April 9, 2003 SOCIAL SERVICES COMMITTEE

The Committee met at 7:00 p.m. in the House of Assembly.

MADAM CHAIR (Kelly): Order, please!

For the record, my name is Sandra Kelly, the Chair of the Social Services

Committee. Before we commence proceedings this evening we have a set of minutes

that need to be adopted. These were the minutes of the meeting from the

Estimates of the Department of Youth Services and Post-Secondary Education that

were held this morning. I thank Mr. Aylward for Chairing that meeting in my

absence.

On motion, minutes adopted as circulated.

MADAM CHAIR: We will start the Estimates this evening for the Department

of Health and Community Services. We usually allocate three hours for the

meeting. Sometimes we have a good record of finishing before. We hope we will

not go too much afterwards, but our hope is that we would finish this evening.

Being that it is the evening the time is more flexible. We usually allocate some

time at the beginning for the introductions of both sides. We will do the

introduction of the members of the Estimates Committee then we will ask the

minister to briefly introduce his officials. We will move right into any remarks

you may have, Minister Smith, then we will move right to the estimates.

I have already introduced myself. Tom, would you like to?

MR. HEDDERSON: Tom Hedderson, MHA for Harbour Main-Whitbourne.

MR. ROSS WISEMAN: Ross Wiseman, MHA for Trinity North.

MS M. HODDER: Mary Hodder, MHA for Burin-Placentia West.

MR. K. AYLWARD: Kevin Aylward, MHA for St. George's-Stephenville East.

MR. BUTLER: Roland Butler, MHA for Port de Grave.

MADAM CHAIR: Thank you very much.

Minister Smith.

MR. SMITH: Thank you, Madam Chair, and good evening everyone.

With me this evening I have my Deputy Minister, Robert Thompson. I will ask

Robert to introduce the rest of our staff. He will get all of their positions

correct, I am sure I will not, so I will ask him to introduce the rest of them

right now.

MR. THOMPSON: Thank you, and good evening.

On the minister's left is Donna Brewer, who is our Assistant Deputy

Minister responsible for support services and primarily responsible for budget

matters as well. On her left is Jim Strong, who is our Director of Financial

Services. Behind me is Lynn Vivian-Book, who is the Executive Director

responsible for programs. Next to her is Dr. Ed Hunt, our Medical Consultant and

responsible for a number of divisions in the department as well. Next to him is

Diane Keough, our Director of Communications; to her left is Loretta Chard, who

is the Assistant Deputy Minister responsible for board services and also

ambulance services; and in the back is Gerry White, who is the Assistant Deputy

Minister responsible for Government and Community Relations.

Thank you.

MR. SMITH: Thank you, Robert.

It is my pleasure this evening again to have the opportunity to present the

Estimates for the Department of Health and Community Services. It is certainly a

pleasure to serve in that capacity and to be so ably assisted by the team that I

have here with me this evening. As I have indicated to them, to be on their toes

because I will certainly be using them this evening. Any line item that is in

their particular area, then they should be prepared to speak to it.

As the Minister for Health and Community Services I think in September of

2002 we, as a department, set out a progressive vision for the Health and

Community Services sector when I was pleased to participate in the launch of our

Strategic Health Plan, Healthier Together. It is nice to have seen this plan,

first of all, be released and also to have seen over the last number of weeks

and months aspects of that plan being enacted.

At the present time we are in the process of consulting with the people on a

health charter of the Province. We look forward to concluding that work soon. As

members here this evening would know, the health charter is an agreement that we

are striking between government and the individual citizen whereby each will

acknowledge his or her responsibility with regards to health care. Certainly,

for the individual, I guess it is a way of reminding individual citizens that in

the first instance all of us have primary responsibility for our own health.

What our health is, in large part, depends on the types of decisions that we

make at any point in our lives. So it is a reminder to people of that. I guess

on government side, and certainly on the department side, it is an

acknowledgment and recognition of our responsibility to the individual citizen

if he finds himself in a circumstance when his health is deteriorating or in

need of some support.

During this past year I guess we all were pleased to see the release of two

major federal reports: the Kirby and the Romanow. I think the Romanow Commission

in particular, a lot of people in this Province and indeed in this country had

awaited with a great deal of anticipation. The report that reported - certainly,

I guess, whether it was not by the commissioners themselves but certainly within

the way it was portrayed in the media, was the Romanow Commission would fix

everything that ailed health care in this country.

First of all the report itself, and subsequently the federal government

report, that we, in this Province, would have to conclude that it certainly fell

short in terms of meeting all of the needs that we have identified. I think it

could have made it a lot easier for all of us if, in fact, Mr. Romanow and

subsequently the Prime Minister had been up to the challenge of meeting all the

needs that had been laid out there. However, in spite of the insufficient

response, we, in this Province, remain committed to building on the current

strengths of our health care system and the vision of creating a better health

and community services system for the future. We acknowledge there many

challenges but we also recognize there are many things that we have

accomplished, and we have made gains in a number of areas.

Looking at the budget itself, this year it is pretty apparent to anyone

looking at the budget that health certainly remains and continues to be a top

priority for this government and the residents of the Province. We heard time

and time again, through the budget consultations and also the health forum

consultations, of the importance of health care and the fact that the people in

this Province place it and identify it consistently as their number one

priority.

In the figures used by Treasury Board and the Department of Finance,

forty-two cents of every current and capital dollar combined is spent on health

and community services. This is up from thirty-three cents in 1994-1995. In

terms of the comparison with our jurisdiction, if you use the same measure as in

others, that, in fact, relates to an expenditure of forty-five cents of every

program dollar. This is expected to rise when funding is allocated for the

physician arbitration award.

As hon. members would be aware, during this past year we were confronted with

a strike by physicians in the Province and the resolution was an agreement to go

to binding arbitration. Submissions have now been completed and we are awaiting

the final outcome of that process. We do know that going into it there was a

baseline that had been jointly agreed to, so I guess all that remains to be seen

right now is if, in fact, there is; and, if there is, how significant a movement

there is beyond that baseline.

The department's budget for fiscal year 2003-2004 approximates $1.6

billion. This is an increase budget over budget of about $71 million. I have to

say, Madam Chair, in the time that I have been in the House, going back to the

times when we brought in some really difficult budgets, even in years when there

was a very modest amount, there was not a year that there was not actually

increased funding in the area of health care. That certainly speaks to the level

of importance not just that government gives to it but obviously is reflective

of the level of importance that all citizens of the Province give to their

health care system.

This year's budget, of course, the expenditures speak to spending for

hospitals, nursing homes, physician and dental services, drug subsidies, road

ambulance operations, blood services, medical and diagnostic equipment, and

numerous community-based programs delivered by the four Health and Community

Services and two Integrated Boards.

Our spending per person on health care in Newfoundland and Labrador is among

the highest in the country. According to the Canadian Institute for Health

Information, Newfoundland and Labrador is projected to spend $2,800 per person

on public sector health care, up from $1,713 in 1995. This is $274 per person

above the Canadian average in 2001, which at that time was $2,526. Again I

think, Madam Chair, that speaks to the level of commitment beyond that. I guess

it also speaks to the challenges that we have been faced with in this

jurisdiction in dealing with the growing costs of health care, especially in the

absence of sufficient amounts of federal dollars.

Specific details of the increased investments in the health care are

contained in the Budget Highlights document, the Speech, and the department's

press releases. Certainly, we will be pleased to respond to any specific

questions that you may have related to any of these.

Certainly, just a few highlights: the increase since 1994-1995 of health

operating expenditures will be about $620 million, an increase of over 60 per

cent. Federal transfers, however, will be $58 million lower, even taking into

account the federal response to the Romanow report. So it becomes pretty

apparent when you look at those figures, it is not difficult to see the

challenges that we faced in terms of the delivery of health care, that they

certainly are significant and continue to be.

One hundred and forty million has been added to the base budgets of boards

since 1997. I have to say, Madam Chair, that we have been especially pleased

with the progress our boards have been making with respect to providing quality

health and community services within the funds available to them. We certainly

understand and appreciate the challenges that the boards have been faced with.

At times they have had to make some difficult decisions, but slowly they have

been getting their budgets under control so that, in fact, in this present year

on the institutional side there was actually - well, there were one or two

boards that were still in a small deficit position overall, that, in fact, we

came through the year with a surplus. That is the first time, I think, in a long

time.

Since 1995-1996, over $600 million has been committed in this Province for

health related capital projects and equipment. The total value committed by this

government in 2003-2004 for capital spending to support ongoing construction of

new health facilities, renovations of existing facilities and equipment, is

$45.4 million.

The new funding commitments this year include a total of $26 million

committed for capital equipment, including a commitment for a second MRI, which

has certainly been long lobbied for within this Province; and $5 million for

PACS; $4.5 million to manage the growth in the institutional health sector. This

additional funding will assist boards to maintain a stable financial position

and to continue to make progress in repaying their accumulated deficits while

maintaining delivery of quality services; $1.3 million to increase rates to

personal care homes and the number of subsidies for individuals. This is the

fourth consecutive increase, and I am pleased as well this year that we will be

providing some additional subsidies because I do know that there has been a

strong lobby in certain quarters to have additional personal care subsidies in

place, and we are pleased to be able to provide that in this Budget.

A further $445,000 to bring the total funding, to provide up to thirty-two

fast-track nursing seats, to $745,000. Again, Madam Chair, an initiative in

direct response of addressing the anticipated shortage of nurses in trying to

position ourselves to be able to deal with that eventuality.

An increase of $1.5 million for Early Childhood Development. It is certainly

an area of great interest to me. In my former career as an educator, I spent a

fair amount of time in establishing and setting up pre-school programs in the

area of the Province where I lived and worked, and I certainly know of the

importance of early intervention. I think the ECD program is a tremendous one.

This is one program that I do commend the federal government on, for partnering

with us, because it is a program that is truly making a difference.

Sixteen point six million dollars for utilization increases in the

Newfoundland and Labrador Prescription Drug Program, which in this year will

bring our total budget in that area to about $100 million. Again, you can see a

fairly large ticket item, but again one that hon. members in this House on a

regular basis are bringing forward in petitions and lobbying for additional

medications and pharmaceuticals to be added to the formulary, because there are

so many things that are coming on the scene. Many of them are very, very

worthwhile drugs, breakthough drugs, as a matter of fact, and in many cases

medications that give people back their lives. Certainly a strong lobby to see

these included.

Speaking to the amount of the increase this year, and the total amount of the

budget, certainly that puts in context the significance of the challenge we face

in that area.

Also, $4 million to stabilize Health and Community Services Boards deficits

arising from the increasing cost of home support. On that side of the equation,

Madam Chair, I think is useful to note that the problem our Health and Community

Services Boards have been faced with in terms of their deficits in recent years

have in fact been a direct consequence of the demands for home support. It is a

program that we have tried to control the growth of, not because we feel that

the program is not worthwhile or not important but, in fact, again, dealing with

the fiscal reality that we have had to contend with. I know again as well that

this is an area where members of this House have been directly involved in

because they hear from many of their constituents, as do I, to lobby on their

behalf to either find home support for them or to see an enhancement of the

level which they receive at this present time.

With that, Madam Chair, I will stop and we would certainly welcome any

questions from the members of the committee.

MADAM CHAIR: Thank you very much.

I will remind everyone to try and identify themselves when they speak,

especially when you are moving from a different speaker. If you have some

interaction back and forth for five or six times, I think downstairs they are

able to tell who it is but when another person speaks, please identify

yourselves.

With that I will ask the Clerk to introduce the first subhead.

CLERK: 1.1.01.

MADAM CHAIR: I assume this evening we will do the same as we have done in

the other committees. We will move from one subhead to another and we will do

them all together at the end, if we finish up.

