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May 20,

SOCIAL

SERVICES COMMITTEE

Pursuant to Standing Order 68, Andrew Parsons, MHA for Burgeo La Poile,

substitutes for Lisa Dempster, MHA for Cartwright L'Anse au Clair.

Pursuant to Standing Order 68, Eli Cross, MHA for Bonavista North, substitutes

for Glen Little, MHA for Bonavista South, until 11:03 a.m.

Pursuant to Standing Order 68, Lorraine Michael, MHA for Signal Hill Quidi

Vidi, substitutes for Gerry Rogers, MHA for St. John's Centre.

The

Committee met at 9:06 a.m. in the Assembly Chamber.

CHAIR (Littlejohn):

Good morning, everyone

there we go, now we are getting there.

MR. KENT:

We are listening to you, Mr.

Chair.

CHAIR:

Thank you.

Good

morning, Minister. Good morning,

Committee. There are just a couple

of quick things. Before we get

started, I am going to ask Committee members to introduce themselves.

We have some substitutions this morning, so I welcome our substitutions,

familiar faces. I am going to ask

our Committee members to introduce themselves and then, Minister, if you would,

I am going to ask you or the individual staff members.

remind individuals of all parties to wait until your light comes on, say your

name and your position first, and that way we will get it on the record in

Hansard. That will be greatly

appreciated.

started at 9:05 a.m., so 12:05 p.m. would be three hours, and we will see where

we go from there.

We will

start with Mr. Flynn.

MR. FLYNN:

Stelman Flynn, MHA for

Humber East.

MR. A. PARSONS:

Andrew Parsons, MHA, Burgeo

La Poile.

MS BUCKLE:

Joy Buckle, Researcher,

Opposition Office.

MS MICHAEL:

Lorraine Michael, MHA,

Signal Hill Quidi Vidi.

MS WILLIAMS:

Susan Williams, Researcher,

NDP.

MR. POLLARD:

Kevin Pollard, MHA, Baie

Verte Springdale, and Parliamentary Secretary to the Department of Health and

Community Services.

MR. CROSS:

Eli Cross, Bonavista North,

swam across the bay this morning because I am substituting for Glen Little of

the south side.

MR. CORNECT:

Tony Cornect, MHA for the

great and cultural District of Port au Port.

CHAIR:

Welcome, Minister, and

welcome to your staff. Minister, I

do not think you need any introductions, but you just point me in the right

direction and we will introduce your staff, please.

MR. KENT:

Sure.

Good

morning, everybody, we will start with Michelle to my right, your left.

MS JEWER:

Michelle Jewer, ADM,

Corporate Services, Department of Health.

MR. COOPER:

Bruce Cooper, Deputy

Minister, Health and Community Services.

MS TUBRETT:

Denise Tubrett, ADM,

Regional Services.

MR. TIZZARD:

Mike Tizzard, Departmental

Controller, Health and Community Services.

DR. ALTEEN:

Larry Alteen, Medical

Consultant, Acting.

MS HANRAHAN:

Heather Hanrahan, ADM,

Acting, Professional Services.

MS CHATIGNY:

Elaine Chatigny, ADM,

Population Health.

MS STONE:

Karen Stone, ADM, Policy and

Planning.

MR. SHEPPARD:

Keith Sheppard, Director,

Pharmaceutical Services, Health and Community Services.

MR. TOMPKINS:

John Tompkins, Director of

Communications.

CHAIR:

Welcome, everybody.

Before

we start, Minister, and I turn it to you for your first introductory remarks, I

am going to ask Kimberley to call the clause.

CLERK (Ms Hammond):

Subhead 1.1.01.

CHAIR:

Minister, you have fifteen

minutes if you so desire.

MR. KENT:

Thank you, Mr. Chair.

I am

not going to use the fifteen minutes.

I suspect my colleagues opposite have lots of questions.

I am very pleased to be here.

This was a job that I was a tad bit apprehensive about taking on.

I did not aspire to be the Minister of Health and Community Services, but

I can honestly tell you that within days of being on the job, I developed a love

for the job and a passion for the job.

Despite the significant challenges we face in health care, there are so

many good things happening as well.

So it has been a challenging and rewarding number of months.

Our

budget for the department is close to $3 billion, which we will be discussing

here this morning. It is about 40

per cent of the overall provincial Budget.

We have some major obstacles to overcome in the years ahead.

We have real challenges around sustainability, but I am pleased to say

that we have solid plans for making the health care system in this Province more

sustainable, working with our regional health authorities and other partners in

delivering health care.

I am

very happy to be here. I will do my

best to answer all of your questions in the next few hours.

CHAIR:

Thank you.

Andrew,

before you start, just for Committee members, we are on 17.3 of the Estimates

booklet, Minister's Office, 1.1.01.

The minister has asked that you direct the questions directly to the minister

and he will defer to staff. We will

go from there.

Andrew.

MR. A. PARSONS:

Thank you.

Before

I begin, thank you to the minister and everybody for making yourselves

available; we very much appreciate it.

I am going to start off on the salary details for the department and

staffing. I am just wondering,

based on your latest payroll, how many additional staff does the department

employ that are contractual? I am

looking at staffing numbers here.

This would have been in the salary estimates section,

Schedule I.

MR. KENT:

Mr. Parsons's question is:

How many of the positions are contractual?

MR. A. PARSONS:

Yes.

MR. KENT:

I am going to defer to

Michelle. I am not sure we have

that precise figure, but we can get it for you.

I can tell you there are a fair number of positions that are contractual.

There are a number of competitions ongoing and like most departments in

government, there are a number of positons in the department that are indeed

contractual.

Michelle, do we have the precise number at the moment?

MS JEWER:

No, I do not have it with me, but I can get it.

MR. KENT:

We can get it for you.

I have no problem providing it.

I just do not have it here.

MR. A. PARSONS:

Okay.

Maybe

what I will say off the top we usually do this is anything I request I am

sure Lorraine will want and vice versa.

MR. KENT:

Yes.

If I commit on the record to providing it, we will provide it for sure.

MR. A. PARSONS:

Excellent, thank you.

MR. KENT:

We will keep a running list

of what those items are and provide them to you.

MR. A. PARSONS:

I am just wondering in the

last year and I do not know if you have this here how many temporary or I

guess thirteen-week positions have there been in the department?

MR. KENT:

I have not signed off on any

in my time as minister, but there likely were temporary positions prior to my

arrival. I do not know that we

would have the precise number either.

We do not have it here, but I am certainly happy to provide it.

Again, in recent months, I have not appointed any thirteen-week positions

in the department.

MR. A. PARSONS:

Okay.

Again,

going to the salary details, under Other Salary Costs there is just about $3.5

million for this year. I am

wondering what the breakdown on that is.

MR. KENT:

Can you tell us where you

are seeing the $3.5 million number?

I am looking at the salary details

MR. A. PARSONS:

Under

Schedule I,

Summary of

Salary Details by Department, it lists all of the departments and then lists

permanent positions, Permanent Salary Costs, and then Other Salary Costs.

For

instance, in this case, Permanent Salary Costs would be

MR. KENT:

Yes.

The

first number, the $13.2 million represents employees and positions that are, in

fact, permanent; the $3.5 million that you reference, which is broken down by

division, represents temporary and contractual employees, any of whom have been

in the positions for quite some time.

In fact, among officials here today, we have a number of temporary and

contractual employees, even at the most senior level of the department.

MR. A. PARSONS:

This is one of the things

that we will get a list of everybody that falls under $3.5 million.

MR. KENT:

That is not a problem.

MR. A. PARSONS:

Excellent.

noticed here there are 190 permanent positions.

I know there has been some talk of attrition and cuts.

How many of these will be cut over the next five years?

Is that part of the planning?

MR. KENT:

We do have an attrition

target, like all departments, for the next five years.

There are four positions that we need to find in this current fiscal

year, and the total over the five years is eighteen positions for the

department.

MR. A. PARSONS:

When you say four this year,

they have not been determined, you are trying to figure out where

MR. KENT:

We are in the process of

finalizing our attrition plan right now.

There has been significant work done.

We have a number of vacancies in the department as well that need to be

considered. There are a number of

competitions ongoing. Because of

some of the work we are doing around system transformation and primary health

care, mental health and addictions, there may be changes to how we do business

within the department.

All of

that is being considered, but we do know that we need to achieve that attrition

target on top of salary savings targets that have been set as well.

MR. A. PARSONS:

This may be just a case of

the wording and stuff. Besides

through attrition, will there be any other positions that are eliminated under

this department for this year?

MR. KENT:

I cannot say with certainty

that there will not be. What I can

say is that we have a lot of priorities to achieve and scarce resources to

achieve them. I also know that when

budgets were reduced in 2013, the Department of Health and Community Services

was hit harder from a staffing perspective than most departments in government

on a percentage basis.

I do

not believe there is a lot of room to find further savings in human resources

within the department. That said,

because of some of the work we have on the horizon, we may need to do some

restructuring within the department.

There

are also a number of vacancies.

Some of those positions may need to be re-profiled to meet some of the

priorities we have set. Whether

there will be further reductions, it is possible.

What I can say with certainty is that there will be at least four

positions eliminated through attrition.

MR. A. PARSONS:

Okay.

Thank you.

MR. KENT:

This year.

MR. A. PARSONS:

Going back to 1.1.01,

Minister's Office, under Operating Accounts there was an underspend by about

just over $30,000. What was the

accounting for there?

MR. KENT:

Thirty thousand dollars?

CHAIR:

Subhead 1.1.01, 02,

Operating Accounts, Minister.

MR. KENT:

Oh, budget to revised.

Sorry, I understand your question.

The

reason for the savings in those various budget lines that are broken down, the

total of which you have just identified like most departments, we implemented

an expenditure management plan in the fall in response to government's direction

to reduce discretionary spending, in light of the Province's fiscal situation.

reviewed the operating budget of the department to determine if there was

anything at all that was discretionary in nature that was not essential, or that

could be delayed to a later time.

That resulted in savings in those areas, travel being the bulk of it.

Some minor savings were related to supplies and purchased services as

well, but the bulk of that was through reduced travel activity.

MR. A. PARSONS:

Okay.

I am

going to move forward to 1.2.01, Executive Support.

Under line 01, Salaries, I think there is an extra $63,000.

Is this a position or is this part of the step by step and the 3 per

cent?

MR. KENT:

That line includes the

Deputy Minister, all of the ADMs including the medical consultant, the Secretary

to Deputy Minister, the ADM's secretaries, the Director of Communications, and

the Media Relations Manager. The

reason that line was over budget is due to the retirement of a senior employee

that resulted in a large payout, as well as another severance payout for an

assistant deputy minister who left government.

We had a retirement and a resignation, both of which triggered payoffs,

but the payouts were offset by savings as a result of vacancies as well.

MR. A. PARSONS:

This year there is $1.7

million budgeted as opposed to what was spent last year.

So there is an increase there.

MR. KENT:

As you alluded to, that is

the 3 per cent.

MR. A. PARSONS:

Okay.

MR. KENT:

The 3 per cent in the new

collective agreement. As well,

there are two ADMs who are currently on higher steps of the approved

classification level than the previous incumbents in those positions.

That is triggering the difference as well.

We have had some changes at the executive level.

As you heard from the introductions, we have a couple of people in acting

roles now so that attributes to some of that.

MR. A. PARSONS:

I am looking at the

Purchased Services line. Last year

there was $22,500 budgeted and $3,500 spent.

We know that by looking at Estimates the year before there was $22,500

budgeted and $7,500 spent.

This

year there is $22,500 budgeted. I

am just wondering in terms of practices in the case of it seems like we over

budget by $15,000 to $18,000 yearly.

Is there a reason for that?

MR. KENT:

There is a reason for that.

There are a number of items that get charged to that budget line within

the executive

section that we are talking about.

There are advertising and communications-related activities.

As well, there are costs for professional training, meeting room rentals,

and taxis.

The

reason for the dramatic decrease in this past fiscal was, again, the review of

expenses overall in the fall. We

needed to reduce discretionary spending based on the Province's fiscal situation

and we paused or stopped anything that was not absolutely imperative.

So that lowered that line by about $19,000.

What was spent in that budget line included media monitoring services,

catering services for a couple of meetings, an ergonomic assessment for an

employee, and that left the remaining funds unspent.

