The Committee met at 5:30 p.m. in the House of Assembly.

CHAIR (Hutchings): Good evening, everybody.

My name is Keith Hutchings, MHA for the District of Ferryland and Chair of the Social Services Committee meeting this evening to hear the Estimates for Health and Community Services.

First off, just a couple of housekeeping duties here – or maybe first I will ask the Committee to introduce themselves, starting at my far right.

MR. PEACH: Calvin Peach, MHA, Bellevue.

MS SULLIVAN: Susan Sullivan, Grand Falls-Windsor-Buchans.

MR. CORNECT: Good evening, minister.

Tony Cornect, District of Port au Port.

MR. COLLINS: Felix Collins, Placentia & St. Mary's.

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

MS BUCKLE: Joy Buckle, researcher.

MS MICHAEL: Lorraine Michael, Signal Hill-Quidi Vidi.

CHAIR: Okay. I would ask for a motion from the Committee to approve the minutes of May 13, 2008, Department of Human Resources, Labour and Employment.

MS SULLIVAN: So moved.

On motion, minutes adopted as circulated.

CHAIR: The format we will use - which is, I think, agreeable to everybody. In a minute I will refer to the minister and he can take fifteen minutes for any opening comments. As well, I would ask that staff be introduced. I would also remind staff that when they are giving any information that they identify themselves each time, for the help of Hansard, before you speak. I guess that is it.

I will ask the Clerk to call the first subhead.

CLERK: 1.1.01.

CHAIR: Shall 1.1.01 carry?

I will turn it over to the minister.

MR. WISEMAN: Thank you, Mr. Chair.

Good evening, and welcome to this Estimates committee meeting. We are going to be talking about Health and Community Services and hopefully, by the time we are through, committee members will have an insight into some of the things that we are doing in the Department of Health and Community Services and some of the activities of our regional health authorities. Certainly, I do not need to remind people to feel free to ask questions.

Let me introduce my staff. To my left is the Deputy Minister, Don Keats; to his left we have Jim Strong, who is the Assistant Deputy Minister of Corporate Services; and then we have, starting at the back, Glenda Power, Director of Communications for the Department; Dr. Cathi Bradbury here, she is the Director of Physician Services; Joy Maddigan, who is the Assistant Deputy Minister of Policy and Planning; then Karen Legge, who is the Director of Financial Services. The empty chair - who is going to be joining us in a few moments - will be Moira Hennessey, who is the Assistant Deputy Minister for Regional Health Operations.

I just want to, Mr. Chair, if I could, make a couple of opening comments. I will not be very long. I will not take my full fifteen minutes, to allow more time for some questioning, but I think this year we - when the Minister of Finance brought down this year's budget, I think we once again saw some significant investments in our health budget. For four consecutive years in a row we have had significant increases in the Health and Community Services budget for the Province, now bringing the total budget for the department to $2.3 billion. In the last three years in particular, I think we have seen some record increases as a percentage over all.

In the last year, particularly, some of the things that we have enjoyed rolling out, that grew out of last year's budget, was the introduction of our new drug insurance program, the Healthy Ageing framework, our new mental health and addictions program. We have had some key investments in some health infrastructure, which has included long-term care facilities in Corner Brook, Clarenville and Happy Valley-Goose Bay; the provincial addictions centre in Corner Brook, which is now completed and they have recently moved in to. We have had dialysis service opened in Burin, in St. Anthony and in Happy Valley-Goose Bay. In fact, I think it was two weeks ago in Happy Valley-Goose Bay that service was launched there. All of these things rolled out as a result of last year's investments.

We put some $40 million last year into capital equipment throughout our health authorities. Last year saw us complete the re-registration process for MCP coverage for the Province. We made some significant investments in the Child, Youth and Family Services system last year; again, improvements in our medical transportation and assistance program, all growing out of last year's budget. A dental bursary introduced last year to give us a tool to be able to attract more dentists to the Province and to be able to expand our dental program, which, again, was an announcement last year in the expansion of the dental program for people between thirteen and seventeen years of age, families on low income.

We saw last year our Regional Health Authorities introduce a new eight-week graduate orientation program to support the nurses who are coming into the system. Last year, we saw also the proclamation of the new Mental Health Care and Treatment Act and the new Regional Health Authorities Act just recently proclaimed.

Last year, as well, we saw the continuation of some of the capital investments I alluded to earlier and we spent some $112 million. In Budget 2008, we are now providing for another $79.1 million investment in this year, as well as some $33.5 million to go into some high priority maintenance and repair areas. We have new facilities that we are going to be building coming up this year. We have identified a new infrastructure program, a new project for Corner Brook, a new hospital for the City of Corner Brook serving the West Coast area and the Northern Peninsula.

We are going to start planning for new acute care services in St. John's - not new acute care services but planning a new program review for acute care services in St. John's to look at the programs we provide, the facilities that we need to provide them on a go-forward basis; looking at replacing some of the long-term care facilities in St. John's with planning money to start this year. We are looking at renovations to the Central Newfoundland Health Facility in Grand Falls-Windsor, some planning money this year going out.

So, there are some significant changes in investments and infrastructure. I will not go through the long list of projects we are going to do this year but just to allude to some of the major ones that we are going to be undertaking. Throughout the evening, no doubt, we will explore some of the other ones.

The maintenance and repair budget; there has been a lot of discussion around the maintenance and repairs budgets for health authorities in recent years, and some questions around the current state of repair. This year we are investing $33.5 million to start to address some of those repairs that have been identified. Obviously, I need to be cognizant of the capacity the system has to be able to manage maintenance and repairs, the extents of maintenance and repairs while we are maintaining a level of service. There are certain logistical considerations. Obviously, as well, the human resource capacity within our authorities for people who are involved in facilities management to be able to manage such projects and see them through to their completion.

These are just some of the things, Mr. Chairman, of the kinds of things that we have been doing from a facilities and a budgetary investment. From the human resource side of things, we are looking at expansion of the medical school to facilitate an ability to enhance enrolments to make sure that we are able to attract Newfoundlanders and Labradorians to stay in the Province after graduation. We are doing the same thing with nursing, attracting new qualified nurses to stay in the Province, always an important issue for the Province. Expanding the School of Nursing is consistent with our thinking and ensuring that we have, not only educational opportunities available for Newfoundlanders and Labradorians but providing that kind of training for them will only, I think, support their desire to stay in the Province.

We are investing more money in enhancing home care programs. This year we will see, with some of the investments we are making, an ability to be able to expand some chemo programs within the community so people can stay at home to be able to receive that kind of care. Additional investments in home support services, so we are able to - some $10 million has been allocated this year to be able to expand home support services; another $6 million to be able to increase the salaries being paid to home support workers. A continuation of the investments we have made each and every year in the last four years, Mr. Chairman.

These are just some of the highlights of some of the things that, no doubt, we will explore a little bit throughout the evening but suffice to say that as a department, as a minister, I am extremely pleased with government's investment in health. As a Province, I think we should be pleased with the general direction we are headed with new initiatives. From a planning perspective, we are very much in the final stages of a strategy to deal with cancer. We are now involved in a strategy development looking at chronic disease management. We rolled out last year the Healthy Aging Framework. So we have been doing a significant amount of work in trying to map out what the future will look like. With the investments we are making as a government and the budgetary support we will have for those initiatives will give us the ability to be able to move forward with their implementation.

With that introduction and those few comments, I am now available for any questions.

Thank you.

CHAIR: Okay.

From the Committee, Ms Jones.

MS JONES: Thank you, Mr. Chairman.

Thank you, minister, for the overview of some of the investments in your department. As we go through the estimates, some of the questions I have may be relevant to some of that information that you have already provided, so I beg your indulgence in providing me with additional information around some of those initiatives. I certainly want to thank your officials for being here this evening as well.

Just a general question to start off with because the health budget has reached, no doubt, a record level in the Province in terms of investment and spending. Over the past ten years, what have been the increases in that budgeted amount year over year? I do not know if you have that information with you or not.

MR. WISEMAN: I do, yes. I have about a ten-year history here.

MS JONES: For some reason I thought you might have that at your fingertips.

MR. WISEMAN: You did, did you? Maybe you heard me allude to it earlier today.

Just going from the profile - I can share with you this evening, back in 1999-2000 for example, the department's budget at that particular point was $1.23 billion. I just commented earlier that we have now exceeded $2.3 billion today. So over that period there has been some significant growth.

MS JONES: Yes. Do you have the breakdown for the year over year? That is what I was wondering.

MR. WISEMAN: Oh yes, sure. Well, if you want me to walk you through sequentially, start to finish, the points I just raised with you, the two point dates I just raised. In 1999-2000, it was $1.232.4 billion; in 2000-2001, $1.317.1 billion; in 2001-2002, $1.478.6 billion; in 2002-2003, $1.534.1 billion; in 2003-2004, $1.662.7 billion; in 2004-2005 $1.665.3 billion; in 2005-2006, $1.786.0 billion; in 2006-2007, $1.888.9 billion, and 2007-2008, $2.161.4 billion. This year, the budget approved the other day brings us to $2.341.0 billion.

If you look at incremental increases that represents this year, the budget we are dealing with this evening represents an 8.3 per cent increase over last year. Last year represented a 14.4 per cent increase over the year before, and 2006-2007 represented a 5.8 per cent increase over the previous year. The year before that, in 2005-2006, there was a 7.2 per cent increase over that previous year. So in the last four years you can see some significant growth in health's budget.

MS JONES: Can I ask what the federal government contributions have been over those periods as well, the percentage of contribution of transfers?

MR. WISEMAN: I would have to get that for you. That is something we do not have with us this evening.

MS JONES: Okay. What about for this current year? I know how much federal transfer makes up the full budget here, it is all drawn out in a pie chart, but in terms of the amount of federal transfer that currently goes into the Department of Health and Community Services.

MR. WISEMAN: Maybe I will ask Jim if he has that information.

MR. STRONG: If I understand your question correctly, you are asking how much is transferred in terms of fiscal transfers into the Consolidated Revenue Fund -

MS JONES: Yes. Well, I think there is 27 per cent into general revenues of federal transfers. I am just wondering, what percentage of that would be the Department of Health and Community Services?

MR. STRONG: That information is collected and maintained by the Department of Finance. We would have to ask that department to get that information.

MS JONES: Oh, okay. So there is no one here from Finance that does your budgeting piece who can answer that?

MR. STRONG: No, because those are considered fiscal related revenues which are their responsibility.

MS JONES: Oh, okay.

MR. STRONG: The only federal revenues we track are related to department expenditure programs where we have cost-shared agreements with the federal government.

MS JONES: Okay. Well, obviously, we can find it out by adding up all the numbers ourselves but I just thought you might have it there in your notes or something; that is why I asked.

MR. STRONG: No, we don't.

MS JONES: Okay.

I am going to start actually with section 1.2.02., which is under Corporate Services. I am going to skip right over the Minister's Office because I know that he is doing diligence in his office. I will start with 1.2.02.; I want to start with the Salaries. This year you are going to spend about $1.5 million for Salaries, and according to the salary and earnings book, $225,000 of that is projected to be used for overtime and other earnings. I am wondering why you are anticipating that level of overtime, because if you look at the previous year's salary estimates that was not accounted for?

MR. STRONG: Most of that money relates to provision for severance payments and paid leave associated with individuals who will be retiring from the department. That allocation is not specific to the Corporate Services Branch. It is an allocation for the whole department, all staff in the department. Very little of that money would actually be overtime. It would be negligible.

MS JONES: Okay, because it is under the heading overtime and other earnings. What you are telling me is that it would be used for severance pay?

MR STRONG: Yes, and paid leave. It would be the other earnings portion of that heading.

MS JONES: I am sorry?

MR STRONG: It would be the other earnings portion of that heading.

MS JONES: Okay.

MR. WISEMAN: It would also include severance and any unpaid leave that had not been used upon retirements.

MS JONES: Okay.

So you must be anticipating some retirements this year?

MR. WISEMAN: Yes, we are.

MS JONES: Also under that section, the Transportation and Communications portion, you actually spent $200,000 more than you had estimated. I am wondering first of all what the overrun was, what transportation or communications costs you incurred that you did not budget for in the past fiscal year.

MR. WISEMAN: You might recall last year one of the comments I made at the introduction, one of the achievements last year was the re-registration of the MCP, the re-registration process. So there was an MCP mail out cost last year of some $155,000 that contributed to some of that.

The second piece was, a major contributor there was, one of the things we are trying to do is to consolidate all of the - within our regional health authorities there is a number of computer software packages that are being used to pay clients various client benefits, particularly some of the people who get home support services or supporting in the community, so we are now moving forward with a new client pay module. It will standardize the process across each of the authorities, and to some extent within the authorities, because one of the things that has been talked a fair bit about in the House is the whole issue of some of the transition issues during consolidation of health authorities and some of the financial software consolidations, a piece of that, so we set up a project team to assist with that implementation. Some of this cost associated with the $216,000, $70,000 of it is associated with that project team doing the implementation of these new client pay modules.

MS JONES: Okay,

The re-registration program under MCP, is that now concluded? I think the date has passed – I know that - because I have gotten calls from people who did not re-register and when they went to seek medical services they found out that they could not access the service without a user pay, without this card.

In that process, how many people re-registered? What was the differential between the ones on the books before and the ones after?

MR. WISEMAN: I don't know, Glenda, if you can recall the total number that we had registered last year. We were estimating it to be about 506,000 or something. I think we had a little under 500,000 register, was it, Glenda? I am not sure of the exact number. I wouldn't want to leave you with a fixed number, but it was slightly less than the Stats Canada figure that we were using as a forecasted number. We could get you the exact number that re-registered last year - I don't have it with me – an exercise that we concluded last year.

Your reference earlier to some recent calls that you have gotten as a result of the re-registration process, now they will all re-register and at some point they will all be on a five-year renewable period, but in order to facilitate the staggering of it some had their re-registrations come up this year.

MS JONES: Okay, so the numbers were actually down. I think that was the intent of the re-registration, because a number of people had left the Province or moved away and were still holding their MCP cards in this Province.

MR. WISEMAN: Exactly.

MS JONES: While we are talking about the MCP cards - another question, too – actually, this issue came up just recently with regard to ambulance services for out-of-Province people who are visiting and are residents who are visiting other provinces. It was brought to my attention about the cost of the bills that they received.

For example, if I was in Ontario and I had taken sick and had gotten an ambulance, I would have paid the full cost of that service. This was a case where there were individuals visiting home, who had moved to Ontario, and they had gotten sick and required an ambulance and they paid a full amount; I think their bill was a couple of thousand dollars for that service.

Is there any reason why there isn't a seamless process under MCP whereby each province can be billed off in a case like that? If I go in the United States, I always check to make sure I have full insurance coverage and things like that, but every time I get on a plan to go to Ontario or Quebec or somewhere, I never think about those things. I just always thought that I was automatically covered.

When this person came to me, I almost doubted what they were telling me, to be honest with you, because I didn't realize it was an issue. I am just wondering why there isn't a seamless process whereby provinces can – I don't know what you call it, but - co-bill or co-pay at the end of the day so it is not the actual patient who has to incur that cost up front.

MR. WISEMAN: The short answer is that the medical transportation within any province is not an insurable service. It is not a service that is identified under the Canada Health Act. What we have within each of the provinces is an arrangement among ourselves for reciprocal billing for all insured services. As people travel to this Province from other jurisdictions we have no ability to bill their equivalent of our MCP for that service, and vice versa. When people are in other jurisdictions from this Province, because it is not an insured service, it is not a part of the reciprocal billing arrangement that we have with each of the provinces.

If you just note the difference - for example, if you are in the Province today and you go to see your family physician, you just present your MCP card and the service is insured and no money exchanges hands between you and your physician because it is an insured service. However, if you call an ambulance this evening and they come and pick you up, what basically happens is you pay a flat amount and the Province picks up the tab for the rest, but it is not picked up as a part of the MCP process because it is not an insured service. It is a part of our budgetary process, and we allocate the funding for it as something we would do in our Province. The financial arrangements would vary across the country as to what portion users pay and what portion is picked up by the public purse, but it is not an insured service.

MS JONES: Is that just on medical transportation or is that on other services as well?

MR. WISEMAN: Medical transportation happens to be one of them, but there may be some services that are provided in some jurisdictions that are not – there may be some provinces that cover certain programs under their insurance scheme that may not necessarily be covered in our Province.

Dr. Bradbury may want to comment further, but there may not be very many variances between jurisdictions as to what is insured and what is not, but there are some differences between jurisdictions and what is considered an insured service. The ambulance piece is not covered in any jurisdiction as an insured service, but there may be some others.

Dr. Bradbury, you may want to comment.

DR. BRADBURY: There are provinces, for example, that will insure chiropractic, naturopathic services, physiotherapy, so there are some variations between provinces. Another example is that our Province has our children's dental program. There is no other province in Canada that insures dental services. So there are variations between the provinces as to what is covered in addition to what is required under the Canada Health Act.

MS JONES: In terms of reciprocal billing, I know in my district, for example, where we border on the Province of Quebec, we have a lot of people who use Quebec hospitals and facilities, and I guess that is why it came as a bit of a surprise to me. I know that my constituents go in there, they present their MCP card for Newfoundland and Labrador, and the billing is done through a corporate service between government to government. I just automatically assumed that it covered everything. So, the fact that it is not an insured service, I guess, causes me to wonder: has this ever been a discussion between Health Ministers in the country that they would look at making it an insured service?

MR. WISEMAN: I don't know what may have taken place historically. I have been the minister just a little over a year. I have not had that discussion. I am not aware that ambulance services have been a topic of any discussion universally across the system, because it is not insured in any province, so it is not one of these where any province has insured it and covered it. As Dr. Bradbury has just indicated, in our Province, where we have the children's dental program, we are the only ones in the country to do that. Others have not followed that lead, but at the same time no one has taken the lead on the medical transportation piece.

MS JONES: Okay.

Now that I have raised the issue with Blanc-Sablon, and the hospital in particular as well, or the Quebec billings - because I know there are some of them in Western Labrador as well, probably more money coming in from Quebec than is being paid out, because I know a lot of people in Fermont use our facilities in this Province - those billing amounts, have they gone down over the years? At what levels are they being maintained now?

MR. WISEMAN: Jim, I don't know if we have made any comparisons of the trend of that over the years. I don't know if you can comment about any trends.

MR. STRONG: What I have observed – I have not done a detailed analysis recently, but what I have observed over the years - is that, depending on the changes in the medical staff complement either in Blanc-Sablon or in St. Anthony, there is some movement of those residents of Quebec between our Province and Blanc-Sablon in receiving service. For example, I think two or three years ago there was a significant increase in services provided by our Labrador-Grenfell board. When we inquired into the board about it, it was due to a decrease in physicians temporarily on the Quebec side of the border, and those residents came and sought services from our Province.

MS JONES: Would you be able to provide me with the breakdown on a year-to-year basis, say, going back to 1999, for instance, of those billings? How much we would have been billed for by the health care system in Quebec on an annual basis going back to 1999?

MR. STRONG: I will try and get that for you, if we have it in the department, yes.

MS JONES: Okay.

MR. WISEMAN: What we will provide you with is the sum total of the reciprocal billings ranging between Newfoundland and Quebec in that ten year period. It won't be broken down by facility but by Province. You will know, then, what Quebec billed us for and what we billed Quebec for.

MS JONES: Yes, that is the information I am looking for.

MR. WISEMAN: Okay.

MS JONES: The reason I asked for it, actually, Jim, falls in line with what you just said about service changing, and providers of service changing, because we went through a period where we did not have physicians, for example, in Forteau, where there were full complements in Quebec, and that made a difference. Now that the complement and there has been a shift of professionals in Quebec hospitals, some of the people who normally would have seen patients in Labrador have moved on and did other things and started other practices, I am just wondering how much that shift contributed to the change in service in terms of where people were going and seeking health care services. That would be my reasoning for wanting to look at the numbers.

CHAIR: Ms Jones, if we could probably move on to someone else?

MS MICHAEL: Do you want to finish that section?

MS JONES: (Inaudible) but I don't want to take up all the time.

MS MICHAEL: (Inaudible) finish that section, sure.

CHAIR: Okay.

MS JONES: Also under that section, last year you had budgeted to spend $1 million in Professional Services. You only spent $100,000. I am wondering what it had been budgeted for and why it did not get spent.

