Social Services Committee — Department of Health and Community Services — 20 May 1999

1999-05-20

Newfoundland and Labrador — Committees

May

20, 1999 SOCIAL SERVICES ESTIMATES

COMMITTEE

Pursuant

to Standing Order 87, Loyola Sullivan, MHA for Ferryland, substitutes for John

Ottenheimer, MHA for St. John's East.

The Committee met at 9:00 a.m. in Room 5083.

CHAIR (Mercer): Order, please!

We will get started. I welcome the minister and her

staff this here this morning. Minister, I am sure you know the drill of how we

proceed by now.

MS J.M. AYLWARD: I do.

CHAIR: Just before I ask you to make some

introductory comments I would ask the members of the Committee to introduce

themselves to you and your staff, starting with our friend to the far right.

Mr. Osborne?

MR. T. OSBORNE: I just wanted to inform the

Committee that Loyola Sullivan is replacing John Ottenheimer for this particular

Committee meeting. I don't know if he has informed you already.

CHAIR: Yes. Just introduce yourselves, now.

MR. T. OSBORNE: Tom Osborne, St. John's South.

MR. SULLIVAN: Loyola Sullivan, Ferryland.

MR. PARSONS: Kelvin Parsons, Burgeo & LaPoile.

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

Clair.

MS M. HODDER: Mary Hodder, Burin-Placentia

West.

CHAIR: I am Bob Mercer, Member for Humber East

and Chair of this Committee.

The procedure is simply this. We would ask that the

minister make some introductory remarks and introduce her staff. I would remind

the staff that when responding to a question if they could state there name. If

there are people in the row behind the minister making a response, if they would

come forward to the mike. We would like to get all those answers on tape for

Hansard.

With that, Minister, as they say, you are on.

MS J.M. AYLWARD: I am on. Thank you very much

and good morning. I would like to introduce my staff. To my right is our newest

Deputy Minister, Debbie Fry. I want to welcome Debbie to her first Estimates

Committee meeting in our department. Sitting next to Debbie is Donna Brewer, our

ADM of Support Services. Sitting next to me at my left is Jim Strong, Director

of Financial Services. Sitting at the end of the table is Pam Elliott, ADM of

Institutions. Behind me there are a number of people as well. I have Gerry

White, ADM of Policy and Planning; Helen Lawlor, Director of Community Health

Services; Debbie Sue Martin, Director of Mental Health; and Eleanor Gardiner,

Director of Continuing Care.

As some opening comments, I just would like to say

that as you know last year, 1998-1999, was a very busy year for us because we of

course had the merger of child welfare and family rehabilitative services as

well as community youth corrections and the ongoing reorganization of the

department.

From a perspective at a national level, our

department was also quite involved with the Social Union Agreement, because a

lot of it was about identifying new roles and responsibilities for social

programs in Canada as it relates to CHST funding. As the lead minister it was

quite a big commitment from my part and the staff, as well as the staff of IGA.

We also had a busy year with negotiations,

particularly the MOU with the NLMA. Again, this is still in the process of

micro-allocation but most of that is completed by now and we are just dealing

with issues as they arise. The whole arrangement was changed from a bipartite to

a tripartite agreement. Once before the agreement was between us and the NLMA,

and the last agreement saw the boards come in as an entity in and of itself.

We also had key legislation brought forward this

year including our Child, Youth and Family Services Act - which again is one we

are very proud of - replacing a twenty-five-year-old act, and our new Child Care

Services Act. We have done a lot of work on our adoption. We were really hoping

to have it done this spring but we are fairly confident it will go forward in

the fall. Again, this is one that I think will be very well received because it

is much more of an open model for adoption compared to what we have been working

with.

We also have been working very hard to implement

our Strategic Social Plan. We are working very hard with the group, through the

Premier's Council, to go the next phase which is developing the social audit for

our Strategic Social Plan. Under our Strategic Social Plan and in conjunction

with our National Child Benefit, we have been able to put in place a number of

initiatives including new funding for family resource centres as well as moving

to put in place the next phase, which will be our community youth networks.

We have also put forward a provincial tobacco

reduction strategy of $900,000 over the next three years, and also a nutrition

policy, which is one we have been working on for awhile.

Again, at the federal-provincial level we have been

quite busy as a result of the Krever Inquiry and working with the federal

government to establish the Canadian Blood Services. Again, that is in response

to the Krever report. We are still working to finalize details: for example, the

sites for various testings. As you can imagine, after the Krever report

provincial governments are really working I guess in very much an advisory role

because we know that the CBS is the one that is making the decisions. We all

have representatives from our Provinces there.

Another big issue that we have dealing with is our

Y2K issues around technology and trying to make sure that particularly our

diagnostic machinery is in place for the year 2000, to make sure they are all

compliant.

I could go on with some more details about some of

the other initiatives but I think we can move on because we have, this year,

invested a significant amount of money into health care.

As you know, we have put $40 million back into the

health care budget to pay down our accumulated deficits for the institutional

boards. We have also added $15 million for hospital equipment and $6 million to

standardize our medi-tech systems, particularly for Labrador, Western and the

Peninsulas.

In addition to that we have tried to put new drugs

in our formulary, again, using evidence to make those decisions. In this year

past we introduced drugs for multiple sclerosis and also type two schizophrenic

drugs under the psychiatric category. We have also put money into the ambulance

grants in the amount of almost $600,000. As I have already mentioned, we have

put a significant amount of money into new initiatives under the National Child

Benefit Initiatives.

I will now turn it over to you, if you would like

to start with the questioning and clarification of the Estimates.

CHAIR: Thank you, Madam Minister. Just before

we ask the Clerk to call the first head, which is the head on which we will do

all of our questioning, is there consent and agreement on that? There usually

is.

I would just like to welcome Mr. Tom Hedderson to

the meeting, the Member for Harbour Main-Whitbourne. Good morning, Tom.

MR. HEDDERSON: My apologizes this morning, Mr.

Chairman.

CHAIR: Not at all, sir. Madam Clerk.

CLERK: 1.1.01.

CHAIR: It is up to you as Vice-Chair whether

you or your critic wish to lead off. It is entirely up to you.

MR. T. OSBORNE: I will lead off because

otherwise Loyola will cover everything. I'm sure we want this meeting to be just

as expedient as last night's.

AN HON. MEMBER: (Inaudible) I won't have a

question then, will I?

CHAIR: After Mr. Osborne is finished, then we

will come back to Mr. Parsons.

MR. T. OSBORNE: Some questions are related

directly to the Estimates, Madam Minister. In 1.1.01.01, Minister's Office,

Salaries, there is a difference in what was budgeted last year and what is

budgeted this year. Is there new staff in the minister's office or is there a

change in salaries?

MS J.M. AYLWARD: It is a combination of a

couple of things. We had a senior person leave in the department and there was a

significant amount of severance because it was a long-term employee. My senior

secretary to the Minister's Office retired.

In addition to that, with the combination of the

two departments under a new department, we did see some significant increase in

demands in terms of secretarial work and organization, so there was an addition

of a new staff member to assist along those lines.

MR. T. OSBORNE: In the secretarial staff?

MS J.M. AYLWARD: Yes.

MR. T. OSBORNE: As well, under 1.1.01.06,

Purchased Services, there was a $2,000 increase in what was budgeted and what

was actually spent.

MS J.M. AYLWARD: Yes. That, again, is related

to entertainment, particularly of dignitaries and other people who visited the

department.

MR. T. OSBORNE: Under 1.2.01.01, Executive

Support, there was a considerable increase, $97,500 more spent last year than

was budgeted in Salaries. I realize that part of that was due to the extra pay

period. What would account for the remainder?

MS J.M. AYLWARD: The remainder is associated

with the retirement of our former Deputy Minister, Dr. Bob Williams. As you can

imagine, Dr. Williams has been with the department for quite a period of time so

that includes severance, holidays and that sort of thing. In addition to that,

we had a senior Deputy Minister come back to work in an associate capacity,

working on special projects for a portion of the year.

MR. T. OSBORNE: What area would he have been

working in?

MS J.M. AYLWARD: He worked under the executive

and support services component as associate Deputy Minister.

