Professional Services, subhead 05, I do not remember – and it could be there – seeing anything in documents at this point that would explain why that is going up to $350,800. It has been low. Last year, the budget was $75,800 and was revised down to $66,000. This year, Professional Services are $350,800.

MS SULLIVAN: Actually, that is more of a bookkeeping item than it is anything. The increase in the 2012-2013 Estimates reflect, actually, an increase in translation expenditures due to the centralization now of Translation Bureau. They are invoicing OFS. The increases will be offset by a matching increase in revenue through the Office of French Services. They will now invoice out to the departments directly as opposed to having invoiced departments previously.

MS MICHAEL: Okay.

Can you explain that again? The departments use the services.

MS SULLIVAN: Yes.

MS MICHAEL: Why would it cost $350,800? I am still not clear, Minister, on your explanation.

MS SULLIVAN: Okay.

Jeff, do you want to give the detail there in terms of the overall cost of the $350,000?

MR. BUTT: Yes, I do not mind giving clarification there. The Government of Newfoundland and Labrador has an agreement with the federal Translation Bureau that we negotiate or renew on an annual basis. The value of that agreement can vary anywhere between $200,000, $260,000 to $275,000 per year.

What we have done is we have asked for an increase to our Professional Services budget because from now on we are going to be paying for all translation costs on behalf of departments.

MS MICHAEL: Okay.

MR. BUTT: Then we will go and recuperate the money internally through an internal invoicing process. Prior to this change, the Translation Bureau would invoice all departments separately and it could lead to some confusion. Invoices were going out all over government.

This is just a way, really, of making it a cleaner, more efficient process. As Minister Sullivan stated, our revenue goes up by the same amount of money. If we do not need to spend the money, we do not. So it all matches there.

MS MICHAEL: Right. That is clear.

Thank you, Minister. That is helpful.

Just one more question under Grants and Subsidies. I notice it looks like maybe $35,000 is kept there and $5,000 last year was spent. What would be the type of grant or subsidy – because it is very small – that would come out of that line?

MS SULLIVAN: Do you have the list there, Jeff, of exactly what kinds of things are under Grants and Subsidies?

MR. BUTT: Yes. Again, I can explain that.

The $5,000 that we would have spent under Grants and Subsidies, basically $3,800 just covers the Province's participation in the ministerial conference on the Canadian Francophonie. It is just our contribution towards the national secretariat of that FPT ministers' conference. Then the remaining $1,200 is money that we would disburse at our discretion based on the proposal. I believe in this past year it was $1,200 given to a Francophone community youth gathering.

MS MICHAEL: Okay great, thank you very much.

If I may, Minister, just to say thank you for the great service that Mr. Butt and the French language services provide, especially the training. I continue to have staff that enjoys doing the training. One actually received an A in her test lately.

MS SULLIVAN: I quite agree. The work that is done by the Office of French Services is invaluable to us in many respects, but certainly those courses have proven to be of a fair bit of benefit to all. The translation services that the office provides for us as well are very, very helpful. I know when we go to FTPs, that the work of this particular office has been lauded by many across the country. So, I am very pleased with the work that they are doing as well.

Thank you, Jeff.

MS MICHAEL: Thank you.

CHAIR: Any further questions, Lorraine?

MS MICHAEL: No.

CHAIR: We are good, okay.

Mr. Ball, that being done, I will give you your fifteen minutes, and we will start – if you wish to have the fifteen minutes.

MR. BALL: If it were okay with the minister, I would just as soon move right into the line-by-line questions.

MS SULLIVAN: Absolutely.

MR. BALL: I would start first of all with the number of permanent employees in your department last year or this year? How many permanent employees would you have?

MS SULLIVAN: The number of permanent employees would be 229.

MR. BALL: Temporary?

MS SULLIVAN: Temporary employees would be sixty.

MR. BALL: Six zero?

MS SULLIVAN: Yes, six zero, so that would give us a total positions of 289.

MR. BALL: I guess as we break that down a bit, the Minister's Office would be how many employees?

MS SULLIVAN: Five.

MR. BALL: Five.

General Administration, Executive Support?

MS SULLIVAN: I am not sure exactly what you mean by general –

MR. BALL: General Administration and the Executive Support, I think it is –

MS SULLIVAN: The broader category, I would have to do some addition over here. I can provide you with the whole series of numbers. We have it broken down by activity, so I have Executive; I have Corporate Services, Professional Services –

MR. BALL: Executive is fine.

MS SULLIVAN: Executive in the Minister's Office would be thirteen.

MR. BALL: Thirteen.

Corporate Services?

MS SULLIVAN: One hundred and six.

MR. BALL: Medical services?

MS SULLIVAN: Professional Services is thirty-seven.

MR. BALL: The RHAs, the Regional Health Authorities?

MS SULLIVAN: Regional Services, not necessarily out in the RHAs, but Regional Services, we are looking at twenty-three.

MR. BALL: Okay.

Public health and wellness?

MS SULLIVAN: Population Health: thirty-one.

MR. BALL: Government relations?

MS SULLIVAN: That is part of what we would have incorporated under Policy and Planning, so we have fourteen in Policy and Planning.

MR. BALL: Okay.

What we are trying to get to, of course, is the book that we did not get last year.

The Audit and Claims Integrity department?

MS SULLIVAN: It would be under Corporate Services.

MR. BALL: Okay.

MS SULLIVAN: I do not have the breakdown here, but we had a total of 106 there.

MR. BALL: Okay.

Can you tell me the total you plan to spend in the department on the following – this would be permanent employees?

MS SULLIVAN: The total would be, for permanent employees, $15,207,870.

MR. BALL: Temporary?

MS SULLIVAN: The total cost for the sixty temporary positions would be $3,542,530.

MR. BALL: What about overtime and any other adjustments that would have come in during the year?

MS SULLIVAN: We have a breakdown of overtime, but I do not know that we have it in here.

My staff are saying that we do not have it broken down here. It is embedded in the overall cost in permanent and temporary.

MR. BALL: Okay.

What about for permanent and other adjustments, if overtime – is that included too? Is that the one number?

MS SULLIVAN: Yes.

MR. BALL: Okay.

The total employees then, what was that number?

MS SULLIVAN: Total permanent positions again?

MR. BALL: Total permanent, we have that number, don't we?

MS SULLIVAN: Do you want the total overall positions?

MR. BALL: Yes, sure.

MS SULLIVAN: It would be 289.

MR. BALL: If you want, we could follow through the Estimates.

MS SULLIVAN: Okay.

MR. BALL: Under 1.2.01, Salaries, last year there was $237,000. We just have a question about why it was not all used, or what happened there.

MS SULLIVAN: The decrease would have been $237,000. Is that what you are referring to there under Revised?

MR. BALL: Yes.

MS SULLIVAN: Basically due to vacancies in the positions of the ADM of Population Health and the medical consultant.

MR. BALL: Population Health –

MS SULLIVAN: Yes.

MR. BALL: – and the medical consultant.

Okay.

In Purchased Services here, bullet 06, there was $32,700, under spent again, savings there. Why was that, and what were the services?

MS SULLIVAN: The savings of $32,700 in Purchased Services, the breakdown basically had to do with a one-time expenditure that we had there for $47,300 and that was in advertising and promotion for our MTAP. So that was one-time spending there for promotion of the MTAP – the Medical Transportation Assistance Program.

MR. BALL: Okay. It is getting late in the day for those abbreviations.

In Corporate Services, in Salaries, we see an increase of $405,000. I am just wondering what the reason is for that?

MS SULLIVAN: Corporate Services, Salaries, if I have the tab number sometimes it is easier, as well.

MR. BALL: Okay, I will try that. It would be 1.2.02.01, Salaries.

MS SULLIVAN: You are looking at the estimate increases there?

MR. BALL: Yes.

MS SULLIVAN: Okay. What we are looking at there is an estimate increase of $403,600 and that is due to annualization, for the most part, of funding for the new Information Management Division, that entire division, which was created in Budget 2011.

Additionally, in Budget 2011, under the Adult Dental Health Plan, there was a new Medical Claims Assessor II position that was created for fiscal year 2012-2013. That was in Grand Falls-Windsor at the MCP office out there to assist with assessing the higher volume of claims that would be expected under the new program. It also contains three months of annualization of raises for management staff of 4 per cent that was granted July 1, 2011.

MR. BALL: So this has created some new positions I take it?

MS SULLIVAN: There was the Medical Claims Assessor II position. They were created last year, but they are fully annualized this year.

MR. BALL: Okay, because you did not actually spend all of the budget last year.

MS SULLIVAN: So we only had half the budget there for 2011-2012.

MR. BALL: Two employees, is it?

MS SULLIVAN: One employee and five under the Information Management Division.

MR. BALL: Okay, now it is stating to add up to $400,000. I am just wondering why you guys over there have not applied for that job.

MS SULLIVAN: You were looking for the job?

Sorry, there were five under Information Management as well and the one for Medical Claims Assessor, and they would have started about mid-year.

MR. BALL: Under 05 Professional Services, we see there was over $1 million last year spent; $29,000, and now we are back over $1 million in the budget this year.

MS SULLIVAN: Okay. You are looking for the revised was it, or the estimates?

CHAIR: That would be 1.2.02.05.

MS SULLIVAN: Okay, sorry.

You are asking again about the revised budget there?

MR. BALL: Yes, and the estimates, of course, going from $1 million to $29,000 and back to $1 million.

MS SULLIVAN: That is a contingency fund essentially for $1 million for federal agreements; any federal, provincial, territorial agreements that we entered into over the year. That is 100 per cent offset for us.

MR. BALL: Okay, you are going to have to explain that.

MS SULLIVAN: By federal revenue. If there are federal, provincial, territorial agreements that we need to enter into with the federal government throughout the year then this money is there to allow us to do that. The money is totally 100 per cent federally offset.

MR. BALL: Can I have an example of that?

MS SULLIVAN: A federal agreement; we did not have any last year, obviously. You can see that is the difference here in the revised. There are any numbers of federal agreements, not one of which will come to mind at the moment.

MR. BALL: No, especially in the Corporate Services area.

MS SULLIVAN: Pardon me? That is where that would be funded, though.

MR. BALL: Yes.

The federal revenue, $1 million was budgeted last year, it did not happen. We have it back in again this year.

MS SULLIVAN: Yes. It is because there were no new agreements this year.

MR. BALL: Okay.

I am going to go back up to Professional Services. Did we go through that?

MS SULLIVAN: That is Professional Services, yes. I am sorry; I thought that was the tab we were looking at.

MR. BALL: Yes, 05. I am talking about Professional Services.

MS SULLIVAN: Yes, right.

MR. BALL: I was confused here. What does this have to do with the federal government?

MS SULLIVAN: It is late in the night.

MR. BALL: Yes. I have been talking a lot, too.

Okay, go ahead. Tab 05 Professional Services.

MS SULLIVAN: Yes, that is the one that I addressed. What we have here – the answer again, is that funding of $1 million represents a contingency fund for any federal, provincial, territorial agreements. Any federal-provincial agreements that we might enter into which might arise during the year. The reason the $1 million was not spent was because there were no agreements that we entered into last year.

MR. BALL: Okay.

One other question before we move on to Lorraine and that will be under the provincial side there. The revenue last year was budgeted for $150,000, the revised is $640,000, and budgeted in these estimates for $350,000.

MS SULLIVAN: Okay. So that is 1.02.02.02. Were you asking about revised or estimates again, sir.

MR. BALL: I guess we should go right across that line.

MS SULLIVAN: Okay.

The revised from $150,000 to $640,000, I am assuming is your first question there.

MR. BALL: Yes.

MS SULLIVAN: The increase of $490,000 is a result of the department receiving higher than anticipated miscellaneous revenue for items such as bursary default payments, repayments by health professionals, and a larger volume of fees from law offices requesting medical records for people involved with matters before the courts.

MR. BALL: Do you have any idea how many bursaries we would have defaulted on last year?

MS SULLIVAN: Do we have those numbers? Larry, do you have those numbers?

DR. ALTEEN: I do not have the exact numbers but we have recovered significant dollars in bursaries. Respecting the fact that we had one particular case where a physician went off to do speciality sub-training, a four-year program, and did not return. We ended up recouping $250,000 from that physician. So the amount of monies that sometimes are put into what are called travelling bursaries, in that particular case. We recover, every year, expenditures that we spend on that particular physician.

MR. BALL: Is there a penalty also associated with that?

DR. ALTEEN: There is. There is a penalty for default and there is also a financial penalty on top of that. It is a certain percentage of the overall cost. It is not just paying back the money. It is money plus a penalty. If it is a default that goes on for a period of time there is interest that is charged on that penalty as well.

MR. BALL: Good.

OFFICIAL: (Inaudible).

MR. BALL: Yes, because let's face it; you lose sometimes two or three years of recruiting because of individuals like that.

DR. ALTEEN: Right.

We do a significant amount of tracking to make sure we are keeping on top of those physicians and know where everybody is. It is a fair bit of work to do, but we do that on a regular basis just trying to make sure that we have recovered what we deem to be recovered when people do not provide their return of service to us.

MR. BALL: Good. Lorraine, do you want to –

CHAIR: Just one second, Lorraine.

I have to do one piece of housekeeping.

Clerk, can you call the first heading, please?

CLERK: 1.1.01.

CHAIR: 1.1.01.

Lorraine, please.

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

Minister, still under 1.2.02, please. The subhead 01, the Salaries – I suspect I know the answer but I would like the details. In last year's book, 2011/2012, the estimate for Salaries under Corporate Services was $1,570,900 and this year the estimate is about $4 million more, it is $6,273,900. Last year the estimate was just $1.5 million.

I am assuming there have been things moved into this area. Could we have the details of what has been moved in and the reason then for the $4 million difference between last year's estimate and now this year's estimate?