Mr. Hedderson, would you like to start?

MR. HEDDERSON: First of all, good night. I hope we have a nice session,

not a long one.

Just starting off with the first subhead. I would like to look at the

Salaries of the Minister's Office. I just want some clarification. For

example, with the Minister's Office, Permanent Employees, $228,884; Temporary

& Other Employees; and then the Earnings. I am just curious about the

temporary and other employees. Just in a general sense, who are we talking about

here? Is this contract work or students or work terms? Because in just about

every heading there is a fair amount of -

MR. SMITH: I am informed that these are two positions. One is clerical

support and one is communications.

MR. HEDDERSON: I do not know if I need to go down through all of them,

but in the Minister's Office there is $55,000 allocated for that and under

Administrative Support, for example, there is $500,000.

MR. SMITH: Excuse me, Tom, which -

MR. HEDDERSON: Oh, I am sorry. I am at the Salary Details. I am sorry,

Minister.

MR. SMITH: That's okay. What page are you on?

MR. HEDDERSON: I am on page 139. Rather than just go through every head,

I just want a sense of - as you look down that column, Temporary & Other

Employees, is this a fair amount of contract work? You can take any head, just

give me a sense of it?

MR. SMITH: Okay, Donna, can you give us some detail on that?

MS BREWER: Well, if I skip down under Medical Services, that is in Dr. Ed

Hunt's area, the primary care office. That is intended to be a temporary

office. Those employees would be contractual. We have a few people who are on

secondment from the system. For example, Mike Doyle is an economist, so he does

not occupy a permanent position in the department. It is really people of that

nature.

Administrative Support, again, (inaudible) area in that would be a lot of IT

people under contract and are there for specific projects.

Policy and Program Services, again, we have a number of people who are on

secondment from the board. Particularly, while we are developing long-term care

strategies; a lot of project work.

Youth corrections was some temporary federal dollars that we had in response

to the new criminal youth justice act.

MR. HEDDERSON: Obviously, Minister, it is predictive though in a sense

that you know these secondments or whatever are coming up so that they can be -

this is not an after fact, you are budgeting for it. So temporary in the sense

that they are predictive temporary or contract work that you have already -

MS BREWER: In the same vein too, we have some staff who are on secondment

to the system. They have permanent positions but we are not able to fill those

positions permanently. For example, Marilyn McCormick has taken up the position

in the Office of the Child and Youth Advocate. So we have now Ivy Burt, but she

is not permanent because basically we have given Marilyn a leave of absence for

a year. We have several permanent positions where temporary people are filling

those jobs.

MR. HEDDERSON: Under Executive Support, 1.2.01, there is a need for

additional staff in that particular area because it started off with $835,100

budgeting last year, it has jumped to $898,400 as the revised, and this year it

is $976,000. Again, the reason for that would be?

MS BREWER: Robert may want to speak to this, but the Treasury Board

Secretariate is actually seconding an executive member from their branch over to

the department to work on a special project for the department.

MR. HEDDERSON: So that would be the extra -

MS BREWER: That was roughly around $90,000. That includes -

MR. HEDDERSON: That is just the one position?

MS BREWER: One position. I understand, Robert, it is for a year?

MR. THOMPSON: Yes, one year. That is right.

MR. HEDDERSON: Under Medical Services - again, disease surveillance,

disease control, immunization, and the whole bit. Obviously, SARS is a big

topic, minister, in it right now. Just out of curiosity, are you taking that

into account? For example, God forbid that we do have to deal with it, but would

that be more of an emergency or you kind of build that in here?

MR. SMITH: To the SARS, there is a provision within the department to

deal with this sort of thing. Actually, there is one position that has specific

responsibility -

MR. THOMPSON: One position that is doing epidemiology and surveillance

but we have several positions within that division who more generally deal with

public health protection. They are networked throughout all of our boards with

equivalent type people, like medical officers in health and public health

officials generally. We have not budgeted extra for this special outbreak

elsewhere in Canada, luckily, so far.

MR. SMITH: There is one position that is dealing with pandemic.

MR. THOMPSON: With pandemic, that's right.

In our normal planning for any future type of outbreak, a pandemic outbreak,

we have developed, with other provinces and the federal government, a plan that

springs into action when something may happen. There is one specific position

that does pandemic planning, that's right.

MR. SMITH: Tom, as well, we do, obviously - I mean, all jurisdictions are

following this quite closely and we do have our medical health officers working

closely with Health Canada to make sure that we are not at risk. At this point

in time there have been no confirmed cases in this Province; there is nobody at

this point in time. I think that is being watched or monitored as a possibility.

Our people are watching it closely because obviously everybody sees what is

happening on the mainland, so it is a concern for all of us.

MR. HEDDERSON: I guess where it is new, probably this time next year

something may be built in, but I am assuming by what you have said that really

you are prepared for any type, whether it be SARS or whatever, and if it were to

occur then everything kicks in.

MR. SMITH: Exactly. The only thing about it is, I guess, if we found

ourselves in a situation, let's say, if we had a major outbreak, then

obviously at some point in time it might require us having to access resources

other than what we have available to us. That would be considered of an

emergency nature and would have to be dealt with as such at that point in time.

MR. HEDDERSON: Under heading 1.2.05 Policy and Program Services,

planning, development, evaluation, under the .06 Purchased Services there is a

little bump there, if you notice, from $194,000 to $360,000 and she has fallen

down to $173,000 this year. Obviously, something came up, Deputy Minister. Would

you be able to elaborate on that?

MR. THOMPSON: Donna, do you have the detail on that?

MS BREWER: Yes, there were some extra costs that the department incurred

last fall as a result of the physician work disruption, and that is where that

money was expended.

MR. HEDDERSON: That was allocated for what particular...?

MS BREWER: Diane, you might be able to help here. Some of it would be

(inaudible) with government's advertising position, in terms of its position

with the physicians.

MR. HEDDERSON: Okay. To the tune of what amount?

MS KEOUGH: Two-hundred and fifty thousand, the majority of which was

advertising for the telephone line that we had in place, the toll-free line.

MR. HEDDERSON: Under heading 2.1.01 Memorial University Faculty of

Medicine, I guess, Minister, more for my own information. You know I am critic

for post-secondary as we stand, and I am just curious to know what part your

department plays in the Faculty of Medicine. Is it just the medical side of it

or the education side of it, or a combination of both?

MR. SMITH: Obviously, I guess, from our perspective, as it indicates

there, it is mainly the provision of providing the grants and subsidies. I guess

the money is channeled through us in terms of the money that is here. The

specifics of it -

MR. THOMPSON: I will add a few remarks and then I will ask Dr. Hunt if he

may wish to add more. This Province is unique in Canada in the way that we

finance medical education. The money for the entire grant for the Faculty of

Medicine flows through the Department of Health in the Province. In another

province it is through the Department of Post-Secondary Education, or as the

case may be. So, this budget finances the entire operation of that faculty and

within that, of course, they are well integrated into the programs and services

of the Health Care Corporation as an academic health science centre. The Health

Care Corporation's budget also comes from the department, so we are actually

financing both sides of that equation; on top, as well, many aspects of the

salary budget for the physicians who may be physicians in the community but have

teaching positions at the faculty as well. We are involved in several different

ways.

Ed, is there anything else to add to that?

DR. HUNT: Robert is quite correct; we fund the entire medical school. All

the universities' medical schools across Canada have the post-graduate part of

the medical school funded by the Department of Health, but we are the only

Province where the undergraduate part of the medical school is actually funded

by the Department of Health, because there are two components to it.

MR. HEDDERSON: Just to go on from that, there is no contact then with the

students who are there. I am thinking, do you enter into any contracts with

them, or incentives for them to, of course, work in your department or work in

your hospitals or wherever? Is there anything, Robert, in that, or Minister?

MR. THOMPSON: There are a number of different things, actually. One is,

the salaries for residents are paid for through - I am not sure if they are paid

directly or if they are paid through -

WITNESS: The Health Care Corporation.

MR. THOMPSON: Through the Health Care Corporation. That is one area.

Also, there is a bursary program whereby we provide certain types of grants to

eligible students in residence, or those who apply. Those bursaries then, of

course, get converted into return in service obligations. That is another way.

Are there other additional things?

WITNESS: (Inaudible).

MR. THOMPSON: We finance a physician recruitment office and that person,

our recruiter, is actually located directly in the Faculty of Medicine area in

order to really make that connection a tight connection.

Those are the main things.

MR. HEDDERSON: Just on recruitment, Minister, again, are we going

national-international as well? How successful have we been? Are bursaries

offered to, let's say, someone from another province or another country?

MR. SMITH: Are you talking about the medical school?

MR. HEDDERSON: Yes.

MR. SMITH: As you would be aware, Tom, as a matter of fact the

competition for our medical school is quite keen within our own Province.

MR. HEDDERSON: It is very much so.

MR. SMITH: I am sure that you have been lobbied yourself from to time.

People figure that we can assist them in these things, but it is the - we have a

lot of our own students who actively apply seeking admission to our medical

school. Right now we have - is it forty-five seats that are going to the

Province? Forty-five of sixty, is it?

DR. HUNT: Forty, but five are Canadian. Generally, all forty-five end up

being Newfoundland, but there are five actually dedicated for Canadian.

MR. SMITH: For the people outside the Province, they would be paying the

full rate because we have an arrangement with the other provinces. How many

international seats are there now?

DR. HUNT: Right now we have one. (Inaudible) because, of the fifteen that

were international, twelve of them now are actually New Brunswick seats that

they purchase for their students. There are three international seats remaining.

MR. SMITH: Other than our own students, the others all pay the full cost

of the program. It is our own students who receive the subsidies.

MR. HEDDERSON: Under the drug subsidization, subhead 2.2.02 Senior

Citizens, I just want to get a sense, Minister, if I could, because there was

thirty-two budgeted, thirty-six revised, and thirty-nine estimated. Is this

simply the demographics of the situation? Can I assume by that, that there is

obviously more of a need? Or is it because of increasing numbers? Can you just

give me a sense of that, perhaps?

MR. SMITH: Certainly it is reflective, as you said, of the demographics

of our society. We are an aging society. As people get older, the demand for

drugs and medication certainly increases. While it would not be reflected in

figure, I did mention in my introduction that there is certainly an increase in

the number of pharmaceuticals and medications that are coming on the market on a

regular basis, that this year's amount is just reflective of what is presently

on the formulary. There are some other medications that are either right now

under active review or have been recommended for inclusion on the formulary and

we have agreed, pending the availability of the funding.

One of the things that we have committed to do this year - because right now

the budget is $100 million. We are engaged in a comprehensive review, looking at

the whole program, trying to determine where some efficiencies may be realized

so that we can find some flexibility, hopefully, and some additional funding

that we can then apply against some of these new pharmaceuticals so we can

actually add them to the formulary.

MR. HEDDERSON: Minister, in determining which drugs - because there are

new drugs coming on the market at all times - do you look at an industry

standard across Canada or do you follow the led of some national body? Are

decisions made in the Province depending on the circumstances?

MR. SMITH: At the present time we are operating under, what is referred

to as an Atlantic Expert Review Committee. It consists of the Atlantic

provinces. All the provinces have a presentation. They review any new drugs that

come on and they make a recommendation. Now the recommendation of the committee

is not binding. I mean they will make a recommendation as to whether it should

be added, but obviously it does carry with it some weight; that does happen.

Interesting enough, moving beyond the Atlantic review committee, there is

actually now a national committee. Is that functional yet?

MR. THOMPSON: It is going to be functional this year within an

organization called the Canadian Coordinating Office for Health Technology

Assessment. That will be functional this year and may, in fact, take over some

of the functions that the Atlantic review has done for us.