MR. T. OSBORNE: Under .03, Transportation and

Communications, there was an additional $50,000 spent last year over what was

budgeted.

MS J.M. AYLWARD: Yes. I think in my opening

comments I mentioned about some of our added responsibilities associated with a

number of initiatives at the federal-provincial level. Whenever you have the

minister involved in extra responsibilities, you often will see that the deputy

ministers and ADMs also have to go in preparation of those extra meetings.

For example, last year, particularly, I was quite

involved in the Premier's meetings because of the heavy agenda that was set

forward with respect to the social union agenda, talking about, mostly, health

education and social services as it relates to roles and responsibilities around

the social union. That is one example.

In addition to that, there was a number of other

meetings around the National Child Benefit Initiatives, which my department

played a significant role in as well, because most of them focused around

children. As you know, that component is now moved over to my department as

well.

Again, whenever you see transportation increased

generally in a minister's office, you will often see an associate increase with

the executive in preparation of those minister's meetings.

MR. T. OSBORNE: (Inaudible) for both the

Minister's Office and Executive Support has increased this year under the

Estimates, but the Minister's Office is almost the same as what the revised

amount was last year. Executive Support is considerably less.

MS J.M. AYLWARD: What are you talking about,

and which category? Under Salaries or -

MR. T. OSBORNE: Transportation and

Communications.

MS J.M. AYLWARD: Under travel. Yes, but again I

would say, in terms of the travel, that some of my travel that I do as minister

with respect to the social union specifically is in relation to the IGA

department. I'm the lead minister for the social union talks, but my support

staff, for the most part, come from IGA, so that would account for that, in

addition to the Premier's meetings, which is also an IGA function.

Not all of the minister's meetings that I attend,

and those on behalf of the Province, are directly related to the department.

Some of them cross over to Intergovernmental Affairs.

MR. T. OSBORNE: Let me clarify my question. The

level of increase in Transportation and Communications for the Minister's

Office, the ratio of the travel increase from last year's budget to this year's

budget, is not quite double. When you look at what the revised amount was last

year for the Minister's Office there is not a lot of change. There is only

$2,000 less, I think, being spent in the Minister's Office this year for

Transportation than last year,

whereas in Executive Support there is $30,000

less.

MS J.M. AYLWARD: Yes. I think I mentioned it

again. We had quite a bit of travel associated with the merger of HRE and with

my department. I think that would account for it because a lot of the national

meetings crossed over. In some cases you would have executive from both

departments in the transition period.

MR. T. OSBORNE: Basically, I guess, you are

going to require less executive support travel with you this year than last

year.

MS J.M. AYLWARD: As much as you can predict,

based on what is happening in my own department, but as I have said I definitely

have two distinct roles that you see under minister's travel. A lot of my

minister's travel is related to my department. You have to remember that I

attend ministers' meetings for social services ministers, for health ministers

and for seniors ministers, and in addition to that I also do the social union

for the country, and also some of the IGA work associated with that.

This year, particularly, the executive did most of

their travel around the transfer of both departments. It should not be as much

next year because, hopefully, we will have the transition completed. There still

will be some travel because we are still working on the National Child Benefit

Initiatives and that is a big component of my department now.

MR. T. OSBORNE: Under 1.2.02, Administrative

Support, the amount budgeted and spent last year was almost the same. There is

an increase this year. I was just wondering if you could clarify whether there

was a change in staff.

MS J.M. AYLWARD: The majority of Administrative

Support increases that you are seeing there are related to .12, Information

Technology. That is the second phase of our client referral management system.

That is what is being used out in our community health system by the community

health boards. That is what we use to actually look at identifying areas around

disease tracking, integrating waiting lists, looking at drug dependency issues,

those kinds of things. It is an IT increase.

Are you talking about the Salaries now,

specifically? Because Salaries were almost identical there.

MR. T. OSBORNE: No, there was a slight increase

in Salaries -

MS J.M. AYLWARD: Yes.

MR. T. OSBORNE: - from what was spent last year

and the amount budgeted this year.

MS J.M. AYLWARD: Yes. That was mostly in

relation to a one-time expenditure that we had for our line-by-line financial

review of the health care system, the institutional budget. That would account

for that increase.

MR. T. OSBORNE: That is anticipated to be spent

this year then?

MS J.M. AYLWARD: It was a one-time increase,

yes.

MR. T. OSBORNE: Under 1.2.02.12, Information

Technology, is that increase there, $334,300 -

MS J.M. AYLWARD: Some of that is replacing our

outdated Y2K technology. Again, some of it is the client referral management

system. Both of those combined.

MR. T. OSBORNE: Under 1.2.03.01, Health Policy

Support, Salaries, again there is a $49,400 increase there this year over what

was spent last year. Are there changes in staff in that particular -

MS J.M. AYLWARD: Yes. That in the Salary

component is mostly related to - as you know, in my opening comments I talked

about a number of pieces of legislation we have been working on. Under the

Health Policy Support division, that is where we go through the process of using

our legal counsel and our research and policy analysts to get ready for the

legislation. That is what accounts for those. Use of the legislative component

and also some of our research services that are required.

MR. T. OSBORNE: Under 1.2.03.06, Purchased

Services, the amounts budgeted last year and this year are the same yet the

amount that was spent was less than half of the amount budgeted. We won't

complain that you spent less there, but I am just wondering why those Purchased

Services were not needed.

MS J.M. AYLWARD: Wow! That is an interesting

question, why we didn't spend the money.

The comment that we have here is in relation to the

cost of printing services under this particular policy component. Had we gone

ahead and printed the adoption documents and that sort of thing for the

consultation and for the distribution, it probably would have been that much

money. We had anticipated that happening, but as I said, that will now probably

go forward this fall. So there was less printing.

MR. T. OSBORNE: Under 2.1.01.03, Administration

and Consultative Services, Transportation and Communications, there is an

increase there of $31,500. Where are you anticipating the extra travel there

this year?

MS J.M. AYLWARD: As you know, we passed our

child welfare legislation in December of last year but it has yet to be

proclaimed. The reason it has not been proclaimed yet is because we are

travelling around the Island to do the necessary education and training of the

staff. That is what we are doing under that heading.

MR. T. OSBORNE: 2.1.01.06, Purchased Services,

again, under that heading there is $8,000 more under Purchased Services. Last

year what you spent was right on budget. I'm just wondering what the additional

Purchased Services would be.

MS J.M. AYLWARD: Printing again.

MR. T. OSBORNE: Under 3.1.01.10, Memorial

University Faculty of Medicine, the Grants and Subsidies there is up $360,000.

I'm just wondering where those expenditures are going, what they will be used

for.

MS J.M. AYLWARD: The reason they are increased

is because the Board of Regents approved a tuition rate of increase of $6,250

which left a shortfall of about $360,000. What we have done is added that as

part of their permanent base adjustment, because they were operating in a

deficit.

MR. T. OSBORNE: That is to maintain the tuition

levels for students?

MS J.M. AYLWARD: No. It is because originally

they had intended to put a higher tuition in place, but in fact the Board of

Regents agreed on a $6,250 increase. Therefore, their budget was based on,

perhaps, a higher tuition going in place that never happened. As a result of

that they were short, so our department has added the amount of money they are

short in the amount that you have identified. That is gone as part of their

permanent base adjustment.

MR. T. OSBORNE: Under 3.2.01.05,

Administration, Professional Services, there is a $45,000 increase there this

year over what was spent last year. I wonder if you could put some clarification

on the need for that increase.

MS J.M. AYLWARD: Under the Professional

Services fees?

MR. T. OSBORNE: Yes.

MS J.M. AYLWARD: Those are the fees that we use

(inaudible) for processing drug plans. I guess there is a whole rationale for

some of the costs associated with that. We also had a fee increase associated

with the pharmacists of an extra fifty-eight cents and that accounts for some of

those increases as well. In addition to that we have had the MS and psychiatric

drugs added to the list.