MS SULLIVAN: That has to do with an organizational restructuring we did in the department. I will get Denise to give the details because she has some of them there with her today.

MS MICHAEL: Maybe we could broaden the question. Instead of asking every time, maybe if you had an overview of the restructuring and where we might see that, I think that might be helpful instead of us having to pick up on it all the time.

MS SULLIVAN: What I will do is I will let Denise answer the first part of the question and then Bruce can give the overall. Hopefully, that will help to give the full picture.

MS MICHAEL: That would be very helpful, yes.

MS TUBRETT: As a result of the new organizational structure, we had to do a reorganization of the estimates from last year. Minister's Office and Exec Support stayed the same. Corporate Services previously included Financial Services and Information Management. We added the Audit and Claims Integrity activity to that activity, Corporate Services. So last year you would see an activity Audit and Claims Integrity, now that is included under Corporate Services.

Last year there would have been an activity Medical Services. This year, that has been changed to Professional Services, which includes divisions from several other activities in the department. Professional Services includes Physician Services and Pharmaceutical Services, which would have been there last year, but this year Health Workforce Planning is added, which was moved from Policy and Planning. Office of the Chief Nurse was added to Professional Services, which transferred from Policy and Planning; Dental Services, which would have been in Medical Services last year, and Pathology and Lab Services was a new division.

Regional Health Operations would have shown up in the estimates last year. That would have included five divisions: Board Services, Mental Health and Addictions, Access and Clinical Efficiency, Aboriginal Health, and National Blood Portfolio. This year, that activity has been restated to be called Regional Services. It includes Acute Health Services and Emergency Response, which is a new division which is similar to the Board Services Division from last year. Access and Clinical Efficiency is there from last year. Infrastructure Management is a new division that was created. Long-Term Care and Community Support Services is now in that activity, moved up from Policy and Planning last year. The National Blood Portfolio remains in that same activity.

Last year you would have seen an activity called Public Health and Wellness. That is now Population Health. There are three divisions that were there last year that are still there: Health Promotion and Wellness, Public Health, and Chronic Disease Management. There are six new divisions that moved in from other areas of the department: Environmental Public Health – actually, Environmental Public Health would have been there last year, too – Disease Control, Aboriginal Health, Aging and Seniors, Mental Health and Addictions, and Public Health Information.

Last year there was an activity, Government Relations, which is now under Policy and Planning. Policy and Planning is also basically carried over into 2012-2013, but it has some new activities added to it: Government Relations, as I just mentioned, the provincial occurrence reporting, and as well some of the changes I mentioned earlier. Long-Term Care is gone to Regional Services. Aging and Seniors is gone to Population Health.

That pretty much captures the structural changes that were made to the Estimates. That is why there were some differences in the salary details as well. The salary details for 2012-2013 are not released yet, and the estimate structure would have followed last year's Estimates.

MS MICHAEL: That is very helpful.

Minister, I am wondering, since it was suggested by the Department of Finance, I am sure you do have the salary details now, would we be able to get a copy of that, the breakdown for each section?

MS SULLIVAN: We do not have it with us, but certainly we can get a copy of that.

MS MICHAEL: That would be great.

Thank you very much.

MS SULLIVAN: Okay.

MS MICHAEL: Okay. That is helpful.

MS SULLIVAN: Bruce, do you want to give the overview?

MR. COOPER: Actually, in Denise providing you with a sense of where divisions have moved and migrated into the new structure, I think you pretty well have a good sense of the architecture of the department now. The way the codes are set up is actually the structure of the department.

The only thing I would add is that as part of our reorganization we went from originally seven branches to five branches, and made some other integrations of responsibility where there was opportunity to actually bring like functions together. We could provide you with an organizational chart, if you wish.

MS MICHAEL: That would be really helpful. When we tried to look for things it was really difficult to figure out where things were. It would really help just from the perspective if we have questions and we want to call a department to find out where exactly they are located. That chart would be really helpful, too. Thank you very much for offering that.

I am not going to ask any general questions yet. I am going to stick with the lines, and I am not going to ask anything about salaries because you are going to get all of that information to us. Then if we have questions maybe we could also have them answered, but I have a feeling we will not. We just need to see what you have and that would be really helpful.

Under 1.2.03.05 Professional Services, you spent $418,500 less than budgeted last year. Could we have a sense of what happened there that you expected to spend money on but did not?

MS SULLIVAN: It was due to less than anticipated consultant requirements in the Physician Services and Pharmaceutical division. The budget has been right-sized now for 2012-2013 based on our best estimate of what we think those demands might be for next year.

MS MICHAEL: Could you give us an idea of what it is that actually covers?

MS SULLIVAN: The breakdown is –

MS MICHAEL: The services that are offered, or the management of the services.

MS SULLIVAN: Yes. We are looking at – the big one would be certainly in terms of senior business analyst contract, NLPDP system enhancements, the Newfoundland and Labrador Interchangeable Drug Products Formulary, the NIDPF, the expert reviewer there.

The 65Plus working group would be another area. I am trying to see where the biggest ones would be. The pan-Canadian Oncology Drug Review would be another one of the big areas in that.

MS MICHAEL: Okay, that is helpful.

Thank you very much.

MS SULLIVAN: You are welcome.

MS MICHAEL: Under 1.2.04, I will not ask a question about salaries because we will get that information. Under subhead 05 Professional Services, you spent quite a bit less than had been budgeted for last year. Actually, $1.4 million less than budgeted and now this year back up to $1.5 million. What happened in that area?

MS SULLIVAN: Okay.

Basically, there are four reasons here that we can look to, to indicate why the budget was revised for 2011-2012. The first one was a savings of $250,000 for a review of the provincial ambulance program and that review will not occur until this year.

The second is $250,000 savings in relation to the review of the Home Support Program. While we did do a fair bit of review internally, we did not need to expend monies at that point in time to do the internal work that we did. For example, the audits that we conducted, Central Health did a financial audit; Eastern Health did a financial audit with the help of our department. There was a clinical audit that was done in Western Health and so on. So, none of those required monies from the budget to be able to do them because they were internal; however, this will be ‘reprofiled' into this year as we look to do an external review.

The big piece of this had to do with an $810,000 savings in the Access and Clinical Efficiency division. That new division that was created, particularly as we looked at wait time and when we looked to experts to help us in trying to clear up some of the wait time issues and the health operations reviews.

We did spend $180,000 of the – I think there was $990,000, close to $1 million that was allocated there. We did spend $180,000 of that. You will recall that we delivered our two wait time strategies within the first 120 days, as we had planned on doing.

We had also, in that area, budgeted for $400,000 for a peri-operative review in 2011-2012, which was completed by existing staff as opposed to going outside. So that $400,000 in Professional Services was not required. Then, the remainder of that is related to miscellaneous regional health reviews that were not required in 2011-2012.

MS MICHAEL: Minister, could you give us an idea of what the audit of the home support – I know it was not done by the department, but I am sure you have a report on that from the authorities. What exactly was the essence of the audit of the home support?

MS SULLIVAN: There were a number of different variances we found across regions that I recall as having seen. The results certainly showed, first of all, some variances across Regional Health Authorities that we need to look at and we need to tighten up. One of the largest things we learned from those reviews had to do with the growth in the programs, particularly with the home support end of that program. As a result of the improved access to the programs, there has been a huge increase in the numbers of persons now eligible for home support. That was one of the results of what we have found.

We found, in particular, that the emergency criteria as a requirement for admission to the program might need a second look at. Certainly, as we have identified in the House of Assembly in the last week or so, issues around the exemptions program and the fact that we need to do some work around that. That was certainly identified, and there were also some issues around consistent appeals processes throughout the program.

MS MICHAEL: Will the department be playing a co-ordinating role around this? Because you have talked about the variances under the various authorities, and that is a concern of ours that we do not have consistency throughout. What role will the department be playing then in trying to get some consistency in this area – in other areas too, but we are talking about his particular area.

MS SULLIVAN: One of the things that I think will be most helpful for us there, and there was money budgeted in this particular budget for it, is the implementation of the interRAI assessment tools. I believe those assessment tools will help us considerably – the MDS particularly in our long-term care facilities, but the interRAI tool itself for assessment within home support areas.

I believe that those tools will be very helpful for us in terms of trying to assess needs and determine that clients get the best care that they require. I think that tool, because it is the less subjective, more objective, will be very helpful to us. Certainly, it is our goal to ensure that consistency exists.

CHAIR: Thank you, Lorraine.

Dwight.

MS MICHAEL: Can I just ask one more related question to that, please?

CHAIR: Dwight?

MR. BALL: Yes.

CHAIR: Okay.

MS MICHAEL: Are those tools now, the same tools, in place in all areas or are you still working on getting it there?

MS SULLIVAN: The MDS tools are substantially implemented throughout the long-term care facilities. We are working on the implementation of the interRAI tools through the Home Support Program.

MS MICHAEL: Okay, thank you.

CHAIR: Dwight.

MR. BALL: Thanks.

Minister, when that happens, it will then be consistent through all authorities?

MS SULLIVAN: That is our hope, yes.

MR. BALL: I will ask the question: What would stand in the way for it not to be your hope?

MS SULLIVAN: Nothing will stand in the way of that. We are committed to that.

MR. BALL: Good. The right answer.

Under 1.2.05, Population Health, of course the big one that jumps out there would be 05, Professional Services and 06, Purchased Services. Both of those categories saw significant variances. Do you want to explain those?

MS SULLIVAN: So we are looking first of all at Professional Services?

MR. BALL: Sure.

MS SULLIVAN: In the sense of the variance between Budget and Revised?

MR. BALL: Yes.

MS SULLIVAN: I just want to make sure that we are looking at the same numbers here. There would be a difference or a decrease of $547,000, approximately, and that is made up of lower than anticipated consulting services in 2011-2012 in various divisions, including the public health division, the mental health and addictions – particularly there around the marketing campaign for raising awareness about mental health and addictions and the health promotion and wellness divisions, as well. So, primarily it is less than anticipated costs.

MR. BALL: So are those programs finished now?

MS SULLIVAN: No. If we look at mental health and addictions and the development of the marketing program and things of that nature, that is an area that we are very focused on and will continue to do –

MR. BALL: What is the name of that program there? Has it been christened yet?

MS SULLIVAN: Colleen, do you want to give us a name?

OFFICIAL: We have been referring to it as the e-mental health and awareness program.

MR. BALL: Okay, thank you. That is a good idea.

Under 1.2.05.06, Purchased Services, we seen the budget virtually cut in half and now back up to $807,500.

MS SULLIVAN: Those two are linked actually – the Purchased Services here are linked with the Professional Services. There is a $482,000 variance and I will explain it in two parts. The $82,000 variance is the result of savings due to lower than anticipated advertising and printing costs for the seniors' program, and the remainder of the savings, the $400,000, is in relation to the Mental Health and Addictions Division.

We originally had funding of $630,000 in that area for the development of the e-mental health and awareness program; $230,000 of that is under Professional Services that we just discussed and then $400,000 is under the Purchased Services here.

Significant work was done during the 2011-2012 budget year and we are working with a group of consultants actually out of New Zealand to do, I think, some pretty innovative work in that area. We will continue to work on that, and that is why you will see that we are going to continue to move some of that funding forward.

MR. BALL: I stand to be corrected, but this is about developing a program or something?

MS SULLIVAN: Around e-mental health.

MR. BALL: At the end of the day, what is the objective? What is it we are going to get – let's say if we fast forward to next year at this time, if we look back, what is it we expect to have?

MS SULLIVAN: There are two aspects to it. There will be an awareness campaign and a Web design, which are the two main components of this program, and we will put RFPs for both of them fairly soon.

MR. BALL: Okay, good.

Grants and Subsidies there, in bullet 10, are there a list of those?

MS SULLIVAN: Yes. We can provide you with that list if you like.

MR. BALL: Yes.

MS SULLIVAN: I am sure you do not want me to read them all out to you, but we will certainly provide the list.

MR. BALL: As long as they are in English.

MS SULLIVAN: We will arrange for that.

MR. BALL: We can move on to the Executive and Support Services– Lorraine, I do not mind if you have anything left in that particular category.

MS MICHAEL: No, that is fine. I have some questions, so I will wait. They are not line items. I will wait.

Thank you very much.

MR. BALL: Executive and Support –

MS SULLIVAN: Are we going back?

MR. BALL: I will draw your attention to 1.2.06, again to 05, Professional Services.

MS SULLIVAN: Sorry, I missed the category.

CHAIR: Under 1.2.06, page 16 –

MS SULLIVAN: So we are going back?

MR. BALL: I do not think we are going back, are we?

CHAIR: No, we are going forward.

MR. BALL: If you want to look at the page number, it is page 16.6 in the Estimates.

MS SULLIVAN: Okay, I have found it.

Your question again was in relation to –

MR. BALL: The Professional Services there, bullet 05. We went obviously from a budget of $1,100,000 down to $737,000, and then Estimates this year at $615,000.

MS SULLIVAN: The variance there is a result of several FPT initiatives ending and funding no longer being required therefore. That is about $304,000. It is also the result of our attempts to right size the budget for the department in that area. The bulk of it had to do with initiatives that were federal-provincial-territorial initiatives that have ended. Therefore, we do not need any monies to continue those.

MR. BALL: You know I am going to ask you the questions: What ones have ended?

MS SULLIVAN: Which ones have ended? Do I have a list of these? I think I might: the consultants' review of policy, HPV vaccine evaluation and research fund, the National Pharmaceutical Strategy, the HIA Secretariat, and the Atlantic Public Health Surveillance.

MR. BALL: Okay. That is pretty much it for that category.

Memorial University, which would be 2.1.01, Grants and Subsidies – we will need a list of those. You do not have to read those out either.

MS SULLIVAN: We do not have a list because all of that goes to Memorial.

MR. BALL: Okay, so you just give them the money –

MS SULLIVAN: We give them the money.