MR. WISEMAN: This budget category here is almost like a plug figure in anticipation of what might unfold with the federal-provincial agreements on various funding things. We had $1 million in there last year without being able to forecast accurately what it might be used for, but on annual basis there are arrangements between the federal government and provincial government on various initiatives. This was put in here to allow some funding to be budgeted for, for the Province's use, if such an arrangement would have surfaced. Last year it did not happen and that is why you see the difference between $1 million and $100,000.

We just put the $1 million back in there again this year in anticipation that something like this might surface throughout the year and we want the flexibility to be able to take the federal government up on the offer and have the chunk of money to work with.

MS JONES: Is that why the federal revenue that you had estimated at $1 million but you didn't receive - is that the same monies that you would be referring to, partnership agreements?

MR. WISEMAN: The revenue side of this would have been the same thing, yes, because it would have been matching money as a part of a shared arrangement with the federal government.

MS JONES: Okay, yes, because you had budgeted $1 million and had received $39,000.

What was the $39,000 for that you did receive from the federal government?

MR. WISEMAN: The Aboriginal Health Initiative.

MS JONES: Under the Purchased Services, you spent $888,000 last year. Can you tell me what services you obtained for that?

MR. WISEMAN: Maybe I will ask Jim if he has a breakdown of that full expenditure item there.

MR. STRONG: Purchased Services for last year, that $888,000, is broken down into a number of categories. The two biggest ones would be for rent - that would be about $395,000, department rent space in Grand Falls-Windsor, Belvedere here in St. John's, and in Stephenville – and the other significant expenditure item there would be for printing costs, and that would be about $424,000. That would be printing, again, for the whole department, for all programs.

MS JONES: Okay.

MR. STRONG: There are a couple of small items, advertising and repairs and maintenance that make up the balance.

MS JONES: The rental space that you are paying for in Grand Falls, Stephenville and St. John's, what is housed in those spaces?

MR. STRONG: What is housed in those spaces?

MS JONES: Yes, what offices are there?

MR. STRONG: In the Stephenville office we would have the application processing team for our Newfoundland and Labrador Prescription Drug Program, so all applications, irrespective of the component, are processed through there.

In the Grand Falls–Windsor office, the staff there is responsible for processing the fee-for-service claims for the MCP program, and there is a small team there that also handle client registrations for MCP as well.

The Belvedere property, the staff that are there are the Medical Services Division, the Pharmaceutical Services Division, and also there is a public services office for the MCP program so people in St. John's and Eastern Newfoundland, their applications are processed through the staff there. That would be the staff complement at that site.

MS JONES: This year you are budgeting almost $100,000 more under that same heading. Is there additional space being acquired? I am assuming that most of it will go to maintain the same space and your printing costs; will it?

MR. STRONG: Well, the lease costs are long-term leases, so the lease arrangements have not changed per se, but we have $100,000 in the budget this year for some renovations at the Belvedere site, to improve the reception area that deals with clients and also to better utilize the space that is in the building for the existing staff and divisions.

MS JONES: Okay.

MR. STRONG: So that would be a one-time cost.

MS JONES: In Furnishings and Equipment this year, you overspent by almost $60,000; well, you did, by $60,000. Was there anything in particular that you had to buy?

MR. WISEMAN: We had a number of staff changes that required ergonomic assessments to their desks because of unique circumstances. As a result, there were some additional furnishings purchased to accommodate those staff.

MS JONES: Okay.

This year you are budgeting a little less.

MR. WISEMAN: That was as a result of some changes last year that we may not anticipate this year.

MS JONES: Okay.

The revenue that you collected - you budgeted to collect $125,000 and you collected $560,000 - what was that for?

MR. WISEMAN: Some of it, the bulk of it, $195,000, had to do with the recovery from a transfer that went to the Faculty of Medicine from a previous year that came back in this year. There was another piece of $92,000 that came from a flow of some money from the Bliss Murphy Cancer Foundation that came about as a result of the department funding the atrium out in Grand Falls–Windsor Cancer Clinic, and the money was just flowing back from the foundation to cover that cost.

MS JONES: How much was that?

MR. WISEMAN: It was $92,000.

MS JONES: What was the rest of the money from?

MR. WISEMAN: There is another $66,000 that came as a result of a reimbursement for some vaccines that occurred in 2006-2007, and there was $75,000 that was – Jim, what is the acronym CCHOTA? What is it? These acronyms, I don't know who creates them but, I tell you, this is the longest one I have seen for a while, CCHOTA.

MR. STRONG: I will refer that question to Cathi, because I think she probably knows that one.

DR. BRADBURY: It is probably easier to describe it in what it is known as now, which is CADTH, which is the Canadian Agency for Drugs and Technologies in Health.

MR. WISEMAN: Fundamentally, the full amount that I have just accounted for you there relates to items that we recovered last year as a result of activities in the previous year, that would have ordinarily been accounted for within that fiscal year but just did not occur in time.

MS JONES: The money from this Canadian agency of drug and health, why would you collect $75,000 from them? What would be your connection there?

MR. WISEMAN: As I understand it, they are part of the assessment process that we have to do for our prescription drugs, the new ones going onto the market, and we pay a fee for that. This would have been a reimbursement of an overcharge on that, I believe.

DR. BRADBURY: During the last three years the medical consultant to the department, Dr. Ed Hunt, was the chair of the board of CADTH, and as chair of the board he was allocated a support person. These are the funds from CADTH, then, for the hiring of this support person in recognition of his chair duties.

MS JONES: He has retired now, hasn't he?

MR. WISEMAN: (Inaudible) until the end of the year.

MS JONES: That money is reimbursement from last year, is it?

MR. WISEMAN: What you are seeing –

MS JONES: He wouldn't have a secretary this year.

MR. WISEMAN: If I just kind of summarize what Dr. Bradbury had indicated, Dr. Hunt was fulfilling - this wasn't anything to do with his role within the department. As a result of his role in the department he was part of a national board, and this money was flowing back to the department as a result of that reimbursement while he sat in that voluntary role on a national board. He is now retired and this Province doesn't hold that chair's role in that board, so this doesn't have anything to do per se with the operation of the Department of Health and Community Services.

MS JONES: The transfer from the Faculty of Medicine, the $195,000, what would that have been for?

MR. WISEMAN: It is a duplicate payment that was made to the faculty the year before.

MS JONES: For what? What was the payment made for, the duplicate payment, or the original payment?

MR. WISEMAN: I don't know if Jim might be able to answer what the detail was.

MR. STRONG: I don't know the reason for the duplicate - the original purpose for the payment – but, as a part of our review processes, our internal controls, we picked up that this had happened and we recovered the money back from the faculty.

Basically, the Financial Administration Act says that, when you do that, you have to put it into related revenue if it relates to a prior fiscal year. That is why that is showing up there.

MS JONES: The money you collected from the Bliss Murphy Cancer Foundation, you said, was $92,000. Why would they have paid that back to the Province?

MR. WISEMAN: As I understand it, when the atrium was built in the clinic out in Grand Falls-Windsor that was a project to be funded by the foundation. So, to facilitate the establishment of that atrium, or the building of that atrium, money was flowing from the department to facilitate the process and the department was then reimbursed by the foundation for the project.

MS JONES: Okay.

CHAIR: Ms Jones, are you almost finished up?

MS JONES: That is all the questions under that section, yes.

CHAIR: Okay, great.

Thanks.

Ms Michael.

MS MICHAEL: Thank you very much, Mr. Chair.

Before I start the line by line of 1.2.03., could you just explain to me, Minister - and you may have explained to Ms Jones but my mind may have been somewhere else - the client referral and management system pay module, what exactly it is.

MR. WISEMAN: Many clients of Health and Community Services in the community - persons with disabilities, for example, who live in the community have varying supports, and people who live in alternate family care arrangements have various supports - the family is providing the care for them, and there is a range of services that they have, an entitlement that they get reimbursed for and paid for.

MS MICHAEL: Right.

MR. WISEMAN: Each of the health authorities had a variety of computer software to be able to facilitate that payment.

What we have developed now is a standard module that will allow us to use that across all of our health authorities. What this will now do is give us a standard payment mechanism, an ability to track, an ability to trend, and an ability to monitor payouts consistently across our four authorities.

MS MICHAEL: Thank you very much.

It just was not clear to me exactly what the pay was about, but I fully understand that program, of course, so thank you. That helps.

If I can just look at 1.2.03., the line by line under this, the salary line in last year's budget was budgeted at $1,956,300, the revision was $1,678,700, and now this year it is back up to $1,883,700.

Is it that you had a vacancy that now you are going to fill? What is the reason for the fluctuation over the three lines?

MR. WISEMAN: Last year, the difference in the budget and the revised budget was $277,000. That came about as a result of: one, there was an organizational review in the department, in Pharmaceutical Services, which created an adjustment. In addition, there were a couple of vacancies that we had in the department. Then, we had some overtime that got paid out, and then there were some adjustments for pharmacist salaries. The net effect of those changes came up with the $277,000 that I just referred to.

The dollar figure associated with this year, the additional $72,000 over last year's revised figure, some of the additional costs, one of the things that we just talked about then was the discontinuance of Dr. Hunt's role on a national board which will see some adjustments in the salary, which keeps it down below the $1,956,300 from the previous year. We have some add-on costs because there are some salary adjustments as a result of the 3 per cent increase for April 1 to June 1. Then, as a result of some reclassifications in the department, there are some additional costs associated with that.

The net effect of those things gives us the $72,000 that you see as a differential here.

MS MICHAEL: Thank you.

Under subhead 03, Transportation and Communications, $108,000 was budgeted in 2007-2008 and only $45,000 was spent. Now, this year $129,300 has been budgeted again. What were you expecting that did not happen last year, and what do you expect for this year?

MR. WISEMAN: Travel is one of those areas where you can sometimes rely on historical practices, and that is sometimes a good measure especially if the people involved in an area do the same activities year over year so it is very predictable. Others, it is the response to the demands that would occur in any one given year. Therefore, if you have a savings it is kind of a bonus. Normally when you are trying to forecast what it might be, you would look at the activities involved in this division or department, the individuals involved and the nature of the interaction that they might have. Any travel that might exist within the Province, but also any involvement they may have with national organizations or bodies, the requirement that they would have to ensure that they are part of a national system, sometimes all factor into that. It is always difficult to forecast with a high degree of accuracy. That is what we are seeing here and that is why the fluctuations.

MS MICHAEL: Right. I am curious though why you would go from $108,000 up to $129,300 unless there was something that you were anticipating. Why change? With that kind of an explanation usually the figure stays at $108,000 and $108,000.

MR. WISEMAN: I do not know if there is anything in the Medical Service there, Dr. Bradbury, that is going to be extraordinary this year that would have given rise to that kind of change.

DR. BRADBURY: With the stabilization of the dental plan and the hiring of the dental director there are now some meetings that he will be attending that will be covered under this program. The other areas: with the closure of the Office of Primary Health Care some of the travel associated with that will now come under the medical services branch.

MS MICHAEL: Thank you very much.

I am curious, though, since you mentioned it: With regard to the Director of Dental Services what would the travel be? What would be the meetings that he would be going to?

DR. BRADBURY: There are national meetings that are held in the different provinces with regard to dental programs. As I stated earlier, it depends on if it is an insured service or not but everybody has a program.

MS MICHAEL: That is what I was wondering. So whether it is insured or not they all have programs. I was curious about that actually when the minister was talking about no other province having insurance, but surely they must have dental programs and they do. Thank you.

Under Professional Services, that is subhead 05, last year the budget was $352,100 and it was revised up to $572,500 and this year coming back down to $381,000. What was it that happened last year that caused the Professional Services to be higher than anticipated?

MR. WISEMAN: One of the things that we did last year was - I commented on it at the beginning - the roll out of the new insurance program, the prescription drug program. As a result of that we needed to have some systems upgrades to our computer system, and X-Wave has the contract for that. Because of those enhancements we had some increased costs last year.

MS MICHAEL: Okay, thank you.

I do apologize if there are times that I am going to refer to something that you mentioned in the general, but this is –

MR. WISEMAN: I did not give a level of detail that you would want in the announcement, so that is fine.

MS MICHAEL: No, that is right. Thank you.

It is not a big amount but under Purchased Services there was some expenditure in the revision that was not anticipated. What would that have been? That is subhead 06.

MR. WISEMAN: Again, this is primarily for printing services, advertising and miscellaneous expenses. The exact breakdown – I do not know if we have a schedule here, Jim, to be able to provide the commentary on the full fifteen?

JIM STRONG: No, I do not have a schedule, Minister.

MR. WISEMAN: We could provide that for you if you wanted. We could do that.

MS MICHAEL: It is not a major one. We will ask for some breakdowns on other things, but it is okay for this one.

Under Revenue, what is the source of this provincial revenue?

MR. WISEMAN: Most of this comes from agreements we have had with pharmaceutical companies to cover the cost of some reviews and the effectiveness of certain prescription drugs.

MS MICHAEL: What exactly is the nature, then, of those agreements?

MR. WISEMAN: For example, just to comment on the $215,000 differential from last year, we had an arrangement with a drug company to look at utilization and looking at an Alzheimer's monitoring program. That $65,000 would have been the dollar amount associated with that. We will have drug utilization research projects that are funded by the pharmaceutical industry, and that is what this revenue source would allow us to do.

MS MICHAEL: So the research is not being done by the pharmaceutical company?

MR. WISEMAN: No. They are providing the funding for us to do it.

MS MICHAEL: To do it.

MR. WISEMAN: Exactly.

MS MICHAEL: Then, would you contract others to do that? That is not research we would do in-house, is it?

MR. WISEMAN: Maybe Dr. Bradbury could comment on who might have carried out, let us say, for example, the Alzheimer's monitoring project. Who would have carried that out on our behalf?

DR. BRADBURY: I am not certain. There is the Newfoundland Centre for Health Research as well as the research group over at Memorial. One of those two sites, I would assume.

MR. STRONG: (Inaudible) some departmental costs, if it was extracting particular data from the computer system or a compilation of information.

MS MICHAEL: I am going to ask the question: is it using the drugs of that pharmaceutical company that the research is being done on?

MR. WISEMAN: This would not be a circumstance where we would be used as a marketing tool for a pharmaceutical company. This would be research that we would use to obviously benefit the people of Newfoundland and Labrador and would be a piece of research that would be used for all residents of the Province, but also be used by the health system; not just for the benefit of the pharmaceutical company, nor would it be used to promote the products of the pharmaceutical company.

MS MICHAEL: But the company that does give you money for the research, even though you are not promoting it, are you using their product or are you using other products?

MR. WISEMAN: It would not be a circumstance where the research funding would be tied to the utilization of – keep in mind that the products we would use under our prescription drug program, and these would be the only ones that we as a system would pay for, are done as a part of a national evaluation and they are added to the formula as a part of that national evaluation and not tied to any kind of research funding that a company would provide. There is a real separation between those two transactions. One is deciding what goes in our provincial formulary and, b, what kind of money we would accept from pharmaceutical companies for research.

MS MICHAEL: Okay. And that is what the research is tied to, making decisions around what gets added to the formulary?

MR. WISEMAN: Exactly.

MS MICHAEL: Thank you very much.

Maybe I can go on to the next one. I could ask Yvonne: do you want to ask any questions on that section? I do not mind stopping if you want to ask something on that section. That might be a good way to do it.

MS JONES: Under Medical Services?

MS MICHAEL: Under Medical Services.

MS JONES: No.

MS MICHAEL: Well then, I will continue to 1.2.04.

MR. WISEMAN: Sure.

MS MICHAEL: Thank you.

This question always comes up every time, of course, the salary line. Under 1.2.04, subhead 01, Salaries, again, are you anticipating new personnel under the Regional Health Operations?

MR. WISEMAN: Yes, there are two new positions that we will have contractually in place this year. One: given the significant amount of investment we are making in infrastructure, we need to be able to have someone in the department with the skills set to assist us in managing that kind of infrastructure investment. The Department of Transportation and Works, on behalf of government, is responsible for the tendering process and managing the capital investments of government. This is someone who we want in-house to work with us and with the health authorities in defining some of the programming issues and defining the kind of capital investment we need to respond to those programming issues. That is a person we are going to bring on this year.

Secondly, we are going to bring on a new Aboriginal health consultant to help us, as a department, look at some of the Aboriginal health issues that we need to be responsive to and look at the whole issue of Aboriginal health with us.

MS MICHAEL: Have you advertised already for that second position or do you have the money there but nobody –

MR. WISEMAN: This is a budgetary process now. We just got it approved in this year's budget and we will be proceeding now to fill both these positions.

MS MICHAEL: Very good.

The others are pretty straightforward.

Subhead 05: in the budget for last year $88,000 was budgeted – this is Professional Services – but you spent $422,600 and then for this coming year the budget is only $13,000. There is a lot of difference there. Can we have an explanation?

MR. WISEMAN: Sure. I will just walk through the dollars that are tied to that.

Last year we had some contracts related to the implementation of the new mental health legislation and we had a couple of people on contract with us to help us with that piece. We had a new gambling and addictions awareness campaign that we conducted last year. The first item I identified was $120,000, the gambling and addictions awareness campaign was $165,000 and linked to that there was a public awareness campaign around addictions services that was $50,000. We did a prevalence study in three regions of the Province that cost us $44,000, and then we conducted a consultation process on substance abuse on which we spent $26,000.

MS MICHAEL: Thank you.

But in this year it looks like there is not a lot budgeted.

MR. WISEMAN: No.

MS MICHAEL: So you are not going to have any more of these campaigns. Recently, didn't I see something about addictions? I cannot remember what it is that I am thinking about. But you do not have any campaigns planned for this year?

MR. WISEMAN: I am just trying to think where this might be budgeted under – Jim, there is a –

MS MICHAEL: Because I saw something recently. A statement from you, I think, wasn't it?

MR. WISEMAN: I am not sure. Where is that being budgeted?

MS HENNESSEY: The money is actually budgeted under subhead 3.1.01, Regional Health Authorities and Related Services. The money is allocated within our Mental Health and Addictions budget, but because these are professional services, contracts, the money is transferred onto this account. If we do some additional ones this year, you will find the same thing at the end of the year.

MS MICHAEL: Very good. Thank you very much.

MS POWER: Can I just add – you mentioned you might have heard something recently. Actually, there was a media advisory out today that the minister will be announcing details of a new campaign tomorrow morning.

MS MICHAEL: That is it. That is what I saw, yes.

You know you are doing that, do you?

MR. WISEMAN: I got worried when you asked the question, because I knew I was announcing something and I did not know where the money was in the budget to do it.

MS MICHAEL: Very good. So now we know you are announcing, and we know where the money is.

MR. WISEMAN: Yes.

MS MICHAEL: Thank you very much.

Under Purchased Services, I am assuming that is sort of the classic answer of knowing you are always going to have to do Purchased Services. What would be the nature of the Purchased Services under Regional Health Operations?

MR. WISEMAN: The items that we are talking about here in – it is 06 you are talking about now, right?

MS MICHAEL: Yes, that is right. I am sorry.

MR. WISEMAN: Most of this is cost of printing and some other miscellaneous expenses.

MS MICHAEL: Sure.

MR. WISEMAN: Most of it is printing.

MS MICHAEL: In most departments that seems to be what it is, actually.

Then, in the revenue from the federal government, is this part of their regular Health and Social Benefits Transfers? Last year you were hoping for $141,200, I guess, but you only got $25,000, and this year –

MR. WISEMAN: This deals with a very specific arrangement, not the normal federal-provincial transfers.

MS MICHAEL: Oh, okay.

MR. WISEMAN: This was a federal agreement for the addictions program. What this item here is very specific to that particular program.

MS MICHAEL: Okay, related to the addictions.

MR. WISEMAN: And the other one, there is a transfusion transmitted injuries surveillance initiative that was also part of this funding pot.

MS MICHAEL: What exactly would that be?

MR. WISEMAN: I believe, and Dr. Bradbury might comment on it, it has to do with blood transfusions, is the - and I gave you that answer by assuming the reference, by definition, I assume would have meant that, but we can clarify what that actually means for you but –

MS MICHAEL: Please.

MR. WISEMAN: Yes, we will.

MS MICHAEL: Okay.

MR. WISEMAN: But fundamentally though, to your earlier question with respect to - this is not a part of the normal transfer of federal funding. This would have been a one-off agreement to do with a particular initiative to the Province that the federal government may have been involved with.

MS MICHAEL: Okay. If we could have just an explanation of what that second program is.

MR. WISEMAN: Sure. Yes.

MS MICHAEL: Okay.

