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

MADAM CHAIR (Kelly): Order, please!

For the record, my name is Sandra Kelly, the Chair of the Social Services Committee. Before we commence proceedings this evening we have a set of minutes that need to be adopted. These were the minutes of the meeting from the Estimates of the Department of Youth Services and Post-Secondary Education that were held this morning. I thank Mr. Aylward for Chairing that meeting in my absence.

On motion, minutes adopted as circulated.

MADAM CHAIR: We will start the Estimates this evening for the Department of Health and Community Services. We usually allocate three hours for the meeting. Sometimes we have a good record of finishing before. We hope we will not go too much afterwards, but our hope is that we would finish this evening. Being that it is the evening the time is more flexible. We usually allocate some time at the beginning for the introductions of both sides. We will do the introduction of the members of the Estimates Committee then we will ask the minister to briefly introduce his officials. We will move right into any remarks you may have, Minister Smith, then we will move right to the estimates.

I have already introduced myself. Tom, would you like to?

MR. HEDDERSON: Tom Hedderson, MHA for Harbour Main-Whitbourne.

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

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

MR. K. AYLWARD: Kevin Aylward, MHA for St. George's-Stephenville East.

MR. BUTLER: Roland Butler, MHA for Port de Grave.

MADAM CHAIR: Thank you very much.

Minister Smith.

MR. SMITH: Thank you, Madam Chair, and good evening everyone.

With me this evening I have my Deputy Minister, Robert Thompson. I will ask Robert to introduce the rest of our staff. He will get all of their positions correct, I am sure I will not, so I will ask him to introduce the rest of them right now.

MR. THOMPSON: Thank you, and good evening.

On the minister's left is Donna Brewer, who is our Assistant Deputy Minister responsible for support services and primarily responsible for budget matters as well. On her left is Jim Strong, who is our Director of Financial Services. Behind me is Lynn Vivian-Book, who is the Executive Director responsible for programs. Next to her is Dr. Ed Hunt, our Medical Consultant and responsible for a number of divisions in the department as well. Next to him is Diane Keough, our Director of Communications; to her left is Loretta Chard, who is the Assistant Deputy Minister responsible for board services and also ambulance services; and in the back is Gerry White, who is the Assistant Deputy Minister responsible for Government and Community Relations.

Thank you.

MR. SMITH: Thank you, Robert.

It is my pleasure this evening again to have the opportunity to present the Estimates for the Department of Health and Community Services. It is certainly a pleasure to serve in that capacity and to be so ably assisted by the team that I have here with me this evening. As I have indicated to them, to be on their toes because I will certainly be using them this evening. Any line item that is in their particular area, then they should be prepared to speak to it.

As the Minister for Health and Community Services I think in September of 2002 we, as a department, set out a progressive vision for the Health and Community Services sector when I was pleased to participate in the launch of our Strategic Health Plan, Healthier Together. It is nice to have seen this plan, first of all, be released and also to have seen over the last number of weeks and months aspects of that plan being enacted.

At the present time we are in the process of consulting with the people on a health charter of the Province. We look forward to concluding that work soon. As members here this evening would know, the health charter is an agreement that we are striking between government and the individual citizen whereby each will acknowledge his or her responsibility with regards to health care. Certainly, for the individual, I guess it is a way of reminding individual citizens that in the first instance all of us have primary responsibility for our own health. What our health is, in large part, depends on the types of decisions that we make at any point in our lives. So it is a reminder to people of that. I guess on government side, and certainly on the department side, it is an acknowledgment and recognition of our responsibility to the individual citizen if he finds himself in a circumstance when his health is deteriorating or in need of some support.

During this past year I guess we all were pleased to see the release of two major federal reports: the Kirby and the Romanow. I think the Romanow Commission in particular, a lot of people in this Province and indeed in this country had awaited with a great deal of anticipation. The report that reported - certainly, I guess, whether it was not by the commissioners themselves but certainly within the way it was portrayed in the media, was the Romanow Commission would fix everything that ailed health care in this country.

First of all the report itself, and subsequently the federal government report, that we, in this Province, would have to conclude that it certainly fell short in terms of meeting all of the needs that we have identified. I think it could have made it a lot easier for all of us if, in fact, Mr. Romanow and subsequently the Prime Minister had been up to the challenge of meeting all the needs that had been laid out there. However, in spite of the insufficient response, we, in this Province, remain committed to building on the current strengths of our health care system and the vision of creating a better health and community services system for the future. We acknowledge there many challenges but we also recognize there are many things that we have accomplished, and we have made gains in a number of areas.

Looking at the budget itself, this year it is pretty apparent to anyone looking at the budget that health certainly remains and continues to be a top priority for this government and the residents of the Province. We heard time and time again, through the budget consultations and also the health forum consultations, of the importance of health care and the fact that the people in this Province place it and identify it consistently as their number one priority.

In the figures used by Treasury Board and the Department of Finance, forty-two cents of every current and capital dollar combined is spent on health and community services. This is up from thirty-three cents in 1994-1995. In terms of the comparison with our jurisdiction, if you use the same measure as in others, that, in fact, relates to an expenditure of forty-five cents of every program dollar. This is expected to rise when funding is allocated for the physician arbitration award.

As hon. members would be aware, during this past year we were confronted with a strike by physicians in the Province and the resolution was an agreement to go to binding arbitration. Submissions have now been completed and we are awaiting the final outcome of that process. We do know that going into it there was a baseline that had been jointly agreed to, so I guess all that remains to be seen right now is if, in fact, there is; and, if there is, how significant a movement there is beyond that baseline.

The department's budget for fiscal year 2003-2004 approximates $1.6 billion. This is an increase budget over budget of about $71 million. I have to say, Madam Chair, in the time that I have been in the House, going back to the times when we brought in some really difficult budgets, even in years when there was a very modest amount, there was not a year that there was not actually increased funding in the area of health care. That certainly speaks to the level of importance not just that government gives to it but obviously is reflective of the level of importance that all citizens of the Province give to their health care system.

This year's budget, of course, the expenditures speak to spending for hospitals, nursing homes, physician and dental services, drug subsidies, road ambulance operations, blood services, medical and diagnostic equipment, and numerous community-based programs delivered by the four Health and Community Services and two Integrated Boards.

Our spending per person on health care in Newfoundland and Labrador is among the highest in the country. According to the Canadian Institute for Health Information, Newfoundland and Labrador is projected to spend $2,800 per person on public sector health care, up from $1,713 in 1995. This is $274 per person above the Canadian average in 2001, which at that time was $2,526. Again I think, Madam Chair, that speaks to the level of commitment beyond that. I guess it also speaks to the challenges that we have been faced with in this jurisdiction in dealing with the growing costs of health care, especially in the absence of sufficient amounts of federal dollars.

Specific details of the increased investments in the health care are contained in the Budget Highlights document, the Speech, and the department's press releases. Certainly, we will be pleased to respond to any specific questions that you may have related to any of these.

Certainly, just a few highlights: the increase since 1994-1995 of health operating expenditures will be about $620 million, an increase of over 60 per cent. Federal transfers, however, will be $58 million lower, even taking into account the federal response to the Romanow report. So it becomes pretty apparent when you look at those figures, it is not difficult to see the challenges that we faced in terms of the delivery of health care, that they certainly are significant and continue to be.

One hundred and forty million has been added to the base budgets of boards since 1997. I have to say, Madam Chair, that we have been especially pleased with the progress our boards have been making with respect to providing quality health and community services within the funds available to them. We certainly understand and appreciate the challenges that the boards have been faced with. At times they have had to make some difficult decisions, but slowly they have been getting their budgets under control so that, in fact, in this present year on the institutional side there was actually - well, there were one or two boards that were still in a small deficit position overall, that, in fact, we came through the year with a surplus. That is the first time, I think, in a long time.

Since 1995-1996, over $600 million has been committed in this Province for health related capital projects and equipment. The total value committed by this government in 2003-2004 for capital spending to support ongoing construction of new health facilities, renovations of existing facilities and equipment, is $45.4 million.

The new funding commitments this year include a total of $26 million committed for capital equipment, including a commitment for a second MRI, which has certainly been long lobbied for within this Province; and $5 million for PACS; $4.5 million to manage the growth in the institutional health sector. This additional funding will assist boards to maintain a stable financial position and to continue to make progress in repaying their accumulated deficits while maintaining delivery of quality services; $1.3 million to increase rates to personal care homes and the number of subsidies for individuals. This is the fourth consecutive increase, and I am pleased as well this year that we will be providing some additional subsidies because I do know that there has been a strong lobby in certain quarters to have additional personal care subsidies in place, and we are pleased to be able to provide that in this Budget.

A further $445,000 to bring the total funding, to provide up to thirty-two fast-track nursing seats, to $745,000. Again, Madam Chair, an initiative in direct response of addressing the anticipated shortage of nurses in trying to position ourselves to be able to deal with that eventuality.

An increase of $1.5 million for Early Childhood Development. It is certainly an area of great interest to me. In my former career as an educator, I spent a fair amount of time in establishing and setting up pre-school programs in the area of the Province where I lived and worked, and I certainly know of the importance of early intervention. I think the ECD program is a tremendous one. This is one program that I do commend the federal government on, for partnering with us, because it is a program that is truly making a difference.

Sixteen point six million dollars for utilization increases in the Newfoundland and Labrador Prescription Drug Program, which in this year will bring our total budget in that area to about $100 million. Again, you can see a fairly large ticket item, but again one that hon. members in this House on a regular basis are bringing forward in petitions and lobbying for additional medications and pharmaceuticals to be added to the formulary, because there are so many things that are coming on the scene. Many of them are very, very worthwhile drugs, breakthough drugs, as a matter of fact, and in many cases medications that give people back their lives. Certainly a strong lobby to see these included.

Speaking to the amount of the increase this year, and the total amount of the budget, certainly that puts in context the significance of the challenge we face in that area.

Also, $4 million to stabilize Health and Community Services Boards deficits arising from the increasing cost of home support. On that side of the equation, Madam Chair, I think is useful to note that the problem our Health and Community Services Boards have been faced with in terms of their deficits in recent years have in fact been a direct consequence of the demands for home support. It is a program that we have tried to control the growth of, not because we feel that the program is not worthwhile or not important but, in fact, again, dealing with the fiscal reality that we have had to contend with. I know again as well that this is an area where members of this House have been directly involved in because they hear from many of their constituents, as do I, to lobby on their behalf to either find home support for them or to see an enhancement of the level which they receive at this present time.

With that, Madam Chair, I will stop and we would certainly welcome any questions from the members of the committee.

MADAM CHAIR: Thank you very much.

I will remind everyone to try and identify themselves when they speak, especially when you are moving from a different speaker. If you have some interaction back and forth for five or six times, I think downstairs they are able to tell who it is but when another person speaks, please identify yourselves.

With that I will ask the Clerk to introduce the first subhead.

CLERK: 1.1.01.

MADAM CHAIR: I assume this evening we will do the same as we have done in the other committees. We will move from one subhead to another and we will do them all together at the end, if we finish up.

Mr. Hedderson, would you like to start?

MR. HEDDERSON: First of all, good night. I hope we have a nice session, not a long one.

Just starting off with the first subhead. I would like to look at the Salaries of the Minister's Office. I just want some clarification. For example, with the Minister's Office, Permanent Employees, $228,884; Temporary & Other Employees; and then the Earnings. I am just curious about the temporary and other employees. Just in a general sense, who are we talking about here? Is this contract work or students or work terms? Because in just about every heading there is a fair amount of -

MR. SMITH: I am informed that these are two positions. One is clerical support and one is communications.

MR. HEDDERSON: I do not know if I need to go down through all of them, but in the Minister's Office there is $55,000 allocated for that and under Administrative Support, for example, there is $500,000.

MR. SMITH: Excuse me, Tom, which -

MR. HEDDERSON: Oh, I am sorry. I am at the Salary Details. I am sorry, Minister.

MR. SMITH: That's okay. What page are you on?

MR. HEDDERSON: I am on page 139. Rather than just go through every head, I just want a sense of - as you look down that column, Temporary & Other Employees, is this a fair amount of contract work? You can take any head, just give me a sense of it?

MR. SMITH: Okay, Donna, can you give us some detail on that?

MS BREWER: Well, if I skip down under Medical Services, that is in Dr. Ed Hunt's area, the primary care office. That is intended to be a temporary office. Those employees would be contractual. We have a few people who are on secondment from the system. For example, Mike Doyle is an economist, so he does not occupy a permanent position in the department. It is really people of that nature.

Administrative Support, again, (inaudible) area in that would be a lot of IT people under contract and are there for specific projects.

Policy and Program Services, again, we have a number of people who are on secondment from the board. Particularly, while we are developing long-term care strategies; a lot of project work.

Youth corrections was some temporary federal dollars that we had in response to the new criminal youth justice act.

MR. HEDDERSON: Obviously, Minister, it is predictive though in a sense that you know these secondments or whatever are coming up so that they can be - this is not an after fact, you are budgeting for it. So temporary in the sense that they are predictive temporary or contract work that you have already -

MS BREWER: In the same vein too, we have some staff who are on secondment to the system. They have permanent positions but we are not able to fill those positions permanently. For example, Marilyn McCormick has taken up the position in the Office of the Child and Youth Advocate. So we have now Ivy Burt, but she is not permanent because basically we have given Marilyn a leave of absence for a year. We have several permanent positions where temporary people are filling those jobs.

MR. HEDDERSON: Under Executive Support, 1.2.01, there is a need for additional staff in that particular area because it started off with $835,100 budgeting last year, it has jumped to $898,400 as the revised, and this year it is $976,000. Again, the reason for that would be?

MS BREWER: Robert may want to speak to this, but the Treasury Board Secretariate is actually seconding an executive member from their branch over to the department to work on a special project for the department.

MR. HEDDERSON: So that would be the extra -

MS BREWER: That was roughly around $90,000. That includes -

MR. HEDDERSON: That is just the one position?

MS BREWER: One position. I understand, Robert, it is for a year?

MR. THOMPSON: Yes, one year. That is right.

MR. HEDDERSON: Under Medical Services - again, disease surveillance, disease control, immunization, and the whole bit. Obviously, SARS is a big topic, minister, in it right now. Just out of curiosity, are you taking that into account? For example, God forbid that we do have to deal with it, but would that be more of an emergency or you kind of build that in here?

MR. SMITH: To the SARS, there is a provision within the department to deal with this sort of thing. Actually, there is one position that has specific responsibility -

MR. THOMPSON: One position that is doing epidemiology and surveillance but we have several positions within that division who more generally deal with public health protection. They are networked throughout all of our boards with equivalent type people, like medical officers in health and public health officials generally. We have not budgeted extra for this special outbreak elsewhere in Canada, luckily, so far.

MR. SMITH: There is one position that is dealing with pandemic.

MR. THOMPSON: With pandemic, that's right.

In our normal planning for any future type of outbreak, a pandemic outbreak, we have developed, with other provinces and the federal government, a plan that springs into action when something may happen. There is one specific position that does pandemic planning, that's right.

MR. SMITH: Tom, as well, we do, obviously - I mean, all jurisdictions are following this quite closely and we do have our medical health officers working closely with Health Canada to make sure that we are not at risk. At this point in time there have been no confirmed cases in this Province; there is nobody at this point in time. I think that is being watched or monitored as a possibility. Our people are watching it closely because obviously everybody sees what is happening on the mainland, so it is a concern for all of us.