We do

believe we will require the full budget for this coming fiscal year.

We believe it will be used under the Communications Division for various

marketing communications materials that will be required to support the

department's activities. There are

a number of projects on the horizon where we feel there will be a need for those

funds, but the funds, we anticipate, will be largely used for marketing

communications purposes.

MR. A. PARSONS:

So that would not fall under

the Transportation and Communications line, it is just a different

MR. KENT:

The marketing materials are

under Purchased Services.

MR. A. PARSONS:

Okay.

I am going to move forward to 1.2.02, Corporate Services.

You will see a jump there in the Salaries, listed as Salaries, operating.

There was $4.8 million spent last year and this year we are up to just

over $5 million. I am wondering the

same question: Is it extra salary or extra positions, or is it the percentage

increase step by step?

MR. KENT:

Yes, a good question.

My response on a number of these will probably be very similar, because

as you suggest, the reason is the same.

So, the revised budget increased due to a severance payout that occurred

in the last fiscal year. The

increase by $234,600 from the 2014-2015 budget is a net result of salary

increases as a result of the 3 per cent raise in the new collective agreement.

MR. A. PARSONS:

Okay, so that is not a new

position or any of this?

MR. KENT:

No.

MR. A. PARSONS:

Okay.

Looking

in the same

section under Professional Services, $1.1 million was budgeted last

year for Professional Services, but just under $80,000 spent.

What was budgeted for that was not incurred?

MR. KENT:

There is a contingency fund

for federal/provincial/territorial agreements that could arise during any fiscal

year. Any agreements like those are

offset by revenue from various provincial, territorial, and federal sources, and

they are recorded within revenue in this area.

In the

department's final projections for the fiscal year there were no potential

federal agreements that we saw on the horizon before the end of the fiscal year.

In addition, the Audit Services within our department conducted less

audit appeals than we had projected in 2014-2015 which resulted in additional

savings.

That

said, you will note as well that the 2015-2016 Estimates are decreasing by

$750,000 over the 2014-2015 budget, and that is really based on historical

trends. We reduced the contingency

for federally funded projects by the $750,000.

This is 100 per cent offset by revenue, so it is money in, money out.

There are a number of federal/provincial/territorial agreements that we

are involved in through the health care system.

CHAIR:

Do you want to leave it

there for now, Andrew?

MR. A. PARSONS:

I will leave it here for now

and come back to this

section after.

CHAIR:

Thank you.

Lorraine.

MR. KENT:

Oh, you are going to have

more questions? That is not it?

MR. A. PARSONS:

Just a couple.

MR. KENT:

Okay.

MS MICHAEL:

Okay, yes, I will continue.

Let's

keep looking at that same

section then, Minister, and I think that you were

answering the question with regard to the Professional Services, correct?

MR. KENT:

Yes, we were just talking

about the Professional Services line within the Corporate Services activity

area.

MS MICHAEL:

Yes, and I understood your

answer.

Coming

down to Purchased Services underneath, again in the budget of last year the

revision was $589,800 down from what was estimated, so I think I would like a

bit of an explanation of that first.

MR. KENT:

Yes, that is a fair

question.

We saw

lower than anticipated purchased services expenditures during 2014-2015,

obviously, and that budget line includes funding for our office space leasing

costs, printing, and other general purchased services.

We implemented the expenditure management plan, that I referred to

earlier, back in the fall. We were

directed to reduce discretionary spending, and professional and purchased

services were an obvious area for departments to target.

We reviewed the department's operating budget to determine if there were

any items at all that were discretionary in nature or could be delayed, and that

resulted in lower purchased services costs.

We also

have decreased the 2015-2016 estimates by $334,200 from the 2014-2015 budget.

We looked at the drop balances that have traditionally existed.

We did a review of those drop balances to try and find areas in the

budget where we could reduce the budget, due to our current fiscal situation,

and we feel comfortable that we can meet our requirements with less resources in

this fiscal year as well.

The

reason the full budget is required ,though I just want to make sure I present

the full picture. The reason we

think the full budget is required for this fiscal year is that we have built in

a contingency fund for a number of expenditures.

For instance, the work of the mental health and addictions all-party

committee's advertising costs, printed materials, and so on needs to be budgeted

somewhere. There is also funding to

deal with potential pandemics such as H1N1, or Ebola, or a matter like that that

could arise.

That is

why we feel the contingency remains important.

Hopefully some of those funds will not be needed, but some certainly will

be because of the work of the all-party committee.

MS MICHAEL:

Right, and actually I was

going to ask you about the all-party committee and where the expenditures for

that would fall. Obviously the

staff are doing their regular work so there is no extra staff

MR. KENT:

Not at this point.

MS MICHAEL:

I was wondering about stuff

like communications and travel because your travel now is covering not just

people from your own department, but also the people who are on the Committee

from the other parties.

MR. KENT:

This is a portion of it,

which will cover printing and advertising and promotion.

We also have some funds within our Population Health budget.

We plan to find the other funds there to support the work of the

Committee. Regardless, we need to

find the funds, but we believe between this area in Corporate Services and

another area within Population Health that we will be able to adequately cover

it based on what is projected to occur over the next few months.

MS MICHAEL:

Right, thank you very much,

Minister.

It just

points to a broader question that we will not discuss here but just to make the

point not just for the sake of making it, but I think it is important, in

making it, that as we move forward as a House of Assembly and we have a standing

committee that should deal with this when the time comes, we need to look at

things like if we have all-party committees where that responsibility falls for

covering the cost of all-party committees, because it is a strain on an

individual department right now.

MR. KENT:

I agree with you.

I think that that is a good discussion for the Management Commission to

have and maybe it is a discussion that other committees of the House need to

have as well

MS MICHAEL:

Yes.

MR. KENT:

Certainly if they are

committees of the Legislature, then they need to be resourced by the

Legislature. This circumstance,

much like the shrimp all-party committee, is a bit unique, but I think you are

raising a valid question and a valid point that the House should consider.

MS MICHAEL:

As a member of the Standing

Orders Committee, I will make sure that it goes to the Standing Orders Committee

when we meet.

MR. KENT:

Sounds good.

MS MICHAEL:

Okay, great.

Could

we just go back up to the Professional Services.

Minister, could you give us an idea of what are the services that fall

under that category?

MR. KENT:

There are a number of items

that fall under that category. The

funding provides for unanticipated federal or otherwise funded projects;

$250,000 of the total budget represents a contingency fund for

federal-provincial funding agreements, which may arise during the fiscal year;

and the level of access varies in each fiscal year depending on what agreements

get signed, as we were discussing earlier.

The

balance of the funding for Professional Services there is funding within the

Audit Services division for audited appeals and in the Information Management

Division for IT consulting services as well.

MS MICHAEL:

Okay, thank you very much.

Still

within 1.2.02, I am just curious about the provincial revenue, $350,000

budgeted, revised down to $300,000 and up to $350,000.

I am just curious about that drop of $50,000.

MR. KENT:

It represents income from a

number of sources such as recoveries related to default on bursaries, MCP

overpayments, refunds from workers' compensation, and other miscellaneous

revenues. Also included are

payments on other miscellaneous billings that occur throughout the fiscal year.

During 2014-2015, we received $50,000 less than what we originally

anticipated, but it is always a bit of a guess, to be quite frank.

We just look at historical trends.

MS MICHAEL:

Right, thank you very much.

Moving

to 1.2.03, Professional Services, in the Salaries you were $264,900 underspent

last year. Could we just have an

explanation of that, please?

MR. KENT:

Underspent last year?

MS MICHAEL:

Yes, the budget was

$3,401,000 and the revised was $3,136,000.

MR. KENT:

Correct.

So the decrease was close to $265,000 and that was a result of vacancies.

Those vacancies may have been for a part of the year or for all of the

year. They included the Director

and the Assistant Medical Director in the Physician Services division; a Claims

Processor and Mail & Messenger Clerk in the Newfoundland and Labrador

Prescription Drug Program Assessment Office; a Clinical Pharmacist I position;

and a pharmaceutical claims assessor I position in the Pharmaceutical Services

Division.

MS MICHAEL:

That is a lot of vacancies,

but they were not all at the same time.

MR. KENT:

They were not all at the

same time. They were throughout the

year. Frankly, it is a concern for

me as well. We have been actively

recruiting for a number of those positions.

Particularly when we are talking about our director and assistant medical

director, those are pretty critical roles in our Physician Services Division.

I would have to say that the folks who are involved in the division

currently have been carrying a fairly heavy load as a result of those vacancies.

Physician recruitment throughout the system, not just within our department, can

be a challenge. Not that both of

those positions would necessarily be physicians, but in both roles they have

traditionally been physicians.

MS MICHAEL:

Thank you.

Obviously you are hoping to fill them because you have brought the budget

MR. KENT:

That is right.

MS MICHAEL:

You are keeping it at the

$3.4 million.

MR. KENT:

Yes.

MS MICHAEL:

Okay.

The

others are fairly straightforward.

Professional Services; there is not an anomaly, but a differential between the

budget and revised figure last year.

MR. KENT:

Yes, the revised budget

decreased by $112,500. That savings

related to a contract for a senior business analyst.

The funding is required in 2015-2016 because the current vendor contract

for the NLPDP system, the Prescription Drug Program system is actually nearing

completion. We anticipate an

analyst could be required as we work through a new RFP.

We will

go to market in this current year for a new provider for that NLPDP system.

Traditionally, we have had a business analyst contracted to support that

system. As we make the transition,

we anticipate there will be a need to have that support again.

MS MICHAEL:

Okay.

Minister, where does the provincial drug program itself fall?

MR. KENT:

That falls under 2.2.01.

MS MICHAEL:

Okay.

MR. KENT:

There is a whole

section

dedicated to the Prescription Drug Program.

MS MICHAEL:

Yes, of course.

MR. KENT:

I am happy to work through

that as we get to it.

MS MICHAEL:

When we get to it.

I just forgot where it was.

CHAIR:

Lorraine, I am going to hold

you there and I will come back.

MS MICHAEL:

Sure.

CHAIR:

Thank you.

MS MICHAEL:

Thank you.

CHAIR:

Andrew.

MR. A. PARSONS:

Thank you, Mr. Chair.

I am

still on 1.2.02, Corporate Services, just under the Salaries.

Last year I believe it was said that two positions were hired or approved

for the enhancement of the Medical Transportation Program.

Were those two hired?

MR. KENT:

Yes, both of those positons

were filled.

MR. A. PARSONS:

Okay.

I am

just wondering, because we see the when you hire, say, for the enhancement or

whatever, I am just wondering have you seen changes with the hiring?

Have wait-lists decreased?

Has the program benefitted for the people who avail of it?

MR. KENT:

There is lots of demand on

the program. Would you like to

elaborate?

MS JEWER:

Sure.

MR. KENT:

I will ask Michelle to

respond in more detail.

CHAIR:

Michelle.

MS JEWER:

We have seen an increase in the number of patients, or beneficiaries who have

come to the program from last year.

There has been an increase in expenditure as well.

MR. A. PARSONS:

I am just wondering, when it

comes to refunds or people trying to pay for it, there have been some complaints

about the wait time in getting reimbursed.

Has there been any decrease in that wait time?

MR. KENT:

It has not really changed.

The wait time remains consistent.

We are constantly trying to improve on that.

We have limited resources.

The

easy thing to do would be to throw money at the problem and hire more people,

but in these times we live in that is not necessarily the responsible thing to

do. So we will be looking, in the

months ahead, at how we can make that whole process more efficient to see if

there is a better way to flow claims through, a better way to do business in

that regard. The wait times right

now have remained pretty consistent.

MR. A. PARSONS:

What is the average wait

time?

MR. KENT:

The average time is about

eight weeks. I understand that

could represent a real burden for those who are availing of the program.

We will continue to try and improve it.

MR. A. PARSONS:

Okay.

Under Purchased Services there is $1.3 million budgeted last year and

$726,000 spent $982,000. I

believe this provides for office space leasing and printing and stuff like that.

Am I on the right track here?

MR. KENT:

I think you are.

Yes, the Purchased Services line includes funding for office space

leasing costs, printing. There

would be some other general Purchased Services in that line as well.

MR. A. PARSONS:

Are we able to get after I

do not expect you to have it here a breakdown of the office leases for last

year?