MR. BALL: – and do not ask?

MS SULLIVAN: Oh, we ask.

MR. BALL: You ask for me then, will you?

Just one question about a couple years ago, a couple of Budgets back there were some twenty seats that was for the addition to the School of Pharmacy: Can I have an update on that to see where those are?

MS SULLIVAN: For the School of Pharmacy?

MR. BALL: Yes, back two or three years ago there were some new seats. At the same time, there were new seats added to the Faculty of Medicine.

MS SULLIVAN: Yes, I am just trying to get an answer with regard to the pharmacy seats, first.

What is your question, specifically?

MR. BALL: At the same time the Faculty of Medicine seats were announced, there were some seats announced for the School of Pharmacy. I have not really heard anything about it since.

MS SULLIVAN: We are going to have to look into that for you. I am not sure about the seats for the School of Pharmacy.

MR. BALL: Okay, no problem.

The next one is 2.2.01, Drug Subsidization, the Provincial Drug Programs. The Professional Services there, we see almost – well, not quite a doubling of the budget this year, and that is for what reason?

MS SULLIVAN: The estimates there, the increase of $1.6 million in there is for a new agreement associated with the on-line, real time processing of claims that are submitted under our NLPDP. That previous agreement just expired actually on March 31, and the new contract is in the process of being finalized now for those services.

MR. BALL: You have a new adjudication system, you mean?

MS SULLIVAN: It will be a new agreement in terms of that on-line, real time sort of processing system there.

MR. BALL: I guess I have been away from it too long.

Allowances and Assistance under 2.2.01.09, you see a $10 million increase in those in that line item.

MS SULLIVAN: I am sorry; I am not seeing the $10 million.

MR. BALL: From the revised; the budget last year of $149 million.

MS SULLIVAN: Okay, from revised to estimates.

MR. BALL: Yes.

MS SULLIVAN: There are four areas there of increased investments. For NLPDP this year, of course, we spent a bit of time talking about that in the last little bit; 65Plus enhancements, of course; the new drug therapies; the new panel agreement and utilization increase would account for that $10 million. Of course, that will be offset by the anticipated generic drug savings of approximately $22 million as well.

MR. BALL: Do you have any idea how many new drugs you will have come off patent this year then, because there should be considerable savings?

MS SULLIVAN: Of the number of drugs?

MR. BALL: There has to be considerable savings there.

MS SULLIVAN: Colleen, would you know the number of drugs that came off patent this year?

MS JANES: I do not have the actual numbers that are anticipated to come off here with me. We could get that. We have done some horizon scanning, but certainly we know there are a number of major molecules anticipated to come off patent in the coming twelve months. In fact, those have been factored into the savings we are anticipating as a result of the new generic drug pricing policy. A precise number, I do not have with me.

MR. BALL: Okay.

One of the problems around that whole program has always been, and people would make the argument, that it does not respond fast enough. Is there a mechanism or any consideration given to getting generic drugs available to the interchangeable formulary faster? There should be a policy in place for that.

MS SULLIVAN: We have made huge improvements in that just in the last little bit of time. I do not recall exactly the numbers but I know even in terms of how often our committee meets to take a look at that, we have made huge improvements.

Colleen can expand on that, but your point is well made. It is a point that we have been concerned about as well; therefore, we have undertaken some work to see that that process is expedited.

Colleen, you can add to that around the detail.

MS JANES: The process for interchangeable review, the review of new generics that come to market in part is outlined in our regulations. There are two processes we undertake, and we utilize an expert review committee to assist us in each.

What we have done recently is change the frequency at which that expert committee meets. Versus seven times a year, we have bumped that up now to twelve times a year. That was in response to the knowledge that we do have a number of significant drugs coming off patent and we wanted to try to expedite moving those onto our generic formulary as quickly as possible. That is the most concrete change.

We have also done a review of our administrative processes associated with moving drugs on. There is some paperwork that needs to move from point A to point B behind the scenes, aside from the actual clinical review of the product. We are streamlining that to the greatest degree possible.

The frequency of the meeting changes is just very recent, within the last month or two. It will take a couple of months before we see how much we have gained in terms of our ability to list drugs more quickly.

MR. BALL: I have never seen an example, and you might have lots of them, I do not know. It would be interesting to know how many times a drug would be available generically and the committee would actually refuse to put it on the interchangeable formulary. Does that ever happen?

MS JANES: It does.

MR. BALL: Really?

MS JANES: There have been occasions where we have de-listed a drug that has been on the formulary because of reports of substandard quality of the drug product. I would not say they are frequent, but it does occur. Because of that we are very sensitive to some due diligence in our process and relying on expertise of committee members who are physicians and pharmacists and an expert reviewer to assist us with that process.

MR. BALL: I want to be clear here, you are telling me that we would have de-listed drugs that FDA would not have put out a notice of saying that they should not be on a schedule? We would have picked that up here in our Province?

MS JANES: There are two distinct processes that happen when a drug comes to market. Marketing license is one thing. Declaration of ‘interchangeability', which Health Canada does not do – it is beyond their mandate – is a separate thing. That is what our interchangeable formulary is about. It declares whether product A and product B can be switched without consulting the physician. It is a separate process, and over the course of the years we have certainly had occasions where we have had clinical concerns brought to the committee.

We will not automatically reach for de-listing. We will explore, and oftentimes we have entered into dialogue with Health Canada. In some cases we have had pharmacokinetic analysis done to have a look at product A versus product B in terms of how it is behaving and worked with Health Canada to try to resolve some of that, but there have been circumstances in which we have removed products from our interchangeable formulary over the course of years. It is not extremely frequent. In fact, I would say it is quite rare. It is a little more frequent to have products come to the committee where they have expressed some concern and have asked for more information before they will consider recommending a listing.

MR. BALL: Yes, that is fine. I asked that question more as a matter of public safety than anything. I would be very surprised –

CHAIR: Dwight, I am going to have to –

MR. BALL: Yes.

CHAIR: Okay.

Lorraine.

MS MICHAEL: Thank you very much.

I want to go back to 2.1.01, which is the money that is given to Memorial University Facility of Medicine. Because of the nature of the grant, the fact that it is a lump sum that is given, I am curious as to why there was a revision downward from the budget item. It went from $53.3 million down to $50.8 million.

MS SULLIVAN: The $1.7 million, closer to $1.8 million of that variance related to savings in operating funding for the Medical School expansion. The savings were realized due primarily to construction delays there.

MS MICHAEL: Okay.

MS SULLIVAN: The remaining $700,000-or-so in savings is related to accommodations for medical students in rural Newfoundland which was not spent in 2011-2012 due to implementation delays.

MS MICHAEL: Okay.

To understand it correctly, it is not just that the money is passed over. They also have to show that the money is going to be spent.

This is just out of curiosity now. Do they get the money at the beginning of the fiscal year or do they get it partway through or monthly?

MS SULLIVAN: We flow that monthly, yes.

MS MICHAEL: Okay, very good.

Thank you very much. That is clear.

MS SULLIVAN: Denise is a tight steward of the money.

MS MICHAEL: Okay.

Under 2.2.01; Minister, I would just like to get a bit of information, and I really am asking it for information. There is a lot of confusion in my mind because of all the things that have been in the media with regard to our legislative change with regard to the pharmaceuticals and the implications of the new legislation for the smaller pharmacies.

What I have been told – and this is what I want clarification on – and what I have heard is that there is going to be or there is a regulation with regard to pharmacies who apply for subsidization. If they are in a certain range to each other, two pharmacies, for example, if they are too close together would not both be able to get subsidization. Is that indeed the case?

MS SULLIVAN: You are talking about the remote subsidy here, which is valued at $1 million. What we have said here is that if there is a retail pharmacy that is the only one in the community and it is twenty-five kilometres or more away from another retail pharmacy, they would be eligible for a subsidy.

MS MICHAEL: If the pharmacy that it is twenty-five kilometres away from is in another community, does that count? It would seem to me that if they were both in the same community I can understand it. I do not know the distances here. I am just plucking them out of the air. Say you have two communities, totally separate, and they each have their own pharmacy, but they are closer than twenty-five kilometres. Do you mean that one of the pharmacies might have to shut down because of not being able to get the subsidy?

MS SULLIVAN: We are still in the process of working out all of those details and exceptions of that nature I am sure would be something we would take a look at. I would suspect there are not very many cases where we would have two pharmacies in rural Newfoundland that are within twenty-five kilometres of each other in any case. Those are things we would look at as we work through all of the specs with regard to the expenditure of that $1 million.

MS MICHAEL: Obviously, keeping a pharmacy in a community is really important for the sake of people, in particular seniors and others, low-income people, who may not have their own means of travel, et cetera. I would hope one of our goals would be making sure we would never have a community that has a pharmacy have to lose it because of our new legislation. That would be awful.

MS SULLIVAN: Yes, and it would be speculative to say that a pharmacy is closing down because of the new generic drug pricing model as well. There are all kinds of reasons why pharmacies might or might not close; however, when we sit down to work out the specifics of this $1 million expenditure that is certainly one of the conditions we are looking at.

MS MICHAEL: Thank you.

We can continue asking questions on that. I wonder, we do have a breakdown going back to 2010 of the numbers of people and expenditures in the different programs, so the number of people in the Foundation, the numbers in 65Plus, Access, et cetera, but our latest figures for 2010, could we have more recent figures of the numbers of the people in the different drug programs? You can both read it out and give us a copy.

MS SULLIVAN: Certainly.

MS MICHAEL: Thank you.

MS SULLIVAN: Okay.

What we have in terms of our statistics would not be the number of people, but we have a listing of the number of valid cards that have been issued.

MS MICHAEL: Right.

MS SULLIVAN: You are looking for the 2012 numbers?

MS MICHAEL: The latest would be great.

MS SULLIVAN: Okay.

Foundation numbers would be 45,766; 65Plus: 49,002; Access numbers: 36,370; the special needs, we are talking the Cystic Fibrosis: 108; the Assurance program: 6,134; the Assurance DCO, that is the drug card only, would be 634; and the extended drug card: 1,390; for a total of 139,404.

MS MICHAEL: Thank you.

There has been a fair jump in the past two years in numbers. If we could have a copy of that as well, that would be great.

Before moving on further, I think what I would like to do – and it makes it a bit more interesting – is to come back to 1.2.05, Population Health. I would just like to ask some questions that I think are related to programs under 1.2.05.

If I am wrong in thinking that what I am asking about is under that head, perhaps you can answer the question anyway because this has to do with not knowing the actual flow chart. Is the Healthy Aging research now under the Population Health area? If it is, could we have some idea of the research that is going on, the issues that are being addressed, and have there been any reports that we could have access to?

MS SULLIVAN: Yes, to the generic question of whether or not that is contained under that head. The answer is there, in the affirmative. In terms of any reports that we have at this point in time – Tracy, can you give us some idea of any reports that we might have available at this point in time?

MS KING: I did not bring the specific breakdown of the research projects, but that is something we can easily provide for you.

MS MICHAEL: We would very much like to see that. That would be great.

MS KING: Yes.

MS MICHAEL: Thank you.

Minister, with regard to the aging and senior secretariat, I am presuming that also fits under 1.2.05. What is the budget breakdown for the secretariat, the number of employees and budget breakdown?

MS SULLIVAN: We will have to get that for you and send it over.

MS MICHAEL: That will be part of that information probably that we have asked for.

MS SULLIVAN: Yes.

MS MICHAEL: Okay, that would be great.

Under the Healthy Aging Framework, what are the action items? Where are things going there? Once again, do you have reports of that? Do you have any kind of documentation that would give us an idea what you have been working on under that?

MS SULLIVAN: I can tell you that under the Provincial Healthy Aging Policy Framework we have expended $7.5 million in Budget 2011. Some of the programs and initiatives under the framework: the $400,000 under Age-Friendly Newfoundland and Labrador Grants Program would be there, the Ageless Public Awareness Campaign we had launched in 2008 would have been there, the Seniors of Distinction Awards would have been there – I am doing a scan of some basic notes I have here – and the $200,000 in the Healthy Aging Seniors Wellness Grants would be there. We can get you the details on all of those, if that is what you were looking for, if that would be helpful.

MS MICHAEL: Yes, that would be very helpful. Yes, please.

MS SULLIVAN: Of course, the Provincial Advisory Council on Aging and Seniors.

MS MICHAEL: Right. That would be helpful if we could have that detail.

A big concern for seniors, obviously, is housing. We all know the housing situation we are in, in the Province. There are many reasons why people, seniors in particular, are actually couch surfing. We do have that going on. We have examples of it. We have people being evicted from rental units because of costs going up, et cetera.

Under the various areas, the research, the work of the secretariat, or the Healthy Aging Framework, is that whole issue being looked at? Not being able to be housed would be a determinant of health. I am just wondering: Is it an issue that has been identified in any of the work that is going on?

MS SULLIVAN: It is not an initiative that the Advisory Council itself has taken a look at to this point in time. We can see what we can do about finding more information for you with regard to that particular issue. I understand what you are saying and I am sure that is an issue you are also going to bring up with Minister Hedderson when you get to look at the Newfoundland and Labrador Housing Corporation itself.

We can speak in general terms, but I do not think that is what you want in terms of affordable housing programs or any of that nature. We can take a look to see, within the department, how it is we are responding in these areas. It is a concern.

MS MICHAEL: It is a major concern because, as I have said, it is a determinant of health, having shelter, having good shelter, and not having to worry about having a roof over your head. I would be very interested in seeing the council actually looking at this as an issue.

MS SULLIVAN: Of course, we can get the information around the Affordable Housing Program and the 355 units that have been specifically constructed or are specifically available for seniors and the ninety-five fully accessible units. We can get you those sorts of information and the fact we have partner-managed housing, upgraded homes for example, 1,400 households – sorry, I was distracted by coffee. Eighty per cent of those 1,400 of course are for seniors. We can get you some more statistics around that.