MR. SMITH: It is intended, Tom, to provide some consistency, which was a

point you were getting at, in terms of decision making. What you will find right

now in terms of the formularies, is if you look at different jurisdictions you

will see some medications are included in some places and not elsewhere. This

sometimes proves problematic, especially when people are mobile and moving

around. If they are in a certain jurisdiction where a certain mediation is

available and then come to Newfoundland, or vice-versa, and find that it is not.

I guess the move is towards some sort of consistency.

I have to say again that even at the national level, at this point in time,

once the committee is functional its authority will be to advise and not to

dictate. In the final analysis each jurisdiction will still make the final

decision as to whether or not to include a particular drug. At that point in

time it will be based on the ability of that jurisdiction to find the resources

to fund it at any given time. Some of these medications, as you would be aware,

especially the newer ones, come with a tremendous price tag. They are very, very

expensive.

MR. HEDDERSON: Under the Special Drug Programs, I notice you have the

cystic fibrosis and other medical conditions. Are they just an individual nature

or have you earmarked any particular condition that it is an automatic, like

cystic fibrosis?

DR. HUNT: This is actually a long-standing program that has been in

existence for years, going back to early Confederation, and it has continued on

since then for just these specific diseases. We just carried on with them since

then.

MR. HEDDERSON: I am sorry, Ed. I did not hear the last part.

DR. HUNT: I said we have just carried on with the program. We have not

cancelled it.

MR. HEDDERSON: Yes, because it seems to be pretty steady. So, I guess,

the need stays pretty steady right along. It is not increasing nor is it

decreasing.

MS BREWER: Other than cystic fibrosis, this also covers growth hormone. I

do not even know what this is, Ed, but it is congenital neutropenia.

MR. HEDDERSON: I would not know either. So whatever you said I would say

yes.

Emergency And Transportation Services, the Road Ambulance. Being from a rural

district, minister, as you know, the ambulance service is always a hot topic, to

say the least. Again, just in a general sense, expectation in this budget -

because I know there have been some demands placed upon you. What, in

particular, is earmarked for the private ambulance services in Newfoundland and

Labrador?

MR. SMITH: In this year's budget what you will see in the Estimates is

the amount that was there last year, because this is a negotiation year. We just

started negotiations with the three groups. The negotiations have started within

the last week or so, and, of course, we will not know until they are concluded

what additional monies we will be putting in there.

The only other piece I would mention is that as part of the $26 million - was

it? - we had on the diagnostic -

WITNESS: Yes.

MR. SMITH: There was $1 million for the provision of defibrillators for

the ambulances. This is something that the ambulance operators have been

lobbying for, for some time, so we have the money available. Also, under that

provision there will be provision for the necessary training; but, again, this

is something that the industry had been lobbying for themselves. So rather than

wait to have that as part of the negotiation process, that is actually included

in the budget. The other piece will be concluded as part of the ongoing

negotiations.

MR. HEDDERSON: Minister, another part of it, too, and I see - especially

some young people who - in my area in particular. I know a couple who were

paramedics, attendants, whatever term you want to use, and it seems like they

got their training and then they moved on. Is this a universal problem across

the Province? Again, I don't know about - some of them moved to St. John's.

I see it as a problem but I only see one or two instances. Is it common? If it

is, or if it isn't, is there anything that you can relate that has been done

to try and stem that?

MR. SMITH: It is a concern. We have made a deliberate movement within the

Province to try to increase the levels of training because, obviously, we want

to offer a first-rate emergency service to the people of the Province. The way

to do that is to increase the training of the people who are providing that

emergency service.

The difficulty we have had, and we certainly acknowledge, is that the

operators - and I have met with all of them during the last year, some of them

on a number of occasions, dealing with these issues. They feel that their

challenge, in terms of being able to compensate them at the levels where they

need to be, is disconcerting for us because we are expending money to train

these people and then what happens in a lot of instances is once they have their

training then they take their training with them and move off elsewhere. So the

expertise is lost to us. I am sure it is an issue that will be - because I know

in discussions that I have had with all three groups, this has been raised by

all of them. I am sure it is something that will addressed as part of the

current negotiations.

MR. HEDDERSON: Minister, with regard to the training - I know you make it

available - who incurs the cost? Is it the people who go through it or is there

a cost-sharing there? Maybe you could give me a sense of -

MR. SMITH: My understanding is that we do make monies available. I do not

know who has the particulars on that. Loretta, could you speak to that?

MS CHARD: We provide a grant to the Health Care Corporation of St. John's

on an annual basis - close to $300,000 - and that enables training to occur

throughout the Province. We work very closely with the industry to try and meet

their training demands as they require it. That is one of the reasons we have

not gone to a private college, because we want to be able to respond in time

where we can. We have made available teleconference courses, on-site courses,

going to the regions to teach courses. We have had some challenges there with

people who take up the programs as well. Some are successful and some are not.

It is like any other industry. We are certainly aware the volunteer base is kind

of eroding. Even if they are a volunteer they need to have a certain level of

training. I think that is essential in this day and age. We also access and have

a partnership arrangement with HRDC to encourage people in the communities to

access the programs through their funding as well.

MR. HEDDERSON: Under Community Services, there is - I know there are a

lot of programs. Minister, any new initiatives this year? I know there is a

little increase in Allowances and Assistance here. Any new initiatives that you

have in place or planning perhaps?

MR. SMITH: I guess one - that Robert is just reminding me of. The one

service that - and it certainly has been in the news, is the one related to

autism, which is a very important service and you would appreciate, Tom, coming

from an education background. We have tried to - I guess the interesting thing

with that particular service as well is that we initiated it in the Province out

of a concern that is there. We were one of four jurisdictions offering it at the

time when there was a human rights challenge that was issued. The decision of

the Human Rights Board was to eliminate the wait list, which we have moved to do

and, in fact, are at least in the process of doing. That is certainly one

program. Are there other new programs that -

WITNESS: (Inaudible).

MR. SMITH: Okay, sure.

MS VIVIAN-BOOK: In terms of the early childhood development initiative,

there were some announcements last year around new family resource centre

projects, as well as prenatal supports called healthy baby clubs. Those are just

getting off the ground and will start to see families participate in those

programs this year. Although you saw low cost for those this year, the full

costs will now be expended as the projects come to fruition. This year the

autism piece has expanded as well.

Also, recently, we are moving down the road of a new agreement with the

federal government around child care where over the next five years we will

start to do further planning and further increases in new directions in terms of

child care.

MR. HEDDERSON: Minister, another aspect of this heading would be home

care. I have to say, and I will say it here, it is probably the most requested

of an MHA. We find ourselves in delicate positions because we have to lobby on

behalf of our constituents. It is not always cut and dried and so on.

Just to give me a sense, Minister, because everything seems to be so tight

under that particular heading, there never seems to be enough. This year are you

anticipating an increased need? I saw it go up and that is why, when I was

looking at the increase in the drug subsidy program for seniors, is there any -

I just want to get a sense of where you are going. Is it going to be the same as

last year, because the need is the same, or do you see perhaps an increased

need?

MR. SMITH: What we have done is, we have budgeted at the same level of

last year. We are again maintaining the criteria. We are still advising the

boards just to deal with the emergency situations.

Just to give you some idea as to where this particular program has gone, in

1997-1998, looking at the actual figures, it was at forty-two point five. In

2002-2003, this was the projection, seventy-three point four. So it is a program

that has grown significantly. It is an area that I guess we are certainly

challenged in terms of trying to respond to because, as you say, I think every

MHA is being lobbied. I know, of the number of calls and letters that I get from

colleagues, that is probably the one program that - because not only are we

talking about new entrance to the programs; we are also looking at people who

have been on the program for awhile and now find themselves in a situation where

they need some additional time. It is two-pronged. So really what is there this

year is to try to maintain. It is a matter of trying to hold the line, maintain

growth, but we certainly have not built in a lot of flexibility here to increase

the program, not in this year.

MR. HEDDERSON: Of course, as an addition to that, I know now that home

care workers are perhaps unionizing, or wherever they are going, and again we

can only predict. I assume that you are looking at it in the same light as you

are looking at other negotiations when it happens, but were it to happen,

Minister, it would obviously cost more, it would not come out of the hours. It

would be an addition put into - if it is an increase in pay or whatever, would -

MR. SMITH: Again, at this point in time none of us know how far off it

is. Certainly, in terms of the agencies, it will probably happen reasonably

quickly but in terms of the self-managed there is a big debate surrounding that

whole piece, as you would know. I do not know, in the final analysis, how that

is going to play itself out because it has been a debate that has been there for

years and I do not know.

Certainly, from our perspective, we would want to honour the commitment that

we have to our clients at this point in time. We certainly could not see

ourselves in a circumstance where we would be scaling back because we would have

to try and make the monies that are available right now just to fit the bill.

MR. HEDDERSON: Okay.

Just a few more questions and then I will be out of your hair.

I know - my health facilities, of course, are Whitbourne and Carbonear - the

foundation goes every year with good fundraising activities, telethons and so

on, and every year the same question is asked, which I am going to ask as well,

and that is the dollar for dollar. I know last year we were very fortunate in

that area. Again, Minister, will that come in time or have you made a decision,

or what can they expect?

MR. SMITH: My understanding is the provision is still there. Is there

money for the matching at this point in time?

MR. THOMPSON: With the Health Care Corporation, which has a provincial

mandate and a regional mandate, there is still a fulfillment on matching

foundations that we will still be paying on. As for other foundations across the

Province, I will have to defer to Donna to give you the details.

MS BREWER: Of the $26 million that was budgeted for capital equipment to

date, we have notified boards of roughly around $20 million of that allocation

so there is flexibility. I guess this year, the proviso, we would have to say to

boards it has to be on equipment that will fit the federal criteria. Another

criteria that we have with boards is that in a lot of cases we would look at

replacement equipment but if it is new equipment they would have to come forward

to us with a plan as to how they plan to manage the operating costs.

They are there and the initial allocation of $20 million - if a board had

indicated to us that they had planned to do fundraising, and it fit within their

priorities and it is something reasonable, yes, we would have said yes.

Throughout the year there is a bit of money that as boards come forward with

requests we will take a look at it.

MR. THOMPSON: We do not have a general Province-wide program for matching

for foundations but where boards have come forward with opportunities, where

they think that they can have a good fundraising opportunity and they are asking

for a one-to-one match for a piece of equipment that fits the definition and

fits overall priorities then there is a marriage there, but it is not a general

program around the Province.

MR. HEDDERSON: I have a list of that equipment from the hospital and I

think it can be matched up because it was the length of my arm. There are a

couple of pieces there that I am sure could match up.

The long-term health facility earmarked, I should not say for Carbonear but

for the area, again I just want to get a sense, Minister, because some of the

municipalities are, even as we speak, lobbying for such a facility. The question

I have, of course, is - I do not think a decision has been made - what is the

process there with regard to that long-term facility?

MR. SMITH: In terms of your particular area, Carbonear-Conception Bay

North, because, as you say, there has been no decision made as to where the

facility will be going, not to my knowledge, but that decision would be a

decision of the board as well once that happens.

During the year, I met with the officials in the area. I have met with the

hospital board and key players in the area, visited the facilities that are

there, and talked to them about that part of it. Where it will be will be the

easy part. The decision right now that everybody is waiting on is whether or not

the development will go ahead.

What we committed to do during the year was to look at three areas: Corner

Brook on the West Coast, Conception Bay North, and St. John's, as possibly

being part of what is referred to as P3 or private-public partnerships as a way

of providing these facilities, and I guess we did that because what we were

looking at was a price tag of about $200 million to deal with the whole

structure.