MR. KENT:

Yes, I would be happy to

provide it now, actually.

MR. A. PARSONS:

Perfect.

MR. KENT:

I would like to keep the

list of homework as short as I can.

The

breakdown for anticipated expenditures in 2015-2016 includes the MCP office in

Grand Falls-Windsor, the total cost of which is just over $165,000.

We have an MCP office on Major's Path here in St. John's.

I should also note that both of those leases are long-term leases.

Grand Falls-Windsor, the term of that lease runs until 2021.

For the office on Major's Path, it runs until 2023.

The 2015-2016 cost is $283,716.

Then, there is space for the NLPDP office in Stephenville as well.

There are two separate leases, the same vendor, and the total cost of

those is just over $69,000. So the

total is just over $517,700.

MR. A. PARSONS:

Okay.

Thank you.

I am

just wondering and I do not know if this exactly falls under there or not and

maybe you answered before how many summer students did the department have in

2014-2015?

MR. KENT:

I will get that information

for you in a second. I think it is

about a dozen, but I will get the exact number for you.

The finance folks do not like it when I guess.

I think it is about a dozen, but we will get the exact number for you.

The number is twelve.

MR. A. PARSONS:

Okay, so that was twelve

last year.

MR. KENT:

Yes.

MR. A. PARSONS:

You might need that sheet

back. Twelve last year and what was

the cost?

MR. KENT:

The cost of students was

approximately $52,000.

MR. A. PARSONS:

Fifty-two thousand dollars.

Okay.

MR. KENT:

It is an interesting

discussion because we definitely benefit from having students in place for

summer relief and to help with, particularly, some of the clerical work that

slows down when people are on vacations.

I think we also have a responsibility to create opportunities for

students who are looking to gain professional experience.

We get

a lot of students apply who want to work in the health care system, for

instance. We also get people who

want general administration, or business experience, or whatever the case may

be. I think government has some

responsibility to create some of those opportunities for students, while at the

same time there is a legitimate business need that exists as well.

MR. A. PARSONS:

What is the anticipated

number of summer students for this year?

MR. KENT:

It would be about the same.

MR. A. PARSONS:

About the same?

MR. KENT:

Yes.

MR. A. PARSONS:

The same budget, obviously.

MR. KENT:

Yes.

MR. A. PARSONS:

Okay.

MR. KENT:

Is there any wage increase

for students?

OFFICIAL:

No.

MR. KENT:

No, so it is the same.

MR. A. PARSONS:

Okay.

MR. KENT:

Approximately.

MR. A. PARSONS:

Okay.

MR. KENT:

It could fluctuate slightly

just because of start dates and end dates, depending on the student, but we are

talking approximately $50,000 or $52,000.

MR. A. PARSONS:

Okay.

I am

going to move forward to 1.2.03, Professional Services.

Under the Professional Services line, there was $304,000 spent last year,

revised, and this year it is $394,000.

I am just wondering is there a list of the professional services that

were utilized and a breakdown.

MR. KENT:

Absolutely.

I would be happy to provide a breakdown.

The bulk well, a good chunk of the funding was for a contract for the

senior business analyst services that we receive, which relates to the

maintenance and support of the Newfoundland and Labrador Prescription Drug

Program system.

That

amount in 2015-2016 would you prefer the 2014-2015 numbers or the 2015-2016

numbers, or both?

MR. A. PARSONS:

We can start with 2014-2015.

MR. KENT:

Okay.

The

revised number for 2014-2015 was $127,400.

There was also money for an expert reviewer for the Newfoundland and

Labrador Interchangeable Drug Products Formulary at a cost of $5,000.

There is funding for the Drug Information Centre at $12,000.

We make

a contribution to the Pan-Canadian Oncology Drug Review at an annual cost of

$77,000. Newfoundland and Labrador

also contributes to the Atlantic Common Drug Review which is managed by the

Government of Nova Scotia. We

contribute $70,000 to that effort as well.

There

is also an NIDPF physician rep at a cost of $6,000.

There is a Revenue Canada contract that relates to the Newfoundland and

Labrador Prescription Drug Program Assessment Office at a cost of $7,000.

The

only thing additional sorry, not the only thing additional, one of the things

additional in 2015-2016, we anticipate a small cost related to the publication

of our new Workforce Plan for the health system.

Because of the change that is happening with the NLPDP system, we suspect

that our business analyst costs will be higher than the revised budget for

2014-2015 but less than the original budget for 2014-2015.

MR. A. PARSONS:

Okay.

Obviously, I want to talk more about NLPDP when we

MR. KENT:

Yes, no problem.

MR. A. PARSONS:

Okay.

I am

going to move forward in my little short period of time here, I will start with

1.2.04, Regional Services, and I just have the one question on Salaries before I

am cut off. Last year, there was an

under spend by between $550,000 and $600,000; this year it is up to $1.8

million. So can I have a breakdown

of that, please?

MR. KENT:

No problem.

Like

most of our divisions, there were some vacancies throughout the year in the

acute health services and emergency response division: two Management Analyst

positions, and two Management Engineer positions.

There were also vacancies throughout the year in the Long-Term Care and

Community Support Division. The

position was a Financial Program Designer.

In the Infrastructure Management Division there was a Director and Senior

Engineer position that was vacant, and the Program and Policy Development

Specialist in the intervention services division.

Now,

some of those positions have already been filled.

For instance, the Financial Program Designer and the Policy and Program

Development Specialist positions have already been filled.

There is a job competition currently ongoing for the Director of

Infrastructure Management, and we will be looking at other vacancies this year

to determine if the positions will indeed be filled, or if we can get the work

done through other positions. So,

as part of the discussion we are having around restructure and attrition, those

positions would be discussed as part of that to determine which we would fill

and which we may not fill.

The

increase from the 2014-2015 budget is a result of the 3 per cent raise that was

approved in the new collective agreement.

MR. A. PARSONS:

Okay, thank you.

CHAIR:

Lorraine.

MS MICHAEL:

Thank you.

Minister if we could go back to 1.2.03, where the appropriations provide for the

development and maintenance of policies, programs, and standards, et cetera.

Under the Health Workforce Planning, what does that involved, and what

would be involved in this coming year?

MR. KENT:

I would be happy to speak to

that. I am just going to find some

more detailed notes on Health Workforce Planning.

The

whole area of workforce planning is a high priority for the department, given

some of the human resource challenges that we have in the system.

As the Department of Health and Community Services, we want to show

leadership and help the regional health authorities tackle some of those

challenges. We work closely with

the Department of Advanced Education and Skills as well to look at some of the

trends that are occurring in the labour market to identify the need for training

opportunities and so on.

So, we

have a Strategic Health Workforce Plan that identifies a framework of five

strategic directions that will enhance the stability, the utilization, and the

productivity of the health workforce, while improving services to residents of

the Province.

In the

absence of the approved plan, we have not stopped undertaking strategic health

workforce related initiatives. This

would include several recruitment and incentive programs.

We are collecting and reporting on key workforce data such as vacancies,

employee turnover, retirement trends, seat capacity, and forecasting models.

Those are just some examples of current programs to balance the supply

and demand of health professionals in the Province.

Our new

plan consolidates existing and future initiatives and programs in a unified and

strengthened provincial approach to Health Workforce Planning.

This was something that the government committed to in the Speech from

the Throne on April 21.

As I

mentioned in response to Mr. Parsons's question, we had allocated a small amount

of money to deal with the publishing and preparation of the new plan.

We had funding in last year's budget that was not utilized so we are

going to need it in 2015-2016. Over

the next three years, we will select actions annually on a priority basis from

that plan based on the highest priority needs within the system.

Many of those actions are already underway.

The Health Workforce Plan that we are talking about can be implemented

within existing funding within the department.

We know

we need to make better use of existing resources if we are going to make the

health care system more sustainable and we also have to position ourselves to

meet the growth in need for health services.

It is incremental increases that we are seeing, but they are relentless.

We see relentless growth in the demand for health services.

This is

a really critical exercise and one that will be a high priority for the

department in 2015-2016, but the Workforce Plan will actually be a three-year

plan.

MS MICHAEL:

Minister, to what degree

does the department engage with an authority if a problematic area becomes

obvious to you, either through the authority or through the media?

MR. KENT:

We engage very directly

through I was going to say through regional services.

In fact, through all divisions of our department we are engaging very

directly with the regional health authorities on a regular basis.

Much to the frustration, perhaps, of some I am a pretty hands-on

minister as well. For instance,

when concerns have been raised about staffing levels in long-term care in St.

John's, I have directly been involved in discussions with officials in Eastern

Health and beyond to talk about how we are going to meet some of those

challenges related to LPNs and PCAs.

It is not something we can solve alone, but there has been a plan.

There have been a number of initiatives undertaken and there is more work

to do.

We are

working closely with the College of the North Atlantic.

We are working closely with Advanced Education and Skills.

We are working closely with the Centre for Nursing Studies.

We are looking at international recruitment, some of which has already

occurred. We are challenging

Eastern Health just to use that example to continue to make that issue a

priority as well.

We see

our role as being critical in providing leadership on these issues.

The regional health authorities have to deliver the services, but the

labour market you have to look at it provincially.

You have to look at the whole picture and at the same time deal with

specific regional issues that may arise as well.

MS MICHAEL:

Minister, is that three-year

plan totally worked out yet on paper?

If not, can it be public when it is worked out?

MR. KENT:

It will be public when

finalized, which we anticipate happening very, very soon, I think would be a

fair assessment.

MS MICHAEL:

You better be careful, it is

not only the finance people who do not want you guessing at stuff.

MR. KENT:

Well, it is near

finalization. It is subject to

Cabinet approval, but we anticipate the plan being released and published very

soon.

MS MICHAEL:

Okay.

Thank you very much. That is

all I have for that area.

Going

on then to 1.2.04, which Mr. Parsons began just let me check my notes here

now. We keep coming to this point

in each area, but let's come down to it here.

The Professional Services, again $843,000, approximately, budgeted, but

$590,000 spent.

MR. KENT:

The funding here provides

for the cost of consulting services in a number of areas depending on the

priorities of the department and initiatives that we are undertaking in any

given year. The expenditures were

less than budgeted in this past fiscal year, primarily due to less consulting

services required for wait-time reviews.

We had

done a lot of consulting work in recent years in that area, and there were less

resources required for consulting services in that area in 2014-2015.

The department, along with the regional health authorities, continued

with the emergency room reviews, which I know is a major concern for people in

the Province. That was funded

through the regional health authorities as opposed to here, hence some of that

difference.

Now you

will also note that the Estimates for this fiscal year have decreased slightly

from the 2014-2015 budget.

MS MICHAEL:

Yes.

MR. KENT:

We looked at historical

trends. We reduced funding for

acute care and long-term care reviews by about $43,000, just based on historical

trends and recognizing the Province's current fiscal situation as well.

MS MICHAEL:

Thank you.

Could

you just give me an idea of what gets included under Purchased Services?

You had a big drop last year in expenditure.

MR. KENT:

Yes.

The funding in that budget line and this area of the budget relates to

the cost of advertising, printing services, and other miscellaneous expenses.

There was an effort through the expenditure management plan in the fall

to reduce any discretionary spending and to defer or stop any items that were

discretionary. That resulted in the

lower Purchased Services costs.

We do

need more funding in 2015-2016 because we have some plans to do a relaunch of

the Newfoundland and Labrador HealthLine.

That was an issue raised in recent years by the Auditor General.

We have a solid plan in place for marketing the HealthLine, which we

intend to roll out in this fiscal year.

That is why those funds are necessary.

acknowledge that we need to increase awareness of the HealthLine and also update

the HealthLine service. We have

some pretty exciting initiatives that I hope to announce over the next couple of

months.

MS MICHAEL:

Thank you.

I have

some questions related to community support services and care.

With regard to the Paid Family Caregiving Home Support Option, how many

clients are in the pilot project per region?

MR. KENT:

I will endeavour to get you

the specific numbers by region. I

am just checking to see if I actually have them with me.

I only

have the total number. I will walk

you through those numbers, but happy to give you a regional breakdown.

We can take that away and provide those numbers.

Just to

provide a little bit of context first, this Paid Family Caregiving Home Support

Option was launched in March of 2014.