MR. HEDDERSON: I guess where it is new, probably this time next year something may be built in, but I am assuming by what you have said that really you are prepared for any type, whether it be SARS or whatever, and if it were to occur then everything kicks in.

MR. SMITH: Exactly. The only thing about it is, I guess, if we found ourselves in a situation, let's say, if we had a major outbreak, then obviously at some point in time it might require us having to access resources other than what we have available to us. That would be considered of an emergency nature and would have to be dealt with as such at that point in time.

MR. HEDDERSON: Under heading 1.2.05 Policy and Program Services, planning, development, evaluation, under the .06 Purchased Services there is a little bump there, if you notice, from $194,000 to $360,000 and she has fallen down to $173,000 this year. Obviously, something came up, Deputy Minister. Would you be able to elaborate on that?

MR. THOMPSON: Donna, do you have the detail on that?

MS BREWER: Yes, there were some extra costs that the department incurred last fall as a result of the physician work disruption, and that is where that money was expended.

MR. HEDDERSON: That was allocated for what particular...?

MS BREWER: Diane, you might be able to help here. Some of it would be (inaudible) with government's advertising position, in terms of its position with the physicians.

MR. HEDDERSON: Okay. To the tune of what amount?

MS KEOUGH: Two-hundred and fifty thousand, the majority of which was advertising for the telephone line that we had in place, the toll-free line.

MR. HEDDERSON: Under heading 2.1.01 Memorial University Faculty of Medicine, I guess, Minister, more for my own information. You know I am critic for post-secondary as we stand, and I am just curious to know what part your department plays in the Faculty of Medicine. Is it just the medical side of it or the education side of it, or a combination of both?

MR. SMITH: Obviously, I guess, from our perspective, as it indicates there, it is mainly the provision of providing the grants and subsidies. I guess the money is channeled through us in terms of the money that is here. The specifics of it -

MR. THOMPSON: I will add a few remarks and then I will ask Dr. Hunt if he may wish to add more. This Province is unique in Canada in the way that we finance medical education. The money for the entire grant for the Faculty of Medicine flows through the Department of Health in the Province. In another province it is through the Department of Post-Secondary Education, or as the case may be. So, this budget finances the entire operation of that faculty and within that, of course, they are well integrated into the programs and services of the Health Care Corporation as an academic health science centre. The Health Care Corporation's budget also comes from the department, so we are actually financing both sides of that equation; on top, as well, many aspects of the salary budget for the physicians who may be physicians in the community but have teaching positions at the faculty as well. We are involved in several different ways.

Ed, is there anything else to add to that?

DR. HUNT: Robert is quite correct; we fund the entire medical school. All the universities' medical schools across Canada have the post-graduate part of the medical school funded by the Department of Health, but we are the only Province where the undergraduate part of the medical school is actually funded by the Department of Health, because there are two components to it.

MR. HEDDERSON: Just to go on from that, there is no contact then with the students who are there. I am thinking, do you enter into any contracts with them, or incentives for them to, of course, work in your department or work in your hospitals or wherever? Is there anything, Robert, in that, or Minister?

MR. THOMPSON: There are a number of different things, actually. One is, the salaries for residents are paid for through - I am not sure if they are paid directly or if they are paid through -

WITNESS: The Health Care Corporation.

MR. THOMPSON: Through the Health Care Corporation. That is one area. Also, there is a bursary program whereby we provide certain types of grants to eligible students in residence, or those who apply. Those bursaries then, of course, get converted into return in service obligations. That is another way.

Are there other additional things?

WITNESS: (Inaudible).

MR. THOMPSON: We finance a physician recruitment office and that person, our recruiter, is actually located directly in the Faculty of Medicine area in order to really make that connection a tight connection.

Those are the main things.

MR. HEDDERSON: Just on recruitment, Minister, again, are we going national-international as well? How successful have we been? Are bursaries offered to, let's say, someone from another province or another country?

MR. SMITH: Are you talking about the medical school?

MR. HEDDERSON: Yes.

MR. SMITH: As you would be aware, Tom, as a matter of fact the competition for our medical school is quite keen within our own Province.

MR. HEDDERSON: It is very much so.

MR. SMITH: I am sure that you have been lobbied yourself from to time. People figure that we can assist them in these things, but it is the - we have a lot of our own students who actively apply seeking admission to our medical school. Right now we have - is it forty-five seats that are going to the Province? Forty-five of sixty, is it?

DR. HUNT: Forty, but five are Canadian. Generally, all forty-five end up being Newfoundland, but there are five actually dedicated for Canadian.

MR. SMITH: For the people outside the Province, they would be paying the full rate because we have an arrangement with the other provinces. How many international seats are there now?

DR. HUNT: Right now we have one. (Inaudible) because, of the fifteen that were international, twelve of them now are actually New Brunswick seats that they purchase for their students. There are three international seats remaining.

MR. SMITH: Other than our own students, the others all pay the full cost of the program. It is our own students who receive the subsidies.

MR. HEDDERSON: Under the drug subsidization, subhead 2.2.02 Senior Citizens, I just want to get a sense, Minister, if I could, because there was thirty-two budgeted, thirty-six revised, and thirty-nine estimated. Is this simply the demographics of the situation? Can I assume by that, that there is obviously more of a need? Or is it because of increasing numbers? Can you just give me a sense of that, perhaps?

MR. SMITH: Certainly it is reflective, as you said, of the demographics of our society. We are an aging society. As people get older, the demand for drugs and medication certainly increases. While it would not be reflected in figure, I did mention in my introduction that there is certainly an increase in the number of pharmaceuticals and medications that are coming on the market on a regular basis, that this year's amount is just reflective of what is presently on the formulary. There are some other medications that are either right now under active review or have been recommended for inclusion on the formulary and we have agreed, pending the availability of the funding.

One of the things that we have committed to do this year - because right now the budget is $100 million. We are engaged in a comprehensive review, looking at the whole program, trying to determine where some efficiencies may be realized so that we can find some flexibility, hopefully, and some additional funding that we can then apply against some of these new pharmaceuticals so we can actually add them to the formulary.

MR. HEDDERSON: Minister, in determining which drugs - because there are new drugs coming on the market at all times - do you look at an industry standard across Canada or do you follow the led of some national body? Are decisions made in the Province depending on the circumstances?

MR. SMITH: At the present time we are operating under, what is referred to as an Atlantic Expert Review Committee. It consists of the Atlantic provinces. All the provinces have a presentation. They review any new drugs that come on and they make a recommendation. Now the recommendation of the committee is not binding. I mean they will make a recommendation as to whether it should be added, but obviously it does carry with it some weight; that does happen.

Interesting enough, moving beyond the Atlantic review committee, there is actually now a national committee. Is that functional yet?

MR. THOMPSON: It is going to be functional this year within an organization called the Canadian Coordinating Office for Health Technology Assessment. That will be functional this year and may, in fact, take over some of the functions that the Atlantic review has done for us.

MR. SMITH: It is intended, Tom, to provide some consistency, which was a point you were getting at, in terms of decision making. What you will find right now in terms of the formularies, is if you look at different jurisdictions you will see some medications are included in some places and not elsewhere. This sometimes proves problematic, especially when people are mobile and moving around. If they are in a certain jurisdiction where a certain mediation is available and then come to Newfoundland, or vice-versa, and find that it is not. I guess the move is towards some sort of consistency.

I have to say again that even at the national level, at this point in time, once the committee is functional its authority will be to advise and not to dictate. In the final analysis each jurisdiction will still make the final decision as to whether or not to include a particular drug. At that point in time it will be based on the ability of that jurisdiction to find the resources to fund it at any given time. Some of these medications, as you would be aware, especially the newer ones, come with a tremendous price tag. They are very, very expensive.

MR. HEDDERSON: Under the Special Drug Programs, I notice you have the cystic fibrosis and other medical conditions. Are they just an individual nature or have you earmarked any particular condition that it is an automatic, like cystic fibrosis?

DR. HUNT: This is actually a long-standing program that has been in existence for years, going back to early Confederation, and it has continued on since then for just these specific diseases. We just carried on with them since then.

MR. HEDDERSON: I am sorry, Ed. I did not hear the last part.

DR. HUNT: I said we have just carried on with the program. We have not cancelled it.

MR. HEDDERSON: Yes, because it seems to be pretty steady. So, I guess, the need stays pretty steady right along. It is not increasing nor is it decreasing.

MS BREWER: Other than cystic fibrosis, this also covers growth hormone. I do not even know what this is, Ed, but it is congenital neutropenia.

MR. HEDDERSON: I would not know either. So whatever you said I would say yes.

Emergency And Transportation Services, the Road Ambulance. Being from a rural district, minister, as you know, the ambulance service is always a hot topic, to say the least. Again, just in a general sense, expectation in this budget - because I know there have been some demands placed upon you. What, in particular, is earmarked for the private ambulance services in Newfoundland and Labrador?

MR. SMITH: In this year's budget what you will see in the Estimates is the amount that was there last year, because this is a negotiation year. We just started negotiations with the three groups. The negotiations have started within the last week or so, and, of course, we will not know until they are concluded what additional monies we will be putting in there.

The only other piece I would mention is that as part of the $26 million - was it? - we had on the diagnostic -

WITNESS: Yes.

MR. SMITH: There was $1 million for the provision of defibrillators for the ambulances. This is something that the ambulance operators have been lobbying for, for some time, so we have the money available. Also, under that provision there will be provision for the necessary training; but, again, this is something that the industry had been lobbying for themselves. So rather than wait to have that as part of the negotiation process, that is actually included in the budget. The other piece will be concluded as part of the ongoing negotiations.

MR. HEDDERSON: Minister, another part of it, too, and I see - especially some young people who - in my area in particular. I know a couple who were paramedics, attendants, whatever term you want to use, and it seems like they got their training and then they moved on. Is this a universal problem across the Province? Again, I don't know about - some of them moved to St. John's. I see it as a problem but I only see one or two instances. Is it common? If it is, or if it isn't, is there anything that you can relate that has been done to try and stem that?

MR. SMITH: It is a concern. We have made a deliberate movement within the Province to try to increase the levels of training because, obviously, we want to offer a first-rate emergency service to the people of the Province. The way to do that is to increase the training of the people who are providing that emergency service.

The difficulty we have had, and we certainly acknowledge, is that the operators - and I have met with all of them during the last year, some of them on a number of occasions, dealing with these issues. They feel that their challenge, in terms of being able to compensate them at the levels where they need to be, is disconcerting for us because we are expending money to train these people and then what happens in a lot of instances is once they have their training then they take their training with them and move off elsewhere. So the expertise is lost to us. I am sure it is an issue that will be - because I know in discussions that I have had with all three groups, this has been raised by all of them. I am sure it is something that will addressed as part of the current negotiations.

MR. HEDDERSON: Minister, with regard to the training - I know you make it available - who incurs the cost? Is it the people who go through it or is there a cost-sharing there? Maybe you could give me a sense of -

MR. SMITH: My understanding is that we do make monies available. I do not know who has the particulars on that. Loretta, could you speak to that?

MS CHARD: We provide a grant to the Health Care Corporation of St. John's on an annual basis - close to $300,000 - and that enables training to occur throughout the Province. We work very closely with the industry to try and meet their training demands as they require it. That is one of the reasons we have not gone to a private college, because we want to be able to respond in time where we can. We have made available teleconference courses, on-site courses, going to the regions to teach courses. We have had some challenges there with people who take up the programs as well. Some are successful and some are not. It is like any other industry. We are certainly aware the volunteer base is kind of eroding. Even if they are a volunteer they need to have a certain level of training. I think that is essential in this day and age. We also access and have a partnership arrangement with HRDC to encourage people in the communities to access the programs through their funding as well.

MR. HEDDERSON: Under Community Services, there is - I know there are a lot of programs. Minister, any new initiatives this year? I know there is a little increase in Allowances and Assistance here. Any new initiatives that you have in place or planning perhaps?

MR. SMITH: I guess one - that Robert is just reminding me of. The one service that - and it certainly has been in the news, is the one related to autism, which is a very important service and you would appreciate, Tom, coming from an education background. We have tried to - I guess the interesting thing with that particular service as well is that we initiated it in the Province out of a concern that is there. We were one of four jurisdictions offering it at the time when there was a human rights challenge that was issued. The decision of the Human Rights Board was to eliminate the wait list, which we have moved to do and, in fact, are at least in the process of doing. That is certainly one program. Are there other new programs that -

WITNESS: (Inaudible).

MR. SMITH: Okay, sure.

MS VIVIAN-BOOK: In terms of the early childhood development initiative, there were some announcements last year around new family resource centre projects, as well as prenatal supports called healthy baby clubs. Those are just getting off the ground and will start to see families participate in those programs this year. Although you saw low cost for those this year, the full costs will now be expended as the projects come to fruition. This year the autism piece has expanded as well.

Also, recently, we are moving down the road of a new agreement with the federal government around child care where over the next five years we will start to do further planning and further increases in new directions in terms of child care.

MR. HEDDERSON: Minister, another aspect of this heading would be home care. I have to say, and I will say it here, it is probably the most requested of an MHA. We find ourselves in delicate positions because we have to lobby on behalf of our constituents. It is not always cut and dried and so on.

Just to give me a sense, Minister, because everything seems to be so tight under that particular heading, there never seems to be enough. This year are you anticipating an increased need? I saw it go up and that is why, when I was looking at the increase in the drug subsidy program for seniors, is there any - I just want to get a sense of where you are going. Is it going to be the same as last year, because the need is the same, or do you see perhaps an increased need?

MR. SMITH: What we have done is, we have budgeted at the same level of last year. We are again maintaining the criteria. We are still advising the boards just to deal with the emergency situations.

Just to give you some idea as to where this particular program has gone, in 1997-1998, looking at the actual figures, it was at forty-two point five. In 2002-2003, this was the projection, seventy-three point four. So it is a program that has grown significantly. It is an area that I guess we are certainly challenged in terms of trying to respond to because, as you say, I think every MHA is being lobbied. I know, of the number of calls and letters that I get from colleagues, that is probably the one program that - because not only are we talking about new entrance to the programs; we are also looking at people who have been on the program for awhile and now find themselves in a situation where they need some additional time. It is two-pronged. So really what is there this year is to try to maintain. It is a matter of trying to hold the line, maintain growth, but we certainly have not built in a lot of flexibility here to increase the program, not in this year.

MR. HEDDERSON: Of course, as an addition to that, I know now that home care workers are perhaps unionizing, or wherever they are going, and again we can only predict. I assume that you are looking at it in the same light as you are looking at other negotiations when it happens, but were it to happen, Minister, it would obviously cost more, it would not come out of the hours. It would be an addition put into - if it is an increase in pay or whatever, would -

MR. SMITH: Again, at this point in time none of us know how far off it is. Certainly, in terms of the agencies, it will probably happen reasonably quickly but in terms of the self-managed there is a big debate surrounding that whole piece, as you would know. I do not know, in the final analysis, how that is going to play itself out because it has been a debate that has been there for years and I do not know.

Certainly, from our perspective, we would want to honour the commitment that we have to our clients at this point in time. We certainly could not see ourselves in a circumstance where we would be scaling back because we would have to try and make the monies that are available right now just to fit the bill.