We have done a fair amount of exploration and analysis, if you will, on P3,

the possibilities. We have had our own in-house committee that has looked at it.

We have had people who have travelled to the mainland and looked at what is

happening in other jurisdictions. We have put together a fair degree of

information, including here in St. John's. We did a pilot with Chancellor

Park, which is the only private for-profit facility right now that we have of

this kind in the Province. Of course, the government has committed to go forward

with an Expression of Interest in the Corner Brook area. So, I guess what

happens to your area of the Province is going to depend on what happens as we -

because right now we are moving with just the one so that we can look at

something that is manageable. This is a whole new experience for us, so rather

than trying to embark on looking at the whole enchilada, if you will, to look at

one particular piece so that we can have it in a manageable size that we can

work with. Should the Corner Brook piece play itself out, I guess at that point

in time then we would have to decide as to whether or not we would then proceed

with your area and St. John's. A commitment is to those three areas. Needs

have definitely been identified. There is absolutely no question there.

MR. HEDDERSON: I just wanted to get a sense of urgency. Obviously there

is not a sense of urgency. There is a sense of urgency in need but with regard

to the process you are more or less piloting and will go from there.

MR. SMITH: They do not need to start lobbying for the location yet.

MR. HEDDERSON: What is that again?

MR. SMITH: They will have lots of time to lobby for the location yet.

MR. HEDDERSON: Okay, just a couple of more.

The healthy living initiatives, and obviously we are talking almost like drug

subsidies and that sort of thing, Minister, is there anything in the near future

with regard to healthy living as getting out ahead? I know it has been talked

about and so on.

MR. SMITH: What we did this year, of course, as a follow-up to the launch

of our Strategic Health Plan, we have set up our Wellness Committee. I do not

know; who can report on the Wellness Committee, where they are right now in

terms of their work. Lynn?

MS VIVIAN-BOOK: The wellness council has been active for the last several

months and hope to have a framework document (inaudible) with priorities ready

for around June for some consultation and so on. They are also very closely

linked to initiatives in Atlantic Canada around obesity, active living, physical

activity, and also at the national level around those initiatives with the

federal government. So, yes, it is definitely a priority and there have been

significant stakeholders brought together to participate in this count. Needless

to say, there are lots of priorities and interests from municipalities to

different interest groups around that table.

MR. HEDDERSON: If I might ask, would you be the leader ministry in this

or just - you would be, obviously -

MS VIVIAN-BOOK: Yes.

MR. HEDDERSON: - and the other departments like Education and that would

MS VIVIAN-BOOK They are all represented around the council.

MR. HEDDERSON: Okay.

One last thing. I seem to be doing my district more than anything, but I

attended a meeting on the dialysis, Minister, and, of course, we are very

hopeful. I just want, again, a sense of where it is and perhaps where it is

going, and the possibilities?

MR. SMITH: Certainly in terms of, as you mentioned, dialysis is a service

that is of concern to a number of areas in the Province. For the last few years,

we have been working on doing a satellite operation, one in Clarenville and one

in Stephenville, as a way of getting the service outside of the larger centres.

Right now, dialysis is offered in Corner Brook, in Grand Falls and in St. John's,

but we have requests from your area. There were requests from Marystown. I know

St. Anthony, actually, has been approved. The unfortunate thing about the St.

Anthony situation, from the time that St. Anthony was approved until we were

ready to move on it, the number of patients who were medically stable who were

there, there was an insufficient number, because so many people had moved on.

They had to go somewhere to get the service, so the numbers are no longer there.

We do have a provincial committee that will be reporting within a few weeks.

What it will be doing is looking at evaluating the operation in Clarenville and

in Stephenville and giving us some input there as to the efficiency of these

operations, as a way to proceed, and also will be giving us advice as to the

provincial picture.

Anything that we do with regard to that particular service will be based on

the report of the provincial committee, which does operate independently. I

think from my perspective, I have said, whenever I have met with people - and

you will recall from my meeting with the group, that yourself and Roland

attended - I think people appreciate that it is better to have that kind of

advice coming from people who operate at the professional level rather than

leaving it as a political decision, because it is just too easy to make a

political decision just to give into the pressure to provide it but it might not

always necessarily be the best decision.

We should know within a few weeks. Loretta, do you have any idea when we

might expect the report?

MS CHARD: Yes, Minister, the committee are in the final stages of their

work right now. They are expecting that within the next two to three weeks they

will be able to wrap that up. As the minister has said, it is an area of high

demand. We know that from a national perspective the increase in need for

dialysis services is about 9 per cent to 10 per cent annually. We are asking

this committee to look at our Province and see if our numbers fit in the same

context, and to look at an overall management process for end-stage renal

disease. It is not simply just lacing someone on a machine. There are various

stages to chronic kidney disease. Some people can manage that process and want

to have some choice with managing it at home versus in the unit. There are also

some learnings from other provinces that, in certain areas, a dialysis unit at a

satellite level worked well. We know that the skill mix in some of those is

different from what we do here as well.

We are looking for a comprehensive approach to the issue of a major disease.

We know that it is going to continue to rise with the aging population, the high

rate of hypertension that we have in the Province, and the high rate of

diabetes, all of which contribute to end-stage renal disease.

MR. HEDDERSON: One final comment, Minister, if I could, and that is to

say that, as I alluded to before, I have some dealings with a lot of your field

workers. I would like to go on the record as saying that in all my dealings they

have been very, very professional. Tough love, I must add, but I would have to

compliment them, more particularly those in my district. I must say, a great

relationship with them and they are a credit to your department.

MR. SMITH: Thank you, Tom, for that.

Also, I say to you, as Minister of Health, I want to compliment you on your

change in your own lifestyle. You are taking this wellness to heart, with all

the weight off you. Even Donna remarked at the beginning of the meeting and said

that -

MR. HEDDERSON: I was kind of hoping to be picked up as a poster boy. I am

open to it, Minister, especially with the election coming up. I do not mind

going before the cameras with testimonials.

WITNESS: Tom and I will do the before and after shots. I am the before.

MADAM CHAIR: Mr. Wiseman, are you ready to start your questioning?

MR. ROSS WISEMAN: Thank you, Madam Chair.

Minister, I have some points I want to cover off with you. Before I do, I

want to compliment you on your announcement today. I think that was a very

humane thing to have agreed to leave the thirty people in the pilot at

Chancellor Park. I think that was a very reasonable decision. I commend you for

that.

MR. SMITH: Thank you.

MR. ROSS WISEMAN: There are a couple of things I want to get into with

respect to the budget itself. Before I do that, can you just qualify for me,

Minister, I just want to get some sense of what the Province got out of the

recent First Ministers' Accord and the federal budget that came down. There

were four or five categories in which funding was allocated through that. If I

run down through them, can you tell me what this Province's share of that was?

MR. SMITH: Yes, we can provide that.

MR. ROSS WISEMAN: There was the $9.5 billion in transfers to the

provinces and territories over the five-year period. What was our share of that?

MR. THOMPSON: Is that the CHST category?

MR. ROSS WISEMAN: No, that was the - I should not say that. It is not

identified as that. There is another category, $2.5 billion in immediate

investment through the Canada Health and Social Transfer.

MR. THOMPSON: Okay.

MR. ROSS WISEMAN: I assume the other one must be as well, actually, there

is no other mechanism to do it.

MR. THOMPSON: There are so many different tables produced, I do not know

which one you are looking at, but from what you have said so far I think I

understand. The $9 billion would have been the amount announced in September,

2000, and therefore -

MR. ROSS WISEMAN: That is the balance of it flowing through, is it?

MR. THOMPSON: Right - had already been built into the Province's base

budgeting. So it was not new to the - if I read your phrase correctly, the $2.5

billion that was being made available through CHST as a result of the FMM

accord, that was - and each Province had an ability to take its share either

spread over three years or all in one year or all in two years. So our Province's

share out of that total amount is $42.5 million. Donna, correct me if I am wrong

there. We have chosen to take it all in year one, so that $42.5 million into

CHST flows into the Province's revenues in 2003-2004.

MR. ROSS WISEMAN: In this year coming, in 2003-2004?

MR. THOMPSON: Correct.

MR. ROSS WISEMAN: Then the other one was the $16 billion over five years

for health reform, targeted primary and for primary health care, home care and

catastrophic drug coverage.

MR. THOMPSON: In the current fiscal year, $17 million of that flows into

our revenues.

MR. ROSS WISEMAN: Seventeen million in this year?

MR. THOMPSON: Correct.

MR. ROSS WISEMAN: Then the other category was the $5.5 billion over five

years in health initiatives, including diagnostic medical equipment, health

information technology and so on.

MR. THOMPSON: There are a number of additional pieces there, but the key

one is the medical and the diagnostic equipment fund. Through that one, and I

believe that was $1.5 billion nationally -

MR. ROSS WISEMAN: Pardon me?

MR. THOMPSON: - $1.5 billion nationally, that particular fund. Of that,

this Province is bringing in $25.5 million, and we are taking that all in

2003-2004. Now you said it was a $5 billion amount. The extra categories -

MR. ROSS WISEMAN: Health information technology was there as well.

MR. THOMPSON: Health info (inaudible). The rest of those items are not

items that have transfers to the provincial government. They might be national

organizations. They might be Health Canada programs, but none of the extra or

those additional ones flow money into our coffers.

MR. ROSS WISEMAN: Okay, but we have gotten all we are going to get out of

that because we have pulled it all into this year.

MR. THOMPSON: Well, except for the health perform fund, because that fund

where we are getting $17 million will grow each year over the next five years.

MR. ROSS WISEMAN: Okay.

Alright, I just wanted to clarify, to have some sense of what came in this

year that was earmarked for health. So what we have, you have taken $42.5

million, which is a three-year allocation, and pumped it into this year. You

have the $25.5 million, which is for the technology. So there is $68 million

that you have pulled from the feds in this year and flowing it in through this

year's budget. Is that correct?

MR. THOMPSON: Right.

MR. ROSS WISEMAN: Maybe I can start, Minister, if you do not mind. Tom

kind of went for the heads and I will probably do a combination. I will refer to

some of the things in the Estimates but also in some of the other documents like

the releases that you had and some of the things in the Strategic Health Plan,

if you do not mind.

MR. SMITH: Sure.

MR. ROSS WISEMAN: If the Chair will allow me to bounce all over the

place.

The $26 million for capital equipment. From within that $26 million that you

announced this year, you are going to buy the new MRI, and PACS comes out of

that as well?

MR. SMITH: That is right.

MR. ROSS WISEMAN: And the rest, will that all be used for diagnostic

equipment?

MR. SMITH: Yes, my understanding is all that $26 million -

MR. THOMPSON: The full $26 million - the $25.5 million is from the

federal fund - is towards diagnostic and medical equipment, and that includes

patient care equipment as well. All of those categories are eligible within the

FMM Accord money.

MR. ROSS WISEMAN: I remember the last time there was some broad

definition of what constituted medical equipment. If I am not mistaken, I think

last year in this same discussion you furnished me with a list of what you did

spend and how you spent it; some carriage bands and things like that, and

dietary equipment did not necessarily fit the medical definition. Are there new

criteria this time that you have to comply with?

MR. THOMPSON: It is an unusual instrument, the FMM Accord, because

essentially the money is being transferred to the provincial government. We get

to make our own decisions about what we invest in, but there are phrases in the

Accord which we must honour. The phrases are diagnostic and medical equipment

and within that, patient care, as I said.

We have a lot of flexibility within those terms to apply to types of

equipment that we chose, but clearly, we are not going to apply it to things

like toasters and lawnmowers and ice-making machines. Those things are not part

of those categories. We develop our investment criteria in this Province for the

things that make sense, but fitting within. We are not constrained by specific

federal criteria. They have not supplied us with words to narrow this down, but

we are honouring a legitimate definition of equipment of that kind.