MS MICHAEL: That would be helpful actually for us to see what is in actual place right now. I would appreciate that.

Thank you.

CHAIR: Last question for this round, Ms Michael.

MS MICHAEL: That is fine, thank you. I will come back to my questions.

CHAIR: Thank you.

Dwight.

MR. BALL: I will move down to 2.3.01, the Medical Care Plan, and Physicians' Services. Again, line item 05, Professional Services.

MS SULLIVAN: Under 2.3.01?

CHAIR: Yes, 2.3.01.

MR. BALL: Item 05, Professional Services, we see we were right on budget last year, so I imagine this is going to be a simple question for you. We do see some increase this year, and that is for what reason?

MS SULLIVAN: Negotiated increases with physicians as per our memorandum of agreement.

MR. BALL: That is what I thought.

MS SULLIVAN: That is primarily where it is, and expected unionization grants as well.

MR. BALL: Line item 10, Grants and Subsidies.

CHAIR: Same section, 2.3.01.10?

MR. BALL: Yes.

MS SULLIVAN: You are asking about the Estimates there again in terms of the increase of $5.5 million? That represents an annualization of a 6 per cent increase awarded to salaried general practitioners.

MR. BALL: Okay. Their pay comes out of that line?

MS SULLIVAN: Yes.

MR. BALL: How many salaried physicians do we have on the Island now?

MS SULLIVAN: How many salaried physicians? Larry, any idea how many salaried physicians we have?

DR. ALTEEN: We do an annual supply report based on March 31. Now, it takes a couple of months to get all of the data in. This report is based on last year's annual supply, but we had as of March 31 last year 1,096 physicians, of which 384 were salaried.

MR. BALL: How many?

DR. ALTEEN: It was 384 of the 1,096.

MR. BALL: Okay.

DR. ALTEEN: We should have another report sometime in May. It will probably be mid-May by the time we have that report done for this year.

MR. BALL: That is as of March 31, 2011?

DR. ALTEEN: Correct.

MS MICHAEL: (Inaudible).

MR. BALL: Sure.

MS MICHAEL: (Inaudible).

CHAIR: Yes, as long as it is agreeable.

Lorraine.

MS MICHAEL: Thank you.

Just so we do not have to go back to it, Dr. Alteen, does that figure cover just family physicians or family physicians and specialists?

DR. ALTEEN: That figure is family physicians and specialists. The breakdown of salaried physicians for family physicians is 167, and 217 were specialists.

MS MICHAEL: Thank you very much.

CHAIR: You are welcome.

Dwight.

MR. BALL: Thank you, Mr. Chair.

Under 3.1.01, Regional Health Authorities, Supplies is $1 million less than last year. Is there any reason for that?

MS SULLIVAN: Yes, what we have done is a review of our vaccine inventory and we have determined that the requirements for vaccines for 2012-2013 – we are able to meet our requirements there. As a result, that vaccines budget was reduced by $1 million for 2012-2013.

MR. BALL: Good, and good expiry dates.

I missed one. I have to go back to 2.3.02 Dental Services. In Professional Services again we are seeing virtually a 50 per cent increase there. I think I know the answer.

MS SULLIVAN: Again, that would have been the annualization in the negotiated increases.

MR. BALL: Lorraine, did you have any questions around Dental Services?

MS MICHAEL: Yes, I do, actually.

CHAIR: Okay, Lorraine, go ahead.

MS MICHAEL: Thank you very much.

I have a couple of questions. What is the uptake looking like now? A couple of years ago it was actually pretty low. Is the uptake, with regard to our dental services, improving?

MS SULLIVAN: I seem to recall that it is marginally improved, but I do not recall where those numbers are. If you give me a second I am going to find them, or Denise is.

Okay, so what we are saying, the uptake on the program now is considered to be exceptional, which certainly speaks to the need for the program. As services are cyclical, exams are every three years and dentures every eight, there will be expected peaks and declines in our expenditures, as this is the case for the first three months of this year of the program.

MS MICHAEL: All right.

MS SULLIVAN: I think you were asking particularly about the numbers, and I do not have numbers. I do not know if we can even get numbers on the specifics there, but I have been told that the uptake is much higher than it has been.

MS MICHAEL: Well, that is good to know. Have you been doing any extra educational programs or anything, or informational programs, to cause that to happen, do you know?

MS SULLIVAN: There is ongoing awareness always, and we have some done some programming around informing the general public about the availability and word of mouth – without any pun intended here – tends to get this information out whenever and wherever, but I cannot recall anything in particular that we have done. I am look for, Colleen –

MS JANES: I can answer a bit of information – there would probably be more that we would have to look for. In terms of specific numbers, on the overall dental program we would have to go look for that for you in terms of how the uptake has grown over the years.

As the minister has said, on the adult dental program, our experience has been that the uptake has been exceptionally good. We have made some gains on the broader dental program as well. By virtue of the attention the new program has gotten, I think that is also helping to build some general awareness, but we are certainly looking at and recognize the need for some broader information sharing to build awareness on the overall program in general, as well.

MS MICHAEL: Great, that is good to hear.

I just have one more question in this area, and especially because we are talking about adults and older youth you have mentioned. One of the issues, of course, for older youth and younger adults is the whole wisdom tooth surgery issue, and I am just wondering if thought is being given to including wisdom tooth surgery in the eligible benefits, because it really is a necessity when it becomes needed.

MS SULLIVAN: It is not something that was addressed this time around. Always, when we look at evolving programs we look to the professionals to advise us as to what the next needs are. So, certainly it will be a consideration.

MS MICHAEL: Thank you.

CHAIR: Dwight.

MR. BALL: Thank you, Mr. Chair.

Back to 3.1.01, and line item 05, Professional Services again; $130,000 last year, spent $696,100 and back to $130,000 this year. The question is about the revision.

MS SULLIVAN: That is a rather complicated issue. It is basically to cover off legal fees here on – I think it was a $2 million third-party liability claim. The lawyer representing the client represents us as well. If there is a big recovery then the cost of that legal case is borne here, and that was about the $600,000, I think.

Denise, can you give any detail with regard to that particular claim? It was a third-party liability claim.

MS TUBRETT: I do not have the detail, actually, for the claim, but it was a $2 million claim that we would have gotten from somebody who would have been injured and we would have provided medical services to them. We are a third-party in the claim process so then if there is any settlement we will get a share of it as well. It is $2 million, which we have received.

MS SULLIVAN: I thought it was $600,000?

MS TUBRETT: $600,000 in legal fees.

MS SULLIVAN: $600,000 in legal fees, yes.

MR. BALL: Yes. The rest of the $130,000, that is just a number –

MS SULLIVAN: That is just going back to our regular estimates.

MR. BALL: Yes, line budgeting.

The Grants and the Subsidies there, line item 10, I imagine this would be going to the four Regional Health Authorities?

MS SULLIVAN: Yes.

MR. BALL: I am wondering if you could provide us a breakdown of the grants for each authority this year.

MS SULLIVAN: Okay.

For the four Regional Health Authorities, and I will give approximate numbers unless you want the –

MR. BALL: No, to the dollar is fine.

MS SULLIVAN: For Eastern Health, $1.1 billion; for both Central and Western, $290 million; and for Labrador-Grenfell, $131 million.

MR. BALL: Western and Central, you said $219 million or $290 million?

MS SULLIVAN: I said $290 million.

MR. BALL: Okay.

The next question would be about the accumulated deficits, where they actually sit now.

MS SULLIVAN: I am sorry, where they –

MR. BALL: Where they are right now, the accumulated deficits for the four authorities?

MS SULLIVAN: Accumulated deficits for Eastern Health as at March 31, 2011 would be $71.9 million; for Central Health, $18.5 million; Western Health, $19.8 million; and Lab-Grenfell, $20.5 million.

MR. BALL: When will we get the more recent numbers?

MS SULLIVAN: In June.

MR. BALL: In June?

MS SULLIVAN: Yes.

MR. BALL: Do you have any idea what is going to be required to cover off the deficits this year?

MS SULLIVAN: For this year?

MR. BALL: Yes.

MS SULLIVAN: Okay.

For Eastern Health, $12.4 million; for Central Health they are actually balanced, as is Western Health; and Lab-Grenfell $800,000.

MR. BALL: Okay.

So we need to send letters of congratulations to Western and Central.

MS SULLIVAN: Good, hard work there.

MR. BALL: You got that right.

In 3.1.02, Grants and Subsidies again, that number has not changed. I am just wondering what they are.

MS SULLIVAN: I am having trouble finding that one. I need to back up, 3.1.02.

Your question again, I am sorry?

MR. BALL: The Grants and Subsidies, and you can provide us with a list of that for later if you want to.

MS SULLIVAN: Yes, and I have pages and pages of that. I would certainly be happy to provide it. If we are tired, I would even read it out.

MR. BALL: That is for community agencies, so it is nice to see that.

I did miss Debt Expenses, if we could go back to 3.1.01. That is line item 11, Debt Expenses. It has not changed much. I am just wondering what that covers, what debt?

MS SULLIVAN: Debt Expenses, your question was around?

MR. BALL: Where is that debt? It is $3.2 million.

MS SULLIVAN: Funding is included for debt expenses which represent the cost of lease payments for the Province's health centres in three communities: Burgeo, Port Saunders, and St. Lawrence.

MR. BALL: Okay.

MS SULLIVAN: Is that enough?

MR. BALL: Yes, I know now. I know exactly where it is.

MS SULLIVAN: Harbour Lodge I believe is in there as well. Yes, Harbour Lodge Nursing Home in Carbonear as well.

MR. BALL: Yes.

Now moving along; Health Care Equipment, that would be 3.2.01.07 Property, Furnishings and Equipment, $58 million. I guess that is an assortment.

MS SULLIVAN: Yes. Do you want the breakdown?

MR. BALL: No, I am fine with that.

MS SULLIVAN: Okay.

MR. BALL: Professional Services in the next one, 3.2.02.05 Health Care Facilities –

MS SULLIVAN: In 3.2.02 or 3.2.03?

MR. BALL: 3.2.02.

MS SULLIVAN: Okay, and Professional Services?

MR. BALL: Professional Services, yes, we see a huge swing there.

MS SULLIVAN: Okay.

You are looking at Professional Services, and you are looking at the revised from $23 million to $13 million?

MR. BALL: Yes, and then down to $9 million.

MS SULLIVAN: All right, and we are going to find the same answer right throughout this whole subhead actually.

The department has a number of infrastructure projects in various stages of construction and planning, like preparation and so on, and as a result, each of those projects will require different levels of funding in any given year depending on how prepared they are or how far along that particular project is.

For example, in 2011-2012 we budgeted for the new St. John's long-term care facility and the budget for the project dropped again. Over last year's budget, that budget dropped this year as the project reaches completion and so on. This is a Transportation and Works issue, more than it is ours. We work in conjunction with Transportation and Works but more realistically, because it is our project, the budget flows out of our coffers if you will, but Transportation and Works actually has oversight on the project.

MR. BALL: Okay.

MS SULLIVAN: You will find that right throughout this particular subhead.

MR. BALL: Then 06 in the next line, Purchased Services.

MS SULLIVAN: Yes, that would be the same thing.

MR. BALL: The same thing?

MS SULLIVAN: Absolutely. In all of these, everything right throughout this whole section you will find the same thing. It is TW primarily, and we flow the money.

MR. BALL: What is the percent completion now for the long-term care site here?

MS SULLIVAN: Of which one?

MR. BALL: In St. John's.

MS SULLIVAN: Tony, do you have those with you? I had them earlier, but I do not have them with me today. Long-term care is –

MR. WAKEHAM: I do not know the exact percent, but I can certainly get it for you.

MR. BALL: Yes, it is quite the building.

MS SULLIVAN: We will get that percentage for you.

MR. BALL: Okay.

CHAIR: Lorraine.

MS MICHAEL: Thank you very much.

I am going to start there and probably work backwards with 3.2.02.

I think, Minister, if we have done our research correctly, there were four new infrastructure projects in the 2011 Budget and there were, I think, seven continued infrastructure projects. There may be more than that; there were seven key ones that we picked out.

My question has to do with, for example, the Waterford. In 2011 there was $4.5 million that was to begin the planning for the replacement of the Waterford Hospital. In this Budget there is no mention of the Waterford Hospital, so I guess what I am asking for is the status of the $4.5 million planning that was supposed to have started over this past year and is that a continuing thing that is still going on.

MS SULLIVAN: Absolutely. You would have noticed in this year's Budget that we invested $750,000 in the forensic unit at the Waterford this year and that is because we intend to maintain and ensure that the patients who are there are served by the best facility that we can have in place at this particular point in time.

In terms of the monies that were allocated for planning, that money will be ‘reprofiled' and moved forward – the $4.5 million I seem to be recalling there.

We have a couple of committees in place. First of all, there is a committee that involves my department, the Department of Health and Community Services, Transportation and Works, and Eastern Health who have done some preliminary work and in-house planning, if you will. We are in the process right now of looking for stakeholders to serve in an advisory capacity as well. So we will continue to work forward on the planning of that.

When we talk about some of these infrastructure builds that we are looking at, it has been a long time since any government has undertaken anything of this magnitude in terms of the Waterford Hospital, for example. It is too bad Mr. Joyce is not here this evening, but the Corner Brook facility as well.

Our job, I think, is to make sure that we are spending the taxpayers' money as wisely and as efficiently as we can so what we are getting for the taxpayer of the Province is the best facility that we possibly can to serve the needs well into the future, and you have heard me say this in the House and I will continue to say it: The planning that we are doing around it is not simply about replacement. It is about ensuring that the facility that we erect and the essentials that we provide in those facilities are going to meet the needs of Newfoundlanders and Labradorians, not just today but well into the future. So that does take some fairly detailed planning and it is that that we are committed to.