MR. HEDDERSON: Okay.

Just a few more questions and then I will be out of your hair.

I know - my health facilities, of course, are Whitbourne and Carbonear - the foundation goes every year with good fundraising activities, telethons and so on, and every year the same question is asked, which I am going to ask as well, and that is the dollar for dollar. I know last year we were very fortunate in that area. Again, Minister, will that come in time or have you made a decision, or what can they expect?

MR. SMITH: My understanding is the provision is still there. Is there money for the matching at this point in time?

MR. THOMPSON: With the Health Care Corporation, which has a provincial mandate and a regional mandate, there is still a fulfillment on matching foundations that we will still be paying on. As for other foundations across the Province, I will have to defer to Donna to give you the details.

MS BREWER: Of the $26 million that was budgeted for capital equipment to date, we have notified boards of roughly around $20 million of that allocation so there is flexibility. I guess this year, the proviso, we would have to say to boards it has to be on equipment that will fit the federal criteria. Another criteria that we have with boards is that in a lot of cases we would look at replacement equipment but if it is new equipment they would have to come forward to us with a plan as to how they plan to manage the operating costs.

They are there and the initial allocation of $20 million - if a board had indicated to us that they had planned to do fundraising, and it fit within their priorities and it is something reasonable, yes, we would have said yes. Throughout the year there is a bit of money that as boards come forward with requests we will take a look at it.

MR. THOMPSON: We do not have a general Province-wide program for matching for foundations but where boards have come forward with opportunities, where they think that they can have a good fundraising opportunity and they are asking for a one-to-one match for a piece of equipment that fits the definition and fits overall priorities then there is a marriage there, but it is not a general program around the Province.

MR. HEDDERSON: I have a list of that equipment from the hospital and I think it can be matched up because it was the length of my arm. There are a couple of pieces there that I am sure could match up.

The long-term health facility earmarked, I should not say for Carbonear but for the area, again I just want to get a sense, Minister, because some of the municipalities are, even as we speak, lobbying for such a facility. The question I have, of course, is - I do not think a decision has been made - what is the process there with regard to that long-term facility?

MR. SMITH: In terms of your particular area, Carbonear-Conception Bay North, because, as you say, there has been no decision made as to where the facility will be going, not to my knowledge, but that decision would be a decision of the board as well once that happens.

During the year, I met with the officials in the area. I have met with the hospital board and key players in the area, visited the facilities that are there, and talked to them about that part of it. Where it will be will be the easy part. The decision right now that everybody is waiting on is whether or not the development will go ahead.

What we committed to do during the year was to look at three areas: Corner Brook on the West Coast, Conception Bay North, and St. John's, as possibly being part of what is referred to as P3 or private-public partnerships as a way of providing these facilities, and I guess we did that because what we were looking at was a price tag of about $200 million to deal with the whole structure.

We have done a fair amount of exploration and analysis, if you will, on P3, the possibilities. We have had our own in-house committee that has looked at it. We have had people who have travelled to the mainland and looked at what is happening in other jurisdictions. We have put together a fair degree of information, including here in St. John's. We did a pilot with Chancellor Park, which is the only private for-profit facility right now that we have of this kind in the Province. Of course, the government has committed to go forward with an Expression of Interest in the Corner Brook area. So, I guess what happens to your area of the Province is going to depend on what happens as we - because right now we are moving with just the one so that we can look at something that is manageable. This is a whole new experience for us, so rather than trying to embark on looking at the whole enchilada, if you will, to look at one particular piece so that we can have it in a manageable size that we can work with. Should the Corner Brook piece play itself out, I guess at that point in time then we would have to decide as to whether or not we would then proceed with your area and St. John's. A commitment is to those three areas. Needs have definitely been identified. There is absolutely no question there.

MR. HEDDERSON: I just wanted to get a sense of urgency. Obviously there is not a sense of urgency. There is a sense of urgency in need but with regard to the process you are more or less piloting and will go from there.

MR. SMITH: They do not need to start lobbying for the location yet.

MR. HEDDERSON: What is that again?

MR. SMITH: They will have lots of time to lobby for the location yet.

MR. HEDDERSON: Okay, just a couple of more.

The healthy living initiatives, and obviously we are talking almost like drug subsidies and that sort of thing, Minister, is there anything in the near future with regard to healthy living as getting out ahead? I know it has been talked about and so on.

MR. SMITH: What we did this year, of course, as a follow-up to the launch of our Strategic Health Plan, we have set up our Wellness Committee. I do not know; who can report on the Wellness Committee, where they are right now in terms of their work. Lynn?

MS VIVIAN-BOOK: The wellness council has been active for the last several months and hope to have a framework document (inaudible) with priorities ready for around June for some consultation and so on. They are also very closely linked to initiatives in Atlantic Canada around obesity, active living, physical activity, and also at the national level around those initiatives with the federal government. So, yes, it is definitely a priority and there have been significant stakeholders brought together to participate in this count. Needless to say, there are lots of priorities and interests from municipalities to different interest groups around that table.

MR. HEDDERSON: If I might ask, would you be the leader ministry in this or just - you would be, obviously -

MS VIVIAN-BOOK: Yes.

MR. HEDDERSON: - and the other departments like Education and that would -

MS VIVIAN-BOOK They are all represented around the council.

MR. HEDDERSON: Okay.

One last thing. I seem to be doing my district more than anything, but I attended a meeting on the dialysis, Minister, and, of course, we are very hopeful. I just want, again, a sense of where it is and perhaps where it is going, and the possibilities?

MR. SMITH: Certainly in terms of, as you mentioned, dialysis is a service that is of concern to a number of areas in the Province. For the last few years, we have been working on doing a satellite operation, one in Clarenville and one in Stephenville, as a way of getting the service outside of the larger centres. Right now, dialysis is offered in Corner Brook, in Grand Falls and in St. John's, but we have requests from your area. There were requests from Marystown. I know St. Anthony, actually, has been approved. The unfortunate thing about the St. Anthony situation, from the time that St. Anthony was approved until we were ready to move on it, the number of patients who were medically stable who were there, there was an insufficient number, because so many people had moved on. They had to go somewhere to get the service, so the numbers are no longer there.

We do have a provincial committee that will be reporting within a few weeks. What it will be doing is looking at evaluating the operation in Clarenville and in Stephenville and giving us some input there as to the efficiency of these operations, as a way to proceed, and also will be giving us advice as to the provincial picture.

Anything that we do with regard to that particular service will be based on the report of the provincial committee, which does operate independently. I think from my perspective, I have said, whenever I have met with people - and you will recall from my meeting with the group, that yourself and Roland attended - I think people appreciate that it is better to have that kind of advice coming from people who operate at the professional level rather than leaving it as a political decision, because it is just too easy to make a political decision just to give into the pressure to provide it but it might not always necessarily be the best decision.

We should know within a few weeks. Loretta, do you have any idea when we might expect the report?

MS CHARD: Yes, Minister, the committee are in the final stages of their work right now. They are expecting that within the next two to three weeks they will be able to wrap that up. As the minister has said, it is an area of high demand. We know that from a national perspective the increase in need for dialysis services is about 9 per cent to 10 per cent annually. We are asking this committee to look at our Province and see if our numbers fit in the same context, and to look at an overall management process for end-stage renal disease. It is not simply just lacing someone on a machine. There are various stages to chronic kidney disease. Some people can manage that process and want to have some choice with managing it at home versus in the unit. There are also some learnings from other provinces that, in certain areas, a dialysis unit at a satellite level worked well. We know that the skill mix in some of those is different from what we do here as well.

We are looking for a comprehensive approach to the issue of a major disease. We know that it is going to continue to rise with the aging population, the high rate of hypertension that we have in the Province, and the high rate of diabetes, all of which contribute to end-stage renal disease.

MR. HEDDERSON: One final comment, Minister, if I could, and that is to say that, as I alluded to before, I have some dealings with a lot of your field workers. I would like to go on the record as saying that in all my dealings they have been very, very professional. Tough love, I must add, but I would have to compliment them, more particularly those in my district. I must say, a great relationship with them and they are a credit to your department.

MR. SMITH: Thank you, Tom, for that.

Also, I say to you, as Minister of Health, I want to compliment you on your change in your own lifestyle. You are taking this wellness to heart, with all the weight off you. Even Donna remarked at the beginning of the meeting and said that -

MR. HEDDERSON: I was kind of hoping to be picked up as a poster boy. I am open to it, Minister, especially with the election coming up. I do not mind going before the cameras with testimonials.

WITNESS: Tom and I will do the before and after shots. I am the before.

MADAM CHAIR: Mr. Wiseman, are you ready to start your questioning?

MR. ROSS WISEMAN: Thank you, Madam Chair.

Minister, I have some points I want to cover off with you. Before I do, I want to compliment you on your announcement today. I think that was a very humane thing to have agreed to leave the thirty people in the pilot at Chancellor Park. I think that was a very reasonable decision. I commend you for that.

MR. SMITH: Thank you.

MR. ROSS WISEMAN: There are a couple of things I want to get into with respect to the budget itself. Before I do that, can you just qualify for me, Minister, I just want to get some sense of what the Province got out of the recent First Ministers' Accord and the federal budget that came down. There were four or five categories in which funding was allocated through that. If I run down through them, can you tell me what this Province's share of that was?

MR. SMITH: Yes, we can provide that.

MR. ROSS WISEMAN: There was the $9.5 billion in transfers to the provinces and territories over the five-year period. What was our share of that?

MR. THOMPSON: Is that the CHST category?

MR. ROSS WISEMAN: No, that was the - I should not say that. It is not identified as that. There is another category, $2.5 billion in immediate investment through the Canada Health and Social Transfer.

MR. THOMPSON: Okay.

MR. ROSS WISEMAN: I assume the other one must be as well, actually, there is no other mechanism to do it.

MR. THOMPSON: There are so many different tables produced, I do not know which one you are looking at, but from what you have said so far I think I understand. The $9 billion would have been the amount announced in September, 2000, and therefore -

MR. ROSS WISEMAN: That is the balance of it flowing through, is it?

MR. THOMPSON: Right - had already been built into the Province's base budgeting. So it was not new to the - if I read your phrase correctly, the $2.5 billion that was being made available through CHST as a result of the FMM accord, that was - and each Province had an ability to take its share either spread over three years or all in one year or all in two years. So our Province's share out of that total amount is $42.5 million. Donna, correct me if I am wrong there. We have chosen to take it all in year one, so that $42.5 million into CHST flows into the Province's revenues in 2003-2004.

MR. ROSS WISEMAN: In this year coming, in 2003-2004?

MR. THOMPSON: Correct.

MR. ROSS WISEMAN: Then the other one was the $16 billion over five years for health reform, targeted primary and for primary health care, home care and catastrophic drug coverage.

MR. THOMPSON: In the current fiscal year, $17 million of that flows into our revenues.

MR. ROSS WISEMAN: Seventeen million in this year?

MR. THOMPSON: Correct.

MR. ROSS WISEMAN: Then the other category was the $5.5 billion over five years in health initiatives, including diagnostic medical equipment, health information technology and so on.

MR. THOMPSON: There are a number of additional pieces there, but the key one is the medical and the diagnostic equipment fund. Through that one, and I believe that was $1.5 billion nationally -

MR. ROSS WISEMAN: Pardon me?

MR. THOMPSON: - $1.5 billion nationally, that particular fund. Of that, this Province is bringing in $25.5 million, and we are taking that all in 2003-2004. Now you said it was a $5 billion amount. The extra categories -

MR. ROSS WISEMAN: Health information technology was there as well.

MR. THOMPSON: Health info (inaudible). The rest of those items are not items that have transfers to the provincial government. They might be national organizations. They might be Health Canada programs, but none of the extra or those additional ones flow money into our coffers.

MR. ROSS WISEMAN: Okay, but we have gotten all we are going to get out of that because we have pulled it all into this year.

MR. THOMPSON: Well, except for the health perform fund, because that fund where we are getting $17 million will grow each year over the next five years.

MR. ROSS WISEMAN: Okay.

Alright, I just wanted to clarify, to have some sense of what came in this year that was earmarked for health. So what we have, you have taken $42.5 million, which is a three-year allocation, and pumped it into this year. You have the $25.5 million, which is for the technology. So there is $68 million that you have pulled from the feds in this year and flowing it in through this year's budget. Is that correct?

MR. THOMPSON: Right.

MR. ROSS WISEMAN: Maybe I can start, Minister, if you do not mind. Tom kind of went for the heads and I will probably do a combination. I will refer to some of the things in the Estimates but also in some of the other documents like the releases that you had and some of the things in the Strategic Health Plan, if you do not mind.

MR. SMITH: Sure.

MR. ROSS WISEMAN: If the Chair will allow me to bounce all over the place.

The $26 million for capital equipment. From within that $26 million that you announced this year, you are going to buy the new MRI, and PACS comes out of that as well?

MR. SMITH: That is right.

MR. ROSS WISEMAN: And the rest, will that all be used for diagnostic equipment?

MR. SMITH: Yes, my understanding is all that $26 million -

MR. THOMPSON: The full $26 million - the $25.5 million is from the federal fund - is towards diagnostic and medical equipment, and that includes patient care equipment as well. All of those categories are eligible within the FMM Accord money.

MR. ROSS WISEMAN: I remember the last time there was some broad definition of what constituted medical equipment. If I am not mistaken, I think last year in this same discussion you furnished me with a list of what you did spend and how you spent it; some carriage bands and things like that, and dietary equipment did not necessarily fit the medical definition. Are there new criteria this time that you have to comply with?

MR. THOMPSON: It is an unusual instrument, the FMM Accord, because essentially the money is being transferred to the provincial government. We get to make our own decisions about what we invest in, but there are phrases in the Accord which we must honour. The phrases are diagnostic and medical equipment and within that, patient care, as I said.

We have a lot of flexibility within those terms to apply to types of equipment that we chose, but clearly, we are not going to apply it to things like toasters and lawnmowers and ice-making machines. Those things are not part of those categories. We develop our investment criteria in this Province for the things that make sense, but fitting within. We are not constrained by specific federal criteria. They have not supplied us with words to narrow this down, but we are honouring a legitimate definition of equipment of that kind.

MR. ROSS WISEMAN: I guess my question, more to the point, would be the types of things that got financed the last time. If in a years' time I ask for the same list, would I get a similar sprinkling of types of equipment that was purchased the last time, or will it be much more focused on direct patient activity?

MR. THOMPSON: It will be somewhat more focused than last time, but you will see things like (inaudible) wheelchairs, bed lifts, specialized equipment like that.

MR. ROSS WISEMAN: I think the last time there was a couple millions dollars spent on computers and stuff. It is a bit of a stretch to say it was medical equipment.

MR THOMPSON: But PACS, as an information technology component. Very, very much related to diagnostic. It is a diagnostic tool, but not just desktops. No, you will not see desktops.

MR. ROSS WISEMAN: The other stuff was for Meditech. The implementation of Meditech software, so it was not PACS.

In the Budget, Minister, you announced - and you commented here tonight as well - the process for making the decision about the MRI. Do you have some sense of when you will be making that decision?

MR. SMITH: We are just starting the process. I do not know how long it will take.

Loretta, are you working with that particular one?

MS CHARD: Yes, we are in the process of trying to now iron out who a good facilitator might be for that process, and to get letters of invitations settled. I guess the date will depend upon when we can nail down an appropriate facilitator and when we can bring the groups together. We are hoping within a month or so.

