecast or something is wrong in how they get management reports out on a timely basis so they would know where they are themselves.

MR. THOMPSON: One thing Donna said earlier was that it was clear, partway through the year, that for the previous year there was an incorrect estimate of what the deficit was in the prior year, in a sense, therefore an overpayment of what their grant would have been in the last fiscal year. But, it was not necessarily clear. That does not necessarily mean they knew right from the start of the last fiscal year that they were going to run a $1.1 million surplus. They were engaged in restraint or careful management measures right from the start. It would not have been until some point later on in the year that it would have become clear the full amount of the overestimated payment would carry right through to the end of the year. On a detailed level, it is something we would have to followup more with the CEO to get a detailed explanation, but it is clear to us that it was not until later on in the year that the picture emerged clearly that the forecast surplus would be as large as it was.

MR. ROSS WISEMAN: I recall when the minister, in a press release in September, was talking about the forecast deficits of institutional health boards, and I think the figure at the time was around $18 million. Within that grouping, PACC was there then as projecting a deficit, if I am not mistaken.

WITNESS: I cannot recall the exact -

MR. ROSS WISEMAN: They were forecasting a balance as of that time?

WITNESS: (Inaudible).

MR. ROSS WISEMAN: Okay.

The other issue - I think I asked this question the other day and it was in isolation of knowing what these figures were, but I think my question, Deputy, in responding to it you provided me with an answer and we talked a little bit about it because I think my question was very much, if I recall it, based on the budgets, the actual operating.... These letters show me the original approved last year rather than the actual expenditures not on this schedule. I think I asked the question based on the money that you are giving boards this year, because it would appear there are in and out adjustments here. It appears that most boards are getting roughly the same as they got last year in terms of service provision, because the adjustment upward deals with mostly negotiated salary increases, reclassifications and the like. In terms of real dollars going into new programs, there is not much increase in any of these board budgets over and above what they had last year.

I guess my question the other day was - not having seen this, of course - based on the level of services that each board provided during last year, did you foresee each board being able to maintain the exact same level of services in this coming year as was provided last year?

MR. SMITH: It is certainly the expectation to the boards, and the direction in the covering letter, asking to do precisely that; because our expectation is that they will still continue to seek to find efficiencies within their budget to maintain their present programming levels.

MR. ROSS WISEMAN: The letters that I raise some questions around are the ones going out to the community health boards. Again, because I have some knowledge of it, I suppose, in terms of the boards that operate within my district, the Health and Community Services Eastern, as I look at their schedule - and only because I have, in the last four or five months particularly, phoned a number of times representing constituents trying to access home care services - I have some sense of the pressures and the bonanza they have had. The answer I keep getting is that it is a budgetary consideration. They acknowledge that the evaluation has been done and they recognize that the person needs a particular level of service but the funding is not there to do it.

As I understand it from last year, just to confirm, your figures here show that Health and Community Services Eastern was going to have about a $1.7 million deficit on last year's operation. They have a $1.7 million deficit from last year and the level of funding that I am looking at here on the schedule, other than the adjustments, is relatively the same amount. It seems to reason that if you said to someone you have the exact same amount that you had last year, and last year you had a $1.7 million deficit but do not do that this year, then it would seem reasonable that the level of service they project to provide this year will not be the same as it was last year, if you take that kind of logic and run through with it. If they continue on the same track and provide the same level of service that they provided last year, with the same purchasing power, they will have a $1.7 million deficit again this year.

I will get back to the question I posed a moment ago. The level of services the boards provided last year - because this kind of scenario and this kind of example of Eastern Community Health would seem to contradict the statement that you just made in terms of the expectations that they will, because obviously Eastern Community Health is not going to be able to provide the same level of service this year as they did last year, if they have to balance their budget.

MR. SMITH: Certainly the community health boards are viewed differently from the institutional boards. With the community health boards, the figures you have there and the budgets that have gone out to them, there are two amounts of money that are not reflected in that. There is one amount for the Brighter Futures program, which is a little over $4 million, and there is also the stabilization fund of some $6 million. You are probably aware that we do have a review under way right now with the operations of the community health boards, the Goss Gilroy report which we are waiting on. We have asked them to have a look at their operations and give us some direction. Once these other amounts are factored in, I don't think you will see the same discrepancy that you are referencing there now.

MR. ROSS WISEMAN: This Brighter Futures fund, did you say it is $4 million?

MR. SMITH: It is a little over $4 million. I think it is $4.1 million or $4.2 million.

WITNESS: It is $4.2 million.

MR. SMITH: It is $4.2 million.

MR. ROSS WISEMAN: Can you tell us what that is?

MS BREWER: Right Futures.

MR. SMITH: It is Right Futures, I am sorry. I am thinking about the earlier end of it.

My understanding of that program is, this is a program that is geared towards individuals who were at one time housed in institutions - the Waterford - and these are individual programs, so we are still awaiting the information from the individual boards as it relates to the individuals so hen we can then disburse the funds.

MR. ROSS WISEMAN: So they were originally receiving services within the Health Care Corporation's budget, I guess?

MR. SMITH: An institutional setting (inaudible).

MR. ROSS WISEMAN: That is a transference of money from the institutional budget, is it?

MR. SMITH: No.

MR. ROSS WISEMAN: Or is that new money?

