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October 1, 2020

SOCIAL SERVICES COMMITTEE

The Committee met at 6:19 p.m. in the Assembly Chamber.

Pursuant to Standing Order 68, Derek Bennett, MHA for Lewisporte - Twillingate,

substitutes for Carol Anne Haley, MHA for Burin - Grand Bank.

Pursuant to Standing Order 68, Gerry Byrne, MHA for Corner Brook, substitutes

for Christopher Mitchelmore, MHA for St. Barbe - L'Anse aux Meadows.

Pursuant to Standing Order 68, Elvis Loveless, MHA for Fortune Bay - Cape La

Hune, substitutes for Sherry Gambin-Walsh, MHA for Placentia - St. Mary's.

Pursuant to Standing Order 68, David Brazil, MHA for Conception Bay East - Bell

Island, substitutes for Helen Conway Ottenheimer, MHA for Harbour Main.

Pursuant to Standing Order 68, Alison Coffin, MHA for St. John's East - Quidi

Vidi, substitutes for Jim Dinn, MHA for St. John's Centre.

CHAIR (Trimper):

First of all, I'm Perry Trimper, the MHA for Lake Melville. I will be your Chair

this evening for the Estimates for the Department of Health and Community

Services.

Let's do some introductions first. I'll start with my left and I'll ask the

minister to introduce himself and his team.

MR. HAGGIE:

Thank you very much, Mr. Trimper.

John Haggie, MHA for Gander and Minister of Health and Community Services.

We'll probably start over there and just go back into …

MR. MCGRATH:

Sure.

John McGrath, Departmental Controller.

MS. STONE:

Karen Stone, Deputy Minister.

MS. HANRAHAN:

Heather Hanrahan, Assistant Deputy Minister.

MS. MCKENNA:

Andrea McKenna, Assistant Deputy Minister.

MS. STOCKLEY:

Colleen Stockley, Assistant Deputy Minister.

MR. SMITH:

Paul Smith, Assistant Deputy Minister.

MR. ANTLE:

Chad Antle, Audit Manager.

MS. ANDERSON:

Alicia Anderson, Executive Assistant to Minister Haggie.

MS. NEWHOOK:

Tina Newhook, Director of Communications.

CHAIR:

Okay, thank you.

Then over on the other side, to my right, I'll start with Mr. Byrne.

MR. BYRNE:

Hi, I'm Gerry Byrne and I'm the Member for the historic and beautiful District

of Corner Brook.

CHAIR:

Perfect.

Mr. Brazil.

MR. BRAZIL:

David Brazil, Opposition House Leader.

MR. LANE:

Paul Lane, MHA for the District of Mount Pearl - Southlands.

MS. COFFIN:

Alison Coffin, MHA for St. John's East - Quidi Vidi and Leader of the New

Democratic Party.

MR. LOVELESS:

Elvis Loveless, MHA for Fortune Bay - Cape La Hune.

MR. BENNETT:

Derek Bennett, MHA for Lewisporte - Twillingate District.

MS. P. PARSONS:

Pam Parsons, MHA for the District of Harbour Grace - Port de Grave.

MS. TUBRETT:

Denise Tubrett, Deputy Chief of Staff for the Official Opposition.

CHAIR:

Thank you all very much.

Just a couple of housekeeping items. First of all, we'll see how it goes. I was

here last night. We had a ruckus evening that went for over four hours, so we'll

see how the energy level is tonight.

I propose we'll stop around 90 minutes in and take a 15-minute break and then

come back. We'll target that and we'll see how we're making progress through. If

the questions and stories are interesting, we could take longer. But we'll try

to finish in about three hours from now.

There's a little issue with the broadcast and how we're working. What we'll do

is as you go to speak you'll say – and this gets very informal after a few

minutes. The minister, will say, John, and the broadcast will know to turn on

your mic and then you'll speak. So if you could just pause for a second to see

that light and that way we can capture everybody's comments.

With that, I will turn to the Clerk now and we will introduce the first

sections. We'll go through this in sort of a logical fashion. She'll propose the

first sections and we'll ask that the questions will come from the Opposition

Members relevant to those sections.

Before I go there, though, Madam Clerk, maybe we'll have the minister make some

opening remarks. Would you like to do that, Sir?

MR. HAGGIE:

Yes.

CHAIR:

Okay.

MR. HAGGIE:

Thank you very much, Mr. Chair.

I was looking back through Hansard to

last year's Estimates and on that occasion I'd actually mislaid my speaking

notes. This year, I had a beautiful set of speaking notes, but they're all

totally irrelevant now because they were for March of this year, and as

everybody knows, the world has kind of turned somewhat since then.

I would like to point out that the staff who are with me are the same staff who

have worked very hard on the budget and have continued to update it, whilst at

the same time being the very same people who, not just during the working day

but I would argue around the clock and through the weeks, have actually been

very operational in managing issues related to COVID in this province, a

pandemic. If there are some pieces of information that we have to go back and

get because we may have omitted to bring them, I would not like anybody here to

take that as a reflection of the diligence of the staff, it's simply we've kind

of had a lot on our plate.

This time last year, ironically or interestingly, one of the key pieces of my

introductory speech was around the groundbreaking new act about which I

enthused, which was the Public Health

Protection And Promotion Act . None of us – certainly not me in my wildest

dreams – would've imagined that rather than concentrating on, say, a five-year

plan for wellness from the chief medical officer, we would've found ourselves

exercising other sections of that act to protect Newfoundlanders and

Labradorians.

To speak specifically to financial issues around the Estimates, the bottom line

for our department is that whilst we are the biggest in terms of expenditure in

government, once again we have flattened another curve and that curve is the

curve of health care expenditure. We have done this for the fourth if not fifth

successive year keeping health care expenditures well below inflation and almost

zero-dollar change at all.

I think the Conference Board of Canada have referenced the hard work of the

department here as an exemplar for cost containment, cost avoidance and cost

control in health care. I would commend the work of the current staff here, as

well as their predecessors, in working hard to achieve what very few

jurisdictions in Canada – and I would argue in the world – have actually been

able to do.

We have done it, however, at the same time by actually enhancing services,

repurposing money, moving from reactive mode to a proactive mode and trying hard

now in the future to look towards the more social determinants of health. For

30-plus years everyone has realized that the true predictors of health don't

actually lie in the activities of the health care system, they lie in the way

that we can look after the other social determinants of health. That is going to

be thrust over the next little while in terms of our longer term and late

medium-term planning.

We have a very clear strategy for the immediate term and the short term. I would

argue that when you look at the fiscal numbers here – that we have rightsized

the budget; we have corrected structural deficits where possible – there are

still more to be done. In doing that, we have enhanced a whole suite of services

from virtual and e-health all the way through more traditional hands-on, drop-in

clinics. At the same time as demand for mental health services has increased, we

have kept waiting lists and waiting times on a downward trajectory, for example.

I think with those comments just to kind of preface things, I would wait and

look forward to the discussion to come.

Thank you.

CHAIR:

Thank you.

A couple of more housekeeping items. I think now is the time to introduce them.

First of all, Minister, as you know – this is your fifth budget – you can handle

every question you'd like or direct them to your team as you could. Again, for

the aid of broadcast, the Clerk has had a nice little guide chart so we'll be

able to find, if you identified somebody else to speak or they wanted to offer

some additional comment, but sometimes – what we were doing last night was just

waiting. They will see you and they will find you and activate the microphone.

You can say your name first, of course, always.

What we're going to do is start with 10 minutes with the Official Opposition,

then go to 10 minutes for the Third Party. Mr. Lane has joined us here and

knowing him well as I do, he, I'm sure, is interested in also being able to ask

questions. He's not a Member of the Committee but with leave of this Committee,

we would be able to grant him the ability to ask questions. Is that acceptable

to the Committee?

AN HON. MEMBER:

(Inaudible.)

CHAIR:

Okay, so be it.

We'll go two rounds and then over to Mr. Lane. So, 10, 10, 10, 10, 10 to Mr.

Lane and we'll keep going until you run out of energy or questions, one or the

other.

We have to introduce the sections.

CLERK (Barnes):

So we're doing the subhead Executive and Support Services.

It's 1.1.01 through 1.2.02 inclusive.

CHAIR:

Thank you.

Mr. Brazil.

MR. BRAZIL:

Thank you, Mr. Chair.

I only have a few quick questions in this particular heading. I thank the

minister for his opening comments and would just ask if it would be possible

that we'd be provided with a copy of his briefing notes after the discussion.

MR. HAGGIE:

Certainly, we will supply that in an environmentally friendly paper format as in

previous years.

MR. BRAZIL:

Perfect, I appreciate that.

Just so we clarify so there's no misconception on numbers, are there any errors

that we should be aware of in the book?

MR. HAGGIE:

Not that I'm aware of.

MR. BRAZIL:

Perfect.

A couple of quick questions here under Transportation and Communications, under

1.1.01. The $40,000 in '19-'20 was budgeted, $24,700 was used, but there's still

$40,000 there. Do you still expect to use that with the situation being minimal

travel or is there some particular use that you may have for that?

MR. HAGGIE:

I think that was a result of zero-based budgeting and rightsizing. Yes, you're

correct that we do have a minimal travel policy; however, we can't predict the

future and we felt it prudent to include it at that current rate.

I have been very careful about trying to work from home, for example, and

minimize the ministerial travel, but there are still occasions when, because of

the nature of the pandemic, my presence here is required. That can be somewhat

unpredictable; hence, we stuck with last year's number.

MR. BRAZIL:

Fair enough. I figured it would be around that just to be prepared.

I want to go to 1.2.01 under Salaries. Just to refresh me from last year – I

remember being here, I'm trying to get my head around it – the original budget

was $1.128 million. Then it went up to $1.336 and now we're looking at $1.347.

I'm assuming it was either payout or another salaried position. Can you just

reflect on what that would have been?

MR. HAGGIE:

The increases are related to overtime for our Communications Division, and that

probably works out to about $40,000. There was a 27th pay period included in

2021, and we have an extra assistant deputy minister for Population Health,

compared with last year's budget. So that would account for the variance under

Salaries.

MR. BRAZIL:

Okay, fair enough.

Same thing, I'm assuming, on Transportation and Communications, the same issue,

just to be prepared you'll have enough money budgeted, even though, in

comparison to what you spent in '19-'20, there's an extra $10,000 there as such.

MR. HAGGIE:

Yes, it's basically to try and predict the future, given the fact that we did

manage to reduce expenditures because of COVID in the latter part of March.

MR. BRAZIL:

1.2.02, are we on that same heading?

CHAIR:

Yeah.

MR. BRAZIL:

Under the Salaries base there, there's an over $2 million increase. Can you

outline exactly what that's for, what positions?

MR. HAGGIE:

Yes. The Auditor General did some work for us and advised us that the staffing

level for the Medical Transportation and Assistance Program was inadequate and

recommended 21 temporary positions. That accounts for $926,500 of that variance.

There is $660,000 in there for overtime related to COVID-19. There's the 27th

pay period again to be budgeted for.

On the other side, we have been able to take out the $38,700 planned for, for

attrition and the $135,500 for the creation of the assistant deputy minister in

Population Health came out of there and was moved to Executive Support.

MR. BRAZIL:

Okay. So these extra positions, have they all been filled, at this point?

MR. HAGGIE:

I would have to go back and check. Maybe the staff would be able to answer that.

MS. STONE:

Yes, they have.

CHAIR:

Just wait for your light to come on there. There you go, okay.

MS. STONE:

Yes, they have.

MR. BRAZIL:

Thank you, Karen.

Okay, under Professional Services there, it seems to be substantially up from

what was actually used last year to this year – half a million dollars. Can you

outline what extra professional services are going to be contracted under that?

MR. HAGGIE:

Yes. There are some – as one of my colleagues would say – puts and takes. We've

reduced it by $79,000 for zero-based budgeting. We have there a consultant for

the negotiations for the Newfoundland and Labrador Medical Association and

government. There's a $61,000 increase because of a new CIHI bilateral

agreement, and $73,000 for extra review board hearings for physician audits,

which we'd not been able to get off the ground in the previous year.

MR. BRAZIL:

So the consultant, has that been contracted to this point?

MR. HAGGIE:

Yes, it has been awarded and we're in discussions and kind of on-boarding with

Invictus.

MR. BRAZIL:

Okay, fair enough. Thank you.