MR. SMITH: With that one, Ross, as you can appreciate, I think what is happening is that we are seeing a lot of - there is tremendous lobbying throughout the Province. I think from our perspective it is almost an impossible situation for any of us right now. So, really, what we are trying to do is find a way - again, going back to a response I made to Tom's question earlier - to try to at least get the politics out of the decision making as much as we can. What we have committed to, as a department, is for our decisions to be evidence-based. Really, in this one here, I know it is not going to be as straightforward.

There are two issues really, one is whether we go with the fixed as opposed to mobile. That is the one piece, and if a decision is that the way to go is fixed, well where should it go? It is kind of a difficult one because politically, regardless of where you put it, it is a no win situation. If we can get the appropriate mechanism in place, especially with our boards and our medical personnel kind of looking at that and saying: On the base of the evidence this is the recommendation we make. We think that is the fairest way to do it.

MR. ROSS WISEMAN: You have a better chance of de-politicizing if you leave it with physicians not the boards, is what I am saying. That is a commentary by the way.

The other is the PACS; the PACS money is coming out of this twenty-five total?

WITNESS: Yes.

MR. ROSS WISEMAN: What will this do now to the Province, this way that you have done here (inaudible) what you have done over the last couple of years? Will we now have any health facility in the Province that has X-ray capacity? Will they be linked in some fashion through a provincial network? How far along in this process will you be with this step right here?

MR. SMITH: We certainly will be, but I do not have the details.

MS BREWER: We will be completing what we call phase one. There will be PACS capability in every single board but it will not be every single site within every single board. There is probably another $5 million or $6 million in phase two. To us it is a good start. From Gander East we have good coverage now. Really, the focus now, in addition to a further investment of the health care corporations, is to look at boards west.

MR. ROSS WISEMAN: Do you have some sense of what phase two will cost you?

MS BREWER: No, I will have to get that for you. I think it is at least another $5 million. It is possibly more.

MR. ROSS WISEMAN: Given that you have taken the three-year federal money upfront it is going to have to come from provincial sources as you move forward with the next part.

MS BREWER: Way back in the beginning - and Loretta may recall this - there was a provincial PACS committee. They, at that time, indicated if they went province-wide there would be operating savings. I think even the health care corporation are saying they may take the $2 million that we have, because what happens is that you have - lets say film costs, you save some storage costs. There may be potential with phase one, if we get it in place, that we can start generating some operating savings which we can probably reinvest.

MR. ROSS WISEMAN: Minister, you commented about the personal care homes and the one-point-three and the increase in numbers of subsidies. Can you tell us how you have broken that down in the last couple of years? Let's say last year and this year; how you plan to do it this year? Last year it equaled one-point-three and this year you are putting another one-point-three in. How much of that went to increasing the number of subsidies and how much of it went then to increase the fees paid to the homeowners for the residents? What was the split?

MR. SMITH: Who has the detail on that? Donna?

MS BREWER: The fiscal 2002-2003, the additional subsidies were roughly around $379,200, and the rate increase was approximately $412, but in addition to that, there were other further rate increases. What happens is that when the federal government increases its OAS and GIS, we then pass that increase on to the private operators in terms of the rate. For anybody over sixty-five it is not a cost, but anybody who is in that home under sixty-five we have to pick up extra subsidy. Of course, we never know from year to year what that rate is going to be. So, we start the year thinking that it is roughly going to be half and half. Right now Lynn and I just signed letters, basically, effective April 1 we are increasing the rate $25.40. That rate increase is roughly around $500,000.

MR. ROSS WISEMAN: How many new subsidies will you be adding this year?

MS BREWER: We hope to be able to add around 136; but, again, it is going to depend on what increases OAS and GIS, and whether or not we have to divert some of that increase subsidy to further rate increases.

MR. ROSS WISEMAN: How many subsidies do you have now in total, provincially? I have the number of subsidized beds but the number of subsidies?

MS BREWER: The number of subsidies; 1,297 is the number that I have here for 2002-2003. It is my understanding there are roughly around 2,200 beds.

MR. ROSS WISEMAN: So if they increase 136, it brings you up another 1,400.

Minister, I know this has been issue that has come across your desk a number of times. A couple of constituents of mine have been party to the letter that has been sent to you from homeowners that have a bit of a quagmire, from what I see of it. The homeowners who got into this business many years ago have subsidized beds, and many of them have not necessarily plowed a lot of money back into the capital improvements in their homes. Now with the subsidies to the client, and not to the homes - which, by the way, I concur with 100 per cent - has created a situation now where they have a competitive position that they did not have before.

If you go from a monopoly to a competition, things change. The more you move away from that monopoly the more difficult it becomes for those who established themselves and have financed themselves, assuming there is a monopoly. Not that I have looked at a lot of them, but a number of them I have, the financial statements of them over the last couple of years, and they do not need very much of a financial blow to close them up. One of the things that will make a difference to some of them is a requirement placed on them by the Fire Commissioner's Office, which again I concur with the need to be safe and it is appropriate that they do.

Have you given some consideration about how you are going to manage that implementation, number one, but the other thing, too, manage what is going to happen to some of those homes? We have seen some of them closed already, not a large number but there have been a few that have closed and there are several on the brink of closing. Have you given some consideration of how you are going to manage that and what you might be in a position to do?

I understand that some have written you requesting a meeting to discuss the concept of eliminating the subsidized bed by having the department buy back the subsidized bed, which gives them a cash infusion, and then let them play the field with the other players who are trying to attract the subsides that the residents have.

MR. SMITH: It is a very important issue. It a very complex one, as you would know. We are currently in the process of doing a thorough review of the whole area of long-term care, including the personal care homes, and looking at all aspects of them. The recent development, in terms of the Fire Commissioner, again, as you say, it is difficult to.... Obviously, when I was asked at the time, it is hard not to supportive of the initiative because you are talking about the safety of the clients who live there, and we certainly have to be supportive of that. Having said that, we are not totally unaware or insensitive to what this is doing to the owners of these establishments. When I was asked at the time, when it was announced, was the department prepared to commit to assist them, the answer was no, because really there is no money there right now for us to assist. As part of our review, it is certainly something that we will be looking at.

Where there are individual homes, I would assume - there is a two-year period in which they have to do this, so it is not like they have been told by the Fire Commissioner that you have to have this next week or next month. There is ample time there, I think, to get a plan in place to deal with it. As each home gets itself in a situation, I know exactly what they are confronted with and it may very well be in the final analysis dealing with them one on one. That is maybe where it has to be, because obviously they do provide a very valuable service. We are certainly not interested in putting these people out of business. That is not what it is about, but in the meantime it is trying to maintain these things.

The other piece, as you mentioned, having the subsidies attached to the person rather than to the home, is again in response to some pressures that we have had over the years, trying to provide people with the mobility and the flexibility to be able to choose where they want to go, and exercise the subsidy and where they want to go to live. Now we recognize that for some of these home owners it may present some problems as well, but I think in part it has been driven by the fact that over the years - I think it is no secret that we certainly hear from people from time to time saying that you see a big difference in the services in one area of the Province as compared to others in terms of the standards that are there. I suppose part of the argument is that if the subsidies are attached to the person then the person has the option to go and select a place where they think they want to live, rather than being forced to go and live in a place they might feel is not up to standard. They have no choice because that is the only way that they can get the subsidy.

We are engaged in a total review of that whole area. We have a number of problems there, on the personal care side and certainly on the long-term care side, and we will be developing a strategy encompassing all aspects of that particular industry.

MR. ROSS WISEMAN: Who is doing that study? Are you doing that in-house?

MR. SMITH: Yes.

MR. ROSS WISEMAN: On that point, by the way, have you responded to that group of people who sent you that letter requesting a meeting to have that discussion about their subsidy?

MR. SMITH: I could not tell you, Ross, there are so many requests for meetings. Give me the specifics after and I will be able to let you know. More than likely, if they asked for a meeting, I would say they have gotten it. I do not know when, but if they haven't gotten it, I am sure it is on my schedule somewhere.

MR. ROSS WISEMAN: They haven't gotten it yet. I was just curious about whether you had it on your agenda.

MR. SMITH: We will certainly check on it. Is it from your area?

MR. ROSS WISEMAN: One of them. There were four of them, I think, who signed the letter. One of them is from my area.

MR. SMITH: Is anyone aware of that request for -

WITNESS: I will check into the timing of it. I know that was in process.

MR. ROSS WISEMAN: I am going to do what Tom did. I am going to take advantage of this discussion and talk to you about an issue that is a district issue. I want to talk to you about the other one where you talk about capital commitments for next year. I have had some discussions, obviously, with you, Minister, about this issue, and yourself, Robert, as deputy: the Clarenville long-term care facility. I just want to clarify a couple of things in terms of what I understand is actually happening. The $500,000 that was allocated last year and the year before is still $500,000 that is there to be used by the board to continue with the design work for the facility.

MR. SMITH: Yes, that is right.

MR. ROSS WISEMAN: That $500,000 is - I need to ask this question again, Minister, because I have gotten a bit of information that suggests otherwise. I understand that is simplistically expressed, I guess - is the SGE Group have been engaged as the company who is going to do the engineering and design work and $500,000 gets allocated for that. The assumption would be that one $500,000 cheque at some point, or a combination of cheques totalling $500,000 will get written to the SGE Group in exchange for that service because they will provide the service because they have been engaged to do it. I have some information that suggests that some other- that fund has been encroached upon for other studies and other activities, planning activities on behalf of the department in designing or defining concepts for long-term care services, long-term care design, and that all of that $500,000 will not necessarily be dedicated to the facility in Clarenville. Can you -

MR. SMITH: Again, that is news to me. I will ask if Robert can speak to that. I am certainly not aware of that.

MR. THOMPSON: I am not aware of that either. To put it again in simple terms, there was $500,000 allocated. We entered into, with Works, Services and Transportation, an arrangement with a consulting firm to undertake work that was estimated to be valued at $500,000. That work will be brought through to completion. I do not know anything about what you say. We will look into it. If have some extra information to help us pinpoint it, that would be helpful, but I know nothing about what you have said.

MR. ROSS WISEMAN: It might be an issue of - works and services are doing the work on behalf of the department. The money was allocated through the department and the vote gets passed over to works and services to engage the work. I assume that is the process, isn't it? So, when it gets in works and services, I understand what may have happened: that works and services have used that pot of money, knowing that it is not going to be flowing quickly in this year, to pay for services that they have needed to have in helping them come up with concept designs for long-term care facilities. In a stretch, one could say that the information gained through that process might get used and that knowledge would be transferred to the SGE Group to be used and incorporated in the design for the long-term care facility in Clarenville. That is a bit of a stretch in my view.

Minister, if you could - I appreciate your response that you will check - I would like you to either confirm that is not true or tell me and confirm for me that, in fact, all of that $500,000 will be used and dedicated to the design. Therefore, I can only assume that it will all be paid to the SGE Group because they have been engaged to do it.

MR. SMITH: Again, just to reiterate, my understanding, Ross, is that certainly as far as the department is concerned, that $500,000 is there for that purpose. Robert and I were just talking because I was asking him about the issue you are raising, how would that money actually flow between our two departments. If there is a concern - we are not aware of any - we will certainly take it under advisement and have Robert follow up on it and see what we can find out and do.

MR. ROSS WISEMAN: I would appreciate that.

MR. SMITH: We can communicate to you on that.

MR. THOMPSON: I will clarify one other point. We would expect that the full terms of reference for the work that was to be completed in relation to the Clarenville facility out of that $500,000 will be brought fully to completion, whether that is $495,000 or if -

MR. ROSS WISEMAN: I know what you are saying. I was not suggesting that a $500,000 cheque would be written as a rounded out figure to the SGE Group. It is based on billed hours.

I can tell you where it came from, actually - not tell you where it came from but how it got expressed. I know the SGE Group have done work that will amount to about $40,000 of billable hours that you have not yet been billed for. When I posed the question that if there is $40,000 worth of billable work going in and there is a $500,000 pot, that means there is $460,000 left. The response I got was that it was not quite that much because we have had to use some of that money for some other parts of that same project. Therefore, that prompted me to start querying it and that is what I discovered. You might want to verify that for me, because if that project is - if the SGE Group are not able to bring it to a level where $500,000 ordinarily should bring you because of that kind of maneuvering of the money, that would be rather unfortunate.

MR. SMITH: I agree, and we will certainly check it out.

MR. ROSS WISEMAN: The other thing, in the other capital projects for this year, will this seven point five finish the Fogo Centre?

MR. SMITH: My understanding is that it will, yes.

MR. ROSS WISEMAN: It will open it, will it?

MR. SMITH: Yes.

MR. ROSS WISEMAN: The three point five will open Stephenville?

MR. SMITH: Yes.

MR. ROSS WISEMAN: What is the story on the Gander project? I ask that for the benefit of Madam Chair, now that we are talking about our own districts. How is that, Madam Chair? There is $400,000 there to the new wing. The other part of that project, I understand, from what I have been hearing at least, has been deferred for a little while to study?

MR. SMITH: That was the plan. The information that we had was that in doing some of the work in the old section of the hospital, there were some concerns that came about with regard to asbestos. There was always a knowledge that there was asbestos there but there was a realization that there was a significant asbestos problem. If we went in there and started to complete the work on the refurbishing of the old section, automatically, the information we had, is that the cost of doing that would increase by some $5 million or $6 million, which causes some concern because the amount that had been budgeted to complete the Gander - the figure that had been set some time ago was $69 million. There has been some $54 million spent to this point in time, but now we are looking at the possibility of the figure going up as high as $75 million, so that caused some concern and we wanted to have a second look at it to see if, in fact - because our concern was: can the group still complete what they need in Gander and stay within that $69 million? Now, I have had further meetings within - as a matter of fact, as recent as today, with officials from Gander who have come in and, in fact, they are saying they have been looking at the design there, what needs to done, and, in fact, are prepared to commit that the project will stay within the $69 million.

They have raised for us some issues which are of some concern to them, that they say will need to be done in order to really make full use of the work that has been done there. So, we have committed to take another look at that to make sure that we are not, in fact, jeopardizing the work that has been done there by not doing something in this year to make sure that we can utilize what is there. But certainly in terms of major expenditures for this year, we have put it on hold while we revisit and look at what, in fact, needs to be done there with this new information that has come to light.

MR. ROSS WISEMAN: The other project announced was the $5 million for the Grand Bank facility. I notice that is a $17.5 million project, and you are scheduling it to be completed by the winter of 2005. Is the plan to flow that through three fiscal years?

MR. SMITH: Donna, can you speak to that?

By the way, as well, Ross, Donna was pointing out to me Fogo was scheduled for - when is it? The summer of -

MS BREWER: The summer of 2004. Fogo starts the next fiscal year, 2004-2005.

MR. ROSS WISEMAN: There will be a need, actually, to finish off Fogo in the next fiscal year as well, so we will see another allocation for Fogo next year.

MS BREWER: Yes, in 2004-2005. There will be another allocation for Grand Bank in 2004-2005 as well. The bulk of the construction looks like it is going to occur in 2004-2005. Our forecast shows $11 million to flow in 2004-2005.

MR. ROSS WISEMAN: $11 million for the next fiscal year?

MS BREWER: Yes, for Grand Bank.