MS MICHAEL: Have you set a date or any kind of hopeful date for the replacement of the Waterford?

MS SULLIVAN: I have not set a date. Within the department I do not think we have actually ever put a number on that. I have heard that it takes many years to get the actual planning done and then to be able to move forward with the construction but to my knowledge – Bruce, unless you have something to add to that – we have never put a date.

MR. COOPER: Of course you need to have a plan before you can move forward and understand what the date is, but certainly our goal for this year is to conclude with a good functional plan and then once we pass through that important gate and stage, we will be in a better position to plan the full project.

MS MICHAEL: Have any consultants been contracted to work with you in this planning stage, or is it all internal?

MS SULLIVAN: Not at this point in time. We have done internal planning at the outset, but there will come a time when we will need to go to external consultants as well. So that money is there – that $4.5 million is there to be able to help us do that.

MS MICHAEL: Okay, thank you.

Moving backwards, it is sort of related to 1.2.05, but not really from a line item, so you do not really need to go back there. I just had a couple of more questions with regard to seniors that I wanted to ask. I do not know if this one actually comes under your department or not, but it has to do with the seniors in receipt of Income Support who were forced to take the early CPP and now that has changed. That is not under your department, is it?

MS SULLIVAN: No, it is not.

MS MICHAEL: Okay, fine. We will ask that to the appropriate minister when we get there. Where would that be, under Advanced Skills?

MS SULLIVAN: I would think AES, yes.

MS MICHAEL: This is where it is really confusing to know where to go with some of the issues.

MS SULLIVAN: Sure.

MS MICHAEL: So you think that is under Advanced Skills?

MS SULLIVAN: I would think that.

MS MICHAEL: Okay, thank you.

A couple of others with regard to seniors – with regard to the Aging Advisory Council, have they done a report of activities yet? Have they annual reports? I mean, if they do, we will go to them and get it.

MS SULLIVAN: They did just recently release – it seems to me that I have seen one of their reports recently or maybe it is just in my process of getting fully immersed in the department that I have seen a report, but there are reports from that group, yes.

MS MICHAEL: Where are they physically located, the staff for the council?

MR. COOPER: They are in our department, West Block, third floor.

MS MICHAEL: Okay. We were not sure if they were actually there or not, so thank you very much.

Could we have an update – this is not seniors, but again still health – on the mental health and addictions treatment facilities especially the ones for youth, where things are in the planning stages?

MS SULLIVAN: A big priority – it is something that I want to see moving forward very quickly. I have let staff know that on a number of occasions. So, where we are with that at this point in time, we have completed the tenders. The tenders have come back. We are in the process of reviewing those tenders for construction on both of those treatment centres in Grand Falls-Windsor and in Paradise. They are being evaluated, and I would hope that we are going to see something happen on that very, very soon.

MS MICHAEL: Okay, so the sites have been finalized in both cases?

MS SULLIVAN: Site preparation has been done in both places.

MS MICHAEL: Great.

Minister, I know that very often advisory councils – it is the practice; I know because I have been on advisory councils in the past. They very often change with ministers. I am wondering about the status of the mental health advisory council that I know was in place with the minister before you.

MS SULLIVAN: The council itself is certainly still in place. I think the full complement is there, so I have not changed that council at all. I am very pleased with the work that is happening there.

MS MICHAEL: That is good to hear because I had met with some of them and I know the issues that were coming up, so it is very important that they are there. I am really glad to hear that.

One of the issues that I know has come up on the council is the whole issue of methadone. For me, there are two different issues and I think for some members of the council it is probably the same. One has to do with the waiting list for methadone and what is happening with that. The other has to do with the use of methadone and should methadone be used for younger people in the same way it is for people who have had the addiction for a long time.

I know there is a lot of research being done into that. Knowing the nature of methadone, I think there is a real reason for being concerned about putting teenagers on methadone. I would just like to know where that discussion is at the moment, but I would like to know also about the waiting list and what is happening with that.

MS SULLIVAN: Okay.

I can tell you that as of January of this year there were 880 clients on methadone maintenance treatments in Newfoundland and Labrador, which is roughly about the Canadian average as well. The methadone clinic here in St. John's provides methadone to about 125 of those clients and the others go to private physicians for the provision of that methadone. I understand that a second part-time physician has been added to the clinic here in St. John's and he has begun taking patients. There is some movement in the wait-list there.

In February, 180 clients were waiting up to about eighteen months, but the wait-list is reducing each week as that new physician starts his practice here. Hopefully, we will start to see some improvements in that wait-list.

I do not pretend to be a physician or understand very much about the need to prescribe and at what age methadone is to be prescribed. I would ask Colleen Simms, who is somewhere back of me – Colleen can provide some of the additional information, I believe, that you are looking for around use of methadone and appropriate ages and times to use.

MS SIMMS: Yes, methadone is just one treatment of course in a whole continuum of services that should be offered. While there may be at times youth who do need to go on methadone, it is usually because of their individual circumstances.

It is related to the fact that they may have been using drugs for a number of years. There may have already been other things tried. All of those things need to be taken into consideration, particularly for youth who are under the age of about twenty-three or twenty-four when the brain is still developing.

The important thing is to look at the continuum. There are still times when that will be considered the first option for youth; however, it is infrequent.

MS MICHAEL: Okay.

I am just wondering, Minister: Is that then monitored by your department, the use of methadone with youth?

Your staff person said it is infrequent, so how do we know it is infrequent? Is it because you actually do monitor?

MS SULLIVAN: Within the division itself, Colleen can speak again more directly to the monitoring that is done. It is certainly an issue we have been concerned about. The monitoring, Colleen, is done within that division.

MS SIMMS: I can speak to it again.

Yes, within the methadone clinic in Pleasantville we get regular statistics. Right now, there are only a small handful of youth who are receiving methadone treatment and have been for some time. In terms of the numbers the minister just quoted, a very, very small percentage of youth are on methadone.

MS MICHAEL: That is good to hear. Thank you very much.

A few more questions here, if I may.

MR. BALL: I have a few questions on methadone, while Colleen is all warmed and primed back there.

MS MICHAEL: Sure, go right ahead.

CHAIR: Dwight.

MR. BALL: Thank you, Glenn.

One of the issues around methadone clinics is, of course, we do not really have a prescriber on the West Coast at all now and it is creating a huge problem. The closest prescriber right now would be in Grand Falls with a significant wait-list there. I do not know what the department plans to do there, or is there anything being done at all? It has been like this from day one.

MS SULLIVAN: Recruitment is a difficult issue there for sure, in terms of being able to find physicians who want to work in this particular area.

Again, I defer to Colleen to give you some more specific detail around what we are doing.

MS SIMMS: Yes, just to confirm that. On the West Coast we do know that there is a particular issue there. We have a methadone nurse who supports people who are receiving methadone maintenance treatment, and we just recently set up video conferencing so that clients who are on methadone can access their physician through video conferencing through Telehealth, but that is not going to meet the full need. So we need to continue to look at that for the West Coast in particular.

In Central, there is a physician prescribing. It does not present as much of an issue, but for the West Coast we have set up the Telehealth.

MR. BALL: Would that nurse be able to change dosing?

MS SIMMS: No, she is there to support the client and to assist with connecting with the physician who is in St. John's, and to case manage because as you can appreciate, somebody who is receiving methadone maintenance treatment is not just receiving the actual medication. There are a lot of supportive services that should be in place as well, addictions counselling, and follow-up.

The goal of this treatment really is to help people get back into their lives, get back to education, and get back to their employment. So, she performs some of those functions as well.

MR. BALL: Have you put any thought into having a visiting physician?

MS SIMMS: I do not know that the Regional Health Authorities have particularly looked at a visiting physician, but I do know there has been a tremendous effort made in trying to recruit physicians. The physician recruitment issue for this, in particular, has been problematic. That is why we have gone to the Telehealth route.

MR. BALL: In all fairness, the problem is probably ten years old. I do not think we have – maybe once have we ever had a physician. No, we have never had a physician out there to write methadone. There was a psychiatrist out there who did it years ago, but I can guarantee you it is about ten years now. Obviously, the recruiting is not going to work and seems unlikely to work.

This is another example of where we get the inconsistent service from, obviously, Western into Central and into St. John's right now. I can assure you, it is a big problem out there, not having that physician available. So, I would really like for you to look at, at least a visiting physician.

In most cases, you actually have to bring all those people into St. John's or into Grand Falls somewhere. You know the type of clients we are dealing with here. There is not a lot of money involved and they are highly motivated – at least when they get to methadone maintenance treatment, in most cases they are highly motivated and want to get on to the next stage of their life. So, I think consideration for at least a visiting physician would be something you need to look at, given the fact that there has been zero success for many, many years now.

MS SULLIVAN: I am going to ask Dr. Alteen to address that issue around recruitment, particularly out on the West Coast.

DR. ALTEEN: The issue is of importance, as you have mentioned, in terms of the recruitment as well. Obviously, the stigma that is attached to mental health, the difficulty that some physicians have in terms of being associated with the prescribing and the challenges that come with that, but I think as we build over time some stability in the physician workforce, I think in different areas, we can do better jobs at engaging them in terms of being involved with methadone treatments and with mental health issues in totality.

In terms of the travelling perspective, when you have limited numbers of providers it is very difficult to take your time and go somewhere else but at the same time appreciating that moving all of those individual patients from a community to another place is just as difficult. We have been spending some time, not just in this area but a number of areas, where we are trying to build a capacity for physicians to travel to different areas to provide services rather than the population moving to where the physicians are. It is an ongoing discussion we are having at the regional health authority levels and certainly my discussions with the VPs of medicine at those areas trying to expand on that.

One appreciates what you said, it does take a period of time to try and get that engagement. Physicians, for whatever reasons, with methadone have the option of saying I do not wish to prescribe methadone and get involved with that. We have to break down that stigma and the difficulties associated with that.

CHAIR: Lorraine?

MS MICHAEL: Thank you.

A few more questions, this has to do with regional services. Again, it is not so much line items but to see where things are with certain programs, et cetera.

Minister, we know there is going to be a pilot project at St. Clare's that the NLMA, Newfoundland and Labrador Medical Association and Eastern Health are going to be doing with regard to creating sort of this centre with regard to seniors who come into ER and to provide a program that will be a more holistic way of dealing with seniors.

Is the department involved with that at all, or is this just NLMA and Eastern Health together?

MS SULLIVAN: I am assuming that you are referring to the new wait-time strategy for the emergency room departments over there where we looked at a community support service over there that would allow us to provide to seniors who come into the emergency department a rapid response sort of program.

MS MICHAEL: That is right.

MS SULLIVAN: What happens is that quite often seniors come in and they need attention but they need someone to help them with that attention at home. So, if a senior comes in and does not have anybody at home who is able to provide that care to them, oftentimes what happens is that the only other alternative is to admit.

What we have done with the rapid response is committed to having a home support style program in place for them for a couple of weeks so that somebody can actually be with them to help administer their care over the period of the week or two where they would need that care, and that would be necessitated as opposed to having to admit.

MS MICHAEL: Has that already started? I did not think it had started.

MS SULLIVAN: Not started, but it is certainly part of that new wait time strategy that we have put in place for them.

MS MICHAEL: Will all of the work that is being done on the ER in St. Clare's allow for space for this program to take place? Is that part of the consideration?

MS SULLIVAN: Yes. The space is not necessarily what is needed there. It is the consultation and then the organization around the home support that would be required to be able to send them home as opposed to admitting.

MS MICHAEL: I guess what I mean by space, I think actually space is required because if you are going to give special attention to a senior who comes in, I think you would need dedicated space so they can be dealt with quickly and not be just in the waiting rooms. From that perspective, I think, in actual fact, the program is going to require space to have it operate well.

MS SULLIVAN: One of the big issues we have addressed and are trying to expand on is patient flow within our emergency departments.

One of the other components of that particular emergency department wait time strategy that we put in place would be the CTAS evaluation that would allow us to evaluate patients when they first come in whose time with a physician or a nurse practitioner does not need to be lengthy, it might be something fairly simple. We are in that process, trying to design an area of the emergency department where we can sort of channel them to go and have that fast – be seen a little bit more quickly and not be out in the general waiting room population. We are very concerned about efficiencies within the patient flow of our emergency departments and we are working toward that.

CHAIR: The last question, Lorraine, for this round.

MS MICHAEL: Okay.

For this round, okay; the last question for this round.

CHAIR: I am assuming it is this round.

MS SULLIVAN: There is going to be a bell, I am sure.

MS MICHAEL: There are a few more.

The last question for this round; I know that we do have the announcement on the wait times with regard to the joint replacement and the ER, and that is good.

Do you have a long-term plan in place with regard to some of the other wait times, especially to the wait times that have to do with specialists, such as rheumatologists and physiatrists?

MS SULLIVAN: Certainly, through our Access and Clinical Efficiency division, that new division that we have created over there, one of the fundamental tasks of that division is to look at wait times generally.

In terms of recruitment of physicians, that is an area that Dr. Alteen looks after and does a very good job of looking after. It is an area that we always focus attention on in terms of being able to attract to this Province the physicians that we need in the areas in which we need them, and I think the MOA that we struck last year has made a huge difference there. We have more physicians practicing in Newfoundland and Labrador now than we ever did. We have more nurse practitioners, we have more nurses, and we have more LPNs. We are looking to fill the gaps in all of those areas, and it is a process.

MS MICHAEL: Could we have – I am sure you have documentation on where things are at the moment, how things have improved, especially with the new MOA et cetera. That would be really great to have that.

MS SULLIVAN: Absolutely.

MS MICHAEL: So we get a sense of how things are moving.

MS SULLIVAN: You are talking in terms of the numbers of physicians that we have been able to attract and so on.

MS MICHAEL: That is right, yes.