MR. ROSS WISEMAN: I guess my question, more to the point, would be the

types of things that got financed the last time. If in a years' time I ask for

the same list, would I get a similar sprinkling of types of equipment that was

purchased the last time, or will it be much more focused on direct patient

activity?

MR. THOMPSON: It will be somewhat more focused than last time, but you

will see things like (inaudible) wheelchairs, bed lifts, specialized equipment

like that.

MR. ROSS WISEMAN: I think the last time there was a couple millions

dollars spent on computers and stuff. It is a bit of a stretch to say it was

medical equipment.

MR THOMPSON: But PACS, as an information technology component. Very, very

much related to diagnostic. It is a diagnostic tool, but not just desktops. No,

you will not see desktops.

MR. ROSS WISEMAN: The other stuff was for Meditech. The implementation of

Meditech software, so it was not PACS.

In the Budget, Minister, you announced - and you commented here tonight as

well - the process for making the decision about the MRI. Do you have some sense

of when you will be making that decision?

MR. SMITH: We are just starting the process. I do not know how long it

will take.

Loretta, are you working with that particular one?

MS CHARD: Yes, we are in the process of trying to now iron out who a good

facilitator might be for that process, and to get letters of invitations

settled. I guess the date will depend upon when we can nail down an appropriate

facilitator and when we can bring the groups together. We are hoping within a

month or so.

MR. SMITH: With that one, Ross, as you can appreciate, I think what is

happening is that we are seeing a lot of - there is tremendous lobbying

throughout the Province. I think from our perspective it is almost an impossible

situation for any of us right now. So, really, what we are trying to do is find

a way - again, going back to a response I made to Tom's question earlier - to

try to at least get the politics out of the decision making as much as we can.

What we have committed to, as a department, is for our decisions to be

evidence-based. Really, in this one here, I know it is not going to be as

straightforward.

There are two issues really, one is whether we go with the fixed as opposed

to mobile. That is the one piece, and if a decision is that the way to go is

fixed, well where should it go? It is kind of a difficult one because

politically, regardless of where you put it, it is a no win situation. If we can

get the appropriate mechanism in place, especially with our boards and our

medical personnel kind of looking at that and saying: On the base of the

evidence this is the recommendation we make. We think that is the fairest way to

do it.

MR. ROSS WISEMAN: You have a better chance of de-politicizing if you

leave it with physicians not the boards, is what I am saying. That is a

commentary by the way.

The other is the PACS; the PACS money is coming out of this twenty-five

total?

WITNESS: Yes.

MR. ROSS WISEMAN: What will this do now to the Province, this way that

you have done here (inaudible) what you have done over the last couple of years?

Will we now have any health facility in the Province that has X-ray capacity?

Will they be linked in some fashion through a provincial network? How far along

in this process will you be with this step right here?

MR. SMITH: We certainly will be, but I do not have the details.

MS BREWER: We will be completing what we call phase one. There will be

PACS capability in every single board but it will not be every single site

within every single board. There is probably another $5 million or $6 million in

phase two. To us it is a good start. From Gander East we have good coverage now.

Really, the focus now, in addition to a further investment of the health care

corporations, is to look at boards west.

MR. ROSS WISEMAN: Do you have some sense of what phase two will cost you?

MS BREWER: No, I will have to get that for you. I think it is at least

another $5 million. It is possibly more.

MR. ROSS WISEMAN: Given that you have taken the three-year federal money

upfront it is going to have to come from provincial sources as you move forward

with the next part.

MS BREWER: Way back in the beginning - and Loretta may recall this -

there was a provincial PACS committee. They, at that time, indicated if they

went province-wide there would be operating savings. I think even the health

care corporation are saying they may take the $2 million that we have, because

what happens is that you have - lets say film costs, you save some storage

costs. There may be potential with phase one, if we get it in place, that we can

start generating some operating savings which we can probably reinvest.

MR. ROSS WISEMAN: Minister, you commented about the personal care homes

and the one-point-three and the increase in numbers of subsidies. Can you tell

us how you have broken that down in the last couple of years? Let's say last

year and this year; how you plan to do it this year? Last year it equaled

one-point-three and this year you are putting another one-point-three in. How

much of that went to increasing the number of subsidies and how much of it went

then to increase the fees paid to the homeowners for the residents? What was the

split?

MR. SMITH: Who has the detail on that? Donna?

MS BREWER: The fiscal 2002-2003, the additional subsidies were roughly

around $379,200, and the rate increase was approximately $412, but in addition

to that, there were other further rate increases. What happens is that when the

federal government increases its OAS and GIS, we then pass that increase on to

the private operators in terms of the rate. For anybody over sixty-five it is

not a cost, but anybody who is in that home under sixty-five we have to pick up

extra subsidy. Of course, we never know from year to year what that rate is

going to be. So, we start the year thinking that it is roughly going to be half

and half. Right now Lynn and I just signed letters, basically, effective April 1

we are increasing the rate $25.40. That rate increase is roughly around

$500,000.

MR. ROSS WISEMAN: How many new subsidies will you be adding this year?

MS BREWER: We hope to be able to add around 136; but, again, it is going

to depend on what increases OAS and GIS, and whether or not we have to divert

some of that increase subsidy to further rate increases.

MR. ROSS WISEMAN: How many subsidies do you have now in total,

provincially? I have the number of subsidized beds but the number of subsidies?

MS BREWER: The number of subsidies; 1,297 is the number that I have here

for 2002-2003. It is my understanding there are roughly around 2,200 beds.

MR. ROSS WISEMAN: So if they increase 136, it brings you up another

1,400.

Minister, I know this has been issue that has come across your desk a number

of times. A couple of constituents of mine have been party to the letter that

has been sent to you from homeowners that have a bit of a quagmire, from what I

see of it. The homeowners who got into this business many years ago have

subsidized beds, and many of them have not necessarily plowed a lot of money

back into the capital improvements in their homes. Now with the subsidies to the

client, and not to the homes - which, by the way, I concur with 100 per cent -

has created a situation now where they have a competitive position that they did

not have before.

If you go from a monopoly to a competition, things change. The more you move

away from that monopoly the more difficult it becomes for those who established

themselves and have financed themselves, assuming there is a monopoly. Not that

I have looked at a lot of them, but a number of them I have, the financial

statements of them over the last couple of years, and they do not need very much

of a financial blow to close them up. One of the things that will make a

difference to some of them is a requirement placed on them by the Fire

Commissioner's Office, which again I concur with the need to be safe and it is

appropriate that they do.

Have you given some consideration about how you are going to manage that

implementation, number one, but the other thing, too, manage what is going to

happen to some of those homes? We have seen some of them closed already, not a

large number but there have been a few that have closed and there are several on

the brink of closing. Have you given some consideration of how you are going to

manage that and what you might be in a position to do?

I understand that some have written you requesting a meeting to discuss the

concept of eliminating the subsidized bed by having the department buy back the

subsidized bed, which gives them a cash infusion, and then let them play the

field with the other players who are trying to attract the subsides that the

residents have.

MR. SMITH: It is a very important issue. It a very complex one, as you

would know. We are currently in the process of doing a thorough review of the

whole area of long-term care, including the personal care homes, and looking at

all aspects of them. The recent development, in terms of the Fire Commissioner,

again, as you say, it is difficult to.... Obviously, when I was asked at the

time, it is hard not to supportive of the initiative because you are talking

about the safety of the clients who live there, and we certainly have to be

supportive of that. Having said that, we are not totally unaware or insensitive

to what this is doing to the owners of these establishments. When I was asked at

the time, when it was announced, was the department prepared to commit to assist

them, the answer was no, because really there is no money there right now for us

to assist. As part of our review, it is certainly something that we will be

looking at.

Where there are individual homes, I would assume - there is a two-year period

in which they have to do this, so it is not like they have been told by the Fire

Commissioner that you have to have this next week or next month. There is ample

time there, I think, to get a plan in place to deal with it. As each home gets

itself in a situation, I know exactly what they are confronted with and it may

very well be in the final analysis dealing with them one on one. That is maybe

where it has to be, because obviously they do provide a very valuable service.

We are certainly not interested in putting these people out of business. That is

not what it is about, but in the meantime it is trying to maintain these things.

The other piece, as you mentioned, having the subsidies attached to the

person rather than to the home, is again in response to some pressures that we

have had over the years, trying to provide people with the mobility and the

flexibility to be able to choose where they want to go, and exercise the subsidy

and where they want to go to live. Now we recognize that for some of these home

owners it may present some problems as well, but I think in

part it has been

driven by the fact that over the years - I think it is no secret that we

certainly hear from people from time to time saying that you see a big

difference in the services in one area of the Province as compared to others in

terms of the standards that are there. I suppose part of the argument is that if

the subsidies are attached to the person then the person has the option to go

and select a place where they think they want to live, rather than being forced

to go and live in a place they might feel is not up to standard. They have no

choice because that is the only way that they can get the subsidy.

We are engaged in a total review of that whole area. We have a number of

problems there, on the personal care side and certainly on the long-term care

side, and we will be developing a strategy encompassing all aspects of that

particular industry.

MR. ROSS WISEMAN: Who is doing that study? Are you doing that in-house?

MR. SMITH: Yes.

MR. ROSS WISEMAN: On that point, by the way, have you responded to that

group of people who sent you that letter requesting a meeting to have that

discussion about their subsidy?

MR. SMITH: I could not tell you, Ross, there are so many requests for

meetings. Give me the specifics after and I will be able to let you know. More

than likely, if they asked for a meeting, I would say they have gotten it. I do

not know when, but if they haven't gotten it, I am sure it is on my

schedule

somewhere.

MR. ROSS WISEMAN: They haven't gotten it yet. I was just curious about

whether you had it on your agenda.

MR. SMITH: We will certainly check on it. Is it from your area?

MR. ROSS WISEMAN: One of them. There were four of them, I think, who

signed the letter. One of them is from my area.

MR. SMITH: Is anyone aware of that request for -

WITNESS: I will check into the timing of it. I know that was in process.

MR. ROSS WISEMAN: I am going to do what Tom did. I am going to take

advantage of this discussion and talk to you about an issue that is a district

issue. I want to talk to you about the other one where you talk about capital

commitments for next year. I have had some discussions, obviously, with you,

Minister, about this issue, and yourself, Robert, as deputy: the Clarenville

long-term care facility. I just want to clarify a couple of things in terms of

what I understand is actually happening. The $500,000 that was allocated last

year and the year before is still $500,000 that is there to be used by the board

to continue with the design work for the facility.

MR. SMITH: Yes, that is right.

MR. ROSS WISEMAN: That $500,000 is - I need to ask this question again,

Minister, because I have gotten a bit of information that suggests otherwise. I

understand that is simplistically expressed, I guess - is the SGE Group have

been engaged as the company who is going to do the engineering and design work

and $500,000 gets allocated for that. The assumption would be that one $500,000

cheque at some point, or a combination of cheques totalling $500,000 will get

written to the SGE Group in exchange for that service because they will provide

the service because they have been engaged to do it. I have some information

that suggests that some other- that fund has been encroached upon for other

studies and other activities, planning activities on behalf of the department in

designing or defining concepts for long-term care services, long-term care

design, and that all of that $500,000 will not necessarily be dedicated to the

facility in Clarenville. Can you -

MR. SMITH: Again, that is news to me. I will ask if Robert can speak to

that. I am certainly not aware of that.

MR. THOMPSON: I am not aware of that either. To put it again in simple

terms, there was $500,000 allocated. We entered into, with Works, Services and

Transportation, an arrangement with a consulting firm to undertake work that was

estimated to be valued at $500,000. That work will be brought through to

completion. I do not know anything about what you say. We will look into it. If

have some extra information to help us pinpoint it, that would be helpful, but I

know nothing about what you have said.