We had a made a commitment to increase choice for those eligible seniors

and adults with disabilities with respect to how their acquired home support

services are delivered. The concept

is to allow the hiring of a family member.

It was

introduced through a very controlled program admission.

We limited update in the first year to 250 subsidized clients.

We did not fill all of those spaces for the 250 subsidized clients.

The approach was to provide an opportunity to assess the uptake, refine

the processes, really ensure quality, and make sure we have planned for program

development.

So we

anticipated quicker uptake and we anticipated higher monthly costs.

I want to see that program utilized because I think it is a beneficial

concept that can help a lot of families in our Province.

I know we both agree that there are challenges that need to be addressed

when it comes to home support. How

we address those challenges we may have a different view on

MS MICHAEL:

We do.

MR. KENT:

but we both acknowledge

that there is definitely work to be done.

MS MICHAEL:

Yes.

MR. KENT:

So, the annual budget has

been adjusted going forward to more accurately reflect the uptake and the

average client costs, not just the uptake.

Expenditures of approximately $1.2 million in 2014-2015 are related to clients

utilizing the program. That is a

very long-winded answer to your question and I have not really answered it yet,

so let me get to that.

As of

the end of March of this year over 290 clients had been assessed for the Paid

Family Caregiving Option, and 103 were actively receiving care through this

option. It concerned me on the

surface when I heard those numbers so I dug a little deeper.

What we

have learned through the assessment process is that following the assessment

some individuals have chosen another care option or they have declined home

support services. As with other

home support options, discharge can occur as a result of the client choosing not

to continue with the option, or there is no longer a need for home support

services in some cases. That has

actually been the case for an additional sixteen individuals who have utilized

the option.

On a

positive note, there is no wait-list for the Paid Family Caregiving Option.

I have asked our officials to look at the program to see if there are

modifications we can make to the eligibility criteria and to the process to

increase utilization. I would like

to see more families avail of this option and we have maintained budget

resources to fund additional capacity.

We are not capping the program at current use because we still would like

to fill those 250 spots.

We are

only a year in, so there will be a need to continue to monitor, evaluate, and

figure out if there is a better way to do this.

I would have anticipated greater uptake, so clearly there is something we

need to do differently. We are

currently working through how to achieve that.

MS MICHAEL:

If I could just do a

follow-up directly to that point.

CHAIR:

Okay.

MS MICHAEL:

When you announced this

program, existing home care clients were not accepted.

MR. KENT:

That is correct.

MS MICHAEL:

Has that been revised?

Are you going to look at that?

Obviously there are people out there who wanted to apply, but could not

because of that criterion.

MR. KENT:

That is one of the things we

will consider in our deliberations.

However, we have to be careful about opening up the flood gates at the same

time, given the financial constraint that exists on the program.

We are open to all possibilities.

I want to make sure the program is better utilized.

Maybe

there are certain cases of existing clients where we should look at

accommodating, but that is all still being discussed.

We have not made any decisions.

I just want to find a way to get more families accessing this program.

It is

also important to note that it is not the intention and I think we probably

all agree on this as well to pay people for natural caregiving roles that

families should, and in many cases, as many of us know personally, as we do

provide. This is about providing

clients with an enhanced choice while maintaining informal caregiving

relationships as well.

MS MICHAEL:

Okay.

Thank you.

CHAIR:

Andrew.

MR. A. PARSONS:

Thank you.

I am

still on 1.2.04, Regional Services.

I will apologize in advance because some of the sections sort of jive together.

If I ask a question on a topic and you want to defer it to whatever, just

tell me.

MR. KENT:

No problem, yes.

MR. A. PARSONS:

I want to talk about

Purchased Services and Professional Services.

Last year, there were a number of reports or projects that were to take

place. I just want to sort of check

and see what the status is or the cost.

I think one of them last year was the review of the James Paton Memorial

ER. That was to be done, so if I

can get the cost and the status.

MR. KENT:

That would be contained

within the budget for the regional health authorities.

That relates to the wait-times review that was, in fact, done.

There was an additional announcement related to that as part of the

budget as well.

MR. A. PARSONS:

Okay.

Like I

say, you look at Regional Services and then there are a lot of topics.

MR. KENT:

No problem.

We are happy to jump around a bit as long as I can follow.

MR. A. PARSONS:

I appreciate that.

Some ministers are not so accommodating.

MR. KENT:

This is much friendlier than

Question Period, so I am happy to keep going.

MR. A. PARSONS:

Okay.

There

was a bed projection modelling project which was supposed to be completed last

year. I am just wondering is it

complete, and if so, what are the results?

MR. KENT:

There is funding that was

spent in 2014-2015. In fact, we

spent more than anticipated on that modelling project.

We are working with the Department of Finance, through the Economic and

Statistics Branch, on that as well.

I believe there is more funding required in this fiscal year to continue that

work. There is.

MR. A. PARSONS:

So how much was spent in the

last fiscal year?

MR. KENT:

There was $380,000 spent.

MR. A. PARSONS:

Now am I correct in saying

that the was the amount supposed to be $243,000.

MR. KENT:

You are right, yes.

In the revised budget numbers it went from $243,200 to the $380,000 I

just referenced.

MR. A. PARSONS:

What are you anticipating?

You say more is needed to finish, what are you anticipating for this?

MR. KENT:

I am going to allow Bruce to

answer that.

CHAIR:

Bruce.

MR. COOPER:

There is still some more

work to be done in terms of bringing in some data around chronic disease

profiles to triangulate within the data set that we had.

It is some of the finishing touches on the model essentially.

There

is a process that we will have to go through to keep the data evergreen because

as we implement new beds, then we need to assess.

So I expect that over time we will have to slip this into our core

operations in terms of how we because the model is being run by the Economics

and Stats area. I expect we are

going to have to have some funding to be able to support that work and

continuing to ensure the validity of the model.

MR. KENT:

If I could just add one

thing, Mr. Chair.

CHAIR:

Minister.

MR. KENT:

I agree with everything

Bruce just said, which is good for both of us.

In addition to that, I would add that the work that has been done to

date, while it is ongoing, has actually influenced recent decisions we have made

around new long-term care beds for Western, Central and Eastern Regions.

We know that the need is great over the next decade and we know that

there are hundreds more new beds required.

The

goal of course is to keep people in the community and in their homes as long as

possible which ties in with our Close to Home strategy.

At the same time, even despite our best efforts to keep people in their

homes and keep people in their communities as long as possible, we know given

the age of our population and the fact that we have a population that is less

healthy than the rest of the country and aging faster than the rest of the

country, the trends tell us we are going to need hundreds of new beds.

As you know, we have chosen a different procurement approach for the next

number of beds that we are going to construct.

MR. A. PARSONS:

So is there any timeline on

when you expect this report to be complete?

I know it is sort of an ongoing thing, but it was supposed to be

completed last year. Do you have a

time that you would like to see it done?

MR. KENT:

I would like to see it done

in this fiscal year. I do not know

if we can be more precise than that at this point.

There will be no final report per se because the model will continue to

generate numbers, but the expenditure certainly will not be as great going

forward, I would not anticipate.

MR. A. PARSONS:

If I understand maybe you

have to dumb it down for me. I

believe the deputy minister said that you may have to change where the money

comes from. You say it might have

to be absorbed. Is there a figure

though, a cost we anticipate that will cost on top of the $380,000, no matter

where it comes from?

MR. KENT:

Related to the modelling?

MR. A. PARSONS:

Yes, to finish this off.

Are we talking another $380,000, less than that?

MR. KENT:

I would say less, but I will

allow Bruce to elaborate.

CHAIR:

Bruce.

MR. COOPER:

Essentially, we are in

discussions with finance now to talk about how we now that we have gotten

through the development phase and we are into kind of fine tuning structure

our relationship going forward. I

anticipate it would be a lower amount because we are moving from development

into maintenance.

MR. A. PARSONS:

Okay.

Thank you.

Still

on the reports, there was a review done on midwives.

I think it was projected for $145,000.

I believe the report is done.

I do not know if the report is available.

MR. KENT:

The funding for the review

related to midwives was actually only $25,000.

The other amount, the $145,000, related to funding for the implementation

of a shared services model, which we recently announced, and also work related

to road ambulance and patient safety initiatives.

We have

made significant progress on the midwife review.

The report you are referencing is actually online.

MR. A. PARSONS:

Okay.

MR. KENT:

So it is complete.

We are actually in the process of finalizing recommendations I am sorry

regulations, I meant to say. I am

happy to provide you with more detail if you wish.

MR. A. PARSONS:

The regulations, do we

anticipate them being will we see them this year?

MR. KENT:

Yes.

MR. A. PARSONS:

Okay, so now I am going to

get more specific; this session or if there was a future session?

MR. KENT:

Do we actually need to go

into the Legislature for regulations?

I do not think we do.

MR. A. PARSONS:

Not usually.

MR. KENT:

In terms of precise timing,

I can tell you that I have asked this to be a priority and that we get the

regulations concluded as quickly as possible.

I do not know if someone else would like to elaborate on time frame?

Karen?

MS STONE:

We are working with the

Council of Health Professionals and a number of advisory bodies on the

regulations. The process is well

underway. We have had multiple

drafts and continue to work with them.

MR. A. PARSONS:

Okay.

Thank you.

I think

there may be a few more under that, but I want to just move forward for a

second. Under Purchased Services

again for this year, do you have a list of what you intend to purchase for this

fiscal year, this coming year?

CHAIR:

We are still under 1.2.04

for Committee members.

MR. KENT:

Thank you for that, Mr.

Chair.

You are

looking for detail on what is going to be this year's

MR. A. PARSONS:

Yes, you have a budgeted

amount. What do you expect to get

for that budgeted amount?

MR. KENT:

It includes advertising,

printing services, and other miscellaneous expenses.

The reason we anticipate needing funds that we did not spend in 2014-2015

relates primarily to the HealthLine.

We are going to meet our commitment to launch a campaign to increase

awareness and to update the HealthLine.

We will have some good news to share over the next couple of months.

MR. A. PARSONS:

You have my curiosity peaked

here. What do we do to update the

HealthLine? I think those were the

words you used, update it.

MR. KENT:

There are a number of things

we are going to do. I prefer to

save that for the announcement. A

couple of hundred thousand dollars of this budget is earmarked for that purpose.

Let me give you a sneak peek though.

We want

to launch an awareness campaign to make sure that everybody in the Province is

well aware of the service. It is a

good service. It provides

twenty-four seven access to a registered nurse to everybody in Newfoundland and

Labrador. Last year, we received

approximately 40,000 calls, about 110 calls per day.

We are spending about $3 million annually for this valuable service.

I never

really appreciated the value of the service as a resident until I became a

parent. My wife and I have had

reason to call the HealthLine a few times over the last five years or so and it

has proven to be a very valuable service.

It is not just a service for young parents, it is valuable service for

anybody who has a question and wants to get immediate access to a registered

nurse.

We want

to expand the role of the HealthLine.

I will provide more detail over the next couple of months because I think

there is great potential to make it more accessible, to enhance the role, and to

make it easier for people to access.

CHAIR:

Follow-up?

MR. A. PARSONS:

Just one follow-up on that.

MR. KENT:

Yes.

MR. A. PARSONS:

Excuse my ignorance; you say

you got 40,000 calls. Is there a

tracking done that you are able to access to show what the results were of each

call and how many calls.

I was

actually at a town hall where somebody was talking about it.

He said the constant refrain was to go to the emergency room go to the

emergency room. So is there a

breakdown of what percentage of people was referred to an ER and what percentage

discussed this or that?

MR. KENT:

We would have some

statistics, but I do not have anything I can share with you right here.

There was actually an evaluation conducted by the Newfoundland and

Labrador Centre for Health Information a couple of years ago.

It actually found that the HealthLine reduced unnecessary emergency

department visits. So, 18.5 per

cent of users had originally intended to go to the emergency department, but

after speaking to the HealthLine they sought a lower level of care.

We also

found through that research that and we do the evaluation on an ongoing basis.

In this particular comprehensive evaluation we also found that the

HealthLine promoted higher levels of self-care at home.

There was also a very high satisfaction rate.

Because

the registered nurse on the other end of the phone cannot physically see and

touch the patient, there are times when you have to err on the side of caution.

It would not be uncommon for a nurse to say: if your conditions worsen,

if these things happen, you should get to a hospital.