Purchased Services, the extra $240,000, do you want to outline what you expect

will need to be purchased under that program?

MR. HAGGIE:

That's for advertising for the COVID response, $240,000 and there's also an

increase through zero-based budget to account for a more vigorous flu

vaccination, campaign, advertising. We've seen significant successes year over

year with that but this year, particularly, there is an emphasis on the flu

vaccine.

MR. BRAZIL:

Okay, fair enough.

The extra Property, Furnishings and Equipment, the extra $50,000 basically from

what was budgeted in '19-'20. Is there new furnishings or additional office

spaces? Is it for these additional people that you've hired?

MR. HAGGIE:

It was $50,000 worth of laptops to try and make sure we had adequate resources

for people working from home during COVID. There is a HRS policy about only

providing that material to people of a certain managerial status. We found that

we needed to operationalize getting the client support officers, for example, to

work from home during COVID. That was the laptops and then it was $2,300 for

phone purchases for the same reason. These are recycled so they go with the

role; they're not necessarily attached to individuals.

MR. BRAZIL:

Okay, I appreciate that.

We're sticking to headings, aren't we, straight through?

CHAIR:

Yes.

MR. BRAZIL:

Okay, so you'll call for that heading first?

CHAIR:

That's right, we'll vote on this first

section and then move on.

MR. BRAZIL:

Okay, can I just have one general question.

How many employees are in the department now?

MR. HAGGIE:

I thought you would ask that. You just give me a moment and I will find that

number for you.

MR. BRAZIL:

Perfect.

MR. HAGGIE:

It was on the tip of my tongue earlier on. I think it's 247. It is 247.

MR. BRAZIL:

Thank you.

I'm good on that section, Mr. Chair; I may come back to other questions.

CHAIR:

Ms. Coffin.

MS. COFFIN:

Thank you very much.

Welcome everyone. Thank you for all your hard work. I thanked the folks last

night because they were working extra to get ready for the budget and all of

that, but you folks, not only have you gotten ready for the budget but you've

been preparing for it during a pandemic so kudos to you all. Thank you very much

for your dedication and hard work, I do appreciate that.

Perhaps I need to apologize now because as our Chair has mentioned we'll keep

going until the questions run out or the energy runs out. I have an

unfortunately large amount of both so sorry ahead of time. Perhaps the questions

will run out before the energy, but let's start.

Under Departmental Operations, I'm not going to ask much about the numbers

because I think my colleague just talked a little about that, but I do have a

number of questions. Minister, you had said that health care expenditures have

remained relatively flat or decreased. The flip side of that is we have an aging

population; we have an awful lot of diseases and disorders.

In Newfoundland, I think, we win when it comes to obesity and diabetes, as well

as a number of other unfortunate conditions. With our aging population and an

increase in what I assume will be demand for medical care, how can we possibly

reconcile keeping costs even or decreasing them, as I notice in the mandate

letter you are working to find ways to reduce health system costs and eliminate

waste. Perhaps you can elaborate on that in the context of the health of our

population and the age of the population.

MR. HAGGIE:

Certainly. It's an extremely good question.

It really is answered in the change of policy emphasis in the department to move

from facility-based care and institutional-based care for seniors, to kind of

age at home, age in place. It is not going to be possible for all but,

certainly, we've seen a whole variety of initiatives around, such as the Home

First program. By investing in those, we can provide better care at less cost to

the system, but better value overall.

With regard to the chronic disease burden, one of our challenges up until very

recently is that wellness and health promotion prevention was somewhat

fragmented because of the way the departments had been organized after what was

jokingly referred to as the great divorce in 2014, when wellness went off to

what was then Seniors, Wellness and Social Development. The realignment of

portfolios in the recent Cabinet shuffle has now brought wellness back into the

Department of Health. That transition has not yet really materialized in any

great way and, certainly, there are lots of operational issues there.

What that will do, ultimately, will be then to align wellness and health

promotion initiatives with what we know from morbidity and outcomes later on,

and rationalize the process to some extent. It will also allow this kind of

dynamic management where cost avoidance or cost savings in one sector could then

be repurposed. We know that in terms of dollars spent in prevention and health

promotion, they are said to be worth $20 per dollar, but that is not seen for

maybe a generation. So our challenge is whilst it's Health and Community

Services, it's actually illness and community services and we're trying to move

back to that wellness and health approach.

There's lots of scope there, but one of the hopes I have of the task force is

that over the medium and long term we will identify ways of using some more of

our cost avoidance and savings to actually repurpose it maybe into the more

social-oriented determinants of health, which traditionally don't actually fall

inside the Department of Health in an illness, or a wellness even, kind of

system. They're the things like some of the green initiatives around waste water

management and these kind of things, things about poverty reduction strategies,

basic income, these kind of things.

I think that's a very woolly, non-financial description, but we can provide some

tangible examples should you want to go a little bit further into the weeds on

that. That's the high-level piece in terms of where I see the department going

and fitting into the problems you've described.

MS. COFFIN:

That's very reassuring. The first question I have as a follow-up for that would

be in helping seniors age at home. I think that's such an important piece. We

know with dementia when you move people from the home that they've lived in to

somewhere else they often deteriorate much more rapidly. So that's a wonderful

thing.

However, with our aging population it means we have less people left to take

care of the people who want to age in place. I see that as an impending problem

along the way, especially in rural areas. My father and I played the game of who

used to live in that house with the lights turned out on Fogo Island a while

ago. That family has moved away, that family has moved away and that family has

moved away. We are going to have communities of seniors with no one to care for

those seniors, so I think that might be an impending issue along the way.

One of the other things that I wanted to ask – that's probably not an ask, more

of a comment on a potential problem down the road – we have the Community

Accounts and we also have a series of indicators that can measure wellness and

well-being. Is your department using any of those indicators, in addition to the

financial indicators, of guides on how money ought to be spent? Identifying:

Have we improved our health outcomes? Are people living better lives as a result

of that?

Not how much money we're spending, but what does it result in. Are people safe

in their homes? Do they feel like they can have access to health care? Are they

eating well? Are their lifespans lasting longer? Things like that. Is that

something that's been actively incorporated into a lot of the policy

development?

MR. HAGGIE:

Yes, in actual fact, those indicators are examined and there's a whole raft of

them. I remember you referencing Community Accounts in this process last year.

We have a variety of mechanisms and now we have a formal section, a department

for want of a better word, based around population health. That's kind of where

the home for that will be in terms of using that kind of data, that kind of

information to highlight areas of need or highlight areas of success, and to

compare various techniques in one area of success and see if we can move them

over and this kind of thing.

Again, a kind of nebulous answer but the short answer is, yes, those indicators

are there. Some of them we supply to CIHI, some of them other departments

supply. We've tried to find a way and we are still working on a way of kind of

amalgamating those into a dashboard or a scorecard, or something like that, for

our

section of Population Health to be able to help advise policy development.

MS. COFFIN:

That's rather exciting. I look forward to that.

You've also referenced the issue of time as one of the other variables that we

measure. We plan our budget on an annual basis, but our health is a continuum

and, like you say, it's half a generation or a full generation before some

initiatives, like eating well at home and eating more raw foods or foods that

have less processing associated with it, before that actually filters through

the health system. That's kind of reasonable.

Let's see. These are just the scribbled questions; let's go over to the ones

that are actually written out here now. Can we have an update on The Mental

Health and Addictions Action Plan? Certainly, I know we've had an ongoing

conversation about the use of a lot of mental health supports that have happened

during COVID. I know we had a huge spike. I'm not sure if that's gone down again

because I don't think I've asked for that recently, but that certainly would be

an interesting segue into how that action plan is coming along.

MR. HAGGIE:

Yes, Towards Recovery was a

54-point-beast, the recommendations from that. I can provide a little bit of an

update there.

In terms of the recommendations, there's progress on all of them. The short- and

medium-term ones – I think there were 26 of those – those are all done. We've

laid out the groundwork, almost literally as well as figuratively, for the new

adult mental health and addictions facility. We have a financial target in terms

of trying to increase the percentage of health expenditure that goes to mental

health and addictions. We are on time or slightly ahead with pretty well all of

our indicators. I had thought I had a little list of them here in terms of that

but certainly we can get you that.

We used to produce the score card, if you remember; we committed as part of the

process. Again, that's one of the boxes that were ticked; we'd give an update at

six months and then 18 months. In actual fact, I think we gave one at two years

as well.

The success in mental health through COVID –

MS. COFFIN:

There's a note being handed to you.

CHAIR:

There's a little birdie trying to reach you.

MR. HAGGIE:

Now, in the good old days it wouldn't be a problem.

MS. COFFIN:

Old school.

MR. HAGGIE:

Twenty-one is the answer to your question, not 26.

The facts of the case are, we are not complacent but we're comfortable with

where we are there. There is still work to be done. We've done very well with

our e-health suite. We've been recognized internationally for that work. New

Zealand, where we originally went to look to see how it was done, have now come

back and said how did you actually get it done, which was quite an interesting

conversation. We're part of the e-mental health collaborative internationally

and that gives us access, for example, to app developers who will rank the

utility and appropriateness of apps for us so we don't have to do that work and

that's all part and parcel of that.

In the e-mental health we are actually leaders. We have BC, we have Ontario,

looking to borrow, clone or get a lot of the stuff we use on Bridge the gApp.

Doorways has been a smash hit really and wait times for mental health, formal

mental health services, the number of people waiting is now done at 51 per cent

compared with 2017 numbers.

There has been an increase in demand for services such as Channal and the Warm

Line and we've put extra money into that. We have funded HealthLine for the

mental health crisis line to try and get that on to a more formal call-centre

basis. It had been run basically off a cordless phone tucked in the back pocket

of the RN on for the PAU. The community work in terms of the mental health

crisis beds, the hub-and-spoke for opioid dependants' treatment, as they

develop, then those will lay a different kind of foundation on which the new

adult mental health facility will be able to practice so that, again, we're

moving away to community-based treatment.

We have FACT teams out in areas that never had them before; we're increasing the

number of FACT teams in St. John's. We have signed and operationalized an

arrangement with the RCMP for their jurisdiction to do the mobile crisis

response teams in the way that the RNC already had rolled out.

Again, those were all things from the All-Party Committee. Any one of those, if

you have a specific question about timelines or a location, I'm conscious of the

time, but rather than read through a long list I can supply that. It's no

problem.

MS. COFFIN:

That would be lovely. Thank you.

CHAIR:

Okay. Thank you.

Mr. Brazil, any further questions? You had indicated – or did something come up?

MR. BRAZIL:

Yes, appreciate it, Mr. Chair.

When we talked about the staffing, has there been turnover, any retirements

within the department last year?

MR. HAGGIE:

I would have to check.

MR. BRAZIL:

Any substantial notice? If there are 10 or 15 people out, it's a different – if

there are one or two gone, it's very minimal. Fair enough.

Are there any existing vacancies there at this point?

MR. HAGGIE:

There's only one retirement I would like to read into the record, and that is

Ms. Simms, the architect in many ways of the new adult mental health and

addictions facility. I don't think that's hyperbole or exaggeration to say that.

That was her dissertation as a bachelor of nurse candidate. At the end of her

career, she retired happy on that score. We certainly miss her. We have

excellent staff coming behind, but I think it was worth acknowledging Ms. Simms.

MR. BRAZIL:

No, and I agree, very diligent, committed civil servant who did great work.

The numbers of vacancies that we have in the department now, are they

substantial?

MR. HAGGIE:

I'm not aware of a substantial vacancy factor. I will refer to my page here and

see what I can find for you.

No, we don't have any substantive vacancies in the department according to the

figures I have. I'm pleased to be able to say that.

MR. BRAZIL:

That's good.

One more on that: Were there any positions eliminated during the last year?

MR. HAGGIE:

Karen, would you be able to answer that.

MS. STONE:

There were no positions eliminated.

MR. BRAZIL:

Okay. I'm good on that heading.

CHAIR:

Okay.

Ms. Coffin?

MS. COFFIN:

I warned you about this. It's not that bad.

Since we were talking a little bit about the mental health and addictions, do

you have any idea of the number of suicides that we have seen this year and are

you able to say whether that's more or less than we've seen in the past?

MR. HAGGIE:

Those statistics are collected by another department. We're in the process of

trying to work with Justice and Public Safety through the chief medical

examiner. The new chief medical examiner is very open to data sharing.

