Pursuant to Standing Order 68, Wade Verge,  MHA for Lewisporte,  replaces Wally Young, MHA for St. Barbe.

The Committee met at 6:10 p.m. in the House of Assembly.

CHAIR (Hutchings): Order, please!

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

Before we get started I will just go through the basic format, which most are aware of, but we will just follow through on it.

Minister, what usually takes places is you will have fifteen minutes for any introductory comments, and, as well, at that time I would ask you to introduce your staff or have them introduce themselves. Any time they are speaking, I would ask that they identify themselves each time for the benefit of Hansard, so they can identify who the speaker is. Then we will go to the Committee, and the Committee can respond for fifteen minutes and then after that we will go back and forth at ten minutes with Committee members.

Before I proceed, I would just like to reference minutes from the Department of Municipal Affairs, Social Services Committee, of 9:00 a.m. this morning. Committee members should have a copy of those minutes there. Just one correction, under number 2, present from the Committee were, the sixth name down says Kelvin Parsons, that should have been Kevin Parsons. So we will have that amended.

Now, if I could have a motion to adopt those minutes.

MR. CORNECT: I move the motion.

CHAIR: Okay. Mr. Cornect.

On motion, minutes adopted as circulated.

CHAIR: Okay, we will call the first subhead.

CLERK: 1.1.01.

CHAIR: Shall 1.1.01. carry?

Before I go there, I will ask the Committee to introduce themselves, starting at my far right.

MR. VERGE: Wade Verge, MHA for Lewisporte.

MR. KING: Darin King, MHA for Grand Bank.

MR. CORNECT: Tony Cornect, MHA for Port au Port.

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

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

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

CHAIR: Thank you.

Okay, minister, over to you.

MR. WISEMAN: Thank you, Mr. Chair.

Let me introduce my staff. To my immediate left is the Deputy Minister, Don Keats; to his left is Assistant Deputy Minister, Jim Strong; directly behind Jim is Charlene McCarthy, who is the Acting Director of Financial Services; Sharon Vokey, my Executive Assistant; Tara Furlong, recently married, the Manager of Communications; Tony Wakeham, ADM; Moira Hennessey, ADM; Faith Stratton, Chief Medical Officer of Health; Jennifer Jeans, an ADM with the department as well; to my right, my Parliamentary Secretary, Terry French.

Thank you very much for the opportunity this evening to be able to provide some responses to questions and to talk a little bit about the Department of Health and Community Services and some of the things that we are doing as a department and some of the things that are happening out in the regional health authorities.

I think the 2009 Budget is a milestone budget. I think, probably if you are looking at milestone budgets, if you look at the growth in budgets in Health and Community Services in the last four years, each and every one of them have shown significant investments over the previous year. The health budget now has grown to some $2.6 billion annually. This year we are recording a 7.8 per cent increase in our budget again. That compares to the last couple of years, or last year for example, where we had 11 per cent, the year before that some 10 per cent, the year before that 10 per cent.

So the last four year's Budgets have seen some significant increases in budget investments that we have made in the Province. In fact, this past year we have now earned the distinction of having been - as a Province in the country, we now spend more on a per capita basis of public expenditures than anybody else, or any other province in the entire country. Last year we surpassed Alberta with that distinction. So the growth in our investment that we have made in health has been significant. We will get a chance this evening to talk a little bit about some of those kinds of investments.

This year's Budget continues to build on things that we have done in the last few years. Again, strengthening the investments we have made in Child, Youth and Family Services. You are all aware of the Speech from the Throne when there was an announcement this year that there was a new department to be created. We will be moving throughout this fiscal year to implement that announcement in the Speech from the Throne.

This year's Budget provides some additional enhancements to the programs and services, and this investment is to be made in programs and services but we also earmarked some money to allow for the transition to a new department as well, and that builds on again some investments we have made in the previous years.

Last year we passed the Protection of Health Information Act, which is a significant piece of legislation that will help us provide the legislative and regulatory framework to provide the adequate protection of personal health information, as people are sharing it as they become a part of or users of the system.

The investments we have made in infrastructure in this year's Budget builds on the investments we have made in recent years. This coming year we will see the opening of the new long-term care home in Clarenville. We will finish construction and open the new long-term care home in Corner Brook and we will continue with the completion of the new long-term care home in Happy Valley-Goose Bay.

We had an opportunity to share in an opening celebration recently in Grand Bank with our colleague, Mr. Chair, a member of the Committee here tonight, the MHA for Grand Bank. I participated in an opening of a new health centre in Grand Bank very recently. A great facility, it provides tremendous enhancement for health services on the Burin Peninsula and more particularly, those individuals in the Fortune, Grand Bank area of the Province; a magnificent facility, a tremendous improvement over what was there. So we had that recent announcement and recent opening and a new celebration of a new facility.

This year, as well, we have made some significant investments and continue to build on past year's investments in the whole area of mental health and addictions.

A couple of highlights, and I know the Member for Signal Hill-Quidi Vidi and I have exchanged commentary in this House many times in the last year or so about home support services. This year we have made some significant investments in the Home Support Program. There are two aspects to this year's investment. One, there is a focus on the clients and a new financial assessment tool that we have introduced that will reduce dramatically the client contribution that people have to make to get home support services.

The other thing we have done, we have announced increases in this coming year for home support, allowances made for home support compensation. One is effective March 1, I think it is, or April 1. The next one is July 1, 2009 and the third one will be January 1, 2010. One of the significant issues around the July announcement, it is a process that starts to widen the gap between the home support compensation and the minimum wage.

Historically, home support salaries have been – I would not use the word tied to, but they have been – incremental changes have occurred coinciding with the minimum wage and they tended to be an equivalent amount, and the July 1 one is a departure from that. The minimum wage increases at that point in time by fifty cents and the increase in the home support allowance is going to seventy-one cents, which is a start of a process to widen that gap. This, again, is an additional investment that we are making this year that builds on the investments we have made for the last three years, because I think in the last three Budgets, the last four Budgets there has been announcements in there about how we have invested new money in home support. In addition to those pieces, we have made some additional investments to expand capacity in the system. So these are things that are significant investments that we are making as part of the long-term care piece as well.

This year we are going to be starting the construction of the new long-term care homes to replace Hoyles Escasoni. This year's Budget also announced the start of a process, to start the land acquisition process for a new long-term care home to be constructed in the Carbonear area. So these are a couple of major investments that we have made in the long-term care and community supports pieces again this year, I say, Mr. Chair.

A couple of other things that we will end up talking about before the night is over, I am certain, again it has been talked about in this House many times, the whole area of child care. With this year's announcement for the increase in subsidy, this now makes us, I think we might be – Jennifer, I think it puts us now the leader in the country, or there is only one other jurisdiction in the country that provides a subsidy greater than ours. Let me qualify that by excluding Quebec for a moment because they are a bit of a unique circumstance, but in the other jurisdictions that puts us now second only to one of the Territories, I think it is, and then only by $1. So these are some significant investments we are making in children and the development of young children in our Province.

Infrastructure money, I made a couple of comments about some of the things that we are doing this year with new long-term care homes, but one of the things we are also starting this year as well is we are going to be doing some work in the new acute care facility in Corner Brook. We are about to, in the very near future, announce the consultants who are going to start to develop the functional program for that. We are staring a process now to define and plan for the acute care redevelopment in St. John's. That was announced in last year's Budget, with additional money this year to continue with that piece of work. So we are making some significant investments to improve the capital infrastructure that we have.

We are very pleased this year as well to be able to continue to make significant investments in equipment. In the last three years - I think last year we spent $52 million, the year before that it was some $48 million, and this year we are spending another $50 million, to be able to enhance the medical equipment used by our health professionals to provide quality patient care.

These are just some of the highlights, and no doubt we will get into some of the detail as we talk throughout the evening. The other thing that we have announced in this year's Budget is a significant investment of some $20-odd million to help us respond to the recommendations made in Justice Cameron's report. The inquiry, as we are all very much aware, looked into what happened between 1997 and 2005 with respect to ER/PR testing, particular within Eastern Health but it spans out to the entire Province as well - or the review did - and these recommendations will not only affect Eastern Health but they will affect every health organization provincially.

These are just some of the highlights, Mr. Chair, and we will no doubt get into some of these discussions as the evening progresses. With that kind of introduction I am now ready to, if you want, answer some questions and explore some of the issues that are important to members opposite. If I do not have the answers we will get them for them.

CHAIR: Okay.

Thank you, Minister.

We will now go to our Committee.

Ms Jones.

MS JONES: Thank you, Minister, for your update, and I thank your officials for being here this evening to answer questions for us. I would also like to introduce my health researcher from the Opposition Office, Joy Buckle, who is with me this evening.

We have a number of questions, and we are going to start with the line-by-line in the Estimates. Then we have other questions that we want to explore after, if they are not covered as we go through the Estimates.

First of all, starting with your office, Minister, we understand in the budget there is $169,500 budgeted for temporary and other employees in your office. Can you tell us what positions they are, and for how long a period they are?

MR. WISEMAN: Temporary positions?

MS JONES: That is out of the salary estimates for your department. It shows that you are spending $169,500 of your $446,900 on temporary and other employees. We know that temporary employees are short-term positions with government that do not necessarily be advertised.

MR. WISEMAN: I have the salary details; I just need to know the positions you are referring to. I just want to make sure I have the appropriate temporary ones. When you use the word temporary, I just want to make sure how they are classified. There is a salary detail in there for a policy advisor that is currently vacant, $72,000, and there is a contractual position of $52,000, an administrative support position, and the others –

I am hesitant here, Mr. Chair, because when you say temporary positions, we have a policy advisor, which is a political position that has been vacant for a while; then we have the characterization of the assistant to the Parliamentary Secretary, again a contractual position, and that is identified there, $51,000; and then we have an administrative support position, which is a contractual position of $52,000. Which other ones would fall in that category of being…?

OFFICIAL: (Inaudible).

MR. WISEMAN: That is the three, so there are only three. Those are the three, Mr. Chair.

MS JONES: Okay, so there is an assistant to the Parliamentary Secretary?

MR. WISEMAN: That is a constituency assistant. They end up showing on our payroll in the department. They are not charged to the House of Assembly.

MS JONES: Okay.

Explain that to me again, because I sit on the Management Commission and I know that money is budgeted for CAs under the House of Assembly budgets as well, so why would it be in the line item in the department?

MR. WISEMAN: I will ask Jim to answer that for you because the constituency assistants to the Parliamentary Secretary and to the minister are in the department's budget, not the House of Assembly.

MS JONES: You can go ahead now, Jim. I am sorry; I was just clarifying something with Lorraine. You go ahead.

MR. WISEMAN: The salaries for the constituency assistants for both the minister and the Parliamentary Secretary are both in the department's budget.

MS JONES: Okay. They are listed under Temporary and Other Employees as opposed to Permanent Employees.

MR. WISEMAN: Jim, you can clarify this but I am assuming, from the way you are characterizing it, that the political staff are separated out from the permanent employees of the department, because they are temporary in that political staff change when the elected officials change, and different people can be moving in and out of there.

MS JONES: Okay.

Under Transportation and Communications, last year you had planned to spend $70,000 and you only spent $40,000. Why was that? You did not get a chance to get out, or a conference you did not get to, or…?

MR. WISEMAN: No, $70,000 is what we are budgeting this year as well, as you note, and we budgeted $70,000 last year because history had shown that was roughly what that office would have spent.

Last year, I did not travel as much as I anticipated. There were a number of FPT meetings that we did not move forward with last year. The Minister of Health and Community Services is involved in the Social Services FPT group and there was no meeting last year, for example, and Health Ministers only met the one time last year, so there are a number of those initiatives that did not see me travel as much as we had thought.

MS JONES: Okay.

In your office as well, you budgeted $16,000 for purchased services and you only spent $3,000. I am just wondering what that would have been budgeted for. What kind of purchased services would you have at your particular office within the department?

MR. WISEMAN: What we spent the $3,000 on?

MS JONES: No, what you are budgeting the $16,000 to be spent on.

MR. WISEMAN: This could be for any number of things: entertainment that the minister's office might do. For example, sometimes I will host – in fact, we will be hosting in September of this year the Atlantic ministers quarterly meeting that will be held here. Those kinds of functions ordinarily would come out of this expense category.

MS JONES: All right.

Moving on to section 1.2.01 under Executive Support, again in this office you plan to spend $445,800 on temporary and other employees. That is $300,000 more than you spent in the last fiscal year. I would like to know what the reason is for that, what positions these are, and for how long they are.

MR. WISEMAN: Jim, do you want to provide an update on what those temporary positions would have been?

MR. STRONG: One position would be a communications manager position that is contractual. There is also an additional ADM position that is in the department's budget right now still classified as temporary, and there is also another contractual support position in communications that will be there for about half a year as well.

MS JONES: Only three positions for nearly $450,000 in salary?

MR. STRONG: I am just going to have to do a little reconciliation here for you. Just give me a couple of minutes to do that, if I could beg your indulgence.

MR. WISEMAN: (Inaudible) reconcile the numbers for you.

MS JONES: Okay.

While you are doing that, this salary obviously includes two communication positions in the department under temporary and other employees. Also, under the Executive Support to the department it is also identified that there is a communications director. That means there are three communications people in the department, or are there more that I am not picking up somewhere in the numbers?

MR. WISEMAN: What we have is one of the people in the communications department is off on long-term sick leave, so that salary is being carried. We have a replacement in for that person so that salary is being carried here as well.

MS JONES: Okay.

When you say the salary is being carried - because I am not showing any vacancy for last year. In fact, you overran your budget last year on salaries in Executive Support, so I do not understand. You will have to explain that to me.

MR. WISEMAN: We have a director of communications, then we have a manager of communications, and there is a third person who works on a – Tara, their title is?

MS POWER: There are two managers.

MR. WISEMAN: A director and two managers, together with an admin support person. It is the admin support person who I indicated has been off on extended leave, but we have a person in to replace them so we are carrying both salaries for those two people.

MS JONES: Okay, so there are four communication positions within the department?

MR. WISEMAN: Yes.

MS JONES: Okay.

MR. WISEMAN: One director, two managers, and an administrative support person.

MS JONES: Also, it is telling me under the Executive Support - that would be the permanent employees in the department - that there are four assistant deputy ministers, and you are telling me that under temporary and other employees there is also another assistant deputy minister. So, is it fair for me to say there are five ADMs?

MR. WISEMAN: What we have is one ADM's salary that we are carrying, a Special Projects ADM that we will be carrying in this year. That person is focusing on some very special projects for the year, and that is a temporary arrangement, but in terms of the permanent structure of the department there are four ADMs.

MS JONES: Do you want to tell me what those special projects are?

MR. WISEMAN: Primarily all of the capital money that I talked about earlier that we have invested. Ms Hennessey is going to be working on the co-ordination of these special capital projects. We have the long-term care piece in Hoyles-Escasoni that I talked about, there is a piece of work doing the analysis of acute care needs in St. John's, and the start of the functional program of the acute care piece in Corner Brook that are the primary and major capital projects that we will be actively involved in this year, and she is going to be, on behalf of the department, focusing on those projects.

MS JONES: Okay.

I am just wondering if Jim had an opportunity to get those numbers before I move on.

MR. WISEMAN: Do you have those numbers reconciled?

MR. STRONG: We just have the three positions there right now. I think the difference might be that the permanent cost listing - when we do up our salary budgets, if someone is temporarily assigned to a position then we list the position at step one, whereas the individual in the position might be at a higher salary. I was just asking my Director of Finance if she could confirm that for me, in which case the money would be in the temporary allocation as opposed to the permanent allocation.

MS JONES: Well, all of the permanent allocations are listed here and they only include the ones I have outlined: the assistant deputy ministers, three secretaries, a medical consultant and a deputy minister.

MR. STRONG: I will just have to get back to you. I apologize for that.

MS JONES: Actually, it was four secretaries for the ADMs, I am sorry, and two others for the department.

While you are doing that I will move on. Under Purchased Services in the department you budgeted $76,500. You only spent $26,500. Can you tell me what you spent that on, and what the other $50,000 was meant for but obviously did not get spent last year?

MR. WISEMAN: The expenditure itself of $26,500, there was $2,293 for general purchased services, there was a $300 entertainment bill cost in there, there was $10,840 for advertising and promotion, and there is $13,000 of unexpenditure funds to date, so that is the allocation. Of the remaining fifty, we did not do as much advertising as we initially had targeted for, so that is where the savings come in.

MS JONES: Under Professional Services this year you only budgeted half of what you had normally budgeted in the last few years in the department.

MR. WISEMAN: One of the things we have done this year is captured in - if you roll up all of these two areas of Professional Services and Transportation, as a part of this year's exercise we were examining what we were spending in those categories and we have taken basically $335,000 out of the Professional Services category from last year as an overall cost reduction part of the department's budgetary exercise. We have taken some $265,000 out of the various transportation categories across these areas. If you look at both Transportation and Professional Services you will notice that we have taken almost $600,000 out of last year's allocation to reflect a reduction in this year's budget.

MS JONES: I am just consulting with my colleague because I do not want to hog all of the time. I am making sure that she gets an opportunity.

CHAIR: We are up to about fifteen minutes now; so, Ms Michael, do you want to –

MS MICHAEL: Sure, I can (inaudible).

CHAIR: Is that okay?

MS JONES: Yes.

MS MICHAEL: Just a suggestion: maybe one way to do it, if I do the next one I probably will cover some questions that Ms Jones would also cover, but if you want to jump in when I get to the end of that section, that might be a good way to do it.

CHAIR: Sure.

MS MICHAEL: Rather than having to go back and forth, because with this one, Executive Support, she has asked all of my questions so I can go on.