MR. T. OSBORNE: Under 3.2.02.09, Indigents,

Allowances and Assistance, there is an increase there of $2,247,000. That is, I

assume, from the appropriations heading for drug cards under Human Resources and

Employment. Subsidized -

MS J.M. AYLWARD: No. The part you are looking

at now is the social assistance recipients. Indigents are what you are talking

about. What that increase actually is about is because we have increased $1.8

million, as I pointed out, in the MS drugs and the type two schizophrenic

psychiatric drugs.

In addition to that we are seeing a change. We just

had some information in fact where we now probably have the highest rate of

prescriptions of antibiotics in Canada from Newfoundland. We have that

(inaudible) as well. Mostly we are talking about the added increase of the MS

and psychiatric drugs up to about $1.8 million.

MR. T. OSBORNE: It is kind of a harsh title.

MS J.M. AYLWARD: Indigents?

MR. T. OSBORNE: Indigents, yes.

MS J.M. AYLWARD: I do not know. That is what it

has always been called, as far as I know. What would you suggest?

MR. T. OSBORNE: I do not know. Maybe drug

allowances. Indigent is almost an insult to the people that are receiving that

subsidy. The basic definition of the word -

MS J.M. AYLWARD: I do not know what the basic

definition of the word is, actually. Do you know what it is?

MR. T. OSBORNE: I do not know. In my

understanding of that, I have always understood indigent to mean less fortunate,

poor, somebody who is unable to provide for themselves. While it is correct it

should probably be called something else. It is a harsh title. Just a suggestion

for next year. Am I correct in that Loyola? You are pretty up-to-date on -

MR. SULLIVAN: I'm no expert on

definitions of

words, but I guess it certainly is a good suggestion to maybe come more just a

little softer out there. It might be something to think about.

MS J.M. AYLWARD: I think we are the only ones

that know what - it is never referred to as the Indigent budget. The first time

I saw it referred to as the Indigent budget was when I looked at the Estimates.

Because we call it our budget for social assistance recipients and our senior

citizens. That is how it is split.

MR. SULLIVAN: It is better to call it that than

say social services (inaudible).

MR. T. OSBORNE: Yes. Drug allowances or

something of that nature may be a little softer than identifying the people as

unable to - where we all know that is what it is for it. I mean, it is a harsh

title, I think.

Now to 3.3.02.10, Physicians' Services, Grants and

Subsidies.

MS J.M. AYLWARD: Let me catch up here now.

Where are you again, 3.3.02?

MR. T. OSBORNE: 3.3.02.10, Grants and

Subsidies. There is a $10,041,900 increase in the amount that was spent last

year and the budgeted amount this year.

MS J.M. AYLWARD: Thirteen million dollars,

isn't it, if I am looking at the same as you, from the budget to the revised

budget?

MR. T. OSBORNE: No, from the revised budget to

the Estimates this year.

MS J.M. AYLWARD: Yes, that is approximately $10

million.

MR. T. OSBORNE: I am just wondering what the

increase there would be accounted by.

MS J.M. AYLWARD: As you know, we just signed a

Memorandum of Understanding agreement with the physicians that gave a $32

million increase spread over a period of years. Some of that is for the

allocation of the yearly amount. Others of it include dental costs and new

salaried physicians which we have put into the system. They are the two things:

MOU and salaried physicians. They are the new ones that we have put into the

system plus the component of the $32 million. That has to go on top of the base

salaries.

MR. T. OSBORNE: Under 3.4.01.01, Emergency

Health, Salaries, there is an increase there of $25,200 over what was budgeted

last year and this year. I understand the revised amount would have accounted

for an extra pay period.

MS J.M. AYLWARD: Yes, that is right.

MR. T. OSBORNE: What was that increase in the

Salaries?

MS J.M. AYLWARD: What happened was there was a

position which was incorrectly funded under Professional Services in last year's

budget. Now it has been transferred to the appropriate one. The budget for this

coming year only increased by $25,200 because, as you pointed out, there is the

elimination of the twenty-seventh pay period, which people would like to see put

back in here, I understand, but we do not have that ability to do it.

MR. T. OSBORNE: I am going to move away a

little bit from the Estimates. I have a couple of other questions so I will save

some of the titles in the Estimates for my colleagues.

Can you elaborate on the $40 million that was

allocated for the regional board deficits?

MS J.M. AYLWARD: What we did was we went out to

each of the boards. We asked them to put forward in writing their deficits. We

also had done, as you know, our own line-by-line budget analysis. We looked at

what they had put forward, we also had our own analysis done with the boards,

and of that we identified $40 million. It was allocated based on those needs on

a one-time basis.

MR. T. OSBORNE: That only covers 1997-1998, it

does not go beyond that?

MS J.M. AYLWARD: That is right.

MR. T. OSBORNE: Are you anticipating that they

will not have a deficit beyond this year, or are there going to be allocations

next year to cover future deficits?

MS J.M. AYLWARD: As you will probably remember,

in addition to the $40 million we also announced an additional $15 million. That

$15 million was put in place to help address the deficits for this year.

We are now in the process of working with each of

the boards. They are in the process of submitting their budgets for this year,

and we will be working with each one of them individually to identify if that

will completely meet their needs or if there will be some slight deficits, but

we will be working with each of them individually. It is just a little bit too

soon to answer specifically.

MR. T. OSBORNE: The new hospital fund, can you

tell me where that money is coming from? Is that the federal Immigrant

Investment Fund?

MS J.M. AYLWARD: Some of it, I believe, or I

know, is the Immigrant Fund and some of it is from our own provincial capital.

MR. T. OSBORNE: There were a number of new

hospitals announced over the past eighteen months or so. Is all of the funding

for those new hospitals reflected in this year's estimates?

MS J.M. AYLWARD: As you know, you do not put

the whole amount of the project in the budget unless you are going to spend it

in that year, and there is a process that has to follow. For example, after you

do your assessment of the needs then you have to do your planning and

programming. Then you do your mechanical, engineering, and the list goes down.

What you have seen budgeted is what we are

anticipating spending in this budget year. That will vary from site to site

depending on the programming.

As you remember, there was an announcement made

just last week about the Gander part of the process. Gander is proceeding with

another $4.5 million to proceed with - I think it is the mechanical and

engineering component that has been identified through Works, Services and

Transportation.

Each of the various facilities will have work done

based on what is able to be done within that budget year. For example, in Bay

d'Espoir they are moving on to the next phase. In some of the other areas they

are working on the programming base. It depends, really, what stage they are at.

MR. T. OSBORNE: Can you give us some idea of, I

guess, the time frame in which you are hoping those hospitals will be built,

over the completion of the new hospitals that were announced?

MS J.M. AYLWARD: From my perspective, I can

only speak to what is in the budget. I cannot tell you what year anything will

be completed because that would be a decision that would be made through the

budget process and the Cabinet process. All I know is that generally when you

begin a process you go through all the stages and, as your money and needs

allow, you complete it.

I know, for example, the Janeway site is moving on

and it is on schedule. In fact, the last I heard it was ahead of schedule. I

understand as well that the Bay d'Espoir hospital is also working on schedule. I

know that the Goose Bay hospital is on schedule. As you know, Inco made the

financial contribution, as well as the Province, and that is on schedule.

I would not be able to tell you today what the

dates of completion would be without having my colleagues here from Works,

Services and Transportation, and also without having the directive from Cabinet

with the budget process. I can only let you know what has actually happened this

year and where we are planning to go with the projects, and I think I have just

sort of given you a very brief overview.

The other outstanding one, Stephenville, I

understand that is in the programming component and that is ready to move

forward. The Fogo Island centre, as you know, is in the process now of

completing the final report to identify the site. Once that is decided we will

move on with the next phase. There is no intention not to move forward with any

of the facilities that were announced, including Bonne Bay.

MR. T. OSBORNE: One final question. The doctor

situation at the Agnes Pratt Home, can you give us an update as to the progress

being made to alleviate the concerns there?

MS J.M. AYLWARD: From the information I have

gotten from the boards, they have physician services covered. They are still

actively recruiting and, as far as I can tell from some of the comments I have

received, the residents are quite okay with the services that are being provided

there right now. I know that one of our own physicians has also been helping out

in that area.