MR. ROSS WISEMAN: So, it is going to flow through two fiscal years, this year and next year?

MS BREWER: Yes.

MR. ROSS WISEMAN: What is the balance of Fogo?

MS BREWER: Fogo, 2004-2005, was $1.3 million.

MR. ROSS WISEMAN: What is the total cost of that project?

MS BREWER: Eleven point five million.

MR. ROSS WISEMAN: Eleven point five million. Okay, it is right there, yes.

Minister, in the Budget document, in the new fiscal year the operating budget for health will increase by a further $52.5 million, so the increased budget for this year over last year is $52.5 million. If my math is correct, what you pulled out of the federal programs for this year is $68 million. Does that tell me that you pulled out $68 million for the feds, you increased the budget by $52 million, so all of the increase in the budget this year is actually federal money and you still have some left in (inaudible).

MR. SMITH: My understanding is, the actual increase is $71 million year over year.

MS BREWER: The $52.5 million just refers to current. Does your $68 million include the capital, the capital equipment?

MR. ROSS WISEMAN: Yes.

MS BREWER: The $52.5 million just refers to current account expenditures revised budget.

MR. ROSS WISEMAN: So it is $77 million.

MS BREWER: And the minister's $71 million is budget to budget but is current and capital.

MR. ROSS WISEMAN: Okay. So the Province's investment in this year's budget is $3 million. Is that correct?

MS BREWER: I am sorry, I missed that last part.

MR. ROSS WISEMAN: That being corrected, then, if $71 million is your total increase in the budget this year, both capital and operating, and you got $68 million from the feds, that means the Province has invested $3 million in this year's budget, of provincial money.

MS BREWER: What is not included in our budget yet is additional money as a result of the ambulance negotiations and also the physician award. So we expect during the year our expenditures are going to increase possibly to $100 million.

MR. ROSS WISEMAN: So in the budget, as I understand, what you have set as a floor on the negotiations is $50 million, but that is over the term of the contract. Is that it?

MS BREWER: Yes.

MR. ROSS WISEMAN: What is the arrangement for the retroactive pay and in the first year? All the retroactive pay is going to be picked up in this year, plus the first year's cost. Would that be correct?

MS BREWER: The money is not in our budget, but I understand the Province has budgeted some sort of contingency.

MR. ROSS WISEMAN: What is the breakout in terms of the - let's say it were $50 million. Let's say that they agree it is only $50 million and not something different. If it is only $50 million, how much of that had your anticipated flowing into this year? Because you have the retroactive pay to pick up this year, plus you have the full annualized cost of that increase in this year, what was going to be your cut of the $50 million?

MR. THOMPSON: As for a precise number, I cannot tell you. Let's assume that there is an annual increase that hits in the first year of $50 million, then that would be a full $50 million for 2003-2004, plus a six month retroactive period for last year. Of course, that is a very simplistic way to put it because the numbers will be a lot different, but that is the concept.

MR. ROSS WISEMAN: It is $50 million over three years, not $50 million a year, is it?

MR. THOMPSON: That is right. Our proposal was that by the third year there would be $50 million more in the physicians' services budget. That might start off at $22 million, go up to $36 million, then go up to $50 million. We do not know what the arbitrator will say. Should you go to 100 per cent in the first year, or 20 per cent in the first year, or a third, third, third.? We do not know what the arbitrator will say.

MR. ROSS WISEMAN: What did you ask for?

MR. THOMPSON: What did we ask for? A third, third, third, I believe, was our position.

MR. ROSS WISEMAN: A third, third, third.

MR. THOMPSON: I am pretty sure it was a third, a third, a third.

MR. ROSS WISEMAN: Realistically if you were to be successful in what you have asked for, you would get one-third of $50 million, plus six months of that in this fiscal year.

MR. THOMPSON: Correct. One-third of $50 million.

MR. ROSS WISEMAN: Okay, plus six months of -

A couple of areas that I would like to zero in on, if I could. In all of the heads under the Professional Services, my math tells me that it was $1.9 million spent last year on Professional Services and you are planing to spend another $1.5 million this year. What do you buy with professional services? Where does that come - what are you buying?

MS BREWER: If you look under, for example, Board Services, which is on page 183, the Professional Services there, that is Loretta's reference to the training which we purchased on behalf of the ambulance that we contract with the Health Care Corporation.

MR. ROSS WISEMAN: So that one there would be ambulance services?

MS BREWER: Right, yes.

Under prescription drugs, 2.2.01, page 185, that is the contract with xwave. They actually do the adjudication of the pharmacy claims. That is $933,000 and the rest is divvied up throughout the department for different divisions to contract with professional consulting services.

MR. ROSS WISEMAN: Can you - and I know, Minister, we had this discussion a couple of times over the last year - furnish us with a summary of the studies that you have had done in the last twelve months? Who they were and how much was paid for the service?

MR. SMITH: Studies that were done?

MR. ROSS WISEMAN: Studies that the HAY Report did. You are doing a report in Labrador - Burnell and Reid.

MR. SMITH: Yes.

MR. ROSS WISEMAN: Can we get a copy of that?

MS BREWER: On page 184, in our Government and Agency Relations, a lot of that - if I understand correctly, Jim - $518,000 are contributions to federal/provincial/territorial work.

MR. ROSS WISEMAN: Okay.

The other area in the Estimates I would like to talk a little bit about is board budgets. You are increasing the board budgets this year by $4.5 million. Minister, did you mention that was going to the community health boards and not the institutional boards, or is that going to be distributed among all boards, both institutional, community and the integrated boards?

MR. SMITH: The four point one -

MR. ROSS WISEMAN: The $4.5 million that has been allocated for the boards this year?

MR. SMITH: No, that is for the institutional.

MR. ROSS WISEMAN: For the institutional?

MR. SMITH: Yes.

MR. ROSS WISEMAN: Okay, so it is going to be distributed to the institutional boards only. The community health boards will not be getting any piece of that?

MR. SMITH: We have not budgeted an increase for the -

MR. THOMPSON: No, that is correct, but we have an allocation primarily for home support to be allocated among the community boards. The $4.5 million you are referring to is to manage growth in the institutional board budgets.

MR. ROSS WISEMAN: Okay.

How much is allocated for the community health boards?

MR. THOMPSON: The $4 million that was increased in our budget for home support will be allocated this year for community boards. So, $4 million extra is the increase that we have for those boards.

MR. ROSS WISEMAN: What I am wondering - I might have missed something because on page 25 of the Budget document, I am reading here, "In the coming year, government will provide the boards with additional funding of $4.5 million." It just says: the boards. My question was, that $4.5 million, was that to all boards or -

MR. THOMPSON: No, just institutional boards.

MR. ROSS WISEMAN: Just institutional?

MR. THOMPSON: That's right.

MR. ROSS WISEMAN: You are suggesting there is another $4.5 million for community health boards?

MR. THOMPSON: Just $4 million.

MR. ROSS WISEMAN: Just $4 million. Okay.

MS BREWER: Just to clarify, that $4 million was allocated in 2002-2003 and just carries forward into the base for 2003-2004.

MR. ROSS WISEMAN: In last year's budget there was a $5 million figure there that you had allocated to be distributed sometime during the year, and you have annualized that $5 million.

MS BREWER: No, the $4.5 million is on top of that $5 million. So there is another $4.5 million. The $4 million for home support actually started to flow to the boards this past month. They had gotten it for 2002-2003 to help them balance their budgets this year and that $4 million will flow again, but it is not an additional $4 million. It is the same $4 million.

MR. ROSS WISEMAN: Okay, it is based in - when I look for it in here, I will find it -

MS BREWER: Under Revised.

MR. ROSS WISEMAN: - built into the revised figure under Grants and Subsidies, on page 188 of the Budget. Is that where I would find that?

MS BREWER: Yes.

MR. ROSS WISEMAN: Last year it was $234 million and now you are going up to $244 million, so there is $10 million there. In that $10 million the $4 million is flowing through that you gave them last year.

MS BREWER: Yes, but it is not an increase over revised. The reason you are not seeing a full $4 million increase over the $233 million with the Budget is that there were some cash flow savings, particularly in ECD and NCD, as we start to ratchet up those programs. You had $4 million added for home support to the boards when you also had savings elsewhere for other programs within that activity.

MR. ROSS WISEMAN: Okay. I am going to phrase the question this way so I will understand it. Don't make it too complicated, I will never get it.

Last year, March 31, 2003, the community health boards had this much money. Over the course of last year you gave them $5 million.

MR. THOMPSON: In that question, we are dealing with institutional boards. There was $5 million last year. We added to the base budgets of institutional boards and it was allocated among them. That allocation became part of their base and, indeed, continues to be part of their base in the current year. On top of that base, for institutional boards, we are adding another $4.5 million. We have not allocated between the boards but it will become part of their base budget. Now, all of that is quite separate from the community. That is a whole different question.

MR. ROSS WISEMAN: Okay.

MS BREWER: (Inaudible) institutional boards.

MR. ROSS WISEMAN: The institutional boards did get an increase, or are getting that $4.5 million as an increase over and above what they had last year; the institutional boards. The community health boards are getting increases based on an annualization of last year's money that you gave them.

MS BREWER: Yes, all else being equal, had we not provided the $4 million late in the fiscal year they would have been in deficit by $4 million. We are keeping them whole starting into the next fiscal year.

MR. ROSS WISEMAN: The $4 million you distributed, you waited until March to see where everybody sat in terms of deficit-wise. You made them flush, and then you carried forward now this year and keep them at last year's base budget.

MR. THOMPSON: Yes, that is fair. From the Estimates document you cannot read it exactly that way because there are a lot of other things going on, but what you have just said is accurate.

MR. ROSS WISEMAN: Is it? Okay. Now I understand. Just stay with me for a little while. I am a bit slow on times but I will get it after awhile.

Let's deal with the institutional boards again. Last year, I believe, when we had the discussion, I asked a question about the total accumulated deficits of the institutional boards, and I also asked a question about the accumulated deficits of the community health boards. Now here we are, a year later, and I understand last year there was no deficit reduction plan per se, but some boards were successful in achieving some surpluses and they have applied it against the accumulated deficit. Can you tell me now - I know you do not have the financial statements, but you have some sense, I am certain - as of March 31, 2003, a month ago, what do you anticipate will be the accumulated deficits of all boards, institutional, community and integrated boards as of that date?

MS BREWER: Right now, we are projecting about $98 million.

MR. ROSS WISEMAN: About $98 million?

MS BREWER: That is down from last year, when it was around $101.5 million.

MR. ROSS WISEMAN: So, you have taken about $2 million off the debts?

MS BREWER: Closer to $4 million.

MR. ROSS WISEMAN: Oh, yes, $102 million.

Minister, the boards obviously carrying that kind of a - I know some of them had surpluses. I understand there were a couple that did not, that had some deficits this year. I will get to that in a second, but with $98 million accumulated deficits - and I remember listening to John Peddle of the Health Board Association commenting on the day of the Budget, making some comment about, and I just forget his exact words, but the suggestion was the boards will have to look at their operations to see whether they are going to be able to achieve some savings to live within that allocation.

If that is the case, they are going to have to do that to determine how they are going to give within their allocation to provide services, what strategy do you have to deal with the accumulated deficit?

MR. SMITH: Again, you mentioned in your preface to the question, one of the things that has happened in the last little while is that most boards have, in fact, done a good job in managing their budgets and most of them in this year either balanced or came in with a surplus.

Our emphasis right now, at this point in time, is still working with the, I think it is two or three boards that are still grappling with a deficit. Those who have balanced their budgets and have moved into a surplus position, they are already working at developing a plan to deal with their long-term debt. For us right now the focus is still on the two or three boards, working closely with them, to help them deal with the situation that they are faced with and the deficit that they are encountering. One, of course, is the Health Labrador Corporation. We have been working, have had consultants working with them this year, and we are expecting a report within the next couple of weeks on that. The other two boards right now are the Avalon, which is still having to struggle, and Western, of course. These are the boards that are having the - so the emphasis right now is to work closely with them to help them. Western has - in recent days there has been some indication that, in fact, they may be coming to us and looking for some assistance again in terms of what we have done with other boards in finding someone to come in and work with them and help them try to see where some efficiencies may be realized. We do not have a request yet to that effect.

MR. THOMPSON: Actually, we do, so we need to go back and forth with them to work out just the way that it will occur.

MR. SMITH: What do you anticipate their deficit to have been -

MR. THOMPSON: March 31.

MS BREWER: (Inaudible) Health Care Corporation? The latest number they have given us is around $700,000.

MR. THOMPSON: Seven hundred thousand.

MR. SMITH: Even if the boards were still in a deficit position, I think they have done a commendable job in grappling with it. All boards have made some major strides and have made some difficult decisions in terms of trying to deal with it. We do not suggest that it has been easy for the boards. They have certainly done a remarkable job. You say yourself, the fact that we are seeing - the debt load is declining. We are actually seeing, for the first time in a long time, that we are starting to move in the right direction. We still have a ways to go but we are certainly starting to move in the right direction.

MR. ROSS WISEMAN: Minister, I am looking at a document here that was on the Health Board Association Web site. It was a presentation that they made to your colleague, the Minister of Finance and President of Treasury Board, in February as a part of the pre-Budget consultations. There are a bunch of headings in here and they have addressed a number of different issues.

On the issue of funding, just let me read this, it said: There are two funding issues which will inhibit the implementation of the Strategic Health Plan if not addressed: health board deficits and the lack of a strategic funding model.

If this is - and I assume it is - the collective view of the health boards in the Province, and I gather from the rest of the document here, from reading it, there has been a fair bit of discussion with the department around developing some kind of a funding model different than you are doing now, how have you responded to the association on these two points?

MR. SMITH: Again, I guess, from our perspective, certainly we work closely with the boards. Obviously, these are the people who are delivering the services and these are the ones who are meeting the challenges.

In terms of the funding models, there are number of specific issues that we deal with them on a regular basis, and some of these we are pursuing on an ongoing basis. The particular document that you referenced, I am not familiar with. I have not seen the actual presentation, but I would assume there would have been discussions that would have been held with Robert and the boards and CEOs, so I will ask him if he wants to speak to that.

MR. THOMPSON: On the point of the accumulated deficit, and the extent to whether or not that inhibits their ability to help address the issues on the Strategic Health Plan, I am not sure we can agree with them, that this is exactly the right way to phrase it, because over the last number of years as their deficit situations grew we provided supplemental funding that allowed them a big enough budget to deal with the interest costs of carrying their accumulated deficit. So at least we provided them with enough funding to remain stable.

Certain boards, too, which were mentioned, might continue to have an accumulating deficit where the interest costs are getting larger, but for almost all boards, and for some of them that are going in the other direction now, their financial flexibility is getting better. It is a variable situation across the Province by board; so, as a generic statement, we take some issue with that.

As the situation gets better, for most boards, without us even providing a higher grant, they will have more financial flexibility than they have now because their interest costs will be reduced. Of course, they do need to find a component within their budget to pay back those deficits, so we will continue to work with individual boards on how that can be sourced.

It is a more complicated area than just this. On the strategic funding model in this Province, it is a very complicated matter to come up with a different funding model than the one we have now, because while the boards' association are saying: If you provided funding based on age, sex, demographic profile, as well as the number of people that come through our institutions, and maybe some of their health characteristics, then you would truly be matching funding with the need that is already there.