Now we are looking at 1.2.02, then, Corporate Services, and some of the questions will be similar. Once again under Corporate Services there is not as much money in temporary and other employees, but there is $290,300 in temporary and other employees in the Corporate Services. Do you have a breakdown of that?

MR. WISEMAN: Do we have the temporary ones there for this one?

OFFICIAL: (Inaudible).

MR. WISEMAN: I have just been advised, because there is some reconciliation that we need to do with these temporary versus the permanent employees and we want to make sure we give you accurate information, one of our officials now has gone back to the department to get that level of detail so we will be able to – not to mislead you. We want to make sure that you have good information, so she has gone back to get that piece. If you want, we can put a place marker here and come back to that question.

MS MICHAEL: That sounds fine. I will hold that question, then.

Is that all right with you, Yvonne?

MS JONES: Yes. I was just going to say that the reason for this questioning is that there is nearly $4 million in salaries paid out to temporary employees in your department. That is an extraordinary amount for any government department, especially when we know that a lot of these positions are not advertised, they are selected, and they are supposed to be short-term periods. It exists in every single sector, so the question will keep coming up. Just to let you know that.

MR. WISEMAN: Yes.

MS MICHAEL: What we will do now, or what I will do, anyway, in the sections that I do, I will wait until you have the information back in the room. There is no sense asking if you do not have it back in the room.

Listening to what you said, Minister, with regard to making cuts in Transportation and Communications and in - what was the other one?

MR. WISEMAN: Professional Services.

MS MICHAEL: Purchased Services.

MR. WISEMAN: Professional Services.

MS MICHAEL: Professional Services. You did make the cut in Transportation and Communications under the Corporate Services for sure, although last year your revision was much higher than your budget. What happened last year that the revised amount went up by so much?

MR. WISEMAN: Two areas that drove that cost were postage and transportation of products. For example, last year we had a cost of some $121,000 for MCP card mail costs out of the St. John's office, and another $108,000 out of the Grand Falls office, and the mailing supplies out of Stephenville, the Low Income Drug Program. So we had, last year, a total cost of some $236,000 in our postage piece.

Associated with those areas as well, we had the Low Income Drug Program, in the period from September to October we had a mass mail-out of some $23,000, and then the same thing with the Healthline card, the advertising for the Healthline card; we did that last year at a cost of some $20,000.

Then we had a campaign with an aging and seniors' awareness campaign and a social marketing campaign to create a better understanding of aging and appreciation for seniors, and that was some $6,500 in cost.

Those are things that drove that cost well above where we had initially budgeted.

MS MICHAEL: Okay.

By making the cut that you are making, you do not anticipate things like that being affected by the cut, under Transportation and Communications?

MR. WISEMAN: We should not have those mass mail-outs this year that we had last year.

MS MICHAEL: Okay.

Could we come up to the Salaries? I know you do not have the temporary information, but do you have the information on – last year your revised amount was about $400,000 less than your budgeted amount, and now this year you are going up by approximately $100,000; if you could just explain the dip in the revision, and then the (inaudible).

MR. WISEMAN: There are a couple of things here that you will see across all of the salary detail.

This year coming there are twenty-seven pay periods versus twenty-six.

MS MICHAEL: Oh, that is right, yes.

MR. WISEMAN: No doubt you have run into this in other departments as well.

MS MICHAEL: Yes, we have.

MR. WISEMAN: The other piece is we have the salary increase negotiated with the new collective agreements that will kick in this year. Those two items themselves will see a change in salaries, just by virtue of those two actions, so that is a piece here.

The other one is we have a number of vacant positions right now. For example, there is a financial officer position, there is a budget analyst, there are two accountants, there is an accounting clerk, and those positions will be filled in this coming fiscal year.

MS MICHAEL: Okay, thank you.

Under Employee Benefits it sort of differs from some departments to the others. Because this is a high figure, what do you cover under employee benefits in your department?

MR. WISEMAN: Jim, can you comment on that?

MR. STRONG: About $301,000 relates to payments to the Workplace Health and Safety Compensation Commission for job-related injuries. The balance of the money is for registration and conference fees for staff.

MS MICHAEL: Okay.

So, it is because of the workers' compensation that it is so high?

MR. STRONG: Yes, where government is self-insured, the department has to pay the cost.

MS MICHAEL: Right. Okay.

That is what I mean about departments being different, because there are other departments that do not put that money in there, so I wanted to ask that one.

Under Supplies, 04, again your revised amount last year went up quite a bit. That might be related to these mailings that you talked about earlier, I am not sure, but could you explain that revised amount being so high?

MR. WISEMAN: A couple of things. We had some new staff coming in. We also had some increased costs as a result of some ergonomic workplace changes that were made, work stations, and we ended up with some significant investments with keyboard trays, chairs, and those sorts of things to accommodate that piece.

As a result of the additional staff we were having other printers, computers and things like that, that we have added to the department.

MS MICHAEL: Right.

The next one is curious, too, because your budget in Professional Services was $1 million, you only spent $60,000 last year, and you have $1 million in again for this year.

MR. WISEMAN: That is a figure that several years back the department started to budget for. It is intended to have a pot of money available to us if we need to do some work with either federal or provincial agreements, that we are able to use that. For example, at a meeting with colleagues in Atlantic Canada last week there was an initiative that we have agreed to partner on with respect to the prescription drug program. We need to collectively work together on pulling together some information and we need to cost share that. Those sorts of initiatives would come out of here.

Sometimes the federal government may come up with an initiative where the provinces are able to access some money through the federal government through a joint arrangement if we are able to come up with our share of the cost-sharing arrangement. So as not to get caught in a spot where there is no provision for that, we created an allowance for it here.

It just so happened last year that the uptake was not that great. This year we could find ourselves in a very different circumstance. We need a pot of money to be able to access those kinds of agreements, or to partner with other jurisdictions in things that we have a common interest in, that we all can benefit from.

MS MICHAEL: What was the $60,000 for last year?

MR. WISEMAN: Jim, you might want to comment on that.

MR. STRONG: That was a small amount of money that was spent with respect to the CRMS system. We are putting in place a new payment system in the RHAs, and some of the training dollars associated with the preparation of that were charged here.

MS MICHAEL: Okay.

How would you have reallocated the money that did not get spent there last year? Because I am assuming, then, there may be other years that you have a very small amount. Do you reallocate that money before the fiscal year is over?

MR. WISEMAN: Sometimes there have been years when we have what is referred to in accounting terms, I understand, what is called a drop balance.

MS MICHAEL: Yes.

MR. WISEMAN: If you do not spend it, then it just stays there on your books at the end of the year and government looks at those figures across departments and shows it as a drop balance. We would leave it in there and bring it forward to next year -

MS MICHAEL: Okay.

MR. WISEMAN: - but it is not necessarily reallocated.

MS MICHAEL: Right.

Do you think this was a drop balance this year, that just brought your money forward, or do you know?

MR. WISEMAN: It was a drop balance, yes?

OFFICIAL: It was a drop balance.

MS MICHAEL: A drop balance this year. Okay, thank you.

Property, Furnishings and Equipment went up. I am assuming that was because of new staff as well as the supplies: desks, et cetera, I would imagine.

You are nodding, so I will accept that.

Now, under the revenue, the federal revenue, you budgeted for a million but it looks like you did not get it last year, in 2008. Is that correct - because there was no revised - or is it that you do not put it in if it is the same amount?

MR. WISEMAN: You are talking about on the –

MS MICHAEL: Under revenue.

MR. WISEMAN: On the summary grid?

MS MICHAEL: Yes, in Corporate Services, 01, Revenue – Federal.

MR. WISEMAN: That is linked to the conversation we just had about the million dollars that is in and out.

MS MICHAEL: Yes.

MR. WISEMAN: We provide a million dollars there for that provision. So if we do not enter into an agreement with the federal government for our investment, we do not get the revenue stream from them either.

MS MICHAEL: Okay, understood. Yes, that is clear.

What is the source of the provincial revenue?

MR. WISEMAN: Jim, do you want to respond?

MR. STRONG: That is just what I call a sundry account. If we just get miscellaneous amounts of revenue in for whatever - a travel claim refund, maybe, or a bursary refund – it is a general provision that we use for things that are really on a non-recurring basis.

MS MICHAEL: Okay.

Ms Jones, do you have any questions under that section?

MS JONES: (Inaudible).

MS MICHAEL: Okay. Do you want to take the lead on the next one?

MS JONES: (Inaudible).

MS MICHAEL: No problem, I will go ahead. I am ready to do it.

I am sorry; we misunderstood each other.

The next one then, 1.2.03, Medical Services, "Appropriations provide for the management of physician services and provincial drug and dental programs."

Last year, in Salaries, the revision was down a fair bit - almost, not quite - just over $300,000, I guess, from the budget. What happened there? I am presuming you must have some positions that were not filled.

MR. WISEMAN: We did have vacancies in the director of medical services position, there was an economist position that was not filled, and we have a pharmacist, a business analyst, and a pharmaceutical claims assessor that were not filled.

The total, if you wrap all of these together, comes up to some $400,000 that we did not spend, as a result of those vacancies.

MS MICHAEL: They have all been filled now, have they?

MR. WISEMAN: The director of medical services is just being filled as we speak; the person is probably on payroll as we speak, or are about to be.

The manager in the pharmacy piece is still not filled, I do not think. I think the claims assessor probably is. The clinical pharmacist, I think there is still one vacancy in that area, too, is there?

OFFICIAL: Yes.

MR. WISEMAN: Yes.

MS MICHAEL: Okay, thank you very much.

I can see under Transportation and Communications, you definitely are cutting back in that line this year.

Under Professional Services, you spent a fair bit more than you had budgeted for last year. Can we have an explanation of that?

MR. WISEMAN: Last year, we did a piece of work on the client registry as a part of that. Jim commented earlier about a piece of work we are doing, CRMS –

MS MICHAEL: Yes.

MR. WISEMAN: – which is a Client Registry Management System, and we did a piece of work on that and spent some $105,000. Then we had an invoice that was in previous year that did not get paid until in the new fiscal year. So there was an expense incurred in the previous year for some $105,000, and then we had some savings in another area for $113,000, which gave us a net of that $97,000 figure that you are talking about there.

MS MICHAEL: Okay.

You are going down substantially in this year's estimate, and you think that is reasonable?

MR. WISEMAN: We do. We believe we are going to be able to stay within that figure. One of the big things that drove that was, as I said, that invoice piece was $100,000 that ordinarily would have been picked up in the previous accounting year and did not. So that was not actually an expense incurred in last year.

MS MICHAEL: Right, okay. Thank you.

Is there anything there, Yvonne, that you want to deal with?

MS JONES: I am just wondering: This is not the section where the dental subsidies come out; that is a different section in the Estimates, is it not?

MR. WISEMAN: It is a different section, yes.

MS JONES: Okay.

That is the only thing I was wondering.

MS MICHAEL: Do you want to do the next section, 1.2.04?

MS JONES: (Inaudible).

MS MICHAEL: All right, I will go ahead.

Under 1.2.04, here is where we get into direction and support to the regional health authorities, including the construction and redevelopment of facilities. I am going to ask a question about that before I go into my questions.

I am assuming that means the planning phase, with regard to redevelopment of facilities and purchase of equipment. Is that what you mean by saying that expenses would include, or what you support includes, the construction and development of facilities and purchase of equipment? Does that mean with advice in how to do it, or…?

MR. WISEMAN: Yes, this would not be the cost centre where you would charge out those expenditures.

MS MICHAEL: No.

MR. WISEMAN: No.

MS MICHAEL: No, it would be more advice, help them make the right decisions, that kind of thing.

MR. WISEMAN: Exactly.

MS MICHAEL: Okay, that is what I thought it was. I just wanted to check.

All right, then, in this one, 01, again the revised was down somewhat from the budgeted figure last year. I am expecting it is that same answer, but I will ask anyway: Is it because of positions not filled?

MR. WISEMAN: Exactly. We had a program manager; there are two program manager positions that were not filled. We had an engineering consultant that we just recently filled; it was vacant throughout last year. Then we have a provision for a manager for capital infrastructure that is still vacant.

MS MICHAEL: Okay.

Your figure for this year is sensible in light of the explanation from the other questions I asked of the other sections.

Transportation and Communications, I think, speaks for itself; it has gone in a direction that you said you had made a definite decision on.

Professional Services here, last year you under spent, the revision is about $300,000 less, and this year it is going up by a fair bit, by $200,000 over last year's budget. Could you give us an explanation of what is happening there?

MR. WISEMAN: You are right about your observation last year; we had targeted several initiatives that we had forecast what the cost would be, and when we followed through with them they did not cost us as much as we originally budgeted. Therein lies the difference from last year's initiatives, but the figure of $737,000 was budgeted based on historical patterns and pieces of work that we normally do, and last year we ended up with those savings. So $947,000 by comparison to the $737,000, which is roughly where we are, there are a couple of hundred thousands dollar increases that we are talking about there.

One of the things that we want to try to do, we earmarked some money this year because there are a number of years that we want to start zeroing in on, in terms of programming and services, and we want to make sure that we have some provision here to do some series of reviews in certain program areas. This is the year we want to try to examine some of the programs and services that we have, and we need to provide some allocations here to be able to provide that kind of professional expertise to help us with that process.

MS MICHAEL: Which program areas are you looking at?

MR. WISEMAN: We have not necessarily targeted a specific area. What we want to try to do, this makes a provision to allow us to be able to – you have raised in this House a number of times, I think your phrase has been a total review of the system, and you have heard me suggest that is not where our heads are, but there is merit in looking at certain program areas. For example, we are doing a piece of work now with mental health services, paediatric mental health services, for example, and being able to bring some expertise to bear in those sorts of areas is always beneficial.

We have the gambling awareness campaign that we have been involved with. You can understand that the prevalent studies that we have been doing to help focus some of our strategies and initiatives are things that we want to try to do there.

Those are a couple of examples of where we know we will have some increased expenditures this year, and we just want to make a provision to allow us to do that.

MS MICHAEL: Right.

Actually, that is one of the questions I was going to ask you under this, so if you could talk a bit more about the gambling. Do you have future studies of the VLT impact plan, for example? We do not have great data on people who are addicted.

MR. WISEMAN: We are going to repeat the gambling prevalence study, because we established a baseline. Now we are going to repeat that to see what progress has been made, because there have been a number of initiatives where we have invested some money in providing additional services. We have had social marketing campaigns, we have had the reduction in the number of VLTs that we have in the Province, as a result of the announcement from a couple of years ago, and these gambling prevalence studies will give us some measurement of whether or not we are having any impact.

MS MICHAEL: Right.

MR. WISEMAN: If it is working, then great; if it is not, then we need to obviously refocus our investments on what we need to do to keep it in line with the trend we want to establish.

MS MICHAEL: Right.

Would you hope to have that study finished within this fiscal year, hopefully, or would it take longer?

MR. WISEMAN: Moira? It will be done –

MS HENNESSEY: The gambling prevalence study has been done. We are awaiting the results right now, so I would think we will certainly have it in the coming weeks.

MS MICHAEL: Great. That is good to hear.

Yvonne, do you have any more questions under that section?

MS JONES: No, just on the next section.

MS MICHAEL: Well, why don't you head up the next section then?

MS JONES: Under section 1.2.05, Public Health, Wellness, and Children and Youth Services, first of all, again as it relates to the salaries, I just wanted to put it on the record so that you can get the information for us, there is $1 million more this year being spent in that particular heading for temporary and other employees, and we do expect to get a breakdown of what those positions are, and the duration that they are for.

MR. WISEMAN: One of the things we might want to provide for you, too, when you talk about people being in temporary positions, many of them are not temporarily created positions; they are positions where there is a permanent position established and they are being filled by someone who is temporary, or it is a position that we plan to create, and through a classification process they have not been officially classified so we fill them in an interim basis. We had a fairly large number – I say large number; there are probably eight or nine like that, which is a large number for a small department. When we were making some changes in the structure of Child, Youth and Family Services, for example, in the department, we had a number of positions that we needed to move on with and fill. We filled them on a contractual basis, a temporary basis, until Classification and Pay had actually done the official classification. We were able then to carry out the public campaign through public advertising to recruit them. There are a number that fell in that category. What we will do is profile those positions, or indicate which ones are permanent, and we are filling them temporarily, or which ones are temporary, because we are slotting someone temporary into a permanently established position.

MS JONES: All of the permanent positions we know, because they are all in the salary estimates and it is all listed; it is all broken down. What I am confused about now is: Why in the department are you continuously placing permanent people into temporary positions? I can see it on a short-term basis, but in other headings under your department these positions have been turned over for several years. We went back through the salary estimates for the past number of years and they are still temporary. Why is that? Is that so they do not receive additional benefits? Is there some other reason? I have no idea.

MR. WISEMAN: There would be no difference in the benefits that the employees get. They would still be entitled to the group insurance programs, they are contributing to the pension plan, so there is no benefit, or lost benefits to the employees who are impacted by that.

I will provide the explanation as to the numbers, the breakdown that you are asking for. I know some of them I can explain because of the nature of the classifications. No doubt, all of them are not in that category but we will provide that answer for you.

MS JONES: Okay.

We will just move on from there but you know what we are looking for, right?

MR. WISEMAN: Yes.

MS JONES: In your department as well, under that heading, you had originally budgeted last year $3.9 million, or a little more, and you spent only $2.7 million. Can you tell me where the vacancies were?

MR. WISEMAN: We had the Deputy Chief Medical Officer that has been vacant this year. We have had a Director of Health and Emergency Management that has been vacant this year. We had a Director of Public Health Information and Surveillance that has been vacant this year. There were a couple of new positions in the Child, Youth and Family Services division that were vacant this year. That is a big difference, if you are looking at the revised from budget, $1.1 million.

