The Committee met at 9:15 a.m. in the House of Assembly.

CHAIR (Hutchings): Good morning, everybody. Welcome to the Estimates Committee for Health and Community Services.

Before we get started, there are just a couple of items. Generally, what we have done in the proceedings is that if the minister wishes he can give an opening statement or, if not, we can go right to Committee members and questions. Then, when we go to questions, we will usually go to a fifteen- or twenty-minute period for a Committee member to ask questions and then we will rotate to others.

What I will do now, Minister, I will go to you and ask if you or your staff could certainly identify themselves. As well, I will just remind everybody, when you speak, if you could identify yourself - the people from the department - so, for Hansard's purposes, when you get your red light on, they can identify who is speaking. So, if we could have everybody identify themselves.

MR. KENNEDY: Thank you, Mr. Chair.

I am Jerome Kennedy, Minister of Health and Community Services. Perhaps we will go to Don Keats, the Deputy Minister, and go around.

MR. KEATS: Don Keats, Acting Deputy Minister, Department of Health and Community Services.

MR. WAKEHAM: Tony Wakeham, ADM, Regional Health Operations.

MR. COOPER: Bruce Cooper, ADM, Policy and Planning.

DR. ALTEEN: Larry Alteen, Director of Medical Services.

MS KING: Tracy King, Executive Director of Strategic Initiatives.

DR. STRATTON: Faith Stratton, Chief Medical Officer of Health.

MS MUNDON: Tansy Mundon, Director of Communications.

MS JEWER: Michelle Jewer, Director of Financial Services.

MS TUBRETT: Denise Tubrett, ADM, Corporate Services.

CHAIR: Now if I could have the Committee members identify themselves, starting with my far right.

MR. YOUNG: Wallace Young, St. Barbe.

MR. RIDGLEY: Bob Ridgley, St. John's North.

MR. CORNECT: Tony Cornect, Port au Port.

MR. KEVIN PARSONS: Kevin Parsons, Cape St. Francis.

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

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

CHAIR: Thank you.

My name is Keith Hutchings, MHA, District of Ferryland and Chair of the Social Services Committee.

We will call the first heading.

CLERK: Subhead 1.1.01.

CHAIR: Shall 1.1.01 carry?

Minister, you are free to make any statements or we can go right to the Committee members.

MR. KENNEDY: We can go right to the questions.

CHAIR: Okay.

Committee members?

Ms Jones.

MS JONES: Thank you.

I am going to start with section 1.2.02. under Corporate Services, please.

Under the section Transportation and Communications, you did spend more money than you had budgeted last year by $123,500. I ask if you could give me an explanation for the increase.

MR. KENNEDY: Sorry, I am having difficulty hearing, Ms Jones.

MS JONES: Section 1.2.02., under subsection 03., Transportation and Communications, you overspent by $123,500 over what was originally budgeted and I would like to get an explanation as to what the extra cost was.

MR. KENNEDY: Do I have to indentify myself each time I speak?

CHAIR: No, you are fine, Minister.

MR. KENNEDY: There was an increase in cost based on the projected actual expenditures. There was a large percentage for business reply mail for MCP card registration and the low-income prescription drug program, which was $307,000. Then, there were increased courier and freight costs associated with shipping vaccines and medical health forms for $77,000, which brings us up to about $384,400 there.

MS JONES: Okay.

Under Professional Services, under the same heading, you budgeted $1 million and you spent $464,800. Was there something you were intending to do that did not get done?

MR. KENNEDY: Yes, the funding of $1 million represents a contingency fund for the federal-provincial funding agreements which may arise during the fiscal year. The level of access varies in each fiscal year and was less than anticipated in 2009-2010. The department drew down $187,500 for agreements signed for the Accelerated Clinical Care through Electronic Streamlined Systems, or the ACCESS agreement, and there were two federal agreements in mental health and addictions which were included in projected revised but were not signed in 2009-2010. That should add up to the four hundred and –

MS JONES: So, you expect you would sign those agreements this year?

MR. KENNEDY: Yes, we have.

MS JONES: Okay.

Under Purchased Services, you did increase your budget this year by $240,000 or a little bit more. What is the reason for that?

MR. KENNEDY: So the Purchased Services, you are talking about the increase in the Estimates for this year, $265,000?

MS JONES: Well, according to my numbers it is $241,000, but –

MR. KENNEDY: Okay. Sorry, one second now.

MS JONES: It is $265,000, is it? Okay, you are right, $265,000.

MR. KENNEDY: Okay.

What is happening there is that there will be an increase because the department and Transportation and Works are planning to renovate the first and third floors of the West Block of Confederation Building, and this increase is to assist in the cost of the renovation.

MS JONES: In the West Block you said?

MR. KENNEDY: Yes, there is. There is more space needed and there is some space available. Was it the financial services of the Department of Finance, I think, either moved or are in the process of moving?

MS JONES: Okay.

Under section 1.2.03., Medical Services, again under Professional Services we see you spent $209,600 more last year than you budgeted, and you have increased your budget again this year. Can you tell me what that money was used for and what the increase is intended for?

MR. KENNEDY: Yes, this money is related to costs associated with having a full-time senior business analyst to manage and facilitate work on a claim adjudication program for the Newfoundland and Labrador Prescription Drug Program. The claims adjudication system is a component of the NLPDP processing system and it is to be used for on-line assessing of requests. So funding for this analyst has been covered from departmental savings during the past few years, but funding was requested for 2010-2011.

MS JONES: What about the other increase? It is over $200,000; I am sure you are not paying an analyst that much money. Why would the analyst be under Professional Services and not under Salaries?

MR. KENNEDY: Perhaps my ADM for finance can take that.

MS TUBRETT: It is not a salary cost, it is a Professional Services cost. We hired an IT firm - I believe it was xwave - to do the work. So that is the amount of money that we have paid for business analyst services to assist with the NLPDP system.

MS JONES: Who is the IT firm?

MS TUBRETT: I think it is xwave. I am not 100 per cent sure though.

MS JONES: So you would have paid them an extra $200,000 last year over what you budgeted?

MS TUBRETT: I think we would have paid it in 2009-2010, except it probably would have been through OCIO's budget, and this year we paid it through this budget.

MS JONES: Okay. The extra money that you are budgeting this year, is that going to the IT firm as well?

MS TUBRETT: Yes.

MS JONES: Why do you anticipate the extra costs? Is there more work, more claims? That is a substantial increase in one year to pay out to an IT firm for doing the same job.

MS TUBRETT: It is actually the upgrade to the system. All those systems when they go in place, they are practically in and then there has to be upgrades, there have to be software modification. That is just a regular part of maintaining the system – well, in this particular case, upgrading the system.

MS JONES: Okay.

Under 1.2.03. as well, the Salaries are projected to increase this year. Is that just the normal step increases and raises or are there more positions being added?

MR. KENNEDY: Okay, so the increase in salaries is approximately –

OFFICIAL: (Inaudible)

MR. KENNEDY: Sorry?

OFFICIAL: (Inaudible).

MR. KENNEDY: Yes, the salaries and step increases amount to about $65,000 but then there is a removal of a twenty-seventh pay period. We have our labour market adjustment for the pharmacists. There is a wage differential for the director from Pharmaceutical Services. When you add it all together we save some money on the removal of the pay period and the salary differentials. It comes out to approximately $51,000.

MS JONES: Just to clarify for myself. Under section 1.2.03., this money is basically for the management of the drug program whereas under 2.2.01. is the amount of money you pay out for drugs, is it? Is that the difference? I am just making sure I understand it. Section 2.2.01. would be what you would pay out for drug subsidies or third party pay rates -

MR. KENNEDY: Yes, this is actually the administration of the medical services and the drug program. This is the running of the services. Later on, we will come up to the actual money spent on the drug themselves and the drug program.

MS JONES: Okay.

Well, I just move on to section 1.2.04., Regional Health Authorities. Again, we are seeing an increase in the budget this year for Salaries for Regional Health Authorities. Are there any specific programs or services being added in any of these offices or is this just normal wage and step increases?

MR. KENNEDY: Yes, this is actually related to four new positions needed to administer the national blood collection portfolio. This is funded - if I remember correctly, Don - from the Canadian Blood Services. There is a temporary health care consultant in the Mental Health Division and we have created a new Aboriginal Health Liaison position.

MS JONES: The health care consultant – what is their job? What do they do?

You said you have a temporary health care consultant.

MR. WAKEHAM: This is Tony Wakeham, ADM, Regional Health Operations.

All of the health consultants are basically responsible for the different programs or (inaudible) of policies that the government sets. So each of the consultants will be responsible directly for an RHA and/or take on a bigger role depending upon the need.

The idea is that they are the ones who would make sure that the policies that are approved by government are implemented in the regional health authorities. That is their basic role.

MS JONES: So these people work out of the department?

MR. WAKEHAM: Yes.

MS JONES: There is one for each board you are telling me?

MR. WAKEHAM: Right now that is the structure that is currently in place. They are assigned to a different area. Now, they obviously all help out, but they all have responsibility for one of the health authorities.

MS JONES: Why would the position be temporary then?

MR. KENNEDY: Actually, I can deal with that one.

One of the things, when I came into the department, I identified mental health and addictions as one of the priorities for me as minister and for the department. There is a restructuring going on of the Mental Health and Addictions Division. What I had seen when I got here was we had a director of mental health and we had two consultations. I did not feel that that was appropriate to deal with what I want it to be, an aggressive agenda in addressing mental health and addictions.

So we are in the process – in the budget we are seeking new positions and we traded off, as we oftentimes do in government. So we traded off a couple of positions to create a couple of new ones. Because there was a resignation of the director of mental health services we were really understaffed, so we hired a temporary consultant on a contractual basis to help us get to the stage between November and the end of March when we would be looking for positions in the budget. That is why that particular consultant is listed as temporary.

MS JONES: Did you replace the director of mental health services?

MR. KENNEDY: The whole division is being restructured. I do not know if Don would like to make some comments on that, but the whole division is being restructured. We are trying to address various issues within Mental Health and Addictions. Right now, the director is not replaced, no.

MS JONES: So what you have now are two permanent consultants, I assume, and one temporary?

MR. KENNEDY: We did second a very experienced senior member of Eastern Health's Mental Health and Addictions staff on a one year secondment from Eastern Health to help us realign the office, to reorganize the office and to make suggestions as to how to go about it. So she is, in essence now, in charge of that division.

MS JONES: Also under that heading under Professional Services, you spent $547,700 less than you had budgeted. I am wondering if that was for anything in particular or specific that did not get completed.

MR. KENNEDY: So you are talking Professional Services – sorry, I did not catch the question. Are you talking about the revised or the Estimates for this year?

MS JONES: I am talking about the fact that you budgeted $547,000 more than you actually spent. I am wondering what that money was budgeted for and why it did not get spent in the last year.

MR. KENNEDY: One of the issues we were looking at was that there had been money budgeted for a road ambulance review that was not spent. We were in negotiations with the road ambulance operators and reached an agreement with them. That is approximately $250,000 budgeted for a road ambulance review. That is one significant portion of it. So that was $250,000 and there were other monies not spent because, to be quite frank with you, when I came in there was a plan to be spending money on TV ads and things like that and I did not feel that was the best way to spend our money dealing with youth programs.

I, personally - and it is supported by some of the people I am talking to - feel that we should be getting out into the schools when we are going to really aggressively deal with the issues of tobacco, gambling, addictions, both alcohol and drugs, and mental health issues. So I did not see the TV ads - there was a plan to utilize TV ads and I did not feel that was the best use of the money.

MS JONES: The road ambulance that you were going to purchase; you did not purchase it, did you?

MR. KENNEDY: No, we are still looking at whether or not the road ambulance review - this money, if I remember correctly, has been budgeted for the last couple of years and we are trying to determine how to - having regard to the issues of geography and simply serving the public. This is for a review of the system, not to deal with purchasing of ambulances or services or anything like that.

MS JONES: Okay, so it was for the review of the road ambulance?

MR. KENNEDY: Review, yes.

MS JONES: Why is it that you did not do the review again?

MR. KENNEDY: Don, perhaps you could deal with that?

MR. KEATS: We had budgeted to do the review, but since we were in the middle of negotiations with the ambulance operators we thought we would not do it at that particular time. This review will give us an idea of what we need to change, if anything, in our road ambulance services, so we wanted to conclude the negotiations before we proceeded with the review.

MS JONES: When will you do the review now?

MR. KEATS: We are anticipating getting the review done in the current fiscal year.