Well, I will turn it over, Mr. Chair.

CHAIR: Okay.

Ms Jones?

MS JONES: Just a couple of questions on that section.

You talked about the $44,000 that was spent to do the prevalence studies in three regions. What regions were they done in?

MR. WISEMAN: We did Bell Island, Fogo and the South Coast, the Connaigre Peninsula area.

MS JONES: Connaigre Peninsula?

MR. WISEMAN: Yes.

MS JONES: Was any of that released publicly, the documents from the study?

MR. WISEMAN: There has just been a recent study. Moira, I will ask you just to – there has been a very recent study that we have had concluded.

MS HENNESSEY: The study has just been received in draft by the department yesterday. So it has not been released at this time. We are in the process of reviewing the draft.

MS JONES: Okay.

MR. WISEMAN: (Inaudible) in due course we will be able to release it publicly and you will get a full view of the document at that time.

MS JONES: Yes. Thirty days, is it?

That study though would have had recommendations attached to it I guess, too, would it?

MR. WISEMAN: This would have looked at - I have not seen the draft -

MS JONES: I do not remember the terms of reference for it, so I cannot recall.

MR. WISEMAN: Moira, you have seen the draft but I think this would have - the prevalence study would have looked at prevalence and not necessarily been looking at appropriate responses (inaudible) action?

MS HENNESSEY: The minister is correct. That is really looking at the prevalence of addictions in these three areas of the Province, and I guess from that we will look at what some potential recommendations may be for service delivery in these areas. The study was received yesterday. It is currently with our addictions consultant and I have not read the document at this time, so I am not able to share any of the information.

MS JONES: You talked about the gambling awareness campaign there, and one of the issues that was raised with us a while ago had to do with the board that was set up for the video lottery terminal players. The Atlantic Lottery Corporation had a board set up, government had a representative on it, but there was no representative from Health and Community Services. I think the representative was from Business, a business rep from the Department of Business. It was raised with me because I guess it was a concern in terms of video lottery gambling in the Province and gaming business all around I suppose, in that people were more at risk for addictions and so on because of some of those games that are out there.

The question was raised with me: Why would the Department of Health and Community Services not have someone on that board to monitor the health and welfare of people, and society in general, in terms of what they are planning and so on would be? I do not know if you have been approached on that or not, or if it is something you have given consideration to.

MR. WISEMAN: As I understand it, there are two people on that board. The Atlantic Lottery Corporation you are referring to, I believe, is it? I think there are two people from Newfoundland and Labrador on that board. One is an official from the Department of Finance and the other person is not a government employee but it is someone from the community who has been appointed to that board. They represent the interests of the Province and the views of the Province, and some of the views that we have in Health and Community Services around the actions and activities of that corporation, or any other department of government, then they would be the voice for that.

The vehicle that we would have as a department to ensure that any thoughts we would have with respect to the operation of that corporation were brought to that table, we would use those two people that we have appointed to represent the interests of Newfoundland and Labrador at that table. The interests of our Province goes beyond the financial interest, obviously, in the corporation, but to include the issues that – the social responsibilities that the corporation has so that their policy decisions are influenced by direction provided by the Province, which would include health and any other department of government.

MS JONES: I would think that none of the Atlantic provinces have any representatives from health and community services on the Atlantic Lottery Corporation board at all, would they?

MR. WISEMAN: I have no idea of the structure of the corporation. I do not have any active involvement with it but I understand that each of the Atlantic provinces appoint to the board, and who they choose to pick, I guess, is up to them. I am not sure if there is any criteria used, other than the province's choice. We have two appointees, too, as I understand it. As I said a moment ago, if there are issues that we as a department want to - I think it is important for the corporation to be giving consideration to and it is our responsibility, my responsibility as a minister, to ensure that that becomes a part of government's direction to our two appointees to that board.

MS JONES: I am just wondering, knowing that video lottery terminals - people who play those machines are probably more at risk for addictions than other gamblers, others that gamble in a different fashion. Is it something that you would give some consideration to, making representation to the corporation to have a representative from Health and Community Services as a part of that board?

MR. WISEMAN: The short answer to that is it is not the corporation that I would need to make representation to. The appointments to that corporation are a decision of government. The corporation, as an entity, is not interested in deciding who should come on or what the criteria would be in selecting.

The Government of Newfoundland and Labrador has identified two people that they would want to be on that board and their role as representing this Province is to bring to that board table the perspectives of this Province. One of the perspectives that, obviously, you are referring to now and the thrust of your question has to do with whether or not there is a mechanism to ensure that those individuals, when they sit at the board table and when they have discussion and when they make decisions, is there an opportunity for the Department of Health and Community Services to influence the input that that person has with respect to the areas around addiction and the role that the corporation should play in either education, awareness, addictions, interventions and those sorts of things. I guess what I am saying to you is that because they are appointed by government and they get their direction from government as to what issues they should bring to that table and what the perspective of this Province is - and there is a mechanism now for the department or me as a minister to have those people who sit at that table bring our perspective to the corporate discussion that the corporation would have.

MS JONES: Yes, and I can certainly see why the Deputy Minister of Finance would be on the committee because it does pay dividends to the Province in huge sums on an annual basis, but who is the private individual? Do you know who that is?

MR. WISEMAN: I will think of his name now in a second. It is not an area that we have a responsibility for in health, but a former city councillor here in St. John's.

MS JONES: A former city councillor?

MR. WISEMAN: I will find it out for you. I should not be speculating but I will -

MS JONES: Okay. I would be interesting in knowing because they are representing our Province and health issues needs to be raised at that table. There is no -

MR. WISEMAN: Yes, I will find it out for you. The Minister of Finance obviously might know because I think his ministry has the responsibility for the corporation, but I will find out for you.

MS JONES: Okay.

I am going to move to section 1.2.05. Last year you budgeted nearly $3.5 million but you spent $1.3 million less than you had budgeted under Salaries. I am wondering why that was?

MR. WISEMAN: If you could give me a moment to get my headset, I am having a little difficulty.

MS JONES: Yes, I moved back from the mike, too. So it is a little bit harder to hear I suppose.

MR. WISEMAN: As you get laid back I have to get more intensely involved.

MS JONES: Yes. I am quieter in the evenings.

MR. WISEMAN: What was that?

MS JONES: I am quieter in the evenings.

MR. WISEMAN: Are you?

MS JONES: Yes.

MR. WISEMAN: I noticed that the House is quieter as well, you obviously incite others.

I am sorry, if you do not mind, I will ask you to repeat your question.

MS JONES: Under section 1.2.05., Public Health, Wellness, and Children and Youth Services. In your Salaries last year, you spent $1.3 million less than you had originally budgeted for and I am wondering why that was?

MR. WISEMAN: Within the department itself - remember last year? In last year's Budget we announced a significant investment to strengthen Child, Youth and Family Services. A bulk of that went to the authorities and some of it was allocated to the department to hire some additional people within the department itself. That exercise did not get completed throughout the whole year. All of the money that was allocated for the department's expenditure was not taken up last year but it will all be reflected in next year's Budget because the positions will be filled for this fiscal year that we are currently into right now.

MS JONES: Can you tell me what positions they were that did not get filled?

MR. WISEMAN: I can undertake to provide it for you. I do not have it with me this evening but I can undertake to get that for you.

MS JONES: It would have been quite a few, it is $1.3 million.

MR. WISEMAN: Yes, there would be. There was something like eighteen or so positions that were involved here and they were in that division, but I will identify those for you.

MS JONES: This year I see that you have increased your budget again on the salary side by almost $400,000; $350,000.

MR. WISEMAN: Last year's Budget would have come down around this time and we would have budgeted for some new positions, and we would not have had them on for the full year. One of the differentials you are seeing here is an annualization over and above the $3.4 million.

MS JONES: Okay. So for the full year of –

MR. WISEMAN: Now this is an annualization of some of those salaries, so you will see a change as a result of that. There are some new positions announced in this year as well that we will be funding that was not in last year's budget.

MS JONES: Okay.

Under Professional Services, in that section - before I go on, you are going to get me the list of the positions, right?

MR. WISEMAN: Yes.

MS JONES: The ones that were not filled. Okay.

Under Professional Services, you spent $373,500. What services was that for?

MR. WISEMAN: We provided consultants who we brought on to do some work for us, research work and evaluation work. For example, as a part of the initiative we announced last year to strengthen Child, Youth and Family Services, one of the pieces of that is a legislative review. The Child, Youth and Family Services Act and the Adoptions Act are under review and the evaluation of those reviews. There is some funding provided here for the health promotion and wellness division to cover some contracts that we had for some website design and some promotional campaign that we had established as well.

MS JONES: Under the Grants and Subsidies, you spent nearly $2 million last year in grants and subsidies under that heading. What kind of grants or subsidies would that be and who would be eligible to access them?

MR. WISEMAN: Which reference are you making here now?

MS JONES: 1.2.05, number 10.

MR. WISEMAN: Last year we would have made – let me see if I have the list here for you. Allied Youth was a couple of thousand; the Canadian Council for Tobacco Control, there was a national conference that we helped fund for $2,000; and for a census building workshop in Central Health there was $20,000. There is a list of miscellaneous smaller amounts like that. This is a list of community organizations. Let me just give you some of the highlights. Maybe I can give you the list but let me just highlight some of them for you: the Newfoundland and Labrador Provincial Perinatal Breastfeeding Coalition, we gave them $50,000; the Lung Association for the Smokers' Help Line is $116,000; and the Safety Services Newfoundland conference funding for $5000.

Within each of our health authorities we have health coalitions, a collection of community-based organizations focusing on wellness. They are not all necessarily employees of the health authority, but they are community-based organizations. They are part of four regional health coalitions that we have and they get together periodically for conferences and for meetings. Many of them, because they are community-based organizations, do not have access to their own large pots of money and so we provide some money for travel for those. There is a total of $18,000 that was distributed among the four authorities for that.

Then there are a bunch of wellness grants we have provided: the Active Living Committee in Western, $40,000; Body Imaging Network at MUN, $40,000; Boys and Girls Club, $20,000; and the Change Island Youth Organization, $27,000. You know, there is a list of community organizations like that that we have provided grants to for various wellness initiatives.

Then there is a pot of money that we distributed through each of our four health authorities, $50,000 each, that was used for health promotion wellness initiatives throughout their respective regions. Then we had the Healthy Living Schools initiative, and $30,000 went to Central Regional Integrated Health Authorities for the Healthy Schools Initiative; $30,0000 in Western, $30,000 in central, $60,000 in Eastern and $30,000 in Lab-Grenfell. The Kids Eat Smart program was in there as well. That is the flavour for them now. I did not give you the full list but we can provide that, but I just wanted to give you a flavour for the kinds of initiatives that we funded.

MS JONES: Well you can send that list along with the other lists, all the rest of them.

MR. WISEMAN: I assume someone here is taking a list of all the lists we have to get.

MS JONES: Jim is on it.

MR. WISEMAN: Okay, as long as we have someone assigned the task.

MS JONES: Those grants and subsidies, are they automatically given out on an annual basis or do they reapply?

MR. WISEMAN: These would be organizations that would apply on a project basis. These particular ones here would be ones that we would have that they need an annual application for.

MS JONES: Okay, and you have increased the estimate for that this year, the amount of money budgeted. Were there a lot of applications coming in or is it a big take up on the program?

MR. WISEMAN: Well, this year the Kids Eat Smart Foundation, there is an increase in the funding to them. It is not a core funding per se but we have been doing it every year now and there is kind of an expectation. We are assuming we are going to do it and they are expecting us to do it, and they are relying on it for the continued operation. This year we are increasing that amount.

The Smoker's Help Line is another one that we have some funding in this year, and the Alliance for the Control of Tobacco is in there as well. It is going to receive a significant chunk of money as well.

MS JONES: So that would be mostly the increases that are built in there.

MR. WISEMAN: Just to give you a sense of how that breaks down: 1.25 is for the Kids Eat Smart Foundation; the Smoker's Help Line will get $116,000; and the Alliance for the Control of Tobacco will get $220,000. The remaining $700 and some odd thousand will be for those kinds of grants that I just talked about. I do not think I will give you any kind of a long list.

MS JONES: I do not have any other questions under that heading, so do you want to move to Lorraine?

CHAIR: Ms Michael.

MS MICHAEL: Under the same head, subhead 04, Supplies: the budget for last year was $312,100, and only $50,000 was spent, and then this year up to $326,000. What are the supplies under that about?

MR. WISEMAN: This particular category here, most of the funding here goes towards the cost of general office supplies, books, periodicals and other incidental kind of supplies associated with the wellness and promotion supplies. The program has been established for a while now so some of the supplies have been accumulated and therefore we are not anticipating a big increase for next year.

MS MICHAEL: But you only spent $50,000 last year and it is back up to $326,000 this year.

MR. WISEMAN: Because of the nature of it. Sometimes if you do not utilize it, then you are kind of relying on the supply you have already in the inventory, and when it is used up you need to replenish it.

MS MICHAEL: Okay, so you want to keep the money in case.

That is all. Well, just one other question though: those supplies then, do they go to schools; you know, the materials?

MR. WISEMAN: I am not sure if there is a distribution list, that someone will get it on a regular basis. I suspect it is that as initiatives are being undertaken in the various regions they are able to have access to those kinds of supplies to be able to carry out the particular initiatives that they are involved with; and we just provide them to them. I do not know for certain, but I kind of doubt that there will be a distribution list that we are mailing this stuff out to on a predefined basis.

MS MICHAEL: Right.

Will I go on then, Yvonne?

MS JONES: Go on, sure.

MS MICHAEL: Okay.

Under 1.2.06, Government Relations, subhead 05, Professional Services, what are the professional services that you require under this head, because it is a fair bit of money each year?

MR. WISEMAN: I have a list of the distribution for the $1.3 million. I do not know who would want to comment on it in terms of how we actually do that distribution. Jim, do you want to comment on that?

MR. STRONG: This is in the Government Relations Division and our department participates in a number of national – there are national, ministerial and deputy ministerial committees that address particular national interests in terms of health. This is the amount of money we need generally to support our provincial share of the committees' work. A lot of it is national work that is being done generally for those FPT committees. The Province's contribution is in relation to their share of the national population. This is the way the formula is done.

The other significant item there is – you may have heard of the CIHI, which is the Canadian Institute for Health Information. We make an annual grant contribution to them and next year it is $323,000. All the provinces make grant contributions to them along with the federal government and they produce regular reports on the health system for the country as a whole.

MS MICHAEL: Would it be possible to get a breakdown? I find this very interesting. This is not something I know about and I do find it interesting. Could we get a breakdown of the various committees that the Province is part of or that it contributes to?

MR. WISEMAN: Yes, sure.

MS MICHAEL: Thank you very much.

The next subhead, 06, Purchased Services: last year there was very little budgeted and very little spent but this year $173,000. You must be anticipating something this year, are you?

MR. WISEMAN: This year our Province is the lead ministry on social services within that FPT group, so we would have additional costs this year. The lead rotates between provinces and this happens to be our turn.

MS MICHAEL: What does that entail, Minister, being the lead province?

MR. WISEMAN: Well, fundamentally, the officials in the department would provide the lead in liaising with other officials in other jurisdictions, defining agenda items, doing the necessary preparatory work in advance of meetings and providing the leadership, whether it is initiatives that deal with some kind of research or profiling when it is happening, to be able to deal with a particular subject matter. As a minister, your role then would be to chair the meetings of, obviously, your colleagues as you meet across the country, and facilitate bringing them together in and around issues. If there is something arises that requires discussion among your colleagues on an issue, particularly if it surfaces with an issue arising out of the federal jurisdiction, for example, that we may want to respond to as a collective voice provincially, then the role of the minister would be to provide the leadership to pull the people together to have that kind of discussion and facilitate a process that would financially provide a collective voice for the provinces; and that can happen.

Then there are the things that most federal-provincial-territorial groups tend to have, agenda items that they are working on from one year to the next, and provide some continuity in the activities that they may be engaged with.

The officials do those sorts of things, and the minister, who assumes that chair role, facilitates those kinds of activities with their colleagues across the country.

MS MICHAEL: Great. Thank you.

More work for you this year, then.

MR. WISEMAN: Exactly, yes.

MS MICHAEL: The provincial revenue, that $150,000, what is that related to?

MR. WISEMAN: That revenue represents money that we received from the other provinces to facilitate that.

MS MICHAEL: That is what I thought.

MR. WISEMAN: As much as you are the lead on it, everybody contributes to the cost.

MS MICHAEL: I thought that is what it was.

MR. WISEMAN: Yes.

MS MICHAEL: I am ready to turn over if you want to do the next one, or I can continue?

MS JONES: No, that is okay.

MS MICHAEL: Okay, good enough.

Under the next one then, 1.2.07, Policy and Planning, subhead 01, the Salaries, again: there is a fluctuation there from budget to revised, in last year's budget, and then up by $500,000 this year. If we could have just an explanation of that, please?

MR. WISEMAN: I will comment on last year's one first. There were some vacancies that did not get filled, representing about $140,000, and then we had some partial year hires. We had anticipated that we would hire them at the beginning of the year, but that did not happen, so we saved some money on that, to the tune of $210,000. Then we added some additional positions to help us with some workload; one on a contractual basis were we had an add-on cost of $68,000. Then we had the announcement of the Task Force on Adverse Health Events. That was an announcement that came midway through the year. The cost of that is flowing through the department, so we had an add-on cost. With the netting out, that is where we ended up with this ninety-seven difference.

As we move forward into the next year, your question was: Why were you up again?

MS MICHAEL: Yes.

MR. WISEMAN: A big chunk of that is associated with the adverse events task force, and the second piece is a piece of work that you have heard me refer to several times with respect to the long-term care and community support strategy.

MS MICHAEL: Yes.

MR. WISEMAN: We pulled together some additional resources to help us expedite that process and to move it along faster, so that is adding $162,000 to our cost. That is why the difference this year.

MS MICHAEL: Since you mentioned the strategy, what is your hope? I know that you have told the media it could be early fall. Is that still your hope, that you might have it ready by early fall?

MR. WISEMAN: Just to give you some sense of – this is a fairly major piece of work.

MS MICHAEL: I realize that.

MR. WISEMAN: One of the things, historically, if you look at the long-term care community support system, the populations are predominantly an elderly population and persons with disabilities. We have had the obvious one, where we have had people get community supports, and what we know have is a circumstance where we have different population groups get various types of services. Some have some benefits, others may not have that same group, so we need to reconcile that.

Secondly, then, we have some limited models of care for certain population groups and we want to be able to look at broader options. We have historically had long-term care homes and personal care homes, and some of these are well established in the Province, so making sure that we have an appropriate mix and the appropriate levels of care being provided in each of them, and the appropriate population groups are being served.

As we start looking at models of care, then that is a big piece of work in and of itself. Then, within each of those areas, one of the things that we don't have in some cases is good standards in place for the – I have heard you say many times, with respect to the home support piece - standards of care.

When you talk about standards, you are talking about the qualifications of people who provide this service, how it gets monitored, and how training occurs. All of that sort of thing has to come into play, and that is a piece of what we are looking at.

As I map this out for you, you can see the order of magnitude that we are talking about here.

Of course, then there is the piece that has gotten some attention recently, which is the financial assessment tool that we use. One of the things that we want to make sure is that the client contribution is appropriate and reasonable and consistent across some of these models; because right now, as we looked at each of those models of care that we currently provide, and the financial assessment process for each, there are inconsistencies, and that needs to be corrected.

Then there is the question around what is an appropriate level of client contribution for any model. That is a piece of work that we need to make sure that we have appropriately nailed down, and consistent and fair and equitable, and we need to understand what is the current best practice around the country, what other models are being used in other jurisdictions, and what we should have as a Province, given our uniqueness.

It is a fairly big piece of work. As a part of that, too, there is a whole legislative and regulatory framework that goes with that. We have a fairly detailed analysis done of the legislation and the regulations around each of those areas, so we have a group of people working on drafting new legislation to deal with such things as vulnerable adults, issues around consent, issues around abuse and the protection of individuals, so that is a major piece of work that is going on.

That is happening with a group of people – they are tasked to do that – and these other things I have just mapped out, what we have tried to do here is pull together some additional resources over and above what we already had tasked to do it, to ensure that we are going to be able to expedite it.

I wasn't being coy or anything in the past when I said, don't nail me down to a date because I can't give you a date.