MS BREWER: Many fiscal years ago there was a transfer.

MR. ROSS WISEMAN: So that $4.2 million has been sitting in the Health Care Corporation's budget, because they had been providing the service up to this point?

MS BREWER: No. What happens is that it is allocated to the boards depending on where the clients are. The clients might move, some clients die; there might be another placement. So basically when we get the caseload information, which we expect to get within the next month, we will then turn around and allocate that money to the boards. As far as the boards are concerned, when they do their budget planning, it is what we call fully funded; it does not impact their bottom line. Whatever expenditures they incur, there is a revenue source to cover it.

MR. ROSS WISEMAN: Minister, the other day I called your office, your communication person, to see if I could get a copy of the terms of reference for the Goss Gilroy report because I wanted to get some sense of what that report was intended to focus on. Is it a financial review? Is it a program review? What exactly is that review to do?

MR. SMITH: Maybe I will ask Donna to answer that.

MS VIVIAN-BOOK: The Goss Gilroy report, which is due very soon to be finalized, was to focus on areas where the biggest cost pressures were within the Health and Community Services Boards, primary focusing on home support, family rehabilitative services, and child, youth and family services, and to look at those first of all from a financial lens of putting together a picture over the last five years of having moved from the Department of Human Resources and Employment, the former Social Services, into Health and Community Services, to get a five-year profile on those program areas and the cost pressures within those areas, and then to look more closely at those areas from a programming perspective, and then to come up with recommendations in terms of how to manage some of those cost pressures and where to go forward from here. We can provide you with a copy of the terms of reference.

MR. ROSS WISEMAN: Can we talk a little bit about those home care services for awhile? I said a moment ago that I found myself recently, particularly in the last five months, I guess, having frequent conversations with the Eastern Community Health Board around home care. I appreciate and understand and, Minister, you have made several comments in the past about the pressures in that area. No doubt, that is not going to change. All you need to do is look at the demographic projections for the Province and the shifts that are going to occur, and that is going to be a continued pressure for you.

In terms of the immediate, because I suspect that the money that you just talked about - the $6 million of stabilization funding that has not yet been allocated - and if we look at the accumulated deficits of the community health boards here, that is roughly what it equates to. So, you could take your $6 million and you could provide it and you would then fund last year's level, but you would not be funding this year's level. I say that because I am making an assumption, and I do not think it is a quantum leap to jump from last year to this year. I think we are going to see continued pressures in that area of home care. So, if your stabilization fund of $6 million will only fund the deficits from last year, then there is no latitude there at all for any increased demand for that service. I know that probably your answer is going to be, wait until the report comes out, but the real issue, the real question with home care, and I won't share some of the examples tonight of the situations that I have had to call on behalf of. I think every MHA in this House has had some or one or two situations where people find themselves in desperate shape and desperate conditions and not able to get home care until someone else falls off the list or some client either is hospitalized or put in a long-term care facility, or should die, and it then frees up the money. It has been my experience in the last five or six months, that is pretty much the case in the Eastern region; and, from what I have heard from colleagues, it is pretty much the case around the Province.

Having said that, Minister, the forecast here of the $6 million stabilization, are you realistically thinking that will satisfy that demand for next year, or will we continue to have this cry from constituents that we now have?

MR. SMITH: I think it is safe to say, as I have stated repeatedly, that this is one of the areas where it is causing us a great deal of difficulty trying to - to me, it is an area where there is a growing demand and, as you pointed out accurately, it is difficult to see it as an area where there is going to be any decline because, just by the demographics in terms of - I suppose we are hoping that the review that is ongoing will shed some light as to looking at some long-term planning in this area as to where we need to be looking.

At the present time, certainly we would hope that the monies that are there will satisfy the demand and I guess we have to try to - it is a cost driver that we are trying to manage. At the present time, the level is at some $60 million. It is a big ticket item in our budgetary process.

To your question as to whether or not it will satisfy the needs that are there, we are hoping that it will, but if you were to ask me to say with absolute certainty that we are going to be able to meet all of the demands, I would not be able to give you that guarantee now.

MR. ROSS WISEMAN: You just used a figure of $60 million. Is that what we spend on home care services across each of the boards, $60 million?

MR. SMITH: What is the total? Donna, do you want to speak to us on that?

MS BREWER: Yes, it is approximately in the vicinity of $60 million but that is not just for seniors; it is also for the physically disabled and mentally challenged clients as well. Also, there is some home support in the child welfare program, primarily in the respite type services. All of those together is roughly around a $60 million program.

MR. ROSS WISEMAN: Sixty million for the Province, that is what I understood.

MS BREWER: Yes.

MR. ROSS WISEMAN: Madam Chair, I am just glancing at the clock. Before I get into another line of questioning, I don't want to be encroaching beyond my twenty minutes.

MADAM CHAIR: The hon. the Member for Humber East.

MR. MERCER: (Inaudible).

MADAM CHAIR: At the present time, the Member for Trinity North may continue with his questions.

MS S. OSBORNE: (Inaudible).

MR. ROSS WISEMAN: If you want to ask some questions, go ahead.

MADAM CHAIR: The hon. the Member for St. John's West.

MS S. OSBORNE: The Perlin Training Centre, and other folks who are put out in (inaudible), when they come out of Perlin - this is my understanding - and they go to the employment programs that are there for them, is it my understanding that they are just employed for a very short period of time and then they are off the employment and on to EI? Does anybody have any statistics on that?