I know

from my own experience with our children, I have heard that said, but in most

cases we have not needed to go to an emergency department or even the family

doctor. We may have had to go to

the pharmacist the next day or even overnight.

It is hard to be incredibly precise over the phone, but it has

definitely, even in my own case, prevented trips to the emergency room.

MR. A. PARSONS:

Okay.

Thank

you, Mr. Chair.

CHAIR:

Lorraine.

MS MICHAEL:

Just some more questions

under that section, Minister, related to the broader community support services.

Just

going back the midwifery report for a minute, you referred to the regulations,

but do you anticipate legislation?

Of course we took the act that was in place around midwifery off the books a

couple of years ago, understandably, because I do not think it related to

anything real. With the attempt to

bring midwifery back in, can we anticipate legislation?

MR. KENT:

We do not believe at this

point that legislation will be necessary.

We believe we can achieve it through the regulations that are now being

prepared.

There

is a committee, as Karen alluded to.

We have a regulatory and policy advisory committee that is developing the

regulations. That will cover things

like entry to practice, continuing education requirements, and standards of

practice. This committee actually

includes practicing midwives, educators, a registrar from another Canadian

jurisdiction, Health and Community Services, the Newfoundland and Labrador

Council of Health Professionals, and the Association of Midwives of Newfoundland

and Labrador.

We are

getting close to getting the regulations done.

There has also been a provincial implementation committee established to

assist with developing processes and policies to establish and integrate the

services of midwives into the health care system.

MS MICHAEL:

Thanks Minister.

I am

trying to remember because I did not think of this, actually, prior to the

question given to you. We have an

umbrella piece of legislation with regard to medical professionals.

Are midwives at this moment in that?

I cannot remember.

MR. KENT:

Yes, they are.

MS MICHAEL:

Okay.

That is fine then. I agree

then. In that case we do not need

any more legislation because they are in that act which I remember well.

MR. KENT:

One of the beauties of the

microphones on but cameras not rolling is I can turn and ask questions, and

people at home do not know that.

They think I know all the answers, so it is a great format.

MS MICHAEL:

Okay, no comment.

MR. KENT:

Members can sneak out and go

to the bathroom without anybody noticing as well.

MS MICHAEL:

Minister, with regard to

personal care homes and nursing homes in the Province, can we have if you do

not have them here, could we receive them up-to-date statistics with regard to

the number of personal care and nursing homes, and also the numbers of residents

by region?

MR. KENT:

Absolutely.

I will give you the numbers that we do have here.

If there are additional numbers that you would like to have, we can do

our best to provide them.

There

are eighty-nine personal care homes in the Province.

Just to give you the quick breakdown on that, forty-eight of those homes

are in Eastern Health, twenty-two are in the Central Region, fifteen are in

Western, and four are in Labrador-Grenfell.

As of

December last year, so as of five months ago, there were 3,982 personal care

home beds available; 3,192 beds were occupied with about a 20 per cent vacancy

rate; and at least 2,479 received a government subsidy, which is approximately

78 per cent of all personal care residents.

further breakdown of occupancy by region we can get those numbers for you, but

I do not have them here.

MS MICHAEL:

Okay.

Minister, in reference to the subsidies, do we have figures on what percentage

of the total of residents in personal care homes have portable subsidies?

MR. KENT:

I am looking for that

figure. I can tell you that in the

last number of years we have provided new funding for new portable subsidies and

some additional respite care beds as well.

We have also increased the monthly subsidized rate.

Do we have

OFFICIAL:

Most are portable. We do not have

the numbers.

MR. KENT:

I do not have the precise

number, but more are portable. We

can get you the number, but more are indeed portable.

MS MICHAEL:

Okay, thank you very much.

Just

some more specific programs that fit, I think, under Professional Services.

The diabetes database pilot project with Western Health, can we have an

update on that please?

MR. KENT:

I am actually glad to be

asked. It is an important issue

that I know both you and Mr. Parsons have raised on several occasions and it was

flagged by the Auditor General previously as well.

When I

became aware of that I asked that we step up our efforts to make progress on

this. We have been actively

working, not just with Western Health, but we have been working with all the

regional health authorities and the Newfoundland and Labrador Centre for Health

Information to develop a truly provincial solution that will measure outcomes.

To date

I was really hoping to get asked in the House I am pleased to report on a

number of pieces of progress that have been made.

We formed a clinical working group to provide advice.

We finalized a case definition of diabetes.

We have identified the key outcome indicators to be monitored.

We have identified the key data sources to link and draw on.

So we

are actually going to have an initial set of test reports from the new database

by early next month. That will

allow us to adjust, as required, the database and data collection processes.

The database, when fully up and running, is going to support the delivery

of diabetes management services in a number of ways.

It is

going to allow us to monitor trends related to the prevalence of the disease.

It is going to monitor the quality of care for clients with diabetes.

We are going to be able to monitor outcomes for residents with diabetes.

It is going to support future research related to diabetes.

I have

tasked the Newfoundland and Labrador Centre for Health Information with

maintaining this new database. They

will produce quarterly reports that will help us at a regional level and also at

a departmental level when making program and policy decisions.

We took

the concerns that were raised in 2011 by the Auditor General quite seriously.

Western Health had been doing some work, which we intended to stretch out

across the Province, but in reviewing that progress we adjusted course to try

and bring about the progress quicker.

The Newfoundland and Labrador Centre for Health Information has shown

good leadership. I approved a

revised plan to develop the database back in February in response to concerns

that I had about progress to date.

MS MICHAEL:

That is great, Minister.

Thank you very much.

MR. KENT:

If you could ask me the same

question at Question Period today, I would really appreciate it.

MS MICHAEL:

I might have a twist on it.

Thank

you, but it is really important information.

As you know, and as I know, people who are living with diabetes and the

whole community around them have great concerns.

MR. KENT:

Absolutely.

This is necessary. It is

overdue. Like I said, with test

results coming next month we will quickly be able to get a provincial solution

in place that will help us on a number of levels.

I appreciate the fact that all parties in the House have been advocating

for a solution and I am pleased to tell you today that we are way, way closer

than we have ever been.

MS MICHAEL:

Wonderful.

That is good to hear.

How

about the electronic medical patient records?

MR. KENT:

I am pleased to provide you

with an update on that as well. You

have asked specifically about the electronic medical record.

We remain very committed to establishing a Province-wide EMR program that

meets the needs of physicians but also the needs of other stakeholders in the

health care system. We have been

working closely with the Newfoundland and Labrador Medical Association and the

Centre for Health Information. A

lot of work has been done to ensure that the development of the EMR program

continues to progress.

A big

milestone was achieved this past year.

We issued, through the Centre for Health Information, an RFP for the

electronic medical record program.

It was issued in mid-October. The

RFP closed in mid-December and we anticipate that the project will be awarded

any day, hopefully before we are into the summer.

That will connect, I believe, approximately 300 physicians to the EMR,

which is an exceptional start, with more progress to come.

What we

are talking about just for the benefit of those who may not be aware the

electronic medical record is a really critical part of the overall electronic

health record. It is a

comprehensive electronic record of a patient's health information and history

that maintains those traditional paper files with all of the coloured tabs that

you see in physicians' offices. It

will allow patient information to be maintained, manipulated, analyzed, and

shared way more easily, which should lead to better patient outcomes, which is

really our focus.

All

other provinces are going down this road as well.

Some have fully implemented; a number are just beginning implementation.

We want to make progress in a hurry, so this RFP that will connect 300

physicians is a major, major step forward for us.

MS MICHAEL:

How do you get the

physicians on board? Is the

department working with the Medical Association in that or is it directly with

the physicians?

MR. KENT:

We are working through the

Newfoundland and Labrador Medical Association and we have actually reached a

general consensus with them on the financial model for the EMR program, but

there is some further analysis required to figure out the precise governance

model. The Centre for Health

Information and the department are continuing to work with NLMA on that.

We are focusing on those two issues really: the financing model and the

governance model.

It is

also worth pointing out that the 300 fee-for-service general practitioners that

would get connected, that will capture the majority of fee-for-service general

practitioner physicians; it will capture 73 per cent of GPs.

While it is only 300, that captures the majority, so it is a great step

forward.

discussions with physicians that I have had when visiting regions, physicians

have actually expressed a desire to get connected.

I think most physicians in the Province recognize how important this is.

It seems obvious to me, if I show up at an emergency room and if I happen

to be unconscious I would like the folks who are going to be treating me to have

immediate access to accurate medical history, medical records.

We also want to make sure that everybody in the system is well connected

and is getting the most up-to-date and accurate information.

This is

fundamental and I am glad we are going to be making major progress this year.

CHAIR:

Minister, I am going to

suggest that we take five. You

mentioned earlier that people can sneak off, but your staff cannot sneak off.

So, we are going to take five, come back and we will continue.

Can we make it five minutes because I know there is a lot more

information we need to go through and all of the rest?

We will take five minutes and we will reconvene at 10:31 p.m.

Thank

you.

Recess

CHAIR:

Welcome back everybody.

We are ready to start, so thank you.

Andrew.

MR. A. PARSONS:

All right, thank you.

believe that the topic of personal care homes was brought up in the last line

there. So I just wanted to ask,

specifically

CHAIR:

Just to be clear, Andrew, of

where we came back, we are still at 1.2.04, Regional Services?

MR. A. PARSONS:

Yes.

CHAIR:

Okay.

MR. A. PARSONS:

I think this was brought up,

so I just want to follow along with that line.

CHAIR:

Okay.

MR. A. PARSONS:

In the budget there was $24

million allocated to personal care homes, but I do not know if I saw any

increase in the subsidy. I am just

wondering if there is a breakdown of that $24 million.

MR. KENT:

I am just trying to find the

$24 million.

To Mr.

Parson's question, I do not know that we have the detailed breakdown of the $24

million here. That funding is

contained within the budgets for the regional health authorities.

So we can get you more information, but I do not think we are able to

provide it at this very moment.

MR. A. PARSONS:

That is fine.

I know the minister will get us the

MR. KENT:

We can tell you about the

increases that have occurred over the last number of years, but I do not know if

that is what you are actually looking for.

MR. A. PARSONS:

No, I think there was a new

$24 million announced. That is my

understanding.

MR. KENT:

That represents new base

operational funding which was provided over a number of years.

We can give you that breakdown.

MR. A. PARSONS:

Yes, okay.

That would be great.

MR. KENT:

I will just ask Bruce to

briefly speak to those numbers.

CHAIR:

Bruce.

MR. COOPER:

So yes, according to my numbers we have added about $7 million in base funding

to personal care homes between 2012-2013 and this year.

There is no new base operating funding in this year's Budget for personal

care homes. The subsidy rate is

consistent with what it was.

MR. A. PARSONS:

I just want to make sure I

am clear. I am pretty sure it does

say $24 million in this year's Budget for personal care homes, so that is the $7

million right?

MR. KENT:

Yes, that is right.

That is accurate.

MR. A. PARSONS:

We just do not know what the

rest is for. Is that $7 million in

base funding, you said, since 2012-2013?

MR. KENT:

The $7 million relates to

increases in base funding. The rest

would relate to the subsidies, the core operation of the program.

That is the total expenditure.

MR. A. PARSONS:

Okay.

There

was a pilot project with personal care homes.

MR. KENT:

Yes.

MR. A. PARSONS:

I am just wondering if there

is any did you ask that?

MS MICHAEL:

No, no.

I said I do not have to ask that.

MR. A. PARSONS:

Okay.

MS MICHAEL:

(Inaudible).

MR. KENT:

Yes, it is a pilot that we

are quite excited about. We have

received a draft of the evaluation report and looking forward to getting that

finalized soon. The pilot phase of

the project was actually completed in February, but it will continue at the

three sites where it was being piloted until we make decisions about the future

of the project.

I am a

believer in the approach at this point. I

have not yet seen evidence that suggests this is not something we should do more

of. The idea was to look at

providing enhanced care in personal care homes.

That really is consistent with our ten-year long-term care strategy Close

to Home.

This

pilot project began in 2013. We had

$1.5 million for the implementation of the project.

Like I said, the evaluation is being finalized.

There has been some early work done and hoping to get that finalized

soon. I would love to see the

program grow, but we need to make sure it is actually effective and that it does

make sense for families, makes sense for patients, and makes sense from a

financial perspective as well.