We find, every time we tackle this problem, that every region is so unique and has such unique needs that the effort that needs to go into measuring the uniqueness of each region, whether it be because of small populations or aboriginal populations or urban-tertiary care needs, that the formulas become so complicated that they actually get in the way of making clear decisions.

I am just trying to give you a flavour for the complexity of it. We can move on many of the elements in the Strategic Health Plan without having this one single issue resolved. All of the twenty or thirty elements of the Strategic Health Plan do not require a revised funding model. We think we can always improve the funding model, but it is not a one-to-one relationship.

MR. ROSS WISEMAN: The other part of this document, Minister, in the conclusion the board goes on to say: We do caution that health boards may need bridge funding to bring about certain changes in the system and hope this will be forthcoming if required.

I guess as we move into some of these new initiatives in a wellness model, there is a transition. The document seems to suggest that there is a transition needed and that transition funding has to be provided to the institutional boards to keep that side going while you are reinvesting money in the wellness model in new directions, (inaudible) just pulling the rug out from underneath them.

MR. SMITH: That is a very valid point. It is a challenge. In times of tight budgets, while we want to really emphasis and underline the wellness piece of our strategy, trying to find the additional resources to dedicate to that, we acknowledge, is difficult. In time, and we are talking long term here, we would hope to see a significant shift from the acute side to the wellness side. Obviously that is long term, because the idea of wanting to focus on the wellness is that over time we would see less and less need, and when people's health had improved, by making that strategic investment, then we would hope in time we would see dividends because it would require a smaller investment on the other side.

Again, it is long term and it is a challenge for us right now in finding the resource. We have in this year - what is our commitment to the wellness piece in the Budget?

WITNESS: (Inaudible) new initiatives $1.1 million.

MR. SMITH: Are there other pieces now in the wellness initiatives?

WITNESS: (Inaudible).

MR. SMITH: Again, very small amounts because the challenge is in terms of trying to find those monies, and for the boards as well. In difficult times, it will be difficult to make that transition, as you referenced. It is going to take us time to get there but, in the meantime, we are moving in that direction and emphasizing the importance of the wellness piece. I guess, from our perspective, the committee we have in place in developing specific initiatives, as these come forward then certainly we will have to find the necessary resources to implement these new initiatives as they are identified and brought forward.

MR. ROSS WISEMAN: Minister, now that I am on this report, I might as well deal with some of the other points that are in here. One of them talks about accountability. Let me just read you this statement: Health boards are particularly concerned with the need for standards and benchmarks for wait times. It is clear that consistently applied provincial standards and guidelines are essential to evidence-based practice leading to the most effective use of health services.

The wait times is an issue. Our office gets, on a regular basis, calls from people who are waiting for months and months for MRIs or for some diagnostic tests. There is a range of things that I have found. Let me just share a couple of examples. When I read this in this report, it stood out for me as being a - obviously they have recognized that we need to address this issue. Let me give you an example.

If you were to call the Cancer Centre to get some information about wait times, you get a bunch of different answers depending on how you qualify your question. If you call looking for - someone who needed to be referred to a cardiologist recently, who needed an appointment with the Cath Lab, the requisition went in and sat on someone's desk until that person was able to actually identify a date. You key them into the system when you can identify a date. So, the date that the requisition is received in the hospital is today. In four weeks' time someone calls and says: Can I find out when my appointment is? They cannot tell them because they are not in the system. The reason they are not in the system is, the person keying it in did not do it until they were able to give them a date. When you then ask the Health Sciences for their wait times, they will go in, if they look electronically, they will tell you: Well, we entered this person today, they have an in appointment six weeks' time, so there is a six week wait. What they do not tell you is that the requisition sat there for four weeks before it got keyed in.

MR. SMITH: I am not familiar with that.

MR. ROSS WISEMAN: There is a range of things, I just use that to illustrate an example, not to talk about these (inaudible) -

MR. SMITH: I understand.

MR. ROSS WISEMAN: - but to talk about the whole issue of developing a set of standards for measuring wait times, because every institution that I have called inquiring about appointments for people, I have had to qualify my question. When I get an answer, I have to qualify the answer they have given me because, if not, I will not understand what the status is when I hang up.

MR. SMITH: It is a very important issue. The particular nuance that you referenced I am not familiar with but I certainly get the point.

Certainly, wait lists are a concern for all of us in all areas and we have tried to move in some specific areas to make the intervention. On the diagnostic side, we have certainly put emphasis on increasing the expenditure of some diagnostic equipment. I was talking to the staff (inaudible) not long ago, the CAT Scan was the piece of equipment that people wanted. Now we have that pretty well right throughout the Province and you do not have to wait. Now it is the MRI. We are moving to the MRI. By the time we get caught up in MRI, I guess it will be the next piece of technology that comes along.

Unfortunately, as people who work within the system know and tell me, just because a new technology does not come along it does not necessarily mean that the old piece becomes obsolete and there is a trade-off, that it just builds one on the other.

One of the specific areas that comes to mind, and we hear a lot of in this Province, is the area of cardiac surgery. We do have a very high incidence of the disease in the Province. We have made a concerted effort in recent years to increase the number of interventions. The number of cardiac surgeries has grown year over year, but yet the wait list is still long. There are plans to - I think the difficulty right now is the shortage of anaesthesiologists. I think once that is done we will be able to increase the number still further, but to eliminate the wait list or to bring them down to a manageable level is certainly challenging. I guess the only thing is, in terms of the wait list as well - if I could continue on for just a second on that - especially in the areas like cardiac, again, where you have to depend on the professionals who work within the system to make sure that the people who are most in need of the service are moving to the top and not just a matter of waiting your turn in the queue, sort of thing. I think that does work. Certainly, we are all concerned about wait lists and we want to try to reduce them as much as we can.

MR. ROSS WISEMAN: Minister, what about the recommendations and suggestions of the board there? There are no standards in place for developing what should be a standard wait time for certain procedures. In fact, having a mechanism - you mentioned cardiac surgery. I went in on a Web site the other day, Ontario, and they have - I can go in today and find out when I can get my next appointment, in half a dozen hospitals, if I want cardiac surgery in Ontario. It is on the Web site. They will tell you when your next (inaudible). If I am a physician, I assume, and I want to refer someone to send them to Ontario I can just go in on the Web site, scan which one I can get into first, call that hospital and get my patient in there if they want to go to Ontario, because it is on the Web site. They monitor. It was a critical issue for them. They needed to have a mechanism in place to have a handle on where they are going with it. I guess that is what they are suggesting here in this report, that in the Province we need to have established some kind of mechanism to get a handle on what it is we have out there.

I remember a few years ago the issue about wait lists to get into nursing homes. They said there were 2,000 people on it. What they found were 1,000 people, but they were on fifteen different lists. Until that got tidied up with a single entry, you did not know exactly what you had going for you. The same thing happens now with these wait lists for all kinds of things that you are getting done. It is a real problem. I think, Minister, especially as you move forward with expanding the use of technology - I will not say it is simple, but it is much easier with the penetration of computer technology that exists in facilities today to be able to do this. I think it is something that is really worth giving some consideration to so that we can get a handle on what we really have out there.

MR. SMITH: It is certainly something that has been talked about. It is a very valid observation and we certainly had discussions around it. In fact, it is something that has been pursued at the national level. I think even as part of the most recent negotiations, there are actually discussions at looking at the national norms. It is certainly a concern for everyone. I think it is a valid observation.

MR. ROSS WISEMAN: There is one other area, Minister, and maybe you can give us an update. I remember last year when we sat here there was a section in your budget that dealt with - where you were talking about putting $800,000 into the expansion at the Waterford. Maybe you can - before I ask my question, what is the status of that project now? Is that done, by the way?

MR. SMITH: I think it must be pretty well near completion right now. Who has the information on that?

MS CHARD: I am not quite sure of the finish date but I know they are working through that process. They are not quite ready yet but it is moving along. I cannot be more definitive than that. I can get a projected date for you and let you know.

MR. ROSS WISEMAN: I guess the most recent inquiry of the two incidents we had with the RCMP and the RNC has really heightened an awareness in the Province around the lack of mental health services. I just read from your last year's budget document where it says: government is awaiting the results of a review of mental health services which will assist in identifying future priorities. That was last year in March this time. When you released your strategic plan in September you had a similar phrase in there about: recognize the need to have a strategic plan or some kind of plan. I forget the phrase now but you acknowledged that it was an area which needed some attention and you need to develop a strategy and a plan.

Then the Speech from the Throne just recently, a similar kind of comment. The government "... recognizes that a new strategy is needed in the area of mental health. It is the lack of community-based services that is most obvious. My Government will formulate a mental health strategy leading to a more comprehensive set of mental health services." I guess what I just read from the Speech from the Throne is not unlike a statement that was included in the Budget document twelve months ago. So I am assuming that you were awaiting it last year. I guess the question now is: Do you have it? The Budget itself, when I look in here, I do not see where you have made any provision for the implementation of any kind of major initiative in dealing with mental health services.

MR. SMITH: The work is ongoing. It is taking place on a number of fronts. One of which is a comprehensive review of all legislation related to mental health, because we recognize that there is a requirement to do an update there. Also, part of this is that you referenced the Reid and Power Inquiries. Obviously, the outcome of these inquiries and the reports which will be produced - we are waiting with some anticipation as well, because obviously we would expect that recommendations coming from both of these major inquiries, which are looking at all aspects of this, we feel will have a lot of information and a lot of implications for what we are considering. Those inquiries are well along and we expect will be concluded within this year. Certainly, we would want to look at incorporating into our work the recommendations and the outcome of those inquiries as well.

MR. ROSS WISEMAN: The study that you referenced in last year's budget, has that concluded?

MR. SMITH: No, we are still working within the department and working on all aspects of that.

MR. ROSS WISEMAN: We had a consultant doing it. Was it Goss Gilroy who did the study of mental health services? Was there someone who looked at mental health services?

MS VIVIAN-BOOK: It was Colleen Hanrahan and her company - which was called the Institute for the Advancement of Public Policy, Inc. - who did that study. That was completed late this summer, early fall.

MR. ROSS WISEMAN: Is that a public document?

MS VIVIAN-BOOK: I do not think it has been officially released at this point in time but I know it has been shared within the system.

MADAM CHAIR: Excuse me. Could you repeat the name of the study again?

MS VIVIAN-BOOK: The study is: The Study of Community Mental Health Services in the Province, conducted by Colleen Hanrahan. I cannot repeat the firm she is with, the Institute for Advanced Public Policy.

WITNESS: The Institute for Advancement of Public Policy.

MS VIVIAN-BOOK: The Institute for Advancement of Public Policy.

MR. ROSS WISEMAN: I am familiar with the company.

MS VIVIAN-BOOK: The other study referred to, the Goss Gilroy study, was around cost drivers through the community health boards, the primary focus being the home support continuing care area.

MR. ROSS WISEMAN: I would be interested, Minister - you indicated that it has been shared within the system so I assume it has been shared. It is not a totally departmental confidential document. Is it possible that document could be made more public?

MR. SMITH: Again, I do not know of any reason why it should not be. There is nothing in there. I guess at this point in time it is information that we have been using as part of our work, and certainly we have shared with people who are working in that particular field. I have to say as well that our efforts have been closely co-ordinated with people who are actually working in that field from the people who are working as lobbyists and people who have special interest there. We work quite closely with them on developing a strategy, as you would be aware, because it does operate and impact on a number of different fronts. It is a fairly comprehensive thing, but certainly to the report itself we can look at it.

MR. ROSS WISEMAN: The reason I raised it and framed the question the way I did, which kind of gave, from my perspective at least, some historical reflection on comments that have come from your department, this is a major issue and I think for a number of years statements about it being an area that needs a lot of attention, not a lot of resources have gone into it, it is a challenge. It is not as simple as just opening clinics and that kind of thing. I understand all of that.

Minister, I think, given it is - and you have identified it in this year's budget document as being a priority along, with four or five other areas. There is a time when you can study, study and analyze but there reaches a point where someone needs to see some progress in moving forward with some action and implementation of some strategy so people have some sense that, it is going to take us a while to implement but I think we know where we are going. I think, from my vantage point at least today, we are not at that point where we say we know where we are going. We know we are going somewhere; we are not sure yet. We do not know where we are going, so we do not know how long it is going to take us to get there.

I think the community is really crying out -

MR. SMITH: No question.

MR. ROSS WISEMAN: - for some kind of a movement. Not an immediate solution but a sense that we are moving forward and we have some sense of where we are going.

I would encourage you to move quickly - not quickly just for the sake of doing it, but I think you have done a fair bit of study, a fair bit of analysis, and you must have some sense of some things that can start. The two inquiries that were just done, no doubt, will give you some information but I suspect that most of the information that is going to come from those inquiries is going to confirm for you what you already know. It will just be another document to show you that you were right. You probably do not need it to move forward.

MR. SMITH: The only thing is, I think you would concede, I think it would probably be considered right now in the context, especially with all the coverage that these enquiries have received, that if we were out there right now we would be seen as being kind of a bit premature in advance of that. This is why -

MR. ROSS WISEMAN: I guess I am suggesting to you, do not wait until the inquiries come out. We are not sure when that is going to be done. It depends on how quick it gets written up, and I think it is prudent to move very quickly, I believe.

MS CHARD: (Inaudible) when the short-stay unit at the Waterford would be projected to finish, it is this fall.

MR. ROSS WISEMAN: This fall?

MS CHARD: Yes.

MR. ROSS WISEMAN: Madam Chair, I am looking at the clock. I have monopolized a fair bit of time and I am cognizant of others in the room. There are some areas I wanted to cover off, but I obviously do not want to monopolize the whole evening.

MADAM CHAIR: Mr. Wiseman, feel free to finish because I think the intention tonight is to stay until everyone is satisfied that they have completed their questions.

MR. ROSS WISEMAN: I do not mind if my colleague wants to - while I have a drink of water to take a breath.

MADAM CHAIR: Okay, no problem. You need a little break.

Mr. Aylward, would you like to make a comment or do your questioning?

MR. K. AYLWARD: It is only short, though. It will be a short comment.

I just wanted to say, first off, that it is a difficult portfolio, his portfolio, but that the minister is doing a very good job, I think.

I want to say how pleased I am with the progress for the new hospital in Stephenville. It has been a little while, Mr. Minister, my colleague, but that facility now is looking very sharp and there are a lot of people very pleased in our area about the future there because of the fact they are getting out of the old American Base building and going into something that is more fit for these times when it comes to attracting medical staff and keeping medical staff, retaining medical staff, that whole effort. I believe that it is a significant development and I want to congratulate the people involved in the Department of Health who have been working on the project.

As you look around the Province, there has been a lot of new physical plant development in the last few years. Besides having the health professionals that we have, we also have to have adequate facilities to attract people, too, because that makes a big difference when you are trying to attract medical professionals.

I just wanted to add my thoughts on that. Also, again, I am very pleased to see the MRI, the new funding for the MRI. I think that is going to be a big help, again, dealing with a lot of people who are concerned about their health and wanting to make sure they have access to the technology, so I was very pleased to see that in the Budget. I will finish it there.

Thank you, Madam Chair.

MADAM CHAIR: Thank you, Mr. Aylward.

MR. SMITH: If I could just have a response, Madam Chair.