Again we are also in the process, as you know, of

graduating nurse practitioners with geriatric experience; so we are hoping again

to put together in St. John's, where we have a number of nursing homes, another

form of a clustered model of services for long-term care which would not only

include physicians but would include physicians, nurse practitioners and nurses,

as well as LPNs, and to try to maximize the capacity for each of those to

deliver all of the skill sets they are able to deliver.

CHAIR: Thank you, Mr. Osborne.

Mr. Parsons.

MR. PARSONS: I have no questions, Mr. Chairman.

CHAIR: We will go by seniority. Loyola.

MR. SULLIVAN: Thank you, Mr. Chairman.

I will probably start where Tom just stopped and

sort of finish that particular aspect. With reference to Hospital Facilities,

4.3.02.19., Development of New Facilities, there is $30,850,000. Do you have a

list of the targeted ones - I know generally which ones are out there - of that

$30,850,000 and how much was allocated to each site? When we say Gander, $4.5

million, for example; each of the locations and the dollar value that has been

projected in this (inaudible).

MS J.M. AYLWARD: I do not have the exact

amounts with me here today on each of the ones -

MR. SULLIVAN: Even ballpark is fine. I do not

really -

MS J.M. AYLWARD: Well, I think I have sort of

done ballpark. I would not be able to give you the ballpark figures because

again, I do not identify the contract amounts through Works, Services and

Transportation. Our role, as a line department, is that once we get through the

programming piece then Works, Services and Transportation takes over the

responsibility of letting the various contracts to move forward.

I do not have the amounts of money here with me.

All I know is that, from our perspective, we are moving forward on all of the

ones that have been announced to either - like, for example, Fogo. The first

obstacle, obviously, is identifying the site. Once we move there we go on to the

next phase, and we are moving forward with that. Fogo Island, again I understand

the programming is moving right along with that. The site is chosen and there is

not any difficulty with that.

With the Melville Hospital, the money has been put

in place - the $3 million from Inco - and they are moving forward with that.

Harbour Breton is moving right along, and I know they are into their next phase.

The last I heard they were on schedule, and I do not know but maybe they are

ahead of

schedule by now for this year.

I can identify for you, if you want, with Works,

Services and Transportation, what -

MR. SULLIVAN: Sure, at you convenience, maybe

you can just get the ones and the rough dollar value. I do not need specifics,

just to have -

MS J.M. AYLWARD: What has been identified?

MR. SULLIVAN: Sure.

MS J.M. AYLWARD: But I would imagine the budget

would give you as good an idea about that as what I would give you.

MR. SULLIVAN: Am I right in assuming that all

of the hospitals that are now being constructed - new facilities, additions or

whatever - are being allocated out of this here with the exception of the Health

Care Corporation? That is my understanding. I know it was the plan that

financing would be arranged by them and carried out through them and the other

facilities would be included here. Would that be correct?

MS J.M. AYLWARD: I understood what you said

about the St. John's Health Care Corporation, but what are you asking about the

other ones?

MR. SULLIVAN: They are included directly in

your estimates here. It is my understanding that the Health Care Corporation of

St. John's, in their initial announcement - I attended when they had their first

AGM - they indicated there, they estimated, that there would be roughly - and I

asked the question actually at the time - that where the initial cost was

projected at roughly $100 million and over twenty years it would be financed,

that would cost really another $100 million and they would pay it back at the

rate of basically $20 million a year. I think at $20 million a year they would

pay it back, or whatever, but $10 million would go toward the debt and there

would be $10 million identified in savings out of that.

I was told in subsequent questions, too, that would

be financed by the Health Care Corporation and they would be the ones that would

finance that and pay that, and they would use the savings then to channel the

money back into the system. I do know, since that, the statement has shown that

it is now going to be $135 million, excluding the five-year plan of projections

that is estimated at another $20 million.

I am just wondering, is it still with the Health

Care Corporation? Are all of these being conducted and expended and showing here

in the estimates, or are they showing in a financial statement at the Health

Care Corporation?

MS J.M. AYLWARD: No, the Health Care

Corporation is assuming the payments for that.

MR. SULLIVAN: All the payments.

MS J.M. AYLWARD: Yes.

MR. SULLIVAN: Yes, that is my understanding.

MS J.M. AYLWARD: As you know, the extra $30

million - and I think it is important for the record because we have talked

about it before - the initial $100 million was identifying just the construction

of that facility. The extra $30 million - and we have discussed this many times

- has been identified to make renovations and changes at the Health Sciences and

at St. Clare's site. It included an expansion of the cardiovascular unit; it

included parking facilities and upgrading the ORs. So that extra $30 million has

been identified as a separate piece over and above.

MR. SULLIVAN: It is $35 million actually now.

MS J.M. AYLWARD: Because a portion of that

would be for their capital equipment which was never included in there as well.

There is a distinct difference in the original $100

million which was for construction, as opposed to other renovations required

associated with it; but yes, the answer to your question is they are carrying

the payment scheme for that facility.

MR. SULLIVAN: The other facilities, of course,

are all directly included. None of the other boards are carrying capital debt on

their books, basically; that is being absorbed directly in the estimates here.

Would that be correct?

MS J.M. AYLWARD: Some of them are being funded

through the Immigrant Investment Fund, and there is a possibility that we are

still working on; some of them will be undergoing a self-financing model. Again,

those are yet to be determined.

MR. SULLIVAN: Do you have an estimated cost to

complete - surely a ballpark figure - for instance, the Gander Hospital. How

many more new dollars, in addition to this contract, the mechanical one that was

just awarded there, what is the targeted amount now to complete that?

MS J.M. AYLWARD: I would not have that with me

right now because a lot of that will depend, of course, on the time frame that

it is completed in. In terms of the ongoing needs, I would not be able to give

you that at this time.

MR. SULLIVAN: It was my understanding that -

and maybe someone might be able to - based on current costs, let's say, as of

today completed, to my knowledge there is probably close to $20 million being

spent now, I think, with this latest contract. I think initially there was an

estimated probably $45 million which would leave, I guess, $25 million or more

there, which means it would be less than half completed. Would that be still

fairly accurate? Because we basically only have a shell there at this point,

right?

MS J.M. AYLWARD: That would be something I have

to ask of Works, Services and Transportation in terms of the letting of their

contracts, what they see, and how they see it progressing, quite frankly.

MR. SULLIVAN: With reference to recent costs

now, since budget and estimates here, there have been other basic announcements

and other costs incurred within the department; for instance, new nurse

allocations and so on, other staff, LPNs, and I think fifty others announced.

Would this be coming out of the contingency reserve fund?

MS J.M. AYLWARD: Yes.

MR. SULLIVAN: All of it would be?

MS J.M. AYLWARD: I do not have the money so it

has to come out of somewhere.

MR. SULLIVAN: Okay, I assumed it would be.

With reference to Long Term Care Facilities,

4.3.03., they are basically all lumped together. Do you have a breakdown on the

allocations to each? I know the funding goes out to each of the specific boards

that administers these. Some are, I guess, under institutional boards outside

the St. John's area, except one, and in St. John's they would go to a nursing

home board.

MS J.M. AYLWARD: That is right.

MR. SULLIVAN: Do you have a breakdown on what

is provided to each of the long-term care facilities in the Province, and how

much they actually receive?

MS J.M. AYLWARD: No, I do not have that

breakdown.

MR. SULLIVAN: Or if I could receive it at a

future date it would be appreciated.

MS J.M. AYLWARD: Sure.

MR. SULLIVAN: I do not expect you to have it at

your fingertips.

MS J.M. AYLWARD: No, because we do the block

funding and particularly where we have the boards. All of our nursing homes,

with the exception of one, are under a (inaudible) board structure. In St.

John's there is a long-term care board, or a nursing home board here, and all of

the others are associated with the community boards across the Province, so that

would be added into their total board budget.

MR. SULLIVAN: Could I get a breakdown of your

allocations to each of the boards in the Province? I guess there are eight

institutional boards and, I guess, four separate community boards, which would

be twelve, and the nursing home board would be the thirteenth. I am not sure if

I am missing either one. Could I get the general budget allocations that go

specifically out to each of them? The Estimates does not provide - everything is

just lumped together under the one heading.