MR. A. PARSONS:

The pilot aspect was

completed, you said, February.

MR. KENT:

It was technically

completed, but we are allowing it to continue until we decide what we are doing.

MR. A. PARSONS:

Okay.

MR. KENT:

If the decision is to

continue it or the decision is to expand it, it would not make sense to disrupt

the care of those who are receiving care right now.

We are continuing the project at the three sites until we make decisions

about next steps.

MR. A. PARSONS:

Like you said, the original

announcement of 2013 allocated, I think it was, $1.5 million.

That is expended so there is additional funding to allow for this to

continue on.

MR. KENT:

That was the funding that

was originally allocated. There

will be an additional cost to continuing the program beyond into this fiscal

year.

MR. A. PARSONS:

What would you anticipate

that cost to be?

MR. KENT:

It would depend on how long

we continue. We have the full

amount in our budget which is, what, for this fiscal?

OFFICIAL:

It is $1.5 million.

MR. KENT:

It is $1.5 million for this

fiscal. So there is $1.5 million in

the budget for this fiscal.

MR. A. PARSONS:

Okay.

Just

quickly to the side a bit; the community care homes.

I believe that there have been some negotiations going on with community

care homes and the department. I

guess they have a shortfall in the funding they require.

I understand there have been ongoing discussions, but it is my

understanding that is, sort of, off the rails. I am just wondering is there any

money allocated for that?

MR. KENT:

I would not agree with that

assessment, I would say respectfully.

There are meetings ongoing between the community care home owners and

operators, and Eastern Health to figure out what can be done about some of the

operational issues that they are experiencing.

You would definitely be right in suggesting that there are issues to be

resolved, but I am actually pleased that the meetings are ongoing and that we

are working towards solutions.

We are

committed to the services that are being provided through Eastern Health's Home

and Community Care Program. They do

provide a unique and valuable service.

We expanded financial support to the community care home operators in

Budget 2014 when funding was approved to increase the monthly subsidy rate from

$1,850 to $1,950. That was to

offset increased operating expenses that operators were, indeed, experiencing.

For

those who may not be familiar with it, this is a mental health and addictions

housing program within Eastern Health.

It has existed for quite some time.

Today, there are thirteen homes with a total of 166 available beds.

There was a meeting earlier this year at the request of the Community

Care Home Owners and Operators Association to discuss concerns they had with the

funding model. That is probably all

I have to say at this point unless you have further questions about it.

MR. A. PARSONS:

Okay.

I am going to move on to 1.2.05, Population Health.

Looking at the Salaries line what was spent last year was very close to

what was budgeted, but there has been a bump this year.

I guess the question is: Is it new salaries or is it the bump/increases?

MR. KENT:

The increase in this year's

budget is your question?

MR. A. PARSONS:

Yes.

MR. KENT:

The increase is the result

of the 3 per cent raise approved in the new collective agreement, but also the

approval of two new temporary positions in mental health.

They are being funded from an agreement with Health Canada related to

mental health and drug treatment funding.

This area is also offset by a reduction related to the attrition plan,

but what you are seeing, in addition to the 3 per cent, is the two new temporary

positions that are being funded from a federal source.

MR. A. PARSONS:

So what are those two

positons; what are their titles and where are they based?

MR. KENT:

They are based here in the

department in St. John's and they are temporary positions I am looking for the

exact titles. They do not have

specific titles at this point. They

are contractual positions under the mental health drug treatment federal

agreement. They are consultants,

but there is not a specific job title that has been classified at this point,

given they are contractual.

MR. A. PARSONS:

Okay.

Under

Professional Services, under the same heading, last year there was an under

spend by just over $500,000. What

was budgeted for that was not actually completed?

MR. KENT:

The funding here relates to

a number of consulting services.

The savings is related to delays in a number of items such as the development of

an environmental health strategy, and reviews and training around mental health

and addictions.

addition, there was $300,000 transferred from Professional Services to the

regional health authorities for the Strongest Families Initiative, which we

announced in recent months. I know

members are familiar with it. It is

a non-profit corporation that provides evidence-based services to children and

families seeking help for mental health and other issues impacting health and

well-being.

MR. A. PARSONS:

I have one question left for

this heading, with Lorraine's indulgence.

CHAIR:

Okay.

Andrew, go ahead.

MR. A. PARSONS:

I am just wondering while we

are under this heading there has been some news lately about the tuberculosis

up in Labrador, specifically Nain.

Obviously it is a concern for everybody, so I am just wondering what steps are

being taken I actually had a number of calls, people saying this seemed to be

ongoing for a while before it became public and there is some concern about a

possible outbreak. From the

department's point of view what is the plan of action?

MR. KENT:

I really want to start by

commending the Nunatsiavut Government for its leadership in this area.

We have been providing whatever support we can on three different fronts.

Through the public officials within Health Canada, there has been direct

support being provided. The

Department of Health and Community Services has been actively involved in

supporting the effort on the ground within Labrador-Grenfell region,

specifically in Nain.

Labrador-Grenfell Health, who is directly involved in providing care, has been

active as well.

Over

the last number of months there has been an increase in clinics actually being

provided on the ground. There is

contact testing being done very extensive testing involving anybody who has

come in contact with a patient with tuberculosis.

There has been an all-hands-on-deck approach.

It is an issue that we must take really seriously, and the statistics

continue to be concerning. The

Aboriginal population of our country is seemingly at greater risk of contracting

tuberculosis. The incidents rates

are higher among our Aboriginal population and to have such a number of cases in

a small community is obviously concerning.

I have

to say that I am pleased with how the Nunatsiavut Government has responded, with

lots of support from Labrador-Grenfell Health, the Department of Health and

Community Services, and Health Canada as well.

MR. A. PARSONS:

Okay, thank you.

CHAIR:

I am going to hold you

there.

Lorraine.

MS MICHAEL:

Thank you.

Minister, I still have a couple of more questions relating back to the Regional

Services. You do not need the line

items, but with regard to some things under Regional Services

MR. KENT:

No problem.

MS MICHAEL:

one is the Clinical Safety

Reporting System. Is the reporting

of adverse events and occurrences happening Province-wide?

MR. KENT:

The reporting of adverse

events is absolutely occurring. I

am going to defer to one of my assistant deputy ministers to provide you with a

little further detail.

Karen.

CHAIR:

Karen.

MS STONE:

The system is being used in all four regional health authorities.

MS MICHAEL:

May I ask a further question

then, Minister? Will occurrence

reporting statistics be made public?

MS STONE:

We have not done that as of yet.

This is the second year when we have had the system up and running in all four

regional health authorities, so it is at this point that we are beginning to

feel confident that everyone is understanding and using the system

appropriately.

MS MICHAEL:

The hope is that it would

become public eventually. Is that

correct, Minister?

CHAIR:

Minister.

MR. KENT:

Yes, that is correct.

MS MICHAEL:

Thank you.

Minister, when I asked you for statistics with regard to the number of personal

care homes, I also included nursing homes, so just to make sure that you know

that it is both the personal care homes and nursing homes and the residents when

I asked you for the statistics.

MR. KENT:

By region?

MS MICHAEL:

By region.

MR. KENT:

No problem.

We can provide that.

MS MICHAEL:

Okay, thank you.

What is

the status of the rapid response team's pilot project for seniors?

MR. KENT:

We have invested over $3

million for a two-year pilot project for four new Community Rapid Response

Teams. The idea is that health

professionals will assess patients at emergency departments to determine if

medically stable patients can return home safely with enhanced community-based

services, which could include increased nursing care, priority access to OT,

physical therapy, short-term home support, which would avoid costly hospital

admission.

There

are teams located in Grand Falls-Windsor, here in St. John's at the Health

Science Centre, at St. Clare's Mercy Hospital, and at Western Memorial Regional

Hospital in Corner Brook. Two teams

in Eastern Health began operating in September of last year, and the teams in

Central and Western started to serve clients in November of last year.

We have a provincial steering committee in place and we are working with

the regional health authorities to operationalize the teams.

I would

say that there is more work to be done.

There is capacity in each of the teams to provide care to additional

individuals, so we definitely have some more work to do.

This is an important initiative that requires some more attention in this

fiscal year.

As of

earlier this month, 251 individuals have been admitted for service through the

Community Rapid Response Teams and they have received enhanced health services

in the community setting: 182 in Eastern Health, thirty in Central, and

thirty-nine in Western.

We are

pleased there has been some uptake but to increase uptake, we have just expanded

the eligibility criteria to include individuals at risk for re-presentation to

the emergency room or at risk to be admitted to hospital at present or in the

near future, as well as those that present to the emergency room after the hours

of operation for the team but appear to meet the criteria.

We are

continuing to monitor. We are going

to probably need to make more changes to ensure full utilization.

It is still a new initiative.

It only launched in the fall, but we are acting with a sense of urgency.

We know it can improve patient care, it can improve outcomes, but it can

also result in significant savings due to less hospitalizations and it will

result in less people sitting in emergency rooms, less patients in hallways,

less people tying up acute care beds.

It is a

high priority, we have made some progress, and we need to make more progress.

MS MICHAEL:

That is really good to hear,

Minister. I did not know that we

had four of them. That is great.

I have to say that I have two friends who are two of the 182 in Eastern

Health and it was amazing actually how quickly they were taken care of, number

one

MR. KENT:

Oh, good to hear.

MS MICHAEL:

and then back in their

homes, one of them with a cracked pelvis, within two weeks on her feet.

I am sure it is the care she had that allowed that to happen.

One who is there now, she fell last week.

They both were falls.

I think

my friend in the fall was told she was the first one I cannot remember if it

was St. Clare's or Eastern Health to actually benefit from it.

I have to say it really is meeting a wonderful need, and I am sure it is

beneficial in both ways that you have indicated.

MR. KENT:

It is, and I am really

pleased to hear that feedback. We

appreciate that. I should note as

well that the primary target group for this initiative is seniors, but the

service is available for all adults.

MS MICHAEL:

Yes.

MR. KENT:

So it is not only seniors.

We are getting good feedback, but we want to make sure that the teams are

operating at capacity. We will

continue to work on that.

MS MICHAEL:

Great.

Thank you.

This is

just a small one, Minister; could we have the current wait-list for home care

and long-term care

MR. KENT:

Absolutely.

MS MICHAEL:

and the number waiting in

acute care facilities, by region?

MR. KENT:

Sure.

I will provide you with some statistics that we have as of March 2015 for

long-term care. We have, as of

March so the stats are a couple of months old, but they have not changed a

whole, whole lot.

MS MICHAEL:

Right.

MR. KENT:

In Eastern Health, the

number of clients awaiting placement was sixty-seven.

In Central Health it was sixty.

In Western Health it was fifty-seven.

In Labrador-Grenfell Health it was sixteen.

Can you

just recap what other numbers you would like in addition to the long-term care

wait numbers?

MS MICHAEL:

Long-term care, home care,

and those in acute care facilities waiting to get into long-term care or other.

MR. KENT:

On homecare I will address

that first of all we do not maintain a wait-list.

MS MICHAEL:

I thought that.

MR. KENT:

If people need care, we

endeavour to get them the care they need.

As far as wait for acute care, would we have those ?

MS MICHAEL:

No, waiting in acute care

beds.

MR. KENT:

Oh, the ALC numbers.

MS MICHAEL:

Yes.

MR. KENT:

Yes, we do track those.

I do not have them handy at the moment, but we can easily get you those

numbers.

MS MICHAEL:

Thank you.

MR. KENT:

I am pleased to say that

there has been some reduction. We

have had a large number, traditionally, of Alternate Level of Care patients,

people in acute care beds who should be elsewhere within Eastern Health in

particular. The new CEO has been

monitoring those numbers extremely closely, and even in individual cases is

trying to drill down and determine how we can move people into a more

appropriate place.

Increasing our long-term care bed capacity will make a huge difference, but in

the meantime we are finding efficiencies within the system to try and reduce

those numbers. It is a real problem

and there is not a family in this Province that has not directly or indirectly

been touched by that challenge in our system.

MS MICHAEL:

Thank you.

One

more question of this nature under this section.

You did make reference to the ER wait times and the continuing work that

will be done there. What is the

strategy with regard to addressing wait times for specialists and for heart

surgery? I know specialist is a

broad term because it is different for different specialists.