MR THOMPSON: It appears we do not have an answer to that question. I wonder, in fact, is it more a question for Human Resources and Employment than this department, given they run the labour market programs for the disabled?

MS S. OSBORNE: Oh, do they?

MR THOMPSON: Yes.

MS S. OSBORNE: Okay. I was not sure because I know that they fall under community services for some of the services that (inaudible) but then -

MR. SMITH: I am not sure, Sheila, what you were looking at but I know that you are probably aware, that particular - and I can speak to the deputy because that was in Human Resources.

The particular programs offered by them were under review. As a matter of fact, there was some concern because the federal government is now of the opinion, with these programs, that they want them community based and not in kind of a closed shop type arrangement. That is kind of the model that they are pursuing. My recollection of that particular area was that - as a matter of fact, they did have a consultant looking at that to try and make a determination because the federal government were putting certain conditions on the funding they were providing and saying that they wanted to get away from this closed shop type arrangement. These people were integrated into the broader community which is the general approach that is being used with programs dealing with people with disabilities.

MS S. OSBORNE: I am aware that. I am not in favour of it, having dealt extensively with the Perlin Training Centre, but I have been away from that for a few years now. I just wondered when people come from Perlin and go into employment, and I fully agree with that, but I have heard some people who are involved there say the employment is for such a short period of time. They are taken out and put in jobs for a short period of time. When they are EI eligible then their job is not there anymore. They are on EI and they are sort of not doing anything. They are home for a good part of the day, probably with some respite and things but their lives are not as fulfilled, even as they were at the Perlin before they went out.

MR. SMITH: That was not my understanding of the intent of the program.

MS S. OSBORNE: No.

MR. SMITH: Again, as to the specifics, I really could not answer. That would be -

MS S. OSBORNE: I heard a couple of people who were involved at the Perlin say that this is the way it was going, and they are concerned. I guess they are concerned the Perlin will close and that this is what will happen.

The other thing that I say, and I have said it at all of the estimate meetings and publicly as well, we give a lot of people choices. People who came from the Waterford into the Right Futures projects were given choices, whether they wanted to go into alternate care or go into an apartment or whatever. I agree with that, we give people choices. Even if the Goss Gilroy Report comes out and says that the place should close or even if the federal government says they are going towards integrating people into the community, but the people want to stay there, then why don't they have choices?

MR. SMITH: Again, I guess it is a good question in terms - and I do not know what the final outcome will be with regard - because, as you know, that program has a long history and certainly was a real pioneer in terms of providing those kinds of support to people with disabilities.

The concerns that have been expressed are based on current thinking. Certainly, the literature today supports the idea of providing for these people in an integrated type system to make them part of the community, not have them exist in isolation. So, my understanding was - I do not think the intent was that the Perlin would disappear. I think everyone kind of recognized - but what they wanted was to have their programing more inline with what is now recognized as the national norm. Of course, keeping in mind that there is federal funding involved there and the fact that - you know, I guess whoever pays the piper sort of thing.

MS S. OSBORNE: Calls the tune.

MR. SMITH: Yes. What they are saying is that they would like to see some of these changes, but they have not just gone in there and made those kinds of decisions. They have provided for that kind of transition. They do have someone working with them. I think the understanding is to try and bring the programs more inline with them.

MS S. OSBORNE: I understand from some people who were involved with the Pre-Voc on Topsail Road that some of the clients, their programs and their plans, are working out for them; but some of them are not. They are sort of spending empty days with a respite worker alone. I mean, there is not a whole lot that you can do. You can bring them to the mall. Some of them are not really able to go to a movie. It does not do anything for them. Some can go swimming and some cannot. It is my understanding, from talking to families of people who were in the Pre-Voc on Topsail Road, that their lives are not nearly as fulfilled now as they were when the Pre-Voc was open. So, I am still an advocate of giving them choices. I know you have to look at it as federal funding and things, but when I talk to people and they say - well yes, they do go out and work, and they are delighted to go out and go to work but it just lasts for a short period of time and then they are into EI. Basically, they are at home with no stimulation at all.

I want to thank you for providing me with the out-of-province hospital billings. I do not know if it is possible to determine how many patients have to travel outside the Province for services that cannot be provided here. I did not get a chance to look right through this. Is that provided in the information that you gave me?

MS BREWER: You will get it from high cost items. There is an amount of around $5 million, almost $6 million, that is in another category and the problem being is that there are certain, what they call, standard in-patient rates. We just know that a person, for example, is in Princess Margaret Hospital as an in-patient, but unless they were having a high cost procedure we would not necessarily know exactly.

MS S. OSBORNE: Okay.

MS BREWER: My understanding from my officials is that it would require a lot of further analysis, but the majority - you would be able to see, for example, the cardiac surgeries, the heart transplants and the liver transplants. Those high ticket items are definitely isolated for you.

MS S. OSBORNE: Do we have access to how many people would be waiting now in the Province for bypass surgery, for instance, or any other surgery?

MS CHARD: We have approximately 300.

MS S. OSBORNE: Is there any record of how long they have been waiting on the list?

MS CHARD: Yes we do, and we can provide you with that information. That is no problem.

MS S. OSBORNE: Yes, okay. It is just something that I am wondering about.