MS J.M. AYLWARD: I guess we can get the general

board amounts there.

MR. SULLIVAN: They are showing, for instance,

in 4.2.01.10, under Health Facilities Operations, Grants and Subsidies,

$650,555,500 allocated this year. If I could have them for each one. I guess you

would not have them for institutions because technically it is all under their

umbrella anyway and what they do -

MS J.M. AYLWARD: It might be all under the

umbrella of the boards. I will have to see.

MR. SULLIVAN: That is right. There is a lot of

movement of services and it would be impossible really to break all of that down

to what exactly each facility uses.

MS J.M. AYLWARD: It might be the same for here.

Like I said, I will see what we have in terms of the breakdown and give you what

we have.

MR. SULLIVAN: Okay.

Also, there was always a breakdown before. You used

to have a breakdown, like personal care homes and nursing homes and then other

acute care institutions. In the past, the Estimates would look at a breakdown of

each of these. Now they are all lumped under the one, so if I could also have

the allocations there. How much is the government expending - I am sure you have

that general figure there - on personal care homes? What is the dollar value

that personal care homes are costing?

MS J.M. AYLWARD: I believe it is $9 million, is

it?

WITNESS: Approximately $9 million.

MS J.M. AYLWARD: Yes, $9 million approximately.

MR. SULLIVAN: That would be including the

resident or bed subsidy cost plus the provision of various material and things,

and disposable things to those subsidized -

MS J.M. AYLWARD: It covers three components. It

covers the medical surgical supplies, it covers night security, and it covers

the cost associated with the person staying in the home.

MR. SULLIVAN: How many would there be right

now? It is my understanding that back in 1995 there were 1,374 at that time and

right now there is in the ballpark of 1,000 subsidized beds. Would that be

accurate?

MS J.M. AYLWARD: I think there are around 1,100

if I am not mistaken, are there?

WITNESS: Eleven hundred.

MS J.M. AYLWARD: Eleven hundred.

MR. SULLIVAN: Roughly 1,100 now.

If one of those homes has a vacancy and they are

not able to fill it right away with a subsidized, and they put in one who is

non-subsidized, do they lose that out of the system then?

MS J.M. AYLWARD: You can only put one person in

the bed, so as long as the person is in the bed -

MR. SULLIVAN: I know before - I will just use

this as probably an example - back about four years ago a specific home had a

job to fill a bed at that moment with one that was subsidized so they put in a

person who was not subsidized even though they had - I will use an example -

let's say twenty beds. Let's say a dozen of those were subsidized and eight were

not subsidized. Normally, if they had twelve subsidized and eight not, and they

could not fill one of the subsidized ones and they only had eleven so they put

in a person to make it eleven and nine, would that home in the future, if they

needed to add one, lose that? Because it happened before.

I went over and met with the previous minister

about four years ago and said that it is not right to be pulling beds out of the

system when someone cannot fill it with a subsidized. To leave it vacant is

costing money, so if they can fill it with another one it should not take away

the number they have been allocated for that facility. Can they get back to

their allocated level again or will they lose that now?

MS J.M. AYLWARD: How is leaving it vacant

costing money?

MR. SULLIVAN: Because they were not getting

income and they had the same overheads and staff.

MS J.M. AYLWARD: It would cost them money, not

me, not the government, not the people.

MR. SULLIVAN: Yes, that is right. For the

person operating that, if they have nineteen or twenty beds they would like to

fill them, or as high a percent as possible. Every one that is vacant is extra

loss of revenue, and it is difficult to operate as it is. Would somebody be able

to answer the question? If they fill what is called a subsidized with a

non-subsidized, can they again, when that non-subsidized is vacant, fill that

with a subsidized one again?

MS GARDINER: In the subsidized beds, if an

operator is approved for twenty subsidized beds and he has only filled eighteen

with his subsidized clients, and fills two beds with private paying clients, if

those private paying clients move out, his two beds are returned to him.

MR. SULLIVAN: Okay, thank you.

MS J.M. AYLWARD: What I just want to say, and I

think it is important for the record, is that in terms of how we spend our

money, if the bed is vacant it does not cost government any money. I think that

is my main concern, as minister responsible for the scarce resources we have,

not making sure that the private operators get their money regardless if anyone

is in the bed or not. I think that is a fair statement.

MR. SULLIVAN: Oh, yes. I understand quite

clearly there. I guess the other point of view I made was that there are people

out there operating with vacancy rates which are reasonably high and it is

pretty difficult for them to operate. Some have gone out of business and others

are going out of business. I have talked to some of them. They have to look at

it from a viability point of view, and if they do not have the revenues we would

not want to see the quality go down in those homes because they have

(inaudible). I think the ultimate result in the resident there, and the care

they are going to get. If the revenues are not there to provide that care, I

think we are compromising something.

MS J.M. AYLWARD: I am glad to hear what you say

about the quality because you know, as well as I do, that some of the personal

care homes out there are vacant because people under our single-entry system do

not choose to live there; and the reason they do not choose to live there

oftentimes is because the aesthetics of the place is not what they would

consider acceptable for a place where they would like to live. One of the things

that we are finding is that we have homes in this Province that are full to

capacity with non-subsidized beds because the homes are beautiful and well-kept.

We have other homes that have vacancies with

subsidized beds because the homes are not that nice and people do not want to

live there. So one of the things we have found, with the subsidies and with the

non-subsidized beds, that people will choose will go to a place in which they

want to live. That is one of the benefits of a single-entry system that we are

very proud of, too.

MR. SULLIVAN: Also, to put new facilities in

and with the requirements, it is sometimes cheaper than having to renovate and

make all these changes in old facilities. It is a pretty cost, especially when

you are doing it on the declining numbers.

MS J.M. AYLWARD: It depends. In some cases,

people want to stay in an environment because they have lived there all along.

The renovations are worth it. In some cases it is cheaper to build, particularly

when a lot of these are being built with federal ACOA monies. A lot of people

are getting a lot of federal funding to build. While they say it is their own

money, a lot of it, as we know, is being built with federal funds.

MR. SULLIVAN: The $40 million was used to

eliminate the debt - I know Tom made reference to it - up to March 31, 1998.

What was the total deficit for all the boards up to March 31, 1999? I know it

has been taken care of up to March 31, 1998.

MS J.M. AYLWARD: Right. That is where we are

looking at now. We are right in the process of getting their budgets in to look

at how we are going to allocate that $15 million. We believe that it will be

close to the $15 million but again, we are looking to see how the budgets are

coming in, in terms of what the various boards are going to do, in terms of what

they can do to try to maximize efficiencies without jeopardizing quality of

service and care. That is what we are in the process of working through with the

boards right now. That is why our money - the $40 million - goes up to $98

million. We have allocated an amount of notional. We have allocated $15 million

to deal with those deficits and we will have a better idea now when we meet with

the boards.

MR. SULLIVAN: Yes, because last year, it was my

understanding, there was $25 million of debt incurred, I think, with your -

MS J.M. AYLWARD: We had $10 million put down.

MR. SULLIVAN: That is right. Out of the -

MS J.M. AYLWARD: That is why I am saying why we

allocated the $15 million, but in terms of the accurate numbers, for the purpose

of giving you the answer, Loyola, we would need to meet with the boards to

actually say.

MR. SULLIVAN: Sure, yes. I was just saying that

my understanding, from what I heard from the boards and probably, I'm not sure,

maybe from you - I can't remember exactly where I heard it - is that initially,

yes, you had sort of set aside $10 million, anticipating that maybe some boards

might have problems meeting on the budgets they were initially given. At least

you would have $10 million to be able to move to trouble areas and areas that

needed that. Then, with the announcement of $20 million after that - I think $5

million for basic equipment and $15 million to go toward it - I drew the

conclusion that this $15 million, along with the $10 million, whether rightly or

wrongly, would be enough to satisfy the deficit for this past year of this $25

million.