We have not been made aware of any excess in the first quarter of this year. The

second quarter data has not passed our ken yet, but certainly we can get those

statistics for you. In general, we have not been made aware of any particular

hot spots in the way we were, say, with Marystown or Lab West where we actually

felt we had to put additional resources on the ground.

MS. COFFIN:

Fair enough. I imagine we're probably not going to see a spike until we see CERB

run out and people's mortgages will come due. I have some concern about what

kind of situation that's going to create.

I guess the next one would be overdoses. Do we have any sense of the number of

overdoses that we are seeing, certainly the types of drugs and the volume of

drugs that have been coming into the province? I think because of the lockdown,

people creatively mixed drugs is what I am hearing. I think that may have meant

that we saw – only anecdotally do I hear this, there may be more overdoses.

Are you seeing anything like that, prevalence of other drugs, drugs that are

mixed and the likelihood of overdoses?

MR. HAGGIE:

It's interesting – and just as an aside, I'm always a bit ambivalent about using

the term “overdose” because I think in actual fact a lot of these overdoses are

really poisonings. There is an adulterated drug supply out there and some people

are really not aware of what it is they're taking or how much.

MS. COFFIN:

Fair.

MR. HAGGIE:

I think there are some inadvertent opioid poisonings, for want of a better word,

because doses are hard to determine.

In terms of the number of fatalities as a result of that, again, that

information comes through OCME, the Office of the Chief Medical Examiner.

We did actually look, because of questions I think you'd raised in the joint

All-Party Committee, at that data. There was toxicology pending. My

understanding, as a result of that, is there is still some toxicology pending,

but there is, at the moment on the face of it, no significant difference between

this year and the previous three or four years. It goes up and down for reasons

that we haven't been able to identify, but taken over that period, so far, the

information I had wouldn't show any significant difference this year.

MS. COFFIN:

That's overdose resulting in death.

MR. HAGGIE:

Yes.

MS. COFFIN:

Right. Do we capture overdoses? Some overdoses can't – poisonings, I like that

term a little better, as much as one can like a term like that. Do you have any

sense of the number of people who are getting, not an EpiPen, the other one?

MR. HAGGIE:

Naloxone.

MS. COFFIN:

Thank you, yes.

Any sense of the use of that? Are you seeing admissions as a result of

poisonings?

MR. HAGGIE:

There is data available through the hospital reporting system on overdoses that

were – they're classified as either intentional or accidental, usually. There is

some national data to show an increase in accidental opioid overdoses with

therapeutic drugs rather than recreational drugs in the elderly. We have not

analyzed our data with that in mind.

Certainly, I'm not aware of any increase in the numbers of either category being

admitted, but that data is something we could certainly go back and see if we

could find for you. It comes on what's called a data dump from the regional

health authorities and that's either monthly or quarterly.

MS. COFFIN:

That would be very interesting to see. Thank you.

I think that might show some unfortunate trends. Hopefully not. Maybe we can get

you a little string to pass.

Let's turn to something somewhat related. Sexually transmitted infections and

rates of things like HIV, I've certainly heard that there has been prevalence

from time to time. I see a news release go out saying be aware, there is an

increase in hep C or there's an increase in whatever. Do we have any data on

that that can give us some sense of what's happening in our communities?

MR. HAGGIE:

Public Health does provide that data on a periodic basis. Quite frankly, the

last data I've seen in that area has been towards the end of the last calendar

year. My recollection at that stage was there was a significant rise in the

number of cases of syphilis in the Eastern region and that there was a problem

with an increasing number of chlamydia cases, particularly in Western.

In terms of other truly sexually transmitted diseases, hepatitis C kind of

confuses the issue a little bit. There are certainly increasing numbers of those

on the West Coast as of last year but, again, I don't have the exact numbers at

hand.

The notes from my partner in crime to the left, there is – in actual fact, in

reference to Mr. Brazil's question, there was a front desk position in the

Department of Health that was not replaced when the incumbent retired. That's

the only job loss as it were, position loss, and that was accounted for as part

of our attrition targets.

MS. COFFIN:

Can I do a follow-up question on sexual health?

MR. HAGGIE:

By all means.

MS. COFFIN:

No, I totally understand.

MR. HAGGIE:

I was just trying to get it out before I got buried in paper and forgot about

it.

MS. COFFIN:

Totally understand.

One of the things that I have heard pretty loud and clear is a need for sexual

health clinics and that's not just you can get a Pap smear or you can get some

condoms and you can just learn about sex. It needs to be a little bit more

comprehensive. It needs to address a lot of the issues head-on.

That demand is there and I think there is a real need for that. Certainly, life

is very different for 20-year-olds than when I was 20, for sure, so I can well

imagine the sexual health clinics need to be dramatically modified. Are there

any plans to have some comprehensive sexual health clinics beyond St. John's?

MR. HAGGIE:

Well, we have supported Planned Parenthood and found them a new accommodation

and helped them set up there because it is a very valuable service. We certainly

appreciate the work they've done.

In terms of across the province, we have really an opportunity now, with

wellness coming in and some of our links with more Public Health nurses being

supplied through the education system, that we can actually start to look at

sexual health in a more coordinated way through a variety of prongs now through

the formal education system, as well as from a wellness perspective. I have not

had any direct discussions with the RHAs about whether or not a specific Planned

Parenthoodish kind of clinic would be suitable, but these are discussions that

we have with the primary care teams and the communities about what they feel

they would like in their area.

Our approach with the primary care teams – which is going to be our

comprehensive hub, really, for primary care for a region or a community – very

much requires community involvement. We like to hear what they think they need

and then that's a discussion to be had with the practitioners to see if that

demand exists there. That's a work-in-progress.

MS. COFFIN:

Okay, let's open up that box just a little bit more. I can't speak to

prevalence, but I do know that it has become more prominent. There are men,

women and transgendered individuals working in the sex trade all throughout

Newfoundland and Labrador. Has this department addressed that in any specific

way?

This is something that used to be very well hidden, very hard to find and now

you open up the right website or you walk down the right street and it is right

there. I think that's a very, very important thing given the higher prevalence

of STI, higher prevalence of drug addiction and the fact that we're in the

middle of a pandemic now. Are there any specific initiatives targeting the sex

trade industry in helping those individuals either make a living or be safer in

that industry?

MR. HAGGIE:

We haven't really taken the lead on the sex trade. That would, I think, have

fallen to then Women's Policy – well, now Women's Policy Office. I think that

question might be better addressed to them. I do know in metro there are clinics

that are more attuned to that.

We have street nurses, for example, whose primary role was probably, in the

first instance, addictions and street drugs, but I think they are also flexible

and will deal with those kinds of things on a case-by-case basis. I think in

terms of a strategic approach to the sex trade, we're followers from the lead of

Women's Policy.

MS. COFFIN:

Okay (inaudible) those questions there.

CHAIR:

Thank you, Ms. Coffin.

Mr. Lane.

MR. LANE:

Thank you, Mr. Chair.

Thank you, everyone, for coming this evening. I echo my colleague's remarks that

I certainly appreciate all the hard work that you guys have done through the

pandemic and in preparing the budget.

Minister, I do just want to say, for the record – and I don't want to swell your

head too much here but as it relates to COVID-19, yourself and Dr. Fitzgerald in

particular, I think you've done a great job in communicating with the public on

this pandemic. I hear an awful lot of positive remarks from people in my

district over that. They may not necessarily agree with every decision, nor do I

necessarily, but I'm not the expert, you guys are. I think you've done a great

job so I did want to say that for the record.

Minister, I'm going to ask you the same question now that I asked last night;

I'm going to ask every one of these to each minister. If there was sort of a

bright spot – and it's hard to find a lot of bright spots through this whole

pandemic – in terms of the operation of government at least that I think has

been presented as perhaps an opportunity is that we've seen that government can

operate differently in the delivery of services, and perhaps more

cost-effectively and efficiently.

I think of things like the use of technology, people accessing government

services online. I think of the use of Zoom, for example, for meetings so that

we're not having to incur travel costs, things of that matter. I think of people

working from home and perhaps the opportunity to be able to consolidate office

space and get rid of more leased office space, again, to save money.

I'm just wondering from the perspective of the Department of Health, the RHAs

and so on, is there any thought in making this sort of a permanent thing? I

understand there are certain services that have to go back to the way they used

to be for good reasons, but if we have people that are working from home now and

doing everything they always needed to do, the job is getting done, and we can

shut down some office space or we can avoid some costly travel and everything

else, is there a plan or a thought about let's start doing this even when COVID

is over to save the taxpayers some money?

MR. HAGGIE:

Thank you for your comments at the beginning. I do appreciate that. I think it's

easy to look good when you have a good team behind you.

MR. LANE:

Very true.

MR. HAGGIE:

I'm just a figurehead in many respects.

The short answer to your question about efficiencies or bright spots in COVID is

yes. From our department's point of view, we've seen, I think the most glaringly

obvious one is the acceleration of virtual care. We had spoken about virtual

care for some considerable time and there had been great debates about how to do

this, what we should use and what technology was right and this kind of stuff.

Basically, the needs of the people of the province to access primary care

particularly, or indeed any kind of care during COVID, really kind of threw all

that planning back into the melting pot. Virtual care has accelerated at a speed

that we would never have achieved without COVID, quite frankly. It's been done

in a way that really seems to suit people.

We've had some very positive feedback around even simple telephone consults

between primary care provider, nurse practitioner or family doc and a patient,

and even specialists because I know specialists are using it as well. I think

the phone has been the quick and easy. It suited particularly the demographic

who are a little bit older and maybe less technologically savvy or familiar. I

would see that being built on.

We're agnostic about the platform. We do have ones for new entrants if they want

to start. NLCHI, who's been tasked with IT across Health, will support a couple

of particular applications. Other than that, however, we've not stipulated you

have to use this to get the fee code.

We introduced an access system for patients who don't have a regular family

doctor and need episodic – low-level as it were – low-intensity care, not

emergency room kind of care, through the nurse practitioner or 811 program.

That's been very well received indeed. It's integrated with the electronic

health record so it's accessible by anybody else in the health care world who

has the appropriate access through eDOCSNL and HEALTHe NL.

That has been a great success. We have virtual fee codes for family doctors as

well as specialists. I know from my own background that there are certain

clinics where the addition of video and the ability to have a camera that you

can move around, even on a phone it would work with the technology that's

available there, without any fancy apps or add-ons. I think I would see that as

the next logical progression.

Some of my colleagues, who I used to work with who are family physicians, have

found integrating virtual phone or whatever into their workflow very

straightforward. They can use it to triage those people who can be managed over

the phone and then also say, well, you need to come and see me. There is a

mechanism there whereby there isn't kind of double-dipping; you don't dip for a

real live consult and a virtual one. We're looking at that from an audit point

of view but we haven't really found anybody misusing it, as far as we can tell

as well.

We have MyGovNL up; it had massive increase in uptake. We started online

renewals of MCP cards and, again, 95 per cent, 90 per cent satisfaction with

that instead of going to a desk service somewhere.

Working from home is, from our point of view, working very well. I know that

across government you'd be better having that conversation with Human Resource

Secretariat. They are the ones who would devise such policies. Certainly from

our point of view, we found some technological challenges with reliability in

the first instance of VPN and access remotely. I burnt out one of those surface

tablets because they're not very good for prolonged video. It heats up and

things inside break, so that was part of the expenditure on laptops that we had

to go find.

Skype, WebEx and Zoom are now part of our routine. We'll even be in our offices

and we think nothing now, instead of walking down the corridor and hanging out

in someone's doorway, to just do a Skype call. That's become routine. Every

morning I have a Skype call, particularly when I've been working from the office

in Gander, and kept up to date very easily with things that are going on. My

executive is really very happy with it. We've saved on consumables; we've saved

on some temporary things.

One of the other spinoffs, as well, has been the ease comparatively with which

we can call up folk in other jurisdictions. It's not the big enterprise it used

to be of trying to organize a face to face or some big affair. There was a

period where we were having two Health ministers' FPTs a week. I believe the

deputies were almost saturated with them daily at one stage, which probably was

not as productive as it sounds.

That has forged links with other jurisdictions and it's told us one thing, we're

all in a very similar boat and we've learnt from them. Funnily enough, we have

skills that they don't and they work for us. That's a précis of where we are

with the department and virtual.

MR. LANE:

Thank you, Minister. I appreciate that.