Lots of times I get calls from people who have had a heart attack and are admitted to the hospital. Sometimes they have been there for thirty days, give or take, waiting for angiograms. This diagnostic service is not available for them. Do we have any record of how many people would be in hospital waiting for angiograms, and how long they are there? What brought that to my attention actually, was a friend of mine was there for thirty days.

MS CHARD: That information is available. I do not have it right with me now but I can certainly add that to the information. No problem, we do regular checks on that so it is not a problem.

MS S. OSBORNE: The Goss Gilroy Report is looking into Child, Youth and Family Services. Do you know what the terms of reference for Child, Youth and Family Services are?

MS VIVIAN-BOOK: The terms of reference for Child, Youth and Family Services are the same as for the other programs. They are looking at it from a financial perspective over the past five years and then looking at it from the programming perspective. So there are no different terms of reference for one piece over the other.

MS S. OSBORNE: I was under the impression, and I do not know the exact details of it, but when a youth turns sixteen - say for instance they went to a social worker and said: I am not happy at home, and it was determined that they are not happy at home, then they are putting choices for youth. Is that right? I do not know this -

MS VIVIAN-BOOK: After the age of sixteen, sixteen and seventeen-year-olds, up to the age of eighteen, can enter into a voluntary agreement. That could be in a foster home, it could be with Choices for Youth, it could be a number of options, but it is a voluntary care agreement with youth. We have over 200 youth who are currently in voluntary care agreements.

MS S. OSBORNE: The reason I asked that, I saw an article in The Telegram this week that Newfoundland did not do it, and I thought they were doing it. That is why I asked it. So that is misinformation that was in The Telegram article, was it?

MS VIVIAN-BOOK: Actually, our Director of Child Welfare, Marilyn McCormick, did a national interview last night with respect to that. You are right, our legislation does provide for voluntary versus mandatory. We do that through consultation with youth, from best practice analysis, and feel very strongly that was the right direction and progressive in terms of the direction of our new legislation.

MS S. OSBORNE: I am hearing from some parents that the Choices for Youth might be working for some of the youth but not working for some of the parents; and these are very good parents. Having raised children myself who are, mercifully, gone passed that age, had that been available - and I am being very sincere. One of my sons did not like the rules so he said: I am going to go to social services, I am not going to live in your house. Had that been available he would have been gone. So I am just wondering, from the point of view of the parents, are we doing the right thing for the children? I spoke to my son about that, he is twenty-eight now and it was based on the article that was in the paper. I said: You would have gone, wouldn't you? He said: Oh yes, but I would have been really sorry. You put up with me until I came to my senses. Things did work out okay and he is happily married, et cetera. I am just wondering, are we doing the youth a disservice by giving them - God, it is a hard way to say it, some youth should not be in the homes that they are in, some should.

This one gentleman came to me, and I feel very comfortable with the fact that he and his wife were providing a good home. Their child just does not like the rules and they are now out. What are the incidents of that happening? This man is really, really concerned. Like I said, I know and feel very comfortable that it is a good home.

MS VIVIAN-BOOK: I cannot speak to it in any detail, but my understanding is there are specific criteria. It is not entered into lightly and the family is certainly involved in that. Situations of abuse would be an example where our voluntary care agreement would be put in place. There is regular monitoring, it is only for a very short period of time. There are checks and balances in there, but if you have a specific question, I would certainly prefer to refer that to -

MS S. OSBORNE: I could probably, with this gentleman's permission, get in touch with you to see - because he is really, really concerned that his child is now out of his home. He said it was because, I think it is a daughter, did not like the rules; had to clean their room, et cetera. I feel very comfortable that this man, unless there is something that I do not know, but I feel very comfortable that the child was in a fairly good home with rules that they did not like, as none of them like when they are at that age.

MS VIVIAN-BOOK: That was certainly not the intent of the act.

MS S. OSBORNE: No, I realize that.

MS VIVIAN-BOOK: But if boards have a referral, certainly we would follow up for you.

MS S. OSBORNE: Okay, thank you. I am finished for now.

MADAM CHAIR: Thank you, Ms Osborne.

The hon. the Member for Trinity North.

MR. ROSS WISEMAN: I want to go back to board budgets, just to follow up on a couple of points.

I want to follow up on a line of questioning that I had the last time we met. It is with respect to deferments. Last year in September boards were asked to put together plans that would see them balance their budgets. By looking at the grid you have given us earlier, most boards had some success, at least the institutional boards, in coming in with balanced budgets. The $1.1 million is a far cry from the $18 million that was projected in September. So, obviously, that was a major initiative on someone's part.

As I understand it, from talking to a number of people involved with a number of the boards around the Province, when those strategies were put forward in the fall many of them included deferments of expenses into this fiscal year. So, they were not really an adjustment in the level of service but merely the deferment of a payment of some kind and a deferment of an expense that does have to occur. If you, hypothetically, take $2 million from last year's budget and say we are going to wait six months to write the cheque; come April 1 you wrote the cheque. So, those deferments - and I did not get an answer when I posed the question the last time with respect to those initiatives that came forward last year in the fall. The cost restraints initiatives that boards identified, how much of those initiatives could you attribute to deferments versus adjustment in levels of service?

MR. SMITH: Do we have this, Robert (inaudible)?