MS JONES: I had a briefing note - I think it was from September - under FOI from the department that talked about doing a review of ambulance services - both road ambulance and air ambulance in the Province. I understand there was a committee put in place. Would this have been part of the mandate for that committee?

MR. KENNEDY: If I remember correctly - and I do not have that briefing note in front of me; I could find it. As a result of the incidents of July 15 in Lab West, especially that incident, that led to a committee being put together because there were problems with dispatching. There were problems between Lab-Grenfell playing a certain role, Eastern Health where the medical communications centre, the doctors were involved and then it had to go to Government Air Services in Gander for the dispatch of a plane. The process itself was somewhat disjointed.

So this committee, if I remember correctly - I was not here at the time in this department - my reading or my recollection of that note was that there was a meeting to determine how best to address the situation that had arisen, how to streamline the process in terms of the dispatching of the planes and how to integrate the way matters were being dealt with.

Don, is that – I was not here at the time; I have only read the briefing note like you fellows.

MR. KEATS: One of the issues that they looked at was, how do we best proceed with doing a review of road ambulance, for example? Do we have the mechanisms to do that internally within the RHAs, or do we need to go out to tender for service through an RFP as we had initially thought? So that was one of the things that they looked at.

MS JONES: Just to clarify because I am somewhat confused. My understanding, from the information I looked at, was back last fall the department actually set up a committee to review road ambulance and air ambulance and dispatch services in the Province. Is that committee still in place? Are they not in place? Was there ever a report done?

MR. WAKEHAM: Tony Wakeham.

I think the committee you are referring to is the one that was set up by the Department of Transportation and Works, and we were part of that committee. The idea was, again as the minister alluded to, they wanted to review all of their services, air services, their water bombers and the whole dispatch piece.

So that was a committee that we participated in. That is the only one that I can recall because we did not set up one ourselves as a single department. There is one set up at the Department of Transportation and we were a member of that committee.

MR. KENNEDY: There was one meeting, I think.

MR. WAKEHAM: Yes.

MR. KENNEDY: What is the date of that briefing note that you are referring to?

MS JONES: I do not have it in front of me. I think it was September –

MR. KENNEDY: September 15 sticks in my mind as there being the date of a meeting. Now I have not -

MS JONES: I think it was September 2009, but I do not remember the exact date and I did not bring it with me, so I am just going from recollection, but –

MR. KENNEDY: I know the meeting you are talking about and I remember the issue especially had arisen and then, unfortunately, there was a second – I am trying to remember the date of the second incident. I think in Happy Valley-Goose Bay there had been a second incident and I am trying to remember if it is August 18 or September 18. Just bear with me one second, I will go find that.

MS JONES: I understand there was a preliminary report completed by the committee. I am just wondering if your department had a copy of that for review because you are telling me now it went to Transportation and Works. So I am just wondering if there was a copy provided to you because I understand there was a preliminary report.

MR. KENNEDY: I am not aware of any report on anything. This committee met once, and then on September 18 the incident occurred in Happy Valley-Goose Bay, in terms of the Best family. Is there anyone aware of a report prepared by anyone on that?

MS JONES: So you are telling me now that the review of road ambulance occurred this year?

MR. KENNEDY: One of the recommendations in Mr. Drodge's report that there has to be an integrated system of ambulance services and the road ambulance was Recommendation # 7. We will certainly be looking at that in terms of whether or not the road ambulance review and how to go about the road ambulance review. There is a recent contract signed with the road ambulance operators. I think one of the things that the review will look at - and I am not sure, Tony, you may be able to help here - I think in Nova Scotia, for example, they have a government road ambulance service.

MR. WAKEHAM: Yes, they do have a single entity that looks after the entire air ambulance, road ambulance system. It is a very expensive system. One of the things that we have to do is review exactly what it is, if that is a model that would be appropriate for this Province.

MS JONES: One of the issues that we commonly hear from ambulance operators in the Province is how there are three different systems of operation. There is no real streamlined delivery of services, I suppose, not that one service is better or worse than the other in any way. There are obviously issues around how people are paid, the amount they get paid, and the amount they get to run their ambulances. Those are the concerns that we commonly hear from people who deliver this essential service in the Province. Would those details be part of the review that you would be doing?

MR. KENNEDY: At this point I cannot tell you what the nature of the review will be or even if it will take place. The road ambulance operators – there has been a contract entered into in October or November, and we will just see where this is going. There are monies there in the budget if we decide to proceed with this review.

MS JONES: You said you have been budgeting this for two years now or three, this review that has not been done?

MR. KEATS: Yes, it has been budgeted two years. We wanted to take a look at the road ambulance and it was for the road ambulance. For the year before last, it did not get done. I really cannot tell you why we did not do it for other reasons.

This year we did not do it - the previous year - because of the negotiations and we wanted to get those finalized. One of the things that we will look at with this, if we proceed with the study, is exactly what you have talked about. Do we need one integrated system and do we need one integrated funding mechanism?

MS JONES: Okay. I am going to pass it to Lorraine now. My fifteen minutes are up I think.

CHAIR: Okay, yes.

Ms Michael.

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

I will not, Mr. Minister, repeat questions that have already been asked, but I may go back to ask a further question on something. Before doing that though just a couple of things I would like to sort of get out of the way.

I would like to make the request that if one or the other of us requests some information, the understanding would be that the information would come to both parties. Sometimes we request some extra information and you are going to send it to us afterwards.

So whether or not I ask for it or Ms Jones asks for it, if the information could come to both, just so we will understand that, so I do not have to repeat that I would like that information also or vice versa.

MR. KENNEDY: That is agreeable, Ms Michael.

MS MICHAEL: Okay, thank you.

When we met with Child, Youth and Family Services, I asked a question about how they came up with the budget and the revised budget for 2009-2010 because where it is a new department I knew that they did not have a defined budget last year. So, they said that the figures came from the Department of Health and Community Services. What I am wondering is – and I know, or I think I am correct because I asked that in the Estimates with CYFS. Some of those line items, you would not be able to go into last year's budget for Health and Community Services and find that information.

What I am wondering is: Do you have a document that was put together because the information came from your department to the new CYFS in order for them to do those line items? Is there a document showing all of that information that was passed from one department to the other for them to do their budget?

MS TUBRETT: Denise Tubrett.

There was a document done to prepare the transfer to CYFS. It was done in conjunction with the CYFS officials. The majority of the money would rest in subhead 3.1.01., the Regional Health Authorities and Related Services. It would have been buried in that pot of money there.

Based on consultation with the boards, we identified what programs would have been CYFS related and we determined what was going to get transferred. There would have also been some money for salaries in operating that would rest in the Department of Health that would be under Public Health and Wellness, which is 1.2.05. We would have identified the positions and the operating dollars and transferred that as well. The total transferred was $135.6 million gross.

MS MICHAEL: Would we be able to have copies of those documents?

MR. KENNEDY: I would have to check with the Minister of Child, Youth and Family Services, but if she has no problem, certainly.

MS MICHAEL: Okay. Thank you.

It is sort of for the record so that we have where that budget came from because the new budget was determined by that information as well. We have no documentation in front of us like we do for all the other -

MR. KENNEDY: I will check with the Minister of Child, Youth and Family Services.

MS MICHAEL: Okay. Thank you very much.

I will start going into some of the specific items. Under 1.2.02. - I have already gotten answers to questions I had - under the Revenues, so that would be 01., 02., the Revenue lines of Corporate Services of 1.2.02. I am curious about the - in both cases, the federal government, for example, last year it did not seem to come through with the money that was expected. There is a $535,200 variance between the budget and the revision. The same thing happened with the provincial government in terms of a major variance. Was it that there was something cost-shared that did not happen? Both in the federal and the provincial donations there was a big variance between the budget and the revised.

MR. KENNEDY: Yes, what happened was when the projected revised was estimated, the department anticipated that three federal agreements would be signed in 2009-2010 under this contingency fund. Again, it is that million dollar contingency fund.

Two agreements did not get signed in the fiscal 2009-2010. The ACCESS agreement -and that is the one, it was an acronym earlier, I went through it all - was signed for $187,500 and the revenue is anticipated. So, the projected revised should only be $187,500 because of the subtracted $277,300.

MS MICHAEL: I figured it had to have been something like that when I saw that both of them must have been agreements not signed. Thank you very much, Minister.

Then I would like to ask a question further to what Ms Jones asked under 1.2.04., Regional Health Operations, subhead 05.,Professoinal Services. You did mention, Mr. Minister, that part of the money that was not spent had to do with the gambling awareness and that you did not agree with what was being planned. Can you give us a bit more specifics about what is now going to be planning because I am assuming with the budget back up to $959,800 we are going to see something around gambling addiction going on?

MR. KENNEDY: We certainly are. We have an approach this year in terms of the addictions, and the problem gambling, to me, comes under the addictions issue. We are aggressively trying to address some of these mental health and addictions issues. As I have indicated, I think in the House yesterday, earlier this year we put approximately $370,000-odd out into various groups who can deal with some of these mental health and addictions issues and offer that peer support, for example, that is necessary and, I think, proven to be successful in terms of combating mental health and addictions issues.

I am not breaking it down. The new adult addictions treatment centre that we announced under the Budget, I see at some point - we are not gambling, we hired a consultant before we looked at the opening of that facility, or excuse me, before the planning of that facility, to address the issues of how we would go about it. I see gambling at some point. I cannot distinguish, myself, in the addiction, if you are dealing with alcohol, drugs, and/or gambling. So, at some point, I am certainly going to look at an in-treatment program for gambling, if it exists. What we did, for example, the consultants looked at, they visited Homewood in Guelph, Ontario, Bellwood in Scarborough, Humberwood. So I am certainly open to in-treatment or residential treatment for gambling.

I just happened, actually I received a note the other day from I think it was a Mr. Fifield, a letter on the VLTs. Although that is under Finance, obviously the health issues come under our department, and I put a handwritten note on it: Mr. Fifield, if you wish to meet with me to offer suggestions on how we can address the gambling issues, I am certainly available to meet.

So I am certainly open to – I know that, for example, in any of these addiction problems that the twelve-step groups are very important. I do know that Gamblers Anonymous exists in St. John's. Now, how successful it is, I am not sure. I would like to find out more information on that.

As we restructure the mental health and addictions, one of the consultants is very knowledgeable about gambling and is doing a lot of work on gambling. So I am hoping that as we sit down and look at this that she will particularly deal with the gambling issue. When I say that I am not supportive necessarily of TV ads, I do not mean I am not supportive of them, I am looking at how do we spend our money best.

Again, I think we cannot look at any addiction issue as simply being that of adults. We have to start in, whether you start in - for example, I know my kids in elementary school at Bishop Field, we have the DARE program, the drugs awareness program taught by the police and it has a significant impact. I am told that junior high is an area where kids are particularly vulnerable.

So, we are looking at all of these issues, and I am certainly open to suggestions. The money will be spent, there will be consultants – we will be hiring people within the department who will be given authority to – authority is not the word – will be given the –

MS MICHAEL: Responsibility.

MR. KENNEDY: Responsibility is a better word – to deal with certain issues, and there will be someone specifically assigned to gambling to come up with – we have done a lot of work on gambling, but there certainly needs to be – I have heard you on that issue and there certainly needs to be more work done on it, because from what I understand, it certainly qualifies or it meets the criteria of addiction. Like any other addiction or mental health issue, families are affected, children are affected and society is affected as a whole.

MS MICHAEL: That is right.

MR. KENNEDY: So we certainly will be doing a lot of work on that.

MS MICHAEL: Good. I am glad to hear you - I agree with you with regard to the youth with regard to VLTs, for example, and I have said this in the House as well. When it comes to gambling addiction, one of the worst is the VLTs because of the very nature of VLTs. If a person has an addictive personality, the VLTs really feed into it more than other forms of gambling. There are studies to show that, but in the recent studies that were done with regard to incidents of addiction around VLT usage, we are seeing the numbers go up for young people.

MR. KENNEDY: Yes.

MS MICHAEL: It is sort of stable for adults, but going up for young people. I am really glad to hear you saying what you are saying because I think we do need to look at the addictive nature of VLTs in particular.

MR. KENNEDY: I can go back to when I was practising as a criminal lawyer. With those VLTs, I saw some of the incidents that occurred. I have stated publicly in the past that, in my mind, at least 80 per cent of what is going through our court system is probably alcohol, drug, gambling - addiction related. I have difficulty distinguishing between the alcohol, the drugs, the gambling. So we are going to be doing a lot of work.