That was a pretty detailed answer and that was a good answer. I'm glad to see it

and, like I say, I hope that's a road we continue to go down.

I'm just looking at my time here. It's hard to know where to categorize some of

these questions because they're more general questions, but I'm going to ask

this one anyway. I want to ask a question about the international rotational

workers. I understand that they fall under a federal piece of legislation.

I've been contacted, for example, by a person in my district. He's in the oil

industry. He's working over in some part of Africa. I can't tell you where but

somewhere in Africa. He said the camp that he has been in, ever since COVID-19

started, there have been zero cases of COVID-19, ever. Yet, he can't get the

same consideration as someone coming from Alberta where they do have cases of

COVID-19.

I understand that it's federal legislation but I'm asking on his behalf, I

guess, and other people in my district and throughout the province who are in a

similar boat. Is there any opportunity – when you're meeting with the federal

minister perhaps or the other provincial ministers or something, is that

something you brought up or is being discussed to look at people in that

situation so that they can have some time with their families just like

everybody else? Understanding the overall health issue, I totally get that.

MR. HAGGIE:

From my point of view, I certainly have sympathy with these individuals. It is,

from a provincial perspective, possible to add on to federal requirements, but

it's not possible to subtract from federal requirements. That's our challenge.

Certainly, I think, through the public health mechanisms, this group have been

discussed. It hasn't been a prominent feature of discussions at the Health

ministers' FPT, but certainly that's something I could raise. We would certainly

look to see what kinds of numbers were involved, but it's a topic I can bring

up. How much traction it will get, obviously, is not up to me; it is a federal

issue.

MR. LANE:

Thank you.

I can only ask that you ask, as I asked on his behalf.

Thank you.

CHAIR:

Mr. Brazil, any questions?

MR. BRAZIL:

Yes, I just have a quick question there on the salary, the contractual work. Can

you outline how many positions that is and the necessity for those, please?

MR. HAGGIE:

Yes, thank you.

Contractual workers – I have so many pieces of paper here with little jottings

on – we have 10 contractual positions outside of the salaried plan, which are

funded through vacancies, and these are work-specific, task-specific jobs.

That's 10 out of a total of 247.

MR. BRAZIL:

Thank you on that.

Quick question around the COVID funding. How much did the department receive

under the COVID funding?

MR. HAGGIE:

Well, the COVID funding, in actual fact, if you're talking about the Safe

Restart money, that is actually held in a block in Finance and, because of the

Financial Administration Act , can't

be released until the budget is passed because these all came in as part of this

fiscal year; can't be done under Interim Supply. I think there is a pot of money

and I will find out the exact value of that held in Finance. Again, just give me

a moment.

OFFICIAL:

(Inaudible.)

MR. HAGGIE:

85?

OFFICIAL:

MR. HAGGIE:

$35 million.

OFFICIAL:

No, page 35.

MR. HAGGIE:

Page 35. We have to get the code words worked out here guys.

We've got testing and contact tracing and data management, which is done on a

per capita basis and would roll out, I was going to say, $41.118 million. We

have another pot of exactly the same size, because it's done on per capita

basis, for securing PPE. We have health care capacity money, which is targeted;

the feds put the restrictions around these, not us, around mental health and

substance use, which totals $16.447 million. The vulnerable population piece,

which we would share with CSSD and Housing, caps out at $10.143 million. The

total adds up to $108.826 million. That's held in block in Finance.

MR. BRAZIL:

Okay, thank you for that.

Did you receive any funds from the contingency fund, and if so, what did you put

that towards?

MR. HAGGIE:

That's a good question. Maybe, John …

MR. MCGRATH:

No, we never.

MR. BRAZIL:

Okay, fair enough.

I'm good on that section, Mr. Minister.

CHAIR:

Okay, thank you.

Ms. Coffin.

MS. COFFIN:

It's a smaller list now, but let's keep talking about sex, since we were talking

about that a lot lately.

I have spoken to a remarkable number of individuals who really, really, really

want to have babies, but they haven't got access to fertility doctors or clinics

or they have to spend enormous amounts of money to travel and quite often the

treatment doesn't work.

Are there any plans to improve access to fertility clinics and support for

individuals who are having difficulty conceiving?

MR. HAGGIE:

Well, several things in no particular order, just to provide a little bit of

context. There is no jurisdiction regarding fertility treatment as an insured

service, and we are consistent in that approach. However, having said that, we

provide monies to the fertility clinic run through Eastern Health to support

that. That clinic is now in a position to do significant diagnostic workup. The

problem with travel there falls into the fact that IVF techniques are very much

volume dependent.

We do not have, in this province, sufficient volume to acquire and then maintain

those competencies in a way that would make the results acceptable in the eyes

of the experts. Indeed, one would argue that even going to a clinic in Halifax

you would not get the volume necessary to get good – you would maintain your

skills, but, again, to polish them you need that extra increment. Paradoxically,

the best results in the country are actually obtained in Alberta, rather than

Toronto. When you think it was purely population issue, then the bigger populace

centre would do it.

So we do provide support in the province, which is monetary and through Eastern

Health, but we go, I think, further than a lot of jurisdictions in doing that.

It's certainly a problem for the individuals concerned, but, again, given the

fact it is an uninsured service and given the fact we have already made some

contributions towards that, it's very difficult in times of fiscal constraint to

put in new measures. Particularly, as I say, when the procedures that people

have to travel for – quite frankly, if you want a good result, you're going to

have to travel for anyway.

MS. COFFIN:

That's really unfortunate for those people. I heard a lady say I've been waiting

for a year. I would love to have a dozen children but I'm waiting a year to get

an appointment to get in to see a fertility doctor. Do you have any sense of the

wait-list, number of people and time for a wait-list, just to see the local

clinics?

MR. HAGGIE:

No, my last figure that I was given was somewhere in the 120ish clients for the

clinic in total. That may be me misremembering. I have done that on occasions.

Certainly we can find that out for you.

The wait times, certainly – the fertility clinic did continue to operate during

some of the alert levels for COVID. I'm not so sure that it operated during

Alert Level 5 but, certainly, I think by Alert Level 3 it had started. There

were time-critical treatments that, I think, were at the discretion of the

physician at any stage in COVID, because we left the discretion with physicians

in this province. We were fortunate that we were able to.

Some jurisdictions, such as Ontario, just simply shut down anything that wasn't

related to a burst appendix or COVID. We did allow clinical discretion to decide

whether or not a consult, a meeting, a treatment needed to go ahead based on

time and urgency.

MS. COFFIN:

If there's anything that I would suggest, I would recommend doing everything we

can to help boost our population.

Let's move over to talk about some other things. Can we have an update on the

various staffing reviews being conducted with the Registered Nurses' Union, NAPE

and CUPE, please?

MR. HAGGIE:

I'm sorry …?

MS. COFFIN:

The staffing reviews being conducted with the RNLU – no?

MR. HAGGIE:

RNU –

MS. COFFIN:

Thank you.

MR. HAGGIE:

– NL.

MS. COFFIN:

And CUPE and NAPE, please.

MR. HAGGIE:

Yes, there is a process that was a side letter around the RNU collective

agreement that was negotiated with Finance. That undertook a core staffing

review. This was to address the RNU's concerns, particularly, at that point,

around the number of staff, the acuity of patients and these kinds of things.

That was determined to – originally was going to do, I think, four facilities.

After further discussion, we increased it to five with the agreement of the RNU.

Essentially, this is a snapshot. There has been a steering committee; it

contains us, the RNU and RHA representatives.

The actual going out to get the consultant was kind of stalled a little bit. The

RFP was not completed at the time COVID started, so it looks like the core

staffing review will get pushed out into next year, possibly even into next

fiscal year, say, into April. The cost to complete it is unknown. We are kind of

working on the half-a-million-dollar mark.

Separate from that were discussions with NAPE around long-term care staffing.

There are two mechanisms there that were put in place; one is a provincial

working group to look at the issue from a provincial perspective. There were

also concerns that were brought forth, particularly about Eastern Health, so

there is also a second group focused more particularly on the issues that might

be particular to Eastern Health.

We met with NAPE and their senior representatives virtually, of course, and had

a very good meeting about moving ahead with this. Both parties accepted that it

had kind of gotten, not mislaid or sidelined but everyone else's – the focus of

all parties had really been COVID, worker protection and dealing with the kind

of hot-button issues there. That's been rebooted and certainly the provincial

committee has met. If I'm not much mistaken, the Eastern Health committee has

met. Everybody there now is conscious that we need to do something with this.

Mr. Earle acknowledged that we had made significant inroads in terms of

allocating extra places. I think there are 96 new PCA seats with CNA and I think

there are 168 new LPN seats across various places. Some of them are completely

enrolled. I know the course in Gander is full; they have 24 out of 24. I think

Grand Falls still has some vacancies.

We also acknowledge that it's 26 weeks for a PCA to graduate. There are some

mechanisms that we can use to address in the medium, in the shorter term, but we

have acknowledged that we need to seek their views on what solutions they think

might help because we need to do something sooner than later.

The other interesting discussion was around what we could look at and monitor

that would be like the canary in the coal mine, to keep an eye on whether the

situation in any facility was getting better or worse. NAPE said they would come

back with some suggestions for that and we'll be happy to implement that.

That's kind of a snapshot of where we are with those processes. We don't have

all the answers immediately, but I think there's a real desire on all parts to

get it fixed.

MS. COFFIN:

I concur; I've heard it from all parties. It's very good to hear that we're

making a little bit of progress on that, so that's excellent.

Oh dear, my computer just shut off. Darn.

MR. HAGGIE:

It's nice to know it does it to you as well.

MS. COFFIN:

Oh totally. It hates me, but that's choice words flung at it.

Can I ask how many people have accessed services under the Home First philosophy

and avoided hospital admission?

MR. HAGGIE:

You can indeed. I just need to find the right page and I'll let you know.

CHAIR:

Ms. Coffin, I'm going to perhaps rule that might be a little bit outside of the

sections that we're dealing with.

MS. COFFIN:

Okay.

CHAIR:

I think you're kind of in the Community Services. Maybe it's just the Chair

being bored but I am trying to keep us focused on the sections.

MS. COFFIN:

Sure and I wasn't quite sure. I have it grouped under the first section, but I

wasn't quite sure. There are a lot of large aggregations of numbers.

Personal home care standards, in this section?

MR. HAGGIE:

I'm sorry, I –

MS. COFFIN:

Would personal home care standards fit in under this section?

MR. HAGGIE:

I'll leave that to the Chair. I mean personal home care standards would probably

fall under long-term care, Community Services.

CHAIR:

Community Agencies. Yeah, same.

MS. COFFIN:

Okay, I'll move that. That's no problem. Enhanced care as well.

Autism strategy?

MR. HAGGIE:

That would probably be Community Care too.

MS. COFFIN:

Okay, no problem.

MTAP, she says hopefully?

MR. HAGGIE:

Yeah, that's a departmental program.

MS. COFFIN:

Excellent. Okay, let's go with that one.

MR. HAGGIE:

Departmental Operations, yes, for sure.

MS. COFFIN:

Have you completed the revised policy for the MTAP for income support clients?

MR. HAGGIE:

No.

CHAIR:

Your time is up, Ms. Coffin.

Mr. Brazil, any further questions on these first sections?

MR. BRAZIL:

No, just waiting to move on to

section two.

CHAIR:

Mr. Lane?

MR. LANE:

I had one question, I suppose. It's a COVID-related question so I'm not sure

where that falls. There's no

section here called COVID-19, so I guess it covers

everything.

I just have a question, Minister, about essential workers and COVID. The

question is kind of spurred by what happened in Labrador. I understand it's

under investigation. I'm not asking for any specifics about the investigation

but in a general sense, because a number of people have asked me and I'm trying

to get my head around it, I understand that if you are deemed an essential

worker, say, on a construction site – we've seen it in the past at the Core

Science. A person can come in, they don't need to self – well, they can come in,

they can get off the plane, they can go to work. After they're finished their

shift, they go and they self-isolate and they go back to work. But the bottom

line is they get off the plane and they go to work.

I understand that to be, generally, the policy and has been, certainly, with

construction, but in the case of health care it seems to be like now we're into

a totally different realm altogether. Now you're taking someone off an airplane

from somewhere that has COVID-19 – a province that has COVID-19 – outside the

Atlantic bubble and placing them right in a health care facility.