I just gave you a sense, then, of the magnitude of this piece of work, so the target is – because some of it will have some budgetary implications for next year and future budgets - I am trying to be in a position, and we are trying to be in a position as a department, that we will advance this to a point where we will be able to map it out for government's consideration in next year's budgetary process, which is in the fall. That is why I am trying to use that as the target here, so that is fundamentally an insight into not only what it is we are trying to accomplish here, but some sense of the order of magnitude of the project ahead of us.

MS MICHAEL: So we really cannot anticipate any changes, then, before next year.

MR. WISEMAN: The piece here is one of - and we need to understand what it is we are going to do.

MS MICHAEL: Yes.

MR. WISEMAN: I said some of it has some significant implications for the budget, and that is something I want to be ready for the next budget year; but, in any program area and service area, obviously when governments understand what it is that needs to be done then sometimes if we are able to do it within the current fiscal framework you are able to do it. If you are not able to do it within the fiscal framework of the budget that you have been allocated, then obviously you need to wait until the next budget year.

The challenge that I have today is telling you what we will define through this process that has cost implications, whether or not we will have the capacity within the current budget that we are dealing with here tonight to be able to make those changes, with moving some money around, because that might be a potential. I cannot tell you that with some degree of certainty because I do not know. I am now prejudging what might come out of this assessment we are doing, and I really am not advanced enough to be able to do that, to tell you.

MS MICHAEL: I know this is hypothetical, but I will put it out anyway. I usually reject hypothetical questions myself, but I will still do it. If it turned out, say, by November, that you had a good sense, as a department, of the direction that you wanted to recommend to government and it didn't take a long time to get that through, and maybe by January you had a sense of the policy that you were ready to go through with, et cetera, and it could not fit within the fiscal framework for the last three months of the year, would you consider coming to look for the money because it is such an urgent situation?

MR. WISEMAN: Again, not to be coy about it but it is hypothetical, it is probably a question you might want to ask me in November.

MS MICHAEL: Okay, I will remember that in November.

Now, where were we? That came up under 1.2.06., didn't it, that question? No, it was 07., right; the salaries related to the strategy.

One other question with regard to the strategy, though. You mentioned a lot of things in terms of parity and equity in terms of the service. Are you also looking at the whole issue of workers in the different categories, and having common job descriptions and pay equity? If you are doing personal care in the home through a private agency and you are doing personal care in a long-term facility, the work is the same. Will you be looking at equity in terms of salaries for people doing the various pieces of work?

MR. WISEMAN: The piece around the standards will start to define the kind of credentials people need to provide a level of service. The whole issue of compensation and classification and position descriptions is a separate piece of work all together, and I would leave that to the people in Treasury Board who do that kind of stuff, and the health authority to provide services with respect to the compensation schemes that they have for their various employees. That is not a piece of work that our department would start to drill down into defining what salaries would be paid and deciding what position descriptions would look like.

The people who have the operational responsibility and assigned tasks are the best people to start developing position descriptions. We will start to frame up the qualifications and issues around training that would be required.

MS MICHAEL: Right.

MR. WISEMAN: The compensation pieces will flow from that, but it is not an exercise that I would envisage our department getting into, defining the compensation piece.

MS MICHAEL: In looking at the standardization, if it is a standard for personal care worker then the standard would be the same whether the person is in a private home through an agency or whether the person is in a long-term care facility. Would the standards be the same?

MR. WISEMAN: The standards that would be required for activities in one model or the other, I wouldn't want to say that they would be the same across all models, because functions may be very different. I had not envisaged that we, as a department, would start getting into position descriptions and compensation related issues as a part of this process.

MS MICHAEL: No, but with standards it is a bit different.

What about training?

MR. WISEMAN: I understand your question, and I am not sure that I have thought it through far enough to be able to give you an answer tonight.

MS MICHAEL: Okay.

My question would also be the same with regard to training, because I know, personally, from personal experience, as well as knowledge of the system, that in the private sector, for example, people are being sent out to do personal care for people on Level III needs of care and they are sending out untrained people.

I had that personal experience myself, where I was expected one morning to leave my mother in the care of somebody who had come from a fish plant and who had no training, and was sent to take care of a Level III patient.

To me, it is a serious issue. If we are going to have standards, certainly around training, then I think they have to be the same, because if somebody gets identified by Community Services with regard to being Level III care, for example, then we know what Level III care requires, whether it is Level III in a person's home or Level III in a long-term care facility. If a social worker from Community Services does that assessment and says somebody is a Level III or a Level II, then the person who comes to do the work is doing exactly the same work – or should be, and should be trained to do it – as if the person were getting the care in a long-term facility.

I would like for you to really think about that.

MR. WISEMAN: I heard your point, yes.

MS MICHAEL: Thank you.

I will move on, then, in 1.2.07. Actually, probably the next one, again Professional Services, subhead 05., what are the professional services under this category that are required? Again, you had $501,500 budgeted, you spent $91,000, and it is now back up to almost $600,000.

MR. WISEMAN: Most of this would be in the area of consulting services that we provide. Most of the professional service categories would be consulting services that we are engaging.

MS MICHAEL: Do you have any expectations this year, or is it that you maintain about the same amount? You have gone up almost $100,000.

MR. WISEMAN: There are some pieces of work that we anticipate doing as a part of the Healthy Aging Policy Framework that we rolled out last year, so some things we want to advance as a part of that agenda, which would be a big contributing item to this.

We have some allowances in there for some work that the Task Force on Adverse Health Events would be doing, and we have some allowances in there for looking at the human resource planning issues that we are going to be engaged in, so these would be some of the larger ticket items that we would envisage doing in this category.

MS MICHAEL: Okay, thank you.

Then, under Purchased Services again, that is a big jump there, too, of not quite $400,000. Do you have an expectation around the Purchased Services for this year that was not there before?

MR. WISEMAN: There is a piece of work that we are going to try to do this year, and it grows out of the Healthy Aging Strategy that we talked about. It is a piece of the long-term care and community supports piece as well.

We are trying to address some of the concerns that have been raised by unpaid caregivers, so we have allocated a fair piece of money here this year to assist us with some work that we want to try to do in that area. We know it is an issue that we need to address. We have some thoughts on how we want to proceed, so what this does for us here is gives us an allocation that allows us to be able to proceed to do some things with it this year.

MS MICHAEL: Research into that, you mean?

MR. WISEMAN: A bit of research into that and we have some initial thoughts as to what direction we may want to go with it. We just needed an allocation to allow us to do it. This is a year which we want to move forward on that front. This gives us a piece of money to work with.

MS MICHAEL: Right.

I support that wholeheartedly, may I say, somebody who has been there and knowing how many women in particular are in that situation.

MR. WISEMAN: It is a big issue, no question.

MS MICHAEL: Yes.

MR. WISEMAN: We heard it quite loudly and clearly when we did the consultations as a part of the Healthy Aging Framework development. So it is an issue that we are very sensitive to.

MS MICHAEL: Under subhead 10, Grants and Subsidies. Could you just give us an idea of what they are? Maybe if there is a list attached you could just send us the list. You do not have to go through the whole list now but just give us an idea.

MR. WISEMAN: We have some money going to the Newfoundland Centre for Applied Health Research. It is research on aging. We have some money going to the Newfoundland Public Pensioners' Association for a conference that they are hosting. There is a Seniors Resource Centre. There is a fair and exposition in Halifax that they are a part of and we are helping provide some funding for that, $10,000. Then we have the Newfoundland Senior Citizens' Strategic Planning in Labrador taking place. We are providing some funding to assist with that particular piece. Then there is another piece of work that the Newfoundland Centre for Health Information is doing on the impact of dispensing fees on seniors, as a part of our Prescription Drug Program. There is a piece of work that the Province was involved with, with other jurisdictions, developing a tool kit that will help support communities who want to become more age friendly, kind of a model. We have some money in there to assist with the development of that kind of profile.

MS MICHAEL: Thank you.

If we could have that list that would be good.

MR. WISEMAN: Yes, we could do that.

MS MICHAEL: Thank you very much.

Thank you, Mr. Chair, I will take a break now I think.

CHAIR: Ms Jones.

MS JONES: I have a couple of questions under 1.2.07. It has to do with the task force on adverse events. Who makes up that task force?

MR. WISEMAN: The task force was appointed as a one person task force. Robert Thompson is the one person. He has with him some staff. I think there are four or five people with him. There are four FTEs that have been assigned to work with him, but it is a one person task force. The staff who work with him support his activity.

MS JONES: What is the process by which he will do this analysis? Will he consult with different groups? Will there be public consultation, invited consultation? At what levels is that stuff going to be done?

MR. WISEMAN: We are going to have to put you on the mailing list for press releases.

MS JONES: Yes, you should do that. I only get about twenty-five or thirty every few hours a day.

MR. WISEMAN: To answer your question, there is a process right now - there are a couple of things. One, there is an invitation for submissions. That is part of - it is information gathering, intelligence gathering.

The second piece, there is a - I forget the date now. It is coming up soon. Maybe someone can remind me.

OFFICIAL: May 26.

MR. WISEMAN: May 26 there is a forum being sponsored by the task force that has put together a good cross-section of good resource people from across the country to be able to present and facilitate a one-day symposium with a - there has been a fair interest expressed in participation. There is a good cross-section of the Province, both health providers, professional associations, consumer organizations, special interest groups, have been invited to be a part of that. I had a brief look at the agenda yesterday. It was very a aggressive agenda, with some very insightful topics, with some very keen resource people being brought together, people who are experts in the field across the country, people who have gained some notoriety in the field and have been sought after resource people across the country to contribute to that kind of discussion. That is the kind of mechanism being used, together with the people who are there on staff with them. There is a lot of research associated with this kind of an issue and there has been a fair bit in recent years developed on this particular event and to this issue anyway.

There is some current information that is evolving across the country. It is a topical issue for all the jurisdictions. There has been a lot of recent research and a lot of recent attention to the issue. So there is a lot of good information that is available, that is very current. What they are doing is pulling together that kind of information, that kind of profile, and together with the people they are bringing together for the symposium, plus the submissions that they are soliciting, will provide the necessary information for Robert to be able to write his recommendations.

MS JONES: Okay.

Under the Healthy Aging Strategy work that you are going to do this year around the unpaid caregivers, what is it you are actually doing? Is it an analysis of other programs in the country, where the gaps are in this Province? I am just trying to get an idea of what you are going to be looking at.

MR. WISEMAN: One of the things that we - as I just commented a moment ago. When we did the consultations, and we heard it pretty consistent around the Province, a lot of the care that is currently being provided is being provided by family members and friends and neighbours and the like.

MS JONES: That is right.

MR. WISEMAN: It is commonly referred to as unpaid caregivers. They tend to be closely associated with the family in some fashion, which is great to be able to have that community support around, but it was important to recognize as well that these individuals themselves sometimes need support because frequently they are seniors taking care of seniors in lots of case. We need to be careful that they get the support they need before they become clients as well. So we need to create a balance here. There has been a number of suggestions that have made as to what that should look like and there has been a fair bit of discussion already taking place in the Province. Particularly, the seniors' resource centres have been involved with creating a network around the Province of support groups for caregivers. They have a fair body of knowledge themselves that we want to try to tap into.

A piece of the work that we are going to be doing this year is more clearly defining what are some of the first steps that we need to take to start supporting and the kind of support that is necessary and then start mapping out what we need to do on a go-forward basis in future years.

MS JONES: Okay.

That was all the questions under that section. So I guess I will move to the audit section.

Again, there was some adjustment in salary this year over last year. I wonder if you can give me the reason for that. It was adjusted downward over your revised spending last year.

MR. WISEMAN: Some $46,000. There were some changes in that. We had a couple of vacancies that existed which resulted in some savings but we had some additional costs associated with it. For example, we hired additional requirements for MCP registrations. We had some additional costs associated with - we had some additional policy positions in policy, planning and research areas and claims processing which added some costs, but then we had some vacancies in some auditors; that resulted in some savings. Then we had some increased costs in severance and some vacation and overtime paid out. The bottom line was we netted out with a $46,000 cost reduction below what we had initially budgeted for.

MS JONES: Okay. So there were no positions changed there?

MR. WISEMAN: No. It was miscellaneous things that gave net in and out.

MS JONES: Yes, but this year you budgeted $100,000 less than you spent last year.

MR. WISEMAN: We have now completed the MCP re-registration process, which is a piece of that, so we were able to pull that out. There have been a couple of positions that have been added and some removed that have resulted in a net savings of $82,000. We had some additional costs as a result of some annualization of the salary increases associated with the 3 per cent increase in April and the net effect of that is a savings of $153,000.

MS JONES: Okay. In Professional Services last year you spent half of what you had budgeted. I am just wondering what service you accessed for that $25,000?

MR. WISEMAN: That money is to be used to provide an audit review and an appeals committee. That cost us $53,000, and then we had - I am just trying to find the other piece here.

Jim, maybe you can comment on the nature of that service, that review process, that appeal.

MR. STRONG: The $55,500 is comprised of $53,500 for the audit review and appeals committee and there is a small provision of $2,000 for the Stephenville assessment office. The change or the reduction there is just based on the number of meetings. There was not a lot of money needed to pay for the appeals committee. It was just less than what we had budgeted for, for the year.

MS JONES: Okay.

Under Purchased Services, what would that expenditure have been for?

MR. WISEMAN: The $50,000?

MS JONES: Yes.

MR. WISEMAN: I do not know if we have a schedule here for that, Jim.

MR. STRONG: No, I do not have a schedule here but generally, it would be the miscellaneous expenses associated with running the three offices that we run in Stephenville, Grand Falls-Windsor, and here at Belvedere in St. John's.

MS JONES: Okay.

What would be the provincial revenue you would collect under that head? You collected $74,400 in provincial revenue?

MR. STRONG: That is an allocation for miscellaneous income that we would get for such things as court attendants, or if lawyers request information from the MCP system, then we bill them for the cost of providing the information. These would be lawyers engaged in some sort of litigation or legal activity.

MS JONES: Okay.

I do not have any other questions there. Did you have – oh, Lorraine is gone. I guess she has no questions there either.

Under Memorial University, last year in the Faculty of Medicine the school received less money than was budgeted. Actually, I think it was around $690,000 less. I am wondering why that was?

MR. WISEMAN: We had budgeted some money for faculty salaries for fringe benefits, and they only required $169,300. So there was a reduction in their requirement that we had budgeted for.

MS JONES: Why did they not require it, was it vacant positions they could not recruit for?

MR. WISEMAN: I assume, yes.

MS JONES: Okay. You would not know what positions they were, would you?

MR. WISEMAN: No.

MS JONES: Okay.

This year you have increased your estimate there, so -

MR. WISEMAN: What we are doing, there is $2 million going in associated with the expansion. We announced the expansion of the medical school, and there is a couple of million dollars as a part of that, capital investment that they need to put some planning money. There is also $800,000 in there for the accreditation process that they are involved with, and we made a commitment to provide some funding over a three year period. This is the third year of that commitment. Then we had some salary increases that they need to fund, and there is $400,000 associated with that. Then there is some professional development, pension plan increases, energy cost increases, and some inflationary increases that they have asked for. The total is $4.5 million.

MS JONES: I am going to move on to the Provincial Drug Programs, 2.2.01.

What contributed to the increase in Professional Services last year in that program, and what kind of professional services do you usually seek under that program?

MR. WISEMAN: Aliant provides some support for us for the software to manage the system and we needed some additional work done last year to enhance the system to accommodate the expansion of programs we announced last year. The expenditure over and above budget, or the revised figure differential, is associated with that.

MS JONES: Okay.

Normally, what professional services outside of that would you have, because you are budgeted another $2 million this year.

MR. WISEMAN: Jim, have we got a list of the total of what we provide under this, or how much of it is Aliant?

MR. STRONG: That is essentially the contract that the Province has with Aliant for the online, real time drug processing system. That would make up the bulk of that budget allocation.

MS JONES: That is the program that you would use to track medications being prescribed in the Province so that there is not duplication of billings or prescriptions? Is that the program that is used for that?

MR. WISEMAN: The piece we are talking about here is the online adjudication that is taking place. When you go into a pharmacy and present your card, then the pharmacy is able to immediately bill your card for that. They are basically online with your eligibility for benefits and coverage because that puts them directly online with the program.

MS JONES: So that would be especially for people who have drug cards by the provincial government, I guess.

MR. WISEMAN: Exactly.

MS JONES: When you are going in, if you are under a co-pay system of seventy- thirty that will come up on that system.

MR. WISEMAN: Exactly.

MS JONES: As Don will know, that is an issue that I am dealing with in Labrador right now. We do not have the technology there so that people can go in and actually get that reduction on their medication up-front and they are having to pay for it and then claim it back through mail service. I guess, for a period of time it was probably taking about three to four, maybe at the most up to six weeks to get reimbursement. In recent weeks now we have been told now it is taking anywhere from eight to ten weeks on an average to be reimbursed. We have talked to your department through your deputy minister and we have also talked to the CEO of the health corporation in Labrador about this, and we are hoping that something is going to be done so that these people do not have that financial burden up-front. I do not know if you can give me an update on what is happening there or what the plans are.

MR. WISEMAN: Don and I had a discussion about this, this morning, actually. You are right that is an unfortunate circumstance the people who live in your district find themselves in. We explored this morning some options to make sure that we correct that, because it is something that we recognize does need to be dealt with. I will be in a much better position by the early part of next week to give you a much more formal update as to where we think we will be and how we are going to deal with it. Suffice to acknowledge for you that I agree with your observation and we need to find a way around it so that it does not happen. To be able to give you a definitive answer tonight I cannot, but early next week I should be able to let you know exactly how we are going to deal with that.

MS JONES: Are there any other regions of the Province that have this problem? I know the North Coast of Labrador does and my district. Are there other regions that are not on the system where they have to do the mail-in rebates as well?

MR. WISEMAN: Well, the uniqueness that you would find in your district does not exist in other parts of the Province. The North Coast obviously is an area but in other parts of the Province, including the Island portion of the Province and into Lab West and the Happy Valley-Goose Bay area, there is a network of pharmacies and so it is a non issue. In your area what you are talking about is the health authorities actually doing the dispensing because there are no private pharmacies. This is an issue that grows out of that anomaly in your area. It would happen in any other area where you did not have a network of private pharmacies which you do in other parts of the Province.

MS JONES: Well, I will wait to get an answer. I know, from your deputy, that it has been a concern and that they are working on it, but you know I just cannot stress enough the urgency. I will tell you that almost every day in my office I get a phone call from a patient regarding this program because they have just been refused medication at the clinics because they do not have the money and maybe they already have $600 and $700 tied up that they are waiting to get reimbursed for. You know it is a problem and the people are buying medications now like almost just on a weekly basis because it is taking so long to get their money back.

MR. WISEMAN: I hear you totally and I agree with you by the way. It is not an issue where we have some disagreement over whether or not we should respond and to what we should do. It is an issue where we need to work quickly to give you a solution. I will be in a better position to give you a definitive answer both in what the solution will be but also timelines early next week.

MS JONES: Can I ask, as well, why it is delayed so much? Is it done here in St. John's? I am not really sure if it is done here or done somewhere else, the rebate?

MR. WISEMAN: Part of the piece of the xwave contract that we talked about earlier, they are the people who facilitate the reimbursement piece and so there are maybe multiple- I will not use the word multiple- several reasons why there would be a delay. Neither one would be an adequate explanation for you or the people that live in your district, but clearly ones that we need to address.

MS JONES: Okay.

Also under that, I want to ask about the special authorization drugs. It is another issue, I guess, that we are getting more calls on than we used to in the past; not that we did not get them in the past but it seems like in recent days it is becoming more of an issue for people. I do not know if it is a longer delay now in getting the authorization than it used to be, but have you guys looked at a different process which people could use that would be a more timely process in terms of accessing the medications they have been prescribed?

MR. WISEMAN: The issue of the administrative problems with the processing time is something we have control over and an ability to influence, and that we need to tighten up. The other piece in terms of concept though, of having some drugs that are covered as part of a special authorization process and those that are just open, just to comment on that for a moment. When drugs are approved for the formulary there is a national evaluation process that we are a part of that does that evaluation. So some products are deemed to be appropriate to put in a program and have open access to them. Other drugs are deemed to be appropriately prescribed under certain circumstance and that is where the special authorization piece comes in. When a physician is prescribing a particular medication it is covered under the program under certain circumstance. For example, it might be a drug that you would use as a third option only when you have tried one or two other options first. Therefore the special authorization process, when the physician completes the documentation, indicates, here is the diagnosis, here is the circumstance, here is what I have tried, it did not work and now here we are. That then meets the criteria of prescribing the drug and having it covered under the program.