I think Kevin makes some interesting observations in terms of what a new facility like the one in Stephenville means on a lot of fronts, not just in terms entirely of what it - it certainly makes a big difference to the community. I think it makes a big difference to how people see their community and how they feel about the level of health care, but I think the point that was made also in terms of the recruitment and retention of health care providers, all too often people kind of overlook the importance that if you have good facilities - and Kevin would know, having been directly involved in helping recruit people to the area - when they do visit and you bring them down and take them around on a tour of what you have, if you are taking them through a nice modern facility, I think you have a better chance of convincing them that it is a place where they might want to stay and work.

The Town of Stephenville is a very progressive and prosperous town and has pretty well all the amenities that anyone would want to find anywhere. Now, with a nice modern hospital, I think it is going to make it a lot easier to convince these health care providers, these physicians, some of them who are in short supply, that when they visit Stephenville and take a look at the area, they will be convinced, after they visit the hospital, that it is a place where they will want to stay and work. We all too often, I think, kind of underestimate the importance of having a modern facility as it relates to that piece of it.

MADAM CHAIR: Thank you.

Are there any further comments, Mr. Butler, at this time?

MR. BUTLER: (Inaudible) questions, but I will see the minister tomorrow.

MADAM CHAIR: Ms Hodder.

MS M. HODDER: Well, I have some questions but I will hold them tonight because I am sure I can discuss them with the minister. There are a number of issues facing my district, as you are well aware from our last meeting down in the Burin Peninsula, because of our geography and the fact that we have to get off the Burin Peninsula during the wintertime. There is always a need for new equipment at our hospitals, and dialysis is a real concern in my district at the present time, a CT Scan, and, above all and everything else at the present time, of course, a personal care facility for the area. These are all of the issues that we will discuss again in the next few days.

I want to take the opportunity to sincerely thank the people in your department, all of your staff, for the co-operation we have always received with quick responses in every inquiry that I make to that department. I thank you sincerely.

MR. SMITH: Thank you, Mary.

Just let me say that on my visit down to your area awhile ago, on a visit to your wonderful hospital that you have in Burin, a beautiful facility, wonderful staff, we were very well received while we were there. One of the things, Madam Chair, that happened the day I visited the hospital and met a number of officials, we had a presentation by the foundation; they were announcing a new piece of equipment. Of course, they took advantage of the opportunity to put the plug in for the CT Scanner that they want, as they should, because of the points Mary was just making, because the Burin Peninsula Hospital can make a very valid argument for a lot of these services, especially this last winter.

They were telling me when I was down there that, because of the severity of the winter that we had, there were times that it was not possible to get to Clarenville to avail of some of these services. The Peninsula was actually cut off for days; there was no way out of there. You could not fly and there was absolutely no way to get off the Peninsula.

The thing that struck me from being down there and visiting the hospital was the commitment of the people. I think we see this everywhere. I know in our own area, in Stephenville - Kevin, with the foundation out there - the amount of interest that people take in health care facilities and their commitment to get out and raise funds for any number of causes - they said to me that day, and if I was in a position to commit, they were prepared that day to commit to fund raise for the CAT scan. They said that to me that day. It is certainly a credit to the people in these areas, and it speaks to the level of support and concern that they have with regard to health care generally.

MS M. HODDER: Every time there has been a piece of equipment needed - and when the economy was at its worst on the Burin Peninsula, when the shipyard was down, and the fish plant workers were not working - one particular time everything was down - that was when we were raising funds for the mammography equipment. The Kinsmen commited $25,000, I think it was at the time, and they did a radiothon hoping they would get $5,000 in the afternoon. They actually realized $52,000. So everyone gives until it hurts when there is funding needed.

We have a lot of other things. My own family were involved for years in the Labatt's 24-Hour Relay. Everyone comes out and does whatever possibly can be done. I know we had our own teams. I think we came in second just about every year in our fundraising. It is just a whole community spirit there. We do have a fine facility there and a great staff all the way around. I visit it quite often and certainly there is always a very friendly atmosphere about the hospital.

We have been fortunate over the last couple of years in getting the mammography equipment, a bone density and the digital X-ray; and quite a few renovations to the hospital and a few other equipments. Of course, there is always a need for others. We always see that if we had a certain piece of equipment it could mean whether somebody lived or died in trying to get to St. John's, because there have been times when we had as much as five days when we were completely isolated and could not get through to the rest of the Province.

MADAM CHAIR: I was noting as you were talking about the bad weather on the Burin Peninsula, how terrible it has been all year. Even according to the news today the poor fish cannot even survive out in the ocean it is so cold.

Mr. Butler.

MR. BUTLER: I said I would wait until tomorrow, Minister, but I think I will ask you those few questions. It is just as well.

One of them is a followup to my colleague from Harbour Main-Whitbourne when it comes to the dialysis system that the people out our way are putting their proposal in for. I just wanted to ask, the study that is supposed to be coming back within the new several weeks, like you said: Will that group, who are doing the study, have the information that has been compiled from that area, or was most of their work done provincially before this came forward?

MR. SMITH: I will speak first and then I will ask Loretta to get into some specifics.

The committee was mandated to look at the whole Island, the whole situation. My expectation is that when they come back they will provide us with specific information on the sites in Clarenville and Stephenville, as to how well they function, because these are the kinds of models that we are looking at. Beyond that, will identify sites within the Province where we need to look at for the establishment of that service.

I will stop there and let Loretta maybe give us a little more detail.

MS CHARD: Mr. Butler, the numbers, I guess, is what you are alluding to and where the patients are tracking?

MR. BUTLER: Yes, I was wondering if they would have that information?

MS CHARD: Yes they would because the doctor who is heading that up, Dr. Brendan Barrett, is a nephrologist at the Health Care Corporation of St. John's. Almost every patient in this Province they have a knowledge of and can track where they are. So, yes.

MR. BUTLER: The other question, Madam Chair, to the minister or some other official. Just this past week I had a meeting with the Trinity Conception Employment Corporation. This is tied to another department but it interlocks with health and community services in the area, where there are several people out there with various disabilities and throughout the year they come up with terms of employment with different businesses out there and they have to have supports with them.

I know that is all outside of your jurisdiction, but where it overlaps - and I think I am saying this right, now I could be wrong - like there are people who have respite care and leave and go to work probably for two, three, four months and it is to the point now apparently that when they take up those positions, their short-term employment positions, well their respite then is discontinued apparently - however the funding goes. Some of them are saying: Well, it is not worth my while to go out. Even though they want to go out and mingle with the other people in the communities and the workplaces, when they come back they have to wait this long period of time to see if they are going to be considered for respite. Some were saying maybe the funding might not be there at that time.

I was just wondering, has it been a concern before? Because the first I heard of it was this past week. I am wondering, is there any way around that to alleviate this concern for these people so they can go out and go to work?

MS VIVIAN-BOOK: I do not know specifically, sir, but I can track it down. I do know that there is a direct link between a person with a disability that is to work as well as the support they need at home. The two pieces have to go hand in hand.

The eligibility for respite and getting back on the system, that may very well be an issue right now within our emergency home support criteria and the processes that are happening which are going on right now. I also know there has been a limitation on the funding through HRE for that program. Some people who may have an opportunity for x-amount of weeks, turns out they only get a smaller number of weeks, that is then translated into an issue in community services. I think you are right, that there is an issue, and it is on both sides.

We have an unfortunate situation now on the West Coast with a strike situation with another employment agency. We are feeling direct impacts of that strike situation to the tune of about $10,000 a week, additional supports for those individuals who would be working. There are two pieces of it and there could very well be issues for us.

MR. BUTLER: Thank you.

MADAM CHAIR: Mr. Wiseman, do you wish to resume your questioning?

MR. ROSS WISEMAN: Thank you, Madam Chair. I will not be much longer.

Minister, I want to talk a little bit about the issues around Human Resource Planning. I understand there is a provincial committee. The committee has been operating for a while, I understand, but I have not seen anything in terms of - and I have asked several different sources in terms of the strategy that the Province has. Does it have some sense of what its recruitment needs will be in the next two, three or five years, or where we are today and where we are going with that?

This Human Resource Planning Committee that exists, I recognize it changes, but do you have any kind of - have you produced something, or have they produced something that gives us a sense, and can give the Province a sense of where we think we are now and what our needs are going to be over the next three, five to ten years?

MR. SMITH: We are certainly focused on that. As you indicated, we obviously had to be because we have to have some sense as to where we are headed. I guess in certain areas we have already started to implement some actions to deal with that.

Who has the specifics on that?

MR. THOMPSON: The Human Resource Planning Committee is currently in the windup phase, very close to the end of the planning process. In fact, they are putting the final touches on their final report which will roll together all of the bits and pieces of the various occupations and some of the other issues that they have looked at. Then what we are going to do is move to a phase where we institutionalize a capacity in the department on an ongoing basis to update and keep fresh the models and the learnings that we have up to now.

One of the early outputs of the planning process was the determination that we needed to expand nursing education. So there was a decision last year on that. Now, we are just about ready - or the committee is I should say, and I will get Donna to comment on - to say things about more occupation. Now, not every occupation faces a shortage situation or a needs measures; some do.

Donna, can you describe further where we are with that?

MS BREWER: Sure. There have been a number of reports. As reports are produced individually they are vetted through the department and through the system. They are actually available on the Web site of the Newfoundland and Labrador Health Boards Association.

Robert is correct, we are in the windup stage. We had hoped to have a final report to the ministry by the end of March. We actually need a little bit more time. We are hoping now, some time this month, to actually complete our forecasting analysis. It is basically a supply forecast for a number of professions and that should be available to the system and to the ministry within the next month. But Robert is correct; one thing we did learn when we started out back in 1999 we were told to assume a status quo system, and whatever human resource needs you have, and basically do the supply forecasting.

Right now today with the Strategic Health Plan we know that the system we have today is not going to be the system that we are going to have in the next three to five years, so there is a need to sustain that planning to continue to monitor.

I think we will find that in most cases our educational programs are sufficient to cover the normal turnover and the normal retirements. The one concern is, and still remains, nursing. On a national level, we have a Canadian Nursing Advisory Committee and one of the final pieces of the committee again is looking at that Nursing Advisory Committee and coming back to the minister with recommendations as to action plans specifically around nursing.

One piece you will not see done is the physicians. About two years ago, they walked away from that process. As a result of the past year, in terms of the physician and the negotiation, their priority was on that process. One of the outcomes of the physician withdrawal was the establishment of a Physician Services Liaison Committee with the department, and one of the priorities for that committee would be human resource planning specifically for physicians. Once this committee winds down its work, it will be working in concert with Dr. Hunt and his staff to start looking in earnest at the physician in more detail.

MR. ROSS WISEMAN: There are a few points I want to raise on the physician one, but before I do, on the nursing issue, Minister, I posed a question to your colleague this morning on post-secondary education with respect to an isolated request from Lawrence College, from an Ontario-based outfit, who wants to come to Newfoundland and set up shop in Grand Falls for thirteen months, and they are prepared to acknowledge the educational credits of LPNs, put them through a thirteen-month program, and give them a diploma in nursing when they are through.

I understand, from some of the information I got this morning, there was some pressure to fast-track the decision-making process. There are a whole range of questions that pop in my head when I see that. Some initial reactions sound good, but when you start to look at it there are a whole bunch of things that obviously we need to be very concerned about.

I guess I asked you the question about where you are with the decision, but I also make the comment that I think there is some caution that needs to be exercised in evaluating that request from your perspective as a health department much more so than maybe the post-secondary people who may want to give consideration to it, because it has a greater impact on you people.

Do you have it across your desk?

MS BREWER: Loretta may know, but Regina Coady is working with the Department of Education looking at that issue and she is doing some analysis. I am not sure if she has made some recommendations.

MS CHARD: No, I think they are still, as you referred to, Mr. Wiseman, whittling away at the undercurrents of all this, because what looks simple on the surface does not necessarily fly. We have brought together with Youth Services Department and the ARNN. There are some issues around licensing and who has the jurisdiction for approving educational programs. Traditionally, that is with the Association of Registered Nurses, but Lawrence College will say that they do not need to be registered here, they are just an arm of the program.

MR. ROSS WISEMAN: That is right.

MS CHARD: All of those issues are being discussed.

MR. ROSS WISEMAN: Actually, I was a little bit startled when I got the information this morning because I understood that it was in process, going to happen, all it needed to do was be sanctioned and signed off by your colleague in another department.

MS CHARD: Right.

MR. ROSS WISEMAN: When I heard the information about it, I guess - I am glad you are giving it the due diligence that it requires.

On the issue of the physician piece, Minister, over the last year or so I have had occasion to make a number of inquiries about vacancies and what we are recruiting and what we are not recruiting and where we need people. Your assistant mentioned the Web site of the health association. If you go in on that and look at the number of vacancies and you start calling around to different boards you get different information. The information on that, I do not believe to be very accurate. At least my experience tells me that it is not very accurate and, depending on what board you talk to - and I understand from those people themselves, who have told me as recently as last week, their information is only as reliable as what the board gives them. If the boards choose not to give them information, they will not be reliable. So what you are seeing on that Web site, I suggest to you, is probably never accurate because boards do not feed the information in because some boards are functioning independent of that group and counter to that group as well.

Minister, this whole issue of physician vacancies, and there are a couple of things that have surfaced as I have been making some inquiries, one observation that I just shared with you. The second is there are number of - when I asked the board about the number of approved positions that are not filled, one of the answers that I have gotten several times is that there was a physician in this position a year or two ago, it is vacant, we could not recruit for a year, and now the budget is gone for the position so the position is no longer considered a funded position and is vacant. So if they had someone walk through the door tomorrow and said, can I start working here, they would hire them but yet there is no vacancy in the position. So when you look at the number of vacancies, you take those two things that I just shared with you now and it is difficult to get a handle on what you are looking at in vacancies out there.

Are you any closer to having a better sense of the number of vacant positions that exist today and whether it is family practice or various speciality areas? A part of that question as you answer that one, I wonder if you could, because it is going to be one of the other points that I was going to raise with respect to your strategic plan when you start talking about location of service and access to service, and no doubt you are thinking a little bit about that particular piece of your strategy, are you able to share with us now where you see us as a Province in terms of the current shortage of physicians in various regions of the Province?

MR. SMITH: Just a brief general comment first of all and then I will ask Dr. Hunt probably to provide us with a little more detail.

Certainly we acknowledge that this is an ongoing challenge for us. Traditionally, we have done well, my understanding is, and for my discussions with the officials on the money recruitment side, but certainly retention is always a challenge that I guess the upside to the arbitration that will be coming down pretty soon is that the compensation package to all physicians in the Province should situate us in a better position to recruit and retain physicians in all of the speciality areas. As to the specifics, I will ask Ed if he can provide a little more detail on that?

DR. HUNT: There are two groups of doctors in the Province, fee-for-service doctors who have the right to set up a practice anywhere they wish under the current structure. There is no way that we can say there is a vacant position or no vacant position in many cases because they are independent.

We have a number of salary doctors. When we talk about vacancies we are generally talking about the salaried physicians. When we have a resource plan in place, hopefully we will be able to count both the fee-for-service and the salaried doctors if we can define how many we need in an area. That job is not done yet.