The other thing is, in this year's Budget I think we budgeted an extra couple of hundred thousand dollars, at least to get more money out into the community groups dealing with the mental health and addictions issues. Under the addictions issues, we will certainly be addressing gambling.

MS MICHAEL: Thank you very much.

Moving on then, under 1.2.05., subsection 06., Purchased Services. There was a variance between the budget and the revision of $85,000. I am just wondering what was it that caused the variance last year?

MR. KENNEDY: Yes, okay. This was related primarily – we are talking approximately $85,000, is that difference? Yes, the advertising costs for the H1N1 and printing costs for H1N1 cost close to $200,000. So that would have been significant. There were some printing costs in relation to wellness. Some minor costs in terms of the maintaining the Go Healthy Web site, but essentially the H1N1 was the significant factor there.

MS MICHAEL: Was under there. Okay. Thank you very much.

Down to 1.2.06. - this is the Revenue line - Revenue – Provincial. I am curious about the fact that last year there was a big piece of Revenue from the provincial government and there is nothing this year. What was that Revenue about? I guess that will explain why there is nothing this year.

MR. KENNEDY: Michelle, I think you explained that to us last night. Do you want to explain that?

MS JEWER: What happened there was the department was the social sector lead province and that was transferred to Manitoba in October. I think we were the social sector lead starting in September 2009 – yes, health sector lead in September 2009. So, that revenue would have been realized in 2009-2010 and not 2010-2011.

MS MICHAEL: Okay. That makes sense. Thank you very much.

Under 1.2.07., Policy and Planning, beginning with subhead 03., I am just going to be asking for variances here that may or may not be related to the creation of the new ministry, but I cannot assume it, so I guess I am just going to ask you to explain each one. The first one being 03., Transportation and Communications, you have a slight variance there of $69,700 between what was planned and what was spent last year.

MR. KENNEDY: There is no real reason for that other than the less than anticipated monies were spent. Obviously, when you are budgeting, you are trying to look into the future, you are outlining what you expect to spend, and there are times when we spend less. You will see there are decreases. This is simply one where there was less money spent.

MS MICHAEL: Okay, no big reason.

MR. KENNEDY: No, there is nothing I can pinpoint for you there.

MS MICHAEL: Under 04., though, we have a major jump from $67,600 - last year's budget - to $402,600 this year, so a jump of $335,000.

MR. KENNEDY: Yes, that is going to be the new funding we announced in the Budget for the hardware and the software related to the implementation of the interRAI assessment instruments for the clients of the long-term care and the community support system. So this is that new tool that was announced - and Bruce can certainly deal with that, but that is what we are dealing with there.

MS MICHAEL: Thank you.

Under 05., Professional Services, again there was a variance downward between the budget and the revision of $206,300, and this year, a variance upward between the two - this year's estimate and last year's budget - of $138,000.

MR. KENNEDY: Yes, essentially, what this relates to is we moved $200,000. We reallocated it for the Grants and Subsidies relating to the Healthy Aging Policy Framework. Is this the age-friendly money?

OFFICIAL: (Inaudible).

MR. KENNEDY: I think we announced earlier this year there will be $200,000 for the age-friendly communities, and then $200,000 in age-friendly grants to various groups. So we reallocated some money out of there. I think it was $200,000.

In terms of the budget – excuse me, are you asking about the budget decrease or the Estimates -

MS MICHAEL: Well, I presume that budget decrease is probably reflecting that reallocation of money as well then.

MR. KENNEDY: Yes, it is.

MS MICHAEL: Yes, the answer to the first one answers the second one. Thank you very much.

Under Purchased Services again, the variance between the budget and the revision is $424,200 that you did not spend.

MR. KENNEDY: Yes, and this is one that – a big portion of this money, it was $325,000 budgeted for respite for caregivers. Now, I do not know if there is someone –Bruce, is that something that you could deal with?

MR. COOPER: Yes, the respite for caregivers is a project that will seek to identify options, the best practices for supporting those who are caring for family members in the community. It is linked in with the goal of enhancing the long-term care and community support services and programs. Essentially, there was some money budgeted last year that did not get spent.

MS MICHAEL: You anticipate that this year that money will be spent?

MR. COOPER: That is correct, yes.

MS MICHAEL: What will make that happen?

MR. COOPER: There is a process in place to work with the RHAs to identify best practices and to seek – we want to figure out what the best use of this money is, whether it is going to be for community-based initiatives; we have to do some research. So, we have a team in place that is looking at that.

MS MICHAEL: Okay. How is that information gotten out to the public that that money does exist for respite care? I know from experience that it is not always just readily known by family caregivers who are involved in care of a loved one, having been one of those people. I know that the information is not readily available; you sort of have to go seeking for it.

MR. KENNEDY: A good comment, but part of that has to do obviously with the development of this long-term care strategy, community services strategy. That is part of how we develop that integrated system that is required, as we have talked about. You have asked me in the House, and I have explained.

Yes, the strategy is not done but what we are looking at – and this is the way I am approaching this. We have invested significant monies in the long-term care sector and in the home care sector, but we have to look at - and I will give you an example. One of our long-term care facilities - I think the Corner Brook facilities, I do not know what the final cost is. Don, it is what, eighty –

MR. KEATS: Sixty-eight million dollars.

MR. KENNEDY: Sixty-eight million dollars for a couple of hundred people. We have to look at process of utilizing home care, personal care homes, independent living. How do we bring all of this together, and I am assuming that respite for caregivers has been identified as an issue that has to be looked at.

What we are hoping to do, I am hoping to talk to my colleagues in the very near future about consultations that we can hear from people because you have raised this, Ms Jones has raised the issue of family members looking after people.

We have to look at all of these issues. So what we have done is we have put a team together but we are still not where we want to be in terms of this strategy. Bruce, am I correct in saying that this is one of the issues that will be looked at as we move further with the development of the framework and strategy?

OFFICIAL: (Inaudible).

MS MICHAEL: I understand, you came in - I have been hearing this for almost two years actually that a plan is happening and you are, obviously, bringing your stamp to this plan; I appreciate that, Minister. Do you have any sense of when you are going to have a comprehensive plan for home care and long-term care in place?

MR. KENNEDY: Let me outline for you some of the steps I have taken since I have come in.

MS MICHAEL: That would be helpful. Thanks.

MR. KENNEDY: Essentially, what we have done – there was a lot of work done. I can honestly say that there was a lot of work done. What we have done is we have now put together a dedicated team. Bruce as the ADM for Policy & Planning is in charge of that team.

We reconfigured and oriented a project team. There was an initiation and revalidation of the critical planning data such as the impact of the aging population on future demands. There is cross-jurisdictional information regarding models of care because the way I see this is that this plan – and again I do not like to use words like vision because there is a grandiose connotation to it.

I see this; we have a plan for ten years down the road. What we have been doing, we have been working towards fulfilling certain aspects of the long-term care strategy with specifically the building of long-term care facilities. We have invested significant monies there but I see this as really an integrated approach where we have to have our seniors. A lot of the wellness grants that went out were to senior organizations. If our seniors remain healthy, if they are exercising, if they are eating properly so that we have to start looking at where are we going to be ten years from now. The scary part of it all, all of us in this room are going to be heading into that demographic that we are talking about.

What I felt was, as opposed to being able to say, and quite frankly, we have it done, I am more interested in doing it right. The consultation process will be crucial. I have heard you talk about the home care workers and we will giving an opportunity to people to have their say, the personal care homes, and how do we come up with a holistic or an integrated approach.

We have that team together. We are close to now having the goals because a lot of the work was done. We are looking now - and I am hoping that my colleagues, as I talk to my colleagues about the preparation of a public consultation plan and discussion document. Then, we will focus in that document or consultations on where we are going to go. Where are we going to be ten, twenty years from now? One of the real issues that we are facing is the problems with the aging demographic in rural Newfoundland and Labrador because the unfortunate reality of a lot of our communities is that there are seniors living there.

So, I do not know how – I know, for example, in my district, in Carbonear-Harbour Grace, because we have the facilities that a lot of people from Minister Johnson's neighbouring district are moving into the Carbonear area. So, what we are seeing is that seniors want to be near the health care facilities, they want to be near recreation facilities. We are seeing a lot of the seniors' groups with their seniors' clubs that they have really taken it upon themselves to socialize. What we are trying to do is address the Level I and Level II care, people who are in that category, and say how do we keep them at home as long as possible or in a situation where they can live comfortably.

I visited, for example, a personal care home out in either North River or Clarke's Beach, and the socialization aspect of it is very important, the fact that they have people to talk to so there is not that sense of loneliness, fear and frustration. It really has to be a more integrated and global approach, but as for when we will actually have the document and the full picture, I cannot tell you. We are working diligently towards it. We are developing a framework, we are developing a consultation plan and we are trying to look at the model for where we will be in the future.

I do feel comfortable right now that we are getting to the point where our long-term care facilities, we are addressing those needs across the Province, but the reality is a long-term care facility, even the new ones in St. John's, the Hoyles-Escasoni, even with 400 people that is still only 400 people of a demographic that is so huge.

These are the issues and I think that the public will have - the seniors' resource centres, seniors' groups, personal care homes, I think the people will have a lot of good ideas about how we should proceed.

MS MICHAEL: Okay, thank you, Minister.

I am sorry it has taken this long to get to that realization, but I am glad you have it, as the minister, that consultation with all of the groups. It is not just something that can be done in-house and that consultation is going to be essential to the process. I appreciate that. I am glad to hear that you have urgency about it and a plan in place, which is good to hear.

CHAIR: Excuse me, Ms Michael, we are about twenty-five minutes in now, do we want to go to somebody else on the Committee?

MS MICHAEL: Sure, that will be fine.

CHAIR: Anybody else?

Ms Jones.

MS JONES: Just before I start, were you finished with your questions under Policy and Planning, Lorraine?

MS MICHAEL: Yes, I am.

MS JONES: Okay. Well, I am going to start at 1.2.08., under the audit and claims section. First of all, again under Professional Services, this year you have reduced your budget by $161,000. Is there any particular reason for that?

MR. KENNEDY: Yes. Due to the completion of the claims monitoring system, funding in 2009-2010 was one time for the development of a new system for the monitoring of the prescription drug claims. This system then randomly selects claims for audit and provides information on the error rate which assists with identifying additional audits and provides feedback to the provider so that the corrective action can be taken. So that is where we had the decrease this year. Was that your question?

MS JONES: Yes. Also under that section, under provincial revenue, you took in, obviously, $510,000 less than you had budgeted for. Where were you expecting to get that money from and why did it not materialize?

MS TUBRETT: Denise Tubrett.

In fact that was an error from the previous year. In 2008-2009 we had expected to get a significant audit recovery.

MS JONES: I cannot hear you.

MS TUBRETT: Sorry.

In fact, that is an error in 2009-2010; it should not have been there. In 2008-2009 we expected to get a significant recovery from a result of an audit that was completed and the money just did not get dispersed in 2009-2010. So it is showing up in 2009-2010 and that is why it is not there for 2010-2011 and not there in revised.

MS JONES: So, it was not an error or it was an error?

MS TUBRETT: It was an error for 2009-2010. It was correct in 2008-2009; it just got carried into 2009-2010. So it was an error, yes.

MS JONES: Okay.

Just out of curiosity, what was the money owing for?

MS TUBRETT: I do not know the answer to that question, sorry.

MS JONES: Okay.

Before I move on to section 2.1.01, I just wanted to ask a couple of questions about the long-term care piece that my colleague for Signal Hill-Quidi Vidi was questioning. In terms of the new long-term care facilities that government are building, is there an increase in capacity over what we currently have in the Province, and if so, can you give me what that increase in capacity is?

MR. KENNEDY: I do not have the actual numbers in front me - Bruce may - but I do not think there is going to be an increase. I know for example the new facility in Carbonear will essentially have the same number of beds that we have in the two facilities in Carbonear - the Interfaith Home and the Harbour Lodge - and in the Clarke's Beach facility. Essentially, that home will have the same number.

The new long-term care facility in Happy Valley-Goose Bay, I do know, will have the same number of beds that the Paddon Home had, for example. There is no increase in beds. I think what will happen is – this is my understanding and Bruce can certainly speak to this, but one of the difficulties we have had with the assessment of who should be going into the long-term care facilities is the difficult line between Level II and Level III care, that the interRAI tools should help us with. Is that correct, Bruce? In terms of the numbers, do you have any of those numbers there in terms of...?