There is no other mechanism to have the physician who is prescribing indicate that they have met the requirements to have the drug prescribed in that circumstance, because that is how it was included in the plan in the first place. As a part of this approval process someone said this drug is a good drug to put under your program if is used in this fashion and under these circumstances and only when these events occur. What we need to do is look at a mechanism to expedite that process because the notion that we would have special authorization drugs is a standard program or a standard process that you would find, whether it is a the provincial program like we have here for recipients of – because we have four different programs in this Province. If you look across the country, other jurisdictions have similar provincial drug programs, and if you look at those of us sitting in this room tonight who have an insurance program through their employer to Desjardins, if you were to get certain drugs prescribed to you under that program, the same thing would happen.

Every drug program, whether it is part of a private insurance company providing it to people who have group benefits or if it is a part of a provincial government who has it as a part of social programs, it is a standard process. The notion that we would have special authorization is never going to change. What becomes incumbent on us is to ensure that we have adequate resources and mechanisms in place to ensure that that is not a lengthy process.

One of the other things that sometimes creates some difficulties is, when information is supplied by the treating physician it may be incomplete. Maybe the form was not totally filled out or maybe there is additional information that is required that is not included in the first time around. Then you find the people who administer the program are going back to the physician and saying, we would like some additional information, can you provide this, this, and this. There is that tooing and froing that occurs, and that creates some delays.

The challenge, as I said, is trying to manage a process and streamline it, because we are not going to eliminate the notion of having special authorization drugs.

MS JONES: Yes, and I certainly would not want to do that. I see the need for special authorization of drugs, and I know how the program works in terms of after all the generic drugs are tried, and all this kind of stuff. I guess what I am trying to put my head around is how that process could be more simplified or done in a fashion that will not require two weeks or three weeks or a month for a patient to have that kind of authorization.

MR. WISEMAN: At some point in time, when we have advanced electronically, adequately enough and sophisticated enough that will allow us to have physicians' offices online, which is the long-term vision, if we look at the long-term future of using electronic technology – in fact, there are some physicians' offices now that have automated their files, automated their communications and transfer of information between their offices and hospitals, for example, where they access results from blood tests and x-rays. Some offices are linked like that already, some are not.

A moment ago when we talked about the four hundred and some-odd thousand dollars we spent to update the prescription drug program with Aliant last year to accommodate the online adjudication, that was something that we did not have two years ago, but we have it now. Now pharmacies are connected online with our prescription drug program. We are able to pull up someone's profile and say, okay, you have a 30 per cent co-pay and you have this approval and here are your drugs. Everybody goes on and the pharmacy bills electronically and then they get reimbursed quicker. The advances of technology allowed us to do that.

At some point we will have physicians in their own offices entering orders for blood work on-line. Now, rather than giving you a requisition, letting you walk up and present it at a counter and get registered, that will happen online. Just like if you are a patient in a hospital and the physician comes down to see you, they enter into the system a requisition to have your blood work done and what they want done, we will advance to a point where the family physician in their office will be able to do that same thing. As we make progress on that front family physicians or any physician who is prescribing will be able to be online with a prescription drug program, and that exchange of information will be able to be done electronically as a part of the input process. We will advance to a point where we will be there. I cannot tell you when but we are making significant progress on that front, moving towards a complete electronic health record.

In fact I can tell you that we are making much more progress than many other jurisdictions on that front. We have had some real good success through the Centre for Health Information and working with Canada Health Infoway in accessing money. In fact, I will just share this little point with you. Through Health Infoway the federal government provides a pot of money where jurisdictions can make applications and the applications are reviewed on their merit. It is one of the few programs the federal government has where they do not distribute the money on a per capita basis. Because of the success we have had and the progress we have made, and the capacity we have and the reputation we have with the Centre of Health Information for doing good work, we as a Province have been able to access much more money out that federal pot than many other jurisdictions. In fact, I think, Jim, we are probably the tops in the country in accessing pots of money for that, because our applications have more merit than other jurisdictions. As a result of that we have been able to advance our work in this area much faster than many other provinces in the country.

MS MICHAEL: What is the name of that again, please?

MR. WISEMAN: The federal government has established Canada Health Infoway. They are a source of funding to help facilitate the use of computer technology to create electronic health records.

MS MICHAEL: Okay, thank you.

MR. WISEMAN: In fact, last year you may have heard by announcement that we now had achieved a total link with all of our diagnostic imaging services and we say we are the first in the country to do it. Nova Scotia said they were first but we were first. That will give you some sense of how we are leaders in that field. I digressed a little bit, but it will give you some sense of the vision for the future. The challenge for us in the interim is how we manage the manual process now to make it smoother and faster so people like you describe are not caught in a spot that they are today.

MS JONES: Under the Allowances and Assistance, obviously it was way down, $30 million less than what you had budgeted for last year. Why was that? Drugs removed? Less people?

MR. WISEMAN: No. This is one of those areas where being down here is a good thing, not because of the financial savings but because we forecast a certain utilization and a certain uptake on our programs and that did not happen, plain and simple, which means that either (a) a lot of people out there have other drug programs, that they did not need to access our programs, which is a good thing because these are means-tested and obviously reflect people who have less capacity to provide drugs and other things that they need in life; and secondly, the other piece is that those who have the cards are not needing to use them as frequently which means that they are healthier than we thought they were going to be and they are using less drugs. Simply put, this is not a bad thing.

MS JONES: No. I am just curious about it because after your re-registration or pre-registration of the MCP program I was just wondering if there is a correlation here.

MR. WISEMAN: No.

MS JONES: Not at all, is it?

MR. WISEMAN: No. MCP is, as we all know, your access to the insurance service in the Province, and every person, regardless of whether you have drug cards, do not have drug cards or you need medicine or not, you get an MCP. If you are a resident of the Province, regardless of age, all you need to do is live here and you get one.

This budget item here, what we are talking about here, is a provincial drug program that the Province provides to individuals on Income Support, seniors who are in receipt of the Guaranteed Income Supplement or individuals who have excessive drugs costs; and that is the insurance program we brought in last year. Then the other one is for individuals whose income is below a certain threshold. We have devised a mechanism to establish a co-pay for them. This is totally unrelated to the MCP piece altogether.

MS JONES: I was thinking of it in terms of the numbers for registration.

MR. WISEMAN: There is no correlation.

MS JONES: Okay. What about the eligibility, the numbers of people who would be eligible? I guess that would have increased this year based on the changes in the program as opposed to decrease?

MR. WISEMAN: The assurance program that we brought in last year, that is continuing to grow. It is difficult to say today whether or not we have peaked where that is going to be, because that is the one where we have the cap on the cost of drugs at 5 per cent and income thresholds of seven and ten.

The one that we had less uptake on than we thought initially was the Low Income Drug Program that we introduced the year before last, where we had the income threshold that was established at $19,000. We have now changed the terms of those, and that is called now the Access Plan. The uptake on that we anticipated to be about eighty-odd thousand people. That was a figure that we took purely from income information from Stats Canada. Here is the number of people who are below that income, so therefore assume that the bulk of them would need the program. That did not materialize. It tells us a couple of things, I suppose. We know that there are people out there under that income because we got the information from Stats Canada. What it tells us, though, is that they obviously have, or are employed in a circumstance where they already have, through their group insurance and things, programs that cover this off. This was a payer of last resort and we did not get the uptake that we initially envisaged.

MS JONES: How many people did you get?

MR. WISEMAN: As of March, 2008, we had approximately 31,000 people.

MS JONES: Oh, a lot lower then.

MR. WISEMAN: Yes.

MS JONES: Okay.

Did you want to ask any questions on that section, Lorraine?

MS MICHAEL: Just one.

How does it work that they get on access? Do they have to make application, and is it possible that there are people who have not gotten the message?

MR. WISEMAN: That is a fair question. The first part of it is, yes, you have to make an application.

Glenda, you can confirm this, but I think we have done two, if not three, blitzes, where we have promoted it. Last year we developed a new – I do not know if you have seen it – a new brochure that profiles our prescription drug program. We then distributed those to physician offices and pharmacies. So we have a good distribution of the pamphlet itself. It was much more colourful, brighter, easier to read and eye-catching so people would see it and want to refer to it, if they saw it in an office place. Then we have had some media campaigns. I do not think we have done it in the last five or six months, but remember we –

MS. POWER: The latest campaign was related to the newest addition to the Newfoundland and Labrador Prescription Drug Program, related to the Assurance Plan, which assists people with high drug costs. Just by the very umbrella nature of the NLPDP you would be promoting the entire program, even though the last media campaign targeted on the Assurance Plan. As the minister mentioned, there has been outreach to physicians' offices and so on, to get the message out, but that is still a point, I think, that we have recently been discussing, how to keep that going.

MS MICHAEL: It never surprises me because I have been a teacher so I know how often you have to repeat something, that it does take a long time before news gets out. We have had a number of cases in our office over the year - they have slowed down recently, but certainly right up to the fall and just after Christmas - of people who still did not know that if they had a person with a disability living in their home, the family now could access that. We are still giving out that information.

MR. WISEMAN: It is one of these things. Because there was such a big gap in what we initially forecast and thought, that is why we only took those initial initiatives to get the message out clearly. You are right; it does take time.

MS MICHAEL: You have to keep at it for awhile yet, I think.

Thank you, Yvonne.

MS JONES: Did you want to carry on now, for a few minutes?

MS MICHAEL: The next one is fairly simple, I guess. It is the Physicians' Services. When it says that this is to provide for the payment of insured physician services provided to residents both within and outside the Province, is that referring to payments to physicians outside the Province who take care of people from this Province outside?

MR. WISEMAN: Exactly. If you were vacationing in Ontario, because the service was not available to you here in the Province and as a Province we referred you outside for treatment, that is what it is intended to do.

MS MICHAEL: Okay, and if I just happen to get sick when I am travelling in the country?

MR. WISEMAN: Yes.

MS MICHAEL: Thank you. That is pretty consistent.

Under Allowances and Assistance, what is it that is covering? That is 2.3.01.09, Allowances and Assistance.

MR. WISEMAN: That particular piece there provides funding payments for services received by Newfoundland and Labrador residents who are out of the Province.

MS MICHAEL: That is what I thought.

The Grants and Subsidies, which is subhead 10, what does that cover?

MR. WISEMAN: I will just comment on one of them, and Jim I will ask you to elaborate a little further on the piece around the other insurance benefits. As a part of the salaried positions we pay a part of the Canadian Medical Protective Association's premiums for those physicians, and a part of that does that.

Jim, there is another piece of that you might want to comment on, the international education piece.

MR. STRONG: I will refer that one to Cathi Bradbury because she is more familiar with that particular agreement.

DR. BRADBURY: The vast majority of the budget under Grants and Subsidies would consist of our salaried physician budget. So it is the budget that we pay for salaried physicians as opposed to the previous budget that was identified which was fee-for-service physicians. There is also a small program where we supplement the insurance payments for physicians in sort of high cost premiums. There is a $2.1 million five-year grant that we have from Health Canada to look at the integration of international educated physicians into the Province.

MS MICHAEL: With salaried physicians, how many physicians do we have salaried in the Province and do you know how they are spread out over the Province? Do you have the numbers of where they are located in the Province?

DR. BRADBURY: We do an annual physician supply report as of March 31 of each year. We are in the process of updating March 31, 2008 as we speak. In March, 2007, which is unfortunately over a year ago, the number of salaried physicians in the Province I would estimate in the range of about 350. They are scattered around the Province. Certainly in rural areas of Newfoundland you are going to see both salaried general practitioners as well as specialists, but we actually have a large number of salaried specialists in St. John's as well. That would be the other main area.

MS MICHAEL: Right.

Will that report be normally brought to the House, the report on the salaried physicians, or can we ask you, when the report for this year is done, that we can get copies as a Committee? Do you usually –

MR. WISEMAN: The report you are referencing is…?

MS MICHAEL: The report on the salaried physicians, the numbers of salaried physicians.

MR. WISEMAN: That would be something that we would create internally as a profile.

MS MICHAEL: Right.

MR. WISEMAN: We can provide that profile to you, yes.

MS MICHAEL: If you can provide that, and we get the update.

I would like to tell you about something that happened to me. I am not sure where to go with it, but I will tell you what happened. I won't tell you where it was, and if we have to have a private conversation I will do that, but I had a very startling experience when I was campaigning during the general election.

It was somebody who owned the building that a couple of doctors were renting, and this person almost accosted me on the street with the candidate I was with – so it wasn't in St. John's; it was outside of St. John's, and I was with one of our candidates – and the person had quite a bias against physicians, and the money that physicians make. She was speaking to me about the physicians who were renting her space, and she talked about how the one who was salaried really didn't work as much as the other one.

She was the landlord for the rental space. She appeared about an hour later and she had a copy of, I guess, the hours that the physician kept, or the invoice that she sent in. She actually had personal information from that doctor's office that she came and brought and put in my face. I said: I don't want to see that, and you shouldn't have it.

Now, I don't know where to go with that with you, but I was really quite startled.

MR. WISEMAN: It is astounding how she might have had so much access to information on the activity of a physician. It is peculiar and unusual.

MS MICHAEL: It seemed to me that she actually used her key, as the person who rented the space, because it was after hours that she did this – I think it may have been on a Saturday – and it seemed to me she had used her key to go in and take this personal information, and said: Well, I can't give it to you - you can look at it - because I have bring it back.

I was in a state of shock.

MR. WISEMAN: It sounds more of an issue of - you appear to have some personal knowledge of what might be questionable, if not illegal, access to a private property, which is obviously a subject that we, as a department, would not be otherwise involved with, other than your sharing it here now.

MS MICHAEL: Yes.

MR. WISEMAN: I guess in terms of how you deal with that yourself, that is more of a personal choice of yours, not one that the department would be involved with, or is in a position to get involved with, because obviously it is a private citizen abusing the benefits she might have to gain access to a building.

No doubt, if any of us here have tenants in something we might own, while we lease it, it is theirs. We do not have access to it.

MS MICHAEL: Right, exactly.

MR. WISEMAN: There is a legal requirement here, so that is kind of disturbing that someone out there would find an ability to breach security like that. The issue about what they might access when they get in there is reason for concern.

MS MICHAEL: Yes.

Do you know what? I had not even thought about it since; because, of course, in the height of the campaign, et cetera, it is just now that I remembered it, but I am going to do further thinking about that.

MR. WISEMAN: No question.

MS MICHAEL: I have no more questions under that section except, yes, the revenue under 2.3.01., the federal revenue and the provincial revenue. What is the source – well, the federal, I presume, is part of the ordinary transfer, is it?

MR. WISEMAN: It covers off an Internationally Educated Health Care Professionals agreement. I will get Dr. Bradbury to comment on what that agreement is, and what it means.

DR. BRADBURY: This is in reference to the five year project that has been funded by Health Canada, so the funds are allocated over a five year period. They were up slightly in 2007-2008 because, based on the work that we have done to date, it was recognized by Health Canada and they provided us additional funds to expand the scope of the project.

MS MICHAEL: Thank you.

The revenue under the provincial category…?

MR. WISEMAN: This comes from – remember, earlier on, we were talking about the process of reciprocal billing?

MS MICHAEL: Yes.

MR. WISEMAN: There is revenue that flows back to us as a part of that process, and this is how it gets recorded.

MS MICHAEL: Okay, thank you.

Unless Yvonne has questions, I guess we can move on to the next one.

CHAIR: Excuse me.

I wonder if we can take a break, maybe, for ten or fifteen minutes.

MS MICHAEL: Sure.

CHAIR: Okay, ten minutes.

CHAIR: Okay, we will get started again. We will reconvene the Estimates of Health and Community Services.

Who is up from the Committee?

MS JONES: I wanted to finish off the section on Physicians' Services.

CHAIR: Okay.

MS JONES: Professional Services: you said that was fee-for-service, that estimate, or does that include salaried physicians and fee-for-service?

MR. WISEMAN: Just let me go back.

MS JONES: Oh, I am sorry, page 204, subhead 2.3.01., Physicians' Services.

MR. WISEMAN: That would be fee-for-service.

MS JONES: All fee-for-service.

MR. WISEMAN: Yes.

MS JONES: This year that has increased by $14 million.

MR. WISEMAN: Yes.

MS JONES: Is that new -

MR. WISEMAN: Increased by $8 million.

MS JONES: Okay, wait now.

MS MICHAEL: Over the budgeted amount.

MS JONES: Okay, the budgeted amount. I am talking about what you spent, I am sorry.

MR. WISEMAN: Yes, I am sorry.

MS JONES: It is over what it was last year. Why is that? Are you adding more physicians? Are you paying out more money? What is contributing to that increase?

MR. WISEMAN: We have some more physicians than we had before. Together with the fee structure there was a fee increase that is coming into effect April 2008 and another one in October 2008. Then we have the annualization of the fee increases that occurred in the latter part of 2007, and then together with just utilization.

MS JONES: The practices of fee-for-service, it seems like there is a lot more take-up on that, obviously, than there is on salaried physicians in the Province. Is that because it enables them to be able to earn more money, or they want the flexibility in being able to move around? What contributes to that mostly?

MR. WISEMAN: It is a physician's choice. Obviously, some physicians would prefer to be in a fee-for-service arrangement, with the fee structure and the level of activity that they may have in a particular area. There are greater financial rewards by being in a fee-for-service situation than there might be in salaried. You might be in an area where you are providing a service where the volume of activity may be such that the fee-for-service arrangement may not provide a stable, reasonable level of income for you, and you may choose to want to have it as a fee-for-service arrangement. It is an issue of choice.

Historically, in some areas where you don't have large practices, physicians may choose to have a salaried arrangement. It is more stable funding, easy to budget, predictable, and you don't have to worry about – most of these salaried physicians are people who are working in and out of health facilities that are currently owned and operated by a regional health authority, so they don't have to deal with their office overheads, and that is provided for in the authority that employs them, whereas the fee-for-service arrangements tend to be in a circumstance – especially in family practice - where they have their own clinics and they maintain their operations and they are employers in that respect.

MS JONES: There is an issue in Labrador West right now with regard to shortages of physician services, and it is my understanding that there are no salaried physicians there. Most of the ones that provide services are on a fee-for-service basis.

I also understand, from a discussion that I had with some people in that region about a week ago, that there is a shortage of services and that people are having trouble being able to get a physician at all, especially with the population increase there, because of the mining activity, and more new people coming in, and they have nowhere to go, basically, for those services.

I am just wondering if there has been any evaluation done on the service in that region, and if there is any intention to look at salaried physicians for the health authority there at this time.

MR. WISEMAN: I understand that the community has been, and the physicians who are in private practice there have been, actively engaged in a process to try to recruit other physicians to come and join their practice in that kind of fee-for-service arrangement. I understand that has been happening. I understand that the community has mobilized themselves actually as a council, as a group of employers and a group of concerned citizens to assist with that process by providing some, as I have heard suggested, financial incentives to help recruit somebody into the town to join the practices that are already in existence there.

MS JONES: Well, one of the people there who is in private practice is Dr. Tom Costello, I think. I did not speak with him personally but I did read a couple of articles that was published in the local papers in that area in terms of comments he made around services. He certainly felt that there was a need to have more physicians and that looking at salaried physicians might be a way to do this. He is the only one I know of in the region who is in a private practice. I am sure there might be others, I am just not aware of who they are.

MR. WISEMAN: It would not be uncommon for any of the Regional Health Authorities - if there is an area that there is some under-servicing and there is some challenges in recruiting fee-for-service physicians to come into an area because the market cannot attract them because of income levels or issues such as that, it is not an uncommon practice for the authorities - because they have a responsibility and a mandate for the provision of health services in their respective regions - to engage in a process to recruit salaried physicians to ensure the region is well serviced.

MS JONES: So at this stage it would be left to the health authority to do that?

MR. WISEMAN: Yes.

MS JONES: Okay. That is all the questions I have under that section.

Under Dental Services, this is the dental program for children. It says "…other persons who are deemed eligible." What other persons would be eligible for dental coverage? Is that low income or human resources and employment clients or -

MR. WISEMAN: Yes. It would be the children of the - remember last year we announced the expansion of the program to include children of low income families between the ages of twelve and seventeen, but also providing for all age groups of families in receipt of Income Support.

MS JONES: Okay. Why was the take-up on it so low last year? Almost half of what was budgeted was not spent, any particular reason?