MS JONES: Under Professional Services in this heading you overspent last year by $195,500. Can you tell me what the overspending was on, first of all? Then I would like to know why you are budgeting less this year and what that will be used for.

MR. WISEMAN: We did some work last year in the health promotion, some social marketing campaigns. We had some contracts for some Web design, promotional campaigns. These are expenditures we had last year that will not be continued into this year.

MS JONES: Okay, but you are not anticipating spending as much this year.

MR. WISEMAN: No.

MS JONES: Are you winding down those campaigns?

MR. WISEMAN: No, these are focus campaigns that we will not be following through with this year. We will continue to do some activity, as you can see; we are still budgeting $289,000 in those areas.

MS JONES: The nearly $200,000 that you are spending on Purchased Services, what would you purchase with that? What services are you buying?

MR. WISEMAN: You are talking about Purchased Services, the $196,000 we are proposing to spend?

MS JONES: Yes.

MR. WISEMAN: Most of that is tied to the focus on the wellness pamphlets and brochures, new food guidelines, which is a fairly significant investment in the last couple of years, as we have been trying to really focus a lot of attention on campaigns that bring people's attention to the benefits of healthy lifestyles, healthy eating, and the dissemination of information is critical for that success.

MS JONES: Okay.

Under Grants and Subsidies, which are pretty much the same through the years, can you tell me what those grants and subsidies were spent on this year, or give us a list, table a list?

MR. WISEMAN: The Kids Eat Smart Foundation, $1.25 million; the Smokers' Helpline, $153,000; the Alliance for the Control of Tobacco, $240,000; the school health liaison position – we have some people within the health budgets but they are working in schools and in school districts - there is $210,000; there is a Wellness Coalition – there is a network of those around the Province which engage a lot of community boards and agencies and volunteer organizations focusing on a single purpose of wellness in their respective regions - we provide some grants to them of $250,000; Brighter Futures, there is $100,000; the Food Security Network is $20,000; Injury Prevention - there is an Atlantic Network that were a part of some initiatives with other provinces - $20,000; and there are some board travel arrangements. These are some of the wellness pieces that we are talking about here.

Then we have a pot of money where we provide some miscellaneous community grants for wellness initiatives, $300,000 for those, and those are the agencies that we support through these grant programs.

MS JONES: Because we are dealing with the funds that are provided for the support of services for children and youth, I wanted to ask some questions about the new department that is being anticipated. First of all, when do you think this new department will be up and running?

MR. WISEMAN: As I said earlier, it was announced in the Speech from the Throne government signalling its intention to create such a department. I also commented that right now we are continuing to operate it as a part of the regional health authorities and a part of the health and community services system.

There is a fair bit of planning work that needs to be done here in terms of what it should look like and how it will transition to a new department. I would not want to start speculating when that might happen. There was just a recent announcement made. Prior to that particular point there was significant enough discussion around the merits of making such a move to help make the decision, but not a lot of detailed planning had gone into it. Clearly, we want to make sure that this is done right, that we set it up appropriately, and that the mechanism is in place to plan for a change and a transition to a new department.

There are a couple of very obvious things: the appointment of a minister, the creation of a department, and then planning for any change that might occur and what that structure might look like. That is a piece of work that the planning and discussion around what that might look like has started. We have not been able to nail down what might be the appropriate timeline here, but if you reflect on changes that have occurred in departments, and realignment of departments over a number of years, the last ten or fifteen years particularly, there have been a couple of examples of where there have been changes like this and they take several months. This exercise could be something that would run for maybe six to eight to ten months, but we want to make sure that we do it right.

One of the critical things that we are trying to do here, and we are very sensitive to, is: for the clients who use the services, the families and children, this should be a seamless process. This is an administrative shift that we are making here. We do not want to be hastily running out and making changes and doing things and then find out that it has an impact on the families that we are serving. We need to do this in a very planned fashion. So, until we are better advanced or further advanced in a planning exercise it is difficult to give you a timeline.

MS JONES: What services do you anticipate seeing in the department? Would it be all of the existing programs under Child, Youth and Family Services that are now currently in the Department of Health and Community Services just being transferred out? Do you anticipate there is going to be a change in the front-line service to communities around the Province, like more accessibility to the programs, more accessibility to the workers on the front lines?

MR. WISEMAN: Let me answer the second part of your question first. I said there was enough thought gone into this, and enough discussion, that we have come to the conclusion that this a decision that is necessary to help us improve the services we provide, and to ensure the services children and families get are enhanced by this decision. What we are envisioning, obviously, is this being a positive move, a positive step, and one that will serve to enhance the services we now provide. That was the primary consideration in making the decision in the first place.

With respect to the first part of your question around what do we envisage in terms of changes in departments or changes at the health authority level, that is a piece of that planning exercise I talked about earlier. Until we have advanced that thinking and planning to a point where we are able to lay it out and clearly articulate it for the staff who might be affected, who are involved in providing this service, and we are able to clearly look at how these pieces fit together, until we are able to clearly articulate that, my speculation of what it might look like would be premature and might create some undue anxiety that may need or need not happen.

MS JONES: Will there be some public consultation around the new department in terms of additional services that could be brought there in terms of front-line delivery, things of that nature that the public would have or want to have input in simply because they are the users of those services?

MR. WISEMAN: We have been going through a fairly significant piece of work in developing a strategy for Child, Youth and Family Services, an exercise that would have started with a public forum – I do not want to use the word public forum; let me rephrase that – a large gathering of stakeholders, back about a year or so ago, a little better than a year ago, that has gone on, and that was the start of a process. So there has been a fair dialogue and discussion with stakeholders in the system. Stakeholders, including the service providers - there are clients, both children and families – have been a part of that process to help, as they have shared with us the kinds of services they believe are important, how they should be delivered, and the kind of supports they need. So there has been a fair bit of that kind of consultation taking place already.

I just want to separate something as we move forward because, inasmuch as I said a second ago that we envisage this kind of move only serving to strengthen the system, in the planning piece that we would do, we would want to plan for a transition here, but I think there are a couple of steps or stages here.

One is to plan for a transition to a new department. Then, once that happens – because that is an exercise in and of itself – and once we have made that shift, then actually starting to define what enhancements can be made to the system is a good piece of work for that new department to be engaged with, and engage in that process, and engage others in helping to define that piece.

I suggest to you that your question around how we might enhance the service will be a critical role for that newly established department with a dedicated focus.

MS JONES: How much money is being budgeted this year for the planning of that new department?

MR. WISEMAN: A couple of million dollars.

MS JONES: Where do I find it?

MR. WISEMAN: It is a couple of million dollars. Jim, you will have tell me where it is.

MR. STRONG: It is in the Regional Health Authority Grants and Subsidies account.

MS JONES: Okay.

That is the 3.1.01 Estimates?

MR. STRONG: That is correct.

MS JONES: Okay.

Why would it be in that budget, as opposed to the policy and planning or some other part? I am just curious as to why it would be over there.

MR. WISEMAN: Jim can probably elaborate on this, but there is a piece of work called the Financial Administration Act which defines how government spends its finances.

We do not have a department established yet, so we cannot put money into a department that does not exist. So there is some kind of an act of Executive Council that gets done, and the department is then created as a result of that action or that decree that comes down. When that happens, then we are able to have a department that will have a budget and we will transfer this money over to them.

It is a fair question, but it is somewhat academic in that the money that is earmarked for this service is going to be going to this new department when it is created, and that is an act that will come about as a result of some Order in Council, I think it is.

MS JONES: Okay.

Did you have any questions on that section, Lorraine?

MS MICHAEL: No. Except, just to be clear, Minister, are you telling us that it could be eight or ten months before the Order in Council happens, that we actually have a minister, a new minister, or would that happen sooner than that?

MR. WISEMAN: I am not trying to be coy about it, because I really don't know.

MS MICHAEL: No, you really don't know.

MR. WISEMAN: Obviously, we made an announcement in the Speech from the Throne so we are not going to be ten months out before we do that, but I would not want to - because I do not know. We have not advanced our thinking to be able to tell you that in x number of weeks this is what will happen and this is what will happen in month two. We are not there yet. We hope to be there real soon, and when we do that we will map that out for people.

The timing of the appointment of a minister and the creation of the department again, that is a piece of work that has not been advanced but it will not be obviously ten months from now. It will be much shorter period of time than that, but I would not be in a position to define it and to give you a ballpark either, actually.

MS MICHAEL: Right.

Is there or will there be a team that is dedicated to the transition?

MR. WISEMAN: There is; we have advanced our thinking to talk about a process here, and we have identified who might be some of the key people who need to be a part of that transition team, and the observation has been made that we need a transition team who are involved in the transition issues while we have others who are continuing with the day-to-day activities and providing the supports and services to families. So, we have two streams of activities happening simultaneously: those who are dedicated and focusing on transition, and those who are focusing on providing care and programs and services.

MS MICHAEL: Will that require new personnel to make that happen?

MR. WISEMAN: Obviously, certain expertise will be brought to bear in that process. Whether or not these people become permanent parts of this new department or their expertise is brought in for a particular task and when the task is over they move on, again I think the critical piece is the decision has been that we need to have a dedicated group of people for the transition piece separate from the operational side.

MS MICHAEL: Right.

MR. WISEMAN: We have identified the key skill sets that we will need for that process - we have not put names on that yet - and where they might come from.

MS MICHAEL: Right.

Well, you will know from some of the comments I have made over the past two years around the transition that I think was needed when the regional health authorities were put together, this is exactly the kind of thing I would want to see.

MR. WISEMAN: We have already made that decision, actually.

MS MICHAEL: Okay. Thank you very much.

This is it, Yvonne.

MS JONES: Under 1.2.06, just a couple of questions here for me.

MR. WISEMAN: Under 06?

MS JONES: Under 1.2.06, General Administration, Government Relations.

MR. WISEMAN: Okay.

MS JONES: Under Professional Services, last year you budgeted $1.3 million; this year you are going to spend more than $1.5 million. Can you tell me where that money goes? What is it for?

MR. WISEMAN: There is a list of initiatives that we are involved with, funding through the federal-provincial-territorial kind of arrangements. For the Canadian Institute for Health Information, for example, there is $333,000; there is a health technology assessment process we are involved with, some $69,000; then there is a – in fact, the easiest way for me to do this is to give you the grid, because there is a long list of initiatives here that we are involved with, with other jurisdictions, and this comes up to $1.5416 million. It is easier for me to share this with you by way of a grid.

MS JONES: All right.

MR. WISEMAN: The dollar amounts range from, like I said, the Canadian Institute for Health Information, $333,000. We have another one, a Fabry agreement that we have with another jurisdiction, and our contribution is $476,000. The rest are amounts like $40,000, $50,000, $10,000, that kind of range. Let me give you the list and you will have it all then.

MS JONES: Okay.

The only other question I have under that one is under provincial revenue. What is the money that you collect? Obviously, you are projecting that it is going to increase next year.

MR. WISEMAN: Jim, do you want to comment on that?

MR. STRONG: The revenue there relates to two things. In the current year the department is the lead province for the social sector across the country, and next year we become the lead province for the health sector. So the revenue that you see there is the contribution from other provinces for the cost of running the secretariat for those years.

MS JONES: Okay.

I do not have any other questions there, Lorraine.

MS MICHAEL: I do not either; they were mine also.

MS JONES: All right, I will just move on to the next one.

Under Policy and Planning, you did not spend as much in the department last year as you had predicted in Salaries. Do you want to tell me why that was, what vacancies existed?

MR. WISEMAN: Yes, I will go through the list for you.

We had a respite consultant; the director of chronic disease management; we had a project lead for the long-term care strategy piece that we are working on, which was vacant for a while. Then, for part of the year, we had a health policy analyst position vacant; a legal research analyst position vacant; we had a director of planning and evaluation; and we had a legal counsel position that was vacant for a while.

MS JONES: Have any of those positions been filled?

MR. WISEMAN: A couple of consultant positions have been filled, I believe, Don, have they?

MR. KEATS: Yes.

MR. WISEMAN: And the director of planning and evaluation is filled, isn't it?

MR. KEATS: No, that one is still vacant.

MR. WISEMAN: Still vacant? Okay.

MR. KEATS: (Inaudible).

MR. WISEMAN: (Inaudible) policy analysts are filled.

MS JONES: Under this section, what would be the Professional Services that you would use?

MR. WISEMAN: Professional Services, last year we targeted to spend, or forecast to spend, some $599,000. We spent some $395,000. To break that down for you, we spent $10,000 on an initiative under aging and seniors, another $226,000 under the healthy policy framework piece of work, the Task Force on Adverse Health Events, $86,000 was spent there, for a total of $395,000.

Next year, we are going to be projecting to spend less than we targeted last year, but some of the changes that we have spent, or some of the savings from last year would have been – we are not going to have the investments in the Task Force on Adverse Health Events; that process is over now. We are doing a piece of work on workforce planning that should be wrapping up this year as well, some time soon.

MS JONES: Okay.

What are you budgeting for this year? Is it basically the same things, or is it a carry-over for those same – well, the Adverse Health Events is completed, I guess, is it?

MR. WISEMAN: What we have done, you can see here, the figure that we are using this year is in the ballpark of what we have been spending prior, what we forecast last year, because some of these, inasmuch as when you start a fiscal year we may not always have the activity mapped out for a full twelve months ahead of us in terms of what kind of initiatives we would undertake, our past history has shown that throughout a year there are always going to be initiatives that we are going to be involved with, and we are going to need to bring in certain expertise and certain outside resources to help us with that kind of process. There are a couple of things that we are anticipating doing this year that we have not firmed up plans around but we know they are initiatives that we would like to see happen in the fiscal year, so we always need to make provisions for those kind of things.

We lots of times rely on our history and patterns of expenditures in some of those areas to help us forecast what we will spend in the coming year.

MS JONES: Okay.

Also, under Purchased Services, what are you anticipating spending that money on this year?

MR. WISEMAN: Purchased Services?

MS JONES: Yes, you budgeted $624,200.

MR. WISEMAN: In the Healthy Aging Policy Framework and the aging and seniors' initiative, some $260,000 we are forecasting to do some work in that area. There is a piece of work that we want to do in looking at some initiatives and some models that we might be able to use to provide some respite care to unpaid caregivers. We budgeted some $300,000-and-some-odd this year to be able to help us with some work that we want to do in developing either – I will not use the word a model necessarily, but to look at initiatives we may undertake to assist us in providing respite to caregivers; unpaid caregivers that is. There are a number of good suggestions we have gotten from seniors' organizations as to how that might look, but we do not have a good feel for what a program would look like that would allow us to roll it out across the Province, so we need to do some piece of work on this to help us develop it.

MS JONES: Are you guys doing any work around personal care homes in the Province in terms of care, standards of care?

MR. WISEMAN: We developed a new policy manual that is probably, Terry, about a year old now? In the course of this past year we have developed a new standards manual, there is a significant revision to it. Bills, standards, are something that is an evolving kind of process, but last year we saw some major revisions to the standards, the biggest we have had for a while.

Standards are one of these things that we will continue to be monitoring and enhancing, because a part of role of the regional health authorities with personal care homes, they have officials at each of the health authorities who, as a part of their regular routine, visit personal care homes and work with the homeowners in identifying areas for improvement or needing improvement, monitor compliance of standards, and they provide valuable feedback to the policy side as to what they have seen out in the field and that we need to have some kind of regulation or policy around, some kind of standard to ensure that there is adequate service and protection for the people who use the service. This past year saw significant upgrades to those standards manuals.

MS JONES: I think, Minister, one of the complaints that we have been getting from personal care homeowners is - and again it is a two-tier system almost, for them, because once they go over fifty beds they sometimes fall under different criteria, they can absorb the costs of new policies a little bit easier than the smaller homes - some of the feedback that we have gotten with regard to the new manual that was introduced is that it did not always take into consideration what the financial impact was going to be on some of the smaller homes.

That is the complaint, I guess, that we have heard, and you are aware of some of those issues because I have raised them in House of Assembly, but one of the issues that has continuously come up is with regard to the requirement for staff complement under the new policies of the department.

When you look at what their requirement is right now for new staffing, and you look at the fact that they have to pay out mandatory increases in the minimum wage - which I have no problem with, by the way - when you combine those two things and you look at the subsidy increase that they are getting, you are not offsetting the cost of these policies to the homeowners. Their complaint is that if I have over fifty beds then I have enough residents to be able to absorb those extra costs, but when I am down to a small home with fifteen beds, with sixteen beds, which we know is the norm across the Province - there are probably I do not know how many but there are over sixty of them in one association, and my guess is that is not all of them - I think there are probably like 100 of them or something, what they are saying is that the smaller the home the harder it is to absorb those costs. So, the subsidy rate that we are getting is not allowing us to be able to meet the increased amounts we pay out, whereas the big homes are meeting those increases and actually earning money on their subsidies.

That is the complaint. I do not know if your department is willing to have a look at it further. I do not know if you have already looked at it and have just decided that it is not something you are prepared to address at this time, but it is a complaint and we have heard it from the association that does represent sixty of those small homes in the Province.

MR. WISEMAN: Just a couple of things back to the way you started to frame the question around standards, because one of the things is that when we developed the standards piece, the rationale for having the standards is for the protection of the residents who are there. So, whether you are in a home that has thirty beds or a hundred beds or fifty beds, the standards for operation and the protection of the residents who are there do not change for us.

When we develop a standard, we develop a standard to recognize the levels of care and support that need to be provided, and we develop it in isolation of any financial considerations. If it is for the best interests of the resident, and for their protection, then that is why we do it.