MR. COOPER: In terms of bed capacity, actually, Tony has those with board services.

MR. WAKEHAM: Yes, the facility in Corner Brook will have an increase of approximately eleven beds but they also built four dementia care bungalows which can accommodate, I believe, somewhere between forty and forty-eight people in those as well.

In this year's budget we also have the dementia bungalow for Bonavista which will increase again by another twelve accommodations down there. The Hoyles-Escasoni is actually going to increase to approximately 460 from a current capacity of 377, so that is approximately an eighty-three bed increase there.

As the minister stated, Carbonear will be projected to be the same, it is just combining the three nursing homes out there.

MS JONES: In terms of the old facilities, like in the case of Goose Bay, and I ask this because I actually had a call yesterday from the local media up there asking what will happen to the old facility, what is the intention of government. I do not know if you guys have made decisions around these facilities, if they will have further utilization, if they will be refurbished in areas where there is a need for more long-term care services or if they will be privatized, sold off, I do not know. I am just wondering what the plan is for Clarenville, Goose Bay and Corner Brook which would be the three that are near completion or completed.

MR. KENNEDY: The Happy Valley-Goose Bay facility I actually visited on Friday. We had a look at the facility. We also had a commercial appraisal done of the facility. Before any decision could be made, we have to look at the integrity of the structure. It appears to be a very good building, in very good shape. It has two separate wings. It is a building that certainly allows for further utilization.

One of the issues in Happy Valley-Goose Bay, of course, is there is such a need for the government buildings that the cost of building anywhere, as you are aware, in Labrador is very significant. What we have to look at here is how we can best utilize that building. We had some discussions with some representatives from the Nunatsiavut Government the other day. There were a lot of issues talked about, there are no decisions made.

We will not simply be giving the building away. There had been a proposal earlier for someone simply to take over the building to use as a personal care home. That is not going to happen. This building is appraised at a couple of million dollars.

I discussed the other day – there were a number of issues we threw out. For example, in Labrador, one of the issues – all over this Province and this country we have addictions and mental health issues. If we have a building there, we can look at the possibility in the future - and I am just throwing out possibilities here - of using one wing for either mental health and addictions issues.

Happy Valley-Goose Bay has a very significant residential training program for doctors. Apparently, a lot of doctors go up there, so they need places to stay. There is a possibility of utilizing it there. There is a possibility of utilizing one wing, if someone wants to make a proposal to us that is a good proposal in terms of the possibility of using it as a personal care home. Government, we are not going to be getting into the personal care home business.

There is the need for all kinds of – where you have the hospital and the new long-term care facility nearby. We are really open to suggestion on the utilization of that building, but that is a good building. It is one that can be used and it is very functional. The way it is set up with the two separate wings can actually allow for a couple of different possibilities. That is one - we only got the commercial appraisal last Wednesday and I visited the facility on Friday.

MS JONES: Also in Goose Bay, the senior cottages that are there, they will continue to operate and be occupied by the residents that are there, will they?

MR. KENNEDY: Yes, that is my understanding. Those are the residents that are right behind the Paddon Home?

MS JONES: Yes.

MR. KENNEDY: Yes, I think they are run by – we asked the other day who was running those. I forget the numbers of people living there, but there is certainly no plan to change anything there.

MS JONES: What about in Clarenville and Corner Brook, the facilities there, are there any plans for those?

MR. KENNEDY: Tony, do you know anything about the – or Don?

MR. WAKEHAM: In Corner Brook we are working with Transportation and Works at what options we might have for the two nursing homes that will be vacated. We are looking at whether or not we incorporate them into the plans for the redevelopment of the acute care facility or Transportation and Works are looking at whether or not they can use it as an office building. They have a number of rental properties over there. They are looking at it as well. That is kind of where we are right now.

Clarenville, I am not sure. I do not think there was a Clarenville facility before.

MS JONES: Okay, maybe not.

MR. WAKEHAM: No, I do not think so.

MR. KEATS: (Inaudible) Clarenville was an add-on to the hospital out there.

MR. KENNEDY: For example, the facilities out in Carbonear, I will be quite frank, I am not sure what they can be used for, whether or not the cost of redeveloping them – the Interfaith Home was a hospital that was built in 1958 or 1959. The Harbour Lodge, the current one, the long-term care facility, was actually built as a hotel back in the early 1970s or something. I am not sure what use those facilities will have, but we will look at them.

What we are finding, as you are all aware, is the cost of new buildings is so significant that oftentimes we are better off looking at can we find an existing building and renovate it and thereby keep our costs down. What we have to look at - and this is, I think, what comes out of Transportation and Works - we have to look at a life span, and we are seeing this actually with our schools and with our facilities. We have to look at a building that we are going to get another forty years out of, thirty to forty years, using our infrastructure money, so the question becomes if we renovate can we get further use out of that building or are we better off to build.

That is the approach that we are taking with a lot of the health care facilities. The reality is the example of the Health Sciences, with no wheelchair accessible bathrooms, something that is a given today, but when built back in the early 1970s – so these are the kinds of issues that we are exploring in the health care and any of the buildings that exist that we can use, we certainly will.

MS JONES: Under section 2.1.01., Memorial University Faculty of Medicine, there was almost $3 million last year budgeted that never got spent in Grants and Subsidies for the university. Can you tell me what that was for and why it was not spent?

MR. KENNEDY: So that is the $2.294 million that did not get spent?

MS JONES: Yes.

MR. KENNEDY: Okay.

This is apparently due to projected one-time savings in the operating costs associated with the Faculty of Medicine's expansion. Now, my understanding is that due to recent developments, the Faculty of Medicine will require most of the operating costs for the expansion and is now only projecting approximately $500,000 in savings.

Is that correct, Denise, in terms of where it is going this year? So the money will be spent on the medical school expansion.

MS JONES: Okay.

So this year you are looking at an increase of $6.109 million. Can you tell me what that money is for? We know that some of it will be for the expansion that did not happen last year.

MR. KENNEDY: So are you adding the $2.29 million for revised with the $3.8 million? Is that where you are getting that?

MS JONES: Yes.

MR. KENNEDY: The $3.815 million increase in the Estimates for this year is that we are looking at the operating cost of the medical school will approximately be $1.7 million – excuse me, the increase will be approximately $1.7 million. Then there are various other factors, such as energy costs and staff step increases. The staff salary increase is approximately $931,000. When you add it all up, it comes up to $3.8 million.

MS JONES: In terms of the Faculty of Medicine now, are we graduating more doctors? Have we increased our enrolment in the program at all? What is our recruitment rate of doctors coming out of our own medical school now?

MR. KENNEDY: What we are seeing here is that – and later on there is reference to the use of the bursary system, but essentially, what we have here in our Province right now is that between 2004 and 2008, 72.5 per cent of all Newfoundland and Labrador medical students who graduated from Memorial set up practice in the Province. So that was between 2004 and 2008.

In 2009-2010 – I will give you some numbers – we had nineteen family residents finish their medical training with two residents delaying their entry having regard to maternity leave. Of the seventeen family practice residents, fourteen are practising in the Province – all with bursaries and return-in-service commitments. So that is a good rate there in 2009-2010.

Then we had twenty-seven specialists in 2009-2010 finish their medical training, again with two residents delaying their entry due to maternity or sick leave. Of the twenty-five speciality residents, seventeen are practising in the Province, nine who have bursaries and return-in-service agreements.

So, the bursaries that we are talking about, for the residents especially, there is a $25,000 per year bursary, depending on the length of your residency, which can be two, three, four years. We had in 2009, forty-one family medicine residents who were availing of the bursary process, seven psychiatry residents, and twenty-eight residents in other training programs. Each bursary has a one-year return-in-service agreement. So if you avail of the bursary for two years, there is a two-year return-in-service agreement.

That bursary program is really working well, and we are seeing a lot of our graduates who are availing of that bursary. So a lot of our residents, a lot of our medical students are staying here, and the bursary program, I feel, is a significant aspect of that.

MS JONES: Can you provide us with the stats on the bursary program, the number of enrolments in the last few years and so on so we have a copy of that, please?

MR. KENNEDY: Yes, in terms of the stats, we have basically spent, between 2004 and 2009, $6.968 million. There are significant numbers awarded each year. In terms of family medicine, the total bursaries are 203, but that is 111 separate residents. In specialist bursaries, we have sixty-four specialist bursaries awarded to fifty-one separate residents. In psychiatry, which is an issue raised by Ms Michael the other day, we have thirteen psychiatry bursaries awarded to fifteen separate residents.

So we have a total number of bursaries, which are 299, and then the number of applicants who have been award is 177 in terms of unique applicants. So we have spent close to $7 million on bursaries in the last five years.

MS JONES: Okay, I am going to move on to the Provincial Drug Program now.

First of all, I guess I am looking at the Allowances and Assistance. I am assuming the Professional Services would all be for the xwave contract, is it, to start with?

MR. KENNEDY: Yes.

MS JONES: Okay.

The Allowances and Assistance, we are seeing what was voted last year - what was budgeted, I should say - and what was actually spent, and we see a difference of over $5 million - $5,822,100.

I guess we are wondering why that amount was down so much. Are there fewer people using the program? Is it harder to access? Are the payouts changing? I would have thought it might have been up as opposed to down.

MR. KENNEDY: There was a reduced uptake. When we bring in these programs – and Dr. Alteen may be able to speak to this – but when we bring in these programs, we base it upon an uptake that is higher than what we are seeing in the actual uptake. I forget the numbers; I had them here earlier and I can certainly find them. So, there is reduced uptake.

Now, one of the difficulties we had in the last number of years – and we have corrected it in this year's Budget – was that the increase in the minimum wage was bringing people outside the threshold. So, that is why we had to put monies into this year, to increase that threshold again to allow people to access the program to get back to where it should be.

So, there was a reduced uptake and then there was a lower cost of drugs by utilizing a couple of generic drugs in the Foundation Plan, the 65Plus Plan, and the extended card plan. If you put all that together, it comes out to –

OFFICIAL: (Inaudible).

MR. KENNEDY: Sorry?

OFFICIAL: (Inaudible).

MR. KENNEDY: Yes, the $5.8 million.

We have a growth provision where there was $4 million. The new drugs approved, $3 million; Access Plan, $2.5 million; new thresholds - $4 million in permanent savings, giving us the $5.8 million.

MS JONES: Okay. This year, of course, over what you spent last year to what you are budgeting is a difference of $11,667,300. That is a substantial increase this year and, I guess, we were of the understanding from the drug companies that with the changes in the drugs, most of them being generic drugs – changing from brand name to generics – we are being told that in revenues to the Province there should be some savings as opposed to increases. So I would like to get some clarification on that.

MR. KENNEDY: This year we do have an anticipated 3 per cent growth in the various plans – an enhancement to the Access Plan to increase the income thresholds. I think it was $2.5 million we put in this year to increase the income thresholds, and we have increased – the funding for the new drugs, for example, is $3.184 million. So when you put all that together with the 3 per cent, it comes up to the $5.84 million.

MS JONES: Have you guys done any calculations on what the savings then will be as a result of a number of the brand name drugs being listed as generic which will change the price?

MR. KENNEDY: That issue is actually a larger issue. It was discussed at the Atlantic Canada Health Ministers' meeting this year. The question becomes - we have a lot of our independent pharmacists who operate in rural Newfoundland and Labrador who have approached us on numerous occasions. If we start to get into the issues like they are doing in Ontario, it will have significant effect, they are telling us, on their ability to do business.

We have made no decisions yet in terms of whether or not the cost to the Province, by doing the same kind of thing that Ontario has done, will justify the effect it could have on our pharmacies. You have seen the effect in Ontario with some of the bigger chains. We have made no decision on that yet.

In terms of potential cost by moving to the generic drugs, that is an issue I think that is heavily under discussion - Don, is it - across this country. Is there anything you would like to add to that?

MR. KEATS: Right now there are a number of expensive brand drugs that are about to come off the brand and there will be generics.

MS JONES: That is right; that is what I am talking about.

MR. KEATS: In order to get your generic drug listed on your formulary, your generic drug had to be a certain percentage of your brand price. In Newfoundland and Labrador, for example, if the generic drug was not 75 per cent or less of the brand, it would not be listed on formulary because it is a cheaper drug. Some of the provinces are now looking at whether or not they might drop that down to as much as 25 per cent, which is a substantial decrease for the drug companies.