MS SULLIVAN: Yes.

MS MICHAEL: And show a comparative analysis of that.

MS SULLIVAN: Sure.

CHAIR: Thank you, Lorraine.

MS MICHAEL: Thank you.

CHAIR: Dwight.

MR. BALL: I will do one follow-up on that too, that chart that you have mentioned there, it should include nurses and nurse practitioners? Actually, I am not surprised that there are more nurses, not surprised that there are more physicians but I am surprised to hear there are more nurse practitioners.

MS SULLIVAN: We actually were out of the gate a little earlier than many provinces, in Newfoundland and Labrador in terms of nurse practitioners. While our number of nurse practitioners per capita may have slowed down a little bit over the last two or three years, it is because we were out ahead of everybody else. We have I think 105 – my memory does not always serve me well at this hour in the evening, but I think 105 nurse practitioners right now.

MR. BALL: Yes. What I would like to see there, as Dr. Alteen compiles that chart, would include all three disciplines. Of course, nurse practitioners who are actually working because I knew some who were only working part-time.

I am going to move some questions now towards some of the long-term debt within the Regional Health Authorities again. The question being, has there been any plan to retire this debt now? Some of this has been around for quite some time. I know the current debt you do pay off every year but some of it has been around since 2005 maybe or the six amalgamations of the boards.

MS SULLIVAN: It is a complicated bookkeeping piece. You are right in terms of year over year and the stabilization funding we have been providing, that has been ongoing for a little while. Of course, one of the things we challenge our Regional Health Authorities to do year over year is to find efficiencies within their boards and to be able to operate within the funds that they are allocated.

The long-term debt is a complicated piece of bookkeeping that Denise constantly tries to explain to me. So I will let her do it one more time.

MS TUBRETT: As you said, the operating deficits of the Regional Health Authorities, their annual deficits, we deal with them through stabilization funding. As the Minister pointed out, in 2011-2012 two of the four RHAs had operating deficits. Two did not. Two actually had surpluses.

With respect to the long-term accumulated deficit, that has been there long before the RHAs have in fact come together. I believe they came together in probably 2004, 2005. Since that time, that actually has not increased. If anything, it has been decreasing.

With respect to how to deal with it on a longer-term basis, the plan would be to have the RHAs get themselves in a financial position where they can start to pay down on the debt so they can reduce it. For example, in the case of Central and Western this year, both of those Regional Health Authorities will be making payments to reduce their accumulated deficit.

MR. BALL: Okay. So that was not balanced budgets. That was actually surpluses?

MS TUBRETT: Yes, they were surpluses.

MS SULLIVAN: Small surpluses.

MR. BALL: Yes, okay.

MS TUBRETT: Central Health had $250,000 and Western was $3.6 million. It is important to point out that the year-end still has not closed off, so these are projected numbers. These numbers will vary. The audited financial statements will not be completed until June. Until that time, these are really projected numbers that could change either way. Generally, this is the trend we would expect them to go in.

MR. BALL: Yes. Obviously, then what happens is this carrying cost, this debt load is still paid for by the respective boards. I am just wondering, since some of it has been around for quite some time, I would imagine some of the interest on some of those loans is not that attractive.

MS SULLIVAN: This is the complicated part that Denise keeps trying to educate me on. There is no interest. Again, I am going to allow Denise to try to explain. Denise realizes it is a complicated piece, but she will go through it again.

MS TUBRETT: From a financial perspective, the balance sheet, this is really accounting oriented. From the balance sheet, this is a paper debt to a certain extent. So there are no interest payments on it. It is a culmination of assets less liabilities. Obviously there are liabilities that RHAs are paying interest on in any given year, but their accumulated debt is the liabilities less the assets at the end of the day. It is accumulative over the years.

MR. BALL: When Eastern Health does their financial statements and they talk about interest on long-term debt?

MS TUBRETT: That would be something different than the accumulated debt.

MR. BALL: Okay. I was not aware of that.

MS SULLIVAN: I told you.

MS TUBRETT: Obviously, the Regional Health Authorities will have debt payments they are making probably for mortgages, or it could be any number of things. It could be lease of equipment, those types of things. That is what they are talking about. This is the accumulated deficits of each and every single annual year since the RHAs have been reporting.

CHAIR: Okay.

MS MICHAEL: Can I just ask a question there?

CHAIR: Sure.

Lorraine.

MS MICHAEL: Thank you.

My understanding is, if I am correct, that debt, though, as you have described, does show up in a Consolidated Revenue Fund.

MS TUBRETT: Yes.

MS MICHAEL: In the Consolidated Revenue Fund you then have a combination of debts that are real cash debts and the debts that are the accumulated debts which are the assets minus the liabilities.

MS TUBRETT: Very good. I am impressed.

MS MICHAEL: Thank you. I am pretty good at that stuff.

MS TUBRETT: Really impressed.

MS MICHAEL: Thank you.

MR. BALL: There is no cost to the authority for that debt?

MS TUBRETT: There is no cost to the accumulated deficit, but the RHAs do have debt-related costs they incur on an annual basis.

MR. BALL: Outside of all of that?

MS TUBRETT: Yes, and that would detailed on their financial statements.

MR. BALL: Yes, that is fine.

We covered off the methadone. Community care homes – right now, there has been some confusion around some community care homes and personal care homes, that they actually serve two different types of clientele, yet the funding mechanism is the same. Is there any reason for that? It would be Colleen, I guess.

MS SULLIVAN: I am sorry, I was not clear on the question – on which homes?

CHAIR: You have to go through the minister, Dwight.

MR. BALL: Pardon me?

CHAIR: You have to go through the minister.

MR. BALL: Okay.

The community care homes – I think what happens is most of the program funding is actually compared to that of personal care home, yet we get community home operators trying to make a distinction between the two. I am just wondering why it is, as a department, that you basically took the two and treated them the same, being the community care homes and personal care homes, in terms of the funding.

MR. COOPER: Just to clarify, when you speak of community care homes, you are referencing the homes that are largely out around the CBS area –

MR. BALL: Yes.

MR. COOPER: – that are an important part of a program of Eastern Health where they care for individuals who may have been deinstitutionalized. You are asking for comparison between the community care homes and the personal care homes?

MR. BALL: Yes, because the funding is basically the same really, is it, per client?

MR. COOPER: I think there may be some nuances, some differences, depending upon the needs of the client, but essentially they are a very similar type of program. There are some different allowances that have been put in place and different services for persons in the community care home program because of their affiliation with Eastern Health.

I just want to turn around to Colleen and see if she can clarify anything there.

MS SIMMS: The community care homes were originally part of the Waterford Hospital many years ago and then when the personal care home guidelines came out – and I am not sure of the exact year of those, but it was at least eight years ago, somewhere around there, and I stand to be corrected on that – community care homes were made part of the personal care home system. They have been part of that, so they have gotten all the same rate increases, they have gotten all the same adjustments and benefits as the personal care homes have.

There are some distinctions in the terms of the population because those homes have people with mental illness, but they also have people with intellectual and developmental disabilities as well. It is not a pure distinction because you will see throughout the personal care home system people with the same kinds of disabilities and challenges. I guess the beginning of that program was a little bit different from the personal care home system, but they came together roughly seven or eight years ago.

MR. BALL: Okay.

We will ask a few questions maybe around the personal care home side of things. I am just wondering about the small homes. Last year there was a grant for small homes. How did that program work out and what was the uptake?

MS SULLIVAN: The uptake on that program, as I recall it, for the small homes grant program was thirty-nine homes availed of that particular grant. The isolation grant on the other hand, the uptake was not very big; in fact, I think there was only one home that availed of that, if I am remembering correctly. Is that the number?

OFFICIAL: That is right.

MS SULLIVAN: One home that availed of the isolation grant.

MR. BALL: What was the isolation grant?

MS SULLIVAN: It is basically a grant for those homes that are in communities that are isolated. They are a good distance away from any other services that could be provided.

MR. BALL: Okay.

One thing that we have been getting that I have heard a bit about in the last few months is about some of the assessment tools. Again, it speaks to the consistency from one authority to the other. In this specific case I know it has been a senior – actually the calls came into our office. When they started calling, there was actually two or three of them who actually came in together. That was about preparing the assessment tool for placement into the homes. There seemed to be a delay.

Central seemed to be doing a much better job. I know some of the homeowners I have spoken with in the Central area seem to be doing much better, whereas some of the ones on the West Coast have been really struggling trying to get through at least the financial piece of it. I do not know if there is any role for the department to play there.

MS SULLIVAN: I am not sure exactly what assessment tools you are referencing here.

MR. BALL: That would be the financial piece. Typically it all gets bottlenecked at the financial piece, which is really the last piece. What happens is the senior would go out and collect all of the information through a medical. What happens then is the financial piece goes through some person. This has to be completed. Once that is done, obviously you get the approval to move into a home. I know it has been very frustrating for some residents on the West Coast.

MS SULLIVAN: I think Tracy is aware of this particular case and she can provide you with some clarification around that one.

MS KING: In Western Health last year there was a particular issue where they were experiencing a period of delay. Western Health has reviewed the issue that was causing an abnormal length of time for some of those assessments. We expect if that issue has not turned around yet – we see a big improvement already was the last report I had. We think that issue has been sorted.

MR. BALL: Good, that is nice to hear.

The Long-Term Care Strategy – I am sure the minister is not going to be surprised to hear about this – we have heard is going to be in a few weeks.

Is that still on track? When do you expect to have that released?

MS SULLIVAN: The Long-Term Care Strategy is a piece of work that is complicated as any piece of work I have ever looked at. It is a strategy that is exceptionally important and it is a strategy that I have committed to getting out. I will see to it that the strategy gets out.

I know you want me to put a date on it, my department wants me to put a date on it, and I will not do it. I will tell you it is coming soon. We are working – I wanted to say around the clock, and some days I think we are. We are working diligently at getting that strategy out.

Again, it is a strategy that is going to be in place for some time. So while we can tweak it, and it will be a living-document strategy, I really want to make sure the foundational pieces of it are as thorough as we can possibly make it. I have committed to getting it out. One way or another, that strategy is coming out soon.

MR. BALL: Well, it sounds like a commitment. I hope it is not our names using the long-term care homes. It is important, I agree, and it has been around for quite some time now. It is important that we –

CHAIR: Time for one more question, Dwight.

MR. BALL: Yes, I want to go right back to Cameron. There were sixty recommendations there.

Are all of the recommendations from Cameron implemented now?

S SULLIVAN: We have fifty-five of the sixty recommendations either fully implemented or substantially implemented. There are three others that we are working on right now that we hope to be able to implement in the very near future. Again, it is a work in progress and a work that we are very focused on in ensuring that the correct work is done.

Accreditation of laboratories is one of the areas, and I can report that the major laboratories in the Province have been accredited. We are working forward on some of the smaller – in fact, it was just this past Friday that Tony and I, and the CEO at Central Health met to talk about some of the issues around accreditation of our smaller laboratories. It was a real eye opener for me, actually, to see some of the work that needs to happen in some of our smaller laboratories in order to get them accredited.

It is something I can tell you that all of our RHAs are committed to seeing through and the implementation of that accreditation – or the work to see that the accreditation is complete soon is certainly ongoing and I expect to hear more everyday.

CHAIR: Thank you.

Thank you, Dwight.

Lorraine.

MS MICHAEL: Thank you very much.

A few more questions; I will stay with the long-term care for a minute, but particularly with regard to the budget item in the personal care homes. I think you have budgeted $612,000 for 100 new portable subsidies.

I am just wondering, what is the ratio with regard to the total number of subsidies compared to the number of people who you think are going to be applying for subsidies? Do you think the $612,000 is going to meet the need? What are the criteria that you use for making a decision with regard to who gets subsidies?

MS SULLIVAN: The $612,000 does accommodate another 100 subsidies and I anticipate we will have full take up on that, on those 100 subsidies as has been the case in the last year as well when we had an additional 100 subsidies.

The actual ratio, I do not know, but I am sure that is a statistic we could work up for you to see what the list might look like in terms of people who are looking for subsidies and the number that we have.

The current number of subsidies that we have now, Bruce, is? How many Tracy?

MS KING: It is 1,712.

MS SULLIVAN: It is 1,712 subsidies, which is an increase of 682 just in the last few years.

MS MICHAEL: This will add another 100 to that.

MS SULLIVAN: That 1,712, does that include the 2012 number of 100, Tracy?

MS KING: It does.

MS SULLIVAN: It does.

MS MICHAEL: Do you keep an account of people who make application? Do you have a waiting list, for example?

MS SULLIVAN: We do have a waiting list, and I am assuming we have an accounting of who is on that list.

MS MICHAEL: Right. If you do not have it at your fingertips could we be given the number?

MS SULLIVAN: I know there are approximately sixty on the waiting list.

MS MICHAEL: Okay.

Thank you.

So, you have allowed for some growth beyond your waiting list.

MS SULLIVAN: Yes.

MS MICHAEL: Okay, thank you.

That is sort of the kind of information I was looking for.

Minister, what are the criteria for people applying for the subsidy?

MS SULLIVAN: Tracy, do you want to address the specifics of that?

MS KING: Sure. Persons applying for a subsidy for a personal care home undergo a financial assessment to determine their eligibility. It is based on their needs, different from eligibility for home support. It is based on their actual income and expenses moving into a personal care home.

Persons qualifying for a subsidy are able to maintain $150 of their income and, as well, the liquid asset thresholds apply. So an individual person may maintain $10,000 of their asset in qualifying to move into a personal care home. If you would like some particular information about how the financial assessment works, that is a detailed process and we can provide some information about how that assessment process operates.

MS MICHAEL: That would be good actually, to have that written down. That would be great.

MS KING: Yes, sure.

MS MICHAEL: Sometimes the reason for us needing this information is because when people call us – when we have constituents who call it is good for us to really have a good understanding of the process.