Because I heard some public figures from some

boards that they were operating a deficit, so I drew the conclusion that the

total accumulated deficit of all boards last year would be more in the $25

million range. When we have this year, in the one we are on, 4.2.01.10 Health

Facilities Operations, $21,641,900 less allocated in Grants and Subsidies this

year than we last year, I'm just wondering this. Are we not going to be faced

with the same situation again where $15 million is not going to be near enough

to meet that?

MS J.M. AYLWARD: That is why I answered the way

I just did when you asked the question. Before you can actually give the answer

you need the audited statements and they are due fairly soon. You need to look

at those statements and work with each of the boards to see. Because as you

know, a number of our boards have done a number of initiatives that have reached

their maximum capacity for operating and some of the boards have not.

We are working with all the boards and once we get

the audited statements, as well as going with them through our line-by-line

budget analysis, I think we will have a much better idea. We do acknowledge that

when you pay the $10 million down, obviously it impacts on what you are carrying

over for the next year. That is why we had a $15 million allocation. We would

need to see their audited statements and work with each of them to see exactly

what is involved.

Also, you know, the situation has changed. As we

know, we have just put more money into the system to try to address some of

those needs, so that is the baseline budget that is not going to go away. The

money we added in it was not a one-time money: the $4 million we have put in

this year, for example. By nature of what we have done, you know the answer to

your question. If you have added $4 million more, then you know that we are

going to have to adjust the base budget again next year because we did that to

address the support staff issues.

We also put in $7.1 million to address the creation

of new nursing positions, plus we put in up to $1.5 million for extra

conversions. So that, in and of itself, would mean that the baseline budget for

next year would be increased based on those alone, without even looking at the

audited statements.

MR. SULLIVAN: Was there any planning when the

figure was given to give the grants to those facilities that facilities would be

operating with less acute care beds this year than last year? I know the shift

has accommodated as much as possible day surgery, and to beef up community

health, and trying to move people. I know there are less beds now, and we are

hearing this regularly. I guess by this summer there will be a lot more. Not

necessarily precipitated by your planning but by -

MS J.M. AYLWARD: Every year, we close the beds

every summer.

MR. SULLIVAN: Yes. Normally it is late in June

when you close beds.

MS J.M. AYLWARD: No, not necessarily. In some

places it is much earlier because it depends on the number of people you have to

get through your system. In a larger place, for example in St. John's, some of

the hospitals have closed their floors - I know, I have worked there - much

earlier to accommodate for vacations. Every single board in the Province have

had bed closures every summer as long as I have known the system.

MR. SULLIVAN: I have gone back to some releases

and looked at them. They say beds will be closed from this period in June to a

date in September. That has been the tradition.

MS J.M. AYLWARD: Yes, some of them have,

(inaudible).

MR. SULLIVAN: Some of them have. I checked some

of these. The recent ones have come in April and May, which really spells

problems and people still have not taken vacation. The question I ask -

MS J.M. AYLWARD: We are saying, and you have

heard me say it publicly, that yes, if you are trying to make your priorities to

give people vacation - which is what the priority is, if it is vacation period -

there is only one way to do that, and that is the way we have always done it,

and that is to close beds. Albeit, we will probably have to close some of them

earlier this year because they have already done it. Yes, there is no doubt

about it that you do close beds to grant vacations.

MR. SULLIVAN: Yes. The beds closed last year

and when it came September or October there were twenty that did not re-open

really. Technically, starting last September or October there were really twenty

beds moved out of the system, and again since that.

My question was this. When the Estimates were

prepared was there, in the allocations given to these, the understanding that

there were going to be less beds budgeted for, therefore less staff and less

appropriate things? Would that be one of the reasons the figure is less in

Grants and Subsidies under Health Facilities Operations facilities this year? Is

that one of the factors? I know there is -

MS J.M. AYLWARD: Definitely not.

MR. SULLIVAN: That wasn't.

MS J.M. AYLWARD: Not one of the figures, no.

Because first of all you are making the assumption that the only place to spend

money is on beds. The reality is that in this Province - I do not ever expect

you to believe it - we still have one of the highest bed occupancy rates in the

country. We have not met the national targets for reducing the number of beds

and increasing the number of ambulatory care. We continue to increase the number

of ambulatory care but we also have one of the highest rates of bed occupancies

in the country. That has been brought to our attention by accreditation groups -

not me, and not internal - from across the country when we are measured in terms

of the service we give. We have had 100 per cent accreditation in this Province.

One of the points that comes out time and time again is our high bed

utilization.

So no, that was not one of the factors, and I do

not think it was ever an intention, and will it be in the future, because you do

not save money. You put money in other services and that is the whole idea and

that is what we have been doing.

MR. SULLIVAN: As to bed utilization, we also

have certainly the highest incidence rates in certain areas, in heart

circulatory disease and so on.

MS J.M. AYLWARD: You are making an assumption

again that you have to be in a bed to correct that. That is why in this

Province, in this government, we focus very much on prevention. We know

ourselves if you look at open heart surgery, statistics show that the mortality

rates probably do not even change significantly after a year with or without

open heart surgery. If you are trying to gather - for example what you are

referring to, increased incidence of heart disease and stroke, you are better

off to prevent those things than treat them after the fact. You have to have

your beds for the surgery but you also have to have your programs all the way

through. Any cardiologist will tell you that it is a combination of the

prevention, early diagnosis and treatment.

MR. SULLIVAN: Plus I think another factor

possibly is lately we have had a net out-migration of 43,000 of which most are

younger people and less likely to depend on our system. Where we are getting an

aging population, therefore maybe based on a Canadian average we may have more

that would need some medical intervention, whether it be hospitalization or

whatever. Our population is going to increase as it is not really the elderly

people, the over sixty-five, who are moving out of this Province. It is

generally the younger people. That alone, in a small population figure of only

over 500,000 people, is going to really skew figures and make us look less

attractive in our per bed utilization than in other parts of the country.

MS J.M. AYLWARD: Not necessarily. Because if

you look at other types of treatments - for example, walk-in clinics, home

support programs, community health centre models - you do not necessarily need

to see people in acute care facilities. You are making an assumption that

because you are older you are sicker, and that is not necessarily true. What you

find is that it depends on the variety of services that you offer.

I mean, even look at the project up your way and

the impact that has had in terms of hospitalization - and I'm sure you must be

very proud of that - and the impact on prevention, because of the intervention

of the nurses in a primary health care model. It has been proven, and it has

been proven right across the world. You cannot make the assumption that because

you have an older population you are automatically going to fill up the beds.

What you will find is there will be an increased need for services but it will

probably be a combination of home support, preventative and long-term care

services. The issue of an aging population is one that is true for the whole

country. We do not have the monopoly on that in Newfoundland.

MR. SULLIVAN: With reference to community

health - I do not, Mr. Chairman, if I am going (inaudible) my time?

CHAIR: No, you can keep going. We usually let

the members speak until they have nothing else to say or until the clock

expires.

MR. SULLIVAN: I thank you for that.

CHAIR: Or until the clock expires, which is

noon.

MR. SULLIVAN: I will not overdo it, I can

assure you. I (inaudible) then. (Inaudible) comments (inaudible) specific ones.

With reference to shifting resources into the

prevention aspect - I know 2.1.01, Administration and Consultative Services -

MS J.M. AYLWARD: I am sorry. What was that

number again?

MR. SULLIVAN: 2.1.01. Under Administration and

Consultative Services it does show a decrease there with some of the areas in

consulting, promotion, disease control, epidemiology, et cetera. Is there a

particular reason? It isn't that the emphasis is any less, really, on that

aspect. Why might it be down that much, which is a very significant drop?

MS J.M. AYLWARD: Under which category are you

referring?

MR. SULLIVAN: That is under .01, Salaries.

MS J.M. AYLWARD: Under Salaries. The estimate

for 1999-2000 is down as much as it is because we do not have the twenty-seventh

pay period. That is one reason. As well, we have re-deployed about $80,000 to

meet critical staffing needs in accordance with our reorganization plan. The

funding of a director of personal care homes and a Nurse II was discontinued in

order to achieve savings, and that is the main reason.

MR. SULLIVAN: Which ones were discontinued

again?

MS J.M. AYLWARD: The director of personal care

homes and, as you know now, that comes under the auspices of Eleanor. It has

really been reorganization. We have not lost the person who has been doing it.