In Ontario, where you have lots of drugstores in some of the bigger centres, that might be something they can achieve, but at the same time the government has to make arrangements to provide additional funding resources to the pharmacies to make sure that they are sustainable and survive.

We have a larger percentage of independent pharmacies than most provinces and we have a large percentage of pharmacies that are in areas where there is only one pharmacy. One of the things we have to make sure we are very careful to do is that we do not put in policies and procedures that will force a large number of these independent pharmacies to go out of business and then we have lots of rural areas in the Province where we do not have access to pharmaceutical services and drugstores.

MS JONES: Okay, maybe I am somewhat confused because I am looking at two different issues here. I am looking at one issue where the drug companies are now claiming and saying that a lot of the popular brand name drugs, their patent will expire on them come 2010. Over the next five years, they are projecting that a lot of these patent drugs will expire, so they will become generic drugs. Notwithstanding what is happening in Ontario, that is a different issue.

As a result of that, there should be savings. In fact, we even asked for projected savings for different provinces, and Newfoundland and Labrador was one of the ones that we got projected savings from these drug companies based on what will go from a patent drug to a generic drug.

So I am asking: Has the department costed any of this and do you have any idea what savings, if any, there will be and is it factored into the budget?

DR. ALTEEN: Larry Alteen.

I do not have information on that other than a part of the planning at NLPDP is that you do recognize that there are generics coming on stream at a lower cost. At the same time, the demands for increased drug access go up and new drugs get added, so it is overall net effect of that that generally tends to drive these things up every year. Every year there is an anticipated number of drugs that go to generic and the cost go down based on that, but I cannot give you specific figures on that right now.

MS JONES: Okay, but can you get it for me?

DR. ALTEEN: Yes.

MS JONES: On the other issue that you raised with what is happening in Ontario and the fact, I guess, that they are lowering the cost of generic drugs by actually cutting the professional allowances, I think, that they pay out to pharmacists is what the issue is. I have not followed it a lot, but I certainly read some about it in the national media.

Is this something that has even been reviewed in this Province? I am not saying that I think we should look at it, or we should not look at it, or we should do it or not do it. I guess I am just wondering is it anything that your department has looked into in any detail at all and looked at what would be the implications on our system to do something like this as opposed to what the benefits would be to consumers.

MR. KENNEDY: We certainly looked at this as I have indicated - this issue arose in the Atlantic Canada ministers' meeting. There was discussions about generic drugs and the effect of bringing generic drugs into the system as proposed and we have heard from both the - there are two different pharmacists' associations we have heard from. There is the PANL, which is the Pharmacists' Association of Newfoundland and Labrador; that is a combination of both the bigger chains and the independent pharmacists. Then, we have the Independent Pharmacists' Association.

All I can tell you is that we are told that if we were to follow the system that exists in Ontario it would have a significant impact on these independent pharmacists' ability to do business, and as pointed out by Don, where they are oftentimes sole pharmacies in rural Newfoundland and Labrador we have to look at the impact and determine whether or not the cost savings justify the approach. We are looking at that. We have not made any decision. We have had submissions put forward to us by both groups.

MS JONES: I guess my only other question around that is - because we do have best price legislation now in the Province, it was brought in a few years ago. What is happening in Ontario with regard to these professional allowances, how does that impact us in terms of our legislation right now?

MR. KEATS: Don Keats.

One of the very difficult things to find out: What is the best price? We have spent a lot of time, through our Pharmaceutical Services, trying to find out what is the best price for a drug -

MS JONES: I am a shopper too; I understand.

MR. KEATS: - in the country and what sells for a best price. Frankly, we have not been able to find out what the best price is. We do have our guidelines like 75 per cent and so on and what will go on our formularies.

As the minister said, we are looking at a number of options. In Ontario, if they drop their threshold for getting listed on the formulary, they will provide, through government, the funding. They have talked about $100 million, $150 million extra to go back to subsidized pharmacies for various things. They have talked about an increase in their dispensing fees and those sorts of things. We have looked at a number of those options.

One of the things we want to make sure of is that any additional money we spend in Pharmaceutical Services will lead to value-added for the client and for the pharmacy services provided to the client. It is not quite simple to do that when you have a drugstore with one pharmacist, for example, to say that he will work with clients and provide education on medications, for example.

The other thing you need to be aware of is one of the differences between Newfoundland and Ontario and other provinces is their drug program covers the public plans. Our drug plan, when it sets a price, is for the private and the public plans as well. So, it is just one price. You have to be careful that you do not – what could potentially happen in Ontario is you might drive down the price for people who get drugs through the public sector and then drug companies may just jack up the prices for people who get drugs through private means.

MS JONES: So, you do not think it is going to have any impact in terms of where our legislation is right now?

MR. KEATS: I do not think it will have an impact in the short term, and as Dr. Alteen said, it is really difficult – the most commonly prescribed drug in the country is Lipitor. I think Lipitor comes off the brand in a short period of time, so there will be generic drugs. The cost of Lipitor will decrease. The company that produces Lipitor may say: We will keep it as a brand. They may drop their prices substantially as well for the brand, so the brand may end up actually being cheaper than the generic, which is what we found has happened across the country at various times.

With the price changes and not knowing exactly what the price changes might be, and with all the new drugs coming on, and we have absolutely no way of knowing what the cost of the new cancer drugs and other drugs will be, then it is really difficult to forecast long term what the implications are for drug costs.

We do have, in the country, three mechanisms for approving drugs for getting listed on the formulary. So Newfoundland does not do its own drug reviews to determine whether or not this is a safe, efficacious drug to list on the formulary. We do that in conjunction with other provinces and territories across the country.

MS JONES: Just a couple more questions on the drug program. One is: Can you give us the statistics on the number of people right now who are accessing the four drug programs that we have in the Province?

MR. KENNEDY: What we do know is, for example, that by increasing the thresholds to the Access Plan we will regain approximately 12,000 low-income residents. What had happened, as I indicated, we announced in the Budget $2.5 million to increase the income threshold; this is for eligibility under the Access Plan. This increase mirrored the 42.9 per cent of the minimum wage increases implemented during the time frame. So, we will regain approximately 12,000 low-income residents with this increase.

MS JONES: Can you give me the breakdown, or send it to me, table it or whatever? I would like to know the stats for the people that are under the Access program, the Assurance program, and the other two programs.

MR. KENNEDY: Don, did you say have numbers there?

MR. KEATS: Yes.

MR. KENNEDY: Okay, go ahead.

MR. KEATS: The Foundation Plan - and this is the Income Support Plan - as of March 2010 there were 46,800 people on that program. The 65Plus Plan had slightly over 47,000. The Access Plan had just under 22,000; it was 21,800, somewhere in that area. Our Select Needs Plan - that is coverage provided to individuals with Cystic Fibrosis or require the Growth Hormone Deficiency - there is about 100 individuals on that plan. The Assurance Plan has 6,800 beneficiaries. The extended drug plan - that is to bridge people who come off Income Support into jobs - there are 1,200 people on that plan.

MR. KENNEDY: So the total appears to be 122,000 people.

MS JONES: Okay. Can you give me the stats as well for the last four years in terms of how the numbers have grown in terms of the number of people on the program and how the threshold changed each one of those years? Could you guys get that information for me?

MR. KEATS: We will have to get that.

MS JONES: Yes, no problem.

MR. KEATS: The last four years?

MS JONES: Yes.

MR. KEATS: Okay.

MS JONES: The other thing is I would like to get a breakdown - actually, we got it last year and I would like to get it again this year - of the amount of monies that we spend on the various drug programs.

MR. KENNEDY: Yes, I think I can give that to you now. Basically, under the Foundation Plan we spent $56.45 million. The 65Plus Plan was $49.67 million. The extended card was $0.7 million. The Access Plan was $5.736 million. The Assurance Plan was $14.46 million. The special needs were $0.76 million. If you add it all up, we see $127, 925,200 spent on the various plans. Is that correct, Denise?

MS TUBRETT: Yes.

MS JONES: The other piece of information I would like to have is the percentage of people under the Newfoundland and Labrador Provincial Drug Program who actually pays less than 5 per cent for co-pay amounts.

MR. KENNEDY: (Inaudible).

MS JONES: Yes.

I do not know, Lorraine, if you have any questions under the drug programs, so I am going to pass it to her.

CHAIR: Okay, sure.

Ms Michael.

MS MICHAEL: Yes, that is a good way to do it, thank you.

Just to push a couple of things further, with regard to the Access Plan, we know that last year in 2006 the program was expected to reach 97,000, and it went up to 31,000, I think, in 2008 and now it is down to 21,800 – which is slightly over where it was in the fall. I think in the fall it was around 20,000, so it has gone up a little bit.

Have you figured out why it has not been near what you expected it to be?

MR. KENNEDY: I think one of the reasons, and I can tell you we have had discussions about this, I think it is education of the public in terms of access. We are going to engage in – is that correct, Tansy?

MS MUNDON: Yes.

MR. KENNEDY: I do not know if it is a social marketing campaign to make people aware we have this money here, this is meant to help you, so how do we go out and make – through use of Web sites, newspapers, whatever it takes to make people aware. So we are going to try to make them more aware.

MS MICHAEL: I am glad to hear that because I do know, from a constituency perspective, that it is one of the pieces of information that my assistant gives out a lot because people do not know. So, the more ways that you can get the information out, the better. I think you and I both agree, as your people do over there, there are many people out there who are not aware and could be using it and could be benefiting and do not even know.

MR. KENNEDY: Yes. I think one of the things we may even look at is that if we get a package together that we send to all MHAs and the MHAs can then have – there are so many different ways to get information out to people today, but a lot of our seniors may not be using the Internet and Facebook and everything as much as others.

MS MICHAEL: That is right.

MR. KENNEDY: So, I am really concerned about making sure they get the information. We have our Seniors' Resource Centre. We have our seniors' groups. I think it is a matter of being creative and innovative and getting the information out. We have the money set aside to pay.

MS MICHAEL: Exactly.

MR. KENNEDY: We want them to avail of this of program and we will do our best to get the information out.

MS MICHAEL: Thank you very much.

I am just wondering - I know that you did raise income caps this year - is there sort of a long-term plan? You do not get to sort of present that so much in budgets, but is there a long-term plan with regard to continuing to look at the income cap, like next year, the year after, as well as looking at the co-pay? Our co-pay is pretty high in relationship to the recommended co-pay, which is around 2 per cent.

MR. KENNEDY: Yes, we will have to look at making this program available to people and the issue of the co-pay has been raised. For example, this year the new income thresholds for the Access program will attract or will be applicable to single individuals with net annual incomes of $27,000 or less; couples without children with net annual incomes of $30,000; and families with children, including single parents, who earn net annual incomes of $42,000.

So obviously, as people hopefully continue to make more money and as minimum wage goes up - I think we have another increase coming up - we have to address these issues. I am certainly very supportive of getting within the budgetary restraints that are imposed upon us and getting the money out in terms of the Prescription Drug Program. I can tell you this is a big issue under the Poverty Reduction Strategy and one that we have had real good results with but we have to get out, make more people aware and hopefully more people will avail of it.

MS MICHAEL: Okay.

So, I do encourage you, Minister, to continue looking at the co-pay because with the insurance plan that is a bit of a barrier for people. There are still many people for whom the co-pay is still too high.

MR. KENNEDY: Yes.

MS MICHAEL: Thank you.

They are all of the questions I had as extra questions under the drug program. I do not know if Yvonne wants to go next.

MS JONES: No, you can continue.

MS MICHAEL: I can continue? Okay, great. Thank you very much.

The next thing I want to look under Physicians' Services, 2.3.01., then the subhead Professional Services, "Appropriations provide for the payment of insured physician services provided to residents both within and outside the Province."

I probably have some idea of why it went up $9.9 million over the budget, but maybe you could give us a breakdown, Minister, of the big increase there between the revision and the budget.

MR. KENNEDY: Yes, are you talking about the decrease, Ms Michael?

MS MICHAEL: Oh, it is a decrease. I am sorry, it is a decrease.

MR. KENNEDY: The decrease in 2009-2010 and the Estimate for 2010-2011.

MS MICHAEL: Yes.

MR. KENNEDY: Obviously, we have to budget each year based the fact that there will be an agreement with the doctors. We have to set money aside. I think what was utilized here was simply the template in terms of what would be the increase so that there is money set aside. I think that the $9 million decrease was the monies that were in the budget for 2009-2010. Again, we have notionally set some money aside in 2010-2011 for a potential - in the hope that there will be a resolution.