MR. THOMPSON: I will hand-off to Donna to see in a moment what specifics she might have. But, I do know that the deferral of - I would actually like to cast it in a different term. It is the use of one-time measures in the last budget year as a way to balance their budget. They were used by, maybe several boards and only for a portion of their deficit reduction strategy. It was not the main strategy or tactic used but it was more by exception. But, there were some, indeed.

In that regard, those boards were not led to expect that they would have any reinstatement or additional money in the following year to deal with that when the expenditure arose again. They were told that, now they have more time to start planning for how they will address that in the next year. On top of that, we have to realize that any of the expenditure measures that they began halfway through last year were also going to result in the current year in a full year of expenditure savings, if you like. That was an offsetting factor to the use of one-time measures last year, but there are no doubt some boards, maybe two or three, that are identifying those kinds of issues for us this year and we are asking them to recast their budgets for May 31 with a plan on how to address reaching a balanced budget in the current year.

Donna, do you have any specifics on that?

MS BREWER: Yes, Robert, I had asked the board consultants to go back and summarize based on the information in our files and, I guess, subject to confirming some of the data with the boards. Right now what it shows is that there was one-time savings of about $5.7 million. There was what we call ongoing savings that resulted in cash flow savings in 2001-2002 of about $10.5 million and those savings will result in annualized savings next year of around $15.3 million, so roughly the annualization. Where we are getting the annualization is that some of these cash flow savings were actually position reductions that might have occurred part way through the year, so you are getting the full value of the annualized salary in those positions. Roughly, it looks like the annualized value of the savings makes up for the fact that there were some one-time measures. Like I said, these were summarized based on expectations of what boards had planned to do. We will need a bit more time to go back with this schedule and ask the boards to confirm the information.

MR. ROSS WISEMAN: So, if I understood you correctly, the answer to the question around - and, Robert, I will accept your terminology - the one-time measures amount to $5.7 million and the $10.5 million came about as a result of adjustments in levels of operation, and the annualization of those adjustments come to $15.3 million, and that is system-wide based on the institutional health boards, correct?

MS BREWER: Yes.

MR. ROSS WISEMAN: If we break that down, that is a system's view of the total, but if I could go back to - and, Robert, you used the term, I think, some boards but not all boards use this one-time savings. I just think, hypothetically, let's say, for example, one or two boards came forward in the fall with a significant amount of their savings, or their balancing initiatives or budget balancing initiatives were going to come from one-time adjustments or one-time measures, that one board may not have made much of a contribution toward the $10.5 million. In other words, the $5.7 million one-time adjustments and the $10.5 million may not have been equally distributed over all boards. In other words, if Board X came forward, and they were forecasting a deficit of $4 million, and said: We can take $2.5 million of that in one-time deferrals and the other $1.5 million we will make some adjustments. That particular kind of board, with that situation, would find itself, come April 1, somewhat disadvantaged in some respects, I suppose, because they took a lot of their initiatives; they were in a position to defer a lot of these costs to April 1. You just indicated that there was no consideration in this year's budget to give boards new money for that deferral and they had to come up with cost savings in addition to that.

As I look at the operations in this past year, most boards, with the exception of the Peninsulas, which is a real anomaly, the others just barely balanced. So, if a board found itself in that position, they are going to be in a bit of trouble this year unless you distributed that $5 million giving them a greater piece of that $5 million than some others. I do not know if I am making my question clear or not.

When you start looking at $5.7 million - and I agree with your comment that the $5.7 million and the $10.5 million annualized across the system gives you $15.3 million, and that sounds great system wide, but, if you look at individuals boards, that may, in fact, put some boards at a disadvantage while others may not be as much disadvantaged.

I guess my question is: Are there any boards in this list I am looking at here, that had the bulk of that $5.7 million one-time savings adjustments? If so, that board could be disadvantaged this coming year, correct?

MR. THOMPSON: What you are saying mathematically is correct; that could be the case. I do not know if we have an analysis yet of what specifically would be the numbers that swing one way and swing the other, unless, Donna, you can produce that analysis.

MS BREWER: Looking at this schedule, Central East had $200,000 and it was all one-time and there was no indication of any annualized savings. Central West had $1.5 million in one-time and annualized savings of $800,000, so it seems like those two boards would be primarily the ones that you would be concerned about.

MR. ROSS WISEMAN: So if I look at the Central East and Central West letter, Central West got a $535,000 piece of the $5 million, but that is for inflation, program growth and supplies. So that would not obviously do anything to compensate them for the $1.5 million in one-time savings they had from last year, would it?

MR THOMPSON: The mathematics, of course, is partly numbers and it is partly behavior as well, that there is a time and opportunity to make adjustments. So, if we take those numbers, the $800,000 in permanent adjustments, Donna is telling me, can turn into -

MS BREWER: The one-time is $1.5 million (inaudible) the schedule, and the ongoing is $800,000 so there is a -

MR THOMPSON: The $800,000 can turn into a larger number on an annualized basis. That is the annualized number, and then we add on top of that the additional funding provided in the current year.

MR. ROSS WISEMAN: The $500,000.

MR. THOMPSON: Right, and then we ask the board to use those in addition to any other measures that they may be able to identify in the current year to bring about our total balance. That is the challenge that we have placed with them, not since last week but rather since last September, when they knew that some of the measures that they were using were to be one-time measures.