The implication of that on the financial side of things, whether it impacts the home negatively or positively or that it creates a higher burden on some than others, when you start looking at financial implications that is a difficult one to try to reconcile. If we were to do that, what you would have is a kind of mixed bag, because in one home you might find that the person has built a new home and they are heavily mortgaged or over financed and therefore a change in standards may impose a financial burden on them that would be harder to manage than someone who maybe has a very small mortgage and is not over financed and has lots of flexibility, and their cash flow is sufficient to service the small debt they may have, so we cannot factor in those variances.

The other thing that you have is there are various break-even points in any business case that you would make for any business operation, so the break-even point for someone who has twenty-five beds might be very different than the break-even point for someone who has forty beds.

Trying to come up with a rate structure - because it is a subsidy that we are providing for those who are eligible - to come up with a subsidy rate that factors in those variables, by having classes or groups of personal care homes, whether they are grouped by bed size or grouped by financial means or debt ratios, that becomes a bit of a challenge. I do not know how you would actually try to build that in.

I hear the point, I hear the question, and I have had many of the conversations with many personal care homeowners who share the implications of various announcements we made, or decisions we have made. In some cases they have been able to share, and felt comfortable sharing, financial information about their operations, so they have been able to demonstrate the impact of various decisions.

The challenge is: How do you actually factor in those kinds of variances? I have had conversations with people who have twenty-five bed homes and their story is very different than someone who has thirty-five. Therefore, we have a range of rate structures to give consideration to an individual home's break-even point. That is a difficult thing to try to manage.

The piece around the standard, to go back to that piece, I will be frank with you: when we develop standards, it is with the clients and residents in mind and we do not give consideration to what the implication might be financially, because that is the second decision then about what our rate structure would be, so I am never guided by the cost implications for standards.

MS JONES: No, and that is not what I am asking, either, and I would not expect that. I understand that there have to be standards that have to be set and they have to be followed. I guess the issue that I have is that government also provides a subsidy to these homes, and I think it is fair to say that we realize that in the society that we live in we need to have those homes to care for people who have no other form of care. Most of these homes exist in rural areas of the Province, so in lots of cases they are being built in areas where they have a smaller population base upon which to draw residents. Therefore, they are not building fifty bed or 100-bed homes; they are building much smaller facilities. I think probably every member in this House would have at least one in their district, and there are members like your parliamentary secretary who have I do not know how many, probably thirty of forty along the Shore.

What I am understanding from them is this: we have no problem following the policy, we have no problem meeting the standards that are being put in place, but if you are going to give a subsidy to homes that you know – you can look at every financial statement, which I do not expect you to do, but you know that many of these smaller homes are not earning large profits. They are not. They are earning very small profits, and all they are asking is that there needs to be a different standard in terms of how you subsidize, because we are not able to receive a subsidy, offset our cost for additional staffing and the increase in the minimum wage, and still be able to carry on and earn a profit, not like the larger homeowners are, because the subsidy is tied to the number of people, and this is where they see the problem.

In addition to that, your government has a policy whereby you claw back any additional benefits that they receive in CPP and Old Age Security from the federal government. The homeowners do not even have the option to say to an individual: Okay, you are now collecting more money every month so I can now increase my residency rate to make up for this shortfall - because you claw that back out of their subsidy at the end of the day, so they really do not have anywhere else to turn.

I know that you have gone through your process, and you did the manual, and that was all about standards of service and care, and that is good, it is acceptable, and I understand that, but I would like to ask that you at least have a look at how the subsidies are working, where they are going, how they are affecting some of these businesses, and if they are offsetting our requirements and standards for the operation of the homes in the Province.

That is all I am asking. I just think there is an issue there where there is a little bit of an inequity being done to some of these businesses that should be looked at. If, at the end of the day, you look it and decide well, it is fair and we are going to keep it that way, I guess we will live with that until someone is prepared to look at a change. I just think, from listening to what they have to say, that they have a legitimate argument.

MR. WISEMAN: I think I answered your question similar to this in the House. We, as a part of this year's budget, as we did last year, this whole piece around the subsidy, we revisited that last year and we did again this year.

There are many aspects of how we actually came to that conclusion, and the various aspects of what we looked at. I think I shared some of them with you a moment ago as I talked about the challenge in trying to have various rate structures to deal with various break-even points of various sizes of homes. The fact that I was able to give you that kind of answer should suggest to you that we did some consideration of, and talked about how that might work, could it work, and what would be the implications of it.

For this year's budget decision we came to the conclusion that having an increase across the board was the way we would go this year. As we do each and every year, next year we will target a process that will affect – it will not be too many months down the road, because we have to have some of the preliminary work done on next year's budget in early fall. Over the course of the next five or six months we will go through that same kind of process again and evaluate where we want to go with a variety of our programs and services, and personal care homes will be a part of that annual evaluation. We will revisit some of those same considerations we gave this year, and some of the issues that we have heard as a result of feedback we have gotten this year will come into that mix.

What I can share with you is that as a part of our annual budgetary process the personal care home piece, together with a variety of other programs, will always get a consideration in that process. Next year will be no different. So, in the next four or five months we will start a process to look at it again. In fact, as you mentioned, my colleague, the parliamentary secretary, has a number of these homes in his district and he has done a fair bit of work on this particular file in looking at that industry and looking at what are some of the considerations from a fee structure and a subsidy rate structure that government may want to give some consideration to. We looked at that this year and we will look at it again next year.

MS JONES: If I could suggest, I think a good start would be to stop clawing back the federal subsidy. It only started to happen when your government took over five years ago. For example, this year you have announced a subsidy in the budget; I can't remember, but $37 I believe it is, per person. We do not know what the federal subsidy rate is going to be yet, but my guess is that in most years it is proportional to about 50 per cent or 60 per cent of what the Province has been bringing in, if you go back through and look at it. I think last year it was a bit lower because your subsidy was a bit higher. The year before I think the federal subsidy was around $30 or $40, what it amounted to.

From what they are telling me, their guess is this year that the subsidy could be somewhere between $15 and $20. That means the $37 that you announced in the budget would realistically only be $17 in a subsidy.

I think a start would be allowing them to keep the federal portion and not clawing it back. That may fix the problem, I have no idea, but it would certainly help the situation.

MR. WISEMAN: We have the residents who are under age sixty-five, too, who do not get any kind of adjustment. There are a couple of hundred of those in the Province as well.

MS JONES: Yes, that is right.

I am going to turn it over to Lorraine, now; I am sure she has questions on home care on that section.

MS MICHAEL: I do want to know under that section, Grants and Subsidies: Could we have a breakdown? If you want to just give us the grid afterwards, that would be fine.

MR. WISEMAN: We are still under –

MS MICHAEL: We are still under 1.2.07.

MR. WISEMAN: Under 07, okay.

MS MICHAEL: Yes.

MR. WISEMAN: That is a relatively small amount, actually. It is $200,000 that goes to the Centre for Applied Health Research. What we have done is we have created a pot of $200,000 for research on aging.

MS MICHAEL: Yes.

MR. WISEMAN: This year there were half a dozen graduate students who applied for grants under that pot, and they are doing some research for us, as a part of their graduate work, on some aspect of aging.

What we are trying to do is to encourage research in this field and also to be able gain some insights ourselves; because, as a part of their acceptance of their research grant application, they need to present their findings to our office of aging and seniors.

MS MICHAEL: Yes.

MR. WISEMAN: So we will start to garner insight into what is happening with aging and some of the issues we need to be addressing.

That is the benefit to us, as a system and as a Province, and for the students. Having this pot of money, we are hoping to stimulate some interest in this area of research and study, because we do have an aging population and we need to better understand the aging process, and that is what this is intended to do.

We have $26,000 for the Seniors Resource Centre, as well, built into this pot here, and there is some $44,000 that is not allocated for any particular piece, but we have it there to be able to respond to issues that may surface.

It is a relatively small pot, $270,000, and it is broken down into those three groupings.

MS MICHAEL: Right.

That money to the Seniors Resource Centre, is that typical of what they get from you, or is that a new pot of money?

MR. WISEMAN: This is a piece of work around the Healthy Aging Strategy that they do, but in addition to that we provide them with a grant to help with their core of operations.

MS MICHAEL: Good.

Thank you.

I do have a question around home care, and it has to do with the planned subsidy that I understand actually began in March, so before this budget. Is that correct?

MR. WISEMAN: The – I am sorry?

MS MICHAEL: The $1.71 subsidy.

MR. WISEMAN: No, what was announced in this year's budget was a funding to support three changes at three different times.

One was, I think it was March 1 or April 1, I am not sure which, to be honest with you.

OFFICIAL: (Inaudible).

MR. WISEMAN: March 1?

MS MICHAEL: It is March 1, yes.

MR. WISEMAN: March 1, so there are eleven months of it in this fiscal year. Then, July 1 there is another seventy-one cents.

MS MICHAEL: Right.

MR. WISEMAN: Then, January 1, 2010, there is another fifty cents.

MS MICHAEL: That is correct.

MR. WISEMAN: Those three changes are funded in this year's budget process.

MS MICHAEL: Okay, so even the one in March 1 was funded in this year's budget.

MR. WISEMAN: Yes, because there is eleven-twelfths of that increase in this budget year.

MS MICHAEL: Okay.

So my question is: How can you ensure that money is going to towards an increase in the wages for the workers, when an agency gets that subsidy?

MR. WISEMAN: What we do with the agency piece, what this rate translates into is an increase fee we pay for the service.

MS MICHAEL: Yes.

MR. WISEMAN: Inasmuch as we do not make a precondition that because we now pay you x number of dollars you must pay your employees that - because they have different arrangements with their employees - what has happened, thought, whether it is a self-policing thing or it is an issue that automatically occurs because the agencies are competing in the workplace for their employees, we have not had any instances - that I have been aware of, anyway - where agencies have gotten these increases, or we paid an increase for the service we get, and they have not, in fact, provided an incremental increase to their employees.

Sometimes those agencies are governed by collective agreements and the salary changes are negotiated, so we may announce a change as of May 1 - or in this case July 1 - and their collective agreement is such that they call for an incremental change in September, but that is the collective agreement that governs their employer-employee relationship.

I am not sure how these collective agreements work in terms of how they get tied to government announcements, or whether or not there is language in the agreement that says if you get money from government then you pass it on. I am not sure what the language would be.

The self-managed care ones, obviously, because the health authorities provide the salary for those individuals - but the agency supplied service is we increase what we pay the agency for the service that we get as a health system. From what I understand, and the commentary that I get, is that the agencies factor that into the compensation that they pay their employees.

MS MICHAEL: Well, I do not think that is necessarily the case, and this comes not just from my own personal experience but from other people's experiences. I did personally have to deal with a home care agency on behalf of my mother and with my mother for almost six years and I have compared notes with other people dealing with that agency and other agencies. Certainly, the increases are definitely not always received; the benefit does not always go to the worker.

It is a real concern that I have, because there is an assumption that is what happens. It could be that some agencies do it and some give some. I am not worried about where they have collective agreement, because they are being represented and that is being worked out, but those who are in the collective agreements are definitely getting more money now. It is still not, as we know, enough - far from enough - but they are definitely getting more money than those who are not in bargaining units. There is no doubt about that.

It is a grave concern of mine. The whole issue of home care is a grave concern of mine, as you know. I just believe that we should be moving towards a more comprehensive real home care program like I know exists in other provinces.

I guess I would like to know if you are thinking that way at all, both from the perspective of the worker and the perspective of the clients. It is not a profession here yet, it really is not, and what is happening – again, this comes from my own experience as well as from speaking to other people, including social workers, so I am not just talking about clients; I am talking about other professionals in the field - what is happening is, because of the low wages, and not just the low wages but because of the low wages, one of the reasons, you are not getting people coming in to the system anyway and you are not getting money going into training. There was a period when training was being demanded, so you have some people who have gone through training and you have some who are coming in with no training.

One example - and I may have used this example with you last year, I do not know; it may have been a bit too raw for me then to use it - I am aware of people, an unemployed plant worker, for example, coming into St. John's because they are not able to get any work in the plant at home, living in St. John's for one month, hired by an agency to do personal care with Level III people. That is a fact; it is not a profession. We have people in it who are not trained. It is fine to see the subsidy go up a bit - we cannot even be sure the workers are going to get that - but there is so much more that needs to be done.

I just have to urge you, Minister, in this day and age, with the revenues that we have coming in, if we cannot start planning a home care program now, I do not know when we are going to be able to plan it. The very fact that you cannot dictate that the increase in subsidy is going to go to the worker, the fact that you cannot do that, that in itself is a major weakness.

I just need to lay all of that out. You have heard me say all of this before but it just appalls me that we continue not to really have a professional home care program in Newfoundland and Labrador, with training, with adequate – not just adequate – well-paid jobs, because they are doing very difficult work.

You know when we are talking about personal care it is different from washing up a floor. That is not what we are talking about. You do have people in their own beds, at home, who are between the second and third level of care, and they should be able to stay at home. My own mother was able to stay at home, because of our circumstances, but an awful lot cannot and we should have a home care program that allows that, but it requires something much more formal than what we have. We just cannot trust the agencies to say, oh, they are going to be okay, because you cannot even monitor them; you do not have authority.

MR. WISEMAN: I hear your point and, as was indicated, I have had this discussion any number of times. If I could just comment on, for a moment, the movement that has been made and investments that have been made in home support in recent years, I will not suggest that there will not be opportunities or should not be opportunities to continue to build on what we have already done. We have seen in the last four years the budget for home support go from about $80-odd million to, I think, Jim, this year we are about $130 million or something. This past year was probably the biggest increase we have had in any one single year, and that is brought about by two aspects. One is the provision that we have made for the increase in compensation, but the other significant piece here, too, is the client side. We have made a major change in the financial assessment tool that will make a tremendous improvement for individual clients who access the service; that is this year's investment.

If you look at the annual investments we have made in the last four years, I think four consecutive years we have made significant investments. We have done some things last year with respect to the training that is provided by agencies to deal with some of the more complex client needs that are there, which was not there before. We have now provided those who are in self-managed care arrangements and with some complex issues they are dealing with, the increased and enhanced role that the public health nursing people have in providing that level of training for those who do that work in a self-managed care arrangement. There are things that we have done in the last couple of years to improve the quality of service that we provide.

We have always said this is an area that we see a trans-value for the people who are recipients of the program. It provides for an opportunity for individuals to live extendedly in their homes, and live independent as long as they possibly can. We want to be able to support and foster that. Making incremental changes with the capacity that we have in any given year, and balancing with the other investments that we are making, we believe that we have made some great progress. Not suggesting that we are there, or that we will now stop doing it because of the changes we made this year. This is one program area that our track record has shown that on an annual basis we have made some enhancements and some additional investments. We will continue to look at those issues, and we will continue to make some improvements.

Someday we may have a system that is described differently than we now have, but I think there is a message in this that I suggest people should read. Anytime a government makes, in four consecutive years, new investments and enhancements to a program area, it sends a pretty strong signal that we take it seriously and that we want to continue to build on and improve what we are doing. This is one of those areas where we have made that commitment, and we will continue to do it.

MS MICHAEL: I appreciate that, I appreciate what you are saying, and I think we both care. We both may come from different ways of looking at the issue as well, but there is still more to be done in terms of this being a homecare program. We still are getting calls to our office from people, and you know what I think about financial assessment. Even with the new tool, when it is in place, then they may benefit from it, but we are still getting calls from people who cannot afford it, as things are at the moment. I understand it will be a while before the new tool comes into play.

Secondly, even when they can afford it, and even if they are being subsidized as clients and they do not have to pay out of their own pocket, they cannot find the workers. We are still in that situation, and I really do believe that until there is a real program of training, based on the fact that people are really trained to do the work, and then a real increase in their wages, that particular thing is not going to change, and that is not having people to do the work. That is an ongoing problem, and that is true both in rural Newfoundland as well as in urban Newfoundland and Labrador.

MR. WISEMAN: Thank you for your comments.

MS MICHAEL: With regard to the new tool, when do you expect to have that financial assessment tool? When do you expect to have that in play?

MR. WISEMAN: We are targeting the first of December, because the new instrument we are using is an income process where we take a certain - and you have no doubt seen the grid that we distributed. For a single person, the first $13,000 of income is exempt from any consideration, on a family unit it is $21,000 of annual income that is exempt, and then there is a tiered system for various thresholds above that.

What we need to do is start a process now where we take the current clients in the system, and we need to now take all of their files and redo the assessment based on this new data. To help us with this process we will take the information directly from their tax return. Their most recent tax return will have, I think it is line 236 in the tax return. That figure will be plucked out and that will be used to determine the calculations for this purpose.

MS MICHAEL: Yes, 236 is the net, isn't it, or is it the gross?

MR. WISEMAN: Is that the line, Jim? I am not sure.

MR. STRONG: Yes, 236.

MR. WISEMAN: Yes. I haven't done a tax return for a long, long time.

MS MICHAEL: Pardon?

MR. WISEMAN: I said I haven't done my own tax return for a long time.

MS MICHAEL: I haven't either.

MR. WISEMAN: That is the figure we will pull out and use. We now need to have everybody reassessed. It will be a very intense exercise by the four authorities now to get everybody set up on this new grid, and there is a bit of time associated with that.

MS MICHAEL: So 236 is the net, isn't it?

OFFICIAL: (Inaudible).

MS MICHAEL: Okay.

MR. WISEMAN: We will be able to start that process now, but it will be a very intense process. It will take some time. We wanted to make sure that everybody came on-stream the same time. It will be a first come, first serve kind of approach. It will be the fall; December we anticipate having it done.

MS MICHAEL: Thank you.