MS MICHAEL: You are hoping that is it not going to cost any more than $30.5 million?

MR. KENNEDY: No, if you utilized the template eight, four, four – we have no idea. I do not know where the negotiations are at this point. If I understand correctly, Denise, that is the way we would have to do this. We would budget by setting monies aside. We know the numbers that are out there right now.

MS MICHAEL: Right. I did say that a bit tongue-in-cheek.

MR. KENNEDY: It would be good if we could.

MS MICHAEL: Yes, right. Don't bank on it, literally, figuratively.

Under Allowances and Assistance - probably similar answers - there actually was an increase between the budget and the revision last year. There is an increase between the Estimates this year and the budget last year.

MR. KENNEDY: Yes, just one second here now. Yes, this is monies that deal with all out-of-province treatment of our residents.

MS MICHAEL: Okay.

MR. KENNEDY: Essentially, there are approximately 25,000 people who are living or travelling outside the Province. MCP will cover them and then we are billed by the host province or wherever. I guess in Canada it would be MCP.

Included in that, though, we have out-of-province residents who are sent outside for treatment not available in this Province. That can be to other parts of Canada where it is mostly, or it can be to the United States. There are approximately 438 people who have availed of the out-of-province treatment.

When you add it all up, there are approximately 25,000 people who have availed of this program. The cost has arisen because of increased utilization of host province medical services.

For example, we had a large proportion of our population over the last number of years who have been travelling to Alberta, but their treatment received in Alberta would have been billed back to us under MCP.

MS MICHAEL: Right.

Now, Minister, those Allowances and Assistance - I am not sure, maybe I should know the degree to which that also covers travel and accommodation costs for people. It does not, does it? It is only the medical services –

MR. KENNEDY: No, this would just be for the medical services.

MS MICHAEL: That is right.

MR. KENNEDY: That would come under the Medical Transportation Assistance Program.

MS MICHAEL: Because that is one of the issues that we get frequently in our office being brought to us.

MR. KENNEDY: Yes.

MS MICHAEL: I know it is not under this head, but it is something that we do need to look at because you have people who have to go outside to get their care and yet not always, but very often some of these will be people on fixed incomes.

Some of the people we have dealt with in our office recently are pensioners who have had to go outside. They are on a fixed income. Their income may look adequate, but in actual fact it is not adequate when it comes to having to pay the extra money involved with airfare, for example, and accommodations. You and I both know I think that there are many people for whom not having those things covered make it very difficult.

MR. KENNEDY: Yes, we are aware of these issues, certainly, in terms of the purpose of the program - and it does apply to out-of-province. We know the number of people who have availed of this program, and the kinds of expenditures that are allowed, but it is meant to assist people in terms of travelling and we hear the same within the Province all the time.

MS MICHAEL: Right. Well, I urge you to continue looking at that issue. Just to give you an example, I have a constituent who is a retired person who recently was recommended by her doctor that she really should go to London, Ontario immediately to have her needs taken care of. Even though the service was offered here in the Province, her doctor felt very, very seriously that she needed to have the treatment immediately – and it involved surgery – and made the recommendation. Now, she really has to struggle to have anything covered, but her doctor was adamant that she really needed to leave. We are working that through with her, but things still have not been taken care of. So, these things do happen.

It is not sufficient that it is just that the person has to go because the service or the surgery or whatever is not offered here, sometimes it may not be offered timely. If a doctor says that he or she really feels the person's condition is going to worsen, then I think that needs to be accepted as a reason for having to leave.

MR. KENNEDY: Has she applied to the program, do you know?

MS MICHAEL: She has, and she is having real struggles getting her expenses covered, but we are working on it with her. I just want to put it out as something for you to know about.

MR. KENNEDY: I understand the airfare will be covered if people are eligible.

MS MICHAEL: The airfare? She was told it would not be.

MR. KENNEDY: Or a portion – yes, because there is a deductible here but there is a –

MS MICHAEL: No, she was told it would not be at all because the surgery could have been done here, but her doctor said the surgery really needed to be done right away. So, it is something that people have come up against, but we are fighting the system and hoping that it is going to work out. If not, we may be back to you in another venue.

MR. KENNEDY: Okay.

MS MICHAEL: Then again, not as much of a variance, but we still do have under subhead 10., under Physicians' Services, between the revision and the budget there was a decrease last year of $2.8 million approximately and for this year the Estimates are $12.7 million above the budget for last year, so just an explanation of those types of things.

MR. KENNEDY: The same reason that we are looking at, we had to budget for. We have a number of different groups of physicians, we have our fee-for-service physicians; we have our salaried physicians. So, this is the same reason again, for budgeting purposes, there is money set aside.

MS MICHAEL: Okay, very good, just to get that for sure.

Under 2.3.02., Dental Services, maybe this is just a matter of budgeting what you think is needed and it is just not all being used. It is $600,000 under what was budgeted. I am assuming it means that, to date, it looks like roughly $7.6 million is good if you could maintain there.

MR. KENNEDY: The uptake was actually lower than we expected which is - I do not know if it is unfortunate or it means that the program is working in terms of the dental care, but obviously, dental care for children up to age seventeen is a significant issue. We recently reached an agreement with the Newfoundland and Labrador Dental Association in terms of the next four years. So, this is a big issue and that again deals with uptake. The $600,000 decrease is based on uptake.

MS MICHAEL: So, it may be that this may be another area where a bit more education needs to be done, information and education needs to be done.

MR. KENNEDY: I agree.

MS MICHAEL: Again, you think everybody who is eligible knows, but we have had examples of people, through our constituency office, that we find out: Gosh, I thought everybody knew that and have to be informed that you are eligible. Thank you.

Under 3.1.01., which is the RHAs, most of this is pretty straightforward; it is the Grants and Subsidies et cetera. I know it is done by the RHAs, but I know you would have the information. Could we have an updated table of the annual health authority deficits for the four authorities?

MR. KENNEDY: Yes, in actual fact there is an accumulated deficit this year but there is no - excuse me, an accumulated deficit over the years, but in terms of the deficit for this year, there will be no deficits for this year because of stabilization funding. So, the accumulated deficit will still remain.

MS MICHAEL: Okay, if you can send that to me.

MR. KENNEDY: I can give you that information now.

MS. MICHAEL: Sure.

MR.KENNEDY: In terms of the accumulated deficit there were no deficits for our recent year ending. Is this correct, Denise? However, the accumulated deficits are still $48.8 million for Eastern; $17.7 million for Central; $22.4 million for Western; and $19.8 million for Lab-Grenfell. So those are accumulated operating deficits – how far do they go back, Denise, until their inception?

MS TUBRETT: (Inaudible).

MR. KENNEDY: Don, if the other boards had deficits, would they have carried them over?

MR. KEATS: They would have been carried over.

MR. KENNEDY: Yes.

MS MICHAEL: What is the plan for dealing with the accumulated deficit?

MR. KENNEDY: We are going to be actually talking with the – last year, when I was the Minister of Finance, one of the big issues I had was the issue of deficits and how to reduce deficits in terms of, as a department, if we are operating within a – we have a budget to operate in, and any reallocation of funds we have to go to Treasury Board in certain circumstances. Operating within the budget is important, but the provision of services has to be most important.

So what we have tried to do, at least in the last number of years, is to deal with the current deficit as opposed to the accumulated deficit, and this is something we are going to have discussions with, and the CEOs of the health authorities are aware of this and again we will address. Is there anything, Denise, that you can add on that? It is something we do have to address, certainly.

MS MICHAEL: Okay, thank you.

I have a couple of more general questions. Under the long-term home care and long-term care, I have just a couple of generalized questions. How many more people are qualifying for long-term care because of the lower caps? Do we know that? Do you have a figure on that?

OFFICIAL: (Inaudible).

CHAIR: Excuse me, Ms Michael; I do not think they heard the question.

MS MICHAEL: Oh, I am sorry; I did not get that.

Do you know, because of the lower caps with regard to home care, how many more people are qualifying for home care?

MR. COOPER: What I can tell you is that there are now 2,260 home care clients. Since the movement to the income-based assessment process, which I presume is what you are referring to –

MS MICHAEL: Yes.

MR. COOPER: - we have seen a reassessment of 2,260 individuals. It did not really lead to an increase in terms of the number of people accessing the service. What this program allowed is for the people who access the service, and new entrants to the service, to actually pay less towards.

MS MICHAEL: So, it has not made a difference to the numbers?

MR. COOPER: I do not have the program growth, but certainly, in terms of the benefit to the clients the vast majority of people who are reassessed after the income model was used in December experienced a decrease in what they had to pay for their home support.

MS MICHAEL: Right.

Has anybody been tracking new entrants? There have to be some new entrants.

MR. COOPER: Yes, I do not have that information with me, but we can certainly make that available.

MS MICHAEL: Thank you very much.

I have a couple of questions under 3.2.01. I guess again they are general questions. In 3.2.01., just looking at Furnishings and Equipment, there is a big increase in the medical equipment, so could we just have a breakdown of what the new equipment is? We probably have this in other – could we have that information here? I know there are new dialysis units and CAT scans, maybe they account for all of it, I am not sure.

MR. KENNEDY: Okay, so are you talking –

MS MICHAEL: I am sorry, 3.2.01.

MR. KENNEDY: I have got that, yes, Furnishing and Equipment.

MS MICHAEL: It is only one heading, the Property, Furnishings and Equipment.

MR. KENNEDY: Yes.

MS MICHAEL: We do have an increase, so I am just wondering what the increase covers.

MR. KENNEDY: In terms of the increase for this year - you are talking about the $4.3 million estimate increase this year.

MS MICHAEL: That is right, yes.

MR. KENNEDY: That will primarily be due to a $9 million increase for the laboratory project offset by the removal of funding for the Panorama project to the delays in the project. Essentially, that is how that number is reached. Don, is that correct?

MR. KEATS: Yes.

MS MICHAEL: Where do things like the new dialysis unit, and the new CAT scan, those things turn up? They do not turn up under this one?

MR. KENNEDY: What happens is, for example, we have approximately a $50 million capital equipment budget. Then, what will happen is - and I think we saw the Auditor General's report - is that the regional health authorities will come to the department with equipment that they are suggesting or that they need. Then we will give them the authority – and that was one of the difficulties the Auditor General found – to purchase the equipment.

It comes under this. We have a list of the equipment, but this is where the fund is that allows for the purchase of equipment. It is a yearly fund of approximately - at least that I am aware of, last year being $50 million and I think this year we are still at $50 million.

MS MICHAEL: Okay, so it all does show up under that one?

MR. KENNEDY: Yes, it does.

MS MICHAEL: Okay, just checking that out.

MR. KENNEDY: The furnishings are sort of a little bit of a – it is really a minor part, what we are dealing with here is equipment and capital.

MS MICHAEL: Oh, no, major equipment I realize, yes.

MR. KENNEDY: I can actually give you the breakdown of the $50 million last year: laboratory would have been $3.589 million; X-ray and diagnostics was $4.03 million; other medial equipment – that is dialysis, is it - $12.42 million; support equipment, $11.13 million; special items, $18 million; and it adds up to the $50 million. So that is something we are putting out there into the system, and equipment, again trying to, this year, certainly make sure that the Auditor General's recommendations are complied with, that the aging of the equipment is properly looked at and then we get some equipment that is very expensive, as we are all aware.

MS MICHAEL: Yes, I realize.

My last questions just have to do with updates. Could we have an update, one, on where things are right now in the planning for the hospital in Lab West? I know at one point other tenders were called, but just an update on where things are with that and an update on planning with regard to the replacement of the Waterford.

MR. KENNEDY: First, I will deal with Lab West because I dealt with that last week.

We went to tender, I think, approximately November 27 or November 28. I think it was November 28 we went to tender for the construction of the building. The tender was awarded to -

OFFICIAL: Pomerleau.

MR. KENNEDY: Yes, Pomerleau was awarded.

This year, we are waiting now for the ground to – my understanding is waiting for the ground to, I do not know if soften up is the word, to start the structural and the steel. That should start this year. What will happen next is that in the fall of this year, the detailed design schedule will be completed this year and then we will move towards the building, but it is my understanding that it will not be completed until late December 2013 with a view to moving in, in 2014.

MS MICHAEL: Minister, as the plans are going on with regard to the actual building itself, are there discussions going on with regard to what is going to be in the building, what programs are going to be included in the new facility?

MR. KENNEDY: Yes, certainly we are looking at all of that.