MR. WISEMAN: That is an interesting question. We wish you knew the answer actually, because for a number of years in the Province the gap between what the Province paid dentists to provide supports and services to children and what the fee structure was for dentists in the Province, there was a pretty big gap.

What we have done is we have eliminated that gap, or narrowed it, to a point where now the dentists are able to provide the services to children without having to bill the families for the difference, which was a big change for them. One of the things that we believed would happen then is families would want to take their children to the dentist because the financial burden was now eliminated. It was not means tested. Anybody who had a child under the age of twelve would be able to bring their child in and have that service, but that really has not happened to the extent that we thought it would. Again, a similar comment as I made about the drug program is the awareness piece. We have community health people involved with school visitation programs and providing services in the community, promoting it and the awareness piece, but fundamentally it has not happened.

There is a certain reality, unfortunately, that many of us think about having a family physician or going to an emergency department if we are sick, but oral health has not been a high priority in many people's cases, and not just families with children but as a society. We have a lot of work to do on creating a better understanding of good oral health practices and its impact on your overall health. It is much more of a commentary I think on society's view of oral heath than it is anything else. We just need to ensure that we promote it and we pay more attention to it.

There is a piece of work being done in the department now. In fact, it is on my desk now as we speak actually, for final review; a piece of work that outlines a strategy for the Province to look at improving oral health services. Part of that piece, obviously, is to create a better understanding of its impact and implication.

MS JONES: I have some issues around dental services in my own district. Again, I have discussed it with people in your department. Actually, your deputy again, and I have also raised it with the CEO of the health corporation and others within the Labrador health corporation region. That is, there are communities in my district that have not had dental service - in one case it was up to four years, and I really, honestly do not think there is any justification for that to be happening. I have another community in my district that has seen a dentist within the four-year period but it was very sporadic and, in cases, it extended beyond a year and sometimes up to eighteen months before there was any service provided.

Even for children in those communities who were under the age of twelve, even though there was a free program, they had no access to the program. The only access would be if they travelled outside of their community and then the health corporation would not make provisions for them to travel under subsidized medical airfare. As you know, in most of these communities they travel under a subsidized system provided through your department, I guess it is managed by the health boards, where they pay a minimum fee of $40 for air transportation as opposed to the probably $240 would be a truer reflection of what the cost would be. So it is highly subsidized but they were not a priority to access the service, and not just the children under twelve but the entire population. They were not given any priority. There were many cases where they had appointments made with a dentist, either in Goose Bay or somewhere, and when the time came for them to travel, unless they were prepared to pay the - I do not know what it is from Black Tickle now for a return ticket. I think it is over $300 - to Goose Bay for that airfare, they would not be able to access the service.

Then there were other cases where they were told if there was space available on the medevac or Skedivac service, then they would get a seat, but when the time came there was no space available. Even the space availability piece did not get utilized after awhile because there were so many demands it was costing a certain amount of money and the health board corporation did not really want to go down that road any longer at that stage. It was an issue and it still is an issue and it has not been resolved.

When I look at these estimates and see that there was nearly $5 million that was budgeted in a program for dental services in the Province and it did not get spent, yet all these people were not being serviced and had no access that was affordable to them, I think there has to be a solution that can be found. Right now there still has not been a solution. I do not know how aware of it you are but your department was made aware of it and we have not seen anything being done on it.

MR. WISEMAN: In this year's budget there is an allocation for another dentist that I think will serve the Black Tickle, Cartwright and Natuashish area. So that is an initiative in this year's budget. That is money that will be allocated in the Regional Health Authority's budget to do that.

The issue of transportation costs for access to dental services is fundamentally the crux of your question.

MS JONES: Well, it is either one way or the other. It is either you are going to be able to recruit a dentist and have them travel to those communities on a regular basis - and I do not mean once a month, but at least once every two months, every six or eight weeks. It is either you are going to do that or you are going to provide a transportation mechanism for people to access the service somewhere else.

MR. WISEMAN: As I understand it too, because these clinics that you are referring to had dental equipment in them on the coast, as I understand, the clinic space that is there.

MS JONES: Yes, there was dental equipment. It was bought some time ago. It was done under an IGA grant program in which they granted the money through the health corporation. A lot of that equipment, I know now, is not suitable for the kind of dentistry that people are practicing today. It is old, it is more obsolete, and it does need to be replaced. I do not know what the cost is of doing that or if there is some kind of travelling equipment that they can access, I do not know.

MR. WISEMAN: As I understand it now, there is a process in place now or about to undertake an evaluation of the equipment that is in these facilities. You are right, some of these communities have not had services for a while and there is a question about whether or not they are adequately equipped to be able to have someone go in and actually provide the service in the community. So if we had dentists travelling, as you have referenced, whether or not we have the facilities to be able to accommodate the visits is something that I understand is currently being evaluated to determine whether or not that exists. If it does not, then what will be needed to bring it up to current day standards and what we would need to have in place to equip the hospitals to facilitate visiting dentists, because there are dentists in Happy Valley-Goose Bay and dentists in Lab City who are there on a fee-for-service basis.

MS JONES: And St. Anthony.

MR. WISEMAN: There are some salaried dentists in St. Anthony as well.

As a region, in terms of the number of dentists that are in the region relative to other parts of the Province, there is a reasonable number there relative to others. I say reasonable, relative to - I am not suggesting that there is an adequate supply because I would not know what would be an adequate number, but for the population being served compared to similar population sizes in other regions there is a fair number of dentists that are there. The question becomes: How do we get them to visit those communities? One of the questions is: The clinics that are there now, do they have the kind of equipment that would facilitate having a visiting dentist go in? If so, then the question becomes: How do we actually facilitate that process by way of the fee structure, the compensation issues and how do we accommodate that visiting dentist?

In terms of dental services, you may have heard me comment recently about a dental surgeon who went into Happy Valley-Goose Bay and provided services to some thirty-odd children while he was there. There is a discussion taking place now I understand about having those clinics continue on some kind of a regularly scheduled basis which will enhance the services available to the people in Labrador and more particularly, on the coast. There are a couple of these things that are currently taking place.

MS JONES: That was the orthodontist service that went in there, was it?

MR. WISEMAN: It was, yes.

MS JONES: Before I get on to the orthodontist piece, because I have some issues around that as well. With this dental service now, even with the funding for an additional dentist it is going to take some time to recruit someone. We have seen, just from looking at these estimates, that there were positions created a year ago that still have not been filled yet in different capacities. I guess what I have been asking for, and I still do not have an answer as to whether they will provide the travel subsidy for people who need to access the service until such time that there is another arrangement in place, whether it is a temporary arrangement for six months or a year, or two years, whatever the case may be.

Right now I am in a situation where almost every person in the community who has to go see a dentist is calling my office asking if I can arrange for them to get a seat on the Skedivac so they can get in to get their dental appointment. To me, I should not have to be doing that. It is not that I mind them calling, they are calling because they do not know where else to call because the nurse has no clear authorization to allow them to get on that plane. Therefore, because there is no process they call me. It would be a whole lot easier if the health corporation under your direction would just put something in place on a temporary basis whereby these people can, if the nurse is referring them. Again, that is only for emergencies right now, because if they want a regular check up - as you know, a child who was eight years old and this year they are going to turn twelve and has not seen a dentist in four years, there is something wrong with that. If they have emergency work that they need to have done and they are in pain, then there will be a way to get them out. They have done that. But if it is routine work or just checkups they want to have or things like that, there is no process whatsoever. They are just being told, sorry, we cannot help you. I do not know if there is something that can be done on a temporary basis even.

MR. WISEMAN: I hear your question. I cannot give you an answer tonight but I hear your question.

MS JONES: I would like for you at least to give me an indication that you are going to look at it in terms of trying to put something in place. Discuss it with the CEO or with the board, to see if there is a temporary mechanism that they can use until they recruit someone and have a regular service there.

MR. WISEMAN: I understand your point and I hear your question but I am not in a position to problem-solve with you tonight to be able to come to a solution. It is an issue that we will have a discussion with the authority, though, in terms of what activity they are currently doing and what they are contemplating doing. I can do that and I commit to do that, but to commit to a solution for you here this evening and what that solution might be, I am not in a position to do that.

MS JONES: Okay.

On the orthodontist piece, as you know this is a concern for me as well. Right now in my district, most people use the orthodontic services out of Corner Brook, and the orthodontist that practices there also provides the travelling clinic services in Goose Bay. When the ferry service is on for those eight months out of the year that they have ferry access, people drive out there and they access the service, the same as people, I am sure, in Gander Bay drive to Gander or in Botwood drive to Grand Falls, wherever you have to go to access the service. They just have to drive a lot further and it costs a lot more to go there, but they do it because they have somewhat of an affordable access to it.

What happens is, when the ferry comes off in that four-month period, the only way they can then access that service is through Goose Bay when that orthodontist visits. Usually they require two appointments during that period of time in which they have to travel by air to access those appointments and it is very costly. Most of the people who are requiring orthodontic work are younger people who have to be escorted by a parent when they are accessing the service. You know it has become a very costly venture for people and it is only those in an income bracket who can afford it who are able to access that service right now.

In the past we have been able to work out agreements, again, with the health corporation whereby they would travel when there was space available on these Skedivacs or whatever the case may be or under a subsidized medical air travel to be able to access that service once a year or twice a year. There are about fourteen people in my district who needed the service who were impacted. However, on the North Coast of Labrador - and I have a problem with this because the same rules should be applying - but on the North Coast of Labrador anyone who was requiring that service with the orthodontist when they came to visit was being transported at the subsidized rate. There was space made available and the only explanation that the board had ever provided for me was that because they had a dedicated Skedivac service that went into all those communities, then they would do it. In my district it was not, it was on a subsidization per person basis. They said it was adding to the extra cost and that was the reason they would not continue it.

I asked them to look at it again and I have mentioned it to your deputy to have a look at that because I do not think it is a big provision to make. They pay the other eight months out of the year to access the service and they do it at a high cost even for those eight months out of the year, but during the other four months there are always those two appointments that run them - I think we cost it out. I do not have the figures now but for their child to meet that appointment it was somewhere like twenty-two hundred dollars for the parent and the child in airfare and hotel accommodations and so on because there is no hostel service or anything in that area that is provided to them. They have to pay the full cost and because of it most of these kids went without seeing an orthodontist for that period of time.

I know you are not going to get them to travel to the Coast of Labrador and I am not expecting that. I know we are not going to get anyone to be based up there. There is no service in St. Anthony even that you would get. Corner Brook is the only closest regular service to us other than the traveling piece into Goose Bay which you would have to access. I am hoping that you will have another look at it.

MR. WISEMAN: We will, yes.

On both of those, by the way, the issue of the orthodontist service and the dental service, I understand clearly the circumstance that you are describing. As I said, I am not in a position to give you a commitment tonight, but I do need to better understand what the health authority has actually done to date and where they are in terms of what they propose to do and how we may create some change, if appropriate, there.

MS JONES: That is fair enough.

I think, by the mere fact that they are the only region in the Province that has subsidized dentists being paid for through the provincial government is an indication of the challenges in providing that service in the region.

MR. WISEMAN: It is different, yes.

MS JONES: Do you want me to continue or do you want to start?

MS MICHAEL: Subhead 3.1.01.01, Salaries: under Salaries I note that $542,700 is the total and in the detailed salary book I note that $234,800 is for temporary and other employees. Do you have a breakdown of how many temporary employees are under that $234,800?

MR. WISEMAN: Jim, do you have that there?

MR. STRONG: No, we do not have that with us.

MS MICHAEL: Maybe you can get that for us and what the positions are, please.

MR. STRONG: We can get that for you.

MR. WISEMAN: Yes, we can do that.

MS MICHAEL: Great! Thank you very much.

Transportation and Communication, subhead 03, probably a similar answer to other ones but I will ask it again; $236,300 was the amount budgeted and only $149,700 was spent. In this head, why is there only $149,700 in this one?

MR. WISEMAN: Again, similar to a comment I made earlier, some of these activities, meetings for example and travel costs, may vary from year to year; the same kind of thing here. Some of the staff who are traveling under this budget allocation here - you heard me make the comment several times about some of the work that we are doing to try to expand the capacity in our child care centers, in particular in some of the smaller communities and smaller regions. We have put together groups of individuals now to work on developing capacity which means some community development kind of activities, so some of the travel associated with that, for example, would come out of this budget allocation here.

MS MICHAEL: Thank you.

Under Supplies, 04, what are the supplies? What does that cover? It is a large category.

MR. WISEMAN: This area is one of the areas where we cover the cost of the purchase of vaccines for the immunization program. That is why the large amount.

MS MICHAEL: Alright then. Thank you.

How many vaccines do exist today? I do not have any nieces or nephews of a young age here in the Province, so I have no idea what we actually cover now in vaccines for children?

MR. WISEMAN: Actually, I will ask Dr. Bradbury. I can talk about some obvious ones that I know about but I am sure I will miss some.

DR. BRADBURY: There are probably, I would estimate, routinely between about ten and fifteen vaccines. The majority of the vaccines that are covered now of course are for childhood and would represent the common ones like measles, mumps, rubella, diphtheria and tetanus. There is also an influenza vaccination for select populations and pneumococcal vaccinations again for select populations.

MS MICHAEL: Thank you.

DR. BRADBURY: The flu shot.

MS MICHAEL: The flu shot, yes. Thanks a lot.

Under Professional Services, 05, what would be covered under professional services here in this category?

MR. WISEMAN: I will just read for the description here and I will get Jim to comment on one piece of it. This covers the cost of professional lawyers fees incurred in the collection of third party liabilities, responsibilities for hospital costs of Newfoundland residents due to negligence and professional service costs for children care programs and allocations.

I will ask Jim to comment on the child care piece.

MR. STRONG: Also included in that $372,000 is about $233,000 for professional - basically consulting fees relating to the child care programs. This will be some studies or the like that we would get during the year.

MS MICHAEL: I see. This is just ongoing consultations that you do around child care?

MR. STRONG: Yes.

MS MICHAEL: Could you give me an example of what you would be consulting about with regard to that? I mean you are not working on a child care strategy at the moment, are you, not that I am aware of? I wish you were.

MR. STRONG: Over the last number of years the federal government provided additional funding for improving the child care area and the Province has created a number of new initiatives in that area. The dollars spent here are basically spent assisting in the rollout with those new initiatives that have been approved and announced previously.

MR. WISEMAN: The contract that we have with the College of the North Atlantic to provide some distance education programs for early educators would be an example of a service that we would have purchased as a part of this funding piece here. That is one example.

MS MICHAEL: And would it have to do with any of the new rural initiatives that were taken with regard to child care?

MR. WISEMAN: No, not necessarily.

MS MICHAEL: No, not necessarily, it is more in the training and that nature.

MR. WISEMAN: Exactly.

MS MICHAEL: Okay, that is helpful.

Well, with that much going to the consultations around child care and that money, the legal fees that you refer to cannot be very high.

MR. WISEMAN: No.

MS MICHAEL: Under 06, Purchased Services, again what would be the types of purchased services that we are talking about under this category?

MR. WISEMAN: I am trying to give you some space. Jim, do we have some explanation as to how we proposed to spend the $228,000? Is there a schedule attached to this?

MR STRONG: No, there is not a schedule attached, but basically the Purchased Services would cover off things like purchase of program materials, printing, meeting space, resources basically associated with the child care programs and promoting them, getting them up and running and maintaining them on an ongoing basis.

MS MICHAEL: Do you have a breakdown of how the $100,000 was spent in 2007-2008? You do not have it here?

MR. STRONG: No, I do not have it here, but I can make it available.

MS MICHAEL: You can make it available?

MR. STRONG: Sure.

MS MICHAEL: Thank you very much.

Under 09, Allowances and Assistance, I note that is going up significantly this year from last year's budget. What is the explanation for that?

MR. WISEMAN: The $8.5 million is made up of: $1.7 million for the medical transportation assistance program; there is $1.5 million for the bursary program for physicians and dentists; there is $800,000 for the bursaries for other health disciplines; there is $2.8 million there for the Early Childhood Educator supplements, the bursary programs for those; and then we have a number of initiatives that we are going to do under the workforce planning initiatives that we talked about, some of the bursary programs, the incentives for recruitment, and we have $1.6 million in there for that, bringing a total of $8.5 million.

MS MICHAEL: I wonder could we have that breakdown as well?

MR. WISEMAN: Sure.

MS MICHAEL: Thank you very much.

Under Grants and Subsidies, again this is quite large, obviously, because of what this area covers and going up by $200 million, almost, slightly under $200 million, from what was spent last year. Why? It is a big increase this year?

MR. WISEMAN: This piece here is the money that we provide to our regional health authorities.

MS MICHAEL: Right.

MR. WISEMAN: What we would have in each of our authorities – each of them would have a block of funding in their global budget and they would provide the range of programs and services. That, to drill down and to account for each of their expenditures, would give us an ability to actually examine the budgets of each of the authorities.

This, fundamentally, as you can see, represents the biggest single expenditure item in the estimates for the department, and it is to allow the four authorities to deliver the range of programs and services that they do. In the budgetary process, we are trying to provide the authorities – there are a couple of things that bring pressures to bear on the budget. One is the utilization increases for the range of programs and services that we now have, you know more surgeries or more admissions or more visits. That is one pressure. The second thing that happens; we have inflationary costs. The cost of fuel and other costs of doing business is increasing and we want to cushion them from those so they are able to maintain services. They have salary increases for the employees that they have as a result of negotiated agreements or step progressions. They have those kinds of pressures that automatically increase annually.

Then on an annual basis they have identified what they would characterize as being some unique pressures in that they have new program initiatives that they want to undertake, services that they are not now providing but they want to provide so we need to provide them additional money to do that.

Then there are some things that, you know as a Province we may want to move forward with and we would introduce, like the example I talked about earlier today in the House about the insulin pumps last year. We introduced that as a new program. Eastern Health was mandated to deliver that program so we gave them some more money in their allocation to be able to fund that particular new initiative that government announced.

The increases that you see in these grants come about as a result of our responding to each of those kinds of pressure areas from within the authorities.

MS MICHAEL: So it is not exactly block funding, it is based on programs and they have to indicate the programs.

MR. WISEMAN: Exactly. Well, some of it is. They will come forward identifying new program initiatives they want to move forward with or they will identify as well, especially if there are significant dollars involved, some real growth areas that they may have had. Over the years there are areas of cardiac surgery, for example, that they needed some special funding for, because the demand has gone so high that they are not able to absorb it in their global budget. Special allocations have been added to respond to those extreme program pressures.

MS MICHAEL: You make those decisions based on the four separate submissions?

MR. WISEMAN: Exactly, from each of the authorities.

MS MICHAEL: They do not have to compete with each other?

MR. WISEMAN: No.

MS MICHAEL: Okay.

I think number eleven speaks for itself. That is the debt expenses for debts carried by the authorities, is it?

MR. WISEMAN: Exactly.

MS MICHAEL: Under the revenue, 01 and 02, the federal, I presume that is straightforward, the health transfer. Well, it is not health anymore but it is straightforward transfer from the federal government for health, that you use for health.

MR. WISEMAN: Does somebody want to comment on that for us?

MS MICHAEL: I notice that it has gone up significantly. In Budget 2007-2008 it was budgeted at $7,932,300 but the revised was $11,209,200 and it is basically almost the same. Well, you have $200,000 more, so almost the same for this year, $11, 339,200.

MR. STRONG: The federal revenue under this activity relates to a number of specific agreements with the federal government, particular program areas.

MS MICHAEL: Could we have a breakdown of that as well?

MR. WISEMAN: Last year the federal government announced a new HPV vaccination, for example, and provided some money for that. There is $1.8 million in there for that. There is a wait-time trust that was set up a few years ago to deal with the wait times and that was another $5.9 million. There is a schedule we can share with you that outlines what that would mean.

MS MICHAEL: That would be great. Thank you.

Under 02, what is the provincial revenue? What constitutes that?

MR. WISEMAN: Just to give you that breakdown - we can share this schedule with you as well, if you want - the reciprocal building piece is $12 million; we have the third party liability recoveries, $400,000; and revenues from the vehicle levy system which replaced the third party liability program was $5.3 million. We can share that schedule with you as well.

MS MICHAEL: Thank you very much.

I will just do that next one; fairly simple, I think.

Oh, you have some questions on that one? Well let's stop there so Yvonne can ask questions.

MS JONES: First of all I wanted to ask: what is the debt now being carried by the health authorities?