MR. ROSS WISEMAN: Don't misinterpret my precise questioning with respect to the math, but I guess it speaks to my earlier question, which was pretty broad, which was the level of service that we could expect boards to provide in the coming year.

I guess, to be frank with you, I was having some difficulties trying to reconcile in my own mind when I looked at some of these budget letters and saw what they were getting in terms of their piece of the $5 million. Just knowing, from conversations that I have had with many around the Province in the last five or six months around what they had to do to come up with a balanced budget last year - and I fully recognize and understood that many of them were one-time savings - I was having some real problems trying to reconcile that in my own head, when you make the statement that we are anticipating delivering the same level of service but you do not give any additional money, and part of the cost reductions last year were one-time deferments. You add it all up and it just was not making a whole lot of sense. That is the rationale for my line of questioning, not necessarily that I was questioning the math on this. I just wanted to get a feel for it.

MR. THOMPSON: Understood. I would add, though, in that regard, that the department has held all along, and that is why we undertook the operational review of the St. John's Health Care Corporation in part, that, within the $900 million or so that we provide to health boards, that there is, in complex organizations where demands are shifting and surpluses are showing, always room to identify additional savings measures. Of the $18 million that went down to just a couple of million last year, all of those were accommodated essentially without changes in service levels, client service levels, or quality. So, we are challenging the boards again to pursue that. Of course, we are acknowledging it is not going to be easy in every circumstance, but that is the strategy that we are trying to deploy.

MS CHARD: If I could add just one more point, the other issue - and you would be familiar with this from your work in the hospital field - is around the whole area of utilization. We have a lot of varying practices that we want to try to direct some activities toward as well. Sometimes we have to look at why people are on waiting lists, or why service demands are up. We have a key piece of work to do in that area because practices vary throughout. Some are efficient because they are good in terms of their processes, and on others we certainly have to do some additional work there.

MR. ROSS WISEMAN: I understand that. Actually, that is a good lead into my next line of questioning, and that is the whole issue around accountability of boards and reporting mechanisms that are in place. I guess it goes back to last year in September. The fiscal year starts in April, and September rolls around and you get the announcement that boards are on target for an $18 million deficit. You are halfway through your fiscal year, and I guess on the surface your initial question would be: How come you are into September before you find out, and when do you find out?

The same thing as we talk about where boards are: some boards, as I said a moment ago when I asked you the question about where they are with these deficits, I recognize these are forecasted and some of them, when their audited statements come in, some of these figures will change a little bit, and I appreciate that, but this whole notion of how boards report and when you report, what are some of the things that boards need to do to comply? What things do they have to do to satisfy you and to provide you with, and what kind of time frames do you find out where boards were as of the end of last month? This is now May. Do you know where they were in April, or are you now knowing where they were in March?

MS BREWER: Right now, our monitoring requirement is that the boards will submit a first monitor report to us for April at the end of May. Usually, by the time they close off their own financial statements, do their own internal adjustments, it normally takes about thirty days from the month end before they can prepare and send us information. Now that is the financial, the dollars, basically, where they spent their money.

The thing that we want to work with them over the next month is, we need some statistical data. We need statistical data so we can, you know, sort of look at, like, work production per units, so we can help boards to not only compare themselves to different units within their own organization but also, hopefully, share some provincial numbers so they can start questioning themselves and see, who is out there, (inaudible) the best practice, so that they can sort of learn from each other and, as Loretta indicated, improve the utilization. It usually takes about thirty days from the end of a particular month, and that will vary. Some boards are further behind in that some boards might take forty-five days, but the majority of boards will meet that thirty-day target.

MR. ROSS WISEMAN: That is done electronically, is it?

MS BREWER: Yes, for most boards, those who have the Meditech system. Last year, the St. John's Nursing Home Board did not and Health and Community Services Central, but they have since introduced that, so we expect they are reporting to improve this fiscal year.

MR. ROSS WISEMAN: I would like to get into that a little bit actually. I guess I will admit upfront I have a bit of a fetish about that issue, Information Systems. You mentioned that the boards have been reporting financial information for some time and are now starting to come on stream with the statistical charter accounts. You will have the standards, that everybody will be reporting in the same fashion.

I would like to talk a little bit about, and get some comments in terms of where you are going and where you see yourself going on that whole issue of information systems. We have heard a lot of talk about evidence-based decision making, and now we are talking about getting good reliable data from boards so we will know what we are doing and how we are comparing.

Let me ask you a very specific question first, and then maybe you can broaden it, to talk a little more broadly. Firstly, the Center for Health Information: As I understand, initially when it started to evolve it had a separate board, but it was almost like an arm of the Health Care Corp. Can you give us some sense of where you envisage that organization going, and what commitment and what investment do you propose to give that organization in this Budget here?

MR. THOMPSON: The Newfoundland and Labrador Centre for Health Information essentially operates as a board like many of the other boards, although it's accounts right now, as you mentioned, are wrapped up with the Health Care Corporation. They will continue to proceed to a more independent status, to recognize it as a separate and distinct entity over time. That is how we view the importance of this whole area of health information and accountability. So that is where we will go with that organization. We continue to see it playing a key planning role, a sort of essential planning role, in improving the quality of information, continuing to build the electronic health record which they have started with the Unique Personal Identifier; so to continue to build that, add systems to it, and to generally attain that electronic health record over a number of years. That is the general outline.