So I'm wondering is that possible? Again, I'm not asking about this situation,

the investigation, but, under the current rules, could an essential worker get

off a plane, outside the Atlantic bubble, and go right into a health care

facility and go to work, without having to be tested, without having to

self-isolate for a week or two weeks before they go into that health care

facility?

MR. HAGGIE:

The issue around essential workers in health care has been a balance about

maintaining services and having some services and the issues that we're dealing

with. So around essential workers in health care, if they are from a discipline

that will allow you to come and work from home and isolate – and there are some,

I'm thinking of radiology, non-interventional radiology – that is the preferred

approach.

The designation of whether or not they're essential is made by the RHA, the

regional health authority. The exemption is you are exempt from the requirement

to self-isolate whilst travelling to and from work and at work. Having said

that, there are COVID-specific precautions that are expected to be taken by the

worker while at work. Those vary, but, in general, they would be things like

masks.

Now, on top of that, the regional health authority may well have additional

requirements in terms of PPE usage by the worker who's come in, but that is the

current situation.

Obviously, given the issues that we're discussing now, part of the inquiry will

be whether or not Public Health feels that should change. Certainly, there is

unanimity of viewpoint that the tests that are currently available do not answer

the question: Does an asymptomatic person reliably not have COVID? That has been

the challenge for Public Health across the country. You can mitigate against

that by various strategies. Whether ours is enough will become apparent as a

result of the inquiry and discussions with Public Health across the country.

MR. LANE:

Okay, I appreciate the answer.

I'm sure a lot of people would – I do have a concern about someone getting off a

plane and going right to a health care facility.

If somebody, for example, again is going – even if they're not going to a health

care facility, even if they're going to a construction site, for that matter, is

there a plan, for example, somebody is hired by the government to go into a

health care facility, they can get off the plane, they can go to work. There are

PPE and all that good stuff, I understand.

Now, this person is supposed to go home, is there like – are they met by

someone? Would there be a contact person in place for them to say, listen,

you've got to go home, but if you had some sort of emergency that you required

something at the store, besides a bag of potato chips, I'm just going to say

something that would be an essential item or something, that there's a plan to

get that to you so that you're not feeling that you have to break the rule and

go out to the store and get it yourself?

MR. HAGGIE:

There is an expectation that for an essential worker who is self-isolating, as a

requirement, the employer would make sure that their ability to self-isolate is

safeguarded. So, for example, they would arrive, a car would be there for them

at the airport or transportation arranged in a COVID-friendly fashion. They

would have a fridge stocked with goodies and arrangements would be made to

replenish that over the course of the two weeks that they would have to follow

that modified isolation. So, that is there.

What an individual RHA might do, I would have to point you to the regional

health authority in terms of how that was actually operationalized. Whether it

was the manager or the director or someone from HR, it would probably vary, but

that's the expectation.

There is also an on-boarding process, anyway, for people who come in from

outside to this kind of work; there always has been. Labrador-Grenfell has used

these kind of workers for decades in one way or another and each of the RHAs has

a need for some from sometime or another.

In terms of that, that's modified for COVID so that there is an understanding of

is, in actual fact, that's even signed by the employee.

Those are the kind of broad-brush outlines of what would happen in the

circumstances you described.

MR. LANE:

Okay, and I appreciate that.

Just to be clear, I'm not talking about – I'm glad that they're going to stock

up the fridge, that's all great. But it was suggested: Well, what about if that

person had a bad headache and they needed some Tylenol, or whatever, or they

needed maybe a feminine hygiene product, or something, that unexpectedly you

needed it, how do you get it? Would there have been some process that I can call

someone who's going to get it for me? Given the fact that I'm not from here,

it's not like I can call my brother or my sister because they're over in

Saskatchewan, or wherever they're to. So make sure there's a plan that if

someone did need something that that wouldn't give them a reason to breach their

agreement, so to speak. I don't even know what happened in this case, but I do

appreciate that.

That's all I have. I have other questions, but I think under this category, I'll

put them somewhere else.

CHAIR:

Okay, thank you.

Ms. Coffin, anything final?

MS. COFFIN:

Nothing on this section.

CHAIR:

Okay, great.

Madam Clerk, let's vote in this section.

CLERK:

1.1.01 through 1.2.02 inclusive.

CHAIR:

Shall 1.1.01 through to 1.2.02 carry?

All those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

This

section of the Estimates is carried.

On motion, subheads 1.1.01 through 1.2.02 carried.

CHAIR:

Madam Clerk, next section.

CLERK:

2.1.01 through 2.3.01 inclusive.

CHAIR:

Thank you.

Mr. Brazil, you may commence.

MR. BRAZIL:

Thank you, I appreciate that.

I'm going through some of the line items there, particularly around the

allowances part of that.

You announced funding for $2.3 million for 14 new drugs. Can we get a list of

those drugs?

MR. HAGGIE:

Yes, you can.

MR. BRAZIL:

Okay, fair enough.

MR. HAGGIE:

In actual fact, one of those drugs was actually withdrawn on an emergency order

yesterday, so I'll make sure the list is modified.

MR. BRAZIL:

Okay, I appreciate that.

Under Professional Services, what are the amounts there for?

MR. HAGGIE:

This is 2.1.01?

MR. BRAZIL:

Yes.

MR. HAGGIE:

Yeah, okay.

The increase under Professional Services is for the new updated drug – hang on,

what's the expression – the Newfoundland and Labrador prescription drug

real-time claim adjudication system, and it's an increase of $44,000. The

countervailing is we had budgeted $100,000 for system enhancements, which were

actually not required in 2019-20.

MR. BRAZIL:

How was this set up again? Just explain that to me.

MR. HAGGIE:

Every claim for NLPDP recipients, when they go into the pharmacy and show their

drug card, this is routed through this system, reconciled with their eligibility

and then the payment is then allotted to that pharmacist.

MR. BRAZIL:

So this is on a contract basis?

MR. HAGGIE:

It is. It's been renewed and retendered, or re-RFPed repeatedly. Bell are the

current winners of that process. This is a new contract and it is $44,000

dearer.

MR. BRAZIL:

When does this one expire? When you say new, like this year done, last year?

MR. HAGGIE:

It was started in 2019.

MR. SMITH:

The current one is three years and this is year one.

CHAIR:

(Inaudible.)

MR. SMITH:

Sorry?

Three years, starting this year. Bell actually provided the service before. It

went to market and they won it again. It commenced this year.

MR. BRAZIL:

Okay.

Any challenges with the vendor providing the services?

MR. HAGGIE:

No, it was a seamless transition, in actual fact, because they already provided

the service before. That was one of the features of the RFP. To become eligible

to submit, they actually had to get a separate transition plan – if they were a

new vendor – approved before they'd be eligible to submit a claim for the

service.

MR. BRAZIL:

Okay, appreciate that.

Under Medical Care Plan, 2.2.01, Physicians' Services, can you give us a

breakdown on what that would cover under that heading?

MR. HAGGIE:

2.2.01.

MR. BRAZIL:

Professional Services.

MR. HAGGIE:

Yeah, sure.

MR. BRAZIL:

A substantial amount of money, $372 million.

MR. HAGGIE:

Yes, it is.

It will cover all fee-for-service physicians, on-call payments and surgical

dental work under the heading of 2.2.01. There is an increase there which is

$2.89 million. $5.5 million is allocated for increased utilization. That's been

a kind of ballpark figure year on year.

$44,000 was reprofiled to the NLPDP for the cost increase on the contract.

$250,000 was reprofiled to Departmental Operations to hire a consultant. $61,000

was reprofiled to Departmental Operations for the CIHI agreement. $73,000 was

reprofiled to operations for the review board hearings for physician audits.

$80,000 was reprofiled to Debt Expenses to cover the lease payments of the

Burgeo, Port Saunders and St. Lawrence health centres.

$2.1 million was reprofiled to RHA Purchased Services for the increased uptake

to the 811 HealthLine. That covered Fonemed and you remember the Red Cross were

also accessible for people who had difficulties with physical self-isolation in

terms of shopping and that kind of thing. $2,423,000 of the $2,610,000

reprofiled was one time only. That's available due to reduced activity during

COVID.

MR. BRAZIL:

Okay, appreciate that.

The difference, the $11 million less in 2019-20, was that the last few weeks of

COVID that this money was spent?

MR. HAGGIE:

It's basically a drop due to less than anticipated utilization. The payments go

out biweekly so they do fluctuate, but they were significantly lower towards the

end of the year because of, actually, Snowmageddon, not COVID.

MR. BRAZIL:

Okay, fair enough.

There is a little over a $500,000 increase there in the next year. Is that to

cover anything specific or is it just natural increases?

MR. HAGGIE:

That's part of the puts and takes with an increased input for increased

utilization.

MR. BRAZIL:

Okay.

The Grants and Subsidies are pretty even across the board. Outline exactly where

that goes.

MR. HAGGIE:

Those are a mix. The salaried physician payments come out of this pot, rather

than fee-for-service. The Canadian Medical Protective Association subsidy is the

physicians' medical malpractice insurance. They are subsidized for all

physicians, but it comes out of this pot. It's subsidized at the rate of about

75 per cent.

MR. BRAZIL:

How many physicians would this cover?

MR. HAGGIE:

That would be the salaried ones. I can get you the number. It will be a

snapshot. I have it possibly in one of two places and it's not there.

Can somebody give me the page number again?

CHAIR:

Look to your left.

MR. HAGGIE:

Page 25. Thank you.

It said nurse practitioners first; I didn't read the next page. Better not tell

the NLMA that.

We have, as of May 1, 2020 – so it's a snapshot on that day – a total of 1,447

licensed physicians in the province, of whom 707 are family medicine and 740 are

specialists.

MR. BRAZIL:

Fair enough.

Question: Your budget is actually going up; could you just clarify what

additional things will be there for 2021, the $14 million?

MR. HAGGIE:

Sorry, which line is going up, Mr. Brazil?

MR. BRAZIL:

Pardon me?

MR. HAGGIE:

Which bit did you say? I missed the beginning.

MR. BRAZIL:

Under the budget line it's up by $14 million from 2021 from what you spent in

2019-20.

MR. HAGGIE:

Under Grants and Subsidies are we talking about?

MR. BRAZIL:

Yes, under the Professional Services.

MR. HAGGIE:

I'm sorry; I still haven't quite caught which line it is. Could you just tell me

again?

MR. BRAZIL:

Okay, sorry, I jumped back up in the drug program.

MR. HAGGIE:

Oh right.

MR. BRAZIL:

I'm sorry, I just noticed. Sorry about that.

MR. HAGGIE:

Okay.

2.2.01 – I'm sorry I'm kind of lost; I'm trying to find $14 million here. Would

you just enlighten me as to which line we're actually looking at?

MR. BRAZIL: $ 358

million to $372 million what was actually spent in '19-'20.

CHAIR:

That's under Physicians' Services.

MR. BRAZIL:

Yeah, under Professional Services.

MR. HAGGIE:

Oh, sorry. That's under Physicians' Services. Sorry, I was looking at the wrong

page again. My apologies here.

$358 million to $372 million – the difference there between the Actuals and the

Budget, I explained, I thought, with the variance there in the list of $5.5

million for utilization and so on and so forth. That would account for the

difference between the $358 million and the $370 million.

Am I missing something, John?

MR. MCGRATH:

I think you're looking at the Actuals compared to the 2021 Estimates, correct?

MR. BRAZIL:

Yes.

MR. MCGRATH:

That's our fee-for-service budget. It realized savings in the previous year due

to less than anticipated utilization throughout the year. The payments are

biweekly and they do fluctuate. They were significantly lower towards the end of

the year, as the minister said, as a result of the state of emergency,

Snowmageddon, and also due to COVID-19 towards the end of March as well.

MR. HAGGIE:

We saved $11,471,609 on the less than usual utilization. That was Snowmageddon

because COVID, under Physicians' Services – we actually have a physician income

support top-up payment, so the bulk of this is that eight days and the cleanup.

MR. BRAZIL:

I'm trying to remember – and I'm going to try not to bring politics into this –

but the former deputy minister only recently saying that there was a plan

presented to save $200 million in the health care system to the department.

Would that have been included in these salaried physician positions? Would that

have been part of the savings plan?

MR. HAGGIE:

My understanding of where the bulk of that money was going to come from, it was

in out years and I cannot link that to anything in this document.