Also, there is a Nurse II, as well. The other reductions - I think that is it,

yes.

MR. SULLIVAN: Yes, that would be generally it,

because the pay period would be about $800,000 there, roughly. I am just

wondering, does that have any impact on the monitoring aspect of personal care

homes? Because even though we are the -

MS J.M. AYLWARD: That is not the monitoring

piece, because the monitoring is done by the community health nurses when they

are out and about.

MR. SULLIVAN: So, basically responsibility has

probably come more with them so the need wasn't really there to have what we

call a full-time director?

MS J.M. AYLWARD: Loyola, need? We would triple

our staff if we could, in terms of need, in our department, but what we are

saying is that when we were looking at achieving savings, we made a decision

that we did not really remove any front line workers from the system and we

merged the management under the existing manager.

MR. SULLIVAN: I do not disagree. I am pleased

with the response.

MS J.M. AYLWARD: No, I am just saying. If you

asked me if I have enough staff, I would say I would like to triple my staff. So

put that on the record. Anyone here disagree with that?

WITNESS: No.

MR. SULLIVAN: Under 3.4.01.05, Emergency

Health, page 203, Professional Services, I know it was anticipated last year

that it would be $290,000. It was $100,000 less, and now it is $254,000. What

would be, first of all, the $100,000 that was projected? What didn't

materialize? Then, what would necessitate another $64,000 over what was spent?

MS J.M. AYLWARD: That included training for our

ambulance attendants. We provided travel training to both the ambulance drivers

and the attendants, and also disaster preparedness training. So that is what

that accounted for under -

MR. SULLIVAN: Okay, but the $100,000? You mean

the -

MS J.M. AYLWARD: Are you talking about

Professional Services?

MR. SULLIVAN: Yes. It was budgeted at $290,000

last year and it was revised as $190,000, so actually you spent $100,000 less.

Was there something that you had planned on doing, or did you identify a major

expenditure that didn't occur -

MS J.M. AYLWARD: I presume.

MR. SULLIVAN: - and some of it is going to be

done this year? See, it is back to $254,000.

MS J.M. AYLWARD: What we noted was that our

savings were due to decreased training needs; because we have obviously, as you

know, been increasing the level of attendants on the ambulances. Therefore, if

they come with the training they do not require it. However, the increase is

proposed to do some upgrading and retraining in the coming year.

MR. SULLIVAN: So I guess the people getting

hired now are people who are probably trained on their own before they come now,

a lot of these people, are they?

MS J.M. AYLWARD: Well, if you do the Emergency

Medical Attendants course - and most of them do because, as you know, they get a

higher rate of pay depending on the level of attendant they have in the

ambulance. So if you have your sooner, we would sooner hire someone with more

training because you can get more money through the mileage and grants program

and that requires you, as an employer, to provide less training. However, as the

department responsible for it, we are trying to keep the upgrading by providing

these professional services.

MR. SULLIVAN: Okay.

With Road Ambulance, page 204, 3.4.02., Allowances

and Assistance last year, it was only down slightly, I guess -

MS J.M. AYLWARD: I can see why you would be

asking questions on that one because I asked a few on that one myself, the

numbers.

MR. SULLIVAN: Yes. Why the difference there?

MS J.M. AYLWARD: You mean between the

Allowances and Assistance and the Grants and Subsidies?

MR. SULLIVAN: Yes. What exactly are you putting

under Allowances and Assistance? Does that come under the kilometrage?

MS J.M. AYLWARD: What we did was we transferred

the Allowances and Assistance to the Grants and Subsidies. That is why you can

see the decrease in the first line and the increase in the second line.

MR. SULLIVAN: So would the grant, whatever it

is now -

MS J.M. AYLWARD: Well, it depends. The grant

depends on if it is the first or the second or the third -

MR. SULLIVAN: Yes, or whether it is a full

grant.

MS J.M. AYLWARD: If it is community versus

volunteer.

MR. SULLIVAN: The direct grant out there now is

under Grants and Subsidies; I would be correct in assuming that would I?

MS J.M. AYLWARD: Yes.

MR. SULLIVAN: And when you submit based on

distance and kilometrage and that, would that be under Allowances and

Assistance?

MS J.M. AYLWARD: Yes, that is my understanding.

MR. SULLIVAN: That is basically what is in that

category?

MS J.M. AYLWARD: That is right.

MR. SULLIVAN: Okay, I just wanted clarification

of what is what.

Under 4.3.01., Furnishings and Equipment:

Appropriations provide for the purchase of furnishings and equipment for health

care facilities...

MS J.M. AYLWARD: Hang on for a second would

you, Loyola, so I can get this right.

MR. SULLIVAN: Yes, page 206, 4.3.01.

Last year there was a projection of a budget of

$4.5 million and an expenditure of $25.5 million. What specifically did the

other $20 million...?

MS J.M. AYLWARD: Well, you have probably heard

most of those announcements but I can go through them again.

MR. SULLIVAN: Yes, I am just wondering where

they are.

MS J.M. AYLWARD: Medical equipment was $9.5

million. We have announced the Medi-tech Information System. This is bringing in

the financial management for Western Labrador and Peninsulas. The Health Care

Corporation has $5 million. Again, that is equipment that they are requiring.

The other $5 million is the Y2K money that may or may not be used, depending on

what is out there in the system designated as essential. So that money is under

the Newfoundland and Labrador Health Care Association.

MR. SULLIVAN: That is basically money now that

MS J.M. AYLWARD: It is one-time money.

MR. SULLIVAN: - because of the extra money that

was there last year, it is -

MS J.M. AYLWARD: No, the $4.5 million is what

is there on a regular basis.

MR. SULLIVAN: Yes. I was not going to say that.

What I was saying is that last year, because there were extra dollars available,

they allocated these in the 1998-1999 budget, really. Even though they may not

be expended, they have been applied to that and that is money they would have at

their disposal as it filters through. Would that be -

MS J.M. AYLWARD: Some of it was expended.

MR. SULLIVAN: Because sometimes you do your

accruals and everything at year end. It is allocated in last year's budget. Is

it prepaid? Probably in some cases, I would assume.

MS J.M. AYLWARD: In come cases it is prepaid

and in some cases it is - obviously the Y2K is in anticipation of, because we

need it this year. We know we are going to spend it, and some of it we will be

spending along as we go. Some boards are further ahead in identifying what their

Y2K needs are.

MR. SULLIVAN: Okay, so there is some already

expended up to March 31, 1999, and the rest of it was really allocated the

1998-1999 year and it is a prepaid expense on 1999-2000.

MS J.M. AYLWARD: No, actually some of it the

boards had already gone out and made the arrangements for, so that would have

just been paying them what they had spent.

MR. SULLIVAN: What did you say the Medi-tech

cost? Was that -

MS J.M. AYLWARD: Six million.

MR. SULLIVAN: Six million, okay.

MS J.M. AYLWARD: That would bring them in line

with all the other boards.

MR. SULLIVAN: Okay, that is it for now.

CHAIR: Thank you, Loyola.

Ms. Jones, and then back to Tom.

MS JONES: I have no questions.

CHAIR: No questions?

MR. HEDDERSON: Minister, they stole all my

questions on me. I don't know what to do.

Minister, I am just looking at some of the issues

in education regarding health. One of them is the smoking, the list of drugs and

that sort of thing. I understand you have a program already announced for

smoking. Is that from health or from education?

MS J.M. AYLWARD: That is from all of us. There

is health, education, justice, cancer society, Newfoundland lung, Newfoundland

heart; it is a whole community initiative. It is not my initiative. I am just

one of the partners involved. We have not announced it yet.

What we have announced as a government is the

money, the $900,000 over three years to do an education program. What we have

announced as the first piece of that is the new tobacco control strategy whereby

we would issue licences to anyone who sells cigarettes, and if they sell to a

minor they will be fined and eventually lose their licence to sell cigarettes.

MR. HEDDERSON: Is it going to be extended to -

I know addiction is a problem with the alcohol and the illicit drugs, but also

the prescription drugs now seem to be appearing on our playgrounds, so to speak.