MR. ROSS WISEMAN: It might be an issue of - works and services are doing

the work on behalf of the department. The money was allocated through the

department and the vote gets passed over to works and services to engage the

work. I assume that is the process, isn't it? So, when it gets in works and

services, I understand what may have happened: that works and services have used

that pot of money, knowing that it is not going to be flowing quickly in this

year, to pay for services that they have needed to have in helping them come up

with concept designs for long-term care facilities. In a stretch, one could say

that the information gained through that process might get used and that

knowledge would be transferred to the SGE Group to be used and incorporated in

the design for the long-term care facility in Clarenville. That is a bit of a

stretch in my view.

Minister, if you could - I appreciate your response that you will check - I

would like you to either confirm that is not true or tell me and confirm for me

that, in fact, all of that $500,000 will be used and dedicated to the design.

Therefore, I can only assume that it will all be paid to the SGE Group because

they have been engaged to do it.

MR. SMITH: Again, just to reiterate, my understanding, Ross, is that

certainly as far as the department is concerned, that $500,000 is there for that

purpose. Robert and I were just talking because I was asking him about the issue

you are raising, how would that money actually flow between our two departments.

If there is a concern - we are not aware of any - we will certainly take it

under advisement and have Robert follow up on it and see what we can find out

and do.

MR. ROSS WISEMAN: I would appreciate that.

MR. SMITH: We can communicate to you on that.

MR. THOMPSON: I will clarify one other point. We would expect that the

full terms of reference for the work that was to be completed in relation to the

Clarenville facility out of that $500,000 will be brought fully to completion,

whether that is $495,000 or if -

MR. ROSS WISEMAN: I know what you are saying. I was not suggesting that a

$500,000 cheque would be written as a rounded out figure to the SGE Group. It is

based on billed hours.

I can tell you where it came from, actually - not tell you where it came from

but how it got expressed. I know the SGE Group have done work that will amount

to about $40,000 of billable hours that you have not yet been billed for. When I

posed the question that if there is $40,000 worth of billable work going in and

there is a $500,000 pot, that means there is $460,000 left. The response I got

was that it was not quite that much because we have had to use some of that

money for some other parts of that same project. Therefore, that prompted me to

start querying it and that is what I discovered. You might want to verify that

for me, because if that project is - if the SGE Group are not able to bring it

to a level where $500,000 ordinarily should bring you because of that kind of

maneuvering of the money, that would be rather unfortunate.

MR. SMITH: I agree, and we will certainly check it out.

MR. ROSS WISEMAN: The other thing, in the other capital projects for this

year, will this seven point five finish the Fogo Centre?

MR. SMITH: My understanding is that it will, yes.

MR. ROSS WISEMAN: It will open it, will it?

MR. SMITH: Yes.

MR. ROSS WISEMAN: The three point five will open Stephenville?

MR. SMITH: Yes.

MR. ROSS WISEMAN: What is the story on the Gander project? I ask that for

the benefit of Madam Chair, now that we are talking about our own districts. How

is that, Madam Chair? There is $400,000 there to the new wing. The other part of

that project, I understand, from what I have been hearing at least, has been

deferred for a little while to study?

MR. SMITH: That was the plan. The information that we had was that in

doing some of the work in the old

section of the hospital, there were some

concerns that came about with regard to asbestos. There was always a knowledge

that there was asbestos there but there was a realization that there was a

significant asbestos problem. If we went in there and started to complete the

work on the refurbishing of the old section, automatically, the information we

had, is that the cost of doing that would increase by some $5 million or $6

million, which causes some concern because the amount that had been budgeted to

complete the Gander - the figure that had been set some time ago was $69

million. There has been some $54 million spent to this point in time, but now we

are looking at the possibility of the figure going up as high as $75 million, so

that caused some concern and we wanted to have a second look at it to see if, in

fact - because our concern was: can the group still complete what they need in

Gander and stay within that $69 million? Now, I have had further meetings within

- as a matter of fact, as recent as today, with officials from Gander who have

come in and, in fact, they are saying they have been looking at the design

there, what needs to done, and, in fact, are prepared to commit that the project

will stay within the $69 million.

They have raised for us some issues which are of some concern to them, that

they say will need to be done in order to really make full use of the work that

has been done there. So, we have committed to take another look at that to make

sure that we are not, in fact, jeopardizing the work that has been done there by

not doing something in this year to make sure that we can utilize what is there.

But certainly in terms of major expenditures for this year, we have put it on

hold while we revisit and look at what, in fact, needs to be done there with

this new information that has come to light.

MR. ROSS WISEMAN: The other project announced was the $5 million for the

Grand Bank facility. I notice that is a $17.5 million project, and you are

scheduling it to be completed by the winter of 2005. Is the plan to flow that

through three fiscal years?

MR. SMITH: Donna, can you speak to that?

By the way, as well, Ross, Donna was pointing out to me Fogo was scheduled

for - when is it? The summer of -

MS BREWER: The summer of 2004. Fogo starts the next fiscal year,

2004-2005.

MR. ROSS WISEMAN: There will be a need, actually, to finish off Fogo in

the next fiscal year as well, so we will see another allocation for Fogo next

year.

MS BREWER: Yes, in 2004-2005. There will be another allocation for Grand

Bank in 2004-2005 as well. The bulk of the construction looks like it is going

to occur in 2004-2005. Our forecast shows $11 million to flow in 2004-2005.

MR. ROSS WISEMAN: $11 million for the next fiscal year?

MS BREWER: Yes, for Grand Bank.

MR. ROSS WISEMAN: So, it is going to flow through two fiscal years, this

year and next year?

MS BREWER: Yes.

MR. ROSS WISEMAN: What is the balance of Fogo?

MS BREWER: Fogo, 2004-2005, was $1.3 million.

MR. ROSS WISEMAN: What is the total cost of that project?

MS BREWER: Eleven point five million.

MR. ROSS WISEMAN: Eleven point five million. Okay, it is right there,

yes.

Minister, in the Budget document, in the new fiscal year the operating budget

for health will increase by a further $52.5 million, so the increased budget for

this year over last year is $52.5 million. If my math is correct, what you

pulled out of the federal programs for this year is $68 million. Does that tell

me that you pulled out $68 million for the feds, you increased the budget by $52

million, so all of the increase in the budget this year is actually federal

money and you still have some left in (inaudible).

MR. SMITH: My understanding is, the actual increase is $71 million year

over year.

MS BREWER: The $52.5 million just refers to current. Does your $68

million include the capital, the capital equipment?

MR. ROSS WISEMAN: Yes.

MS BREWER: The $52.5 million just refers to current account expenditures

revised budget.

MR. ROSS WISEMAN: So it is $77 million.

MS BREWER: And the minister's $71 million is budget to budget but is

current and capital.

MR. ROSS WISEMAN: Okay. So the Province's investment in this year's

budget is $3 million. Is that correct?

MS BREWER: I am sorry, I missed that last part.

MR. ROSS WISEMAN: That being corrected, then, if $71 million is your

total increase in the budget this year, both capital and operating, and you got

$68 million from the feds, that means the Province has invested $3 million in

this year's budget, of provincial money.

MS BREWER: What is not included in our budget yet is additional money as

a result of the ambulance negotiations and also the physician award. So we

expect during the year our expenditures are going to increase possibly to $100

million.

MR. ROSS WISEMAN: So in the budget, as I understand, what you have set as

a floor on the negotiations is $50 million, but that is over the term of the

contract. Is that it?

MS BREWER: Yes.

MR. ROSS WISEMAN: What is the arrangement for the retroactive pay and in

the first year? All the retroactive pay is going to be picked up in this year,

plus the first year's cost. Would that be correct?

MS BREWER: The money is not in our budget, but I understand the Province

has budgeted some sort of contingency.

MR. ROSS WISEMAN: What is the breakout in terms of the - let's say it

were $50 million. Let's say that they agree it is only $50 million and not

something different. If it is only $50 million, how much of that had your

anticipated flowing into this year? Because you have the retroactive pay to pick

up this year, plus you have the full annualized cost of that increase in this

year, what was going to be your cut of the $50 million?

MR. THOMPSON: As for a precise number, I cannot tell you. Let's assume

that there is an annual increase that hits in the first year of $50 million,

then that would be a full $50 million for 2003-2004, plus a six month

retroactive period for last year. Of course, that is a very simplistic way to

put it because the numbers will be a lot different, but that is the concept.

MR. ROSS WISEMAN: It is $50 million over three years, not $50 million a

year, is it?

MR. THOMPSON: That is right. Our proposal was that by the third year

there would be $50 million more in the physicians' services budget. That might

start off at $22 million, go up to $36 million, then go up to $50 million. We do

not know what the arbitrator will say. Should you go to 100 per cent in the

first year, or 20 per cent in the first year, or a third, third, third.? We do

not know what the arbitrator will say.

MR. ROSS WISEMAN: What did you ask for?

MR. THOMPSON: What did we ask for? A third, third, third, I believe, was

our position.

MR. ROSS WISEMAN: A third, third, third.

MR. THOMPSON: I am pretty sure it was a third, a third, a third.

MR. ROSS WISEMAN: Realistically if you were to be successful in what you

have asked for, you would get one-third of $50 million, plus six months of that

in this fiscal year.

MR. THOMPSON: Correct. One-third of $50 million.

MR. ROSS WISEMAN: Okay, plus six months of -

A couple of areas that I would like to zero in on, if I could. In all of the

heads under the Professional Services, my math tells me that it was $1.9 million

spent last year on Professional Services and you are planing to spend another

$1.5 million this year. What do you buy with professional services? Where does

that come - what are you buying?

MS BREWER: If you look under, for example, Board Services, which is on

page 183, the Professional Services there, that is Loretta's reference to the

training which we purchased on behalf of the ambulance that we contract with the

Health Care Corporation.

MR. ROSS WISEMAN: So that one there would be ambulance services?

MS BREWER: Right, yes.

Under prescription drugs, 2.2.01, page 185, that is the contract with xwave.

They actually do the adjudication of the pharmacy claims. That is $933,000 and

the rest is divvied up throughout the department for different divisions to

contract with professional consulting services.

MR. ROSS WISEMAN: Can you - and I know, Minister, we had this discussion

a couple of times over the last year - furnish us with a

summary of the studies

that you have had done in the last twelve months? Who they were and how much was

paid for the service?

MR. SMITH: Studies that were done?

MR. ROSS WISEMAN: Studies that the HAY Report did. You are doing a report

in Labrador - Burnell and Reid.

MR. SMITH: Yes.

MR. ROSS WISEMAN: Can we get a copy of that?

MS BREWER: On page 184, in our Government and Agency Relations, a lot of

that - if I understand correctly, Jim - $518,000 are contributions to

federal/provincial/territorial work.

MR. ROSS WISEMAN: Okay.

The other area in the Estimates I would like to talk a little bit about is

board budgets. You are increasing the board budgets this year by $4.5 million.

Minister, did you mention that was going to the community health boards and not

the institutional boards, or is that going to be distributed among all boards,

both institutional, community and the integrated boards?

MR. SMITH: The four point one -

MR. ROSS WISEMAN: The $4.5 million that has been allocated for the boards

this year?

MR. SMITH: No, that is for the institutional.

MR. ROSS WISEMAN: For the institutional?

MR. SMITH: Yes.

MR. ROSS WISEMAN: Okay, so it is going to be distributed to the

institutional boards only. The community health boards will not be getting any

piece of that?