CHAIR:

Okay, thank you, Mr. Brazil.

Ms. Coffin, you are next.

MS. COFFIN:

Thank you.

I think there are less questions in this

section than the last one, so we can

breathe a little sigh there.

Let's start with the provincial drug program. Do you have any biologics included

in that?

MR. HAGGIE:

Yes, they would be covered under the drug program. Yes.

MS. COFFIN:

Okay, that's wonderful to hear.

Have any drugs covered under the drug program been removed? I know we increased

the scope. I assume that's under the provincial drug program. We recently

announced an increase in – or a number of new drugs have been added to the

coverage. Have any of them been taken away?

MR. HAGGIE:

I would have to check to get you that list.

By and large, we tend not to concentrate too much on the drugs that have come

out because they're usually cents compared with the hundreds of dollars that we

add at the other end.

MS. COFFIN:

Yeah.

MR. HAGGIE:

Over the years, my experience of sitting here is that the drug budget never goes

down and that the amount that we need to find some years has been a challenge to

get the drugs that we've agreed and got product-listing agreements there. We

rightsized the budget somewhat this year and we will just need to keep an eye on

that because that is a pressure.

MS. COFFIN:

Certainly, I would imagine, as we work more into wellness then perhaps our

reliance on drugs will reduce somewhat as a result of that, which will be

something to look forward to in half a generation, hey?

I was wondering, you have said that the budget increases this year, amount

allocated for the insulin pump, by $1.7 million, and promises a further $3.3

million for next year. Can you expand on how that's going to be allocated? Is

there going to be a change in age requirements? Are you going to add people in

who were not previously eligible? How do you plan to expand that?

MR. HAGGIE:

It will essentially become a universal program for all eligible Type 1

diabetics. It's Type 1 diabetes only.

MS. COFFIN:

Yes.

MR. HAGGIE:

The issue there in more granular detail – again, I'm trying to avoid relying on

my memory in case I misspeak. The $1.7 million is for the remaining six months

of this year and it will annualize to $3.3 million.

What it will essentially do is it will be a universal coverage without income

tests for children and youth up to the age of 18. Then at the age of 18 it will

be provided on an income basis with this program as the payer of last resort, so

if there's insurance or income sufficient to cover it within the parameters that

are set. So there will be no other constraints on that, except it is for Type 1

diabetes.

MS. COFFIN:

That's wonderful. I knew that had been a problem for a number of individuals,

especially those who are going to age out of the program. There was some concern

if I need my pump before I turn 25 or else I won't get a new pump.

MR. HAGGIE:

We dealt with that by removing the age cap as a first step so no one would age

out. They'll just keep rolling up, but you're right there were people who had

aged out but this will hopefully address that.

MS. COFFIN:

Fantastic, that's great news. Thank you.

Is the number of client expenditures in each drug plan in this current year, or

in the past year, in the binder?

MR. HAGGIE:

I think it is, in actual fact. Yes, it is. We have the various plans listed and

we can provide you with the numbers within each segment of the plan. The total

coverage is 121,620 recipients across the plans.

MS. COFFIN:

All right, that's great.

I think my other questions on that particular

section were asked by my colleague

here, so we'll go on to Physicians' Services

Do you have a breakdown of the number of family physicians and specialists for

each region broken down by salaried and fee-for-service?

MR. HAGGIE:

No but that's not too difficult to get for you.

MS. COFFIN:

That would be lovely.

MR. HAGGIE:

Again, I'll just point out, it will be a snapshot because literally these vary

week by week. We tend to simply take a date and use that. That's what we did

when I gave the figures earlier to Mr. Brazil, it was May 1.

MS. COFFIN:

I imagine they don't vary incredibly throughout the year. You're not going to

see variances of 10 or 20 per cent.

MR. HAGGIE:

No, no they fluctuate. Sometimes it will be 1,401 and then it will be 1,460 and

these kind of things, depending on people coming and going and that kind of

stuff because of the temporary nature of some of our staff. We have people who

come and visit, want to work while they're here, do so for a few months then

their licence lapse and go back again.

MS. COFFIN:

Okay, interesting.

I notice that we spend more money on fee-for-service than we do salaried

physicians. Can you, for the benefit of everyone here, just explain that a

little bit and how that might be good or bad for whoever chooses that particular

method of payment? Do doctors get to choose if they want to be a fee-for-service

or a salaried? I guess that kind of depends on where they're employed as well.

MR. HAGGIE:

No, it's entirely their choice. If they have the desire to be fee-for-service,

they can be fee-for-service. Included in that are a couple of alternate

compensation mechanisms. There are things called an alternate payment plan,

which is recognized as fee-for-service self, small business income, even though

in a sense it would be regarded by others as a fixed payment every two weeks.

There are a few of those. There's also sessional where you get paid for a period

of four or five hours, that kind of thing. The choice of remuneration is

entirely down to the physician.

There is a bit of a shift. Traditionally, going back 10, 20 years, a significant

majority were fee-for-service. That percentage has slowly dropped and been

balanced by a rise in salary. A lot of newer grads of programs really don't want

to be business managers, so they are opting for salary in the first instance.

Just as a further aside, there are challenges in terms of equity to both

schemes. So one of the things that is on the table with the Medical Association

is around new methods of compensation, particularly in primary care, where the

issues you brought up before about seniors, complex patients and these kinds of

things aren't really fully addressed by the current fee structure and probably

are not recognized in some respects either by salary. So we'll be happy to

explore what options exist with the Medical Association as we kind of move

forward over this next year or so.

MS. COFFIN:

Okay, I look forward to that. That's a very – okay, I have time, excellent –

interesting piece.

I guess one of the second questions that would come from that is in terms of the

services that we receive for physicians being paid under both of those,

physicians being paid under fee-for-service, do you see that they are providing

more or the same or less amount of service than the salaried physicians?

I imagine if you're salaried you have a workday and you see as many patients as

you possibly can in that workday. You do whatever you are being salaried for,

but in your fee-for-service you're being tracked as a business manager. You get

paid for the service that you provide. So if you want to see 50 patients in the

run of a day then your fee would be incurred appropriately, and if you want to

work for 12 hours that's up to you.

So in terms of what we're getting, do you find that you get an equal amount of

output or services provided by the salaried physicians as you do by the

fee-for-service, or is that even something that you track?

MR. HAGGIE:

It has, quite frankly, been a challenge to track salaried physician workload. In

the past, we tried a whole variety of things. I can remember back in my day when

I was on the other side of the table, as it were, we actually had a shadow

billing system. So salaried physicians could've received 10 per cent of the

fee-for-service simply to submit billing as a way of tracking their workload.

That failed. Nobody even bothered to do it in sufficient numbers to track.

The regional health authorities do have the data on clinics on site, and these

kind of things, for salaried physicians and I think one of the challenges there

is simply getting that data, amalgamating it and making it into usable

information. That's one of the things that we're certainly looking at with the

consultant that we've hired because one of their fortes is data management and

analysis. Again, that is harder to track. The fee-for-service is very

straightforward. You can look at the billing codes for a given day and you can

determine volume from that point of view.

MS. COFFIN:

I say this because I don't have my own physician, but when I have gone to them,

occasionally, I'll save things up. So I might need a hearing test and I might

need something checked out or a prescription refilled and things like that. When

you go in you can only talk to the doctor about one thing. You can't save all

your stuff up and go in and say: Hey, there's all of this stuff that needs to

happen. I guess, that's more of a fee-for-service thing, you can come in and

talk about A, but if you want to talk about B you need to make another

appointment, versus perhaps the salaried physician when I can come in and say: I

got 15 minutes, here's the things we need to talk about.

MR. HAGGIE:

That, actually, is a professional practice issue and the college have a very

definite view that there is no such thing as one visit, one problem.

MS. COFFIN:

That's kind of what I was thinking.

MR. HAGGIE:

They have been quite categorical about that because it has been a challenge,

particularly for complex patients and for complex care. I think that has

generated some significant heat in the past. The college have said quite clearly

that that is not – they don't use the term: standards of practice. They have

advised practitioners that they do not expect them to maintain that approach.

In terms of what actually happens during a consultation, fee-for-service is

fairly broad in what the requirements are, you simply have to be able to supply

documentation to support the billing. In terms of any further discussion about

that, that has been a challenge, but my understanding is that it's supposed to

be remedied through the physician's own licensing body and standards and that

kind of thing.

MS. COFFIN:

Okay, thank you.

CHAIR:

Okay.

Thank you, Ms. Coffin.

I propose a 15-minute break, so I ask everyone to be back here at 2011, 8:11.

Recess

CHAIR:

I think we better – for the interest of recording – ask Mr. Brazil to repeat

your question, please.

MR. BRAZIL:

I was just talking about the fact that myself and the minister have had some

discussions around the number of individuals who don't have access to a

physician in Newfoundland and Labrador. Looking at the budget lines here and the

different types of models that we have, particularly around salaried physicians

or fee-for-services, would the minister share or give me some insight on what he

thinks would be the most equitable way to provide it financially while, at the

same time, providing the services with the uniqueness that we have in this

province, geographically and that?

MR. HAGGIE:

Yes, it is a good question. I think the short answer is, there is no perfect way

to remunerate physicians. It depends on a whole variety of factors. One of the

things we'll want to talk about with the NLMA, in negotiations, is what kind of

changes make sense to get the best access for the money and the physicians that

we have.

Fee-for-service, by and large, in sense volume and throughput, and there are

circumstances where that is exactly what you want. It doesn't, however, value

time with the patient in the same way that maybe a salaried physician may have

the luxury, in the sense if some people call it that, may be able to do a more

thought through discussion about things that patients find of concern.

That's very simplistic and not meant in any way to be a reflection on whatever

choice of remuneration physicians have. There are upsides and downsides to both

of them. There is no perfect way. The NLMA and us have recognized that and hence

some of the discussions from their 10-year college document around the Patient's

Medical Home and maybe blended capitation and these kind of things. Because

there isn't a way to use compensation alone to address the access issue.

I think one of the things we're seeing very clearly from COVID is that virtual

care has a place and it is widely appreciated, but access is our problem. We

have argued over the numbers and we'll probably continue to do so, but, I think,

physician compensation in a binary sense of either/or isn't the answer.

MR. BRAZIL:

I appreciate that. I'm glad you brought up the virtual care because that has

been a hot topic and people have utilized it. For all intents and purposes, what

I've heard from individuals, it has been beneficial and maybe become a

mainstream for some remote communities or access to particular types of

specialists and all that.

I know we talked about it a little under the dollar figures, but is there a move

to expand that beyond the COVID concept? I would suspect the COVID concept has

upped it to a level we wouldn't even have comprehended a year ago, but is this

the intent to continue to do that and expand it where possible?

MR. HAGGIE:

I mean, I think, virtual care will now become just a part of the way the health

care system does business. What we've seen is a migration from physicians who

previously would use telehealth, and I use that in the sense of the

infrastructure in facilities that Dr. Max House set up back in the '70s and was

a world leader at the time, but that hardware is now being used more by allied

health professionals who deal with clinical issues in smaller facilities where

their services aren't as readily available. It's been a way of defusing some of

those outlet, but in terms of physicians, primary care providers and

specialists, it's kind of exploded.

I don't see us putting that genie back in the bottle and I would not want to

because I think it's really coming in to its own. So it's how best to use the

technology, how government, as a whole, fills the gap with broadband so there's

a video component and that more face-to-face connection for those people who

desire it. But there's certainly convincing evidence even now that the telephone

has been an acceptable way of doing business for a significant number of people,

not-COVID related; prescription refills, simple, straight-forward acute stuff

and the clinician makes a determination as to their comfort level of dealing

with it over the phone or virtually. The option is entirely theirs.

MR. BRAZIL:

Totally agree and I think it's a great tool in the medical toolbox to address

some of the shortfalls that we have or some of the challenges in a province like

this.

I did, ironically, have a discussion with a physician from Ontario last weekend

on Bell Island who – he doesn't see clients. He has never seen a client in about

five years, it's through telephone and discussions back and forth between the

pharmacist and these types of things. A full, total different service that seems

to be very unique in doing it. He did talk about talking to some of his friends

here, the physicians here that since telemedicine because of the COVID or since

we've upgraded that and made that a mainstay, that it would see the benefits in

particularly to some of the rural and remote communities. So I'm looking forward

to seeing how we expand that.