That is an improvement, having it based on the net, because many people have other medical expenses like drugs. They pay for everything out of their pocket, so they may have $30,000 as their gross income but half of it is going out. Having it on the net is extremely important if you going to use a financial assessment tool.

Thank you very much. That is all for that section then, I think. That was a long one.

Did you want me to go on, Ms Jones?

MS JONES: Yes.

MS MICHAEL: Under 1.2.08, there is not a lot to ask here, but if you have that information now on the temporary, I did want to look at this one, the Audit and Claims Integrity. I think I know why, but I will ask anyway. There is a large amount here under Temporary and Other Employees, it is $864,800. I am assuming it is because of the nature of Audit and Claims Integrity that that is so high. Do you have that information now?

MR. STRONG: (Inaudible). The $864,800 is for Policy and Planning.

MS MICHAEL: Oh, I am sorry. Could we look at that then, for Policy and Planning. I thought that that was under Audit and Claims. That is pretty high, so could we have an explanation? I am sorry, we will go back to 1.2.07, Policy and Planning. Could we have an explanation of the $864,800?

MR. STRONG: Some of the positions there that would be under that temporary consultant would be the respite consultant that was mentioned earlier that was vacant. You would also find that, under that category, there are four clerical positions working in our records section that are working on a special project. Basically what they are doing is entering into the CRMS system information relating to old CYFS files for reference. It was one of the recommendations from the Turner review, I believe. They are on a special project putting that information in. Our legal counsel is also on contract so they would be in this section as well.

MS MICHAEL: How many?

MR. STRONG: We just have one legal counsel.

MS MICHAEL: Just one.

MR. STRONG: Yes.

We have a privacy and health information consultant who is working on helping with the new PHIA legislation implementation. That would be illustrated with some of the positions in this section.

MS MICHAEL: Okay.

MR. STRONG: We can give you the complete list when we put the full package together for you, okay?

MS MICHAEL: That would be great. When you put the whole package together I would like to have the full list. I am sure Ms Jones would too.

MR. WISEMAN: (Inaudible) 1.2.08 as well. Was that a similar question you were posing?

MS MICHAEL: Yes, but it is a much smaller number. I expected that to have the larger one because of the nature of it but I am willing to wait until we get the package.

MR. WISEMAN: Okay.

MS MICHAEL: It was because the other one was so high that I was really interested in it.

Under 1.2.08, really the only question I have is around the Professional Services, because last year the budget was $55,500, then it went up to $238,500, and you are keeping it in that ballpark for this year. What is it that came in under Professional Services that changed that last year?

MR. WISEMAN: The biggest item there was part of the claims monitoring system that we put in place for MCP audits. There was $120,000 for that particular piece and then there were some expenditures associated with the NLPD access and assurance plans. We had to make some upgrades for $63,000, and that gives us the $183,000.

MS MICHAEL: Thank you.

That is the only question I had for that section. I do not know if Ms Jones has any questions for that section.

MS JONES: Yes, I do have a couple of questions.

Under the Newfoundland and Labrador Provincial Drug Program, is xwave still doing the claims under that program?

MR. WISEMAN: They are, yes.

MS JONES: Okay.

What are the terms of their contract like? Are they on a long-term contract or is it tendered every so often? How does that work?

MR. STRONG: The current contract has another three years to run.

MS JONES: Okay.

How long was that, Jim?

MR. STRONG: I believe it was a five-year contract.

MS JONES: Okay.

Under the MCP registry, you went through a new process of re-registering everybody in the Province. What were the numbers? Was there much shift in the numbers upward or downward in that process?

MR. WISEMAN: I will get the exact number for you, but when we did the re-registration and that got cleaned up there was a significant reduction in the number of people we had registered in the system versus what was there when we started. I do not have with me that exact number. We can get that for you. There was, I guess, a recognition that when we did it and realized how many people were actually out there running around with cards who really were not eligible for re-registration, it verified for us that this was an exercise that was important to have done, and to protect the integrity of the system in the future we need to maintain this annual renewal process; this renewal process that occurs annually but everybody is on a different five year cycle. It was a significant number and we can get that for you actually. I am not even sure that it was last year because this was an issue that we had. I think last year the first re-registration process would have occurred, a little better than twelve months ago. We will get that number for you.

MS JONES: I guess the reason I was asking is because I have been looking in your estimates for the department and the ones for Finance which would have paid out, to see if there was much of a shift. The cost is pretty much maintained about the same, so that is why I was trying to remember the numbers.

MR. WISEMAN: Yes, we will get that for you.

MS JONES: Also, under third party billings, under MCP, what amounts now are we paying out to other provinces for services?

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

You are talking about the reciprocal billing process?

MS JONES: Yes, like, for example, Quebec. I know because all my constituents go there. I know there is reciprocal billing from them and I know as well the other border in the Labrador West area, and I am sure there are others from Ontario and other provinces where people need to go to get services.

MR. WISEMAN: There are people travelling on vacation and that kind of stuff all the time. They are all over the country, so the result is the reciprocal billing piece. Do we have the number Jim?

MR. STRONG: The budget next year for reciprocal billings is $8.9 million.

MS JONES: Is that up or down, Jim, from the previous?

MR. STRONG: That is up about $500,000 from last year. Now, that figure I just quoted will be a combination of us paying other provinces for the cost of our residents.

MS JONES: Could you give me what the shift in those numbers has been for the last five years? Are you able to get that and send it to me?

MR. STRONG: I will get that for you, yes.

MS JONES: Are they broken out by services at all? How is the billing done? How is it broken down?

MR. STRONG: Basically the reciprocal billing agreement sets the parameters by which one province claims from another. Really, what you pay is the rate in the other province, so you are dependent on the other province's billing structure. Each province has it own individual billing structure. I do not know the specifics of that in terms of what level detail we can get.

MS JONES: I guess what I am asking is: When you are billed, is it billed based on dental services, physiotherapy services, or general emergency services? I do not know how they code it in the system, but is there a coding or some kind of a way in which it is broken out?

MR. STRONG: I believe it is broken out but I could not speak to the specifics.

MS JONES: Okay.

When you provide the information, is it possible that I could get it broken by category?

MR. STRONG: Sure.

MS JONES: The purpose of my asking the question is because I have been running into some cases with my own constituents where the reciprocal billing for certain services is not as easy or as accessible as it used to be. Now they have to go through authorization through the provincial Department of Health in our Province and it has to go back and be preauthorized. I know in one case I dealt with recently I think it was nearly two and a half to three months before a person got their drug prescriptions sorted out for a patient who was suffering from MS, who could not access those medications in my district because they had to be purchased from a pharmacy and at that time we did not have one. It was just things like that that I did not think would be a problem that ended up being a problem after a period of time, but we did get it sorted out and all is well now.

MR. WISEMAN: Just to separate it for you here, because the reciprocal billing arrangement is one where jurisdictions agree to provide and then the other jurisdictions agree to pay for medically insured services as defined by the Canada Health Act. That is the fee that we end up paying here. When you get into prescription drugs and those sorts of things, they would not be part of a reciprocal billing arrangement. The way you asked the question is, for those reciprocal billing arrangements, are we able to provide the dollar amount that we paid out, and I have indicated targeting to spend about $8 million this year. Your other question was: How do we actually cost, what kind of procedures? Were they all cardiac surgeries or were they all hip replacement surgeries? What kinds of procedures were they?

MS JONES: Yes, PET scans or whatever.

MR. WISEMAN: That level of detail may be providable, but when you get into the drug piece that may be a little bit more problematic in trying to give you that level of detail, because that would have been billed as part of a prescription drug program and not as part of the reciprocal billing arrangement.

MS JONES: If it is not available certainly I do not expect you to give me what you do not have, but if it was I would like to have the breakdown.

MR. WISEMAN: We have it. We will get it for you.

MS JONES: That is it for me, Lorraine.

MS MICHAEL: Do you want me to move on, then?

MS JONES: Yes.

MS MICHAEL: Okay.

I will move on, Mr. Chair, to 2.1.01, the MUN Faculty of Medicine. Of course here the grant is just given directly to the school, but I am interested in what the increase of $5 million was based on.

MR. WISEMAN: What we are trying to do is - you might recall that we announced an expansion to the medical school.

MS MICHAEL: Yes.

MR. WISEMAN: The medical school is a little bit different from some other institutions. For example, by comparison, to make my point, we are opening a new long-term care home in Clarenville in the next couple of weeks. Therefore, when you are ready to open and the building is built, you can start recruiting your staff to support that. You can do that and measure the timeline in a matter of months. What we are trying to do with the medical school is build some capacity throughout positions so that we have the faculty to be able to be a part of that expansion when we actually get the building done. What we are trying to do is to ramp up the operation of the medical school. The position has to be ready when it opens because there are some recruiting time lags here to get the people we need for that.

Also, we have now increased the enrolments up to sixty-six as of now. We have more enrolment than we had before and we are trying to ramp up for that piece. Then we have the other normal inflationary costs associated with running a facility. We consciously now provided some additional funding to help them ramp up so there will be a position, from a faculty perspective, when the medical school is done.

MS MICHAEL: Right.

One of the things that I have had said to me by people in the school itself, and other people at the University, is a concern that - naturally everybody understands the programmatic growth, it is absolutely essential, but what about the actual plant itself being able to deal with the increased enrolments that are planned, et cetera, at the medical school?

MR. WISEMAN: For the expansion of the medical school, there are two aspects. Obviously there is an enrolment expansion, we are going to bring ourselves to eighty, but there is a new physical construction project to take place as well because we are expanding the school physically.

MS MICHAEL: But the enrolment is starting before that, isn't it?

MR. WISEMAN: Yes. The enrolment is only starting to go up by six, so we have the capacity to deal with that small increase of six but we are not going to do this incrementally. We need the building capacity expanded in order to be able to get us up to the eighty where we need to be.

MS MICHAEL: Okay.

MR. WISEMAN: When I talk about incrementally, we are increasing the staffing incrementally to build us to have capacity when we have the new building done. When we have eighty students, then we have the faculty capacity already built in to the system.

MS MICHAEL: Okay. That was not clear to me.

This $5 million, then, is to do deal with –

MR. WISEMAN: Portions of it is to deal with that.

MS MICHAEL: To deal with that.

MR. WISEMAN: In terms of the other increase, there are normal inflationary costs associated with salary increases and the like, but in addition to that normal staff, because that would happen anyone.

MS MICHAEL: Right.

MR. WISEMAN: We have now built in an extra piece to allow us to ramp up for the expansion piece.

MS MICHAEL: That is fine.

If I could ask: I think the money that goes to the Faculty of Medicine includes the bursary programs, is that correct?

MR. WISEMAN: No, the bursary program is handled separately from that altogether. The Faculty of Medicine deals with the operation of the school itself. The issue around the physician recruitment piece and the financial incentives we provide as a Province would be handled separate from the medical school. There are students at the medical school who get it, but the actual administration of the program does not rest with the medical school.

MS MICHAEL: Where does that happen?

MR. WISEMAN: That is in the Physicians' Services one, 2.3.01, I think, is it, Jim?

MS MICHAEL: Is it? Under Grants and Subsidies?

MR. WISEMAN: No, I am sorry. I did not mean to mislead you then, but I have just been told it is under another heading.

MR. STRONG: It is under Regional Health Authorities, 3.1.01, under 09.

MS MICHAEL: I cannot find it.

MR. WISEMAN: I am sorry, did I miss a question?

MS MICHAEL: Did you say where it was, because I did not hear if you did?

MR. WISEMAN: Okay. It was under 3.1.01, under the RHAs and Related Services.

MS MICHAEL: Okay.

Would that be under Allowances and Assistance?

MR. WISEMAN: It would be, yes, 09.

MS MICHAEL: Thank you very much.

MR. WISEMAN: The total amount within that piece would be $1.5 million.

MS MICHAEL: $1.5 million. Thank you very much.

That is all for that, unless Yvonne has some questions under the Faculty of Medicine.

MS JONES: I do not. I do on the next one, but you can go ahead.

MS MICHAEL: We will move on then to 2.2.01, the Provincial Drug Programs.

The Professional Services under this section has not gone up much. I am just curious about what the Professional Services is under the Provincial Drug Programs.

MR. WISEMAN: That is the reference earlier to the question around the contract we have for the administration of that, with Aliant. That is a big piece here.

MS MICHAEL: Okay, so a contract for delivery.

Then the Allowances and Assistance, that would be the actual money that goes out.

MR. WISEMAN: Exactly.

MS MICHAEL: Okay.

Do you have any questions you want to ask under drug subsidization?

MS JONES: Yes.

MS MICHAEL: Okay. I might have a couple too. You go ahead.

MS JONES: Just give me a minute here now.

MS MICHAEL: I hope we are not driving the technicians crazy. I do have a couple, if you want me to go ahead, Yvonne, unless you are ready.

MS JONES: I am not sure if you have the information there, but you can give it to me. What I am looking for is the breakdown for last year, 2008-2009, and this year, 2009-2010. I am looking for it based on the various drug programs, the plans. One is the Foundation Plan, the other one is the 65Plus Plan, the Access Plan, and the Assurance Plan. Those are the four I am interested in.

I would like to know what you actually budgeted last year in those particular programs, what you actually spent on those four different plans, and what you are budgeting under those four plans this year.

MR. WISEMAN: The best way to do that is, I can read them out to you, but there is a grid that I can share with you so you will have the details. I can read it out to you if you want to engage in the conversation this evening, or I can provide it to you so you can have the information, whichever you want.

MS JONES: Actually, the Page can photocopy the grid if you want, just to give it to us.

I am just looking at the Estimates here. I was a little bit preoccupied and I am not sure if you already gave the explanation as to why you have decreased the drug cost this year from the Estimate last year?

MR. WISEMAN: We budget based on what we anticipate the use to be, but the uptake becomes the uptake. It is like the MCP budget. We have a figure, here is what we think we are going to be billed, but if people go to physicians more then whatever is billed is the bill we have to pay. In the drug program the parameters are defined and the uptake is the uptake, so if we under budget we have to pay it because the program is in place. When you get the grid you can see the various program areas that we have some savings in as a result of the uptake. It is purely that. It is a product of utilization and uptake.

We may have the same number of clients covered today, but next year we may not have as long a flu season so therefore the uptake may not be as great. It is one of these numbers where there is no ability for us to change, redirect, or stop when you run out of money. I will get you the grid there now.

MS JONES: Last year you spent a lot less than you were anticipating. Were there any drugs that were dropped from the formula last year?

MR. WISEMAN: No.

MS JONES: There were not.

MR. WISEMAN: These numbers and variances have to do with the uptake rather than the discontinuance of a – sometimes you will see drugs come off the formulary but they come off because there are new drugs that have entered the market and replaced the treatment for those kinds of diseases. There are, yes, drugs that come off the market, but they do not impact these variances here. This is a product of uptake and utilization.

MS JONES: Do you guys ever add new drugs to the formula throughout the year? I know every year at Budget time there is always one new drug or two new drugs that you may add to the formula for subsidization, but throughout the year is it often common to add new meds or new drugs?

MR. WISEMAN: I forget the name of the drug now, if I have it here I probably cannot pronounce it anyway, but there are a couple of drugs this year that we have in the Budget, but there is also an allowance we have made here this year. There are a couple of drugs that we know are going to go through the evaluation process, the Common Drug Review process. At the time we do the Budget we know that there is a certain line of products or drugs that have gone through the Common Drug Review process, and the decision has been made and we will add them. We also know that there are a couple of drugs coming up for review several months down the road or something and there is a strong indication that these will be approved in that review process as well, so we make a provision for them. We have done that this year for a couple of products. I will not use the word wholesale numbers, but we have had occasion where, throughout the year, a new drug gets reviewed by the Common Drug Review process and we have the ability within the budget to actually add them in that year, and that has happened on occasion.

So we are not always tied necessarily to the budget cycle, but I guess in the past we have had some flexibility because the budget - because of the uptake, we now find ourselves halfway through a year and we are on target to be well under budget, so therefore we can add new at that point.

MS JONES: So, even if the new drug that you are adding is going to be a cost to the Treasury, you still would add it outside of the budget year, would you?

MR. WISEMAN: Depending on the amount of money we have in the budget. If we are budgeting this year, for example, we are going to budget what is it, one hundred and -

MS JONES: You are going to budget a lot.

MR. WISEMAN: - one hundred and thirty-odd million dollars worth of cost, and if we find ourselves halfway through the year and we have 85 per cent of that taken up then we do not have the capacity to start adding because it is a significant budgetary implication, but if we are only about 40 per cent uptake, 70 per cent through the year, then we have some flexibility.

MS JONES: Has government been looking at changing the special authorization on certain medications? Are you shortening the list? How is that working? We are not getting quite as many calls about it, so I am wondering if there is a change.

MR. WISEMAN: We did last year, actually. I just forget the time of the year, but it was some time throughout the fiscal year, spring or something. Was it spring?

OFFICIAL: August.

MR. WISEMAN: August, we took a whole bunch of products and put them on the open enrollment list. That probably speaks to the point you made about the number of calls you get, because the analysis we did of those drugs that we moved to open enrollment, they represented a significant portion of the special authorizations, so there was a significant reduction in the number of special authorizations as a result of that.

The concept of having special authorizations is a natural part of all drug administration programs. Our own, as employees or as MHAs, we have our own group plan that has a process similar to that. All drug programs do.

What we did last year was a piece of work to ensure that we provided easier access when it was possible, and the drugs that we created as an open enrollment were ones now that the utilization of those drugs dictated that they should be in an open enrollment.

MS JONES: I do not have any more questions there.

MS MICHAEL: I do have one.

CHAIR: Okay, go ahead.