MR. SMITH: We have not budgeted an increase for the -

MR. THOMPSON: No, that is correct, but we have an allocation primarily

for home support to be allocated among the community boards. The $4.5 million

you are referring to is to manage growth in the institutional board budgets.

MR. ROSS WISEMAN: Okay.

How much is allocated for the community health boards?

MR. THOMPSON: The $4 million that was increased in our budget for home

support will be allocated this year for community boards. So, $4 million extra

is the increase that we have for those boards.

MR. ROSS WISEMAN: What I am wondering - I might have missed something

because on page 25 of the Budget document, I am reading here, "In the

coming year, government will provide the boards with additional funding of $4.5

million." It just says: the boards. My question was, that $4.5 million, was

that to all boards or -

MR. THOMPSON: No, just institutional boards.

MR. ROSS WISEMAN: Just institutional?

MR. THOMPSON: That's right.

MR. ROSS WISEMAN: You are suggesting there is another $4.5 million for

community health boards?

MR. THOMPSON: Just $4 million.

MR. ROSS WISEMAN: Just $4 million. Okay.

MS BREWER: Just to clarify, that $4 million was allocated in 2002-2003

and just carries forward into the base for 2003-2004.

MR. ROSS WISEMAN: In last year's budget there was a $5 million figure

there that you had allocated to be distributed sometime during the year, and you

have annualized that $5 million.

MS BREWER: No, the $4.5 million is on top of that $5 million. So there is

another $4.5 million. The $4 million for home support actually started to flow

to the boards this past month. They had gotten it for 2002-2003 to help them

balance their budgets this year and that $4 million will flow again, but it is

not an additional $4 million. It is the same $4 million.

MR. ROSS WISEMAN: Okay, it is based in - when I look for it in here, I

will find it -

MS BREWER: Under Revised.

MR. ROSS WISEMAN: - built into the revised figure under Grants and

Subsidies, on page 188 of the Budget. Is that where I would find that?

MS BREWER: Yes.

MR. ROSS WISEMAN: Last year it was $234 million and now you are going up

to $244 million, so there is $10 million there. In that $10 million the $4

million is flowing through that you gave them last year.

MS BREWER: Yes, but it is not an increase over revised. The reason you

are not seeing a full $4 million increase over the $233 million with the Budget

is that there were some cash flow savings, particularly in ECD and NCD, as we

start to ratchet up those programs. You had $4 million added for home support to

the boards when you also had savings elsewhere for other programs within that

activity.

MR. ROSS WISEMAN: Okay. I am going to phrase the question this way so I

will understand it. Don't make it too complicated, I will never get it.

Last year, March 31, 2003, the community health boards had this much money.

Over the course of last year you gave them $5 million.

MR. THOMPSON: In that question, we are dealing with institutional boards.

There was $5 million last year. We added to the base budgets of institutional

boards and it was allocated among them. That allocation became part of their

base and, indeed, continues to be part of their base in the current year. On top

of that base, for institutional boards, we are adding another $4.5 million. We

have not allocated between the boards but it will become part of their base

budget. Now, all of that is quite separate from the community. That is a whole

different question.

MR. ROSS WISEMAN: Okay.

MS BREWER: (Inaudible) institutional boards.

MR. ROSS WISEMAN: The institutional boards did get an increase, or are

getting that $4.5 million as an increase over and above what they had last year;

the institutional boards. The community health boards are getting increases

based on an annualization of last year's money that you gave them.

MS BREWER: Yes, all else being equal, had we not provided the $4 million

late in the fiscal year they would have been in deficit by $4 million. We are

keeping them whole starting into the next fiscal year.

MR. ROSS WISEMAN: The $4 million you distributed, you waited until March

to see where everybody sat in terms of deficit-wise. You made them flush, and

then you carried forward now this year and keep them at last year's base

budget.

MR. THOMPSON: Yes, that is fair. From the Estimates document you cannot

read it exactly that way because there are a lot of other things going on, but

what you have just said is accurate.

MR. ROSS WISEMAN: Is it? Okay. Now I understand. Just stay with me for a

little while. I am a bit slow on times but I will get it after awhile.

Let's deal with the institutional boards again. Last year, I believe, when

we had the discussion, I asked a question about the total accumulated deficits

of the institutional boards, and I also asked a question about the accumulated

deficits of the community health boards. Now here we are, a year later, and I

understand last year there was no deficit reduction plan per se, but some boards

were successful in achieving some surpluses and they have applied it against the

accumulated deficit. Can you tell me now - I know you do not have the financial

statements, but you have some sense, I am certain - as of March 31, 2003, a

month ago, what do you anticipate will be the accumulated deficits of all

boards, institutional, community and integrated boards as of that date?

MS BREWER: Right now, we are projecting about $98 million.

MR. ROSS WISEMAN: About $98 million?

MS BREWER: That is down from last year, when it was around $101.5

million.

MR. ROSS WISEMAN: So, you have taken about $2 million off the debts?

MS BREWER: Closer to $4 million.

MR. ROSS WISEMAN: Oh, yes, $102 million.

Minister, the boards obviously carrying that kind of a - I know some of them

had surpluses. I understand there were a couple that did not, that had some

deficits this year. I will get to that in a second, but with $98 million

accumulated deficits - and I remember listening to John Peddle of the Health

Board Association commenting on the day of the Budget, making some comment

about, and I just forget his exact words, but the suggestion was the boards will

have to look at their operations to see whether they are going to be able to

achieve some savings to live within that allocation.

If that is the case, they are going to have to do that to determine how they

are going to give within their allocation to provide services, what strategy do

you have to deal with the accumulated deficit?

MR. SMITH: Again, you mentioned in your preface to the question, one of

the things that has happened in the last little while is that most boards have,

in fact, done a good job in managing their budgets and most of them in this year

either balanced or came in with a surplus.

Our emphasis right now, at this point in time, is still working with the, I

think it is two or three boards that are still grappling with a deficit. Those

who have balanced their budgets and have moved into a surplus position, they are

already working at developing a plan to deal with their long-term debt. For us

right now the focus is still on the two or three boards, working closely with

them, to help them deal with the situation that they are faced with and the

deficit that they are encountering. One, of course, is the Health Labrador

Corporation. We have been working, have had consultants working with them this

year, and we are expecting a report within the next couple of weeks on that. The

other two boards right now are the Avalon, which is still having to struggle,

and Western, of course. These are the boards that are having the - so the

emphasis right now is to work closely with them to help them. Western has - in

recent days there has been some indication that, in fact, they may be coming to

us and looking for some assistance again in terms of what we have done with

other boards in finding someone to come in and work with them and help them try

to see where some efficiencies may be realized. We do not have a request yet to

that effect.

MR. THOMPSON: Actually, we do, so we need to go back and forth with them

to work out just the way that it will occur.

MR. SMITH: What do you anticipate their deficit to have been -

MR. THOMPSON: March 31.

MS BREWER: (Inaudible) Health Care Corporation? The latest number they

have given us is around $700,000.

MR. THOMPSON: Seven hundred thousand.

MR. SMITH: Even if the boards were still in a deficit position, I think

they have done a commendable job in grappling with it. All boards have made some

major strides and have made some difficult decisions in terms of trying to deal

with it. We do not suggest that it has been easy for the boards. They have

certainly done a remarkable job. You say yourself, the fact that we are seeing -

the debt load is declining. We are actually seeing, for the first time in a long

time, that we are starting to move in the right direction. We still have a ways

to go but we are certainly starting to move in the right direction.

MR. ROSS WISEMAN: Minister, I am looking at a document here that was on

the Health Board Association Web site. It was a presentation that they made to

your colleague, the Minister of Finance and President of Treasury Board, in

February as a part of the pre-Budget consultations. There are a bunch of

headings in here and they have addressed a number of different issues.

On the issue of funding, just let me read this, it said: There are two

funding issues which will inhibit the implementation of the Strategic Health

Plan if not addressed: health board deficits and the lack of a strategic funding

model.

If this is - and I assume it is - the collective view of the health boards in

the Province, and I gather from the rest of the document here, from reading it,

there has been a fair bit of discussion with the department around developing

some kind of a funding model different than you are doing now, how have you

responded to the association on these two points?

MR. SMITH: Again, I guess, from our perspective, certainly we work

closely with the boards. Obviously, these are the people who are delivering the

services and these are the ones who are meeting the challenges.

In terms of the funding models, there are number of specific issues that we

deal with them on a regular basis, and some of these we are pursuing on an

ongoing basis. The particular document that you referenced, I am not familiar

with. I have not seen the actual presentation, but I would assume there would

have been discussions that would have been held with Robert and the boards and

CEOs, so I will ask him if he wants to speak to that.

MR. THOMPSON: On the point of the accumulated deficit, and the extent to

whether or not that inhibits their ability to help address the issues on the

Strategic Health Plan, I am not sure we can agree with them, that this is

exactly the right way to phrase it, because over the last number of years as

their deficit situations grew we provided supplemental funding that allowed them

a big enough budget to deal with the interest costs of carrying their

accumulated deficit. So at least we provided them with enough funding to remain

stable.

Certain boards, too, which were mentioned, might continue to have an

accumulating deficit where the interest costs are getting larger, but for almost

all boards, and for some of them that are going in the other direction now,

their financial flexibility is getting better. It is a variable situation across

the Province by board; so, as a generic statement, we take some issue with that.

As the situation gets better, for most boards, without us even providing a

higher grant, they will have more financial flexibility than they have now

because their interest costs will be reduced. Of course, they do need to find a

component within their budget to pay back those deficits, so we will continue to

work with individual boards on how that can be sourced.

It is a more complicated area than just this. On the strategic funding model

in this Province, it is a very complicated matter to come up with a different

funding model than the one we have now, because while the boards' association

are saying: If you provided funding based on age, sex, demographic profile, as

well as the number of people that come through our institutions, and maybe some

of their health characteristics, then you would truly be matching funding with

the need that is already there.

We find, every time we tackle this problem, that every region is so unique

and has such unique needs that the effort that needs to go into measuring the

uniqueness of each region, whether it be because of small populations or

aboriginal populations or urban-tertiary care needs, that the formulas become so

complicated that they actually get in the way of making clear decisions.

I am just trying to give you a flavour for the complexity of it. We can move

on many of the elements in the Strategic Health Plan without having this one

single issue resolved. All of the twenty or thirty elements of the Strategic

Health Plan do not require a revised funding model. We think we can always

improve the funding model, but it is not a one-to-one relationship.

MR. ROSS WISEMAN: The other part of this document, Minister, in the

conclusion the board goes on to say: We do caution that health boards may need

bridge funding to bring about certain changes in the system and hope this will

be forthcoming if required.

I guess as we move into some of these new initiatives in a wellness model,

there is a transition. The document seems to suggest that there is a transition

needed and that transition funding has to be provided to the institutional

boards to keep that side going while you are reinvesting money in the wellness

model in new directions, (inaudible) just pulling the rug out from underneath

them.

MR. SMITH: That is a very valid point. It is a challenge. In times of

tight budgets, while we want to really emphasis and underline the wellness piece

of our strategy, trying to find the additional resources to dedicate to that, we

acknowledge, is difficult. In time, and we are talking long term here, we would

hope to see a significant shift from the acute side to the wellness side.

Obviously that is long term, because the idea of wanting to focus on the

wellness is that over time we would see less and less need, and when people's

health had improved, by making that strategic investment, then we would hope in

time we would see dividends because it would require a smaller investment on the

other side.

Again, it is long term and it is a challenge for us right now in finding the

resource. We have in this year - what is our commitment to the wellness piece in

the Budget?

WITNESS: (Inaudible) new initiatives $1.1 million.

MR. SMITH: Are there other pieces now in the wellness initiatives?

WITNESS: (Inaudible).