MS SULLIVAN: Absolutely.

MS MICHAEL: If we have that ahead of time we do not have to be calling you all the time just to get a sense of what they are dealing with and what we are dealing with. It helps us then to ask questions if we have to call somebody inside the department. That is really helpful.

I had one more question around that. The assessment tools that would be used for personal care homes, are you also trying to get uniformity in those tools as well as in the other areas?

MS SULLIVAN: Yes, it is very important that we are consistent from one area of the Province to the other.

MS MICHAEL: Right.

Minister, one of the groups of people who we do continually hear from in our constituency offices are seniors who, sometimes they lose their drug card. They do not physically lose it, but they no longer are eligible because it is tied to eligibility for the federal GIS and sometimes they lose the eligibility for the GIS. Sometimes they do not do their taxes on time. There are all kinds of things that happen, and sometimes the income is just slightly over the GIS cut-off and different factors can cause that to happen too, even after they have had a card.

I know it is not in this year's budget, but are you looking at trying to increase – I know we have done it in the past, but we still have an awful lot of seniors out there who need access to a drug card and we are getting a lot of calls in our offices about that.

MS SULLIVAN: It is an ongoing issue. Whenever there is a threshold, there is obviously somebody just on either side of that threshold. So that is an ongoing issue for us.

MS MICHAEL: Which is why I am against thresholds, you know what my stand is on that. That is the reason for being against thresholds.

MS SULLIVAN: I do not know how better to do it. I know you would want to talk about pharmacare, and when we can get the federal government to come to the table to do that, then that would be helpful for us. In the meantime, I think we have really stepped it up. If we look at $159 million annually in drug costs that we cover in Newfoundland and Labrador, I think we have one of the most robust programs in the Atlantic province area in terms of what we are doing and how we are covering and so on.

We are always concerned about people who do not quite meet that threshold, and sometimes we can find accommodations in other areas. If they have high-cost drugs, for example, then there is a program that can help to look after that for them as well. It is always an issue, always one that we are cognizant of and looking to find ways to help our population. That is what we do. I think our goals are the same goals as yours, and that is to better serve the residents of Newfoundland and Labrador. We do that to the best of our ability.

Sustainability in the health care system, though, is still something that we have to be concerned about here in Newfoundland and Labrador. For me to go to budget defence and look for any more than 40 per cent of the budget, I think I would be marched out of the room; and not because we do not care, as Kevin Pollard would tell you, but because 40 per cent is a huge percentage of our budget that we expend.

You have heard me say this many a time, and I am probably going to say it again. We have doubled the cost. We have gone from about $2.3 billion to $5.6 billion in a couple of years in terms of what we are spending here in Newfoundland and Labrador, more per capita than anywhere else.

We have to find ways to do that, though, that allows us to sustain the health care system of Newfoundland and Labrador. The best way that I know to do that is to look for efficiencies. In finding those efficiencies, not being able to take them back for Treasury, necessarily, but to reinvest to make those people who sit right on the margins eligible for some more of our programming.

MS MICHAEL: Do you want me to say the next sentence then? You do not, but I am going to say it anyway: which is why I think we do need an overall evaluation of our whole system because I think we would find efficiencies. I am just going to make that statement because I really do believe that.

MS SULLIVAN: I know you do. I have heard you say that on a number of occasions in the House of Assembly. I just want to say this one sentence as well, which is: if I remind you of what Hay recommended, particularly in Western Newfoundland, we are going to see a lot of facilities closed. I am not sure that that serves the overall good of Newfoundland and Labrador.

MS MICHAEL: Yes.

MS SULLIVAN: That is a debate that we can have at another time, and I am sure we will.

MS MICHAEL: That is right, exactly. I will not go any further. I said I would say one sentence, and I said one.

MS SULLIVAN: I think I said two.

MS MICHAEL: I have a couple of more questions, then.

In the budget, there is a $508,900 for additional positions in the regional authorities for home support services.

What were you thinking about with regard to those home support services? What exactly are you talking about for that money?

MS SULLIVAN: Primarily it is to deal with the growth in the program. In order to be able to more efficiently get the assessments done we need more people because we are seeing the numbers increase fairly substantially since the new eligibility requirements. We do not want people on a wait-list. If people are in need of home support, then we need to get them assessed as quickly as we possibly can. That money is set aside specifically to do that, to ensure we have enough personnel and enough human resources out there to continue the assessment process.

Apart from the assessment process, we would also like to get some monitoring and some evaluation done. Hopefully these positions will help us in that area as well.

MS MICHAEL: Thank you.

We all know that dementia seems to be a growing problem, and I think it is because people are living longer. That is the reason we are seeing more dementia. There are other reasons too, but I think that is a major factor.

I am wondering: What kind of a plan do you have with regard to accommodations for people with dementia? A bungalow here and there to help have somebody with dementia in a unit with all of the services that are needed, et cetera, I do not think is meeting the need.

Are you actually looking at putting a plan in place with regard to the care of dementia patients, in a way they can be near their homes for their family's sake?

MS SULLIVAN: Yes, and yes. A bungalow here and there in the meantime is a cost of $1.7 million, so it is not frivolous work we are doing when we are constructing dementia bungalows. From the reading I have done around the provision of care one might find in a dementia bungalow, it is something I think we would all want for our loved ones. I would not want to dismiss them as not being a significant contribution to what it is we are doing around dementia.

MS MICHAEL: I did not mean it that way.

MS SULLIVAN: Okay, thank you.

However, as part of the Long-Term Care Strategy, that is certainly a component we have to look at. We all recognize the aging demographic in Newfoundland and Labrador and in the Atlantic Provinces generally, but particularly here in Newfoundland and Labrador. With an aging demographic will come some of those particular issues, particularly around dementia.

I hate to use Tom Marshall's "stay tuned", but it certainly is a piece of work we have dedicated a bit of time to. We are trying to find more innovative ways forward to be able to address the issues around dementia. There were huge concerns within the population of Newfoundland and Labrador around that. There are huge concerns that we hear on a daily basis from families who are struggling to look after loved ones who are experiencing issues around dementia.

It is a piece of work we take quite seriously. We are always looking for creative, innovative ways that we can find to focus that closer-to-home kind of care as well, which is really the focus of our Long-Term Care Strategy; it has to do with providing care in the most efficient way possible, as close to home as we possibly can.

MS MICHAEL: One more question – all these questions have to do with care. You are obviously thinking intently with regard to the Long-Term Care Strategy. I am concerned about the first available bed policy that Eastern Health has in place. I do not know if the other three have that in place or not, but I believe that there are other ways of dealing with the issue of people needing to be in a facility and other ways in which make sure that they are not in acute care beds in hospitals than just saying the first available bed policy.

I am wondering if this is something that you are looking at in the Long-Term Care Strategy and policy that I hope that you plan on putting in place, because I think this is where home support does come in – while somebody may not be a candidate to be at home with home support on a long-term basis, permanently, but could be short-term while waiting for a bed that is closer to home. Is this issue of trying to keep people as close to home and to their loved as possible part of the Long-Term Care Strategy that you are looking at?

MS SULLIVAN: We are certainly looking at a variety of alternatives and alternate models of care that can help to accommodate that. Certainly, home support is one of those pieces, one of those components that can make a difference there, and some of that can happen now. If you have somebody who could not stay home, if they are supported in their own homes, then that is something that is available to them now. That is not necessarily a new piece for us; that is something that we can accommodate.

Again, they are huge issues. They are issues that we tackle on a daily basis. Tracy and her department, on a daily basis, are looking at those concerns and trying to find those ways. So I would invite – and I always want you to feel free to offer up the ideas and the suggestions that you can. I think we are all in this for the same reasons, we all want to make a difference, and we all want to do the right thing. So whatever ideas that you have, whatever suggestions that you might have, bring them forward. They are critical to our being able to provide that best care, but there are a number of evolving models of care we are studying to try to find what might work for us.

We are not going to have a complete answer in one model of care. We are going to have to look at a number of models on a continuum that will, I think, meet the needs of our population out there.

MS MICHAEL: I will not go into details now, but you and I both agree, there is a wonderful group of professionals out there looking at the whole issue of long-term care. I really do think they include people who have been involved in long-term care who have been part of putting those together in other Provinces, nurses, et cetera. I would really recommend you sitting with that committee, and I would love to give you that information.

MS SULLIVAN: That is all part of the work we have been doing. That is ongoing work for us, always.

MS MICHAEL: Yes, but this committee in particular I think would really be a good one for you to meet with.

MS SULLIVAN: You can give me the details on that.

CHAIR: Thank you, Lorraine.

MS MICHAEL: Thank you.

CHAIR: Dwight.

MR. BALL: Yes, I will just stick with that topic for one question, actually: How many people would we have on home support now in the Province?

MS SULLIVAN: Seven thousand seven hundred.

MR. BALL: Wow.

MS SULLIVAN: Every now and then a number comes back to me, and then I hope it is accurate.

MR. BALL: I just want to talk about physicians again.

We have discussed the number of physicians we would have, but is there any particular area in terms of specialities right now we are having problems with? Where are the shortages?

MS SULLIVAN: I can address it generally, but we will defer to Dr. Alteen to give you the specifics of the areas. I have been saying that we have 1,100 physicians. I found out tonight that we only have 1,096. I want to make sure now we get the numbers perfectly accurate.

DR. ALTEEN: We do have issues of concern, and this is an ongoing process. Right now in the Province obviously rheumatology is of some concern in terms of wait times and that. There is a new rheumatologist who has started work in the last year in the Province and has made some difference in terms of the wait times.

Urology, certainly in Eastern Health, is a concern. Eastern Health has recently engaged with a physician to start a urology service here this summer on a one-year contract, but he may commit himself to staying in the longer term.

Part of the strategy with a number of these things is trying to look at physicians who are in residency training positions presently, both in the various specialities within Newfoundland and outside the Province for some of the subspecialties, and engaging them through a bursary program and through other means of returning to the Province. We have seen improvements in that, but there are some particulars.

For example, internal medicine – we have a lot of subspecialists in internal medicine of cardiology, gastro-neurology, and those sorts of things. The general internal medicine physician is very, very hard to come by these days because people go off and do subspecialty training. What we need in the Province, in a lot of areas, are the generalist physicians as opposed to some subspecialists. It is an ongoing area. We have made great improvements.

If you look at medical and radiation oncology, we have made great improvements over the last five to six years in terms of those areas, but it is ongoing. Psychiatry outside of the St. John's area, there are huge issues in terms of recruitment and retention. It is something that we work with, with the RHAs, with the Medical School itself in terms of opportunities to even provide additional residency training positions, but it a tough process. It needs a lot of energies put to it to recruit the proper people. We have also put in place regional recruiters at each of the RHAs who will be engaged with the Medical School and more engaged with the ongoing recruitment process.

If we look at bursary programs, just providing a bursary to somebody, if you do not engage them and have further conversations and provide training opportunities while they are going through the residency program in the local area, that is some of the ways of improving our recruitment and retention.

We have also been engaged with Health Canada. When the minister talked previously about a Health Canada project, we have a Health Canada project we are involved with in terms of having family medicine residents do a lot of their training, a substantial portion of their core services at a rural site. Both Grand Falls-Windsor and Burin were chosen as the sites because they were the sites that were ready for this. Hopefully, part of this whole process is improving how we will attract people to stay in our facilities. Right now rheumatology and urology are the major areas. Like I said, internal medicine across the Province can be problematic at times.

MR. BALL: Okay. Thanks, Larry.

The Medical Transportation Assistance Program, this was something I was made aware of about two weeks ago, which I did not know it worked like this. The story goes, what happens if you have a couple that – I must say, in this particular case the couple ended up in Halifax for treatment. Rather than stay in a hotel somewhere they stayed with some friends of the family. Obviously, the surroundings were much more comfortable. What we found out, however, is they could not claim for any meals. That seems to be a little unfair in some ways, when they actually saved money by not using up accommodations money but yet, cannot claim a meal.

Is that the way it is? Do I have it right?

MS SULLIVAN: I would suggest to you that our MTAP, our Medical Transportation Assistance Program, if it is not the most robust program in the country, it is among the top programs in this country.

Denise was just trying to point out some of the eligibility criteria. It does not have a provision for assisting with meals when accommodation is provided by family or friends. Yes, that is accurate. However, if you look at what is provided as opposed to what is not provided, I think we are able to say without shame that this is one of the best programs that is offered within this country.

MR. BALL: Yes. In this situation, it was not that the meals would have been in, obviously, where they were staying. It was more about the meals they had to buy at the hospital. I know the situation was in Halifax and they were there for quite some time.

I was also told there was a different amount paid for meals if you were in Halifax versus in St. John's. I do not know if that is accurate either.

MS SULLIVAN: There are in-province and out-of-province thresholds and fee structures that are here. In-province is a maximum of $29 a day, out-of-province to a maximum of $43 a day.

MR. BALL: It seems unusual, that do, I must say. Anyway, I guess they were right.

It is a good program. It is not to say there are not opportunities or areas that could make a significant difference, even though they are little things like that, that could actually create some consistencies.

MS SULLIVAN: We actually improved that program this year. Again, it is another one of our programs that we pay attention to, that we add to when we have opportunity to add to and when we see opportunity to improve the program.

Like all of our programs, we do not implement, close the door, and then that is it we have a program. We are always looking to find ways and means to be able to support our programs and to improve upon them.

MR. BALL: Do you have any idea how many individuals actually used that program last year?

MS SULLIVAN: I do not know if we have that in the notes, but I am sure we can probably find some way to be able to get those statistics for you.

MR. BALL: Yes. I would like to have that, and the amount that was paid out. That is fine.

MS SULLIVAN: Yes.

MR. BALL: The air ambulance moved from St. Anthony to Goose Bay. What is the update now on the status of the team in Goose Bay?