MS MICHAEL: You do not have anything to announce on that yet in terms of is it status quo or is there something new going to be added or is something going to be lost.

MR. KENNEDY: We are all aware, one of the issues was raised last week was the issue of whether or not there will be a CAT scan in the new building, for example. We are looking into all of that.

That was the main issue that was raised in terms of the plans that have been presented to the town councils in terms of the layout of the building. The projected cost of that building right now is at $90 million.

Last week in Lab West, one of the issues raised was: Can you do it faster? We would certainly love to do it faster because we see an increase of approximately 10 per cent to 15 per cent per year in the cost of these buildings. So the quicker we can get that building up the better it is for everyone – the better it is for the taxpayers of this Province.

MS MICHAEL: Thank you.

What about any planning with regard to the Waterford?

MR. KENNEDY: We were into a study for the redevelopment of the St. John's health care system. Initially, I think, Don, there had been some discussion of one big facility, but you will see there is a lot of work going on at the Health Sciences right now with the genetic centre and the expansion of the medical school. So, we have to look at now a recognition that this is going to be a huge project.

My inclination – and we will have to look at this further – is that we have to move separately on the Waterford, that the Waterford needs to be replaced, that we have to look at how and when we go about that, and the location. So the Waterford has, in essence, in my discussions with Ms Kaminski, the CEO, been taken out of the big redevelopment, knowing that we have to move a little quicker on that one.

MS MICHAEL: Thank you very much.

Those are all of my questions for the moment, Mr. Chair.

CHAIR: Thank you very much.

Ms Jones.

MS JONES: I just need to go back over some of the Estimates because I have some questions on some of the things that the Member for Signal Hill-Quidi Vidi has asked as well.

I will start with the Waterford Hospital because I know recently when you guys announced the $1.7 million for wheelchair accessibility in hospitals across the Province, you were asked about the Waterford. I think your response at the time was that you did not want to spend money on a facility that had an uncertain future.

What we are wondering is when you will make some final decisions around what the future of the Waterford Hospital will be and what the services will be or where they will offered.

My other question is: Have there been any services moved out of the Waterford Hospital within the last year?

MR. KENNEDY: On the first point, we are obviously looking at the issue of – there are discussions ongoing as to how we will deal with the Waterford Hospital and the redevelopment. I am sure that Tony can answer in terms of their services being moved out, but I think Ms Kaminski's office was in the – she recently moved into the Health Sciences. Now, I do not know if that is (inaudible).

MR. WAKEHAM: Tony Wakeham.

I do not have the information here, but I can certainly check to see if there were any other programs and services moved out of the Waterford. I know the administration section – Ms Vickie Kaminski moved her office back into the Health Science complex.

MS JONES: Okay.

Have you set any particular date or deadline in terms of when you will make decisions around the Waterford Hospital?

MR. KENNEDY: Obviously, this is going to be a significant budgetary issue so it will have to be looked at in the next year in conjunction with the redevelopment because it is not only the Waterford. We do not only have the services there in terms of mental health services, there are dialysis services at the Waterford and there are other services that are provided there is my understanding.

So we have to look at a number of factors, but as we look at the redevelopment of the St. John's system the Waterford Hospital will be a significant part of that. We have taken the Waterford out of the bigger redevelopment picture and are looking to can we move ahead quicker with that project.

MS JONES: Just going back to section 2.3.01., under Physicians' Services –

MR. KENNEDY: I am sorry?

MS JONES: Section 2.3.01. I wanted ask if you could give me a breakdown by board of how much we are paying out for locum services in the Province for doctors.

MR. KENNEDY: For locum services? That is not something that I have. Larry, do you have that? Just one second there now, Ms Jones.

MS JONES: You could always send it to us if you do not have it right now.

MR. KENNEDY: Okay, that is fine. We will just make a note of that.

MS JONES: Actually, I would like to ask you to provide me with a list of two other things because you gave it to us verbally, but I did not get it written down. One was the board deficits in the Province and the other one – I cannot remember it now. You gave it to us a few minutes –

OFFICIAL: (Inaudible).

MS JONES: No, it was not the last one.

OFFICIAL: The breakdown of capital equipment?

MS JONES: Yes, the capital equipment breakdown that you just gave a few minutes ago, I did not get it down.

MR. KENNEDY: Yes, certainly.

MS JONES: You gave the breakdown for last year, what you spent money on last year. I guess most of the breakdown is in the current budget this year, but I would like to get it broken out.

The other thing I was wondering, the commitment for the dialysis equipment for Labrador West, will that be done now or will it be done in 2013, 2014 –

MR. KENNEDY: No, that is being done now. That arose last week because the note I had been given indicated it would take us fifteen to eighteen months to get the dialysis in. I met with the doctors the next day and we indicated surely we can train people because there just needs to be a couple of people with specialized training.

The money is there in the budget for this year for the dialysis. It is a question of finding the people to run the dialysis machine. As soon as we get that done, that is going to happen. That will be done now. When I say now: in the current fiscal year into the next year to finalize it.

MS JONES: Okay.

Now moving along to the boards, 3.1.01, first of all I have some questions regarding the numbers. Under 3.1.01., you did not give us the breakout for 01., 02., and 03., which were included in the Estimates in previous years. You did not give us a breakdown of the Salaries, the Employee Benefits or Transportation and Communications. I am wondering why that is, or I had a bad Estimates book.

MR. KENNEDY: Sorry?

MS JONES: Section 3.1.01.

MR. KENNEDY: You are saying in last year's Estimates you were given a breakdown of Salaries?

MS JONES: Yes, page 204 of last year's Estimates and every previous year before that, that we went back through we were given the breakout of Salaries, Employee Benefits and Transportation and Communication for the boards. This year those details were omitted from the Estimates and I wonder why that is.

MS TUBRETT: Denise Tubrett.

That is part of the transfer of dollars to CYFS. That would have been there last year in the Estimates. As part of the creation of the new department, the money for 2009-2010 was transferred over to CYFS and the budget was restated. So, it disappears in these current Estimates.

MS JONES: All of the salaries for all of the positions for each of the health boards in the Province are now going to be managed through Child, Youth and Family Services?

MS TUBRETT: No, I do not have last year's Estimates in front of me, but I think the salary dollars that would have been there would have been related to salary positions for CYFS. The salary positions related to the board are under Main Object 10., under Grants and Subsidies.

That is where all the dollars are, so that does not get broken out. These would have been positions that were in the Department of Health related to CYFS that got transferred to the new department.

MS JONES: Okay, well that makes sense because the budget for Salaries last year was less than $1 million, so that would make sense.

MS TUBRETT: Right.

MS JONES: Okay. So all of the employees then under the health boards, outside of the ones that would be going with Child, Youth and Family Services, are all paid for out of number 10?

MS TUBRETT: Yes.

MS JONES: Okay.

The other thing I want an explanation for is when I looked at the Estimates under the board last year – I think I know the answer, but I want to make sure that it is on the record – the numbers have all changed.

For example, in the budget for 2009-2010, we voted that there would be $424,500 in Professional Services, but when you look at the budget for this year it says that last year it was only $130,000 budgeted. Every one of your numbers under this section are all different, every number has changed from last year. So, what we voted on and passed as a budget is not what you have in your document and I would like to know why that is.

MS TUBRETT: That is the same explanation that I just provided. It has to do with – as part of the budget process in the new year we restate any monies that have been moved to – if you look, for example, in the CYFS Estimates for 2010-2011 you will see a budget for 2009-2010, of course, if you looked in last year's Estimates that would have not been there, so everything gets restated. Those dollars has been moved over to CYFS. They would have had $2 million, I believe, last year in their Estimates.

MS JONES: I am just making sure because if we voted and passed that amount last year, it should still be the amount budgeted. The amount that is revised should be the changed amount, isn't it?

MS TUBRETT: No, actually, as part of government's budgeting process, you would restate the 2009 budget to where it actually is located to make it comparable because if not all we would be talking about today would be variances related to CYFS. We, I guess, smooth out the numbers so that they are moved over to CYFS so you can see they were budgeted for CYFS and you can see what the revised is and you can see what the new 2010-2011 budget is. If we did not restate the budget you would see a lot of variances and you would not be able to see the comparative numbers.

MS JONES: So, if we took the budget for Child, Youth and Family Services and we took this budget, our numbers should all come out the same as what was budgeted last year.

MS TUBRETT: They should, yes. You will have difficulty trying to do that because a good amount of the numbers of the 135 that went to CYFS would be under Grants and Subsidies. So, it would be very difficult for you to try to determine what the breakout would be. For all intents and purposes, yes you could that if (inaudible).

MS JONES: Because I cannot do that, you are telling me, and I cannot find that information, could you give me the information?

MS TUBRETT: Yes, we are going to give you a list of how we come up with the numbers to transfer to CYFS. You will see the budget that was in here in 2009-2010 and you will see where the 2009-2010 budget got moved to CYFS.

MS JONES: You asked for that while I was out; did you?

MS MICHAEL: Yes, that is right.

MS JONES: Support to Community Agencies – it is nice to see that it increased this year. Are there some new groups added?

MR. KENNEDY: Where are we?

MS JONES: Section 3.1.02.

MR. KENNEDY: Yes, what has happened in Support to Community Agencies, what we have looked at is there is an additional $300,000 with a primary focus on mental health and addictions groups, in terms of community agencies, but not necessarily restricted to them. That is where the $300,000 is meant to go.

MS JONES: I actually have some questions around the mental health services, so maybe I will ask those now. One, I am wondering: What support services have been implemented in the last year in the Province for children and youth who suffer from mental illness?

MR. KENNEDY: We have the facility that is being built. That is not done yet, but that is being built in St. John's for youth with complex needs. I think in this budget there are monies for the Janeway psychiatry – is that correct? Yes, monies for the Janeway psychiatry.

In terms of the programs this year, that is an issue that we have to address. In the restructuring of the Mental Health and Addictions Division, I am hoping that there will be a consultant who will be assigned to youth mental health needs. So that is certainly a big issue with us and one that I think has to be looked at separate and apart from – even though it is part of a bigger picture, it is a very significant part of an issue that has to be addressed. I am hoping that just as there will be a consultant who will be primarily – may not only be dealing with gambling, but will be dealing with gambling, we will also have then a consultant who will be assigned to dealing with the issues of youth.

MS JONES: Back when the children were taken out of the Janeway in handcuffs, your government announced that they were going to do a review of the J4 ward at the Janeway and the services. I am wondering if the review was ever done, where the report is, if it is going to be released to the public, were there any findings in it that government took to improve services or change services at the Janeway as a result of that review.

MR. KENNEDY: Don or Tony may be able to help with that, but what we did this year there is $482,900 to enhance child psychiatry services at the Janeway hospital. That is in this year's budget and I think some of that will deal with, for example, services and programming.

There was a review that I can see - Don is that correct? It was to enhance the quality, efficiency and the effectiveness of the acute mental health services for children, youth and their families. In July 2009 Eastern Health publicly released the report of a comprehensive external review of the Child/Adolescent Mental Health Unit of the Janeway hospital. There was a range of recommendations. So, what we have done is to now, I think this year, to provide close to half a million dollars to enhance services.

So, you are correct, there was a review, but it was done by Eastern Health and I think publicly released.

MS JONES: That is not the report I am talking about.

MR. KENNEDY: Is it the Child and Youth Advocate -

MS JONES: That was an external review that was done, right? You committed to do an internal review or investigation into what was happening over there. I do not know if that was completed or not.

MR. KENNEDY: It certainly would have been before my time as minister. Don, are you aware of that?

MR. KEATS: The review that was done was done externally. Eastern Health brought in mental health professionals from Ontario to take a look at their staffing, their staffing mix, as well as the physical layout of the unit and that basically was what was completed in accordance with the review. I guess we go back to December 2008 when Eastern Health said they would undertake a review.

MS JONES: Actually, I think the Office of the Child and Youth Advocate were the ones who were going to do it. I think they interviewed 100 people as a part of that review. We just never heard anything about it after, so I am wondering where it is and I understand that they come under your department.

MR. KEATS: This was done by the Child and Youth Advocate who initiated a review of the psychiatric services at the Janeway. To my knowledge, that review was not completed.

MS JONES: Do you know if it will be completed?

MR. KEATS: I cannot answer that.

MS JONES: Can someone find out for us if it will be completed?

MR. KENNEDY: That would be under the Office of the Child and Youth Advocate. They would know the status of that review.

MS JONES: Yes, but they fall under your department.