MR. WISEMAN: The total accumulated operating deficit is $110.8 million. That would be when the boards reconcile their year-ends. That is what we are forecasting them to be at by March 31.

MS JONES: Did any of the boards run a deficit in the past fiscal year?

MR. WISEMAN: Labrador Grenfell did.

MS JONES: Can you give me –

MR. WISEMAN: Yes. Labrador Grenfell was $.7 million and Central was $1 million. These are the only two.

MS JONES: So, $7 million for Labrador Grenfell?

MR. WISEMAN: No, $700,000.

MS JONES: Oh, $700,000, and $1 million Central. Okay.

The increase for funding for the boards this year, can you give me the breakdown of what the budget is for each of the particular boards for both 2007-2008 and for 2008-2009?

MR. WISEMAN: The actual full budgets?

MS JONES: Yes.

MR. WISEMAN: These are the increases, Jim.

By region, Eastern's allocation for this year was $891,064,000.

MS JONES: That was 2008-2009?

MR. WISEMAN: Yes, 2008-2009. I am sorry! The budget we are dealing with here, yes.

MS JONES: Okay.

MR. WISEMAN: Central was $222,169,861; Western was $217,640,404; and Labrador-Grenfell was $105,321,063.

MS JONES: Can you give me Eastern again, Minister. I did not hear it.

MR. WISEMAN: $891,064,027.

MS JONES: What were the board budgets for last year?

MR. STRONG: For Eastern it would be $875 million.

MS JONES: Wait now, your mike is not on.

MR. STRONG: Oh, sorry! $875 million.

MS JONES: For Eastern?

MR. STRONG: Yes.

MS JONES: Okay.

MR. STRONG: This will just take a minute.

MS JONES: Oh, no! Take your time, we have lots of time.

MR. STRONG: Labrador-Grenfell, $102 million; Western, $211 million; and Central, $219 million.

MS JONES: Okay.

My next question is around the recommendations or the lobby that has been ongoing in the Province for the government to consider some kind of a long-term treatment facility for addictions. I do not know if that is on your radar anywhere or if there is any work being done by any of the particular boards in the Province to look at that or not.

MR. WISEMAN: We just opened the new treatment facility in Humberwood and officials now are looking at the merit and feasibility of what might be a – because one of the things that we do not have in the Province right now is a treatment facility like that or akin to that, because that is an adult population. We are currently looking at what we can do with children who are addicted. The officials now are looking at what might be the feasibility of and the implications of establishing a centre in the Province versus having people sent outside.

MS JONES: The Humberwood facility, that is the facility that is going to look at the twenty-one day program for addiction services, is it?

MR. WISEMAN: Yes.

MS JONES: What is the post-addiction program from that? Because from my very limited understanding that I have of those treatment facilities and what is being provided, twenty-one days is a good start but it is not enough in many cases to be able to meet what the needs of the individuals are. I do not know if there is any kind of a postoperative program that comes after that or not.

MR. WISEMAN: As I understand it, you are right in terms of the definition of the program, but there are times when people are there for a period longer than that. The long-term residential program might be the one you are referring to and that is something that we do not provide in the Province. What we are finding is most adults who need treatment are able to be accommodated in the Humberwood program with some extensions of the normal timeframes. Currently, the people who need longer term residential programs are sent outside the Province.

MS JONES: Where are they sent now? Is it Ontario or Western Canada?

MR. WISEMAN: You might want to answer that, Moira.

MS HENNESSEY: A number of the adults go to Ontario. There may be some going out West but I am not sure about that. I think primarily our sites are in Ontario.

MS JONES: For the addiction services for adults for long-term stay programs, what facility would that be in Ontario? Where would it be, or what facility would it be?

MS HENNESSEY: I will have to get those details for you.

MS JONES: Okay.

Also, there are concerns about people who suffer from, I guess, mental health and addiction problems in terms of treatment programs or facilities for those individuals. I do not know how we deal with cases like that right now. I guess it is done through the Waterford Hospital, is it?

I know when I met with some of the ad hoc groups on addiction services, that was one of the things that they were raising, was the facilities and programs being offered for people who suffer from both mental illness and addictions programs.

MR. WISEMAN: Moira, could I ask you to comment on that, please?

MS HENNESSEY: These clients are known as people who have concurrent disorders. They would be seen through our case managers or our mental health counsellors and decisions made with respect to what professional services would be required to treat both of their disorders.

MS JONES: Do you have any stats on how many people suffer from concurrent disorders like that in the Province? What is the range, because it is a newer piece for me in terms of people that I have had discussions with? I am just trying to get an understanding of what the need is that is actually out there.

MS HENNESSEY: I do not believe we have any data at the provincial level but I can certainly make a contact with the former regional health authorities to see if we can get that information.

MS JONES: Okay. I would appreciate it if you could do that. I do not even know if they keep stats on it because I know there isn't a program and it is only people who are walking in to either look for one or the other particular service, as I understand it. I do not know if there is actually an identified population and that is what I have been trying to find out.

MS HENNESSEY: Yes, I will certainly make the inquiry to the four health authorities and provide the information if it is available.

MS JONES: Okay. Thank you.

I am just wondering, how many children did we send out of the Province last year for care or for treatment? I know that we have a number of children who are sent out of the Province that are in custody cases and I know a lot of them are Aboriginal children in Labrador who are placed in those arrangements, but I am also wondering how many children we would have sent out of the Province last year for addictions services or treatments?

MR. WISEMAN: That is something we will get for you. We do not have that available this evening but I can get that for you.

MS JONES: Okay. Could you also get me the number of children that we sent out of the Province in care?

MR. WISEMAN: We can. We can do that.

MS JONES: That were placed in - and I think most of them are in Ontario as well.

MR. WISEMAN: They are, yes. We can get that for you.

MS JONES: Okay.

I am getting through it; also, the number of adults, as well, that we had in care outside the Province who are in treatment programs.

Are you getting all this down, Jim? I want to make sure because I have an awful list here of stuff.

MR. WISEMAN: Make sure you remind us.

MS JONES: Just a couple of questions on the foster care program as well. Not just the children who are in care, but what are the numbers right now of Aboriginal children who are currently in foster care in the Province? Do you have the breakdown in terms of each of the Aboriginal groups?

MR. WISEMAN: Again, that is something that we would not have brought here for the estimates for you, but it is something we can get for you.

MS JONES: Okay. I will just add that to my -

MR. WISEMAN: Add that to your list.

MS JONES: There is an issue that was raised in a more public way back some months ago about the availability of foster homes and foster families in the Province. Has anything been done to address that issue at this stage?

MR. WISEMAN: Together with the Foster Families' Association and the four authorities and government itself, you will probably hear some of the regular ads that are running on radio, particularly, still actively engaged in a recruitment process. One that the Foster Families' Association and the authorities are focusing on is some initiatives that are using existing foster families as a tool and a recruitment initiative to bring other people into the system. Obviously, those who are providing foster care today are in a much better position to talk to others and talk about their experiences.

One of the things families need to understand is what is involved, what they can expect, what is expected of them and the kinds of circumstances that they run into, because it does require a fair commitment by a family. Understanding what is involved, both the commitments and the rewards associated with it becomes an important part of the decision making process. One of the things that we are starting to use now in a much more formal structured way is using existing foster families to assist with the recruitment.

MS JONES: Good idea.

MR. WISEMAN: I think this is the last of the three. This is the third year of a three year increase in the rates associated with the foster families. The current rate paid for foster families, this is the third year of a three-year commitment to increase rates. There is a working group with the department, the authorities and the association reviewing the current rate as it exists now to determine whether or not we need to make some future changes on a go forward basis now that this kind of commitment has been honoured and responded to as to what we might want to do on a go forward basis.

MS JONES: What is the rate now for foster families, and is the rate paid out based on the level that the child is assessed at? I am sure there are some foster children who have greater needs than other foster children in terms of medical care and other difficulties or problems they may be dealing with, or is there just one set rate for the program?

MR. WISEMAN: There are two components to what gets paid to a foster family. There is a piece that is a basic rate, that is a foster family rate, but as you have described, each child may have a variety of differences. So there are a bunch of allowances that are provided for children who have those special circumstances. If there is a child with high needs and some unique circumstance, there are additional provisions, financial provisions made for those. That is how those differentiations, that you are making, are accounted for.

MS JONES: What is the basic rate now, then?

MR. WISEMAN: I do not have that with me here but I will get that for you.

MS JONES: Don't worry, I can find out.

MR. WISEMAN: Okay.

MS JONES: It might even be on-line. I have no idea.

MR. WISEMAN: So, you didn't need to ask me at all.

MS JONES: I don't know. I just thought you might know. I give you a lot of credit, minister.

MR. WISEMAN: You do, and I thank you.

MS JONES: In the budget as well, there was $1.7 million for the mental health, addictions and gambling. I guess that is into this estimate too, is it, some way or another? I did not see it anywhere else when we went through.

Anyway, what my question was - it was around what specifically the money was going to be used for?

MR. WISEMAN: Okay, let's see if we can find that answer for you.

Moira can speak to it, actually.

MS HENNESSEY: The $1.7 million will be used for introducing assertive case management teams to Central and Western Newfoundland under the new mental health legislation. We established an assertive case management team in Eastern Region in January of this year with the introduction of the community treatment orders under the legislation. We will be establishing teams in Central and Western Newfoundland sometime during this fiscal year. Some of the monies will be directed towards the mental health legislation. We will also be putting some additional addictions counsellors in Eastern and Central Newfoundland, some mental health case managers in Central and Labrador Grenfell, and some additional positions, psychologists and social workers, in various locations in the Province.

We are in the process now of trying to finalize the allocation of the $1.7 million for mental health and addictions. So the allocations have not been done to the Regional Health Authorities at this time, but that is just some examples of what the money will be used for.

MS JONES: Okay. What is a case management team?

MS HENNESSEY: A case manager, we have a number of them in the Province now. These are individuals - they are primarily either nurses or social workers - who manage clients who have persistent mental illness.

MS MICHAEL: Could I add a question here?

MS JONES: Yes, go ahead.

CHAIR: Yes, certainly.

MS MICHAEL: Thank you.

Because you are answering questions I put to the minister today, I am going to ask a couple of more questions.

Did I hear correctly when you said that you have money to allow for the assertive community training teams in Central and Western, but you did not say Labrador Grenfell?

MS HENNESSEY: No. I guess one of the challenges we have in Labrador Grenfell is that we do not have a psychiatrist in that region, so we do not have a full model -

MS MICHAEL: So you (inaudible) the assessments, right.

MS HENNESSEY: - in that area of the Province.

MS MICHAEL: Yes, I understand. Right, because you will not be doing the assessments there, they would be moved outside of Labrador.

MS HENNESSEY: Yes. A number of these clients, unfortunately, have to come out of the region for extensive services.

MS MICHAEL: Right. Do you have any idea how long it is going to take - the money is in the budget, I know - how long it will take to get the training teams in place in the other two regions on the Island?

MS HENNESSEY: The plan, given the dollars that are available this year, are to establish the assertive case management teams in Central and Western by October.

MS MICHAEL: By October.

Thank you very much.

I had one other question, too. Is there any focus with regard to people with serious mental illness and compliance with the Mental Health Act? By that I mean, will any of this money go towards enhancing services in the community so that when people come out of hospital there will be more services in the community? This is one of the issues that we are facing, especially with the most recent case that we have had in the Province. The act says that they really need to go into communities where there are services to help them. That was very deliberately put in the act, and yet we know that the services are not always available in communities. Will any of this money be going towards enhancing those kinds of services?

MS HENNESSEY: I guess I would see a number of these clients who become certified under the new mental health legislation. These are clients who have persistent mental illness. So there will be new case management positions established in some areas of the Province. In addition, the psychologists, social workers and occupational therapists who would be put in place, they would all provide support to these individuals following discharge from hospital.

MS MICHAEL: Okay. So all of that is part of the plan?

MS HENNESSEY: Yes.

MS MICHAEL: Okay.

Thank you very much.

MS JONES: I wanted to pick up on that point, the question that Lorraine just asked because I think, not just the recent case on the Port au Port Peninsula, but there have been other cases in the last couple of years, cases relative to murder suicide as well. A lot of these are in regions where there is no mental health services being provided to any extent. I guess that is why I started to ask the questions about the case management teams in terms of how extensive or how far-reaching their services are going to be.

I know of cases even in my own district where it has not come to that extreme but they are persistent mental health patients or people who suffer consistently from mental health illnesses. I know of cases where some of them have been hospitalized up to three and four times in a year in St. John's, but then they are dismissed and they are sent right back to the Coast of Labrador where there is no mental health nurse, where there is no psychiatrist, no psychologist, in most cases not even a public health nurse and in some cases no addiction services. There is no one other than the regular nurse who has to deal with a full clinic and a broad population of people, who is working 24-7 either on call or on shift. The service is just not there and I do not understand why this continues to happen without having some follow-up.

It is all right to say there is a clinical physiatrist down at the Health Science or down at the Waterford hospital where I know patients have been hospitalized on a number of occasions. They are their physiatrists and they are going to follow them. The reality is these people are over extenuated too and once you are dismissed or you leave that facility oftentimes you are then placed in a position where you have to have other services and they are not there. I just do not know. Although there is not even a case management team for Labrador, but even if there was I still would have trouble understanding how that team could reach out to all the other areas of Labrador even if they were based in Goose Bay or in Labrador City.

I guess my question is: what is the process that has to take place to do the kind of follow-up that is required? I think there is a recognizable gap there. Even people like myself who have very limited knowledge about these services and these issues, I am recognizing a gap just in dealing with my own constituents. I really believe there is a gap that exists, not just in that area but in many areas of the Province.

I would just like to understand about where your department is going with that and what it is you are trying to do to try and remedy it in a longer term way.

MR. WISEMAN: That question, I think, is one of the things we have reflected on the last couple of years, and we have looked at the introduction of new legislation. It is a major step revamping the legislative framework around mental health services; after what was on the books for some thirty odd years, a major first step.

If you look at the last three Budgets, the investments we have made in mental health and addictions services, the network of offices we have – we have some twenty-six offices, I think, around the Province today providing counseling services, a network of those that did not exist five years ago but they exist today. If you look annually in the Budgets, this year again the $1.7 million referenced a second ago, building on investments last year and the year before that, in terms of your broader question of what the vision is and what the future is, we are continuing to invest, to expand capacity, to provide greater access and to provide the strengths and the supports that we have out there. We recognize, as you have just described, that there are some issues, and as the system evolves and continues to expand the intent obviously is to continue to improve upon what we have done.

It has been a gradual process, particularly and very intensely in the last three years. We have had a very intense focus on mental health and addictions services. The legislation, the long-term strategy, investment of money, the additional new human resources and a network of offices around the Province are part of the commitment that we have made to ensure that this population gets the kind of service that they want and need to have. We will continue to do what we have been doing in the last three years.

We know that this is an area that for many years did not get the kind of attention that it deserved and needed, and I think the investments that we have made in the last three years reflect our commitment to respond to those changing demands.

MS JONES: One of the things that I would like to see is a process whereby these people, once they are discharged from the hospitals and they are sent back to these remote areas, especially areas where there is no metal health services at all - there needs to be some kind of a process for follow-up. I cannot give you the answer right now in terms of what they should be, but I think it needs to happen. If anything, it may cut down on the number of visits, the number of people who are having to be sent back for hospitalization and treatment. In most cases when they are that far away from the service it is not a matter of just coming back then to see that psychiatrist or psychologist for a day for an appointment. In most cases it is hospitalized visits.

The other issue that I would like for you to address is around - and this is probably more of a district piece for me, and that is that in my district we have, I think, right now only two mental health nurses. I cannot even be sure that there are two there. I know there is still one there, because I talked to him a few weeks ago, so I know that for certain. I know that a mental health nurse is not a psychologist or a psychiatrist, or no one else, but it is a first level of intervention. It is a first of level of treatment of some sort for people.

I think when you look at things like clinics on the coast of Labrador and you recognize the need to put a public health nurse in those clinics, you recognize the need to put in regular RNs and nurse practitioners, I think there needs to be a recognizable need that mental health services have to become a critical part of that frontline care in those regions as well. Right now that is not the case.

I appreciate and understand the resources that are being invested, and I know that you recognize that this has to happen, but I guess I just want to stress to you that there are still regions where this service is practically non-existent and it needs to be improved upon, and can be, I think, in a much better way than it is now.

MR. WISEMAN: One of the things that we have not fully developed to the extent that it has a greater application than we now used it for is the whole area of telehealth. We have much potential in providing that. As you said a moment ago, having a nurse on the South coast of Labrador working with maybe just one other colleague in providing mental health services sometimes can be challenging, and having the ability to be able to tie in electronically to a support network of others who might be in other regions can become a major tool for them to use. It is an issue where we see some great potential for expanded application. Mental health services is one that is very much in its infancy in terms of use of that kind of technology, to provide access to a greater variety of resources beyond what might be available now in some of the more rural and remote parts of the Province.

MS JONES: Yes, and I certainly recognize that there is a role for technology in terms of providing especially some of the higher levels of skills, like assessments by psychiatrists or psychologists and so on. I am not going to belabour the point, but I want to stress that I think placing mental health nurses in a lot of these regions will cut down on some of the longer-term problems that we are seeing, which are probably contributing to a lot higher costs in the health-care system in the long run. I just think it warrants having a good look at.

MR. WISEMAN: Thank you for your comments.

MS JONES: I think I am ready to move to the last section.

CHAIR: Ms Michael, did you have a few questions?

Go ahead.

MS MICHAEL: Thank you.

Just one line item under subhead 3.1.01.11, the debt expenses: I was just noticing, thanks to the good research of my researcher, that the accumulated debt of the regional health authorities in March, 2006 was $119 million, and I think, Minister, you told us that now it is $110.8 million. So the debt has gone down yet the debt expense for this year has gone up.

MR. WISEMAN: I won't profess to be an accountant like Jim is but it is a cash flow issue. For example, Eastern Health has an accumulated operating deficit of some $49 million, but because of the size of their budget and the way money will flow from the department into the health authorities at any given time they may not have a debt on the books of the bank where they are borrowing money to that same extent. Basically, the cost of debt servicing, the interest cost, is tied not to the total accumulated operating deficit, because that is a paper entry, a paper figure, but more to the size of their operating credit that they are drawing down on at any given time. It is a product of that rather than a product of the $119 or $110 figure.

MS MICHAEL: And rates can change because of that.

MR. WISEMAN: Rates can change. Rate variation is not the significant piece. The significant piece is how much they are drawing down on their operating credit versus what is on their books as a paper debt.

MS MICHAEL: I understand. Thank you.

MS JONES: Let's start the last couple of sections. Section 3.2.01 under Furnishings and Equipment -

MS MICHAEL: Before you do that can I interrupt again?

MS JONES: Yes, go ahead.

MS MICHAEL: Subhead 3.1.02: rather than get into detail tonight I would be quite satisfied to just receive a listing of the Grants and Subsidies under that, if that is alright.

MR. WISEMAN: No problem at all.

Jim just reminded me too, the debt expense piece, I gave you the right answer to the wrong question, a question you did not even ask.

MS MICHAEL: And I accepted it. That is the worse part.

MR. WISEMAN: It is the right answer but to a different question.

MS MICHAEL: Okay.

MR. WISEMAN: The figure that you referred to, the $3.1 million, is funding that is included in the debt expenses which represent the cost of the lease payments. You may recall, a few years back, the former administration provided facilities in Port Hope Simpson, St. Lawrence and in Burgeo as a part of a lease arrangement. Basically that money is the costs associated with those debt expenses, associated with those particular facilities, with Burgeo, Port Saunders and St. Lawrence. There is an old interest debt associated with Harbour Lodge in Carbonear. That is where that figure comes from.

MS MICHAEL: Okay, thank you.

MR. WISEMAN: I apologize for unintentionally misleading you earlier.

MS MICHAEL: Thank you.

Then, with regard to 3.1.02, as I said I would be satisfied just to get a list – I do not know if Yvonne is – but to get a list of the community agencies that receive the grants and subsidies under that, for last year and for this year.

Thank you. Now you can go on.

MS JONES: 3.2.01, Furnishings and Equipment: do you want to tell us what that was used for last year? You spent $43 – I do not know if I am in millions or in thousands here now.

MR. WISEMAN: It is millions.

MS JONES: $43 million dollars last year.

MR. WISEMAN: This is millions.