MS MICHAEL: I am just wondering, Mr. Minister, if you are going to be reviewing the co-pay rates in the future, based on phone calls from constituents, et cetera, with regard to the access program. We really do believe that 70 per cent of the net income is really too high.

For example, a single person with a net income of $19,000, 70 per cent is a high percentage to pay, and a childless couple, for example, is about $21,000. We are just wondering if you are looking at an assessment of the co-pay rates.

MR. WISEMAN: It is similar to a comment I made a few moments ago about the home care program and the personal care homes. These are subject periodic reviews, obviously, and these were ones that we pegged as being something that we could implement the plan with and were sustainable long term. Your point is well taken.

What has been interesting as well is when you look at the utilization information; those who have the access plan and who have significant drug costs tend to peel back into the assurance program, because that gives them the more favourable treatment.

MS MICHAEL: Yes.

MR. WISEMAN: So those who remain in the access plan with the co-pay, at the range we do, the fact is that they generally – I will not use the word always, but generally – are not spending large amounts. So the financial impact as a percentage might be great, but dollar-wise, the dollar amount, is not necessarily a huge amount. Because, if it becomes a huge amount it is easy then to fall down into the next category, because of where your income is, and you get in on the lower threshold.

MS MICHAEL: But even the next category is above what the national recommendation is for the percentage of one's income, so I would like to see that reviewed.

MR. WISEMAN: I made your point.

MS MICHAEL: Thank you.

Will I go on to the next one, then?

MS JONES: Yes.

MS MICHAEL: The next one is Physicians' Services, 2.3.01, and my first question is pretty straightforward. The Professional Services line is going up by $21 million, which is a fair amount of money. Is this your anticipated money for physicians' increases for this year?

MR. WISEMAN: No, some of that is utilization and some of it is provision for adjustments we know we will be making in the coming year. We made a provision for some of that to occur, but some of it is utilization as well.

MS MICHAEL: About what percentage would be utilization and what would be the adjustments?

MR. WISEMAN: We have a little over $9 million provided for the new arrangement that we will have with physicians and the rest is around utilization, and there were some increases in some of the fee structures from last year, so some of it is an annualization of those increases that were made throughout the year last year.

MS MICHAEL: Yes.

With regard to Grants and Subsidies, last year it was slightly over budget by about $3 million and this year it is increased by $13 million.

MR. WISEMAN: That is the salaried physician block; that is salary.

MS MICHAEL: That is the salary position.

MR. WISEMAN: We announced in the budget the increase of thirty new salaried physicians as a part of that program. Then, obviously, again you have the provision for a new agreement for those people as well. With those, that represents the increase here.

MS MICHAEL: Right.

I am going to ask what may be considered a touchy question now, but I think I have to ask it.

MR. WISEMAN: It hasn't stopped you before, has it?

MS MICHAEL: Oh, you found the others touchy, did you?

MR. WISEMAN: No, not tonight.

MS MICHAEL: Not tonight, okay.

You obviously have made some decisions around the expected adjustments when it comes to the physicians' salaries. When you allotted money to the RHAs, did you make a similar decision with regard to money that is going to be offered to nurses?

MR. WISEMAN: There is some provision for the salary increase base included in the utilization information, but obviously when you are talking about making provisions they are just that. There is a set of negotiations taking place and the budget process creates an allowance for and a provision for it, but the budgeting process is a separate exercise from collective bargaining.

MS MICHAEL: Right.

MR. WISEMAN: When the results of the collective bargaining are concluded, or the process is concluded and we know what the results are, then government needs to make the appropriate funding allocations to fund them.

MS MICHAEL: Okay, whereas with the doctors it is not really collective bargaining. It is, isn't it, through the association?

MR. WISEMAN: We have an agreement with them; we tend not to refer to them as service agreements. We talk about a fee structure for those services that are provided. We sit down with their association and work through what that arrangement will look like, so there is a set of negotiations. We do not refer to it as collective bargaining per se -

MS MICHAEL: No.

MR. WISEMAN: - but it is a negotiation process that will start soon.

MS MICHAEL: Yes.

They have an idea of what might be being offered.

MR. WISEMAN: As I said to you a second ago, these are provisions we make in a budget process so it would be irresponsible not to make some kind of provision, knowing that you are going to be sitting down to have a discussion and that some day you will end up with an agreement that will be effective during this fiscal year, so you have to make a provision for it.

As I said, after it is over and done, the agreements are signed and they are costed, then someone needs to say, well, we need to make an appropriation to now fund it. That is a mechanism that could be – at the end, how you do that is a budgetary exercise.

MS MICHAEL: Okay.

Yvonne, do you have anything else under that one?

MS JONES: I do, actually.

Can you tell me how many vacancies exist in physician services now throughout the Province in specialty services? Would you be able to give us a list of that?

MR. WISEMAN: The issue around vacancies, we can tell you where the vacancies are now. We can get that list for you. I do not have it to share with you this evening, but we have a turnover of about 100 physicians a year.

MS JONES: Okay, and by board area, right? Yes.

The other thing we were wondering about is how many locums - by day, I guess, would be the best way to calculate it - are retained in the Province now on an annual basis? Could we get the breakdown of how many days locums were retained last year and what the total cost of providing that service was?

MR. WISEMAN: We would have to get that for you.

MS JONES: Okay.

We would also like to have it for the previous year, for the Estimates of 2008-2009.

MR. WISEMAN: Yes.

MS JONES: That is all for me on that.

MS MICHAEL: (Inaudible). You can go ahead and do that.

MS JONES: I guess the obvious question under Dental Services is why the Estimates have dropped this year.

MR. WISEMAN: Again, it is in the same kind of category as I commented earlier about the MCP and the drug piece. This is a program that we have, and the coverage is provided to a given population. We do not turn anybody away, we do not stop paying bills, so if the uptake is greater than the budget we continue to pay it and we need to provide appropriation for it in some other fashion.

What we did when we made the enhancements to the children's program a couple of years ago, we immediately dumped in a major enhancement to the budgeting for that year in anticipation or to ensure that we did not get caught short with a big uptake.

One of the things that we have found is the uptake has come much more gradual than we anticipated. We have done a lot of promotion and marketing with this, and the Dental Association themselves have done a lot of promotion and marketing of the service, so the uptake has been very gradual. The amount of the money that we had in the initial allocation to prepare for what we thought was going to be a huge uptake overnight did not materialize, so we now just peel it back from a budgetary point of view.

Again, it is one of these areas where if the uptake increases we are going to pay it and we will deal with the budgetary process in a different fashion, but until we get the buildup to where we initially thought it was going to be when we made the major improvements a couple of years ago then we will just budget accordingly, but no one will get caught short because the uptake runs out or the budgeted amount is spent halfway through a year and we still have dentists who are providing services and will bill us for it; we will pay it.

MS JONES: What is the number of children under the age of – is it twelve? Is that the age for that program?

MR. WISEMAN: No, seventeen.

MS JONES: It is seventeen, okay.

Could you tell us what the number of eligible children is, for that program, and the number of people who actually use the program?

MR. WISEMAN: I will have to get that for you. I would not be able to tell you.

MS JONES: Okay.

Has you department done any demographics around that? Because my guess is there are still kids in the Province who are not able to access affordable dental services. Even thought it is free, they still cannot access it. I know that because I represent a district that has that problem.

MR. WISEMAN: Just so I am clear on your question, you are asking for the profile of the Province for those children who would be of age to access the service and, secondly, how many children are actually accessing the service. Those are your two questions?

MS JONES: Yes, those are the numbers I am looking for.

My question was: Have you looked at any of the demographics around why they would not be accessing the service? Is it because the service is not provided, or is there another reason?

MR. WISEMAN: It is interesting, I just had this discussion with the Dental Association very recently and it is a fair question. Someone might say, if you have a region of the Province where you do not have a dentist then it is reasonable to assume that maybe you do not have many people using that service, but a proportion of the population, their commentary is that in areas where there is a strong servicing by dentists and there are a number of dentists in the region, there are still lots of children in those regions who are not availing of the service. It is fair to say that there may be areas where there is not easy access to the service and therefore people do not use it. That would really stand out for you as being the dominant reason, given the fact that other contrasting comment was made as well.

One of the things that they have suggested to us is that we need to continue our efforts to market the benefit of dental health and world health as being a critical piece of maintaining your own health. Historically as a society we have not placed a lot of value on oral health and that is really starting to change but it is a gradual change. Some of it can be attributed to that, but it is a fair question around access, and where you have easy access obviously there is greater potential to have a greater uptake. Even in areas that are well serviced, the observation they have made is that we have a ways to go before people really appreciate the value and recognize that they need to have good oral health.

MS JONES: Yes, which is unfortunate.

The other point I want to raise, I guess, I want to make a comment because I think it is important to show appreciation when things are done appropriately as well. Last year in the Estimates, I did raise the question with you with regard to access to dental services in communities in my district; and if you remember one community in particular had not had dental service in five years. Those kids had trouble accessing any kind of service except in an emergency. I was pleased that your department and the health board did act to put in clinical facilities and new dental equipment in those clinics, and I am being assured by the health corporation that they are well on the way to having a dentist recruited to start servicing those areas. I cannot tell you how much that has been appreciated by the people in those communities. They are still complaining yet but they know it is coming. They know it is coming.

MR. WISEMAN: I am sure you are reassuring them that it is coming.

MS JONES: I am, because I have had the conversation a number of times now. I think it is important that in areas where we can provide services, even if they are only two-three times a year, that the effort be made to do so. The effort is being made in this case, and I wanted to put it on the record because I did raise it last year.

MR. WISEMAN: Thank you.

MS MICHAEL: Just one comment. Because of what you have said with regard to the need for more promotional work, because that was another question I was going to ask, I think you are correct, and that is based on my knowledge of people in my own constituency which is right here in St. John's. Are you planning on continuing promotional work?

MR. WISEMAN: That is our intent, yes.

MS MICHAEL: Okay, because I think it is needed.

The next section, 3.1.01, the Regional Health Authorities and Related Services, most of this is actually fairly obvious I think. I will come right down to the Grants and Subsidies, subsection 10, and we do have a fair increase here. I think I understand the increases, but I did notice that last year, under the Grants and Subsidies, the budget was $1.7 billion. I will not go through the whole number there. It was revised down to $1.6 billion, which sort of surprised me. Why did that happen? You have a sense of why that happened?

MR. WISEMAN: One of things that we do in budgeting for the health authorities is, we make an allocation through budgetary process like this and there are some provisions we make for certain programs and services to be rolled out throughout the years. For example, you heard me say throughout the last year that we are working on this long-term care and community supports piece. I said a couple of times it was becoming more complex than we envisaged, or at least I envisaged. We had a provision in last year's budget to do some of that. We did not get to use all of that money last year, so we had some money in last year's grant that was not used. It is a slippage in last year's money, and we will maintain it in our base.

There is a group of categories like that. We have made some investments in the electronic health records, for example. We moved with these initiatives and all of it did not get advanced in the fiscal year. We had a series of expended areas that were like that, that we did not spend all that we had allocated. What we have now done is, we will continue to spend and we will continue to move forward these initiatives, but we just did not use it all last year. We advance it to the authorities as they need it, as these initiatives are advanced. What you are seeing here is a result of those kinds of activities that did not get fully operationalized throughout the year, but their initiatives at least are.

MS MICHAEL: Right.

The $21.4 million to put recommendations in place, would that be under this section here?

MR. WISEMAN: It would be, yes.

MS MICHAEL: It would be. So, all of the things that are outlined in the Budget highlights would be all of the things that would be included there as well?

MR. WISEMAN: Yes.

MS MICHAEL: Okay.

Is this also where the transitional money for the new department will be located?

MR. WISEMAN: Yes.

MS MICHAEL: Under the same heading there?

MR. WISEMAN: Yes.

Just to reiterate my comment earlier, it is $2 million that is allocated for that.

MS MICHAEL: Pardon?

MR. WISEMAN: It is $2 million, as I said earlier.

MS MICHAEL: Yes, $2 million, and that would be in there as well.

Do you have a question?

MS JONES: I just want to intervene before we move on, because if you are talking about 3.1.01, number 10, Grants and Subsidies, if you look at what the estimate was last year, the $1.7 billion, and this year it is $1.871 billion, you are telling me there is $200 million in there for the new department.

MR. WISEMAN: No, no. I am sorry, there is $2 million. God, no! It is $2 million.

MS JONES: Good enough. Move on.

MR. WISEMAN: I did not mean to give you a heart attack.

MS JONES: I thought I was falling asleep, but I was not sure if I heard you correctly. Anyway, that sorts that out.

MS MICHAEL: No problem.

I will continue then. Under 11, the Debt Expenses are going up. I guess I am interested in what is the accumulated debt and why are the expenses going up? Has the debt gone up?

MR. WISEMAN: This particular piece here: you might recall a few years ago the former Administration purchased or developed or had built or entered into an agreement to have facilities built in Port Saunders, Burgeo and St. Lawrence. I am not sure of the financial arrangement around that, but basically they were built as part of some kind of buyback arrangement. Fundamentally government gets the use of it but we are paying through the nose to have those facilities. That cost is driven by that agreement that goes back some years.

MS MICHAEL: Okay.

What is the accumulated debt now?

MR. WISEMAN: The debt is not ours. The debt is the company's who built that. What we are doing is we are paying their costs as a part of the arrangement here.

MS MICHAEL: We would have to go to their books to find what that debt is.

MR. WISEMAN: It is not something that we end up doing, managing that debt.

MS MICHAEL: Right, I understand.

I have a number of general questions around programming that sort of all fit in here because of its being the regional health authorities and the services, so if could ask some of those then.

MR. WISEMAN: Before we get into that, could I ask the Chair if we could take a five minute break?

MS MICHAEL: That sounds good.

CHAIR: Sure, yes.

CHAIR (Hutchings): Okay, everybody, can I have your attention again. We will reconvene Health and Community Services Estimates. I believe, when we left off, we left at heading 3.1.01.

Ms Michael, do you want to continue?

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

I just have some questions now around things that actually fit under the Regional Health Authorities and Related Services. I would like to pose some of those questions. There is some information I would like to get.

I do not have the figures in front of me, Mr. Minister, with regard to last year when we talked about contract and temporary nursing positions that were going to become permanent. I am wondering: What did happen over the past year with the four authorities, with regard to any changing from contract temp to permanent positions? Do you have any figures on that?

MR. WISEMAN: I can get you the numbers of conversions that may have taken place.

What I understand is current practice is that there are some nurses who want to stay working as casual, for a variety of reasons.

MS MICHAEL: Yes, there always are.

MR. WISEMAN: Those who wish to have a permanent position are being granted permanent positions. There are some who might be in casual positions because of circumstance, and you might find some who might be in those circumstances because of not necessarily that their desire, but that is how they – just to illustrate my point, I remember talking to a nurse one time recently who is working in a casual position because she wants to work in a very specific area and it is easier to get shifts and to get shifts equivalent to fulltime hours when she works in that very specific area. There are no vacancies there right now, and if there were, because of an internal posting process seniority will prevail and some other more senior nurses in the building will probably get the jobs. She has chosen to be a casual for that reason. Now, if she had her druthers, she probably would be permanent, but that is a choice of her calling. There are circumstances like that out there were nurses are still working as casuals.

As I understand, health authorities have created what they are referring to as permanent float positions. Your status is permanent, so whatever benefits that entitles to you, you have, and you have a permanent schedule. You may be assigned to a number of different areas when you report to work, but each of those areas that you would be orientated for and trained for may not always being on the same floor or the same unit.

MS MICHAEL: Right.

Since you have mentioned that – I did not even think of raising this, but I am going to raise it now, because it refreshed my memory. I was informed two weeks ago about four nurses, actually, in the hospital in Grand Falls-Windsor who were taken from the dialysis unit and put into permanent float positions. I have had that verified by three different people, that that in actual fact has happened. I did try to get verification from Central Health itself. We tried many times and phone calls were not returned. We wanted to get this clarified. I do know from the people who gave me the information that it is definite that this has happened.

These were nurses who were especially trained for dialysis and because of that, the fact that they are now permanent floats, the unit is taking fewer patients and you have patients who are west of Grand Falls-Windsor - I know of one in Baie Verte and I think Springdale might have another one, there were three different ones I have been told about - who are having to bypass Grand Falls to go to Gander for their dialysis. I do not know if you have heard of this but I am sure it is definite even though I have not had confirmation from authorities at Central Health itself.

MR. WISEMAN: I understand that there are some patients who are getting dialysis services in Gander who may live closer to Grand Falls-Windsor. The circumstance that gave rise to that with nurses is not a story that I have heard so I cannot comment on it. I do not know.

MS MICHAEL: I would like for you to check up on that because I think they might answer your message when they are not answering mine.

MR. WISEMAN: Yes.

MS MICHAEL: What made me think of it was you mentioning permanent float because that was the position that those four permanent dialysis nurses were put into, permanent floats.

Having said all that, if you could get us numbers with regard to conversions that may have happened over the year with the four authorities that would be really helpful.

A couple of questions under childcare. Last year after estimates your department provided us with a good idea of the spaces that existed in the Province and where they were. Could we have an update on the childcare?

MR. WISEMAN: Yes.

MS MICHAEL: Were there new spaces created this past year? Can you answer that question?

MR. WISEMAN: Oh, were there new spaces. I thought you said where they were.

MS MICHAEL: No.

MR. WISEMAN: Okay.

We have gone from 5,972 to 6,024.

MS MICHAEL: Thank you.

There was a small number. That is good. It is better than none.

I will not ask you where that all happened because when you send me the grid I will get all of that information.

This is the last year of the child care trust money from the federal government that came in 2006. What are plans for after this year?