The salaried doctors, about one-third of them in the Province, we do have a list of positions. There are two types of positions, one of those which are funded and one which are unfunded. The unfunded positions are those positions where traditionally there was a doctor and now, for one reason or another, the physicians who are there prefer not to bring another doctor in but using that current position to receive additional funds through which we call additional workload. In other words, there is not enough work there for the extra doctor or there is a little bit too much for the person who is there so they get paid extra to do that extra work.

The other positions that are funded - the whole salary budget is not a fully funded budget. Quite often what happens is that if someone leaves for a year - there is no money spent there - that money is then used to pay for a position that was vacant last year when now there is a position hired this year, a doctor came in. So money is shifted around to try and make sure that whenever a doctor comes in that person is funded. It does not mean that because a person, a position, was funded a year ago and is not funded now, would not be funded. All it means is that the board would have to come forward and make a request for the funding so that we can actually shift it around to accommodate that.

MR. ROSS WISEMAN: It is only the airlines overbooking.

DR. HUNT: Pretty well.

MR. ROSS WISEMAN: Assuming (inaudible) is not going to show up.

DR. HUNT: Yes.

MR. ROSS WISEMAN: Thank you.

Do we have a handle on physician turnover? Because that was one of the issues which got a lot of publicity during that disruption with the physician turnover. I know, minister, yourself and your colleague from Treasury Board were of the view that we have not had much turnover. As you said earlier, we have been successful in recruiting and we have not had a lot of turnover. The medical association had obviously a very different view. Do we have some sense, statistically, of what the turnover rates are in the Province?

DR. HUNT: These are not formal figures but roughly, in the past three years, we have had a turnover of about 100 physicians per year in total. That is about 10 per cent, and that is a very crude figure because we do not track those statistics. We have no means for doing that; but we have done it, at some point in time, throughout the last three years.

MR. ROSS WISEMAN: Are you any closer to - you might have answered a moment ago Dr. Hunt when you said you have not defined yet where you would need the numbers of physicians and what areas. Have you done much with the model that you proposed in your strategic plan in terms of access to service?

DR. HUNT: That would be a question, I think, for Robert or the minister.

MR. SMITH: Ross, are you referring to the secondary and tertiary levels of service?

MR. ROSS WISEMAN: Yes, location of services.

MR. SMITH: Obviously, that is still something that we are going to have to do. We are no where near - right now we are on the - initially, what we are looking at right now is the primary care. That is our initial emphasis in looking at developing the (inaudible). We are further along with that piece right now. As a matter of fact, Ed tells me that his committee is making great progress there. I guess the encouraging thing is that we are getting a great deal of interest being expressed from various regions of the Province interested in pursuing that new model. That, for us right now, is clearly a number one priority for us. I guess the location of the secondary service is an important piece, but right now the primary care is a bigger concern for us.

MR. ROSS WISEMAN: Do you have a proposal in now, either from a physician group or health board to implement that model anywhere?

MR. SMITH: I am sorry, I did not hear that.

MR. ROSS WISEMAN: Do you have a request in, as of now? Do you have any request in either from a physician group or health board to establish that kind of (inaudible) theme concept that you were talking about? Do you have any proposals like this now?

MR. SMITH: Yes, we do. I will ask Ed to speak on it because he is doing the lead work on this. I will ask him to give us some details where his work is right now.

DR. HUNT: The office department health care is fully staffed right now. This past winter it actually developed a discussion paper to try to get some sense around the Province as to where we should go, what kind of model, and so on. It has gone around the Province and had a discussion with over 500 stakeholders and people in the Province, with a very good response rate. During that same exercise, people were asked to send us letters to express their interest in primary health care models, with a request for the proposal development.

The framework itself is pretty well nearing completion. We are trying to iron out a few bugs right now, but that is almost done. To date we have had about twenty different letters of intent from practically all regions of the Province, so the interest is quite high. Our next stage now will be to select some of these to help in developing the proposals and then to move on from that and hopefully develop the projects.

MR. ROSS WISEMAN: One other area that my colleague from Harbour Main talked a little bit about and I just want to touch on it a bit, is road ambulance services. I understand there is a group of Treasury Board people, or a couple of Treasury Board people, travelling around the Province now doing an evaluation of ambulance operations. Obviously, a part of some kind of evaluation they are doing is a piece of the negotiations.

I am not going to ask you what you are talking about in the negotiations, or how much you are going to be budgeting for that, but the ambulance service - some of the discussions that I have had with some operators, the phrase that gets used is: We are trying to define a model for ambulance operations in this Province akin to what exists in Nova Scotia and New Brunswick. We are trying to do it on a shoestring budget, and it is not going to work.

Forgetting the dollars for a moment, does the department have a sense of the model it wants to have for road ambulance service in the Province? We have a mix now of community-based services, and we have some private operators, and we have some that are hospital-based.

MR. SMITH: First of all, I was just asking Robert about your reference to the Treasury Board. From what Robert tells me, these are officials who were actually involved in the negotiations, who are just going around just to kind to get a sense for the industry itself. They know very little about it, they are travelling around just to give them some feel for it.

MR. ROSS WISEMAN: Probably not good people to be at the table negotiating either, obviously.

MR. SMITH: In terms of the model, I guess, right now the system that we have in the Province, while it does at times run into some problems, overall it is functioning very well. As I said, I have met with all of the groups during the course of the year, with some of them on several occasions. It is an area that I do have some interest in, because prior to getting into politics I was involved in establishing a community ambulance operation in my own town so I have a sense of the importance of the service and I also have a sense of what it takes to do this.

If I could just speak to that piece alone first, we do understand that when you are talking about community-based, you are talking primarily volunteers. That itself brings with it some challenges. We do know that in some areas of the Province this type of approach functions better than others.

During this round of negotiations, I am sure that there will be opportunities again to discuss the pros and cons as to how the service is delivered. I know in areas where community ambulance services have sprung up it has been because there has been insufficient volumes to attract private operators. It is just a pure business decision. They cannot go in there because there is not enough money to sustain it.

I guess whether we could, at this stage in our history, find the resources to go totally, first of all, to the point where we could privatize the whole service and put sufficient monies there to support and sustain all of these and also, if we can, in this round find sufficient monies to meet all of the needs and demands that have been brought forward by the groups, I would say to you that it is going to be a challenge.

I guess for us, what we are hoping to do is certainly to continue to move the agenda forward. I think we made considerable progress the last time around, while in certain quarters there are some differing opinions on that. I think in the main, overall, from what I have seen in the time that I have been with the department and taking an interest in that particular service and having a look at it, I think we have made some tremendous gains. I think if we continue to move along that road, continue to improve the training levels of the people who are providing the service, recognizing that as well as a consequence of that we have to look at a compensation package - because one point that I made earlier in response to Tom's question was, there is no point in training them if we are just training them to lose them to go on somewhere else. We acknowledge that is a challenge and hopefully it is something that we will be able to address partway in this round of negotiations. Again, I would not want to leave the impression that we expect to be able to solve all the problems this time around but we certainly recognize there are some of them that we have to deal with in this round of negotiations.

MR. ROSS WISEMAN: I agree with your comment about the improvements. The direction that you are headed with increasing the standards and establishing a standard that provides a sense of safety and security for the general public is an appropriate direction. The funding issue is an issue that you are discussing, and we will not get into that negotiation process but I encourage you to continue to work from a base of standards.

MR. SMITH: We acknowledge that because again, we recognize that these are the first responders and this is an important service.

MR. ROSS WISEMAN: There are just two other areas, Madam Chair, and I will conclude if you do not mind.

WITNESS: She is gone anyway.

MR. ROSS WISEMAN: She is gone anyway. I can take all the time I want now. I have no one controlling me.

Addiction services; I guess there are some of these program areas that when Health and Human Resources made some changes a few years ago - I know it is not broken out separately under the community health budgets, but I am just wondering if you can, minister or your staff, speak to the investment you are making in addiction counselling, and how you are making those services available throughout the communities because obviously that is a community based program?

I have had some experiences in the last twelve months, particularly, and some of the stuff does not necessarily come out of my district but in my role as a health critic it ends up on my desk. What has become very apparent is the lack of supports once you get outside of St. John's. That can be said for a lot of the areas, I am sure, but it is a real issue. To be frank and honest with you, it has only been in the last year that I have had an appreciation for that service and some of the challenges associated with addictions and the difficulties in getting access to resources. As a part of the wellness strategy and the issues around (inaudible) will be highlighted in your social audit; you know, the well-being of communities. This becomes a significant piece of that, or one of the pieces of that.

Can you tell us a bit about some initiatives and where you are going with any initiatives in addiction counselling?

MR. SMITH: I have just a general comment, and then I will ask one of the staff to provide you with some specifics.

I think you are right on in terms of the whole wellness piece. Again, this is an area of concern. One of the things that I see on the addiction side - you mentioned that once you move outside of St. John's. The other thing is, too, what becomes pretty apparent is that - depending on where you are in the Province, you will find it better developed in certain regions than in others. A lot of it is due to local initiatives that people have taken on. It has become an interest in a certain area. Local groups have provided the leadership and have given it their priority and, as a result, have been able to assemble and identify resources they have been able to address to that.

I am going to defer it to one of the staff.

MS VIVIAN-BOOK: I can provide some general overview, but I can get more specific information if you would like.

In terms of addictions, and the gambling area as well with additions, I know there are some additional support revenues that come from - for the addiction side for gambling. Some of that has gone into additional positions at Humberwood, in Corner Brook; some has gone into training; some has gone into expanding resources available to current workers. Some of the funding under the National Child Benefit for youth and residential services has gone into mental health and addictions' workers around youth. Also, some priority has been given in the prenatal area to additions, issues during pregnancy and additions, and the outcomes in that area. That is not to say there are not a lot of new other areas that we really need to strengthen in the area of addictions, but that has been some of the initiatives over the last little while. A lot has gone into some additional training, this year in particular, and updating on resources that had not been done in a while for staff.

MR. ROSS WISEMAN: What do you think the provincial budget would be?

MS VIVIAN-BOOK: Between $4 million and $5 million.

MR. ROSS WISEMAN: Between $4 million and $5 million across all the health boards?

MS VIVIAN-BOOK: Yes.

MR. ROSS WISEMAN: I looked at last year's budget and the general accounts and we are, as a Province, taking in almost $300 million from tobacco tax, dividends from the liquor commission and Atlantic Lottery. That does not include the tax we are getting on the liquor sales at liquor stores. That would put it up to probably $350 million or $375 million. If you look at the addiction treatment, these are the areas that we are treating.

If you are talking about $5 million to treat addictions that we are generating revenues from, about $350 million or $375 million a year, there is a disproportionate amount of the money going back into that, which raises a question, Minister, around public policy and across government departments.

Last year, as an example, I went into a liquor store in Clarenville and they were selling those rip-off tickets. Atlantic Lottery are putting those rip-off tickets on the counters in liquor stores because it is a revenue generator. I frequently find myself in schools in my district and they are still selling junk in their cafeterias. If you have chips and gravy and that kind of stuff being sold in our school cafeterias, and we have the Newfoundland and Labrador Liquor Commission, whose main purpose is to promote the sale of alcoholic beverage in the Province and distribute it in a regulatory way, deciding that they are going to go out and now enhance their revenue by selling lottery tickets in liquor stores, we generate that kind of revenue and we see the devastation that addictions are doing around the Province, there are some contradictions there that we need to reconcile.

I do not mean to be preachy on this issue now but it is a significant contradiction when we sit here and say that we want to spend the $350 million that we generate from those sources in health care and education and then we turn around and put a measly $5 million into the treatment of addictions, and then we let other government departments outside of Health, and agencies that get government funding or created by government, establish policies and practices that are contrary to what you are trying to do in your health promotion. Fundamentally there is something wrong with that.

MR. SMITH: Again, that is certainly a valid observation. Just a couple of comments with regard to it, when you referenced some of your experiences and you talk in terms of government policies. I guess one of the things that we have done over the years, governments generally have certainly encouraged things like good nutrition and good health practices.

I was really interested when you referenced visiting a school that showed evidence of the absence of a nutrition policy, which kind of surprises me. I have been out of the education system now for ten years. In my school, when I was there ten years ago, we had developed nutrition policies, and most things that would be considered junk food were not allowed in the school; nowhere near it.

Obviously what it says to me, I guess some of the agencies of government are probably not as committed as they might, because certain school boards - for example, one of the things in our own department that we have really been aggressive on is the anti-smoking. As a department, we have really gone after that as an issue of public policy.

In this Province, it was really schools that took the earliest lead in that. Years ago, schools were outlawing any smoking on their premises, so our school boards in the main have been very progressive. There have been a lot of agencies of government that have been very progressive.

You are right in saying that in certain area we do need to be conscious and cognizant of the fact that not everybody is committed to it. For example, just getting back to our own example of the smoking, we have been very aggressive in terms of dealing with it. We are at the stage now where we are being pressured to move our policies to the next level, which will be outlawing smoking in the bars and bingo halls. I have said to my crowd, I am probably willing to take on the bars, but I am not so sure about the bingo halls.

Obviously, that is where it is. It is a matter where very shortly we need to make those kinds of decisions because it is a matter of public health, and the things you referenced as well, because when you are talking addictions, if you are talking about nutrition, if you have a school where so-called junk foods or certainly foods that are not nutritious are available to children, I mean they are developing these kinds of habits that we do not want them to. These are believed to lead to lifelong habits of poor nutrition which will in turn, somewhere down the road, lead to poor health. So it is all part and parcel, and these are all things that we need to be aware of, as you said, in terms of developing public policy. Government does have to be aggressive and does have to be upfront in developing these things and taking the lead and making sure that we are pursuing proper practices in these areas.

MADAM CHAIR: Mr. Wiseman, do you have another question?

MR. WISEMAN: Just one other area, the coordination of services between Human Resources. With the transition that occurred in the mid-1990s there were some areas where there are some gaps, people are falling through the cracks. What is happening is that where HRE is a line department, if they are eligible for the benefit they get it. Health and Community Services are board operated. They are living within a budget. They are making decisions about benefits based on having the funding to do it. It is becoming a problem. A line department will respond and if you are eligible for the benefit you will get it. The board says: We do not have the money now, you are on a wait list. You are dealing with the same client, and that is a major problem for you.

MR. SMITH: Well, I am not going to deny that it is not. It is one of many that we have to grapple with. The only thing I can say with absolute certainty is that in our department there is never a day when you have to wonder about what problem you are going to deal with today; just wonder which one are you going to deal with first. Again, I think it is a valid observation. We get concerns of those natures expressed to us on a regular basis.

MR. WISEMAN: Thank you, Madam Chair, and I thank everybody for their patience.

The issues that I talked about, minister, it was not an issue of criticizing what you are doing or suggesting that it was inappropriate. It is just that I wanted to gain the insight and understand and share with you some of the issues that I think are important for you to give some consideration to. I thank you for your answers and your insight.

I thank you, Madam Chair, for your tolerance.

MADAM CHAIR: Thank you very much.

I want to thank everyone for their attendance tonight, and I have to say it has been a rather interesting evening. We did not have to sit and listen and go through with a ruler for all of these pages and pages of Estimates here.

Could we ask the Clerk to call the headings inclusively, please?

On motion, subheads 1.1.01 through 3.3.02 carried.

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

MR. SMITH: Thank you, Madam Chair, and thank you to the members of the committee.

MADAM CHAIR: Thank you all.

On motion, the Committee adjourned.