MS SULLIVAN: Sorry, the update on the –

MR. BALL: On the air ambulance team that was supposed to be relocated to Goose Bay. Are they fly in, fly out now? What is the situation with that team in Goose Bay?

MS SULLIVAN: It is not a matter of relocating a team to Goose Bay. We were looking for a brand new team. There was not a team in St. Anthony, so we are looking to find a team to put in Goose Bay. That is an ongoing process for us and has not been without its challenges.

We have had a lot of challenges finding qualified people who want to be part of that team, but it is not anything we have given up on. We continuously are looking for opportunities to recruit or new ways of being able to deliver that program there as well.

MR. BALL: Is there any success at all? I think there was, what, twelve that was required?

MS SULLIVAN: Twelve to fifteen people who are required, yes.

MR. BALL: Do we have any at all? How many do we have?

MS SULLIVAN: We would have had two or three?

OFFICIAL: In terms of recruitment?

MS SULLIVAN: Yes.

OFFICIAL: There have been five people who have been identified as potentials.

MR. BALL: Okay.

How is that working now? How is that program working?

MS SULLIVAN: Well, I can tell you that our air ambulance program, again, is one that works very, very well. We maintain that we can have an air ambulance up and running within sixty minutes anywhere within this Province.

I think it is important to point out, too, that the total number of flights from Labrador versus St. Anthony is quite an interesting number. There were 273 total flights from Labrador last year versus 158 from St. Anthony, when the flights were originating from there. Of those 158 flights that were originating from St. Anthony, 37 per cent were non-urgent. In other words, they were for diagnostic reasons or appointments or so on versus 9 per cent from Labrador.

So, the program is still working. We are confident, but like you, we too would like to be able to get that new team in place.

MR. BALL: We do not hear much about smoking, yet it costs the health care system a lot of money. Are there any plans for a smoking cessation program within the new funding model that we know of? With the savings from the drug plan, is there anything there at all for smoking cessation programs?

MS SULLIVAN: There is no money from the savings from the generic drug plan for a smoking cessation program; however, we do have a smoking cessation program that is fairly robust and is still quite active here in the Province.

MR. BALL: Okay. How does that work?

MS SULLIVAN: Tracy, do you want to give us some detail?

MS KING: The key component to the Province's smoking cessation program relates to the Smokers' Helpline and to the Alliance for the Control of Tobacco. The Province provides a grant each year to the Smokers' Helpline. In fact, we increased that amount last year by another $25,000 to a total of $225,000. Okay, $225,000, and that is in addition to a grant from the federal government for $200,000 for the operation of the Smokers' Helpline. That is our key initiative related to smoking cessation.

As well, the Province provides funding, an additional $45,000 last year to the Alliance for the Control of Tobacco to reach out to youth and young adults through social media. As well, last year $50,000 was provided to develop a new students' choice tobacco education resource program in Grade 9. Those would be the key things we have done in the last number of years.

MR. BALL: What are the rates now, anyway – it is?

MS KING: Around 20 per cent.

MR. BALL: Where is that compared to where we were?

MS KING: Certainly it is lower than where we would have been ten years ago, but has really plateaued over the last number of years. That is certainly the reason behind the increased investments in the Smokers' Helpline and the new programs last year.

MR. BALL: That is what I thought. The same thing is happening everywhere, isn't it?

MS KING: It is consistent with the trend across the country.

MR. BALL: Yes.

Mental health – I have a few questions on that. I speak primarily here from experience on the West Coast side. It seems to me that the number of different programs available for people who are obviously looking for services, a lot of it depends on where you live and a particular cap on the number of cases we can actually handle in some of the programs.

As an example, in the White Bay area, for instance, you cannot get support, yet if you live in the Deer Lake area or the Pasadena area, supports are available. Again, it is another example where we get inconsistencies. When you look at the lack of resources, in particular in health care, when even right now we do not even have a physician – we have one physician out there in that whole area. Then when you look at the support that a lot of the people who suffer from mental illness, there is zero support at all.

I am just wondering if there are any plans to expand that program and make it a provincial-wide program versus something that is in specific communities.

MS SULLIVAN: That is one of the reasons why we are putting so much time, effort, and money into the development of the e-mental health program, with particular emphasis on being able to reach out to our younger populations who, of course, are very comfortable using social media as a means of reaching out and as a means of discerning information and asking for help. That program certainly is one that I look forward to seeing some huge uptake in once we get that established.

Of course, the awareness that we are doing around mental health, particularly around the stigma and so on, is a piece of work that is ongoing and I think is meeting with some success out there.

I hear and I understand what you are saying about having physicians in place and about having health care providers in place in all areas of the Province to be able to meet the need. Again, that is an ongoing problem we have around recruitment. It is one we are attempting to address and it is never very far out of sight for us.

MR. BALL: It is a huge problem because what will happen is you will see the caseload. It is very difficult to explain to people with mental illness: No, you cannot get treated because your caseload is at sixty versus if you had diabetes, and you could be 1,060, the next person who walks in can get treatment. It is very difficult to explain that to some of those people.

I will tell you: Be very careful the emphasis you put on e-health and the e-initiatives. In the area I am talking about – you know exactly what I am going to say – they do not even have access. To be quite honest with you, it would do us all good to get in the car sometime and drive around some of those communities just to see what the limited resources really are. There is no cellphone there. There is no high-speed Internet there. Yet when you look at the degree of mental illness that is prevalent in some of those communities, the numbers are astounding and a lot of it never gets treated.

MS SULLIVAN: I hear what you are saying. The prevalence of mental health, though, is an issue that is not isolated to smaller communities. It is an issue that is concerning right across the Province. It is a growing issue and I think it is because we are doing a better job of naming it and identifying it. I think that is progress.

I fully concur that we need to be able to find more specialists to be able to deal with those problems. In some of our smaller communities where we have nurse practitioners who are going to work, my understanding is they are encountering more and more people in need of mental health attention. They are responding to those needs as well out there in some of our smaller communities.

CHAIR: Thank you, Dwight.

MR. BALL: I just want to finish up because I do not want to leave this on a negative note. I tell you, where people can access those teams, the success is remarkable – it is, absolutely. When you see the success those teams are having, it is unbelievable. When you see those outliers who are just searching and looking for a piece of the action, they want to be included, that is what I am talking about where the difficulty is. It is not about the people who are in the system. They are doing a great job.

MS SULLIVAN: Sure. The ACT teams I think you are referring to specifically are doing some fabulous work.

MR. BALL: Absolutely.

CHAIR: Thank you, Dwight.

Lorraine.

MS MICHAEL: Thank you very much.

Just a couple of requests first: Minister, could we have the updated statistics – the latest ones we have are April 2010 – with regard to the wait-lists for long-term care facilities under the four authorities, please, the updated information on that?

MS SULLIVAN: Sure.

MS MICHAEL: There is a piece of information we have been trying to get and are having a problem getting it. I suspect the department might be able to get it for us.

There was one point at which a couple of years we had some information on this. This would be under Eastern Health, especially for the hospitals in St. John's: the number of chronic care or acute care beds that are being taken up by seniors or others who are waiting to get into a long-term care facility. We would like to know what the latest number is on that.

MS SULLIVAN: We have those numbers and we can supply those to you.

MS MICHAEL: Thank you very much.

Now a question with regard to the issues around wait time: I am just wondering if this whole approach is part of the thinking that you might be doing. I am sure you have, because we have the evidence that the wait times, for example, under one health authority is not the same as under another. You have specialists in one health authority who are underutilized in their area.

While it is not the same as saying to somebody in Labrador West the only place to get care is if you come into St. John's for a special area, you have to travel – is any thought being given, especially when two authorities may be very close together, to doing the sharing of resources in terms of the use of a specialist, certainly around the joint replacements?

The evidence I have is that especially with Central and Eastern there could be a lot of sharing going on there with people who are right on the border of the two health authorities. Whether you go to St. John's or Gander, it is all the same travel distance, et cetera.

MS SULLIVAN: That is something health authorities have been trying to encourage for quite some time. There is no policy in place that says that cannot happen at present. In fact, it is something we have been trying to encourage physicians to encourage patients to do as well.

There are all kinds of reasons why people do not necessarily avail of that. I have heard because I have asked those questions as well. In fact, I was not very long in the department when I started asking those questions. I have heard things come back from patients who themselves have made decisions not to go to other parts of the Province for whatever reason. Sometimes they might say: I have family in this community; therefore, I want to have that particular procedure done here. I do not want to go somewhere else. There is a myriad of reasons that have come back to us.

However, we have been doing a fair bit of work with encouraging physicians particularly to encourage their patients to avail of other areas of the Province for some of that work particularly, as you pointed out and rightfully so, around hip and knee joint replacement. The wait-list in Gander is certainly much better than in other areas of the Province. Again, we hear from some of our patients and from some doctors who want to maintain control – control may not be the right word – but contact with their patients. They do not necessarily want to refer them out. There are a number of issues around that, but it is something we have kept our eye on and we have been trying to encourage as well.

MS MICHAEL: That is what I am wondering: Is the department playing a role in trying to deal with this, especially with neighbouring authorities?

MS SULLIVAN: Absolutely. Certainly when we did the piece of work around our two wait time strategies that we just recently released, that was something that very much came to light as a result of our analysis of our numbers, particularly around areas of the Province where there were wait times. We were really surprised to see some of the numbers that came back to us. So we have been working with the regional health authorities and, through them, with our health care providers to try to encourage the sharing of opportunities throughout the Province.

MS MICHAEL: Thank you.

I think this might be my last question, but I should not say that because every time at Estimates I say that something else comes to me after the next person. For the moment, this is my last question and it has to do with the electronic occurrence reporting systems of the regions that I understand are being co-ordinated by the department.

Is that correct?

MS SULLIVAN: That is correct.

MS MICHAEL: I am wondering: Could we have an update on how that is going? Will this recording and reporting include statistical data on frequency and type of occurrences in adverse events by region? Is that information we are going to be able to get from the electronic occurrence reporting?

MS SULLIVAN: That is a very important piece of work we have been working on for quite some time. I am not sure where it is in my notes. I think we are all getting tired at this point in time, and I have my glasses off now, Bruce.

I will ask Tracy to give the detail. Tracy has been working very arduously around the task of occurrence reporting and ensuring that we are putting in place a very efficient program. Tracy, if you would not mind giving some of the detail there.

MS KING: Sure.

The electronic occurrence reporting system has been implemented in Eastern Health since fall 2011. Implementation is continuing in Central, Western, and Lab-Grenfell. In Central Health and Western Health, implementation is expected to be completed by the end of June, and in Labrador-Grenfell in the fall this year.

MS MICHAEL: Excellent. Thank you very much.

Those are all of my questions at the moment.

CHAIR: Thank you, Lorraine.

MR. BALL: I have just a few, quick ones on updates on the youth mental health facility going in Paradise. Where is that? What is the status of that now?

MS SULLIVAN: The tenders have been done. All of the site work has been done. It is my direction that we conclude the evaluation of those tenders as quickly as we can and we get to work.

MR. BALL: The teen addiction facility in Grand Falls?

MS SULLIVAN: The same thing.

MR. BALL: Same thing?

MS SULLIVAN: Yes.

MR. BALL: So site work is done?

MS SULLIVAN: Yes.

MR. BALL: Engineering is done and you are looking to go to work. Good.

When will that open? It was anticipated to be 2012.

MS SULLIVAN: Yes, again, it is dangerous to put a time on that. You will come back after me in the House next year and say: You said it was going to be open on this date. We are hoping to be able to move into construction this year.

MR. BALL: What about the medical detoxification treatment, was that part of that too? Was that going to be included in that facility?

MS SULLIVAN: I think you are talking about the adult centre in Harbour Grace. Is that the centre you are talking about?

MR. BALL: Yes, okay. Is that going to Harbour Grace or where is that going?

MS SULLIVAN: The adult centre?

MR. BALL: Yes.

MS SULLIVAN: It is scheduled for Harbour Grace.

MR. BALL: That would include the medical detoxification program?

MS SULLIVAN: Well, it is for adult addictions. Is that the centre you are referring to? I just want to make sure we are talking about the same centre here. I am assuming that is the centre you are talking about.

MR. BALL: The one in Grand Falls never was going to include the medical detoxification, was it?

MS SULLIVAN: That is youth.

MR. BALL: I know that.

MS SULLIVAN: The one in Grand Falls – Windsor is for youth.

MR. BALL: Yes, that is the teen one, but no detoxification program?

MS SULLIVAN: It is an addictions program, so yes.

MR. BALL: Good.

Can I get an update on the one in Harbour Grace?

MS SULLIVAN: That is a project that Eastern Health is working on and it is my understanding that they are going to get started on that project very soon.

MR. BALL: That is about it for me – right on the clock.

CHAIR: Do we have any further questions from the Committee?

Minister, first of all, I want to thank you and all of your staff. It has been a very informative evening for all of us. You and your staff have been very obliging and accommodating this evening and I want to thank you all so much for taking the time to do this. We really appreciate it.

Thank you so much.

MS SULLIVAN: You are very welcome.

CHAIR: At this time, Clerk, could you call 1.1.01?

CLERK: We called that already. (Inaudible).

CHAIR: Shall 1.1.01 carry?

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

On motion, subhead 1.1.01 carried.

CLERK: Subhead 1.2.01 to 3.2.02 inclusive.

CHAIR: Subhead 1.2.01 through to 3.2.02 inclusive. Shall it carry?

SOME HON. MEMBERS: Aye.

CHAIR: 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?

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

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

CHAIR: Being no further business, can I call for a motion to adjourn?

MR. LITTLE: So moved.

CHAIR: Moved by Mr. Little.

All those in favour, ‘aye'.

SOME HON. MEMBERS: Aye.

CHAIR: Carried.

Good night, folks.

On motion, the Committee adjourned.