If you wish, we can get into some of the individual systems that are going to contribute to that, and I could ask Donna to add to that; that is, if you want to go there.

MR. ROSS WISEMAN: Could you do that, please?

MR. THOMPSON: Sure. Donna.

MS BREWER: The main focus of the centre now is on the development of the electronic health record. The vision within this Province is very much consistent with the vision across the country in terms of the beginnings of the electronic health record, what they call Phase I, which is to provide registries, client registries, a pharmacy network and a lab network. We are very fortunate in this Province where we have a single platform called the Meditech. A lot of our institutions already have what they call the key feeder systems. We feel that we are very well positioned to demonstrate to Health Canada, if they wanted, how an electronic health record can be implemented and achieve health benefits. We feel that we are a good, I guess, test ground. We are small enough that we can do something quickly, but we are also large enough that we could show that we can make a difference.

We were just recently approved $800,000 to begin scoping of the Newfoundland and Labrador Pharmacy Network which is sort of, I guess, step two of the whole health information network. The UPI was approved and was implemented just this last winter within the fourteen health boards. We are hoping that we will be able to lobby the federal government. You may recall in September, 2000, the federal government actually invested $500 million in our independent corporation, Canada Health Infoway. It is my understanding that Canada Health Infoway is doing it's business plan now and hopes to start being able to address, make some strategic investments probably, as early as this fall. So it is timely to have that $800,000 approved, that we can get our plans in place to be able to lobby for some funding for that pharmacy network.

MR. ROSS WISEMAN: So $800,000 is coming from this Budget (inaudible)?

MS BREWER: Yes, it came out of the capital equipment allocations.

MR. ROSS WISEMAN: I commend you for that, by the way, minister. I said earlier I have a bit of a fetish about this.

The comment you made about Meditech, I guess this reflects another personal bias I have. Why is it that each individual health board - and I can see how it originated - still today would hold licences with Meditech itself, as in one provincial licence, and different health boards are embarking on very different levels of investment in Meditech, so that you may have some boards pretty advanced? They have put in place all the modules that are necessary that Meditech would provide? Other boards do not have the same fiscal resources or made different choices about how they, in fact, invest their money and may decide, for example, not to put a nursing module on or not to put a utilization module on, and may make choices to do something different. It is in the best interests of the entire Province to have good information from across all boards so that it is reliable, comparable and consistent from each board, so that one board is not handicapped because they do not have the resources or make different choices to invest in different information, a level of investment in different information systems.

Has the department given some consideration to having that system become a part of the Centre for Health Information or become a provincial system, and the Province hold the licence and the Province be responsible for the communication network that is necessary to link up all health facilities, pharmacies and clinics? Because that is the eventual goal, as I understand it, which is a fairly significant undertaking, a fairly significant cost, to start having individual boards make choices in their individual areas as to what they are going to invest and make choices about service deliveries or investing in information systems. In fact, what we are trying to do is create a provincial grid. Has the department given some consideration to making that a provincial initiative rather than a board initiative?

MS BREWER: It is my understanding that the way Meditech licenses is basically on the size of an organization. I think they even get down to how many beds they have in an organization. So, whether each individual board is licenced or whether it is provincial licence, I am not necessarily sure you are going to get that much economy as a scale in terms of licencing. I guess it is difficult to turn back the clock. I think if someone had had the vision ten years ago, you know, if I had to do it all over again, I think we would have gone with the provincial approach. That is what we are trying to do with the health information network. The UPI is a provincial network. To have to go back now and reinvest and redo all that IT structure that is there, I think we could work with - the fact that it is all Meditech in terms of interoperability and being able to have one system talk to another, it makes it easier than had it been all different systems. To go back and redo Meditech, I do not see that happening.

I think what we intend to do is put the network sort of on top of it. Communications and technology, everything is going to be linked. I guess I do not ever see a day where we would replace, and have a provincial system that replaces, what is currently there in the hospital system.

MR. ROSS WISEMAN: Or assume ownership for it?

MS BREWER: Well, a lot of it is leasing anyway. It is not even ownership. You know, you are just paying Meditech the right to use that system and to get the upgrades. What we will see as individual pieces is probably more standardization; You know, that the data dictionary for peninsulas, say on the lab side, will have to be the same as the data dictionary of the Health Care Corporation. Unfortunately, when you had individual applications, there might have been some modifications that may be troublesome as we go to run up health information that is certainly not show-stoppered by any means.

MR. ROSS WISEMAN: Thank you.

Just one final area of questioning, Minister. With Dr. Hunt present tonight, I want to go back to the discussion. I will qualify it by saying, I don't want you to tell me what is in your strategic plan, but I do want to go back to the discussion around primary care. You did share, in the last discussion, some sense of what you might see as the model for primary care. You have used the phrase, I think, yourself that: The primary care model that you will be implementing will probably form the cornerstone of the system for the future. Do you want to give us some sense, if you could, of what that might mean for, I guess - because you have used the term teams in the concept of using other health providers, other than physicians, to the level of the training which they had. Are you in a position to share with us some sense of how you would see that rolling out, and what that might mean for investment and training for disciplines other than physicians?

WITNESS: I will ask Robert to-

MR THOMPSON: Your last part was, to address things other than physicians?