MR. KENNEDY: The Office of the Child and Youth Advocate does not fall under ours.

MS JONES: So, who answers because –

MR. KENNEDY: Sorry?

MS JONES: Who answers for that office because he will not talk publicly about any of the things that goes on in his office, so who answers for that office?

MR. KENNEDY: The Child and Youth Advocate is an office of the House and so any questions in relation to the Child and Youth Advocate, or complaints or concerns, would have to go through the House of Assembly. We are all aware what the act says.

MS JONES: Well, the last time that they were contacted he said that he was not prepared to talk about any of these reports or studies publicly. If that is changed, we will try again, but in the absence of that, who answers?

MR. KENNEDY: It is an independent office of the House, so it would have to be the House of Assembly. The Speaker would be the person who would – the Child and Youth Advocate certainly does not report to us.

MS JONES: Okay.

In terms of the youth mental health facility, do you have any idea at this stage when the facility might be operational for youth in the Province?

MR. KENNEDY: I do know that in Grand Falls a couple of weeks ago we dealt with the addiction centre. Tony, do you have any information on the status of the centre for youth with complex needs?

MR. WAKEHAM: Both projects have been working together to develop a common building, if you will, for these programs. We realize the programs are different, but both groups have been working together. They are in the process of the site identification now and soon - the program piece has been done. They met as late as yesterday to finalize that and the next step will be to hire the services of an architect to actually physically lay out the design work now. Once that is done, then they will move on to the tendering process.

MS JONES: Okay.

When you talk about location though, that facility is going in the St. John's area, right?

MR. KENNEDY: That is correct.

MS JONES: Okay.

In the Budget this year I noticed that the money that was being allocated was around $5 million. What portion of the project is this because obviously it is probably not enough to complete the entire facility or maybe it is, I do not know?

MR. WAKEHAM: Tony Wakeham.

The budget that was allocated, I think, for each of those facilities was around $5 million a piece. So, I think that the plan this year is to have the actual tender out to start construction. That number is there, I guess, as an estimate of what we might spend in this fiscal year on both of those.

MR. KENNEDY: I think our Budget release indicates that there is a $2.4 million for continued planning and construction of the new residential treatment for children and youth with complex needs and/or behavioural issues to be located at St. John's, and $2 million to further a new residential treatment centre in Grand Falls-Windsor for children and youth with addictions. So, they certainly will be moving ahead this year.

In Grand Falls they are looking at sites and they are ready to move ahead. In St. John's I am hoping - there was a meeting yesterday, I have not had the opportunity to be briefed on that, but I want these processes speeded up and I want these facilities built because we have youth out there who need the assistance of these centres and we have to get these moving.

MS JONES: So we would be looking at a completion of around 2012, would that be fair? What is the time frame? I am just trying to get a handle on it.

MR. WAKEHAM: Tony Wakeham.

I would hope that the tenders will go out this fall and that the construction can start next year. Of course, I will have to defer to Transportation a little bit on that, but clearly the intent would be to get this completed as quickly as possible, as the minister has said.

MS JONES: Can you give me some sense of what the capacity of the facility will be once it is completed? I know you have not found the location yet, so we do not know if it is a new building or an existing building that will be used, but you must have a sense of the capacity and the type of programs that will be offered through this facility.

MR. KENNEDY: I think it was mentioned last week, Ms Jones. I cannot remember the details right now - a few weeks ago in Grand Falls-Windsor - as to the capacity of the addictions centre and something tells me around a dozen youth and it would be set up in pods. That is information that we can certainly provide. At least in terms of the youth addictions centre, I know information exists. In terms of the residential treatment centre for youth with complex needs, we can certainly attempt to find out for you.

MS JONES: Okay, well maybe you could just send me along the information, which is fine, in terms of capacity.

MR. KENNEDY: This would be in the consultants' report. The consultants were hired to propose how these facilities – what kind of needs they would accommodate, and the set-up. What I understand is they were looking at both. Although they were treating different needs, they were dealing with youth, so that the needs of youth in terms of whatever treatment, modality would be similar, in terms of location and set-up of buildings et cetera.

MS JONES: Okay.

Again, in terms of the Grand Falls facility, I guess you still cannot give me a definite date on that. It will go to tender this fall as well.

MR. KENNEDY: The dates I gave in Grand Falls were certainly more definitive. Again, I cannot remember exactly but that is something - we can provide you with that information. In the announcement, the $30 million of the redevelopment of the Central Newfoundland health care facility, that same day I made announcements and gave details on where the facility, the youth addictions facility was. That is something I know is back in my office and we can find fairly soon.

MS JONES: The new adult addictions facility for Grand Falls, will that also be a medical detoxification treatment facility?

MR. KENNEDY: Sorry, the new –

MS JONES: The new adult addictions facility for Grand Falls.

MR. KENNEDY: No, that is in the Avalon region.

MS JONES: Oh, that is in the Avalon region.

MR. KENNEDY: Yes.

MS JONES: Okay.

Will that facility also be a medical detoxification treatment facility?

MR. KENNEDY: One of the issues when I became minister, it came to my attention that the detox had closed down. The recovery centre in Pleasantville was an approximately a twenty-bed facility that was a short-term stay to help people detox from alcohol and drugs and, essentially, then move on then into the next stage of their recovery. That was closed down and we were using a facility on Hamilton Avenue, I think it was. That as recently reopened - the facility in Pleasantville has recently reopened, so the main detox will be the recovery centre.

What you would see would be a transfer – again, I am making certain assumptions here, but I think some of them are common sense. If you are going to bring someone into a residential treatment program then the detoxification is a necessary part of that program. So, what I see is that sort of continuum of care where they end up, either through their doctor or their counsellor, perhaps into the recovery centre. After spending a period of time in the recovery centre, the detoxification process, then with a view to moving into a treatment facility. Although, I know there is difficulty with that now because of waiting lists.

The main detox or the detox will still be here in the recovery centre. Although, there is no reason that a facility itself could not have a room or two for detoxification purposes.

MS JONES: A couple of questions on the Medical Transportation Assistance Program because I am not sure where that is paid for out of the Estimates; I must have missed it somewhere along the line. Maybe someone can tell me where it is actually paid for.

MR. KENNEDY: Medical transportation – 3.1.01., 09.

MS JONES: Okay, under Allowances and Assistance?

MR. KENNEDY: Sorry, where is it?

MS JONES: Okay. What other programs are paid for out of that? Is that all medical travel?

OFFICIAL: (Inaudible).

MR. KENNEDY: Okay. Yes, under 3.1.01., you see a heading Allowances and Assistance. What we see are a number of different areas covered in the same area. This also includes position bursaries, but it includes the Medical Transportation Assistance Program also.

MS JONES: Okay.

Can you tell me how much of it goes for the Medical Transportation Assistance Program?

MR. KENNEDY: In 2009-2010 we spent $1.9 million. The budget or the estimate for 2010-2011 is $2.7 million. I guess that will go to the increase with the road - the mileage allowance.

MS JONES: Okay.

Can you also give me the breakdown of how much of that is for in-province and how much is for out-of-province?

MR. KENNEDY: What we did earlier - and I do not know if you were here at that point - I dealt with the issue of the out-of-province costs for medical services. What we have is – where was that Denise? In what section was that?

We have approximately 25,000 people who avail of services outside the Province. These can be people who are living, travelling, going to university or other schools in Canada. For example, our workers in Alberta who will go to a hospital, our MCP program covers them.

We also then have approximately 438 people who go out-of-province for specialized medical treatment, treatments not available here. Approximately 430 of those are in Canada and eight, I think, who have gone to the United States.

It gets a little bit complicated because some of them receive money through the Medical Transportation Assistance Program and some receive transportation benefits from HRLE.

MS JONES: Under Health Care Facilities, 3.2.02 –

MR. KENNEDY: Sorry, three point –

MS JONES: Section 3.2.02.

You are going to spend $40 million more this year. Can you tell me what you are building there. I am sure that is all the long-term cares and the hospitals and so on, but I would just like to get an idea of where you are to with all of those projects.

MR. KENNEDY: Yes, okay. What we have here - you are right – is the various engineering design work for the construction of hospitals and long-term care facilities. That is in relation to long-term care homes, hospitals, et cetera.

MS JONES: Yes, I just wanted to know which ones it is, just to refresh my memory.

MR. KENNEDY: Okay.

We are looking at - there is a whole bunch of them. I will give you an example. In the Eastern we have the protective community bungalows in Bonavista. We have the Burin North, or the redevelopment of the health care facility in Marystown North, where we are closing down a couple of little clinics or will phase out a couple of little clinics and put them in one central location. There is the Carbonear long-term care. There are monies there for the Iris Kirby House. There is the $1 million for the redevelopment of St. John's hospitals. There is the Faculty of Medicine expansion. So, all of the capital infrastructure that comes under Health.

Out in Central, we would have, for example – we had the parking garage, St. Clare's Emergency Department redevelopment, the Dr. H. Bliss Murphy cancer care expansion. In Gander, we have redevelopments of the James Paton hospital and the Grand Falls-Windsor regional health care facility, the Lewisporte long-term care facility. In Western, we have the long-term care facility and the development of the acute care. In Labrador-Grenfell, we have the Flower's Cove Health Centre, the Labrador West Health Centre, and the Happy Valley-Goose Bay Long-Term Care Facility. So anything that is currently under construction or planning for would come within these monies.

MS JONES: One of these issues that came up in the last year has been out of Deer Lake, where they have all of their services in a building, but the building is not owned by Western Heath Care. I think they have a lease agreement or something, but the building is actually owned by a non-profit group. There has been concerns expressed by the professionals in that area that they feel that the facility that needs work - the non-profit group do not have the money to do any of the work on the building and they would like to see it taken over by the Health Care Corporation so that all of the professional services could stay under the one roof, but it needs work. I think it needs exterior and interior work.

I think the last questioning in the House of Assembly - I think you were not the minister then, I think it might have been Minister Oram. I think at that time they said they were going to have a look at this. I do not know what the status of it is now or if anything is being done to address that issue.

MR. KENNEDY: Other than our capital infrastructure monies, we also then have a budget for repairs and renovations. Last year's budget was approximately $40 million, and I think we spent $34 million or $35 million of that. This year's budget is approximately $31 million. We have monies available for repairs and renovations and it is something that, obviously, we know we have to maintain our buildings because if we do not then the cost in the long run becomes much more significant, so the repairs and renovations budget is something that can be used.

I am not aware of this issue with the not-for-profit group owning the facility. I thought we had actually put some money into Deer Lake.

MR. WAKEHAM: Tony Wakeham.

Yes, shortly after that there was a meeting out there and there was significant renovations made to that building. Air conditioning was put in, the parking lot was paved, new windows were put in, and there was a significant electrical upgrade to accommodate the new X-ray machine that was being installed there as well. There have been significant improvements made to that building.

MS JONES: Okay. So, there was a grant to do the work, but the corporation still never took over the building as such, right?

MR. WAKEHAM: No, it is still the non-profit group.

MS JONES: Okay, good. Thank you.

I do not have any other questions

CHAIR: Are there any other questions?

I will ask the Clerk to call the first head, please.

CLERK: Subhead 1.1.01.

CHAIR: Shall 1.1.01 carry?

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, ‘nay'.

Carried.

On motion, subhead 1.1.01 carried.

CLERK: Subheads 1.2.01 to 3.2.02 inclusive.

CHAIR: Subheads 1.2.01 to 3.2.02 inclusive.

Shall these carry?

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, ‘nay'.

Carried.

On motion, subheads 1.2.01 through 3.2.02 carried.

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

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

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: All those against, ‘nay'.

Carried.

On motion, Estimates of the Department of Health and Community Services carried without amendment.

CHAIR: For the Committee, we have before us the minutes of the Social Services Committee, Department of Justice, April 27, 2010.

Could I have a motion to accept those minutes?

MR. YOUNG: So moved.

CHAIR: Okay, a motion.

Thank you, Wallace Young.

On motion, minutes adopted as circulated.

MS MICHAEL: (Inaudible).

CHAIR: Excuse me?

MS MICHAEL: Mr. Chair, I have not received those (inaudible).

CHAIR: Okay. Do we have those distributed?

CLERK: Yes.

CHAIR: I would like to thank the Committee for their participation this morning, as well as Minister Kennedy. I certainly thank your staff as well for their participation here this morning.

I now ask for a motion to adjourn.

MR. RIDGLEY: So moved.

CHAIR: Thank you.

We are adjourned.

On motion, the Committee adjourned.