MR. KENT:

That is a good question.

When it comes to wait times, the issue you are raising is probably the

next big one for us to tackle. We

have made major progress with wait times in a number of areas, as you are aware,

but there is still work to be done in some other areas.

Just to

give you an example within the cardiac program, Eastern Health oversees the

provincial program and works with regional health authorities to ensure that

patients are seen in a timely manner based on urgency.

There are standardized assessment tools being used.

There

is a well-defined wait-list management process in place.

For patients who are awaiting surgery, the list is reviewed on a daily

basis. The cardiac care team holds

weekly rounds to review the patient priority for surgery and if conditions

change, then there are processes in place to ensure they are re-evaluated as

well. There is a 182-day benchmark,

and currently there are no patients awaiting cardiac bypass surgery beyond the

182-day benchmark.

More

broadly I would say while we have improved wait times in a number of areas and

we are ranked, actually, as the best in Canada in wait-time benchmarks for

cataract surgery and hip and knee replacement for instance, we do know that when

it comes to access to specialists, there is still more work to do.

On a positive note, we are the only Province to achieve nine out of ten

benchmark results compared to the rest of Canada, in which eight out of ten

patients are receiving access to priority procedures.

We are

doing well, but when it comes to certain speciality areas, we know there is

still work to do to improve wait times.

We are tackling each area specifically to try and figure out how we can

best do that.

CHAIR:

Okay.

Lorraine, can I hold you there, or do you just have one quick follow-up?

MS MICHAEL:

Yes, it was just one

follow-up to that.

CHAIR:

Okay.

MS MICHAEL:

What can be identified at

the moment, Minister, as the worst areas with regard to specialities?

MR. KENT:

Your question was: What are

the worst areas for wait times for specialists right now?

MS MICHAEL:

Yes.

MR. KENT:

I am trying to think of what

areas would be the worst.

I am

actually going to ask Dr. Alteen to comment because there are certainly areas

where we do have challenges around physician recruitment.

Attracting specialists to fill certain roles can sometimes contribute to

longer waits.

MS MICHAEL:

That is right.

MR. KENT:

So I will see if he wants to

add anything.

CHAIR:

Dr. Alteen.

DR. ALTEEN:

I think the two problem areas that I would identify are probably neurology and

rheumatology as being the high priority.

MS MICHAEL:

Still the same.

DR. ALTEEN:

Yes, and there are issues with recruitment into those areas.

If you

look at urology, for example, we had major issues three years ago.

We have done substantially better in terms of recruitment.

We are now up to seven urologists in St. John's and eight next year.

The urology wait-list has been taken care of.

There are significant areas of recruitment in those areas that we are

working on.

MS MICHAEL:

Okay.

Thank you.

CHAIR:

Okay, Andrew.

MR. A. PARSONS:

I am on 1.2.06, Policy and

Planning. I specifically wanted to

talk about legislation and policy.

This is further to my questions in the House yesterday about e-cigarettes.

I know the Premier answered and talked about how this is a concern.

I am glad to hear that.

I am

just wondering, in terms of the actual work that has been done, where are we on

it in terms of when we could expect to see legislation?

We are in the House and we hear, I am working on it.

It might be soon, whatever.

I am just wondering constructively when

MR. KENT:

I will give you the best

answer I can. The reason I cannot

be precise is that I am not responsible for that work.

That initiative has fallen under the Department of Seniors, Wellness and

Social Development. The reason I

did not answer the question yesterday is that I am not the alternate to Minister

Jackman who was not available to answer the question at the time.

behalf of Cabinet, I can tell you it is an issue that is actively being worked

on, but I would encourage you to pose the question to Minister Jackman who can

probably give you a more precise idea on when it is going to be brought forward.

MR. A. PARSONS:

Sometimes that line between

wellness and health

MR. KENT:

It is a blend.

On that issue, it is one that we are very concerned about, as people

working in the health system. The

responsibility for moving that new legislation forward and continuing that

analysis has fallen under the new department.

I do

know, just from discussions because we are in discussions every day with

Seniors, Wellness and Social Development, given the obvious link as you just

pointed out. I do know that it is

truly actively being worked on. We

have been watching very closely what is happening in other jurisdictions to see

if we can learn from their best practices.

I know a number of provinces even close to us have recently tackled this.

MR. A. PARSONS:

Nova Scotia, yes.

MR. KENT:

There is a need for

regulation, there is a need for legislation, and the new department is

continuing to work on that.

MR. A. PARSONS:

Thank you.

I am

going to apologize again in advance because we are at 11:00 o'clock and there is

so much to cover. So I am going to

just, sort of, go through a little list I have.

I apologize. I may jump all

over the place.

MR. KENT:

No problem.

Prioritize as you see fit and we will do our best to respond.

MR. A. PARSONS:

I really appreciate that.

I am

going to start with the Waterford.

We know that there is a draft functional plan I guess it was four years ago

there was $4.5 million invested.

There was a draft functional plan that cost roughly $500,000.

I am

just wondering in terms of the timeline, given that right now, am I correct in

saying that 2019 is the year you would expect the and I hate to use the term,

'unpause'. Right now it is on

pause. That is the term that has

been used. Would you say 2019 would

be the go forward year?

MR. KENT:

We are going to continue to

monitor the Province's fiscal situation really closely.

If we can find a way to 'unpause' so to speak, prior to that, I would

love to do so.

I have

publicly expressed my disappointment at this project being paused, but there are

a number of things that we are going to do in the meantime.

We want to ensure that patients at the currently facility continue to

receive high-quality care from well-trained professionals, obviously.

We also want to figure out what changes can we advance within the

existing facilities while we wait for the new hospital.

For

instance, one of the things I suspect we will talk about, through our All-Party

Committee work, is the need to focus more on recovery as we move forward.

We are looking at how we can integrate the recovery model of care where

patients are put at the centre of decision making.

We want to introduce that regardless of when a new building is

constructed.

The

work that has been done to date on the master plan and on the functional program

is really good work. It is not lost

and it will help contribute to the design of the new facility when we can move

forward. Could it be as late as

2019; it could be, depending on the Province's fiscal situation.

I can

assure you that we want to continue to improve programs and services in the

meantime. We want to improve what

is going on within the existing infrastructure in the meantime.

I will continue to be looking for ways to get the facility constructed

faster and hopefully cheaper.

There

may be some work that needs to be done to the existing facility while we are in

that pause state. It truly is a

pause. We are not cancelling the

project. We are still committed to

the project. As soon as we can

afford to move farther faster, we will do so.

MR. A. PARSONS:

You mentioned cost there.

I think in last year's Budget the approved budget for the facility was

$470 million. Is that the most

recent number? Or does the

department have an updated number on the cost and that is one that was used to

sort of make this current decision?

MR. KENT:

We are just looking for

those numbers for you. The design

phase, if we had proceeded, would be another $20 million.

I thought the anticipated cost of the facility itself was over $300

million. We can get you more detail

on those numbers.

MR. A. PARSONS:

I think last year in the

budget it said $470 million.

OFFICIAL:

Yes, I do not have the exact

number in front of me.

MR. A. PARSONS:

This is something that can

go on the list.

MR. KENT:

Yes. Not a problem.

MR. A. PARSONS:

I would appreciate that.

Not a problem.

The

last question I have for this is the dialysis section.

In the plan that you have, what is the plan for the dialysis units at

this facility? Would they be still

there or moved?

MR. KENT:

We still believe that the

dialysis units need to move. We

have been working to invest in some new equipment for the unit, but even with

new equipment the current location is not ideal at all.

We are actively working with Eastern Health to try and figure out how to

move forward, despite the fact that the whole hospital redevelopment is on hold.

The

intention was to move that unit into another space into the community.

That is still the intention.

We have to come up with a way to achieve that.

MR. A. PARSONS:

Okay.

I am

going to move to the long-term care facility in Pleasantville.

I will certainly give you time to put the binder around.

The question I would have is how many beds are in that facility?

MR. KENT:

The total number of beds in

the Pleasantville facility. I know

the rough number. I am just trying

to find the exact number. It is 460

beds.

MR. A. PARSONS:

Four hundred and sixty.

MR. KENT:

Yes.

MR. A. PARSONS:

Okay.

How many are currently open?

MR. KENT:

There are thirty beds

remaining unopened, so there are 430 open.

MR. A. PARSONS:

What is the reasoning for

these beds being unopened?

MR. KENT:

The reason for those beds

being unopened relates to the need for additional staffing.

We need to hire additional, primarily, licensed practical nurses and

personal care attendants in order to open those additional beds.

There have been really concerted efforts made to staff up to address that

There

was the recent recruitment of additional LPNs from Jamaica.

There were local graduates from the LPN program in Newfoundland and

Labrador. We anticipated that with

those new graduates plus the Jamaican graduates coming in, that would give us

sufficient staff to open the remaining thirty beds, or I should say it would

give Eastern Health the sufficient staff to open the remaining beds, but

retention of staff has continued to be a challenge.

While the new staff have come in, we have had other losses.

So these new staff who have come in have been required to meet core

staffing needs for the facility.

We need

to make sure we do not compromise quality of care, so we will not allow beds to

open if we not adequately staffed to do it.

We can make the decision to open the beds now, but if we are short

staffed in the facility overall it just would not be responsible to do so.

We have

been able, though, to open up some additional beds at Chancellor Park until the

remaining beds at the St. John's long-term care home can be opened.

That has addressed some of the demand.

We have opened fifteen of the thirty.

We have opened fifteen additional beds at Chancellor Park to offset those

beds that are not yet open in Pleasantville.

It is

very difficult for us to say exactly when those beds will open.

We had hoped that it would be by now, but with some of the attrition

issues at the Pleasantville facility the new staff who have come in have not

been sufficient to allow the new beds to open.

MR. A. PARSONS:

You say that you are short

staffed. How many staff do you

estimate that you need to get these beds open?

MR. KENT:

We require an additional

twenty-six staff.

MR. A. PARSONS:

Twenty-six staff.

Okay.

MR. KENT:

To be as precise as possible

we anticipate two registered nurses, eleven licensed practical nurses, and

thirteen personal care attendants.

There are staffing shortages throughout the long-term care system within

Eastern, so we also have to look at the full picture.

If we

channel all the new staffing resources into opening up those thirty beds and

leave other facilities short, then we are only going to create a problem this

summer that would not be reasonable.

Patient safety has got to be the top priority.

As any nurse will tell you, overtime, unfortunately, is being used to try

and address staffing shortages.

I would

also like to highlight, though, the things we are doing to try and address this.

It is far beyond the Jamaican initiative.

There are a lot of things being done to try and deal with this issue on

an ongoing basis, recognizing that we are going to need more staff in the

future.

Eastern

Health has commenced a cross-country recruitment drive.

They have actually been to New Brunswick, Ontario, and Alberta to recruit

staff. We have strengthened

partnerships with licensing body and immigration officials to try and make sure

people are getting through the processes quickly and to try and identify early

promising talent pools nationally and internationally.

Eastern

Health has issued a Request for Proposals for an international recruiting firm

to target recruitment in specific countries.

We are evaluating the potential to recruit additional graduates from the

Centre for Nursing Studies program in Jamaica.

We are working with Advanced Education and Skills and the Centre for

Nursing Studies to actually get more students enrolled.

We have lots of seats available in Newfoundland and Labrador.

We need more people to enroll in the program.

Eastern

Health has been reducing non-nursing duties for nursing staff to ensure they are

working the full scope within their area of clinical practice.

They are looking at hiring temporary administrative and other support

positions to assist in resident care areas.

They are also looking at revising the current

schedule to maximize

nursing staff availability.

There

are a dozen things being done to try and address this.

It is a real problem. It is

not going to be solved overnight but for many months, people have been trying to

solve it. I have just been pushing

to ensure that everybody is doing everything possible, given the urgent need.

MR. A. PARSONS:

Thank you.

CHAIR:

Lorraine.

MS MICHAEL:

Thank you.

Minister, I have two questions but they are totally related.

It has to do with the chronic disease policy framework.

I am wondering: Are there new initiatives around that being planned; and,

related to that, how many people have participated in the web-based Chronic

Disease Self-Management Program?

MR. KENT:

That is a good question.