MS JONES: Oh, yes.

MR. WISEMAN: The $53 million – I do not know, I have not seen many other prior budgets, but I suspect this is an unprecedented investment in any one given year on equipment for health facilities, and the $53 million allocation in this year's budget is a big investment. Last year we spent $43 million. That was distributed throughout our four authorities to provide a range of equipment, from imaging services to laboratory services to surgical equipment for operating rooms to emergency room equipment to hospital beds. This covers a very wide range of equipment that is necessary to keep our health facilities operating and provide the necessary tools to our clinicians to do the job that they do. I just gave you a sampling of what that might mean in terms of the range, whether it is scopes for surgical procedures or whether it is anaesthetic machines for operating rooms or whether it is beds for in-patient rooms, but there is an array of things.

The process we went through is, each of our authorities identifies what they – because they are the people on the ground who understand what it is they need - through their internal mechanisms, with their medical advisory committees and their divisional managers and department managers identifying the equipment that they need for each of their program areas, identify for us then what they believe are their priorities for this year.

This year, as well, we had a representation made by the medical association where they talked about the need for diagnostic imaging equipment throughout the Province and the need to replace the aging equipment that we have. One of the things they identified for us at that time was we had many pieces of equipment that were twenty or twenty-five years old. One of the things that we are very happy to say now is that with this investment we are making this year, we will have identified all of the high priority items which were identified as aging equipment, that were identified through this exercise.

For example, in diagnostic imaging, we will not have any equipment in the Province now older than fifteen years old. If you look at anytime over the last ten or fifteen years, you could not pick a year where you could not walk into some building in the Province where you ran into some piece of X-ray equipment that was twenty or twenty-five years old. That will not happen after this money gets spent this year. It will all be less than fifteen years old, which is phenomenal, given our history as a Province and the kind of state we have been in for many, many years. Technology changes fast.

The mammography units that we are providing this year, there are twelve new mammography units going in. These are digital mammography machines, provide a much better image, a much clearer image and will provide for a much more accurate diagnosis for diagnosing potential breast cancer. With these twelve, now we will have every single mammography machine in the Province using digital technology and not the old analog. That has all happened since we formed government. We have replaced all of the old mammography technology with new start-of-the-art equipment.

These are just some samplings of the kinds of major investments; a new MRI out in Central. The MRI has changed in terms of the kinds of procedures it can do. We have just finished upgrading the MRI machine in Corner Brook that allows us to expand the kind of procedures that we are able to do on it. We have done retrofitting and enhancements to the one in St. John's in the last couple of months, I think it was. In the last two years particularly, with $40-odd million last year and $50-odd million this year, in that twenty-four month period, that is a major investment with a lot of nice new initiatives.

The health authorities and the medial association have applauded the investment we have made because we now see that there is a real commitment to ensuring that we have state-of-the-art technology and we are replacing the old stuff that we have.

MS JONES: Yes. No doubt, a lot of this equipment needed to be replaced, too, because technology does change fast. I guess the better the equipment, the better diagnosis you can make.

We had a request from the Newfoundland and Labrador Medical Association, back prior to the Budget, of something like fifty-one pieces of equipment they had identified through the health boards that needed to be purchased in the Province and replaced in hospitals. At that time, the other thing they were asking was that the department put in place a schedule for the replacement of this equipment over a period of three to four years. Judging from the equipment that was approved in the Budget, and I cross-referenced it with most of what was on their list, now outside of the mammography equipment, I think there was a couple of other pieces there that is being funded this year that was on that list as well. Is there any plan within the department to now look at - where you are doing a good job at replacing a lot of this equipment - a replacement program for the next two to three years to ensure that all of it gets done?

MR. WISEMAN: We have not been in – well, not in a position, because what you are talking about is multi-year funding, and we want to make sure that we assess this as we go in terms of the kind of commitment we would want to make for next year. Obviously, $43 million last year, the year just finishing up, and $50-odd million this year, this puts us into a certain ballpark. Obviously, if we could continue to do that kind of investment we will deal with all of the kinds of items that the medical association identified, and Eastern Health, and Western and Central and Labrador Grenfell have identified for us.

One of the challenges that we have had is, as I said a moment ago, diagnostic imaging. For example, we have had, up until this year, equipment in the Province twenty and twenty-five years old. We needed to get ourselves current, and that is what we are trying to do now. Some of the technology will change because new stuff will come on the market, and some technology will just get worn out. After a while it will be beyond its useful life and it will just get worn out.

We are very much cognizant of what we have left on the list which has been identified that needs to be done. With last year's investment and this year's investment, we have identified and dealt with and responded to all of the high, critical priority areas. Now we are in a position where we need to map out what we might want to do next year to see us deal with the - this year we dealt with all the urgent and emergent stuff. Next year we want to identify what we want to do with the remaining identified items that need to be replaced that were not on an urgent list this year. We are not in a position to say that we will invest $50 million a year for the next three years and we are committing to that today, therefore we can say this item is being purchased next year and this other item is being replaced the year after. Clearly, we are on a path that takes us to making significant investments in this area in future years.

The commitment we are making is rather than to a fixed dollar item, a fixed dollar amount on an annual basis, we are making a commitment to ensure that we are staying current with the technology to ensure we have the best that is available to us and state of the art. Also, the equipment that is being used in our health facilities and by our professionals providing this care is safe, meets current day standards, and is able to do the job that we are asking them to do.

MS JONES: Next to the mammography equipment, which I was very, very pleased to see in this budget, it would have to be the PET scan equipment. I guess a couple of questions around that. When do you actually think that you will be in a position to kind of purchase that unit and to have it installed in the Province?

MR. WISEMAN: Right now, today, there is a space issue. Right now, for example, we have some space requirements within the Health Sciences Centre that we are trying to identify how we are going to approach it. We have the expansion of the medical school that is taking place, and that will take place on that site. We are just about to open up the two new radiation bunkers that we saw there, expanded the facility to be able to accommodate that. We are doing a piece that we announced last year, a research piece for the medical school. That is underway as we speak.

That diagnostic area within the Health Sciences, we need to get our heads around how we are going to physically accommodate the unit. Obviously, you see from the budget that there is no money allocated to actually make the purchase this year but what we want to do this year is to make a determination of where it is going to be located. Keep in mind, I made a comment earlier, about we are evaluating acute care services in St. John's. To run down to the Health Sciences and pick out a corner and say we are going to stick it here, invest the money to put it there tomorrow, only to find that in the master plan we are doing, that is the corner that is going to become the cafeteria and then we have a problem and have invested a lot of money unnecessarily.

We need to wrap our heads around that particular piece first so we know that where we place the PET scan will not compromise what we want to do in some future change that we may want to make in the facility. That is the first thing we need to determine, and that is a piece of work that is underway as we speak. In this year, we will understand what it is we are going to do and hopefully, start to work on making that space ready for the acquisition of the unit. Then in next year's Budget, we will be providing some money to start with the acquisition process.

MS JONES: Along with the PET scanner, will you be purchasing a cyclotron as well?

MR. WISEMAN: Yes, we will. There is a very practical consideration there that has to do with geography. There is a shelf life for the production of it. You have to pretty well schedule your procedure in St. John's, schedule the production of it in Halifax and schedule your flights so that it all gets here at the same time so that it is still useful when it gets here. There is a very practical consideration for having to do that here.

My understanding of it now, unless something changes between now and the time we acquire it, but as it now appears, from a very practical point of view, we are going to have to have that here.

MS JONES: Yes. Actually, we had discussions with the Department of Health in Nova Scotia because they had been going through this process as well. I think when they originally started they did not have any plans for a cyclotron and had a direct chartered air service, which I think they are still using, between Quebec and Halifax, Nova Scotia. They realized very early on that they had to install this piece of equipment and I think they are almost ready to have that done now.

We are probably looking at about two to three years out, I guess?

MR. WISEMAN: I do not know. It sounds like you did a fair bit of research, you could probably tell us. I would not want to nail it down. All I know is that this year it is not in the Budget. We cannot do it this year because we do not know where we are going to put it. In terms of the mechanics of getting it, we had said that - this is a commitment we made as a party last year, as a part of an election platform, and we are committed to it and we will deliver it.

MS JONES: I am really happy to see it there and I certainly wanted to tell you that.

Do you have any questions on that section?

MS MICHAEL: You can go on.

MS JONES: Just under that section, the federal money that you have, the $3.5 million. What was that for?

MR. WISEMAN: (Inaudible) Furnishings and Equipment?

MS JONES: Oh yes, sorry.

Subhead 3.2.01. under head 01.

MR. WISEMAN: That was the wait time trust. It is the money that was set up to deal with the wait time.

MS JONES: Oh yes, meeting the targets?

MR. WISEMAN: Yes.

MS JONES: Okay.

It looks like you did a little bit better on those targets than you projected in your budget; $265,000 more.

MR. WISEMAN: We did really well on achieving the targets, too.

MS JONES: Yes, that is what I mean. That is what you get paid for, achievement, isn't it?

Under the next heading, Health Care Facilities; the Professional Services that you had budgeted for last year was the same -

MR. WISEMAN: My God! There can't be a question under this heading. With all the bricks and mortar we are putting in, and all the buildings we are putting up, My God!

MS JONES: Oh, lots of questions.

MR. WISEMAN: I did not know you would have any questions on this one at all. I just thought you would want to get up and thank us.

MS JONES: Well, you spent $32 million less than you budgeted for. The announcements are good but I am wondering how come it was $32 million less money.

MR. WISEMAN: We are making the announcements so fast that the contractors cannot keep us with us.

MS JONES: That could be, too. That could very well be, too.

My question was under 3.2.02., Professional Services 05., there was $32 million less spent than was budgeted and I am wondering why that was?

MR. WISEMAN: I said that kind of flippantly a minute ago about making announcements and capacity. What we are trying to do is trying to manage these projects, get the design work done, get them to tender and getting them built. The volume of work that we are doing and what we are forecasting as being the cost associated with this, because the budget dollar amount reflects what we are forecasting the cost to be. As we are announcing it we are putting it in the budget. Managing the process, getting the projects to start and to plan, design and actually conclude is where the capacity issue is coming into play. Well, obviously, the fact that we have it in the budget means we are committed to it and we have the money allocated for it. Just as fast as we can get the work done, we will get it done.

We are running into some real capacity issues, to be frank with you, with the capacity on a number of fronts; capacity within the consulting community to be able to do the design work and the planning work for us and capacity within the construction industry to be able to handle the work that we are doing, and not just on this front, because it is education spending a lot of money and with municipal infrastructure investments municipalities are spending a lot of money. All around, with government's infrastructure investments, not just health, it is taxing the capacity we have in the system provincially. Managing the flow of the cash is a bit of a challenge for us and getting the work done on time is going to continue to be a challenge for us.

MS JONES: In the report that was done on the health facilities in the St. John's region and the work that needed to be completed: how much of that work is going to be done this year? Can you give me the breakdown for each facility?

MR. WISEMAN: Not by facility, I cannot. I can get it for you but I cannot give it.

I am glad you asked that question in a different setting than question period in the House, because an understanding, I guess, is important to have with respect to that report. One of the things that report – because it is a software package, really, that is developed by a company to help you manage your facilities.

Let us say, for example, if they had placed carpet on the floor of this building we are in here now and the carpet we are looking at, the manufacturer said, this should last you twenty years. Day one you put it in, you set it up in your inventory as a $50,000 item and it is going to last you twenty years, so it depletes over a twenty-year period. When you get into the twentieth year, then it falls off the useful life. It should be replaced immediately and becomes a high priority because now it has outlived its useful life of twenty years and needs to be replaced. The way that system works, it automatically says that your carpet has now outlived its useful life, it now should be replaced, and it is in a priority one category. But it is carpet, and you look at it and it still might be fine.

The other might be the siding on the outside of your building. It might fall into that same category. So it is a category one, it is a high priority, it needs to be replaced because the siding is only due to last for twenty years and this is year twenty-one. That report and that analysis of that report and what gets categorized as high priority, simply expressed that is how it gets done.

Now, in our world and in the health authorities' world, saying, what is your number one priority, they would say, health and safety issues are a number one priority so let us get these done because there is patient safety involved, there is staff safety involved or the general public's safety is compromised here. So let us get that fixed. Now, the fact that the fire alarm system has just malfunctioned, we go back to the inventory and this new software says, well, that was only installed a couple of years ago, it has twenty years of useful life. Other than the normal maintenance on it on an annual basis, it should not come up for any kind of activity. It is not a budgeted item, it does not give you any red flags that say this is a high priority.

The management of our health facilities in doing maintenance and repair work needs to be left in the hands of the people who manage the facilities to judge what needs to get done. They use that as a tool, so it is not appropriate that you take that report on its face and say, everything that is in category one has to be done today, and if it does not the sky will fall, because on that list there are a bunch of carpets, there is a bunch of cushion floor, there are a bunch of ceiling tiles, and there is some siding on the outside of the buildings, there are walkways that people do not walk on anymore. It is all in the inventory, and so you need to be careful, careful for all of us, as we jump to conclusions when we see reports like that. You need to look at them and understand what it is they do, what it is they are intended to do. They are a tool to help inform management of what they need to do. They are not the bible to guide you into exactly what you have to do, but they are a tool.

What we are doing this year is we have said to each of the authorities, tell us what are your number one priorities from a safety perspective and have to be done right away. Tell us how much you can handle, what capacity you have. Because each of the authorities out there have to deal with the capacity they have. to manage these projects, in addition to all the new buildings that they are doing, so the human resource piece has to be considered.

The other thing with the renovations of these buildings is the logistics. We might have, for example, in Eastern Health at the Health Sciences Centre, twenty-five patient rooms that need to be repainted tomorrow. They are on a list to be done. Now, do you shut down twenty-five patient rooms to go in and paint them? No, you do not. What you do is you try to work through the logistics of having a room painted between discharges and admissions, and so instead of doing them all one weekend with a big blitz and shutting everything down, it might take you thirty-six months to do twenty rooms. That is just the logistics of managing the process.

When we are talking about how much do we allocate, this year we are allocating $33.5 million to do the maintenance and repair work. That comes about as a result of our discussions with the authorities. They are saying, these are our priorities and this is as much as we can handle, and if you add it all up it comes to be $33.5 million. That is what they got. Simply put, that is, in a nutshell, how we approach the process.

Yes, there is a list out there by this VHF or whatever the name of the company is that says there is $100-and-some-odd thousand worth of repairs that need to be done within Eastern Health alone. That is true, I will not refute that, but you need to put it in some kind of context. If you said to Eastern Health, here is a cheque for $100,000, go at it and get it all done in the next twelve months, they do not have the capacity to do it nor can they logistically do it while maintaining operations.

MS JONES: The data program that you are referring to then that was used in that review, it did list things as critical and potentially critical, and you are telling me that floor,

MR. WISEMAN: One of them was carpet and one was cushion floor.

MS JONES: - carpet and wall paint were part of the critical and potentially critical pieces that were listed here.

MR. WISEMAN: Exactly. That is software. That is how it works. It is a facilities management piece. You buy the equipment today and you plug it into your system where you say, here is the purchase price, here is the date I bought it, here is the useful life and here is how much we need to budget on an annual basis to maintain it. All of that data is plugged in. Every month they produce a report and say, this is on your red flag for this month. Every year they send you an annual report, or can produce an annual report, that says, here is the stuff that is going to be urgent in the next six months so start looking at it. When they look at it, the person who has responsibility for facilities management needs to look at it with some rational thinking. You cannot just run off and say, we have to do all of this today because the report says it has to be done. It is a tool to help them manage the facility.

MS JONES: Can you give me the breakdown then on the $33.5 million that was allocated in the budget?

MR. WISEMAN: By region? Yes, we can give you that.

MS JONES: I would like to have it by facility if I could get it.

MR. WISEMAN: I do not know if we have it by facility because the regional health authorities would have given it to us by authority. They may have it by facility, but they may have given it to us as their lump sum by their authority. Put it this way, the degree to which we have it drilled down by facility or by room, then we will give it to you to whatever we have.

MS JONES: Do you have any questions on that?

MS MICHAEL: No, I think that is all.

Just one question with regard to the Waterford: what discussions are going on with regard to the Waterford, if any, with regard to full replacement of that facility?

MR. WISEMAN: The issue of the Waterford Hospital, St. Clare's, the Health Science and the Miller Centre are the facilities that we have in the City providing acute care services. We have $1 million in this year's Budget to allow us to do an assessment of the acute care services that are required from a tertiary perspective because the Waterford and the Health Science are tertiary centres. From a tertiary perspective, what does the Province need by way of programs and then what kind of facilities do we need to provide those programs.

Secondly, within the greater northeast Avalon area there is a secondary level of care that is needed, acute care services, for the people who live in this particular neck of the woods here on the northeast Avalon. That is a programming piece that we need to better understand. Again, what kind of services, what kind of facilities do we need for that?

We know we have these four buildings today. When we better understand the range of programs and services that we need to be providing within the greater St. John's area, then the next question is: okay, what kind of buildings do we need to provide those services; what kind, what number, the capacity and how they might be configured? When we conclude that, we will make decisions around all four of those facilities, and those decisions may include, could include, the range of from doing nothing to painting them, to renovating them, to knocking them down, to building new ones and any and all things in between. There are fundamentally no definitive decisions.

One of the things we can share with you is that as we assess each of the facilities we recognize that in their current configuration the current physical structures themselves have some real inadequacies in terms of the nature of the building. How you fix that is the $64 question and we will not know the answer to that till we finish that analysis.

I would like to be in a position by the end of this fiscal year to start planning for next budget, to have in next year's budget an allocation that would see us, in a very tangible way, responding to the analysis we have done with the $1 million we have this year. We do need to be in a position to start moving quickly on identifying what that should be and to start the planning exercise for that. If planning is required to do renovations, changes, modernization, construction, demolition, whatever that entails, we need to be ready to start mapping that out in a more definitive way for the next budget year.

MS MICHAEL: That is helpful.

At one point - I do not know how long ago, maybe six or seven weeks - the current CEO of Eastern Health did talk about the growing need for acute care beds, so all of that, of course, is going to be looked at in the context of this study.

MR. WISEMAN: That is the programming piece. When we look at some of the programming things we talk about, for example - that is why the Miller Centre becomes a part of that equation. If we have people in the Health Science in acute care beds who need rehabilitation services and they are not available then that creates a bottleneck on the admission side. That is why someone may be in the emergency department waiting to get in a bed. There is a piece of that comprehensive review that we need to do. We are not just taking a stab in the dark, we understand fully the number of acute care beds we need and what level of acute care services will be provided at a tertiary level or a secondary level, what kind of rehabilitation services are necessary, and then the whole piece around mental health services, how that might be.

MS MICHAEL: Okay.

I think that covers the questions that I had.

MS JONES: I do not have any more questions but I certainly want to thank you, Minister, for your time and your cooperation and your informative answers. I thank your officials as well for taking the time to sit with us tonight and go through all of this. I know it is a grueling process but one that is necessary if we are to understand how the expenditures of government work and where money is being invested.

Thank you very much and thank you, Mr. Chairman.

CHAIR: Thank you.

MR. WISEMAN: It is our pleasure. Thank you for your insightful questions as well. Obviously, you have done some research. In fact, given some of your comments about the research you have done on some aspects maybe we should get you to come over and do an in-service for us or something sometime.

MS JONES: I work on commission.

MR. WISEMAN: Do you? Good stuff!

MS MICHAEL: Parliamentary committees would do it, Minister. We share all of our knowledge together all of the time.

CHAIR: I will ask the Clerk to call the subhead.

CLERK: Subhead 1.1.01 to 3.2.02 inclusive.

CHAIR: Shall 1.1.01 to 3.2.02 inclusive carry?

All those in favour, 'aye'.

OFFICIALS: Aye.

CHAIR: All those contra minded.

On motion, subheads 1.1.01 through 3.2.02 carried.

CHAIR: Shall the total carry?

All those in favour, 'aye'.

OFFICIALS: Aye.

CHAIR: Contra minded.

Shall I report the Estimates of the Department of Health and Community Services carried without amendment?

All those in favour, 'aye'.

OFFICIALS: Aye.

CHAIR: Contra minded.

Carried.

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

CHAIR: Minister, just before we leave, certainly on behalf of the Committee I extend a thank you to you and your officials. It has been a long night but I certainly appreciate your time. As well, thanks to the Committee.

I ask for a motion now to adjourn.

OFFICIAL: So moved.

On motion, Committee adjourned.