I do ask: Has there been discussions with the NLMA about how we move that to the

next level? Because I would suspect some are comfortable, some are not. There

may be some additional training, some additional resources that may be

necessary. Maybe even some new types of approaches in the medical school in

advance of moving this forward.

MR. HAGGIE:

Well, certainly to deal with the latter point, we've had exchanges with Dean

Steele at the faculty about how to not just train residents, but also how to

train preceptors so they can mentor residents in virtual care, because that's

not necessarily a skill set they would've had before, simply because of the fact

that they don't necessarily have an awful lot of experience with virtual care.

We had put in place what was originally a time-limited, temporary, virtual care

code system. We have lifted the time restriction on that without really any

concerns. In terms of how that looks and how that goes forward, I think that

would probably now morph into as much a discussion with the NLMA. There may be a

negotiations piece rather than necessarily a great policy piece.

MR. BRAZIL:

Fair enough, I appreciate that.

I'm going to a line item now, and try to keep moving as part of that. Under the

Dental Services, 2.2.02, under Allowances and Assistance. We originally in

2019-20 had budgeted $200,000. The actuals were $63,000, now we're budgeting

$100,000. A little bit of clarification on why the $63,000 and, obviously, that

may have a bearing on why the $100,000?

MR. HAGGIE:

It's the way that the accounting is done. This is for dentists that are paid

opted out, so they charge the patient and we reimburse the patient. Less

dentists are opted out and so that amount goes down, but there may be a

corresponding rise under Professional Services where the direct payments to the

professionals is recorded. So that's why one's gone down. But if you look at the

Professional Services line, you'll find that that's adjusted.

MR. BRAZIL:

Okay. So I'll assume there that there's no reduced service being offered, it's

just being picked up in a different manner.

MR. HAGGIE:

No, it's simply a mode of payment. They've gone from one box to another.

MR. BRAZIL:

Okay, fair enough.

I just want to go back a bit. The attrition plan that was put forward, is that

still being followed within the department?

MR. HAGGIE:

There were various attrition plans that were being put forward. The short answer

is that we're probably coming to the end of attrition in a sense of yielding

significant reductions in the workforce in Health. There are still workforce

adjustments that need to be take place and where we need to alter skill sets

we're not minded to lay people off, but we would wait until that individual

transitioned into something else and fill the post with a different skill mix.

MR. BRAZIL:

Fair enough.

One last question there. We've all been lobbied by certain interest groups,

particularly around the seniors' dental program. Has there been any discussion

around expanding the seniors' dental program in the coming year?

MR. HAGGIE:

It's a source of continuing discussion. The bottom line is that we're in the

middle of the pack from a provincial point of view. I think the comment I made

in answer to an earlier question is: Given our fiscal restraint what we would

like to do and what we're able to do fiscally don't quite match up.

Certainly, we are aware, in terms of wellness and this kind of thing, that oral

health is important. It's a question of how to find the wherewithal to do that.

Maybe in time there would be an opportunity to shift resources, but at the

moment we haven't been able to find that. Where we are is not the best place.

It's not the worst place either.

MR. BRAZIL:

Fair enough.

I'm good there.

CHAIR:

Thank you.

Ms. Coffin.

MS. COFFIN:

Thank you very much.

Let's chat a little bit about Physicians' Services. Can you tell me how many new

primary health care teams were established in private clinics under the primary

health care renewal program in the last year and how many do we expect for the

current year?

MR. HAGGIE:

I can't give you the exact number for that. That program, the Family Practice

Renewal Program, is funded by the department, but the money is held and the

secretariat is located in the NLMA. I would have to go and find that out for

you. No problem.

MS. COFFIN:

That would be lovely. Thank you.

This question is especially for my colleague in Labrador West. He would really

love to know what we are doing to recruit more doctors.

MR. HAGGIE:

It's interesting. We have had a very good meeting with the new president of the

NLMA. I think both parties acknowledge that recruitment and retention is an

issue. We don't do badly. Sixty-five per cent of Memorial residents are still

practicing in the province at 10 years, which is on a par with other

jurisdictions.

I would like to see that a lot higher. It's actually not usually an issue about

compensation; it's more an issue about lifestyle. It's more an issue, I think,

as well, about support for entry into practice as they come off their residency

programs.

We alluded to the discussion about salary versus fee for service. I think there

is a certain reluctance now for physicians to engage in business management.

There are those who still like it, are adapted to it and wired that way, but not

everybody is. I think that mitigates against fee-for-service practice.

They would also like to work in the environment that they were trained in, which

is very much a team-based approach. I think one of the synergies, as we roll out

more with the primary health care teams, is that they will become more

attractive to a larger proportion of residents. Those are more medium- and

longer term issues.

The challenge quite frankly, locally in Labrador West, was about air services,

because these physicians, while they lived in Lab West, they did turn around

with their families who lived in other jurisdictions. I don't know that we have

an answer yet – certainly not in Health – to what to do with the airline

industry. If you have a magic bullet, then please share it. I think that will

certainly help.

We have increased nurse practitioner positions in Labrador West to provide extra

primary care. Again, I would reference for the non-urgent episodic care there is

now virtual consultation by phone or by video with a nurse practitioner. That

will help take some of the strain off. It is not a substitute but there is

continuity available there, through that nurse practitioner consultation

process, because it's wired into HEALTHe NL. The other doctors there would be

able to access that without any difficultly at all times, should they need to.

MS. COFFIN:

Two comments on that a little bit. I was in Corner Brook over the summer and the

hotel I was staying at – it was a new hotel, it's a lovely spot. There was a guy

going around with a video camera and we were curious: What are you doing? He

said I'm doing a recruitment video for, I think, doctors; it might have been for

the university, I'm not sure which one.

They were showcasing what Corner Brook had to offer and that was going to be a

part of the recruitment strategy for professionals, so good job on that. It was

a lovely sunny day and a beautiful hotel, so that's a really special piece. I

think that will help change people's minds. I certainly hope so.

In particular, in Labrador, the conversations I've had with individuals up

there, there's an underground network, of course. When you talk to people about

flying out and getting an appointment and, then, when you get your appointment,

you find out then you have to come back and you have to have your procedure, but

you knew you were going to have your procedure before your appointment.

What they do now is they say: Well, do I have an appointment for a tonsillectomy

– I don't know what services are provided, that's just an example. I have an

appointment for a consult on a tonsillectomy, so I'll get that consult but I'll

also try and book the surgery while I'm there so I don't have to fly twice and

make another claim on MTAP, because my first claim on MTAP is 100 per cent, my

next claim on MTAP is somewhat reduced from that and it takes a really long time

to roll the claims through.

They've had the good sense to at least try and book a procedure at the same time

as the consult, if it's all available. It helps them, it's a cost savings for

them, but I assume it would also be a cost savings for the department as well. I

don't know if that's something that the department or the people who are making

these appointments are even considering along the way, because it sounds like a

more efficient process.

MR. HAGGIE:

Yeah, to coin a phrase of a famous politician: It's not rocket surgery. I did

that in Grenfell when it was the old Grenfell Regional Health Services. I knew

that people coming to St. Anthony for a consult in my clinic on a Tuesday, who

will likely need a hernia repair of a colonoscopy or whatever, I would arrange

for the space for them for the following day. In the event there was a no-show

or a weather issue, there was nearly always a similar case you could bring in

from a more local community.

That's been out there for a long time. I think we need to build in some

encouragement to do that. It becomes a challenge in the fee-for-service

environment where those physicians whose offices are physically located outside

of the hospital or the facility. That has been highlighted as a significant

issue with wait-time management and we've had discussions with the previous

president of the NLMA, the other Dr. Fitzgerald, about how we can better access

information that's held in private physicians' offices about wait-lists, because

we really don't know what we don't know.

By and large, in that scenario in Eastern Health, the wait-list that's given to

the regional health authority is really an allocation for the next two weeks of

operating time for that particular physician. Beyond that, we have no way of

knowing what the demand is.

The NLMA undertook to get in touch with their members in that category and feed

it back to us. Our wait-time coordinator is waiting to process some of that and

see how we can look at a more centralized approach.

MS. COFFIN:

I look forward to seeing that. The efficiencies there could be good.

Dental Services: Is the number of clients and the expenditures in the Adult

Dental Program and Children's Dental Program for '19-'20 in the budget? So

number of clients and expenditures.

MR. HAGGIE:

One moment.

MS. COFFIN:

That can be a yes or no, because if we're getting the budget it will be great.

MR. HAGGIE:

I just need to have a quick look at my stuff.

MS. COFFIN:

Sure.

MR. HAGGIE:

I'm not sure that it is but we can certainly find that number out for you and

make sure that it is provided.

MS. COFFIN:

Excellent.

I think the answer to this was already given. I have a question here about the

Professional Services was slightly under budget at $1.5 million, but I think

that was because of the Snowmageddon?

MR. HAGGIE:

Yeah.

MS. COFFIN:

Yeah, that's what I thought. Okay, good, I have been paying attention.

Faculty of Medicine at MUN. The faculty has the same budget amount this year

that it had last year, after five years of cuts. They've actually spent almost

$5 million more than budgeted in the last fiscal. Is the budgeted amount

realistic or ought it be – well, I guess a little too late to adjust it now.

MR. HAGGIE:

The feeling was in discussions with the dean that this was a one-time structural

issue that could be addressed and that thereafter we would examine it on a

year-by-year basis and see. We felt, from the department's point of view and

from Finance's point of view, that this was where the number should be.

Obviously, we'll find out if we're right in a year or so time.

MS. COFFIN:

Good enough.

Oh, and good news, that's all my questions for this section.

CHAIR:

Okay, Mr. Lane.

MR. LANE:

Thank you, Mr. Chair.

So a couple of questions I had have actually been asked. I would just add to

what my colleague from the district of –

MR. BRAZIL:

Bell Island.

MR. LANE:

Bell Island, there you go.

MR. BRAZIL:

Bell Island is good.

MR. LANE:

Bell Island is good – that I, too, have received a number of calls from people

about the seniors' dental program. I understand it's a budgetary issue and it

was removed in 2016, I believe. I hope we get to a point that we can get it

back. I've personally seen some pretty sad, heartbreaking cases, I'll say. A

couple of them we got resolved because of underlying medical conditions, but

some of them are still tough on people.

Just a quick question on the Insulin Pump Program. I know this was asked as

well, I think it's great news, I just want to confirm that it is what I think it

is. Of course, in last year's budget, we expanded the insulin pump to once you

were older than 25 you would continue on with the insulin pump, which was great.

The problem was, at the time the policy came in, if I was 26 or I was 30; you

said, well, it would carry on if you were younger than 25 at the time. So am I

to understand now if somebody is 27 years of age today that now they are going

to get an insulin pump?

MR. HAGGIE:

If that is the recommendation of a physician –

MR. LANE:

Yeah.

MR. HAGGIE:

– and they have Type 1 diabetes, they are eligible for the program.

MR. LANE:

Yeah.

MR. HAGGIE:

The only question then would be around the financial piece as to whether or not

they had insurance.

MR. LANE:

They qualify and the means, yeah.

MR. HAGGIE:

If they did, we would expect them to draw down on that first.

MR. LANE:

Yeah.

MR. HAGGIE:

We are going to be the payers of last resort.

MR. LANE:

Okay, but it does resolve that issue. That's excellent. That's a proactive move

there, for sure.

I'm just wondering, Minister, are there any current issues around people

skipping appointments and stuff? I know there has always been this issue of

trying to get to see a specialist, or whatever, and then people don't show up

and then that's a space that someone else could have had. Then there was the

issue of: Was the health authority calling, were we calling people to remind

them of their appointments and all this kind of stuff? Is that issue kind of

resolved now or are there still a lot of people missing appointments?

MR. HAGGIE:

The situation has improved. There is an automatic notification system now in use

across a variety of clinics and a variety of locations. Any no-show is a double

opportunity loss because the person, obviously, has missed their care

opportunity and it deprives somebody else of the opportunity.

MR. LANE:

Correct, yeah.

MR. HAGGIE:

My information – although, I don't have a number at the moment to quantify it in

any particular place – is that the automatic notification system has gone some

considerable way to help reduce that.

MR. LANE:

Okay, that's good.