The

self-management program launched in 2011 and 1,275 individuals have met and

supported each other in finding solutions to the common challenges they face in

living with a chronic disease.

There

was a recent evaluation of the Chronic Disease Self-Management Program and it

showed improvements in health outcomes even six months after completing the

program: improved energy levels, decreased health distress, less pain, positive

impacts on life, improved quality of life, better communication with health care

providers, greater confidence, and fewer nights spent in hospital.

It is

also worth noting there are twenty-four diabetes clinics that operate throughout

the Province. We are making some

really good progress so far and great feedback from participants in the

workshops and in the groups 84 per cent of participants were women,

interestingly enough. I am not sure

why that is, but it is interesting to know.

The

statistically significant improvements in eight outcome areas are really

significant as well.

MS MICHAEL:

Could we have that

information of the improvements?

MR. KENT:

Yes, we can provide that.

The evaluation information, you mean?

MS MICHAEL:

Yes.

MR. KENT:

Sure, no problem.

MS MICHAEL:

Thank you.

Minister, under 2.1.01, Memorial University Faculty of Medicine, the Grants and

Subsides. It is a general heading

of course, but it was down by $393,500 from what was budgeted.

How are

these grants and subsidies given?

Obviously, it is not just a lump sum given or else the $57,800 approximately

would have been given to them.

MR. KENT:

The Faculty of Medicine

would make a budget submission would make a funding proposal to the department

on an annual basis. This is the

only Province in Canada where the medical school is actually funded through the

Department of Health and Community Services.

So it is a bit of a unique circumstance in our jurisdiction.

We saw

savings of $750,000 in 2014-2015 related to the initiative for medical student

and resident accommodations. The

strategy for this initiative was changed, as the Faculty of Medicine was not

able to assume responsibility for the management of the accommodations in

various communities across the Province.

So the department has been working with the faculty and with the regional

health authorities on another model.

We will be going to Cabinet for approval on that in the next three or

four months, I suspect.

The

need for those accommodations will gradually be rolled out over the next few

years as the impact of the expanded medical school class size is realized.

The savings was partially offset by one-time negotiated signing bonuses

paid out to facility and staff during the year as well.

MS MICHAEL:

Okay.

Do you

receive their budget prior to the provincial Budget being done?

How does that work?

MR. KENT:

Yes, we receive a submission

prior to the provincial Budget being finalized.

MS MICHAEL:

Okay, and basically what

they submit was approved.

MR. KENT:

What they submitted was not

approved in its entirety, no.

MS MICHAEL:

All right.

there any danger down the road of tuition hikes having to happen in the Facility

of Medicine?

MR. KENT:

I would say that is

possible, yes.

MS MICHAEL:

Are the discussions going on

with the faculty about that?

MR. KENT:

Yes.

MS MICHAEL:

Thank you.

Moving

down to Drug Subsidization, 2.2.01, Provincial Drug Programs, I do not have many

line questions because there are not many lines, but under Allowances and

Assistance, basically $9.5 million was not used last year.

Is that just because of lower than anticipated uptake?

MR. KENT:

Savings were due to the

delayed implementation of several new drug therapies that were approved in

Budget 2014; $4 million actually relates to one drug, Zytiga, and $1 million was

for other drugs that were delayed such as Everidge, which is an easier name to

pronounce.

There

was also $2 million in savings related to lower costs of brand name drugs due in

part to the increase cost of generics, and $1.5 million in savings from a

reduction in the generic markup that was not factored into the budget.

There were savings realized in the Smoking Cessation Program.

MS MICHAEL:

What was the uptake for that

program, Minister?

MR. KENT:

That is a good question.

The

actual number was 1,185 and some beneficiaries may have changed drug plans

during the treatment cycle and could have been counted under other plans but the

actual number, to the best of our knowledge, is 1,185.

MS MICHAEL:

Is there follow-up done to

see the effectiveness of the program, that people continue to be non-smokers?

MR. KENT:

There is some monitoring and

evaluation being done. I am just

wondering if one of my officials would like to speak to that in more detail.

Elaine.

CHAIR:

Elaine.

MS CHATIGNY:

Thank you.

Yes, in

collaboration with the Department of Seniors, Wellness and Social Development,

we are going to be partnering to do an evaluation.

They have a piece of this program, we have the drug dispensation piece of

the program, but together we are going to evaluate to try to do just that, the

ongoing monitoring of whether or not this program, the drug medication program

plus the other wraparound services that are part of the overall service

offering, actually led to long-term cessation.

MS MICHAEL:

Right.

Thank you.

Minister, you may not want to give me this information now in the interest of

time. Maybe it would be sufficient

for you to send to us the breakdown of expenditures by drug program, and the

number of clients in each program for the past year, not coming up, but

2014-2015.

MR. KENT:

We would be happy to provide

that information. Some of it I do

actually have here.

MS MICHAEL:

Okay.

MR. KENT:

The breakdown of expenditure

by drug program for the last year, I will just give you the approximate numbers.

MS MICHAEL:

Sure.

MR. KENT:

Through the Foundation Plan,

it was over $62 million; for the 65Plus Plan, it was almost $46 million; for the

Access Plan, it was $7.6 million; and, for the Assurance Plan, it was $19.4

million. There is also funding for

special needs such as growth hormones and the cystics program.

That was $935,000 for a total of almost $136 million.

MS MICHAEL:

Minister, is the budget for

each of these plans basically the same in this upcoming year?

Have there been changes?

MR. KENT:

It is basically the same.

I am just going through the numbers to see.

Yes, it varies. There is

about a $170,000 difference spread across the board.

So they are virtually the same when we are talking about a $147.5 million

budget.

MS MICHAEL:

Right.

Thank you very much.

I only

have thirty-nine seconds. I will

just pass it back to Andrew.

CHAIR:

Okay.

Andrew.

MR. A. PARSONS:

Thank you.

CHAIR:

You have totally lost me so

you continue on.

MR. A. PARSONS:

I have sort of lost myself

here, Mr. Chair.

I am

going to start with the hospital in Corner Brook.

MR. KENT:

Yes, I thought you might

bring that up.

MR. A. PARSONS:

You did not think you were

going to get to 12:00 o'clock and not have that happen.

MR. KENT:

No, I love talking about it.

MR. A. PARSONS:

Just a few questions on it.

Last year's Budget document said the approved budget was $608 million.

I am wondering what the approved budget is today.

MR. KENT:

We anticipate that the

project will cost in excess of $800 million overall.

MR. A. PARSONS:

Okay.

I think in March you had indicated you were close to finalizing the

functional plan.

MR. KENT:

That is right.

MR. A. PARSONS:

Is it complete now?

MR. KENT:

No, but it is going to be

complete very, very soon. When I

say very, very soon, I am talking within several weeks.

MR. A. PARSONS:

Okay.

MR. KENT:

It is really, really close.

MR. A. PARSONS:

So once it is complete and

you get it, do you anticipate that the public will have an opportunity to see

it?

MR. KENT:

Absolutely.

MR. A. PARSONS:

Okay.

MR. KENT:

I would like to get it out

there very soon. It is just about

final. We anticipate being able to

release the functional plan this month.

MR. A. PARSONS:

Okay.

MR. KENT:

We want to make sure we

communicate better on this particular issue.

I think it is important to get more out in front of it than we

traditionally have been. There have

been lots of challenges over the last seven or eight years with this project and

I have acknowledged that multiple times.

So as

we release the functional program, people will have lots of questions.

We want to prepare for its release and be as transparent and forthcoming

as we can be in answering people's questions about what that final functional

program looks like. I should be in

a position to release it before the end of this month.

MR. A. PARSONS:

Okay, excellent.

Thank you.

Two

questions left on the hospital; one, from your understanding of the plan as it

stands, what can you tell us about obstetrics beds?

I understand there is going to be a reduction, but I am just wondering

about the number.

MR. KENT:

There is a reduction.

The number of beds overall in the new hospital is greater.

The number of services and programs being offered in the new hospital is

greater. In certain areas there may

be a reduction based on the historical realities of usage.

When it

comes to obstetrics my officials may be able to provide me with exact numbers,

I am just recalling from memory traditional usage was around 50 per cent.

So there were eleven beds, I think, in the current hospital.

Andrew, I am doing this from memory.

MR. A. PARSONS:

I understand.

MR. KENT:

My numbers might not be

precise, but they will be pretty close.

I believe there are six suites proposed in the new hospital.

There will be fewer maternity beds in the new facility, but that does not

equate in any way to a reduction in service.

Now the Member for Bay of Islands may have some other things to say about

that, but

MR. A. PARSONS:

Really?

MR. KENT:

the need for the six beds

is actually based on demographic and population projections for the region, and

it is based on the current utilization.

I have

found the numbers now, it is eleven to six.

The current utilization is about 40 per cent.

Why would we spend public funds to overbuild a facility in that

particular area if those beds can be better utilized in another area?

Overall, more beds, more services, and the facility will be modern.

There will be flexibility so that if needs change over time,

modifications can occur. Based on

current usage, we are only using the beds 40 per cent of the time.

It would not make sense to construct the exact same number of beds for

each area.

fact, that is what got us into trouble.

When this process started, we got to a final master plan and functional

program in 2009-2010 that was basically proposing to build a replica of the

current hospital. We want to build

a hospital that is going to meet the needs of the West Coast of the Province

well into the future. It did not

make sense to just simply replace exactly what is there, which is why the due

diligence review was done by Stantec which has led us to the new functional

program that is about to be released.

It is

unfortunate that it has taken that much time, but I think we have come up with

the right answer as a result of this extremely long process that we have been

through. We also did not

contemplate the PET scanner and radiation therapy services in the original plan.

That is included in the new functional program as well space for the

PET scanner.

MR. A. PARSONS:

I am just wondering now,

when it comes to the statistics again, I do not have this, but this is sort of

anecdotal.

MR. KENT:

Yes.

MR. A. PARSONS:

I have no doubt that the

number of births has likely gone down, but I get reports that there are times

when all eleven beds are in use. It

might not be frequently, but there are times when all eleven beds are in use.

I have my own experience there where my wife was brought in and there was

no bed available. That is my

concern; what happens in those situations.

MR. KENT:

All hospitals in our system

build in surge capacity to deal with that.

The design of the new hospital will certainly accommodate that.

There may be those rare occurrences, as you say.

That would be true not just in obstetrics, but in any area of the

hospital.

Any

young parent would expect that there would be a bed readily available to

accommodate them when the need arises and those patients will absolutely be

accommodated. It would be very,

very rare today for those eleven beds to be in use.

MR. A. PARSONS:

Okay.

MR. KENT:

I would suspect it is

extremely, extremely rare.

MR. A. PARSONS:

It is not fun when you

travel that 220 kilometres in the winter and you get in and there is no bed.

That is not a pleasant experience.

MR. KENT:

No, absolutely not.

MR. A. PARSONS:

Okay, last question, for the

hospital sorry to get your hopes up.

Is there any contemplation with this hospital of the P3 partnership being

used for the construction?

MR. KENT:

At this point in time, it is

all systems go for the current plan, traditional build, using the procurement

approach with the Corner Brook Care Team.

The funds that are in this budget for the West Coast hospital project

will allow the Corner Brook Care Team to continue its design and planning work

on the acute care facility. There

are also funds to do more site work and to construct the water treatment

facility.

Despite

our change of the procurement approach with long-term care, there is going to be

activity on that site this year. As

a result of the move we have made with long-term care, we will able to get the

long-term care facility open a year earlier than planned, despite the fact that

construction will be probably a few months late starting and we still plan to

get a contract awarded this fall for the long-term care facility.

I am

open to exploring other procurement approaches.

I want to be upfront about that.

If we can find a way to build the West Coast acute care facility faster,

cheaper without compromising quality or care in any way, shape or form, then I

am definitely open to that possibility; but, at this point, that is not the

direction we are taking and that is not the decision that Cabinet has made.

We are continuing with the current approach.

Could there be a better approach?

Well, I am open to exploring that, absolutely.

MR. A. PARSONS:

What is the construction

date anticipated now, start of construction of the hospital, the fall?

MR. KENT:

We would hope that

construction would begin for the acute care?

MR. A. PARSONS:

Yes.

MR. KENT:

Not this fiscal year, but

next fiscal year.

MR. A. PARSONS:

I am g