MR. SMITH: Again, very small amounts because the challenge is in terms of

trying to find those monies, and for the boards as well. In difficult times, it

will be difficult to make that transition, as you referenced. It is going to

take us time to get there but, in the meantime, we are moving in that direction

and emphasizing the importance of the wellness piece. I guess, from our

perspective, the committee we have in place in developing specific initiatives,

as these come forward then certainly we will have to find the necessary

resources to implement these new initiatives as they are identified and brought

forward.

MR. ROSS WISEMAN: Minister, now that I am on this report, I might as well

deal with some of the other points that are in here. One of them talks about

accountability. Let me just read you this statement: Health boards are

particularly concerned with the need for standards and benchmarks for wait

times. It is clear that consistently applied provincial standards and guidelines

are essential to evidence-based practice leading to the most effective use of

health services.

The wait times is an issue. Our office gets, on a regular basis, calls from

people who are waiting for months and months for MRIs or for some diagnostic

tests. There is a range of things that I have found. Let me just share a couple

of examples. When I read this in this report, it stood out for me as being a -

obviously they have recognized that we need to address this issue. Let me give

you an example.

If you were to call the Cancer Centre to get some information about wait

times, you get a bunch of different answers depending on how you qualify your

question. If you call looking for - someone who needed to be referred to a

cardiologist recently, who needed an appointment with the Cath Lab, the

requisition went in and sat on someone's desk until that person was able to

actually identify a date. You key them into the system when you can identify a

date. So, the date that the requisition is received in the hospital is today. In

four weeks' time someone calls and says: Can I find out when my appointment

is? They cannot tell them because they are not in the system. The reason they

are not in the system is, the person keying it in did not do it until they were

able to give them a date. When you then ask the Health Sciences for their wait

times, they will go in, if they look electronically, they will tell you: Well,

we entered this person today, they have an in appointment six weeks' time, so

there is a six week wait. What they do not tell you is that the requisition sat

there for four weeks before it got keyed in.

MR. SMITH: I am not familiar with that.

MR. ROSS WISEMAN: There is a range of things, I just use that to

illustrate an example, not to talk about these (inaudible) -

MR. SMITH: I understand.

MR. ROSS WISEMAN: - but to talk about the whole issue of developing a set

of standards for measuring wait times, because every institution that I have

called inquiring about appointments for people, I have had to qualify my

question. When I get an answer, I have to qualify the answer they have given me

because, if not, I will not understand what the status is when I hang up.

MR. SMITH: It is a very important issue. The particular nuance that you

referenced I am not familiar with but I certainly get the point.

Certainly, wait lists are a concern for all of us in all areas and we have

tried to move in some specific areas to make the intervention. On the diagnostic

side, we have certainly put emphasis on increasing the expenditure of some

diagnostic equipment. I was talking to the staff (inaudible) not long ago, the

CAT Scan was the piece of equipment that people wanted. Now we have that pretty

well right throughout the Province and you do not have to wait. Now it is the

MRI. We are moving to the MRI. By the time we get caught up in MRI, I guess it

will be the next piece of technology that comes along.

Unfortunately, as people who work within the system know and tell me, just

because a new technology does not come along it does not necessarily mean that

the old piece becomes obsolete and there is a trade-off, that it just builds one

on the other.

One of the specific areas that comes to mind, and we hear a lot of in this

Province, is the area of cardiac surgery. We do have a very high incidence of

the disease in the Province. We have made a concerted effort in recent years to

increase the number of interventions. The number of cardiac surgeries has grown

year over year, but yet the wait list is still long. There are plans to - I

think the difficulty right now is the shortage of anaesthesiologists. I think

once that is done we will be able to increase the number still further, but to

eliminate the wait list or to bring them down to a manageable level is certainly

challenging. I guess the only thing is, in terms of the wait list as well - if I

could continue on for just a second on that - especially in the areas like

cardiac, again, where you have to depend on the professionals who work within

the system to make sure that the people who are most in need of the service are

moving to the top and not just a matter of waiting your turn in the queue, sort

of thing. I think that does work. Certainly, we are all concerned about wait

lists and we want to try to reduce them as much as we can.

MR. ROSS WISEMAN: Minister, what about the recommendations and

suggestions of the board there? There are no standards in place for developing

what should be a standard wait time for certain procedures. In fact, having a

mechanism - you mentioned cardiac surgery. I went in on a Web site the other

day, Ontario, and they have - I can go in today and find out when I can get my

next appointment, in half a dozen hospitals, if I want cardiac surgery in

Ontario. It is on the Web site. They will tell you when your next (inaudible).

If I am a physician, I assume, and I want to refer someone to send them to

Ontario I can just go in on the Web site, scan which one I can get into first,

call that hospital and get my patient in there if they want to go to Ontario,

because it is on the Web site. They monitor. It was a critical issue for them.

They needed to have a mechanism in place to have a handle on where they are

going with it. I guess that is what they are suggesting here in this report,

that in the Province we need to have established some kind of mechanism to get a

handle on what it is we have out there.

I remember a few years ago the issue about wait lists to get into nursing

homes. They said there were 2,000 people on it. What they found were 1,000

people, but they were on fifteen different lists. Until that got tidied up with

a single entry, you did not know exactly what you had going for you. The same

thing happens now with these wait lists for all kinds of things that you are

getting done. It is a real problem. I think, Minister, especially as you move

forward with expanding the use of technology - I will not say it is simple, but

it is much easier with the penetration of computer technology that exists in

facilities today to be able to do this. I think it is something that is really

worth giving some consideration to so that we can get a handle on what we really

have out there.

MR. SMITH: It is certainly something that has been talked about. It is a

very valid observation and we certainly had discussions around it. In fact, it

is something that has been pursued at the national level. I think even as part

of the most recent negotiations, there are actually discussions at looking at

the national norms. It is certainly a concern for everyone. I think it is a

valid observation.

MR. ROSS WISEMAN: There is one other area, Minister, and maybe you can

give us an update. I remember last year when we sat here there was a

section in

your budget that dealt with - where you were talking about putting $800,000 into

the expansion at the Waterford. Maybe you can - before I ask my question, what

is the status of that project now? Is that done, by the way?

MR. SMITH: I think it must be pretty well near completion right now. Who

has the information on that?

MS CHARD: I am not quite sure of the finish date but I know they are

working through that process. They are not quite ready yet but it is moving

along. I cannot be more definitive than that. I can get a projected date for you

and let you know.

MR. ROSS WISEMAN: I guess the most recent inquiry of the two incidents we

had with the RCMP and the RNC has really heightened an awareness in the Province

around the lack of mental health services. I just read from your last year's

budget document where it says: government is awaiting the results of a review of

mental health services which will assist in identifying future priorities. That

was last year in March this time. When you released your strategic plan in

September you had a similar phrase in there about: recognize the need to have a

strategic plan or some kind of plan. I forget the phrase now but you

acknowledged that it was an area which needed some attention and you need to

develop a strategy and a plan.

Then the Speech from the Throne just recently, a similar kind of comment. The

government "... recognizes that a new strategy is needed in the area of

mental health. It is the lack of community-based services that is most obvious.

My Government will formulate a mental health strategy leading to a more

comprehensive set of mental health services." I guess what I just read from

the Speech from the Throne is not unlike a statement that was included in the

Budget document twelve months ago. So I am assuming that you were awaiting it

last year. I guess the question now is: Do you have it? The Budget itself, when

I look in here, I do not see where you have made any provision for the

implementation of any kind of major initiative in dealing with mental health

services.

MR. SMITH: The work is ongoing. It is taking place on a number of fronts.

One of which is a comprehensive review of all legislation related to mental

health, because we recognize that there is a requirement to do an update there.

Also, part of this is that you referenced the Reid and Power Inquiries.

Obviously, the outcome of these inquiries and the reports which will be produced

- we are waiting with some anticipation as well, because obviously we would

expect that recommendations coming from both of these major inquiries, which are

looking at all aspects of this, we feel will have a lot of information and a lot

of implications for what we are considering. Those inquiries are well along and

we expect will be concluded within this year. Certainly, we would want to look

at incorporating into our work the recommendations and the outcome of those

inquiries as well.

MR. ROSS WISEMAN: The study that you referenced in last year's budget,

has that concluded?

MR. SMITH: No, we are still working within the department and working on

all aspects of that.

MR. ROSS WISEMAN: We had a consultant doing it. Was it Goss Gilroy who

did the study of mental health services? Was there someone who looked at mental

health services?

MS VIVIAN-BOOK: It was Colleen Hanrahan and her company - which was

called the Institute for the Advancement of Public Policy, Inc. - who did that

study. That was completed late this summer, early fall.

MR. ROSS WISEMAN: Is that a public document?

MS VIVIAN-BOOK: I do not think it has been officially released at this

point in time but I know it has been shared within the system.

MADAM CHAIR: Excuse me. Could you repeat the name of the study again?

MS VIVIAN-BOOK: The study is: The Study of Community Mental Health

Services in the Province, conducted by Colleen Hanrahan. I cannot repeat the

firm she is with, the Institute for Advanced Public Policy.

WITNESS: The Institute for Advancement of Public Policy.

MS VIVIAN-BOOK: The Institute for Advancement of Public Policy.

MR. ROSS WISEMAN: I am familiar with the company.

MS VIVIAN-BOOK: The other study referred to, the Goss Gilroy study, was

around cost drivers through the community health boards, the primary focus being

the home support continuing care area.

MR. ROSS WISEMAN: I would be interested, Minister - you indicated that it

has been shared within the system so I assume it has been shared. It is not a

totally departmental confidential document. Is it possible that document could

be made more public?

MR. SMITH: Again, I do not know of any reason why it should not be. There

is nothing in there. I guess at this point in time it is information that we

have been using as part of our work, and certainly we have shared with people

who are working in that particular field. I have to say as well that our efforts

have been closely co-ordinated with people who are actually working in that

field from the people who are working as lobbyists and people who have special

interest there. We work quite closely with them on developing a strategy, as you

would be aware, because it does operate and impact on a number of different

fronts. It is a fairly comprehensive thing, but certainly to the report itself

we can look at it.

MR. ROSS WISEMAN: The reason I raised it and framed the question the way

I did, which kind of gave, from my perspective at least, some historical

reflection on comments that have come from your department, this is a major

issue and I think for a number of years statements about it being an area that

needs a lot of attention, not a lot of resources have gone into it, it is a

challenge. It is not as simple as just opening clinics and that kind of thing. I

understand all of that.

Minister, I think, given it is - and you have identified it in this year's

budget document as being a priority along, with four or five other areas. There

is a time when you can study, study and analyze but there reaches a point where

someone needs to see some progress in moving forward with some action and

implementation of some strategy so people have some sense that, it is going to

take us a while to implement but I think we know where we are going. I think,

from my vantage point at least today, we are not at that point where we say we

know where we are going. We know we are going somewhere; we are not sure yet. We

do not know where we are going, so we do not know how long it is going to take

us to get there.

I think the community is really crying out -

MR. SMITH: No question.

MR. ROSS WISEMAN: - for some kind of a movement. Not an immediate

solution but a sense that we are moving forward and we have some sense of where

we are going.

I would encourage you to move quickly - not quickly just for the sake of

doing it, but I think you have done a fair bit of study, a fair bit of analysis,

and you must have some sense of some things that can start. The two inquiries

that were just done, no doubt, will give you some information but I suspect that

most of the information that is going to come from those inquiries is going to

confirm for you what you already know. It will just be another document to show

you that you were right. You probably do not need it to move forward.

MR. SMITH: The only thing is, I think you would concede, I think it would

probably be considered right now in the context, especially with all the

coverage that these enquiries have received, that if we were out there right now

we would be seen as being kind of a bit premature in advance o