MR. HAGGIE:

It's a work-in-progress. I doubt you will ever get to zero. The system engineers

will tell us that somewhere between 3 and 5 per cent is ideal, and maybe up to

10 per cent is acceptable. We were running at 30 per cent in some areas and that

seems to have faded.

MR. LANE:

Good. Well, that's good news. I'm glad to hear that because, as you say, what a

waste of resources.

I guess this would relate to Physicians' Services, even though I'm not going to

ask about a physician, per se. Nurse practitioners, I know last year, I believe,

there was a move made, as it related to nurse practitioners, they could have

their own practice and so on, which I see could possibly be helpful in some of

the more rural areas and stuff, where you can't get doctors and so on. Not to

replace a doctor, but, certainly, would be a good help, I would think.

Obviously, if those nurse practitioners are working for the health care

authority and they're doing their travelling clinics, or whatever they do,

that's all fine and dandy, that works. It was also said that a nurse

practitioner could open his or her own clinic, but that is not going to work

unless they can bill MCP because most people are not going to go and pay a nurse

practitioner, or anybody for that matter, out of their pocket for the service.

Is there any plan to expand the program that you currently have for doctors, for

physicians, to allow nurse practitioners to have a clinic and actually charge

MCP?

MR. HAGGIE:

I'll take a backwards answer. I think that there's a role for nurse

practitioner-led clinics. We certainly opened that kind of discussion with the

RNU and, through them, the Association of Nurse Practitioners. One of the

challenges, and we've discussed it before, around physician compensation is what

exactly do you get with a salary? What exactly do you get with fee-for-service?

The general dissatisfaction in primary care and complex care with

fee-for-service as a method of compensation.

From a philosophical point of view, I don't think it is any merit in repeating

the mistakes as it were or the errors that have come out with using

fee-for-service for nurse practitioners in the primary care setting. The

question then is what model of compensation would be appropriate? I think that's

a discussion we have yet to engage in with the RNU who do the kind of other side

of the table discussions.

I think the other thing is as well, MCP is probably not the place to put a

budget for nurse practitioners, necessarily. That would be how I would answer

that question, it's a kind of categorical approach, but I think there is a role.

Certainly, we're looking to Ontario and other such jurisdictions to see how

their nurse practitioner-led clinics are working and see what we can learn from

that.

It's difficult, and I've said it before, to transpose directly a model from one

jurisdiction to another simply because the environment, the ecology of health

care here is different than in Ontario or other provinces.

MR. LANE:

Sure. Thank you for that, Minister.

I guess my next question is – it kind of ties into it to some degree and we've

talked about this many times in this House of Assembly and so on, over the years

– scopes of practice. I guess that does kind of tie into the whole nurse

practitioner piece. It ties into pharmacists. I know that you expanded some of

the things, but do you see more – and you would know, I honestly wouldn't –

opportunities to expand scopes of practices whether it be through nurse

practitioners, whether it be through pharmacists, whatever, more things we could

be doing to help alleviate some of the strain and perhaps even make the system

more efficient and possibly more cost effective?

I know that's a big, broad question but –

MR. HAGGIE:

It's a very good one. I think there are a lot of opportunities just on a fairly

low-hanging fruity kind of approach is community paramedicine. We have

community-run ambulance services who are really keen to get into the idea of

paramedics doing wellness checks. We have some pilot schemes. I think Lourdes on

the West Coast is one where there is a paramedic-delivered primary care kind of

a community outreach approach. With now growing our own advanced care

paramedics, I see the possibilities just keep opening up in that regard.

Similarly, we have midwives. They have a really expanded expandable role in

women's wellness, sexual health and reproductive health. Their scopes of

practice cover that from an education and a treatment point of view. I would

love to see them, as we get the numbers to grow, to use them in that kind of

setting.

If you look there are other disciplines, almost anywhere, where they do not

actually practice to their full scope of practice. They practice the way that

history has kind of dictated it. We have optometrists who would love to do some

simple screening for simple eye conditions or even things like glaucoma, maybe

get involved in the management of simple eye conditions or eye aliments.

You referenced pharmacists. Now the clinical components, as it were, of that,

the diagnosis and assessment piece, is baked into the Pharm.D. degree. Now all

our pharmacists, when they finish, will have that degree. We transitioned away

from the B.Sc., where they tried to introduce some of that, but you kind of

needed add-on components. Now for a Pharm.D. it's simply maintenance of

competence approach, which is common to physicians and nurse practitioners, for

example.

So, yeah, is the short answer and I just elaborated on a longer version.

MR. LANE:

Thank you, Minister.

I do have a few other questions but I think they would probably fall under

section three, so I'll leave it for now.

Thank you.

CHAIR:

Mr. Brazil, do you have further questions on this section?

MR. BRAZIL:

No, I'm good on that section.

CHAIR:

I think Ms. Coffin said she was happy.

Madam Clerk, let's vote on this section.

CLERK:

2.1.01 through 2.3.01 inclusive.

CHAIR:

Shall 2.1.01 through to 2.3.01 carry?

All those in favour, 'aye.'

SOME HON. MEMBERS:

Aye.

CHAIR:

All those against, 'nay.'

This

section of the Estimates is carried.

On motion, subheads 2.1.01 through 2.3.01 carried.

MR. HAGGIE:

Mr. Chair, I have some numbers related to questions, rather than sully the next

heads of expenditure.

CHAIR:

Let's not sully.

MR. HAGGIE:

Let's not sully, okay.

Home First clients to date: 3,700. Adult Dental 2019-20: $2.26 million, 5,695

patients; and Children's Dental: $7.89 million, 37,697 patients.

CHAIR:

Okay, thank you.

Madam Clerk, final section.

CLERK:

Health and Community Service Delivery, 3.1.01 and 3.1.02.

CHAIR:

Thank you very much.

Mr. Brazil, you may commence.

MR. BRAZIL:

Thank you, Mr. Chair.

Under Supplies I just noticed the $1.6-million difference there. Can the

minister outline the difference there from 2021 to now?

MR. HAGGIE:

Certainly. Additional flu vaccines due to the anticipated increased uptake.

Funding was reprofiled from our out-of-province payments budget. Not that many

people are out of the province and seeking care. That's flu, that's in

anticipation.

We have bought well over 400,000 doses of this year's flu vaccine and we have

the supplies to deliver that too. The feds, at some point, have agreed to do it

but I'm not sure where the money is yet. They have agreed to pay for seniors in

personal care homes and long-term care.

MR. BRAZIL:

For their vaccines?

MR. HAGGIE:

Yes.

MR. BRAZIL:

Okay.

MR. HAGGIE:

That was part of their COVID initiative. Because of the way it was defined

originally, it would only have included people in formal long-term care

facilities, but yours truly had a word with the minister and she came back with

an amendment for us.

MR. BRAZIL:

So they'll pay for the vaccine but not the actual administering of it?

MR. HAGGIE:

No. I mean we actually administer it anyway and always have done. It obviously

requires staff but that's kind of built into our system. It's usually rolled out

in advance of the publicly available flu clinics so they get a head start.

MR. BRAZIL:

I read somewhere the other day and I saw three different numbers, three

different payment schemes – or scheme is not the right word, processes – one for

doctors, one for pharmacists and the third one was for, I'm going to say,

licensed practical nurses, but I don't think that's what it was. I saw three

different amounts.

MR. HAGGIE:

We only have the two that I'm aware of. The physician code for vaccines, which

was removed, has been temporarily reinstated for this flu season with a series

of riders about involvement and using documentation. We have a new vaccine

surveillance documentation system which is electronic, so we need to use that.

There is their old fee code re-established.

The pharmacist fee code is simply an extension of eligibility for the code. We

previously paid for NLPDP clients; it's now available to all.

MR. BRAZIL:

What's the difference in the costing?

MR. HAGGIE:

It's 13 versus 1706, I think.

MR. BRAZIL:

Okay.

MR. HAGGIE:

Those are historical fees. We didn't mess with them; we just got on with it

because it was COVID.

MR. BRAZIL:

Historically, where are most being administered?

MR. HAGGIE:

The vast majority of vaccines last year were administered in Public Health

clinics. The physicians beat out pharmacists last year. The pharmacists had been

increasing. They never got past 9,000. Their eligible base at that time was

127,000, but they only ever managed to vaccinate 9,000 of them. The physicians –

I was speaking from memory but it is 6,000 or 7,000.

MR. BRAZIL:

Okay, thank you.

Are the vaccines here now? Do we have them or are they …?

MR. HAGGIE:

I think the first lot has been delivered but we can check on it. It comes in two

or three tranches because –

MR. BRAZIL:

Are they distributed equally? Like physicians so much, your own health officials

and then the pharmacists when they apply?

MR. HAGGIE:

It's distributed through – the vaccine program is based in Public Health. The

bulk of the storage, I believe, is in Eastern Health and then it's sent out to

the RHAs. There has been a mechanism in the past for supplying physicians who

are going to hold vaccine clinics. I think that's going to be reactivated. I'm

not sure of the exact arrangement with pharmacists. That may have changed but

I'll check.

MR. BRAZIL:

Okay, I appreciate that.

Under the same heading, 3.1.01, under Professional Services, the change from

$430,000 to $1.26 million in 2020-21, what does that include?

MR. HAGGIE:

The increase is due to $300,000 for the core staffing review which we allocated,

which I referenced earlier on with the RNU. $530,000 was reprofiled from Grants

and Subsidies. It's funding for a new contract for lab accreditation. It was in

the wrong place before. It should really have been allocated to Professional

Services. It wasn't, so that's been moved over. It was in Grants and Subsidies

and shouldn't have been.

MR. BRAZIL:

Okay, appreciate that.

Under Purchased Services, the almost $15 million, up $8.7 million, what's

included in that now, or is it (inaudible)?

MR. HAGGIE:

The increase is money that's come in to cover increased uptake for the

HealthLine. That's $2.1 million. $3.3 million has been reprofiled into this for

funding nurse practitioner virtual care and $3.30 million was provided to

address a structural deficit in our component of the air ambulance service which

is around contracts with PAL and EVAS.

MR. BRAZIL:

What approvals are there now for capital equipment and how are these connected

to the regional health authorities?

MR. HAGGIE:

The capital equipment, there's been some discussion – and I would have to defer

to staff, potentially – around the fact that all infrastructure money was to be

held by Transportation and Infrastructure. There is a discussion at the moment

about bringing some of that back because of the fact that it relates to repairs

and renovations. At the moment, I think, just shy of $100 million has been taken

from our Capital and moved to TI, but TI and us both agree, some of that, maybe

$30, $35 million may have to come back.

MR. BRAZIL:

Okay, fair enough.

Under Allowances and Assistance, give us a breakdown on what normally would be

covered under that.

MR. HAGGIE:

The Allowances and Assistance is insured services. It's MTAP which is $3.34

million and $6.4 million for income support medical travel. There's bursary

programs for physicians' services which amounts to $1.69 million and there's

money there for workforce planning which is $2.034 million.

MR. BRAZIL:

The big heading, Grants and Subsidies, take us through the breakdown.

MR. HAGGIE:

Do you want a breakdown by regional health authority or –

MR. BRAZIL:

No, just a general concept of what's covered.

MR. HAGGIE:

So what's in there is care and services received by the residents of

Newfoundland and Labrador in RHA operated facilities. That's health centres,

long-term care, acute care facilities and group homes are included in there,

too. Direct services would include: nursing, diagnostic, therapeutic and such.

Indirect include: dietetics, corporate services, planned maintenance and things

like that.

It also includes community-based services, so that would be public health,

continuing care, home support. It's a share the province pays towards the

Canadian Blood Services, the recruitment program for donors, fractionated

products and those kind of things.

There is money in there for NLCHI, the Centre for Health Information. Public

health lab comes out of that. Emergency medical transportation services come out

of that and there are some renovation monies in there, too.

The overage and actuals is related to severance reimbursements, nurse retro and

some stabilization funding that wasn't accounted for in the original budget. The

savings from stabilization were one-offs.

MR. BRAZIL:

Okay.

We talk about the regional health authorities, and again the budget line, trying

to keep them flat. What's the plan if a regional health authority, particularly

in this situation now, runs over budget?

MR. HAGGIE:

The regional health authorities have expenditure caps on a line of credit and

the mechanism there is that the line of credit would deal with that. We have

gone some ways towards correcting the structural deficit, but the discussion

about the rest would be with the Department of Finance.

MR. BRAZIL:

Okay, fair enough.

The new mo