Are there initiatives going to be taken in that direction, would you think?

Again, has anything come across your -

MS J.M. AYLWARD: There is another approach, and

there are two pieces to this. Under the addictions piece - one of our main

concerns under addiction is smoking because, as you know, that is more addictive

than heroin so that is one of our main priorities. In terms of other drugs like

Ritalin, Valium, and other drugs that they are selling in the school yards, we

are working closely with the RNC, with my department, the Department of Justice,

and with the Department of Education. One of the main pieces around that is the

whole prescribing piece with physicians.

MR. HEDDERSON: Yes.

MS J.M. AYLWARD: They are also an active

partner in this as well. That is why we have been working with all of the

partners to try to come up with a way to deal with a confidentiality piece. That

is a bigger issue here, trying to identify.

For example, if you know a physician has been

over-prescribing, what happens? Who do you report it to? How do you access that

information? How do you report it to the medical board? They need to have

(inaudible) to act upon it. So we are trying to work through that process as

sort of a side piece to this. It is an issue, one that we are concerned about.

These kids have to get prescription drugs from a physician.

MR. HEDDERSON: Exactly.

MS J.M. AYLWARD: You cannot get them without a

prescription, so the bigger issue is trying to get to some of the roots

associated with some of the problems. We have been working with the medical

association - well, not the medical association as much as the medical board, on

this.

MR. HEDDERSON: Two conditions again regarding

education with the dyslexia and autism. I was out on the West Coast last week

and one of the paediatricians out there indicated that there is nowhere in

Newfoundland really where you can get that diagnosed. Is that correct or is this

a West Coast thing? He had talked about referring a couple of his people to Nova

Scotia. I was just curious. He also referenced that there had been a diagnostic

centre at the Janeway closed down in 1991 or something.

MS J.M. AYLWARD: We are certainly not as far

along in some of our children's programs as some of the other provinces, and a

lot of that is around resources. We have just identified a pilot project to look

at doing some of those things around autism and early diagnosis, and around some

of the treatment programs. Most of the work for autism, in terms of early

diagnosis, is being done out of Montreal and in the U.S. That is where they are

sort of leading the way.

We have been working very closely with a number of

the other provinces and we have put together a pilot project based on two models

that we will be testing. One is an APA model and another is a physician resource

model out of Montreal. We have the parents involved, and the participants, so

hopefully that will help us sort of get the process under way.

In addition to the child one there is also the

youth autism and there is the adult autism, so we have been heavily lobbied on

all three pieces of that. We are trying to work, first of all, with the younger

ones based on our principle of prevention and early intervention. The earlier

you diagnose a child the more success they will have. We are aware of some of

our shortcomings in terms of early diagnoses with autism.

Dyslexia is another area that is being handled,

perhaps more effectively, by some of our reading specialists in the Province

through your system or through the education (inaudible). With some of our

reading specialists we have seen some very good progress in terms of moving even

up to three reading grades, once they are diagnosed and given the proper reading

advice. We are seeing some minor improvements there but, again, almost every

child in the school was having difficulties. Unfortunately, when the process is

happening they are ADDH or dyslexia. That is another issue to deal with.

MR. HEDDERSON: Again with the schools, the air

quality seems to be again another issue. What

part is your department playing in

the air quality in schools?

MS J.M. AYLWARD: When we are notified of air

quality we work under our Departments of Environment and Labour and Health, most

(inaudible) community health boards, and they work with the various agencies to

ensure that the testing is done in terms of the fungus growth and any other

bacterial sources that may cause a health problem. Once they are identified as

having an air quality control, they are brought in to do the environmental

assessment piece of it.

MR. HEDDERSON: The last one deals with the

private ambulances. (Inaudible) one of the people in my district had gone in and

upgraded (inaudible) course - Paramedic II or whatever - but the concern he had

was that he had the training but he did not have the equipment. He is a private

operator. Is there any consideration given to assisting the private operators to

upgrade not only their qualifications, but of course the machines that would go

along with it, or the equipment?

MS J.M. AYLWARD: That is the whole idea of the

Grants and Subsidies. They are given an amount of money and I guess they choose

if they are going to put it on a vehicle or buy some new equipment. Last year we

put $566,000 back into the system. Or not back, but reallocated an increase in

the overall base budget. Some of that went for grants and some of it went to

allowances and subsidies.

MR. HEDDERSON: So he could apply for that sort

of a -

MS J.M. AYLWARD: I am sure if he is in the

business he knows exactly what he is able to get because it is a very small

operation in the Province. They are aware. They would have been represented at

the table. Because we had community ambulance operators, we had the private and

we had the medium, the three groups. It took a while to get all the three groups

of ambulance operators to meet together in the same room, but once we got that

working we were able to move on to the other pieces of it. I think, Donna, you

have been working specifically with the ambulances. Their issue is $566,000.

MS BREWER: Yes, $566,000 was the actual

increase to the grant but that is a fixed amount. What they do with it, as the

minister indicated, is their choice.

MR. HEDDERSON: Thank you, Madam Minister.

CHAIR: Thank you, Mr. Hedderson. Ms Hodder.

MS M. HODDER: I do not have a question for the

minister but I am glad to see her staff here this morning so that I have an

opportunity to thank them for the cooperation, the efficiency and timely fashion

they have dealt with many issues and concerns that I have come to them with, the

little ones and the major ones. We have Debbie initiated right from the very

beginning. Thanks Debbie, for all of your cooperation and help last week.

I also want to have a positive word for the

minister. It is something I can say in all certainty, that we have one of the

finest, most responsible, most knowledgeable ministers of health -

MS J.M. AYLWARD: Take notes now, Loyola.

MR. SULLIVAN: I am taking notes. I am writing

extra fast.

MS J.M. AYLWARD: Get it all down.

MR. SULLIVAN: Could you just slow down a little

bit, Mary?

MS M. HODDER: - that we have ever had here in

this Province, and I think we will have for some time to come. This is not just

my own opinion, Loyola. That has been expressed to me by members on your side

but I am sure I would not expect them to come out and say that.

I just want to thank you, Minister. I hope you are

feeling better today.

MS J.M. AYLWARD: Thank you very much.

MR. T. OSBORNE: That was discussed in great

detail at caucus.

MR. SULLIVAN: We just have a job to do, that is

all. It is just a job. If we didn't do it we would be delinquent in our

responsibility.

MS J.M. AYLWARD: I would like to say, if I

could, that I would like to take this opportunity too, for the record, to thank

my staff. Mary, I appreciate your comments as well, and the comments of other

people here. I do believe they work the hardest of all the staff. I know I am

biased because I said that in my last department too, but I do believe they work

so hard, and I really want to thank you all very much for all the time you have

put in. It is very much appreciated and there seems to be no end to it, and

there will not be I am sure.

Anyway, thank you all very much, we really

appreciate your work.

CHAIR: Any further questions?

MR. SULLIVAN: Just one final one. Could I have

a copy of the Atkinson report?

WITNESS: For the record.

MR. SULLIVAN: For the record, no response, Mr.

Chairman.

MS J.M. AYLWARD: For the record, Mr. Chairman,

it still hasn't gone through the Cabinet process yet. I think I have made it

quite clear I have not said I would not release it, it is not up to me, but if

it goes through the process I look forward to doing that.

MR. SULLIVAN: Good, thank you.

CHAIR: There being no further questions I would

ask the Clerk to call the heads.

On motion, subheads 1.1.01 through 4.3.03, carried.

On motion, Department of Health and Community

Services, total heads, carried.

CHAIR: Thank you kindly.

Unless there are some concluding remarks from any

members of the Committee, the minister, or her staff, I would ask for a motion

to adjourn.

This being the last meeting for this year of this

Social Services Committee, we will not be reconvening until next year.

The Committee adjourned.

Document details

Collection	Newfoundland and Labrador — Committees
Citation	1999-05-20
Type	committee
Volume / chapter	committees_standingcommittees_socialservices_ga44_1999-05-20_ssc-hcs_.htm
Language	en
Format	html
Source	PROVINCIAL
Identifier	0c245bf606563634bda54d3ee1e606c38efa9f08

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