MR. WISEMAN: You are right in that. Obviously the desire and hope is that those agreements will be renewed. We do not have an indication yet whether that is going to be a reality and probably will not know for some time. Obviously, we want to maintain capacity, so if that arrangement does not get renewed in some fashion, or the funds either through that program or some other that gives us the capacity to do it, then we, as a Province, are going to have to deal with that shortfall from the federal revenue sources.

MS MICHAEL: Okay.

That is good to hear.

A couple of more general questions. I will probably ask one or two more and then maybe Ms Jones - I know she will have more questions. I would be surprised if she did not, I will put it that way.

I have to say that we were disappointed, and users were disappointed, that there was nothing new in the budget for MTAP, for the medical transportation. I am just really curious as to why expenses such as the auto transportation and per diem for those staying with friends or relatives was not brought in. There has been a lot of lobbying with regard to this. Certainly the Cancer Society has been. It is not just people who have cancer, there are many who are affected, and I am disappointed that it was not brought in. I am just wondering why the decision was made not to do so.

MR. WISEMAN: Budgets are always exciting times because you get a chance to make some announcements around new initiatives and expansion of programs, but at the same time they are also about choices. Whenever we go through a budget cycle and we start off – in early fall we will start developing some budget scenarios identifying some program initiatives that we want to undertake and we will start then examining how much capacity we might have to increase and we will start making choices around how we are going to spend the money that we have. This year was no different than all the past years in that same kind of exercise.

The money that we spend on the Medical Transportation Program, the current level of spending at least, reflects adjustments and increases that have been made in that program year over year for the last three years. In one or two particular years we have made some significant changes in it and another year, too, we made some minor tweaking of it, but they were enhancements. This year we went through that same exercise, looking at how we might improve the program, and we listened to the commentary we received during the pre-budget consultations. We recognized your comment around the lobby efforts that have been underway by a number of organizations. Obviously we are armed with that kind of insight.

The other thing we had some sense of is in terms of how well we, as Newfoundlanders and Labradorians, do and how well we, as a Province, do relative to the rest of the country. One of the things that I found in that jurisdictional comparison is that there are very few other jurisdictions in the country that have a program similar to ours and there are some variations of it in some other jurisdictions that do a couple of things. In Ontario, for example, Northern Ontario so it is not unique for the entire province, they have built some parameters around geography. Other programs that have done something similar have means testing, a process. The construct our program today is more generous and more extensive than any other jurisdiction in the country. There are some nuances to theirs that may be different than ours, but on the whole we have a much more generous program than those jurisdictions that have it, because not everybody does have it.

We are very much aware of what is happening elsewhere and we are very much aware of the competing demands we had in this budgetary process that we are into now. This year we decided that we only had a certain amount of capacity to increase and a certain amount of capacity for new investments and enhancements and we had to make some choices. The thinking was that we made the choices to place the money, as we are debating here tonight and talking about here tonight, in a number of categories. We have outlined them in the Budget document. In the end it is about choices. We are not suggesting that the program and the request that came in, and the lobby effort for enhancements, were not valid points and that they did not warrant some consideration, because they did. They were given full consideration in our budget process, but at the end of the day it came down to some choices, as it comes down to choices between health and transportation, health and education, or education and municipal affairs. Across departments and throughout government we make choices, within the departments themselves we make choices, and we are never able to – I have never yet been a part of the budget process where we were able to - respond to all of the competing needs and be able to fill all of the gaps that we would like to be able to fill in one fell scoop. We need to do these things gradually. Given the fact that we have made some investments year over year for three years, we made some other choices this year.

MS MICHAEL: I hope next year this might be the choice you will make. We have done our research as well. I have seen the programs. We have a grid where we put everything together. The personal auto transportation is more common than not common in the other provinces. I know there are some who do not have it, and some you do have to cost share, that kind of thing. I really think some people are going through real hardship because of not being able to get that covered. I guess all I can do today is to say I hope, as you go into the fall this year, that this will be something you will give consideration to, because we are still getting people calling us about that. I do not mean the associations; I mean individual people. Of course, when the associations lobby they are lobbying because they have individual people who are contacting them, so it is a bad issue.

I will leave any other aspects of medical transportation to Ms Jones. I am sure she will probably have something to ask about that.

This is more for information; I am interested in knowing how things are going. Last year, of course, $1.7 million was budgeted for introducing the assertive case management teams to Central and Western Newfoundland. I am just wondering: What is the status of those teams, and has there been an evaluation of how that has gone so far?

MR. WISEMAN: I will ask Moira to make some comment on that program for you.

MS HENNESSEY: Last year we did put partial teams in both Central and Western Newfoundland. A team is made up of about ten members, so when I say partial I think it was about five physicians in each of the two regions last year. They began the recruitment. It was in the fall when the recruitment started.

The partial teams are in place in this year's budget. In Budget 2009 there is monies allocated to add the other four to five team members in each of those two parts of the Province. Because the teams are really in their infancy stage right now there has been no evaluation done at this time.

MS MICHAEL: Okay, thank you.

Just one more question, if I may ask, for further information. How did you make the decision about what would be left out initially in the teams? How did you make that decision?

MS HENNESSEY: The decisions would have been made by the two regional health authorities, which physicians they would put in place first. Now some of it, I think, would have been dictated by their ability to recruit, because with some of the health professionals it does take a longer period of time to recruit than in others.

MS MICHAEL: Right. Yet, they were able to start operating as partial teams?

MS HENNESSEY: I am sorry?

MS MICHAEL: They were able to start operating as partial teams.

MS HENNESSEY: Yes, they are both operational, one in Grand Falls-Winsdor and the other in Corner Brook.

MS MICHAEL: Hopefully they will become full teams this year.

Okay, thank you.

You know that I was going to have to ask this question, Mr. Minister, moving into home care and long-term care: When is the long-term care and community support strategy going to be ready and be released?

MR. WISEMAN: Obviously, the piece of work that I commented on earlier about the home support piece, the client contribution piece and the financial assessment, inasmuch as we were able to announce that this year, that piece of work that helped inform that decision is a critical piece of the work that we have done as part of that piece.

The next piece of work to be done will be a public consultation process that we are going to go through on some models of programming service, some delivery models that we will be engaging in, hopefully in the fall. That will be the next wave of that piece because we want to be able to have some public dialogue and solicit some input on some of those models we were talking about.

MS MICHAEL: Okay.

Just one more question, actually, at this point. Right now, in long-term care, how many people do we have at the moment on waiting lists at the long-term care facilities? Do you know that?

MR. WISEMAN: I would have to get that for you.

MS MICHAEL: Okay, I would be interested in having that, a breakdown.

Just to confirm this, the new building to replace Hoyles-Escasoni is still only going to hold the same number of beds? Is that still the case?

MR. WISEMAN: There may be some minor variances, because I am not sure of the exact number of beds that are currently operating in either one of these places, but the intent is, generally speaking, yes. At the end of the day there might be a difference of eight or nine or ten beds, so there might be some minor differences - because of design considerations we are able to accommodate a larger number - but the intent would be not to have any fewer beds than are currently in existence at those two facilities.

MS MICHAEL: May I ask why that, because my understanding is there is a big waiting list in the St. John's area – not just in St. John's itself.

MR. WISEMAN: The reason we are using the phrase, we are going to replace, is because we are replacing the two buildings. What we are trying to do is to kind of recognize, inasmuch as it is an institution, yes - but design considerations - try to make it a little more of a home setting. The larger the complex, the more institutional in nature it becomes.

We are trying to preserve that atmosphere of being a home environment, and we want to be able to try to contain the numbers, I suppose, in terms of: we could put it all in one and have a 500 or 600 bed facility which, in terms of capacity of beds, would satisfy that, but I think you would lose something in programming by making it that huge. So we are trying to replace facilities that we now have and that need to be replaced, like Hoyles-Escasoni. As a part of the planning that we are doing, we are looking at the capacity needs that we will need to deal with as a part of that whole strategy that you were asking about a second ago.

Right now, the announcement that you are referring to is about replacing two existing buildings that are no longer suitable for the level of care – in the same way as we made the announcement of Carbonear. We have facilities in the Conception Bay North area that need to be replaced, and when we replace them the intent is to take that capacity that currently exists and move it into the new building. Because, once you get beyond a scale larger than those numbers it becomes much more of an institutional-type setting and you lose some of that kind of flavour, that kind of atmosphere, that you are trying to maintain as a home.

MS MICHAEL: Well, maybe after this one is done there might be consideration given to a second similar size one in St. John's, because we might not need it quite as big but I still think we need greater capacity.

Thank you. Those are all the questions I think I have under that section.

CHAIR: Ms Jones.

MS JONES: Thank you, Mr. Chairman.

Under the jurisdictional review that you did for the medical transportation program, did you also take into consideration the availability of services, and what services people had to be referred out for, in terms of looking at that?

MR. WISEMAN: The geography of Newfoundland is a big issue. Therefore, especially some of the tertiary level services are located in St. John's. There are some tertiary level services in Corner Brook. The tertiary level, for example, is all in St. John's so we have a significant geography to consider. Obviously, that was a part of our consideration as to what impact that would have, and what impact it is having on people now who travel.

The factors that gave rise to our analysis, or part of the analysis, it was not just a cost analysis in terms of how much capacity do we have to increase, but what might be the construct of this program. Because, if we are going to enrich it and enhance it, then who is it we are trying to benefit here, and who are the people who are going to get the maximum benefit from this, and which individuals now, or what groups of individuals, either by virtue of the disorder that they have and their frequency of travel, or by virtue of where they live relative to where they access services, what populations would be impacted the most if we were to make some enhancements? That would help us define the kind of enhancements that we would make. Obviously, we needed to include that kind of data in the assessment in order for us to be able to have a good feel for what we needed to do.

MS JONES: I can hardly hear you.

MR. WISEMAN: I sat back in my chair, so maybe I contributed to that.

MS JONES: I think it is safe to say, and I do not know if you guys have done any analysis on this, but my experience has been that more people are expected to travel for more services medically. I do not know what your analysis tells you on that, if that is correct or not, but I know that, just in my own district, services that normally people would be able access years ago at St. Anthony hospital now are being referred to Corner Brook or St. John's. In a lot of cases it is necessary because the technology is available to be able to make more accurate diagnosis, to do the kind of diagnostic testing that needs to be done to determine, I guess, what the sickness is and what the treatment should be. In cases like that, you know they are getting a better service sometimes by going where they have better technology, more specialists and all of that stuff, but it seems like it is happening a lot more.

I know in my area of Southern Labrador it was always difficult enough for people to have to access St. Anthony hospital because they have to do it by air, and although there is a subsidy for that air travel there is still a lot of expense incurred with hotels, hostels, meals, and road transportation when you get there and so on. Now they are being referred more and more to Corner Brook, and the only bus service that operated on the Northern Peninsula was discontinued in the last few months, so now they do not have the option of even flying in to St. Anthony and then taking the, I believe it was called the Viking Express, the bus – I am trying to think of the name of it - down to Deer Lake, where they would change over to get on another bus to go to Corner Brook to get those services. That option is not even there for them now, so they either have to have someone drive them when the ferry is on – which, as you know, three or four months out of the year it is not on - or they have to fly to St. John's and then fly to Deer Lake and have road transportation to Corner Brook.

It is a very expensive process, and I have tried a number of times now just to change people's appointments from Corner Brook to St. John's, to save them that additional airfare of having to fly here and fly back on the West Coast. Sometimes we have been successful, but not all the time.

I think government needs to look at that, because if we are going to continue to refer people to where the better service is, and where the specialties are, and where the technology is to be able to treat them in that manner, we also have to consider the financial hardship that it puts them under.

I have dealt with patients, and I am sure you are aware of this, whose monthly income was a lot less than their expense for one trip to a hospital, and that was for themselves. The only subsidy they could get is what is afforded under the program now, and if they already made their claim once that year, they get $1,000 once and then they get 50 per cent after.

I am dealing with a case again this week where they were four days short again in this year so they are still getting just the 50 per cent back, so they are still out of pocket $1,500 or something on trying to access that service. I just think it is way too much to be expecting of people.

Now, whether we have to look at a program that becomes more tied to income levels, or we look at a program that is going to allow people more accessibility, I do not want to sit here and proclaim the answer to that, but I think there is a problem and we are omitting to look at what that problem is and how to deal with it properly.

I have advocated as well for mileage to be reimbursed to people, only because sometimes it is cheaper and simpler to have someone drive you that 300 or 400 kilometres to get to a hospital. It is cheaper on the government when the claims come in, and it is cheaper on them when they are paying it up front, out of pocket, but I understand that government would find themselves in a dilemma as well; because, if you do it for one group of people, do we do it for everybody in the Province?

So, if I live in Carbonear and I am being referred to a hospital in St. John's, should I be entitled to claim my road transportation costs, or should I only be allowed to claim that if I live out in Baie Verte and have to come to St. John's?

These are all decisions I know that government has to make, but I think realistically when you are asking people to travel up to 400 or 500 kilometres by road, to and from the nearest service that they can get for the health problem they have, then it warrants considering.

So, whether the restriction becomes a matter of distance in terms of where you are restricted, or it becomes another factor in terms of affordability, I think one way or the other it needs to be looked at.

I know the Cancer Society, as Ms Michael has already alluded to, has gathered a petition. I think you presented it here, and there were thousands of names that were on that petition, but this does not only affect cancer patients; it affects everyone.

I just would like to see government at least show a better understanding of the financial hardship it is causing people, and attempt to have a look at it over the next year to see if there is a way to revamp the program to allow for more affordability for people who have to travel to access services.

MR. WISEMAN: I appreciate your commentary. Just to reiterate something I said a moment ago, we did a fairly extensive analysis this year into the construct of the program, and what might be a way in which to deal with it differently as we move forward.

You raised a couple of interesting points. One is around whether or not we make it universally available, which is what is there now, regardless of income; someone making $15,000 a year is given the same consideration as someone who is making $150,000 a year. Whether that is fair and reasonable, that is something to be discussed.

The other piece you talked about is distance, the distance from the service you are accessing. The other piece is frequency. You may have someone who has a chronic illness who travels 200 kilometres five days a week, and someone who might be travelling once every two years and travels 2,000 kilometres. Are they the same; could they be treated the same?

MS JONES: That is right.

MR. WISEMAN: The other one is mileage; you used the word mileage. Another option would be to look at actual reimbursement of expenses. Because mileage in our world here, for example, employees who work with government charge thirty or forty cents, whatever it is, a kilometre, when they travel, but give consideration to the fact that they are doing it on behalf of their employer and they are getting reimbursed for some depreciation of the cost of commercial insurance for their cars together with the operating expense.

If you are going to reimburse someone for accessing a service that they benefit from, would you use the same rate of reimbursement, for example, or would you try to legitimize or come up with a rate structure that gives them a reimbursement for their actual expenses, and depreciation on their car and all that kind of stuff is a normal wear and tear and they will absorb that?

There are a number of options, and I am able to share these with you because it will give you some sense of the kind of thought process we went through ourselves as to what this might look like and how it would be structured as we move forward.

I want to give you the assurance that we did give it a very thorough analysis as a part of this year's budget process. As I said earlier, there were some difficult choices that had to be made. This one did not get considered in this year's budget, but it will be a part again of this upcoming year's review as we do on an annual basis.

We have done a fair bit of research and gathered a lot of data and gained some insights into how other programs were structured and what might be some options to change the construct of the one that we have here now, or just to make some minor changes to the one we have and enhance it a little bit.

We have done a fair bit of analysis on that, so a lot of background work has already been done that will help inform again this upcoming year's budget. Next year we will be back here having a discussion, I am certain, around next year's Estimates, and who knows what next year's budget will bring.

MS JONES: The other piece of this program is the pay up front reimbursement piece. I guess because I understand the administrative processes of government I know that it would be somewhat of a little bit of a nightmare to try and do that.

MR. WISEMAN: That is an understatement.

MS JONES: I do not know if you have examined any ways in which that might be something similar done, especially on the airline piece. I think this is where the bulk of the cost comes in from people. I get calls from Labrador City and the Wabush area all the time simply because the airfare is so expensive getting out of there and people have to pay up front. I do not know if there is any way that there could be some kind of a process whereby they could get an authorization number or something from the department that allows them the percentage they are eligible for, whether that is 50 per cent or their full $1,000, some form or another that they could use to help them access that airline ticket.

MR. WISEMAN: I have officials now doing a piece of work on what might be options to allow us to do that, actually. One of the challenges that we have run into, and it is identified as something we need to work our way through and see if it is manageable, is to recognize that this program is a program that reimburses you for expenses for insured services. We have had examples of where people have been referred for services, and have gone to access those services, and they have made a claim after and they were not eligible for reimbursement because they were accessing a non-insured service.

How do we actually put in place a mechanism to help you with expenses up front without adjudicating on their eligibility for the reimbursement in the first place? You run into that particularly where people are going out of Province sometimes to access services in private clinics that may be in other parts of Canada or the U.S., and the service they are accessing is not an insured service; therefore, eligibility is defined by insured service.

There are a few wrinkles like that, that we have to work through, but officials in the department are now looking at what could be, if possible, and what would it look like? What kind of processes would we have in place, or could put in place, to ensure that we are still only dealing with claims that are eligible for reimbursement, because they are accessing insured services somewhere, and that they are getting appropriate referrals from their family physicians to go outside for some specialist level service, and that the referral is attached to the piece rather than someone deciding: I would like to see a doctor in Corner Brook, or I would like to see a doctor in St. John's, or I want to go to Halifax to see a doctor and I am booking my flight and going.

There are a few things like that, that we need to work through, but we have officials now looking at the possibility of doing that, and what it would look like, and what kind of parameters we would have to have around it. I hear your point in terms of this up-front cost.