MR. ROSS WISEMAN: Yes.

MR THOMPSON: The primary health care reform: We are now coming to a stage, after having completed pilot projects and the primary care advisory committee, as well as good experience with nurse practitioner models and training, and an evaluation of that program, where it is time to set out the direction that reform should take throughout the Province. That is the stance we are taking as we head into the Strategic Health Plan.

Clearly there will be some main elements. One would be interdisciplinary teams. There is a physician component to that, clearly, which has many details that will need to be worked out, and on top of that, how the physicians work together with the whole array of other health care providers, most of whom, currently, if you look at the array of health care providers, are already employees of boards in one way or another. So there would have to be some form of organizational design that will occur to make sure that those other health care providers are linked together in a management sense. Then there will have to be a model worked out, taking into account populations and practice protocols of what kind of geography they will cover, and then, finally, how they deal with cases when individuals present themselves, how they get sent to one kind of provider or another, how these cases get dealt with on a team basis, how providers refer their cases to each other and how they care for these individuals or treat or intervene with these individuals as a team. Now the specific protocols for how those teams will work and how cross-referrals will occur, and exactly where these individuals will be located, that is a level of detail that - we have not accomplished all that detail yet, nor will that level of detail ultimately be in the plan, but it is something that we have to turn our minds to right away.

That is where I will stop now. I will ask Ed: Do you want to add anything to that description at this point?

DR. HUNT: I guess just to add that we haven't started it all (inaudible).

MADAM CHAIR: Dr. Hunt, just one moment. There you go. It just takes awhile for the camera to find where you are.

DR. HUNT: Okay, thank you.

Just to add to what Robert has said that, we do have an office of primary health care created within the department. We have four individuals of different backgrounds. One is a nurse, with a nurse practitioner background. There is a physician. There is a health economist there. Then there is another lady with a teaching background who has been working with the three sites around the Province in the past three years in the pilot projects. So, they are working hard to look at the protocols and what needs to be done, what kind of relationships do you have with the board structures and how this whole thing fits into the strategic health plan which, of course, has yet to be announced.

There is a lot of work to be done and it is important that it be done correctly. They are concentrating on looking at standards - standards of care, standards of practice - and also looking at how these different individuals interrelate with each other. As you may appreciate, it can be a bit of a touchy area because each profession has it own interpretation of where its parameters are and sometimes people do not want other people to step on their toes. So we want to make sure, in primary health care, that we are not into a competitive environment but one in which one profession enhances the other and each professional is practicing to the highest of their skill set.

This is the challenge that the committee has. It is going to take some time as well, as I said, to roll that out because there is a fair amount of work involved. Their mandate is to have something, at least preliminary, to get going later this summer or this fall.

MR. ROSS WISEMAN: Thank you very much, Mr. Minister, and I thank you, Madam Chair, for your patience.

MADAM CHAIR: Thank you, Mr. Wiseman.

The hon. the Member for St. John's West.

MS S. OSBORNE: Thank you.

I just have one or two questions on Right Futures. You say there is $4.2 million allocated for that this year. How many patients or persons are involved in Right Futures now as compared to when it started? It started eight or nine years ago, I think, didn't it?

WITNESS: (Inaudible).

MS S. OSBORNE: Okay.

What is the success of the program? How are the folks doing who are involved in the program? Do you have any records on that?

MR. THOMPSON: We will follow up and get you what information that we have available.

MS S. OSBORNE: Thank you.

Home support emergency services criteria, the last paragraph: In all circumstances clients shall be encouraged to consider personal care home placement when the cost of home support exceeds the personal care home subsidy. What is the maximum that goes into home support?

MS VIVIAN-BOOK: The ceilings?

MS S. OSBORNE: Yes.

MS VIVIAN-BOOK: The ceilings for seniors effective April 1 of this year is $2,707.

MS S. OSBORNE: A month?

MS VIVIAN-BOOK: Yes. For persons with disabilities it is $3,875 a month.

MS S. OSBORNE: That is $3,875 for persons with disabilities.

MS VIVIAN-BOOK: And $2,707 for seniors.

MS S. OSBORNE: Okay, that's fine.

It says: Should the clients refuse to consider this care option - $3,875, that would not be twenty-four hours a day is it, or is it?

MS VIVIAN-BOOK: No, it is not.

MS S. OSBORNE: How many hours a day is that?

MS VIVIAN-BOOK: Maximum hours is about fifteen to sixteen hours a day.

MS S. OSBORNE: That comes to $3,875 a month does it?

MS VIVIAN-BOOK: Yes.

MS S. OSBORNE: Thank you. That is all I have.

MADAM CHAIR: Thank you, Ms Osborne.

It seems there are no other questions from the committee members at this time, so I will ask the Clerk to call the remaining subheads.

CLERK: Subheads 1.1.01 to 3.3.02, inclusive.

On motion, subheads 1.1.01 through 3.3.02 carried.

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

MADAM CHAIR: I would like to thank all the committee members for their participation in the Social Services Committee. That now concludes the estimates for the six departments that we were dealing with.

Thank you very much for your cooperation. I thank the Minister of Health and all of his officials for the time and the commitment that you have shown to our committee in answering the questions and providing information at the level that you have. We really appreciate that.

On that note I would like to ask for a motion to adjourn, please.

On motion, Committee adjourned.