MS JONES: A couple of more questions just on that program. How much did government pay out last year under that program?

MR. WISEMAN: Jim, I do not know if we have that figure here. It was about $2 million, I believe. Jim is that figure here somewhere?

MR. STRONG: It should be, Minister.

MR. WISEMAN: $1.9 million. I was off by $100,000.

MS MICHAEL: Just having some technical problems.

MR. WISEMAN: Getting yourself all tied up there?

MS JONES: I have that many headphones here, and none of them work very well.

MR. WISEMAN: It is easier for me to speak louder so you do not have to tie yourself up.

MS JONES: I do not know what your problem is tonight, I have no trouble hearing you in the House.

Okay.

MR. WISEMAN: You are alright now?

MS JONES: Yes.

MR. WISEMAN: Plugged in?

MS JONES: I am plugged in, yes.

MR. WISEMAN: Way to go!

CHAIR: Could I just ask: We are into about our fifth hour, I guess, in terms of these Estimates, not to put any limit on it but obviously we can reconvene, but what are the thoughts of the Committee on how long we are going to go and if you want to continue tonight?

MS JONES: I would say I am going to be another hour. I do not know about you, Lorraine?

MS MICHAEL: I won't be any more than that. I do not have that much left. I certainly will not be any more than that.

CHAIR: Minister and your officials?

MS JONES: Well, we are into the two biggest parts of the department now, so it is taking a bit longer.

MR. WISEMAN: Based on the commitments we have, we can go to 10:30 p.m. and then after that we can reconvene this at another time.

CHAIR: Okay?

MS JONES: Yes, but I think I can be finished by eleven anyway, but we will see.

MR. WISEMAN: We will pick 10:30 p.m. and we will then set another time.

CHAIR: Okay.

MS JONES: Okay.

You paid out $2 million last year on that.

MR. WISEMAN: One point nine something.

MS JONES: Okay.

Was that for in-province and out-of-province?

MR. WISEMAN: That would be all, yes. That is all-inclusive.

MS JONES: Do you have a breakdown of the two programs?

MR. WISEMAN: We would have to get that for you.

MS JONES: Is that up or down from the previous year?

MR. WISEMAN: It is around the same ballpark actually. It might be slightly above, but not much, not a lot.

MS JONES: Can we get the comparison on out-of-province and in-province for the past two years, just so we can see if there are any changes?

MR. WISEMAN: We could do that, yes.

MS JONES: Okay. That would be it on that program.

Also, under that section I have some questions around the boards, what the board deficit was and accumulated debt for the boards of the Province.

MR. WISEMAN: This year they are all forecasting a balanced budget. Western, I think, are forecasting a small surplus. We have Eastern as an accumulated operating deficit of $48.7 million; Central has $17.9; Western has $25.1; and Labrador-Grenfell has $20.1; for total accumulated operating deficits of $111.8 million.

MS JONES: Have those accumulated deficits grown much in the last five years?

MR. WISEMAN: I am looking at a grid here now that goes back three years and three years ago in 2005-2006 it was $119.8 million. It is down by $8 million over that period the last three years. I would not want to speculate on the previous two years, that would give you your five figures, but I suspect that figure, if you go back five years, was more than the $119.8 million. There would not have been any growth in deficits in 2005-2006 onwards, so I suspect that the figure, if you go back to the fifth year, is probably slightly higher than the $119 million. We can get the detail for you, but the three-year figure is $119 million.

MS JONES: Yes, I would like to have a look at that.

Can you give me the accumulated deficit on Eastern again? I missed the number when you said it.

MR. WISEMAN: Eastern right now is $48.7 million.

MS JONES: In terms of vacancies in the board regions in specialized services such as psychiatry, paediatrics, gynaecology, those particular areas, would you be able to provide us with a list of where there are vacancies, what the complement is supposed to be and where it is today?

MR. WISEMAN: We can do that, yes.

MS JONES: My other question is around the boards themselves. In light of the Cameron piece, the review that was done around that, and the role of the boards, is government looking at a different process for boards in terms of what their responsibilities are, what levels of authority they have, and what their accountability measures are to the delivery of health care? Is anything being reviewed, looked at, considered, around any aspect of the boards themselves?

MR. WISEMAN: A couple of things that govern the boards are - you may recall when they created the new health authorities there was new legislation that went with that. Prior to the consolidation of health authorities the piece of legislation that governed them was the Hospitals Act and then we passed new legislation called the Regional Health Authorities Act. That was proclaimed in the spring of 2008. I think the last spring session I think had not adjourned when we actually proclaimed it last year. That new legislation was proclaimed last year which clearly spells out the role and responsibility of the authorities and what they are responsible for, what they are accountable for, and the role and responsibility that the minister has in relationship to that authority.

Then we have the accountability framework that government has. I am just trying to think now; the levels. The grading system government has for the accountability - a, b, c and d - so that there is a higher level of accountability in terms of their reporting, I think health authorities are at that higher level. So their level of reporting to government and to the public is at that highest level. That speaks to their accountability piece. The legislative framework that already exists speaks to their accountability.

I think one of the things that speaks to your question around the Cameron Inquiry and what that would have done in terms of accountability - I think the big piece here now growing from the recommendations that came from the Cameron Inquiry and recommendations that came from the Task Force on Adverse Health Events is more public reporting of events and occurrences in the health system and more reporting in a public way around the performance of the health authorities. That is a piece that we will achieve through the implementation of those policies within the authority.

MS JONES: Can you give me a list of what the vacancies are on the boards in the Province now? I know on the Labrador board there have to be at least six or seven vacancies that have existed some nearly two years and there have not been any new people appointed. I am just wondering what the vacancy rate is on the other boards in the Province.

MR. WISEMAN: We can get that for you.

MS JONES: Okay.

I also have some questions around mental health services. I guess you do not need any background in this one, but there was $2 million in the Budget towards new programs and services for mental health. Do you want to tell me where that is going to be applied? Is it going to be towards the medical service delivery to patients or is it going to be used for something else such as community mental health or something of that nature?

MR. WISEMAN: Just to give you some sense of the breakdown of some of those items. A fair piece of it is going into the Janeway child and adolescent services. A fair bit of it is going into that piece. We are putting some money into the Canadian Mental Health Association who are doing some work with us on a number of projects as a part of our wellness piece. They are going to be doing some work for us on that piece. The other is there is a Consumer Health Awareness Network. Some money is going in to support their efforts and the work that they do with the strong volunteer base that they have around the Province.

Then, when we get into Eastern Health, the child adolescent psychiatric unit is going to get some significant investment, together with the child adolescent emergency services that are also going to get some significant investment as well. The Janeway Family Centre is going to get some significant investment as well, as well as the short stay unit at the Waterford. These are some of the major areas where we are going to be making some investments.

We already had a question a moment ago around the assertive community treatment teams are in place and enhancements to those that are being made this year. These are the primary areas where we are making investments in this year's Budget.

MS JONES: The investment that you are making at the Janeway, what does that mean? I am really concerned by the fact that certain youth in the Province are not being taken into the program there, and in fact they are being diverted to the Waterford Hospital. What does this mean in terms of that program? Is it enhancing it, creating more space, adding more staff, or putting in more services?

MR. WISEMAN: Two aspects - you hit on a couple of them obviously, enhancing the service that we are providing and additional staff being added to the system.

In terms of the other piece of this, where Eastern Health has just recently had an independent reviewer come in to do some assessment of the services that they provide to children and adolescents to determine what kind of service delivery models they may be using that might be enhanced: What are some of the service gaps that might exist that need to be dealt with and what are some of the resourcing issues that need to be addressed? With the investments that we are making here and the allocations we are making in this year's Budget, together with the assessments that Eastern Health are doing as to how we might continue to improve on what we are doing, these investments and that initiative should serve us well in terms of being able to increase capacity but also to provide a better service to the clients.

The other piece you raised is the use of the Waterford. I guess there has been occasion when the judgement of a treating psychiatrist and others who are involved as care providers, that there have been determinations that it is in the best interest of the individual involved to have the service provided at the Waterford. It is not something that has happened continuously and frequently, but if there is a belief that the safest and most appropriate care would be at the Waterford then that is a clinical judgment that they have made. There have been some incidents in the recent past where that judgment call has been made by the care providers, that that was the safest and most appropriate place to provide the care that was needed by individuals.

MS JONES: I am not going to get into the issues that I have around all of that tonight but I do have issues around the programming, around the services.

You know that I have dealt with a number of these cases and I am just going to use this one case in particular because it is one of the more extreme cases that I have seen. This young person has been hospitalized, institutionalized, in this Province now for a year and a half. Between the Janeway and the Waterford Hospital they have spent up to four months in isolation where they have not even seen the light of day. They have gone without any child psychology services for up to four months, at periods of time. They have had no recreational therapy during extended periods of their institutionalization. They went without music therapy.

The issue that I have is that they put youth like this in facilities and they are locked down to protect themselves - and I understand that fully – but, at the same time, all of a sudden they decide in their clinical judgement that they can now be let out. They are let out, and within twenty-four hours they are back in the emergency room because they have attempted suicide again.

As long as we keep locking them up and not providing the programs, that is going to continue to happen. In this case it has happened no less than six times in the last year-and-a-half.

I do not have the experience, I do not have the knowledge, and I do not claim to have any understanding whatsoever of what is required, but surely there are people who do.

When you constantly have families and parents coming to you with stories like this, and telling you where the gaps are, at some point there has to be a way to start fixing it. I do not know. Recently, I was just told again of another incident where the Janeway was refusing to take a young person, a youth who was suffering from mental illness, and basically had them referred to the Waterford Hospital because they had problems when this person was on the floor before, and all these kinds of issues.

I do not think those things should enter into it. If there is a problem between a nurse and a patient who is suffering from mental illness, I think it is easier to look at how you make some staff shifts as opposed to how you continue to bar this child from programming at that facility.

That is a story that I was told by the parents and by the legal counsel for this family, so I am only speaking as I have been told. I do not profess to know the intimate details of it all, but, to me, that tells me there is something seriously wrong.

I do not know how long this child will be in the system. Eventually they will turn eighteen and I guess they will be in the adult system, but I think our focus should be on making them better, not getting them into one program and into another one where they can actually get more services.

I do not even know if you have a response for me on that. I know you have done a lot of work on it, and I know that your department has been engaged in it, but in many cases we are not seeing those results.

MR. WISEMAN: You have the luxury – or not luxury, necessarily - you may have the flexibility, with the consent of the parents, to be able to pose a question or to raise a circumstance. I, unfortunately, do not have the ability to be able to make public comment around what may or may not have occurred, or will be occurring, or has occurred, with any one patient, and to respond to the specifics that you raise, because I think both you and I would recognize that we both understand and know who we are talking about, so I will not do that.

A couple of things I will comment on, though, in terms of the thrust of your comment - because we both share that same interest - that we have improved mental health services for children and youth in this Province.

You asked a question at the very beginning in terms of where these investments are going this year. As you would have gathered from my answer, much of it is going into services at the Janeway, and services for children and youth, which has been a real thrust of this year's investment.

You may have heard me comment a second ago, as well, around the piece of work that Eastern is doing by bringing in external resources to evaluate the programs that are there with the view of how can they be strengthened and how can we build on what has taken place.

You would also be very much aware of the announcement we made around the new residential treatment program we are going to establish for children with complex mental health issues, and the resources that we need to build around those services.

Clearly, we share the same view that we need to ensure that we have appropriate services for children and youth who find themselves experiencing some difficult times and who are dealing with sometimes what are very complex mental health issues. Both of our desire is to do that.

We are, through our actions, demonstrating that we want to be able to invest in those services and provide the appropriate resources, and are interested in understanding better what it is we need to do, what it is we are doing now, and what it is we should be doing as we move forward.

In a general way I can comment, but I cannot speak to the specifics of the case that you raised.

MS JONES: Although I am just using one particular case, and I know that case - as I said in the beginning, it is a more extreme case - it is a systematic problem that I have seen with a number of youth who are in the system, who suffer from mental illness, and not just here but even in other parts of the Province.

We have dealt with a number of cases in Central Newfoundland where they were being referred to use services at the Grand Falls hospital that were not being provided, that were not there. Cases of where they had to take their young child and drive to St. John's in the middle of the weekend and go into the emergency room here to get treatment.

I think there are lots of gaps that exist in the system, not just for this one patient, but we were really pleased when we heard that government would actually invest in a treatment facility. I guess we have lots of questions around that as well, and I will ask you a few tonight.

Are there existing facilities that you are looking at using, or are you looking at using a new facility to provide that kind of a treatment?

MR. WISEMAN: One of the things that we have said, we were going to establish a new facility. I will give you the same answer as I gave a CBC reporter this morning when they talked the addictions centre out in Central Newfoundland, because he asked a similar question. Is there another building that is out here, that you could use right away?

First and foremost as a part of this piece of work we announced that we were going to establish such a facility, or such a residential treatment program, in both cases: the addictions and children with complex mental health issues. Our first order of business is to develop the programming around both of those services. When we develop the programming that will help define, then, what kind of shape a physical structure needs to have to be able to deliver that program appropriately.

We envisage needing to build something new; however, when we get the programming piece done – we envisage and we are prepared to build something new, if that is what is required - when we get the programming piece done, if there is an existing building that would satisfy that programming need, then great. If there is a building that can be modified to some extent to meet it, then that is fine, but we are fully prepared to invest in a new building, if that is what is required, but that decision would be driven by the programming piece, because a building is a building. The programming is what is going to be important here, and the success of both of those initiatives will depend on programming.

MS JONES: I guess what we want to know is: How far along are you in that process, in determining those factors, and what is the time frame around having a treatment facility in place in the Province?

MR. WISEMAN: The addictions piece is probably one that could proceed a little faster, because the addictions piece is a piece of work that we are doing in the Province now. We have a fair degree of expertise in that area, and we believe that we will be able to develop the programming within the Province itself.

Dealing with children with complex mental health issues - because we do not have a level of service that is comparable to that now in the Province - we believe we would like to bring in some outside expertise to help us with that programming piece. We are now identifying that expertise that we need to bring in and get this piece of work done for us, so that it does not measure it in years of getting it done; we want to do that now.

These buildings, inasmuch as they may be purpose-built, they are not complex structures. There is not like a lot of high technology in them, so the construction period should be relatively short. Because by definition this is residential, this is not going to be a large institutional-type facility. Now, it will not be a building that you can put on a residential lot, either, but it is not going to be a huge institutional-type complex that you would need to have complex approaches to construction. It is intended to be a residential program. It will look like a large residence. You need, obviously, education programming, you need recreation programming, so the room size with be grossed up to give you space to be able to accommodate that part of the program piece, but this is not a complex building by any means.

MS JONES: No doubt. The facilities that I visited over the past year in Ontario, which were treatment facilities, were definitely not institutional care.

MR. WISEMAN: No.

MS JONES: They were nowhere near it. That was why I was a little bit astounded when people started to refer to it as that in the Province, because what I saw was very uplifting and very much designed for spiritual healing as well as medical healing, or clinical healing, of these young people. I hope that is the concept that government will follow when they start looking at this as well.

MR. WISEMAN: You might have heard, recently there has been some question around the size: How many beds will it have, or how big will it be? We need to be careful. Like you said, if you said we need to accommodate fifty people, do you build one building for fifty people? Well, that is an institution you have just built.

MS JONES: Yes.

MR. WISEMAN: That is not what we are doing here.

This will be a small unit and it will be a home-type setting, to the extent you can, because you are accommodating a number of different people in the same space and you need open space, free space, education and recreation space, so it will be larger than a big two-storey house, but it will be clearly designed in a fashion to give a home-like atmosphere. The programming needs to reflect that kind of nurturing environment as well.

MS JONES: Is there any money in the budget this year for the planning and the strategy around that?

MR. WISEMAN: There is, yes.

MS JONES: Okay.

Also, can you give me the statistics on the number of children and youth right now that you have on your books, who are suffering from mental illness – what stats you have, if you have any?

MR. WISEMAN: I do not have the data to share with you, and I am questioning whether or not we would have that in a single sort of – because, recognize that many of these children may be treated by their family physician; these are private clinics, physicians. They may be treated by a psychiatrist, again, who is a private physician who maintains their own charts.

We could give you some information around the number of children who may have been admitted or discharged from the Janeway, for example, or one of the other units around the Province, but when you start talking about children who may be – there is a variety of children who may be receiving counselling from a variety of social workers, psychologists and others in private practice, so I do not know if we would be able to capture that figure without qualifying in some fashion. We could probably get for you who goes in and out of the Janeway, but the caseload or physicians who would be in private practice, or other practitioners in practice, I am not sure we would be able to capture that for you.

MS JONES: It might be data, though, that the department could ask that people would keep statistics on. I do not know how you would do that.

MR. WISEMAN: I will tell you what I will do: to the extent that we have data, we will provide you with what we have, but I would not want to tell you what we have because I am just sharing with you some of the problems I see in trying to give you a definitive number.

MS JONES: The other piece of data I would like to have is the number of children and youth that are in custody outside the Province, whether that be in mental illness, foster care or addiction services.

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

CHAIR: Okay, it is now 10:30 p.m. Do we want to adjourn at this stage?

MR. WISEMAN: Unless there are just one or two more questions, but we have made the commitment so we can reconvene this at some point.

MS JONES: We will have to reconvene, because we have not done any of the capital infrastructure and that is a big part of the budget.

CHAIR: Okay.

I thank everybody for their participation tonight, and we will reconvene at the call of the Chair.

I will ask for a motion to adjourn.

MR. KING: So moved.

CHAIR: Thank you.

On motion, the Committee adjourned.